Mr. Martin:

This is the same policy as that now followed with respect to the existing Saskatchewan and British Columbia schemes.

Mr. Dinsdale:

The minister concluded his remarks by saying, "Of course we know that most of the treatment is given in provincial mental hospitals." Now it seems to me, and I repeat this point, that mental illness, with which we are dealing, is the most difficult health problem. Unfortunately this measure is going to make no substantial contribution to the solution of that problem and I think, as we move into the field of health insurance or hospital insurance, we should be thinking more of the preventive measures than the curative ones. It has been demonstrated that many of the physical illnesses emerge from preliminary emotional and mental problems and, if we are going to emphasize the preventive aspect of these measures, it seems to me that we should give very careful thought to making provision for the inclusion of mental illness.

Mr. Knowles:

Mr. Chairman, every time the minister stands up and says the government is following a pattern set by the provinces in this regard he is, in effect, emphasizing the point that the provinces accept responsibility for hospitalization no matter what may be the nature of the disease, whereas the federal government is prepared to accept responsibility only for certain diseases. He cannot get away from that.

There is something else which the minister has done repeatedly and which he did again this morning in answer to the question of the hon. member for Peace River. He said that at the meeting in January of 1956 the provinces of course wanted all the money they could get and therefore they asked for the tuberculosis and mental hospitals to be included but, says the minister to the member for Peace River, when it was brought out that the provinces are already paying these costs, they accepted that fact. He tried to create the impression that the provinces have agreed that the federal government's plan goes far enough.

Now, of course, the provinces which have signed agreements in principle have, in effect, agreed that it is better to get this money

than none at all, but that does not mean they have necessarily agreed that the plan should not go further.

I have been drawing on British Columbia and Saskatchewan for my arguments a number of times this morning, and I now turn to Ontario. I have in my hand a copy of a booklet entitled "Hospital Care Insurance for Ontario"; this is the proposal of the Ontario government and it is dated January, 1957. I would emphasize that date, because the minister is trying to make out that this whole question was settled at the meetings here in Ottawa in January, 1956.

In this booklet the Ontario government sets out the fact that the federal government's proposal specifically excludes benefits for the hospitalization of patients having mental illness or tuberculosis. That is on page 11. Again, over on page 13, this Ontario government booklet protests that because the shareable items do not include tuberculosis and mental illness, it means that really the federal government proposes to share in perhaps no more than one-third of the cost of the entire program. That is a further protest against the fact that the costs in respect of these two types of hospitalization are not included.

Then I draw the attention of the minister to page 18 of this booklet, paragraph 6, which reads as follows:

Despite the refusal of the federal government to participate in the costs of care in mental hospitals and tuberculosis sanatoria, the government of Ontario does not believe that a hospital services program is truly comprehensive unless such services are included. The Ontario government, therefore, proposes to offer such additional coverage in its basic contract, to be financed by the Ontario government.

Unless the federal government changes its views with respect to the important area of mental and tuberculosis care-

The minister says that the provinces accepted this a year ago, in January, 1956; but in January, 1957, the government of Ontario is still expressing the hope which we are expressing now, that the federal government will change its views with regard to this matter. Perhaps I should read that full sentence:

Unless the federal government changes its views with respect to the important area of mental and tuberculosis care, the costs of the additional benefits of care in mental hospitals and tuberculosis sanatoria will be borne solely by Ontario.

Mr. Martin:

As they always have been. That is the whole argument-

Mr. Knowles:

Up to the present time, in the provinces where there has been any state responsibility for hospital care at all, it has been borne solely by the provinces.

Mr. Fleming:

And the municipalities.

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Mr. Knowles:

And the municipalities. The federal government is coming into this field, but is coming in with only one foot instead of both feet.

Hear, hear.

Mr. Knowles:

Turning now to page 19 of this booklet I read the following:

These are the essentials of the Ontario proposal for a federal-provincial hospital care insurance program. They are in close accord with the plan announced by the Prime Minister of Canada and the Minister of National Health and Welfare in January, 1956. The early acceptance of the Ontario proposal by the government of Canada will enable the necessary administrative steps to be taken to make basic hospital care insurance coverage available to all, irrespective of age, disability, or condition of employment.

My purpose in quoting from this Ontario booklet is to make the point that although in order to get something the provinces may have agreed in principle to the federal government's proposal, they still think the federal government should change its views with respect to the important area of mental and tuberculosis care.

Mr. Barneti:

Mr. Chairman, I would like to register my accord with the arguments advanced on this question of mental illness and tuberculosis treatment by the hon. member for Winnipeg North Centre and others. I do not think there is anything I can add to these arguments already advanced, but this is one matter which does come within the scope of the definition the minister gave a short time ago in reference to the costs which are incurred as an individual responsibility. I am referring to paragraph (f) (i) of Bill 320, which reads as follows:

in-patient services" means all of the following services to in-patients, namely,

(i) accommodation and meals at the standard or public ward level.

I would like to ask the minister first of all whether any of the existing provincial insurance plan coverage allows for any more coverage than is indicated in paragraph (f) (i>?

Mr. Marlin:

I understand my hon. friend is asking whether what we are proposing to do here is more or less than what is done in any one of the provinces at the present time. These are benefits that are generally provided under the existing provincial schemes and under the Blue Cross scheme except that unlike in the case of the latter, we do not have any limit on the number of days of treatment a patient can receive.

Mr. Barneil:

I think that should be on the record at this point in the discussion, because I would have hoped that out of the federal participation in the hospital insurance coverage scheme it might have been possible to

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extend that basic minimum set forth in this paragraph (f)(i) concerning accommodation at the public ward level.

I want to make it clear I am not suggesting that those who have the means and the fancy to go into private wards should have their expenses covered under a national plan, but I do feel that before our hospital insurance coverage can be considered as complete as it should be, provision should be made under the plan to cover those who, because of the serious nature of their illness, may need private or semi-private ward care, probably under certification, to facilitate their recovery.

I raise this point now because I feel this is an important matter to which consideration should be given, and if it cannot be dealt with at this time it should certainly be the subject of future discussion and review between the responsible federal authorities and the provincial authorities. I realize this is something which would have to be worked out very carefully so it would not be subject to abuse. Nevertheless I think this is an important point and one which has not yet been incorporated into any of the existing provincial schemes, according to the statement the minister has made. If the minister has any information as to what consideration may have been given along the lines I have been suggesting I would be very glad if he will give us that information now.

Mr. Martin:

I can only say that no province proposed that we should go any further than we have gone. If at some future time we ever thought this would be desirable, it could always be done under this provision in subparagraph F(x) of section 2, but I am sure it is not the desire at the present time.

Mr. Castleden:

Mr. Chairman, I have

already registered my objection to the fact that this bill is represented by the minister's party as making hospitalization available to all when in reality it does not. It makes hospitalization available to all who come under a general hospitalization scheme, and that is just over half the hospital patients of Canada.

I would like to ask one or two questions of the minister. Since his department has the care of Indians in this country, what is to be the status of Indians under these proposals? Does this plan provide health insurance for Indians, and who would be paying the cost if that is the case?

Mr. Martin:

We shall, of course, as I said the other day, continue to be responsible for Indians suffering from tuberculosis and mental illness, when hospitalized in tuberculosis and mental hospitals. But for general

hospitalization purposes the provinces must covenant to include all residents, including the Indians.

Mr. Castleden:

Then Indians in those provinces which come into the scheme will be covered by health insurance, but in any province which refuses to enter the scheme-

Mr. Martin:

Except in tubercular and mental institutions, we will look after them there.

Mr. Castleden:

If the minister would set aside his legal technique of interfering with people when they are trying to make a statement it would help us both a great deal. I understand from his statement that in those provinces which come into the scheme the Indians will be covered by health insurance, but that in any province which refuses to come into the scheme there will be no health insurance under this plan for Indians. Is that correct?

Mr. Martin:

The scheme must be universally available.

Mr. Castleden:

You still have not answered me.