April 10, 1957

LIB

Louis-René Beaudoin (Speaker of the House of Commons)

Liberal

Mr. Speaker:

It must be very clear to all hon. members that when I said that the amendment, if it were carried, may not serve any useful purpose, I was echoing the words and the reasoning of Mr. Speaker Macdonald; he did go along with the reasoning of the hon. member for Winnipeg North Centre on March 5, 1952 as it appears on page 23 of the Journals. However, on page 27, the next day, he rose and said:

Since that time I have given further consideration to the amendment and although it may have been technically in order I am rather doubtful of the practical result which would have followed if it had carried. The committee would have reconsidered an amendment which would have necessitated an expenditure of money. But the committee could not have taken any action on the matter without a motion by a member of the government. The government had intimated that it would not propose such an amendment. Accordingly I am doubtful if any useful purpose would have been served by referring the matter back to the committee. The purpose of this statement is to advise the house that, for the reason which I have stated and for other reasons, should a similar amendment be moved on any future occasion, I would not feel myself bound by the ruling which I made yesterday.

I was merely repeating this and this is the reason why I have been troubled about this amendment from the very start. If it were not for this ruling of Mr. Speaker Macdonald I would have said nothing about this amendment. However, why did Mr. Speaker Macdonald, after having made the statement which he did on an amendment of a similar nature at page 23, feel that it was his duty at page 27 on the next day to make the further remarks which I have just read to the house?

Therefore I have been examining and reexamining the point and the conclusion to which I have come is that on a matter of this kind you can just as easily go either way. I could take the reasoning of the Minister of National Health and Welfare and say that is good enough for me and make a ruling along that line. On the other hand, I could take the reasoning of the hon. member for Winnipeg North Centre, because that would be just as good. I could find decisions both ways more or less on a half and half basis. Because of all the difficulties involved

I would like to have more time to go behind the reasons that motivated the statement of Mr. Speaker Macdonald on the very next day after making a ruling.

I would ask the house to go along with the suggestion that I have often made that the amendment be modified by unanimous consent, so that we do not have a dispute on the point of an amendment respecting third reading of the bill giving instructions to reconsider a money clause in a money bill which must necessitate a money resolution at the time of introduction and must be moved by a minister of the crown. I see no reason why the house cannot agree to have the amendment simply read that the bill be referred back for the purpose of reconsidering subclause 2, clause 6, because any member has the right to change a word, or a comma into a colon or a semicolon. So therefore I do not think if the house should agree to have the wording of the amendment changed in that manner, that the point with respect to the financial initiative of the crown would be involved in any way whatsoever. Of course that is left to the unanimous consent of the house. If the house does not wish to give unanimous consent I would not at the moment feel prepared to declare the amendment out of order. Does the house agree that the amendment be changed so as to read that this bill be not now read a third time but that it be referred back to the committee of the whole house for the purpose of reconsidering subclause 2 of clause 6 of the said bill?

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:

That is satisfactory to me, Mr. Speaker.

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Subtopic:   AUTHORIZATION OF PAYMENTS FROM CONSOLIDATED REVENUE FUND
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LIB

Louis-René Beaudoin (Speaker of the House of Commons)

Liberal

Mr. Speaker:

Is it agreed?

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

Some hon. Members:

Agreed.

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PC

Donald Methuen Fleming

Progressive Conservative

Mr. Donald M. Fleming (Eglinion):

Mr. Speaker, one of the pretensions of the Minister of National Health and Welfare (Mr. Martin) with respect to the present bill and the system of hospital insurance that it envisages is that the scheme is of a comprehensive nature. That is a hollow pretence. The scheme is not of a comprehensive nature. It is in fact a scheme of very limited extent.

The limitation of which I wish to speak briefly now is in my submission a most unfortunate limitation. I refer in particular to the express exclusion from this bill and from the scheme for which it provides of patients-whether in-patients or out-patients -in tuberculosis hospitals cr sanatoria and in hospitals or institutions for the mentally ill.

From the time this government proposal was first introduced these patients enjoying either in-patient or out-patient services of such institutions have been excluded from any benefit under the scheme. We as a party and as Her Majesty's loyal opposition have already expressed in the strongest terms our view that there is no justification whatever for the exclusion of these hospitals and institutions from among those that lie within the scope of the scheme of hospital insurance.

The hon. member for Lanark (Mr. Blair) in his speech on March 25 set out an unanswerable case in this respect. But from its narrow and stiff-necked position this government has never wavered in this regard. The defence which the Minister of National Health and Welfare has sought to make in this house during the course of consideration of the bill, and last year in the committee on estimates when the whole subject was reviewed by that committee, has been hollow and unconvincing. Indeed, in the case of a minister as loquacious as is the Minister of National Health and Welfare, it has been so hollow as to lead those who know him well to the inevitable conclusion that he himself has no sympathy with the exclusion of the hospitals of the kind of which I have been speaking from the scope of the scheme, and that he is simply trying to defend a compromise in order to protect some of his colleagues in the cabinet who were prepared to go this far and no further.

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LIB

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

Liberal

Mr. Martin:

Mr. Speaker, may I assure my hon. friend that there is not the slightest foundation for that statement.

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PC

Donald Methuen Fleming

Progressive Conservative

Mr. Fleming:

I was trying to defend the minister.

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?

Some hon. Members:

Oh, oh.

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PC

Donald Methuen Fleming

Progressive Conservative

Mr. Fleming:

He has never sounded more hollow and more unconvincing in anything

he has said in this house than he sounded in the shilly-shallying excuses that he has made for the exclusion of these institutions.

Does the house adequately realize that if these exclusions are permitted it means that the house is drawing a clear line of distinction between certain types of illness. It means that if patients are suffering from what are called physical ailments and go to hospitals they will fall within the scope of the scheme of this bill. However, if they are suffering from tuberculosis and go to hospitals provided for patients so suffering they will not fall within the scope of the bill. Similarly, in the case of patients suffering from mental illness, if they go to hospitals or institutions designed for the purpose of providing care for such patients then they lie outside the scope of the bill. No scheme which tries to draw a line of distinction between institutions of the kinds of which we are speaking, where the attempted distinction is based upon the type of illness, could possibly be sound.

In the next place, the minister had said, and this must have surprised those who heard him, that the reason why tuberculosis hospitals and sanatoria and hospitals or institutions for the mentally ill are to be excluded from this scheme is that this type of care is already being provided by the provinces at the expense of provincial governments, and in certain cases with contributions from municipal governments as well. He said that the federal government in this respect has no wish to assist the provinces, but only the patients.

It is quite obvious that this government has no wish to assist the provinces; that has been obvious for a long time and in many particulars. I want to make it quite clear that in this regard there is the widest difference between the approach of the government and the approach of Her Majesty's loyal opposition. We of Her Majesty's loyal opposition consider that if the provinces are assisted by the inclusion of institutions of this kind within the proper definition of "hospital" under the bill that would be all to the good. If this government did not characteristically and typically take this rigid, stiff-necked attitude, this unyielding attitude in every matter where the rights or interests of the provinces are concerned, then a great deal more progress would be made in this country in the solution of problems that require a common dominion-provincial approach. In this respect this government is standing in the way of progress and it is doing so without the slightest pretence of even blushing about it.

There is a third aspect to this matter as well. It is the size of the problem presented

by the number of patients who are today confined in tuberculosis hospitals, sanatoria and in hospitals and institutions for the mentally ill who exceed the number of all patients in general hospitals. I do not propose to retrace the ground which has been covered by the hon. member for Lanark in his speech on March 25. He gave the house the clearest possible picture of the extent of the problem, the very large number of persons in this country who are confined in institutions of the kind I have mentioned which are to be excluded from the scope of the scheme. If the house is content to pass the bill in its present form, it means the house is either closing its eyes to a major problem or deliberately denying such benefits as this bill may bring to that large number of Canadians who are confined in institutions of the type that are to be excluded from the bill.

There is yet another aspect of this matter. I do not propose at this stage to attempt to retrace the ground or review the arguments on the terms upon which the whole scheme, in its present limited form, is to be brought into effect, namely when six provinces containing more than half of the Canadian population signify their intention of participating in the scheme. This aspect of the matter is directly relevant to the point I am submitting to the house now. One of the shortcomings of the present proposal of the federal government embodied in the present bill which has had so much to do with the fact that only five provincial governments have so far indicated their adherence to the scheme is that the scheme is of such limited effect and the federal government does not propose to share hospital costs of patients who are confined in institutions of the type to which the government bill refers as tuberculosis institutions and those for the mentally ill. If those institutions were brought within the scope of the definition of a hospital in the present bill the whole proposal would be very much more attractive to provincial governments and much less forbidding to those provinces which are suffering so acutely from financial difficulties that they do not feel they can afford to come into the scheme in its present form. The minister knows very well and the whole government knows that if it were not for the exclusion of institutions providing hospital care for tubercular patients and mentally ill patients more provinces would have found the proposal much more attractive than at the present and undoubtedly a majority of the provincial governments would have indicated their adherence to the plan if it had been on a wider basis.

We say, therefore, that this measure is not a comprehensive measure. It cannot pretend to be comprehensive as long as there are

Health Insurance

excluded from the definition of hospitals under this measure those hospitals and institutions that provide care for tubercular patients and the mentally ill. When the measure was before the committee of the whole I introduced an amendment to clause 2 subclause (e), to make a simple change in the wording of line 8 on page 2. It would have changed the words which now read "but does not include" to "and does include". The purpose of the amendment was to make it very clear, by way of a direct reversal of the provisions of the bill, that the definition of the word "hospital" should include: (1) tuberculosis hospitals and sanatoria; (2), hospitals and institutions for mentally ill; (3), nursing homes and home for the aged where persons are receiving custodial care.

This amendment was ruled out of order by the chairman of the committee on the ground that in its direct form it would involve an increase in expenditure in excess of the royal recommendation preceding the introduction of this bill. Having regard to the provisions of the amendment which was introduced two evenings ago by the hon. member for Winnipeg North Centre (Mr. Knowles), and which I had hoped would have been upheld this afternoon as a proper amendment to be introduced on third reading, I had purposed to seek to give effect to the argument I am now submitting to the house by moving an amendment in the following form:

That Bill 320 be not now read the third time, but that the said bill be referred back to the committee of the whole for the purpose of reconsidering the provisions to exclude tuberculosis hospitals and sanatoria and hospitals and institutions for the mentally ill in clause 2 (e) thereof.

Within the last few minutes, Mr. Speaker, you have confessed to some doubt as to whether an amendment in that form might be in order. Therefore, having regard to the course followed by you, Mr. Speaker, with the unanimous approval of the house but a few moments ago on the amendment moved by the hon. member for Winnipeg North Centre, I now wish to submit my amendment in the following form:

That Bill 320 be not now read the third time, but that the said bill be referred back to the committee of the whole for the purpose of reconsidering clause 2 (e) thereof.

My purpose is to ask the house to refer the bill back to the committee of the whole in order that this same clause which contains this unjustifiably narrow definition of the word "hospital" may be reconsidered. I put before the house the ground that there can be no justification in good sense or in principle or in humanity or in the existing facts of life as applied to the financial difficulties of the provinces

Health Insurance

and municipalities of this country, for this government to try to drive a wedge between general hospitals on the one hand and tuberculosis hospitals and sanatoria and hospitals and institutions for the mentally ill on the other hand. It is only by changing the definition that the government proposes in clause 2 (e) that this unworthy distinction can be eliminated. I ask the house, therefore, to send this back in order that this clause, unworthy of the Canadian parliament, unworthy of the pretensions of the government that this is a comprehensive scheme, should be reconsidered and that its shortcomings should be remedied and that the scheme should in fact be made what the minister improperly pretends it to be, a comprehensive scheme of hospital insurance.

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

Alexander Malcolm Nicholson

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

Mr. A. M. Nicholson (Mackenzie):

Mr. Speaker, I should like to rise to support very briefly the amendment which has just been placed before the house. I think it is most unfortunate that half of the people who are sick every day in the year are barred from the benefits of this so-called national health insurance plan. This matter has been discussed on a number of occasions, and the minister just has not a leg to stand on in trying to pretend that this very large number of sick people in Canada should not be covered by this scheme.

When the resolution was before us I placed on the record the cost per day for the patients in the mental hospitals of Canada in the last year for which statistics have been supplied to me. They were $2.70 per patient per day in the mental hospitals; $6.29 per day in the tuberculosis hospitals and $10.77 per day in the public hospitals. It now becomes clear why the minister is trying to get from under the responsibility of the federal government for this very large group. It would be necessary to improve the services in the mental hospitals.

I read in one of the publications put out by the mental health association that in Canada at the present time we have only five doctors for every 10 required; we have six registered nurses for every 10 we need, and four social workers for every 10 required. There are about 90 mental health clinics in the country, and many of these do not operate full time; there should be 150.

After having waited since 1919 to take this step, I think the minister could at least persuade his colleagues in the cabinet that those who are mentally ill and those who are suffering from tuberculosis should not be barred. It is not so very long ago that those who were mentally ill were housed in the jails with the criminals. I think it is most unfortunate that in the year 1957 the Minister of National

Health and Welfare (Mr. Martin) is carrying on that old tradition. If you have a broken leg, or if you require an operation for appendicitis why of course you can go to a hospital and the federal government should share in the cost, but if-

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LIB

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

Liberal

Mr. Marlin:

Why do they not do it in

Saskatchewan?

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CCF

Alexander Malcolm Nicholson

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

Mr. Nicholson:

In Saskatchewan we do

have free and complete care for the mentally ill. We had that before we had a provincial hospital scheme.

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LIB

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

Liberal

Mr. Marlin:

But it is not part of the hospital insurance scheme.

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CCF

Alexander Malcolm Nicholson

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

Mr. Nicholson:

No; after the people have gone to a mental hospital you cannot tell them that they must come out and start to pay their insurance before they are eligible for the benefits.

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LIB

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

Liberal

Mr. Marlin:

What about those who have not gone in?

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CCF

Alexander Malcolm Nicholson

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

Mr. Nicholson:

Those who have not gone in pay their hospital insurance.

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LIB

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

Liberal

Mr. Marlin:

No; no one is covered for hospital insurance with respect to mental illness and tuberculosis in Saskatchewan. What we are doing here is following the same practice.

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CCF

Alexander Malcolm Nicholson

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

Mr. Nicholson:

Everyone in Saskatchewan is covered by provincial account whether he is suffering from mental illness, cancer, or any other illness.

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LIB

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

Liberal

Mr. Marlin:

That is right.

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CCF

Alexander Malcolm Nicholson

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

Mr. Nicholson:

As I said, we had a program in operation in Saskatchewan before we had our province-wide hospital scheme, and surely the minister is not suggesting that when it was decided to set up a provincial hospital scheme we should discontinue our responsibility for those who are mentally ill?

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April 10, 1957