1960-02-29

PRIVILEGE


Hon. J. W. Pickersgill (Bonavisia-Twillingate):: Mr. Speaker, I am rising on a question of privilege which I do not think will be in the least controversial. In committee on Friday last there was some discussion, which will be found in Hansard at page 1484, about a request of mine to have a table printed in Hansard, and it was finally decided by the chairman of the committee, with the unanimous approval of the committee as I understood it and as the record seems to show, that the table should appear at that point. It does not appear, and I am sure it was left out quite inadvertently. I would hope it might be inserted in an appropriate place in the official record. I do not want to have the official record torn to pieces or to make difficulties, but I hope it may be inserted as a correction in today's unrevised record.


Mr. Speaker:: I understand the hon. member is referring to a table, and asks that the table be printed in today's Hansard as an appendix?


John Whitney Pickersgill: That would be quite agreeable to me, or any other course which Your Honour thought was reasonable.


Mr. Speaker:: Otherwise I should think it might stand till the committee again sat and be inserted in Hansard then.


John Whitney Pickersgill: I think that would perhaps be preferable, and I understand the committee will be sitting tomorrow.


Mr. Speaker:: I think the house will give concurrence. It is understood, then, that the table requested by the hon. member, which was omitted from the former report, will be inserted in the report of tomorrow's sitting of the committee.


EXTERNAL AFFAIRS
Hon. Howard C. Green (Secretary of Stale for External Affairs):: Mr. Speaker, the house will recall that on July 9 of last year I announced with respect to the Indus waters 79951-0-97
question that the Canadian government had agreed in principle to participate in the program that had been drawn up by the international bank on the understanding that the funds required for this purpose would be provided as part of our increased Colombo plan contribution. I said on that occasion that I was confident that the house would endorse the government's view that it was in Canada's interest to help in the solution of a problem which has stood in the way of better relations between two of our commonwealth partners in Asia.
It is a matter of great satisfaction to me to be able to inform the house that good progress has been made in working toward a solution of the Indus waters question acceptable to the two states concerned, India and Pakistan. These discussions have now reached the point where the bank and those countries, including Canada, which joined together to help in reaching a mutually acceptable solution have agreed that an announcement on the Indus settlement should be made today by the international bank in Washington. The bank's announcement will give full details of the proposed settlement. Meanwhile I should like to mention the major points briefly.
The Canadian government, subject to the ratification of a water treaty between India and Pakistan now under negotiation, has agreed to contribute $22.1 million (Canadian) over the next ten years to the program for the development of the Indus waters. Parliament will be requested to approve this grant at the appropriate time.
In addition to the large loan which the bank has agreed to make, Australia, New Zealand, the United Kingdom, the United States and Germany have all agreed to contribute funds; the United States has offered to provide additional sums through loans, and India and Pakistan will each make substantial contributions.
The proposed development program provides for the construction of very large works which will divide the waters of the Indus in accordance with the treaty which India and Pakistan are currently negotiating. It is estimated that it will take 10 years to complete this project, which will provide water for irrigation and land reclamation, and important potential hydroelectric power resources as well as flood control works.

External Affairs
I am sure I speak for all members of the house when I say how gratified I am at the progress which India and Pakistan, with the resourceful help of the bank, have made in working toward a settlement of this question. With the continued good will which has characterized the discussions so far, I am hopeful and confident that full agreement will be reached and that a new and important phase in the development of the great potential resources of these countries will be opened.


Hon. L. B. Pearson (Leader of the Opposition):: I am sure hon. members of the house will share the minister's satisfaction over the progress which has been made in this important matter. We may now hope that this difficulty which has caused trouble between India and Pakistan, two sister nations in the commonwealth, may be resolved by the steps which have been taken; and that the solution of this problem may help bring these two nations closer together within the commonwealth and thereby assist peace in that area. I note from the minister's statement that any financial contribution from Canada to this end will be made through our membership and participation in the world bank, and our contributions for the Colombo plan.


Mr. H. W. Herridge (Kooienay West):: On
behalf of this group I want to say that I heartily endorse the announcement made by the Secretary of State for External Affairs, and tend to look upon it as an international projection of C.C.F. policy to develop national resources as a result of government action in planning for the benefit of human welfare as well as in the interests of promoting peace.



COMMITTEES OF THE HOUSE


Mr. H. C. McQuillan (Comox-Alberni) moved: that the first report of the standing committee on mines, forests and waters presented to the house on Thursday, February 25, be concurred in.


Some hon. Members:: On division.


[Stage Direction]
Motion agreed to, on division.

Mr. Hayden Stanton (Leeds) moved: that the first report of the standing committee on agriculture and colonization presented to the house on Thursday, February 25, be concurred in.


Some hon. Members:: On division.


[Stage Direction]
Motion agreed to, on division.


[Stage Direction]
Motion No. 59-Mr. Pickersgill (for Mr. Hellyer):
For a copy of a boundary and a topographic survey of the site purchased, or being purchased from Toronto Industrial Leaseholds (1957) Limited by the Canadian Broadcasting Corporation for its proposed new Toronto area office.
Hon. George C. Nowlan (Minister of National Revenue):: I am not conversant with what the law requires as far as a boundary and topographic survey is concerned, but I presume copies are available, and in any event I will certainly make available all the documents we have in connection with this matter.


John Whitney Pickersgill: I should say that would be quite satisfactory.


[Stage Direction]
Motion agreed to.

[Stage Direction]
Motion No. 60-Mr. Caron (for Mr. Dupuis):
For a copy of all correspondence exchanged between the city of St. Jean, province of Quebec, or its representatives, and the Minister of Transport, the board of transport commissioners, or any other federal agency, concerning the installation of a signal system at level crossings in the city of St. Jean.
Hon. George H. Hees (Minisier of Transport):: I wonder if the item could stand until I have had a chance to talk to the hon. member about the detail which he wishes to have produced.


Some hon. Members:: Agreed.
Motion stands.


Mr. W. M. Benidickson (Kenora-Rainy River):: On a question of privilege, I should like to say a few words before we pass from this item. Last Wednesday Your Honour invited us to comment specifically if we could with respect to lateness in producing certain papers that should be produced by the ministry pursuant to orders passed by this house. I wish to draw the attention of the Secretary of State to the slowness in the procedure that seems to be developing in this connection.
On February 2, 1959 three motions moved by me for the production of papers were passed. None of the three was produced until February 12 of this year, although the motions were passed on February 2, 1959. I cannot see with respect to any of them that there was anything very complicated in complying with the orders of the house. I refer to sessional papers Nos. 106-C, 106-D and 106-E.
Indeed, when the returns were made I think the officers of the house did not realize that a whole year had gone by before these

documents were produced, because when they submitted the documents to me they indicated that they were in response to motions passed in 1960, although of course all three motions were passed in 1959. I submit that these motions are not being respected as they should.


Right Hon. J. G. Diefenbaker (Prime Minister):: Mr. Speaker, I am glad to have the attention of the house drawn to these three particular matters. That has been the experience all through the years, that there have been delays not in any way due to any improper purpose. I am glad to have this information and will certainly bring to the attention of the departments the necessity of producing those returns which can be readily or immediately produced.
There are, of course, some returns that contain many details, some of which cost a great deal to produce. Indeed, there have been questions asked in the house in the last two months the cost of the production of which would run to several thousand dollars.


John Whitney Pickersgill: Mr. Speaker, I should like to say just a word on this point. Hansard wrongly attributed to my colleague the hon. member for Laurier (Mr. Chevrier) a question I asked on Wednesday last, as reported at page 1401 of Hansard. The question was directed to the Acting Secretary of State (Mr. Balcer). The question was whether he would be good enough to do what his predecessor had done previously; that is, to furnish us with a list of those returns which were authorized in previous sessions and which had not been made.
I wonder if the Acting Secretary of State would now be in a position to do that?


Hon. Leon Balcer (Acting Secretary of State):: Mr. Speaker, that list will be available on Wednesday.



COMMUNICATIONS


[Stage Direction]
On the order: Notices of motions:
January 14-Mr. Argue-The following proposed resolution:-That, in the opinion of this house, the government should consider the advisability of referring to an appropriate committee of this house for such study and recommendation as the committee may deem advisable the following question:
1.	The extent to which the ownership of mass media, newspapers, both daily and weekly, radio and television stations, is becoming concentrated, both nationally and in specific areas, in the hands of fewer corporations.
2.	The degree of concentration of control within these corporations and the extent to which such
79951-0-97i
Motions for Papers
monolithic concentration may affect the free expression of opinion and the emergence of new vehicles of opinion.
3.	The relationship between the public service responsibilities of mass media and their function as corporate enterprises.
4.	The advisability of encouraging the creation of a communications council made up of representatives from the mass media the purpose of which would be to develop and protect standards of public service, protection for the individual from any excesses of mass media, and the encouragement of a free expression of public opinion.
Mr. Speaker:: Stand.


Hon. Gordon Churchill (Minister of Trade and Commerce):: Mr. Speaker, this motion, I think, requires unanimous consent if it is to retain its position on the order paper. We are quite prepared to give that consent.


Mr. Speaker:: Is the hon. member referring to motion No. 5, in the name of the hon. member for Assiniboia?


Gordon Minto Churchill: Yes.


Mr. Speaker:: Does the house give unanimous consent with respect to that item?


Mr. G. J. Mcllraiih (Ottawa West):: Mr. Speaker, before unanimous consent is given may I inquire what is the reason for giving unanimous consent to have it retain its position in the order paper ahead of other motions which we may wish to debate?


Gordon Minto Churchill: This was a suggestion made to me, Mr. Speaker, by the hon. member for Assiniboia, who is unavoidably absent today. It is perfectly agreeable to us that it should retain its position on the order paper.


George James McIlraith: In the hon. member's unavoidable absence I have no objection.


Mr. Speaker:: Is the house prepared to give unanimous consent that notice of motion No. 5 retain its position on the order paper notwithstanding its having been previously called twice?


Some hon. Members:: Agreed.
Motion stands.



HIGHWAYS


[Stage Direction]
On the order: Notices of motions:
January 14-Mr. Granger-The following proposed resolution:-That, in the opinion of this house, the government should give early consideration to the advisability of providing increased financial assistance to the Atlantic provinces for the completion of the trans-Canada highway; and special assistance for other key trunk highways in those provinces as a means of equalizing facilities for transportation between the Atlantic region and other parts of Canada.
[Stage Direction]
Health Insurance
Kon. J. W. Pickersgill (Bonavisia-Twil-lingaie): Mr. Speaker, I believe the hon. member is unavoidably absent from the house, and we hope this item will not lose its position on the order paper.
Mr. Speaker:: This is the first call, I believe.


Some hon. Members:: Yes.


Mr. Speaker:: Is it agreed?


Some hon. Members:: Agreed.
Motion stands.



HEALTH INSURANCE


Mr. Arnold Peters (Timiskaming) moved:: That, in the opinion of this house, the government should give consideration to the advisability of introducing a comprehensive system of national health insurance, more particularly to give consideration to the advisability of: (a) amending the Hospital Insurance and Diagnostic Services Act to provide benefits on behalf of patients in tuberculosis sanitaria and patients confined to mental institutions; (b) introducing legislation to provide medical, dental and optical insurance.
He said: Mr. Speaker, in rising to introduce this resolution I have in mind the problems that have faced the Canadian people in the past in regard to health insurance, and the work that has been done by governments in the past in investigating the possibilities of establishing a plan in Canada and some of the results that have been achieved.
Throughout the lifetime of the C.C.F. it has been our hope that we would be able to have implemented in Canada an insurance plan that would cover all the costs of health care for all the people in Canada, regardless of the amount of that cost. On many occasions we have been faced with the problem of Canadian people receiving medical and hospital care in relation to their wealth. As the costs of health care increase it becomes increasingly necessary that some form of health insurance be implemented in Canada to take care of the needs of those people who are less able to finance a plan of their own.
Over a period of years health insurance programs have become somewhat common in Canada. The federal government now has a hospitalization plan which has been put into effect without interfering with the British North America Act or with provincial jurisdiction in this particular field. We have gone into hospital insurance to the extent that most of the provinces in Canada have joined in the plan, and even those that are not now in are contemplating implementing some type of hospital insurance for themselves.
We believe that the federal government, which has given the lead to some of the provinces in this particular field, should also give a lead in completing the coverage of free health insurance to all the people of Canada. The responsibilities of the provincial and federal governments have been completely established in this field, and I quote from the reference book for the dominion-provincial conference on reconstruction, 1945. Under the heading "Division of Responsibilities" we find the following:
Jurisdiction respecting public health is based upon the British North America Act. 1867, and all health activities are conducted within the limitations of the statutory jurisdiction laid down by that act. To the dominion government was assigned jurisdiction over "quarantine and the establishment and maintenance of marine hospitals'', and to the provinces "the establishment, maintenance and management of hospitals, asylums, charities and eleemosynary institutions in and for the provinces, other than marine hospitals". But the residuary power for public health has been generally accepted as being in the province by virtue of provincial jurisdiction over "property and civil rights in the province" and "generally all matters of a merely local or private nature in the province".
In this study that was inaugurated by a previous Liberal government some time was taken in consideration of some of the problems that have arisen through the implementation of hospital plans and other types of plans throughout the country, plans that were being discussed at that time. It was generally conceded that it was not necessary to have unanimity amongst the provinces as to the coverage that would be afforded, and that coverage could be granted by the federal government as was done in the case of hospital insurance.
Before we go into some of the other aspects of health insurance I think it would be interesting to note some of the things that have happened in the hospitalization field. A plan of hospital insurance was implemented in Saskatchewan in 1946, under which the provincial government took full responsibility for the plan. In their election promises that year they indicated that if any assistance was made available from the federal government it was their intention to put into effect a complete health insurance plan in that province. The federal government made certain proposals in the dominion-provincial conferences of that day. They instituted studies of the matter, and indicated to the voters in 1945 particularly that they would consider some kind of complete health insurance. Saskatchewan carried their plan for a number of years, and later the federal government did come into the plan in various ways as requested by the province.

It seems to me that some of the provinces that have put hospital insurance into effect have not wanted hospital insurance at all, but have met a demand by the people themselves for this type of coverage. The plan in Ontario is probably a good example, because we find that many people who were brought under the hospitalization plan in that province on a voluntary basis are now suffering a great deal of hardship because of the inefficiency of the method of collecting money for the particular plan. I have received quite a number of letters from people who thought their medical plan was prepaid, inasmuch at it was prepaid originally for three months. They thought their former Blue Cross plan was being carried into effect. The fact of the matter is that in most cases these people received no notification that their next payment was due. After the three month period had expired they received letters saying that they were no longer under the plan, and that they could reapply if they wished but there would be another three month waiting period.
Therefore it would appear, as has been suggested many times, that if the people putting a hospital insurance or complete health insurance program into effect do not believe the plan is one that should be and can be applied to all the people, there will be ineffectual coverage; the plan will not be the success that it could be if it were implemented by people who believe that the idea of health insurance is to give coverage to all people regardless of their ability to pay or their wage structure, and that everybody should have the advantages of the plan.
These are the types of problems that have developed. I think the problem in Ontario can be solved; but it is an indication that if these plans are not put into effect by people who believe in them, many problems can develop that should not develop, and this is certainly true in the province of Ontario at the present time. I should like to quote one article from Comment which contains the following:
One of the most revealing, although not surprising, features of the Canadian sickness survey, the results of which were published last year, is that low income groups get less medical care although they have proportionately more illnesses. The report states:
"While the low income group reported proportionately far more disabling illness than other income groups, they received much less physicians' care. In relation to the number of days of disability reported, persons in the low income groups received on the average only about half of the amount of physicians' care received by persons in the medium income group and only two fifths of the amount received by persons in the high income group. The low income group reported 8.78 doctors' calls and clinic visits per 100 disability days, as against 16.82 for the medium income group and 20.78 for the high income group.
Health Insurance
"In relation to disability days reported the low income group received the least of graduate nursing care-0.39 visits per 100 disability days. The medium income group received a little more (0.42 visits per 100 disability days), but a considerably greater amount was received by the high income group (0.61 visits per 100 disability days)".
It was the same story with dental care.
"Only 9.1 per cent of persons in the low income group visited a dentist during the year, as against 14.0 per cent of the medium income group and 19.3 per cent of the high income group".
Likewise for miscellaneous health care.
"The low income group reported 78 miscellaneous treatments per 1,000 persons which was about half the number reported by the medium and high income groups (150 and 155 per 1,000 persons respectively)".
We can all remember back to the days of the last war, when a large number of people were entering the services. Many of them were considered to be suffering from malnutrition, and others from medical problems that could and should have been corrected when they were in their growing years. In Canada the proportion of those who had to be turned down for military service because of their inability to obtain proper medical, dental and optical care during the years when it was needed most was much greater than in many other countries. Canada being the large and progressive country that it is, it seems to me that we in Canada can afford the best type of health care for all our people irrespective of their earning power; and that if we can afford this care we should be able to supply it. It was for this reason that I introduced this particular resolution.
The history of the rich and the poor in relationship to health care was pointed out in the proposals of the government of Canada in August of 1945 to the dominion-provincial conference on reconstruction. At page 28 of the green book they pointed out:
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. These inequalities in part reflect differences in personal incomes, and in part are due to differences between rural and urban areas. Great differences between provinces arise from these same factors.
Then it goes on to say this:
Under our present system, for the man who car afford to pay, the cost of ill-health falls at the very moment when his earning capacity is cut off. The cost of treatment and cure for the individual who cannot afford to pay is borne to a considerable degree through the benefactions of well to do members of the community and the generosity of doctors who give so freely of their time and skill, and more and more by the provincial governments and municipalities. In spite of these efforts desirable treatment is still not obtained in many cases. While much of the cost of illness is thus hidden, it can only come out of the total productive capacity of the country. The advantages of a broader provision of health services on a more equitable basis are obvious.

Health Insurance
It goes on to say this:
There are also wide variations in the quality of services across Canada-widely varying patient-day costs, patient-doctor ratios and salary ranges in hospitals. There are just as great variations in the incidence of tuberculosis, venereal disease and other communicable diseases.
To remove the disparities in standards of health services in different parts of Canada, to avoid the risks of sudden heavy expenditures, and distribute health costs more widely and equitably, and above all, to obtain the benefits of better health for the great majority of our people- these are the objects of the proposals which the federal government is now making with respect to health insurance for all, and increased public health services assisted by federal grants.
We are fortunate today-and I say that with my tongue in my cheek, probably-that we still have in the house with us the former minister of national health and welfare. I am quite sure that in speaking on this resolution he will point out that if his government had remained in office these things would have come to pass. However, let me point out that he was also the minister of national health and welfare from the time these proposals were made in 1945 until 1957, and that very little was done. I am also pleased to say that his consideration at this time hinged on the fact that the provinces were all going to have to co-operate before anything was done. I am happy to say that he had a change of heart in later days, and that these services were provided in the hospital field when the majority of the provinces indicated their desire for those services.
However, I would suggest that his party promised health insurance since 1919 and we are still asking for it, as is obvious by this resolution. If it had been provided, this resolution would have asked for an increase in some of the services that were provided under a health insurance scheme, and we would not have had to ask for basic coverage.
Over the years Conservative governments also have made many attempts to provide the electors with a health insurance program before elections; but, singularly, they have made very few proposals after they were elected. I should like to use the example of Ontario. In Ontario there was a Conservative government at that time; and not only were there the Progressive Conservatives in Ontario but there were the Union Nationale and Social Credit governments in other provinces than Ontario; and the only province which expressed any desire for health insurance on a broad scale was the province of Saskatchewan. The Ontario Conservatives promised to launch a provincial health program in 1943 when Mr. Drew, in announcing his 22-point program to the electors of the day, promised as his second point in that program-and he indicated that it was extremely important by putting it at the top-as follows:

2. We will at all times work In effective co-operation with the dominion government and with all other governing bodies in Canada in all activities which will assist in the prosecution of the war to a successful conclusion, and in establishing a sound basis of social security, health insurance and protection in their old age for all our people.
Section 11, dealing directly with health insurance, said this:
Health measures will be established so that medical, dental and other health protection will be available for all.
That was reported in the Toronto Daily Star of July 9, 1943. Yet Mr. Drew came and went. The 22 proposals in Ontario were dusted off and added to many times, and this proposal is just as good in the province of Ontario today as it was then because it has been implemented only to a very limited extent. With the Conservative government now at Ottawa, and having among its members some who sat in the Ontario house at that time, I hope they are going to indicate that at that time they believed in those 22 proposals and that some of them will be rising in their places and saying they are still in favour of a complete health program which will accomplish what Mr. Drew in his 22 proposals indicated when he suggested that a program of medical, dental and other health care would be available for all.
This program of health insurance has been considered to be a socialist proposal that cannot be implemented. It has been considered that the socialists are dreaming when they suggest that all people in Canada, even those who are not able to pay the expenses that are incurred in hospital and medical care, should be protected, and that all people should be protected without any relationship to the amount of money they earn.
I think the Canadian people have indicated on numerous occasions that governments should have this in their election programs, that something should be done; and that they are willing to pay their share to see a health insurance program put into effect. It seems surprising to me that Saskatchewan, where there is a socialist government, should be the only province which went ahead before the federal government gave any notion or sign of participation to any degree in this plan. I believe they will suggest this year in their election program that they will give the people of Saskatchewan prepaid medical coverage to implement the hospitalization program. I think the people of Saskatchewan are aware that if they re-elect the government the plan will be implemented as they suggest it will, and I believe we should be entitled to expect over the years the same type of program which has been adopted in election compaigns in federal and provincial fields.

Great Britain entered into a social health scheme upon which many have passed comments. Some people say that you should not give eye glasses away, and there is a row going on now in Great Britain because the eye glasses are not considered satisfactory. Apparently they were too plain for some people while others were getting dark rimmed glasses, and there is talk that they should jazz them up a little more, similar to other countries where you have these paste diamond frames, and so on. But this is a country which is supplying people with eye glasses.
There are many people in Canada, certainly many students in rural schools, who need some kind of glasses, no matter what they are. They would be happy to have them no matter whether they had steel rims and were very plain looking. They need them not only to look pretty but because they have a functional use as well, but they are not supplied at the present time. This type of plan was put into force in Great Britain, and in my opinion and the opinion of the world in general this plan has been a success.
I have here a quotation from the London correspondent of the Wall Street Journal, which I suggest is not a pro-Labour publication. In the issue of November 27, 1951 it had this to say:
... one pillar of socialism-socialized medicine-is certain to remain intact... The "free" health service set up by the Labour government is so popular that it can no longer be made a political issue here.
Listen to Bert Greenaway, a postman whose route is in Chelsea ... "It's the finest thing that ever happened to this country. Since the service started my wife has had two babies and a new set of teeth after pyorrhea, the little girl got cured of mastoid with streptomycin, the boy had a broken arm x-rayed fourteen times and reset and we all had our tonsils out-without me paying a penny!"
In Clapham Junction where Greenaway lives-a thickly populated railway centre-infant mortality has dropped since the health service from 50 per 1,000 to 20 per 1,000. The working class children in the area get fresh milk, orange juice and cod liver oil for five years after birth at a minute charge, and mobile x-ray units pay regular visits.
About 95 per cent of the British people have registered with the health service. They pay nothing for personal health services-including operations, specialists, maternity and child welfare, home nursing, medicines and appliances. Only exceptions are false teeth and spectacles-since May they pay half of the cost of these.
The cost of the health service is 46 cents a week for each and every member of all British families ... supplemented by the employers' contribution and money from the national budget.
Then it goes on to indicate what the doctors' views are. We have another problem in Canada with regard to the doctors. We hear that most of the doctors are opposed to these medical plans. I do not want to quote organizations which I do not know anything about, but I think I can talk about some of the organizations I do know. I was a miner
Health Insurance
in Timmins for years, and we got very low wages. I can remember when I went to work in the mines for 57 cents an hour and we paid $1 to a medical plan which supplied free medical care. In most cases I think the plan supplied cough medicine and aspirins and sometimes potassium-something which you put on your feet for athlete's foot. That was pretty well the extent of the service, and it had something to do with the fact that the mining communities assumed some responsibility and made some payment toward this type of plan.
This plan was felt to be so good by the miner, that he could get aspirin and cough syrup for nothing, that he wanted his wife to be able to get aspirin and cough syrup for nothing and a few other things at a reasonable price too. So they organized a medical plan for the miners and their families which cost $3-odd, and the mines made a contribution. All the doctors enjoyed this plan very much. They no longer had to send out bills. They did not have to dun anyone for a payment which a man could not make anyway. They did not have to accept potatoes, cheese or milk for six months as they had to from farmers in the surrounding area at that particular time. They were all fairly comfortable on the income they received from the prepaid plan.
As the years went on they increased its scope and gave wider and wider coverage. They provided specialists' care, and specialists and surgeons came in from the major clinics of Canada. This plan was highly satisfactory. In Kirkland Lake they have a similar plan to which the miners belong, but some of these plans have finally run into very strong opposition in recent months. I am not suggesting that the plan in Kirkland Lake has run into strong opposition because some of the Liberal people did not believe in it; in fact the lady who was a Liberal member in this house for a long time is secretary treasurer of that organization. But within the last few months they have found after 18 years of operation that the plan is not legal. There is some point which has been overlooked and the plan is illegal, and they cannot operate this kind of plan. The miners have held meetings and said they would pay more money to the plan, because their wages are low and they need prepaid health insurance; but they are being turned down, and the last I heard'of the plan was that it was going to be washed out.
It seems to me that all across the country these plans have been put into effect by the people themselves, but unfortunately the only people who receive coverage are those who are employed and can afford to pay their contributions. All I am suggesting in this

Health Insurance
resolution is that the matters mentioned be considered by the federal, provincial and municipal governments, and that a conference be held similar to the one in 1941 to draw up a bill which will be put into effect. Care is not being given to those people who need it desperately but cannot afford it.
We have another problem in Canada which was brought to my attention, and it concerns the plan in use in Great Britain. People who come to Canada are surprised to find that a country this wealthy has no health plan. Mr. M. J. Coldwell, when speaking in the house on March 23, 1956 mentioned something which has been brought to my attention by the Scots miners in particular who have come into the Kirkland Lake area in the last two or three years. They were told before they left Scotland that conditions in Canada were as good as in Great Britain, and that wages and opportunities were much better. Mr. Coldwell said, as reported at page 2551 of Hansard:
When I was in Britain a year and a half ago I found there was a very general understanding that Canada had no national health plan. When I was there letters were appearing in some of the British papers from immigrants who had come to Canada pointing out that they had done pretty well for the first two or three years, but then a serious illness had attacked one of the family and the medical and hospitalization expenses had not only wiped out all they had been able to save but had put them into debt.
When one considers that in most overseas countries from which we like to get as much immigration into Canada as we can they have quite comprehensive plans, then I say to the government, and particularly to the Minister of Citizenship and Immigration, that Canada needs such a plan to attract immigrants. I believe that we want immigrants because our country is one that still has wide open spaces with plenty of opportunities... The future is very bright for those who come here, but today all the progressive countries have social security plans that are quite comprehensive. People who think of coming to this country look for social security measures of the kind they would be giving up on leaving home.
This has been a particular problem in the mining areas, and it is one which I think the Canadian people should make every attempt to solve. We have the necessary wealth in this country, and I think we should give immediate consideration to this question. We set up many committees to investigate matters which are not nearly as important as the health of the Canadian people. If there were only a few people who lacked proper medical, dental and optical care today it would still be worth while implementing this plan to provide a national service. The more advanced parties and elements in Canada have for years been suggesting that we should give consideration to such a scheme and that we should use as a basis the reports made to the federal government in 1945. We

might well dust off those proposals, bring them up to date and decide what we are going to do about them.
I have seen a health insurance bill which was drafted at that time and widely circulated. I suggest that this plan, brought into line with present day needs, would be as acceptable to the mass of the Canadian people today as it was acceptable to them in 1945. It is interesting to note that at that time those who were pressing for a complete national health insurance program received by far the majority of the electors' votes. It is my firm belief that those proposals are as important today as they were when they were first put forward.
The extent to which hospital costs have increased was brought home to me very clearly yesterday in the town of Elliot Lake. We have heard a great deal about Elliot Lake in the last two or three days. I was there over the week end, and I met a young lady who has been working in the province of Quebec for some time. She had been employed with the telephone company, and had been transferred to Elliot Lake only a few weeks ago. Some six days later she went to hospital with an acute attack of appendicitis. Her appendix was removed, and she went home the day before yesterday. She told me that because she was covered by no hospitalization plan-the province of Quebec has not seen fit to enter the scheme, and she had not been in Ontario long enough to become eligible-the cost in that beautiful little hospital we have established in Blind River amounted to $27 a day. I am told this is an exceptionally hight cost. My brother informs me he paid $24 a day in one of the Toronto hospitals. I can tell hon. members straight away that there are many people in my riding who would not be able to enter hospital at all if they had to pay $27 a day.
On another occasion a farmer came to me and told me that because the Ontario government had not seen fit to send out notices to those who were making voluntary payments in connection with its hospitalization plan in Ontario, he had incurred an unexpected hospital bill amounting to $1,500, which meant that he had to sell all the beef cattle he had intended to keep during the winter.


Mr. Mariin (Essex Easi):: Was he paying his contribution under the act?


William Arnold Peters: He thought he was.


Mr. Martin (Essex East):: But was he?


William Arnold Peters: No. Previously, under the Blue Cross scheme, he received notices that he had to make his payments. He attached his cheque

to the notice and sent it in. He thought his wife was sending these in at the present time, but when he made inquiries he found that he was not being billed. Through this oversight he found he had slipped up. This is not an isolated case. I can give examples of four or five others which have come to my attention in the last two weeks.
I am pointing out that all these costs have gone up and that many people, particularly those living on fixed incomes, are finding that the cost of medical, dental and optical care is beyond their means. Moreover, they cannot afford the type of coverage they have now. In Canada, as in other countries, we have found that proper use of the medical skills available has led in the last 30 years to an extension of the life span from an average of 40 years to well over 60 years in the case of our male population and even more than that in the case of our female population. I think this is an indication that with proper care we shall be able to decrease our mortality rate still further and increase the life expectancy of all our citizens. If this can be achieved we should use all the means at our disposal to do so.
While this may be a socialistic measure, I remind hon. members that throughout Canada we are finding that many measures which at one time were called socialistic measures are not so bad after all; and one of them, I suggest-


Paul Joseph James Martin: This is not socialism. It was introduced by Lloyd George in Britain, and he was a Liberal.


William Arnold Peters: Whether that is so or not,
socialists and most of the politically educated people throughout the world believe in it, and it is usually referred to as socialistic. A provision of this kind will be implemented in Canada eventually, and in my view we should not wait for more time to elapse. We should co-operate to the best of our ability to make this type of coverage available to any province which wants to develop it on a provincial basis.
Judging by the interest which has been shown in the coverage already provided, I think the provinces would be ready to act with greater speed in introducing legislation which would take full advantage of the leadership which could be given by the federal government at this time than they were with regard to the implementation of the hospital insurance plan. For this reason the sooner we set up a conference to assess the cost and ascertain the legislation that is necessary to implement this project on a broad and comprehensive scale, the sooner the people of Canada will be able to enjoy the benefits of an effective health insurance program.
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Mr. G. C. Fairfield (Porlage-Neepawa):: Mr. Speaker, I have been wondering what is the purpose of this resolution. I heard from my friend the hon. member for Essex East (Mr. Martin) that this is not the original socialist doctrine; yet to all intents and purposes the hon. gentleman on your near left introduced this resolution as such.. I think it is probably just another of their frequent attempts to force everyone into the same mould, and of course they reserve the right to fashion the conception of what the mould shall be. By this method they attempt to accomplish the feat of stamping out any individual initiative and ambition and reward only the average. Hon. gentlemen in the small group to your immediate left parade under the banners of altruism, but their route seems to be marked by their milestones on the march toward state dictatorship.
The attitude of the these hon. gentlemen reminds me of a story I once heard about a very left-wing gentleman who was speaking to a large crowd. To close off his speech he said, "Comes the revolution you will all have strawberries and cream." One meek voice came out of the crowd saying, "But I do not like strawberries and cream." The gentleman who had been speaking pounded his desk and thundered, "Comes the revolution you will eat strawberries and cream."
This appears to be a "strawberries and cream" resolution, but I propose to show that there is available to the people of Canada a considerable amount of strawberries and cream which the public may take or leave as they wish without having to be force fed. In 1943 the previous government established an advisory committee on health insurance which produced the following definition of health insurance concepts:
The modern conception of health insurance is the reduction of morbidity and mortality by prevention and treatment.
The committee produced the impressive volume I hold in my hand, which is a large and comprehensive document. It was the suggestion of the committee in this report that there should be a contributory plan. That is, the federal government, the provinces, the municipalities and individuals should pay into the plan. Unfortunately this would seem to lead to the type of situation that obtains under the plan operating in Great Britain, under which the doctor is paid a shilling a month or something like that.
I do not propose to read very much from this document, the report of the advisory committee on health insurance, but I refer hon. members to the bottom of page 31, subsection 3 of section 44, where we find the

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following regulations governing the conduct and practice of the doctors concerned:
44. (3) Subject to any regulations made hereunder, the duties and responsibilities of the regional medical officer shall be
(a)	To advise practitioners in the discharge of their duties under this act;
That is to say, the boss man will tell the practitioners in his area what to do, as they do in England. He will advise them in the conduct of their duties.


Mr. Winch:: It says he will aid them.


George Clark Fairfield: He is to advise them.


Harold Edward Winch: Aid them.


George Clark Fairfield: No, there is no reference to aid. I continue:
(b)	To keep in touch with practitioners with the object of raising the standards of service under the act;


Harold Edward Winch: Any objection to that?


George Clark Fairfield: None whatsoever. I continue:
(c)	To examine and satisfy himself of the accuracy and sufficiency of the clinical and other records of practitioners;


Harold Edward Winch: Any objection to that one?


George Clark Fairfield: Not at all. I continue:
(d)	To investigate any case of alleged excessive prescribing of drugs, medicines or appliances by any practitioner; and-


Harold Edward Winch: Any objection to that one?


George Clark Fairfield: Yes, a strong objection. This means one doctor ruling over another and saying, "You are giving too many antibiotics" or something of that nature, despite the fact that the doctors under the jurisdiction of the director may have more training or maybe more competence. I continue:
(e)	To perform such other duties and to assume such further responsibilities as may be prescribed.
This describes the mold into which this method forces not only the medical profession but the patients.
I have had some experience with municipal practices. Hon. members will recall that before the war there were many rural areas in Manitoba and Saskatchewan where in order to get practitioners established it was necessary to devise a scheme of paying them salaries to look after all the people in the municipalities. The usual maximum was $5,000, out of which the doctor provided his own travelling and office expenses although he did not have to supply drugs. When I visited some of these areas I found myself wondering how those fellows made a living, and I learned that in fact they did not make a living at all, despite the value of the dollar as it was in those days.
Let us turn our attention to the English scheme, which is supposedly the basis of

so much of the health insurance clamour in this country. We find that a number of false conceptions abound with respect to the British scheme and the Canadian plan. The hon. member for Timiskaming said, I believe, a business man from Shelburne stated that he did not have to pay anything for any work that was done. I think it should be obvious to all having to raise half a billion pounds in that country to pay for those services, the cost will be met by the taxpayers; because certainly the money is not to be found in the trees or dug out of the English channel. People should not forget that no matter what they receive they will have to pay for it. Despite the fact that some people have to pay as much as $800 in doctor's bills in Canada, I propose to show later on that Canadians on the average do not have to pay very much for medical services.
Let me review in brief some of the health services that are available to Canadians at this time. Several federal provisions for health service already exist. Under the Department of National Health and Welfare we have food and drug control. The Department of Agriculture has certain responsibilities in connection with food production and examination. The defence research board administers medical research programs.
In 1948 a federal program of national health grants was introduced under the aegis of the hon. member for Essex East. There have been nine continuing grants from 1948 to 1953 relating to hospital construction, professional training, general public health, public health research, mental health, tuberculosis control, cancer control, venereal disease control and crippled children grants. In 1953 three additional grants came into being affecting child and maternal health, medical rehabilitation, and laboratory and radiological services. Under the Indian and northern health service 152,000 Indians and
11,000	Eskimos receive free medical care. Treatment is also given to immigrants coming to Canada. Another form of assistance is that given to sick mariners and lepers.
The total cost from 1948 to 1958 of these services was $258,971,674. In the year ended March 31,	1958 the assistance totalled
$34,606,064. The figures I have given exclude medical treatment for veterans.
Last year, as hon. members know, we brought in a hospital scheme. We also have provincial and municipal health facilities, sanitation and inspection in environmental conditions in city and urban areas. These are usually controlled by the municipalities.

We have occupational health, usually in industrial areas, to prevent accidents and occupational diseases; we have workmen's compensation boards, and there are boards which set standards and measures for health and safety. We have communicable disease control in six provinces; we have maternal and child health care in local units in many provinces; nutritional guidance in school lunches, and school examinations. Health education is practically a normal thing in all provinces. There are special programs: owing to the severity or the chronic nature of diseases such as mental health, tuberculosis, cancer, poliomyelitis, dental health in nine provinces, venereal disease; and there are four provinces which have agencies for research and education in alcoholism, while three have rehabilitation programs.
What about the national voluntary health organizations? There are many of them. There is the Canadian Welfare Council which gives information and technical evaluation to assist agencies such as community chests. There is the Canadian Red Cross Society. Everyone knows that they are a great help in times of disaster and, more particularly, in the last few years in their intense efforts to keep abreast of the need for blood in the provision of blood banks. Incidentally, I noticed in the paper this morning that the Red Cross were nearly $400,000 below their needs last year, owing to the dearth of money which should be coming from the Canadian people to assist them in their worth-while causes.
We have the Victorian Order of Nurses, a not inconsiderable group, which gives professional home nursing and health counselling. The Canadian National Institute for the Blind provides examinations and eye treatment, and also spectacles for the needy. The health league of Canada has 60 national member associations, and their desire is to promote personal and community health through education. The St. John Ambulance Association is really two; there is the St. John Ambulance Association which trains people in first aid and gives health education, and there is the St. John ambulance brigade, which is quite noticeable at parades and at large gatherings and in times of disaster, where they do first aid work.
The Canadian tuberculosis association has given technical advice, and some of their funds have been used for chest X-ray programs in the provinces. The national cancer institute of Canada was founded in 1947 to promote research and professional education programs. The Canadian mental health
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association promotes public education and is a consultant to government departments, welfare agents, and so forth.
The Canadian cancer society is interested in education and also in home nursing. It provides free dressings for cancer cases, transportation to treatment centres, and fellowships to medical graduates for advanced study. The national heart foundation promotes research in cardiovascular diseases. The Canadian paraplegic association gives aid to patients by therapy both in the home and in institutions. It also provides for prosthesis loans, training and rehabilitation.
The Canadian council for crippled children and adults has established cerebral palsy clinics throughout the country. It operates summer camps, and it pays for treatment services and hospital and nursing care. Incidentally, it is responsible-I hope everyone supports it to the full-for the Easter seals campaign.
The Canadian arthritis and rheumatism society puts on an education program and operates some 70 mobile units for treatment in the home. In Manitoba it is doing a magnificent job. It also provides nursing care and physiotherapists and stationary units in hospitals.
We have the multiple sclerosis society, which has 12 provincial and local chapters and which raises funds for public education and research. There is the Canadian association for retarded children, which was organized only last year but already has 10 provincial and 105 local groups. Its objective is the training of retarded children and research into the cause of retardation. We have the muscular dystrophy association, which was formed in 1953, for research and treatment into this terrifying disease.


Paul Joseph James Martin: Did my hon. friend mention the Canadian public health association?


George Clark Fairfield: No, I did not.


Harold Edward Winch: Did the hon. member name the association which pays for personal doctor's bills when you are ill?


George Clark Fairfield: I will come to that. Besides all these we have prepaid medical insurance schemes in many areas in the country, mostly industrial areas or urban areas, and we also have insurance schemes and groups across the country. Medical service is provided by private insurance companies which look after the payment of any expenses in connection with the health conditions of the family. Certain industries have medical group plans. In my area alone I would say that fully 50 per cent of the people have these insurance plans.

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The hon. member for Timiskaming talked about expenditures. I hold in my hand a survey which was made in 1950-51 of 10,000 homes throughout Canada. This is representative of 4,555,000 separate family units. We will just take the average cost per family unit or the average total expenditure, and we find from compilation No. 1, on page 11, that the average estimated expenditure per family unit, with expenditures for particular items by size of family unit, was $95 per year, all sizes. This actually is about the amount the ordinary smoker spends in a year.


Harold Edward Winch: All medical expenses?


George Clark Fairfield: This is the total expenditure; this is physicians, hospital, dental, and so forth.
Now we come to the other estimation and who pays it; the expenditures, and how heavy they are. This is found on page 18 of special compilation No. 3. Take the average family of three to four people, and we find that only 2 per cent of this large group paid over $500 in any one year. In that year 10.9 per cent paid between $200 and $499; 27.4 per cent paid between $100 and $199; 27.2 per cent paid between $50 and $99; 19.3 per cent paid between $20 and $49; and 11.1 per cent paid between $1 and $19 while 2.2 per cent paid nothing, had no expenditures. So you find that the big noise is made about possibly 2 per cent of the people. On the average across Canada 2 per cent of the people have to pay over $500 for all health expenses, medical, dental, hospital and otherwise.


William Arnold Peters: Probably 20 per cent could not afford to pay $500.


George Clark Fairfield: I will get to that in a little while. What about the role of the medical practitioner under this altruistic, wonderful measure that the hon. member would like to bring into effect? We find that 11,800 doctors paid income tax in 1956. I cannot seem to find how many were in institutions and receiving salaries. I would estimate that probably 2,000 were working in institutions. That means that there were about 9,000 doctors for over 17 million people. We have a big country thousands of miles wide, with nearly 18 million people spread all over the country. There is one doctor for every 2,000 people, and the great majority of doctors are concentrated in the urban areas. What about their role under this sort of plan?


Peter Francis Martin: Did the hon. member say one doctor for 2,000 people, on the average?


George Clark Fairfield: I would say there are about
9.000	active practitioners and we have about 17 million people, so the figure is roughly one in 2,000.


Mr. Martin (Essex Easl):: I think the proportion depends on the province and the city and area.


George Clark Fairfield: Certainly it depends on the province and the city. We all know that in urban areas there is a greater proportion of doctors. You will very often find that in rural areas the proportion is one doctor to
5.000	or 6,000 people. The hon. member has said that doctors provide much better treatment to persons with means. I would quarrel with that statement, knowing the clinical aspects of the larger hospitals and the way relief cases are handled. Such patients have the benefit of the finest clinicians, and they do not have to pay. The doctor receives nothing. The patient receives the finest medical consultative care that can be found anywhere, and I do not even except Europe or England. They get the finest care, and I quarrel with the statement that the poorer patient does not get as good care.
Doctors do a lot of charity work. From my own small practice I would estimate that nothing is paid by 30 per cent of the patients I see. There are many for whom you do not even show a charge on your books, because you know it is hopeless. There may be a very few exceptions, but I do not think medical men generally anywhere in the country will ever turn down charity patients other than under exceptional circumstances.lt may be that you have a person who is a fool as well as being poor, and who calls you at the slightest tingling sensation indicating a cold in the nose. After all this is a nuisance, and doctors also turn down such people who can pay. Never in any emergency have I seen a poor patient turned down.
The hon. member has said that costs have gone up, but if they have the increase is only slight. Perhaps specialists may charge more, but their charges have not gone up as much as the cost of living has risen. The cost of an operation right now is not more than 10 per cent greater than in 1936. This is a fact. You can look at the suggested fees of any medical association throughout the country, and you will find that the costs have not gone up in comparison with the rest of the economy.


Harold Edward Winch: They certainly have for office and home visits. In the last 12 months they have gone up terrifically, and you know it.


George Clark Fairfield: You had better come and see me from now on.


Harold Edward Winch: I do not want to see a doctor at all, but I know they have increased in British Columbia.


George Clark Fairfield: I do not know why you are backing this bill. What else do doctors do in their communities? They examine children free in the schools. In certain areas where there are hospitals with training schools they teach the nurses free of charge. There are many things they do. But here is the point. In 1956 there were 826 graduates from medical colleges throughout Canada. This is barely enough to maintain the ratio of one in 2,000. But in my own province last fall only 39 young men decided to go into medicine, whereas there are usually 100 or more. I can tell hon. members that the medical profession is frightened as to what is going to happen five years from now if the downward trend with respect to people studying medicine continues. One of the fears, and I make no bones about it, is the fear of state medicine, state control of the medical profession.
But you say they will be given a salary. These things do not count. If you give a doctor a salary it does not matter particularly what he does or where he goes. There is a meeting taking place in Montreal this week of 500 general practitioners from all over the country, who have paid their own expenses to go to Montreal in order to gain more experience at lectures and clinics; but if they were salaried-


Harold Edward Winch: They would be paid to go.


George Clark Fairfield: Oh, you would find that the doctor would sit in his office, and as he would get his salary in any case there would be no need for him to show initiative and take further postgraduate work.


Harold Edward Winch: Apparently I have more admiration for the ethics of doctors than you have.


George Clark Fairfield: Well, put them in a mold in the way they are in a mold in the old country right now, and you will see what will happen. You should talk to doctors who have come to our country. Talk to recent emigrants from England who have come here because they were stifled in their practice there. They tell me that they go to Mrs. Jones' house and she has swatches of cotton and bottles of pills, and they say this scheme is going to ruin the country before it does any good. A workman will come in the day before soccer cup day and say, "Write me out an excuse or I will not get paid", and if you do not write him out an excuse for a shilling he will say, "I will go down the street and get one". These are the things that undermine the ethics of the profession.
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William Arnold Peters: Are you interested in ethics?


George Clark Fairfield: I certainly am. I wish you could meet some of these young doctors who have come to this country after practising for four or five years in England. They decided to give up their practices because they are ethical enough to believe-


Harold Edward Winch: Because they want profits, not
ethics.


William Arnold Peters: I have one in my area, and he is the only doctor there.


George Clark Fairfield: You have one, but I have seen many. As to the rising population and the decreasing number of young men who are going into medicine, this situation is due- and of this I am quite sure-to one factor alone, namely socialized health and medical care. The doctor will be in the position, as is stated in this book, of being another civil servant on a certain salary in certain areas and under certain rules, without any chance to further himself other than by political means; and we are going to end up in a very short time-in five years or so- with very few doctors coming out.
Then what are we going to do? Are we going to bring them out from Europe? I have seen some who have come out of Vienna lately. They have certainly rushed them through their medical colleges and clinics in that area. I do not blame them at all because in the post-war years and during the war they did not graduate many and they had to hurry them through. But they are not up to the standards of medicine that prevail in this country or in the United States of America. Do not think for one minute that I do not know about the standards of medicine in England. They have dropped proportionately every year since this socialized medicine came into existence, and I know they have dropped.


Harold Edward Winch: England has the highest standards in the world.


George Clark Fairfield: You are a long way behind there.


Harold Edward Winch: I am not. I was over there last year and I met the minister of health.


George Clark Fairfield: The minister of health? That is a different matter. Talk to the president of the British medical association and see what he thinks.


Harold Edward Winch: I saw them too.


George Clark Fairfield: I suppose he is happy about the situation? Not at all. So far as the medical profession is concerned, this is the great fear. It is the fear that not only will you not have enough doctors but that you will not have proper medical care.

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There is nothing further that can be said on the matter. I think it is up to the house to discuss this matter, not on the basis of altruism but on the basis of what is best for the country. I hope that in their discussions hon. members will realize that this is a very deep fear, based on the fact that the number of people graduating in medicine is going down each year.


Harold Edward Winch: May I ask the hon. member a question?


George Clark Fairfield: Yes.


Harold Edward Winch: I have been trying to follow the hon. member closely. Is it his contention that medical men will not give service unless they have the profit motive? Does he contend that they will not do it on an ethical or humanitarian basis but that they must have a profit motive?


George Clark Fairfield: I never said any such thing. Obviously that is rubbish. I said that I wrote off a great deal of money every year. Every doctor does so. Every doctor does charity work continually. I have written off in one year far more than my salary here. I can say that without pangs; I know the people cannot pay. This is not an isolated case. All of us do it. As I said before, all we ever collect on the average is 70 per cent.


Murdo William Martin: Will the hon. member permit a question? I also followed his speech very closely. On the basis that national health insurance drives doctors out of the country, how is it they have doctors in Germany which has had national health insurance since 1880 or something like that?


George Clark Fairfield: I think the hon. member is stretching a point there. Their health insurance is of a different type from this. It is not a socialistic scheme and it never was. If the hon. member will read his book he will find that it is not and has not been a socialistic scheme. It was not a capitation scheme.
(Translation):


Mr. Augustin Brassard (Lapointe):: Mr. Speaker, it is with great pleasure that I take part in this debate on the resolution introduced by the hon. member for Timiska-ming (Mr. Peters) and dealing with health insurance. Health is one of our most valuable possessions, if not indeed the most valuable of them all. Therefore, it is quite in order for the Canadian people's representatives in the House of Commons to attempt to improve the hospital insurance plan which was implemented by the former
fMr. Fairfield.]
administration, under the able and experienced direction of the hon. member for Essex East (Mr. Martin).
We sometimes read in the papers or hear comments to the effect that the resolutions introduced in this house by opposition members serve no useful purpose. I do not share this view at all because I think that the discussion of a matter of vital importance can help us to prepare public opinion and convince members of the government to put into effect some of the very sensible suggestions made by members of Her Majesty's loyal opposition.
Mr. Speaker, I think moreover that the resolution of the hon. member of Timis-kaming might be considered from another point of view, in that it may serve to remind hon. members opposite of the solemn promises they made to the Canadian people in respect to hospital insurance.
The hon. member for Timiskaming possibly wanted to be funny when he said that the Liberals had been talking about hospital insurance for a long time. As I see it, he does not have to offer many excuses to as far as his own party is concerned. While the Liberals had promised this hospital insurance plan for a long time, members of the C.C.F. in this house have promised it ever since their party was founded, and, as far as I know, the C.C.F. party never had occasion at any time in our history, to keep, in the Canadian parliament, even one of the many promises they have made to the people of Canada.
Mr. Speaker, one thing is sure and it is this: before acting on promises and putting suggestions into effect, the former administration always gave practical thought to what the Canadian taxpayer would have to pay in taxes of all kinds if those promises were kept. In fact, it was as a result of those careful studies that the Liberal party succeeded in establishing a true social security charter for Canadians throughout this country.
I need not mention who it was that spent almost eleven years of his life, at the head of the Department of National Health and Welfare, in studying those suggestions, in drafting the legislation and in having it adopted by the house. The hon. member for Essex East has shown a measure of devotion, understanding and intelligence unexcelled by any other member of the house.
Therefore on behalf not only of the members of my group, but of the citizens of my riding and of my part of the country, I want to tell him once again all our appreciation for his very remarkable contribution in the field of social security.

I also listened with much attention to the hon. member for Portage-Neepawa (Mr. Fairfield) who with restraint and intelligence, made some very sensible remarks.
However, he expressed fear that a comprehensive hospital insurance scheme might lead to state medecine; I do not share his point of view.
It was certainly neither in the legislator's nor in the government's mind when the act was passed, to establish state medecine in this country. It was only a matter of giving Canadians another social security legislation which would in no way hamper individual freedom.
As far as I am concerned, I admit that if ever health insurance or hospital insurance were to lead to state medicine, I would not hesitate to register disagreement.
The hon. member for Portage-Neepawa gave a long list of professional associations, medical associations and social welfare societies which have done, and are still doing, an extraordinary amount of work for the welfare of Canadians. Indeed, I believe that he rendered at the same time, though in rather veiled terms, a fine tribute to the former administration, because most of those organizations were furthered-in some cases even financially I think-by the Liberal government.
The hospital insurance scheme that is in force in most provinces of this country is, as everybody knows, a creation of the former administration. I therefore deplore the fact that legislation which is so beneficial for all those who lack the necessary means to be treated in our hospitals, is not yet available to people in the province of Quebec.
Oh, I know that, when the legislation was introduced in this parliament, some politicians in my province decried it as socialism. All sorts of reasons were advanced for not joining the hospital insurance scheme.
Unfortunate events have happened since the fall of 1959, as we had, among other things, the misfortune of losing one of our premiers, Mr. Duplessis, and then another, the Hon. Paul Sauve, who, to my mind, was a great Canadian. Now Mr. Sauve's attitude was completely different from that of his predecessor. By this time, there were no more cries of socialism, and it was recognized that the matter of hospital insurance for the province of Quebec would have to be considered.
This legislation has been in effect since 1957, Mr. Speaker. The hospital insurance act was passed by parliament almost three years ago,
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and I am very sorry that it was not until recently that thought was given to the setting up of a commission to study the hospital problem in Quebec at the same time as the possibility of having Quebec citizens benefit from the great federal hospital insurance scheme.
I hope this is not done for some unacknowledged reason, that is, the preparation of an event which is to take place in June or July, but that there is a genuine wish to have the citizens of our province benefit from a measure which is needed by most people in Quebec.
I deplore this delay for yet another reason, Mr. Speaker. It is well that the richer provinces in this country should help the poorer ones. I believe that Quebec has given its contribution in this field, and I am glad of it. But it would also be advisable that the hard-earned money of the citizens of the province should come back to them in some shape or other, because the vast majority of Quebec Canadians need this support. It is enough that none of the millions earmarked for universities are going into our province. I would like to see taxes paid by the people of Quebec return to us, as soon as possible, in the shape of hospital assistance for our province.
I bear the other provinces no grudge, who are benefiting from the help of Quebec or Ontario. I think that this is our way of contributing to national unity. Nevertheless, I think there are limits to a province letting its tax revenue go elsewhere, i.e. the money represented by the hard-earned daily wages of our workmen.
I therefore trust that it will not be long now, before the commission set up by the Quebec government-or which is about to be set up-considers the hospitalization problem in Quebec and concludes its study with a recommendation, which the next Liberal administration of the province will apply with the least possible delay.


Mr. English:: We shall see after the elections.


Mr. Habel:: We shall see.


Roland Léo English: We shall see.


Augustin Brassard: Mr. Speaker, the question of extending the benefits of the legislation on hospital insurance to sanitaria and mental institutions, is not a new one. Hon. members of the Conservative party frequently discussed it when they were sitting on this side of the house and one of them, the much regretted Dr. Blair, former hon. member

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for Lanark, always took a very intelligent view in this house in respect of the administration of such hospital insurance scheme, and that is why I am happy to pay him this tribute today.
So let me recall to my ex-colleagues who now occupy choice seats in this house, some of Dr. Blair's remarks. I should also like to recall some remarks from the present Minister of Finance (Mr. Fleming) as well as certain comments made by no other than the Prime Minister (Mr. Diefenbaker) when we discussed the hospital insurance plan, which at the time was being proposed by the hon. member for Essex East (Mr. Martin).
On March 25, 1957, Dr. Blair took part in the debate at the resolution stage, I think, and I should like to quote the following paragraph which is found on page 2647 of volume III of Hansard for 1957:
The problem of mentally ill patients-
Dr. Blair said,
-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 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.
Later on, when the bill itself came up, Dr. Blair made this further statement, as recorded on page 3100 of the same volume, that is to say for April 4 of the same year:
I point out to you, sir, that we have a problem in mental disease in Canada that we will have to cope with some place somehow. I do not like the fact that mental disease is not recognized because I feel it is a backward step. It is a backward step for this reason. Mental disease may occur just as you may have pneumonia or any other disease in the categories of diseases that are treated in hospitals at the present time.
I am sorry that, some place in this bill, the minister cannot go a step farther and give further financial help to the mental hospitals. It would be of great assistance.
Perhaps some of my friends opposite will say: "Why did you not include them in the bill?" Once again, it is not a question of harking back to what we have done in the past. The fact that we did pass this bill on hospital insurance is in itself a great asset to the Liberal party. If we made a mistake- assuming that it was a mistake-in failing to include sanitaria and mental health institutions, it should be remembered that the Conservative members, headed by the present

Prime Minister, promised to correct the situation. I think that is the point on which we ought to concentrate now.
The present Minister of Finance had even gone much further in the debate. He had gone so far as to move an amendment which I wish to draw to the attention of the house. It is found on page 3380 of Hansard for 1957, volume III, and I quote:
The limitation of which I wish to speak briefly now-
I am quoting the present Minister of Finance, who was then sitting in the opposition.

is in my submission a most unfortunate limitation. I refer in particular to the express exclusion from this bill and from the scheme for which it provides of patients-whether in-patients or out-patients-in tuberculosis hospitals or sanitaria and in hospitals or institutions for the mentally ill.
From the time this government proposal was first introduced these patients enjoying either inpatient or out-patient services of such institutions have been excluded from any benefit under the scheme. We as a party and as Her Majesty's loyal opposition-
This is still the present Minister of Finance speaking:
-have already expressed in the strongest terms our view that there is no justification whatever for the exclusion of these hospitals and institutions from among those that lie within the scope of the scheme of hospital insurance.
A little farther down, on the same page, the present Minister of Finance said:
Does the house adequately realize that if these exclusions are permitted it means that the house is drawing a clear line of distinction between certain types of illness. It means that if patients are suffering from what are called physical ailments and go to hospitals they will fall within the scope of the scheme of this bill. However, if they are suffering from tuberculosis and go to hospitals provided for patients so suffering they will not fall within the scope of the bill. Similarly, in the case of patients suffering from mental illness, if they go to hospitals or institutions designed for the purpose of providing care for such patients then they lie outside the scope of the bill. No scheme which tries to draw a line of distinction between institutions of the kinds of which we are speaking, where the attempted distinction is based upon the type of illness, could possibly be sound.
And he added, page 3381:
The minister knows very well and the whole government knows that if it were not for the exclusion of institutions providing hospital care for tubercular patients and mentally ill patients more provinces would have found the proposal much more attractive than the present and undoubtedly the majority of the provincial governments would have indicated their adherence to the plan if it had been on a wider basis.
Here, Mr. Speaker, I pause for a digression. I believe the argument made at that time by the hon. member for Eglinton, who is now Minister of Finance, is altogether fallacious, because a majority of the provinces have joined the hospital insurance program without the inclusion of institutions for the mentally ill and of sanitaria.


Paul Joseph James Martin: All provinces have joined it.


Augustin Brassard: All except Quebec, because our province is not a province like the other provinces. I resume my quotation of the remarks made by my hon. friend:
We say, therefore, that this measure is not a comprehensive measure. It cannot pretend to be comprehensive as long as they are excluded from the definition of hospitals under this measure those hospitals and institutions that provide care for tubercular patients and mentally ill.
Here is now the important part of the proposal of the present Minister of Finance:
When the measure was before the committee of the whole, I introduced an amendment to clause 2 subclause (e) to make a simple change in the wording of line 8 on page 2. It would have changed the words which now read "but does not include" to "and does include". The purpose of the amendment was to make it very clear, by way of a direct reversal of the provisions of the bill, that the definition of the word "hospital" should include:	(1) tuberculosis hospitals and
sanitaria; (2) hospital and institutions for mentally ill-
The present Minister of Finance went much further:
- (3) nursing homes and homes for the aged where persons are receiving custodial care.
When we consider what the present Minister of Finance advocated in the field of hospital insurance at the time he was sitting on this side of the house, we wonder if he was really sincere. Let me say that I would be the last to question his sincerity, but people may wonder about his sincerity when he advocated such measures or proposed that such measures be included in the bill then submitted to the house.
Now, to conclude my quotations of utterances by great personalities of the Conservative party, may I repeat what the Prime Minister said, at the time he was sitting on this side of the house, when the bill was introduced in 1957. I find on page 3386 of Hansard, volume III, for April 10, 1957, a few comments of the present Prime Minister about the amendment moved by the hon. member for Eglinton. Here is what he said:
The amendment moved by the hon. member would refer the bill to the committee of the whole for the purpose of considering this clause and thereby giving an opportunity, even at this late hour, of including within the ambit of the legislation sanitaria, tuberculosis hospitals and institutions and hospitals for the mentally ill. I cannot understand the omission. While tuberculosis is in recession, mental diseases are on the increase.
On the second column of the same page, I find the following:
There is also the further disqualification of sanitaria and mental hospitals. Why is this? Why are these hospitals and institutions discriminated against? I say that the legislation in its present form is discriminatory in that it denies these institutions a right that should be theirs.
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T!ie legislation as it is in its present form, beneficial as it will be, acceptable as it is to members in all parts of the house, is a step in the right direction.
And for once I am glad that the present Prime Minister, when in the opposition, admitted at least one thing that the former administration did, i.e. that it was a step in the right direction. I can assure you, Mr. Speaker, that I have not very often heard such flattering admissions directed to the Liberal government.
Eut the goal that all of us have in mind will not be achieved until the two kinds of institutions to which I have made reference are included within the provision of this legislation.
The words I have just quoted are from persons, at least two of whom are now ministers in the present government. Those statements were made in 1957, when the measure was introduced.
But the present Prime Minister did not speak of hospital insurance in this house alone. During the 1957 election campaign he travelled across the country and made fantastic promises in connection with all fields of federal administration. Of course he talked about the hospital insurance plan, and I should like to remind the house of what the Prime Minister himself said on May 14, 1957 in Winnipeg. I quote these words from the Winnipeg Tribune of May 14, of the same year:
(Text):
The Conservatives, he said, would repair a "serious omission" in the federal health plan which does not include tubercular and mental institutions.
(Translation):
On May 27 of the same year, in Saskatoon, as recorded in the Toronto Globe and Mail of the following day, the Prime Minister said: (Text):
Mr. Diefenbaker said the Conservative party still believes that hospital insurance should cover patients in mental and tuberculosis institutions.
(Translation):


Paul Joseph James Martin: What date is that?


Augustin Brassard: May 28, 1957.
The following year, in 1958, the Liberal party, at a convention where its present leader was elected, gave the people of Canada an outline of Liberal policy in the field of social security. As regards hospital insurance, it stated, as recorded on page 26 of the document:
For these reasons, the measures which the Liberal party recommends for consideration are the following:
1. Another step toward the implementation of the health insurance plan-

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Because we had actually made a first step, the major one at that, to implement hospital insurance in Canada.
-provision for medical, dental and surgical expenses which, together with hospital insurance, would mean that no Canadian could be handicapped, through illness, on account of financial difficulties.
In the same year, on March 16, 1958, in Moncton, the present Leader of the Opposition, a few days before the election, stated:
Besides, Mr. Pearson, winding up in Moncton, New Brunswick, a tour of the Maritimes, promised that a Liberal administration would make of the national hospital insurance program a genuine and complete health insurance plan covering medical, surgical and dental expenses.
I believe that the Liberal party, when it was in power, clearly showed that it understood what social security means for the welfare of Canadians. And what I admire in all those who have put into practice the legislation which is now in our statute books, is the fact that they have done all that work in the social field without at any time interfering with individual liberties.
I do not believe that in amending the hospital insurance act to include sanitaria and mental institutions, contrary to what was said or suggested by the hon. member for Portage-Neepawa (Mr. Fairfield), would mean a further step toward socialism. On the other hand, I believe that the moment has now come where the Conservative party must put into practice what it has been preaching to Canadians, and which has contributed to its election in Canada. Its representatives now have the responsibility of leading the people of Canada toward general welfare and I believe they must remember the solemn promises they made.
Mr. Speaker, if, before resuming my seat, I may make a recommendation I would urge the federal government, through its Minister of National Health and Welfare, to try to get in touch again as the former minister of national health and welfare, the hon. member for Essex East, used to do-with the government of the province of Quebec, so that in our province we might, at last, benefit from such a measure.
We only have to look in our constituencies to realize what a luxury it is today to be ill. Workers who are unfortunate enough to have some member of their family in hospital find that their salaries are mortgaged for weeks, months and even years. Their family budget is upset, and yet the citizens of the province of Quebec contribute a large share of the federal revenue which, in turn and to a

large extent, serves to finance the hospital insurance plan in the other provinces of the country.
Also, I am wondering why part of the money that the citizens of the province of Quebec earn through their daily work should not return to our province, to help poor families who really cannot afford the luxury of being ill.
Mr. Speaker, before resuming my seat, I wish to say that I will not hesitate for a moment to support the resolution introduced by the hon. member for Timiskaming, if it is put to a vote today.
(Text):


Mr. Percy Vivian (Durham):: Mr. Speaker, I listened with a great deal of interest to the hon. member for Timiskaming (Mr. Peters) speaking to this motion and I am sorry he is not now in the house because I should like to make some observations on what he said and also on what he did not say.
I should first like to draw the attention of the house to motion No. 10 which, in essence, is a motion proposing that the dominion government should provide a study and funds to support a comprehensive national health insurance system in Canada with particular reference to two points; (a) the inclusion of benefits on behalf of patients in tuberculosis sanitaria and patients confined to mental institutions under the Hospital Insurance and Diagnostic Services Act; and (b) the introduction of legislation to provide medical, dental and optical insurance.
While I listened very carefully to the hon. member for Timiskaming I am not aware that he said anything about point (a) and it is now left open-
Mr. Speaker, may I interrupt myself to say to the hon. member for Essex East that if he would listen he might learn something. The hon. gentleman who was former minister of national health and welfare will have ample opportunity later to lecture his backbenchers but this is not the time.
If I may now continue without competition from the hon. member for Essex East I should like to comment on the remarks of the hon. member for Lapointe (Mr. Brassard) who dealt at some length with the matter of the inclusion of benefits for patients in tuberculosis sanitaria and patients in mental institutions. I believe there is a very sound and justifiable reason as to why this has not been done up to now and while it may be considered advantageous to include them in the future I should like at this time to bring to

the attention of the house an argument which I have not as yet heard dealt with here.
There is a great fear on the part of the provinces generally, and particularly certain people in provinces, that action taken by this house should not tend to overcentralize things that come within the ambit of property and civil rights, since they guard those rights assiduously and over which they have a particular measure of control. Therefore, I should like to point out what I am sure most hon. members know, namely that tuberculosis is a communicable disease and as such comes within the purview of the administration of provincial governments, as far as the provinces are concerned, and inmates of mental institutions are there by commitment of the provincial courts. This does not mean that those patients are bereft of benefits in respect of hospitalization, not at all. These types of patients who are treated in an active treatment hospital, either as a participating psychiatric case under the open-door policy, a day clinic, or a tuberculosis patient, are hospitalized and surgery is undertaken when it is needed in a public general hospital, or other treatment which comes under the normal provision of this act and therefore they have the full benefits of this act with its contribution by the dominion treasury.
But where it is not specified in particular is the instance of sanitaria or mental institutions. These are institutions which are the direct responsibility of the provincial governments with, I think, good and sufficient reason, because this has to do with the matter of property and civil rights. I do not want to stand on that alone, but all of these plans really have three particular aspects: one is service, one is administration and the other is the matter of finance. Both service and administration are kept as close to the matter of finance as possible. I think this is a principle of all good government and therefore when this responsibility is aligned clearly with provincial administration it seems to me that until such time as it can be shown that it can be better dealt with under another level of government it should remain where it is. This is not to say that financial consideration should not be given to those problems of the provinces by the dominion treasury in support of patients of this sort. It should.
I do maintain that with the rate of tuberculosis mortality going down and taking into consideration the care which is now being given to the mentally ill that the long stay or custodial care which tuberculosis sanitaria gave to patients in the past and care which was given in mental institutions is not as likely to be as prevalent in the future as it has been in the past. I simply point this out.
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At the moment I personally see no reason why this should not be as it is and in an evolutionary way the provinces could prepare to give up this responsibility if they wish to do so and the other additional financial provision which I understand is now made under the dominion-provincial agreements could meet this present situation. I do not want any member of this house or any member of the public to fear that because this type of patient is not included in the Hospital Insurance and Diagnostic Services Act they are not receiving financial assistance from the provinces in which they reside or are institutionalized.
Let me pass on to the (b) part of this resolution to provide medical, dental and optical insurance. With regard to optical insurance I must say that in this instance blinkers have been held over the house in taking a good look at this proposal, and this is not a proposal that we can afford to look at with blinkers because it is essentially a proposal for the dominion treasury to finance in large part the cost of a program within the provinces over which they may have little or no control, without being able to evaluate the good results which may accrue or to correct the bad results which might come from its overuse. I come back to my same premise, that any of these health measures must be looked at in the field of service, in the field of administration, and in the field of finance.
I am sorry that the hon. member for Timiskaming confused the issue in some of his assertions because he did not seem to be quite clear in his own mind exactly what public health was or the limit of the extent of hospitalization or really the content of medical care, because these three are the elements which make up any health plan on a generalized basis. I would like to avoid the word "insurance" in this connection because these things are not actuarially sound nor can they be made actuarially sound. The program of the United Kingdom is known as the national health service or the national health plan. In my opinion to mislabel it as insurance is to mislead those people who have to pay for it.
The other thing in which the hon. member for Timiskaming is confused about is the word "free". None of this service is free. The services may be provided, such as they are, at low initial cost to the consumer, if you like, but the lower the cost to the consumer it appears the higher the cost to the consolidated revenue fund. There is no control; there is no measure of evaluation, and this is why the United Kingdom from the beginning had trouble with the pharmaceutical preparations of one kind and another, such as cough mixtures and aspirin tablets.

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can the provinces undertake these responsibilities which are their own. In any of these schemes we must remember that you cannot require another level of government to undertake something and then say, "All right; we will pay part and you pay the rest". This is exactly what broke down the 1944-45 proposals on health insurance because the plan as then submitted by the then government was impossible of implementation in the province at the level of financing they would supply. It was not so much a lack of desire to do it as it was an impossible situation to meet in terms of cost, in terms of available personnel and in terms of administration. Nobody knew the cost and nobody was prepared to underwrite it until more information and more experience were obtained.
So I come back to the public health program with which my hon. friend had a great deal to do because it meant that one could deal in a province with the creation of what is known as a health unit. A health unit is nothing more nor less than a larger municipal unit of public health administration. In other words, in a city you have enough population to employ qualified, fulltime staff. In small urban and rural municipalities, while you need a full-time program of good content you cannot afford to employ the necessary staff full-time to do that at a strictly municipal level. Therefore by merging several municipalities, as in a county or as in several portions of a county or 'as in certain townships, a larger unit of public health administration can be created and the program for this then instituted on a full-time basis and paid for in part by the taxes of this unit on the basis of equalized assessment.
But because communicable disease is no respecter of municipal boundaries, it therefore becomes important to a province as a whole to aid by subsidy in the setting up of satisfactory programs. Therefore practically everywhere in Canada of which I know these health units or larger units of public health administration are subsidized in part by the provincial government which hopes in one way or another to obtain financial relief from the dominion treasury. This provides a full-time medical officer of health, full-time nursing personnel, full-time sanitary inspectors with transportation, offices and what-not, to be able to bring to even outlying rural municipalities those services in preventive medicine which are the reasons that our birth rate has been maintained with the drop in infant mortality, why there is this longer expectation of life at birth now than we have ever known

before and why in general the control of communicable disease has now been achieved wherever we can get people to pay attention.
These are the only two mandatory things in a public health program, namely control of communicable disease and the control of nuisances which boils down to a matter of sanitation, both environmental and communal. These are the only two mandatory things in a public health program. But when it comes to immunization, unless you have an understanding on the part of the public and their willingness to subscribe to an immunization program, you do not get anywhere. Prior to the development of Salk vaccine and its use here and elsewhere, the great cry of course was this: why does not the medical profession develop a vaccine which will rid us of this great scourge? You had all this going on and we all hoped it would come and eventually it did come. On the introduction of Salk vaccine great care had to be taken to prevent from getting it people who were anxious to obtain this vaccine, who were prepared to pay large sums of money to get it ahead of others; in other words, there was a danger of bootlegging Salk vaccine.
These measures of control-and my friend the hon. member for Essex East had a hand in it and it was very well done-meant that Salk vaccine could be reserved for that level of age group in the population which was most susceptible to poliomyelitis and which should have had it first. Now a few years after the introduction of Salk vaccine, we are obliged to go on television and radio in order to get parents to bring their children in to complete the course in this immunizing program. Hence I say that the matter of the education of the public, the understanding of the public, is one of the most essential things in any health scheme. We do it in terms of public health. We do it in terms of medical care. I think this is one of the problems in a medical care program.
For instance, we have seen the rise of programs in the name of preventive medicine that are programs of health supervision for groups of people. These are called group hygiene programs, if you will. There is the matter of the expectant mother and her child, the so-called maternal and infant programs; the school child which goes from school age to the adolescent period in the high school; and what was formerly the industrial but now is the occupational program. The possibilities for these health supervision programs lie in the fact that you are dealing with groups of people of relatively similar age who have a task in common. In other words, the pregnant woman has a task in producing live young.

The school child is there because it is receiving an education; and the worker in industry or other occupation has a task to perform and many of their problems are common to the group as a whole.
My friend the hon. member for Timiskam-ing talked in terms of weak eyes, bad teeth and other things which he hoped would be corrected late in life through a medical care plan. That is not the time to correct them. They should not exist. The time to correct them is through the instruction which is given to the expectant mother, by the understanding of her own care, the care of her newborn child and the care in the raising of this child into the school age group. I must say the women of Canada are doing extraordinarily well in raising their children because when they come into the first grade now all over the country they are healthy, bright, able specimens. Then the school program picks up with the supervision of the school medical officer, the civic nurse and where this much does not exist, it is the fault of the province or the municipality in which that school resides. It is no fault of anybody else but the local community because there is money available for it.
There has been publicity as to its value and if people will not take advantage of these things which are there in the name of the province I do not know how you are going to institute a program of cure by care or care for cure that will achieve the same result at so little cost. Therefore continued publicity, continued education in the value of these measures at these group levels is a most important field and the Department of National Health and Welfare is doing this with considerable success.
In the occupational field-and I come back to the hon. member for Timiskaming; I think anybody who has worked in a plant has had experience with it-formerly there was some sort of provision for medical care. The aspirin, cough syrup and sulphur and molasses type of treatment it hinged upon has now been displaced-and I think fairly thoroughly displaced-by thoroughly appreciated programs of initial periodic medical examination, the availability of advice from physicians and nurses within the plant, the opportunity to assist people to help themselves.
This is one of the most important single contributions that anyone can make to the health of a population, namely to help people to help themselves. No doctor or anyone else can do it for them. It is something that rests essentially with the individual and only that individual can do it as far as that individual can go himself, at which time he must have
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additional support, advice and skilled care. But the educational program through use in our occupational and medical program is having great value; with its medical examination at periodic intervals, taking into account the age and sex of the individual; having an appreciation of the individual as an individual, not as a number on a chart, not as something which is legislated into the necessity of having a medical examination but rather as something which is available to them and which in time they appreciate. Many of these things in their origin were difficult to establish because people had this natural fear that any medical plan in a plant, office or store was designed to seek ways and means of eliminating them from their jobs on excuses of ill health when, in fact, it was for some other reason.
This has been overcome, and I would say from my own personal experience and experience with associates that this matter of the periodic medical examination of the adult group is doing more to reduce the severity of those disabling conditions which are noninfectious, the cardio vascular diseases and malignancies. It is doing more to reduce their severity by the earlier discovery of their existence before the individual has noticed sufficiently to visit the doctor to find out what is his trouble.
In the case of cancer particularly we have gone a great distance to break down the fear, particularly in women, of a visit to the doctor in case cancer would be discovered. In other words, as part of the periodic medical examination, perhaps once a year or once in eighteen months, they would go through this routine. They have learned to do this. They are not afraid to have this examination, and if by chance-and it is not often-some early untoward sign or symptom is discovered, then these people have the opportunity of seeking further and skilled medical advice to pursue this early sign or symptom in the hope, of course, that the diagnosis will not be malignant cancer.
As a comfort to those who have to be told that there is a problem, of those which are sent for further investigation of malignancy arising out of the early sign or symptom, a very high percentage do not have cancer. Of the very small percentage of those-it is less than one half of one per cent-which have symptoms which are or could be cancer, which of course relates to the particular group, the 45-68 group, only a small percentage are found to have a definite malignancy which needs immediate surgical care. Our surgical care is such at the moment

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that we are finding that the period of expectancy of active, healthy life after operation has been extended from five to ten, and now to fifteen years longer. So many of these people in the older age group end out their days and die from something else, not from the cancer of which they were afraid.
Mr. Speaker, other speakers have emphasized the role voluntary services have played and all the things which have happened to raise the standard of medical care in Canada. I would like to say that I agree with anyone who says that the standard of medical care here is the best in the world.
I believe it. I have seen most of the other countries which have standard medical care, but I believe that our present interns and the people who come from our medical schools have skill, ethics and ability which are second to none. I think that is borne out by the number of people we receive from abroad who come to lecture on visiting professorships and spend some time here. I know this because I am one of the examiners periodically for the medical council of Canada and I have people who sit with me occasionally who are astonished at the skill and knowledge of our graduates.
I hope that this trend which is certainly interfering with recruitment of people from medical schools for one reason or another is reversed, because Canada needs more doctors not fewer. Until we have more doctors this question of equitable distribution is a difficult one. Medicine is so specialized today that the services of highly technical laboratories, expensive apparatus, and so on, has to be concentrated largely in urban centres. It must of necessity. Therefore you have a higher percentage of specialists in urban, particularly university centres than otherwise.
This is particularly so with the system of medicine as now practised in our children's hospitals. I could give you as one example the hospital for sick children in Toronto, which is not just a Toronto hospital but a province of Ontario hospital with an outstanding and nationwide record, with the rest of the province of Ontario channelling their children into it. This is what is happening all over the country. You cannot create artificial drainage areas of trade. You cannot create artificial areas for supply in medicine or in anything else. Therefore this has to be something which is natural, which has grown and is liked and respected and can be supported. That would be my fear, the participation of-let us call it quite plainly-a state medical care plan upon a relatively unsuspecting public at heaven knows what cost, when if we look at what we have, which is good, and tidy up those things which are the

main things of which people complain, we have sufficient care provided at this time.
What are these main things of which people complain? They complain, first of all, that it is difficult to get a doctor. That may be so. On the other hand, this is not always the fault of the doctor in the community. It may also to some extent be the fault of the patient, who could call at seven in the evening instead of midnight, who could have come into his office the day before. A doctor on an average looks after some two thousand patients and just cannot work round the clock. With consideration from the public the problems of the medical profession would be helped.
This is also true in pioneering areas, for example, where you may have no physician at all. I think I can tell hon. members of this because it was an extraordinary situation. One section of the United States with the lowest morbidity and mortality rate and with a comparable population with other states was an area where they had not had a doctor for ten years. Of course, I do not want that to be a reflection generally on the medical profession, but that is true, and therefore without a doctor perhaps one might take more care and consider those things which should be avoided because one would know that there was difficulty in obtaining help.
Again, I do not want to be facetious about this but let me go back to Saskatchewan once more. The hon. member admitted there was a lot of good in Saskatchewan. I suggest that the system of aeroplane service and the flying ambulance service which was instituted there and elsewhere could be organized by provincial administrations. I am sorry to see the hon. member is not in the house because he might have learned something about this.


An hon. Member:: He is not interested.


Reginald Percy Vivian: So I come back to the availability of the doctor and the question of cost. In a survey of the province of Ontario in 1942 the average cost per day of a bed in a ward in a public general hospital was, I think, $3.88 per day. This did not include the depreciation of the building; that was the cost averaged over the province as a whole. The cost of semi-private accommodation was not much more than a dollar more, and the cost of private accommodation in that same hospital was under $5.


Mr. Deputy Speaker:: Order. I regret to interrupt the hon. member but his time has expired.


Some hon. Members:: Continue.


Paul Joseph James Martin: Mr. Speaker, I think we would all be happy to have the member continue.


Mr. Deputy Speaker:: Is the house willing to give unanimous consent?


Some hon. Members:: Agreed.


Reginald Percy Vivian: Thank you, Mr. Speaker, and I thank the house; I have very little more to say. However, I would like to say that this was the average cost in Ontario at that particular time.
Costs since that time have sky-rocketed. They have sky-rocketed because the price of labour, the price of food, the price of everything which goes into a hospital has gone up to the point that the average charge per day is now somewhere around $15, $16, or even more. This is not something with which we can quarrel. This is something which we have to meet. It is important on the part of hospital administration that they do not think they have a blank cheque to cash every time they want more money for services which they render. They have a responsibility to continue to provide good service at the lowest possible cost to the public treasury.
It seems to me that some consideration will have to be given to the number of patients in hospitals who are there for more than 30 days, because it has been shown that the transference of such patients from the active general hospital to convalescent institutions of a rehabilitation type which might be situated in a wing of the hospital or in the same grounds would reduce the average days stay per patient so subtantially that it would be possible in a year or two to build a new hospital unit with the money saved. This is an established fact.
We have all been impressed, and, I think, hurt, by the stories-and we all know of them-of people whose life savings have vanished and to whom great hardship has been caused by reason of these difficult and long illnesses. These cases are not numerous in terms of the total load of illness, but they seem to occur at the least convenient times and usually to the people who least expect it and can least afford it. It may therefore be desirable to provide for a further extension of insurance of a disaster type, partly or even wholly under government auspices, so as to prevent a family's savings being wiped out by the tremendous cost of these long enduring illnesses.
In addition, there is the continuing and pressing problem of outpatient hospital services. The wise use of hospital outpatient facilities is, in itself, a most important part of the field of preventive medicine. For years these departments were run as clinics, and the loss sustained by most hospitals with respect to their outpatient departments represented the total loss for the year. This is 79951-0-98
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particularly true with regard to the city of Montreal. The loss in this department in the Montreal general hospital which has had a fine record in the community for over 100 years, has been fantastic as a result of maintaining these services to the community.
Thus, apart from the interest I have in the province of Ontario, I express the hope that at some good time those responsible for the administration of Quebec will see fit to implement a hospital insurance plan in keeping with the Hospital Insurance and Diagnostic Services Act, and that the hospitals themselves, in co-operation with the medical profession, will enable us to find a way to improve and assist the work of hospital outpatient departments which, I believe, is one of the best single means of keeping people reasonably well and discovering and treating difficulties before more serious illness results, thus extending the happiness and longevity of our people.


Mr. H. J. Robichaud (Gloucester):: In making the few brief remarks which I had intended to make on this resolution, I must first of all apologize for not being in a position to compete with the knowledge and experience in this particular field of the two hon. members on the government side who have so far taken part in this debate. Both are medical practitioners and have had ample opportunity to familiarize themselves with this subject, particularly the aspect now under discussion.
I must say that it is the duty of parliament not only to introduce new legislation but also to amend and approve existing legislation. We must admit that no legislation is perfect, and it should be improved if possible after it has been observed in operation for a period of time. This applies to the hospital insurance plan which was introduced by the hon. member for Essex East (Mr. Martin) in April, 1957. The hospital insurance act, or the health insurance act, is only one of the many social security measures which were introduced by the Liberal administration and which are enjoyed today by the entire population of Canada.
The present resolution introduced by the hon. member for Timiskaming (Mr. Peters) calls for the introduction of a comprehensive system of national health insurance, and, more particularly, to give consideration to the following:
(a) Amending the Hospital Insurance and Diagnostic Services Act to provide benefits on behalf of patients in tuberculosis sanitaria and patients confined to mental institutions; (b) introducing legislation to provide medical, dental and optical insurance.
The hon. member who has just resumed his seat attempted to show good and justifiable reason why this has not been done, why

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tuberculosis and mental disorders have not been included in the provisions of the Hospital Insurance and Diagnostic Services Act. I would have liked to have heard the hon. member say why, if such reasons exist today, they did not exist in 1957. I should also have liked to have asked him to explain, if he could, the position taken then by hon. members of the opposition of that day and particularly by the hon. member for Eglin-ton (Mr. Fleming) and the right hon. member for Prince Albert (Mr. Diefenbaker) as well as by the late hon. member for Lanark, Mr. Blair. It is the responsibility of members of the present government to implement by positive and concrete action the promises which they made to the electors of this country, and to put into effect now the things they were advocating when they sat on the opposition side of this house.
Many of those who are now members of the present government took part in the debate which took place in April, 1957 when the health insurance bill was introduced. Those of us who were here at that time will recall the remarks made on that occasion by such hon. members as the hon. member for Prince Albert, the hon. member for Eglinton and the hon. member for Kamloops (Mr. Fulton). All these gentlemen are today members of the government, and it is interesting to hear what they have to say with regard to the measures which they were advocating less than three years ago. They have had ample opportunity to implement those very same measures. What have they done about it? Was it not the hon. member for Eglinton, now the Minister of Finance, who moved on April 10, 1957:
-that Bill 320 be not now read the third time but that the said bill be referred back to the committee of the whole for the purpose of reconsidering clause 2 subsection (e) thereof.
In explaining the purpose of his motion the hon. member called to the attention of the house the financial difficulties experienced by the provinces and municipalities of this country and insisted on the elimination, to use his own words, of the unworthy distinction in the definition of hospitals to be covered by the act. If the clause then referred to was unworthy of the Canadian parliament, to use the minister's own words as recorded at page 3382 of Hansard for April 10, 1957, the hon. minister should listen to his own conscience and practise now what he was preaching when he addressed the house on that date. The financial difficulties of the provinces and municipalities are just as severe today and if not worse than they were in 1957. What about a municipality which must borrow at 7 or 7J per cent as compared with interest rates in the vicinity of 5 per cent as they were in 1957?
[Mr. Eoblchaud.l
What about the hon. member for Prince Albert? What did he have to say on the occasion to which I referred? As Prime Minister of this country can he now question the omission which he could not see in 1957 when sitting on the opposition side of this house? Has he now found a serious reason as to why tuberculosis and mental hospitals should not be included in the hospital insurance scheme? Why is he now taking an attitude so different from the one he took in 1957 when he made the statement which was placed on the record earlier in this debate by the hon. member for Lapointe (Mr. Brassard)? I shall again place that statement on the record. The Prime Minister said, as reported at page 3386 of Hansard of April 10, 1957:
I say that the legislation in its present form is discriminatory in that it denies these institutions a right that should be theirs.
The hon. gentleman was referring at that time to tuberculosis and mental institutions.
The hon. member for Timiskaming in the second part of his resolution calls for the consideration of the introduction of legislation to provide medical, dental and optical insurance. The Liberal party's policy favours the implementation of health insurance provisions against major medical and surgical expenses which, combined with hospital insurance, would ensure that no Canadian would be financially crippled by illness. Such a policy, I am convinced, could be implemented in co-operation with the provinces and each individual concerned. I am therefore of the opinion that this part of the resolution dealing with medical, dental and optical care should also receive very careful consideration.
At this point I must admit, however, that we should perhaps make certain reservations. I feel that such provisions should be carefully looked into before being put into effect so as to avoid as much as possible the introduction of abuses and also to ascertain the availability of practitioners in adequate numbers to take care of cases without possible discrimination.
The experience gained from the application of the present hospital insurance plan could be of great value in the introduction of a health insurance program. Most of us are fully aware of the problems created by the shortage of hospital beds in those provinces where the hospital insurance scheme has been introduced. The problem is aggravated by the almost impossible position of municipalities, religious congregations or other groups in terms of financing new hospitals or even additions to existing facilities.
We must admit there is a shortage of hospital beds and the situation is becoming

more serious every day as the hospital insurance scheme is being taken advantage of by a larger number of patients. How can we expect, for example, a religious order to undertake the construction of a new hospital or even an addition to an existing one if the interest and depreciation charges cannot be included in the per diem rate charged hospital patients? Can municipalities be expected to contribute further to hospitals when their sources of taxation have been exhausted and the present rates of interest have reached an all time high?
Let us take for an example the conditions in my own province of New Brunswick or even my own constituency of Gloucester. In Gloucester county today there is a shortage of from 200 to 250 hospital beds. How can we expect religious orders to proceed with new construction unless they have an assurance with respect to depreciation and interest rates. Our municipal taxes are about the highest in Canada and any further increase would force existing industries to close their doors. Something must be done in order to provide additional hospital beds. This can be made possible only by including interest rates and depreciation in the existing hospital insurance scheme. I would urge the government to reconsider this most important aspect of the hospital insurance plan. I would suggest that this is just as important and urgent as the suggestion included in the resolution presently under discussion.
The present Minister of Justice must recall his intervention with respect to this matter in the debate on April 4, 1957. If he was convinced then that depreciation costs and interest should be included in the scheme he must be in a better position today to convince the government of which he is a member of the need for implementing at this time the suggestions he was advocating when the legislation was introduced in this house. This was a promise and a commitment made inside and outside the house by hon. members of the government and we are anxious to see what will be the attitude of the government on this particular aspect of the hospital insurance program.


Mr. H. M. Horner (Jasper-Edson):: Mr. Speaker, I too, should like to make a few brief remarks with regard to the resolution we have been discussing today. We have heard various hon. members in the house give us their views with regard to the question embodied in the resolution. The resolution, of course, has two distinct parts, the first relating to the inclusion of tuberculosis sanitaria and mental institutions under 79951-0-981
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the Hospital Insurance and Diagnostic Services Act and the second relating to the introduction of legislation to provide medical, dental and optical insurance.
It is my opinion that the time has not yet come when these matters should be implemented. Certainly the problems of tuberculosis and mental health are of extreme importance in Canada. As we all know, tuberculosis is gradually declining and some of the facilities built in Canada in past years for this purpose are now empty. Mental health is one of the most important special medical problems in Canada and in this field we are also witnessing a change in concept of treatment. We are turning from the concept of treatment in large institutions to the type of treatment associated with the so-called open-door policy, community planning and the prevention of mental illness. This subject was capably outlined by my colleague the hon. member for Durham (Mr. Vivian). In my opinion it would not be appropriate at this time to include tuberculosis and mental hospitals in the national hospital scheme.
Just for the record let me say that in 1957 only 2 per cent of the revenue of tuberculosis hospitals and 9 per cent of the revenue of mental hospitals was derived from self-paying patients. In other words, it could be considered that it is well within the financial resources of the provinces to completely cover these services.
The hon. member for Gloucester (Mr. Robi-chaud) says that the provinces are no better off as a result of this scheme. The province of Alberta is certainly better off because of the receipt of funds from the federal government under the hospital insurance plan. Unfortunately, the government of Alberta chose to replace the funds it had been using for hospitals with federal funds and therefore the municipalities must continue to carry a considerable load. Certainly, psychiatric units in general hospitals are now covered and, as the hon. member for Durham pointed out, active surgical treatment of tuberculosis patients is also covered.
Then we come to the more thorny problem of part (b) of the resolution with regard to the very sweeping generalization of medical, dental and optical insurance. First of all, may I say that the hon. member who introduced the resolution probably introduced it mostly for political purposes; for he failed to stay in the house and listen to the arguments presented, particularly that of the hon. member for Durham. His whole attitude toward the idea of medical insurance seemed to be political. May I clear up my position immediately. I am in favour of a plan which

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in co-operation with the provinces will give the people the maximum amount of service and yet will be a plan of freedom, freedom for the patient and freedom for the doctor.
I should like to consider the British health scheme which was mentioned by the hon. member for Timiskaming. First of all, it is very difficult indeed to compare the system, usage and medical practice in Britain with that to which we are accustomed in Canada. He says the United Kingdom scheme is good and everybody is happy with it. I have a quotation here which does not seem to bear that out. It is a quotation from Hansard of 1954, by the late Dr. Blair who was quoting one of the eminent physicians in the old country with regard to his opinion of the health scheme in England at that time. I am quoting from page 6298 of Hansard of June 19, 1954:
Dr. Hale-White listed four complaints against the medical scheme, which has been in effect since 1948.
They were:
1. The introduction of the scheme led to the belittling of the general practitioner, because the government stressed that the public would have access to the best specialists under socialized medicine.
Here we come to another problem. In England at the present time the standard of medical practice as undertaken by the general practitioner is nowhere near the standard that we have in Canada in general practice. This has been brought about specifically by the introduction of their socialized state medicine. This is not something which we in Canada can afford to do today, for the standard of care which we want in our system of medicine in Canada has been based on-and I hope very strongly it will continue to be based on-the strong position of the general practitioner in both urban and rural areas.
The second complaint that he had with this scheme in effect in the old country was that:
People began bothering the doctors and hospitals with trivial matters.
As a practising physician I say that this is an important matter and it has already come to our attention with regard to hospitalization schemes. We are now being asked to put people into hospital for a rest; we are asked to put people in hospital so that they can get away from some stresses and strains that they are running into in their ordinary life, and it becomes very difficult for the doctor to do anything about this, and it can become particularly serious under a state system of medicine.
I understand, as the hon. member for Portage-Neepawa (Mr. Fairfield) pointed out, it has got down to the point where to get

extra income which these poor chaps in general practice in England have, they have to get down to giving out certificates so that people may miss work and attend football games and the like. This could happen here. It used to happen in the days of prohibition when doctors were writing prescriptions for alcohol. The doctor's time was taken up in writing prescriptions and he never saw patients. This was not practising medicine. This is not what we want in Canada.
Third, the incentive for the doctor to give good care was not there under the state system which was in effect in England. The hon. member for Portage-Neepawa has gone over that and has pointed out that this incentive would be lost; that we who are in the practice of medicine are not in it only for the income but for other intangibles, if you like, and also the idea of serving the people, not as wards of the state or civil servants but as free men willing to practise as we wish. This is our incentive. We take post-graduate work. This is our incentive, to increase our knowledge; this is our incentive, to give our patients the best possible care, and this cannot be accomplished under any statism sort of medical practice.
As I said, I am personally in favour of some sort of plan but I do not believe that we in Canada are ready for that plan yet. If we take a look at sickness or illness we will find that there are several components. Several things happen when somebody gets sick. It is not just a question of going to the doctor. There may be the question of hospitalization; there may be the question of buying drugs. There may be the question of loss of income of the breadwinner, and this is the question I want to deal with for a moment. Certainly in Canada, now that we have a national hospital scheme-we were all very happy to see this come in and we are very pleased that this government brought in the scheme-we have to look at what is the next big cost to the patient or to the patient's family at any time that illness strikes. I would suggest that the next big cost to these people is the loss of income. Perhaps we should give further consideration to this; perhaps it has priority over just the cost of medical services alone.
There are other things we have to do in Canada before we are ready for a generalized system of free comprehensive medical care. First of all, the hospitalization scheme has shown the need for more hospital beds and here I might say that I feel we should work along the lines not necessarily of bigger hospitals but perhaps more hospitals generally. I feel very strongly that we could

economize on our hospital construction; we could economize on hospital care if we were to come forward with a system of cottage hospitals surrounding large urban areas, and get away from those massive institutions of
1,000	beds and more. It seems to me it is something like corporate enterprise. Once you get so big you start to run into overhead; you start to run into other problems which come from bigness alone. We perhaps require one large centre in a large area where we can have centralized pathological and other diagnostic equipment; but certainly, for the active treatment of most people, we can do these things more economically and give better care and be more humanitarian in the care of our patients with a system of cottage hospitals surrounding some of those larger urban areas. I say this with a knowledge of what is going on in northern Alberta. I feel very strongly that a lot of the beds in those institutions, beds in research institutions are taken up by people who could very well be taken care of in beds in cottage hospitals surrounding those larger centres. Certainly, if we are going to give a comprehensive medical care plan to our people besides hospitals we need personnel.
My hon. friends have pointed out this afternoon that registrations in medical schools across Canada are going down. I believe that one of the reasons they are going down is this statism which has been talked about and which people are afraid is going to be brought into the field of medicine. Doctors are a little bit like farmers. They are individualists and they want to stay that way. They want to be able to practise medicine in their own way, using the best methods that can be devised.
If we are going to have a comprehensive health scheme we are certainly going to need other types of personnel that we do not have now and that are not in training now. I refer to mental health people who would be involved in social work in the mental health field and psychologists and psychiatrists. The number of people entering these fields for training at the moment is not what it was even a few years ago. Surely before we commit our country to a national health scheme it is sound to continue our training grants along these lines so we will have more mental health personnel and all the other technicians that would be required as part of a comprehensive health scheme.
Another great part of medical practice which must be given some consideration and discussion is the question of nursing personnel. In this field things are evolving but certainly they have to evolve more so that we
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will have a greater number of nursing personnel and more adequate standards. Over the past few years we have seen the development of the use of ward aids or nurses' assistants. I think this is a good thing but certainly we still have to have our nurse executives, the people who run the show in the hospitals. These are the people who will be doing the actual nursing and administering the regulations. We have to give consideration to the training of more personnel if we are going to cover all our people under a comprehensive scheme.
Basically, the point is that now is not the time for a national health plan. We must work on all these other things and bring them up to a standard where they will fit into a national health scheme. Throughout the country there are various voluntary associations formed by interested people, some of them sponsored by groups or provincial associations of medical practitioners. These associations are doing a good job. In a discussion of this kind it might be worth while to consider whether or not, they could not do a better job with government assistance, and provide comprehensive coverage for all the people within their areas. This is the type of system which I should like to see brought in because it would leave that freedom which is so vital to a country like Canada. We have to do this groundwork first.
I was going to mention public health and I only do so to reinforce the argument of the hon. member for Durham in which he so capably outlined the possibilities and necessities in that particular field.
I have mentioned some of the things that I believe should be done before we have a national health scheme. Again, if it is at all possible I would ask the C.C.F. party to keep this sort of thing out of politics. This is not something that should be used as a political club in the way that they have tried to use it. This is not something that they should use as a plank to weep over in their platforms. They are dealing with people, with their illnesses and their health. Health is so often a matter of attitude and concept, and these are things which socialism never takes into consideration. To my mind that is why socialized medicine can never enhance the general health of the country to any great degree at all because if you do not have freedom in this as in other things your general level is going to fall.
Again I say that if any national scheme is put into effect in Canada I hope we will consider the basis on which medical practice is now carried on in Canada. The basis has to be the general practitioner and he must be preserved at all costs because he is of

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great value to the general health of the country. In England he has not progressed with the rest of the medical profession because he has not had the opportunity to do so. He is restricted from practising in the larger hospitals. Only lately has there been talk of cottage hospitals in which the general practitioner can practise. These are important things. If you tend to take incentive away from these people who are the backbone of the medical profession then your scheme will not be very good for the health of the people of the country.
At six o'clock the house took recess.


[Stage Direction]
AFTER RECESS

The house resumed at 8 p.m.
Murdo William Martin: Mr. Speaker, we have heard three members from the government side of the house speak in this debate today. All three are also members of the medical profession and, as a result, should be men who are well qualified to speak on this subject before us today. Unfortunately I missed part of the speech of the hon. member for Durham (Mr. Vivian); but from what I heard of it, I thought he made an excellent speech; and I am referring particularly to the last part of it.
However, I am afraid I cannot extend the same congratulations with regard to the speeches made by the hon. member for Portage-Neepawa (Mr. Fairfield) and the hon. member for Jasper-Edson (Mr. Horner). In fact, I thought that the hon. member for Jasper-Edson did not measure up to his usual standard in the inference he made about the mover of this motion, when he referred to the fact that the hon. member for Timiskaming (Mr. Peters) was not in this house at the time. I should like to say that if the hon. member for Jasper-Edson devotes to his job the same amount of time as does the hon. member for Timiskaming and if he serves his constituents as well, he can face them in the next election with a clear conscience.
I listened carefully to the speech made by the hon. member for Jasper-Edson and I must say I found it extremely difficult to follow the line of reasoning throughout his speech. He was against this proposal, he was for it and, above all, according to him, we must wait until everything else is in shape before we can hope for a national health insurance plan in this country. He also with great

regularity brought in the old, frayed-edged cliches about regimentation, state medicine and control, lack of freedom and all the rest of it.
The hon. member for Portage-Neepawa also proceeded to impute motives to the hon. member for Timiskaming, implying that the only interest he had in this particular resolution was a political one and not anything else; that it was not meant to assist the health of people of Canada but was meant to place people in a mould, to regiment them and all that sort of thing. To me it seems strange that both hon. members, while insisting that we should keep this matter out of politics, proceeded to give, in my opinion, a political diatribe instead of a constructive speech on this subject. They both also made a great effort to try to create the picture that doctors are flocking out of the United Kingdom to get away from regimentation under the national health insurance plan in Great Britain.
I should like to look into the facts with regard to this allegation. I have here in my hand a copy of The Lancet which I believe is a weekly medical journal published in Great Britain. This one is for the week of Saturday, November 23, 1957. It deals with this very matter raised by the hon. members today with regard to the flocking of British doctors to get away from this regimentation. At page 1043, where it is dealing with a report of a committee to study this particular subject, I find this:
But they believe that continuation of the present increase of students would yield after 1961 more doctors than are likely to be needed and a reduction of the present intake by about one tenth as soon as practicable would be wise.
I fail to see any resemblance between this report and the picture these two hon. members tried to create in this house today. Then again at page 1058 we find something else which deals with some allegations made by the hon. members or at least with the picture they tried to create, namely that doctors were flocking out of Great Britain. At that page I find this:
The committee estimate that the present number of doctors from Great Britain who leave to settle and practise overseas (including medical missionaries) is just under 400 per annum. The present number of doctors from overseas ... who settle and practise in this country is just over 200 per annum. There is thus a current net export of just under 200 doctors per annum.
That figure is out of a total count, as of 1955, of 53,260 doctors in Britain which means that they have 0.3 per cent of the doctors in Britain leaving to get away from this terrible regimentation we hear so much

about. I do not know what is the percentage of doctors leaving Canada but I am willing to bet that it is in excess of 0.3 per cent.
We also heard that since this plan came into effect in Britain the doctors have been swamped with patients who call on them for no reason at all and that the standard of service has deteriorated rapidly year by year. We find again in the same report- and this is from the Willink report-the following at page 1057:
Between 1952 and 1955 the number of patients per doctor's list fell from 2436 to 2283 in England and Wales and from 2074 to 1975 in Scotland-
The picture which the two hon. members tried to paint in this house is not borne out by the facts.
They also expressed grave alarm about young people in this country not going into the medical field and they said this was due to fear of this terrible regimentation which was hanging over their heads. I would say that the only fear is in the minds of those two hon. gentlemen and other hon. gentlemen who base their opinions on prejudice rather than on facts. If we look again at page 1043 of this publication we find the following:
When the national health service was started, fears were expressed lest the quite obvious underdoctoring of the country should lead politicians to insist that medical schools should step up their production, even though for a time they had to lower standards. These fears were not realized: though the schools increased their intake, they did so chiefly because more young men and women (including many from the forces) wanted to be trained.
The hon. member for Portage-Neepawa (Mr. Fairfield) listed some figures compiled from various service organizations, and so on and so forth, which are supposed to look after all the ills of this country. If I recall rightly, and I have to recall from memory because I have not seen the report of his remarks, he said that since 1942 there had been something like $260 million spent in this field. I would like to point out that that is just twice the amount that has been spent since 1948 to service the sick gold' industry, and when we look at the health of all the people in Canada, I think they deserve better treatment than that.
Another thing I would like to deal with very briefly is a subject which has been raised by government members, I believe in an attempt to try and make out that the C.C.F. are recommending free medicine. I would like to make it very clear that I do not subscribe to that idea. I do not even
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believe in the free gifts we receive from stores today-which we have to pay for-let alone trying to tell people that they can get free medicine. You get nothing for free in this world, and if you get medicine it just has to be paid for somehow. Whether it is paid for by a premium or through your taxes, it still has to be paid for by the people who get the service.
It was not very long ago when the many hon. members of this house said the same things they are saying now about the dread of health insurance about the dread of hospital insurance. It was just as big a bogey in those days as is health insurance today. Where are those voices now? I suggest that when health insurance comes to this country, as it will come inevitably regardless of how many people try to fight it, and regardless of whatever unsound reasons they use to try to fight it, the criticisms which we hear today and the fears which we hear expressed today will be gone like a fog which disappears in the morning. I would suggest that hon. members for Portage-Neepawa and Jasper-Edson do a little more studying on this subject. They should not base their remarks on old cliches and old prejudices but should try to study this subject, look at it dispassionately and come out with facts. I suggest that if they keep on in the way they are now they will be doing a disservice both to their profession and their country as a whole.
There is only one other point I want to raise tonight because I know that many other hon. members would like to speak in this debate. It has to do with another matter covered by this resolution, and it is the implementation of some kind of dental service which is so badly needed in this country. I think the reports from dental associations show that that is one of the biggest needs in this country, a better dental service than we have at the present time. I am not saying this in criticism particularly of the dentists themselves; I am saying it in criticism of the way we have looked at the dental service which is provided and the lack of interest we have shown in it in the past. We have only to think of the terrible condition we find when our children start school because of the terrific backlog of dental attention needed by our children.
I would also like to point out that doctors and dentists, like members of parliament or any other profession in the country, have their good ones and their bad ones, and I do not think any one profession or any one group of

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people are all good or all bad. However, there are some dentists who can, and should bear looking into.
I recall one instance from my own experience concerning something which happened to a member of my family who was recommended to go down to a dentist in the city of Ottawa who is supposed to be one of the best in the profession, Dr. Lome Mac-Lachlan. When we went to see him we received a two-hour sales talk which would put to shame many of our top salesmen who we see on the T.V. medium today. We also discovered that this sales talk was pretty expensive because it was going to cost us something in the neighbourhood of $500 for one set of dentures plus a few extractions. He was not even going to do the work himself; this was purely for the teeth which were required. In the mixup of the dental surgery which was done we received a bill which we paid thinking it was for the work which had been done. Much to our chagrin we discovered afterwards that we had paid $60 only for the two-hour interview and we still owed the money for the work done. Finally it transpired that the bill in Ottawa for a few extractions and a little dental surgery was $120 and the bill for the balance of the extractions and the set of dentures, which work was done in the town of Timmins, amounted to another $120. As I said, I am not accusing the whole dental profession, but it seems dentists, the same as anyone else, can stand some looking into.
(Translation):


Mr. Charles Richard (Kamouraska):: Mr. Speaker, I do not want to take undue advantage of the time provided by the house for the discussion of this matter. I therefore propose to deal as briefly as possible and without any introductory remarks with an issue that is of great interest to all Canadians; I mean hospital insurance. My chief purpose is to explain my position here as a member from the province of Quebec, and also as a practising dentist, a profession which I have been practising for many years and which gives me, in any case, some experience as well as the right to make my viewpoint known in this house.
The hon. member for Timiskaming (Mr. Peters) suggests that the benefits of the hospital insurance scheme be extended. His proposal is to allow people in sanitaria or in mental hospitals to come within the scope of the present legislation. He suggests that the act apply to people who need medical, dental and optical care. I entirely agree
[Mr. Martin (Timmins) .1
with him, but I maintain that, first of all, the hospital insurance scheme be made acceptable to all provinces in this country.
Health, as all hon. members will agree, is, according to the British North America Act, under the jurisdiction of the provinces. Provincial governments have, indeed, the right and the responsibility to determine what must be done in that field. They have the right to do so, without first obtaining the federal government's permission, whose part with regard to health and hospitalization is only to assist and second provincial legislation in this field. In this respect, I want to point out that, since the Conservatives have been in power in Ottawa, the present government has never taken the least action which would infringe upon the principles of autonomy which we, Conservatives from Quebec or from other provinces, have preached outside this house.
While discussions regarding the establishment of a hospital insurance program started at the time of the Liberals, we cannot ignore the fact that the leader of the Ontario Conservative government, the Hon. Leslie Frost, was first to launch the movement. And if I am prepared to recognize the part played in that field by the representative from Essex East (Mr. Martin), the hon. member will not hesitate to recognize that the Liberals were led into that undertaking by the premier of the government in Toronto, and that it is only fair to stress this fact.
This being said, I note that the first agreements which made the national program applicable were entered into under a Conservative administration and as a consequence of amendments introduced by the federal Conservatives. Those amendments still seemed impossible early in 1957, so that if our party had not come into office in June 1957, this generous measure would still be a mere project. On the other hand, being a member from the province of Quebec, I must admit, Mr. Speaker, that I would like my constituents to share in this national program to which they contribute just as much as people in the nine other provinces. Indeed, it is impossible not to see at this time that, whenever a dollar is paid out of the federal treasury to operate the hospital insurance scheme, whether in Ontario, in British Columbia or elsewhere, 33 cents on the dollar comes from taxes paid by Quebec taxpayers, in spite of the fact that they get nothing from the federal government to pay for hospital costs in their own province.

I fully realize that the three premiers we have had in Quebec since June 1957 did not want to engage in something as important as this without giving the matter serious consideration. Besides the three Union Na-tionale premiers have clearly and frankly explained that the hospital system of the province of Quebec is different from that of the nine other provinces of Canada. Therefore, all federal members of parliament who think, as I do, that provincial autonomy is more than just a hollow byword to be flung about at election time, recognize that we, of the federal government, have no right to tell the provinces-the provincial premiers-what sound autonomy should consist of.
I believe that we must leave the provincial government absolutely free to tell us whether a joint measure such as this is acceptable or not. It is with this feeling and in line with this idea that the party to which I belong has signed agreements with nine of the ten provinces, while the Quebec legislature is discussing the possibility of establishing a hospital insurance program which will be accepted, I hope, by the central government.
I think the ministers of this government have done all they could to make the hospital insurance program acceptable by all provinces. I think that in implementing that national program, the present federal government did not want to play the role of the one who dictates what should be done, but that of an assistant, in the light of existing provincial hospital systems. It will be up to the Quebec government's ministers to determine whether the present national program is acceptable or not.
It is up to the Quebec government, and to it alone, in fact, to say whether it is left free to set up hospital insurance in Quebec, in accordance with existing legislation and hospital traditions in that province.
If the study undertaken in this respect by the Quebec government showed that federal assistance in the field of health cannot be accepted by the province of Quebec, this would mean that in all fairness we should amend our legislation so that it would be applicable to and in harmony with the Quebec legislation to enable the province which I represent in this house to get a fair share of the federal tax revenue.
Another point of great interest to me in the resolution of the hon. member for Timis-kaming has to do with insurance for medical, dental and eye care. Because you are a dentist, you will say. And I do not hesitate to answer, 79951-0-99
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yes. In thirty years of dental practice, I was able, in fact, to realize that too many people are unjustly deprived of care, not only of dental care, but also of medical and eye care, because their income does not enable them to seek treatment when it is time.
All my colleagues, dentists, physicians or specialists, who are members of this house will, without hesitation, agree with me when I say that we have allowed the health of Canadians to decline because we have failed to give them the means to see the doctor, the dentist or the specialist except at the point of death in the case of general medicine; only when the most drastic treatment became imperative in the case of dental care; and Anally, only when mere relief was possible in the case of eye care.
I shall not waste the time of this house, Mr. Speaker, in trying to show how it pays dividends to practise preventive medicine. Everybody in this house, whether he be a doctor or not, knows that the majority of diseases affecting patients can be prevented or, anyway, that the ravages of most current diseases can be alleviated to a considerable extent, if the patient is cared for early enough. However, the patient must have the means of paying for the required treatment before his sickness stops him from performing his daily work and earning his living.
There is a lot of talk today of great achievements in the intellectual field, and I am happy, as a Canadian, to find that our intellectual culture is much more widespread today than it was 25, 30, 40 or 50 years ago. I am very pleased about it, but still I think that physical health remains a primordial matter and the essential object of our attention. It would be useless to want people to have a well-furnished mind if they lack the required health to enjoy the intellectual training which our educators strive to give them.
I am therefore in favour of extending the national hospital insurance program so as to allow all Canadians, whether poor or wealthy, the small man and the tycoon, the cultured and the uneducated man, to receive the care required by their state of health. I want Canadians from all provinces to be able to say that we, in Canada, do not waste this essential asset given us by Providence: health.
In saying this, I do not think my words are those of a specialist who cannot see beyond the limits of his field of activity, and I am convinced more than ever of the truth of the old Latin adage: mens sana in corpore sano.

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(Text):


Mr. C. W. Carter (Burin-Burgeo):: Mr. Speaker, part (a), of this resolution merely suggests that in the opinion of this house the government should give consideration to implementing the promises made in the 1957 election and put into practice the policies which hon. members in the government party so energetically advocated when they sat on this side of the house.
My friend the hon. member for Essex East (Mr. Martin) who as minister of national health and welfare in the Liberal administration introduced the Hospital Insurance and Diagnostic Services Act in April of 1957, pointed out that the purpose of the legislation was to assist individuals only and was not designed to subsidize services provided free by the provinces. Therefore, patients receiving free treatment in provincial institutions would not be included under this act but tuberculosis patients and mental patients who were receiving care in general hospitals would be included under the benefits of the measure. Those who were paying their way in provincial institutions were also covered by this legislation.
The Conservative party at that time severely attacked the Liberal administration for not including tuberculosis and mental patients under this legislation. I could not help but notice the great contrast between the stand taken by Conservative members at the time of the introduction of the act and the stand taken today by the hon. members for Portage-Neepawa (Mr. Fairfield) and for Durham (Mr. Vivian). The stand formerly taken by members of that party was that by not including tuberculosis hospitals and sanitaria and mental institutions the act discriminated between physical illness and mental illness and that it was driving a wedge between tuberculosis hospitals and sanitaria and mental institutions on the one hand and general hospitals on the other.
The present Minister of Finance (Mr. Fleming) was most bitter in his attack on the Liberal government of that day. His remarks as recorded in Hansard on that occasion are most interesting and I was wondering today whether the hon. members for Portage-Neepawa and Durham had familiarized themselves with the statements of their colleagues on that occasion before taking part in today's debate.
In the discussion that ensued at the time of the introduction of the act the present Minister of Finance, who was then the private hon. member for Eglinton, set forth his party's

stand in very clear terms. I am reading now from page 3380 of Hansard of April 10, 1957, where the present Minister of Finance is reported as having said:
We as a party and as Her Majesty's loyal opposition have already expressed in the strongest terms our view that there is no justification whatever for the exclusion of these hospitals and institutions from among those that lie within the scope of the scheme of hospital insurance.
The hon. gentleman's remarks previous to that clearly indicate that the institutions he had in mind were tuberculosis hospitals and sanitaria and mental institutions. During that debate the present Minister of Finance went so far as to move an amendment to the effect that the bill be referred back to the committee with the object of inducing the committee to persuade the government to amend the measure and include these institutions. In this stand he was supported by the present Prime Minister (Mr. Diefenbaker). I will not repeat the remarks of that hon. gentleman which were placed on Hansard today by the hon. member for Lapointe (Mr. Brassard) and which may be found at page 3386 of Hansard of April 10, 1957.
Then followed the election. During the election definite commitments were made to the people of Canada. These have already been put on the record today but I think it is well to again bring them to the attention of the house. At Winnipeg, according to a report in the Winnipeg Tribune of May 14, 1957, the present Prime Minister said:
The Conservatives, he said, would repair a "serious omission" in the federal health plan which does not include tubercular and mental institutions.
Later on in the campaign the hon. gentleman was reported in the Toronto Globe and Mail of May 28 as having said at Saskatoon:
Mr. Diefenbaker said the Conservative party still believes that hospital insurance should cover patients in mental and tuberculosis institutions.
I submit that these are very clear statements. They stand out today in very sharp contrast to the position which has been taken by the members of the Conservative party in this debate.
Following the election there was a dominion-provincial conference. During that conference there was a marked change in the stand which the Prime Minister took. He is reported as having said at that conference that he and his party had no objection to including those two institutions under the Hospital Insurance and Diagnostic Services Act, but if that were done then the cost of these services would be deducted from any further increase in fiscal grants to the various

provinces. There clearly were no strings attached to the promises and commitments made during the election.
Nearly three years have now passed and although some hon. members opposite will still get up and say that every election promise has been kept this promise is clearly still outstanding. There was some excuse for not including these services in 1957 because then it was clearly a first step and time was needed to see what flaws would develop and what problems would emerge in the administration of the act, but whatever excuse may have existed in 1957 there is certainly much less excuse today because the plan is no longer in its first stages and has been clearly established.
The problem of mental illness is not decreasing but is getting greater and more costly every day. The distinction between physical and mental illness has also grown less. There is still outstanding what is perhaps the most tragic problem of all in connection with mental illness, the woeful lack of facilities for the treatment of children who have the misfortune to be afflicted with this illness.
Therefore the government is morally bound to implement this part of its election platform or else, on the other hand, it should admit to the people that they were wrong in advocating it and in attacking the Liberals in 1957, and they should apologize to the people of Canada for having done so.
Part (b) of this program has been in effect in my province for some time in a limited degree. I can inform my hon. friend from Portage-Neepawa that our experience has been such that the fears which he expressed today are not very well founded. It is proving a great blessing to the people, and especially to the children, because in my province it is restricted to children under 16 years of age. But it certainly has not moved us one step further forward toward the establishment of socialized medicine, which everyone seems to fear so much.
Our national health, the health of our people, certainly is our most precious asset and no one should be prevented from availing himself of medical, dental and surgical services because of financial handicaps. Therefore, I endorse this resolution.


Mr. O. H. Phillips (Prince):: Mr. Speaker, in rising to take part in the debate on the resolution now before us dealing with extension of the Hospital Insurance and Diagnostic Services Act, I am reminded of a debate which took place in this house on trading stamps a short while ago. A number of members, especially in the C.C.F., were opposed to trading stamps on the grounds that they 79951-0-99J
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created the impression that people were obtaining something for nothing. This resolution is guilty of the same so-called crime in that it is designed to create the impression that the people will receive these services free.


William Arnold Peters: It does not say that.


Orville H. Phillips: In the fact, it could be said that the hon. member who proposed the resolution is dealing in trading stamps with the electorate. The only thing is that he is giving them red stamps instead of green. To the hon. member for Burin-Burgeo (Mr. Carter) and the hon. member for Lapointe (Mr. Brassard), who spent a great deal of time on the remarks of the late Dr. Blair and the Minister of Finance (Mr. Fleming) when they were in opposition, I would simply say this: It is too bad those remarks did not impress you when you sat on this side of the house as they do now when you are on the Speaker's left. The hon. member who has just resumed his seat said there could be no excuse for the delay in carrying out that election promise. I wonder how he explains the fact that the Liberals first promised hospital insurance in 1928, and it did not come into effect in most parts of Canada until 1958. Perhaps it was not all delay; probably changing conditions contributed to it. But my advice to them is to be patient, as you were from 1928 until 1958.
Several members have spent a good deal of time on the first part of the resolution dealing with tuberculosis and mental cases. I do not think I need to spend a great deal of time on this portion of the resolution, except to point out that the pattern of treatment is changing and today a great number of our mental patients are treated in psychiatric wards in active treatment hospitals, and many of them who are admitted to hospital receive shock treatment and are discharged before the 30-day period has expired.
As a practising dentist I am naturally most interested in the second portion of the resolution. In that regard I should like to refer to the remarks of the hon. member for Timmins (Mr. Martin) who made reference to one dentist. In my opinion this was a rather cowardly act. He attempted to take advantage of his parliamentary immunity. I can only say to the hon. member that I believe the dentist made a mistake. He must have thought he was making dentures for the hon. member for Timmins and he certainly would be entitled to a much larger fee than he ordinarily receives.
The idea of insurance involves the principles of a group of people paying a premium for protection against loss, or to meet the costs of some specific item. Perhaps the

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resolution should be considered in that sense. Canada has made considerable progress on the road to socialized services, and instead of proceeding at a rapid pace without consideration of what we are doing I think we should stop, consolidate our position, review our program, decide what we want, what our objective is, and the best way to proceed toward that objective.
Perhaps the idea is prevalent that the Canadian Dental Association is opposed to any scheme involving health insurance. This, Mr. Speaker, is not so. I refer to a policy statement on health insurance approved at the annual meeting of the Canadian Dental Association held in June, 1956. I refer specifically to items 3 and 4 of that statement. Item No. 3 states:
The principle of contributory health insurance is approved, provided that such plan or plans assure the development of both preventive and treatment services of the highest standard and that fairness to both the recipients of the services and to those rendering the services be assured.
Item No. 4 states:
The patient must have freedom of choice of dentist and the dentist must be free to choose patients. The personal relationship between patient and practitioner is essential to a successful health service.
Item No. 3 emphasizes, first that preventive and treatment services be both included, and in preventive services would be included fluoridation, dental health education and to a certain extent the treatment of pre-school age children. But I think probably even more important in item No. 3 is that treatment services of the highest standard be retained. This is often a fault with a completely socialized scheme, that there is a tendency to cut down expenses and to give the less expensive treatment regardless of the effectiveness of the treatment.
Item No. 4, I think, is equally important in that both the patient and the dentist must have freedom of choice. In many socialized countries-in fact, Great Britain started out this way-the dentist was given a list of patients and was instructed by a civil servant that he must be responsible for those individuals and the list constituted his practice. In turn, the individuals on that list were instructed to apply to so and so for treatment and were restricted to the practitioner designated unless referred to someone else by that practitioner.
I think it would be appropriate at this time to pause and consider the number of people in Canada who are already covered by various dental schemes. The number of schemes vary in their operation and in their scope, but it is surprising the number of

people in Canada who are already covered. This list would include, of course, the Indians and Eskimos as well as the recipients of war veterans allowance. Various provinces have their own schemes. My small province of Prince Edward Island has a very good scheme when one considers the limited funds available. The province has attempted to have a number of mobile dental units visit the various parts of the province in which dentists are not available. They treat children of grade one and grade two. At the present time, there is only one operator but he has done an excellent job since joining the department. The parents of the child are requested to pay $1.50, but if they are unable to pay the child is still entitled to treatment. When the treatment is completed the child is given a certificate entitling him or her to a free fluoride treatment. The treatment is a topical fluoride treatment and is given by a registered dental hygienist.
I understand that the province of Ontario has a similar scheme for school children and, in addition, the recipients of social services are also entitled to free treatment. The various provinces, such as British Columbia and Saskatchewan, use part of their federal health grants for dental treatment. British Columbia, I understand, has two schemes, one using salaried dentists in mobile units, and the second scheme involves the use of the office and time of a private practitioner. I am told that a survey carried out by the province of British Columbia to compare the benefits and costs of the two plans indicated that the use of the private practitioner and his office was by far the most economical. Saskatchewan, in turn, uses dentists as civil servants who operate in mobile units. They, of course, spend most of their time in areas not serviced by practising dentists.
The Canadian Dental Association also emphasizes that any plan should begin with the young, and I believe that is a very wise idea because a comprehensive plan would include many people who, in the language of the dental practitioner, are classified as dental cripples. Item No. 20 on this pamphlet to which I previously referred, reads:
Variation exists from area to area as to number of children and number of practitioners which necessitates planning on an area basis. It would be unwise to institute services which could not be provided. From the preventive standpoint, complete services for a younger age group is preferable to partial services for a larger group.
Item No. 21 reads:
The growth of the plan should be determined on an annual appraisal basis, dependent on the dental health of those already in the plan, any increase in the number of practitioners and any increase or decrease in the number of children involved.

The number of various private plans in effect makes one question whether it is wise from an economic viewpoint for the government to proceed beyond a certain stage. In the United States there are a number of excellent prepaid dental plans operating very much on the system of the Blue Cross and Blue Shield in Canada. They are providing complete dental treatment at a very reasonable cost. Some plans, not of course providing complete dental care, are as low as $19 per annum, and I believe it would be extremely difficult for the government to compete with this premium. The labour unions in the United States have used a great deal of their welfare funds for medical and dental treatment. This is very interesting when one considers the attitude of labour unions in Canada, or at least certain ones, that would prefer to hand over their treasury to an unborn political party.
In the United States the unions have negotiated with various medical and dental groups to provide complete coverage for their union members and their families from welfare funds. This plan has been particularly successful in the southern United States and has completely obliterated the clamour for socialized medical and dental services in that area. The Blue Shield is still available in Canada for the medical practitioners. I think that this is an excellent plan and very reasonable in cost. I noticed that the hon. member, in moving his resolution, stated that one of the drawbacks to the present hospitalization scheme was a mix-up in hospital premiums. I do not think anyone has ever had that experience with Blue Cross or Blue Shield. It illustrates the fact that these private organizations function extremely efficiently, perhaps more so than do government plans.
This afternoon various hon. members, particularly the hon. member for Portage-Neepawa (Mr. Fairfield), referred to the difficulty of the medical practitioner operating within a socialized scheme. The same thing applies to dentists. In a government organization there is a tendency for the amount of paper work to keep on increasing. Forms must be filled out in duplicate and triplicate, be forwarded to various individuals for their approval and finally they end up before the treasury board of a department to be stamped. This procedure not only adds to the cost of a scheme but-what is more important-it takes the practitioner's time away from the patients. In England various practitioners were forced to discontinue their practice an hour or an hour and a half earlier than they normally did in order to complete the reams of paper work for the day.
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Recently I visited my constituency and was speaking to a fellow dentist. He was complaining of difficulty in a war veterans allowance case and I think this experience illustrates the danger in these socialized schemes. A recipient of war veterans allowance presented himself at this dentist's office for treatment. The dentist filled out the necessary forms containing his recommendations for treatment and forwarded them to Ottawa for approval. In the treatment form he had recommended the insertion of partial dentures. Someone in Ottawa looked it over and wrote back saying, "We agree with you that this is a fine case for a partial denture but we do not think the man will ever wear it; therefore we cannot approve it". I think that is the big fear in the minds of doctors, dentists and optometrists, namely that we will have at the top someone who disagrees with the treatment recommended to the patient, and this results in a loss of confidence by the patient.
It might be well for us to consider the experience in other countries which have undertaken this socialized scheme of treatment. Perhaps it would be well to take a look at the experience of the British people. At first there was a great rush. Everybody wanted admission to hospital, dentures or new eye glasses. The cost of the program was extremely shocking to the British taxpayers and today we find gradual progress being made toward a stage where the patient is expected and required to pay for a certain portion of his treatment. In fact, the program got so badly out of hand in England that, as many hon. members will recall, Sir Winston Churchill, in some remarks he made during an election campaign, said that everyone had gold teeth and nothing to eat. That remark may be a bit extreme but I think it points out the danger to the treasury from these plans.
I was interested last fall to read in the Saturday Evening Post an article on Sweden. The article was entitled: "Sweden; A paradise with Problems". As hon. members know, Sweden is a highly socialized country enjoying all the so-called benefits of socialism. However, it has become very disturbing to the Swedish government that juvenile delinquency is on the increase, that alcoholism is rapidly increasing and that there has been a disturbing increase in the suicide rate. When I read that article, I recalled my history lectures at Prince of Wales College. Dr. Lily Seaman, the lecturer in history, often compared the decline of the Roman empire with socialism. As the Roman empire conquered various countries and then disbanded its army, the disbanded troops tended

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to collect in Rome and there was very little employment for them. The politicians of the day engaged in a game of offering free games at the forum and free grain. The more games and the more grain that were offered, the more popular was the individual candidate. The people paid no attention to the efficiency of the government. Consequently there was the decline of the Roman empire. When we are dealing with a measure calling for complete socialism, I think we should bear this fact in mind.
In closing, Mr. Speaker, may I say this? I think we should bear in mind the consideration that any plan should be contributory and that the practitioners should be represented on the governing body. We must also bear in mind the fact that both the individual and society as a whole have a responsibility. When both the individual and society assume that responsibility, Canada will be a stronger and better nation.


Murdo William Martin: Will the hon. member permit a question?


Orville H. Phillips: Yes.


Murdo William Martin: I do not like to interrupt any hon. member when he is making his maiden speech. Will the hon. member explain what he meant by red stamps and green stamps?


Orville H. Phillips: Red stamps were associated with socialism.


Paul Joseph James Martin: I think we all agree, Mr. Speaker, that this has been a useful discussion and that we have had some valuable contributions with regard to a subject that engages the attention of many hundreds of thousands of people in this country. I am sure that the speeches of the hon. member for Durham (Mr. Vivian), the hon. member for Gloucester (Mr. Robichaud), the hon. member for Lapointe (Mr. Brassard), the hon. member for Portage-Neepawa (Mr. Fairfield) who put on the record valuable information, and others, will help considerably in trying to formulate the kind of judgments and decisions we shall be obliged to take in this particular matter.
In our discussion today we have not always followed the terms of the resolution. I offer no criticism in that particular, except to say that I think it would be well at this time if we recall the resolution that has been proposed by the hon. member for Timiskaming (Mr. Peters).
The resolution reads as follows:
That, in the opinion of this house, the government should give consideration to the advisability of introducing a comprehensive system of national health insurance, more particularly to give consideration to the advisability of:	(a) amending
the Hospital Insurance and Diagnostic Services Act

to provide benefits on behalf of patients in tuberculosis sanitaria and patients confined to mental institutions; (b) introducing legislation to provide medical, dental and optical insurance.
The government is not being asked now by the proposer, or those who support this resolution, to make a decision on any of these points. The government is merely called upon to give consideration to the advisability of introducing a comprehensive system of national health insurance with special emphasis on the inclusion of tuberculosis sanitaria and mental institutions in the Hospital Insurance and Diagnostic Services Act, and to provide for a system of medical, dental and optical care insurance. It would seem that it would be very difficult for the administration to refuse to accept this resolution, as all that is being asked is that the government give consideration to the recommendations embodied in the resolution.
Surely at the present time the government is giving consideration to these matters. Surely it is the responsibility of the Minister of National Health and Welfare (Mr. Mon-teith) and of the department which he administers to give consideration to all of these various matters. It would certainly be difficult for the minister to satisfy the house tonight that the government should not give consideration to amending the Hospital Insurance and Diagnostic Services Act to provide benefits on behalf of patients in tuberculosis sanitaria and patients confined to mental institutions.
The government could not possibly take the position that it was not prepared to give consideration to that matter, because as the hon. members for Lapointe, for Gloucester (Mr. Robichaud) and for Burin-Burgeo (Mr. Carter) pointed out, when hon. gentlemen now sitting on the treasury benches were in opposition they, on the occasion of the introduction of the hospital insurance act, moved an amendment to that act so that mental institutions and tuberculosis sanitaria would be included in the federal government's offer to the provinces to share in the cost of a nationwide scheme of hospital insurance. So that the minister tonight, when he replies, will not I am sure seek to defend himself by arguing that this resolution cannot be accepted on that particular count.
Hon. gentlemen opposite not only urged such a proposition but moved an amendment. It was moved by the present Minister of Finance (Mr. Fleming). The Minister of National Health and Welfare cannot take the position tonight that he has not been able to persuade in particular the Minister of Finance, who has the responsibility of getting the necessary moneys to implement

this proposition, because this very amendment was moved not by the late member for Lanark but by the Minister of Finance himself. So that the government of the day, whatever its disposition about considering this resolution, cannot in all logic, and I would say in all honour, refuse to accept at least that part of the resolution.
Hon. gentlemen opposite have been in office for two and a half years, and notwithstanding that they have taken no step whatsoever to amend the hospital insurance act so as to include as insurable items individuals who are patients in mental institutions or tuberculosis sanitaria. Not only did they urge this on the house when they sat in the opposition, but during the course of the election, in 1957 in particular, the Prime Minister (Mr. Diefenbaker), speaking deprecatingly of the hospital insurance act in many parts of the country, pointed to its weaknesses and said that if his party were returned to power he would see to it that the act would be amended so as to bring in patients in tuberculosis sanitaria and mental institutions; and we were reminded today by the hon. member for Lapointe of the very words which he used in that context.
Now it is true, as we know, that in November 1958, when the federal government as presently constituted met with the provinces, there was a suggestion that these two groups of patients could be covered by the act but that any expenditures in that regard by the federal government must be considered as diminishing any amounts of money which the federal government might extend to the provinces under the federal tax sharing arrangements with the provinces. But that was not the position taken by hon. gentlemen sitting on this side of the house when they were in opposition, and I would suggest to the Minister of National Health and Welfare that he is in a very difficult position tonight in facing a resolution that does not call upon him to do this but merely to consider something which hon. gentlemen opposite urged when sitting to your left, Mr. Speaker, when the hospital insurance act was first proposed.
Then with regard to the second part of the resolution, surely it is not difficult for the administration to accept this resolution, because, as we know, the provinces and the various bodies that meet with the Minister of National Health and Welfare from time to time-the dominion council of health and the various medical and other health associations-discuss these and other like problems and it would be difficult to believe that the minister could tonight take the position that he has not been giving consideration to these various proposals for medical care insurance.
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I think our objective in this country at this time, and I would take it that it must be the objective of all of us in this house, is that our primary concern is to see to it that no individual in Canada is denied the best possible medical, dental and optical care regardless of financial circumstances. That is the objective. It would be difficult surely for anyone to take the position that in this day of social progress the advantages of medical science should not be made available to everyone in this country who needs it. It would be difficult to say, for instance, that a cancer sufferer, because he or she should happen to be poor, should be denied the opportunity of getting the best possible treatment for cancer; and one could apply that principle to other diseases and to other forms of disability which may or may not attend individuals in our country.
The question is, how can we best do this? I would suggest that what often looks like a radical proposition one day, very soon as the result of the effluxion of time comes to be accepted as routine. I think of the criticisms levelled against the hospital insurance proposal when it was first enunciated, not in 1956 but, in so far as I am concerned, in 1948.
Mr. Pallet!: Do not forget what we have done.


Paul Joseph James Martin: I said "so far as I
am concerned". If the hon. gentleman wishes to be political, that is his right. I am trying to discuss a serious subject in a serious way, as the hon. member for Durham did, but maybe the hon. member for Peel (Mr. Pallett) would not understand the possibilities of that kind of approach.
In 1948, when the hospital insurance measure was proposed, there was criticism from many quarters and from many places in this country. That was socialism, they said; that was a dangerous step; that was something which would cost too much money; that was something which would destroy private enterprise; that was giving unnecessary power to the state. Today, there is not a member in this house, and there are very few individuals in this country, who would deny the validity of the hospital insurance program which now prevails in nine of our ten provinces.
This is not socialism, as I told the hon. member for Timiskaming today in an endeavour to correct him. This was simply the recognition of a principle which has been in vogue in many countries for a long time, a principle which was recognized in 1910 when Mr. Lloyd George introduced the first health insurance scheme in the United Kingdom. The criticism which arises out of abuses in

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the existing system in Britain represents innovations to the basic measure which was introduced, as I say, before the great war.
Thus when we consider the second portion of this resolution, let us remember this experience of the hospital insurance act; that what today may look like a dangerous innovation may tomorrow be recognized as the kind of solution which should have been provided a long time ago. The criticisms which were levelled 75 years ago with respect to secondary school education apply to these various measures which are put forward from time to time as solutions to problems which affect the people in terms of social and economic desirability.
Thus, with regard to this matter, it ought to be possible to discuss the subject without being accused of being in favour of state medicine, without being accused of socialism. Socialism means something else altogether, and it is not incorporated within the provisions of this resolution. For my part, if we can reach the same objective by voluntary effort, by private professional effort, I would see no reason for asking the community or the state to assume responsibility. The important thing is to make sure that this is done; that is to make sure that no individual is in want; to make sure that every individual in Canada, regardless of financial means, is given the best possible treatment that medical science can give. That is the principle which should actuate us. I cannot see why the Minister of National Health and Welfare should have any difficulty in accepting this resolution in the form in which it has been presented to us today. As far as this party is concerned, we have gone on record at our national convention in 1958 as follows:
The policies which the Liberal party recommends for early consideration are:
1. As a further step, to implement health insurance provision against major medical, dental and surgical expenses, which combined with hospital insurance would ensure that no Canadian would be financially crippled by illness-
We all recognize, I think, that it is possible for us in this country-for a people dedicated to the preservation of freedom-to see that freedom is maintained. No one wants to see the traditional relationship between the patient and the doctor destroyed. Most of us in this country recognize, I think, the desirability of that, and we recognize, too, the important position which the federal government has in a matter of this sort vis-a-vis the provincial governments.
We are a federal state. The ten provincial departments of health in this country are responsible for the administration of health in Canada and any effort on the part of the

central government to interfere in what is traditionally and, perhaps, constitutionally the responsibility of the provinces would properly be resented. I agree with the hon. member for Kamouraska (Mr. Richard) that it ought to be possible to pursue this great objective which we have in mind in a spirit of co-operation, in a spirit that is consistent with the basic concepts of our confederation. No effort ought to be undertaken by the federal government which could in any way be regarded as a usurpation of provincial autonomy, provincial responsibility or provincial jurisdiction. No one has suggested that today; I mention it simply because the hon. member for Kamouraska brought this question before us, quite properly, as he would wish to do, coming from the province of Quebec.
No one suggests now, I am sure, that the hospital insurance act was an invasion of provincial rights. Yet we have heard hon. gentlemen at various times, in some quarters of this house at any rate, suggest that this was a centralizing policy, a policy designed to interfere with provincial authority and jurisdiction. Happily, now, we all recognize that those arguments had no real validity. No one wishes in any way, let me repeat, to propose anything which interferes with the basic philosophy of people in any part of Canada. All this federal government and this parliament can do is to make offers to the provinces; it is up to the provinces to accept them in the light of their considered needs and their judgment as to their capacity and desire to meet those needs.
I believe the hon. member for Portage-Neepawa was justified today in putting on the record as he did such a splendid recital of the health activities which are carried on in this country on federal account, on provincial account and through the voluntary organizations. I am inclined to agree with the hon. member for Durham that in a discussion of this sort we should recognize the contribution made by all the health professions, and he mentioned particularly the medical profession. It is fashionable to criticize the doctors and to say that the doctor stands in the way of progress. I had 11 years of close contact with all the health professions in this country, and while at all times I did not agree with them- and I do not agree always with them now-[DOT] in every particular, I join with the hon. member in saying that the Canadian medical profession possesses and practises standards of responsibility and social understanding as high as those of any group of doctors in any other country of the world. They will, therefore, I am sure recognize that when we consider these matters we do so not because we want to interfere with the basic integrity of a great profession but, because of the general

interest, we want to make sure that we devise those steps by which we can ensure the kind of medical care, the kind of dental care, the kind of optical care and, I may add, other forms of health care which as a result of scientific discovery, as a result of endowment, have increasingly been made possible to the people of our country and to the people of the world generally.
It must not be forgotten that the first step in health insurance in Canada was not, in so far as this party is concerned, the result of the introduction in 1956 of the Hospital Insurance and Diagnostic Services Act. When in 1948 the national health grants were announced by the then prime minister of the day he said, as reported at page 3931 of Hansard of May 14, 1948:
I should like to make a statement to the house on government policy with respect to health services and health insurance.
Then he went on to point out that the program being announced was a necessary prerequisite to the ultimate establishment in Canada of a system of health insurance. It will be recalled that at that time the federal government decided to embark upon a system of grants in aid to the provinces. First of all there was the general survey grant which made possible an assessment by each province of its health needs. The federal government assumed full financial responsibility for the surveys that were carried on by the provinces on terms which they themselves laid down. Then followed the grants for federal public health, for tuberculosis, for mental health, for venereal disease, for the prevention and control of crippling conditions in children, for blindness prevention and control, for professional training and for public health research and, as the hon. member for Portage-Neepawa reminded us this afternoon, three other grants including the grants for rehabilitation, for child and maternal care and for laboratory and radiological services were added.
I agree with the hon. member for Durham that the general public health grant represents one of the really great achievements of that program because, as the hon. gentleman said, one of the elementary phases in the organization of attack against disease and in the building up of healthy bodies in this country is the public health unit. The public health unit has been expanded all over this country to the extent of many millions of dollars by the grant provided for by the federal government in the field of public health. What one could say about that grant one could likewise say about the improvement in mental illness, the extension of professional personnel as a result of the professional training grant, and so on.
Health Insurance
The next significant thing is that following the introduction of the health grant in 1948, which was announced as a prerequisite to a system of national health insurance, was the resolution placed before parliament on March 25, 1957 when, as a member of the government of that day, it was my responsibility to move 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.
I am not going to enter into any argument as to who is responsible for hospital insurance in Canada but the fact is there we have the legislation placed on the statute books of our country by a Liberal administration. No one for a moment has ever suggested that measures of this sort can be carried out only by the federal government. They represent a co-operative enterprise. The fact is, however, that with the exception of what was done in the province of Saskatchewan the only other step taken in the field of hospital insurance was taken in this house on March 25, 1957, and I believe that hon. gentlemen opposite in their effort to take political advantage one way or another would want to recognize that fact and would want to recognize the announcement of May 14, 1948 and also recognize that these measures were always proceeded with on the basis of consultation with all of the provinces in our country.
All but one of the provinces now have accepted the Hospital Insurance and Diagnostic Services Act, an act that now in spite of all the criticisms levelled at it is recognized as something that we should have had a long time ago, a measure-


Joseph-Alphonse-Anaclet Habel: Except Quebec.


Paul Joseph James Martin: Yes, except the province of Quebec. That is a decision for the government of Quebec. As one who lives in the province of Ontario I do not seek to tell the province of Quebec what it should do but I do hope the Minister of National Health and Welfare, consistent with his responsibilities as a federal administrator, not seeking to impose his will, nevertheless is showing some initiative in making sure that all the advantages of this federal act are being made known to those now in authority in the province of Quebec so that the government of that province can make up its

Health Insurance
mind with the greatest possible opportunity of realizing what the facts and advantages are.
The Hospital Insurance and Diagnostic Services Act as it now stands made available to all persons a simple method of budgeting in advance the unpredictable costs of essential hospital care. Under this plan no one is denied benefit because of age, health or economic circumstances. No time limit has been placed on the number of days' care and so the individual is protected against catastrophic costs of protracted illness requiring hospitalization over a long period. No dollar value has been placed on the special services in hospital that may be required and because one half of the national costs of hospitalization are being paid out of the federal treasury it is possible for the provinces as we now know to offer premiums that are more attractive than those that can be charged under any existing plan.
The Hospital Insurance and Diagnostic Services Act now extant in nine provinces in co-operation with the federal government provides that an individual will be free to purchase any additional protection required in terms of private or semi-private care or other special benefits through regular commercial or voluntary insurance plans.
In resuming my seat, I say there is a record behind us. We have taken an important step, one that has been recognized as being in the public interest. The resolution before us does not call upon the government to take any decision. All this resolution does is to call upon the government to consider the advisability, first, of doing something that hon. members of the government recommended when they sat on this side of the house and, second, to consider the implementation of legislation providing for medical, dental and optical insurance.
We will wait with interest the reply of the Minister of National Health and Welfare. This will be his first opportunity in a long time to make a comprehensive statement on health care. We will listen to him with sympathetic interest and, I am sure, with great anticipation.


Mr. Joseph Slogan (Springfield):: Mr. Speaker, it is not often that I get the opportunity of following the very eminent, distinguished and eloquent member for Essex East (Mr. Martin). I cannot say that my regard for him extends to accepting all the proposals that he made, and certainly I do not intend to join with him in swinging on that political trapeze which has carried him in flights of fancy into the past.
Before beginning my remarks, I should like to congratulate the hon. member for Kamouraska (Mr. Richard) on the occasion

of his very eloquent maiden speech tonight. May I say that I am very proud to be participating in this debate in that it has given an opportunity to those in the medical profession and to those of us in the dental profession to express some views other than political regarding our professions.
I am going to confine myself in the short time that was left to me by the hon. member for Essex East to some remarks regarding mental care and dental care. As we all know, mental hospitals and sanitaria are now under provincial jurisdiction and I think the closer they are to the people, the better the service is for the people. I do not believe the federal government should impinge any further upon this area of provincial activity.
Just for a moment I want to mention something that has been a very sore point with me for a long time. Before I entered the profession of dentistry I worked in the rehabilitating of mental patients, and one thing that caused me great concern-and still does because it still exists-was the matter of the committal of mental patients. After a mental patient is committed on the certificate of a physician he is brought in to the hospital by-in Manitoba, at least-two Royal Canadian Mounted Police constables. The first impact upon this patient on entering a mental hospital is most unfortunate indeed because often he is put in a strait-jacket and held up between two Royal Canadian Mounted Police constables and put into this institution which is supposed to be the hospital which will rehabilitate him. Often he is put into a small cell and subsequently he undergoes treatment by insulin shock, electric shock or both. All of these treatments seem to have a very profound effect on the patient. Indeed, it has been amazing to me that 70 per cent of them actually go back into society.
However, that was 10 years ago and I must say I am amazed at the progress that has been made in mental hospitals in the last 10 years. In fact, today in most hospitals you do not see any strait-jackets and there is very little restraint and indeed a very great deal of freedom. This has been brought about by the discovery of tranquilizers and other sedatives.
I think I had better proceed now onto giving a few suggestions regarding dental health insurance. May I say to the hon. member for Timmins (Mr. Martin), with regard to the unfortunate experience that he related today, that there are Fords and Cadillacs, and perhaps the hon. member, seeking to purchase a Ford, by mistake strayed into a Cadillac dealer.
Owing to the fact that there is very little time at my disposal, Mr. Speaker, I wonder

whether I could have the unanimous consent of the house to have printed in Hansard at this point the official statement of the Canadian Dental Association on health insurance as adopted by them in June of 1956?


Paul Joseph James Martin: Was that not put on by the hon. member for Prince (Mr. Phillips)?


Joseph Slogan: A few points were mentioned but I think this is a very vital policy statement and it would be enlightening if we could place it in Hansard, because I certainly would not want to read it to hon. members.


Mr. Deputy Speaker:: Would the house desire to have an indication as to the extent of the document before considering unanimous consent?


Joseph Slogan: The document is not very long; it consists of 23 statements, which are quite short, elucidating the official policy of the Canadian Dental Association on health insurance.


Some hon. Members:: Agreed.


Mr. Chevrier:: Mr. Speaker, on this very subject you, I think, have ruled on two occasions, once in connection with the statement which the hon. member for Bonavista-Twil-lingate (Mr. Pickersgill) requested to put on Hansard and again in connection with the hon. member for Cape Breton South (Mr. Maclnnis). I presume the ruling should be the same in all cases.


Mr. Deputy Speaker:: Of course the house can give unanimous consent. I think it has been the feeling generally that we should resist any practice of placing on Hansard documents which are taking the place of a speech by an hon. member. I understand the hon. member has not unanimous consent to have this document printed in Hansard.


Joseph Slogan: I will pass it over, since the hon. member for Prince has already elucidated the more important points in the statement. However, in the few minutes at my disposal I want to deal with the principle of insurance as it applies to dentists. The insurance principle is based mainly on the presumption that a great number of people will pay premiums and a much smaller number will get the benefits and as such have the security which is theirs in knowing that in the event that they need the treatment it will be available on payment of those premiums. That is how the insurance principle works.
However, it cannot work when it is extended to dentistry because of the fact that dentistry is the only area of activity mentioned in this resolution which is almost universal. In fact when we find a person
Health Insurance
who has a perfect set of teeth it is cause for rejoicing and we send him down to the dental college and we investigate the type of diet he has had and we even go into his heredity and so forth, because individuals of that nature are so rare. Therefore, I cannot see how the insurance principle can be applied to dentists because if it were, then the costs of the premiums would be raised so high that people would not be willing to pay them. Therefore, we have to look for some other alternative. This is not to say that we are not in favour of health insurance, or not in favour of dental health insurance, because we have gone on record as being in favour of it provided that the right climate is there for the institution of it.
There are three things we must remember when we consider dental health, namely education, prevention and treatment. The hon. member who moved this motion mentioned it was a fact that some people in the low income groups seem to need more dental care. The one thing that we can do as a society through a system of education is educate those people to care for their teeth in such a way that treatment would be lessened. In fact, if people did a little more to take care of their teeth the incidence of dental caries could be cut in half. But it seems that the very low income people who should take a much greater interest in their oral hygiene are exactly the ones who tend to neglect it. This is most unfortunate.
Then there is the preventive program. Before we embark on a scheme of health insurance, it seems to me that there are many schemes that would benefit society greatly which have not, as yet, been instituted. One of these schemes which I should like to mention is the fluoridation scheme. Here is a scheme which at a cost of from four to 17 cents per capita per year would cut down the incidence of dental caries by at least two-thirds. As a matter of fact, the cost of fluoridation varies from area to area. In the Sudbury area it would cost about four cents per person per year, whereas in Brantford, where we have had fluoridation for a long time, the cost sometimes ran as high as 17 cents per capita. The reason for this is the type of water they have and the type of compounds that they use. However, even at 17 cents per capita this is certainly a small price to pay for dental health for the children of Canada.
For a moment or two I should like to mention a scheme that is in vogue in England. When this scheme was introduced it was found that people believed everything was free so everybody was getting dentures whenever they felt like it. They would drop them and break them, then come back for new

Health Insurance
dentures. It was soon found that in order for this scheme to work at all there had to be a nominal sum paid by each person. As soon as this scheme was instituted it was remarkable how many fewer dentures were necessary in order to satisfy the public. The thing about socialized dentistry that hurts most is the number of dental cripples that are created. I have a practice that consists mostly of children, and I have been amazed at the number of children who have come from England for whom the dental profession have yanked out teeth rather than provided adequate preventive measures. This, in essence, has created dental cripples because many of these teeth, if they had been filled at the proper time, would have saved the child a much greater expense in later life. Perhaps that is the result of conditions under socialized dentistry, but perhaps there are other reasons to be considered. However, it seems to me the dental profession in socialized countries tends to lack the same pride which we, as dental practitioners in Canada, have.
I am sure that every dentist in this country has thousands of dollars on his books representing treatments which he has rendered and for which he will never secure a dollar, a large part of it he does not expect to collect because we feel that this is a part we are playing for society. I think the great amount of work that is being done by dentists in various dental health and treatment programs which are in vogue today should not be overlooked. There are many of these treatment programs set up by service clubs. Many service clubs from various cities tend to sponsor dental clinics. They approach the dentists who work in these clinics for one morning per week for a very nominal sum, certainly much less than they could earn in their own offices. They do this because they know the need is there, and certainly they are only too happy to co-operate in this regard.
We must always consider the attitude of the public towards dental care. I know when I was in the Canadian officers training corps treating service personnel we often found soldiers and airmen for whom we would prescribe a treatment plan but they would say, no, we want our teeth pulled; we do not want them filled. This again points up the great impact education could have upon people. It seems to me if we can only educate the people to follow the proper diet they would only have to spend half the money to provide a better diet than they have today. They would have much healthier teeth.
Regardless of how a dental health insurance plan would be brought in, one of the most

important considerations would be that it be directed toward the children. The children are most important in this treatment scheme because we get incidence of dental caries at the age of two. By the age of four, 50 per cent of the children already have dental caries. So often before a child is able to care for itself or to have any realization of the impact of lack of care for his teeth he is already a dental cripple. As the hon. member for Prince (Mr. Phillips) mentioned, one of the things about which you have to be very careful is that the patient-doctor relationship is maintained. It is extremely important and when this relationship is destroyed, then I am sure the general respect for the profession would be destroyed along with it.
I could not conclude my remarks without mentioning the great advances there have been in the technology and practice of dentistry. It has been possible with the recent advances, the more modern drills and so forth, to do a great deal more work than was ever possible before. This is certainly a good sign because in many parts of the country the personnel is limited and these advances mean that many more will be able to receive treatment. Perhaps as more and more people realize that health insurance is not necessary in dentistry but that group purchase plans are the answer, groups of people such as civil service organizations or unions, will underwrite such plans. There are a great number of them in vogue in the United States and they are becoming more popular in Canada. When this day arrives we shall certainly be on our way to understanding a great deal more about this problem.
May I move the adjournment of the debate, Mr. Speaker?


William Arnold Peters: I should like to ask for the suspension of the standing order and request unanimous consent to allow the minister to reply to some of these suggestions.


Some hon. Members:: Agreed.


Some hon. Members:: Ten o'clock.



BUSINESS OF THE HOUSE

Lionel Chevrier: May I inquire what the business is for tomorrow, Wednesday and Thursday, if you like?


Gordon Minto Churchill: Tomorrow we will carry on with the supplementary estimates. If they are completed we will proceed then with the resolution standing in the name of the Prime Minister dealing with tenure of office for judges; following that, the resolution standing

in the name of the Minister of Public Works dealing with the National Housing Act. If those items are finished, then we shall take the motion in the name of the Minister of Citizenship and Immigration to set up a joint committee to consider the Indian Act. For Wednesday, I think those will be the items that we will consider, but not necessarily in
Business of the House that order. I may have to make an announcement tomorrow night about that. For Thursday, much will depend on whether or not the supplementary estimates are cleared away.


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

[Stage Direction]
The following answers, deposited with the Clerk of the house, are printed in the official report of debates pursuant to standing order 39:

Mr. McWilliam: 1.	What was the increase, if any, of persons employed by the federal government in 1959 as compared to 1958?
Persons employed by federal government in departmental branches, services
and corporations	
Persons employed in agency and proprietary crown corporations and other agencies	
2 and 4: The latest available figures are for September, 1959 and show:
Total earnings of persons employed in departmental branches, services and
corporations*	
Total earnings of persons employed by crown corporations	
*Includes the R.C.M.P. but excludes the armed forces.


LABOUR FORCE SURVEY ENUMERATORS
Mr. Howard: 1.	Since July 1, 1957 have any representations or recommendations been made to the government or any department or agency thereof, regarding appointments as labour force survey enumerators?
2.	If so, what is (a) the name and address and occupation, if occupation is applicable, of each person or organization who made such representations or recommendations; (b) the date of each such representation; (c) the name and addresses of each person recommended by each such person or organization; (d) the disposition of each such recommendation?
Answer by: Hon. Gordon Churchill (Minister
of Trade and Commerce):
1.	Yes.
2.	The detailed information requested is not available. Neither the Department of Trade and Commerce nor the dominion bureau of statistics maintains records of the source from which interested individuals are made known. In many cases enumerators are required in areas where no applicants are readily available. In these cases it is
2.	What were the total earnings of persons, apart from the armed services, employed by the federal government in 1959 as compared to 1958?
3.	What was the increase, if any, of persons employed by crown corporations in 1959 as compared to 1958?
4.	What were the total earnings of all persons employed by crown corporations in 1959 as compared to 1958?
Answer by: Hon. Gordon Churchill (Minister
of Trade and Commerce):
1 and 3: The latest available figures are for September, 1959 and show:
September
1958 1959	Increase
196,736 199,074	2,338
143,385 144,878	1,493
Oct. 1, 1957	Oct. 1, 1958
to	to
Sept. 30, 1958	Sept. 30, 1959
$699,589,000	$728,727,000
$562,819,000	$586,586,000
necessary for the officers of the dominion bureau of statistics to recruit from any source available. However, before any appointment is made, the individual must have passed a written qualifying examination and been successful in convincing a field representative of the dominion bureau of statistics as to his personal qualifications. Each regional office of the dominion bureau of statistics maintains a record which is limited to (a) the name and address of each individual appointed as an enumerator and (b) the usual administrative records of each individual's performance as an enumerator. A list of the enumerators was provided to the hon. member on February 2, 1960, in answer to Inquiry No. 38.


EXPORTS CREDITS INSURANCE APPLICATIONS
[Stage Direction]
Question No. 222
George James McIlraith: 1.	Have any applications been made to the export credits insurance corporation, since the coming into force of the act, 1959 statutes, chapter 24, for (a) guaranteeing the payment of promissory notes, bills of exchange or other negotiable instruments; (b) the sale to the corporation of a guaranteed instrument; (c) lending money upon the security of a guaranteed instrument?
2.	If any such applications have been made and refused, what were the reasons for the refusals?

Answer by: Hon. Gordon Churchill (Minister of Trade and Commerce):
1.	(a) Yes. (b) No. (c) No.
2.	None refused.


DREDGE CONSTRUCTION, BURRARD SHIPYARD, B.C.
Mr. Bourget: 1. Is a new dredge being built at the Burrard shipyard in British Columbia?
Questions
2. If so, is it being equipped with a Canadian engine? If not, from which country is the engine to be procured?
Answer by: Hon. D. J. Walker (Minister of Public Works):
1.	Yes.
2.	No. The engine is being procured from Holland.

Tuesday, March 1, 1960