April 10, 1957

LIB

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

Liberal

Mr. Marlin:

Certainly not.

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

Alexander Malcolm Nicholson

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

Mr. Nicholson:

All I am asking the minister to do is to support the amendment that we have before us after having heard arguments from so many. There are members in his own party who would like to have spoken in support of this proposition, but have not. If he takes this action he will demonstrate that the economy of Canada can stand the cost of seeing that those who are mentally ill, those who are suffering from tuberculosis, those who represent more than half the sick people in Canada every day in the year, are permitted to share these benefits to which they are entitled as Canadian citizens.

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

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

Liberal

Hon. Paul Marlin (Minister of National Health and Welfare):

Mr. Speaker, there are a number of considerations that I should

like to lay before the house at this time in connection with this bill and this amendment, which I think is out of order. Nevertheless, it affords me an opportunity to say that the house should not forget that under the proposal made by the federal government last January we indicated that once six provinces accepted the proposal we would take the necessary legislative authority to carry out our portion of the proposal.

As I pointed out, we have not got six provinces now, we have only five. Nevertheless the federal government has considered it desirable, notwithstanding the terms of its proposal, to bring forward legislation at this time, anticipating, as I think we have every reason to, that before too long we shall have at least one, if not two more provinces. But whether or not that eventuates, the fact is that we have taken a step which goes beyond what we told the provinces we would do; we have acted although six provinces have not come in, so that the legislation, once it receives third reading, will be on the statute books and will be our authority for paying out considerable sums of money on a sharing basis with the provinces in respect of hospital and diagnostic insurance schemes.

It should also be noted that we have been able to reach this particular proposal as a result of the co-operative effort between provincial governments, ourselves, voluntary agencies and others throughout the country during the period of the last eight years, in the steps that have been taken to improve the general public health and to improve the health facilities of the nation, to an extent that we now have facilities which justify our embarking upon the important step that now confronts us. Together with the provinces and voluntary bodies which have borne the greater brunt of the load, we have built some 70,000 hospital beds which represents a considerable achievement and in the language of the premier of Ontario it was the national health program which spearheaded this whole program.

Very little has been said about one feature of the bill which is extremely important and that is the diagnostic services feature. All provinces will not take advantage of the diagnostic services feature to the same extent. For instance, we have been told by Ontario that they propose to take advantage of the moneys made available by the federal government for diagnostic, radiological and other services of that character only in so far as they apply to in-patients, and this despite the fact that the bill provides for diagnostic services for out-patients as well. Some provinces will take advantage of that proposal

Health Insurance

and others, as I have said, will not, but it is very important to recognize the significance of that phase of the proposal covering diagnostic services concerning which there has been very little mentioned here today or throughout the debate.

The advantages of this bill are very considerable. I have not suggested in any way that as a result of the action of the federal government alone we are going to have hospital insurance. I have clearly indicated time and time again in answer to my friend the hon. member for Winnipeg North Centre (Mr. Knowles) that in a matter of this sort co-operation with the provinces was an essential prerequisite to action. Premier Frost has indicated that he cannot begin his scheme until January 1, 1959 but when the scheme does get into operation in a number of provinces the co-operative effort that has taken place will result in making available to all persons a simple method of budgeting the unpredictable costs of essential hospital care in Canada. That will be the first result.

Second, no one will be denied the benefits of the plan because of age, health or economic circumstances.

Third, no time limit will be placed on the number of days of care so the individual will be protected against the catastrophic cost of protracted illness requiring hospitalization over a long period.

Fourth, no dollar limit has been placed on the specific services in hospitals that may be required.

Fifth, because one-half of the national cost of hospitalization will be paid out of the federal treasury-indeed in the case of some provinces over 60 per cent-it will be possible for the provinces to offer premiums that will be more attractive than those charged under any existing plan in Canada.

Sixth, the individual will be free to purchase any additional protection he may require in terms of private or semi-private care or other special benefits through regular commercial or voluntary insurance plans.

Finally, in addition to insuring patients against their hospital bills this program will provide an organized system of financial support for hospitals and will thus largely eliminate the problem of hospital deficits that are now plaguing so many Canadian municipalities.

This measure which is being supported by all sides of the house and which I hope every hon. member will have an opportunity of voting for-

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

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

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

Mr. Knowles:

Hear, hear.

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

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

Liberal

Mr. Marlin:

-is one that does represent a very significant step and is an extremely important measure affecting the health and

Health Insurance

welfare of the people of this country. I think that the discussion throughout this debate indicates the merits of this proposal, a proposal first put forward by the Prime Minister of Canada. Premier Frost in speaking of his plan said that it comes within the four corners of the proposal made by the federal government.

I recognize, of course, that some hon. members thought they found some shortcomings in the bill. Most of the discussion in this particular has concentrated on two features. The first of these was the insistence that we have at least six provinces. In this regard I can only repeat what I have said a number of times in this house, that that condition is a very necessary one if we are going to have a nation-wide system. I am satisfied that if we had not that provision we would not today have had five provinces signify their acceptance. From negotiations that are under way at this time between the federal government and at least two provincial governments, I know that this is a very important condition to retain in the bill and it is for that reason we opposed the amendment proposed by the hon. member for Winnipeg North Centre which we voted down a few moments ago.

The other question raised by those who found some inadequacy in the bill related to the inclusion of tuberculosis and mental hospitals. The reason I refer to this is because I think it is unfortunate to give the impression that a line is to be drawn in the coverage provided by this bill between those who suffer from tuberculosis and mental illness and those who suffer from other illnesses and who will be covered by this bill. No attempt is being made to discriminate against tubercular patients and those who suffer from mental illness. As I have indicated, so far as the federal government is concerned we will continue under the national health program to provide the largest single grant, which is for mental health and we shall continue to do what we are now doing to assist the provinces in their work of trying to carry on programs of prevention and treatment in the matter of mental illness.

As I indicated the other night, the great development that is taking place now is to provide psychiatric units in general hospitals. Right here in the city of Ottawa two of the large general hospitals have psychiatric units. The cost of the equipment for these two units has been provided for by the federal government under the national health program in addition to the salaries of all the individuals employed in those units. That is also true of the psychiatric units that have come into being since the national health program was announced in 1948.

It is not true that little attention is being paid to those who suffer from mental illness but the reason they are excluded under this bill is that what we are seeking to do is to provide financial assistance, not to the provinces to carry on their normal accepted responsibilities but to help individuals in meeting their individual hospital costs. Any individual suffering from tuberculosis or mental illness in a general hospital where he has to pay his own costs is covered by this bill; but individuals who are in provincial institutions paid for, as the provinces admit, to the extent of about 90 per cent by them and by the municipalities, will not be covered by this bill for the simple reason that this bill is designed to assist individuals in their individual hospital problems and not to subsidize provinces which are receiving assistance in other ways from the federal government.

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

Alexander Malcolm Nicholson

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

Mr. Nicholson:

Very little assistance.

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

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

Liberal

Mr. Martin:

My hon. friend says very little; the assistance provided by this measure alone amounts to some $200 million annually.

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

Alexander Malcolm Nicholson

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

Mr. Nicholson:

A very small percentage.

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

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

Liberal

Mr. Martin:

It was not our purpose by this legislation to subsidize the provinces which are already receiving assistance from the federal government through other channels; but whether or not they are receiving other assistance there can be no justification for imposing upon a hospital insurance bill the responsibility for paying public moneys to the provinces for responsibilities which they rightly recognize.

The moment an individual has to pay for treatment in a general hospital he will be covered by this bill for any kind of illness, including tuberculosis or mental illness. The fact that we are right in this is seen in the case of Saskatchewan and in the case of British Columbia and in the case of any other country but one that I can call to mind. In Saskatchewan they have a hospital insurance scheme and they have one in British Columbia. In the case of Saskatchewan the cost of the scheme is borne in the main by premiums paid by individuals.

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

An hon. Member:

Half.

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

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

Liberal

Mr. Marlin:

No, a little over half. But that only covers individuals who are treated for illnesses other than tuberculosis and mental illness. Those two illnesses are adequately treated in Saskatchewan and I am not suggesting that they are not. However, they are provided for out of the consolidated fund of the province, in a separate account, being precisely what we are going to do

under this measure. We are providing for the assistance of these people in so far as they are hospitalized in general hospitals.

In further confirmation of the position we have taken is the report of the government of Nova Scotia examining this matter. It recommended that the Nova Scotia government should accept the proposal made by the federal government and there they said, as I indicated I think the other night, that in the matter of mental health and tuberculosis these illnesses should not, they thought, be included in the proposal which is embodied in this bill.

Therefore, I do not think we should go on giving the impression that we are seeking to draw a distinction between those who suffer from these two forms of illness and those who suffer from other illnesses. What we are seeking to do, let me repeat, is to help individuals in Canada in meeting their individual hospital costs. If an individual has hospital expenses as a result of mental illness or tuberculosis he will be taken care of under this bill, but if he is in a provincial institution where the province pays for it out of the consolidated fund it cannot be seriously arguable that the provision in the bill should be otherwise than it is, with the exclusions provided.

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

Frederick Samuel Zaplitny

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

Mr. Zaplitny:

Would the Minister of National Health and Welfare permit a question at this point. I refer to the statement that to the extent an individual pays his own costs he would be provided for under this legislation. In the province of Manitoba, as the minister may know, an individual does pay part of the cost in the mental institution. Does the minister feel that that part of the cost should be covered by this legislation?

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

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

Liberal

Mr. Martin:

The figures in Manitoba show that about 90 per cent of the cost is borne by the province and 10 per cent, roughly, by the individual. Those are the figures given to us by the province and we had this whole thing thrashed out with the provinces a year ago. The hon. member can get these figures and he will see that they are correct. I think that in the case of tuberculosis it is higher than that but in the case of mental illness I think it is around 90 per cent, although I am speaking roughly.

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

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

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

Mr. Knowles:

I would like to just be sure that the figures include the municipalities.

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

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

Liberal

Mr. Martin:

Yes, my hon. friend is quite right. I think there is nothing further for me to say on this bill, except that the wide measure of discussion in this house indicates the value of this proposal. It represents a very important step in Canada for us to embark on this particular kind of program;

Health Insurance

it is a program that arises out of the efforts, not of any one group but it is the product of many people of this country. I think, for instance, at the moment, of Dr. Fred Jackson an officer in my department who at this time is very ill, and one of the great men of this country. Dr. Jackson has had so much to do with this proposal, as have many others throughout the country. It is the result of co-operation between the provinces and the federal government and it is a proposal which I think will rank as the foremost of the steps taken by this house in the field of health and welfare. I am grateful for the strong measure of support given in principle to this bill, a bill which I know will mean much to the welfare and good health of the people of this country.

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

Some hon. Members:

Hear, hear.

At six o'clock the house took recess.

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

AFTER RECESS The house resumed at eight o'clock.


PC

John George Diefenbaker (Leader of the Official Opposition)

Progressive Conservative

Mr. J. G. Diefenbaker (Leader of the Opposition):

Mr. Speaker, I rise for the purpose of saying but a few concluding words on behalf of this party with regard to the bill which we hope will soon be implemented and become of the law of the land. Indeed, one cannot but feel on this occasion that in the legislation now before the house we have come to the end of a long road that began in 1919 when the Liberal convention of that year promised health insurance legislation, and in successive elections Canadians have heard of the possibility of its introduction should the Liberal party be successful.

We have come now to the end of the road so far as the general skeleton of the legislation is concerned but there still remain various sectors of the community that should be included in the provisions of the legislation which are as yet untouched. Naturally we are very pleased with the legislation. I think a word of tribute is due to the premier of Ontario the Hon. Leslie Frost, who, at the last dominion-provincial conference, demanded that this subject be placed on the agenda and ever since has applied pressure in order to achieve the legislation now before us, although not being entirely satisfied that all hospitals which ought to be included are included within the ambit of the legislation.

Our desire while giving full support to the legislation as we have throughout, and in the amendment moved by the hon. member for Eglinton (Mr. Fleming), is to do our part even at this late hour to improve the legislation in order to make it more effective. I am

Health Insurance

going to read clause 2, subclause (e), the definition of "hospital", to which the amendment moved by the hon. member has reference. It is in these words:

"Hospital" means a hospital or other facility, prescribed by the regulations, providing in-patient or out-patient services, but does not include

(i) a tuberculosis hospital or sanatorium,

(ii) a hospital or institution for the mentally ill, or

(iii) a nursing home, a home for the aged, an infirmary or other institution the purpose of which is the provision of custodial care.

The amendment moved by the hon. member would refer the bill to the committee of the whole for the purpose of considering this clause and thereby giving an opportunity, even at this late hour, of including within the ambit of the legislation sanatoria, tuberculosis hospitals and institutions and hospitals for the mentally ill. I cannot understand this omission. While tuberculosis is in recession, mental diseases are on the increase. The hon. member for Lanark (Mr. Blair) placed on Hansard the record in this regard, a startling record, a frightening one, one which indicates a terrible toll and that mental diseases are, to a challenging degree, on the increase. The statistics he placed before the house indicated that between 1932 and 1954 there had been an increase of 87 per cent in the number of patients in mental institutions, or a total of 68,050. That is a very serious situation.

I listened to the minister as he made his explanation. I always find the minister intensely interesting. He possesses an unusual capacity for elucidation without providing the same degree of light, and what he says he says with a becoming suavity. But in all the arguments that he advanced I found no serious reason why these two groups, mental hospitals and tuberculosis hospitals or sanatoria, should not be included. His attitude was that to do so would be to assist the provinces, to subsidize them, I think was the expression.

As I have followed the course of the legislation I have wondered sometimes whether the government really intended when it was introduced that it would go into effect, for the minister imposed a veto on its application by providing that a majority of the provinces in number and in population would have to join the scheme before the legislation would become effective. That I cannot understand. Why is there this departure from the provisions in the past for the bringing into effect of social legislation unless the reason for the imposition of the qualification in question was the hope that the legislation could not or would not be implemented?

[Mr. Diefenbaker.l

There is also the further disqualification of sanatoria and mental hospitals. Why is this? Why are these hospitals and institutions discriminated against? I say that the legislation in its present form is discriminatory in that it denies these institutions a right that should be theirs. The hon. member for Eglin-ton said that it had that effect and that there was no reason to draw a distinction. The minister says that no distinction has been drawn. In point of fact, whether or not the distinction was intentionally drawn, the result is that there is discrimination against these two types of institutions.

At the present time the provinces find themselves with a smaller and smaller share of the tax dollar and with an increasing problem intensified by our modern way of life which has resulted in the multiplication of the number of mental patients. This load of responsibility cannot be discharged properly by the provinces. I suggest that now the minister give reconsideration to the question and accept the amendment of the hon. member for Eglinton which he moved on behalf of this party. Now that we are passing such legislation every reasonable facet of the problem should be met, for once the legislation finds its place on the statute books an amendment in order to cover tuberculosis sanatoria and institutions and mental institutions will be almost impossible of attainment. I cannot see that this demand is unreasonable and I feel that reality demands acceptance of the principle contained in the amendment moved.

This legislation which is designed to bring about the beneficial results which were pictured in such lucid language by the minister just before the dinner adjournment should not remain incomplete by denying to these institutions equality with the hospitals qualified under this legislation. The legislation as it is in its present form, beneficial as it will be, acceptable as it is to members in all parts of the house, is a step in the right direction. But the goal that all of us have in mind will not be achieved until the two types of institutions to which I have made reference are included within the provisions of this legislation.

Having said that I conclude my argument, for I do not wish to cover ground already covered. We in the opposition throughout the years have favoured this type of legislation. All parts of the house are in support of it. I ask the minister, before a vote is taken, once more to reconsider the matter to the end that, after a period of 38 years of promises periodically made and unkept, the legislation should be as complete as it is possible to make it and should cover all classes of medical institutions within our

country instead of discriminating against two, thereby placing upon the provinces a greater load of responsibility than their financial position permits them to discharge.

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

Daniel (Dan) McIvor

Liberal

Mr. Daniel Mclvor (Fort William):

Mr. Speaker, I cannot see that this amendment is in order, considering the speeches that have been made to include hospitals for tuberculosis patients and mentally ill patients. Where reference was made to "does not include" to take the word "not" in line 8 out so as to make it read "does include" surely makes this amendment out of order.

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

Gordon Knapman Fraser

Progressive Conservative

Mr. Fraser (Peterborough):

Do you not

want them in?

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

April 10, 1957