1957-03-25

STANDING ORDERS


[Stage Direction]
Mr. J. H. Harrison (Meadow Lake) presented the second report of the standing committee on standing orders, and moved that the report be concurred in.
Motion agreed to.


Hon. George C. Marler (Minister of Transport) moved: for leave to introduce Bill No. 319, to amend the Canadian Vessel Construction Assistance Act.


Mr. Green:: Could we have an explanation?


George Carlyle Marler: The purpose of this bill is to encourage shipbuilding in Canada by extending the benefits of the act to further classes of ships and to amend certain taxation practices so as to enable a taxpayer selling vessels for replacement to benefit immediately even although he may still own other vessels in his tax pool.
Motion agreed to and bill read the first time.



PRISONS AND REFORMATORIES ACT


Hon. Stuart S. Garson (Minister of Justice) moved: the first reading of Bill No. 282 (from the Senate), to amend the Prisons and Reformatories Act.
Motion agreed to and bill read the first time.



FINANCE


[Stage Direction]
On the orders of the day:
Mr. J. M. Macdonnell (Greenwood):: Mr. Speaker, I should like to ask the Acting Minister of Finance a question of which I have given him notice. Will the minister comment on the dispatch in this morning's
Gazette stating that Mr. Gordon Ball, president of the Bank of Montreal, has called on the government for a prompt "public announcement that no fundamental changes in the Canadian banking structure are contemplated without the fullest possible investigation of what might be involved"? Second, will the minister say what form of investigation will take place? Third, can the minister comment on the statement in the Gazette dispatch which says that Mr. Ball "has approached Finance Minister Harris about Mr. Coyne's proposals outlined in the Bank of Canada's report earlier this month"?


Stuart Sinclair Garson: Mr. Speaker, I want to thank my hon. friend for his courtesy in giving me notice of his question but really these questions which he has asked-all three of them -raise such important matters of policy that I do not think, as acting minister, I should undertake to offer any comments upon them in the minister's absence, more especially since he will be back in his place tomorrow and can himself more appropriately comment upon them.



CANADIAN BROADCASTING CORPORATION


[Stage Direction]
On the orders of the day:
Mr. Stanley Knowles (Winnipeg North Centre):: Mr. Speaker, may I direct a question to the Acting Prime Minister. What is the government's reply to the serious charge made by Arthur Blakely in this morning's Montreal Gazette to the effect that the government is interfering in C.B.C. public affairs programming?


Hon. Paul Martin (Acting Prime Minister):: Mr. Speaker, I saw the article by the distinguished journalist mentioned by my hon. friend. I can only say that I am sure the story is inaccurate. If there were any accuracy, all I can say is that any such alleged intervention has proven to be wholly ineffective.



INQUIRY AS TO CORRESPONDENCE BETWEEN MINISTERS AND CHAIRMAN OF BOARD

[Stage Direction]
On the orders of the day:
Howard Charles Green: Mr. Speaker, may I ask the Minister of National Health and Welfare or the Minister

Inquiries of the Ministry of National Revenue whether there has been any correspondence between the Prime Minister or any other minister and Mr. A. Davidson Dunton, chairman of the board of directors of the Canadian Broadcasting Corporation?


Hon. J. J. McCann (Minister of National Revenue):: Mr. Speaker, nobody could answer that question. I do not know anything about the Prime Minister's correspondence with anybody. So far as I am concerned, as minister, there has been no correspondence between myself and Mr. Dunton relative to the matter suggested.


Howard Charles Green: Would the Minister of National Health and Welfare ascertain whether there has been any correspondence between the Prime Minister or any of the ministers, except the Minister of National Revenue, and Mr. Dunton?


Paul Joseph James Martin: I shall take notice of my hon. friend's question and direct it to the attention of the Prime Minister when he returns.



HOUSING


[Stage Direction]
On the orders of the day:
Mr. H. O. While (Middlesex East):: I intended to ask a question of the Minister of Finance similar to the one asked by the hon. member for Greenwood, but in the minister's absence I shall direct a question to the Minister of Public Works. My question is, why not make use of the present legislation under the National Housing Act providing $150 million for low cost housing and quit tampering with the people's savings in chartered banks?


Hon. Robert H. Winters (Minister of Public Works):: Mr. Speaker, I can hardly conceive that the question was framed in such a way as to elicit a serious answer. I do not know of any tampering with anybody's savings in this country.


Stanley Howard Knowles: What about inflation?



COMBINES INVESTIGATION ACT


[Stage Direction]
On the orders of the day:
Mr. W. B. Nesbitt (Oxford):: I should like to direct a question to the Minister of Justice and I regret I have been unable to give him notice of this question because the matter has just come to my attention. The question is as follows. In view of the report of the restrictive trade practices commission concerning the production, purchase and sale

of flue-cured tobacco in Ontario, and in view of the fact that on April 1 next a vote is being taken amongst tobacco growers in Ontario for the purpose of deciding whether or not the growers should come under the jurisdiction of the Ontario farm products marketing board, is there any action the minister can take to assure that the funds and records of the flue-cured tobacco marketing association will not be used or misused to influence the vote in favour of the flue-cured tobacco marketing association?


Stuart Sinclair Garson: Mr. Speaker, if my hon. friend planned not to give notice of his question he certainly produced a very complicated one of which he gave no notice. Offhand my impression is that the matter which he raises is the responsibility of the provincial attorney general of Ontario.


Wallace Bickford (Wally) Nesbitt: May I ask a supplementary question. In view of the recommendations of the report, does the minister not consider that his department has a direct interest in the present situation?


Stuart Sinclair Garson: I do not apprehend that any recommendation in the report gives me authority to invade a field of activity which is provincial.


Mr. Speaker:: Order. I suggest to hon. members that they cut down a bit on the length of the foundation for their questions.


Wallace Bickford (Wally) Nesbitt: I should like to ask the Minister of Justice a supplementary question. Since the minister is somewhat uncertain as to the situation, would he be good enough to look into the matter right away and see if there is anything his department can do, as I am informed there is fear among the growers that the funds and records of the present association are being used to influence the vote?


Stuart Sinclair Garson: Mr. Speaker, it goes without saying that we will be glad to look into the matter and take any appropriate steps which may be within our power.



LIVESTOCK


[Stage Direction]
On the orders of the day:
Mr. H. W. Herridge (Koolenay West):: should like to direct a question to the Minister of Justice, whom I seldom crossexamine. In view of the fact that the acting minister of agriculture in British Columbia, Kenneth Kiernan, moved in the British

Columbia legislature an amendment to a motion concerning humane slaughter of animals, which urged that the government of Canada amend the Criminal Code to prohibit slaughter of food animals in packing houses without stunning prior to bleeding, and is reported as stating that anything other than federal legislation would be just an expression of pious opinion and would not accomplish what is wished, would the minister consider such an amendment to the Criminal Code?


Stuart Sinclair Garson: The minister is always prepared to consider any amendment to any federal statute which will produce beneficial results. But I do not think in the present case an amendment is required. Section 387 (l)(a) of the Criminal Code reads as follows:
387. (1) Everyone commits an offence who
(a) wilfully causes or, being the owner, wilfully permits to be caused unnecessary pain, suffering or injury to an animal or bird, . . .
I think before we consider changing that provision we should have some demonstration that it has been invoked and has been found to be wanting in such a set of circumstances as that to which my hon. friend's question refers.



ST. LAWRENCE SEAWAY CAUGHNAWAGA INDIAN RESERVE    REQUEST FOR SETTING UP OF CLAIMS COMMISSION

[Stage Direction]
On the orders of the day:
Mr. D. S. Harkness (Calgary North):: Mr. Speaker, I should like to direct a question to the Minister of Citizenship and Immigration. In view of the dissatisfaction of a considerable number of Indians of the Caughnawaga reserve over the offers of settlement made for the lands taken over from them for the St. Lawrence seaway, will the government consider the setting up of a claims commission in order to settle those claims and numerous other claims of Indians across Canada in regard to their property rights in what they own and do not own?


Hon. J. W. Pickersgill (Minister of Citizenship and Immigration):: Mr. Speaker, there is a relatively small minority of those persons who have an interest in property on the Caughnawaga reserve who have not yet made settlement with the St. Lawrence seaway authority for the lands that have been taken over for the seaway. They were assured from the outset that if they were not satisfied with the compensation which was offered by the seaway authority and which, after very careful consideration by independent experts, was accepted by the Department of Citizenship and Immigration, any individual
Inquiries of the Ministry case could be referred to the exchequer court for adjudication. It seems to me that that puts these people on a basis at least equal to that of any other persons whose property is being taken, and it would, I think, be quite wrong to substitute for the accepted procedure for settlement of expropriation cases a procedure that was somewhat different. Indeed, I would think, sir, in view of the fact that this offer was made, it might be construed as being a reflection upon the exchequer court, which I would not want to have any part in making.


Mr. Colin Cameron (Nanaimo):: Mr. Speaker, I should like to ask the Minister of Citizenship and Immigration a question supplementary to the one asked by the hon. member for Calgary North. He spoke of independent appraisers. Could the minister tell the house who engaged the independent appraisers with regard to the Caughnawaga reserve property?


John Whitney Pickersgill: Well, Mr. Speaker, I do not know which of my officials may have advised me as to whom to engage but I engaged the appraisers.


Colin Cameron: That is the point in which I was interested. They were employees of your department?


John Whitney Pickersgill: No, they are not employees of the Department of Citizenship and Immigration, because they are in the business of appraising; but they were engaged and contracted with by my department.
I think it is highly commendable, sir, that hon. members on both sides of the house are anxious, as we are, to see that these Indians get a fair deal. As there is some misunderstanding perhaps I should say that the seaway had its appraisers and we had our appraisers. I, as minister, have taken the view that my first duty was to be fair to the Indians and I have not agreed to any settlement that was not recommended to me by the appraisers we engaged.


Colin Cameron: Could I ask
another supplementary question, Mr. Speaker. Was it true that there was at least one appraiser who acted on behalf of both the department and the St. Lawrence seaway authority?


John Whitney Pickersgill: Not to my knowledge, sir, and I do not think that could have happened.


Mr. T. S. Barnett (Comox-Alberni):: Mr. Speaker, I should like to direct a further question to the Minister of Citizenship and Immigration supplementary to the question

Inquiries of the Ministry asked by the hon. member for Nanaimo. I should like to have the minister explain to the house how it is that officers of his department are making offers on behalf of the St. Lawrence seaway authority to members of the Caughnawaga Indian band.


John Whitney Pickersgill: What happened is that the St. Lawrence seaway authority expropriated this property for a specific purpose and I believe under the law it is the responsibility of the Minister of Citizenship and Immigration to satisfy himself that the compensation is adequate. When in our negotiations with the seaway authority we reached the point where we thought that what they were then willing to pay was adequate, an officer of my department discussed the matter with the Indians. We felt that it would be a rather ridiculous thing to have an officer of the seaway, without much detailed knowledge of conditions on the reserve, spending his time discussing these matters with the Indians.
In every piece of property on the reserve there is a band interest, that is the interest of all the Indians living on the reserve and having the right to live on the reserve, and in most cases also there is the individual interest of an individual Indian. Compensation is being paid both for the band interest and the individual interest.
Once we had come to the conclusion that what the seaway was willing to pay in a particular case seemed to us to be adequate compensation for the individual Indian, then we felt it would be better for our officers to carry on negotiations with the individual Indians. I took the position, and I have taken it repeatedly with the president of the seaway authority, that I could not agree to any over-all figure for the compensation until all the individual claims were satisfied.


Thomas Speakman Barnett: Just one further question,
if I may. Earlier the minister made some reference to the use of the exchequer court. Could he explain what advice has been given to the Indians by the department in regard to going to the exchequer court if they are not satisfied with the offers being made by the seaway authority?


John Whitney Pickersgill: Any band council, any
members of a band or any individual concerned knows because he or they have been told that if he or they are not satisfied the department will do whatever it can to facilitate a reference to the court. It may be possible that no action can be taken in the ordinary sense, but whether that is so or not, the government has given an undertaking to facilitate a reference to the court

for the purpose of determining what is appropriate compensation for the individual interests. All hon. members know that an Indian does not have title in the sense that a freeholder has and there is a band interest as well as an individual interest to be considered which complicates the whole business.


Douglas Scott Harkness: Mr. Speaker, may I-


Mr. Speaker:: Perhaps this matter could
be pursued on some other occasion. We have had several questions on this matter now.


Douglas Scott Harkness: I should like to direct a further question to the Minister of Citizenship and Immigration. Do the minister and/or his legal advisers consider there is a right of expropriation as far as Indian reserves or Indian lands are concerned?


John Whitney Pickersgill: That matter has recently been adjudicated upon by the high court in the province of Quebec. I believe notice of appeal has been given, and it would be very presumptuous on my part to give an opinion on a subject before the appeal court-the court of Queen's bench, I believe it is called- in the province of Quebec.


Douglas Scott Harkness: May I ask the minister what position the Indian affairs branch has taken on this matter up to date?


John Whitney Pickersgill: Of course the hon. gentleman is a member of parliament just as I am and he took part, whether he supported it or voted against it, in the passing of a bill at the last regular session of parliament, I think it was, to confirm this very right. However, it has been questioned whether parliament had the right to pass that legislation-


Douglas Scott Harkness: That is the very point.


John Whitney Pickersgill: -and that question is before the court. It would certainly be very presumptuous on my part to express any opinion on a matter before the courts.



HARBOURS


[Stage Direction]
On the orders of the day:
Mr. F. S. Zaplitny (Dauphin):: Mr. Speaker, may I direct a question to the Minister of Transport. Is the minister now in a position to enlarge upon the answer which I received

to a question which I asked on February 28? In order to assist him, may I read the question:
Have any steps been taken, as a result of representations from the government of Manitoba, to improve and modernize port facilities at the lake-bead?
At that time the Minister of Trade and Commerce indicated he would consult with his colleagues before giving a full reply. The Minister of Transport is one of those colleagues.


George Carlyle Marler: Mr. Speaker, I think there is a misunderstanding in the mind of the hon. gentleman as to my responsibilities in connection with facilities at the lakehead. I think he is, or ought to be, well aware of the fact that all such facilities are constructed by the Department of Public Works.


Frederick Samuel Zaplitny: May I ask a supplementary question. In view of the fact that the Minister of Trade and Commerce indicated that the Minister of Transport would be one of the colleagues to be consulted, and he disclaims that responsibility, may I direct the same question to the Minister of Public Works?


Robert Henry Winters: Mr. Speaker, as I recall it, a notice of motion for the production of papers was recently accepted. It reveals the correspondence between the Minister of Trade and Commerce, the Minister of Transport and myself and the appropriate minister of Manitoba. I would imagine the correspondence will be tabled very shortly, and it will give the hon. member the information he is seeking.



IMMIGRATION


[Stage Direction]
On the orders of the day:
Mr. G. R. Pearkes (Esquimalt-Saanich):: May I ask the Minister of Citizenship and Immigration whether any plans exist to assist with their transportation Canadian residents of the United Kingdom who are anxious to return to Canada?


John Whitney Pickersgill: Well, sir, an amendment was made last year, I believe, to the Appropriation Act in one or other of my estimates-I am speaking from memory and I cannot be sure which one it was-which inserted the word "settlers" as well as "immigrants", and that was done precisely for the purpose of making it possible to give assisted passage loans to Canadian citizens who had
Inquiries of the Ministry ceased to live in Canada but who had not given up their citizenship and who wished to come back to settle in this country. Of course, it would not be the practice to give assisted passage loans to Canadians who had gone to England or to some other country in the last year or two, and, having been a failure as emigrants, decided they would like to get their passage back to Canada; but there are a great many people who went- not a great many, perhaps, but a good number-20 or 30 years ago, particularly before the war when times were pretty rough in some parts of Canada, and particularly before 1935-


Some hon. Members:: Oh, oh.


John Whitney Pickersgill: Now that times have
changed they are rather anxious to come back to Canada and we felt it was desirable to give them every opportunity we could.


George Randolph Pearkes: Might I ask a supplementary question, Mr. Speaker. I am thinking particularly of those cases of men who served during the second world war and who for one reason or another-perhaps marriage- decided to remain in the United Kingdom but who now feel that they would like to return to Canada.


John Whitney Pickersgill: Oh, they would certainly be covered.


George Randolph Pearkes: They would be covered?


John Whitney Pickersgill: They would be covered, yes.



SHIPPING


[Stage Direction]
On the orders of the day:
Howard Charles Green: Mr. Speaker, may I direct a question to the Minister of Transport. What is the present situation concerning the royal commission on coastal shipping which was appointed on March 1, 1955? I ask that because I have some hope that their report might be available for the debate on the bill which was given first reading today.


George Carlyle Marler: Mr. Speaker, the government has not received the report from the royal commission examining into the question of coastal shipping, and I do not really believe there is a direct relationship between the subject matter of this report and the bill which 1 presented earlier this day.


Howard Charles Green: Could the minister give the house some idea as to when the report is expected?

Inquiries of the Ministry


George Carlyle Marler: Well, Mr. Speaker, a number of dates have been mentioned in the past, and as the report did not materialize on those dates I have ceased to speculate as to when it is going to be brought down.


Howard Charles Green: Will the Minister of Transport make inquiries of Mr. Justice Spence, who is chairman of the royal commission on coastal shipping, and ask him when he expects to present his report? Then the minister can give the house that information. A similar course has been followed by some of the other ministers in the case of commissions where there has been a long delay.


George Carlyle Marler: I shall make inquiries.



TRENT CANAL


[Stage Direction]
On the orders of the day:
Mr. Harold E. Winch (Vancouver East):: Mr. Speaker, I should like to direct to the Minister of Transport a question of which I regret I have not given notice. If desired he can take this question as notice. Will the minister inform the house why the marking of water buoys has been changed on certain waterways in Canada from white to black? The result is that those on ships are not able to see the black buoys, and consequently accidents have occurred.


George Carlyle Marler: Mr. Speaker, if the hon. member will supplement the information contained in his question so I can make the necessary inquiries, I shall be glad to do so.


Harold Edward Winch: The Trent waterways in Ontario are a prime example.



TRANSPORT


[Stage Direction]
On the orders of the day:
Mr. H. R. Argue (Assiniboia):: Mr. Speaker, I should like to address a question to the Minister of Transport. Now that the government has announced that a comprehensive examination of the entire transportation system of the Atlantic provinces will be made in order to determine what can be done to contribute to their welfare, will a similar comprehensive examination of the system on the prairies be carried out in order to assist the economic welfare of that region and to remove the discriminatory freight rates?


George Carlyle Marler: Mr. Speaker, I would repudiate the suggestion that there is any possible comparison outside of the mind of the hon. gentleman between the two areas which have just been mentioned. I cannot think at the moment of any reason why the government should consider making an inquiry into transportation conditions in the west.


Hazen Robert Argue: Mr. Speaker, does the minister not agree that the recent increases in freight rates of 7 and 4 per cent are discriminatory against the prairies, and further, that the $7 million subsidy-


Mr. Speaker:: Order. Certainly that question may be construed as debating the answer given by the minister.


Mr. F. G. J. Hahn (New Westminsler):: Mr. Speaker, I have a supplementary question. I would ask the Minister of Transport if he is not possibly considering a study of the west coast shipping situation under the same suggestion?


George Carlyle Marler: Mr. Speaker, I can allay the hon. gentleman's curiosity by saying that the government is not considering such an inquiry at this time.



PARLIAMENT HILL


[Stage Direction]
On the orders of the day:
Herbert Wilfred Herridge: wish to direct a question to the Minister of Public Works because I am concerned about the maintenance of the dignity of parliament. Has the minister now informed himself as to the correct protocol with respect to the use of our flag over the parliament buildings? If so, will he tell the house what the procedure is?


Robert Henry Winters: Mr. Speaker, I am familiar with a number of whys and wherefores with regard to the flying of the flag over the parliament buildings, but if my hon. friend would be more specific perhaps I could be more specific.


Herbert Wilfred Herridge: What I have in mind particularly is this. While we all understand that the flag is flown at half mast on occasions when members of the house and the other place depart, I have noticed that people consider there is a certain irregularity with respect to the flying of the flag at half mast on other occasions. Would the minister tell the house for whom we fly the flag at half mast, other than senators and members of

parliament? I have particular reference to the heads of other states and so on. Who issues the order?


Robert Henry Winters: Mr. Speaker, the flag is flown at half mast when members of either house of parliament pass away, also members of the privy council and heads of foreign states. On one recent occasion to my knowledge it was flown at half mast when a member of the supreme court died. Apart from that, I think the procedure is pretty well regularized.


Herbert Wilfred Herridge: Would we fly it on Nasser's account?


John Whitney Pickersgill: Is he dead?


Mr. Brooks:: We would like to.



EXTERNAL AFFAIRS


[Stage Direction]
On the orders of the day:
Mr. Lucien Cardin (Parliamentary Assistant to the Secretary of State for External Affairs):: Mr. Speaker, on Friday last the hon. member for Restigouche-Madawaska asked the Secretary of State for External Affairs to confirm the holding of a meeting of the United Nations committee on resolutions which was supposed to have been held in New York on Thursday, March 14, between the hours of three o'clock and five o'clock. I am sorry the hon. member is not in his seat, because I feel sure he would be quite interested in the answer.
The answer is that the department has confirmed that there is no United Nations committee on resolutions. As a matter of fact, on Thursday afternoon, March 14, there was a meeting of the United Nations standing committee on petitions of the trusteeship council. As hon. members know, Canada is not a member of this council nor, of course, is she a member of the committee which on the day in question was concerning itself with the reception of petitions from the French Cameroons.
If the hon. member attended this meeting in any official Canadian capacity his initiative, while perhaps very praiseworthy, was entirely unconstitutional. However, the meetings of the committee, as hon. members know, are open to the public so perhaps the hon. member listened from the gallery as any visitor to New York is entitled to do. Perhaps I should also inform the hon. member that the committee's meetings are continuing this week.
Inquiries of the Ministry


SUEZ CANAL
[Stage Direction]
On the orders of the day:
Stanley Howard Knowles: Mr. Speaker, may I direct a question to the Acting Secretary of State for External Affairs. In view of conflicting reports from Cairo as to whether or not agreement has been reached between Mr. Hammarskjold and the Egyptian government concerning the future of the Suez canal, can the minister say if the government has any information whether there has been such an agreement?


Paul Joseph James Martin: Mr. Speaker, as other hon. members have, I have seen reports to the effect that a solution of the Suez canal dispute has been agreed upon between the government of Egypt and the Secretary General of the United Nations. However, I also have noticed that the same press reports mention that there has been no comment on this story from the secretary general. The government has received no such report from any authoritative source.



NATIONAL DEFENCE


[Stage Direction]
On the orders of the day:
Mr. G. S. White (Haslings-Frontenac):: should like to ask the Minister of National Defence if he can answer the question I asked him on March 7 concerning the additional forces and equipment for the United Nations emergency force and with reference to Canadian troops now in Egypt. The question was:
Does Canada pay the entire cost of transport, pay and allowances and all other costs while these troops are serving with the United Nations emergency force? If Canada does pay the entire cost, will the United Nations repay to Canada all or any part of such cost?


Hon. R. O. Campney (Minister of National Defence):: The pay and allowances of the Canadian troops serving in UNEF are paid by the Canadian government. Cost of the food and most of the incidental expenses are being paid for by the United Nations. There are some charges that are being paid by Canada which are being negotiated with the United Nations to decide who shall ultimately pay.


George Stanley White: Does the minister expect that the United Nations will repay to Canada part of the expenditures that have been made?


Ralph Osborne Campney: Yes, we hope so.

Health Insurance HEALTH INSURANCE



AUTHORIZATION OF PAYMENTS FROM CONSOLIDATED REVENUE FUND

Paul Joseph James Martin: that the house go into committee to consider the following resolution:
That it is expedient to introduce a measure to authorize contributions to be paid out of the consolidated revenue fund to provinces in respect of costs incurred by them in providing insured hospital and diagnostic services pursuant to provincial law and to agreements made in accordance with the said measure, to commence when at least six provinces, containing at least half the population of Canada, have entered into such agreements and qualified for the receipt of such contributions.
Motion agreed to and the house went into committee, Mr. Robinson (Simcoe East) in the chair.


Mr. Marlin:: Mr. Chairman, this resolution is based on the government's offer to the provinces on hospital insurance and diagnostic services as announced on January 26 last by the Prime Minister. I should like now briefly to summarize the federal government's proposals in the following manner.
First of all, the government declared its willingness to assist with technical support and financial assistance any province wishing to embark upon agreed phases of provincially administered health insurance schemes involving no constitutional change or interference with provincial affairs as soon as a majority of provincial governments representing a majority of the Canadian people indicated their readiness to proceed. Since the opinions expressed by the provincial authorities at the conference on the question of priorities confirmed fully the view of the federal government expressed by the Prime Minister at a meeting held with the provinces on October 3, 1955, the government gave priority of attention in its offer to the development of plans to cover diagnostic services and hospital care. The government declared as well its readiness, once a majority of governments representing a majority of the people of Canada declared that they were ready to introduce hospital insurance, to recommend to parliament that it provide by legislation grants to cover a share of the cost of this element of health insurance to take effect when that majority of provinces have such plans in operation.
I should like to note that it will be apparent now from the wording of the resolution to which I now speak and from the text of the bill when it is before the house that a favourable modification has been made in the original requirement that a majority of

provinces must have their plans in actual operation. It should also be noted that the government has not waited until six provinces have declared their readiness to proceed but has proceeded in advance of its commitment a year ago to introduce legislation at a time when one additional province is needed to make up the required majority.
The federal offer stipulated that provincial hospital insurance plans, in order to qualify, should make coverage universally available to all persons in the province, include provision of specified diagnostic, laboratory or radiological services to persons in hospital and within an agreed time to persons outside of hospital; and provide for a limit to be placed on co-insurance or deterrent charges so as to ensure that an excessive financial burden will not be placed on patients in respect of hospitalization costs at the time of receipt of service.
Mr. Chairman, the federal government went on to propose that its contribution to the cost of hospitalization provided for under a recognized provincial hospital insurance plan would be a specified proportion of shareable costs and these would be determined on the basis of normal operating and maintenance costs for certain standard ward care, and provide for certain exclusions. Costs would be shared by the federal government not only with respect to care in active treatment or general hospitals but also with respect to care in chronic and convalescent hospitals. Furthermore, the federal government would share in the costs of treating and caring for tubercular and mental patients in general hospitals.
The federal contribution in respect of each recognized provincial plan would be based on the following formula, applied to shareable costs as already defined: first, 25 per cent of the annual per capita costs for hospital services in Canada as a whole and, second, 25 per cent of the annual per capita costs in the province itself multiplied by the population covered. This formula takes into account the fact that hospital costs vary greatly from one province to another and also that some provinces have greater financial resources than have others. By basing contributions in part on the national rather than the actual provincial average the formula is weighted in favour of the less wealthy provinces, particularly the maritimes, whose available financial resources might otherwise make it difficult for them to provide the services which are possible in the better-off provinces.
In that portion of the formula which involves paying 25 per cent of the actual shareable costs in each province, recognition is

given to the position of the higher cost provinces, namely British Columbia, Alberta, Saskatchewan and Ontario. In that portion of the formula which involves paying 25 per cent of the national average, recognition in the government's formula is given to the position of the lower cost provinces, particularly the maritime provinces which, incidentally, are also for the most part those provinces with similar financial resources from which to provide their smaller share of the cost.
That is in general an outline of the proposal which the federal government has made to the provinces and in respect of which five provincial governments have signified their concurrence in principle acknowledging in so doing that their schemes in being or in the planning stage come within the four corners of the proposal which was first announced to parliament last January.
I am sure the house will recall the day when the former prime minister, the late Right Hon. W. L. Mackenzie King, on May 14, 1948, announced to this house and through this house to the nation the national health grants program. I venture to remind the house of what he said on that occasion, for the words which he then used have not, in the intervening years, been far from my mind or from the mind, the judgment and the consideration of the government as a whole. Mr. King pointed out then that the grants provided important financial assistance to the provinces in the development of better health services for the people of Canada wherever they might live. But their true significance and purpose, he emphasized, went far beyond that; they were, in fact-and I quote the exact words he used at that time-"a fundamental prerequisite of a nation-wide system of health insurance". Ever since that time, Mr. Chairman, this government has kept-as have others-that concept of the purpose and goal of the national health program in the forefront of its thinking and planning. We have laid the groundwork for what is now being done. We have planned, stimulated and financed, in collaboration with the provinces, the expansion and development of our local public health services, our skilled health personnel, our hospital plant and equipment, to meet the requirements of our growing population.
This foundation has involved federal expenditures of over $200 million, and also substantial expenditures by provincial governments and by voluntary organizations all over the country. As a result of this program, in communities all across our country, hundreds of new hospitals have been built to better serve the health needs of the people. Improved care has been made possible for
Health Insurance
the victims of cancer, tuberculosis, mental illness and so on. Progress in medical research has been greatly speeded up. The children of Canada have been given the protection of the Salk polio vaccine, as a result of the joint efforts of the two senior levels of government. These and other developments have helped to bring the nation's health services to a most desirable level and to set the stage for the hospital insurance legislation we are now seeking to introduce.
In all these years we have constantly reminded members of this house, the governments of the various provinces, and indeed the Canadian people of our longer range objectives. We have sought to enlist enough of the provinces in support of our objective to take the step envisaged in the original plan. Now, after this period of careful and responsible preparation, in co-operation with the health departments of the provincial governments, through the national health program, we are ready. We are now, I believe, with confidence, in sight of our long-sought goal. One more province is required to make up the needed majority representing the majority of the people of our country to make our program of hospital insurance a reality.
Now, sir, the basic objective of the federal hospital insurance proposal is to provide, in co-operation with the provinces, protection for all Canadians against the possibility of heavy or unexpected hospital expenses. An important by-product of the program, moreover, will be to put the nation's hospitals, again in co-operation with the provinces who will have the responsibility of administration, on a much sounder financial footing. It is in the confident hope that not just one but several more provinces will indicate shortly, I trust, their intention to proceed that I am now presenting to the committee this resolution under which we are seeking the necessary authority to introduce legislation which will make possible the realization of a nationwide system of hospital care insurance in Canada.
I need say little about the resolution, nor would it be in order for me at this juncture to point out the details of the contents of the bill whose introduction we seek through this resolution. It will be sufficient, I think, to state that the bill will embody and implement the full intent of the federal government's proposals as presented by the Prime Minister last January. It will neither require, nor indeed countenance, federal interference in provincial affairs. It will fully respect and safeguard provincial autonomy and jurisdiction. It will leave undisturbed the constitutional relationships of the various levels of government, and requires no constitutional

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amendments. It will authorize the conclusion of agreements with provincial governments desirous of embarking upon provincial programs of hospital insurance and diagnostic services; and will provide the authority necessary for the payment of substantial federal contributions in accordance with the terms of these agreements.
It will require that coverage under provincial hospital insurance plans be universally available without arbitrary exclusion, artificial residence or other barriers or discrimination of any kind, to all persons in the province. This will include Indians, Eskimos or other groups of persons who might otherwise be excluded by statute or on grounds of provincial policy from participation in provincial hospital insurance programs. It will provide for the determination of shareable costs, and for the exclusion therefrom of certain items which are not shareable by the federal government. The details of these items I have already given before the estimates committee which sat during the course of the last session of parliament. The bill will embody the formula for sharing costs, based partly on the national experience and partly on the actual provincial experience, which has already been set forth in the offer which I outlined a few moments ago.
For all provinces, taken as a whole, the federal contribution will amount to 50 per cent of those costs defined as shareable, while for each province the federal contribution will amount to 25 per cent of the per capita shareable cost for the nation as a whole, plus 25 per cent of the per capita shareable costs for the province itself, multiplied by the population covered in the province. Finally, Mr. Chairman, the bill will define the nature of the benefits to be provided under approved provincial hospital insurance plans, including bed care on the public ward level, without any arbitrary restriction as to the number of days, the usual hospitalization extras, out-patient and diagnostic services as may be agreed upon.
The resolution makes clear, of course, the requirement that six provinces, representing at least half of the population of Canada, must have passed the necessary provincial legislation; concluded agreements; established the required provincial administrative machinery and otherwise qualified for the receipt of contributions before the federal obligation under any of the agreements becomes effective. This is not, of course, inconsistent, with the general proposal which was announced to the house by the Prime Minister, but modifies in some degree the

more detailed proposal which I discussed with the ministers representing the ten provincial governments.


Hazen Robert Argue: Why don't you pay the money now?


Paul Joseph James Martin: Now, Mr. Chairman, presentation of this resolution is, I am sure, for all of us in this house an historic occasion.
I wonder if I may say, without criticism, that in all the years I have been in this house I have had no greater feeling of satisfaction than at this very moment. Never has the government, and I am sure others in this house, had such a feeling of complete conviction as to the vital importance of the legislative action we are now proposing the terms of which, in its financial implications, must be considered as imposing added responsibilities on the people of Canada who will be called upon to accept the decision of this parliament. I can say that the government has never felt more completely certain that the good that will flow from an act of this parliament will be understood and appreciated and valued in the years to come by the people of this country.
We are witnessing today, in the presentation of this resolution, the culmination of much effort and much study; the work of countless persons in this house and in this country; and the collaboration of many governments, federal as well as provincial. All of them, government and individuals alike, have been imbued, in my judgment, with a common determination to find some means of bringing improved health and hospital services to our people, to ensure the availability of skilled hospital and diagnostic services when required, to spread more equitably the financial burden of expensive hospital care.
I know this problem can only be reached and solved by co-operation between the two senior levels of government. It cannot be done on any other basis and preserve the traditional constitutional and administrative patterns in our country. And so we have reached the end of the period of preparation and preliminary planning. We are now ready to move along a new highroad of progress, a highroad which leads to the assurance of better, more adequate health and hospital services, whenever they are needed, for the people of Canada.
I take my seat with the words of a great Canadian citizen, those of Laurier, who said:
The fight of democracy for freedom, for equality of opportunity and for substantial justice to all individuals still goes on. Canadian politics still has its greatest work to do; the welfare of the common man at the common task is its first consideration.

Therefore, Mr. Chairman, I express the hope that in the spirit of these noble and moving words of a great Canadian prime minister, every member of this house, regardless of party, will support this resolution which can mean so much to the people of this great nation.


Mr. Blair:: Mr. Chairman, the resolution before the house reads:
That It is expedient to introduce a measure to authorize contributions to be paid out of the consolidated revenue fund to provinces in respect of costs incurred by them in providing insured hospital and diagnostic services pursuant to provincial law and to agreements made in accordance with the said measure, to commence when at least six provinces, containing at least half the population of Canada, have entered into such agreements and qualified for the receipt of such contributions.
I have read this resolution into the record, sir, in order to point out that this is a measure for insuring hospital and diagnostic services. That is a point on which I wish hon. members to be quite clear. We have been aware for some time that negotiations have been proceeding between the government of the province of Ontario and the federal government to bring such a plan into effect and I am proud that Ontario has taken such a forward step to bring such an agreement to the present point where at last we can visualize a hospital insurance plan for Canada. It has been a long road since 1919 when the Hon. W. L. Mackenzie King, as leader of the Liberal party, promised health insurance for Canada. From 1919 to 1948 covers a period of 28 years since health grants were first introduced. To the health grants we gladly assented, and today we have before us the present resolution for the introduction of hospital insurance.
For the past 12 years, on behalf of the Conservative party, I have advocated measures to benefit health conditions and care for the people of Canada. All political parties in this house have been in favour of such a measure. We may not all have agreed on the general form of insurance, but one point is clear, and that is that we all appreciate the fact that the public money that is spent on legislation to combat sickness, disease and misery, will pay high dividends in health standards and happiness of the people of our nation.
Sir, I wish to quote from the closing paragraph of a book written in 1945 by Henry E. Sigerist, professor of the history of medicine in the Johns Hopkins University.
The problem of financing such health services is secondary. More difficult economic problems have been solved. We have all the money we need when we are attacked by a ruthless enemy. Disease is also an enemy. Its attack may be less spectacular but is just as pernicious as any that occurs in actual warfare, and we certainly can find
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the comparatively small funds required to fight this war to a victorious end. The health and welfare of every individual is the concern of society, and human solidarity beyond the boundaries of nationality, race and creed, is a true criterion of civilization.
This is a measure for health insurance. Throughout the ages, in the attempt to combat disease and sickness, there were generally evolved special types of structures, and chief among those structures was the hospital. I bring this in because it shows how hospitals first came into being. In the early centuries of our era it was a guest house that provided shelter for the indigent and the stranger and later became a place where the indigent sick were nursed and received free medical treatment. When medical science progressed, giving rise to aseptic surgery, and to better diagnostic methods, the hospital was no longer a place of death, but the source of all medical activities sought by the rich and poor. From the few rooms that were then maintained for the sick, in the early medieval monastery, the hospital developed into the large wards of the middle ages. As the development progressed it became the highly complex institution of our present day with large and small sick rooms, solariums, operating rooms, laboratories and facilities for medical research. The modern hospital has lost the gloom of the earlier eras where every feature reminded one of the proximity of death. Today the modern hospital remains a place of suffering and disease but the accent is on life.
I have previously pointed out in this house, not later than last year, that the matter of keeping well is of the utmost importance. This particularly applies in the present agreements to the diagnostic feature. A few hundred years ago, in European history, the point of view among those interested in the healing arts was concerned with the curing of disease. At this point I wish to point out that there is a great deal of difference between curing and using preventive measures. Preventive measures were almost unknown at that time. The most they hoped for was to have physicians sufficiently versed in the understanding of disease that sick people under their care would rapidly recover.
Under conditions such as these it becomes clear that only a small proportion of the population shared in the benefits of the increasing skill of the physicians; but under present conditions, hospitals, laboratories and physicians are in close contact with new scientific equipment. Today physicians are armed with new drugs, advanced methods of treatment, and methods which would have

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been considered unbelievable in the previous centuries. Today curing is not sufficient. The problem today is not only to get people well but to keep them well. If we were still to pursue the old idea of keeping people well by curing disease it would be a costly and expensive proposition from the taxpayer's point of view. We must also pay particular attention to prevention. From year to year we are making progress in the campaign to keep people well. When I spoke on this last year on the health estimates I said that one could even now visualize a period in the future when the needs for hospitals would diminish owing to the great objective of full preventive measures rather than the older concept of curing disease.
In our consideration of health measures we must note the fact that while illness creates suffering it is also an economic loss. The sick man cannot work and therefore he loses his wages. Sickness may disable a worker for long periods of time. Then, if in addition to his loss of wages he is faced with a heavy hospital bill he is placed in a position of financial hazard.
While many diseases can be prevented, many can be cured in the initial stages by early treatment. This is the point where diagnostic methods and hospital care become very important, and the phrase "diagnostic methods" assumes importance in relation to the resolution. But the hospital, which plays an increasing part in all aspects of medical care, has been forced to raise its costs considerably. Medical supplies, drugs and appliances are not only more expensive but are needed in rapidly growing quantities.
At this point I should like to remind hon. members that while new treatments are often expensive the duration of stay in hospital has been markedly cut down and earlier cures effected by their application. Nevertheless, new drugs, new methods and the cost of hospitalization present a financial burden with which the average citizen finds it difficult to cope.
Some medical care is obtainable collectively through public funds but most of it
Net Operating Expense of Public General
Year	Hospitals
1947		 $34,777,586
1948		 41,406,417
1949		 47,384,181
1950	  54,239,079
1951	  65,801,700
1952		 75,475,955
1953		 82,717,006
1954		 95,667,327
must be paid for by the individual at a time when he is undergoing the financial handicap of sickness. It may be difficult to estimate the risk of sickness for the individual but it can be estimated for large groups and therefore in order to spread the risk among a number of people the principle of insurance must be applied.
Few hon. members of this house can be unaware of the burden which falls on the shoulders of the individual faced with heavy hospital bills. Not only must we consider the financial position of the individual but we must also consider the financial position of the hospitals and the municipalities.
Boards of management of hospitals during the past decade have been engaged in a constant struggle to maintain their institutions in a period of rising costs and yet keep down the cost of bed and room accommodation to the patients. But in the main hospital costs have been steadily rising, and this of necessity has caused increasing financial burdens on the patients.
The point has been reached now where the average citizen cannot afford to pay for hospitalization in the event that he or the members of his family incur severe sickness. The cost of patient day care, and the increase in the number of days of care provided, has meant an increase in the total expenditure on hospital care by our people.
For the information of the house I wish to present the following statement of the province of Ontario contained in their proposals for hospital care insurance of January 1957. These figures are necessary for a clear understanding of the problem. Hospital operating deficits in 1954, after provincial grants, amounted to approximately $10 million. This was substantially reduced by income from endowments, donations and almost $3 million in deficit payments by municipalities.
At the risk of burdening the house-and I do realize that figures become tiresome-I wish to read the following table covering the period 1947 to 1954 which I think assists us to appreciate the true situation:
Total Adult and	Cost per	Increase in Cost per Patient DayChildren Patient	Patient	Over PreviousDays	Day	Year4,663,568	$ 7.46	-4,811,276	8.61	15%5,023,544	9.43	10%5,252,566	10.38	10%5,510,301	11.94	16%5,857,258	12.89	8%6,140,929	13.47	4%6,534,306	14.64	9%

Between 1947 and 1954 the latest year for which figures are available the net operating costs of public general (A,B,C,) hospitals nearly tripled, total adult and children days of care increased by 40 per cent and per diem costs nearly doubled. The average increase in per diem costs over the previous year during the period 1945-1954 amounted to about 10 per cent. In these eight years such increases have ranged from a low of 4 per cent to a high of 16 per cent in a single year.
Now having considered capital costs, sir, let us consider sources of revenue. Referring again to the province of Ontario statistics, I quote from the proposals of the Ontario government as a source of information:
As the deficits referred to indicated, hospital revenue failed to keep pace with rising costs, even though, in the period 1947-1954 the revenues of all hospitals in Ontario increased from $38.9 million to $99.8 million in 1954. While this represented a total
Total Expenditure	
Total Revenue	
Income from Patients	
Income from Municipalities for treatment of patients	
Ontario government maintenance grants, etc. ..
Property donations, etc	
Grants from municipalities	
There was a surplus in 1947 of $1,154,180 and there was a residual deficit in 1954 of $3,567,541.
Now, having considered revenues and costs, I come to a point of what is apparently disagreement in the discussion to date between the Ontario and federal governments. It would appear that the federal government does not agree that depreciation charges and interest on capital debt should be allowed as part of the formula for their contribution to the costs of hospital care. The Canadian Hospital Association has requested the federal government to reconsider the allowable expense in hospital services to include depreciation on buildings and fixed equipment and interest on capital loans. Under present conditions if no allowance is made for this purpose hospitals will be again in the position where they will have to seek funds for rebuilding or replacing equipment. I would point out that public campaigns for this purpose will be increasingly more difficult in the future. I quote from the Canadian Hospital Accounting Manual:
Depreciation of hospital buildings and equipment should be recognized as an element of hospital
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increase of 157 per cent, income from patients increased by 161 per cent and payments from the Ontario government increased 394 per cent.
Income from municipalities for the treatment of patients, increased 70 per cent while deficit payments by municipalities increased 353 per cent. In 1947 Ontario government payments amounted to 5.6 per cent of total revenue; these payments increased to 10.8 per cent in 1954. The Ontario government maintenance grants, et cetera rose from $2.2 million to $10.8 million over this period.
The biggest increases in payments during the period 1947-1954 were made by the Ontario government and by the municipalities to cover deficits. Notwithstanding these sharp increases and other increases in revenues which were received by general hospitals over the period, the residual deficit in 1954 came to $3.6 million.
The trend in costs and revenues are shown as follows-this includes public general hospitals, Red Cross outposts, chronic care and convalescent hospitals, selected years 1947-1954.
The following interesting table shows the expenditures and revenues in the period 1947 to 1954:
1947	1954	Percentage Increase 1954-1947$37,747,989	$103,375,770	17438,902,169	99,808,229	15728,727,518	74,879,897	161(73.8%)	(75.0%)	4,578,450	7,765,727	70(11.8%)	(7.8%)	2,183,623	10,792,861	394(5.6%)	(10.8%)	2,795,545	3,577,374	28(7.2%)	(3.6%)	617,034	2,792,370	(1.6%)	(2.8%)	
expense. The depreciation and value of buildings and equipment represents a real cost of hospital service even though such assets may originally have been donated to the hospital.
Representatives of the federal government accepted this principle in 1951 but not in 1957. In all reason it would appear only just that depreciation on buildings, equipment and the interest on capital loans should be recognized in a national hospital insurance plan.
It must be clearly recognized that health is under the jurisdiction of the provinces. However, a review of the present hospital situation would not be complete without a review of the present mental health situation in Canada. This has been another point of discussion in regard to present negotiations between the province of Ontario and the government of Canada. The federal government has not recognized mental patients in the present agreements under discussion. It does agree to the inclusion of these mental patients while in general hospitals. The problem of mentally ill patients is one of our greatest problems. Owing to advanced methods of treatment it must be pointed out that the length of stay in hospital has been steadily

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cut down in the past 20 years, enabling the hospital to care for more patients. However, to make full progress there must be general recognition of the fact that mental illness is a form of disease comparable to any other disease which affects the human body. In 1934 patients discharged from mental hospitals had a stay of 5.4 months in comparison with 1954 when the stay was 1.8 months. The point to be noted is that in 1954 three patients could be treated in the bed required to accommodate one patient in 1934. Mental health clinics, private physicians and out-patient departments of general hospitals are giving an increasing amount of treatment for this disease. But the fact remains that the 1954 statistics indicate there were over 68,000 patients in mental institutions in Canada. This number exceeds by 10,000 the number of patients in public hospitals.
While the health grants have assisted in this matter, I cannot but feel that this is one of our foremost problems in the field of national health and should receive further consideration in these agreements in order that it can be dealt with more adequately. This fact must be recognized. According to the statistics of the Canada Year Book, of the 68,157 patients on the books of mental institutions at the end of 1954, 62,323 were in hospital. This is 87 per cent more than the 33,290 reported in hospital at the end of 1932.
The minister has argued that to recognize mental patients in hospitals would under this scheme increase the costs and help defeat the objective of insurance. Nevertheless, even if the care of these patients remains the duty of the provinces consideration should be given in the discussions for further available funds to enable the provinces to carry out a program of hospitalization and treatment to cut down the incidence of this disease.
It would be impossible in the time allotted for debate to fully discuss all that is entailed in this resolution. The resolution is to introduce enabling legislation to deal with the proposed hospital insurance. We regard the whole matter as of the most vital importance. This party is of the opinion that such a plan should be available to any or all the provinces. Under the present proposed legislation it will be necessary to have six provinces or a majority. Statistics show the necessity of a hospital insurance plan. If it is necessary now, let us put a plan into operation as soon as it can be done in an orderly way. Every month of delay is another month when we permit these discrepancies to exist.
As a resident of Ontario I am proud that the government of Ontario has taken this forward step. We of the Conservative party

have long advocated a step of this kind. We support this resolution but we believe that the plan should be available to any and all provinces which enter into such agreement and qualify for the receipt of such contributions. Therefore I move, seconded by the hon. member for Middlesex East:
That the resolution be reported to the house with the proviso that the words after "when" in the fifth line of the resolution to the word "entered" in the sixth line of the resolution be deleted and the following substituted therefor:
"(a) when any province of Canada has
(b) that the word 'agreements' in the fourth line and sixth lines of the resolution be changed to 'agreement' ",


The Chairman:: I shall of course consider the amendment.


Stanley Howard Knowles: Mr. Chairman, the resolution placed before the committee today by the Minister of National Health and Welfare deals with a matter which is of equal if not greater importance than any subject which could be dealt with by a legislative body in this country. It deals with the health of our people and proposes a forward step in social concern for that health. Therefore we shall support the resolution. I shall indicate the features in this proposal which appeal to us and which we think are good, but it will also be necessary for me perhaps even to a greater degree to refer to the features in respect of which we think the resolution falls short.
We welcome in particular the proposal of the government that the services to be provided under this resolution shall be universally available in the provinces in which this measure becomes effective. There have been some discussions during recent weeks as to the meaning of universality, but I dare to believe that whatever differences there may be between the government of Canada and the government of Ontario regarding universality those differences relate only to the time as to when full universality will be realized.
I dare to believe that there is agreement between the two governments to which I have referred, as well as on the part of all the other governments that are in on discussions of this matter, that sooner or later, but sooner rather than later, the services provided under any hospital scheme must be available to every resident of the province concerned. In our view no social program in the health field is worth its salt unless it is based on the principle of universality, and we welcome that important aspect of this legislation.
We also welcome the fact that the legislation provides for a proportion of the costs of the services covered by this legislation to

be paid for out of the general revenues of the federal treasury. I shall have something to say later about the percentage proposed in the resolution, but at the moment I am dealing with the good points of the matter and I say that we welcome the fact that a proportion of these costs is to be paid for out of the consolidated revenue fund of the federal government.
The reason we welcome that feature is that we feel that health care-indeed, we go a lot further than the hospital care covered in this resolution-is something that should be paid for by the people of Canada according to their ability to pay rather than according to their particular need of health or hospital care. Any program of health insurance or hospital insurance that requires people to pay for it on a fixed premium basis, if you are dealing with it nationally, or that requires people to pay for it on a basis that is related to the amount of care that they receive, violates that principle. But when you pay for a portion of health or hospital care out of the consolidated revenue fund you are drawing on those funds of the nation which are acquired mainly through corporation and income taxes and they are the funds that most nearly approximate the principle of paying according to ability to pay.
It will be obvious from what I am saying that we feel that the percentage of hospital care to be paid for out of the consolidated revenue fund should be much higher than the 50 per cent indicated in this legislation, but we welcome the fact that the government has gone at least that far. We welcome the fact that the government realizes that the day has come in Canada when a considerable portion of the health care of our people, as reflected in their hospital costs, should be paid for not according to the particular need of the individual who has to be hospitalized but according to the ability of the people of Canada to pay. Those are the two features of the legislation which we welcome the most, its universality and its recognition in part of the desirability of health care being paid for according to ability to pay.
When the minister was speaking I made a note of an additional point to welcome but as he got a little farther along in his remarks I found I had to cross out the note. At this moment I am not just sure where we stand with respect to the matter he knows I have in mind, but perhaps it will be cleared up before the discussion in committee has been concluded. The minister said early in his remarks that a change was to be made in that part of the statement made by the Prime Minister in January, 1956, and indeed there would be a change in the corresponding part of this
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resolution, that referred to the necessity of having the six provincial plans in operation before payment could be made to any of the provinces.
I dared to hope from what the minister said when he first referred to this matter that a modification was being forecast which would make it possible, once the required number of provinces had agreed to establish their plans, for payment to be made to those provinces which have their plans in operation without having to wait for all six plans to be in actual operation. Something the minister said later suggested that I had gone too far in my understanding of the modification because he said later that no province would draw any money until all of the provinces were in a position to draw the money simultaneously.
I regret very much that the change forecast in the legislation in that respect is not more substantial than it seems to be. We feel very strongly that the whole formula that the government has laid down is not a good one. We think that its requirement that there be six provinces representing a majority of the population of Canada before anything is done is too stringent a requirement. As we have tried to point out a number of times already in this session, there are now five provinces that have agreed and the population of those five provinces represents over 56 per cent of the population of Canada. We feel that the spirit of the suggestion made by the Prime Minister in January, 1956, has been met and that the government should now modify the requirement that six provinces must agree before anything is done.
The minister will say that the government has modified its position to some extent in that it is now introducing this legislation even though only five provinces have indicated their agreement but, although he has introduced the legislation, right in the resolution itself is the requirement that six provinces agree and that six provinces have their plans in operation before the operation as a whole can come into effect. We feel that this is a mistake.


Paul Joseph James Martin: I do not think that last statement is quite right.


Stanley Howard Knowles: Well, I will not develop that part of it too fully until we have all made our initial speeches. We can then discuss the matter further. I take it that some modification is in prospect which will be known when we get the actual bill that is based on the resolution. But, Mr. Chairman, the resolution does set out the requirement that there be agreement by at least

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six provinces. At this point I want to object very strongly to any such requirement being written into any act of parliament. I concede the government's right to stipulate before it brings in legislation that any proposed legislation will not be brought in until certain terms satisfactory to the government have been met, but I suggest to the government that it is not good practice to include in an actual law to be placed upon our statute books what amounts to a right to any one province of the country to veto legislation passed by the parliament of Canada.
It is understood according to the British North America Act that once an act has been passed by the House of Commons and the Senate and has been given assent in the name of the Queen by the Governor General the legislation is in effect and I submit that it is not proper for any such legislation passed by the three branches of parliament to have in it a provision that keeps that legislation from coming into effect by virtue of a veto of some-indeed of even ore-of the provincial governments. Once the government has come this far and is prepared to lay legislation of this kind before parliament, once it is satisfied that it has virtual agreement from enough of the provinces, I think there should be no inclusion of that kind of a formula in the legislation itself. Once the legislation has been passed and given assent it should be clear that it is the law of the land so far as Canada is concerned.
The Minister of National Health and Welfare says this is an historic occasion. One would expect him to say that. After all it has taken the unrolling of a good deal of history for us to reach this point. But I feel that I must draw to the attention of the Minister of National Health and Welfare and those who sit behind him the fact that the end is not yet.


Paul Joseph James Martin: The best is yet to come.


Stanley Howard Knowles: My hon. friend is admitting that there is more to come. I am glad to hear that.


Paul Joseph James Martin: I said that the best is yet to come.


Stanley Howard Knowles: I draw to his attention and to the attention of those opposite the fact that even yet-even after this period of 38 years-the government made up of members of the Liberal party is still not implementing the plank in this respect adopted by the Liberal party at its national convention in 1919. That convention, by the way, was held before some 10 or a dozen members of this house whom I might name were even 
born. What was the proposal in that convention of 1919? Was it a proposal for hospital insurance? No. It was a proposal for sickness insurance. We know that sickness insurance, as it was called then, is now referred to as health insurance. But are we now getting from this Liberal government an implementation of that promise to bring in sickness or health insurance? No. We are getting just a mere portion of that promise, namely a proposal to finance hospital insurance, and even that only to a limited extent.
Since the historic nature of this occasion has been referred to by the Minister of National Health and Welfare, I might just take a moment to invite hon. members to read the debate on this resolution that took place at the Liberal convention in August, 1919. It was moved by Mr. King and seconded by Mr. Arthur Roebuck who is now a member of the other place. There were two other speakers, namely the late Hon. George P. Graham and Mr. D. D. McKenzie.
It is a very interesting debate. The resolution was a lengthy one under the general heading of "Labour and Industrial Conditions". There were in all some 20 points to it, including the commitment with respect to sickness insurance. But to my disappointment I find that of the four speakers whose speeches occupied 20 pages in the record of that convention, not one of them referred to this question of health insurance at all. They put it on the record, passed it and let it lie there. Most of those who spoke to this comprehensive resolution, which included a promise of sickness insurance, spoke primarily to the last paragraph in the resolution that was then before the convention, which was a paragraph that promised that the Liberals would do their best to restore the control of the executive by parliament and to restore parliamentary responsibility to the people of Canada.


Some hon. Members:: Oh, oh.


Stanley Howard Knowles: They might better have
talked about the health insurance proposal which was included in that resolution. Not only was the 1919 promise a promise of health insurance but, down through the years, every time the Liberals have talked about this matter, until very recently, they have talked about health insurance, in broad and general terms. For example, to jump across the years, in 1943 when the speech from the throne was read opening the session of parliament for that year, there was a promise that there would be a study of health insurance. It was not hospital insurance but rather the whole question of health insurance.

Later that year-and I have in my hand a copy of the Ottawa Journal of Tuesday, March 15, 1943-there were laid on the table of the house certain reports which produced big headlines about social security and health insurance. Later in that parliament, in the next year, there was laid on the table of the house a draft bill on health insurance, public health, the conservation of health and the prevention of disease. The short title of it was "The National Health Act". In 1948, when Mr. King brought down the health grants program to which the Minister of National Health and Welfare has referred today, he said very clearly that the purpose of that health grants program was to lay the foundation for a nation-wide plan of health insurance; and I note that the Minister of National Health and Welfare today referred to that. So it is, Mr. Chairman, all down through the years the references made by the government in this field have been to health insurance. Now we are getting just a portion, just an instalment, of a promise made 38 years ago. We welcome it. It is a step in the right direction. We will support it. Our support is a foregone conclusion. But, Mr. Chairman, the people of this country are still waiting for that full program of health insurance which the Liberal party has been advocating across the years and which now has the support of all the political parties in this country.
I point out, Mr. Chairman, that even as a hospital insurance program it does not go far enough. To begin with, it does not include two extremely important fields, namely tuberculosis and mental health care. We have been through these arguments before and we will probably go through them again in the course of this debate, either at this stage or in committee on the bill.


Murdo William Martin: I think it would be better
on the bill.


Stanley Howard Knowles: All right. We will do it
then. But I simply make the point now- and it may be developed by one of my colleagues-that it is not even full hospital insurance, leaving out as it does tuberculosis and mental health care.
I also point out that as a hospital insurance program it is deficient with respect to the percentage that the federal government proposes to pay. I do not quarrel with the way in which the formula is divided into two parts, 25 per cent of the average cost across the nation and 25 per cent of the average cost in the province multiplied by the number of individuals in the province. However, what we quarrel with is the total of approximately 50 per cent. We feel that, in relation to the importance of health to all the Canadian
Health Insurance
people, a much greater percentage than 50 per cent should come out of the federal treasury which receives, more than does any other treasury in Canada, its income according to ability to pay because that federal treasury draws its receipts so heavily from corporation tax and income tax.
We in this party urge that the contribution of the federal treasury to any health plan- and certainly it should apply to the hospital plan now proposed-should be 80 per cent rather than 50 per cent. We would have no objection to that 80 per cent being split into two parts of 40 per cent each along the lines proposed by the government but we insist that the federal government is not bearing its proper share of this important phase of our national life when it pays only 50 per cent of only a part of the hospital costs of our people. It should be paying at least 80 per cent.
I join with my friend the hon. member for Lanark in regretting that no provision has been made to include depreciation costs and administration costs in the definition of shareable costs. After all, these are certainly part of the major costs of hospitalization in any province. We feel that they should be included.
I want to say something more about this matter of when the plan will come into operation. The minister wants to discuss this matter later. However, from what he said it is fairly clear that even the best discussion that we may have will not satisfy us on one particular point. As I have already said, we do not think this should be delayed until there is a sixth province. We feel that the present five provinces that have agreed, representing as they do over 56 per cent of the population of Canada, should be sufficient and that there should not be any limitations contained in the bill such as are now there apparently referring to the requirement that six provinces agree. Even after we get over the hurdle as to when this legislation becomes effective, Mr. Chairman, we still have the problem as to when the payments will start to be made. I listened carefully to the Minister of National Health and Welfare (Mr. Martin) -


Paul Joseph James Martin: That will come out in the bill.


Stanley Howard Knowles: The minister talked about this today and, after saying there would be certain modifications on this point, the minister also said towards the closing part of his speech that there would be no payment to any province until all the provinces-whether he meant five or six or ten I do not know, but I presume he meant six-


Paul Joseph James Martin: Six.

Health Insurance


Stanley Howard Knowles: He says he meant six-there would be no payment to any province until six provinces were ready to receive that money.


Paul Joseph James Martin: You will have to wait until you see the bill, because that is not the situation.


Stanley Howard Knowles: Is that statement not correct?


Paul Joseph James Martin: No, that statement is not correct.


Stanley Howard Knowles: Then, will it be possible for provinces which already have their plans in operation to start drawing their money before the others are ready?


Paul Joseph James Martin: When we get the bill before us my hon. friend will see what the situation is.


Stanley Howard Knowles: If my hon. friend would like me to discontinue my remarks on this phase of the matter, all he has to do is tell me that those provinces that have plans in operation will be able to draw their money from the federal treasury without having to wait for the rest of the six to have their plans in operation. If he is not in a position to tell me that, I submit this is the time when I should urge upon him to make any necessary changes in the legislation so that will be done.


Paul Joseph James Martin: Perhaps I could relieve my hon. friend's mind right now, so he will be under no misapprehension. What he is asking now is that we should do now what the government of Canada has not done in respect of the provinces of British Columbia and Saskatchewan. The policy of the government is clear. We do not propose to use the money of the majority of the people of Canada to assist a province or groups of provinces which, in the particular context, represents a minority of the total population. Now, that is the situation.


Stanley Howard Knowles: That is a point about which we have argued over the years and I recognize that the government, with its majority, has been able to override our requests for help to a province like Saskatchewan which has led the way in this field. I am talking now about the present situation, about a situation that will obtain immediately after this legislation, brought in by the federal government, is passed. It is my contention that once this legislation has passed, it will be because five provinces representing a majority of the people of Canada have agreed to bring in these plans. It then becomes only a matter of time as to when all five will have their plans in actual operation. Ontario talks

about having its plan in operation on January 1, 1959, but during the interval between now and the time when Ontario will have its plan in operation, I submit it is unfair to deny this assistance to provinces like British Columbia and Saskatchewan which already have their plans operating.
The Minister of National Health and Welfare says the government is not going to change its position. Well, I suppose I cannot do other than object if the Liberals insist upon being stubborn, but I would point out that on February 26 of this year, as recorded on page 1653 of Hansard, I put this question to the Prime Minister:


Stanley Howard Knowles: May I direct a supplementary question to the Prime Minister. In view of the fact that the five provinces which have agreed have a population amounting to over 56 per cent of the population of Canada, would the Prime Minister not agree that the spirit of the conditions laid down by the government has been met, and that it is time to introduce the legislation to which reference was made last Thursday?


Right Hon. L. S. St. Laurent (Prime Minister):: The government has not decided to modify any of the terms of the proposals that were put forward a year ago.
Now, Mr. Chairman, there was a clear statement by the Prime Minister on Tuesday, February 26, that there would be no change from the proposals of a year ago which called for legislation not to be introduced until six provinces had agreed. Three days later, and I congratulate the minister on this, that stubborn stand of the Prime Minister's was set aside and with only five provinces having agreed, the Minister of National Health and Welfare filed notice of the resolution which is now before the committee. It is my hope that the government, having yielded on that point and having retreated from the stubborn insistence on six provinces before it would introduce a resolution, will now yield on some more points upon which it will have to yield sooner or later. One of these points on which they must yield is this question as to when payments will start to be made.
I submit it is not only unfair to provinces like Saskatchewan and British Columbia which already have plans in operation-I am not overlooking Alberta, I might say to my friends to the left, except that I believe the Alberta plan is not up to 100 per cent universality as are the plans of the others, although it may be soon-what I am saying is that I think this is unfair, not only to provinces like British Columbia and Saskatchewan which have their plans in operation, but it is unfair to provinces like Ontario. Apparently the Ontario government wishes to go ahead and build up a plan, establish the machinery, and so on, so as to start a program of hospital

insurance in Ontario on January 1, 1959. I should like to see it start sooner for the people of Ontario, but at any rate is it fair to the government of Ontario to expect it to go ahead and get machinery ready, get civil servants employed or get a building program under way, and not be sure in advance whether or not it is going to get federal money on January 1, 1959? This is a certainty which might be removed by some province like Newfoundland, for instance, failing to be ready when that time comes.


Paul Joseph James Martin: I hope my hon. friend will ask me that question when the bill is before us, because I will be able to give him a very satisfactory answer. It is a very important question.


John Whitney Pickersgill: An uncalled for innuendo.


Stanley Howard Knowles: I did not intend to cast any innuendo on my hon. friend's adopted province. I was simply taking that province as an illustration. If provinces A or B, out of the six that have agreed, and perhaps through no fault of their own, are not ready to start on a certain fixed date, then you find the other four or five provinces, by the formula we now have, denied the right to receive money at that time. I gather from the agitation of the Minister of National Health and Welfare, that there may be some change in this formula in prospect.


Murdo William Martin: No, no.


Stanley Howard Knowles: Now he says "no".


Murdo William Martin: My hon. friend is not well today. He is suffering from a cold and that may account for his unusual lack of calmness.


Stanley Howard Knowles: Not on your life.


Murdo William Martin: When we get to the bill I will be able to explain the provision we have made which avoids the very thing my hon. friend, understandably, is so concerned about.


Stanley Howard Knowles: I shall welcome that explanation. I hope when that explanation comes it will also make it clear that provinces like Saskatchewan and British Columbia which have been pioneering in this field and carrying the load for a long time will get the money which is coming to them without having to wait for some slower provinces to come along.
Now, if my hon. friend, the Minister of Citizenship and Immigration, wants to know what I have in mind when I refer to the "slower provinces" I will say I have my own province particularly in mind. I am sorry I am not in the position of my friend, the hon. member for Lanark, who can stand up and express pride in what his province has done. I come from one of the provinces that seems 82715-168
Health Insurance
to think only in terms of a disastrous plan. I know the provincial minister calls it a disaster plan but it is, in fact, a disastrous plan.


Mr. Hodgson:: May I ask the hon. member a question? Will he tell the house what party is in power in that province?


Stanley Howard Knowles: I am talking about Manitoba, where a Liberal government is still in power, the only province on the mainland of Canada which has a Liberal government.


Mr. Robertson:: It is the Liberal government of Canada that is bringing it in.


Stanley Howard Knowles: Under the Manitoba plan the provincial government is prepared to pay the hospital cost of an individual only if he has been in hospital more than 180 days in any particular calendar year. The Manitoba government calls it a disaster plan. As I say, it perhaps might be called something else.
I congratulate those provinces, the five of them, which have indicated their agreement, their readiness to go ahead with the federal government's plan. Because they represent over 56 per cent of the population of Canada and because the people of Canada have been waiting for many a long year for steps in this direction, I hope that something will be done soon. I hope that this will not be the case of a bill being laid on the table just before an election. I say that because of the draft bill back in 1944. That is all that was done on that occasion. I hope this bill will be passed at this session and that it will include provisions to make it possible to get this program going at the earliest possible date. When the election is over-


The Deputy Chairman:: Order.


Stanley Howard Knowles: May I have 30 seconds?


Edward Turney Applewhaite: I am sorry to interrupt the hon. member but I have already permitted him considerably to exceed his time.


Mr. Bell:: Tell us what is going to happen when the election is over.


Stanley Howard Knowles: I will, later on.


Mr. Shaw:: Mr. Chairman, there is evidence to indicate that the minister is anxious to have the committee pass this resolution so that the bill based upon it might be introduced. We feel that probably we shall be in a much better position to discuss it at the bill stage, and for that reason I do not intend to occupy very much time.
I listened to the minister this afternoon waxing eloquent in his usual fashion and obviously without too much effort. He demonstrated an extremely high degree of

Health Insurance
enthusiasm, which caused him to use such expressions as this being a memorable day, and being an historic occasion. In fact, at one stage I almost thought he was going to shed tears but he did not. It was obvious, too, upon this occasion, as upon previous occasions-whether it was intentional or not- that the minister was endeavouring in some way or another to create the impression in the minds of certain people in certain places that this was the first step in the field of health insurance. In fact, I was thinking back to those times when the federal government granted assistance to the provinces to help them carry out responsibilities in the field of health where it was in their jurisdiction to do so, and I could not but conclude that there is not a single solitary field where the federal government has finally agreed to make grants that at least certain provincial governments have not themselves blazed the trail, pioneered, and suffered ail the headaches that go with this sort of thing.
We have already had references to the hospital insurance scheme in Saskatchewan, for example, to the one in British Columbia and to ours in Alberta. They have been operating under such plans for a considerable period of time and now, as far as they are concerned, the federal government has come along, dragging its feet as usual, and has now proposed a plan under which assistance will be granted to the provinces to enable them to bear the burdens which some of them have borne for some time and to enable other provinces which have not yet ventured into this field to do something for their people. I just said that to remind the committee that the real pioneering in connection with these things has been done by the provinces in co-operation with the municipal governments with voluntary help, with organizations, and so on, and not by the federal government at all.
We heartily endorse the basic principle of this resolution, Mr. Chairman, namely, that the federal government should assist the provinces in this field of health insurance. As I say, we support the basic principle included in the resolution. We heartily approve of the fact that the administration is to remain on the local level in the sense that the provincial governments will conduct the work of administration. We have stated upon many occasions that whatever is done in this federal field by the provinces and the federal government-in most cases the municipalities enter into it- the administration should remain on the local level. I think this is a particularly good feature of this proposal. We feel that every effort possible should be made, particularly in this field of health, to avoid

unnecessary, and what I would call most undesirable, centralization of administration.
We have not at any time, Mr. Chairman, urged the federal government to plunge in all at one time in a hasty fashion, in a showy fashion, for political purposes, on an allembracing, comprehensive national health insurance scheme.
I personally feel that while there seems to be a good deal of tardiness at times, it is better to lay a good solid foundation with respect to any of these matters and build on those good solid foundations. By that I am not suggesting for a moment that certain of these things could not have been done prior to this time; but we do feel that it is wise to proceed carefully-I will not use the word "slowly"-and cautiously, and not by ill-advised leaps which some would seem to want us to do.
I think, too, it is extremely important that while we are considering treatment we should never at any time forget to assist in the field of prevention. I am vitally concerned about legislation of this kind, Mr. Chairman, particularly because of the fact that it becomes more obvious every day that the Canadian people are finding it more and more difficult, if not impossible, in so many cases, to secure and pay for hospital, medical, dental, optical and other services, and to pay for the drugs which so many of them have to purchase because of illness. It must be obvious that not only are families becoming impoverished as a consequence of illness involving hospitals, and so on, but there is ample evidence that that very thing has happened to a good many families already. One reason why it is becoming increasingly difficult for people to meet these costs is the fact that almost every day the cost of everything is going up; almost every day we find the tax burden, no matter at what level of government, becoming more oppressive, leaving less and less all the time for the individual to pay his own way, as it were. Many families are being left without sufficient with which to purchase the necessities of life, thereby creating a condition, involuntarily, of course, where health deteriorates as a consequence. It almost has a double-barrel effect; it is almost a vicious circle. I sometimes wonder where we are going eventually to arrive.
As I said a moment ago, on the one hand government spending increases by leaps and bounds; taxation increases by leaps and bounds; and living costs are going up by leaps and bounds. Citizens are left with less and less, which results in more and more help being required from the government and more government assistance, leading people

to be more and more dependent upon the government. That makes me wonder. Of course, as they become more and more dependent on the government they become more and more subject to government regulation. I wonder perhaps if this is not the sort of thing which my leader had in mind in 1953 when I recall his saying that a grave danger facing us is a tax dictatorship.
This situation results, as I said earlier, from a vicious combination of factors. I do not want it to be taken from that comment that one can in any sense be opposed to the principle of the resolution now before us, but it is a side thought to which I have devoted a great deal of attention. This appears to be a vicious circle and one wonders where we are going to eventually land in this whole scheme.
As far as that amendment is concerned we cannot at this point understand why it is the government is so insistent upon waiting until a certain number of provinces have signed up, as it were, before bringing into operation the proposal contained in this resolution.
It has been intimated that the five provinces which have already indicated agreement represent more than 50 per cent of the population and that rather limits the value of the statement made by the minister only a short time ago. I do not remember the exact words he used but his statement was to the effect that they were not asking the minority to pay for the costs-no, that was not it. Perhaps the minister could repeat the statement for us?


Paul Joseph James Martin: Yes. What I said was that the policy enunciated by the Prime Minister and repeated by me in the estimates committee when I met with the provincial ministers was that the federal government was not prepared to recommend a policy that would result in the payment by the taxpayers of Canada of financial assistance in the matter of hospital insurance to a group who represent in the broad context of the over-all plan a minority in the nation.


Harold Edward Winch: A minority of the provinces.


Paul Joseph James Martin: No, a minority of the people. Well, a minority of the provinces, yes. And may I say, by the way, that view was supported by the minister of health for Alberta and others at the conference.


Frederick Davis Shaw: It would appear that whether or not he agrees that he is, what the minister is talking about is a majority of the provinces and not a majority of the population because we already have five provinces in which we have a majority of population.


Stanley Howard Knowles: Fifty-six per cent.
Health Insurance


Frederick Davis Shaw: Yes, 56 per cent. It is small wonder that some of us are confused with respect to this. However, in the course of considering the bill itself we may clear up some of the confusion and receive information in answer to the questions which are in our minds.
There is one other matter I am wondering about. I am interested in knowing if it is the intention, when and if the agreement of six provinces is obtained, to make this proposition apply in the same way in each of the six provinces. I have a reason for asking about this.


Murdo William Martin: Do you mean the insurance scheme itself?


Frederick Davis Shaw: Yes. I want to know if the same rules and regulations will apply in one province as in another.


Paul Joseph James Martin: Do you mean that the schemes, must be the same?


Frederick Davis Shaw: Yes. Whatever plan we endorse here, is it to be applied in each of the six provinces in the same way?


Murdo William Martin: Perhaps in order to understand my hon. friend's question I may be permitted to ask this. Does he mean that in order to come within the purport of this broad proposal each province must have the same kind of insurance scheme?


Frederick Davis Shaw: No. Let me give you an illustration of what I mean. When the federal Disabled Persons Act came into operation there were two provinces in Canada which already had their own schemes.


Murdo William Martin: Yes, precisely.


Frederick Davis Shaw: I refer, of course, to the province of Alberta and the province of Ontario; but they were not treated in the same way. I understand that all the people who qualified under Ontario's disabled persons act were immediately permitted to come under the federal scheme but each case was reviewed later on and if following the examination of a particular case by the board of review it was found that the recipient of the disabled persons pension did not qualify under the federal regulations then that person was dropped from the role, but during the period of time which elapsed while they were attempting to determine his eligibility under the federal scheme the central government paid.
In Alberta they did not do that as far as I can learn. In Alberta they had to establish the fact that a person receiving a disabled pension under the act of that province could qualify under the federal act before he was

Health Insurance
brought in under the federal act, the difference being that for a period of months the Alberta government had to continue paying a pension to certain disabled persons who were qualified to come under the federal act but who had not proven that they possessed the qualifications because a board of review cannot handle these things overnight while in Ontario, as far as I am aware, a different situation obtained.
That is the sort of thing I have in mind. I am not suggesting that any two provinces should have exactly the same scheme. That could not be expected particularly where you have provinces with differing schemes operating at the present time. What I am anxious to see is that whatever we pass here each of the participating provinces will get the same kind of deal, if I may use that expression. I am interested in seeing that we secure fairness.
I notice that the minister gives me a rather strange look but I cannot believe he does not know what I mean regardless of how I may have complicated my question in expressing it.


Paul Joseph James Martin: I do not understand, really. When we get into a discussion of the bill perhaps this can be cleared up. We are certainly going to treat all the provinces fairly. I sincerely do not quite understand the hon. member's question but when we get into discussion of the bill perhaps my hon. friend can illustrate his point to make it more clear.


Frederick Davis Shaw: My point is this. Let me put it this way. If the provinces of British Columbia, Alberta and Saskatchewan happen to participate in the scheme there will not be one set of rules for one province and another set for the others?


Paul Joseph James Martin: I can give my hon. friend that assurance.


Frederick Davis Shaw: I shall have a few more questions to ask when we reach the discussion of the bill.


Paul Joseph James Martin: Thank you.


Mr. Hees:: Mr. Chairman, the minister in his very histrionic speech-I have not yet seen him more so-said this was an historic occasion. Well it certainly is. This is the occasion when we celebrate the end of 38 years of promises by the Liberal government concerning health insurance. For the last eight elections we have seen this same government bring out the subject of health insurance, dust it off, promise it, wait until the election was over, wrap it up in cellophane again, place it back on the shelf marked "E" for elections, and wait for

another election to come along. But two years ago, Mr. Chairman, a very statesmanlike gentleman in this country, Premier Leslie Frost of Ontario, decided that this Liberal dishonesty should come to an end and so, to the great dismay of the Liberal government, he demanded that the question of hospital insurance be placed on the agenda of the dominion-provincial conference to be held in October 1955.
The Liberal government, of course, was dismayed and disconcerted by this prospect because they were planning to use the subject of health insurance as bait for the ninth successive election; to promise it again, and tell the people that if they voted the government in they would have health insurance. Of course the government had no more intention of bringing in a health insurance plan following the ninth election than they had in the case of any of the eight previous occasions.
However, Mr. Frost is not a man to be fooled with. He was very determined, and demanded that this question be placed on the agenda of the conference, and this was done. The other provincial premiers were very glad that this was done, and thought it was a good thing that Mr. Frost had taken an adamant stand in this matter. The question of a health insurance plan was well received at that conference, with the result that in January of the following year, 1956, a three-day conference was held on the subject of health insurance. Following that conference the Minister of National Health and Welfare made a statement in section 4 of which he said:
Provincial hospital insurance plans, in order to qualify for consideration, should:
(a) make coverage universally available to all persons in the province.
Further on in that statement the minister referred to certain costs in which the federal government would not share, including capital costs-for example, depreciation, interest, amortization of debentures, etc.- and provincial administrative costs and the cost of caring for mental or tubercular patients.
Mr. Frost agreed with the requirement of the federal government that coverage should be universally available, as stated by the minister. He and his health department thought they could get a coverage of 85 to 90 per cent, or higher if possible. It is to the advantage of any province to get the highest possible coverage, because the higher the coverage, the lower the unit cost to the province.
That is obvious, because when a plan like this comes into operation, those who tend to stay out are the young and healthy, the

ones who cannot see a need for hospital insurance for some time to come, while the ones who enter first are those who need hospital care and will thus constitute the greatest drain on the province's resources. So it is to the advantage of a province to get as high a coverage as possible, and that is what Ontario intends to do.
Mr. Frost and his government disagreed with the unwillingness of the federal government to participate in capital costs, administrative costs, and the cost of caring for tubercular and mental patients. They contended quite rightly that administrative costs are very much a cost of any plan, and that you cannot have a plan without administrative costs. You also cannot have any kind of a plan without capital costs, as you must rebuild your institutions, provide new machinery and equipment and so on from time to time. Administrative costs are very much a part of the cost of your plan. The Ontario government also feel that two very important categories of treatment today are those affecting mental and tubercular patients. They feel, I think quite rightly, that those costs should be shared by the federal government.


Paul Joseph James Martin: I know my hon. friend would not want to give a wrong impression to the Canadian people on a matter of such importance. Tubercular and mental patients, as the hon. member for Lanark mentioned, who are in general hospitals are being taken care of. I am sure the hon. member is not arguing that we should use a hospital insurance plan to subsidize provincial governments. A hospital insurance plan is intended to subsidize individuals in connection with their hospital costs.


George Harris Hees: It is a question of whether the federal government is willing to assist the provincial governments in caring for tubercular and mental patients. I think it is most desirable.


Paul Joseph James Martin: So do I. My hon. friend knows that will be done under the national health program.


George Harris Hees: I hope it will; I am glad to have the minister's assurance that it will be done. Mr. Frost is an easy person to get along with, and he was most co-operative and ready to do anything to help this federal hospital insurance plan get under way. Therefore he said that until the federal government saw its way clear to agreeing to share these additional costs, which he believed should be shared, the provincial government would continue to pay the full amount. To use his own words, he fitted his plan into the four corners of the requirements laid down by the minister in January
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of 1956, and which were expressed in the statement he made following the conference. That was all very well until January of this year, when it seems the minister suddenly realized that he was going to have five or six provinces agreeing, and the plan would soon be put into operation. Things were probably moving a little too fast to suit him, so he then decided that instead of the coverage being universal, the coverage should be 100 per cent of the people in the province.


An hon. Member:: Who said that?


Paul Joseph James Martin: My hon. friend of course is badly informed on this subject.


George Harris Hees: Then the minister had better get that straightened away with Mr. Frost, because that is certainly the impression you conveyed to him and his ministers.


Paul Joseph James Martin: Has my hon. friend read the correspondence between the premier and myself? I am sure if he rereads it he will want to correct that impression.


George Harris Hees: I read it very carefully, and it was certainly my impression and the impression of officials of the Ontario government that the minister was putting a serious block in the way of this plan becoming a reality. However, Mr. Frost persuaded him that this requirement of 100 per cent coverage would be very costly and would require coercive methods in order to make it work. If there are people who do not want to come into a plan you have to use coercive methods to force them to come in, and that is a very costly thing to do. However, once again, thank heavens, Mr. Frost was able to persuade the minister of the error of his ways, and the minister finally came to agreement with the province of Ontario on the details of the plan that would be put into operation.
The only block seems to be that a sixth province is required. Why that requirement was ever brought into the negotiations I do not think any person can understand.


Paul Joseph James Martin: Would you like me to explain
right away?


George Harris Hees: Yes.


Paul Joseph James Martin: If we had not insisted on a sixth province we would not have five now. I would ask my hon. friend to give very careful consideration to this. What we are after is a nation-wide system. If you just have a program which says it will apply to any province that wants to come in, you would not get any more than the five we have now. If my hon. friend is sincere in trying to promote a nation-wide system, then let him not argue against this essential condition of having six

Health Insurance
provinces. If we insist on six, we will get six or even seven, and if we insist only on five that is all we will have.


Clayton Wesley Hodgson: How do you know?


George Harris Hees: That is the strangest bit of
arithmetic I have ever listened to. If we have six we will have seven, but if we do not require six we will not have any, or some such nonsense. The provinces which have come in have done so, not because of any requirement on this government's part but because they wanted to come in, because the great majority of the people in this country want a hospital insurance plan. That is the reason the provinces which have already come in have done so. I do not think there is any logic in the minister's statement that if you require six you will get seven. It sounds like some kind of shell game.
This seems to be just one more difficulty being placed in the way of this plan coming into operation. You have five provinces, and for heaven's sake realize that those five provinces are in because they want to come in. If a sixth province wants to come in it will come in because it wants to, not because of the minister requiring it to.


Paul Joseph James Martin: We will sign with the five provinces as soon as the legislation is passed.


George Harris Hees: Will the legislation be passed before the sixth province comes in?


Paul Joseph James Martin: If my hon. friend will help to pass this bill, the minute it does pass we will sign with the five provinces.


George Harris Hees: And start the plan immediately?


Paul Joseph James Martin: I did not say that.


George Harris Hees: How soon will you start the plan?


Murdo William Martin: My hon. friend has read my speech. I said when the six provinces passed the necessary legislation and had agreements in being and had their acts in force. My hon. friend knows that if we are not beginning until January 7, 1959, that is not the fault of this government.


George Harris Hees: I still cannot see any logic in requiring six instead of five. Why not pick seven; why not pick four? How did you arrive at six? Can you tell me that?


Paul Joseph James Martin: I have already explained it.


George Harris Hees: Well, Mr. Chairman, it seems that the minister just does not want to make sense. I do not think his statement that the requiring of a certain number makes the thing more desirable or less desirable adds up. I will simply conclude by saying that as far as I can see the people of Canada owe a very great debt to Premier Frost for being
(Mr. Martin.]
the prime mover in all this. If it had not been for the fact that he demanded that hospital insurance be placed on the agenda of the dominion-provincial conference in October, 1955, we would not have this legislation before us today.


Mr. Patterson:: Why did not Premier Frost bring in a provincial plan?


George Harris Hees: That is exactly what he is in the process of doing.


Alexander Bell Patterson: Why did he not do it
before?


George Harris Hees: So, Mr. Chairman, I think perhaps this plan could be called the Frost plan, because if it had not been for him we would not have it before us today. If it had not been for his foresight and determination, and his desire to see a measure like this put into operation, it is certain that we would not be debating it at this moment.
I end by urging the minister to waive this silly requirement of six provinces. Take five provinces, sign them up and let us get the whole matter under way without further ado.


Mr. Habel:: May I ask the hon. member a question. Can we agree on one thing? Is it not a fact that the premier he is talking about so much noticed the need of health insurance when he felt the pressure of public opinion in his own province?


George Harris Hees: Mr. Frost does what he feels is good for the people of his province. He wants health insurance.


Joseph-Alphonse-Anaclet Habel: Under pressure.


George Harris Hees: He is doing everything to force its adoption.


Joseph-Alphonse-Anaclet Habel: When pressure is brought upon him by the people.


George Harris Hees: No, not at all. He is the one who is bringing pressure on the federal government to make good on the promises that were made over 38 years ago.


Mr. Mclvor:: Mr. Chairman, I have a few brief words, because in 1937 I had a resolution on the order paper with respect to health insurance.


Robert Henry Winters: Who pressed whom into action now?


Daniel (Dan) McIvor: I spent two years on a committee under the chairmanship of the late Right Hon. Ian Mackenzie. We were ready with our bill but something happened and we could not get it across.


Clayton Wesley Hodgson: Still Liberal promises.


Daniel (Dan) McIvor: Some said at that time that we did not have the co-operation of the provinces. Whether or not they were asked I do not know, but we did not get the bill through. Now we have the bill and it is not state medicine. I think the medical associations all over Canada will appreciate that it is not state medicine. It is a hospital plan. It does not interfere with the doctors. The patient can choose his own doctor, and I expect that the doctor can charge his fee in the usual way.
It has been said that the Liberals have been terribly slow in bringing in the bill. We know it is a law of nature that things that grow fast do not abide, whereas things that grow slowly and steadily do abide. After this slow growth over long years we now have a bill that the opposition supports up to a certain point. I congratulate the minister on the way he has stuck to his job. I congratulated him once before when he wiped out all the different nationalities in Canada and made us all Canadians, not Irish Canadians, not Scotch Canadians. Now we have him sticking to his task and bringing in this legislation after hard and faithful toil. Some people criticize him for being slow but they never tell him that he is lazy. They dare not do that, because he might step across the floor of the house to prove that he is not.
I congratulate the minister on bringing in the resolution at this time, and I am looking forward to seeing the bill. I may have some criticism too, but as I see it now this is a job well done. Stick to it, Honourable Paul.


Mr. Nicholson:: Mr. Chairman, it is apparent that the hon. member for Fort William is very easily satisfied. The Minister of National Health and Welfare boasted of the expenditures which have been made in the field of health. He has spent something over $200 million. May I remind him that his colleague the Minister of Defence Production has spent more than that on the development of the CF-105. He spent more than that on the mid-Canada radar line.
It has been admitted that the federal authority has some responsibility in this field of health, but I think the present resolution is quite inadequate. Indeed, I find that the speech of the minister does not hold out as much help as the green book proposals of the government of 1945. On page 28 I read the following:
Although great progress has been made In Canada during the first half of this century, there still remains a tremendous job to be done in improving the national health and in extending the benefits of modern science and medical care to all parts of the nation and all sections of the population.
If that was true 12 years ago it is even truer today. At that time the federal authorities were able to take some credit for the
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fact that the tuberculosis death rate had been reduced from 200 per 100,000 at the beginning of the century to 48 in 1944, and I am quite prepared to admit that there has been a substantial drop since 1944. But at that time the federal government did indicate that they were interested in the fight against tuberculosis. At that time they went on to point out in the green book:
There are great inequalities in the quantity and quality of health care available to different groups of Canadians, and in the costs of such public and private health services and medical and hospital facilities as are now available.
I also read the following:
Nearly all countries have adopted health insurance in one form or another. The chief exceptions to date have been Canada, Australia and the United States . . .
Then the federal authorities outlined some of the advantages that would accrue to the nation as the result of having an over-all scheme, and I am particularly interested in the section that outlines the fears the federal government had at that time that the provinces would hesitate to go along until they had a firm commitment in black and white that they were not going to be caught away out on a limb with expenditures which were far beyond the provincial resources. Then the federal government went on to point out the following:
A province's participation In the plan would begin
(1)	Upon a province making use of the proposed planning and organization grant within 18 months and presenting a plan, satisfactory to the governor in council, describing the existing services and benefits in the province and the stages by which benefits will be provided and the full health insurance plan put into effect:
(2)	within the same period of 18 months making an agreement with the federal government to provide the initial benefits for the first stage of general practitioner services, hospital care and visiting nursing services within two years of the signing of the agreement. The agreement should further provide for the carrying into effect of the total health insurance program over a term of years, for a registration fee to be paid by or on behalf of every person, who has attained his 16th birthday and whose normal place of residence is in the province or area where benefits are provided . . .
I should like to draw the attention of the committee to the fact that at that time the Saskatchewan government entered upon a hospital insurance program in good faith. Although it was known that the collecting of a registration fee would not be especially popular, it was understood clearly that if Saskatchewan were to qualify under the national health insurance program envisaged by the federal government it would be necessary for Saskatchewan to follow the letter as laid down here.

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So more than ten years ago we made provision for setting up a hospital insurance program which, by the way, is extremely popular.
There were some critics at the time, but in no election in recent years have any of the political parties pledged that they will abolish the hospital insurance program. From time to time we hear some criticism about the costs. The costs have gone up. But let me remind the committee that the federal authorities then, working on this matter estimated that you could provide hospital care for an average cost of $3.60 per person per year. Our authorities though they would be on the safe side by fixing the amount at $5, but at the time of this green book, $3.60 was considered to be ample. The costs have gone up again as a result of the federal policy, but it was estimated that to give general practitioner service, hospital care and visiting service the total cost would be $10.20 per person per year. It was also set out here in black and white that the federal government would participate with the various provinces as they proceeded to set up these programs.
I am greatly disturbed that the minister is not prepared to give a very firm undertaking that if this legislation is passed he will do everything in his power to have the federal authorities start sharing immediately with provinces like British Columbia, Alberta, and Saskatchewan, which have been carrying out a program suggested by the federal government several years ago.
Again we should like to present the problem that faces the province of Ontario. According to the information the minister gave us a year ago when we were discussing this matter in committee, the estimated cost for Ontario then was $129,200,000. The people of the province are expected to pay $66 million. This presents a real problem for the province of Ontario if they start to negotiate now to set up a program which is going to cost $129 million, on the assumption that about half is to be paid by the federal government, and then find that this government is really not serious; that this is another election issue such as the one proposed back in 1919; that this government is prepared to adopt proposals which are politically popular with a view to getting back into office, but when the election is over this scheme will be put in cold storage for another ten or twelve years.
If we are to behave as a responsible federal parliament, I think we must decide that the arguments advanced away back in 1945, still hold good; that a nation that was able to do such spectacular things during the war must face the problem of providing

complete medical and hospital care for all our people; and we should not wait another 12 years or another 38 years until a great many people who are now waiting for something better have passed on.
I am sorry that the proposition before us deals with such a small segment of the problem. Even when it comes to dealing with hospital care this program leaves out of consideration over half the sick people of Canada. I think that is a great pity, Mr. Chairman.


Paul Joseph James Martin: That is not accurate.


Alexander Malcolm Nicholson: I have here a return from the bureau of statistics brought down on March 12 of last year-


Paul Joseph James Martin: My hon. friend is interested in this problem. I know he tries to be very sincere in these matters. I wonder if he would mind waiting for the bill so I can deal with that matter, because that statement is not accurate. On a particular section of the bill my hon. friend could have all the freedom which he does not have right now. I just make that suggestion.


Alexander Malcolm Nicholson: That would be all right if the minister would assure us that the program will proceed, regardless of the date of coming into operation, if and when six provinces have decided to carry on the program and the programs they are outlining meet with the approval of the minister. If at this point the minister is prepared to give an undertaking that the federal government will start paying immediately to those provinces which have already set up their plans, without waiting to give a province like Newfoundland a chance to veto this program that might be satisfactory. But while Newfoundland might decide in good faith now that they want to go ahead, if in December, 1958, Newfoundland reach the conclusion that they cannot proceed with the program, they could place all the other five provinces in an extremely difficult position.
But, Mr. Chairman, before the bill comes in, I think it is very important that the minister have another look at the question of tuberculosis.
(Translation):


Paul Joseph James Martin: Nova Scotia will participate in the national health insurance plan.
(Text):
A year ago I asked this question:
For the last year for which statistics are available of the number of patient days spent in Canadian hospitals, how many and what percentage were in the following: (a) mental hospitals; (b) psychiatric wards in hospitals; (c) T.B. hospitals; (d) public hospitals; (e) federal hospitals; (f) private hospitals?

I find that the percentages given at that time were as follows: 39.72 per cent in mental hospitals; 0.89 per cent in psychiatric wards in hospitals; 10.66 per cent in T.B. hospitals. If you add those three together you have over 50 per cent. Then when we consider the costs in the various categories, what do we find? This question was answered on the same day:
What was the estimated cost per patient per day in the following hospitals: (a) mental; (b) T.B.; (c) public?
In 1953 it cost $2.70 per patient per day in the mental hospitals, $6.29 in the T.B. hospitals and $10.77 in the public hospitals. I think the minister cannot come here and ask us seriously to bar from benefits which he anticipates will follow the introduction of the national hospital program over half the people who are sick.
In the field of caring for T.B. patients we have had a remarkable record over the years. I am very happy to say that my own province of Saskatchewan has had free and complete care for tubercular patients since 1929. The C.C.F. cannot claim credit for this fact. As a matter of fact the only Conservative government we ever had introduced the free care for tubercular patients. When the Liberal government succeeded in due course it did not change that policy. For example, I find that in 1954, though the Canadian death rate from T.B. was 10.5 per 100,000, our death rate in Saskatchewan was 4.8, the lowest in all Canada. We have been able to demonstrate to ourselves that it has been a very good investment, first of all, to provide public sanatoria where people get the very best of care regardless of their ability to pay. Although, to begin with, they were charged $2.50 a day, which charge was later reduced to $1 a day, we find that when the free treatment was introduced our death rate dropped remarkably and for a long time was by far the lowest in all of Canada.
Coming to the problem of mental health, in a little pamphlet put out by the Canadian mental health association I find that right now one million Canadians are suffering from mental crippling. A million people are suffering from disability because of mental sickness. It points out here that one in every 16 in Canada is suffering from some form of mental disability. There are 70,000 men, women and children under the care of mental hospitals, nearly as many as there are in all other hospitals combined. Each year more than 20,000 new patients are admitted to mental hospitals. The average mental hospital has only about five doctors for every 10 it needs; it has 6 registered nurses for every 10 it needs; it has four social workers for 82715-169
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every 10 it needs, and six clinical psychologists for every 10 it needs. There are about 90 mental health clinics in the country. Many of these do not operate full time. There should be at least 150 full time clinics.


Murdo William Martin: Would my hon. friend permit me to interject again. I know his point of view on this matter, and he knows I can ask him if the practice we have in mind in this particular measure is not the same as the practice in Saskatchewan. I do not want to get into that now, but I think if we could get into committee on the bill we could have a fairer argument, a more complete one. Would my hon. friend not think it would be possible for him to delay this phase of his argument at any rate until he gets the bill?


Alexander Malcolm Nicholson: My colleague the hon. member for Winnipeg North Centre and I tried our best when we were in committee a year ago to get the minister to change his point of view and bring it in line with the opinion of the mental health association.


Murdo William Martin: Would my hon. friend not agree that what I am proposing in this particular measure with regard to T.B. and mental cases, apart from those suffering from these diseases in general hospitals is precisely what is done in Saskatchewan, and properly so, and in British Columbia?


Alexander Malcolm Nicholson: The minister is still refusing to allow half the people in Canada who are sick to participate in what he described as an epoch making step in the field of health. The Canadian mental health association has supplied hon. members from time to time with very carefully thought out arguments to the effect that this proposal is only providing hospital care for half of all the patients presently receiving treatment in hospitals. They point out this represents a distinct retrograde step in planning for the nation's health. It is a serious setback in the long struggle to establish psychiatric treatment on a satisfactory basis. It would tend to emphasize the proposition that there is a decided difference between physical and mental illness, to the disadvantage of the latter. This, in turn, would increase the stigma and the barriers to progress which have long been a handicap to scientific and technical development in this field.
I think, Mr. Chairman, if the minister would give some assurance that he will consider my argument again and make provision in the bill for mental and tubercular patients in all parts of Canada to be treated as sick people, just as the people in general hospitals are, I would conclude my remarks immediately and do my very best to see that the legislation is passed.

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In the meantime, I have here some pamphlets put out by the health league of Canada. They point out that this legislation has failed to consider one of the most serious health problems. It is reckoned that we need from 10,000 to 20,000 more hospital beds before the demand can be satisfactorily met. Even now the cost of mental hospital care for these patients is amounting to more than $50 million annually. I think those figures I have given previously, to the effect that we are only spending $2.70 per day per patient in mental hospitals compared with $10.77 in general hospitals, would suggest that the provinces are unable, with their limited resources, to cope with this staggering problem. From the health league pamphlet I read:
The best estimates that can be made for Canada suggest that there are at any one time 200,000 people disabled on account of mental illness- 100,000 permanently and 100,000 temporarily-and another 600,000 partly disabled. These 800,000 mentally unwell people constitute a population larger than that of any Canadian city except Montreal and Toronto. The total costs of this mental sickness and its complications including loss of productive capacity and national income, approximates one billion dollars.
I think the minister cannot boast of having spent $200 million over a period of years when this very important health problem is being disregarded. He has produced a book on mental health services in Canada. It is an excellent study prepared by his department. It is hard for me to understand why he authorized the preparation of this valuable material and then ignored the logical conclusions to which this study would lead.
I hope before the bill is introduced the minister will reconsider his stand because I am very sure that eventually public opinion will force him to change his view and permit the tubercular patient and the mental patient to have exactly the same treatment that is available to every other Canadian.


William Alfred Robinson: Order. Before the hon. member for Queens proceeds, I should like to draw to the attention of hon. members that earlier in the afternoon I read an amendment moved by the hon. member for Lanark, in the following terms:
That the resolution be reported to the house with the proviso that the words after "when" in the fifth line of the resolution to the word "entered" in the sixth line of the resolution be deleted and the following substituted therefor:
(a)	when any province of Canada has
(b)	that^ the word "agreements" in the fourth line and sixth lines of the resolution be changed to "agreement".
Shortly afterwards I indicated to the hon. member for Lanark that it might be desirable to change the wording somewhat in order to

give clarity to the amendment. He has been kind enough to send me the following amendment:
(a)	that the words after "when" in the fifth line of the resolution to the word "entered" in the sixth line thereof be deleted and the following substituted therefor:
"any province of Canada has", and,
(b)	that the word "agreements" in the sixth line of the resolution be changed to "agreement".
I presume it is the wish of the committee that this improved wording be substituted for the original wording of the amendment.


Paul Joseph James Martin: I was very interested in what the Chair was saying, but I have not before me the new amendment. I should like to see it.


William Gourlay Blair: It is just a clarification.


William Alfred Robinson: After reading the amendment of the hon. member for Lanark earlier this afternoon I immediately indicated that I would need to give it consideration. I have now done so, and I must confess that I have some doubt as to whether it is in order. I am prepared to give a ruling on the amendment at the present time, but if any hon. member had some observations to make before I do so, I would be glad to hear such observations.


Mr. Fleming:: Then may I take advantage of your invitation and offer a few remarks on the subject of the amendment. My purpose is to submit to you that the amendment is in order.
This is a resolution preceding, of course, what is known as a money bill, and I recognize that the type of amendment which can be introduced at this stage of the proceedings must conform with certain well-known requirements. In my submission this amendment does conform with those well-established requirements for an amendment to a resolution contemplating the introduction of a money bill.
May I first observe, Mr. Chairman, precisely what is the effect of the amendment. The resolution which has been moved by the Minister of National Health and Welfare contemplates the introduction of a measure:
... to authorize contributions to be paid out of the consolidated revenue fund to provinces in respect of costs incurred by them and providing insured hospital and diagnostic services pursuant to provincial law and to agreements made in accordance with the said measure . . .
And the payments out of the consolidated revenue fund are to commence, according to the resolution, when at least six provinces, containing at least half the population of Canada, have entered into such agreements and qualified for the receipt of such contributions. The amendment does not touch the

opening clause of the resolution at all. That still remains in the present form:
That it is expedient to introduce a measure to authorize contributions to be paid out of the consolidated revenue fund . . .
And so on. The amendment deals only with the time at which, or the conditions under which, the payments may be inaugurated. Instead of the requirement that there be at least six provinces containing at least half the population of Canada having entered into agreements, the amendment would substitute the provision that the whole scheme should be inaugurated or commence when any province of Canada has entered into the agreement. There is an essential point there, Mr. Chairman. It is that the amendment does not touch the main body of the resolution; it simply relates to the date on which, or the circumstances under which, the scheme may commence.
The references I should like respectfully to offer to you, Mr. Chairman, commence at page 169 of Beauchesne's Parliamentary Rules and Forms, third edition. The first is citation 440, which reads:
The fundamental terms of a money resolution submitted to the house with the Governor General's recommendation upon which a committee of the whole is set up cannot be amended. Amendments will only be in order if they fall within the terms of the resolution.
I emphasize these words, "if they fall within the terms of the resolution". It is my submission that this amendment is of a kind which does fall within the terms of the resolution now under debate. I conclude reading citation 440:
The procedure in committee on those resolutions follows in principle the procedure of the committee of supply, and amendments are out of order if they are proposed with a view to substituting an alternative scheme to that proposed with the royal recommendation.
I emphasize, sir, that the amendment in no sense offers an alternative scheme to that proposed in the royal recommendation. It accepts the royal recommendation; it accepts the scheme which is proposed; it simply concerns itself with the date on which and the circumstances under which that scheme can be brought into operation.
There are examples in citations 441 and 442 of amendments which have been ruled out of order because in effect they proposed alternative schemes to that proposed with the royal recommendation. For instance, in citation 442 there are amendments proposing to substitute a loan for a subsidy; to change the destination, purpose and conditions of a subsidy; attaching a condition to a subsidy; affecting the ends and provisions of a subsidy.
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But, sir, may I next draw your attention to citation 444, which reads as follows:
Private members may introduce resolutions that do not directly involve the expenditure of public money and have no operative effect but simply express an abstract opinion on a matter which may necessitate a future grant.
Now, sir, there is a point that I think with respect has to be considered at this time. The resolution contemplates the introduction of a bill. It is quite clear that the bill in turn, in addition to what is contained in the resolution, would require the appropriation of money by parliament in the form of a supplementary appropriation if it were to be brought into effect during the fiscal year to commence April 1, 1957; or an estimate, if it is to be brought into effect in the following fiscal year, whatever it might be. And that, it seems to me, is no suggestion that the amendment would involve any increase in public expenditure.
It is quite correct that the amendment, by easing the conditions under which the hospital insurance scheme may be brought into effect, in that way may accelerate- indeed, it is intended to accelerate-the inauguration of the scheme, the effective date of it. It is quite true that is certainly the intention of the amendment, and it is the effect it would have. It still requires a later vote of supply.
In my submission the amendment is one falling within the terms of the resolution, according to the language of citation 440. It is not one that substitutes an alternative scheme to that proposed with the royal recommendation, according to the language used in citation 440, and it does not of itself create an increase in public expenditure. That would necessitate a supplementary appropriation.
For these reasons, sir, it is my submission that the amendment is in order and fully conforms with the recognized conditions to which an amendment to a money resolution must conform in this committee.


Paul Joseph James Martin: Mr. Chairman, it is not clear that the amendment, even as clarified, assists Your Honour in ruling in its favour. The clarification which, as I indicated a few moments ago, came to my attention, only a short time ago, has a restrictive effect, but that does not in any way change the character of the amendment.
The question before us is whether or not the amendment involves any kind of charge on the crown. The rule is pretty clear. My hon. friend who has just taken his seat has directed our attention to citations 440 and 441 of Beauchesne's Parliamentary Rules and Forms, third edition, but I am at a loss
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to understand how he can seriously argue that these references help him in any way in this particular. Citation 440 is quite clear. It says:
The fundamental terms of a money resolution submitted to the house with the Governor General's recommendation upon which a committee of the whole is set up cannot be amended. Amendments will only be in order if they fall within the terms of the resolution. The procedure in committee on those resolutions follows in principle the procedure of the committee of supply, and amendments are out of order if they are proposed with a view to substituting an alternative scheme to that proposed with the royal recommendation.
The scheme proposed by the amendment is clearly an alternative one. It proposes that the federal government should pay money, not on the condition that there will be six provinces, as the resolution stipulates, but at the moment at which one province gives its acceptance. The federal government, according to the amendment, should on that account agree to pay moneys toward the realization of that particular scheme in that particular province, so that on the basis of citation 440 it is clearly out of order.
Citation 441 equally does not assist my hon. friend in his contention, and citation 437 is clearly on the point when it says:
No cases can be found of any private member in the Canadian commons receiving the authority of the crown, through a minister, to propose a motion involving the expenditure of public money. No principle is better understood than the constitutional obligation that rests upon the executive government, of alone initiating measures imposing charges upon the public exchequer.
That is precisely what this amendment does. The effect of the amendment, even as clarified, is to add to the financial burden on the crown, and it is therefore out of order.
The fact that it is suggested that the money required in a particular instance might be less seems at first glance to be attractive, but certainly it does not add to the strength of the argument, because the fact is that under the amendment as now proposed and clarified, expenditures would be involved in one province at a time when the crown does not intend to be so involved financially.
Therefore, Mr. Chairman, I have no great difficulty in supporting the ruling which you have indicated to be in your mind, holding this amendment to be one that is clearly not within the mischief of the rule as contemplated in this house.


William Alfred Robinson: I would like to thank the hon. member for Eglinton and the hon. Minister of National Health and Welfare for their assistance in the matter of the validity of this amendment. May I draw the attention of hon. members to one authority which was not mentioned by either of them. I am

referring to May's fifteenth edition at page 678, where we find the following words:
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 draw the attention of hon. members particularly to the latter words:
. . . not only the amount of a charge, but also its objects, purposes, conditions and qualifications.
The paragraph continues:
In relation to the standard thereby fixed, an amendment infringes the financial initiative of the crown, not only if it increases the amount, but also if it extends the objects and purposes, or relaxes the conditions and qualifications, expressed in the communication by which the crown has demanded or recommended a charge.
I read this in conjunction with the citation in Beauchesne's third edition to which my attention was drawn by both hon. members, and I would like to repeat the latter part of citation 440:
The procedure in committee on those resolutions follows in principle the procedure of the committee of supply, and amendments are out of order if they are proposed with a view to substituting an alternative scheme to that proposed with the royal recommendation.
It was with these two authorities in mind that I indicated earlier some doubts as to the validity of the amendment. The hon. member for Eglinton has said that in his opinion the amendment merely affects the date on which the scheme will commence and that it does not create an increase in the public expenditure.
The amendment actually would substitute for the words "at least six provinces containing at least half the population of Canada" in the midst of the original resolution the words "any province of Canada", and I would be in some doubt as to whether the bringing forward of the date might not have the effect of creating an increase in the public expenditures.
Without, however, expressing too definite a view on that phase of the matter, I do feel that the proposed amendment would substitute an alternative scheme in that the original resolution contains the words "at least six provinces containing at least half the population of Canada", and the amendment would substitute the words "any province of Canada". Therefore, reading the citation in May with the latter part of citation 440 in Beauchesne's third edition, and applying them to the terms of the amendment, I feel that for the two reasons I have stated I must rule the amendment out of order.


Mr. MacLean:: Mr. Chairman, it is a
pleasure for me to take part in the debate on this resolution preceding legislation which has for its objective the alleviation of human misery and the sharing by society of some of the financial burden which from time to time may fall on individuals due to illness. That is not to say, of course, that I agree wholeheartedly with the proposed legislation in every particular, but I do think it is a step in the right direction though long overdue.
Seventy five years ago or so

in relatively recent times-medical attention from a financial point of view was a somewhat inexpensive matter compared to the expense it can involve today, because in those days when illness struck usually the only facilities available were the attention of a general practitioner and attention and convalescence in the home.
In that connection I might point out that many general practitioners performed great service for the poorer classes in our communities by being very generous in forgetting to send bills in cases where they knew it would be difficult for the people to pay. The work that has been done by the general practitioner over the years for the benefit of society in this regard cannot be overstated, and it is something for which we should all be grateful.


Paul Joseph James Martin: Dr. W. J. P. MacMillan in Prince Edward Island is an excellent example.


John Angus MacLean: Yes, a perfect example. In those days if the attention the general practitioner could provide and home treatment were not sufficient to provide a cure the case was generally considered hopeless, because no facilities existed anywhere else that could effect a cure. You were faced then with the reality that the case was probably hopeless.
Great advances have been made in medical science in the last 75 years, one of the most important being the invention of the X-ray. However, all these advances brought with them complications in the form of greater expense and the necessity of bringing the patient to a central point such as a hospital where these facilities would be available. Cures are obtained regularly today which 75 years ago would have been considered phenomenal if not almost beyond belief.
The use of these specialized forms of treatment brought with them added expenses as far as the individual was concerned and, as I have said already, the necessity of treatment in a hospital. As a result many individuals faced with illness today find that the cost involved may prove to be a catastrophe from
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the financial point of view. It is something the average family cannot afford, or if they do pay these costs it quite often leaves them in an economically unfavourable position for many years. A family might be faced with having to forgo the education of children and such things which should not have to be considered.
However, we live in a civilization which believes that human life is beyond price. In line with that philosophy we believe that cost in itself should not be a deterrent to restoring individuals to health if the means are available to do it. In addition to the necessity for hospitalization brought about by these new techniques, which involve added cost, there is the further increase in the general cost of hospitalization. As a result of all this the burden becomes almost impossible for the average family to pay, and as a result a prolonged sickness can prove to be a near catastrophe.
Some people may be lucky enough to gd through their lives without having to enter a hospital, but in this day and age we find that more and more people start their lives in a hospital and perhaps end them there as well, even though they may be lucky enough to not require hospitalization during the years between. But there are others who are not so fortunate. Although the burden of illness may be crushing for the individual, it should be something that could be borne by society at large. Therefore the sensible thing to do is to introduce the insurance principle so the load may be carried by society as a whole, and in that way prevent disaster coming to any family or individual because of sickness or accident.
I have said that the advances in medical science have brought about a general increase in the cost of treatment and hospitalization. However, it should not be forgotten that because of these advances in medical science great savings have been achieved in the way of time and money. The advances in preventive medicine have proved of great benefit to our society. Medical science has succeeded in eliminating a number of diseases which had disastrous consequences in the past, and I refer particularly to smallpox, diphtheria, and we hope polio as well. As a result of these advances in medical science it has been made easier for society to carry the remaining burden, and that is something that should not be forgotten.
There is still a great field open in this regard for the curing of disease, and any advance in that direction will be of great benefit. I believe money spent to that end will return dividends from an economic point
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of view as well as in the form of the elimination of human suffering. There are still diseases for which there seems to be no cure, and my feeling is that research should be pressed in order to find some means of combating diseases such as multiple sclerosis and cancer. Early diagnosis can pay dividends economically as well as eliminate needless suffering.
It may be said by some that this business of finding cures for diseases which a few years ago would have been fatal in most cases runs counter to the principle of the survival of the fittest; that if we carry on long enough we will succeed in creating a race susceptible to every ill to which man is subject, and the incidence of disease will increase so the long-range result may prove that we have adopted a self-defeating program. Nevertheless we believe that human life is priceless, and that nothing should stand in the way, even momentarily, of achieving the ends we have in view at the present time.
In this connection I believe there is a great field for research into heredity, so we may have a wider knowledge of the results of heredity upon susceptibility to disease. That might result in a healthier population, which would decrease the incidence of sickness and the need for hospitalization.
At six o'clock the committee took recess.


[Stage Direction]
AFTER RECESS

The committee resumed at eight o'clock.
John Angus MacLean: Mr. Chairman, when the committee rose at six o'clock I had already commented on the great services of general practitioners, especially in the past, to the people of the communities in which they laboured. I want to thank the minister in that connection for his recognition of the services that a distinguished resident of my province, Dr. W. J. P. MacMillan, has rendered to the community generally as far as all problems of health are concerned. Just at six o'clock I was pointing out that I considered that pressing on with medical research is an effort that can be highly justified from every point of view.
I now want to turn for a few moments to the application of the proposed legislation to the provinces. The minister pointed out that the formula which he proposes is weighted slightly in favour of the provinces that will find the burden most difficult to carry. I think it is commendable that the minister has even nodded in the direction of the need of such recognition, but I do not think the recognition goes far enough.

At the time of confederation the taxgathering capacity of the provinces and their responsibilities were fairly well balanced, but since confederation the tax fields over which the federal government has jurisdiction have proved to be the most lucrative ones, the ones which have expanded most over the years, while with the exception of defence and a few other fields of that sort, the greatest expansion of responsibility has been in the fields which are the responsibilities of the provinces. This legislation is an example of the sort of thing to which I refer. Social security of all types is another example.
As time goes by there is an ever-increasing discrepancy between the resources of the provinces and their obligations, and the various types of matching grants which the federal government has proposed to the provinces from time to time are not by any means the answer as far as the poorer provinces are concerned. Here we have a situation where the federal government in relation to the provinces is rather in the same position as a wealthy man coming along and offering to sell a bankrupt a Cadillac at half price. Something you cannot afford is not a bargain at any price. The person who is pretty nearly down and out would probably more appreciate a free pair of boots than a Cadillac at half price, because the latter is beyond his reach and is really no benefit at all.
The premier of my province, speaking in the legislature the other day with regard to this proposal, said it is definitely beyond the financial capabilities of the province of Prince Edward Island at the present time, and therefore out of reach of the people of that province. If that is the case, it can be of no benefit to them in the immediate future. When speaking in the legislature Premier Matheson had this to say:
There is a limit to the type of gift Ottawa gives through matching grants and that limit is the economic resources of the province.
It is estimated that the cost of this scheme to Prince Edward Island would be approximately $1,130,000 a year in addition to their present expenditures in this field. While that may sound like a small amount to the federal government, it is something my province cannot afford because over the last number of years the province of Prince Edward Island has been going into debt by about this amount annually.
I believe the other maritime provinces will also find it extremely difficult to take advantage of this legislation. I am afraid that from the point of view of the maritimes its principle is the old biblical one, namely, that to him that hath shall be given and from him that hath not even that which he hath shall be taken away.

In order that a proposal might be evolved which would be within the reach of the maritime provinces, I think consideration should be given to some special aspects of this proposal. The first is that the general share of the federal responsibility should be increased. I feel that the maritime provinces cannot possibly with any degree of ease take advantage of this proposal unless the federal share is at least 60 per cent.
Then there are other considerations which I would commend to the minister. In my opinion hospital depreciation, as has already been pointed out by several other members, should be considered one of the expenses in which the federal government will share.


Paul Joseph James Martin: Is my hon. friend aware that on the basis of the 1956 figures the contribution from the federal government to Prince Edward Island will be higher than that?


John Angus MacLean: Higher than what?


Paul Joseph James Martin: Than 60 per cent.


John Angus MacLean: I am not aware of that; I have not seen the bill. That was not the interpretation which the provincial government put on the proposal, and I was going on that basis. I am very pleased to hear the minister say that according to his formula more than 60 per cent of the cost will be borne by the federal government in the case of Prince Edward Island.
I hope this is true; and if it proves to be true I hope the provincial government will see fit to come into the scheme.
The administrative cost is another item that I feel should be not borne entirely by the provincial government. As far as the provinces are concerned there is the very heavy expenditure in the fields of mental health and tuberculosis. Most people feel, and I think correctly so, that these are illnesses which should not be differentiated from general illness, and that those who suffer from those diseases should reap as much benefit from the scheme as anybody else.
Having said that I should like to point out that as far as the provinces are concerned, I feel that no real solution to the problem-and I recognize that this is not only the responsibility of the Minister of National Health and Welfare-will be arrived at until the whole field of dominion-provincial fiscal policy is readjusted.


Mr. Regier:: Mr. Chairman, I am pleased to be able to say a few words in this debate on national health insurance. I hope we shall label it by its right name. It is a national hospital insurance plan and not a national health insurance plan such as we have looked forward to for many years.
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I hope this plan is not once again a hoax being perpetrated on the people of Canada in order to enable the Liberals to win yet another election. I think the people of Canada have had enough of the use of national health insurance as a political football in order to get the Liberal party into office, and then having it promptly forgotten once the election is over. The Canadian people have heard this story ever since 1919, as has already been pointed out. On one occasion the Liberals even had the audacity to present a bill to the House of Commons, or rather to table a bill and go to the people and mislead them into thinking that the bill would become an actuality if the Liberals were returned to power.
If this is not to be a repeat performance I would say the Liberal party could well show that this time it means what it says when it speaks of national health insurance, and that it could accept the challenge being issued by the spokesmen of the western provinces. The challenge is this. If you mean what you say, pay now to each of the provinces who are ready to take you up on your offer and to proceed. I think that would be a fair request for these people in the west to make of the Liberals at this election. If they are sincere, are they willing to amend the legislation they are now proposing to enable the government to pay now and not to pay as far away as 1960 if by then enough provinces agree to enter the scheme.
I come from British Columbia, the fastest growing province in Canada. I am extremely pleased to notice that the latest issue of the Financial Post, the issue of March 23, devotes a special section to outlining the tremendous developments that are taking place in our province at the west coast. However, such a rapid growth also brings with it a large number of problems. They are mainly social problems. We might very well have had attached to this newspaper another special circular outlining some of the unusually severe difficulties which we have in our province and which are partly caused by the rapid industrial expansion and the growth in our population.
One of the problems we have is directly related to the essence of the resolution before us. I refer to the problem of hospital construction costs. One of the municipalities in my riding-and I am referring now to Burnaby-in 1931 had some 30,000 people. In 1957 it has 83,000. The same story can be told for almost any of our industrial areas there. We are obliged to build new hospitals, new schools and other social needs almost more rapidly than our architects are able to design them.

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I greatly regret that the minister has indicated, if not today at least on other occasions, that the capital costs of hospitals cannot be included in the plan. Some years ago I pointed out to the minister that his grant of $1,000 per bed for the building of a new hospital is entirely unrealistic in the light of what has happened to the costs of building hospitals since the plan was first begun. To build additions to the Vancouver general hospital costs at the rate of $20,000 per bed. For the federal government to offer $1,000 out of $20,000 is leaving a very large share on the shoulders of the provincial and municipal governments and to the volunteer efforts of our good citizens. Even a moderate hospital cannot be built at the present time in British Columbia at less than $10,000 a bed.
The federal grant is only 10 per cent of the capital expense. I realize that all the rest of it-the $9,000 to $19,000 per bed-must be raised partly by voluntary effort, partly by a tax on real estate in municipalities, and in part by grants from the provincial government. The niggardly attitude of the federal government in this regard, especially as it applies to rapidly growing areas of Canada, is to be regretted.
I have yet to hear the government advance a sound argument or I have yet to hear them advance any argument-they may have done so but I am unaware of it-as to why they cannot include capital costs in this program. I should also like to know why they cannot include the costs of administration. The government will find that this problem of capital costs of hospitalization is going to be more severe than ever once their plan gets under way; because in Saskatchewan, in British Columbia and in Great Britain experience has shown that once you introduce a hospital plan for all, your hospitals immediately become greatly overloaded at least for the first several years of such a plan.
With regard to the problem that will be faced I should like to read into the record what was said by the premier of British Columbia in his budget speech of 1954. This will be found at page 18:
The most difficult, most pressing, and certainly the most vexing problem requiring early and realistic solution is the provision of comprehensive hospital insurance at a reasonable and equitable cost to all of our people.
A few years from now I can picture the Minister of National Health and Welfare, not the one who is now occupying that post but some other person, rising in his place and having to admit to the parliament of Canada that this business of hospital insurance is certainly a complex problem.
I was pleased to hear the minister make some reference to the fact that the plan [Mr. Hegler.l
envisaged taking care of chronic cases. I hope we will hear a little more of the details in that regard when the bill is introduced. We in British Columbia look with some envy at Saskatchewan where, as long as the doctor certifies you as being in need of hospital care, you can obtain hospital care without any fee whatever. This is not so in our province. We are anxiously looking forward to the day when, either through the help of the federal government or through our own government in British Columbia, we will have hospital care without charge for our chronically ill people.
I regret that mental cases in mental institutions are not going to be included. In my riding there is a mental institution at Esson-dale in which there are upwards of 5,000 mentally ill people. I see no reason why there should be this discrimination against them. This government gets over 70 per cent of every tax dollar; and simply because most of the provincial governments have now assumed full responsibility for mental care as well as for T.B. care the federal government saw a way of saving some money. I think this is ducking the responsibility simply because another government, in former years, has seen fit to assume that responsibility. This is no reason why the care of these people should now be excluded from the plan.
I should like to spend just a minute or two on the vast amount of propaganda we have been fed over the past several years warning the Canadian people that health insurance would ruin the economy of Canada. I should like to ask those people who have been carrying on this propaganda just who pays now for the health care of our people. Most of our people have to pay their own bills. Hundreds of millions of dollars are being paid by the people of Canada when they pay their doctor bills, hospital bills and dental bills, so there is this tremendous sacrifice by the people in terms of dollars and cents.
In many cases health care is being paid for by people who have to mortgage their homes in order to meet unusually heavy medical bills. Boys and girls of 15, 16 and 17 are having to leave high school because of illness in the family and the economic hardship involved. This is a loss to our nation, when young boys and girls are forced to leave school without finishing their education. This lack of health care is being paid for, in many cases, with the lives of our people.
I am sure all of us in this house know of individuals who, had they received adequate health care as it could have been supplied under a national health program, would have been alive today and useful citizens.

We suffer a great deal of economic loss by way of unemployment caused by the illness of Canadian working people. The deficits of the hospitals from one end of Canada to the other are being paid for, in some cases by religious organizations but in most cases by municipalities. These losses represent a burden on the home owners. Health care is being paid for also by the sacrifices made by those who work in our hospitals from one end of Canada to the other. I feel the day is long past when our nurses-in-training should have to obtain money from outside sources in order to keep themselves in the institutions where they are working toward their nursing degree. These nurses have made tremendous sacrifices over the years to maintain the standards of efficiency of our hospitals. The other help in most hospitals of Canada are being greatly underpaid. It is time these wage earners had their wages brought into line with the general level of wages paid in Canada.
We as a nation, in one way or another, pay for our health care now in a haphazard manner which is uneconomical, and a lot of people who need it most have to do without it. The nation as a whole, under a national hospital scheme, would be much better off than under the present scheme. We in the C.C.F. movement believe it is up to the strong to help the weak. We believe, as the hon. member for Queens pointed out, that at some time or other all of us have used or will use hospitals. We believe that when we are well is the time for working men to pay for the days when they are going to be ill.
I ask the government, before appealing to the country for support on its national hospital scheme, to promise to pay now to the provinces that are ready to proceed. I do not think the minister meant exactly what he said the other day. At page 2612 of Hansard for Friday, March 22, 1957 the minister said:
-the federal government made a proposal to the provinces under which we are undertaking to provide 50 per cent of the public ward hospital costs of every individual in every consenting province.
I believe he rectified that in the statement he made this afternoon. The statement he made on Friday should have been amplified by saying that if the governments of the provinces will agree to the scheme, then beginning January 1, 1959, we will assume some responsibility. We are asking, when do we get some of this money? We are very much concerned. According to the statement filed by the premier of British Columbia on February 22 last, when he presented the 1957-58 budget, the net estimated outlay for hospital services was $33,666,800. According to the statement by the Minister of
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National Health and Welfare we would have received a grant of at least $16 million a year toward that. This $16 million a year is a lot of money to be losing. I understand that if the plan goes through as announced our first payment will be received in 1960, for 1959. In other words, for the years 1957 and 1958 we are to receive nothing, so we lose $32 million.
If this government is sincere in offering hospital insurance to the people of Canada this year, then we in British Columbia have the right to demand a payment of $16 million this year and $16 million next year.
We hate to lose that $32 million, which we feel is ours. If this parliament passes a law establishing a principle, then those areas of Canada which live up to the principle should be entitled to their fair share of the amount available. In fact the people of Saskatchewan and the people of British Columbia should not be discriminated against. If anything they should be given some extra consideration, because the many experiences those two provinces have gone through are going to be of great value to not only the federal government but to other provinces as well that are attempting to introduce hospital schemes. We feel that we are being robbed of $32 million; and if this government means what it says, and if this is not just an election hoax, it will agree to pay us that $32 million over the next two years.
The interesting feature of this whole national health insurance program, Mr. Chairman, is the attitude shown by the various political movements in our country. In the province of Saskatchewan there are many areas known as health regions where people are supplied with medical, dental and hospital care without any special fee at the time those services are used. Saskatchewan, under a C.C.F. government, was the first to establish a provincial hospital insurance plan. I wish the resolution introduced by the minister went further along this line. I am reading from "Share Canada's Wealth! The National C.C.F. Program". Under "Comprehensive Health Services" it has this to say:
A nation-wide health insurance plan to provide every man, woman and child in Canada with full medical, hospital, nursing, dental, optical and other health care, with the federal government paying 80 per cent of the cost and the provinces the remaining 20 per cent;
Decentralized administration in co-operation with the provincial governments, and with full freedom for everyone to choose his own family doctor.
I am very pleased to say that in British Columbia the Social Credit party, in my opinion at least, have undergone a very radical change in their attitude toward this whole problem. I can well recall how in

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1952 they went through the province and fought against our compulsory hospital scheme. They would remove the compulsory features from it. In fact in his budget speech in 1954 the premier of the province admitted that an "effort was made to convert the plan from a compulsory to a voluntary one".
Well, I suppose that was good politics at the time. However, I am sure that even at that time the premier of British Columbia knew that you could not successfully operate a hospital scheme if you were to allow to participate, or have in it, only the aged and the sick people, and let the healthy ones get away without entering the scheme. They have certainly undergone a change of heart. I hope they will have a further advance in that direction and will do something to expand and make a little more liberal the hospital insurance scheme that we now have.


Frederick George Hahn: If it needs doing we will do it.


Erhart Regier: It may well be that when they get the money from the federal government that is their due they will make some moves in that direction. If the hon. member for New Westminster had not been so hasty in interrupting he would have found that I was going to compliment the premier of my province on his last statement. At page 39 of his budget speech this year he had this to say:
The welfare of our people demands the earliest possible provision of a national health program embracing hospital, diagnostic, medical, surgical and dental care; it requires also that more generous and dental care; it requires also that more generous the government of Canada. The government of this province vigorously will press for action on both these matters.
I know interruptions are sometimes pretty good politics, but I do think members of the C.C.F. should be allowed to compliment a Social Credit premier when he finally realizes that health is a vital problem of the people, and that it deserves the recognition he has given it in his recent budget speech.
When we look at the attitude of the Progressive Conservative party I am pleased that the Minister of National Health and Welfare was able to outmanoeuvre the frosty Frost plan of the province of Ontario. I am convinced, and have been for months, that there was a sincere desire to use Ontario's hospital insurance plan as a political football in the province of Ontario in the forthcoming election. I think this has now been avoided. As I first saw the frosty Frost plan, it consisted of a sort of half-baked voluntary plan, with ample provision to allow all the

shyster health societies to keep on making a good rake-off at the expense of the poor people of the province.


Mr. Fraser (Peterborough):: You are terribly wrong, and you know it.


Erhart Regier: Companies selling their plans and taking up to 40 per cent in cost of overhead will now be eliminated. Of course the worst attitude of all was taken by the Liberal government of Manitoba. The hon. member for Winnipeg North Centre called it a disastrous plan. It was that, indeed. The very idea of offering to supply people with hospital coverage after they have been in hospital for six months. By that time I imagine the people would no longer be very interested in who would be paying the bills.
I spoke of the attitude of the Liberal government of the province of Manitoba, which again brings me back to the subject of just how sincere is the Liberal government that we have sitting across the way and now proposing a national hospital insurance plan. This house opened two and a half months ago. The session is about over; yet the minister waited until March 4 before he put his resolution on the order paper. When the resolution was put on the order paper and we thought now we were getting somewhere, the government saw fit to wait until March 25; three full weeks went by before we were given a chance to act on this resolution. It is rather odd that on the very day we are given our first chance at this resolution there also appears on the order paper a proposed motion indicating very clearly to us that our days in this house are numbered. Therefore we may not see the actual implementation of this hospital insurance plan.
I want to deal for just a moment with the sharing of the cost. I believe indications have been given that we in the province of British Columbia can expect to get somewhere around 45 per cent of our present hospital insurance plan paid for by the federal government. I believe we are under the 50 per cent. At any rate I think we receive the lowest of the percentages. I think most of us who have been following this subject for some years have always hoped that something in the neighbourhood of 70 per cent of the cost would be forthcoming from the federal treasury. Later, because of the statements made by Liberal spokesmen, we had to revise our figures downward and we finally came down to 60 per cent. Even the premier of British Columbia understood for a while that we could expect 60 per cent to come out of federal funds.
However, when I look for possible reasons why this government with its huge budget

surplus is offering the provinces only an average of 50 per cent, I think I am able to pinpoint the reason. I remember hearing this proposal as given in this very chamber on October 3, 1955, in the proceedings of the federal-provincial conference, when the premier of British Columbia-being perhaps too eager and not as shrewd a bargainer in this respect as he sometimes is-as reported at page 73 of the report said:
I can't help noting here, Mr. Prime Minister, that in the original submission by the national government, the federal offered to participate on a 60 per cent basis. Our province, being always fair, says we will now enter into a program on a 50 per cent basis with the national government.
I may say that during the recess that followed this statement I had occasion to speak to a few of the representatives of some of the other provincial governments, and they were all most annoyed at the premier of British Columbia coming out and offering to have his province pay 50 per cent of the cost. When a province offers to pay 50 per cent of the cost you can hardly blame the federal government for not offering to pay more in turn. After all, they would be accused of throwing money away needlessly if they did.
I come now to the last point I wish to make. I regret that the understanding that has been reached between the Minister of National Health and Welfare and the various ministers of health and premiers of the provinces has not helped the people of Canada in one respect. I realize there was nothing the minister could do about it, but what we in British Columbia would like to know is this. What is the provincial government going to do with the $16 million a year when and if they get it?
We in the C.C.F. party sincerely hope that when and if the federal government will be paying 45 per cent of the cost of our British Columbia hospital plan the new arrangement will also have some real significance for the people of that province by way of added health services. Although I am not going to deal with them now, there are many ways in which an additional $16 million could be well spent in my province in a further move toward the goal of a national health service, as the premier himself so ably outlined in his budget speech this session.


William Alfred Robinson: Order. I am extremely sorry to interrupt the hon. member, but I am obliged to advise him that his time has expired.


Harry Oliver White: Mr. Chairman, I do not propose to take a great deal of time this evening, but I do feel that this is a most important subject, and I realize that many of the people in southwestern Ontario have
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been expecting and hoping for a measure of this kind for quite a number of years.
While we in the Conservative party welcome this resolution we regret that it has taken the present government and preceding governments 38 years to get around to the point of introducing it. Just to refute what the last speaker had to say I would point out that if it had not been for the action taken by Premier Frost of Ontario we might very well have had to wait another five years before this measure was introduced.


John Whitney Pickersgill: You mean the premier of Newfoundland.


Gordon Knapman Fraser: That is true.


Harry Oliver White: The Canadian people are well aware of the need for some measure of this kind. The very fact that 70 per cent of the Canadian people are now covered by some type of insurance indicates the extent to which they are interested in this subject, and demonstrates the hope that a co-ordinated scheme with the provinces might in some cases reduce the cost.
I do not think anyone should labour under the impression that this is going to be free. Someone is going to pay for it, and who could that be but the taxpayers of the country? The increasing cost of illness makes this measure imperative. I was very much interested in what was said this afternoon by the hon. member for Lanark who, in dealing with the subject of the increasing cost of illness, said that whereas the average patient per day cost in 1947 was $7.46, it had risen to $14.64 in 1954. I was speaking to the hospital authorities in my home city just last week, and I was informed that the per patient per day cost was something over $15 in that particular hospital last year.
We are glad that some form of universal coverage will be provided. I am inclined to doubt the wisdom of the statement made by the hon. member for Winnipeg North Centre, who said that the greater part of the cost should be borne under a plan that would take it from those with the greatest ability to pay. He mentioned the corporations and large companies. What happens in a case like that is that their contribution becomes a part of the operating cost of the company, which will be added to the cost of the goods they sell and the consumer will be the person who pays ultimately, not the corporation. I do not think that plan is practical, and probably it is not as fair as many other schemes which could be proposed.
Many middle class people are fearful of rising hospitalization and medical costs, which in some cases are ruinous. I am going to cite

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two or three illustrations. These cases were brought to my attention just last week end when I was home. In one case a child was in hospital for seven days, and the Middlesex county co-operative medical services were carrying the risk. They paid the cost of hospitalization up to $7 per day. The cost of the room per day was $7.50 so in this case the family was charged only a total of $3.50 for the room. The unfortunate part of the case was that because of the rather peculiar type of illness the diagnostic and special examinations, including X-rays and tests of one kind and another, amounted to $154, or $22 a day for the period of seven days during which the child was confined to hospital. Although the family believed they were covered with insurance, they learned that their total costs were $157.50. That same family last year also had other medical expenses amounting to approximately $500. This is one case of which I had personal knowledge.
I was inquiring about some other cases, and learned of one near my home. The child involved was confined to hospital in St. Thomas. The parents, who were young farmers, received a bill amounting to $2,200. They had to put a second mortgage on their farm, and only after many years were they able to pay the bill.
I know of a similar case in which the breadwinner of the family, a working man, was stricken and the costs of his hospitalization and treatment amounted to $2,400. Following his recovery the man and many of the men who worked in the plant with him sold their blood in order to help eliminate the debt against him. This serves to point up how necessary it is to have some scheme of this kind.
It is well known, of course, that those in the higher income brackets can afford hospitalization and medical care and those in the townships and municipalities are taken care of, but the vast majority of middle class people find this an extremely difficult situation to meet.
We come now to another problem having to do with nurses and nurses in training. There is no doubt that with the inauguration of a plan of this kind there is an increased demand for hospitalization. I am told that the experience in other countries and other provinces has been similar to what we found with the introduction of television, when the attendance at theatres dropped off; and that is that with the inauguration of such a plan there is a high demand at the beginning, which levels off as time goes on. We know there is a shortage of nurses at the present time. A girl getting her matriculation may

enter hospital for training or she could enter teachers' college, where upon graduation she might earn anywhere up to $3,400. It might be pointed out that the supervisor of nurses at a hospital will receive about $3,500. There are probably not enough of our young ladies being attracted to the nursing profession.
Another matter to be considered is that not all hospitals have the same standing. I am thinking now of London, where we have a medical school whose students may attend the hospital to receive valuable experience and training for their medical careers. Some hospitals provide nursing training and others do not. These are some of the details with which no doubt the Minister of National Health and Welfare and the ministers of health in the various provinces will find it necessary to deal.
I would cite the case of a man in Ontario becoming seriously ill and being sent to the Montreal neurological institute. Until such time as Quebec enters the scheme the question would probably arise whether he would be eligible under this plan. That is something else that will have to be worked out. There is no doubt that the same coverage will be extended to all hospitals regardless of the type of training they may provide.
Some mention was made in the newspapers about the possibility of one or more of the existing health plans in the province being made the administrative core once the act came into force. I think I read something in the paper to the effect that some of the officials of the Blue Cross might provide this administrative core. I wonder about the advisability of that, because there are many other worth-while groups, and I am thinking particularly of P.S.I. and Associated Medical Services. Then I might mention that we have in Middlesex county the Middlesex co-operative medical services which provides health insurance at cost. I have looked into that plan and I find it is most comprehensive, being provided at a much more reasonable figure than that of the Blue Cross. No one organization has a corner on good ideas or on administration.
Perhaps I should not mention the Blue Cross in that way, because it has been said that they operate on 5 per cent of their income. I heard someone mention a 40 per cent cost, so I do not want anyone to get the impression I am against the Blue Cross because of their cost of administration, since I realize that a 5 per cent cost is fairly moderate.
There is another thing which we as Canadians should not overlook, and that is that in practically every province or nation where a health measure has been introduced it has

been found necessary to increase the rates. This is understandable, because we know that we learn by experience and rising costs due to the inflation that has been going on all over must be considered. We hope we will be able to level off, but if the inflation envisaged by the Gordon report continues we can look forward to ever-rising costs all down the line.
I do not wish to speak further, as there have been many hon. members, including the hon. member for Lanark, who have spoken on behalf of this party. But I do want to say that I think the vast majority of Canadians have been expecting and hoping for a plan of this kind for a long time, and we hope the minister will get on with the legislation.


Harold Edward Winch: Mr. Chairman, I feel I must say something on this resolution. I understand it was back in 1919 that the Liberal party first campaigned on the basis of a sickness insurance plan for Canada, now known as health insurance. Back in 1919 I was a student in public school, and since that time I have had a number of years in public life. In the federal House of Commons and in provincial legislatures we have had the representatives of different parties speaking in favour of health and hospital insurance. From a start in their campaign in 1919 we find the Liberals introducing a resolution on March 25, 1957. The Minister of National Health and Welfare has now presented a resolution covering hospital insurance.
There are occasions when perhaps we as members of parliament forget the work of those who are not members. I can remember my first session of the British Columbia legislature, in 1936. At that time there was a Liberal government and the minister of health and welfare, Hon. George Weir, introduced an over-all health insurance plan in February of that year.


Paul Joseph James Martin: A great man.


Harold Edward Winch: In February of 1936 a Liberal minister of health and welfare in British Columbia introduced an over-all, complete health insurance plan. It was carried in the British Columbia legislature, and under the provisions of that legislation a board of four was set up. The members were named by order in council, but something then killed the legislation. It never went into actual operation. I knew Hon. George Weir very well. He was a wonderful man and a good minister.


Paul Joseph James Martin: He was a great man.


Harold Edward Winch: Although the health insurance plan had been adopted by an act of the legislature the legislation was killed by the
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medical profession, who told Hon. George Weir that they would go on strike if he ever put it into effect. They not only killed the bill, but in my humble estimation they also killed Hon. George Weir.
However, the point I want to make at this time in speaking on the resolution is that although there have been parties in favour of such a plan and even legislation passed, there were also those who worked for a complete over-all health insurance program before the bill was introduced in the legislature of British Columbia. I refer to one man who worked for it and who became the first member of the board although the legislation never went into effect. He later came to Ottawa, and I believe he was employed for some time in the department of the Minister of National Health and Welfare.
Because upon occasions such as this not enough tribute is paid to pioneers not known to the general public, on this day when we are debating the resolution preceding the introduction of the first bill that will provide a national health insurance plan I should like to pay my respects to Dr. Allon Peebles. Starting in 1932 he began the work which preceded the introduction of the bill in the legislature of British Columbia providing for a complete health insurance plan. He was the first commissioner appointed, and he worked for some time in Ottawa in the Department of National Health and Welfare. Though now and for a number of years very ill, he is still a resident of the city of Ottawa. On an occasion like this I believe that we should honour those who work behind the scenes. I am very sorry that neither the province of British Columbia nor the federal government of Canada has seen fit to assist this man in his illness.
A lot has been said by those who have preceded me about varying aspects of the resolution and why it is unfair that the provinces that have pioneered should be crucified and penalized until the others come under the plan. I am not going to speak on that aspect now, because all that could be said has already been said. What I want to do is draw the attention of the Minister of National Health and Welfare to a speech I made in the house about ten months ago. On that occasion I said that before there was a general election the government would introduce a hospital insurance bill, if not a health insurance bill. I was right. At that time I told the minister that a great many hospital beds would be required, and that whatever plan he introduced and irrespective of the formula, basically the federal government would be assuming approximately 50 per cent of the cost of hospitalization.

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I pointed out then, and I do so again, that as the federal government will not start to pay for at least two years after the passage of the legislation, now is the time to spend money in order to save money. I refer naturally to the federal government's contributions to the construction of hospitals for chronic and convalescent cases. I am not referring to chronic cases from the point of view of what are generally recognized as chronic cases in the medical sense. I am referring to convalescents who now have to remain in hospitals for acute cases.
I do not want to repeat to any great extent what I said last year, but in view of the fact that apparenty it did not sink in, since no action has been taken, I think I should at least give the broad general principles. In the vast majority of cases it is not necessary for people having entered a hospital for acute cases and having received treatment to remain in such a hospital. They can easily be moved to a hospital for convalescents if it is adjacent. I am told by hospital authorities and doctors that the cost of caring for a person convalescing from an acute illness is approximately half the cost of caring for that person if he remains in a hospital for acute cases. I am told by the minister's own department that the cost of building a wing for convalescents on a hospital for acute cases is between 50 per cent and 60 per cent of the cost of building an acute hospital.
As I understand the resolution now before us, and work out the formula any way you want, it actually means in the broad analysis a payment of approximately 50 per cent of the cost of hospitalization. That being so, and inasmuch as the minister is going to have to spend the taxpayers' money, the minister is interested not only in giving proper treatment and care but in doing so at the lowest possible cost.
Under these circumstances I should like to make this appeal to the minister. Under other legislation he now pays $1,000 a bed in the construction of hospitals for acute cases and $1,500 a bed in the construction of hospitals for convalescent or chronic cases. I suggest to the minister that by way of aid and encouragement to the provinces that may come under the legislation envisaged by the resolution, and in the interests of giving proper treatment and care at the lowest possible cost, the minister should increase the amount for the construction of hospitals for convalescents adjacent to hospitals for acute cases.
I am absolutely convinced-and I have seen no arguments whatsoever in any way, shape or form to show me that I am wrong-that the

expenditure of money on convalescent hospitals adjacent to hospitals for acute cases will in the long run mean a great saving to those who are obliged to pay the taxes, and also a more efficient operation of hospitalization itself.
Along the same line may I suggest through you, Mr. Chairman, to the Minister of National Health and Welfare that he give more than lip service to the usage of naturopathy and physiotherapy. I am speaking now on the resolution under which the federal government is going to pay half the cost of hospitalization. The concern of the minister, I am sure, is not the money, though he must be concerned in part with that aspect; but in the main his concern is for the health of the people of Canada. I am convinced that we in Canada are missing the boat. We still insist upon being ruled by orthodox medicine, and we have refused so far to take advantage of the knowledge of the world of naturopathy and physiotherapy. It is being done in part in the hospitals today. It could be greatly extended.
I repeat what I have said I believe on three occasions in this house. Canada can eventually be known as the health mecca of the world. The minister was kind enough to refer this matter to his own research department and to make application to the C. R. Best institute to see if they could undertake some studies in that direction.
But because of this resolution and what it means, not just in the interests of the taxpayers but in the interests of the health of the people, I should like to ask if in your hospitalization regulations and details more thought and attention cannot be given to naturopathy and physiotherapy.
After this resolution passes, followed by the bill, when the scheme goes into effect in 1958 or 1959 the cost of hospitalization will be of quite great concern to the minister and his department. I am not going to repeat what has been said by others. I just want to add my words to those that have been spoken, and to pay my tribute to a man not very much known prior to 1935; I refer to Dr. Allon Peebles.
I want to ask that the minister give some thought to this matter now, in the two years before this plan goes into effect. I understand it will take about two years to do so. Perhaps by spending money now on convalescent hospitals adjacent to hospitals for acute cases and by the use of nature's own work and those who know it, it may mean a great deal in the administration of this new principle, a saving of money and a granting of new health to the people of this country.


Hazen Robert Argue: Mr. Chairman, I am sure all members of this group are greatly pleased

that the resolution has been introduced. We naturally welcome any step forward toward an over-all health program. Our only regret is that this legislation has been delayed for so many years, and that it is not a great deal more comprehensive than is indicated by the resolution.
I was elected to this house in 1945, and I can remember that at that time and for a few years thereafter, the main discussion with regard to health matters was with respect to the government's proposal to the provinces contained in the now famous green books. The government's proposals at that time were much more comprehensive than anything contained in this resolution. At that time the government looked forward to an over-all program of health insurance in which the federal government would pay approximately 60 per cent of the cost of major health services.
We have waited 12 years since that time, and instead of the government today making to any province that will come in an offer to pay part of the cost of an over-all health insurance program, we have a resolution that covers a hospitalization program only; and as I understand the minister's statement, no payments will be made to any province, even though that province has a hospitalization plan at present in effect, until six provinces are prepared to inaugurate a hospitalization program and in fact are in a position to receive money for a program that is in operation or is about to commence operation.
I hope I am mistaken. If I am, I should certainly not be speaking at this time. As I understand it, in practical terms the statement is that the province of Saskatchewan-and the province of British Columbia, I take it, as well-will be obliged to wait in all probability until January 1, 1959, before any moneys are paid by the federal government under the terms of the present resolution.
The people of Saskatchewan have already been waiting for many years with a hospitalization program already in operation. The province of Saskatchewan led the way in Canada by implementing the first scheme of over-all hospitalization insurance. It has been most successful over the years. Although it was opposed at the time by members of the opposition in the Saskatchewan legislature, it is now, as far as principle is concerned, a program that is above and beyond political discussion, because no political party in the province of Saskatchewan would dare to oppose the Saskatchewan hospitalization program.
The Minister of National Health and Welfare this afternoon said that one particular provision of the bill would relate to the
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amount of deterrent charge or co-insurance that might be levied. I am proud that in Saskatchewan we have no deterrent charge, and that anybody whose doctor says he should be hospitalized is able to go to the hospital and obtain hospital care as provided by the plan without a deterrent charge or without coinsurance.
That is one of the features of the Saskatchewan plan which I believe is most important, and which puts it well to the fore with respect to all hospitalization plans in Canada.
I think sometimes we are inclined to think that a health program has as its chief or perhaps its whole purpose merely the paying of the cost of hospitalization or the cost of health services when they may be required. This is important. It is important to remove the financial burden from those who are sick, or from their dependents, or from the breadwinner. However, just as important are the added facilities and the better services that can be made available by a hospitalization program operated by a province, or a health program that might be assisted by a national plan.
I have had people close to the Saskatchewan hospitalization plan tell me that in Saskatchewan services are provided in hospitals that are not available in hospitals of comparable size in Manitoba or Alberta. They tell me that facilities in Saskatchewan are available in hospitals of a given size that are not available in other provinces.
This afternoon the Minister of National Health and Welfare mentioned the contributions the federal government had made through hospital construction grants. Then he mentioned that other grants were made available by the provinces. He did not mention, and I do not think he overlooked this intentionally, the very important role played by local governments, by municipal hospital districts and by religious orders. It is true that the largest amount of money has come by way of grants from provincial and federal governments, but the initiative in the building of hospitals has come from the local people and the local governments themselves.
One advantage of the Saskatchewan hospitalization plan is that a local district which is embarking upon the construction of a hospital can build and equip it with the full knowledge that the cost of the building, the cost of the equipment which is amortized over the life of the building or the equipment, will be paid for by the grants to which the minister referred and by the payments under the Saskatchewan hospitalization plan. The fact that the financial burden of building and equiping hospitals is removed from

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the backs of municipalities in local districts enables us to provide a standard of hospital service and a standard of equipment that, I suggest, cannot be matched in any other province under any local or privately operated scheme.
I could go on to point out that the Saskatchewan provincial scheme does not control the operation of the local hospitals. The hospitals are autonomous. Their operations are governed by the local boards. The hospitalization plan merely says to them, depending on the standard of service you provide we shall pay you the average cost of providing those services. There is no control at the provincial level over the operation of the hospitals.
I had hoped the Minister of National Health and Welfare could announce that a grant would be made by the federal government under this legislation to cover hospitalization of patients in provincial mental institutions, as well as for the hospitalization of patients in provincial sanitoria. Until these patients are covered the scheme will not be adequate and will not be comprehensive.
In recent years the Saskatchewan hospitalization plan has been costing something in excess of $22 million annually. I believe that in 1955 the figure was just over $22 million. I am informed, though I cannot say whether these figures are accurate-the minister, I think, would know-that under the government's proposed legislation this province would have a claim, on the basis of the 1955 operations of the Saskatchewan hospitalization service, to approximately $10 million from the federal treasury.
It is because Saskatchewan needs this additional money, because Saskatchewan wants to extend its health service, that we are so concerned about the provision which, as I understood the minister this afternoon, gives each of the first six provinces going into the plan the power to veto payments to the other five. Under the plan, as I understood the minister to outline it this afternoon, Saskatchewan will get nothing in 1957 and will receive no payment in 1958. Saskatchewan will have to wait until January 1, 1959, as the earliest possible date, under the minister's conditions, before receiving any money.
The people of Saskatchewan have now been waiting since their plan began operations more than 10 years ago. They are tired of waiting. They believe the federal government should have gone a lot further than it did in implementing its own proposals of 1945, its green book proposals. The government has retracted the health insurance program and retrenched until it is offering just

a hospitalization program, so it should not provide the further impediment that no payments will be made from the national treasury under this scheme until six provinces have plans in operation.
Saskatchewan is proud of the plan it now has. I have had no consultation whatever with any member of the Saskatchewan government as to what the Saskatchewan government might do if this program were to be made effective immediately. Hon. members will realize that the Saskatchewan government could do one of two things. It could reduce its own costs under the hospitalization tax or, alternatively, it could expand its health program. I do not know what the government might do, but I imagine it might do both those things.
The people of Saskatchewan want an extension of the health program. They have extended it in certain regions now to cover all medical expenses. The people of Saskatchewan led all Canada in the hospitalization program brought in 10 years ago. I have no doubt that the people of Saskatchewan stand ready today to be the first in experimenting in further extensions of the present health program. They do feel that the minister and the government are being shortsighted, are being small minded, in fact are discriminating against the province which went ahead in good faith 10 years ago in the light of the government's proposals at that time.
I can say this to the minister. The people of Saskatchewan will be critical of any legislation that forces them to wait another two years until the federal government becomes a full partner in the hospitalization program. The important thing is not that Saskatchewan is asking for money. It is that a hospitalization program in Saskatchewan and in any other province will provide more adequate health and hospital services for the people in those provinces. One has only to walk into some of the hospital institutions to realize how badly they are in need of money. I can believe that in the rich province of Ontario a great many hospitals would welcome such a hospital program, not only because it would improve the services to the people coming into those institutions, but it would in fact enrich the treasuries of the hospitals themselves so they could provide a better standard of service.
The people of Saskatchewan are asking the minister and the government to take another look at the statement made by the Prime Minister in January, a year ago, and the statement made by the Minister of National Health and Welfare today. Take another look at it, and give Saskatchewan the green

light to show Canada how we can pioneer in an extension of health services.


Murdo William Martin: Mr. Chairman, I propose to take but a few moments in closing the debate to express to the committee the satisfaction one naturally must have in finding this measure so widely supported in all sections of the house. It is true that some hon. members have suggested additional features, but I think a review of all the statements that have been made will show that this resolution commends itself to all sections of the house, as I am sure it will to all sections of the country.
Much has been said about one or two points, and because I understand that there is a disposition now, in view of the importance of the matter, not to discuss the bill on second reading tomorrow, rather than have some misinterpretations go out I think possibly I might as well deal with them at this moment.
Reference has been made to tuberculosis control and mental illness not being regarded as insurable illnesses except for those suffering from these diseases in general hospitals. I think the situation will be generally understood when I point out that in those provinces in Canada, where they now have hospital insurance schemes, such as the provinces of British Columbia, Alberta and Saskatchewan, they do not themselves include tuberculosis or mental diseases as insurable diseases. In the case of Saskatchewan they are covered in a separate account, but are not provided for in the premium system they have for the hospital insurance scheme in that province.


Mr. Ellis:: They are covered.


Hazen Robert Argue: And they are free.


Paul Joseph James Martin: That is the fact. They are not covered under the hospital insurance scheme. The same is true in British Columbia and in Alberta.


Mr. Quelch:: They are free in Alberta.


Paul Joseph James Martin: Yes, but it is not part of the hospital insurance scheme. Tuberculosis and mental illness are provided for almost to the extent of 90 per cent of the cost in most provinces out of the consolidated funds of the provinces themselves. That was revealed to us at the conference we had with all the ministers of health and the provincial treasurers a year ago. Likewise, in all countries I know of but one, tuberculosis and mental illnesses are not treated as insurable diseases.
That does not mean to say, as the interjections have properly noted, that the responsible governments do not look after the tubercular
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and those who are mentally ill. Of course they do, and of course they should and must, and they will continue to do so in this country. But it would be wrong by any principle, in addition to what I have revealed to be the situation, for us to include as part of the hospital insurance scheme tuberculosis patients and mentally ill people who receive treatment in provincial institutions.
Those individuals in Canada who will pay for their mental illness treatment and their tuberculosis treatment in general hospitals will be insurable under the scheme that is now covered by the resolution before the committee. In addition to that, under the national health program we will continue, as we have done in the past, to enable the provinces to carry on their important work of treatment and research in the fields of tuberculosis and mental illnesses. Therefore the impression should not go out into the country that there is no interest in those unfortunate individuals who suffer from mental illnesses or tuberculosis; that they are being ignored by this scheme. They are not being ignored in Canada; they are simply not being covered in this particular measure, except in the case of those in general hospitals, for the simple reason that they are now being taken care of substantially by the provinces, who regard them as their normal charges.
What we are seeking to do in this measure is to provide assistance to individual Canadian citizens to help them to bear their hospital costs. By this measure we are not seeking to subsidize the provinces in respect of responsibilities which they have normally regarded, and continue to regard, as their own.


Stanley Howard Knowles: Will the minister permit a question at this point? Should he not then make it clear that the federal contribution to the provinces will not help them to the extent of 50 per cent of their total hospital costs but only to a lesser figure, say 30 per cent?


Paul Joseph James Martin: I could not agree with that statement, as I am now going to indicate. This particular proposal, in so far as hospital insurance is concerned, if anyone will give it the examination it deserves, is a most generous proposal, a much more generous proposal than the one put forward by the government in 1945. In 1945 there was a ceiling. It was also tied in with medical care. It was part of a package deal which could not be segregated from the various components.


Stanley Howard Knowles: And was never implemented.

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Paul Joseph James Martin: And, as my hon. friend says, it was never implemented, but not because of any action by the government of Canada.


Alfred Claude Ellis: Inaction.


Paul Joseph James Martin: To give an indication of the importance of this measure I would like to put on Hansard figures that I mentioned before in the estimates committee, which I think will indicate the extent of this proposal made by the federal government.
We have sought to recognize as a result of the formula of 50 per cent-taking into account 25 per cent of the national per capita cost and 25 per cent of the provincial per capita cost-that all provinces are not in the same economic position to meet their share of the costs of this measure. The result is that the maritime provinces will receive greater percentages of contributions as a result of this formula from the federal government. For instance Newfoundland, on the basis of the cost figures of 1956, would have received $8.70 per capita, or 72 per cent of its total shareable costs; Prince Edward Island, $9.27 per capita, or 65 per cent of its total shareable costs; New Brunswick would have received $9.89 per capita, or 59 per cent of its total shareable costs on the basis of 1956 estimates. Nova Scotia would have received $10.21 per capita, or 57 per cent of its total shareable costs on the same basis. Quebec would have received $10.91 per capita, or 53 per cent of its total shareable costs. Manitoba would have received $11.21 per capita, or 51 per cent of its total shareable costs. Ontario would have received $11.77 per capita, or 51 per cent of its total shareable costs.


Stanley Howard Knowles: Is that not 49 per cent?


Murdo William Martin: Saskatchewan would have received $12.22 per capita, or 47 per cent of its total shareable costs. Alberta would have received $12.36 per capita, or 46 per cent of its total shareable costs, and British Columbia would have received $12.84 per capita, or 45 per cent of its total shareable costs.


Stanley Howard Knowles: Mr. Chairman, may I ask the minister a question. I was following the figures he gave me a year ago, and last year in the case of Ontario he gave the figure as 49 per cent. Just now he gave it as 51 per cent. Can he reconcile those two figures?


Murdo William Martin: I believe I said 49 per cent for Ontario. Manitoba is 51 per cent. I may have inadvertently read the figure incorrectly, but it certainly was not my intention to mislead the hon. gentleman or the committee. In order that the figures may

appear correctly in Hansard perhaps with the consent of the committee I may place the table on the record.


William Alfred Robinson: Does the minister have unanimous consent to place the table on Hansard?


Some hon. Members:: Agreed.


Murdo William Martin: The table is as follows:
Province	Per capita	Percentage of total shareable costs (based on 1956 estimates)Newfoundland 	... $ 8.77	72P.E.I	... 9.27	65New Brunswick 	... 9.89	59Nova Scotia 	... 10.21	57Quebec 	... 10.91	53Manitoba 	,... 11.21	51Ontario 	.... 11.77	49Saskatchewan 	... 12.22	47Alberta 	,... 12.36	46British Columbia ...	.... 12.84	45
Those figures speak for themselves. The federal government will not in any way interfere with the way in which the provinces will raise their share of the money; in fact it would have no legal authority to do so. That would be the responsibility of the provincial governments, just as it would be our responsibility to find ways and means of raising our share which in the first year of operation, assuming 10 participating provinces, will come close to $200 million.
The provinces will have this advantage. At the present time in all provinces, in varying amounts and proportions, individuals subscribe to such hospital insurance schemes as the Blue Cross, some co-operative agricultural hospital insurance schemes, and other contractual arrangements with commercial companies and so on, so that a considerable percentage of the population in every province is now habituated in some way toward paying premiums for hospital costs. They will continue to pay premiums in the case of consenting provinces to provincially-sponsored schemes, so that taking into account the number of people who have been paying these premiums the net economic load of each province will certainly be much lighter than that borne by the federal government, not in respect of one particular jurisdiction but in respect of the whole country, or at any rate in respect of all the provinces which will agree to participate.
When hon. gentlemen argue that the federal government should assume responsibility for capital debt, depreciation and so on, as was suggested, what they are asking is that the federal government should assume a much greater burden than it is assuming under present arrangement which is much

more generous-four of five times, if one will analyse it-than the proposal of 1945.
No one in this house should think for a moment that in adopting this resolution we are proposing something that represents an inadequate contribution on the part of the federal government. As the treasurer of the province of Saskatchewan himself said at the conference, and so did the minister of health of British Columbia-and I thank them for the observation-the figures I have recited tonight indicate that the financial proposal made by the federal government is indeed a very generous one that will go a long way toward meeting the burden of individual hospital care in this country.
I want to make it perfectly clear that notwithstanding the provocations, if I may put it that way, or the temptations, I am not going to seek to try and suggest in this debate that this particular province or that particular political personality in a province has held up this scheme or is responsible for it. The facts are clear: the proposal was made by the Prime Minister of Canada following eight years of careful preparation on a co-operative basis with the provinces. In my judgment all the provinces have been seriously considering this matter, looking at it in the light of their responsibilities, and I say that the provinces without exception have taken a responsible attitude toward this problem.
If we establish a hospital insurance scheme, as we are obviously now going to, it will not be because of the efforts of one particular person but of a group of persons and of all those who have the responsibility at the two senior levels of government of meeting their share of the burden and of their responsibility in this matter. I believe that is the way to look at this situation, and not to seek to try and cause divisions at a time and in respect of a matter that can only move forward providing this spirit of co-operation exists.
That is what the people of Canada expect us to do in this matter, and I am sure that kind of motivation and consideration will give us the opportunity of realizing all the benefits of this measure much more readily and much more effectively. Mr. Chairman, when we get into a discussion of the bill we will have an opportunity of dealing with the various sections, and I take my seat now in closing this debate-


Stanley Howard Knowles: Oh, no. There are one or
two questions yet to be answered.


Murdo William Martin: -in the confidence that this resolution-
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An hon. Member:: Do you want to hold it up some more?


Hazen Robert Argue: We have waited 38 years.


Murdo William Martin: -will be followed by legislation the implications and benefits of which will mean a great deal to the men, women and children of Canada.


Hazen Robert Argue: Let us take one more day and get the money this year.


Stanley Howard Knowles: Mr. Chairman, I had hoped from the way the minister started his remarks just now that he was going to deal with at least two or three of the important questions raised in the debate this afternoon and this evening. He dealt with one of those important questions, not to our satisfaction-


Mr. Byrne:: Who could ever satisfy you?


An hon. Member:: Results would satisfy us.


Stanley Howard Knowles: -but at least I give him credit for dealing with it, namely the question of the non-coverage of tubercular and mentally ill patients.
The other important item with which the minister did not deal is the uncertainty that exists as the result of today's discussion as to when payments under this legislation are to commence. As the minister knows, the things he said this afternoon did not-


Paul Joseph James Martin: I left it out purposely. When we come to the bill we will deal with the actual section and can discuss it, I think, more properly.


Stanley Howard Knowles: As the minister has already pointed out, there is one group in the house that does not want to go on with this debate tomorrow. It does not happen to be this group, but it does mean that we will not be discussing the bill tomorrow, and some of the things the minister said today have left a considerable uncertainty which I think should be cleared up right now. Let me put this question to the minister. What is the meaning of that portion of the resolution which with respect to the commencement of the plan says it will:
. . . commence when at least six provinces, . . . have .	.	. qualified for the receipt of such
contributions.
In my question I have quoted the last few words of the resolution which I would like the minister to consider and of which I ask him to tell us the meaning. In particular I would like him to tell us whether they mean something different from what the Prime Minister said a year ago and from what the minister quoted in the estimates committee, when he said the plan would take effect "when that majority of the provinces have such plans in operation".

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Is there any difference between six provinces having their plans in operation and six provinces qualifying for the receipt of contributions? If there is a difference I wish the minister would explain it. I wish he would tell us tonight before this resolution passes when these contributions will be available to the provinces which have plans in operation.


Paul Joseph James Martin: When we get to the bill we will be able to discuss it much more effectively. The answer is that there is a difference. In the original proposal we said that when six provinces representing the majority of the people had plans in operation the federal government would pay, but the plans had to be in operation. It is now proposed that once we have the necessary authority we will conclude agreements with at least six provinces. If those six provinces sign and if they have the necessary legislative authority to implement their various schemes, as some now have, and if the law with respect to those schemes has been proclaimed or otherwise in force, that will be sufficient. In other words we do not have to wait for them to be actually in operation. When we come to the bill my hon. friend will have an opportunity to discuss this.


Stanley Howard Knowles: I thank the minister for that statement which is the most important one he has made all day. Is it clear that if six provinces have legislation in this field which has been proclaimed it will be possible at that moment for provinces having plans in operation to start drawing money from the federal government?


Paul Joseph James Martin: With an agreement signed.


Stanley Howard Knowles: Good. May I ask the minister another question. Does the minister realize that in this insistence upon six rather than five provinces he is really straining at a gnat? Does he realize that at the present time the five provinces which have agreed represent 56.3 per cent of the population of Canada. The government formula upon which it is so stubbornly insisting requires that one more province come into the scheme. That one more province could be Prince Edward Island, which would add six-tenths of 1 per cent to the population of the agreeing provinces. The percentage of the population of Canada represented by the provinces then agreeing would be 56.9 per cent instead of 56.3 per cent. Does the minister not think the government is really drawing it pretty fine to require that much by way of an addition?


Paul Joseph James Martin: I have already dealt with that. I believe the requirement of six provinces is an important condition. Hon. members may not agree, and my hon. friend may not agree,

but what we are seeking is a nation-wide system. I am sure if we had not put in the condition that there be at least six provinces, we would not have had five.


Stanley Howard Knowles: You have five now.


Paul Joseph James Martin: I know, but I say we would not have had five. I have every hope, every belief and every reason for being optimistic that there is no question but that we are going to get one more and more than one more province. I am sure that the condition of six has been correct, and I am sure time will prove that to be the case.


Stanley Howard Knowles: The government has already modified its proposal by introducing legislation at this stage when there are only five; why not modify it further and be sensible?


Alexander Malcolm Nicholson: Am I clear on this one point? The minister intimated the other day that he hoped there would be six provinces shortly. Assuming that there is a sixth province, would it then follow that the province of Saskatchewan would be eligible to be qualified this year rather than having to wait until the beginning of 1959?


Murdo William Martin: I have already explained that this afternoon. Under those conditions the answer is no.


Alexander Malcolm Nicholson: I think in answer to the hon. member for Winnipeg North Centre the minister said if there were six provinces which decided to participate in this program, and if the legislation had been proclaimed, then the province of Saskatchewan, which ten years ago introduced a program in good faith believing that it would be a program with which the Minister of National Health and Welfare would agree with; after having had that program for ten years, Saskatchewan should be able to qualify in 1957. May I ask the minister whether I am right in assuming that Saskatchewan would qualify as soon as six provinces pass legislation and have it proclaimed?


Murdo William Martin: I cannot add anything to what I have said.


Hazen Robert Argue: If six provinces proclaim such legislation, is the federal government prepared to pay money to the provinces which have schemes in operation?


Murdo William Martin: That is one of the conditions.


Hazen Robert Argue: I know it is. Has the minister had any assurance from any province other than Saskatchewan, Alberta and British Columbia? I take it they would come in readily. In other words, has the minister assurance from either Ontario or Newfoundland that they will have an act proclaimed within a year?


Murdo William Martin: No, I cannot say that. All the provinces and the federal government are now in the process of considering the terms of a draft master agreement, and negotiations are under way. The provinces that have expressed their concurrence are all doing their utmost to expedite matters as quickly as they can. I do not think I can add anything more at this time.


Hazen Robert Argue: We may not be back to where we started, but we are a considerable distance on the way back. If the minister is saying that six provinces must have schemes proclaimed this year in order for Saskatchewan to get money this year, and if the minister cannot give any assurance that there will be any law proclaimed in any province other than Saskatchewan, Alberta and British Columbia, it is then obvious to everyone that there will be no money in 1957 for the provinces, some of which have had schemes in operation for many years.
I think that attitude of the government is wrong and shortsighted; that the government should now say, in 1957, that they are prepared to pay money from the national treasury to any province which has a plan in operation. I am sure that would not detract from the spirit of co-operation across the country, but would be a solid indication to the people of this nation that this government really means business now.
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Murdo William Martin: That would be one way of going about it.
Resolution reported and concurred in.
Mr. Marlin thereupon moved for leave to introduce Bill No. 320, to authorize contributions by Canada in respect of programs administered by the provinces, providing hospital insurance and laboratory and other services in aid of diagnosis.
Motion agreed to and bill read the first time.



BUSINESS OF THE HOUSE

John Whitney Pickersgill: Mr. Speaker, tomorrow we will take the bill to amend the Prairie Grain Producers Interim Financing Act, 1956; then the two bills standing in the name of the Minister of Justice, one to amend the Exchequer Court Act and the other to amend the Royal Canadian Mounted Police Act; then the bill to amend the Eastern Rocky Mountain Forest Conservation Act; then the bill to amend the Territorial Lands Act; then the bill to amend the Department of Northern Affairs and National Resources Act; then the fur seals resolution, and then anything else that is on the order paper.


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At ten o'clock the house adjourned, without question put, pursuant to standing order.
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Questions