April 8, 1957

LIB

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

Liberal

Mr. Martin:

I have not a copy of the amendment but, as read by my hon. friend, it is quite clearly out of order.

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:

Order. Mr. Fleming has moved that clause 2 of Bill 320 be amended by changing the words "but" to "and" and striking out the word "not" in line 8 on page 2.

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LIB

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

Liberal

Mr. Martin:

As I say, it is quite clear that this amendment is out of order as it would add to the financial obligations of the crown.

I just want to reply briefly, largely in connection with the observations made by the hon. member for Kootenay and the constructive spirit in which he made them. He may not have heard the argument that has been adduced before in connection with this question. He should not conclude that no disposition exists to look after tubercular and mentally ill patients, but should remember that this is a measure to provide assistance for general hospital care. It is not a measure intended to provide for the subsidization of responsibilities that are now accepted by the provinces, and in the discharge of which they provide substantially free care and treatment for those suffering from tuberculosis and mental illness.

This measure will provide for persons who are the victims of tuberculosis or mental illness and who are receiving treatment in general hospitals. If hon. members request that, under this hospital insurance measure, we provide for individuals in provincial mental or tuberculosis institutions, they are simply asking us to use this measure to subsidize provincial governments, and that it is not intended to do. Let it be clearly understood that individuals responsible for their own hospital care in general hospitals in respect of mental illness and tuberculosis are included in this bill, but individuals who are being treated in Whitby or in the institution at Brandon or at Essondale in British Columbia are not included.

If one puts forward the argument that they should be included in this bill, then one is 82715-205i

Health Insurance

putting forward an argument which we have threshed out over and over again, and which could not be accepted. Of course we fully agree with all the suggestions made concerning the importance of treating mental illness. We will continue to do our share under the national health program, in which the largest single grant goes toward mental health.

I do not think I need add anything more, Mr. Chairman.

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:

Are we discussing the point of order or the substance of the matter?

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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:

Is the hon. member rising to speak to the point of order?

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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:

I am rising to answer the substance of the argument advanced by the minister.

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:

The hon. member for Eglin-ton has moved that the word "but" be changed to "and" in the eighth line and also that the word "not" be struck out in line eight on page two. This would have the effect of removing the exclusions in paragraph (e), and I would be forced to the conclusion that this would increase the expense to the crown. I think I have referred to this question on a number of occasions and I need not elaborate upon it. However, I shall quote once again from May's fifteenth edition, page 678:

The guiding principle in determining the effect of an amendment upon the financial initiative of the crown is that the communication, to which the royal demand or recommendation is attached, must be treated as laying down once for all (unless withdrawn and replaced) not only the amount of a charge, but also its objects, purposes, conditions and qualifications.

I think the rule is quite clear, and I would be forced to declare the amendment out of order.

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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:

May I say a word in reply to what the minister said the last time he was on his feet, regarding the matter of hospital for tuberculosis and mental illness. I am not going to repeat the arguments that have already been made in answer to other points in the debate, but I should like to answer his statement, if I took it down correctly, that the federal government does not wish to enter into the subsidization of responsibilities now accepted by the provinces. I think that is a fair resume of what the minister said a moment ago. He goes on from that to say that the provinces are now accepting the responsibility for the care and hospitalization of tubercular and mentally ill patients. His argument is that the federal government is not going to share in that responsibility.

Health Insurance

What is the difference between that and the responsibility that a province like Saskatchewan or British Columbia is already carrying with regard to hospitalization for all its residents? As the minister knows, the provinces of British Columbia and Saskatchewan, if this legislation goes through and comes into effect, will receive from the federal treasury money toward the responsibilities they are now carrying. If I may use the language the minister used a moment ago, it will be a form of subsidization of responsibilities now being carried by those two provinces I have named.

It seerns to me that that argument is rather weak. The government is doing precisely that in this legislation. It is offering to make a contribution in respect of programs administered by the provinces; it is offering to carry part of the load; it is offering to subsidize to some extent the responsibilities being carried by the provinces. The minister draws this hard and fast line between responsibilities the provinces accept regarding general illness and the responsibilities the provinces accept regarding these two particular types of illness. We think the government's argument does not stand up at all.

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PC

Walter Gilbert Dinsdale

Progressive Conservative

Mr. Dinsdale:

I should like to have a word on this matter of mental illness. I am sure the minister is aware, as are all hon. members of the house, that the problem of mental and emotional illness is one of our most difficult health problems at the present time.

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?

Murdo William Martin

Mr. Marlin:

We do that in another way.

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PC

Walter Gilbert Dinsdale

Progressive Conservative

Mr. Dinsdale:

I appreciate the minister's viewpoint. There is just one comment I want to make on this matter of excluding mental illness and tuberculosis from the provisions of the present bill. The minister is well aware that mental illness has always been placed in a special category by public opinion, and down through the years one of the major difficulties in dealing adequately with this problem of mental illness has been the misunderstanding on the part of the general public. There has been an attitude of discrimination, an attitude of misunderstanding surrounding the whole difficulty.

I gather that it is not the intention of the minister to place mental illness in a special category at all.

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?

Murdo William Martin

Mr. Marlin:

Of course not; my hon. friend knows that.

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PC

Walter Gilbert Dinsdale

Progressive Conservative

Mr. Dinsdale:

We are all aware that medical science today is of the opinion that mental and physical illness are inseparable. The field of psychosomatic medicine is pretty well a predominant approach to health problems today. Perhaps the minister, in scoring and

underlining in a special way this problem, I might say unintentionally, contributes to the tendency to place mental health problems outside the regular category.

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?

Murdo William Martin

Mr. Marlin:

We are not putting them in a special category; that has already been done by the provinces. If my hon. friend will look at what I said last week-

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PC

Walter Gilbert Dinsdale

Progressive Conservative

Mr. Dinsdale:

This problem still prevails in connection with the public attitude toward mental illness. For example, the cost per day for hospitalization for mental illness is something like $2.92 while the cost today for care in a general hospital averages around $13. There is this tendency, it seems to me, to ignore the fact that mental illness is our basic health problem.

We are placing all the emphasis on what has been recognized down through the years as the more orthodox types of illness, but we have now come to the conclusion-

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

Murdo William Martin

Mr. Marlin:

This legislation is to help the individual who is paying his own costs. We are dealing with my hon. friend's suggestion through the mental health grant in the national health program.

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PC

Walter Gilbert Dinsdale

Progressive Conservative

Mr. Dinsdale:

Yes, I admit, Mr. Chairman, that certain provisions have been made through the national health program. I have the Department of National Health and Welfare bulletin on the subject before me. I have the percentage breakdown of the grants under the mental health program. For example, in 1954-55 the total amount available was $7,234,868. It was broken down as follows: 55 per cent to mental hospitals; 10 per cent for mental health clinics; 10 per cent for psychiatric services in general hospitals; 10 per cent for research; 5 per cent for training; 5 per cent for bursaries; and 5 per cent for provincial mental health divisions. I conclude that the breakdown is much the same during the current fiscal year.

The point the minister has made in supporting the present grants is to the effect that adequate provision is made through psychiatric services provided in general hospitals. In other words the care of the mentally ill carried out by general hospitals is going to be included in these new health measures but, as these figures demonstrate, only 10 per cent of the existing grants is used in the division of psychiatric services in general hospitals.

The point I do want to make, without enlarging on my remarks, is that there is the unfortunate tendency all the way through the health measures to discriminate between mental illness and regular illnesses. With the very successful research going on today

in the chemical treatment of mental illness, the members of this house should do their utmost to ensure that we give primary and greatest emphasis to our greatest medical problem, which is the problem of mental illness.

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?

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PC

William Gourlay Blair

Progressive Conservative

Mr. Blair:

No. The minister said the purpose of this legislation was to assist the individual who was paying his own costs. The mental patients have difficulty; the insurance principle is difficult for them. They pay their costs even when they are declared mentally incapable; when they are put into a hospital the official guardian, if that is the correct description of the man in charge, takes over the estate so the patient does pay his costs. He does not have recourse to insurance. The situation in regard to insurance is just the same for the mental patient as for the other person who is ill-

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LIB

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

Liberal

Mr. Martin:

Almost 90 per cent of the cost is borne by the provincial governments.

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April 8, 1957