April 4, 1957

LIB

Jean Lesage (Minister of Northern Affairs and National Resources)

Liberal

Mr. Lesage:

That is worse.

Topic:   HEALTH INSURANCE
Subtopic:   AUTHORIZATION OF PAYMENTS FROM CONSOLIDATED REVENUE FUND
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CCF

Stanley Howard Knowles (Whip of the Co-operative Commonwealth Federation)

Co-operative Commonwealth Federation (C.C.F.)

Mr. Knowles:

There does seem to be some question as to whether or not the Northwest Territories is a province. The minister said the other day that for certain purposes it is. Then, if that is the case, the federal government could easily arrange for agreement to this proposal by the governing body of the Northwest Territories and then we would have our six provinces. However, even without any consideration of that point, I stress the fact that the five provinces whose governments have already indicated their willingness to agree to this plan represent 56.3 per cent of the total population of Canada. When I say, "the total population of Canada," I am including the Yukon and Northwest Territories as well as the 10 provinces and that percentage

is based on figures from the census of 1956. I submit that to insist that the population percentage should be any higher than that before further steps are taken is really ridiculous.

As I said the other day, if the province of Prince Edward Island were to agree that would make the sixth province. Were the population of Prince Edward Island added to the population of the five provinces that have agreed it would bring the total percentage up from 56.3 to 56.9. Surely a difference of that amount is not sufficient to delay putting this legislation into effect.

There has been one other change made with regard to the formula as to when the legislation will come into effect. We welcome this other change. It is that instead of the six provinces having to have their plans in actual operation it will be sufficient, according to the terms of this bill, if those provinces have their laws respecting their hospital plans in force. Provincial laws can come into force by virtue of a bill being assented to in the legislature or they can come into force by virtue of a proclamation. I believe that is an improvement over the former requirement that the six provinces had to have their plans in actual operation. I commend the government on the progress that it has made.

The government had taken a rather firm position and when the government takes a firm position, and particularly when it is hammered at by the opposition, it does not like to retreat from that position. The government has done so in these two respects; first, by introducing legislation when only five provinces have agreed and, secondly, by changing from the stipulation that plans must be in operation to the requirement that the appropriate provincial laws must be in force. I commend the government for what it has done.

I say to the government that, in all common sense, it ought to make this one further change. Surely, five provinces representing 56.3 per cent of the population of Canada are sufficient to get this great project launched. I hope consideration will be given to that point by the government while we are dealing with this bill. I emphasize that now because the requirement that a majority of the provinces representing a majority of the population in Canada have their plans enacted is written right into the bill itself. In our view, this is one of the changes that ought to be made before this legislation is put on the statute books at this session.

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One of the reasons I emphasize this-I say this quite frankly-is to reduce the extent to which this matter will be kicked around in the election campaign that is coming up in a matter of a week or 10 days.

The minister knows that if the requirement for six provinces stays in the bill it will look as though that is the basis for still further delay in the actual coming into force of this plan. But if he were to change the bill to make five provinces sufficient bearing in mind the fact that five provinces, namely British Columbia, Alberta, Saskatchewan, Ontario and Newfoundland have agreed, then that element would be removed so far as the election campaign is concerned. I say, for our part, and I say it quite clearly, we will still contend in the election campaign that we should have comprehensive health insurance rather than just hospital insurance. But surely we can get this point settled, namely that this legislation is not just something that is to be put on the statute books now without any chance, under its present terms, of being put into effect for a year and a half. Surely, we can have it changed so it can come into effect in a matter of a few months at the latest.

There will be other remarks that we will want to make on some of the sections as we reach them. We did feel however, that the house having shown its full support of this subject and having co-operated by giving unanimous approval to the bill on second reading, that these remarks should be made at this time on clause 1 of the bill.

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PC

William Gourlay Blair

Progressive Conservative

Mr. Blair:

It is not our intention to hold up this bill in any way. We have been in agreement so far as the bill is concerned. At the resolution stage, I pointed out certain things with which we were not in agreement. However, we do welcome this bill and we want to see it in operation. It is not our purpose, therefore, to hold up the bill by prolonged discussion. I intend to repeat some of the matters with which we are not in agreement. One of these is the question of depreciation. At the resolution stage I pointed out that depreciation should be allowed as a cost of these hospitals. I am aware of a hospital which lately wrote off some of their depreciation costs and this became a debt. Once this bill is passed, as I pointed out at the resolution stage, it is going to be very difficult for the organizations concerned with hospitals to go out to the public and seek donations, or try to raise money by the various means used by hospital committees.

Health Insurance

It is very apparent, and has been for years, that there is a need for a bill of this kind. I cited figures at the time of the resolution stage showing the high cost of hospitalization. The cost per patient per day, as I indicated at that time, has gone up from $7 and some odd cents to $14 and $15, a cost that makes it imperative that some measure of relief should be given to people who find it necessary to go to hospital. Such a cost is beyond the means of the average person in this country. When there is added to the cost of a severe illness, laboratory fees and fees for special nurses and the like, the fees of the medical man or the surgeon, sickness becomes a terribly expensive proposition.

I do draw your attention again to the fact that depreciation costs are something which should receive consideration in this bill on account of the difficulty of raising money, because the public feeling will be that once this bill is put through the federal or the provincial government in some way will be responsible for hospitals.

Another thing I do want to point out is that we should make very clear that this is a hospital insurance bill. Since the time that the resolution was brought in I have heard it discussed as health insurance. This is a hospital insurance bill.

The other matter that I brought up at the resolution stage was the question of tuberculosis and mental patients. It is true that tuberculosis is being well taken care of at the present time. Indeed the lists are going down. The number of cases is rapidly being reduced, and we are coming to a position that has not been common for a good many years. It is possible to get a patient into a sanitarium because we are arriving at the place where beds are available. That is owing to the fact that the measures which have been taken by the provincial departments of health, especially in Ontario, are cutting down the incidence of this disease year by year. The mass surveys conducted by the province have done a great deal in the cutting down of tuberculosis; but at the same time, those people who remain in hospitals are still hospital patients; they are still afflicted with an illness, sometimes a long-term illness. They are sick people. The same thing applies to mental diseases. There are some other things that I wish to say, in a consideration of mental disease, while we are on this bill.

In the estimates committee last year the minister gave his reasons for not recognizing mental disease. He agreed to accept mental disease while the individuals were patients in hospitals; that is, in the psychiatric wards of general hospitals; but his argument from there on was that mental disease patients, if accepted under this plan, would raise the cost

so that it would more or less defeat the plan and raise the cost of the insurance to the person wishing to obtain it. I point out to you, sir, that we have a problem in mental disease in Canada that we will have to cope with some place somehow. I do not like the fact that mental disease is not recognized because I feel it is a backward step. It is a backward step for this reason. Mental disease may occur just as you may have pneumonia or any other disease in the categories of diseases that are treated in hospitals at the present time.

The very fact that the statistics of Canada show there must be something done about this beyond the amounts that are given in the health grants for certain clinics and research proves my point. The number of people, as I pointed out the other day, suffering in mental hospitals is 10,000 more than the people who are occupying beds in all the other general hospitals put together. Something has to be done about this.

There was one bright spot brought out the other day. I noticed in statistics issued about a week ago that there were some signs of a letting-up of mental disease in Canada. We hope the percentages shown there will continue to grow, and that we may feel we are adequately dealing with this disease. We require more than what is laid down in the health grants for the treatment of mental disease.

I am sorry that some place in this bill the minister cannot go a step farther and give further financial help to the mental hospitals. It would be of great assistance. We need something more than the fact that under this scheme, when they are patients in general hospitals in this country, they qualify.

It is true that this bill is only the beginning. From time to time certain changes will be made in this legislation. I think that certain conditions laid down in the legislation at the present time may even have to be changed by legislation in the future. But in discussing this hospital situation, there is one point that I wish to bring to the attention of the minister. He did not say it the other day when he was speaking on the resolution but I have noted his remarks in the press. I have read his speeches and I have heard him say that the health grants were responsible for the addition of 70,000 beds in Canada. May I say to the minister again, as I have said on previous occasions, and for the benefit of the committee, we ought to look at it in this way. Suppose we were building a hospital in the Ottawa valley-and I think the cost would run around $12,000 per bed-under the health grants the dominion government would give $1,000 for each new bed

and the province would give a matching grant. The donation of the federal government would be $1,000. If you took the $1,000 that is added by the province, and if the cost of the hospital bed in this year would be $12,000, it would leave $10,000. That money would have to be put up either by the municipality or by the various organizations interested in building hospital beds.

I feel very jealous on behalf of those people who have worked and are working to produce the $10,000. Therefore I think it is not altogether fair to say that the program has been responsible for 70,000 hospital beds. It is helping. Certainly, the assurance of $1,000 by the federal government and $1,000 by the provincial government is an incentive, but it is a long way from producing the 70,000 hospital beds.

The hon. member for Winnipeg North Centre spoke of this as an election argument. I have said before in this house that in dealing with health I hope this matter will never become a political football. One must realize that every party in this house has been committed to some form of health or hospital insurance, and has been saying it over the years. I do not know how many speeches I have made on behalf of this party-the minister will agree with this-asking that something like this be done. I hope that when we go to the country we will not have any supporter of the government, any cabinet minister or anyone else, spreading his chest and saying, "I brought in health insurance". We have been asking for it; we want it. We are not going to delay this bill in spite of the fact we do think it has imperfections. We are going to vote for this bill. We want it passed and we want it passed as soon as possible.

The other day I brought in an amendment regarding the required six provinces and a majority of the people. The amendment was thrown out; it was not in order. We did express our opinion at that time regarding the number of provinces necessary to bring this bill into effect.

If this bill is necessary at the present time, if it is going to help people, let there be as little delay as possible. Again I point out it is not necessary to have the six provinces, or a majority of the people agreeing to it to bring it into effect.

Under these conditions the sooner we get this bill into operation in any province the better it will be. It is possible that when the bill is being discussed in the house we will make suggestions from time to time but we want to see this bill passed and the plan put in operation as soon as possible.

Health Insurance

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SC

Ernest George Hansell

Social Credit

Mr. Hansell:

Mr. Chairman, we have pronounced ourselves on this measure, particularly when it was in the resolution stage, and as has already been said, I think, all parties in the house are agreeable to having some form of hospital insurance provided for all the people in Canada if that is possible and we hope the day will come when all the provinces will strike some sort of agreement with the federal government so that it can truly be known as a national hospital insurance plan. I doubt very much whether the present bill can be called a national hospital insurance plan. It is only national to the extent that the provinces agree to enter the plan and sign a consequent agreement with the federal government.

I look upon the bill as one that will enable the provinces to better pay for hospitalization for their citizens. I cannot see that it really goes much farther than that. Perhaps that is a good thing after all, because it must be recognized that according to our constitution health is a matter which comes under the jurisdiction of the provinces. Since the subject of health constitutionally falls within the jurisdiction of the provinces I would suggest that they should have all the freedom possible in the administration of their own plans within the agreement that is struck with the federal government.

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LIB

Paul Joseph James Martin (Minister of National Health and Welfare)

Liberal

Mr. Martin:

Hear, hear.

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SC

Ernest George Hansell

Social Credit

Mr. Hansell:

I see that the minister nods his head and I am sure he will do his best to see that this is done.

I suppose we all like to boast about our own provincial hospital scheme. My colleagues to my right frequently boast about the plan operating in Saskatchewan. That is perfectly all right and I think perhaps the people of Saskatchewan might think their plan is the best.

I am equally sure that the government of British Columbia feels that their plan is the best. The government in British Columbia, of course, inherited their hospitalization scheme. However, at the time they inherited it I think it can be said that the plan was in a terrible mess. It was based on the principle of the payment of premiums many of which had lapsed and the former government had a difficult time collecting premiums and making ends meet. A new government was elected there and they began to straighten out the complications of the scheme they inherited and I think today the people there are fairly well satisfied with it and perhaps think their plan is the best one.

Coming now to my own province of Alberta, we think we have a scheme which is the best. Because I come from that province I think I might be permitted to place on the

Health Insurance

record an outline of our scheme. The provincial government will enter into a contract with any municipality or city for the purpose of granting hospitalization to the citizens of Alberta at an extremely low rate. I think the rate throughout the province would presently average approximately $1.50 or $1.60 a day. Not many years ago it was known as the "dollar a day" hospitalization scheme. Of course, under the agreement that is struck with the municipalities the province gives grants under a certain formula and the municipalities make up the balance. They must include their contribution in the over-all municipal taxes they levy because they must get the money from some source.

If I may be permitted to cite a personal illustration I will tell you what happened in my own particular case. I took ill with sciatica in my left leg. I visited the doctor on a number of occasions and despite the fact that my leg was punctured with a needle a good many times the sciatica reached the point where I could not move. My wife said, "Well now, you have had it, I am going to call an ambulance." I was taken to the hospital in an ambulance and aside from the fact that I had sciatica there was nothing organically wrong with me and I was a hungry man.

I ate three square meals a day and I might say they were very good meals. Our local hospital is small but it is a highly efficient one. While there I received some shortwave treatments approximately every two or three days and I had a few small doses of medicine, a blood transfusion and an intravenous. I remained in the hospital for 30 days and on the thirtieth day I walked out and collected my bill at the desk. The total of my bill was exactly $30. I was very pleased at this and one cannot blame me if I walked out of the hospital feeling that we in Alberta had one of the best possible hospital schemes. In fact, I went home and in a jocular vein told my wife that I thought I would go back to the hospital because I could live there more cheaply than I could at home.

Of course, I did not get hospitalization for a dollar a day because there was an amount included in the annual tax bill on my home which represented my contribution to the scheme. However, I have my tax bill which I carry around in my brief case and the proportion of my taxes that went for hospitalization was $23.

One does not mind paying a little sum like that through taxes and one does not mind paying a moderate daily rate at the hospital either. It gives one an element of choice, a feeling that one is helping to pay for one's treatment. We in Alberta think we have one of the best hospitalization schemes.

I was in the hospital because of sciatica but they are able to give other patients much better treatment than that financially. The maternity cases are free; hospitalization is free; the old age pensioner accommodation is free and some other things of that nature.

Now I said that we would welcome the bill and the minister will not find opposition here in respect to it, but I would like to say something else and in so doing I do not want to say anything against the bill or the principle of hospitalization or insurance therefor. I do however believe that the government itself must look at these things in a much broader sense. I will pose this question: Why is it that hospitalization insurance schemes are necessary? Now the very moment I pose that question I think it is obvious that there can only be one answer to it and that is that the over-all picture shows that there are people in the country who cannot afford to pay for hospitalization.

We will grant that there will always be some people who cannot afford to pay their own hospital bills; that is natural. The poor are always with us, but I do believe that in the over-all picture the responsibility of the government is clear. I have said this before and I say it now, the best welfare state is a state where the income of all the people is sufficient for them to live on a very high standard of living where the production, not only of material wealth but of skills and services of the country, are at their disposal. In this way they are completely free to choose their own hospital, to choose their own doctor and to feel that they are financially able to take care of themselves when, unfortunate circumstances arise and they must be hospitalized. Now I think the responsibility of government must go that far and that is my main criticism of government policy on many other things as well as in matters of this kind.

There is one other point I would like to mention which was put forward by the hon. member for Winnipeg North Centre and that is that this issue may be kicked around in an election campaign. I do not know whether that would be so in his particular constituency or province or indeed in any other part of the country-perhaps it will be. I am going to say this, however, that I have passed through a good many elections personally and have fought quite a number of them but, do you know, the strange thing about it is that I have never fought a federal election when I have had to answer one question in respect to a national health or hospitalization scheme. Never have I been asked whether or not we support it; never

have I been asked whether or not the people can expect it. It may be that the people in my province and in my constituency are well satisfied with the scheme they have and therefore have no reason to ask the question.

However this does pose a question in my mind as to whether or not the people themselves really want it. From some quarters you would imagine that people would be clamouring for this thing; well, I do not know whether they are. I am not saying it is not a good thing, perhaps it is, but I have not personally witnessed any great clamour for it. I know there are organizations the officials of which will embody in their briefs certain proposals and urge the government to put in the plan because there are so many people who cannot afford hospitalization. Why can they not? That in my personal view is because there is something wrong somewhere else.

I do not think I need to say anything else along that line. The minister is going to receive our support and I do urge that the provinces should have every freedom. I will sit down now with just this last question to the minister so that when he gets up to reply to all he might answer whether or not the provinces who have agreed to come into this scheme-or all of them as far as that goes-have now seen this bill.

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LIB

Paul Joseph James Martin (Minister of National Health and Welfare)

Liberal

Mr. Martin:

Yes.

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SC

Ernest George Hansell

Social Credit

Mr. Hansell:

The minister says yes; I am very happy to know that because otherwise we would be passing a bill which the provinces had not seen. We are therefore very glad to have that assurance.

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CCF

Alfred Claude Ellis

Co-operative Commonwealth Federation (C.C.F.)

Mr. Ellis:

Mr. Chairman, like my colleagues, I am most anxious to see this bill passed.

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?

An hon. Member:

Then sit down.

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CCF

Alfred Claude Ellis

Co-operative Commonwealth Federation (C.C.F.)

Mr. Ellis:

But I would like the opportunity of saying how disappointed I am that the government has seen fit to water down its original proposal of a comprehensive health insurance program to that of a program covering hospital care only.

I appreciate the argument that might be put forward by the minister, that this is part of an over-all program, but I think that the need in this country for a comprehensive scheme is so urgent at the present time that I do not think too many Canadians relish the idea of waiting as long for the next step as the period of time we have had to wait for this step to be taken.

I think that surveys have indicated that there is roughly twice as much being spent by the average Canadian on doctor bills, 82715-196J

Health Insurance

medical bills than on hospital bills, and consequently it would seem to me that the provision of some assistance in the field of medical care is long overdue.

I do not know when the government decided to stop talking in terms of health insurance and to emphasize the words "hospital care". This is of fairly recent origin. We used to hear speeches by supporters of the government referring to health insurance up until a few years ago and then gradually it has been a watering down process. Now I am sure that just as we are not satisfied that the legislation has gone far enough there are other groups in the country who are equally as dissatisfied. The Canadian Labour Congress in its submission to the federal cabinet made rather specific recommendations regarding health insurance and pointed out that health insurance should have the highest priority and that there should be an early implementation of a nation-wide program of health care.

You will note that they did not merely ask for hospitalization. They asked for something which has been promised for many years. They asked for over-all health care. They went on to point out that this should include preventive, diagnostic, curative and rehabilitation service rendered by physicians, dentists, surgeons and other health agencies. They recommended that such a comprehensive program should be initiated on a nation wide basis either by the government of Canada or jointly in co-operation with the provinces as a complete health insurance plan.

The step taken by the government of Canada in offering to pay a share of the cost of hospital care in the six provinces is worthy of commendation. It is a move in the right direction, but the Canadian Labour Congress does not take the view that a comprehensive nation wide health insurance plan cannot be implemented without further delay. The last sentence in these recommendations outlines their position quite clearly-that while they agree with the proposals advanced by the government as far as they go, the Canadian Labour Congress is not satisfied that the government has gone as far as it could go at the present time.

There are a number of other shortcomings in the legislation. I was rather disappointed in the comments made by the minister when he introduced this legislation at the resolution stage, and turned his thumbs down on what I thought was a reasonable proposal that the federal government should be prepared to provide for the care of those who are in mental hospitals and t.b. sanatoria. The fact that some of the provincial governments have undertaken to provide full care is no reason why this should be used as an excuse

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to the disadvantage of the provinces. It is no reason why the federal government should discriminate against such provinces with respect to the care of patients in mental hospitals or in t.b. sanatoria.

I agree with our mental health officials who say that one of the most important things we must do is eliminate the artificial distinction between illness of what might be called a physical nature on one hand, and illness of a mental nature on the other. We must erase from the public mind the attitude that there is something different between a patient who is in a mental hospital and one who is in an ordinary general hospital. I think we could go a long way toward doing that if we included all sick people who require hospitalization within the scope of this

legislation.

The government has not seen fit to do

this, yet statistics reveal that a very high percentage of hospitalized people in this

country are in mental institutions.

I think the government should be prepared to go a long way in an effort to build up a better attitude of mind among the general public with regard to mental illness. One way of doing that would be, as I have

suggested, to include all hospital patients within one over-all hospitalization scheme.

It seems to me, that there are a number of other grave shortcomings in the legislation. Some of them have been noticed by newspapers which normally support the government. I have here a copy of an editorial from the Saskatoon Star-Phoenix of March 29 of this year entitled: "Two Glaring Omissions" and it has to do with this present measure. The editorial states, among other things:

One matter in particular has not attracted the public attention we think it deserves. We refer to the federal government's omission of two legitimate and familiar expense items from the list of shareable hospital costs on which calculations of Ottawa's proposed contributions to provincial plans depend. These two items are annual depreciation charges and annual interest charges on capital debt. Depreciation charges are the amounts set aside each year by a hospital for the day when expensive renovation and expansion programs will have to be undertaken. Interest charges are the annual payments an institution must make on outstanding capital debt.

Ottawa ignores both these cost items in calculating per capita hospitalization costs. As a result its percapita cost figures do not give a true account of the operating costs of the nation's hospitals. Consequently, Ottawa will not be contributing an average "50 per cent towards the national cost of standard public ward care and the normal services that go with it," as health minister Martin is so fond of saying.

I think it is significant that this quite valid criticism of the legislation should come from a newspaper which over the years has consistently supported the Liberal party. I was

not too greatly impressed by the minister's presentation when he introduced this measure, because it seems to me that after many years of waiting the minister sought to take too much credit for himself and for the government for having at last brought forth a part of a program, a program which should have been instituted a great many years ago.

I know that before the last general election whenever we raised the question of health insurance we were told, in my constituency at least, that we already had a health insurance program. The rather tortuous argument was used that since some of the grants had been provided by the government, that because this amounted to, perhaps, one-twentieth of a program, that constituted a health insurance scheme. I think the man in the street is not going to judge a program on that basis. He is going to look for results, and I think we have long passed the time when we can allow this business to continue as it has done in the past.

Good health is essential to the nation's well-being, and a comprehensive health insurance plan should not be measured merely in terms of dollars and cents. The amount of money which it is going to cost should be considered in terms of how the expenditure will affect the well-being of the Canadian people. I think it is shortsighted to take the attitude that we must regard this program merely in terms of money spent.

There are a number of other matters I would like to mention at this time but it is not my intention to hold up the legislation. I want to see it go through and I want to see my own province in a position where it can apply for and obtain some benefit from the measure now before us.

Reference has been made to the hospitalization programs in the various provinces. As a citizen of Saskatchewan, I want to say that I have always been proud of our own scheme. I am very proud of the fact that Saskatchewan has pioneered in this field, and I think the hospitalization legislation brought in by the C.C.F. government immediately after that government went into office has set the pace for other provinces. As is well known, several other provinces have followed suit.

However, I do wish to draw this to the attention of the committee-that when we were elected to office we immediately began to implement the commitments we had made regarding hospital care. We got down to the job. We did not wait around for 10 or 12 years. In the first session of the legislature when the C.C.F. were in charge legislation was brought down to institute a hospitalization plan and I would say that largely as a

result of the initiative shown by our government at that time the province of British Columbia followed suit a few years later.

I feel that record of hospitalization in Saskatchewan was of sufficient importance to have hastened the type of legislation now before us. What I find so difficult to understand, in view of the example set by our provincial government, is why the minister took so long to bring down these particular proposals.

I should like to get some information from the minister as to when we may expect the next step in this proposal. How long are we going to have to wait until the federal government brings down proposals dealing with medical costs? In other words, I wonder whether the minister would indicate how many years we might be expected to wait until the government-if it is in power after this next election-decides to keep the commitment made originally to bring down a comprehensive health insurance scheme.

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CCF

Alexander Malcolm Nicholson

Co-operative Commonwealth Federation (C.C.F.)

Mr. Nicholson:

Mr. Chairman, I thought by the signals I was getting from the minister that if I would sit down he would indicate that he would give sympathetic consideration to the representations that have been made.

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LIB

Paul Joseph James Martin (Minister of National Health and Welfare)

Liberal

Mr. Martin:

I am suggesting that on the appropriate section I can deal with this question.

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CCF

Alexander Malcolm Nicholson

Co-operative Commonwealth Federation (C.C.F.)

Mr. Nicholson:

There are a few remarks which might not be in order when we come to the next section and which I should like to make at this stage. I was reading the debates in connection with the introduction of old age pensions back in 1926; that is nearly 31 years ago. I was surprised to find at that time that although there was a suggestion that the government of the day wait until six or seven provinces were prepared to go along with the federal government in sharing the cost of old age pensions, the then prime minister, Mr. Mackenzie King, at that time felt that the government of Canada had the responsibility of deciding what was good and what was not good for Canada, and the old age pension legislation was put on the statute books.

I am greatly disappointed that the Minister of National Health and Welfare has not had more influence on his colleagues in the cabinet and has not been in a position to say to the committee today that having decided that this step should be taken the government of Canada is now prepared to enter into agreements with the five provinces which have over 50 per cent of the population and start immediately to use up some of the surplus that his colleague the Minister of Finance has available. I am also greatly disappointed that the minister has not reconsidered his unwise decision that more than half of the sick people

Health Insurance

in Canada are to be barred from this legislation. I am referring to the people who are in the mental and tubercular hospitals day after day. Since I spoke on March 25 I have been to a penitentiary-

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?

Some hon. Members:

Oh, oh.

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CCF

Alexander Malcolm Nicholson

Co-operative Commonwealth Federation (C.C.F.)

Mr. Nicholson:

I was surprised to find what good meals they served in the penitentiary; they are much better meals than the Minister of National Health and Welfare makes available for the old age pensioners on $46 a month. But I find that we spend about $6 per day for every person in the penitentiary down at the federal training centre in Quebec. The amounts spent in some of the other penitentiaries are not quite so high. But when you consider the $2.70 per patient per day in the mental hospitals, the $6.29 per patient per day in the T.B. hospitals and the $7.77 per day in the public hospitals, it is not surprising that patients in the mental hospitals are not getting better treatment.

I have also visited the institution out at Smiths Falls in the constituency of the hon. member for Lanark. The Minister of National Health and Welfare has a financial interest in this place. I understand that the federal government has put in about a dollar for every $10 or $12 invested by the province of Ontario. The average cost is $2.70 per patient per day in these large institutions. Even at this stage I hope the minister will change his stubborn position and recommend to his colleagues that all Canadians, regardless of whether they are in mental hospitals or in tubercular hospitals, should share in the benefits of this legislation.

Topic:   HEALTH INSURANCE
Subtopic:   AUTHORIZATION OF PAYMENTS FROM CONSOLIDATED REVENUE FUND
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LIB

William Alfred Robinson (Deputy Speaker and Chair of Committees of the Whole of the House of Commons)

Liberal

The Chairman:

Shall the clause carry?

Topic:   HEALTH INSURANCE
Subtopic:   AUTHORIZATION OF PAYMENTS FROM CONSOLIDATED REVENUE FUND
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PC

Robert Hardy Small

Progressive Conservative

Mr. Small:

I should like to speak on this clause, Mr. Chairman, but it is six o'clock. Can we take the adjournment?

Topic:   HEALTH INSURANCE
Subtopic:   AUTHORIZATION OF PAYMENTS FROM CONSOLIDATED REVENUE FUND
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LIB

Paul Joseph James Martin (Minister of National Health and Welfare)

Liberal

Mr. Martin:

Would my hon. friend not find it possible to proceed with the clauses of the bill so that we might get on.

Topic:   HEALTH INSURANCE
Subtopic:   AUTHORIZATION OF PAYMENTS FROM CONSOLIDATED REVENUE FUND
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?

Some hon. Members:

Six o'clock.

Topic:   HEALTH INSURANCE
Subtopic:   AUTHORIZATION OF PAYMENTS FROM CONSOLIDATED REVENUE FUND
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April 4, 1957