1966-11-29

EXTERNAL AFFAIRS


[Stage Direction]
On the orders of the day:
Right Hon. J. G. Diefenbaker (Leader of the Opposition):: Mr. Speaker, I do not know whether or not the Prime Minister is in a position to report to the house, but I would hope he would be able to say something regarding the ominous situation in the Middle East and the report today that various areas in the Middle East are on the brink of an explosion the like of which has not been seen since 1956.


Right Hon. L. B. Pearson (Prime Minister):: Mr. Speaker, I can only express the hope that the report to which my right hon. friend has referred, that we are on the brink of an explosion in that area involving greater danger than that of 1956, will turn out to be greatly exaggerated. It is true that a dangerous situation has developed as a result of Israel's reaction against what it considered to be serious border provocation. This is the matter which was dealt with by the United Nations Security Council when a resolution was passed criticizing Israel's reaction.
It is also true that there was a report about an air engagement that took place this morning. According to the information so far available, and naturally we are making further inquiries, a small number of Israel and United Arab Republic aircraft were engaged in an action near the midpoint between the Israel and Arab borders. Early reports indicate that two U.A.R. aircraft were shot down in this encounter.
As hon. members are aware, the United Nations has a peace-keeping force stationed in this area. I think we can take some satisfaction from the knowledge that this force is there. We expect to have more precise information shortly and when that information arrives I will report to the house at once.


MIDDLE EAST-SHIPMENT OF STARFIGHTERS BY U.S. TO JORDAN
[Stage Direction]
On the orders of the day:
John George Diefenbaker: Will the Prime Minister say whether or not Canada was made aware in advance of the shipment of 36	F-104
Starfighters by the United States to Jordan? Was there any consultation between the United States and Canada before that action was taken and, if so, what attitude did Canada take?


Lester Bowles Pearson: I have seen that report and inquiries are being made to ascertain whether there is any foundation to it, and whether this transfer has in fact taken place. I will be glad to report in that regard as soon as I receive further information.


John George Diefenbaker: Will the Prime Minister allow one more question? Does his answer mean that an inquiry is being made as to whether the United States is shipping or has shipped these aircraft, and that there was no consultation between Canada and the United States before this action was taken, if in fact it was taken?


Lester Bowles Pearson: Mr. Speaker, my answer indicates that I have not received authoritative information as to whether or not the transfer in fact has taken place. That is what we are inquiring into.



LABOUR RELATIONS


[Stage Direction]
On the orders of the day:
Mr. T. C. Douglas (Burnaby-Coquiilam):: Mr. Speaker, I should like to direct a question to the Minister of Labour regarding reports that the B.C. Maritime Employers Association has decided not to call out working crews, thus constituting a giant lockout in consequence of which, it is reported, some 50 or 60 ships are tied up in the Vancouver harbour. Has this situation been drawn to the minister's attention and what, if anything, is he or his department doing about it?
November 29, 1966

Inquiries of the Ministry


Hon. J. R. Nicholson (Minister of Labour):: Yes, Mr. Speaker, this situation has been drawn to my attention and I have had a discussion about it within the last 15 minutes. The employers have taken and continue to take the position that since they have had to resort to the use of the courts by way of damage actions, and have indicated that they intend to proceed to enforce their legal rights through the courts, consequently this matter is sub judice, and this makes it very difficult for the Minister of Labour or any other official of government to intervene at this time. The employers have stated, and they make no bones about it, that while they have a limited number of supervisory employees, namely their foremen and some former foremen who have been recruited for service, they cannot provide all the direct supervision needed in view of what they allege is a planned work stoppage. Since they are not getting the return for the money they are expending, they have decided on this course of action and have said they are going to press their rights in the courts.


Thomas Clement (Tommy) Douglas: A supplementary question, Mr. Speaker. While the damage action has to do with the employers and does not come under the purview of the Department of Labour, surely the matter of a lockout does. What action does the minister propose to take to see that these men are allowed to return to work and that the ports are allowed to function?


John Robert (Jack) Nicholson: The position that they take is that this is not a lockout. Complaints have been made by some employees that they do not have adequate supervision in certain areas, and employers say on the other hand that it is impossible for them to function effectively.


John Robert (Jack) Nicholson: While I am on my feet I wish to deal with a question asked earlier by the hon. member for Burnaby-Coquitlam (Mr. Douglas). Information that I have received since the question was asked shows that some stevedoring companies on the west coast have not ordered the longshoremen's gangs out to work general cargo-but bulk cargo is still being handled by the gangs. Supervision is being provided by available foremen. My information happily is that grain loading is moving fairly well.



HEALTH AND WELFARE


[Stage Direction]
On the orders of the day:
Mr. Real Caouette (Villeneuve):: Mr. Speaker, I should like to put a question to the Minister of National Health and Welfare.
We are now considering Bill No. C-227 dealing with the medical care plan. Has the minister received any representations from the various provinces asking for the inclusion in that bill of services rendered by podiatrists, optometrists, chiropractors and, if so, does he intend to accede to those requests?


Mr. Speaker:: Since the hon. member said himself that the bill was now before the house, he could easily put this question during the discussion in committee.


David Réal Caouette: On a point of order, Mr. Speaker. I realize that I can ask questions in committee. Besides, I took that opportunity last night, but I would like to know whether the minister's intention is to include in Bill No. C-227 the services of podiatrists, chiropractors and optometrists.


Mr. Speaker:: The hon. member put the same question at ten o'clock last night when the house adjourned and it is my impression that he will probably raise it again later this afternoon.


EXTERNAL AFFAIRS
[Stage Direction]
On the orders of the day:
Mr. R. N. Thompson (Red Deer):: Mr. Speaker, my question is addressed to the right hon. Prime Minister. In view of the pending visit of Sir Saville Garner, Undersecretary of State for Commonwealth Relations of the British government, to Washington and Ottawa, could the Prime Minister inform us whether he has had consultation with our representative in London serving as chairman of the sanctions committee on Rhodesia, or with the British government with regard to the reply they have received from the Rhodesian government?


Lester Bowles Pearson: Yes, Mr. Speaker, we have been in continuous consultation through our High Commissioner at Canada House, the United Kingdom
November 29, 1966	COMMONS DEBATES
High Commissioner here and the British government direct on this matter. As my hon. friend knows, the Secretary of State for Commonwealth Relations was in Salisbury visiting the governor for a few days. He has returned to London with certain suggestions made by the de facto government in Salisbury, apparently, through the governor. I understand that the Undersecretary of State for Commonwealth Relations, as my hon. friend has mentioned, will be visiting Washington and Ottawa. I expect to see him when he arrives Friday morning, when he will be bringing the views of the United Kingdom government on the question, presumably, of selective mandatory sanctions which might be put forward by the British government to the United Nations in case the talks with the Rhodesian government in Salisbury finally break down. That is all I think I can say at the moment.


Thomas Clement (Tommy) Douglas: supplementary question, Mr. Speaker. I should like to ask the right hon. Prime Minister this question. Assuming that the talks break down, am I right in assuming that the Canadian government will support economic sanctions under article 7 of the United Nations charter?


Lester Bowles Pearson: Mr. Speaker, we have already stated that in the event talks break down and the United Kingdom government produces a resolution at the United Nations for selective mandatory sanctions, after discussion with the British and other commonwealth governments, we would support that resolution.


David Réal Caouette: I have a supplementary question, Mr. Speaker.
The right hon. Prime Minister, as he has just stated, is very well aware of the Rhodesian situation. However, when the right hon. prime minister there, Mr. Ian Smith, decides to disregard both the commonwealth of nations and Canada, is the right hon. Prime Minister of Canada in a position to say whether Canada will approve of coercive action against the Smith government or whether Canada is getting ready to recognize what Mr. Smith is now doing in Rhodesia?


Lester Bowles Pearson: Our position has been made quite clear, that we do not accept the legitimacy of what my hon. friend calls "the Smith
Inquiries of the Ministry government" in Salisbury, and we have already joined other Commonwealth governments in taking economic action against that government through voluntary sanctions. If the matter of UN economic sanctions comes before that body, we would support them, as I have just indicated, if they were on a satisfactory selective basis.



AIR POLLUTION


[Stage Direction]
On the orders of the day:
Mr. Heward Graffley (Brome-Missisquoi):: Mr. Speaker, my question is addressed to the Minister of National Health and Welfare. In the last few days a near crisis situation arose in many eastern seaboard cities because of smog and air pollution. One Canadian city was mentioned in the news dispatches. Last week the minister said he would study and answer my question relating to anti-fume devices in 1968 cars. Can he now inform the house whether or not Canadians will enjoy the same protection in 1968 as will United States citizens in this regard?


Hon. A. J. MacEachen (Minister of National Health and Welfare):: Mr. Speaker, according to the information which was made available to officials of my department by the manufacturers, the safety devices contemplated will be available for cars for Canadian distribution.


William Heward Grafftey: On a supplementary question: Will all cars made in or imported to Canada be equipped with these anti-fume devices, and are Canadians being protected solely because of United States federal government initiative in this regard or because the Canadian government has passed similar regulations?


Mr. Speaker:: Order. I wonder whether the second question is in order.


William Heward Grafftey: I have a further supplementary, Mr. Speaker. In this regard do the Canadian people have to wait on United States initiative and regulations for protection?


Mr. Speaker:: Order, please. I think the supplementary question is argumentative.



PUBLIC SERVICE


[Stage Direction]
On the orders of the day:
Mr. Paul Tardif (Russell):: Mr. Speaker, my question is directed to the President of the Treasury Board.
November 29, 1966

Inquiries of the Ministry


An hon. Member:: You will win an election on that.


Some hon. Members:: Hear, hear.


Paul Tardif: Thank you very much. That is accepted with a great deal of humility.
Since the successful solution of the negotiations with the postal employees can the minister advise what is being done or contemplated in respect of other employees in group D?


Hon. E. J. Benson (Minister of National Revenue and President of the Treasury Board):: Mr. Speaker-


Mr. Starr:: The minister cannot answer the question from memory; he has to read it.


An hon. Member:: Why does the hon. member for Russell ask the minister that question?


Michael Starr: Which came first, the question or the answer?


Edgar John Benson: Mr. Speaker, since the successful intervention of Judge Montpetit as mediator to settle the recent dispute with the postal workers, discussions with the Public Service Alliance and the proposed interim increase recommended by the Civil Service Commission for group D have continued.
These discussions were resumed on a bilateral basis at the request of Judge Montpetit who felt that further direct exchanges between representatives of the employer and the Public Service Alliance might prove useful.
These discussions have now reached a point where it would seem to be timely to request Judge Montpetit to enter the picture once again. I have therefore arranged for him to return to Ottawa to resume his functions as mediator in that portion of the dispute which involves the Public Service Alliance, which incidentally represents some 28,000 employees in group D. Judge Montpetit has arranged on very short notice to come to Ottawa tomorrow, and I am hopeful that he will be able to achieve without undue delay a successful result for this group of employees, as he did in the case of the postal workers.


John George Diefenbaker: Mr. Speaker, I rise on a point of order. I would have thought Your Honour would have stopped this self-serving statement prepared in advance. It should have been made before the orders of the day. It is very wrong to use up time by this kind of self-serving procedure. I will not say that the question was planted: The question was seeded.


Edgar John Benson: Mr. Speaker, on a point of order, I believe that the settlement in respect to the 28,000 employees in group D-


Michael Starr: Mr. Speaker, on a point of order-


Edgar John Benson: -who are in the same classification as the postal workers is an important concern to this house.


Mr. Speaker:: Order. I understood that the minister was rising on a point of order.


John George Diefenbaker: The minister was making a gratuitous statement that does not answer the question. The concern now being expressed for civil servants is belated, and this is an alibi.


Edgar John Benson: On a point of privilege, Mr. Speaker, I should like to say that no government in history has had more concern for civil servants than the present government.


Mr. Speaker:: Order. I doubt whether much could be served by pursuing the point of order, the question or the statement, which it has been suggested was more than a mere answer to a question. There may be some merit in the point raised by the Leader of the Opposition, but the question appeared to be genuine, whether seeded or not. I am afraid that many questions asked from time to time are either seeded or planted, and it is very difficult for the Chair arbitrarily to rule whether or not they are in order. In any event the question was asked, it has been answered and we have had a point of order and a question of privilege. Perhaps we might now go on to something else.



REQUEST FOR ADDITIONAL SUPERANNUATION BENEFITS

[Stage Direction]
On the orders of the day:
John George Diefenbaker: Mr. Speaker, in view of the interest expressed in civil servants I would ask the Prime Minister whether the government has given consideration to the request of the Civil Service Association of Canada contained in a 12-page letter delivered to the government on November 7 asking for action to be taken on behalf of retired civil servants, the R.C.M.P. and armed forces personnel who retired prior to 1953. What action will be taken in this connection?


Lester Bowles Pearson: Mr. Speaker, this matter is under active consideration.
November 29, 1966



NATIONAL DEFENCE


[Stage Direction]
On the orders of the day:
Mr. J. M. Forrestall (Halifax):: Mr. Speaker, my question is unsolicited and probably unwanted. Nevertheless I direct it either to the Minister of National Defence or the associate minister. Could either minister confirm to the house what is now a matter of public record, having appeared in at least one major daily newspaper in Canada, and that is the colour of the uniforms proposed for the new Canadian armed forces?


Mr. Winkler:: Answer.


J. Michael Forrestall: On a question of privilege, Mr. Speaker, surely this type of information cannot be allowed to continue to be spread throughout the country by the minister at his discretion. If he is out flying balloons or kites, that is one thing; but surely the house is entitled to have an answer to this question.


Mr. Speaker:: Unfortunately for the hon. member the rules do not provide that he is entitled to an answer, or an answer that would satisfy him. If the minister chooses not to reply there is nothing more the Chair can do to help the hon. member.


Hon. Paul Hellyer (Minister of National Defence):: Mr. Speaker, the story that appeared in the newspapers was strictly speculative.


An hon. Member:: The story was quoting you.


Paul Theodore Hellyer: The story did not come from any reliable source that I know about. In any event, when these decisions are taken they will be announced in the usual manner, and I hope I will be able to advise the members of the armed forces before any public announcement is made.


J. Michael Forrestall: A supplementary question, Mr. Speaker. I thank the hon. minister for answering, but are we to conclude that this is just speculation, as the minister suggests, and has no foundation in fact?


Paul Theodore Hellyer: It is about as pure speculation as can be, Mr. Speaker.



WHEAT-REQUEST FOR HIGHER PRICE IN INTERNATIONAL NEGOTIATIONS

[Stage Direction]
On the orders of the day:
Hon. Alvin Hamilton (Qu'Appelle):: Mr. Speaker, my question is for the Minister of

Inquiries of the Ministry Trade and Commerce. Has the question I asked last Wednesday been brought to the attention of the minister?


Hon. Robert Winters (Minister of Trade and Commerce):: Mr. Speaker, it has. On Wednesday last the hon. member for Qu'Appelle sought information on the international negotiations with respect to the price of wheat. These negotiations are taking place in the GATT cereals group as an important element of the Kennedy round. In these negotiations Canada, together with the other chief exporting countries, including the United States, is seeking a significantly higher price range than that provided under the current international wheat agreement.


Francis Alvin George Hamilton: A supplementary question, Mr. Speaker. Do I understand that there are no plans to carry out negotiations at all with the International Wheat Council? Does the minister's answer mean that the long-term international wheat agreement is now defunct?


Robert Henry Winters: No, I do not believe that assumption would be quite valid. The council representative is in close touch with the negotiations going on at GATT and I think it is fair to say that he has a part to play in the general discussions and negotiations.



THE BUDGET


[Stage Direction]
On the orders of the day:
Mr. Stanley Knowles (Winnipeg North Centre):: Mr. Speaker, my question is directed to the Minister of Finance. Is the minister reconsidering his previously announced intention to bring in a baby budget, the principal feature of which would be increased taxation for pension purposes?


Hon. Mitchell Sharp (Minister of Finance):: No, Mr. Speaker. The intention of the government is to proceed with a small budget before Christmas. Of course I might have to change my mind about that if the house does not make satisfactory progress in other legislation. As the hon. member has said, the principal feature of that budget would be to raise money to pay this very important supplement to old age pensions.


Stanley Howard Knowles: A supplementary question, Mr. Speaker. Because of the amount of money in the old age security fund, is increased taxation for this purpose necessary?
November 29, 1966

Inquiries of the Ministry


Mr. Speaker:: Order, please. I do not think the question is in order.



OLD AGE SECURITY


[Stage Direction]
On the orders of the day:
Hon. E. D. Fulton (Kamloops):: A supplementary question, Mr. Speaker, directed to the Prime Minister. Now that the house is well launched in its committee discussion of the medicare legislation and as we have the resolution preceding the old age legislation on the order paper, is the Prime Minister in a position to give the house the assurance that the government has its legislation dealing with old age pensions ready to introduce into the house the moment the resolution passes?


Lester Bowles Pearson: Mr. Speaker, it has been ready for some time.
While I am on my feet-


Edmund Davie Fulton: A supplementary question, Mr. Speaker, so that the Prime Minister may deal with this matter as well. Can the right hon. gentleman tell us when, under the provisions of this legislation, the first cheques incorporating the increases will be available to the recipients?


Mr. Speaker:: Order, please, I doubt if that
question is in order.



NATURAL GAS


[Stage Direction]
On the orders of the day:
Robert Norman Thompson: My question is directed to the Minister of Energy, Mines and Resources. Because of statements made in the Federal Power Commission hearings in Washington yesterday, rejecting the proposal to import Canadian gas into the United States on the basis of the gas being too expensive as compared with Texas gas, can the minister tell the house of any communication or information coming from those F.P.C. hearings?


Hon. Jean-Luc Pepin (Minister of Energy, Mines and Resources):: Mr. Speaker, may I take this question as notice and answer tomorrow?



AGRICULTURE


[Stage Direction]
On the orders of the day:
Mr. Alcide Simard (Lac-Saint-Jean):: Mr. Speaker, I have a question for the Minister of Forestry and Rural Development.
Would he tell the house whether the matter of setting up community pastures, especially in underdeveloped designated areas, comes within the jurisdiction of ARDA?


Mr. Speaker:: I think the hon. member is asking the minister for an interpretation of an act, and that type of question is not acceptable.



HOUSING


[Stage Direction]
On the orders of the day:
Mr. John Addison (York North):: Mr. Speaker, my question is for the Minister of Labour, who is responsible for Central Mortgage and Housing Corporation. In view of the report in the Globe and Mail this morning that President Johnson has ordered the release of $250 million in special federal mortgage funds to spur the lagging construction of housing in the United States, and because the housing shortage appears to be a North American problem stemming from a lack of funds, is the government contemplating making additional funds available for direct C.M.H.C. loans?


John Robert (Jack) Nicholson: Mr. Speaker, the government's program for direct loans-and direct loans of course include loans for public housing as well as those in the private sector-is under study. A number of officials were actively engaged in a special study yesterday. They have been studying the matter for some time. The government's program for next year will be announced within the next week or so. Certainly it will be announced before 1967.


John Hollings Addison: A supplementary question, Mr. Speaker. May I ask the minister if figures are available showing the ratio between direct C.M.H.C. lending here, and direct lending in the United States, on a per capita basis?


Mr. Speaker:: Order, please. That question seeks statistical information and cannot be asked at this time.
November 29, 1966	COMMONS DEBATES	10495


John Robert (Jack) Nicholson: Mr. Speaker, having read the article-


Mr. Speaker:: Order, please. The hon. member for Gaspe.



C.M.H.C.-POSSIBLE REDUCTION IN DOWN PAYMENTS

[Stage Direction]
On the orders of the day:
Mr. G. H. Aiken (Parry Sound-Muskoka):: supplementary question, Mr. Speaker. May I ask the minister if consideration is being given to reducing the down payments on Central Mortgage and Housing Corporation's houses?


John Robert (Jack) Nicholson: have no knowledge of such a proposal. May I take the question as notice.



UNEMPLOYMENT INSURANCE ACT


[Stage Direction]
On the orders of the day:
Mr. J. R. Keays (Gaspe):: On November 25 I inquired of the Minister of Labour if certain amendments to the unemployment insurance regulations had been approved by cabinet. The minister misunderstood me at the time, thinking I referred to agricultural amendments. I now ask the minister if amendments have been approved concerning forestry operators?


Mr. Speaker:: The hon. member for Wellington South.


James Russell Keays: I do not believe the Minister of Labour heard the question.


An hon. Member:: Read the Globe and Mail.


John Robert (Jack) Nicholson: beg your pardon, sir. There was a diversion on my right. I did not hear the question.


James Russell Keays: I repeat the question. On November 25 I inquired of the minister about amendments to the U.I.C. regulations. The minister at that time thought I was referring to amendments concerning agricultural employees, whereas I was referring to amendments affecting forestry operators or employees.


John Robert (Jack) Nicholson: Mr. Speaker, if I misunderstood the import of the hon. member's earlier question, I apologize.
The hon. member asked about an earlier statement that I had made. In that earlier statement, in a reply I believe that I gave to the 23033-664
Inquiries of the Ministry hon. member for Humboldt-Melfort-Tisdale (Mr. Rapp), I stated that the new regulations had been passed by the government and were being gazetted. These are the only U.I.C. regulations which have as yet been passed by this government. I have no knowledge of other pending changes in the regulations.


James Russell Keays: As a supplementary question, Mr. Speaker, since I was informed last June that studies were being undertaken with a view to amending the legislation affecting the employees, would the minister pursue this matter in view of the pressing need to do so?


John Robert (Jack) Nicholson: Mr. Speaker, I think I should mention that the interdepartmental committee that was announced by the Prime Minister some months ago has completed its studies dealing with proposed or suggested amendments to the Unemployment Insurance Act. That report, which is a very detailed and comprehensive one, is now under study by me, and I hope to be laying it before my colleagues in the cabinet before too long. I cannot guarantee, however, that this would be within the next two or three weeks.



EXPO '67 USE OF SYMBOL ON PRINTED MATERIAL

[Stage Direction]
On the orders of the day:
Mr. A. D. Hales (Wellington South):: Mr. Speaker, may I direct a question to the Minister of Trade and Commerce. It arises from inquiries I have received from printers, publishers and business houses, wondering whether it is permissible to use the insignia or emblem for Expo on certain printed material that they are preparing for publication. Would the minister state the policy in this regard?


Robert Henry Winters: Mr. Speaker, I wish to thank the hon. member for giving me notice of his question and I shall endeavour to answer it. The regulations covering the use of the symbol are set forth in the corporation's publication called the Graphics Manual. It is necessary to obtain permission in writing to use the symbol; but generally speaking the Expo corporation, and all of us, wish to see the widest possible use of the symbol. It is therefore general practice to grant permission for the use of it to anybody who wishes to use it to promote the interests of Expo.
If it is to be used for the specific purpose of increasing the saleability of a product, then permission must be obtained in writing and a small fee, negotiable between the user and the
November 29, 1966

Inquiries of the Ministry corporation, is charged. Otherwise no fee is charged.



POSSIBILITY OF FURTHER PUBLICITY IN U.S.

[Stage Direction]
On the orders of the day:
['Hear, hear.']
Mr. David MacDonald (Prince):: As a supplementary question, Mr. Speaker, in light of the fact that a recent survey indicated that most Americans are still unaware of what Expo means, or what the Expo symbol is, can the minister say whether increased advertising is contemplated in the United States, or whether consideration has been given to the use of another name?


Robert Henry Winters: No, Mr. Speaker, there is no intention to use another name. The message is getting home. There is more penetration now and recent surveys have shown that Expo is better known and understood in the United States.



[Stage Direction]
On the orders of the day:
Lester Bowles Pearson: Mr. Speaker, yesterday I indicated in reply to a question that we would be participating in meeting or helping to meet the requirements for imported food into India to cope with the danger of famine, a very real danger in that country. Canadian officials have been examining the Canadian supply and transportation situation and, on the basis of the present evidence, they have advised the government that up to $21 million worth of foodstuffs required by India, largely wheat but some flour, could be moved in the next few months.
The government will therefore ask parliament to provide in the current fiscal year a supplementary vote of $22,500,000 for food aid, and in the fiscal year 1967-68 parliament will be asked to vote $75 million for food aid. This, Mr. Speaker, will permit Canada to maintain the food aid program for India at the exceptionally high level of the current year, and also to make an appropriate response to the requests that have come in from Pakistan for Canadian assistance in this field.


Some hon. Members:: Hear, hear.



INDIAN AFFAIRS


[Stage Direction]
On the orders of the day:
Mr. Frank Howard (Skeena):: Mr. Speaker, I would like to direct a question to the Minister of Indian Affairs and Northern Development and ask whether his deputy, Mr. Cote, was correct in declaring in Quebec city recently that the government is preparing legislation to protect Indian arts and crafts?


Hon. Arihur Laing (Minisier of Indian Affairs and Northern Development):: Mr. Speaker, my deputy rushed to me the following morning to assert that he had made no such statement.


Frank Howard: As a supplementary question, Mr. Speaker, may I ask the minister whether in fact he is preparing such legislation.


Arthur Laing: Mr. Speaker, I am preparing it. [Translation]



FINANCE


[Stage Direction]
On the orders of the day:
David Réal Caouette: Mr. Speaker, I wish to direct a question to the Minister of Finance.
A few days ago I asked him if the $5,400,000 loan made by Canada to Mexico was an interest free loan granted by the Bank of Canada or some other Canadian financial body. The minister told me then that he was taking my question as notice. Is he today in a position to tell me if interest is being charged on that amount of $5,400,000?


Mitchell William Sharp: Mr. Speaker, I draw the hon. member's attention to yesterday's Hansard, page 10445 and there he will find the answer.


David Réal Caouette: I wish to ask a supplementary question.


Mr. Speaker:: Order. The hon. member cannot ask a supplementary question to a question ruled out of order.


David Réal Caouette: I wish to direct a supplementary question to the Minister of Finance.
He told me to refer to yesterday's Hansard. Now, is the minister in a position to tell the
November 29, 196G

house how much time Mexico will have to repay that $5,400,000 loan?


Mr. Speaker:: Order. I do not know to what extent it is possible for me to rule out of order the second part of the question, but it seems to me that the hon. member is now asking for detailed information which could be easily obtained some way other than asking a question at this stage of our proceedings.


David Réal Caouette: Mr. Speaker, in view of the fact that the hon. Minister of Finance is authorized to tell me the rate of interest, which is 6 per cent on the amount of $5,400,000, could the minister not also inform the house as to the length of time for which it is granted to Mexico?


Mr. Speaker:: Order. I was worrying about this. I think the hon. minister did not have the right to tell the member what the interest was.



INDUSTRY


[Stage Direction]
On the orders of the day:
Michael Starr: Mr. Speaker, following up the question I posed to the Minister of Labour yesterday regarding the supplementary brief of the city of Oshawa in respect to the impact of the auto pact on that city, I wish to ask the minister when the city of Oshawa can expect reasonably to receive a reply or decision on the requests contained in that supplementary brief?


John Robert (Jack) Nicholson: At an early date, Mr. Speaker.



RECORDING OF DEBATES BY UNIVERSITY STUDENTS

[Stage Direction]
On the orders of the day:
Mr. J. R. Tucker (Trinity-Conception):: Mr. Speaker, I wish to direct a question to the Minister of Public Works, and I hope he will forgive me for not giving him notice of my intention to do so.


Thomas Clement (Tommy) Douglas: Absolution granted.


James Roy Tucker: In view of the action by five Carleton University students in taping 30 minutes of the question period in the house last Thursday, does the minister propose to tighten security measures for the protection of members and of the press gallery?
Inquiries of the Ministry


Mr. Speaker:: Order. I am sure the hon. member knows that this is a matter which comes under the jurisdiction of the Speaker. Perhaps he would like to communicate with the Chair in this respect.



CANADIAN BROADCASTING CORPORATION


[Stage Direction]
On the orders of the day:
Hon. Judy V. LaMarsh (Secretary of State):: Mr. Speaker, the other day the right hon. Leader of the Opposition (Mr. Diefenbaker) asked for additional information respecting recent announcements regarding Mr. Earl Cameron of the C.B.C., which I have now obtained. Effective December 11, Mr. Stanley Burke, former C.B.C. correspondent in Paris and London, is to replace Mr. Earl Cameron as regular night national news reader on the C.B.C. English television network.
It is proposed that Mr. Cameron be reassigned to early evening network news. This will have the effect of replacing Mr. Lamont Tilden in the latter assignment; but this is no reflection of Mr. Tilden's ability nor does it mean that he can no longer be useful as a news announcer.
The replacement of Mr. Earl Cameron does not represent any change in the basic policy of C.B.C. news, nor is it a demotion for Mr. Cameron. The Cameron-Burke change was first recommended by the management of the news service as part of a plan to develop broadcasters who would be able to combine the specialized talents of both announcers and news reporters. This plan has been discussed with the two unions involved and, as an interim step, the appointment of Mr. Burke, a qualified journalist, to the role of news reader for the national news bulletin was recommended by the news service and approved by senior management of the corporation.
In using an experienced professional journalist to present the news, the C.B.C. is following a practice which is widely and successfully used elsewhere. The forthcoming changes constitute a re-assignment and in no way reflect on Mr. Cameron, an outstanding news reader who has been appreciated by the Canadian audience.


Some hon. Members:: Hear, hear.


Michael Starr: Is everybody happy now?


John George Diefenbaker: Mr. Speaker, I should like to ask

November 29, 1966
Medicare
the minister a question. What did the union which represents the broadcasters have to say regarding this decision and, second, what qualifications has Mr. Burke, great as they are, to take the place of one who throughout the years has been able to enunciate the news and place before the people of Canada what is taking place day after day in a way which has met with general approval? Why change it?


Julia Verlyn (Judy) LaMarsh: Mr. Speaker, I do not wish to appear to be flippant about this matter because it is obvious from correspondence that a number of people would prefer to continue on with what has been the practice in the past, and retain Mr. Cameron. There really seems to be little more information I can obtain. It is within the C.B.C.'s responsibility to manage and they have decided in the news department to try a new look. While I am quite aware of what my right hon. friend and members of the public are saying, I really feel I have no right to interfere in this matter and can only report to him what the situation is.



GENERAL POLICY IN ANNOUNCING NEWS

[Stage Direction]
On the orders of the day:
Julia Verlyn (Judy) LaMarsh: To answer a further query of the right hon. gentleman, the C.B.C. news will continue to be governed, as it has been since the establishment of the service in January, 1941, by the following policy directive:
Integrity of C.B.C. News:	The policy which
guides operations of the C.B.C. National News Service is based on the primary conception that the service is in the nature of a public trust: to present by radio and television all the significant news of the day's happening in Canada and abroad factually, without bias or distortion, without tendentious comment, and in a clear and unambiguous style.
[DOT] (3:20 p.m.)



HEALTH AND WELFARE


[Stage Direction]
The house resumed, from Monday, November 28, consideration in committee of Bill No. C-227, to authorize the payment of contributions by Canada toward the cost of insured medical care services incurred by provinces pursuant to provincial medical care insurance plans-Mr. MacEachen-Mr. Batten in the chair.
On subclause (d)-"insured services".
The Chairman:: When the committee rose last evening we were dealing with subclause
[Mr. Diefenbaker.l
(d) of clause 2 and the amendment proposed by the hon. member for Winnipeg North Centre. If it is the wish of the committee, I am prepared at this time to make a ruling on the amendment.


Some hon. Members:: Agreed.


David Réal Caouette: I am in agreement as long as I do not lose my right to speak afterwards.


Herman Maxwell Batten: First of all, I should like to thank hon. members for the contributions which they have made to the discussion in respect of whether or not the amendment before the committee at this time is valid. Much of the discussion which followed the moving of the present amendment by the hon. member for Winnipeg North Centre centred around the desirability of including in insured services the services of optometrists. As I pointed out on an earlier occasion, this is not a matter to be decided by the Chair. What will be or will not be included must be defined by the bill itself.
The question to be decided by the Chair is whether or not the present amendment is procedurally correct, and whether it involves charges or obligations over and above what was authorized by the resolution which preceded Bill No. C-227 and which was adopted by the house on July 12, 1966.
The hon. member for Winnipeg North Centre, in supporting his amendment, quoted from Beauchesne's third edition, page 439. This citation is similar to section 3 of citation 250 contained in Beauchesne's fourth edition and, in my view, applies more directly to proceedings in the committee stage on the resolution than to proceedings on the committee stage of the bill. His further citations from May's thirteenth edition are those which have given me greater concern. I have been impressed, too, with the argument presented by the member for Fraser Valley as recorded on page 10473 of Hansard and by the hon. member for Greenwood, page 10483 of Hansard.
On an earlier occasion I quoted citation 246 of Beauchesne's fourth edition with reference to such amendments as we now have before the committee. I should like to quote citation 246 again, or that part of it which is applicable to this particular situation. Citation 246, subsection (3) at page 207 reads as follows:
The guiding principle in determining the effect of an amendment upon the financial initiative of the Crown is that the communication, to which the royal demand of recommendation is attached, must be treated as laying down once and for all (Unless withdrawn and replaced) not only the amount of a charge, but also its objects, purposes, conditions and qualifications.
November 29, 1966

I continue to believe that this principle should be seriously considered. A previous amendment to bring paramedical services within the ambit of Bill No. C-227 was ruled out of order. In the opinion of the Chair the amendment by the hon. member for Winnipeg North Centre is a limited or specific part of the proposal put forward by the hon. member for Hamilton South. In other words, the present amendment proposes a restricted form of the larger question.
It is the opinion of the Chair that the present amendment tends to exceed the objects and purposes of the resolution preceding this bill. It tends to extend the services for which provision was originally made. In this connection, may I refer hon. members to May's seventeenth edition, page 798 where, in dealing with the procedure on amendments, the following is found:
The approval or the reduction of the expenditure under consideration, or an increase in the stringency of the terms and conditions of the charge thereby created, are the matters specially entrusted to such a committee, and to these objects amendments are directed.
An amendment proposing to substitute for the resolution an argumentative justification for the refusal of the demand is out of order, as are also amendments proposed with a view to substituting an alternative scheme to that proposed with the royal recommendation.
In accordance with the constitutional principle which reserves the initiative in finance to the Crown, the terms of the message under the sign manual or of the resolution recommended by the Queen for imposing a charge are treated as laying down a maximum charge, which amendments may reduce but may not extend, in respect of the amount of the expenditure, the area of its operation and the objects to which and the conditions under which it applies.
I should like to particularly draw to the attention of the committee the last words of that citation namely "the area of its operation and the objects to which and the conditions under which it applies."
It is for those reasons I regretfully have to rule the proposed amendment out of order.
Perhaps I should point out to the two hon. members who are now standing that I did make a commitment to the hon. member for Villeneuve before I made my ruling.


David Réal Caouette: Thank you, Mr. Chairman. We will no longer deal with the amendment moved by the member for Winnipeg North Centre (Mr. Knowles), since it has just been ruled out of order.
Mr. Chairman, we will simply come back to Bill No. C-227, which is before us. This
Medicare
Bill No. C-227, indeed stipulates quite clearly that the federal government shall dictate what the provinces have to do in the field of medical insurance. And I repeat here what I was saying yesterday, namely that first, such a plan must provide complete coverage and extend to all the services performed by medical practitioners.
Mr. Chairman, there are services essential to the health of the Canadian people which cannot be performed by medical practitioners, but which can be performed by those who are familiar with the treatment or people specializing in a particular field, such as chiropractic and podiatry, for instance. I received telegrams from Vancouver this morning. The Minister of National Health and Welfare (Mr. MacEachen) has undoubtedly also received similar telegrams. [English]
Dear Mr. Caouette,
A news release by Robt. Cohen of the Ottawa bureau appeared in the Vancouver Province Nov. 24th stating that the federal medicare program may cover a wider range of services including podiatry. The B.C. podiatry association is most interested in placing before you the following observations.
1.	The treatment of foot problems will be included in the coverage offered. Podiatrists are legally qualified and licensed to treat these problems.
[DOT] (3:30 p.m.)

Podiatrists are recognized in British Columbia and Alberta. And now the present federal government does not want to recognize them or would not join with these two provinces, respecting the laws they passed.
Second-

2.	If podiatrists are not covered for these foot conditions by the bill people will simply go to the practitioners whose services are insured. The expense will still be there and the podiatrist will have been discriminated against.

Mr. Chairman, I believe that the Minister of National Health and Welfare must agree with this view that medical practitioners who are in no way specialists in this field will be paid for services which they will be unable to perform as completely and adequately as podiatrists can.
Third-

3.	Podiatrists are included on the paramedical staff of the Vancouver General hospital and have been covered by workmen's compensation for the past 15 years. M.S.A. and C.U. and C. the two

November 29, 1966
Medicare
larger provincial medical health underwriters include podiatry services in their extended health plans. Federal government employees plan includes podiatry services.
4.	A preponderance of patients requiring foot care fall in the old age pension group. It is to be hoped that any widening of coverage in the medicare program will seriously consider the foot health of this group.
Sincerely,
N. Mathews, B.Sc., DSC, President, B.C. Podiatry Assn.

Mr. Chairman, this comes from British Columbia and, besides, the Minister of National Health and Welfare is quite aware of this. As far as the province of Quebec is concerned, I read in the newspaper Le Devoir, in the March 24, 1965 edition-almost two years ago-the following:
Quebec will have its own health insurance plan within two years.
Now, this means that on March 24, 1967, Quebec will have its own health insurance plan. A statement to this effect was made by the former premier of the province of Quebec, Mr. Jean Lesage, who said:
The experience I had in Ottawa, in 1950, when I presided the Senate and the House of Commons joint committee on old age pensions has convinced me of the excellent work that can be performed through a body made up of representatives of both houses.
I have already submitted certain names to the cabinet, said Mr. Lesage. Normally, he added, such a committee should include experts representing the government, insurance companies, medical practitioners, and so on, an economist and an actuary.
Mr. Chairman, it was after this statement made by the former premier of the province of Quebec on March 24, 1965, that the then federal minister of national health and welfare said:
Under the Canada Assistance Plan that we are ready to put up one dollar for every dollar now spent by the provinces on mothers allowances, an assistance to mothers with dependent children.
We are ready to share the costs of health services provided by the provinces to public assistance recipients.
[DOT] (3:40 p.m.)
The former minister of national health and welfare, the present Secretary of State who was minister of national health said:
We shall arrange to include the costs of medical, nursing, dental, optical and pharmaceutical care.
She said that on April 20, 1965, a month after the statement made by the Quebec premier, Mr. Jean Lesage. A month later, Ottawa said: We will follow step, we will give dollar for dollar to the provinces which

will take steps to include medical, nursing, dental, optical and pharmaceutical care. And today, Mr. Chairman, two or three amendments have been refused so far because, according to the minister, they would entail additional expenditures.
Why is the present Minister of National Health and Welfare introducing in the house a bill which does not agree with what his predecessor told us on April 20, 1965, when it was stated that everything would be included, medical, nursing, dental, optical and pharmaceutical care. Today, an attempt is made to limit Bill No. C-227 with regard to medical care and paramedical care, which are related to medicine just the same. As far as I know, a chiropractor, for instance, does not prevent a physician from practising his profession, medicine, but I know that, quite often, a physician needs a chiropractor to help him heal someone. The same thing happens in the dental field. Why is not a dentist officially recognized under Bill No. C-227? Or an optometrist? The minister knows very well that the ophthalmologist will put in a claim for an eye examination, giving another reason to be paid by the state or from public funds, whereas the optometrist will not be able to do so.
Mr. Chairman, I am not a physician, I will not be in charge of the medical care program proposed by the government. However, I want to put the government and the department face to face with their own contradictions. I did not state in April that all services would be included and that the federal government was ready to spend dollar for dollar, with any province, for a full medical care program. And today Bill No. C-227 says exactly the opposite: optometrists, podiatrists and chiropractors are excluded. All kinds of professions are excluded.


Joseph Alcide Simard: Before the 1965 elections.


David Réal Caouette: Before the 1965 elections, naturally. Before elections, the government is always willing to do everything; but after the elections, the bill is limited, slashed; in plain language, it is shrivelled down to the dimensions allowed by the financial means available to the Minister of National Health and Welfare (Mr. MacEachen):
Moreover, I am convinced that the minister agrees with me; if he had the money, he would be the first to accept the amendments, the first to recognize that podiatrists, chiropractors, optometrists should be put on the same footing as medical practitioners. What
November 29, 1966

prevents him from doing so, as concerns the proposed plan? The financial system. But the minister does not say so. He tells us: we cannot afford to do it. Why not, when it is physically possible, when we have podiatrists, chiropractors, optometrists, when the physical means exist, are tangible? The minister tells us that the budget is too small and that such high expenditures cannot be considered. In my opinion, the fact that Bill No. C-277 is restricted to one or two main social classes will require us to conduct investigations which will cost more to the government than all those professionals, such as optometrists, chiropractors, podiatrists and others were covered by the bill. The minister will find that out. It might take two, three, five years or even longer and the present minister will probably no longer be minister at that time, but in any case, the solution to the medical problem of Canada is not the one provided in the present bill.
I feel rather that the federal government and the Minister of National Health and Welfare should fully co-operate with the provinces. Besides, the province of Alberta has told him: Do not dictate our line of action to us. We have our own plan. Both Alberta and British Columbia have a medical insurance plan and object to the federal government interfering or assuming rights which do not belong to it. The provinces say: Let us administer our own plan; help us if you wish, but do not interfere. We welcome your assistance, but do not dictate our policy. The province of Quebec wants the same thing.
I feel that the medical field comes under provincial jurisdiction and that the only thing the federal government can do is to help the provinces as much as possible; let the federal government contribute on a fifty-fifty basis to the implementation of a medicare plan in Quebec, Alberta and Ontario. Premier Robarts of Ontario said himself: respect our wishes.
Mr. Chairman, the Minister of National Health and Welfare will then help the provinces instead of annoying them. In its present form, Bill No. C-227 annoys the provinces in general. When it is said that the plan should be sponsored by a provincial government but recommended by the federal government, then the latter comes up with the bill and asks the province to sponsor Bill No. C-227.
Third, the portability of benefits from one province to another is an excellent provision.
Medicare
Fourth, all residents of a province should be eligible. That is also quite good.
But for the federal government to dictate the medical plan to be carried out and ask a province afterwards to sponsor a bill which it has introduced is, I feel, nonsensical and illogical. I agree especially with the former Quebec premier who stated:
Quebec will have its own health insurance plan within two years.
All he asked was that Ottawa help the province establish its plan as in Ontario, Alberta, etc.-
The following may also be read in the newspaper article from Le Devoir, and I quote:
Close co-operation among physicians.
What kind of medical care plan will Quebecers have? At present, according to various sources of information, it appears that the government is leaning toward a plan resembling that of Alberta more than that of Saskatchewan.
Because the Alberta plan has more respect for individual freedom, freedom of the patient, than does the Saskatchewan plan.
In doing so, they would be acting in accordance with the recommendations made by the "College des medecins" in a brief submitted to the Prime Minister last September.
That was in September, 1964.
The brief recommended a universal medical care plan available to everyone covering the whole spectrum of medical services, including diagnosis, treatment, rehabilitation and prevention, leaving the physicians free to choose whether or not they will subscribe to the plan which will be financed through premiums paid by the individuals and, whenever necessary, by the state.
The "College des medecins" made the following suggestions, among others:
1.	Services shall be remunerated only if they are performed and prescribed by a medical practitioner duly authorized to exercise his profession.
2.	The patient shall be free to choose his own physician-
Therefore, the government should not force a physician upon a patient:
The freedom of a patient to choose his own physician and that of the physician to choose his patients should be respected.
That would mean that the government must not force a physician upon a patient.
3.	Remuneration for medical services must be in accordance with services rendered, must not be entirely a function of the financial situation of the disbursing organization and must be acceptable to the "College des medecins". Tariffs thus determined by agreement must not allow any fee in excess thereof. If the plan is optional, the public will be

November 29, 1966
Medicare
Inclined to subscribe. The patients treated by nonsubscribing physicians will nevertheless be remunerated by the underwriter on the basis of tariffs agreed upon.
4.	The right of doctors to choose the type of remuneration they prefer must be respected.
5.	Negotiating mechanisms will have to be set up which will enable the medical profession to be present at every stage of development of the medical care plan.
We witnessed one of these imbroglios between the government, between the state and the Saskatchewan medical practitioners, and the member for Burnaby-Coquitlam (Mr. Douglas), when he was the premier of Saskatchewan, saw this for himself when he had to meet the physicians in his province who did not want to submit to dictation of their line of conduct by the socialist government which he was leading.
6.	Once the plan is established, administrative and legal mechanisms under which the medical care plan will function must provide adequate representation of the medical profession at all levels where decisions affecting medical practice are to be taken.
Mr. Chairman, the Ralliement Creditiste is in favour of this freedom, declares that the patient's freedom to choose must be respected and wants the medical practitioner to be respected in the exercise of his profession.
[DOT] (3:50 p.m.)
When one tries to interfere with this liberty, one is not doing his duty. And today, Bill No. C-227, and the Minister of National Health and Welfare (Mr. MacEachen) knows it, because of its interference, is an affront not to medical practitioners as such, but to optometrists, podiatrists and chiropractors, who should be recognized and included in this bill if the province or the provinces should decide to include them in their own medical insurance plan.
No matter if it is one, two or three years from now, the minister should come out and say, once and for all, that optometrists are entitled to perform eyesight examinations under the act, under the medical plan submitted to and approved by the House of Commons.
Then, Mr. Chairman, we will show respect for the patient, the chiropractor, the optometrist, the podiatrist and even the whole population. And the Canadian parliament will assume its responsibilities, not in accordance with an outdated monetary system, but in accordance with the possibilities we have to provide for each and every one, the medical care they need and to which they are entitled.


Mr. McCleave:: Mr. Chairman, in continuing the discussion on subclause (d) may I say that by now it will be obvious, even to the most obtuse on the government side, that there is a great deal of dissatisfaction with the wording of the subclause. It is a moot issue because we will either come up with a very good plan of medicare for Canadians or we will come up with one which will turn out to be quite fossilized, rigid and almost incapable of change.
The proposal which was presented to us by the Minister of National Health and Welfare-who, because he is a Nova Scotian, should know better but does not-is one that is fossilized, rigid and almost incapable of change. What is enshrined here in the legislation is not simply a federal act; it is a concurrence on the part of federal and provincial authorities, or at least I presume it is. I had hoped that at least someone would have tried to work out partnerships with the provinces, although sometimes I wonder about it after hearing the government's comments. The minister put forward legislation which would be almost impossible to change, should we want to do so at some future time. I say this very sincerely and seriously.
I know that the same complaint has been leveled at the Canada Pension Plan, that it is almost impossible to amend it. I suggest that this very rigid formula which we have before us would be impossible to change in this parliament unless the provinces were to raise such an outcry that even we would be driven to accept the common sense of their complaints. But such will not be the case because there will always be one province holding back. We have, therefore, decided to adopt the definition suggested by the minister for the least common medical denominator which it is humanly possible for any government to adopt. Most of us in the house are not satisfied with that approach. I suggest that much of the dissatisfaction is among the members on the other side of the house, and this would become apparent if they ever had the courage to stand up and proclaim their doubts.
So far three amendments were ruled out, two of them have been advanced by members of the New Democratic Party and one by a member of my party. I will suggest another amendment but I will not propose it formally because I am getting tired of these pernicious and unnerving exercises in pedantry on niggling, parliamentary procedures.
November 29, 1966

I am sorry to be saying this in the hearing of the hon. member for Winnipeg North Centre. I know he is a great repository of such parliamentary virtues as are enshrined in the rules of the house, but rules and procedures can kill the spirit and I am trying to get at the substance of this particular issue. I might say that when I was here before I went into the wilderness for a short period, I used to rejoice in exercises in parliamentary procedure. Now, I think they have as much sense and virtue as the arguments of people in the middle ages regarding the numbers of angels the head of a pin can hold. I leave this exercise to my hon. friend from Winnipeg North Centre and to others.
Mr. Chairman, I say that this formula is rigid and I hope we will fight it all day and, if necessary, all week until even the Minister of National Health and Welfare is persuaded to suggest to his colleagues a more flexible course which, even if only in the field of regulations, would allow for some change. The words I suggest should be added, which I will give the committee in a moment, are two only.
[DOT] (4:00 p.m.)
Quickly reviewing the amendments which have been presented to date, there is the one moved by the doctor from Hamilton South, to the effect that health and paramedical services be included in insured services as they are included in provincial plans. So, a provincial yardstick would be used in that case, but it is at least a half way formula, if I may use that expression.
Then there is the amendment moved by the hon. member for Kamloops, who sought to add the words:
-or by or on the advice or with the consent of medical practitioners.
This amendment referred to substituted services if given medical approval.
We then had the amendment moved by the hon. member for Winnipeg North Centre, a man for whom I have great respect; and I say that very quickly because I was a little harsh on him. We do need keepers of the parliamentary procedural keys, and God bless him for every moment he keeps them. He sought the addition of the words:
-and services rendered by optometrists which, when rendered by a medical practitioner, would be considered as insured services.
This again is the substitute approach; that is, the doctor either performs the services so as to make them insured services, or he gives
Medicare
his blessing that they be performed by somebody else. I am using the same approach; I cannot see any other choice open to us.
I suggest to the minister, his parliamentary secretary, his colleagues, the officials of the department, the deputy minister and others upstairs who are watching us, that they consider insured services as encompassing all services rendered or authorized by medical practitioners. I seek to add the words "or authorized".


Stanley Howard Knowles: Why not move it? It might be in order.


Robert Jardine McCleave: My hon. friend from Winnipeg North Centre suggests that I should move it, that it might be in order. I think I will accept his challenge but I hope that someone will quickly type out these two words, six copies in English and French, so that they may be distributed around the chamber before I am through. Are there any volunteers?
I make the suggestion because any doctor, lawyer or other professional man worth his salt is not necessarily going to treat his patient or his client himself, having interviewed him in his office. Let us consider the common or garden variety lawyer, for example. Let us suppose that a client who comes into his office has a special problem involving income tax. This problem should not be dealt with by a lawyer at all but by a chartered accountant. Similarly, a doctor may find that a patient who comes into his office requires special attention to his teeth, in which case I presume the doctor would have sense enough to refer him to a dentist. If I may use the example I used the other day from the mining area of Saskatchewan, he may have a patient who has a sore back, and the doctor instead of trying to manipulate his spine suggests that the man see a chiropractor.
One can multiply examples of this kind indefinitely, Mr. Chairman. But the point is that the first professional man a patient or a client sees is not necessarily the person who will cure him or prescribe cures. I am sure that many of us have gone to general practitioners and been shunted along to specialists in heart disease and in other diseases, so that the general practitioner is absolutely sure that the patient is given the best possible advice.
Why should not an ophthalmologist, for example, refer a patient with an eye complaint to an optometrist if he thinks the optometrist is best capable of dealing with the problem, especially if the ophthalmologist need not

November 29, 1906
Medicare
worry because there is no real disease involved? Surely, these points must commend themselves to the medical experts in the Department of National Health and Welfare. I think they commend themselves to the Minister of National Health and Welfare and his parliamentary secretary.
So I ask, Mr. Chairman, why this sort of example cannot be considered a substituted service where it is authorized. If we wish to put the medical establishment fully in charge of medicare, that is all right for the time being. As I have said before, this is going to be a very hard thing to change, but at least give that much flexibility to the plan.
Several million words ago, as we measure time in this place, I took part in the debate on the resolution and said something to reinforce that argument with regard to optometrists. I am not going to go over the ground again except to point out one ground which I did not cover. Volume 1 of the Hall Royal Commission on Health Services report, at page 45, deals with optical services and starts out with this simple proposition:
The problem of visual deficiency is one of our most prevalent health defects. It is most serious among the aged, but failure to recognize and to correct visual deficiency early in children can adversely affect the course of their lives.
The Hall report then deals with the historic development of eye services. I do not know how far back in time the commissioner went, but he seems to have gone back to the days when you could go down to the five and ten and buy some kind of glasses which might possibly do your eyes some good, or to the itinerant peddler of glasses, to whom reference is made. Then the report points out that:
The technique of refraction by a trained "re-fractionist" which permits a scientific measurement of refractive error and therefore the prescription of accurately correcting lenses represents a more advanced stage. And for the majority of people needing glasses this limited procedure may be satisfactory because the eye is healthy.
In other words, the muscles of the eye are somehow out of joint, but the eye is pathologically sound and good sight can be obtained if one obtains glasses, as 90 per cent of the people in this chamber do.
Then another technological point made by Judge Hall is:
-that of diagnosis of pathological conditions and other abnormalities that may or may not be related to refractive error or which may, in fact, actually reveal pathological conditions elsewhere than in the eye to be treated by medical and surgical procedures.
[Mr. McCleave.l
Again, Mr. Chairman, everyone will recognize the common sense of this, and there is a special name for a gentleman of this kind. He is an ophthalmologist. In fact, if he is a real specialist, he may be what is known as a rhino-otolaryngologist. These are people who deal with the eye, ear, nose and throat.
The Hall report continues:
It is estimated by the professional societies of both groups that there is a shortage of personnel and, in fact, despite increased populations, there were in all but two provinces fewer optometrists in 1960 than in 1955.
In looking ahead to medicare, the commission had to make its decision between the two groups. Should it recommend the one group, should it recommend the other, or should it recommend none at all? It made this finding:
It is obvious that there are not enough ophthalmologists to provide complete services including refractions for the entire population. Accordingly, a decision must be made with respect to the role, if any, of optometrists in the program.
Finally, at page 49 of the report we find recommendation No. 83, which is:
That the health services program provide optical services (but not spectacles) to all insured persons.
Recommendation 84 is in these terms:
That diagnostic services be provided, as now, by medically licensed pratitioners.
And recommendation 85 reads:
That refractions be provided by ophthalmologists, other qualified physicians, and by optometrists who graduate in or after 1968, and by optometrists who by the year 1967 have taken the recommended additional training in anatomy, physiology, pathology, and in the use of cycloplegics.
[DOT] (4:10 p.m.)
It is obvious, looking at the extensive training an optometrist has, that while he does not have the letters M.D. after his name, he has a great deal of specialized knowledge. I say that to support arguments advanced by many people on this side of the chamber. I am sure that their arguments are supported, though secretly with sealed lips, by members on the government side who think that optometrists and other supporting services ought to be included in medicare.
I emphasize again that the formula we are adopting for a joint federal-provincial plan in this legislation will be inflexible, rigid, and will fossilize the standard of medical insured services in this country. Unless we change our approach now it will be almost impossible to change it later. In making my point I make it thinking of dentists who have been discriminated against in favour of other groups
November 29, 1966

of specialists. The discrimination in favour of medical practitioners, as set forth in this bill, is discrimination against dentists. The argument is made forcefully in a letter to me by Dr. Alexander E. Hoffman, a dentist in Halifax. I quote his reasoning as my own.
Starting with the proposition that dentists are discriminated against by the definition of insured services, which is the clause we are now considering, he says this:
A definition of "medical practitioner" which does not include dentists will have the following harmful effects:
(1)	The act will, in effect, imply that physicians as a group are better qualified to perform oral treatment services than are dentists who by education, training, experience and licensure, are equally entitled to render the same services. Dentists have always provided these services and frequently upon the request of the medical practitioner.
That is the point I made in my opening remarks. I continue the quotation:
(2)	The public when aware that oral treatment services are compensable only when performed by physicians, will be denied the unencumbered free choice of a practitioner.
That is the point made about a dozen times in the debate so far.
(3)	Dental practitioners will be contributing to public funds which will be used to persuade the public to receive oral treatment services from other practitioners.
Touche; Dr. Hoffman is so right.
(4)	The education of dentists, and particularly oral surgeons, will be adversely affected. If dentists in practice experience little demand for these procedures under the medical care act, then there's little point in continuing to include training in these procedures in undergraduate and graduate programs. The omission of the pertinent subjects would cause the total of these services to be diminished.
These are powerful arguments by a reputable dentist. The dentists are thinking a lot about this bill nowadays, and though Dr. Hoffman should not be termed the thinking dentists' dentist, he puts very well the points related to the discriminatory provisions of clause 2(d) of Bill C-227.
I have another letter from another dentist in Halifax, a Dr. R. Epstein, who makes these arguments about the bill:
1.	It recognizes physicians as the only qualified group for oral treatments when dentists are fully qualified to do these.
2.	It induces patients to seek these services from physicians only.
3.	It penalizes patients who want these treatments from dentists.
4.	Public funds (to which dentists contribute) are being used in a way detrimental to dentistry, as well as to the public.
Medicare


Allan Joseph MacEachen: May I ask the hon. member a question. Can he tell me exactly what the dentists who write him letters mean by oral treatments? That is a vague expression, and to put any meaning into what is said we have to know exactly what is meant.


Robert Jardine McCleave: I am advised by my medical adviser that oral treatment means oral surgery. If I had been left to answer that question, I should have said that it is treatment of a disease or condition around the mouth that, if not treated, would lead to bad health, and if treated would lead to good health.
Surely, the point of the bill we are considering-whether you are treated by a witch doctor, the village blacksmith or heaven knows who-is the good health of Canadians.


Allan Joseph MacEachen: Is an amendment to this effect contemplated?


Robert Jardine McCleave: Saying that one man who has gone through university for 10 or 11 years should be allowed to cure, and to be reimbursed from the public treasury, but that another man who has gone through university for 10 or 11 years, such as a dentist, should not be reimbursed, is discriminatory. Optometrists go through specialized training for a number of years, perhaps not at university, but they are specialists also. To discriminate in this way is to adopt a caste system in this country, a health treatment caste system that defies rationalization or reason.
I have made the point over and over again and will not repeat it ad nauseam. I ask the minister to consider the guts of the medical care bill, clause 2(d), because we are paying for the healing services of qualified practitioners. Those who treat us, who perform the services under the act, must be qualified. They must have qualifications which would preclude, I would think, the village blacksmith or the witch doctor approach.
Perhaps we might adopt the amendment suggested by the hon. member for Kamloops, or the hon. member for Hamilton South. I will leave out the amendment suggested by the hon. member for Winnipeg North Centre because, had he been able to include optometrists he would have added five or six other categories of practitioner. But he and I are on the same bandwagon, because we are trying to remove the rigidity from medicare. We have a number of alternative ways to do that, one of them being some form of regulation providing for a high standard of care by paramedical groups, if that is the correct expression. I should like the minister to consider

November 29, 1966
Medicare
that. Another alternative is to adopt the motion suggested by the hon. member for Kamloops. I am afraid I do not have copies of an amendment written out-


Thomas Clement (Tommy) Douglas: Be careful; he will charge you legal fees.


Robert Jardine McCleave: -but it seeks to amend clause 2(d).
I move, Mr. Chairman:
That paragraph (d) of Clause 2 of Bill C-227 be amended by inserting the words "or authorized" after the word "rendered" in line 17 thereof.
I apologize to the committee for not having copies in English and in French.
[DOT] (4:20 p.m.)


The Deputy Chairman:: Before there is an expression of opinion on the validity of the amendment, I think I should read it to the committee. It is moved by the hon. member for Halifax:
That paragraph (d) of clause 2 of Bill No. C-227 be amended by inserting the words "or authorized" after the word "rendered" in line 17 thereof.


Allan Joseph MacEachen: Mr. Chairman, aside from arguing against the form of the amendment, which I would do very strongly if it were before the committee, I simply want to repeat the argument which I made yesterday in connection with the amendment moved by the hon. member for Kamloops. This amendment had the effect of adding after the words "medical practitioners" in line 18 the words, "by or on the advice or with the consent of medical practitioners."
The purpose of that amendment was to provide a method by which other health professions would be brought under the purview of the bill, and that method was "by or on the advice or with the consent." We have now precisely the same approach in the amendment moved by the senior member for Halifax, except that we have substituted for the words, "by or on the advice or with the consent of medical practitioners" the words "or authorized."
The effect is identical to the effect of the previous three amendments, namely, it would widen the scope of the bill beyond the terms of the resolution and bring in all the other professions which, however desirable at some future point, is certainly not authorized or foreseen in the resolution.


Robert Jardine McCleave: If I may speak to my own amendment, Mr. Chairman, I would point out that there are some slight differences between

it and the one moved by the hon. member for Kamloops. For example his said "with the consent of medical practitioners", and I believe the fair meaning one could take from my amendment, which would read "or authorized by medical practitioners", is that a patient or client may go to a professional man and be referred to a better source of relief or help.
I do not believe anybody has to assume that this involves a greater outlay of money from any public treasury. It simply means that the services that are being provided are being provided from the best possible source. They might cost a dollar or $2 more in one case, and $5 or $10 less in another case; for example, if a man goes to an ophthalmologist or eye doctor and is referred to an optometrist, or he goes to a doctor and is referred to a chiropractor. In such a case, nobody can argue that this means a greater outlay of money from the public treasury.
The point I am making, and it is one which could have been made with respect to all the other amendments, is that it is wrong for the minister to say that we are trying to spend money from the public treasury. We are not. We are trying to provide the best level of medical service at whatever level it is best provided. This is the whole argument which is being presented by over 100 members on this side of the chamber. This is our primary objective. The minister cannot tell you, nor for that matter can I tell you, Mr. Chairman, within $100,000 whether the treasury will benefit or lose a certain amount of money. Nobody can tell you that. We on this side of the chamber are simply saying, in the best way we can but apparently ineffectively under these rules that have come down to us from the time of George I or perhaps before that, that there is another way of looking at medicare. The other way probably does not involve a greater expenditure of public money, perhaps involves less expenditure of public money, and certainly provides better health services for Canadians. That is the point I am making in trying to show that my amendment is in order.


Eric Alfred Winkler: May I ask the hon. member a question. Is it not possible that the charges made by some of the paramedical people would be less in many cases?


Robert Jardine McCleave: Yes, I will say that, and I will say it for the hundredth time this afternoon.


Thomas Clement (Tommy) Douglas: Mr. Chairman, I do not wish to speak on the proposed amendment or on
November 29, 1966

the point of order with reference to its validity. However, I do not want to lose my place on the list and I do want to speak on paragraph (d).


Maurice Rinfret: The Chair is still considering the validity of the amendment. Is there any other hon. member who wishes to express an opinion on its validity?


Some hon. Members:: Question.


Maurice Rinfret: Order. The amendment moved by the hon. member for Halifax is meant to extend medical services beyond those rendered by physicians.
In the light of previous rulings, the chairman of committees has ruled out of order the amendment meant to extend professional services to those given by people other than physicians.
The amendment moved by the hon. member for Halifax (Mr. McCleave) provides for an extension of the services mentioned in the resolution passed by this house on July 12, 1966 and also in paragraph (d) of that clause. Like the chairman of committees, I will quote the citation from May's 17th edition, page 798, chapter 29:
In accordance with the constitutional principle which reserves the initiative in finance to the Crown, the terms of the message under the sign manual or of the resolution recommended by the Queen for imposing a charge are treated as laying down a maximum charge, which amendments may reduce but may not extend, in respect of the amount of the expenditure, the area of its operation and the objects to which and the conditions under which it applies.
In view of previous rulings rendered by the chairman of committees and the reasons given in May's citation, I declare the amendment out of order.


Thomas Clement (Tommy) Douglas: Mr. Chairman, I want to make one last appeal to the minister to reconsider paragraph (d) which defines "insured services" as meaning "all services rendered by medical practitioners that are medically required ..."
[DOT] (4:30 p.m.)
I hope the minister will believe me when I say I do not make this plea in order to create difficulties for the minister or to obstruct the passage of the legislation. I make this plea to the minister because members of this party are profoundly interested in this legislation
Medicare
and are deeply concerned that when this legislation is passed it will prove to be effective. When the minister introduced the resolution preceding this bill, he said that it was a milestone in Canadian welfare history. I agree with him. All of us want this legislation to operate and to operate successfully. We want the medicare plan to be the kind of program of which the Canadian people can be justly proud. Moreover, there are progressively minded people in the United States who are showing a deep interest in this legislation, and I have no doubt that it will be followed with considerable interest by certain circles in the government of the United States. It is important, therefore, that this medical care services plan operate to the satisfaction of the people of Canada, and that it operate to the satisfaction of those who are providing the services. It is important also that the people of Canada are satisfied not only with the medical care services plan itself, but also will be prepared to have successive governments use this plan as the foundation upon which to build a comprehensive health insurance program providing other services such as prescription drugs, dental care, glasses, prosthetic appliances, and so on.
Therefore, Mr. Chairman, I ask the minister to believe that our only concern is that this plan be a success, and that he will have the least possible difficulty in operating the plan in conjunction with the provincial authorities. Our objection lies in the fact that the minister has taken a general concept and given it a very narrow interpretation. The resolution which preceded the bill, and the preamble to the bill itself, referred to insured medical care services. These are four very simple words. There is no reference to services provided by medical practitioners, but rather to, "insured medical care services". This is a broad concept. In the bill the minister has limited the medical care services to only those services which are provided by a medical practitioner. This rules out services authorized or prescribed by a medical practitioner. It rules out ancillary services which a medical practitioner may require in order to complete the cure of a patient or the treatment of a patient.
In this party we have two major objections to this narrow and restrictive interpretation. The first is that we are convinced this narrow interpretation of medical care service will prove to be unworkable. The minister will run into endless difficulties. He will find, for instance, strange anomalies. Let me cite just one or two. Under this definition a child who is

November 29, 1966
Medicare
vaccinated in a doctor's office by a doctor will incur a cost which will be shareable by the federal government with the province, but if the doctor's nurse vaccinates the child, which happens in a great many cases, then the cost is not a shareable cost. In many cases of accident, particularly where the injuries are to the face and skull, a doctor finds it necessary to deal with the mouth. In many of these cases he must call in a dental surgeon. The bill submitted by the medical surgeon will be shareable, but the bill submitted by the dental surgeon will not be shareable. There will be other cases. I am sure the hon. member for Simcoe East could give us many instances when medical doctors have to operate for a carcinoma of the mouth where they have to call upon a dental surgeon for assistance. The cost in respect of one part of this treatment will be shareable and the other will not be shareable.
There will be instances where the doctor must prescribe physiotherapy for a patient. I presume that if this physiotherapy is provided in the doctor's office, under the doctor's supervision, it may be that the cost of that will be shared. But if the doctor does not have the services of a physiotherapist in his office and has to send the patient to a physiotherapist, I assume that that cost will not be shared. The same thing will be true when the doctor is consulted by a patient who needs an eye examination. If the doctor chooses to set up the equipment to test a patient's eyes and gives the patient a prescription to take to an optometrist, then that will be a shareable cost. But if he does not have the equipment to carry out an eye test and sends the patient to an optometrist, then the charge will not be shareable. I submit to the minister that there are dozens of anomalies which he and the provinces will meet which could be avoided by some flexibility in this definition of "insured services".
The second weakness in this definition is that it will prevent the federal and provincial plans being coterminous. The plans which the provinces set up should be four square with the federal government's plan, but they are not going to be. For instance, the province of Saskatchewan already has a medical care plan. Subsection (1) of section 26 of the Saskatchewan Medical Care Insurance Act, 1961, sets out all the various services which may be rendered by a physician or a doctor or surgeon, including anaesthesia, inoculations, vaccinations, maternity care, and so on. Subsection (2), however, mentions additional services which may be provided. Physiotherapy

is included when provided by a physiotherapist on the order of a physician in the course of terms of conduct specified by the commission. Clause (b) provides for dental services where these are provided by a dentist in conjunction with maxilla facial surgery. The commission may provide for other services under the authority of the Lieutenant Governor in Council.
What will happen, when the legislation we are discussing now becomes effective, is that the people in Saskatchewan will find that some of the medical bills which they incur will be shareable by the federal and provincial governments but other bills will have to be borne solely by the provincial government.
[DOT] (4:40 p.m.)
If the minister really wants an administrative nightmare and if he wants to find himself in a miasma of red tape, then he should imagine what will happen when the medical care plan in Saskatchewan has to sort out of every account those things not shared with the federal government, on the one hand, and include those things which are shared with the federal government on the other hand. Surely, it would be much neater if the plans set up by the provinces fit on all fours with the plan which the federal government is seeking to establish.
The same will be true if other provinces set up medical care plans. They will try to follow, to some extent, the voluntary plans which are in existence, many of which provide for these related paramedical services. The federal government will find itself in the same predicament. The provinces will be providing for services which are not shareable with the federal government. What will be the result? The result will be a black eye for the minister's plan and we do not want that to happen.
The tendency will be for provincial governments to say that the federal plan is not adequate because it does not share the costs of all the services which are provided and that the medicare plan sponsored by Ottawa is only a partial medicare plan. The medicare plan which the minister is seeking to promote will not get the enthusiastic support from the provinces which it could otherwise get.
As I said earlier, we in the New Democratic Party hope that this medicare plan will be the foundation upon which a much broader and comprehensive insurance plan will one day be established in Canada. That is not going to happen if this plan is looked upon by provincial governments as being niggardly, partial and ineffective.
November 29, 1966

The minister has been pleaded with, cajoled and argued with, but so tar he has been completely rigid and inflexible. I want to point out that the minister himself recognized there will have to be flexibility, and that other services will have to be added as time goes by. At page 7547 of Hansard for July 12, 1966 the minister is reported as having said:
Provincial governments may, of course, wish to expand the provincial programs so as to include additional benefits; there is nothing in the federal plan to deter them from doing so. We have assured the provincial governments that as soon as there is a consensus on the timing of further benefits to be provided over and above physicians' services, the federal government would consider enlarging appropriately and in due course tire scope of benefits to which it would be prepared to contribute. As a first phase, however, the present resolution contemplates only the provision of physicians' services.
May I say to the minister that in my opinion it is not practical to suggest that if the provinces include any related services they will have to wait until the federal government gets a consensus from the provinces before the legislation is amended. There will, then, be a hiatus during which the provincial governments will be paying all of the cost of some services and getting a share of the costs of other services from the federal government.
It would be much better if the federal government were prepared to say to the provinces, when any province is prepared to provide additional services the federal government, by order in council, will agree to extend the services in any province that wants to avail itself of that extension.
I intend to propose an amendment, but certainly not the kind I consider would meet the situation. I would much prefer to see the kind of amendment which was moved yesterday by the hon. member for Hamilton South adopted as being the answer to the problem. The amendment I intend to propose will not place any burden upon the government and will not be mandatory, but it will at least leave the minister with sufficient flexibility that, if in the light of experience he wants to ask the governor in council to extend or include any of these services, he will have the power to do so. This would first of all enable him to act without having to wait for every province to concur, and it would prevent him having to wait until legislation could be passed in parliament. It would enable him to meet the situation as it arises from time to time, in light of the experience which he will get from administering this legislation.
I am convinced that if the minister persists in asking the committee to pass paragraph (d)
Medicare
of clause 2 as it now stands, restricting medical care services to only those services provided by a medical practitioner, he will find that inside of one or two years after the plan is in effect he will be wishing he had asked for a certain measure of flexibility so that he could deal with this problem much more adequately than I think he will be able to do under the present definition.
Therefore, Mr. Chairman, I should like to move:
That paragraph (d) of clause 2 of Bill C-227 be amended by inserting therein, immediately after the word 'required,' in line 19, the following words:
'including such other related services as may be authorized by the governor in council,'.
It seems to me that the advantage of an amendment like this is that it does not open the gate to the sharing of the cost of any further services by the federal government, but it does give the minister some elbow room if he finds the present definition too restrictive. All he will have to do is persuade his colleagues that there ought to be, by regulation or by order in council, some arrangement whereby such services-optometric care, dental surgery or physiotherapy-could be covered providing, of course, the provincial governments which will be operating the plan, desire to provide that service to the people.


Allan Joseph MacEachen: Mr. Chairman, I should like to have an opportunity to consider the amendment moved by the hon. member for Burnaby-Coquitlam. Perhaps, that opportunity could be taken while the debate continues in respect of other paragraphs.
[DOT] (4:50 p.m.)


Maurice Rinfret: Do hon. members agree to follow the suggestion made by the minister?


Thomas Clement (Tommy) Douglas: Let us stand the clause, Mr. Chairman, if there is no further debate on it.


Allan Joseph MacEachen: Stand the paragraph.


Thomas Clement (Tommy) Douglas: Yes, stand the paragraph.


Maurice Rinfret: I think other members of the committee wish to express their opinion on paragraph (d). The hon. member for Fraser Valley.


Mr. Patterson:: Mr. Chairman, the representations I wish to make this afternoon follow somewhat the line that has been taken by many speakers in this debate. But I trust I will be able to inject at least several new points into the discussion that will help to convince the minister he ought to make some

November 29, 1966
Medicare
amemdments or allow some amendments to be made in order to broaden the terms of this particular clause.
I endeavoured to get the floor several times yesterday, but seemed to run into procedural obstructions. Therefore, I hope I have better success today. I believe that the whole of this debate could have been avoided had the minister and the government introduced a proposal based upon the provisions of provincial plans. The various provincial governments have their own plans in operation. There are some variations as far as insured coverage is concerned, but I do not think they are so different that the types of services that are to be covered in this particular plan require spelling out detail. Therefore, had the government introduced a proposal that was based on the provincial plans, it would have saved a great deal of debate and misunderstanding.
I believe that the interpretation placed upon this particular clause is far too restricted. We recognize the importance of every health service provided in this nation, not only by medical practitioners but by many other professional men. These people are recognized, authorized and licensed by provincial governments and provincial authorities just as are the services of medical practitioners. Therefore, it would seem to me that in inaugurating a plan under which the federal government would contribute to the cost of these services, it should be made all-inclusive and should not be restricted to the interpretation the minister has placed upon it.
I further believe that these services should be provided on their own merit and not through a referral by the medical practitioner. I believe that the people of this country ought to be able to make their choice and go to whatever health practitioner they desire in order to seek help and assistance. It should not be necessary for them to go to any particular one, and then proceed on a program of referrals from one to another. It seems to me this is not only unfair but is improper and should not be recognized in this proposal. Reference has been made to a number of people who are engaged in the health services field. I shall refer to two or three this afternoon and try to point out some other reasons why they should be included within the terms of this measure.
First of all, I should like to refer to those engaged in the chiropractic field. These services, as I stated before, should be included within the terms of this legislation. It has been brought to our attention, and I did get

an opportunity last evening to make at least this brief interjection, that at the present time medical practitioners are being given a very short course in the therapy that is provided by chiropractors. The course lasts one hour, two days or up to five days. Then, they are able to provide the service that chiropractors would provide. I do not believe this is wise because, after all, chiropractors take a course that stretches over a period of four or five years. It would seem to me they would be much better qualified to provide this service than medical practitioners who have had only one hour's or up to five day's training in this field.
It has also been brought to my attention that the Quebec La Croix royal commission report referred to the inadequate training being thus obtained and stated that it constitutes a grave danger. They give warning against the practice of giving a very short course in this particular field of health care. The report of that royal commission also states that chiropractors are well qualified in this field of treatment. I call your attention, Mr. Chairman, to the fact that this report was approved and accepted by the Hall commission. In view of the fact that the minister is basing many of his proposals upon the recommendations of the Hall commission, and many arguments are being advanced in this debate based upon the recommendations of that royal commission, we ought to remember this reference to the need for recognizing and approving the services provided by chiropractors.
There are several other reasons for believing that those engaged in the chiropractic field ought to be recognized in the provisions of this measure. They are recognized in the Health Resources Fund Act. I understand they are able to obtain assistance from this particular federal provision. I submit that if the services rendered by this profession are recognized and provided for under the Health Resources Fund Act, there is absolutely no reason why they should not be recognized under the terms of the measure we are now contemplating.
I also understand it is possible for those who are entering this particular field of health service to obtain assistance through the Student Loans Act. Therefore, Mr. Chairman, what is the use of providing young men and young women with funds in order that they may qualify themselves in this particular field, if the federal government is going to turn around and say: Your services are not
November 29, 1966

going to be recognized. You are to be excluded from this medical care program which the federal parliament is implementing?
I would also refer to the T1 short individual income tax return. In the description of the deductions that are allowed under medical expenses, on the second page of the explanations you find the following:
The following are the types of expenses you may claim:
(a) Payments to a hospital or qualified medical practitioner, dentist or nurse. (The expression "medical practitioner" includes a qualified chiropractor-
I suggest that if the minister has not checked with the income tax authorities and read this form, he ought to do so. Let me repeat this passage:
(The expression "medical practitioner" includes a qualified chiropractor, Christian Science practitioner, naturopath, optometrist, osteopath, podiatrist or therapeutist).
[DOT] (5:00 p.m.)
It seems to me that if the federal government is going to recognize these particular services under the terms of the Income Tax Act, then they should also include them within the provisions of the medical legislation which is now before us. In addition to this, certain provisions are made under the War Veterans' Allowance Act which recognize these particular fields of health service.
Perhaps I was naive in suggesting that I would be able to present one or two more arguments which might help to convince the minister he should relax his position with regard to the clause we are now discussing and allow other services to be recognized. However, we are presenting these arguments in this particular context.
I would now like to refer to optometric services. I suppose most hon. members have obtained a copy of the brief which was prepared by the British Columbia Optometric Association entitled "Optometry and Health Care". This brief was written for the purpose of stressing the desirability of including this particular field of health services within the provisions of this bill. On the first page of the brief the following statement is made outlining the qualifications of the optometrist:
An optometrist, Doctor of Optometry (O.D.), is a person specifically educated, trained and provincially licensed to examine the eyes and related structures to determine the presence of vision problems, eye diseases, or other abnormalities. He prescribes and adapts lenses, or other optical aids, and may use visual training when indicated, to restore maxmum efficiency of vision.
Medicare
Farther on in the brief, the following suggestion is made.
"For any service provided in the health program, all practitioners legally licensed by their province to provide such service shall be entitled to participate."
I think this is a fair presentation and a fair request. It seems to me that those who are engaged in providing a health service to our people should be recognized under the provisions of the bill.
With reference to the principle incorporated in the proposed legislation that only medical practitioners will be recognized, I believe it is an unfair one. The services provided by the other health practitioners are often identical with the ones provided by medical practitioners, and yet we find that the services of the medical practitioners are covered whereas the services provided by the other health practitioners are not. I think that this legislation is discriminatory in the worst sense. I believe the the singling out of one profession at the expense of the others is unfair. A young man or woman wishing to enter the field of health care will consider this particular provision and say: "Since the government covers medical services provided by medical practitioners and not those provided by others, we had better enter the medical field." I think the entire approach is fundamentally wrong and the minister should not continue to maintain an adamant position with regard to it.
He must not insist that this is as it must be, and as it will be.
The suggestion has been made that the recognition of other health practitioners will not necessarily involve an added cost. I think this is true because the same service is covered when it is performed by a medical practitioner. Therefore, I do not think that the added cost of the plan is an argument. As I stated last night, the plan insures the service and not the practitioner. I think we should keep this particular factor in mind.
I do not propose to take up much more time on this particular clause but I should like to read a letter from the Department of Veterans Affairs addressed to Mr. William H. Wood. It reads as follows:
Dear Sir;
We are in receipt of a report from Doctor P. J. Haayen. Guelph Ontario in which he states that you want chiropractic treatments.
The department cannot approve of the services of a chiropractor. If you wish this treatment it will have to be at your own personal expense.
The same service is available to you through the physiotherapy department at the hospital, and is covered by your Ontario Hospital Insurance that

November 29. 1966
Medicare
the War Veterans Allowance Board pays on your behalf. These treatments are available at no additional expense to the government of Canada. Your doctor can prescribe and arrange a course of physiotherapy treatment for you if he considers that this treatment would be of benefit to you.
N. G. Dorland, for Senior Treatment Medical Officer
This applies not only to chiropractors but also to the other practitioners whom we mentioned today. I think we are in an impossible position. The minister should, therefore, take another look at some of the statements he has been making, at the position which he has been assuming, and accept the recommendations which have been made.
I should like now to deal with the matter of dental care. Here again, the services rendered by a dentist are not covered, and yet the same services provided by a medical doctor are covered. I cannot see any sense in this provision and, as I said before, it seems to be a highly discriminatory provision which should be corrected. The same statement applies to others such as practitioners in the naturopathic field, in optometry, psychology and so on.
I will suggest once again that the minister should give serious consideration to the recommendations which have been made from this side of the house. I suppose they would also be made by hon. members on the other side if they were not sitting there. I trust he will recognize and acknowledge the validity of the arguments, and will make some changes which will more adequately fit the realities of the situation.
[DOT] (5:10 p.m.)


Mr. Mongrain:: Mr. Chairman, the present debate on Bill No. C-227 and especially on the four or five amendments which were moved concerning subparagraph (d) will be considered as one of the most constructive debates of this parliament, because no superficial or partisan arguments have been made, and I listened to nearly everything which has been said until now.
I think that all our colleagues, even those of the opposition, should be commended for the seriousness they showed during the study of this bill and the quality of the arguments they made to the minister in order to improve his bill.
I was especially impressed to see that nobody in the opposition was opposed to the bill. On the contrary, there was a sort of emulation in trying to improve it. I believe that among all the amendments moved until

now, I would support immediately the one moved by the leader of the New Democratic Party, the hon. member for Burnaby-Coquit-lam (Mr. Douglas), because, in my opinion, it is a comprehensive amendment which opens the door to all sorts of other amendments and which complies also with all the prescriptions and the restrictions of parliamentary procedure. 1 would like to support the hon. member and I am under the impression that even though I am not in his confidence, the minister will approve it. It is correct to say, Mr. Chairman, that all kinds of excellent suggestions have been expressed here to improve the bill.
Among the things we learned during the debate, there is, for instance, the lesson on medical terminology given to us last night by the member for Gatineau (Mr. Isabelle) when he made an intervention while the member for Villeneuve (Mr. Caouette) was speaking. We also learned from him that he had given the member for Villeneuve an injection which allowed him to come back from Lebanon, something which annoyed a number of his antagonists, in no worse condition than he was when he went there, and that also reassured his colleagues.
We learned among other things that there was a limit to the talent of the hon. member for Gatineau, because he could not give the member for Villeneuve an injection to cure him from his verbosity. And this is certainly a disease, because he made four or five speeches at least last night on this medical care scheme.
Now, to speak seriously, Mr. Chairman, I believe that, in considering that bill, one is bound to come to a principle governing nearly any great legislation and say to oneself that when perfection is not possible, one must be satisfied with a lesser evil.
It struck me to hear the minister tell us- we were able to check his remarks-that he had consulted the provinces, that he had even wanted, at a certain time, to submit his bill to them and was prevented from doing so by circumstances, but he is still determined to do his utmost to bring the provinces together and discuss with them the various provisions of this bill in anticipation of future amendments.
This shows that the minister is favourably disposed, as all members of the house have surely noted, and that, even though the bill is not perfect, of course-I feel like most members of the opposition, that a great number of minor services which were left
November 29, 1966

out could have been included, leaving only the medical profession proper-the government must have given some thought to those things, such as, for instance, the consistency of standards required in order to secure the unanimous agreement of the provinces. The financial means of the Canadian people also probably had to be considered in the drafting of this bill, as well as a great number of other factors.
Besides, Mr. Chairman, in order to determine the value of a bill, one must first consider not only its good points, but also the objections raised.
To sum up, after studying the extensive material handed to us, I believe the objections came from three sources. From the opposition, first, which says: the bill is not bad, it is good, but does not provide a wide enough coverage. It seems, therefore, that the opposition already agrees to the plan in principle. The minister has immediately accepted the possibility of a more extensive coverage since he said: "I am ready to discuss with the provinces and to improve it."
If the minister could accept the amendment of the hon. member for Burnaby-Coquitlam (Mr. Douglas), I think that it would leave the door open, as the opposition would like to have it and would enable as soon as possible to include certain professions which I would call paramedical, even if the term is not the proper one, such as optometrists, chiropractors, naturopaths, podiatrists -as would say my hon. friend from Ville-neuve (Mr. Caouette)-and all others which have been mentioned.
Another series of objections come from the medical profession, and I think that the most serious condemnation has been made in a memorandum prepared and published by Dr. L. D. Wilcox, an associate professor at the department of medicine of Western University. He stated last June that this bill would become a national disaster.
Mr. Chairman, I admit that I was impressed. I read the whole report and the considerable data submitted therewith. I asked myself some questions, because just like all the hon. members, I am open-minded and when it is especially stated that this would give rise to a national disaster, you can imagine that it can impress a person concerned with the common good of his electors and fellow-citizens.
In spite of the fact that I have gone through all the objections, just the same I am not convinced. I see that the first
Medicare
objection of the learned doctor is as follows: The medical insurance bill will be subjected to some political pressures. He seems to say that the various political parties will outbid each other.
Mr. Chairman, I, of course, do not always accept partisan pressures, but I find they fall into three categories. For example, a party of the opposition can filibuster in order to prevent the government from passing a good measure and gaining a certain prestige. Then, there are ways of using parliamentary measures so as to seem to be doing something for the welfare of the people, knowing that this particular thing cannot be done. Then, there is what I will call competition with regard to good measures, to see who will introduce the best and most perfect bill.
I think this is what happened in the case of the present bill, and the speakers of all the political parties are, as I call it, competing with regard to good measures. They are not trying to condemn the bill, but to make it as perfect as possible.
I think the good doctor is not correct at all when he blames the politicians for politicking in the sense of competing with regard to good measures.
Then also, the Hall report is superficial. I took the trouble to go through it several times, and I must confess, Mr. Chairman, that I am much more impressed by the Hall report than by the brief submitted by this eminent doctor from Western University, which seems to me much more superficial. The Hall report is a collection of evidence given by a great many qualified professionals. He also adds that "Canadian medical care is now the best in the world". We do not doubt it. The doctor claims that "health insurance will lower the quality of medical care," but that has yet to be proved. He adds the argument that "the needy are already well taken care of". Doubtless, he would like to assimilate all Canadians to welfare, to public welfare. Where health is concerned, there is no question of charity; health is precious human capital for a nation and helping the Canadians to keep in good health is not charity.
He also states that "the geography of Canada will prevent the plan from being universal," but again that has not been proved at all.
Therefore, I feel that the bill, as it is, constitutes a major effort toward what might be called a universal project acceptable to all ten provinces.

November 29, 1966
Medicare
He adds that "doctors are overworked, that their care shows it." We know that, they have always been overworked and always will be.
I feel that the bill will be an incentive, not only for the government, but also for the bodies concerned, toward helping the medical profession to expand, so that it might meet all the needs. If you first create a need, you stand a better chance of having to find the necessary means to satisfy that need.
In my opinion, what the learned professor considers to be a major objection will rather be an incentive toward the betterment, the development and the progress of the medical profession.
He adds that the patient will become just a number. That is possible in extremely socialized countries and it is dangerous. But, a clause of the bill provides that all patients will be free to choose their doctors, they will be able to be treated by their family doctor, and it is not likely that the family doctors will consider their patients like numbers, at least as long as we preserve the freedom to choose our doctor.
Referring to the experience in Great Britain, he adds that 'the cost of services in that country has been increased by 500 per cent."
I read on this point some other briefs which are at considerable variance with these figures, and which explain that there has been an increase but that, on the other hand, health in general has improved, because there were too many people who did not get proper medical care or who did not bother with what is called preventive medicine, which is much better than the ordinary curative medicine. He adds that "medical and surgical research will unavoidably be downgraded because of the medical care plans."
I find this very illogical. It is based on the experience of Great Britain. But he says immediately after that Great Britain is training enough physicians to send some to almost every country of the world. Therefore, the health insurance plan has certainly not contributed to slowing down the training of doctors in Great Britain.
He also adds that Great Britain loses 10 per cent of her medical staff and he says that this is due to this project. I would rather think, if this is true, that the project has been ill-conceived. And I find in our project some points that are much better than the plan now in force in Great Britain. But I do

not have time now to comment on that. The good doctor adds that this health insurance plan does not exist yet in the United States. But he finds a reason for that and, Mr. Chairman, I will read it verbatim.
[DOT] (5:20 p.m.)

-because the American Medical Association is so firmly rooted in its beliefs and position.

He sees as an obstacle the opposition of a powerful American organization: The American Medical Association. Of course, this does not convince a layman such as I.
Then he adds that we lack doctors, and that ours go to the United States. There may be another reason for this besides health insurance: perhaps the fees are higher there. Some doctors have told me that in the provinces where part of the medical fees are paid, doctors are very happy with their salary. Therefore, I see this as an argument in favour of the program. He continues in this vein, giving several disparate arguments.
Mr. Chairman, I think the government should be concerned instead with the attitude of the general public, which needs medical care, whatever some doctors who see in this a personal disadvantage may think. Incidentally, I do not think professor Wilcox is speaking for the whole medical profession, for I myself have had the opportunity of meeting quite a few doctors in my riding and in my province, and I must say that nine out of ten would be satisfied with such a program, even if they are ready to suggest some amendments such as those suggested by the opposition. And the doctor concluded his argument to prove that health insurance would be a national catastrophe-this is the word he uses-a national calamity. Let me read the paragraph in his own language as written:

It cannot be stated too strongly that Canada's problem in medical services is in a shortage of doctors and in our loss of them to the United States. I repeat the statement of my conviction that medicare or the fear of it is a major factor in this loss. Even should one choose to question this conviction and to discount the evidence and experience reported here, it must be clear that medicare would be certain to add to the Canadian loss problem rather than to relieve it or to improve our position in any way. Medicare or even the prospect of it is truly a national danger to our maintenance of essential medical and health services.
November 29, 1966



Well now, if the only result achieved by the doctor's brief were to warn the government and the medical profession of this danger, his essay will at least have done this much. Surely the government is not launching such legislation without being aware that a sufficient number of well-trained medical practitioners will be needed. And moreover, other pieces of legislation show us that the government is taking other steps to provide for greater expansion of medical research, and also of professional schools that are turning out competent physicians. Therefore, it is taking the necessary steps to fill in this gap and I submit that the learned doctor's objections are-if we interpret them in the right way-arguments which could be made in favour of the medical care plan.
I also went through certain briefs submitted by the Canadian Medical Association. I find that their recommendations are much more reasonable, much more realistic than those of the Western University professor. As I understand them, their suggestions to the government boil down to this: medical care services should be restricted to those who are unable to pay for them. They would also like to see provincial governments dealing with the known bona fide organizations, such as insurance companies, or others, a provision obviously not included in the present bill.
But I see that, by and large, the Canadian Medical Association has no objection to the bill itself, and they simply want to protect the particular interests of the medical profession or some companies.
I have heard other objections, Mr. Chairman, and I would like to sum up what my friend, the hon. member for Villeneuve, said last night in four or five speeches, voicing the opinion of some other members of the opposition for extended coverage of the medical plan. But he strongly stressed the point that the federal government was interfering in the affairs of the provinces, that it dictated to the provinces. I was astounded. With his usual exuberance, his usual power of persuasion, he railed so much against the government for several minutes that an inexperienced member would leave this debate convinced that the government is a real tyrant bent on destroying what we call in my part of the country the autonomy of the provinces.
Medicare
I do not see it that way, Mr. Chairman. I see in this bill, as well as in most social legislation passed here, not federal interference but what I would call federal leadership. The federal government has launched across the country social movements and social legislation which benefit the whole population and which each province would be slow to put into effect had the federal government not given this leadership which is an inspiration and stimulus for all the provinces.
I believe that this is the role of the government, but I do not believe the government dictates, commands or imposes anything on the provinces. I have read the bill for the tenth time and I still see that the provinces will administer the plan, make the decisions and receive money from the federal government.
There are, of course, four clauses, and everyone knows what they are: portability, universal coverage, public administration and universality. I think that the government thus wanted to insure uniformity in the provinces, and I feel that is essential.
If, as Canadians, we live today in Quebec and decide tomorrow to move to Saskatchewan or Ontario, we will be able, at a few days' notice, to move to western or eastern Canada and benefit from that legislation. It is important, therefore, that the main characteristics of that bill at least should be made uniform, and I think the government did the right thing. Who will be able to object to portability?
[DOT] (5:30 p.m.)
Universal coverage, of course, because if it is necessary to make an investigation each time people need medical services, they might die sometimes before the investigation is completed. Therefore it is good that the coverage should be universal.
Public administration, of course, since companies must not be left free to make money out of public funds and there is a greater guarantee that no abuse will result from those measures if the province continues to administer the plan.
Universality, of course, it is a striking feature. I do not think, once again, that those clauses are liable to be considered as interfering with the administration of the province. Besides, if they do, I think that it is fortunate and I even feel like repeating what an American patriot said: "If this be treason, make the most of it."

November 29, 1966
Medicare
It is high time, I believe, that the government should assume its responsibilities and bring home to some backward provinces that these are necessities imposed by present conditions and that we should act immediately. I understand that certain circumstances bring about dilatory measures. For instance, we have decided that the bill would not take effect immediately, on account of financial contingencies. As far as my province is concerned, I believe that this is a happy occurrence, because our people ask themselves many questions on different subjects and besides, suffer from this acute financial problem; they want to be given a breather before embarking on this project. I believe that this delay will give the central administration an opportunity to meet with representatives of the ten provinces to try to come finally to an understanding on those basic clauses and, perhaps with the consent of the ten provinces, to add to what has been suggested up to now, that is, to offer even more coverage under this bill.
Therefore, Mr. Chairman, I say that this is a good piece of legislation providing for what I shall refer to as minimum benefits which, of course, will have to be extended further eventually. In this regard, I would be ready to support some of the amendments proposed, if they did not have the effect of delaying passage of the bill or perhaps creating certain complications or aggravating that lack of comprehension between provinces. As I say the most understanding and acceptable amendment, in my view, is that moved by the hon. member for Burnaby-Coquitlam. Again, I would be ready to support it any time. Furthermore, I suggest that those who still entertain doubts on certain aspects of the bill should read carefully the speech delivered by the Minister of National Health and Welfare (Mr. MacEachen) last October 25, which I believe was circulated among all hon. members, and which makes a very careful analysis of all clauses, and all objections. Of course, the only one which I find perhaps a little drastic is when he refers to the political aspect and to the criticisms made. I want to keep away from dealing with that aspect. I sum up by saying this: the legislation, as drafted, is an acceptable, worthwhile and well-timed initiative which, as presented, will allow sufficient time for the discussion to continue at the federal-provincial level and for the governments eventually to profit by all the suggestions made and to

which, of course, the government and their experts gave thought themselves.
Therefore, I intend to support this bill, and I think I can take the liberty of appealing to all my colleagues in the opposition to consider it precisely in this light: this is a minimum plan which, for another year at least, the government can discuss with the provinces, a year during which the government can consider the act anew and, perhaps, amend it along the lines of the suggestions made, particularly if it accepts the amendment of the hon. member for Bumaby-Co-quitlam, which opens an avenue that should meet with the wishes of all men of good will.


Mr. Brand:: Mr. Chairman, I have not much to say on this matter but I would like to say something different about clause 2 (d). In so doing I wish to refer to what the minister said on October 25, as recorded at page 9103 of Hansard. My reference is to paragraph (d) which reads in part: "insured services" mean "all services rendered by medical practitioners ..." My concern is whether or not doctors, if they so desire, will be able to practise outside the ambit of such a medical plan. Since the paragraph refers to "all services rendered by medical practitioners" I cannot see how a doctor can practise apart from the government scheme and charge fees accordingly. Undoubtedly, there are a few doctors who will wish to do so. If they look at some one with a chest condition, or take out a pair of tonsils, they will in effect be performing an insured service.
This is a plan to insure people against the cost of medical illness. The minister has said so on many occasions, and I can quote him if he wishes, but in fact what we are proposing to do here is insure the services of the doctor, which is a different thing entirely.
As recorded at page 9103 of Hansard the minister said:
However, what we are proposing in this legislation will make it possible for any physician to practise outside the plan if he so wishes. He will have full freedom to practise outside the plan, as do physicians with respect to certain medical care insurance plans now in operation in Canada.
He went on to describe the full freedom of the physicians and, as recorded at the bottom of that page, the minister said:
We have met them on that point. Naturally I do not think that in any province this will be widely exercised by the medical profession, but it is a right which they wish to have and which I think they can have without affecting the operation of the plan.
November 29, 19G6

I concur with the statement of the minister both as to the number of doctors who might exercise this right and as to the desire of doctors to have this right available to them. But I am concerned and perplexed as to how a doctor can practise outside a bill of this nature when everything he does is insured under the plan. I would like the minister to explain how this can be done, because it brings up another point.
If doctors can practise outside the plan, and therefore presumably charge fees to their patients, can the patients then go to a governmental agency in a province and receive reimbursement since, under another provision of the bill, they are insured persons? I would like to have clarification from the minister on this point because I frankly do not see how this can be done. I am not proposing any amendments but would like the assurance of the minister on this point with respect to paragraph (d).


Mr. Lewis:: Surely that would come under provincial plans?


Lewis Mackenzie Brand: But provincial plans, if I may answer the hon. member, will depend entirely on the bill that we pass here. That is the point we have been making for the past day or so. This depends on how provincial plans will operate within the framework of the federal scheme. If the minister would be kind enough to answer me then I would be prepared, in view of the fact the minister may want time to consider the amendment before us, to move, seconded by the hon. member for Simcoe East that clause 2(d) stand for the time being.


Mr. Herridge:: Mr. Chairman, I intend to be quite brief because I realize the committee has spent considerable time on this clause to date, something which has been worthwhile-


Edmund Davie Fulton: On a point of order, Mr. Chairman, I understand there is a motion before the Chair that the paragraph stand, and therefore I am wondering whether ordinary debate can continue until that motion is disposed of.


Allan Joseph MacEachen: If I may intervene, Mr. Chairman, I think when the hon. member for Burnaby-Coquitlam read his amendment the committee agreed to stand paragraph (d) at that time, but debate continued on the paragraph. I do not really know where we stand now.
Medicare


Herbert Wilfred Herridge: Well, Mr. Chairman, the hon. member for Fraser Valley continued after the hon. member for Burnaby-Coquitlam completed his remarks, and I am sure we all enjoyed the remarks of the hon. member for Fraser Valley, something I do not do on all occasions. However, I intend to be quite brief-


Herman Maxwell Batten: Order, please. It is my understanding that what actually happened when the hon. member for Burnaby-Coquitlam moved his amendment was that it was agreed to defer a decision on whether or not the amendment was in order, but it was not agreed at that time to stand paragraph (d). There is now a motion before the committee, moved by the hon. member for Saskatoon, that paragraph (d) stand.


David Lewis: On that point of order, Mr. Chairman, and with great respect may I say that the motion was not moved. What the hon. member said was that if the minister would answer his question he was prepared to move such a motion, but he did not move it at that time. The motion, therefore, has not been moved, and I respectfully submit that the hon. member for Kootenay West is entirely in order.


Lewis Mackenzie Brand: This is the way I phrased it, Mr. Chairman, and I have not received an answer from the minister.


Herman Maxwell Batten: The hon. member for
Kootenay West.
[DOT] (5:40 p.m.)


Herbert Wilfred Herridge: That is as we heard it here, Mr. Chairman. As I said before, I intend to be quite brief but I do want to express my support for the amendment moved to clause 2(d) by our leader, the hon. member for Burnaby-Coquitlam. Once again, I might say I am sort of an elder statesman when it comes to supporting the principle of a national health insurance scheme. One always falls back on this "elder statesman" theme when one finds that he no longer is young and his memory is failing. I might say there is only one other member in this house, other than the member for Kootenay West, who supported a national health scheme at the time of the election of 1921, and that is the hon. member for Cochrane. I might say that since that time the others have gone to their reward, to defeat, to retirement, or to the other place; some were not residents of Canada at that time and others were not born. I have had long experience in advocating this principle.

November 29, 1966
Medicare
Now, Mr. Chairman, I support the remarks made by other hon. members. I do not intend to repeat the excellent arguments made by the hon. member for Burnaby-Coquitlam or the excellent arguments by the hon. member for Fraser Valley and others. I do believe, however, that this bill should be amended so that it will include the services which can be provided by dentists, optometrists, chiropractors, osteopaths, naturopaths, serologists, physiotherapists, and other practitioners of the healing arts. Like the hon. member for Burnaby-Coquitlam, I believe that if the minister would only agree to what is included in our amendment this would greatly improve the services which can be rendered under the provisions of this bill. All of us have received numerous briefs from organizations representing the professions I have mentioned, from church organizations, labour organizations, and from other groups which are interested in ensuring that this bill is as good as possible under the present circumstances.
I have in my hand a letter, which 1 opened only this afternoon, from the Registrar of the University of British Columbia. This letter terminates with the following paragraph:
Resolved, that the Faculty of Dentistry of the University of British Columbia urges the federal government and all members of parliament to amend Bill C-227 so as to permit compensation for those insured services which dentists are especially qualified to perform, when they are rendered by dentists.
When the hon. member for Burnaby-Coquitlam moved his amendment I was very pleased to note that the minister rose in his seat and stated that he wished some time to consider the amendment. I trust that the minister has had some representations from members of his own party to the effect that the bill which he is presenting to the house is too limited and prevents the introduction of the services which people require. I might say that the Department of Veterans Affairs has pioneered in this field. When the veteran requires it, they will permit the veteran to receive many of the privileges which we are asking to be included in this bill at this time. This is the situation also in respect of compensation boards in some provinces. Even some of the private schemes which are in effect at the present time make provision for the inclusion of some of the privileges which have been mentioned by speakers in this debate.
In conclusion, therefore, along with the others who have spoken on this amendment, I do urge that the minister give consideration to
IMr. Herrldge.l
amending the bill as suggested by the hon. member for Burnaby-Coquitlam. Then, at least, the provinces will have the option to include the services which they feel their people require. There are some people who have indicated their support for all the services we have mentioned. Others have indicated their support for some of the services we have mentioned. If the minister could see his way clear to amend the bill to make it possible for the provinces themselves to include those services which they think are required by their people, then we would have a bill which would be much wider in scope than the present bill and one which would be fair to all the provinces concerned.


Mr. Tremblay:: Mr. Chairman, I have followed closely the debate on second reading and yesterday's debate on Bill No. C-227.
It appears, at least to me, that in certain quarters of the house, the purpose and the very nature of the bill now before us have not been understood. The purpose of this bill is not to set up a federal insurance plan, because it says so, and I think reference has to be made to the title of the bill itself to understand its nature and its purpose: an act to authorize the payment of contributions by Canada. In other words, a money bill. Had the federal government assumed full responsibility for medical care services, it would have introduced a bill accordingly and established criteria whereby people could go and see any medical practitioner or specialist, be billed accordingly and then apply directly to the federal government for a refund.
But it is because provincial responsibility has been made abundantly clear, as far as medical care services are concerned, that we are now considering an appropriation bill, that is a bill which, subject to certain conditions, authorizes the federal government to make financial contributions not to individuals belonging to a medical plan but to the various governments which have established, under the constitution, their own medical plan for their own citizens.
This appropriation bill has a very definite purpose, and that is to have some uniformity in assistance programs across the country. Contrary to what could have been done under a federal act specifying in detail the terms under which it would apply, this bill provides four basic criteria, and any present or future provincial plan conforming to those four basic criteria will make the province concerned eligible to receive 50 per cent of the costs of such a plan.
November 29, 1966

It is, therefore, primarily a financial measure, and consequently, is not intended to cover all cases or all details of the plans; these are left to the provinces. They will adapt what programs and services their respective populations wish to have. This is a financial measure intended to establish uniformity on four well known basic principles: the plan will be public, transferable from one province to another, universal and, up to a point, compulsory.
To my mind, today's debate would make sense only to the extent where we would be discussing whether the federal measure should cover care other than strictly medical care. I submit, Mr. Chairman, that such a debate should be held by the legislative assembly when a provincial medical care insurance plan is being passed. The purpose of this financial measure is not to define the qualifications of those who will give medical care but merely to limit the federal contribution to the basic expenses incurred by the provinces, that is, the cost of medical care provided by medical practitioners.
I am convinced, Mr. Chairman, as the members surely are also, that as citizens of the Canadian provinces, whether it be under existing programs or programs to be established, we wish to see the most extensive care possible to be given and paid for by our various provincial governments. I should be happy, as a citizen of that province, to see Quebec adopt a plan wide enough in coverage to enable one to be reimbursed by the province for all expenses incurred, not only for doctors' care, but also for the services given by all other specialists; the plan should also cover drugs, which represent considerable medical expenses.
[DOT] (5:50 p.m.)
But from a federal point of view, this bill is precisely designed to prompt the provinces to participate in a medical insurance plan. The federal government is willing to repay, under certain conditions laid down in the bill, 50 per cent of the total expenditures incurred with regard to medical services rendered by physicians.
Mr. Chairman, the amendment moved by the leader of the New Democratic Party (Mr. Douglas) would enable the minister and the cabinet to extend the services covered under the federal plan. I do not know how the government and the minister will view this amendment. I feel personally that if the house is willing to surrender some of its rights to the executive, without amending the
Medicare
legislation subsequently, then it is up to the house to determine whether it is wise and fair to allow more latitude to the government in return for extending the coverage of services provided in the bill now before us.
I only wished to remind the house during this discussion about extending medical services that, in my opinion, we have before us a supply bill designed to prompt the provinces to enter a field, or at least to meet four basic requirements, in order to be eligible for federal assistance, and all details, including the extension of services, concern the provinces. It is up to them to determine which specialists will be qualified under provincial plans.
I submit, Mr. Chairman, that the bill in its present form, and considering the substantial financial contribution involved in medical care, will surely achieve its purpose, that is, implement in every Canadian province plans which, as a citizen of the province of Quebec, I hope will be as extensive as possible and cover, in addition to medical services, all other specialized services which may prove useful to us.


Edmund Davie Fulton: Mr. Chairman, it seems to me that we are now in a vacuum to some extent in that an amendment has been moved by the hon. member for Burnaby-Coquitlam, yet the suggestion was made that if the minister is in some doubt as to its acceptability we should defer discussion of the amendment. Accordingly, further discussion of this amendment seems to have been postponed by general consent. I suggest to you, and to the committee, that this is not a very satisfactory situation, as far as I am concerned at any rate. I find it difficult to make a meaningful contribution in respect of paragraph (d) until a decision has been made as to the acceptability of the amendment proposed by the hon. member for Burnaby-Coquitlam. If it is accepted I believe there should be a further amendment, but there does not seem to be any point in moving that further amendment now, or discussing it as a separate subject, in view of the fact that the amendment before us may be ruled out of order or rejected. We are not even discussing that amendment itself.
There are other important matters in clause 2 which should be considered, and I am prepared to move that paragraph (d) stand until such time as the question regarding the amendment is settled. In the meantime we should move on to paragraphs (e) and (f).

November 29, 1966
Medicare


Lewis Mackenzie Brand: I will second that motion, Mr. Chairman.


Allan Joseph MacEachen: Mr. Chairman, perhaps the hon. gentleman would agree to stand paragraph (d) for a short period of time, let us say an hour or two, and then come back to it at eight o'clock.


Thomas Clement (Tommy) Douglas: After dinner.


Mr. Rapp:: Mr. Chairman, may I suggest that we adjourn for dinner between the hours of six and eight. This would give the minister and members an opportunity to consider the amendment.


Allan Joseph MacEachen: Mr. Chairman, the government house leader is now in attendance. Perhaps he will be able to give some direction as to what is proposed in respect of the dinner adjournment. Regardless of what we do in this respect, I suggest it would be a good idea to stand this paragraph for a couple of hours and return to it tonight. At that point we could have a ruling and then, depending upon the nature of the ruling, we could proceed from there. I have no objection to standing it for a couple of hours, if that is agreeable.


Edmund Davie Fulton: I do not wish to complicate this matter or attach conditions, but I think we should stand it for a definite period of time. I do not think that time should be influenced one way or another by our decision as to whether we adjourn for dinner. I am prepared to stand the paragraph for two hours or, alternatively, I will put my motion that we stand the paragraph and go on to other paragraphs. If it appears appropriate to return to paragraph (d) at any later time, I see no reason why we cannot do that.


Allan Joseph MacEachen: I see no objecton to standing the paragraph and then returning to it in two hours, at which time a decision can be rendered. I suggest we do so independently of what we decide about a dinner adjournment.


Edmund Davie Fulton: That is agreeable, and I would modify my motion accordingly.


David Lewis: Mr. Chairman, I do not have the minister's experience, but it seems to me that if we set a definite time it will mean that at eight o'clock, in the middle of somebody's remarks which could be concluded in two minutes, we would be obliged to come back to this question. I ask the minister through you, Mr. Chairman, whether it would not be better to leave the situation as the hon. member for Kamloops suggested. We could stand this

clause and if at any point there is a consensus of the committee, or a common sense situation which indicates that we should return to it, we can do so. I do not have the minister's experience, but as chairman of other meetings I have always been worried about having to go back to something at a specific time no matter what happened to be before the assembly at that moment.
[DOT] (6:00 p.m.)


Mr. Mcllraifh:: That is the best way.


Allan Joseph MacEachen: I think that is a reasonable position, Mr. Chairman. I am sure that if at eight o'clock an hon. member is making a speech, or we are engaged in something else, we could agree as to the time remaining.


Edmund Davie Fulton: I just want to be clear on this, Mr. Chairman, because the minister mentioned eight o'clock. Are we agreed that the two-hour period is irrespective of any dinner adjournment?


George James McIlraith: The minister said eight o'clock.


Edmund Davie Fulton: My understanding is that the debating portion, the time within which we will discuss this paragraph in debate, is adjourned for two hours. If we adjourn for one hour or one and a half hours for dinner, that two-hour period starts to run when we reconvene; that is my understanding.


Michael Starr: Mr. Chairman, I think that if there is a motion that this clause stand, there should be no time limit; it stands until the committee gets back to it. Meanwhile, I would suggest, if it is agreeable, that we recess for dinner until eight o'clock.


George James McIlraith: Mr. Chairman, I wonder whether we could clear up this point first, so that we are not met with a loss of time later in the evening. I think we should understand just what the situation is. However it is decided, I should like what is going to happen to the clause to be clarified.


Edmund Davie Fulton: We go on with the next clause.


George James McIlraith: Is it for two hours, or not?


Edmund Davie Fulton: Would it not be better to adopt the suggestion of the hon. member for York South and our house leader, that we stand the clause by agreement now and then adjourn for dinner?


Michael Starr: Another paragraph has been allowed to stand.
November 29, 1968


Herman Maxwell Batten: Is it agreed that paragraph <d) stands?


Some hon. Members:: Agreed.


Herman Maxwell Batten: Shall we proceed to the discussion of paragraph (e)?


Michael Starr: Mr. Chairman, I made the
suggestion that we recess for dinner. I think this is agreeable to everyone.


Herman Maxwell Batten: If there is to be discussion as to whether the committee should suspend its sitting, that matter should be decided with the Speaker in the chair. There is no way for the Speaker to get in the chair unless the committee gives me permission to rise and report progress.


Some hon. Members:: Agreed.
Progress reported.



PROCEEDINGS ON ADJOURNMENT MOTION


Mr. Deputy Speaker:: It is my duty, pursuant to provisional standing order 39A, to inform the house that the question to be raised at the time of adjournment tonight is as follows: The hon. member for Kootenay West (Mr. Herridge), finance-effect of United States tax on inventories of Canadian products.


George James McIlraith: Mr. Speaker, I understand there have been some requests for a suspension of the sitting. I would suggest a suspension of one hour.


Michael Starr: To six minutes after seven?


George James McIlraith: Yes, that would be agreeable.


Michael Starr: Make it two hours; don't be such a tightwad.


George James McIlraith: Mr. Speaker, I should point out that we have been on clause 2 for two days now. We had a longer adjournment last evening at the dinner hour at the request of hon. members, and I think a careful analysis of what happened afterwards would indicate that it would have been just as well to have adjourned for the rest of the day.
There is a great deal of legislation before the house, and there are many requests from hon. members as to when we may expect to get the business dealt with, and so on. I think
Medicare
the sensible thing to do, in the circumstances, is to agree to abridge the rules for one hour and then get on with the business of parliament.


Mr. Rynard:: Mr. Speaker, I wonder whether I could ask the government house leader if he would give us another half hour, because we have a meeting of the voluntary health committee. There is another meeting here tomorrow, and they have barely started yet.


George James McIlraith: We are hearing from splendid organizations such as the voluntary health committee. But with deference to them, Mr. Speaker, it is not appropriate, in my view, for parliament to be continually making way for these associations, no matter how laudable and fine they are. Some judgment has to be used in the matter. I suggest that an hour's suspension of the sitting is reasonable, in the circumstances.


Some hon. Members:: Seven thirty.


Michael Starr: Mr. Speaker, it looks as though we have to bargain. Would 7.30 be agreeable?


George James McIlraith: No.


Michael Starr: Then 7.15?


George James McIlraith: Yes.


Mr. Deputy Speaker:: Is it agreed that the house suspend the sitting for one hour?


Some hon. Members:: Until 7.15.


Mr. Deputy Speaker:: Until 7.15?


Some hon. Members:: Agreed.


Mr. Depuly Speaker:: Accordingly, I do now leave the chair.



SITTING SUSPENDED


[Stage Direction]
The house resumed consideration in committee of Bill No. C-227, to authorize the payment of contributions by Canada toward the cost of insured medical care services incurred by provinces pursuant to provincial medical care insurance plans-Mr. MacEachen-Mr. Batten in the chair.
[Stage Direction]
November 29, 1966
Medicare
On subclause (d)-"Insured services".
Herman Maxwell Batten: When the committee rose just after six o'clock subclause (d) of clause 2 was being discussed and also an amendment thereto moved by the hon. member for Burn-aby-Coquitlam. It was then agreed that the subclause should stand. If this is still the agreement of the committee we will proceed to subclause (e).
Subclause stands.
Subclause (e) agreed to.
On subclause (f)-"Medical practitioner".


Philip Bernard Rynard: Mr. Chairman, I have a few remarks to make on this subclause and I wish to bring up a point that has not been stressed. My point is that we are now in a period of acute shortage of medical practitioners throughout Canada. I should like to go back over a period of years and refer to what has happened. For instance, in the year 1910 there was one doctor to every 1,000 to 1,100 people. There were very few specialists at that time and very few doctors in administrative positions. In 1965 an altogether different situation faced us. Last year there was one doctor to every 950 people. But what do we find? We find that out of 20,000 doctors almost 50 per cent are either specialists or engaged in administration. This means in effect that we have one general practitioner to roughly every 1,900 persons.
The point I am making is this. Never before in our history has there been such a need for paramedical personnel as there is today. A great many doctors today are forced to call for assistance to help them with their work. I am sure that if the situation is looked into the minister will find that in some areas-they may be few; I do not know-ophthalmologists engage paramedical personnel to do the op-tometric work in their offices because they do not have the time to do it.
This is common right across the field of medicine. In the province of Ontario today, and the same in true of other provinces, you will find in the field of physiotherapy that a doctor can refer a specific case to a hospital, with the cost of treatment being paid by the Ontario Hospital Commission. But if the doctor refers the case to a physiotherapist who, although he is not working in a hospital, has received the same training as one who is, the physiotherapist does not receive payment from the hospital but is paid by the patient. To me this practice works unfairly right across the board and is discriminatory.

The hon. member for Burnaby-Coquitlam quoted some cases in point and I could go on at length to quote other examples. For instance, in the province of Ontario a doctor can refer a case to a chiropractor and the province through the workmen's compensation board will pay the chiropractor for treating the patient.
The point I want to make is, as I said yesterday, that two things are happening to the medical profession today. First of all, either doctors are seeing more patients than they should see to treat them properly and as a result the quality of care is suffering or, second, doctors are refusing to see more cases because they do not want to jeopardize their patients' interests and want to retain quality of care. Consequently some people cannot get attention from them. This comes back to my plea that all doctors should be allowed the maximum paramedical personnel permissible under the provincial act if they are to perform their functions as they should and to the best advantage.
There has been a change of thinking in our hospitals. I remember that about five years ago no one but a doctor could start an intravenous process. In our hospitals today you will see nurses starting intravenous procedures, which shows how technological training is helping the doctor by relieving him of part of his work, and is helping out in the shortage of medical doctors.
Let me take the case of the radiologist, a qualified specialist. He does the screening and examines the plates. But who prepares these plates and takes the pictures? Who is entrusted with the task of turning on the current, taking the pictures and preparing the plates? No one but the X-ray technician, and his services are paid for by the hospital.
[DOT] (7:30 p.m.)
This whole question deserves very careful consideration in view of the fact that doctors today require more and more personnel to help them perform their duties. I venture to say that with the changing picture in the medical field very soon we will have technicians assisting in operating rooms across the country. This may take ten years but we will have them there. I should like the minister to acquiesce in this view and plan accordingly because I am sure we are advancing along these lines. In view of the acute shortage of medical practitioners, not only would this help the people and be fair and equitable but it would also help our doctors to perform more work. It would relieve doctors from burdensome tasks which could be performed by
November 29, 1966

paramedical personnel. I appeal to the minister to give this matter his thoughtful consideration.
I also draw to the minister's attention that in Ontario people insured under medical plans are already being paid for treatment by physiotherapists, optometrists, chiropractors and others. If this bill becomes law we shall take away from people receiving such treatment something they already have. In other words, the bill will be backward looking and not forward looking; it will take a backward step.
Next I want to refer to oral surgeons. In my province-the minister I am sure knows this-oral surgeons are paid, under the plans in the province, only for the work they do in hospitals. This, I think, is wrong. I have talked to quite a few oral surgeons who have told me that in 95 per cent of cases they can do as good work in their offices as in hospitals under local anaesthesia with the patient's cooperation. Having oral surgeons treat patients in their offices will decrease costs. I submit that the field of oral surgery should be included under this medical plan.
I pointed out that in the Hall commission report, an excellent report as the minister will no doubt agree, it is said that optometrists must be included in the plan. The report recommends that optometrists who are qualified by training take a refresher course to brush up on a few contentious points. I suggest that course be at the expense of the country. Optometrists ought to be given a short course to make them proficient in those details of practice in which they are not quite proficient so they can do types of work they are not now doing. I say to the minister that it is paramount that optometrists be included in this plan, and the Hall commission report states that they ought to be. I am sure the minister has read that report.
I shall not detain the committee much longer, but before sitting down I move that clause 2 of Bill C-227 be amended by deleting paragraph (f) thereof and substituting therefor the following:
(f) "medical practitioner" for the purposes of this Act means any person lawfully engaged In the practice of rendering services to individuals in the field of the healing arts whose qualifications and entitlement to practise in the place in which such practice is caried on by him are recognized by the government of a province or by an association approved for the purpose by the legislature of a province:


Allan Joseph MacEachen: May I raise a point of order on this amendment?
Medicare


Herman Maxwell Batten: Would the minister permit me to say a word? I shall then be pleased to hear him. I point out that we should be careful about the procedure to be adopted here since we already have a paragraph in this clause with an amendment thereto. Citation 397 of Beauchesne's fourth edition, page 282, says:
If the latter part of a clause is amended, it is not competent for a member to move to amend an earlier or antecedent part of the same clause.
The Chair will not object if this paragraph is discussed but before the amendment is put it will be necessary to look again at paragraph (d).


Allan Joseph MacEachen: I raise an argument famil-liar to the Chairman and to the committee. I submit that the amendment moved by the hon. member for Simcoe East is out of order. Clause 2(f) defines a medical practitioner as follows:
-a person lawfully entitled to practice medicine in the place in which such practice is carried on by him;
The amendment moved by the hon. member for Simcoe East defines ''medical practitioner" as any person lawfully engaged in the practice of rendering services to individuals in the field of the healing arts. We are aware of the implications of this definition from the comments of the hon. member. The effect is to define "medical practitioner" as including a whole range of additional professions such as optometrists, podiatrists, chiropractors, chiropodists, nurses, the whole range.


Some hon. Members:: Hear, hear.
[DOT] (7:40 p.m.)


Allan Joseph MacEachen: If this amendment were accepted it would have to be considered in conjunction with paragraph (d). Paragraph (d) defines "insured services" as "all services rendered by medical practitioners", so that by this amendment we would effectively include within the scope of the bill services that are beyond the meaning of the resolution. What I am arguing, Mr. Chairman, is that this amendment raises precisely the same issue that has been raised on four previous occasions. The ruling on those occasions was to the effect that the amendments increased the meaning beyond the scope of the resolution. Obviously this amendment is defective for the same reason because it seeks to broaden the ambit of the bill beyond the scope of the resolution and beyond the recommendation from His Excellency the Governor General.

November 29, 1966
Medicare


Edmund Davie Fulton: Mr. Chairman, I would like to speak to the point of order raised by the minister. I admit at the outset that there is some but only a very limited similarity between the purposes proposed by this amendment and those proposed by the amendments moved to paragraph (d). But on the other hand, sir, I submit to you that there are very real differences which compel a different decision on this amendment from that which you arrived at with respect to the earlier amendments.
I make this submission on a number of grounds. The first is that nowhere in the resolution is "medical practitioner" defined. Indeed, sir, nowhere is "medical practitioner" even referred to in the resolution. With respect to insured medical care services the minister was able to point to those words which were used in the resolution, and he submitted that any attempt to enlarge the meaning of that phrase went beyond the scope of the resolution. However, sir, as I point out, the words "medical practitioner" are not referred to in the resolution.
Therefore this bill is the first place where the use of the words "medical practitioner" occurs and I submit to you, with deference but with all seriousness and urgency, that while, as you have said, it is not the Chair's responsibility to define any of these terms, neither is it the minister's responsibility to define them or to say, "If I"-the minister -"think they should be defined in this way then the committee is precluded as a matter of order from substituting its definition for that which I have put in the bill."
Such a proposal is not a point of order, nor does it really raise a question of whether the amendment is in order. What is involved is the right of parliament or a committee of parliament to say, no, we don't think your definition is sufficient or adequate and we suggest and move as an amendment that some other definition be substituted.
I am prepared to admit that in such a case one goes back to the resolution, according to the minister's point of order, to see if the resolution sets any limitation on the meaning of the words. If we do so, we find not only does it not set any limitation but it does not even mention the words. Thus, in my submission, prima facie this committee is entitled to say what it thinks should be the definition of "medical practitioner."
Coming to the question of definition, I want to refer to some standard dictionary definitions, and I take the authority of the Concise Oxford Dictionary which is on the table of the

house and available to all members of the committee. I first look at the word "medical" as defined on page 756, because in this argument we are dealing with the definition of "medical practitioner." At page 756 the first definition of	"medical"-adjective	and
noun-is found to be "of the healing art."
I point out to you sir, that the amendment now proposed describes "medical practitioner" for the purposes of this act as "any person lawfully engaged in the practice of rendering services to individuals in the field of the healing arts." Unless the minister is going to challenge the Concise Oxford Dictionary he cannot deny that persons engaged in the field of the healing arts are medical practitioners by definition.
Second, the Concise Oxford Dictionary at page 914 defines the word "physician." Last night and today the minister was at pains to say that the only kind of service and the only kind of practice that could be contemplated in this bill, because of the resolution, are those rendered by qualified medical doctors, and I suppose he would include "physician" within the meaning of the term "medical doctors" or "medical practitioners." At the bottom of page 914 and the top of page 915 the Concise Oxford Dictionary defines "physician" as a norm in these words, "one who practises the healing art including medicine and surgery."


David Lewis: What about some sciences?


Edmund Davie Fulton: I am dealing with the science of definition at the moment and I rely for my authority on the definitions contained in the Concise Oxford Dictionary. By definition "medical" means "of the healing art" and a physician, who is certainly a medical practitioner, is "one who practises the healing art." Therefore, Mr. Chairman, I submit to you that by definition "medical practitioner" includes or means a "person lawfully engaged in the practice of rendering services to individuals in the field of the healing arts", as is set forth in this amendment.
Now I come to the minister's next point, that by amending the bill to include such a definition we are going outside the scope and intent of the resolution, and I quote the minister's own words to refute his own argument. I have here Hansard for June 14, 1966. The point I am making is that the minister now says, "in this bill we meant"-the government meant and the Governor in Council meant-"only qualified medical doctors." But he has not specified this in the resolution. He only says, "that is what we meant," and he
November 29, 1966

invites you, Mr. Chairman, to accept his interpretation of what he meant or what he says he meant, and insists that not only must you accept his interpretation, but you must rule that what we say is a proper definition goes beyond the meaning of the resolution.
Again I remind you, Mr. Chairman, that the resolution does not mention or define "medical practitioner," but more importantly, let me quote the minister himself on what was intended and meant by the resolution preceding this bill, which, as I recall, was also on the order paper on June 14. On June 14 the minister, introducing the resolution preceding the bill to set up the health resources fund, said, as reported at the bottom of the first column of page 6377 of Hansard:
Mr. Chairman, I am pleased to begin the discussion on this resolution setting up a health resources fund. As hon. members are aware, the government proposes to introduce shortly legislation under which it will be possible to give financial support to the provinces for the provision of medical care benefits.
That legislation is the bill now before the committee, and it is what the minister was referring to in that portion of his remarks. The minister continued:
Such a program-
That is the program envisaged in this current legislation and in the resolution preceding the legislation.
-will undoubtedly help to create a professional climate which will attract increasing numbers of able people to the study and practice of medicine and related professions and will thereby improve still further the quality of care available to our people.
May I emphasize the words, "and related professions". I also emphasize those words by which the minister gave his interpretation of what was intended by this bill and what was implicit in the resolution upon which it is based:
[DOT] (7:50 p.m.)
Such a program will undoubtedly help to create a professional climate which will attract increasing numbers of able people to the study and practice of medicine and related professions-


Some hon. Members:: Hear, hear.


Mr. Fulion:: That was the minister's intention.


Eric Alfred Winkler: That is what he meant too.


Edmund Davie Fulton: That is what is included in this bill based on that resolution.


Allan Joseph MacEachen: You are not serious, are you?
Medicare


Edmund Davie Fulton: Was the minister not serious on June 14? Was he attempting to mislead the house?


Allan Joseph MacEachen: I was perfectly serious, but I am wondering whether the hon. gentleman is serious in drawing the conclusion he is drawing from that sentence when he concludes that the resolution which preceded this bill is somehow governed by a sentence drawn from a speech made last June. You are not serious in that?


Eric Alfred Winkler: Have you changed your mind since then?


Edmund Davie Fulton: I am suggesting that the minister was serious last June when he was interpreting the effect of the resolution then before the house. That is what I am suggesting. On June 14 he said that the intention of the current proposal was that such a program would help to create a professional climate which would attract increasing numbers of able people to the study and practice of medicine and related professions. Today he says that was never his intention at all. He says he never intended that by the resolution. He cannot maintain both positions. I suggest that he should revert to the much more practical, meaningful and sincere position which he outlined on June 14 when he gave his interpretation of the intention of the resolution and the legislation we are now discussing.
There are one or two other reasons why I submit this amendment is perfectly in order. One is the matter referred to already by the hon. member for Red Deer and the hon. member for Fraser Valley. The income tax guide gives the government's interpretation of medical expenses and we find it includes payments to hospitals, doctors, dentists-I am leaving out some of the words here-chiropractors, Christian Science practitioners, naturopaths, optometrists, osteopaths, podiatrists and therapeutists. This establishes clearly by definition, not a dictionary definition but a legislative definition, that the words "medical practitioner" embrace far more persons than those who are qualified to practice by the regulations of the Colleges of Physicians and Surgeons. So, on all these various grounds, as well as on the ground of what I might call a homely and simple illustration, the point made by the minister simply is not tenable.
Let me put it to you in this way, sir. Suppose I said that I propose to introduce a measure which will provide for the living expenses of the minister, but I did not define living expenses and the resolution did not

November 29, 1966
Medicare
place a ceiling on the amount of money which was intended to be devoted to that purpose. Then the bill comes in and the minister finds that it provides only for the cost of his meals .and clothing. He says, "Oh, but what about the rent of my house? That is a living expense". Then I say, "Oh, no; I didn't mean that. I didn't intend to include the rent of the house. I only meant that it should include your meals and your clothing and therefore you are bound by my interpretation. " Would you not be inclined to say, Mr. Chairman, "You cannot make that arbitrary limitation now because living expenses, in any normal and sensible interpretation of the words, include rent." Of course you would say that, Mr. Chairman. But the minister invites you to say the contrary now because he invites you to agree with him that when he used the words "insured medical care services" he intended to exclude, he says now, services rendered by those other than licensed medical doctors. But he did not say so in the resolution. Nor did he put a limit on the amount of money the government was prepared to devote to the purposes of the bill based on the resolution.
I submit to you, sir, that that homely illustration indicates that the minister's argument simply will not stand up. It is not realistic. If the minister had attached a money limitation or if he had said at the time of his speech in respect of the resolution that he did not intend to cover the services of anyone but medical doctors, there might be no question but that this amendment would be out of order. But he did not say that. So, not having said it in his speech or in the resolution and indeed having given a clear indication that the bill was intended to cover the services of persons in related fields, there is no question but that the amendment is in order. I am tempted to go on to argue on the merits, but I think that aspect of the argument speaks for itself and I will confine myself to the point of order.


Eric Alfred Winkler: Mr. Chairman, my hon. friend from Kamloops has discussed the technical side of the point of order. I suggest to you, Mr. Chairman, that there is a very practical side to the argument. From a personal point of view I might say that it would be perhaps wise for us on the opposition side to stay in our seats, pass the entire bill and get it over with, because the minister seems very adamant in his view and very unco-operative in his approach to assisting the people of Canada and everyone who will be affected by this bill. I suggest there is a very practical side to the hill of which the minister obviously refuses to

take cognizance and refuses to look at. I would be inclined even to go so far as to say that instead of having Bill C-227 as it now stands we should eliminate the bill and bring in some kind of political aid bill to bring the minister to his senses.
First of all, there is the political aspect of this bill. One of the things which has happened here is that apparently the minister has become so determined because of his political situation that he has argued with his cabinet colleagues that he is going to stand by this bill, and even though he might have said something else previously he is prepared to forget what he said. He is prepared to take the position that that does not matter. He is not going to let any other matter interfere with this bill. He is saying, I have to prove my position in the cabinet: I am going forward come hell or high water. That is precisely how the situation looks tonight.
[DOT] (8:00 p.m.)
Let me suggest a practical aspect of the amendment before us now. Apparently the minister is not aware of this fact, but because I know he is not a particularly stupid man I am sure he must realize what is taking place in the offices of physicians this year. I am sure the hon. member for Simcoe East will back up what I say. Every practitioner is so busy he does not know how to deal with the number of patients currently visiting his office. Many of these patients require only the services of a nurse. They may require a shot for one thing or another and really do not need the services of a doctor or the services provided at a hospital. The minister has already referred to the current situation in respect of nurses.
The minister has ignored accepted practice. Perhaps he has been in touch with the ministers of health in each of the provinces where medical insurance is available to the residents. It may be that the provinces do not want anything more than is provided by this bill. Perhaps they want plans which require payment by everyone. I would be inclined to doubt that, but if that is the case surely the minister should inform us. We should like to know whether the minister is prepared to accept any amendments to clause 2. I have not been present during the entire debate on this clause and therefore do not know whether he has given any indication in this regard, but I doubt that he is prepared to accept any amendments.
November 29, 1966

Would it cost more to include the services provided by optometrists? One of the minister's colleagues has suggested that this inclusion would cost an extra $18 million. I am not prepared to admit that it would cost that much because many patients who need visual correction will go to their doctor's office for an examination of their eyes rather than to an optometrist who would prescribe glasses and rectify the difficulty. I suggest that this practice will result in a great deal of additional expense, far outweighing the expense of including optometrists in this scheme.
Let us turn our attention to what will happen in the case of dental surgery. I suggest if oral surgeons are not covered by the plan patients will go to their doctors to have a tooth removed. How many doctors is the minister aware of who take their patients to a hospital to remove a tooth? Surely this practice will create an additional workload on physicians and a tremendous additional expense so far as the government is concerned.
Let us consider the situation in respect of chiropractors who are, after all, accepted as therapists in some provinces which have medical care plans. I am sure that in certain circumstances individuals who could properly be treated by a physiotherapist will turn to an orthopedic surgeon for treatment because his services will be covered under the bill.
The minister is not being practical in his arguments. Whether this amendment is accepted or rejected is of no particular consequence to me. What is of consequence is that the minister is not being sensible in his approach to this whole problem. It seems that he is not being politically astute in forcing this bill down his colleagues' throats, perhaps for the sake of his own ego. We know that health services fall within the responsibility of the provinces, so in the light of the minister's argument perhaps he should drop the entire plan. It may be that if the money is available the government should say to the provinces, you take this money and use it because this is your responsibility.
We have listened to arguments in respect of the inclusion of paremedical services. I hope what I have said to the minister in regard to the four categories I have mentioned will strike him as sufficiently important that serious consideration will be given. In the small rural area from which I come there is a 48-bed hospital which is now looking after 62 patients as a result of the hospitalization plan adopted by the province of Ontario. There is
Medicare
no doubt that this difficult situation is aggravated by the adoption of a medical plan. Yet the minister refuses to increase hospital grants.
Everybody who has approached this situation from a sensible point of view has suggested that we are putting the cart before the horse. If the minister will not listen to us and accept some of our reasonable suggestions we intend to carry on the argument until he does change his mind. We are now approaching the conclusion of the second day of debate and the minister still continues to take an extremely adamant position, even more so than last June. Individuals on that side of the house seem to be able to get away with that type of attitude. Unfortunately we on this side cannot always depend on the individuals who sit here. If we were able to depend on them we could defeat the government on this measure.
Let me hasten to add that there are other considerations which must be taken into account. Notwithstanding that fact, if everybody on this side of the house took a sensible and responsible attitude toward Bill C-227 and the arguments that have been advanced the government would not last another 48 hours. It is also my belief that if the minister wanted to do the right thing he would stop this debate now and let us discuss old age pensions for one day.
There is a member of the press gallery, whose name I do not know, who feels that what I have said in the past about old age pensioners is wrong. In spite of that I believe the responsible thing to do would be to end this debate and discuss old age pension amendments. This is particularly true in view of the refusal on the part of the minister to accept any amendment to Bill C-227. We would then have something to work on and an opportunity to do something in the interests of Canadians.
I have referred to our point of view in respect of the inclusion of paramedical people and the expense which might be involved. Let me repeat, if a doctor has to examine a greater number of patients in his office because they cannot visit an optometrist under the provisions of this bill, then the bill is working against the interests of the people of Canada.
I conclude my argument at this point. The minister should accept some of the sensible and responsible amendments placed before the committee by the opposition.

November 29, 1966
Medicare


Mr. Howe (Hamillon South):: Mr. Chairman, it is certainly not my purpose tonight to attempt to defeat the government on the medicare bill, but I am hopeful I can get the minister to use some reason in approaching the purposes of this measure. One of the arguments used in opposition to the amendments proposed relates to the extra expenditure required for the inclusion of these paramedical groups.
Many people will require the services and advice of these paramedical people. Whether these services are provided by medical practitioners, according to the definition of this bill, does not really matter in the long run, but what does matter is that the government will incur greater costs on behalf of these people because they will be forced to consult specialists rather than paramedical people. If everyone who needs eye glasses has to visit an ophthalmologist the cost will be a great deal higher than if he were allowed to consult an optometrist. The same situation applies to visiting orthopedic surgeons rather than chiropractors or physiotherapists. It is certainly more expensive for a patient to consult a psychiatrist than a psychologist.
[DOT] (8:10 p.m.)
For the reasons I and others have outlined I fail to understand the argument of the minister in refusing to accept amendments which would include paramedical services because of an increased cost so far as the government bill is concerned. I cannot see that this is a legitimate reason for refusing the amendment proposed by the hon. member for Simcoe East.


Lewis Mackenzie Brand: Mr. Chairman, I would like to speak briefly on the minister's point of order with regard to the amendment proposed by the hon. member for Simcoe East. At the outset I would say that the minister should not forget that it is not intended to open the door for each and every type or kind of paramedical service, but only those which are recongnized by the government of a province or by an association approved for that purpose by the legislature of a province. I think this is an important point and I will deal with it further. I personally am interested in hearing the minister's definition of what is a medical practitioner and what are medical services. I am interested in seeing the definition widened to include such things as optometry, oral surgery and physiotherapy.
The minister has said a great deal about the inability of the committee at this time to provide a definition of what are medical services

or what is a medical practitioner because, he says, it will cost the crown more money and the resolution did not carry this implicit understanding in it. I recall-unfortunately I do not have the pertinent copy of Hansard with me but I can certainly find it-a speech in which the minister made the statement, in response to speeches from this side of the house, that in actual fact the government was only going to spend a specific amount of money above what was being spent in this country for medical care. I believe the amount was approximately $80 million. The minister said that about $600 million would merely be redistributed. If the government is merely redistributing this money and we take some of the paramedical services and redistribute the money, how will it cost the government any more money? In case the government asks, what about the $80 million, I would say that it involves coverage for those people who do not have medical care at this time. I can quote the minister's words in respect of what is already being done in this regard. I believe the minister's argument is completely fallacious when he says it will cost the government more money.
As reported at page 9105 of Hansard of October 25 this year the minister said, when referring to an amendment moved on second reading of Bill No. C-227:
-I want to lead into this part of my comments by reminding the house that we have already taken action this session through the Canada Assistance Plan to provide medical care for persons in need.
The minister said this in reference to the amendment proposed by the hon. member for Simcoe East, part (d) of which suggested immediate care for those not able to provide for themselves by reason of financial disability. Here we have a redistribution of moneys already spent, with only an additional $80 million to be spent by the government. The minister says that any other care will be provided under the Canada Assistance Plan. I would point out to the committee that the minister also said at page 9105 of Hansard:
It may be helpful to refresh the memories of members by stating exactly what Is provided through the Canada Assistance Plan. Through the plan, the federal government is prepared to contribute 50 per cent of the cost to provinces, and to municipalities in the provinces, of providing what are known as health care services to persons in need.
I want you to note very carefully, Mr. Chairman, the minister's expression, "health care services to persons in need". The minister made a great point yesterday and today that there is a difference between health care
November 29, 1966

and medical care. This has been the sum and substance of some of the decisions made by the Chair. I would not attempt to question the judgment of the Chair, but I would certainly question the judgment of the minister in proposing this to the chair. As I continue reading what the minister said it will become clear, I think, beyond any doubt that the minister equates the two as being one and the same thing. I do not intend merely to interpret what the minister said; I will read his words and hon. members can make their own interpretation. As reported at page 9,106 of Hansard the minister said:
-of providing what are known as health care services to persons in need.
He went on to say:
Health care services include medical, surgical, obstetrical, optical, dental and nursing services.
It is interesting, is it not, to note the separation of medical and surgical services here? When I suggested to the minister last night that there was this difference, he said there was no difference between surgical and medical services. Then the minister said:
Health care services include medical, surgical, obstetrical, optical, dental and nursing services.
He went on to say:
The definition includes drugs, dressings, prosthetic appliances and any other items of health services necessary to, or commonly associated with, the provision of the specified service. It is clear, therefore, that the Canada Assistance Plan makes comprehensive provision for all health services that may be required by persons in need.
That is very laudable indeed. Then the minister stated that the Canada Assistance Plan is effective as of April 1, 1966. Many provinces are not aware of this, as we know, but that is neither here nor there in this debate. The minister continued:
It might also be mentioned that there is a special provision in the act which enables the provinces to claim for the costs of health care services provided to persons who receive assistance under any one of a series of acts, notably the Old Age Assistance Act, the Blind Persons Act, the Disabled Persons Act or the Old Age Security Act. This section provides that costs for such persons may be claimed retroactively to April 1 provided-and I now reply to the question of the hon. member for Ontario (Mr. Starr)-that a test of need is applied at any time prior to March 31, 1967. This provision will be helpful to the provinces in alleviating the burden of providing health care services.
I deliberately emphasize these words:
The health provisions of the Canada Assistance Plan carry out the intent and the spirit of paragraph (d) of the amendment disposed of by the house.
The minister was there referring to the amendment of the hon. member for Simcoe 23033-666J
Medicare
East suggesting the immediate provision of health care services for those who by reason of financial inability were unable to pay. Once again we are equating medical care and health care. The minister went on to say:
I would also point out that in the implementation of the Canada Assistance Plan the federal government has secured the co-operation of all the provinces, and the extent to which these health services will be provided is a matter of decision for the provinces.
This, of course, is exactly what the hon. member is proposing in the amendment he moved a few minutes ago. The minister continued:
So, Mr. Speaker, the opportunity now exists through the Canada Assistance Plan to provide health care for persons in need. I make that point because it is a principle of the law already passed.
If that was not enough, he went on to say:
We on this side of the house regard the health provisions of the Canada Assistance Plan as an interim measure until a universal medical care system is in effect.
What does that mean? Surely its intent is that the health care services are to be supplanted by medical care services. If this is the case, how can the minister say that health care and medical care are not the same thing? I would emphasize that the minister said:
Health care services include medical, surgical, obstetrical, optical, dental and nursing services.
How can one justify a difference in these services? The minister quotes from the report of the Hall Commission and with your permission, Mr. Chairman, I will read what the minister quoted because I think it is very important in this debate. As reported at page 9106 of Hansard the minister said:
I want to remind the House of Commons that the Hall Commission considered this aspect of medical care insurance very carefully. They asked themselves whether it was good public policy to attempt to meet the health needs of the Canadian people on this basis.
He was referring, of course, to universal coverage such as is being proposed in the bill before the committee. I will read only one paragraph from the conclusions of the Hal] Commission. At page 743 of their report the following statement appears:
Our reasoning is as follows:-
That the number of individuals who would require subsidy to meet total health services costs is so large that no government could impose the means test procedure on so many citizens or would be justified in establishing a system requiring so much unnecessary administration.

November 29, 1966
Medicare
I know we are not discussing the means test at the moment, but the next sentence is important:
The health services will make enough demand on our resources. We must not waste them.
[DOT] (8:20 p.m.)
That is from the report of the Hall Commission from which the minister has repeatedly quoted in the numerous speeches he has made on the various phases of the bill. The minister went on to say:
To that argument made by Mr. Justice Hall in his commission report I merely add one further argument.
He then gives his interpretation of what was said about health services and universal coverage, namely, that voluntary coverage will not meet the problem of health care in Canada. What are we talking about? Are we talking about the bill now before the committee? Certainly that is what we are talking about.


An hon. Member:: We are talking about subclause (f).


Lewis Mackenzie Brand: If the minister is not listening closely I will again bring him up to date regarding the point of order he raised. He pointed out that we must relate subclauses (d) and (f). He said that, and I think the chairman will bear me out. In his previous arguments on subclause (d), as well as in his point of order on subclause (f), he advised the Chair that the amendments were out of order because they expanded the definition.
I merely point out that he is on record in the house as saying that in fact no extra expenditure of money would be involved. I am sure the minister will not object if I quote his own words as recorded on page 9107 of Hansard of October 25. I would say that was a good day in the house. The minister was referring to the Alberta plan which he said was not good enough. He said:
-but I want to Illustrate the argument that this approach will not provide medical care for persons who need it in the kind of approach that is contemplated.
A few lines before he said the same thing when talking about health care. He is equating the two. Also on the same page he said:
That is why we are advocating a universal system. It is not for ideological reasons, not, as has been suggested, because we are in favour of compulsion, but because it is the only system that will bring health care within the reach of all the people. And it will bring health care within the reach of all the people without the spectre of compulsion, so frequently raised in this debate and so demonstrably proven a red herring.

It seems that there are quite a few red herrings here. The minister has been imputing them to every hon. member who has spoken on the subject.
One paragraph farther down the same page the minister said, speaking about health care:
I argue that the partial plan proposal put forward by the official opposition is unacceptable, not on ideological grounds, but because it will not reach the objective of providing medical care for those who need it most.
In other words, the minister merely rephrased what he said a few minutes before regarding health care. How can the minister in all honesty stand before the committee and claim that there is a difference between health care and medical care for Canadians or that the definition of a medical practitioner should be narrowed down? How can he say that we are going to spend more money when he himself pointed out that actually we are not going to spend any more money, that we will just be spending $80 million and anything above this sum will be covered by the Canada Assistance Plan? I can quote him on that.
With regard to the point of order raised by the minister, I do not believe the amendment is out of order on this ground. We will not be spending extra money on this basis. The minister pointed out that health care and medical care are one and the same. He defined health care and spelled it out as being medical, surgical, obstetrical, optical and so on. In view of this I contend that the amendment is in order and should be accepted by the committee.


Maurice Rinfret: The Chair wishes to bring to the attention of the committee citation 397 of Beauchesne's fourth edition which appears on page 282 and reads as follows:
Amendments must be made in the order of the lines of a clause. If the latter part of a clause is amended, it is not competent for a member to move to amend an earlier or antecedent part of the same clause. But if an amendment to the latter part of a clause is withdrawn then it is competent to propose one to an earlier part.
In view of this citation may I suggest to the committee that the amendment proposed by the hon. member for Simcoe East to subclause (f) be allowed to stand so that the proceedings may not prejudice subclause (d), that the committee proceed to the consideration of the remaining subclauses of clause 2, and that when consideration of the remaining subclauses is concluded we revert to subclause (d) and subsequently to subclause (f). Is the committee agreed to proceedings in this manner?
November 29, 1996


Edmund Davie Fulton: Mr. Chairman, may I point out to you with respect that that part of the citation which you read is as follows:
_ Amendments must be made in the order of the lines of a clause. If the latter part of a clause is amended, it is not competent for a member to move to amend an earlier or antecedent part of the same clause.
I have read this section of the citation to show that it is not applicable in this case. The hon. member for Burnaby-Coquitlam has already proposed an amendment to subclause (d) and the committee stood the subclause with the amendment. Since the amendment has already been moved, in my submission it would not be prejudiced by our action in dealing conclusively with the amendment proposed to subclause (f). In other words, this portion of the citation is not applicable to the present situation. We certainly do not wish to prejudice in any way the consideration of the amendment proposed by the hon. member for Burnaby-Coquitlam nor do we wish to create confusion in the committee's proceedings, but it does seem to me that the two subclauses can be disposed of on their separate merits. Therefore we would like to urge that the committee proceed with the discussion of the amendment with respect to subclause (f).


David Lewis: Has the Chair ruled on the point of order?


Allan Joseph MacEachen: Mr. Chairman, the matter before the committee is the point of order which I raised with respect to the amendment moved by the hon. member for Simcoe East. The next logical step is to determine whether or not the amendment is to be put to the committee. If that decision were made we would then know how to proceed, because if it is not to be put to the committee then the objection which might otherwise stand in the way would be removed. On the other hand, if it is to be put to the committee we can reach a decision at that time.
[DOT] (8:30 p.m.)


Herman Maxwell Batten: Order. Is it the wish of the committee that we now revert to subclause (d) and to the amendment moved by the hon. member for Burnaby-Coquitlam?


Edmund Davie Fulton: Mr. Chairman, I made the request, and I have not heard a counter request, that we proceed to deal with the amendment moved to paragraph (f).


Michael Starr: We would like a ruling on the amendment.
Medicare


Stanley Howard Knowles: Mr. Chairman, might I make a comment on the opinion expressed by the Chair a moment ago, namely, that citation 397 stands in the way of our dealing now with the amendment to paragraph (f). With respect, I submit that we would be in difficulty if we passed an amendment to paragraph (f) so far as going back to paragraph (d) is concerned, but I see no problem in having a ruling on the admissibility or otherwise of the amendment to paragraph (f) and continuing to discuss that paragraph. If the amendment is in order and we vote on it and amend paragraph (f), then we are in some trouble, but let us cross that bridge when we come to it. Let us find out first of all whether the proposed amendment is in order.


David Lewis: May we have a ruling now?


Herman Maxwell Batten: I recognize the argument presented by the hon. member for Winnipeg North Centre, but let me read again part of citation 397 in Beauchesne's fourth edition:
If the latter part of a clause is amended, it is not competent for a member to move to amend an earlier or antecedent part of the same clause.
I think the committee will recall that when the amendment was moved to paragraph (f) I did mention to the committee that the procedure we were adopting then might indeed become somewhat irregular. The citation says:
If the latter part of a clause is amended, it is not competent for a member to move to amend an earlier or antecedent part of the same clause.
Are there any further comments on this question?


Edmund Davie Fulton: Mr. Chairman, I do not know whether you were in the chair when I made the observation that the citation you have read refers to the competency of a member to move to amend an earlier or antecedent part of the same clause. I pointed out that the hon. member for Burnaby-Coquitlam had already moved his amendment and all that happened was that his amendment together with paragraph (d) was stood. It has been regularly moved and is before the committee.
Therefore, Mr. Chairman, I submit that this portion of the citation is not applicable to the situation in which we find ourselves. I submit it is competent for the committee to deal with paragraph (f) and the amendment moved thereto without prejudice to an amendment already moved to paragraph (d), which paragraph stood. Therefore I make the request that we deal with paragraph (f) and the amendment thereto.

November 29, 1966
Medicare


Herman Maxwell Batten: I am sure that members of the committee, including the hon. member for Kamloops, would want to make sure we are following the proper procedure. When the amendment to subclause (f) was proposed I read it to the committee and advised hon. members that if the amendment should carry the committee would be in some difficulty with regard to paragraph (d). This is the position in which we now find ourselves.


Michael Starr: On a point of order, Mr. Chairman, in order that we do not contravene the rules or create any difficulty with regard to a preceding paragraph and an amendment thereto, I point out that it is not the intention of the members of the committee to vote on the amendment proposed by the hon. member for Simcoe East but rather to receive a ruling from the Chair as to its validity or acceptability, and that is all. Then we could probably revert to the other in order to regularize our procedure.


Mr. Baldwin:: Mr. Chairman, in support of what the hon. member for Kamloops has said may I refer you to the very last sentence of that citation:
But if an amendment to the latter part of a clause is withdrawn then it is competent to propose one to an earlier part.
The fact that the words "to propose" are used there makes it self-evident that what was in the mind of the distinguished Speaker who made the ruling in respect of which this citation has been engrossed was that it is a question of the orderly use of motions to amend. In other words, you must start at the beginning and work through a bill clause by clause. Once a motion has been made and is recorded, as is the motion of the hon. member for Burnaby-Coquitlam, then surely there can be no objection under those circumstances to considering a subsequent amendment, because it cannot in any way disturb the validity or legality of the motion to amend already made by the hon. member for Burnaby-Coquitlam. I think the use of the words "to propose" in the latter part of that citation makes that proposition self-evident.


Herman Maxwell Batten: The Chair is still of the opinion that the proper procedure in this case is to decide what is to be done with the amendment to subclause (d) and then to proceed with the amendment that has been read to the committee, having in mind the admonition of the Chair that there might indeed be some difficulty. According to citation 400 of Beauchesne's fourth edition, the clauses of a

bill in committee of the whole must be considered in their proper order, beginning with clause 1, then taking up clause 2, and so on. I presume that when a clause is divided into different subclauses, as is the case here, the subclauses themselves should be taken up in the proper order. I recognize the procedural difficulty in which we find ourselves.


David Lewis: Mr. Chairman, in view of the fact that you have some doubt about the amendment now before the committee, I as one member of the committee would suggest that we now revert to paragraph (d). I cannot think of anything less productive than to continue to argue for the rest of the evening about which comes first, the hen or the egg. If the Chair has any doubt about the procedure that has been suggested, may I respectfully urge that we revert to paragraph (d) and to the amendment moved by my leader and have your ruling as to its admissibility.


Herman Maxwell Batten: At this particular point the Chair believes that the proper procedure is to revert to subclause (d).
On subclause (d)-''Insured services".


Allan Joseph MacEachen: Mr. Chairman, you were good enough to stand subclause (d) at my request and at the request of other members of the committee to give us the opportunity of considering the amendment that had been moved by the hon. member for Burnaby-Coquitlam. In the intervening period I have attempted to give some consideration to the regularity of this amendment, especially in light of the preceding rulings rendered by the Chair on earlier similar points.
[DOT] (8:40 p.m.)
It is true that this amendment does not immediately impose a financial burden on the crown, because such a burden will occur when action is taken by the Governor in Council to extend services. To that extent no financial burden is involved until action is taken by the Governor in Council. But once that action is taken by the Governor in Council, then one asks, what authority is contained in the royal recommendation to support such financial undertaking?
It seems to me that the Governor in Council is obligated by the terms of the royal recommendation in precisely the same way as a member of the house is obligated in making an amendment. I had attempted to see if in some way this amendment might fit into the four corners of the rules but for the reasons previously stated I have serious misgivings
November 29, 1966

whether the amendment can be accepted as a regular amendment.


Herman Maxwell Batten: Are there any other comments?


Thomas Clement (Tommy) Douglas: The minister is basing his argument on the inadmissibility of this amendment not on the ground that the amendment imposes some additional charge on the treasury at the moment, but rather on the ground that the Governor in Council may add services which the minister says were not envisaged in the original royal recommendation. I point out that the original royal recommendation was:
That it is expedient to introduce a measure to authorize the payment of contributions by Canada toward the cost of insured medical care services incurred by provinces pursuant to provincial medical care insurance plans.
Giving the Governor in Council the right to provide certain paramedical services surely is not going beyond the three words used in the royal recommendation, namely, "medical care services." As a matter of fact the amendment makes it possible for the Governor in Council to do what the bill does not do at the present time, that is, carry out the intent and purpose of the resolution containing the royal recommendation. I suggest that far from authorizing the Governor in Council to go beyond the royal recommendation the amendment gives the Governor in Council power he does not have now, the power to implement the royal recommendation.


Herman Maxwell Batten: Order, please. During the dinner hour the Chair considered the amendment moved by the hon. member for Burna-by-Coquitlam. The hon. member's amendment reads as follows:
That paragraph (d) of clause 2 of Bill C-227 be amended by inserting therein, immediately after the word "required," in line 19, the following words:
"including such other related services as may be authorized by the Governor in Council,"
The complete paragraph would then read:
"insured services" means all services rendered by medical practitioners that are medically required, including such other related services as may be authorized by the Governor in Council, except any services that a person is eligible for and entitled to under any other Act of the Parliament of Canada or under any law of a province relating to workmen's compensation;
The Chair has two objections to the hon. member's amendment. The first one is that the amendment seems to be essentially a new
Medicare
motion, coming very close to being a substantive motion in that it not only amends clause 2(d) but if adopted could empower the Governor in Council to superimpose a set of new conditions and, indeed, to enlarge the plan with provincial governments at any time.
The second and more serious charge is this. In the ordinary course of events the Governor in Council is empowered to provide regulations for the implementation of any act of parliament but the Governor in Council is not authorized to provide regulations outside the authority contained in the particular act. As the Chair understands the proposed amendment it would have the effect of empowering the Governor in Council to enact regulations for the purpose of enlarging upon the provisions of this bill. In other words, what the committee is here doing is providing to the Governor in Council an authority which this house does not have. As I said earlier in my remarks, the amendment would have the effect of enlarging upon the provisions of the legislation as set out in the resolution. The amendment would enable the Governor in Council to bring under the provisions of the act services not covered in the bill nor in the resolution preceding the bill agreed to on July 12.
For these two reasons, particularly for the second one, I must rule the amendment out of order. Does this complete the discussion on subclause (d)?


Mr. Pascoe:: Mr. Chairman, five times we have sought to amend paragraph (d) of clause 2. I wish to argue for an amendment which I am sure will commend itself to the minister and to the committee. I trust the amendment will not be ruled out of order on the ground that it involves an extension of the services contemplated in the bill or an increased output of money from the federal treasury.
[DOT] (8:50 p.m.)
All day we have been speaking in the interest of having the most effective health program possible. The minister on many occasions has said that the aim of Bill C-227 is to ensure adequate health care for the people of Canada. In paragraph (f) we are attempting to define clearly what is meant by the term "medical practitioner", and before this bill is passed we must have a clear interpretation of all definitions. Other hon. members have referred to podiatry and I shall not deal with that matter too long except to say my contention is that in order for us to have an effective

November 29, 1966
Medicare
medical care plan podiatrists and oral surgeons must be regarded as being included in the term "medical practitioner."
I wish to deal particularly with podiatrists but I think my remarks will apply equally as well to oral surgeons. Under provincial statute the podiatrist now performs surgical excisions of cysts and tumours under anaesthesia, also treats fractures, sprains and dislocations. He provides medical and surgical care for the feet. He is a trained medical specialist in diseases and ailments of the foot. If podiatrists are not included in the term "medical practitioner", in my opinion this would be discrimination against a legally licensed branch of the medical profession.
In presenting this argument I refer to briefs already submitted to the minister, and I am sure he will recognize many of the points I will be making. I quote from a brief submitted to the minister by the Canadian Podiatry Association in which it is stated:
Podiatry is that specialized field of medical practice which is concerned with the prevention, diagnosis, medical, surgical, mechanical, physical and adjunctive treatment of, and the prescribing for, all diseases, defects and disabilities of the human foot-
It also says:
No practitioner of any branch of the healing arts receives the intensive training in the field of foot care as does the podiatrist and no other branch is as equipped to deal with these problems.
At another point it says:
Aspirants for a career in podiatry must meet high standards of preliminary education, take at least two years of university training in arts and sciences, similar to a pre-medical course, and successfully complete four years of the podiatry course prior to the award of a degree.
A little farther on it refers to a comparison of educational training as between medicine and podiatry and gives the following statistics. It shows that the basic medical course takes 2,288 hours compared with 2,076 hours for podiatry. For pharmacy and therapeutics the figures are medicine, 198 hours, podiatry, 186 hours; for clinical sciences, medicine, 2,682 hours, podiatry, 2,740 hours; and for the complete four year course of scientific study, medicine 4,970 hours and podiatry 4,548 hours.
It also states:
In the accredited colleges of podiatry, all medical and basic science departments are headed and, in the main, taught by medical teachers affiliated with medical schools or medical specialists in private practice.

In another section the brief states:
Before the granting of a licence to practise, the candidate must pass the examinations of the medical or podiatry board of the province or state in which he wishes to practise.
The provinces of British Columbia, Alberta, Saskatchewan, Manitoba and Ontario have legislation governing the practice of podiatry. Quebec is in the process of obtaining a podiatry act.
The brief also states:
Podiatry does not contend that a medical services insurance plan must include benefits for foot conditions in the contract to be written. If the government chooses to sponsor a plan which excludes such benefits, this would be within their rights, and all practitioners of the healing arts would then fare the same. However, if reimbursement for the care of foot conditions is contained in the policy, then the carrier must recognize the right of any licensed podiatrist to treat, if so selected by the insured...
The medical profession constantly reminds the country of the shortage of physicians and the need for more men to handle the heavy patient loads. Increased utilization of the services of the podiatry profession results in freeing the doctor of medicine from the care of the feet, thereby allowing him to spend his time caring for the other ills of humanity.
I submit, Mr. Chairman, that the inclusion of podiatrists within the meaning of the term "medical practitioners" is not an extension of medical services as envisaged in the legislation. The inclusion of podiatric services would not result in a greater outlay of money from the federal treasury because the surgical treatment of the foot, if not performed by a podiatrist, would have to be performed by some other medical practitioner. I am sure there will be a scale of fees established under this legislation and that the cost of treatment by podiatrists would not be more than the cost of foot treatment by other medical practitioners. I repeat and emphasize that the podiatrist is a medical practitioner.
In this connection I would like to quote from an editorial which appeared in the Canadian Medical Association Journal, written by Dr. J. H. MacDermot, in which he said:
(the podiatrist) is now a trained professional man with rigid training ... It is clear, then, that the modern (podiatrist) is a specialist in his own right ... So we cannot deny the (podiatrist) of today an equal status with the dentist as a recognized part of the medical structure ... He is really a trained specialist, a trained medical specialist, in diseases of the foot.
Dr. Philip Lewin in his book, "The Foot and Ankle", says:
Podiatry is the practice of diagnosis, medical, physical and surgical treatment of the ailments of the human foot.
November 29, 1966

I could give many quotations along this line. A report of hon. Mr. Justice A. M. Harper, commissioner under the public inquiries act in British Columbia, states that podiatry "is in reality a branch of medical science." Dr. MacDermot, to whom I have referred, has himself quoted the American Medical Association as referring to podiatry as "medical practice in a limited field...an important branch of medicine.. .a necessity, an important branch of the medical profession."
[DOT] (9:00 p.m.)
In many hospitals in the United States and some in Canada there are podiatrists and oral surgeons on staff. It is becoming recognized more and more that the lack of detection of foot trouble can lead to impairment of health. In this regard I have seen reports to the effect that there has been a very heavy increase in the number of improvements in respect of diabetic patients since podiatrists have assisted in their treatment.
I wish to move, seconded by the hon. member for Saskatoon:
That paragraph (d) of clause 2 of Bill C-227 be amended by inserting therein, immediately after the word "required" in line 19, the following words:
"and services rendered by podiatrists and oral surgeons for medical and surgical care administered by them within the limits provided by provincial statutes."
I submit this amendment, Mr. Chairman, as a clarification and definite interpretation of the term "medical practitioner". I repeat my argument that the work performed by podiatrists and oral surgeons, in my opinion, will not add at all to the cost of performing the services provided by Bill No. C-227, and I trust that the committee will accept this amendment.


Herman Maxwell Batten: For the benefit of those who do not have a copy of the amendment I am going to read it. It is moved by the hon. member for Moose Jaw-Lake Centre:
That paragraph (d) of clause 2 of Bill C-227 be amended by inserting therein, immediately after the word "required" in line 19, the following words:
"and services rendered by podiatrists and oral surgeons for medical and surgical care administered by them within the limits provided by provincial statutes."
Do hon. members wish to make any comments in respect of this amendment?
May I refer hon. members to standing order 50 on page 44 of the provisional standing orders:
Whenever Mr. Speaker is of the opinion that a motion offered to the house is contrary to the rules 23033-667
Medicare
and privileges of parliament, he shall apprise the house thereof immediately, before putting the question thereon, and quote the standing order or authority applicable to the case.
While there is no objection on the part of hon. members to this particular amendment, the Chair does have an objection. I should like to refer to the ruling made yesterday regarding paramedical care. I think the motion moved by the hon. member for Moose Jaw-Lake Centre is in connection with a service that could be included in paramedical services. At that time regrettably I had to rule out of order the amendment moved in respect of paramedical services. In view of the fact that I consider the services referred to now in this amendment as being included in paramedical services, I therefore must rule the amendment moved by the hon. member for Moose Jaw-Lake Centre out of order. Does this terminate discussion on subclause (d)?


Lewis Mackenzie Brand: Mr. Chairman, previously I rose in connection with this subclause and asked the minister some questions which I think are of vital importance to the medical profession of Canada. The bill does not contain any clear provision which would allow a doctor to practise outside the act. In view of the minister's previously quoted statement to the effect that he would be very much in favour of this, I should like to quote his words again as they appear at page 9103 of Hansard:
However, what we are proposing in this legislation will make it possible for any physician to practise outside the plan if he so wishes. He will have full freedom to practise outside the plan, as do physicians with respect to certain medical care insurance plans now in operation in Canada.
I am wondering why there is nothing in this bill which indicates that the physician will be able under the law to practise apart from this plan if he so desires. I should like to ask the minister for his opinion in this regard. I should also like to ask him whether he will give his assurance if this indeed will be the case when the plan comes into effect. If a doctor decides to practise outside the plan and bills a person who comes under the plan as an insurable resident, as outlined in clause 2(b), will the bill in respect of that patient be paid directly to the doctor who does not work under the plan or will he be able to receive reimbursement for such service from the government plan? I assure the minister that I will continue to rise all evening and, if necessary all day tomorrow until such time as I have an answer from him in respect of what I consider to be very important questions.
COMMONS DEBATES	November 29, 1966
Medicare
[DOT] (9:10 p.m.)


Allan Joseph MacEachen: I agree with my hon. friend that this is an important matter. It has been the subject of discussions between the members of the Canadian Medical Association and myself on several occasions. What has been requested by the Canadian Medical Association is that no provision of this bill prohibit the possibility of provincial arrangements which would permit a physician to elect to practise outside any plan, and that there be nothing in this bill to prohibit, for example, an insurable resident of any province from paying a physician directly or having the services rendered by a physician payable to the patient or the insurable resident. I can give my hon. friend the assurance that these two types of arrangements are possible under this bill, but this is a matter for decision and determination on the part of the provincial authority on the one hand and the provincial medical associations on the other. I am quite confident in saying at this point that the discussions between myself and members of the Canadian Medical Association were concluded in a mood of agreement.


Lewis Mackenzie Brand: I thank the minister for his assurances, but I wish I were as optimistic as he. I cannot understand, if you insure the services of a physician so that every act he does in his professional capacity is an act of the government of Canada, how he can practise outside this plan. I cannot understand that any more than I can understand how I, if I were inducted into the armed forces of this country by an act of parliament, could say that I would not serve. I heard the minister say that such a refusal would be good enough and that I could do that, but does the minister think I could get away with it?
At the moment I quite frankly do not care what the medical association wanted. I am concerned about clause 2(d). It has been said that what is being done is to insure people against the cost of illness, but what in fact has been done is not only to insure people against the cost of illness but to insure the services provided by doctors. That is the key point.


Allan Joseph MacEachen: There are doctor-sponsored plans in existence in various provinces and certainly physicians opt out of those particular plans and practise outside of them.


Lewis Mackenzie Brand: Those plans were not adopted as a result of legislation.


Allan Joseph MacEachen: This parliament cannot determine the arrangements that provincial legislators will establish, but there is nothing in this legislation which will prevent provincial legislators from doing exactly what the hon. gentleman proposes. This legislation gives the provinces full freedom. This is all we can do and to do otherwise would be to impose upon the provinces certain arrangements which I think would not be acceptable. The provinces are quite free under this measure to work out arrangements such as my hon. friend earnestly seeks.


Mr. Muir (Lisgar):: Mr. Chairman, when the opposition was forced to accept the resolution preceding the bill we were given to understand that amendments would be considered at the committee stage of the bill. Some amendments have been submitted but none has met with the favour of the minister. I should like to ask the minister at this time, and I hope he will be courteous enough to reply, whether there are any amendments the opposition might offer which would be acceptable to the minister and the committee, and does the minister have any amendments to offer?


Allan Joseph MacEachen: Mr. Chairman, I have not had the opportunity of accepting or rejecting any amendment that has been put forward in the committee. No amendment has been found in order and put to the committee by the Chair. All I have argued is the irregularity of them. If any of the amendments had been ruled in order I would have been in a position to say whether they were in accordance with the policy of the government.
All the amendments which have been put forward in the committee and which have been ruled out of order have had to do with one single aspect of medical insurance, namely, the range of professions to be included under this particular bill. It should not come as a surprise to any member of the committee that this bill provides for contributions to provinces in respect of only the services provided by medical practitioners. This was the policy laid down by the Prime Minister in July of last year. This was the policy that was put forward by the Prime Minister at federal-provincial conferences. It has been restated at every federal-provincial conference of ministers of health.
We have stated that the initial stage of insurance for health services in Canada is the making of contributions to provinces in respect of services provided by the medical
November 29, 1966

profession. We have also stated that any province is free on its own responsibility and at its own expense to add additional professions to any plan it sets up. We have also stated that the federal government is prepared, as this plan develops and as provinces wish and as a consensus develops, to consider the addition of further services in the field of health and to pay contributions for those services. That has been the policy stated since the very beginning by the Prime Minister and restated by members of the government. It is the policy that is embedded and embodied in this particular bill and it ought not to come as a surprise to members of this committee.
We all appreciate that there are other services in the health field. The hon. member for Simcoe East has referred to a great number of paramedical services including eye refractions, dental care, the services of optometrists, physiotherapists, nurses, osteopaths, podiatrists, chiropractors and other health professionals. We quite frankly admit that these additional professions are not covered by this bill. We never said they would be covered but we have said that as a consensus develops within the provinces we are prepared to add further services and share the cost of those services with the provinces. We will be prepared to give consideration to that addition as the provinces develop their own plans. This has been the policy from the very beginning and it is the policy now before the house.
There is undoubtedly in various quarters of the house a desire to add further professions. We were castigated by a distinguished gentleman in the opposition at the resolution stage, the hon. member for Kamloops, for our financial irresponsibility in proposing this limited phase of health insurance, namely, medical care. We are now urged by the opposition to add every single health profession in existence to the bill. I do not make any point of that except to say that the addition of every single profession adds additional costs to the treasury and adds additional costs to the provinces. I take the view that if the amendments placed before the house to include the paramedical professions had been in order and I had accepted them on behalf of the government I would have been breaking faith with the proposals made by the federal government to the provinces.
[DOT] (9:20 p.m.)
We have had consultations with the provinces on several occasions. They know what we are proposing to do, namely, make contributions with respect to services provided by 23033-6671
Medicare
medical practitioners. We cannot on our own account, without consultation, now say that we are going to make proposals to the provinces for the inclusion of optometrists and all the other allied professions. I suggest that if we were to do that and were to accept this amendment, this bill would be delayed and we would have to begin a new round of discussions with the provinces. There is a further point. Hon. gentlemen may say, that is what you ought to do, but, Mr. Chairman, I think it would be necessary to do so before changing the concept of our proposals at this stage.


Eric Alfred Winkler: You have lots of time.


Allan Joseph MacEachen: I think we ought to take a look at what has been provided in provincial medical care plans. Hon. gentlemen seem to overlook the magnitude of the step that is now being taken, a step that involves the-


George Robson Muir: Mr. Chairman, on a point of order, the minister is missing the import of my question. I suggested to the minister that during the debate at the resolution stage we were forced to accept the principle of the legislation because the minister himself assured the house that certain amendments could be considered. The minister is now telling us that this is a selective type of legislation, and he is actually admitting that the legislation is discriminatory as between different professions. I should like to point out before I sit down-


Allan Joseph MacEachen: On a point of order, Mr. Chairman-


George Robson Muir: I am still on my point of order, Mr. Chairman.


Allan Joseph MacEachen: There is no point of order here.


George Robson Muir: I am still on my point of order.


Allan Joseph MacEachen: On a point of order, Mr. Chairman-


Maurice Rinfret: Order, please. The Chair would like to hear the balance of the remarks of the hon. member.


George Robson Muir: I am still on my point of order, Mr. Chairman. I am just coming to my point of order, namely, that during the discussion of the various points raised at the resolution stage many hon. members pointed out just as an illustration that the inclusion of optometrists-

November 29, 1966
Medicare
The Depuly Chairman: Order. I think the hon. member is making a speech and is not referring to a point of order.


George Robson Muir: I am coming to my point of order, Mr. Chairman.


Maurice Rinfret: I think the minister should continue his remarks. If the hon. member wishes to reply to the remarks of the minister, he will be able to do so. The Minister of National Health and Welfare.


George Robson Muir: Mr. Chairman, if you will allow me to continue with my point of order, I am just coming to it. I am rising on a point of personal privilege-


Some hon. Members:: Oh, oh.


George Robson Muir: -and I am just coming to my point of order. My point of order is that during this discussion-


Allan Joseph MacEachen: Mr. Chairman-


George Robson Muir: -some of our speakers have pointed out-


Maurice Rinfret: I regret to interrupt the hon. member but I have recognized the Minister of National Health and Welfare.


George Robson Muir: But, Mr. Chairman, I am on a point of personal privilege.


Mr. Churchill:: Mr. Chairman, I rise on a point of order. Surely it is the custom in this house, when an hon. member says he is presenting a point of order, to hear him out. The hon. member-


Some hon. Members:: Hear, hear.


Gordon Minto Churchill: -said three times that he was coming to his point of order. Surely we should hear him on his point of order before Your Honour makes a decision. I ask you, in fairness to the house, to hear the hon. gentleman and let him state his point of order. If there is no point of order, Your Honour can so rule. If the point of order is valid, Your Honour can so rule. I think it is quite unfair and a restriction on freedom of speech to refuse to hear the hon. member.


Some hon. Members:: Hear, hear.


Maurice Rinfret: I regret to hear the hon. member mention unfairness. If the hon. member for Lisgar wishes to raise a point of order, he should state his point of order and not give an explanation of speeches made in this house.


George Robson Muir: Thank you, Mr. Chairman. In his reply to me the minister said that the reason these amendments could not be accepted was that they involved additional costs. My point of order is that some of our speakers this afternoon pointed out-as an illustration I am taking optometrists-that 70 per cent of eye care is handled by optometrists and it would not cost any more if their services were included in the provisions of the bill than it would if the patients were to go first to a doctor. In fact, it would probably cost less. Thus there would be no additional cost in respect of this particular health service.


Some hon. Members:: Hear, hear.


Allan Joseph MacEachen: Mr. Chairman, I do not intend to deal with the point raised by the hon. member for Lisgar-


George Robson Muir: Why not?


Allan Joseph MacEachen: -except to say that it is so obvious that the inclusion of additional professions will involve extra costs. The only other conclusion is to believe that either one or another profession at present is a costless profession, and I do not think any of the professions would agree with that.


Mr.   Kindi@: On a point of order, Mr. Chairman, the minister has tried to put across a false statement.


George Robson Muir: Absolutely false.


Maurice Rinfret: Is this a point of order?


Mr.   Kindi@: Yes, Mr. Chairman.


Maurice Rinfret: The Minister of National Health and Welfare.


Mr. Clancy:: Mr. Chairman, may I ask the minister a question? Is the purpose of this bill to give the best service to all Canadians regardless of what ails them?


Allan Joseph MacEachen: Yes, Mr. Chairman. I am sorry that my hon. friend was not in the house to vote for second reading of the bill, or to vote against it as he suggested he would.


Mr. Simpson:: Where were you this afternoon?


Allan Joseph MacEachen: Hon. gentlemen-


An hon. Member:: You will be sorry for that statement.
November 29, 1966


Allan Joseph MacEachen: -have apparently overlooked the importance of the step being taken in this bill. They have in their discussions apparently overlooked the experience of the provinces. The hon. member for Burnaby-Coquitlam talked about the experience in the province of Saskatchewan. This is the only province in Canada in which there is in effect a comprehensive medical insurance program. Members of the New Democratic Party, notably the hon. member for Burnaby-Coquitlam, the hon. member for Hamilton South and the hon. member for Winnipeg North Centre, have urged very broad coverage under this bill. I think it would have been instructive for them to look at the range of coverage in the province of Saskatchewan where experience does exist. Chiropractors, whose inclusion has been urged upon us, are not covered in the Saskatchewan plan. Neither are optometrists nor physiotherapists.


An hon. Member:: Yes, they are.


Allan Joseph MacEachen: Not under the medical care insurance act. They were covered at one point and the coverage was discontinued.


David Lewis: Mr. Chairman, may I ask the minister a question? I have in my hand a copy of the act. May I ask the minister when physiotherapy was discontinued, because it is written right in the act which I have in my hand?
[DOT] (9:30 p.m.)


Allan Joseph MacEachen: In what year?


David Lewis: In 1961-1962.


Lewis Mackenzie Brand: Can I straighten out the problem for hon. members?


Allan Joseph MacEachen: I understand that the hon. member for York South has the original act which did cover physiotherapy. It has now been discontinued under medical insurance and I believe it may be covered under hospital insurance. But hon. members should remember that nursing is not covered.


David Lewis: May I ask the minister a question? When was this change made? I am ignorant of the date.


Allan Joseph MacEachen: I do not know either but I will find out. In the province of Saskatchewan, which has been held out as a model- and I have no complains about that-the only service in addition to medical care which is covered at present is dental care. The whole range of health professions which has been urged upon the house is not covered under the Saskatchewan plan.
Medicare


An hon. Member:: Neither is general care.


Allan Joseph MacEachen: I think the experience in Saskatchewan illustrates the magnitude of this step. I believe it would be very unwise to begin with total comprehensive coverage of all the professions at the present time.


An hon. Member:: Why not?


Allan Joseph MacEachen: We have had the recent experience of the development of OMSIP in the province of Ontario. This is a publicly administered plan. For example, eye refractions are not covered, nor are optometrists and physiotherapists.


Eric Alfred Winkler: What about workmen's compensation?


Allan Joseph MacEachen: Under that plan nursing, osteopaths, podiatrists and chiropractors are not covered. This is a publicly administered plan in the province of Ontario. We are attempting to relate the provisions of our medical care insurance to the plans in existence in the provinces and while undoubtedly there is some variation among the provinces in the administration of their plans we are proceeding along the lines of the publicly administered plans in the provinces with respect to the inclusion of benefits.
A great deal has been said about the inclusion of optometrists in this plan. We have not proposed in the plan to cover optometrists and I would suggest that if it were possible to enlarge the sphere of coverage in addition to the medical profession hon. members would have to ask themselves what is the next order of priority. We would have to ask ourselves whether the next profession to be covered under the plan should be that of the optometrists or the podiatrists, as the hon. member for Moose Jaw has suggested, or should it be chiropractors, as the leader of the Social Credit party suggested? We have stated that first priority should be accorded to the services rendered by medical practitioners, namely, physicians, general practitioners and specialists.
If we were to go beyond that, what would be the next order of priority? Would hon. members say that the professions which have been mentioned are more important to the health of the Canadian people than, for example, the coverage of drugs? Would coverage of prescribed drugs be more or less important than any of the proposals which have been made in the house? I think we all agree that each of the items which I have mentioned and which have been mentioned in the house is

November 29, 1966
Medicare
undoubtedly important to the health of the Canadian people, but based on the priority established by the provinces there is no province in Canada which has a publicly administered plan covering eye refractions as a benefit under prepaid coverage. That should be of some assistance to hon. members.


Eric Alfred Winkler: Would the minister permit a question? Mr. Chairman, after permitting a number of questions I am sure you will allow me to ask one and I am grateful for that opportunity. I should like to ask the minister a question which I have already put to him earlier. Does he have any amendments of his own to clause 2 of this bill? If so, it would help us to expedite matters if he could advise the committee of them.


Allan Joseph MacEachen: Mr. Chairman, I have no amendment to clause 2. There is an amendment which I propose to put before the committee later in relation to another clause. I trust this amendment will assist the position of the optometric profession. It is not my intention to include the optometric profession under the plan and I believe I would be on very dangerous ground with the provinces because no province has included in its public plan eye refractions, although in Alberta optometrists are included under an extended benefit plan. I would therefore be very hesitant to include optometrists in the plan in view of the experience in the provinces, but I hope to propose an amendment at a later stage on another clause which will at least maintain a non-discriminatory position with respect to the optometric profession. It is an important and numerous profession in Canada and I would like to meet their representations by making an amendment so as to avoid at least any element of discrimination which might exist within the bill.
I want to tell my hon. friends that I have been wrestling with the problem of oral surgeons and, although I am not absolutely certain, it might be possible for me to put a proposal to the committee which will assist in that particular field. I would like to do so, and it may be possible for me to place a proposal before the committee for their consideration. If it is favourably considered it might be put in the form of an amendment. In each of these cases I have to bear in mind the fact that the provinces are under a definite impression that we are proceeding in a certain direction, and any further alterations will have to be permissive in character so as to allow the final determination to be made by the provinces.

I want to make the general point that we laid down a policy many months ago. This policy is now embodied in the bill. We have said that the provinces which want to add further benefits may do so on their own responsibility and that we will consider, as a consensus develops in the provinces, sharing the cost of the additional benefits. It is important that a consensus develop because some priority has to be given to the competing demands for additional benefits.
With respect to the optometric profession and to oral surgeons-and I do not underestimate the importance of any group-I hope later in the committee, if not to propose amendments, at least to make proposals which might be embodied in amendments if they meet with a favourable reaction from the committee.


Stanley Howard Knowles: Would the minister permit a question at this point? Would he now be willing to tell us the nature of the proposals he has the intention of making with respect to these two groups? It might shorten the debate on clause 2 if we knew what was coming.
[DOT] (9:40 p.m.)


Allan Joseph MacEachen: In connection with the optometric profession it is a fact that a major function performed by the optometric profession is eye refractions, the measurement of vision, and this is not at present an insured service under the bill. If eye refractions are performed by an ophthalmologist it will be an insured service. It seems to me there is a situation there which I should like to correct by giving the provinces an opportunity to remove eye refractions from insured services so that a parity of treatment would exist between opthalmologists and optometrists and the patients of each. This may be described as removing something from the plan, but it does maintain equality of treatment between both professions and the patients. This is not the most desirable move from the point of view of the optometric profession, but I have had letters from members of the profession saying that this would be an acceptable solution for them.


Thomas Clement (Tommy) Douglas: That is progressing backwards.


Allan Joseph MacEachen: The alternative has been to suggest that at this stage, when it has not been put up to the provinces, this parliament should now decide unilaterally to ask the provinces to accept eye refractions as an insurable service. As I have pointed out, this
November 29, 1966



has not been done in any publicly administered plan in Canada and that is why I am giving consideration to following that procedure. I am suggesting that this as a way to overcome this difficulty. I believe this will be accepted as a genuine effort to meet the problems of the optometric profession.


Philip Bernard Rynard: Mr. Chairman, I should like to thank the minister for his explanations, but I am wondering whether anything was said about this at the federal-provincial conferences. Were optometrists not spoken about? Has the minister no indication of what the provinces intend to do about this question? If he has, why does he not take us into his confidence and tell us what is going to be done? Surely something must be done. At the present moment in the field of physiotherapy in Ontario there is discrimination. If patients are sent to a hospital they are covered under the plan. If they are sent to a physiotherapist who does not work in a hospital, his services are not paid for under the plan. This is discrimination.
The points we would like cleared up are: What are the prospects? What is being proposed? Where are we going from here? As I say, I thank the minister for his explanations. I think some of them were overdue but he did give us some good explanations. But the key points are the attitude of the federal and provincial governments and what the situation is regarding optometrists and the other paramedical services in view of the statement in the Hall commission report that optometrists could be included very easily.


Allan Joseph MacEachen: Mr. Chairman, the feelings of the provinces have been expressed, of course, in their own plans. They have not included eye refractions as an insured service. This has been reflected in the discussions we have held. I believe the proposal I now suggest is the kind of proposal that the provinces would feel is the correct one at this time.


Edmund Davie Fulton: Mr. Chairman, I should like to ask the minister a question. The minister seems to miss the whole point of the argument which has been put forward by this particular part of Her Majesty's Loyal Opposition. Our position is that the federal government should supplement provincial schemes. If the provincial schemes allow the services to be rendered and to be compensated for, the federal government should agree to pay one half of the cost. When the minister tries to reproach us for increasing the cost of the scheme, he is
Medicare
completely misinterpreting and distorting our position.
Our primary position is and has always been that the role that the federal government should be playing is to supplement provincial schemes, and the minister cannot deny that. Not being able to deny it, when he says that by our insistence, if the provinces include these related services, we will be running counter to what we criticized him for on the resolution stage, he must admit he is guilty of a distortion of our position.
Why, therefore, does he not now say to the provinces and to this house that what we will do is supplement medical insurance plans which the provinces introduce. The provincial governments are not unintelligent. They are responsible for the licensing of medical and paramedical people. Does the minister want to arrogate that power unto himself? I would think not. Why then does he not say to the provinces: If you institute a prepaid medical insurance plan and decide to cover under it the cost of the services of qualified practitioners in the field of medical care generally speaking, we will pay half the cost? That is what we are asking him to do.
Why does the minister go through these long and obfuscated arguments about whether certain provinces do or do not now include these services? The province of British Columbia has one scheme, the province of Alberta has another. The province of Ontario has a different one and the province of Saskatchewan a different one still. Presumably they are satisfactory to the voters in those provinces. If they are not it is not the business of the minister to say that they should be changed.
Therefore, Mr. Chairman, why does the minister not simply and straightforwardly say that he will now accept amendments in this committee to this bill to provide that services in the field we are discussing here, services which the provinces are prepared to include in a prepaid medical insurance scheme, will be compensated for the extent of 50 per cent by the federal treasury? That is all we are asking the minister to do. If he will do that we could get on with the bill and really bring about a medical insurance scheme to cover all the people of Canada and do so very quickly. This is our common aim and objective.


Allan Joseph MacEachen: Mr. Chairman, I will tell the hon. gentleman very quickly why it is not possible to accede to his request. We had this out fully on second reading. The proposal the

November 29, 1966
Medicare
hon. gentleman is now putting forward was rejected by this house on second reading of the medicare bill.


James Ross Fulton: That is no answer at all. What a piece of casuistry. We were told that when we got into committee we would be invited to bring forward amendments and have a serious discussion to improve the bill. The minister now says that we may not improve the bill, that we will have to take it the way it is, the way the majority voted for it, whatever the merits of the case. I completely reject that argument, Mr. Chairman, and so will the Canadian people.


Allan Joseph MacEachen: The hon. member for Kamloops can get as indignant as he wishes. That is his prerogative and his tendency, I might add. But I would remind him that he put forward the proposal to the federal government that the federal government subsidize existing pension plans. He put that in an amendment.


Edmund Davie Fulton: I did not.


Allan Joseph MacEachen: The hon. member for Simcoe East put it in an amendment which was voted on and rejected during debate on second reading of the bill. He knows perfectly well that it is not competent for this committee at this stage to enter upon a scheme that was sustained by the house on second reading and now try to change it. This is the argument I am making.


Mr. Bell (Carleton):: Absolutely ridiculous.


Edmund Davie Fulton: Does the minister seriously say that it is not competent for this committee to amend the clauses of the bill?


Allan Joseph MacEachen: I am not saying that at all.


Edmund Davie Fulton: That is exactly the proposition the minister is putting forward.


Allan Joseph MacEachen: I said that the committee is not competent to alter the principles that were accepted on second reading. That is what I am saying.
[DOT] (9:50 p.m.)


David Lewis: Mr. Chairman, I have not taken part in the discussion on clause 2 but the minister's explanations in rejecting all of the amendments put forward seem to me to be an argument of obstinacy rather than logic. The hon. member for Matapedia-Matane reminded us this afternoon in his thoughtful speech that what we have before us is not a medical care

plan at all but a financial bill, a bill by which Canada will provide 50 per cent of the cost of services covered under provincial medical care plans. What the various amendments said to the minister, had they been in order-the minister's argument, I suggest with the greatest respect, is utterly specious-was not that he include in this bill all these services to be covered immediately; he cannot do that. This bill is not a medical care plan; the bill says that Canada will pay 50 per cent of the cost of those services included in provincial medical care plans. All we are saying to him is that he should say to the provinces: Any medical service which you provide for in your plans, whether that service is performed by a medical practitioner or by any other recognized profession, we will participate in the cost of it. That is all we are asking the minister to say. We are not asking him to set out in any schedule that all the following services will be covered and that every health profession will be covered.


Allan Joseph MacEachen: May I ask my hon. friend a question? Is he accepting the point of view of the hon. member for Kamloops?


David Lewis: I certainly am not.


Edmund Davie Fulton: Is that any disgrace?


David Lewis: I am not arguing to subsidize any plan. All that the amendments of the hon. member for Hamilton South and the hon. member for Burnaby-Coquitlam said, had they been in order, was that all services covered by any provincial plan would be shared, assuming that any provincial plan met the four basic principles to which my hon. friend opposite referred this afternoon. That is all those amendments said to the minister. In fact, I point out to the minister that in part perhaps he has departed from one or two of those principles. We insist on those principles. The minister cannot argue that we are seeking to cover all the health services or that we are through the amendments trying to set priorities. We are doing nothing of the sort. We are saying to the minister that the purposes of this bill, the two reasons it is desirable to have a federal bill of this sort, are clear.
The reasons are, first, that the poorer provinces which cannot provide adequate medical care plans for themselves will be assisted to have such plans and, second, because the federal treasury will make a contribution toward services it will enable the provinces to expand those services in the years ahead and to include other health services that are so direly needed by the people of Canada, if the
November 29, 1966

federal treasury is willing to participate in the cost of those services.
If the minister says to me that that means that we shall be paying for one set of services in one province and for another set of services in another province, I say to him that is exactly what the bill now provides. In fact, this bill now provides that if provinces a, b, and c should choose not to have a medical care plan for the next two or three years they will not get a penny out of the federal treasury toward medical services, and those provinces with medicare plans will get 50 per cent of the cost of qualifying plans. Surely that is the principle of this bill. The principle of this bill is that when a provincial legislature has used the constitutional powers it has to establish a medicare plan, the federal treasury will contribute 50 per cent of the cost of services.
All we have been asking is to extend the area toward which the minister can make that contribution. The minister's argument is that this means we are establishing priorities or taking rights from the provinces, that he needs another conference with the provinces. It seems to me that is entirely specious. It will be up to each province to decide what services it wants in its own plan. When the provinces decide that, this bill will provide assistance to them to encourage them to expand those health services until they cover the entire spectrum of health care, preventative as well as curative.
I rose to my feet because it seemed to me that the minister, in the explanation he gave, either misunderstood or adroitly turned on its head the proposition put to him by members in the opposition. And while he may adroitly turn things on their head, it seems to me that none of the people of Canada, and certainly no member of this house, will fail to see the rather unnecessary adroitness which he exhibited today.


Gerald William Baldwin: To put the proposition enunciated by the hon. member for York South in specific terms, let us say that a province introducing enabling legislation bringing into effect the provisions of this act says that for the purposes of its act practitioners of medicine shall include chiropractors, osteopaths and homeopaths. I refer to osteopaths and homeopaths specifically because they are registered under the medical professions act in the province of Alberta. I should also include optometrists. If in a province's enabling legislation a declaration of this kind were made, what would be the minister's position?
Medicare


Allan Joseph MacEachen: Mr. Chairman, the answer is obvious from the bill.


Mr. Bell (Carleion):: Well, what is the answer?


Lewis Mackenzie Brand: In a spirit of co-operation, knowing the difficult time the minister has undergone in the last few hours-I sympathize with him because of the morass of his own making, in which he finds himself-I should like to know whether the minister would accept the sort of amendment I shall refer to in a moment. The minister has objected to amendments because they meant the spending of more money. The kind of amendment I propose would mean the spending of less money. Would the minister be willing to consider an amendment which might read something like this?
No provision of this act shall be interpreted to prevent any medical practitioner from practising outside a provincial medical plan, or any insured resident from receiving reimbursement from the plan for the costs of insured medical services incurred from a qualified medical practitioner who is not a member of a plan.
As the minister has said, undoubtedly some provinces may not come in right away, but a person visiting in those provinces could be reimbursed for costs incurred when he was away from home if this amendment should carry. Would the minister agree to this?
[DOT] (10:00 p.m.)


Allan Joseph MacEachen: Mr. Chairman, I want the amendment before me. I am not quite sure what it means. From what I can gather of its meaning, it is that this parliament will attempt to determine the arrangements which exist between the provincial government and the medical profession. If that is the meaning of the amendment and the effect of it, then I think it would be difficult for me to accept it. As the bill is now drawn it gives freedom to any province to enter into arrangements with the medical profession so that a member of the profession may work outside any plan if he so wishes. It gives freedom to any patient to accept or not accept insured services. I would think that from our point of view it would be much better to leave these arrang-ments to the provinces and the medical profession. Our bill gives them full freedom to work out their own arrangements. We would not impose any arrangement upon them and I think that is the preferable situation.


Lewis Mackenzie Brand: May I call it ten o'clock, Mr. Chairman?
Progress reported.
10544	COMMONS
Proceedings on Adjournment Motion BUSINESS OF THE HOUSE


Edmund Davie Fulton: Business of the house?


Allan Joseph MacEachen: Same thing tomorrow.



PROCEEDINGS ON ADJOURNMENT MOTION

[Stage Direction]
A motion to adjourn the house under provisional standing order 39A deemed to have been moved.

Herbert Wilfred Herridge: Mr. Speaker, I must inform this rather inspiring audience-


Stanley Howard Knowles: Thank you.


Herbert Wilfred Herridge: -that a very unusual situation was brought to my attention as the result of reading an article in the Financial Post of November 26 last. It seemed so serious to me that yesterday I asked the Minister of Finance (Mr. Sharp) the following question:
Mr. Speaker, I should like to ask a question of the Minister of Finance. May I preface my question by saying I am not an expert on taxation. Has the minister been informed of a decision by the United States Supreme Court upholding the right of the city of Los Angeles to impose taxes on the value of inventories of imported raw materials, and that the right to impose these taxes by local United States authorities could affect commodities such as Canadian nickel, lead, zinc, lumber or any other raw material? Could the minister inform the house what action he proposes to take in order to deal with this unprecedented situation?
At that point Mr. Speaker rose and proposed that the question should be placed on the order paper. However, I think it is a matter of considerable importance and in order that the minister will be informed of the circumstances I am going to read from the article in the Financial Post of November 26. It is headed, "U.S. Ruling May Hurt Some Canadian Exports-Supreme Court Refusal To Deny Los Angeles Right To Tax Inventories Of Imported Raw Materials Eliminates Big Advantage For Us." The article is date-lined Washington and reads as follows:
Decision by the U.S. Supreme Court upholding Los Angeles' right to local taxes on the value of inventories of imported raw materials held by U.S. firms could have profound effects on Canadian and other foreign exporters to the U.S.
It could lead local U.S. authorities to tax such things as Canadian iron ore imports by U.S. steel companies, or Canadian nickel, lead, zinc, lumber or any other raw material.
If the interpretation of the court ruling were extended to cover manufactured goods, as some local tax authorities believe, every Canadian

DEBATES	November 29, 1966
businessman exporting to the U.S. would be affected-even though the tax would be paid by the U.S. customer.
In the past, raw material and manufactured goods from Canada and other countries have been largely free of local taxation. U.S. raw materials and U.S. manufactured goods have not. Thus, imported goods have had some advantage over competitive U.S. production. This advantage has now been eliminated, at least for raw materials.
The court's decision is bound to set off a lengthy governmental and legal review of U.S. laws relating to taxes and duties on imports.
The battle over the right of local communities to tax foreign imports has been in the courts for at least seven years. The court cases have involved Canadian products as well as imports from other nations.
Arguments on the matter stem from a section of the U.S. Constitution which says: "No state shall, with or without the consent of Congress, lay any imposts or duties on imports or exports except what may be absolutely necessary for executing its inspection laws ..."
This was considered a complete ban on local taxation of foreign imports for a long time. About seven years ago, however, the issue came before several courts, including the Supreme Court.
In the course of the litigation the doctrine was established that the local taxes could apply to that portion of the inventory of imports which is needed by firms for "current operational needs."
In a case involving Canadian newsprint, Denver Publishing Company resisted Colorado's right to tax imported newsprint from Canada. The eventual ruling was that because the company needed six days to replenish its supply of newsprint from Canada and used 60 tons of newsprint a day, the amount necessary for "current operational needs"- and which was therefore taxable-was 360 tons. Any amount the company held in inventory above the 360 tons was not taxable.
Under the new court ruling, however, it would seem that all the newsprint in the inventory would be taxable.
The Los Angeles case began when the county taxed three firms on their total in March, 1960, of imported raw materials. The companies were Virtue Bros., which imported plywood from Finland; Clayton Manufacturing Co., which imported steel tubing from Britain; Anchor Post Products Inc., which imported wire from Australia.
The trial court in Los Angeles found a five-day supply of the imported goods to be the "current operational needs" of the three firms, broadly following the principles established in the Denver case involving Canadian newsprint.
The appeal court, however, found that all imported material in the hands of the importing manufacturer was required for "current operational needs" regardless of when in the future it was going to be used.
The California Supreme Court denied a hearing on the case requested by the three companies and now the U.S. Supreme Court has denied a hearing. Thus the appeal court decision stands that merchandise imported for use in manufacturing loses its constitutional immunity from local taxes upon completing its journey at the manufacturer's warehouse.
The companies argued that this ruling is in direct conflict with the Denver case, but the Supreme Court disagreed in refusing a hearing on the case.
November 29, 1966	COMMONS
This is a very interesting situation, Mr. Speaker. It offers some problems to the importers of raw materials from Canada. Because I feel this involves a matter of serious concern to the exporters of lumber, newsprint and other raw materials from British Columbia, I urge that this very serious question be given careful attention by the minister, that it be discussed with the appropriate authorities in the United States, and I suggest that the minister report to the house later the results of these discussions and his findings.


Mr. Albert Bechard (Parliamentary Secretary to Secretary of State):: Mr. Speaker, on behalf of the Parliamentary Secretary to the Minister of Finance I will try to deliver to the house the answer prepared by the department to the question asked by the hon. member for Kootenay West.
[DOT] (10:10 p.m.)
The Canadian authorities have not received a report on any such decision of the United
Proceedings on Adjournment Motion States Supreme Court to which the hon. member refers. The Canadian embassy in Washington has been asked to investigate this matter immediately. In the event that such a court decision is confirmed, we will be in a better position to decide on what course of action might be appropriate in the light of the details of the decision. Provided the decision applies equally to domestically produced raw materials it would probably not be a direct contravention of our trade agreement rights. In any case we will be anxious to ensure that Canadian export interests are protected.
In concluding, Mr. Speaker, I should like to thank the hon. member for drawing this matter to our attention.
Motion agreed to and the house adjourned at 10.13 p.m.

Wednesday, November 30, 1966