April 4, 1957

CCF

Alexander Malcolm Nicholson

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

Mr. Nicholson:

I am quite sure that there will be no objection whatever from the people in that area if the appropriate authorities decide that those living there may qualify for the benefits which the minister has outlined in this great national hospital program.

I notice that the hon. member for Moose Jaw-Lake Centre has not been taking part in the discussion. The minister will recall that a year ago when this matter was being considered in the estimates committee the hon. member for Moose Jaw-Lake Centre was concerned about the cost; this proposal was to be a tremendous cross on the shoulders of the Canadian people. My colleague the hon. member for Winnipeg North Centre made a good case, I think, when he pointed out that the Canadian people are now spending a very large amount on hospital care, and while this program will no doubt increase the cost it will certainly result in improved hospital services if the record is anything like our record in Saskatchewan.

The minister has a very efficient research department. In endorsing what my colleague has said I draw to the committee's attention the fact that this same department did some research work prior to the publication of the green book in 1945, and it was estimated in 1945 that $3.60 per person per year would be sufficient to provide hospital care. That figure was arrived at by taking into account the number of Canadians who went to hospital each year and the cost which prevailed

Health Insurance

at that time. We set a $5 figure in Saskatchewan and, of course, we found that this has not been adequate because of rising costs.

But there has been another important factor which entered into this picture. Prior to the introduction of our hospital service program in Saskatchewan only a small percentage of women counted on going to hospital to have their babies. But today that practice is changed, and it is rare that babies are born outside hospitals. People are getting better care, and we find that infant mortality and maternal mortality have decreased; the situation has changed dramatically since this program was introduced.

I would like to ask the minister whether he has done anything in the past year to bring to the attention of provinces such as Manitoba, New Brunswick and Nova Scotia the fact that they are losing money by failing to agree to go along with this plan? The minister himself placed on record a very interesting table on page 192 of the report of the estimates committee a year ago-

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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:

If I may reply, I certainly have. I appreciate now what the hon. gentleman is saying, because he recognizes the generosity of our proposal.

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CCF

Alexander Malcolm Nicholson

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

Mr. Nicholson:

Let me point out that the province of Manitoba, for example, according to the information given by the minister a year ago, would have to raise $5,700,000. But the minister also advised us that in Manitoba they are now paying $3,347,000 to the Blue Cross and $691,000 to private insurance companies, and that individuals were themselves contributing $3,762,000. In other words, the people of Manitoba are now paying $7,800,000 for hospital care, and if they came under this program they would only be paying $5 million.

In the province of Nova Scotia, the minister told us, they would have to raise $2,400,000. But they are now paying $1,085,000 to the Blue Cross, half a million dollars to private insurance companies, and $1,719,000 which individuals are contributing for hospital care. So in Nova Scotia they would save about $900,000 if they came into the plan.

New Brunswick would be able to save about $2 million.

The province of Prince Edward Island was not able to provide an estimate of what they now pay, except to the Blue Cross and the private insurance companies; but it would appear to me that if the minister had been doing an active job during the past year he

Health Insurance

would make some progress toward persuading a province such as Manitoba, which will save nearly $1 million, to enter the scheme when it comes into effect.

The people of Manitoba are citizens of Canada. The federal treasury does not get money in a mysterious way. The federal government is prepared to roll on and introduce a national hospital program which will become available as soon as we have six provinces in it, and all the minister has to do now I think, is to convince his colleague the Minister of Northern Affairs and National Resources and his friend the premier of Manitoba that they are putting brakes on progress in Canada by holding up this scheme.

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PC

Daniel Roland Michener

Progressive Conservative

Mr. Michener:

Following the questions

asked by the hon. member for Calgary North, I seem to recall that in past sessions we have voted $18 million or $20 million for hospital services to Indians, and reading the bill which is before us I do not see anything which would relieve the federal government of that responsibility. Without raising the question of whether the Northwest Territories are a province, or whether they could enter into an agreement or not under this bill-I assume they could-I would like to ask whether there is anything in the bill which would relieve the Department of National Health and Welfare of the responsibility which it now exercises toward the Indians with regard to hospitalization if the Northwest Territories themselves entered into an agreement?

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LIB

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

Liberal

Mr. Martin:

Even if they did we would have to continue our responsibility toward the Indians as far as care for tuberculosis and mental illness is concerned. All that we are asking is that there be no discrimination as to residents in a province for the purpose of hospital insurance for general ward care in general hospitals. Our responsibility continues.

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PC

Daniel Roland Michener

Progressive Conservative

Mr. Michener:

I am not satisfied that the terms of this legislation are broad enough to affect the status of an Indian under the treaty obligations. If the minister has an answer to that question I think that if he would produce it it would save a lot of discussion.

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LIB

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

Liberal

Mr. Martin:

When we come to section 6-

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PC

Daniel Roland Michener

Progressive Conservative

Mr. Michener:

I have not read section 6.

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LIB

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

Liberal

Mr. Martin:

When we come to section 5 (2)(a).

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PC

Douglas Scott Harkness

Progressive Conservative

Mr. Harkness:

When we get to section 5 you will say it is out of order.

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CCF

George Hugh Castleden

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

Mr. Casileden:

Mr. Chairman, when I was discussing this matter earlier the minister nodded his head in assent. There was very little record of that in Hansard-not very much to depend on-with regard to the people who are included under this act. I was further confused by the hon. member for Welland, a respected medical practitioner, whose answer was to the effect that this hospital insurance plan would cover everyone who is sick.

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?

An hon. Member:

That is all he knows about it.

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CCF

George Hugh Castleden

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

Mr. Casileden:

I would be pleased if the minister would endorse that. If he will, it would mean that subsections (1) and (2) in clause 2 would have to be deleted. Would the minister put this matter straight? One of his colleagues has said that this covers everyone who is sick in Canada. As I interpret clause 2, it does not. Will the minister straighten this out and let us know what hope there is of making this scheme universal so that it will include everyone who is sick?

Will the minister put us straight on this matter? One of his colleagues has said that this legislation takes in everyone who is sick in Canada. As I interpret clause 2, it does not do so. Will he set us straight and let us know what hope there is of making it universal so that it will take in everyone who is sick?

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LIB

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

Liberal

Mr. Martin:

As to universality, that is one of the covenants to which the province must agree and that is covered in a later section. This bill provides for the federal government's sharing in the kind of treatment provided for under the Blue Cross arrangement and under private insurance schemes, with additional supplementary benefits for those persons in general hospitals as defined under the interpretation section of the act and in accordance with the provincial licensing provisions. This bill covers people who are suffering from mental illness and it includes those suffering from tuberculosis, where their treatment is provided for them in general hospitals and where they have to pay. We are not including those in tuberculosis sanatoria or mental health institutions which are operated by the province for the simple reason that that is a responsibility accepted by the province. We are simply following the pattern that exists in the province of Saskatchewan where tubercular patients and mentally ill patients are not covered by the hospital insurance scheme which, as my hon. friend knows, is basically on premium; but they are covered under a separate account for tubercular people and mentally ill people. The same practice is observed in the province of British Columbia

and everywhere else except in one other country that we have been able to examine. But let it be clear that mentally ill people and tubercularly ill people in general hospitals, where the individual is responsible for the care, will be and are covered by this act.

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PC

Douglas Scott Harkness

Progressive Conservative

Mr. Harkness:

A little while ago the minister was complimenting me on my good humour. However, I must say that his unwonted reticence has been trying me sorely since that time. It is not usual for the minister to be so reticent. As a matter of fact, he is usually one of the most eloquent and long-winded members we have in this house. The fact that he has continued stubbornly to sit in his seat instead of getting up to answer the questions I have asked makes me doubly suspicious.

In replying to the hon. member for York-ton, I think it was, the minister said that as far as tubercular cases and mental cases are concerned among Indians and Eskimos, the department will continue to look after them. But the point is this: At the present time the department is responsible for all health matters as far as Indians and Eskimos are concerned. The very fact that he said they would continue to look after tubercular cases and mental cases only leads me to suspect very strongly that they hope to have the territories council, if it comes into the scheme, assume the responsibility as far as other health and hospitalization care of the Indians and the Eskimos is concerned. In effect, that would mean that it would be assumed by that third of the population which would be subject to taxes and which is particularly concerned as to whether they are going to come in under this scheme or whether they are not going to come into it and the terms under which they are going to come into it.

If the minister is not prepared-as he has not been prepared so far-to say anything further than he has said, I think the only assumption we can draw is that if the Northwest Territories come under this scheme, the white population is going to be saddled with the ordinary hospitalization and health care of the entire population. In effect this means that a third or less than a third of the population is going to be obliged to assume the financial burden for that care. In other words, if the minister has nothing further to say on the matter than what he has said so far, it would appear that so far as the Northwest Territories are concerned the idea of the government is to "get out from under" with regard to a certain amount of the medical and health expenses which they have for Indians and Eskimos at the present time.

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PC

George Harris Hees

Progressive Conservative

Mr. Hees:

Is the minister going to answer?

Health Insurance

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PC

Douglas Scott Harkness

Progressive Conservative

Mr. Harkness:

I see the minister shaking his head up and down. I assume that is the situation. Under these circumstances, I would hope most sincerely that the government, apart from the fact that it controls the territorial council, will not force the Northwest Territories into this scheme and thereby place upon the shoulders of the non-Indian and non-Eskimo population in that area part of the burden of health and hospitalization care which the dominion government, under the treaty with the Indians and under the entire set-up we have had so far, has carried.

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SC

Ray Thomas

Social Credit

Mr. Thomas:

I just want to ask the minister one question in this regard. Under the definition of "hospital" there are mentioned three special types that are not included under the act. I wonder whether a specialized clinic or a hospital privately owned would be included under the act. At the moment I am thinking of something in the line of the Banff arthritis clinic.

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LIB

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

Liberal

Mr. Martin:

If it is licensed by the province as a hospital it could be so regarded.

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PC

William Gourlay Blair

Progressive Conservative

Mr. Blair:

Is a nursing home licensed by the province a hospital?

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April 4, 1957