1966-07-12

Mr. G. Roy McWilliam (Norlhumberland-Miramichi) moved: that the first report of the standing committee on privileges and elections, presented to the house on Thursday, July 7, be concurred in.


Mr. Gregoire:: On division.


[Stage Direction]
Motion agreed to, on division.
[DOT] (2:40 p.m.)


Hon. C. M. Drury (for the Minister of Trade and Commerce) moved: the first reading of Bill No. S-42 (from the Senate), to amend the Canadian Corporation for the 1967 World Exhibition Act.
Motion agreed to and bill read the first time.



AIR TRANSPORT


[Stage Direction]
On the orders of the day:
Right Hon. J. G. Diefenbaker (Leader of the Opposition):: Mr. Speaker, I would ask the Secretary of State for External Affairs whether there is any basis for press reports to the effect that President Johnson, or someone on his behalf, raised strong objections to Canada signing an air agreement with the Soviet union or Soviet government. When were those representations made, and were any of them in writing?


Hon. Paul Marlin (Secrelary of Slate for External Affairs):: Mr. Speaker, the Can-ada-U.S.S.R. air agreement, copies of which were tabled in the house yesterday afternoon, provides for air service between Moscow and Montreal only. It is expected that both Air
Canada and Aeroflot will fly one round trip per week between these two cities, but there is no question in the agreement of an extension to other points.
So far as I am aware the United States is not opposed to this agreement. Indeed, hon. members may recall that in 1961 the United States negotiated a somewhat similar agreement with the Soviet union, although this has not yet been brought into effect.
In any event, the agreement signed yesterday by the Canadian government is based on decisions taken by the Canadian government.


Some hon. Members:: Hear, hear.


John George Diefenbaker: Mr. Speaker, the question I asked was whether objections had been raised by President Johnson or someone on his behalf, and it requires just a simple answer. If such did not take place then surely a negative answer would be the answer, rather than a generality.


Mr. Marlin (Essex Easl):: Mr. Speaker, I have not used generalities in my response. I have given a pretty detailed reply to most of what my right hon. friend asked-


John George Diefenbaker: Most of it.


Murdo William Martin: -but since my right hon. friend reminds that he had another aspect to his question I might as well address myself to that.
As my right hon. friend knows, it is not normal to confirm or deny whether exchanges of communications between heads of government have taken place on any particular subject. Such communications are privileged. Of course there has been an opportunity not only for the United States but for other countries to express their views, but I would repeat that the agreement signed yesterday, so far as I am concerned and so far as I know, is not opposed by the United States. I also added that in any event the decision taken was a decision taken by the government of Canada.


John George Diefenbaker: If there was not any
objection, wherein did the courage consist?


Murdo William Martin: In replying to my
right hon. friend.


Some hon. Members:: Hear, hear.
July 12, 1966

Inquiries of the Ministry EXTERNAL AFFAIRS



LAOS-REPORTED BOMBINGS BY U.S. AIR FORCE

[Stage Direction]
On the orders of the day:
Mr. T. C. Douglas (Burnaby-Coquillam):: Mr. Speaker, may I direct a question to the Secretary of State for External Affairs. In view of reports from Saigon to the effect that for several months the United States air force has been bombing targets in Laos to the extent of some 100 strikes a day, I should like to ask the minister whether he is in possession of this information; and was he ever given the information by the United States government or by the Canadian representatives on the international control commission?


Paul Joseph James Martin: Mr. Speaker, my hon.
friend will recall that some weeks ago this question was asked and I indicated that the commission had received a complaint about these alleged bombings in Laos and that the commission, which of course includes a Canadian representative, depends upon those who made the complaint to facilitate the commission's examination of the allegations. Such permission has not yet been granted.


Thomas Clement (Tommy) Douglas: May I ask a supplementary question, Mr. Speaker. Will any representations be made either to the government of Laos or the United States government for permission to investigate these charges?


Paul Joseph James Martin: The permission in :his case in practical terms would not necessarily be given entirely by the royal government of Laos but also by those forces in Laos opposed militarily to the royal government. It is to these forces that a request by the Laos government to make an investigation must be made. The royal government of Laos does not fully control the whole territory of Laos.


Thomas Clement (Tommy) Douglas: I have another supplementary question. With reference to the United States airports in Laos and in Thailand from which some of this bombing is going on, has any request been made of the government controlling these areas with regard to an investigation?


Paul Joseph James Martin: There have been communications quite recently-I am not familiar with the details-addressed by the commission along the lines of those referred to by my hon. friend.



FINANCE


[Stage Direction]
On the orders of the day:
Gilles Grégoire: Mr. Speaker, I wish to put a question to the Minister of Finance.
Can the minister advise the house whether he has received any representations to the effect that legislation should be passed in this house to lower the interest rates charged by small loans companies and whether he intends to have such new legislation passed this year?


Hon. Mitchell Sharp (Minister of Finance):: Mr. Speaker, I cannot recall having recently received any such representations on this subject, although it is a matter of continuing interest to Canadians generally. It is my intention, as 1 said when speaking to the resolution preceding the introduction of the bill to amend the Bank Act, to convene a federal-provincial conference this year to discuss consumer credit, which of course will include interest and the revelation of true interest charges.



NATIONAL DEFENCE


[Stage Direction]
On the orders of the day:
Mr. Lloyd R. Crouse (Queens-Lunenburg):: Mr. Speaker, I should like to direct a question to the Minister of National Defence. The men in the highland regiments of our armed forces are delighted to know that the minister intends to retain the kilt. In view of the interest in our seagirt provinces, would the minister give a similar assurance that the uniforms now worn by the officers and men of Her Majesty's Royal Canadian Navy and reserve will not be changed in design, pattern or colour?


Mr. Speaker:: Order. I allowed the hon.
member's question yesterday, but I think perhaps this one should not be asked at this time. It might be placed on the order paper or discussed at ten o'clock this evening.


Lloyd Roseville Crouse: On a point of order; I believe the morale of our armed forces depends on many things, not the least of which is an adherence to tradition which builds esprit de corps among the men.
July 12, 1966


Mr. Speaker:: Order, please. I think the morale of the armed forces will hold up until this evening at ten o'clock.



UNITED NATIONS


[Stage Direction]
On the orders of the day:
Mr. Heward Graffiey (Brome-Missisquoi):: Mr. Speaker, in view of the Prime Minister's answer yesterday to the member for Oxford I should like to direct a question to the Secretary of State for External Affairs. Has the government set up a special body of officials to advise on a course of action relating to the seating of communist China at the next session of the United Nations and, if so, will the government make its attitude known before the session begins? I think it is important that this question be asked at this particular time.


Paul Joseph James Martin: Yes.


William Heward Grafftey: May I ask-


Mr. Speaker:: Order, please. Is the hon. member rising to ask a supplementary question?


William Heward Grafftey: Yes, I have a supplementary question, Mr. Speaker. Does the answer given by the Secretary of State for External Affairs mean yes, a body has been set up, and yes, the government will make its decision known before the session begins?


Paul Joseph James Martin: So that my hon. friend's important question will receive the treatment it deserves, when I said "yes" I meant that we are studying this and we have employed the technique for our departmental study that my hon. friend mentioned in his question.



OLD AGE SECURITY


[Stage Direction]
On the orders of the day:
Mr. Stanley Knowles (Winnipeg North Centre):: Mr. Speaker, may I address a question to the Minister of National Health and Welfare. Can the minister tell us the day or the order of business under which he will make his promised statement to the house regarding old age pensions?


Hon. A. J. MacEachen (Minister of National Health and Welfare):: Mr. Speaker, I am not
Inquiries of the Ministry exactly sure of the day, but at the moment I think the most appropriate time to make it would be on motions.


Stanley Howard Knowles: Is it still true that it will be on a day during this part of the session?


Allan Joseph MacEachen: Yes.



DEFENCE PRODUCTION


[Stage Direction]
On the orders of the day:
Mr. Eric A. Winkler (Grey-Bruce):: Mr. Speaker, I should like to direct a question to the Minister of Industry in relation to the question I asked yesterday. Has the minister anything to report to the house today in regard to the cancellation of contracts with the Canadian government or Canadian companies by the United States government? I have in my hand a quotation from a statement by the secretary of defence regarding such contracts.


Charles Mills (Bud) Drury: Mr. Speaker, perhaps the hon. gentleman would read the quotation he has in his hand.


Mr. Speaker:: Order. I would prefer the hon. member not to read the quotation.


Eric Alfred Winkler: Mr. Speaker, the minister cannot get away with that sort of business.


Some hon. Members:: Oh, oh.


Eric Alfred Winkler: I should like to ask-


Mr. Speaker:: Order, please. The hon. member has asked a question and I think the question in itself is complete. It is now up to the minister to either reply or refuse to answer.


Eric Alfred Winkler: Mr. Speaker, I wish to pose another question for the minister. Have any export permits for the sale of aerial bombs been approved by the government?


Charles Mills (Bud) Drury: Mr. Speaker, no export permits for the sale of aerial bombs have been approved by the government of Canada.


Eric Alfred Winkler: I have a supplementary question. I should like to ask the minister whether any applications for the sale of bombs have been received by the government.


Charles Mills (Bud) Drury: Although this is not my
responsibility as minister, to the best' of my knowledge no applications for export permits

July 12, 1966
Inquiries of the Ministry for the sale of aerial bombs have been received.


Eric Alfred Winkler: Whose responsibility is it, Mr. Speaker?


Mr. Speaker:: Order, please.


John George Diefenbaker: Mr. Speaker, I should like to ask the Minister of Industry whether it is a fact that as a result of production decreases and rising costs an aircraft parts contract for Canada in the amount of $62.8 million has been lost. I refer to a contract under which De Havilland of Canada undertook to supply wing and stabilizer units for the new DC-9. Can the minister say whether in fact this contract has been lost to Canada, and whether the government has an alternative means of making up the consequent economic effects of this very large reduction?


Charles Mills (Bud) Drury: Mr. Speaker, I shall be glad to attempt to ascertain the facts of this situation. I am not aware that a large contract of this kind has been cancelled.


Eric Alfred Winkler: Mr. Speaker, I have a supplementary question based on a statement made by the secretary of defence for the United States. He said:
-I recall one contract with a Canadian concern for bomb production which will be cancelled as a result of this cutback.


Mr. Speaker:: Order, please.


Eric Alfred Winkler: I wish to ask the Acting Minister of Trade and Commerce whether any applications in any form have been received by the Canadian government for the sale of aerial bombs to the United States.


Charles Mills (Bud) Drury: The question is sufficiently urgent, Mr. Speaker, to warrant a very thorough and profound inquiry. I will have this made.


EXTERNAL AFFAIRS
[Stage Direction]
On the orders of the day:
Mr. David Lewis (York South):: Mr. Speaker, I should like to address a question to the Secretary of State for External Affairs in view of a story in this morning's paper that mainland China has apparently applied a ban on tourists. In view of the fact that a

group of Canadian high school teachers, and maybe others, are now in Hong Kong awaiting admission to China on previously obtained visas, would the minister make inquiries and take steps to get the Chinese government to agree that such groups should be admitted despite the present ban?


Mr. Speaker:: Order, please. I have very serious doubts that this is the type of question that can be asked during this period of our daily procedures. The hon. member has made a point and has brought a situation to the attention of the minister, and I assume that the matter will be taken into consideration, but I suggest to the hon. member that it should not be raised as a question at this time.


David Lewis: With great respect, Mr. Speaker, and just to make it clear, the reason for the question having been asked is that the group I referred to is now in Hong Kong awaiting admission in the next day or two, and stands to lose a very substantial sum of money which has been paid into the Bank of Peking for that purpose.


Mr. Speaker:: I suggest that the problem and difficulty pointed out by the hon. member cannot necessarily be solved by the question being asked at this time.



INDUSTRY


[Stage Direction]
On the orders of the day:
Mr. L. R. Sherman (Winnipeg South):: Mr. Speaker, my question is for the Minister of Trade and Commerce, but in his absence I should like to ask the Minister of Industry whether he is aware that the three American owned flour mills in Canada, Robin Hood, Quaker and Pillsbury, have received letters from Washington forbidding them to mill Canadian wheat in Canada for sale to Cuba; and does the minister consider this action to be in keeping with the principles of good corporate citizenship expected of firms operating in Canada?


Mr. Speaker:: Order, please. I suggest to the hon. member that this question is not so urgent that it should be asked just now.


Some hon. Members:: Oh, oh.


John George Diefenbaker: Mr. Speaker, I rise on a question of order. The question that was
July 12, 1966

asked by the hon. member for Winnipeg South is one of great consequence, as to whether the United States of America is asserting extraterritoriality over Canadian corporations.


Some hon. Members:: Hear, hear.


John George Diefenbaker: They tried that when I was prime minister, and I want to And out where the courage is now on the part of this government to face this situation.


Some hon. Members:: Hear, hear.


Mr. Speaker:: Order, please. The Chair does not deny that the matter is one of great importance from the Canadian standpoint; but I did not think, and still do not think, it is a question that can be asked at this time because it is of such a general nature. If the hon. member feels aggrieved and thinks it is very urgent the House of Commons, itself, has provided an alternative; it allows hon. members who feel they have a matter of urgency to raise to take the question up at the adjournment debate. The course is open to the hon. member for Winnipeg South to do that this very evening at ten o'clock, at which time he can ask the question and there can be an answer.
I have pointed out before, and do so again, that it is very easy for the Chair to make a mistake on this kind of question. The decision has to be made on the spur of the moment, and certainly mistakes can be made. But it is to guard against such mistakes that an escape valve has been supplied through provision for discussion later in the day. Therefore if the hon. member for Winnipeg South feels he has a matter of extreme national urgency he can discuss it in just a few hours' time in the adjournment debate.


John George Diefenbaker: I rise again to ask a question arising out of the question that was asked previously. I wish to ask the Secretary of State for External Affairs whether it has come to his notice that the United States administration is today endeavouring to dictate to Canadian corporations, even though they have been capitalized by the United States.


Mr. Speaker:: Order, please. The right hon. Leader of the Opposition is obviously asking the same question.


John George Diefenbaker: No, Mr. Speaker.
Inquiries of the Ministry


Mr. Speaker:: The right hon. gentleman says no. I am here as the servant of the house, and if there is a general feeling that a question which has been ruled out of order as not being of extreme urgency should be recognized and answered, then certainly I am quite willing to swallow my pride and allow the question.


Some hon. Members:: No, no.


Paul Joseph James Martin: As we are nearing the end of the session, Mr. Speaker, may I take the responsibility of suggesting, as this question has been asked by the right hon. gentleman as well as by other hon. members, and without in any way suggesting that Your Honour's decision is wrong, that perhaps you would want the government to clearly indicate that if there is any extra-territorial application in this matter, then of course the government will take the strongest action in the national interest.


Some hon. Members:: Hear, hear.


Thomas Clement (Tommy) Douglas: Mr. Speaker, I wish to rise on the point of order which has been raised.


Mr. Speaker:: Order. There is no point of order. The question has been asked and answered. I will certainly allow supplementary questions, and I understand the hon. member for Winnipeg South wishes to ask a supplementary question now.


Louis Ralph (Bud) Sherman: I was merely going to point out, Mr. Speaker, that I asked in my question whether the minister was aware of the situation. However, I respect the Chair's ruling, and I will ask for permission to debate the question at ten o'clock.


Mr. Speaker:: We will have our cake and eat it.


Thomas Clement (Tommy) Douglas: May I rise on a supplementary question and ask the Secretary of State for External Affairs whether it has come to the attention of the government that any of the three milling companies mentioned by the hon. member for Winnipeg South had been instructed by the U.S. government that they are not to mill flour to fill the U.S.S.R. contract?


Paul Joseph James Martin: This has not been brought to my attention. The Acting Minister of Trade and Commerce informs me he has already asked that this matter be examined, which I will also request when I leave this chamber.
Inquiries of the Ministry



LABOUR RELATIONS


[Stage Direction]
On the orders of the day:
Mr. T. S. Barnett (Comox-Alberni):: Mr. Speaker, I have a question for the Minister of Labour which perhaps his parliamentary secretary would be prepared to deal with in the minister's absence. I should like to ask the Minister of Labour whether he will table in the house a copy of a telegram to the longshoremen in British Columbia, on the strength of which it is reported that the longshoremen who were in jail have paid their fines and been released.


Mr. B. S. Mackasey (Parliamentary Secretary to Minister of Labour):: I will bring the matter to the attention of the minister, Mr. Speaker, who will be back here within an hour.



FISHERIES


[Stage Direction]
On the orders of the day:
Mr. J. P. Nowlan (Digby-Annapolis-Kings):: My question is directed to the Minister of Fisheries. Since I began this session with a question on fisheries I might end it with one.
Can the minister inform the house whether there are any changes to be announced in the fishing regulations pertaining to seiners on the Bay of Fundy between the New Brunswick coast and the Nova Scotia coast? Several questions relating to this subject have been asked by myself and other hon. members during this session. The urgency of the matter lies in the fact that the house may not be sitting when the next season starts and the discrimination might continue.


Hon. H. J. Robichaud (Minister of Fisheries):: Yes, Mr. Speaker, in the last few days I have signed a recommendation to the governor in council suggesting changes in the existing regulations. The closing date will be advanced from November 15 to, I believe, September 30. Furthermore, I have also amended the regulations in order to protect the weir operators on the Nova Scotia side by not allowing seiners to operate within one mile of set weirs.

July 12, 1966 EXTERNAL AFFAIRS



VIET NAM-RESOLUTION OF CANADIAN UN ASSOCIATION

[Stage Direction]
On the orders of the day:
Mr. L. M. Brand (Saskatoon):: Mr. Speaker, I wish to address a question to the Secretary of State for External Affairs. On July 7 I asked the Prime Minister whether he or the hon. gentleman opposite had received a resolution from the United Nations Association of Canada supporting the recommendations of U Thant made on June 20, 1966 regarding the war in Viet Nam. At that time the Prime Minister said he could not recall it but would look into the matter together with the hon. gentleman opposite and give us an answer in a few days. I wonder whether the minister is prepared to answer this question now.


Paul Joseph James Martin: I apologize for not having responded as quickly as we indicated we would. I will look into the matter right away.



AIRPORTS


[Stage Direction]
On the orders of the day:
Hon. W. G. Dinsdale (Brandon-Souris):: have a question for the Minister without Portfolio, notice of which I have given to him. Can the minister indicate whether final clearance will be given for the new terminal at Brandon in time for summer construction?


Hon. John N. Turner (Member of fhe Administration):: I wish to thank the hon. member for having given me notice of this question. May I say in answer that discussions with officials from the city of Brandon are still continuing, and it might be a little difficult to have the terminal opened this summer.



NATIONAL DEFENCE

[Stage Direction]
NATO-INQUIRY AS TO CLOSING OF AIR BASES On the orders of the day:
Hon. Gordon Churchill (Winnipeg South Centre):: Mr. Speaker, may I try my luck with the Minister of National Defence and ask him whether he is planning to shift the Canadian air bases from France to other places in Europe, or will he reduce Canada's financial obligation by closing those bases and not reopening them elsewhere?

July 12, 1966



Hon. Paul Hellyer (Minister of National
Defence): As soon as the government's decision is made on this matter, Mr. Speaker, it will be announced in the normal way.


Gordon Minto Churchill: The minister said that several days ago. May I ask whether he has resolved his differences with the Secretary of State for External Affairs, who wants to maintain Canada's heavy expenditure in Europe although this appears to be unnecessary?


Mr. Speaker:: Order, please. I suggest to the hon. member with respect that his question is argumentative.


Mr. Hellyer:: May I just assure my hon. friend that-


Mr. Speaker:: Order, please.


Gordon Minto Churchill: There is a difference of opinion there, Mr. Speaker.


Gordon Minto Churchill: Mr. Speaker, I have a question for the Acting Prime Minister. Is the minister of external affairs insisting on the retention of two extra Canadian air bases in Europe when they have to be moved from France, and does he realize that this is perhaps an unnecessary expenditure under the circumstances?


Paul Joseph James Martin: Mr. Speaker, my hon. friend has been reading the same article that I myself saw yesterday in the Globe and Mail. Of course my hon. friend knows that government policy is not disclosed until it has been formulated.


Gordon Minto Churchill: When will the government's policy be formulated; because the movement of these air bases has to be made very soon?


Paul Joseph James Martin: My hon. friend's question gives me an opportunity to say to the hon. member for Winnipeg South that no such resolution has been received either in the Prime Minister's office or in mine.



INDUSTRY


[Stage Direction]
On the orders of the day:
Mr. Thomas M. Bell (Saint John-Albert):: wish to address my question to the Minister of Industry concerning the recent appeal for
Inquiries of the Ministry proposals from New Brunswick to the Atlantic Development Board. Will the minister refer the matter of the exclusion of Saint John and Halifax from the incentive program to the board, which action would be under the minister's jurisdiction and which has been intimated by the government for some time?


Charles Mills (Bud) Drury: number of premises are postulated in that question with which I cannot agree.


Thomas Miller Bell: Since the minister has lost his only two supporters in New Brunswick for his proposal, the premier of that province and the mayor of Saint John, will he act on it this summer?


Mr. Speaker:: Order, please.


Lloyd Roseville Crouse: wish to put a supplementary question to the Minister of Industry. The area development incentive program has stimulated tremendous interest in the establishment of fish processing firms in Nova Scotia which may well be essential to the full development of the potential of that industry. In view of this fact will the minister indicate whether there is any truth in the rumour that the federal government is considering the complete elimination of the incentive program?


Mr. Speaker:: Order, please. This question is on general policy, and cannot be asked at this time.



DEBATE ON PROTOCOL TO CARIBBEAN CONFERENCE AGREEMENT

[Stage Direction]
On the orders of the day:
Mr. Robert McCleave (Halifax):: My question is addressed to the Acting Prime Minister. Because of protests over the shipping provisions of the Canada-Commonwealth Caribbean conference agreement, when can we expect a debate on the protocol in this house?


Paul Joseph James Martin: I will give consideration to that matter and answer the hon. gentleman later.



NORTHERN AFFAIRS


[Stage Direction]
On the orders of the day:	*
Walter Gilbert Dinsdale: have a question for the Minister of Northern Affairs and National Resources, but in his

July 12, 1966
Inquiries of the Ministry absence perhaps the parliamentary secretary could take the question as notice. Have tenders been issued for a $5 million school-hostel complex at Cambridge Bay? If so, how does this square with the policy of having smaller school units to avoid the disruption of families, which has been causing such serious social problems in the north?


Mr. Speaker:: Order. This question should be placed on the order paper.


Walter Gilbert Dinsdale: With deference, Mr. Speaker, the house is expecting to adjourn shortly, and I hardly think there would be an opportunity for a reply to a question placed on the order paper. I would appreciate it if the parliamentary secretary could take the question as notice and have a reply at a later time.


Mr. Stanley Haidasz (Parliamentary Secretary to Minister of Northern Affairs and National Resources):: I shall be pleased to take the question as notice and bring it to the attention of the minister upon his arrival in Ottawa tonight.



IMMIGRATION


[Stage Direction]
On the orders of the day:
Mr. Marcel Prud'homme (Saint-Denis):: Mr. Speaker, I should like to put a question to the Minister of Citizenship and Immigration.
Is the minister now in a position to tell us whether he has considered the possibility of extending the July 25 deadline with regard to the application of the special regulations he announced on Friday, July 8?


Hon. Jean Marchand (Minister of Citizenship and Immigration):: Mr. Speaker, since yesterday I have received many representations asking me to extend the deadline set in the statement I made in the house concerning immigrant visitors. I am ready to consider the requests submitted, and within a few days I may be in a position to indicate whether we shall extend or maintain this deadline.



NATIONAL DEFENCE


[Stage Direction]
On the orders of the day:
Thomas Speakman Barnett: I
should like to ask the Minister of Industry

whether, since the federal government has sold Sunnybrook hospital to the University of Toronto for one dollar, the government will consider taking like action and selling much less valuable former national defence property in Alberni for a like amount.


Mr. Speaker:: Order. The question should be placed on the order paper perhaps in a more clear way.


Thomas Speakman Barnett: Ten o'clock, Mr. Speaker.



ADMINISTRATION OF JUSTICE


[Stage Direction]
On the orders of the day:
Eric Alfred Winkler: I have a question for the Acting Prime Minister. Can he inform the house if he has any knowledge as to whether the report of the Spence commission is ready for publication?


Paul Joseph James Martin: really do not know; 1 shall have to make inquiries.


Eric Alfred Winkler: I wonder if the minister could tell us whether we might expect it next week.


Paul Joseph James Martin: I really do not know.



HEALTH AND WELFARE


[Stage Direction]
On the orders of the day:
Allan Joseph MacEachen: Yesterday the hon. member for Kamloops asked me if I would reply to starred question No. 1,710, which reads as follows:
Is it the intention of the government to pay to provinces which decline to accept the federal medicare plan, the fiscal equivalent of the payments thus forgone from the federal treasury on the same basis as the arrangement generally known as "opting out" approved in negotiations with the province of Quebec in recent years?
In reply to the question I wish to state there is no provision for federal contributions to provinces which do not have medical care plans which conform to the four criteria.
In regard to the hon. member's reference to "opting out arrangements", I should note that these apply only in respect of shared cost programs where an agreement between the two governments exists. The medical care
July 12. 1966

legislation will not require agreements between the federal and provincial governments; it will simply authorize payments from the consolidated revenue fund to any province which has a medical care plan as described in the federal legislation.


Gilles Grégoire: Mr. Speaker, I did not quite understand the meaning of the minister's statement. If the province of Quebec should decide to set up its own medicare plan, can the minister tell whether it will be entitled at the same time to a financial compensation, as in the case of other joint programs of which it chose to opt out?


Allan Joseph MacEachen: This is not contemplated in the proposal made by the federal government, which has been well known for some months.


Gilles Grégoire: A supplementary question, Mr. Speaker.
Can the Minister of National Health and Welfare tell us whether he intends to look also into this proposal and to see to it that a financial compensation is granted to the province as in other fields?


Allan Joseph MacEachen: Mr. Speaker, there is no opting out arrangement contemplated under this proposal. It is rather a question of opting in on the part of the provinces for federal contributions toward plans which meet the four criteria.



REQUEST FOR INCREASE IN QUOTAS

[Stage Direction]
On the orders of the day:
Right Hon. J. G. Diefenbaker (Leader of
ihe Opposiiion): I should like to direct a question to the Minister of Finance. It arises out of the fact that many farmers on the prairies have a great deal of wheat in their granaries. Will the minister report now as to whether, between now and July 30, there will be an increase in quotas so that farm storage may be reduced to the greatest possible extent? I am sure the minister is now in a position to answer this question, because the other day he stated he had been in communication with the wheat board.
Mitchell William Sharp: I was in communication with the chairman of
Inquiries of the Ministry the Canadian Wheat Board yesterday, Mr. Speaker, and he told me that the objective of the Canadian Wheat Board is a general quota of ten bushels per acre, which he hoped would be in force at all points. If in fact there were a few points which were not on the ten bushel quota, they would be very few indeed. It will be the policy of the Canadian Wheat Board to facilitate the movement of Canadian wheat, and whatever measures are necessary to attain that end will be followed. I say this because it may be necessary in the coming crop year to vary policies that have been followed in the past.


John George Diefenbaker: I want to thank the minister for that statement. In view of the fact that we are approaching the end of this portion of the session, and all western farmers naturally are most interested in this subject, can the minister give the house and the country a general idea of some of the changes that will be necessary, as he envisages the situation now, to permit the filling of the very large contracts for wheat that have been undertaken?


Mitchell William Sharp: I doubt whether it would be possible to do this before the house adjourns. I can only repeat that the wheat board is now considering the changed situation that has arisen out of the fact that there is, for as far ahead as we can see, a very strong demand for Canadian wheat. It will be most important that wheat always be available to meet this demand, so the wheat board would not want to permit a quota system, which was introduced under very different circumstances, to interfere with the fulfilment of these contracts.
I should like to go further at this time, Mr. Speaker, but I do not think it will be possible. However, I am sure the Canadian Wheat Board, whether or not parliament is in session, will give as much information as possible to the farmers of western Canada for their guidance.


Thomas Clement (Tommy) Douglas: May I ask a supplementary question regarding the minister's statement that there" may be some delivery points that will not reach the ten bushel quota. Will the wheat board give any consideration to taking this into account in setting the quota for those delivery points in the next crop year, if they were not able to reach the ten bushel quota this year?


Mitchell William Sharp: This subject is invariably considered by the board at the end of every crop
7544	COMMONS
Inquiries of the Ministry year during which there has been any suggestion of unfairness in quotas. The decision has always been not to cause overlapping between two crop years. Therefore I have to answer the question in this way, that the wheat board would not take a shortfall in quotas in this crop year into account in fixing quotas for the coming crop year. This has never been done, and I doubt very much whether it would be done this year. However, circumstances are changing so rapidly in the demand and supply situation for wheat that I suggest to the hon. gentleman he should wait until we see what conditions are like at the opening of the crop year, when his question may be quite irrelevant.


Thomas Clement (Tommy) Douglas: A supplementary question, Mr. Speaker. I would ask the minister whether the wheat board would give consideration to giving those points that did not reach the ten bushel quota a higher priority for the coming year, if it is not prepared to give them compensation in the form of a higher delivery quota.


Mitchell William Sharp: The Canadian Wheat Board of course makes the decisions in these matters and will, I am sure, take into account the views of the hon. gentleman.


Mr. Jack McIntosh (Swift Current-Maple Creek):: I rise on a point of order, Mr. Speaker. Yesterday, when I asked a question similar to that now asked, you ruled that it was hypothetical. If it was hypothetical when I asked it, should it not be hypothetical when some other member asks it?


Mr. Speaker:: Perhaps the question has become more urgent since yesterday.


John George Diefenbaker: A supplementary question, Mr. Speaker. Now that the minister has gone as far as he has, would the house be right in coming to the conclusion that the tremendous demand for wheat will mean that the quota system is going to be set aside?


Mitchell William Sharp: I do not think I should like to go that far, Mr. Speaker. Some changes in the administration of the quota system may be required.


Mr. Speaker:: Order, please. The question period has now expired.

DEBATES	July 12, 1966



HEALTH AND WELFARE


Allan Joseph MacEachen: that the house go into committee to consider the following resolution:
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.
Motion agreed to and the house went into committee, Mr. Batten in the chair.


Allan Joseph MacEachen: Mr. Chairman, it is a privilege for me to sponsor this resolution and to begin debate on a program which, if approved, will enable the government of Canada to provide financial support to provincially administered medical care plans.
I would point out that this program is the fourth major step in the health insurance plan initiated some years ago by my colleague who now holds the position of Secretary of State for External Affairs. The other three are the health grants program, hospital insurance, and the establishment of the health resources fund.
In 1948, when the health grants were being discussed in this house, the then prime minister described them as being fundamental prerequisites of a nation-wide system of health insurance. The second phase, which was also piloted by my colleague now the Secretary of State for External Affairs through the legislative procedures in the spring of 1957, culminated in the hospital insurance program which provides benefits to virtually the whole population of our country. Members, of course will be familiar with the health resources fund, which was only recently approved by this parliament.
I am proud, Mr. Chairman, to be the pilot of this new measure, which will extend the benefits now available beyond the doors of the hospital, ensuring the availability of physicians' services whether these be provided in the doctor's office or in the patient's home. As hon. members know, the federal government has for some years been examining ways and means of ensuring that the opportunity for good health which is now viewed in western democracies as a right possessed by all should be available to every citizen of our country.
This effort springs not only from a deepening of our humanitarian concern for our fellow citizens, but from a realization that we
July 12, 1966

cannot afford the social and economic consequences of our failure to do so. In an industrial country such as ours we cannot afford the loss to our economy stemming from ill health.
It was these considerations, undoubtedly, which led to the appointment of the royal commission on health services, whose report has been subjected to considerable study by the government. The royal commission on health services, consisting as it did of representative professional personnel, recruited a corp of experts in many health fields and had the assistance of many of the best brains in Canada, to quote the chairman, an eminent Canadian jurist. It was the view of the royal commission on health services that there is an enormous gap between our scientific knowledge and skills on the one hand and our organizational and financial arrangements to apply them to the needs of men, on the other.
The commission described its recommendations as a method of closing this gap. One of its recommendations was partially implemented by the Health Resources Fund Act recently passed by the house. Another essential recommendation was for a comprehensive universal health services program consisting of several phases, one of which is for a universal program of medical services benefits-


John George Diefenbaker: Could I interrupt the minister. In view of the fact that the press has available copies of his remarks, would it not be possible for the hon. member for Simcoe East also to have a copy so he could follow the minister's speech?


Allan Joseph MacEachen: Yes, Mr. Chairman, I regret that I have failed to provide copies to my hon. friends.


An hon. Member:: That is twice in one week.


Allan Joseph MacEachen: Mr. Chairman, this will be accomplished through the present bill. The basic question, of course, is why do this through a nation-wide, government sponsored medical insurance system.


An hon. Member:: Where is that copy?


Allan Joseph MacEachen: The answer is simple. The government of Canada believes that all Canadians should be able to obtain health services of high quality according to their need for such services and irrespective of their ability to pay. And we believe the only
Health and Welfare
practical and effective way of doing this is through a universal, prepaid, government sponsored scheme.
This same conclusion was reached by the royal commission, which spent almost three years examining Canada's health needs and seeking ways to improve and extend health services. The royal commission's recommendation for a universal, prepaid, publicly administered system was endorsed by all its members, including members of the medical, nursing and dental professions and a doctor who had been president of the Canadian Medical Association.
The commission, and the government, recognize the fundamental principle that health is not a privilege tied to the state of one's bank account, but rather a basic right which should be open to all.


Mr. Rynard:: On a point of order, Mr. Chairman, I wonder if it is not possible to get a copy of the paper the minister is reading from.


An hon. Member:: The press have it.


Philip Bernard Rynard: How can we listen to this long speech and comment on it afterward if we have not got the paper the minister is holding in his hand? It is ridiculous. This sort of thing has been done over and over again.


Allan Joseph MacEachen: I regret that I did not make copies' available to my hon. friends. It was an oversight, and my parliamentary secretary is seeking to obtain copies. Frankly, I do not know how the hon. gentleman can profit more from reading the speech than from listening.


Thomas Clement (Tommy) Douglas: Is there not any remedy for those who cannot do either?


Stanley Howard Knowles: What about the rule against the reading of speeches?


Allan Joseph MacEachen: Mr. Chairman, I think we recognize, too, that while an individual's health is a highly personal affair in many respects, his or her good health is of direct benefit to the wider community.
[DOT] (3:30 p.m.)
These are the fundamental points which I believe every Canadian can and does support. The question is how best we can assure that this goal is met. The federal government's proposal, as hon. members know, is to offer the provinces a sizeable sum of money to support provincial medical care insurance programs which meet certain established standards.

July 12, 1966
Health and Welfare
We have taken this approach because we recognized that under our constitution health is a provincial responsibility and, because of this, federal initiative in this field is limited to encouraging provincial action. This is an important point, but one which I am afraid has been lost sight of in some of the debates on this subject.
It would be much simpler and, to some, more attractive to shunt these considerations aside and promise broad and direct federal action in this field. But in practice this would amount to little more than an exercise in futility, for it would mean making federal promises that are not within the federal power to keep.
It may be a matter of interest to members to note the manner in which changing times and conditions are reflected in the varying methods by which federal assistance has been made to provincial programs in the unfolding of our health insurance plan. When the health grants were introduced in 1948, many provincial governments were financially hard-pressed and because of this condition, but at the same time respecting the constitutional position, the federal government set up a series of health grants only some of which required the matching of the funds by a province. Thus, for many years in certain areas, the federal government has been providing through some of the health grants payments in full for projects designed and administered by the provincial governments.
By the time the hospital insurance program was introduced, federal sharing had become the usual means through which the government of Canada made contributions toward programs which clearly fell within provincial jurisdiction. Thus, the hospital insurance program became a conditional grants program under which the federal government began providing very considerable sums of money, but only with respect to shareable items of expenditure approved by the provincial governments.
The present phase of health insurance comes at a time when the conditional grants technique is undergoing some rethinking. Hence, it would not be in conformity with this policy to bring in a measure designed along the lines of existing conditional grant programs.


Mr. Hees:: On a point of order. I wonder whether the minister would send his parliamentary secretary to the press gallery to see whether there is an extra copy of his speech available. Every member of the press gallery
[Mr. MacEachen.l
has a copy and I am sure there must be an extra copy left over. As a courtesy, could not one be given to the opposition critic, who still has no copy?


William Heward Grafftey: It is a matter of courtesy. We shall read it; you make the speech. Is that a deal?


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


William Heward Grafftey: Modern methods include
courtesy.


Allan Joseph MacEachen: I have said twice that whatever copies are available will be made available to hon. members. In the meantime, if hon. gentlemen opposite will bear with me I will seek to place copies at their disposal. I do not think there is any point in making an issue of this matter. Maybe I have a copy here for the hon. member. Here is one.


Philip Bernard Rynard: On the point of order, I have
just received one from the press. Thank you very much.


An hon. Member:: That was well staged.


Mr. Ricard:: Well staged? We asked five or
six times before you did anything.


Allan Joseph MacEachen: The resolution under consideration does not envisage a plan designed along the lines of existing grant programs but employs another avenue through which federal support will be provided. I shall discuss this further later in my remarks.
I have mentioned that there is no question at this time as to the role allocated to the provinces under our constitution in the health field. This role is a predominant one, and provincial governments individually will devise programs, as some have in fact already done, which undoubtedly will differ from province to province, as existing programs already do.
At the same time not all of the provinces have the same fiscal capability of providing such programs or of meeting the costs of programs designed for all residents. Thus, although Canada is one country a Canadian resident of one province may be at a distinct disadvantage when compared with a Canadian resident of another province.
Of even greater national concern is the disadvantage which may be suffered by a Canadian who, having resided in one province, moves to another province only to find that his position is the same as it might have
July 12, 1966

been had he moved to a point beyond his own national boundaries. Clearly these are considerations which give rise to certain federal responsibilities in the health and welfare fields.
Thus while it is the policy of this government to redefine its role in so far as conditional grant programs are concerned, it may not abrogate its obligation to ensure the national character of our country by establishing an acceptable level of services available to all citizens. It is proposed, therefore, that with the full co-operation of the provinces the federal government will support medical care programs which meet the four basic principles which the government of Canada believes will serve the national interest.
The first of these principles involves the scope of benefits which it is considered should be made available as a minimum, regardless of any other benefits a province may wish to include as well. It is considered that the medical care program should offer all of the services provided by physicians.
This would mean that the services of general practitioners and specialists would be insured services, regardless of where these services were made available. Whether the insured person is seen by the physician in the doctor's office, in the hospital, in a nursing home, or in a private home belonging to the insured person or to anyone else, the benefits of the medical care plan should be available.
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 the 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.
The second principle which is considered to be essential if the federal government is to make substantial financial contributions is that of coverage. In discussions with the provinces the matter of universal coverage, which we feel to be essential, has been examined carefully and closely. We have explained to the provinces that the principle of universal coverage should not be confused with compulsory coverage.
Health and Welfare
It is a fact that if a province chooses to finance its share of the costs by levying a premium, then and only then would the question of compulsion arise. It would be the decision of a province whether premiums would be compulsory in the sense that taxes are compulsory. Certainly this measure does not contemplate compulsion on individual doctors to join a plan; nor would there be any compulsion on individual persons to use the services provided under the plan.
I do not wish to appear to be splitting hairs, but it would seem to me that certain adverse comments which have been made on the question of compulsion give the impression that doctors would be required to treat patients they do not wish to treat and that individuals would be required to accept benefits under a program which they did not wish to accept. At the risk of repeating myself on this point, I should like categorically to state that neither of these two circumstances would be involved in the principle of universal coverage in the context of medical care.
[DOT] (3:40 p.m.)
Members might be interested in an assessment of the experience which has been gained in this regard under the various provincial hospital insurance plans. It will be recalled that under that program insured services were also required to be made available on equal terms and conditions to all residents. Universal coverage was automatically achieved in those provinces which chose to finance their share of the costs out of the general revenues of the province, or by means of a sales tax, or by a combination of these methods with or without an authorized charge for which provision was made in the legislation.
In these provinces persons who are residents become entitled to services by virtue of such status. Universality if achieved without compulsion of any sort except the compulsion to pay provincial taxes, which we all must pay.
However, when the hospital insurance program began five provinces chose to finance their share of costs by means of a premium. This entailed the registration of individuals and the payment of the premium fixed by provincial legislation. Within a relatively short time two of these provinces abandoned the premium system of financing and achieved universal coverage automatically by adopting a non-premium system. Of the remaining three provinces which still use the

July 12, 1966
Health and Welfare
premium system, only two have made it compulsory under provincial law tor all residents to be covered-


John George Diefenbaker: What are those two provinces?


Allan Joseph MacEachen: I believe they are British Columbia and Alberta, and the third province would be Ontario. I am speaking according to memory. The third province has maintained an element of voluntary enrolment. Nevertheless, the extent of coverage under hospital insurance at the present time in all provinces, including the province with a partial voluntary element, is now over 99 per cent of the eligible population.
I have explained this situation in some detail because I am anxious to illustrate my initial point, that universal coverage does not necessarily mean compulsory coverage.
In my discussions with the provinces as to what percentage of coverage the federal government will be prepared to view as universal, if a premium system of financing were adopted, I have agreed that for the initial period coverage of 90 per cent would be acceptable. It would be expected, of course, that this would rise to 95 per cent over a period of time.
Hon. members may ask why the federal government considers the principle of universal coverage to be so important. I believe that if the considerable expenditures which will have to be made to provincial programs are to be justified, then the federal government must have the assurance that as many people as possible will benefit. That is the case for the federal parliament. From the national point of view it is also essential to ensure that there is no differentiation in coverage between the residents of one province and another if federal funds are to be provided.
Before I leave the question of universal coverage I should like to draw the attention of hon. members to the report of the Royal Commission on Health Services and to studies made for that commission. All of these reached the same conclusion on the need for universality.
The third principle which the federal government considers to be essential is that of public administration. It is obvious that when the federal government makes substantial financial contributions available to the provinces, a provincial government must be capable of taking full responsibility for the use to which these contributions are put. The provincial plans should be non-profit and subjected to public audit, and the administrators

of the plan should be answerable to the public through the provincial legislature.
Once more I would like to point to the experience we have had in hospital insurance, which is as relevant to public administration as to universal coverage. Hospital insurance programs, without exception, are administered by the provincial governments, either directly by departments of health or, alternatively, by commissions established by provincial governments specifically for this purpose. I believe I am correct in saying that there is no jurisdiction in this country which has had reason to regret this method of administration.
The last principle which it is considered essential to incorporate in provincial medical care plans relates to transferability or, if you like, portability. This simply means that when a resident of one province moves to another province his entitlement to benefits will continue long enough for him to become entitled to benefits in the new province.


The Chairman:: Order. I apologize for interrupting the minister but the time allotted to him has expired.


Some hon. Members:: Let him continue.


Herman Maxwell Batten: Does the minister request extra time to complete his remarks?


Allan Joseph MacEachen: Yes, I do.


Herman Maxwell Batten: Does the committee give unanimous consent?


Some hon. Members:: Agreed.


Allan Joseph MacEachen: As I pointed out earlier, residents of provinces are also residents of Canada. It is essential, therefore, that the federal government ensures that mobility of the population between provinces does not place any resident in the same position as would apply if he moved to another country. This is particularly relevant when the federal government contributes to the cost of provincial programs.
Where provinces bring in medical care programs meeting these principles then the federal government, under the proposed bill, would accept fiscal responsibility for a contribution equal to one half of the present per capita cost of insured services in those provinces participating in the plan. Insured services, of course, mean medically necessary services provided by medical practitioners. If such a program were to be provided in all provinces next year, it is estimated that the cost to the federal treasury for a full year would be $340 million.
July 12, 1966

It has been estimated that approximately $600 million would be spent next year on physicians' services if no change were made in the present methods of providing these services. I would ask hon. members, therefore, to compare the estimates on which we are basing public expenditures for public programs covering the whole population if these go into effect next year, namely, a total of $680 million including the provincial share of half the costs. Thus, by redistributing the estimated $600 million and adding another $80 million, all residents of all the provinces of Canada will have physicians' services available to them. These are estimates and these comments are for illustration purposes.
Members of the committee may be interested in knowing that some 6 million Canadians still lack any medical insurance coverage, and 3 million more have only limited coverage. Probably not more than 10 million Canadians at the present time have what could be called adequate comprehensive coverage. Those without adequate coverage include primarily residents of rural areas and people with moderate or low incomes, unable to acquire low-cost group insurance. I might mention that these figures do not include those who will benefit from the health provisions set out in the Canada Assistance Plan.
These, then, and the financial proposal are the principles which have been discussed with the provinces. The response from the provinces has, I must say, been most encouraging. Some provinces have already indicated their readiness to proceed by our target date of July 1, 1967. Others have not been in a position to commit themselves, although some of these pointed out that they would be able to change existing plans to meet the principles described above. I should like to state that no province has stated that it will definitely not participate although, as hon. members are undoubtedly aware, the premier of Alberta has expressed criticism of the proposal.
[DOT] (3:50 p.m.)
The introduction of this resolution, Mr. Chairman, I believe marks an historic day for this parliament and for Canada. The program it spells out goes a long way toward closing the gap in our over-all social security system. It is our hope it will result in the commencement of provincial medical care plans covering all Canadians on the 100th birthday of Confederation, July 1, 1967. This would be a most appropriate way to mark our birthday, since it would ensure ready access to medical
Health and Welfare
care to all of our people, regardless of means, of pre-existing conditions, of age, or other circumstances which may have barred such access in the past.
At some time in each of our lives such care is necessary, if only to avoid the pitfalls of ill health. An investment in health is an investment in human resources. Only strong human resources can fulfil the promise offered to us by the other resources of our great country.
In concluding and in thanking the members of the committee for allowing me additional time, I should like to say I am confident that this measure will receive the constructive and conscientious attention of the committee and receive approval at a later hour this day.


Thomas Clement (Tommy) Douglas: Mr. Chairman, before the minister sits down, might I ask him whether it is his intention and the intention of the government to proceed with the legislation after the house has passed this resolution?


Allan Joseph MacEachen: Mr. Chairman, I am not in
a position to indicate what the situation will be or at what stage we will terminate, but I should like to have second reading of this bill today if possible or before the summer adjournment. That is not a commitment on the part of the government; it is what I should like to see.


Stanley Haidasz: Mr. Chairman, may I ask the minister whether this bill will be placed before the House of Commons committee on health and welfare for further study; and can the minister say today also, whether, in view of the federal contribution of 50 per cent of the cost of provincially sponsored health plans, the premiums of provincial health plans will be cut by 50 per cent?


Allan Joseph MacEachen: Mr. Chairman, I appreciate the importance of both these questions. When members of the committee have had an opportunity to examine the clauses in the bill I believe they will come to the conclusion that committee study, other than study in committee of the whole, may not be necessary in respect of this bill, because the bill itself merely embodies the principles about which I have been talking for the past half hour.


Stanley Howard Knowles: They have been studied for nearly 50 years.


Allan Joseph MacEachen: It is, I believe, true to say that the main negotiations with regard to individual plans will occur between provincial governments and members of the medical

July 12, 1966
Health and Welfare
profession and others on a provincial basis. It would seem to me that committee study in these jurisdictions would be more appropriate.
In answer to the second question, the federal government proposes to pay half the per capita cost of providing insured services in the participating provinces. It will not be the intention to pay half the cost of premiums, which would be a double form of assistance.


Mr. Kindi:: Mr. Chairman, may I ask the minister two questions? The first has to do with choice and rights between patient and doctor, in other words, the right of the patient to choose his own doctor and the right of a doctor to refuse a patient. I think that first question should be answered and amplified.


An hon. Member:: Get a horn.


Allan Joseph MacEachen: Mr. Chairman, there will be no interference under the terms of this bill with the freedom of a doctor to practise medicine inside or outside the plan. They have freedom in that regard, and a patient will of course be free to choose his own doctor. There will be no compulsion on either hand.
The Leader of the Opposition asked a question and I should like to tell him I was almost totally wrong in my answer. The provinces which have the premium system are Saskatchewan, Manitoba and Ontario. I was right so far as Ontario is concerned.


Lawrence Elliott Kindt: My second question has to do with portability. It was made clear by the minister that a person moving between one province and another would have medical services. Does that same situation apply if he moves to a foreign country temporarily or permanently? In the plan which is now envisaged what is the position of the government with regard to a person who may be travelling in a foreign country? Second, what would the position be if he is going to live there temporarily?


Allan Joseph MacEachen: On the particular aspect of reciprocal arrangements with other countries, I should like to wait until we have an opportunity to have the bill before members before discussing this point which is important but which is not a principle so far as the resolution stage is concerned.


Lawrence Elliott Kindt: Mr. Chairman-


Herman Maxwell Batten: Order, please. The Chair hesitates to interrupt to rule the questions

which have been asked out of order, but I think I should remind the committee of a citation from May's seventeenth edition, page 798:
Debate in committee on a financial resolution is confined to the terms of the resolution itself and must not be extended to the related bill.
It is the opinion of the Chair that many of the questions being asked might be asked more properly when the bill is before the house in committee of the whole.


Lawrence Elliott Kindt: Mr. Chairman, in furtherance of my question, we are at the resolution stage and, while I respect the statement made by the Chair, it is most important to have answers to these questions. Surely the minister is in a position to tell us whether those who travel abroad, as many of us from time to time have to do, will have to carry with them excess money for medical services.


Mr. Deachman:: On a point of order-


Lawrence Elliott Kindt: I want to know the answer to this before we get away from the resolution stage.


Grant Deachman: On a point of order-


Herman Maxwell Batten: Order. There is already a
point of order.


Lawrence Elliott Kindt: Mr. Chairman, I should like the minister to answer my question. He said there would be an absolutely free choice between patient and doctor. That satisfies me. Now I am asking a second question concerning whether or not the plan applies when persons travel abroad. Suppose a person went to England. Would he be covered under the plan?


Allan Joseph MacEachen: Mr. Chairman, I think the fact that I answered the first question shows how dangerous it is to attempt to deal with these details at the resolution stage. It is obvious that a person having membership in a Canadian medical care plan or rather a provincial medical care plan could only have benefits in another country if reciprocal arrangements were worked out with that country. At present, for example, under the Canada Pension Plan such an effort is being made right now. We announced yesterday that a committee of officials was working with the United States government to reach some reciprocal arrangement. There is nothing in any Canadian bill which could determine such an arrangement except through an agreement with another country.
July 12, 1966



[DOT] (4:00 p.m.)


Mr. Monieilh:: I do not wish to interject at this stage, Mr. Chairman, because I feel that speeches should follow the normal course, but is it not true in respect of hospital insurance that if someone is taken ill in Michigan or New York state, for example, part of the hospital bill is paid?


Allan Joseph MacEachen: I think that is the case, yes.


Herman Maxwell Batten: Is the hon. member for Perth asking a question as to what might be contained in the bill?


Jay Waldo Monteith: I will go into the subject at a later time, Mr. Chairman.


Herman Maxwell Batten: If that is what the hon. member is asking I would rule his question out of order.


Lawrence Elliott Kindt: It seems to me, Mr. Chairman-


Herman Maxwell Batten: Order. Is the hon. member for Macleod rising on a point of order?


Lawrence Elliott Kindt: Yes, Mr. Chairman.


Herman Maxwell Batten: I recognize the hon. member for Macleod.


Lawrence Elliott Kindt: Surely the minister, who is now ready to bring in the bill, knows enough about it to satisfy the people of Canada and hon. members whether or not an individual taken ill outside the country is entitled to medical care. Surely the minister can answer that question now before asking us to pass the resolution and move on to the second stage. The minister's attitude makes one believe that he is perpetrating some kind of subterfuge. Why is he bringing in the bill now if he does not know the answers to these obvious questions?


Herman Maxwell Batten: Order, please.


Philip Bernard Rynard: Mr. Chairman, first of all I should like to say that the resolution brought in this afternoon by the minister represents something that all of us would like to see achieved in this country, namely, the best medical care possible for all Canadians. There can be no argument against such an achievement.
It is not my intention to deal in detail with the resolution but I do wish to speak in generalities. The hon. member for Burnaby-Coquitlam was the premier of Saskatchewan when that province adopted hospital insurance. I do not wish to misquote him, but
Health and Welfare
I believe he said that the work load of hospitals and physicians there increased by some 26 per cent following the adoption of that program. As the result of neglect in the training of a sufficient number of doctors we now have an acute shortage in Canada.
The minister has spoken about hospital insurance and I am sure that no one disagrees with the principle involved. In the province of Ontario the federal government pays only 14 per cent of the capital cost of constructing hospitals. Surely the federal government should be paying at least one-third of the capital cost throughout Canada. I suggest that the federal government is abrogating its responsibility in this regard.
Let us look at the tax burden the ordinary individual is carrying under the hospitalization plan. I should like to quote briefly at this point from a press release of the Ontario Hospital Association dated February 18, 1966 regarding a brief submitted to the provincial government. It states in part:
The brief's strongest comments are reserved for the federal government, which has not increased its basic $2,000 per bed grant since 1958-
Let me remind the minister that the grant in 1957 was $1,000 per bed and that we doubled it when we were in power. This release states that the federal government has not increased its $2,000 per bed grant since 1958 in spite of the fact that costs have multiplied many times over. If my memory serves me correctly, the cost per hospital bed in 1958 was $5,000. Today this figure runs closer to $30,000. The press release then continues:
-and makes no contribution at all toward many essential supporting areas such as operating suites, dietary departments, treatment rooms and delivery suites.
The president of the Ontario Hospital Association, Mr. Glen Phelps, had this to say:
-already some of the figures in the brief might be out of date.
I place part of the blame in this regard on provincial governments, and particularly the government of Ontario which should be applying more pressure on the federal government to make it live up to its responsibilities. The press release then states that Mr. Phelps said:
During the past few weeks . . . we have been hearing of cost estimates for new buildings running closer to $30,000 a bed than $20,000. So the $14,000 we have recommended as the fair share of senior governments would not be enough to cover the desired two-thirds. It also seems fairly clear now that last month's dominion-provincial health


Mr. Munro:: Would the hon. member permit a question?


Philip Bernard Rynard: Certainly.


John Carr Munro: Would the hon. member quote the source of his figures in relation to the ratio of doctors to patients?


Philip Bernard Rynard: If the hon. member wishes to find these figures, let him look at the Canada Year Book or the address of Dr. McCreary, dean of the faculty of medicine at the University of British Columbia and president of the Association of Canadian Medical Colleges. If the hon. member wants the reference I will be very glad to send it to him. I have three or four references here which show that the figures are only out perhaps a few points. I

[DOT] (4:10 p.m.)
This situation concerns me a great deal because it is quite obvious that Canadian doctors are already carrying a 25 to 35 per cent greater work load than their counterparts in the United States and New Zealand. The doctors in those countries practice at about the same level that we do in Canada. If the government imposes a full medicare plan on these people, what will happen? Medical care will be broken down because a doctor will have less time to spend with his patients. This is obvious when there is more work to do. What happens then? There is only one answer, Mr. Chairman. There will be poor quality work and the practice of medicine will be set back years and years.
My one concern in raising this matter at the resolution stage is: How will we correct this shortage? The Hall Commission report said that we had to add 476 students each year to our present classes. Mr. Chairman, do you realize that this was said in 1964, two years ago? Do you realize that at that time the target date was 1971? This is the equivalent of nine or ten medical schools the size of Queen's University or Western. What is the cost? The nearest I can come to the cost is that Toronto university will add 75 this year to its freshmen year class and they say it will cost them $35 million to do this. There is $250 million right there. By 1970, 7,100 doctors must be added to the profession. This means that we must have 11,860 doctors by that time, so that you have 5,340 left as a minimum after taking out retirements, etc. We are in the same position with regard to dentists and nurses; 35,000 nurses have to be trained and some must receive university training. The Hall Commission report stated that there will be no substantial increase in graduating classes in medicine before 1971.
No move has been made until just recently, and this is 1966. I criticize the government for their lack of action in this regard, and I probably would be right in criticizing some of the universities as they are letting the public down. This report was made in 1964 and the target date was 1971, because it takes seven years to graduate a doctor with the minimal amount of training. It takes 11 years to train a specialist; and if a doctor is to have good, sound training he should spend two years as an intern, so there you have eight years for general practice.
July 12. 1966



This resolution should be taken step by step so that the plan does not break down completely and so that the minister will have a monument to what he has done rather than something that people will look at and say it is a great pillar of salt. I am really concerned about this situation, which is all the more serious because today in Canada out of every two doctors that graduate one carries on to be a specialist. In this country today 37 per cent of the doctors are certified specialists and 13 per cent are non-certified specialists.
In other words, Mr. Chairman, half the doctors that graduate today specialize, with more crowding into certain fields. We are short of optometrists. There has been a 75 per cent increase in the population but only a 15 per cent increase in optometrists. It takes seven years for a doctor to graduate, and here we are just starting in the fall of 1966. This means it will be 1976 before we will have doctors who have graduated with specialist training, and 1974 for General Practitioners.
There is another problem in this connection, namely, that four of our medical schools now are below par. Four have not enough good teachers or facilities to teach their students properly. I should like to read another article. Somebody might ask where it came from so I will make sure the source is on the record. It is a newspaper article which quotes the Canadian Medical Association Journal. The article says:
It has been whispered about for a long time. Now it is in the open: one-third of Canada's medical schools, during the last ten years, have been warned that if they don't improve they may lose their North American accreditation. This is a recognized method for judging the quality of medical schools, and loss of accreditation is a sad, bad blow . . .
"The primary fault in the four schools was not with respect to their basic orientation or the quality of existing staff, but rather that they had insufficient staff and resources to meet the needs of modern medicine."
How derelict in our duty can we be?
"If the teachers for the expansion of existing schools and the staffing of new medical schools are recruited from within Canada, a sort of academic musical chairs will occur in which the staffs of existing schools will be rapidly diluted, and, if the bidding is brisk, an unfortunate concentration of the best talent in a few centres may develop."
And it surely will be through lack of facilities.
The editorial is an urgent appeal for government to heed the warnings and the proposals of the Gundy report on medical education. It refers to the "twilight sleep of lethargy" which enfolds both the public and those in high places. It does not add- although we gladly do-that a government that has
Health and Welfare
pushed its expenditures beyond the $9 billion mark, should find it possible to rectify and reverse the existing starvation of medical science.
This brings me to another point. We are spending $10 million on research. The United States is spending $1,200 million. We have been very derelict in this chamber in this regard. If this medicare plan breaks down and is not handled most carefully a step at a time, there will surely be serious consequences because we have not the background at present to operate such a plan. And who is responsible? This government in particular and other governments are responsible because of their starvation of medical science and education. The article continues:
Canadians complain endlessly about their abject position vis-a-vis the United States. But they refuse to face the fact that much of it is simply due to failure to spend money where it will do the most good. We are prepared, apparently, to institute medicare at vast expense. We do little to improve medical science and education upon which, obviously, medicare ultimately depends. The amount of money involved is trifling in comparison to the global budget total.
What are we going to do about this situation? Whether we have medicare does not matter so much. The important thing is the care of those people who need medical attention. These are the people we must protect, because we are not providing this medical care at the moment. How are we to get out of this rut? I have already said that we are extremely short of teachers, so short, in fact, that four universities may lose their accreditation. How do we get these teachers? Do we train our graduates in Canada or do we bring back some of our teacher scientists from the United States? We have supplied the United States with 200 to 400 medical graduates a year. Out of our 1963 graduates, 49 per cent moved to the United States. What is the reason for this? The reason is that here they lack opportunity. The United States can count on well over 200 young, energetic Canadian doctors with 40 years of earning power, and this is costing this country a total earning power of over $100 million a year.
[DOT] (4:20 p.m.)


An hon. Member:: What are your sources?


Philip Bernard Rynard: You asked me that before. I will give them to you later.
It costs the Canadian people $50,000 to educate a doctor in this country. I was amazed at this figure because the last figure I saw was back in 1959 at which time I think it cost $25,000. This is a good illustration of what it is costing Canada to train a doctor

July 12, 1966
Health and Welfare
these days. It costs $100,000 to train these young doctors to become teachers. The loss of our medical graduates is a tremendous economic drain on our country. It also makes it very difficult to maintain the quality of our medical services and to man our universities with good teachers. The loss of our teacher scientists over the last few years has indeed been calamitous.
The minister made a statement which amazed me. He said, if I heard him correctly, that doctors did not have to visit their patients. Where would they send them? I wonder whether the minister knows that there are many hospitals in Canada operating without interns. I know of one such hospital, the name of which I will give to the minister if he wishes, that only has a third of the interns it should have and one of the interns has been brought here from abroad. I wonder whether the minister knows that, at one of our university centres in the province of Ontario, out of 11 graduates who were to practice as interns in that hospital eight have gone to the United States. Why do they go? They go because of the greater opportunities, higher salaries, more independence and more incentives available there. We can keep our teacher scientists here by setting up research centres. Instead of spending $12 million on such facilities we should be spending $100 million. This is the way to keep these people. We have to give them equipment and greater opportunities.


The Deputy Chairman:: Order, please. May I point out to the hon. member that his time is up. Is it agreed that the hon. member for Simcoe East may continue his speech?


Some hon. Members:: Agreed.


Philip Bernard Rynard: I will not take up much more time, Mr. Chairman. There are just a few more facts I wish to present. Only 2 per cent of our medical graduates will become teachers and only 0.5 per cent will become scientific researchers. This means we will have to get the teachers from somewhere if we are to man our medical schools and if we are to follow the recommendations of the Hall Commission. First we must train students, then doctors, then teachers and finally scientists.
Let me say, Mr. Chairman, that building palaces with fine laboratories is of no value if we do not have teachers, teacher scientists and pure scientists. For the past 15 years one-third of our doctors per year have been coming from Great Britain. In one year up to

600 doctors came from Great Britain. I knew the figure was high but I was amazed to see how high it was. I think it was in the year 1964 that three-quarters of all the graduates of British universities emigrated, and today 50 per cent of the interns in some of their, hospitals come from outside of Great Britain. A great many of them come from Africa and Asia.


Allan Joseph MacEachen: Will the hon. member permit a question? Why does he think the British doctors are coming to Canada and Canadian doctors are going to the U.S.? Has he any over-all explanation for this movement on the part of the members of the medical profession?


Philip Bernard Rynard: I think the reasons for the movement of these doctors are better working conditions and the incentive of better pay. If the minister would look at the records he would find out that the average doctor in England looks after approximately 2,000 patients. I had the privilege of visiting the office of one of those doctors. There were chairs lined up along the walls of his office with many patients waiting. There must have been 20 or 25 people in that room. That doctor could not have possibly spent more than two or three minutes with each patient.


Mr. Alkenbrack:: Was that under the medical plan in England?


Philip Bernard Rynard: That was a few years back under the national health plan. In Orillia, whence I come, there are three doctors from Great Britain. Two are surgeons and one is a general practitioner. They have told me very definitely that their reason for leaving England was overwork and the fact that they were being regimented under politics. One doctor, whom I referred to earlier, was a very nice chap and he told me that he was being over-worked, as anybody with a work load of 2,000 or more patients must be.
The afternoon I saw him he referred one or two of his patients to the local hospital but he did not know when they would be admitted. He said it might be in two or three months time. I pointed out to him that one of his patients might be in a serious condition. He told me he had seen him on three or four previous occasions but the patient had not improved with the treatment that had been given him. The doctor did not follow his patient to the hospital. He was sent to an entirely new doctor who had never seen him
July 12. 1966



before and might not care to perform the surgery. This is the reason for the dissatisfaction of the doctors. To return to the case of this patient, he might, three months following his dismissal from the hospital, return to the doctor for a check-up but the doctor might not even have his history because of lack of time and facilities.
The immigration of foreign doctors has developed in us a lazy attitude in the last 15 years. We have been derelict in our duty to the Canadian people and the government has been derelict in its duty. I want to put that on the record.
[DOT] (4:30 p.m.)


Allan Joseph MacEachen: My hon. friend is suggesting that it is costing the Canadian society $50,000 a year to train a doctor and $100,000 to train a teacher or scientist. What is his conclusion from the movement of Canadian doctors to the United States, a movement which is quite unrelated to the medical care program we are now discussing? What steps should we take aside from medical care, which is quite unrelated?


Philip Bernard Rynard: I assume the minister did not hear me. What I said was that there should be an incentive given to these people to remain in Canada. It could be a research work or tax incentive for a few years. Doctors in the United States pay less taxes and get more salary, than doctors do here. I guess the minister missed that part of my speech, but I do believe I alluded to it. If I did not, I intended to.
I should like to refer to what Dr. T. W. Gorman, former President of the Nova Scotia Medical Society, said with respect to this problem. He comes from the minister's own area and he said the problem was serious. He recommended that the length of the medical course be reduced. He pointed out that the profession and the medical schools had a responsibility to supply quantity and quality and suggested a shorter medical course. Dr. Gorman suggested that area of eastern Canada was going to be very short of doctors. The minister must be well aware of these facts. We are short of trained doctors, short of teachers and scientists. The Hall Commission recognized there would be such a shortage up to 1971, but now that we are implementing a health plan the shortage will be accentuated by 1971. The minister has had ample time to introduce this plan; yet we are about two years behind schedule. I should like
Health and Welfare
to quote from page 14, volume I of the Hall Commission report:
We recognize, of course, that this whole program cannot be put into effect immediately or simultaneously in all provinces. We do not foresee the program coming forth full-grown but rather as an orderly and well planned series of steps which taken together will in a period of years accomplish our objective.


Allan Joseph MacEachen: The hon. member is not concluding that there is any contradiction between the conclusions of the Hall Commission and the proposal we are making today? What we are doing is completely compatible with their recommendations.


Philip Bernard Rynard: If I understood the minister correctly he intimated that this plan would be effective across Canada. I realize he probably has to consider the wishes of the provinces, but he was estimating this plan would cover 90 per cent of the people. If I am wrong, I want to be corrected. I understood him to say that 90 per cent of the people would be covered next year.


Allan Joseph MacEachen: I am referring to the development of services. This proposal refers to only one aspect of the recommendations made by the Hall Commission, namely, physician's services. They recommended this as one phase, and this is the first phase. Their total recommendations are much broader and more extensive than anything we are doing.


Philip Bernard Rynard: All I can say is that the Hall Commission made its report in 1964 and we are now in 1966. At any rate, medical care will be available. Medical care is available in the province of Ontario and, as I have said, four million people are covered in that province. I should like to congratulate the Ontario Minister of Health for introducing OMSIP because it is a step in the right direction.
As I said a moment ago, I am reserving my decision on this plan until I see the bill. I am wondering if this is the type of step we should be taking. In the province of Ontario we have blind people's allowances, disabled persons' allowances, mothers' allowances, old age assistance, the rehabilitation act, and so on. There is assistance to those on lower incomes. If a family of two have a taxable income of $100 or less, the government pays 50 per cent of their medical expenses. Perhaps this is a better type of plan. I do not know. I noticed that in the last election campaign the present Minister of Trade and Commerce stated on November 4 that the

July 12, 1966
Health and Welfare
Liberal party may have to delay the introduction of a national medicare scheme because of the shortage of doctors and nurses. I am having similar thoughts. We may break down the whole system, and this is what worries me.
I noticed an alarming article in Barron's of England the other day under the heading, "Cradle to Grave?". The article indicated the British were turning away from socialized medicine. I hope we can avoid the pitfalls that have been evident in the British scheme. The British people have received reasonable care, but there have been many quarrels with doctors and complaints from patients. I am told that in England there are insurance companies that are now insuring people so they can get proper medical care. They would rather be under the care of their family doctor than be pushed around under the national health plan. These are the things I want to see avoided in Canada. I am greatly interested in making sure that we avoid these mistakes. I am sure the minister will feel this plan has to be as nearly right as we can make it. It is human to err, but I hope he will review the whole situation in consultation with the provincial ministers who know the situation in the provinces. I hope the minister will then come to the conclusion that he will proceed cautiously and carefully in light of what the ministers of health advise.
We should remember that today the Canadian people are getting fed up with taxes. They are paying more taxes than ever to the federal government, provincial governments and municipal governments. They are getting fed up, and they do not want any mistakes made in this plan. The reason we are having so many strikes and so much labour trouble is that the people do not have enough money to make ends meet. I say with great sincerity that I am not going to be unduly critical. I hope my criticism has been constructive. I should like to see a plan adopted that will be the best in the world. The minister nods his head but I am not sure, after listening to what he had to say, that he knows what the right thing is. I hope he is right because, personally, I like the minister. We owe it to the Canadian people to see that they get the best type of service possible so that we will make this country great medically. Then we will not lose graduates to the United States but will attract them to remain in Canada and we could have one of the greatest medical centres in the world for post-graduate work.


Thomas Clement (Tommy) Douglas: The Minister of National Health and Welfare was quite right, Mr. Chairman, when he said this is a historic day because it marks another milestone in Canada's long march toward comprehensive health insurance. The legislation which we hope will immediately follow this resolution will be another step in the attainment of a goal for which the Canadian people have been waiting a long time. I do not need to remind members of the day when the first official promise of comprehensive health insurance in Canada appeared in the Liberal party's platform at the convention in August of 1919.
The next time official notice was taken of this question by a Liberal government was in 1945 at the federal-provincial conference on reconstruction when the green book proposals set out a fully delineated health insurance program to be brought into operation in conjunction with the provinces. The other day I came across a copy of the Toronto Star for Wednesday, April 21, 1948, with the great, streamer headline, "Health Insurance At Once Said Plan Of Premier King".
[DOT] (4:40 p.m.)
In 1948 the people were led to believe that they were to have health insurance. The health grants of 1948 of course were of some assistance. The first real step was taken when legislation was brought down by the Liberal government in 1957 to set up national hospital insurance. Unfortunately that legislation was so restrictive that it was of no benefit to any province unless the majority of the provinces representing the majority of the people of Canada signified their intentions of coming into the plan. Consequently the plan was not established until a Conservative administration removed the restrictive features, and the hospital insurance plan became a reality in 1958.
Then we had the Hall Commission which did a superb piece of work and brought down in June of 1964 what I think is the finest statement on medicare that has ever been published in the English language. That commission recommended immediate action. It asked that within six months of the report being tabled the government convene a federal-provincial conference. The government did convene a conference here in Ottawa on July 19 and 20 of 1965. And on this day, July 12, 1966, we have a resolution preceding the bill which will take the next step in comprehensive health insurance, namely, a measure to provide for medical care for all Canadians in
July 12, 1966

those provinces where the provincial governments are prepared to co-operate in setting up such a plan.
Before I comment on this program may I say I think we should keep in mind that it is only a step in a long-term program, that even though medical care is being established I think we have been too long in getting to it, and that the plan still leaves a large area of health needs untouched. We shall still have to think in terms of essential and prescribed drugs, dental care, optometric care, and all of the ancillary health services. We must bear in mind that, while the present measure is one of the most important steps, we must be under no illusion that the implementation of the plan to be contained in the legislation coming before us is the end of the road.
I want to commend the minister for the work he has done and which his predecessor did in this field. I am sure that they will get a good deal of criticism from many quarters about the drain on the federal treasury and about the increased costs which can be anticipated. I think the public sometimes lose sight of the fact which the minister pointed out this afternoon, that it is already costing the Canadian people some $600,000 a year for this kind of care and that the cost of medicare is not a new cost. It is simply a redistribution of the cost, so that instead of the burden being placed on the sick, it is distributed over the entire population on a basis that has some relation to ability to pay.


An hon. Member:: What about the taxes?


Thomas Clement (Tommy) Douglas: The hon. member says:
"What about the taxes?" Well, what about paying doctors' bills? People who pay taxes also pay doctors' bills. Most of us would rather pay taxes when we are well than pay doctors' bills when we are sick.


Some hon. Members:: Hear, hear.


Thomas Clement (Tommy) Douglas: The hon. member for Simcoe East made some reference to the fact that in Saskatchewan our experience with hospital insurance was that the load went up some 26 per cent. This is true. It levelled out, however, once we got over the backlog. I do not think that medicare will go up at the same rate; which might be of some comfort to the minister.
Perhaps I could draw his attention to the experience of Saskatchewan. The Thompson committee, which did a great deal of research into this matter before the legislation was introduced in 1961, gave it as their opinion 23033-4781
Health and Welfare
that the plan would probably cost about $25 million annually and that the cost would rise for a while and then level off. The interesting thing is that the plan, which is now in its fourth year, never reached $25 million and in fact has slightly declined lately.
An article that appeared in the Edmonton Bulletin on June 15, 1966, had this to say:
A leader of the 1962 Saskatchewan doctors' strike admitted Tuesday some of his profession's fears about medicare have proved unfounded . . .
Dr. Barootes broke what he called a self-imposed vow of silence. He told his colleagues:-
This was at the Canadian Medical Association Conference:
"Some of the qualms we have had have been disproved and some of us should revise our thinking. The idea that total medical care results in constantly-mounting costs has been shattered," he
said.
The fact is, he said, that the total cost of Saskatchewan medicare dropped last year by $500,000, from $23 million to $22.5 million . . .
He said in an interview later he could not explain why medicare costs have not shot up, as he and other doctors had predicted. He said it may be because Saskatchewan residents have been saturated with medical service-that they now have been treated for all the ailments that, before medicare, went untreated.
This is a courageous statement by Dr. E.W. Barootes, who was chairman of the committee that masterminded the doctors' strike in Saskatchewan. He is a man for whom I have great respect. While I cannot agree with him, I think he is the kind of man who, when he found out that he was wrong, was quite willing to admit that his estimates of the fantastic costs which medicare was supposed to impose upon the people were not well-founded.
Since we have very limited time at this stage of debate I shall confine myself to two questions. One is, what kind of medicare plan are we to get, and the second is, when are we to get it? I am convinced that there is little value in setting up a medicare plan unless it is soundly based. It would be better to postpone the plan than to have a poorly structured plan because once the plan is launched it will take years to undo the damage if it is not soundly based. It is extremely important, therefore, that this plan be on a sound basis.
That sound basis, of course, has been spelled out by the Hall Commission in its very excellent report. It was also spelled out by the Prime Minister in the four basic principles which he set forth as the criteria upon which the medicare plan should be based. I am hopeful that when the legislation

July 12, 1966
Health and Welfare
is brought down it will be on all fours with the criteria elucidated by the Prime Minister on July 19 and 20 of last year. These four criteria have already been mentioned by the minister.
The Prime Minister in his address to the federal-provincial conference said that the first principle was that the scope of benefits should be, broadly speaking, all the services provided by physicians, both general practitioners and specialists. He went on to say:
A complete health plan would include dental treatment, prescribed drugs, and other important services, and there is nothing in the approach we propose to prevent these being included, from the start or later, if this were the general wish.
He also said:
We regard comprehensive physicians' services as the initial minimum.
In light of that statement about the scope of benefits I was hoping that the measure which the minister was going to bring down would be an open-ended plan that would allow the provinces to proceed as fast as they were ready to do so, and that the plan would not slow the provinces down to the pace of the slowest of the Canadian family.
[DOT] (4:50 p.m.)
I noticed that the minister in his statement this afternoon said, if I may quote him, "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, the scope of benefits to which it would be prepared to contribute."
I wish to ask the minister why we should have to wait for a consensus. I am certain that had we waited for a consensus in 1957 and 1958 the hospital insurance plan would have been long delayed. I see no reason why this legislation should not be sufficiently flexible to provide that when a province has established physicians' care under the plan- and one province has already done so-it is free to make provision for some other health service. This would be in accordance with the green book proposals of 1945.
The province would have a choice. It could select dental care and might start with dental care for children. It could select optometric care or the provision of certain drugs such as insulin and cortisone, and then move into the field of prescribed drugs. I had hoped for legislation sufficiently flexible to make it possible for a province to move as fast as it could build the necessary administration and

find the funds with which to pay its share of the cost.
I am disappointed that the scope of the benefits is to be restricted entirely to physicians services and that the program will not be sufficiently flexible to enable other health benefits to be added as provinces are prepared to make them available. I hope the minister will reconsider this matter and that he will not ask the provinces which are most anxious to proceed to wait for a consensus. This is an attractive modern term which everybody likes to use nowadays. But I think we should be encouraging the provinces which wish to move ahead, not asking them to wait until the more laggard provinces are prepared to catch up with them.
The second principle which the Prime Minister laid down in his address to the federal-provincial conference on July 19 was as follows:
Second, we would propose that the plan should be universal. That is to say, it should cover all residents in the province on uniform terms and conditions.
The next day, July 20, the Prime Minister spelled out in more detail those basic conditions, and on this matter of universality he said:
The objective, as we see it, must be universal coverage. I cannot see any basis otherwise for a federal contribution.
He went on to say:
There is often confusion as to the relation between universality and compulsion. Our purpose is that everyone should qualify for benefits. This involves compulsion in the sense that, if a premium is chosen by a province as part of the method of financing, the premium would be compulsory in the sense that taxes are compulsory. Obviously there is no compulsion on people to use the services, nor any compulsion on the individual doctor to join the plan if the demand for his services is such that he can practice successfully outside it.
He went on to say:
The "principle of need" which was referred to yesterday rejects the idea of universality on the grounds that, if low-income people are covered, others can afford the premiums under private insurance plans. To us, the weaknesses of this are that (1) it sets up an undesirable distinction according to income levels; and (2) even people with quite high incomes can face medical costs which are just as crippling as ordinary illnesses are for low-income people. Most such people may be covered by private plans, but not all will be. In practice, therefore, no extension of private plans will meet all the needs.
I have put this on record, Mr. Chairman, because I think these words of the Prime Minister should be kept in mind when we come to examining the legislation and the
July 12, 1966

extent to which the general principles laid down are, in fact, implemented in the statute itself.
The third principle which the Prime Minister enunciated at the federal-provincial conference is as follows:
Third, I think it will readily be agreed that a federal contribution can properly be made available only to a plan which is publicly administered, either directly by the provincial government or by a provincial non-profit agency.
Elaborating on this the next day, the Prime Minister said:
A universal plan with a federal contribution must be a plan for which the provincial government takes full responsibility. It is necessarily a replacement of existing plans of other types. The procedures followed by provincial governments in dealing with the transitional arrangements in the case of hospital insurance would seem to have been highly satisfactory and equally applicable in the case of medical Insurance. This means that the experience and skills involved in carrying out existing large programs can be transferred to the public program.
Again, as in the case of hospital insurance, there will of course be scope for the continuation of private insurance for services above those provided in the public plan.
I underline the word "above"-not as part of the public plan.
The Depuiy Chairman: Order. I regret to interrupt the hon. member but the time allotted for his speech has expired.


Some hon. Members:: Go on.
The Depuiy Chairman: Is it unanimously agreed that the hon. member for Burnaby-Coquitlam may continue his speech?


Some hon. Members:: Agreed.


Thomas Clement (Tommy) Douglas: July 12. 1966
Health and Welfare
amounts oi money for the medicare which they require.
The final point which the Prime Minister outlined in his speech of July 19 was as follows:
-and finally, I think it is important to recognize the mobility of Canadians; each provincial plan should therefore provide full transferability of benefits when people are absent from the province or when they move their homes to another province.
Of course there will be no quarrel with that. That is basic.
In answer to the question put by the hon. member for Macleod, who was worried about what happens when people go overseas, under the medicare plan in Saskatchewan-and I assume most provinces will follow the same practice-the medicare card is acceptable in any country of the world for medical services provided in another country. The bill can either be sent to the Saskatchewan medicare commission or the patient can pay the bill himself and later get reimbursement from the commission.
May I now turn briefly to the other question which is, when will we get medicare? The government has talked about a target date of July 1, 1967, but I have been somewhat concerned about the statement made by the Minister of Finance last November 5 when he said medicare would probably have to be postponed because of the shortage of doctors. I hope the government will not delay.
There is much in what the hon. member for Simcoe East has said about the need for more doctors, the need for medical schools and the need for more medical research. Also he is quite correct when he says that we, the Canadian people, have been derelict for the last 20 years in grappling with this problem. But on the other hand I want to say to the minister that if we delay in setting up medicare until the situation is entirely satisfactory, the plan will never be put into operation.
There is something about human nature whereby we never do things until we have to do them. We work best in a crisis and under pressure, and since the preparatory work has not been done-there has been some done but not sufficient-I would hope the government would go ahead with medicare and that it would cling to its target date of July 1, 1967.
The hon. member for Simcoe East warned the government not to fall into the pitfalls experienced in Great Britain. I think he was

somewhat unfair to the British health plan when he spoke about a doctor sending patients to hospitals where some other doctor treated them. That has been the practice in Britain, Germany and other western European countries for a century. They have a totally different medical system. They separate their doctors into physicians and surgeons, and a general practitioner is not allowed to take his patient into a hospital.
The things to which my hon. friend has referred cannot be attributed to the British health plan. If one wants to use quotations, I can say that one day at a luncheon meeting I was addressing in London I sat beside one very senior Conservative cabinet minister who said to me, "I voted against the British health plan, I campaigned against it, but I have to admit now it is the best thing we have ever done on these islands. Even if it cost us twice what it is costing, it would be worth it; our children are healthier and our general level of health is vastly superior to anything it has ever been throughout our history."
Of course the hon. member for Simcoe East is right. There has been congestion. There have been problems and wrinkles to be ironed out, as there will be in the Canadian health plan, but if we wait until we have a perfect setup we will never start.
We in Canada have waited far too long for a step which has already been taken by most of the countries of western Europe, and in fact taken by some of them before the turn of the century. The information I want to get from the minister is whether the government is going to proceed with this legislation. We have had a variety of reports. As late as June 6 the house leader, the Minister of Public Works, said that the medicare bill would be dealt with before the summer recess. More recently he has been talking about only the resolution being passed.
Three times on Sunday the C.B.C. reported that the Prime Minister had indicated he wanted all stages of the medicare legislation passed before a summer recess. I do not know whether that is true. The C.B.C. is sometimes given to managing the news and lately has taken to manufacturing it. This also may have been manufactured, but I want to say to the government that it will make a great mistake if it does not deal with this legislation before we adjourn.
If this legislation is left until the fall some of the provinces may use that as an excuse to
July 12, 1966

say they have not had sufficient time to prepare the complementary legislation which they must submit to their legislatures. I think any province that is really interested could have its legislation drafted by now or would be in the process of drafting it, but the minister and this house cannot afford to give any province an alibi for not being ready to come into this plan on July 1 next.
[DOT] (5:10 p.m.)
I think this matter ought to be dealt with at this session before we recess for a summer adjournment. It may be said that members wish to get back to their constituencies. Certainly, as much as any other member, I would like to get back to my constituency. I may point out to the government that it is not our fault that this legislation was not brought down two or three months ago; it is not our fault that the government has dallied and delayed in bringing this matter to the attention of the house. But now that it is here I suggest we have a duty to the people of Canada and have a debt to posterity to see that this legislation is put on the statute books of Canada before we leave here for a summer holiday. I should like to tell the government that so far as members of this party are concerned we are prepared to stay here and take whatever time is necessary to deal with this legislation.
A while ago a question was asked with regard to whether this legislation would go to the committee on health and welfare. We would point out to the minister that this legislation is the result of a royal commission which spent four years studying this matter and travelling from one end of Canada to the other. In every section of Canada the people were allowed to make representations irrespective of who they were, what their profes-ion was or what their interest was. This matter has been amply studied. Moreover, this legislation is enabling legislation. The real details of the medicare program will be drafted by the provincial legislatures. All this parliament can do is, first, say that the government of Canada will pay half the average per capita cost of providing this service in any province which cares to establish a plan and, second, it can lay down the basic principles upon which that provincial plan must be predicated. This is all this parliament can do. I see no reason why those principles cannot be put into legislation without submitting this matter to a committee. If the provinces wish to submit their legislation to provincial committees to discuss the details of the plan, that is their business.
Health and Welfare
I do plead with the minister, and perhaps more necessarily with some of the other members of the government: Do not let this house adjourn for the summer recess without passing this legislation. I ask the government not to weaken and not to delay. I believe the members of this house are prepared to support the minister in passing this legislation as expeditiously as possible. All the members of this house are asking of the government is that they give us some leadership in this regard. If we get that leadership, we will give the government continued co-operation to see that this legislation is passed without delay. It is important legislation because, as the minister himself has already said, this is another milestone in Canada's march toward the day when every Canadian citizen will be entitled to health services irrespective of their colour, their race or their ability to pay. For that reason we want it placed on the statute books as quickly as possible.


Gilles Grégoire: Mr. Chairman, I listened very intently to the speech made by the hon. member for Burnaby-Coquitlam (Mr. Douglas) and I must say that I am at variance with him on several points, for instance, when he asks us to whisk this legislation through. The hon. member for Burnaby-Coquitlam (Mr. Douglas) says that it is not even necessary to refer this bill to a committee for consideration, while we do not even have the bill before us yet.
And everything seems simplified in the mind of the hon. member for Burnaby-Coquitlam. Again this afternoon, during the question period, we asked if certain provinces which are a little more jealous of their constitutional rights want tax compensation instead of a subsidy. What would happen? Well, the minister seemed a little uncertain, and I am convinced that there is nothing in the bill now to cover that and that consideration in committee could be helpful in finding a solution to those problems.
The hon. member for Burnaby-Coquitlam seems eager to hurry things, and not give the members of the house or the provinces too much of an opportunity to consider this legislation. Yet, it must be recalled that health is a provincial matter, and that the provinces are the ones which, in the final analysis under the terms of the constitution, have jurisdiction in the field of health.

July 12. 1366
Health and Welfare
And that is why I am surprised at that last-minute suggestion made by the hon. member for Burnaby-Coquitlam. Although we are ready to sit during the summer, although we are ready to study Canadian problems, we are not ready to whisk such legislation through.
What we would be ready to accept, however, is that the bill be referred to the committee and that the committee sit during the summer months to take it under consideration. That would be acceptable to us.
We want to take our time in studying this bill, not because we want to avoid working, nor shirk our duty, but because, on the contrary, we want it looked into properly so that, later on, we will not blame ourselves.
The hon. member for Bumaby-Coquitlam mentioned, as if it were something terrible, that health insurance should not be in the hands of private enterprise, adding that it would then be more costly.
Mr. Chairman, I should like to point out that, in Canada, or at least in the province of Quebec, there are health insurance companies the purpose of which is not to make profit; they operate very well and give satisfaction to those who deal with them. For instance, the Quebec Health Service or Blue Cross can manage that type of health insurance program, at a lesser cost than what it would cost the state.
Saskatchewan has been given as an example. But it is in that province that the population has grown the least. Let someone tell us why the people of Saskatchewan leave it to go and live in Alberta and British Columbia. They do, because they are fed up with socialism, where the state tries to manage everything for the individual. The individual is not trusted; he is denied his responsibilities. And so, the citizens of Saskatchewan go elsewhere to live. The last census proved it. If there is a province where the population did not increase, that is Saskatchewan.
To what is that due? To the fact that an attempt was made to decrease the responsibilities of the individual, to strip him of his personality, in order to hand everything over to the state. We can see what it has led to: not much. It kept the province from progressing in comparison with the other prairie provinces which have developed much more rapidly.
Well, Mr. Chairman, I am not prepared to let this bill be rushed through in such a way
[Mr. Grcgoire l
that will prevent us from realizing what has happened. We do not even have a copy of the bill.
If the hon. member for Burnaby-Coquitlam agrees to the committee sitting during the summer so that the hon. members can look into this bill, we have no objection. But if they try to railroad a bill in such a way that nobody is able to see anything, well, then we raise an objection.
Mr. Chairman, it was said a while ago that the federal government had only two things to do: to pay the 50 per cent of the cost and, second, to enumerate the conditions. But we should like to know how the 50 per cent will be paid to the provinces. We do not agree at all with the federal government collecting tax money and then saying to the provinces: set up a program in such a way so as to use this tax money in an orderly fashion. We prefer a system like the one adopted for many other programs, that is a fiscal compensation. If they expect that medicare is going to cost such an amount to the province of Quebec and the federal government is going to pay half the cost, the province of Quebec should get a fiscal equivalent for what that will cost the federal government.
That is one of the first conditions we would like to see included in the bill, because we believe it is very important that the jurisdiction of the provincial government in the field of health should be respected as much as possible. We think that is possible in the case of medicare. That has been done in other areas, in many joint programs; therefore, why could this not be done with medicare? I think the minister will not object and if he failed to make such provision in the bill, he will see to it, before introducing the bill, to move an amendment so as to enable the provinces to choose either between a fiscal compensation or any other plan that the federal government will make available to them or leave them free to accept.
As far as the province of Quebec is concerned, it is a known fact that this province has decided to establish its own medicare plan. The only thing we can do here to support this plan is to demand that a fiscal compensation rather than a straight subsidy or grant be paid by the federal government, because we feel that the federal government would override its jurisdiction and we are against any further infringements on the rights of the provinces. Once the federal government has decided to pay a certain amount
July 12. 1966

or give a fiscal compensation, it may then leave the provinces a free hand in the administration of their medicare plan.
[DOT] (5:20 p.m.)
If the provinces want to go through private, non-profit organizations, let them. In many cases, it has been demonstrated that the administration of such a plan by a private organization-by this I mean a private, non-profit insurance company-is preferable and less expensive. Let the provinces take their own decisions on their own programs, since this is under their jurisdiction, under their responsibility in this area of health.
Mr. Chairman, that is all we have to say at this stage and we object to this being a state plan, where all is controlled by the state, that is the doctors, the drugs, the hospitals and the rest. We want individuals to preserve their right to choose, that they may continue to live in accordance with their own decisions and their own responsibilities; we object to any infringement by the state in the field of health. The goal to be attained in a health insurance plan is to provide health care for all Canadians, regardless of wealth, rank, race, religion, or age. The objective is to make it possible for each citizen to have access to medical care. There is a way to reach that goal. It can be done through a government program administered, directed, supervised, inspected by the government, and we want none of that.
In the field of health, even more than in others, the individual has a right to his freedom, he must be free to choose his own plan, his own doctor. And in the field of health also, the doctors must be left free. Since medicine is a profession, we must leave to the doctors as much personal ambition as possible, as much personal initiative as possible; only if those conditions are respected will we have good doctors, in short competent doctors. They must not be turned into government employees. They must not be turned into bureaucrats who will have to work in shifts. We must give that profession all the freedom it needs. We must also give the individual, the human being, all the freedom he needs. The government must set up a plan where everyone will be free to choose but will have access to medical care, whatever his means, and even if he has no money at all, to get medical attention when he is sick, to go to the hospital when the need arises, to see a doctor.
Health and Welfare
That is the goal to be attained and the bill which will be introduced should seek to attain that goal, while leaving his freedom to the individual and the human being.
Mr. Chairman, the minister did not mention in his statement what such care will be; he said: it must be as general as possible. Well, it will be necessary to include all medical care, including dental care, etc.
Mr. Chairman, such are the few remarks we wanted to make; we will wait until we see the bill before discussing it further. We believe that it should be referred to the committee for further study. If that can be done during the summer months, we are ready to do it; if that must be postponed until the fall, we would deplore it, because we would prefer things to go even faster, but in any event, we are ready to co-operate if the bill is referred to the committee for further study, so that the legislation will be the best possible, to the benefit of each and every Canadian citizen.


Mr. Thompson:: Mr. Chairman, in commenting on this resolution, which is a preliminary to the medicare legislation that has been talked about by the government now for such a long period of time, I should like to say that we in the Social Credit party are in complete agreement with the proposition advanced by the minister that every Canadian citizen and every Canadian family, regardless of financial status or any other classification that might be applied, must have full access to the highest quality, comprehensive health care possible, according to physical or mental needs. This is a basic principle, and I think we, not only as members of this house but as members of society as a whole, must assure every Canadian citizen and every Canadian family that it will be achieved.
In this regard I am just as anxious as any member of the New Democratic Party, the government or any other member of the house to see that every Canadian citizen receives complete health care according to his needs at a price he can afford. Therefore my remarks regarding this resolution at this time and in reply to the minister's statement are not in disagreement with that objective-we agree with that objective-but rather in disagreement with the method proposed as to how this objective should be achieved. Just because the government says that medicare is the most logical, efficient and economic way of achieving this objective, and just because

July 12, 1966
Health and Welfare
the government suggests that its proposal is the best way of achieving this objective, does not make this necessarily true.
Having said that, I do not believe that the federal, provincial or municipal governments have any responsibility to care for the health needs of Canadian citizens who are themselves able to provide that care. That is the false philosophy of the welfare state. In my opinion the government does have a responsibility to assist those who are unable to provide for their own needs. If we accomplish that then we are meeting our responsibilities as our brothers' keepers.
Nothing less than the very best of health care must be made available to all Canadian citizens according to their needs, but that does not mean the government must provide this care. I have in mind now those citizens who are able to provide for themselves. If we provide hospitals, health services and various forms of health treatment then I think it is only reasonable for everyone to have access to them, but to throw that whole responsibility on the shoulders of the government is not necessary; in fact, it is wrong.
[DOT] (5:30 p.m.)
We are told today that this legislation is intended to pay for only physicians' services and the estimated cost is approximately $28 per capita, half of which is to be paid by the federal government. This represents only one small area of the over-all field of health care. For those who advance the thesis that the government is responsible for everyone, regardless of whether they can afford it or not, this is a major step. However, it is committing not only the federal government but the provincial governments to a program that will be vastly more expensive than $28 per capita. In fact, it is just the beginning, because if we say we are going to supply only physicians' services we are neglecting very important areas of health care that must later be included in the plan.
What about optometric care, particularly for our children? What about dental care? What about other forms of health care that are legitimate in the over-all field of caring for the sick, such as chiropractic treatment? These things must be included later. Therefore in dealing with this legislation we are actually committing ourselves to a program of health care that will be vastly more expensive than the plan we are talking about now.
I believe there are other things that are vitally important and which are inherent in this legislation. A government-dominated

scheme, whether it is compulsory by direct premium or compulsory by being charged to general taxation leads inevitably to a loss of individual freedom. Nothing is more compulsory than taxation. Is it not possible for us in this democratic society to meet our basic responsibility to our fellow men without destroying, weakening or eroding those basic elements of freedom that are inherent in the democratic process? I think it is. Therefore I think we in this house who represent the Canadian people should make sure that in approaching the objective with which we all must agree we are using the most efficient and effective methods. I do not believe the legislation as outlined in this resolution and the minister's statement is the most efficient and effective method. To say that we must deal with this matter prior to the recess is to cut short essential discussion on the one hand and on the other to force upon the provinces and the people of Canada something which cannot deal with that quickly. It has been said that the report of the Royal Commission on Health Services has adequately dealt with the problem. I disagree. It made recommendations, some of which are very excellent. But this may not be the best answer to the problem. Just to commit the government to this phase of health care is to override many of the recommendations that were made relating to the supplying of adequate services to meet the needs of our people as they relate to health care.
The first speaker after the minister in the debate this afternoon, the hon. member for Simcoe East, a man in the medical profession whom I respect very much, raised a point that was also included in the report of the Royal Commission on Health Services. I refer to our ability to provide the facilities, doctors and nurses necessary for the proper functioning of this program. Just to ignore certain aspects of the commission's report because we think we must now force a commitment upon the government of Canada and the governments of the provinces is absolutely wrong. In fact, Mr. Chairman, I am convinced that if the public were fully aware of the ultimate cost in relation to the benefits that will be received under the legislation as proposed at the present time, they would be most hesitant to accept such a plan; in fact, I think they would reject it.
Another vital area, as medical care relates to the general field of welfare, is that of priorities. I believe we are approaching the
July 12, 1966

general responsibility of public welfare in reverse. There are priorities within our responsibilities in the area of public welfare which must be established. We cannot afford, the public purse cannot pay for, the over-all cost of public welfare to which we are today committing ourselves.
I think the basic priority that we have to the public at large and to our children is one of education. I believe it is necessary to make sure that we give education the priority it must have. I refer not only to general education but to the education involved in giving our people the health care they deserve. This includes the training of doctors, the building of hospitals and providing research facilities. If we move in with a medicare program for which we have not laid adequate foundations or made complete provision, we are cutting off our nose to spite our face. I say it is absolutely imperative that we give education in all its aspects the first priority so far as our welfare responsibility is concerned.
I would say that our second priority in this area of responsibility concerns health care. But again I say that I do not believe it is the responsibility of the government to assume the health care of all Canadian people. If the Canadian people are what I believe them to be, they want to accept their own responsibilities as they relate to themselves and their families. In the area of government we must accept responsibility through the public purse to take care of those unable to take care of themselves. If we do this we are meeting our over-all responsibility because we will have made available to everyone the health facilities and services we are able to provide. This is our second area of responsibility, so far as priority is concerned, in the general area of welfare.
I would suggest that the third area of welfare in the priority picture is that of pensions, providing for our older people and those who cannot work. What we are doing now is approaching the problem in reverse. We have imposed upon the taxpayer a costly pension plan. It is described as a compulsory saving plan; it is actually a compulsory pension plan. Now we are dealing with medicare. Some time in the near future we will be dealing with education and will get ourselves into trouble. In fact, we are in trouble already in this regard because those concerned with education of whatever kind know very well that the dollar available for education is not 23033-479J
Health and Welfare
adequate. The provincial departments of education, the Teachers' Federation, the ratepayers' associations, are concerned about the fact that they do not have enough money with which to bear the responsibility that is theirs, and the federal government must come in and assist them.
But you cannot solve the problem by pushing it farther from you. There is only the tax dollar available to meet all these charges. Whether it is collected and used by the federal, provincial or local governments does not really matter so far as the taxpayer is concerned, because it is he who pays the tax. Therefore I think it is imperative that in dealing with this legislation we consider the area of priority as it concerns our financial ability to pay through the public purse.
Coming to the points the minister elaborated on today in introducing this resolution, I would make a few comments in the order of his presentation. The minister said the first requirement that will be imposed upon the provincial governments, in relation to their being qualified to receive the 50 per cent contribution from the federal government, is that their medicare schemes provide doctors' services on a universal basis. First of all I believe that the scope is entirely too narrow.
[DOT] (5:40 p.m.)
There is a question which I wish to address to the minister and which I think he owes it to us to answer even before the legislation is introduced. Who will set the doctors' fees? The minister says arbitrarily that the plan will cost $28 per capita and the federal government will pay $14 out of that sum, but has the federal government set up a scheme for doctors' fees to which the doctors of Canada and the provincial governments must adhere?


Allan Joseph MacEachen: No, Mr. Chairman.


Robert Norman Thompson: How then can the federal government force the provincial governments into a program that requires complete coverage by the medical practitioners? Twenty-eight dollars will probably not be enough to cover it. Perhaps the medical fees will vary from one province to another. The matter of the doctors' fees is very important, and for the minister to say that the government will not set those fees means that the door will be opened to much confusion, trouble and inequity in the various provinces.


Allan Joseph MacEachen: May I clarify this point for my hon. friend? It is certainly not the

July 12, 1966
Health and Welfare
intention in the federal legislation to set up any schedule of fees. This would be a matter for determination within a provincially administered medical care plan.


Robert Norman Thompson: The minister says this will be the responsibility of the provinces but in this legislation the federal government is stating, or I expect it will, how much will be allowed for doctors' fees to each province on a per capita basis.


Allan Joseph MacEachen: The federal government will reimburse the provinces on the basis of actual experience in the amount of one-half of the per capita cost of providing insured services in the participating provinces. The federal government's role will be the reimbursement of the fees established within the provinces according to their experience.


Robert Norman Thompson: Time does not permit me, Mr. Chairman, to debate this point at the present time. I hope it will turn out to be as simple as it is now outlined by the minister. I have certain reservations about it.
I say to the minister, in regard to the narrowness of the scope of this scheme, that I suppose the prepayment of medical practitioners' fees is one area where the program can be initiated, but it is very unfair because there are other areas of health service which do not concern medical practitioners and which are omitted in this legislation.


Mr.   Chairman@: Order please. I apologize for interrupting the hon. member for Red Deer but the time allotted to him has expired.


Some hon. Members:: Please continue.


Herman Maxwell Batten: Does the committee of the whole give consent to the hon. member for Red Deer to continue?


Some hon. Members:: Agreed.


Robert Norman Thompson: I appreciate the indulgence of hon. members and your own, Mr. Chairman, in permitting me to continue.
My third observation on the first matter raised by the minister concerns our ability to supply adequate numbers of medical practitioners on the basis that is proposed in this legislation. This has already been dealt with in the debate but I think it represents a very real problem.
Experience with medicare programs in Saskatchewan, Great Britain, New Zealand, Sweden and elsewhere has indicated that
immediately the services of medical practitioners are made available on the basis demanded in this legislation the work load of the practitioners is increased. I think that our own inability to increase the number of medical graduates in this country, together with the loss of our graduates through immigration to other countries, in spite of the numbers that arrive here from Great Britain, will pose a very real problem in the implementation of this plan. It is one thing to say we will implement it by July 1, 1967; it is another thing to make it functional on an equitable basis.
Second, we were told this afternoon that any provincial medicare program must give universal coverage but that it will not be compulsory. I find that in this explanation the minister has made a play on words. It seems to me to be practically an exercise in semantics because what could be more compulsory than having to pay for the medicare program through a general tax contribution. In fact it amounts to political blackmail, although I hesitate to use the word because I know the minister, not being that kind of a person, does not really intend it, so far as the provinces are concerned and the individuals as well who do not choose to accept that it is the government's responsibility to meet their own health needs. How can he say it is voluntary if he intends to force the provincial governments to pay for something they are not going to get? It is certainly very compulsory. It includes everyone arbitrarily, whether they need it or not, and therefore to say it is not a compulsory scheme so far as payment is concerned is incorrect.
I have been referring specifically to the financial aspect being made compulsory. It is a good feature of this legislation that the freedom to choose doctors is left up to the provincial authorities and is not made compulsory. I believe it is also a violation of individual rights. I suppose one cannot accept the government's responsibility in areas such as these without sacrificing one's individual rights, but that is really unnecessary. I think other alternatives or approaches might be found to be more satisfactory.
In the third point which the minister made in his statement he referred to the fact that one of the prerequisites of the federal government is that the provincial governments must apply the medical program through provincial plans which are non-profit and subject to public audit. What the minister is actually doing here is wiping out the private

July 12, 1966



carrier. How can a private insurance scheme operate under the qualifications that have been outlined to us this afternoon? An hon. member had just said they are not supposed to do so but why should we accept something that is less efficient and more costly if it can be done another way? I believe that today it is possible, because of the efficiency of private enterprise and with proper government regulation, to supply medicare insurance through private carriers at a more economic rate than can be done through public carriers because, whether we like to admit it or not, the government is the least efficient body in administering such schemes.


Thomas Speakman Barnett: May I ask the hon. member, in connection with his suggestion regarding the relative efficiency of public and private plans, whether he heard the figures on the administrative cost put before the committee earlier today by the hon. member for Bur-naby-Coquitlam?


Robert Norman Thompson: I have certainly heard them but the fact is that when you begin to deal with public administrative costs, much of it is hidden in other services that are not directly related to it. The hon. member for Bumaby-Coquitlam did not say very much about the tremendous escalation of the first projected cost of the Saskatchewan medicare system. Only two years after the system was implemented in Saskatchewan the premium cost had more than doubled. Inherent in this are other charges which are also related to public expense. Perhaps there could be justification for doing it that way if the public purse can afford it. But this is not a proven fact by any means. I do not understand why the minister demands that every provincial government eliminate the private carriers now providing health insurance. Certainly this is not good economy or efficiency so far as the citizens of this nation are concerned.
Time does not permit a lengthy debate on this subject but I should like to say very briefly that portability, as explained by the minister, is very necessary. However, this is something which I think can be worked out without forcing this type of medicare program on the provinces. I believe every provincial health administration realizes it is unfair to implement a provincial medicare scheme that is not transferable. The transferable feature has worked rather well so far as hospital insurance is concerned and I am sure it could be
Health and Welfare
worked so far as medicare is concerned without making it a prerequisite, as in this legislation, although in principle we must accept it. [DOT] (5:50 p.m.)
I believe it would be wrong to criticize the remarks the minister has made this afternoon without offering some alternative proposals. Very briefly, I should like to mention to him another way of achieving the objective which we all agree must be our ultimate goal in the area of health. If the government had said that they were going to be completely responsible for the medical care of pensioners in Canada, they would have relieved provincial health administrations of one of the most costly areas of medical care. Because we are concerned with pensions for our senior citizens, the government could well have said that they were going to extend that pension responsibility to include complete medical coverage for these pensioners.
I believe the provision of medical care is even more essential for these older citizens than increasing the pension to $100 per month. We all know that the most expensive time of our life, in so far as medical costs are concerned, is in our senior years. This would have been an area in which the federal government could have legitimately claimed jurisdiction, and it would have saved provincial departments of health tremendous amounts of money in the implementation of their own medicare programs. I do not believe we have to have uniformity in medicare programs across the country simply because the needs of areas differ.
Another practical way of meeting the increasing costs of medicare would be to supply the provincial governments with a per capita grant. If it were desired to place prerequisites on the making of the grants, it could have been stipulated that they must be used for preventive medicine. They could also have been designated for the care of our children because it is in these areas that preventive medicine offers the greatest opportunity of service.
I would also suggest to the minister that I believe it is the desire of every Canadian citizen to take care of his own needs. Unfortunately there are some who are unable to do so. This is particularly true when some unfortunate accident happens to the family. I am speaking from experience in this connection because throughout the years my father's family had tremendous health costs. 1 remember, as a young school teacher, that my dad took me into the room where he kept his

July 12, 1966
Health and Welfare
records and showed me receipts for more than $10,000 for medical and hospital care. This was at a time when dollars were worth a lot more than now. This burden of medical costs made it difficult for him to provide assistance to those who were fortunate enough to have good health and who wanted an education. There are many families in Canada today who face such a calamity. I believe the one great fear many Canadian parents have in so far as medical costs are concerned is that some unfortunate accident or disease will hit them and they will not have the financial means to meet it.
Thus as a third point I believe the federal government, therefore, could easily justify providing every Canadian family with some form of basic calamity or accident insurance policy which would take care of hospital and medical fees say in excess of $1,000. In summary if the government had proposed such a program that would take care of our senior citizens first, that would assist the provinces in taking care of our school age children or pre-school age children with respect to preventive health care through the provision of a per capita grant or if we had some kind of insurance scheme to take care of extreme cases of accident or disease catastrophe, I think they would have had an alternative so far as their responsibility for medicare is concerned. Then the provinces would be able to take care of the remaining medical costs without placing too great a burden upon them. This is why, Mr. Chairman, I find it very difficult to accept the arguments that have been put forward by the minister today that this is the best method by which our responsibilities in the area of health care can be met.
On the basis of those arguments it is impossible for us to give support to the legislation he is proposing. I do not agree with the hon. member for Burnaby-Coquitlam that this legislation must be dealt with in the next week or two. I hope that if this resolution does pass, as we expect it will even though we cannot give it our support, the legislation will be referred to the proper committee. If it is possible for some of our committees considering major legislative items to meet prior to parliament reconvening, that would be good. I believe therefore that provision must be made before we leave here to send this legislation to a committee for further study. We should not pass the legislation in an autocratic fashion that would deny the provinces

the medical profession and others, the right to make representations before a committee. We should not force something on the provinces which is going to commit them to vast sums of money without the provinces having too much to say about it. I believe, therefore, that as soon as the legislation is introduced it should be referred to the committee for the further study which it deserves and must have.


Mr. Isabelle:: Mr. Chairman, it is always a pleasure for me to rise to speak in this house, because I am sitting on this side of the house which has always been in the vanguard of Canada's future. We have been given a further proof of this in the last two hours because it seems that hon. members opposite who have taken a position on the measure do not seem to know what medicare is about. Everything was mixed up: socialism, drugs and medicine. It seems to me it might be well advised at times, to consider whether speeches should not be somewhat shorter, but mean something.
We have always been the party of the people. We are the party dealing daily with the needs of the Canadian people and that is why I am doubly pleased to take this opportunity to say a few words about this social security measure which is part of the vast general humane program of my party, I mean medicare as proposed by our government.
The right hon. Prime Minister (Mr. Pearson) at the federal-provincial conference of July 65, had, as you know, stated that the federal government would financially assist the provinces willing to introduce medicare, provided they meet the four basic requirements or principles which are that the schemes be universal-a much discussed point about which I shall say more later-transferable, that they provide assistance for or, if you prefer, that they include all medical services provided either by practitioners or by specialists, whether in the hospital, in the office or at home and, finally, that such plans be administered by a provincial government or under its responsibility.
Of these four principles, two-transferability of benefits and complete assistance or coverage of all medical services, seem to have been almost unanimously approved by Canadians.
I shall try, as much as possible, to speak today on the two other requirements laid down by my government to help the provinces
July 12, 1966

anxious to attract their citizens, that is universality and public administration. The basic principle underlying the provision of medicare by the government is society's responsibility to provide all citizens with adequate health services.
[DOT] (6:00 p.m.)
Every Canadian citizen has a perfect right to complete and continued protection. That is a basic human right like the right to education, life and freedom. The government cannot divest itself of its responsibilities by relying on the administration of private enterprises, whatever they may be, for profitable purposes or not. Physical health, like mental health, is equally important in remaining able to work, in holding a remunerative job. Furthermore, it is essential to the economic security of a nation; if an army's victory depends on a full stomach, the economic prosperity of a country depends on the health of its citizens.
Anyway, why should private companies be interested in the administration of a program on a non-profit basis, which would be the only acceptable way? These companies would have to see some advantage in it, for example publicity for their life insurance company, because many such companies were established for non-profitable purposes simply to have free publicity throughout the country. I do not see how these public funds can be used to this end, even in such an indirect way.
The federal government undertakes to pay 50 per cent of the cost of this program and must see to it that this money is used to provide protection for all its citizens on equal terms and conditions throughout Canada. Under the circumstances, in my humble opinion, only a public administration system can give the government this assurance without burdening the administrative machinery to no purpose with a control which is increasingly difficult to maintain and a nuisance to all.
Universal application, as the hon. Minister of Health and Welfare (Mr. MacEachen) said several times, means that at least 90 per cent of the population of a province must be covered for the moment by the provincial program, again under uniform conditions and without differentiation as to age, financial position or ill health.
In a few years this 90 per cent of the population will become close to 100 per cent, the figure we are to reach. In my opinion, the government is wise to insist on this universal application, for, as I said earlier, it
Health and Welfare
is responsible for the health of every individual, for humanitarian and economic reasons. The financial barrier which prevents many people from receiving medical care, affects not only the individual himself but all of society.
A person's illness creates a social void around him which affects not only his near relations but all society. It creates general disorder.
The question of the famous arguments, that is, whether the provinces are ready to receive the compulsory health insurance program called medicare, may be raised. Some sharp discussions have already taken place, but the government was wise enough, before entering this field, to appoint a commission called the Hall commission to inquire into health services in Canada and their needs.
Now, this commission which looked into the matter for almost three years, studied health needs and sought means to extend and improve present services, reached the same conclusion. It recommended a universal plan on a public management basis. All members of the commission seconded this recommendation, including doctors, nurses, dentists and even a former president of the Canadian Medical Association, an organization which comprises approximately 75 per cent of all Canadian doctors.
I feel that in the present situation, especially as I pointed out earlier, it rests with the government to provide for education and health services. It is up to the government to provide the required funds so that no Canadian in 1967 is deprived of the bare minimum, including health.
And I know that in this very house, on August 22, 1958, when hospital insurance began to take shape in the province of Quebec, it was said that that province would only participate in a hospital insurance plan, as stated by the member for Quebec West:
When we have beds for the sick.
It was only two years later that the province of Quebec, with the same number of beds or almost, went down to history as being the last to participate in the Canadian hospital plan, after losing approximately $154 million in benefits.
I shall now give a brief historical account of what has taken place in Canada over a good many years.

The interest which all provinces now have in public health insurance began first in the

July 12. 1966
Health and Welfare
western provinces of Canada and in Newfoundland. While the legislature of British Columbia was probably the first to consider the issue of health insurance with the appointment of a royal commission in 1919, the first action was taken in the prairie provinces during and after world war I with the operation of the union hospital and municipal doctor systems, and in Newfoundland with the introduction of the cottage hospital system in 1934.
Further action was taken by several provinces during the period 1943 to 1949. In Quebec in 1943 an act to constitute a health insurance commission was passed. The commission was directed to study the problem of health insurance and to suggest a plan. However, in 1945 the legislation was repealed and the work was terminated. The Municipal Health Services Act was passed in Ontario in 1944 to enable municipalities to develop contributory plans subject to approval of the provincial department of health for whatever medical care services were required.
Under the Health Services Act of 1945 Manitoba made provision for the extension of health services and for the organization of medical care districts in which, subject to approval of the Minister of Health, municipalities could enter into contracts with physicians for specified, prepaid medical care. A Health Services Act was passed in Saskatchewan in 1945 to provide comprehensive health services including hospital, medical and dental services, and pharmaceutical benefits for persons receiving old age pensions, mothers' allowances, and general welfare. Beginning in 1946, under the same legislation the Swift Current health region operated a universal, prepaid, public medical care service for residents of that area.
The Saskatchewan hospital services plan began operation in 1947. It was the first provincial program to provide comprehensive, prepaid hospital insurance on a compulsory basis to almost the entire population. Alberta introduced a maternity hospital care program in 1944 and the Alberta hospital services plan in 1949, which were available without charge to all residents. The British Columbia hospital insurance service began also in 1949 in that province.
Public medical care insurance plans are presently in operation in seven provinces: Newfoundland, Manitoba, Ontario, Quebec, Saskatchewan, Alberta, and British Columbia. Newfoundland provides coverage for medical and surgical care to part of the population,

under the cottage hospital medical care plan. In Manitoba, under the provisions of the Health Services Act, 1945, voluntary, prepaid coverage is available in organized medical care districts for medical care specified in contracts between physicians and municipalities. Since 1962 Saskatchewan has been operating a province-wide, compulsory medical care insurance program. The Swift Current regional medical care insurance plan conti-ues in contract with the medical care insurance commission of the province. Public programs for the provision of voluntary medical insurance to any resident have been in operation in Alberta since 1963, and in British Columbia since 1965. Ontario has amended its legislation passed in 1965 and has scheduled a plan of voluntary coverage for any resident which commenced operation on July 1, 1966. Quebec accepted a modified health plan for its social beneficiaries last April. It is presently studying a medical care insurance plan and the provincial government has expressed its intention to introduce a plan by January 1, 1968.
[DOT] (6:10 p.m.)
The three maritime provinces of New Brunswick, Nova Scotia and Prince Edward Island have not taken any independent action to plan or introduce public medical care insurance except that at the conference of federal and provincial ministers of health, held in Ottawa on February 1, 1966, New Brunswick accepted the federal proposals but Nova Scotia and Prince Edward Island did not make any commitment on these proposals for health insurance. Maybe Prince Edward Island will change its mind after what happened yesterday.
The first recorded official interest of the federal government in health insurance was in 1928 when the standing committee on industrial and international relations was authorized to investigate and report on insurance against unemployment, sickness and disability. Their recommendations culminated in the Employment and Social Insurance Act, 1935, which provided for the appointment of a commission to gather information on health insurance plans and to submit to the Governor in Council proposals for federal cooperation in the provision of benefits. The act was subsequently declared unconstitutional by the Supreme Court and the Privy Council.
More thorough study of the issue began in 1941 when the minister of pensions and national health presented a report on the deficiencies in public health and medical services
July 12, 1966

in Canada to the annual meeting of the Dominion Council of Health. The members were sympathetic to the formulation of a plan for health insurance. A study was then launched, with that objective, under the direction of the department of pensions and national health. The Canadiana Medical Association formed a committee on health insurance to assist in the preparation of a draft plan for public health and health insurance. The outcome of this study was a draft bill which was reported to the House of Commons on July 29, 1944. It was discussed with provincial ministers and deputy ministers of health in May of that year. The federal proposal based on the bill was presented to the dominion-provincial conference on reconstruction convened in 1945. The proposal included a comprehensive health insurance program supported in part by federal contribution and administered by the provinces, health grants to improve public health services throughout Canada, and loans to assist and promote the construction of hospitals. However, discussion at the conference centred mainly on financial arrangements and taxation. Since all provinces failed to reach agreement with the federal government on those arrangements, adoption of the proposed national health program was precluded.
In the following years parts of the federal proposal of 1945 were separately put into effect. The national health grant program was introduced in 1948 to provide grants in aid of public health services, health surveys, professional training, and hospital construction. Then the Hospital Insurance and Diagnostic Services Act was passed in 1957. By the end of 1960 agreements had been made with all provinces and territories to make the program national in scope.
On June 20, 1961, the Royal Commission on Health Services was appointed with Chief Justice Emmett M. Hall as chairman. By Order in Council P.C. 1961-883 the commission was required to inquire into and report upon the existing facilities and the future need for health services for the people of Canada and the resources to provide such services, and to recommend such measures, consistent with the constitutional division of legislative powers in Canada, as the commissioners believe will ensure that the best possible health care is available to all Canadians. The commission's report was tabled in the House of Commons on June 19,
Health and Welfare
1964. This report further focused the attention of the federal government on the desirability of some system of nation-wide medical care insurance.
Subsequently, at the federal-provincial conference held in Ottawa in July, 1965, the federal government made certain proposals to bring about a system of health insurance in all provinces by a target date of July 1, 1967. During the meeting of provincial and federal ministers of health in Ottawa on February 1, 1966, three provinces accepted the federal proposals and the others remained uncommitted without making any definite refusal of the offer. In reviewing the situation the federal Minister of National Health and Welfare hoped that all provinces would accept the proposals by the target date.

This shows, Mr. Chairman, that since 1919, for nearly 50 years, Canada has been seeking some solution for the conservation of the health of the individual. The Hall Commission has concretized this desire for medical care offered to every Canadian.
Many will say that conflicts will arise between physicians and patients. I do not think so. I think that even if we do not have yet the necessary material for the task which is shortly to be ours, and if we must make a superhuman effort, perhaps when these programs are implemented, I am speaking of physicians eventually, everything will level off. With our professional and technical training and health resources program, toward which the federal government put aside $500 million to develop that manpower of technicians, nurses, medical research centres, new universities which will train more physicians, everything will be phased-in, as was the case for hospital insurance. I am speaking of the province of Quebec and of a need its people wants to be fulfilled.


Herman Maxwell Batten: I apologize for interrupting the hon. member for Gatineau but the time allotted to him has expired.


An hon. Member:: Carry on.


Herman Maxwell Batten: Does the committee give consent to the hon. member to continue?


Some hon. Members:: Agreed.


Gordon Minto Churchill: Mr. Chairman, when members are given extensions of time, except for

July 12, 1966
Health and Welfare
spokesmen lor parties I think some limit should be placed on that extension, I would say five minutes.


Joseph Gaston Isabelle: A minute and a half.
[DOT] (6:20 p.m.)

This is the implementation of a general plan. This answers the needs of the population and we cannot afford not to grant it, because it is not only a need, but a right.
We must do it for the sake of our fellow-citizens, for the sake of our present government which is always ready, as it has always been in the past, to practise its theory of liberalism which consists in serving those in need, those who need its assistance.
This comes within the general implementation of social welfare programs and leads the way toward their fullest application in the near future.
Medicare will be the greatest piece of legislation ever undertaken by any government, since it will affect personally and directly each and everyone of 20 million Canadian citizens.
I ask the medical profession, to which I have the honour to belong, to be courageous as it has always been since the beginning of medical history, in order to prove to the other citizens that we are worthy of our forefathers, who worked without cease under .extremely difficult conditions to accomplish the most humanitarian task, that of caring for one's fellow-men, so that they might enjoy the greatest gift all-health.
Before closing, Mr. Chairman, let me tell those who say that Canada is not ready for a medicare program that the same thing happened in 1958. At that time, the Canadian hospitals, having only a limited number of beds, were not ready to accept the hospital insurance plan. I have before me a book which dates back to 1895, where the doctors of that time are advised to study so as to keep up with the progress of science in the last 15 years, that is since 1880. The doctors are asked to go back to university so as to be up to date. If the doctors of that time had followed this advice, they would have been forced to close their offices and their patients would have died while they were studying. We should not postpone indefinitely the establishment of the medicare plan in Canada, because it must come into operation in 1967. People are asking for it.


Herman Maxwell Batten: Order. Before the hon.
member for Peace River proceeds, perhaps he would permit me to announce the item for the adjournment debate this evening. There is one question: the hon. member for Winnipeg South (Mr. Sherman), Industry-instructions from U.S. respecting flour for Cuba.


Mr. Baldwin:: Mr. Chairman, with reference to the remarks made by the preceding speaker I congratulate him on the simple and abiding faith he seems to have. I only wish I had it. It may be that he sits in a different position than I do, and maybe he has not been here as long, but I hope he can continue to have that sort of faith. It is very touching.
I intend to make reference later to some of the comments of the hon. member for Simcoe East, who made a tremendous contribution to this debate. So far as the hon. member for Burnaby-Coquitlam is concerned, he said what was predictable, and I think what he said was mostly wrong. There is one thing about the hon. member. When he is wrong he is consistently wrong whereas, in contrast, the government is usually wrong but it is usually inconsistently wrong.
The hon. member for Burnaby-Coquitlam spoke of the necessity of staying here to complete all stages of this legislation. The minister did not go quite that far. He was not quite that ambitious. He is prepared to make three or four bites of the cherry, and indicated a lurking desire to finish second reading.
There is, Mr. Chairman, no monopoly of political virtue in any part of this chamber. I am prepared, as I am convinced is each other member of this party, to stay in session if it is necessary. However, not only is it not necessary but it is quite undesirable that we should deal with any more than resolution stage at this time.
Despite the considerable finesse exercised by the minister when glossing over what 1 think are some compulsive features which will be embodied in this legislation, there are these aspects of it. The hon. member for Burnaby-Coquitlam said that there has been a royal commission preceding this legislation and there had been studies and surveys made which generated a lot of comment. So far as royal commissions are concerned, we have so many of them that when Canadians hear about a report of another royal commission they usually hide their heads under a pillow. But that is not the point. This debate should be on a national scale.
July 12, 1966

There are interests involved of provincial governments, of professional institutions, of hospitals and municipalities, and over and above that there are the interests of every person in Canada. It is my sincere view that when the resolution is passed and the bill is exposed it is desirable we should stop there so that the contents of the bill may become fully known. The minister knows what is in the bill. So far as he could he gave us some indication of what it contains, but it is a condition precedent to any further debate that during the course of the summer there should be an opportunity for the people of Canada to inquire into this measure, to formulate their views about it and pass those views on to their members of parliament who in turn can debate the measure. In that way we could make a greater, more interesting and more valid contribution when we return in the fall, and so I cannot go along with the hon. member for Burnaby-Coquitlam on that suggestion.
As a matter of fact, Mr. Chairman, my views are very much the same as those of the hon. member for Red Deer, with whom I do not always agree. It may be that the Chinook winds which originate in Calgary and blow up to Red Deer sometimes get as far as Peace River, but many of the things he has said are comments with which I find myself in agreement, especially those concerning welfare.
The phrase contained in the American Declaration of Independence, "life, liberty and the pursuit of happiness," has been translated in this country by this government as "life and the pursuit of welfare." Welfare, in its broadest sense and ordinary meaning, is fine, but the narrower, restrictive and artificial interpretation which is now all too often accepted is something else entirely.
Any step which is directed against the triple evils of poverty, disease and ignorance must of necessity be of overriding concern to any legislative body, but this does not relieve us of the obligation to scrutinize measures like this with the greatest of care. Not only must we look at the merits of the proposal itself but at its relationship to the national interest and the over-all economy.
As to the intrinsic merits certainly the Hall report, at first blush, appears to be ample authority. Any reader of this report will find a carefully documented argument, well buttressed with supporting material. To take the report by itself, one would be hard put to find reasons to oppose it but, set in the context of the contemporary political, social,
Health and. Welfare
and economic background, I have some misgivings which I must voice.
The minister has given us some hint, although it is not in terms of the report, of the cost of the scheme in terms of the federal contribution. To this we must add the provincial costs. One wonders about the validity of these figures. The original estimates prepared for almost all government proposals, for the great public works starting with the building of the railroads down to the building of the St. Lawrence Seaway, have always been greatly exceeded. In addition, there are the maintenance and annual carrying charges which are always substantially greater than estimated. This applies also to most of the social welfare schemes which we have introduced in Canada, and these costs are reflected in increased taxes-income, excise, sales, customs and property-a cost which is borne by the small consumer in two forms.
In the first place, it is an inescapable fact that as a result of the proven extravagance, waste and bad management in government the taxpayer's dollar when returned to him in the form of benefits has decreased when passing through the government establishment. Conversely, the cost is further increased because that portion of the public which has the opportunity to pass on the increased taxes paid always manages to do so in such a way, and with such an increment, that the aggregate of the amount passed on, in higher costs of goods and services, invariably exceeds what has been contributed in the form of taxes, and so there is a loss at both ends.
[DOT] (6:30 p.m.)
In the orthodox inflationary consideration, higher taxes mean higher prices, higher prices require higher wage levels, and sometimes there are strikes and work stoppages to obtain these with all the loss of production and confusion that follows. This in turn involves still higher prices with demands for more government-sponsored assistance, increases in pensions and so on. There is an ever-increasing, dizzy, upward spiral. Ask any housewife who goes to the supermarket to do her shopping. The improved standard of living and the related collateral social benefits that we all desire then become a mirage held out for us on the one hand- pension plan, assistance programs, medicare, higher wages-but then snatched away on the other by the fantastic increases we have to pay for everything needed for the ordinary business of living.

July 12, 1965
Health and Welfare
Social programs must be or ought to be financed out of increased national productivity. Surely there should be some relation between the quantum of such benefits and the index of our productivity. Unfortunately Canada has a top-heavy three level government structure, national, provincial and municipal, and with a tax system frequently operating to stultify incentive has been dispensing social welfare and wage increases without too much regard to its ability as a nation to pay for them out of increased productivity.
As a nation we seem to have acquired an infinite capacity for self-deception on this score. Certainly the capacity has been fostered and nurtured by the present government which gives the people a series of temporary palliatives, something to keep them momentarily content without regard to the ultimate cost. I think it is about time for some real sincerity and honesty, a time for a government to say: Here is the benefit if you desire it but here is the cost. Certainly this is what the Hall Commission suggested. I do not know what the minister will do in this regard, but recommendation No. 194 at page 88 of the Hall Royal Commission report reads as follows:
That taxes collected by the federal government to pay for the expanded health services program be identified in such a manner as to make it clear to the taxpayer that the taxes paid cover the health service benefits made available to him.
I hope this will be in the bill when it is introduced.
The case which the government makes is as usual nothing but its stock of shop-worn cliches cunningly interwoven with the selfadulation which is the trade mark of the Liberal party. Rather than concentrating on baking a bigger and better pie, it has become obsessed with the task of trying to divide and subdivide the existing one.
I have tried to give some idea of the price we pay. What do we get in return? There is a guarantee of adequate medical care for those who might not otherwise have this benefit. We must, of course, consider this in terms of the shortage of personnel needed to provide this care. Here I should like to make a very brief comment in respect of the remarks of the hon. member for Simcoe East. Here is a man who obviously is sincere and who has made a powerful contribution to this debate. He is a man who is on the firing line in this fight to provide health services, and he tells us honestly and sincerely of his fears for the

future in the light of what he feels the government may have in mind. I do not think it is possible for anyone who heard the hon. member for Simcoe East to dismiss lightly the cautions and warnings he has uttered.
It is a very desirable and laudable objective to drive away the spectre of fear and the burden of having to endure the indignities and the misery and pain of illness which is susceptible to treatment and help. Certainly we must move to achieve this objective. The question is whether the government in its bill will provide a proposal which is acceptable without change and whether it can advance persuasive arguments that are logical that the scheme it proposes must be taken in its total form. It is my view, Mr. Chairman, that the time has come to take a stand, not necessarily a stand against the establishment of a program to provide a better medical health program in Canada but a stand that such programs, and all other social welfare programs, be dealt with with due regard to the essential priorities, with due regard to the impact they have on the life of people, and with due regard to the inflationary aspect of our economy. I have apprehensions about the slap-happy, haphazard, helter-skelter programs which this government has been introducing with more emphasis on political advantages than on proper planning.
I think we must consider our ability to finance these things. I am not speaking in terms of cost in dollars but rather in terms of the deteriorating dollar and in terms of the continuing diminishing amount which the doRar buys today. That is the consideration which I fear and which I have in mind. We must also think in terms of the necessity to provide adequate national savings in the form of real wealth for these programs as weR as other essential programs which I see in relation to our need for increased productivity such as the development of national resources, improvements to our national transportation system, education generally, as well as increases in the productive skills of labour forces, increases in technological improvements required in respect of industry and so on. In addition we must be prepared to increase sharply our external aid to developing nations, not only to help them but in enlightened self-interest.
So, without opposing this resolution at this time until I have an opportunity to see, digest and discuss the legislation, I think it is essential that there be an objective and impartial survey and evaluation of our position
July 12, 1966

vis-a-vis the use of our resources, one that should be made outside of government on a non-political basis.
I therefore have considered and suggest an amendment as follows:
"The said act shall not come into operation until such time as the Economic Council of Canada has made a report to parliament and to the government as to the relative priority in terms of time and capital to be assigned to present and proposed social welfare programs and such other measures as are required to develop productive capacity to provide for these and other requirements of the people, the said report to be made by July 1, 1967".
I am quite prepared to say, Mr. Chairman, that there may be some question about the amendment being in order. I am not going to make an argument on that now, but I propose it in order to emphasize the point of view I have been making. I feel that the Economic Council, a body independent of government which already through its reports has made a study of the over-all pattern of government costs and expenditures with relation to the price structure and productive capacity, is the proper body. Such a survey should examine these various proposals from the economic point of view including a study of the contribution they make and the extent to which they affect the price structure so that the net value and net worth of these programs can be assessed.
It is not my intention to suggest that the Economic Council should assume the responsibility of the government. Parliament and the government can never abdicate their sole responsibility in this regard. It is always for the government to initiate and for parliament to legislate these programs. But it is now apparent that we should provide ourselves with the best available information and that this requires at the present time a survey of the economy to see what effect these measures will have and to see what can be done to contain the price structure. I say quite sincerely that this is not necessarily a position in opposition to the measure. It will require a study of the terms set out in the bill to form an opinion in that regard.
In my view, however, we have failed to recognize the cumulative and pyramiding result that all such programs have on the general economic situation and the eroding effect on the financial position of the majority of Canadians, for example, those who have fixed incomes and farmers whose income is established by external conditions. This is on the assumption which we are entitled to make that no action or inadequate action is
Health and Welfare
being taken to develop our productive capacity to stabilize price levels.
[DOT] (6:40 p.m.)
There is an Alice In Wonderland quality, or at least a great deal of hypocrisy, in the position of the federal government. We pass these various measures I have mentioned and thereby set a bad example in our extravagance in government. We provide, even initiate, wage increases without regard to sound basic guidelines. We shirk our duty to increase productivity. As a result of these factors or at least in large part because of them, when prices go up we complain in this house and elsewhere and we mumble about price control.
Even if imposed price controls ever make political and economic sense we have absolutely no jurisdiction to tamper directly with these controls. We are limited to the indirect method of fiscal and monetary steps. We set in motion inflationary forces; we inject their pressure into our economic system and then we whine and whimper about the results. For this reason it seems to me that such unbiased, non-political report should be available before we proceed. There would be no interference with the procedure of legislation.
If it should happen, Mr. Chairman, that the minister is impressed by the comments I have made, perhaps we could design the amendment I have moved in such a way as to satisfy him.


Thomas Speakman Barnett: Mr. Chairman, would the hon. member for Peace River permit me to ask a question before he completes his remarks?


Gerald William Baldwin: Yes.


Thomas Speakman Barnett: I have listened carefully to the hon. member. He made reference several times to social welfare and said, if I understood him correctly, that he was not using that term in its broad sense. Is there any distinction in his mind between a social welfare program such as the recently adopted Canada Assistance Plan and a social insurance program such as the proposal in this resolution? I ask this question not only because of the references in his speech but because of the use of the expression "social welfare programs" in the amendment he desires to move. In my mind this involves the whole question of relevancy.


Gerald William Baldwin: Mr. Chairman, I think I made the distinction that there was a difference between the welfare of the people and social welfare as that term has been used. It

July 12, 1966
Health and Welfare
may well be that certain types of social welfare programs in the final analysis have a beneficial affect on the welfare of individuals. The point I was trying to make and express in my amendment was that you must take the whole impact of this program on a price structure and a priority basis. A distinction can be made at times between a social welfare program and the welfare of the people generally. The whole picture has to be taken into view.


Thomas Speakman Barnett: The hon. member has not dealt with the question whether he makes a distinction between a social welfare program and a social insurance plan.


Gerald William Baldwin: I do not think there would be a great distinction in relation to the amendment I moved.


Allan Joseph MacEachen: Mr. Chairman, I rise on a point of order. Do you wish argument at this time?


Maurice Rinfret: I shall put the amendment to the committee. It is moved by the hon. member for Peace River that:
The said act shall not come into operation until such time as the Economic Council of Canada has made a report to parliament and to the government as to the relative priority in terms of time and capital to be assigned to present and proposed social welfare programs and such other measures as are required to develop productive capacity to provide for these and other requirements of the people, the said report to be made by July 1, 1967.
The Chair would like to have the assistance of hon. members in order that a decision can be made as to the admissibility of this amendment. It must be relevant to the resolution before it can be admissible.


Allan Joseph MacEachen: Mr. Chairman, the motion before the house reads as follows:
That it is expedient to introduce a measure to authorize the payment of contributions by Canada towards the cost of insured medical care services incurred by provinces pursuant to provincial medical care insurance plans.
The question before the house is whether it is expedient to introduce such a measure. The amendment in its present form does not relate to that motion because it states in part:
The said act shall not come into operation-
There is no connection in that regard with the motion now before the house. I do not think it is necessary to go beyond that simple point to demonstrate the inadmissibility of this amendment, because the simple connective tissue has not been provided to link the two. We are dealing with a resolution and not

with an act. The form of the amendment is deficient. I do not wish to go beyond that in this argument.


Thomas Speakman Barnett: Mr. Chairman, I should like to make one or two comments on the question of the admissibility of the amendment. As I understand the proposed motion, it says it is expedient to introduce a measure. In my understanding that has always meant it is expedient to introduce a measure which will in fact be an act of parliament. It appears to me that in this practical sense the proposed amendment is a direct negative of the resolution put forward by the minister. It states in effect that it is not expedient to introduce a measure for the purpose of assisting in provincial medical insurance plans until certain other things have taken place. Therefore it cannot properly be attached to the main motion as an amendment inasmuch as the passing of it would negative the original motion.


Mr. Olson:: Mr. Chairman, I do not have a copy of the proposed amendment before me, but I am afraid I cannot accept the argument advanced by the minister to the effect that it is irrelevant because it refers to an act whereas the resolution refers to the fact that it is expedient to introduce a measure.
Any measure that follows a resolution is a bill and once a bill is passed it becomes an act. I presume the hon. member for Peace River is trying to use a word that would properly describe what would in fact result if the proposed measure were passed. He wants the government to wait until the Economic Council of Canada has made a report to parliament and to the government as to the relative priority in terms of time and capital. He has stated that by that time, if there is to be no interference with the passage of this resolution, measure, bill or act, it would in effect be an act.
I am concerned about another aspect regarding the propriety of introducing an amendment of this kind, notwithstanding the fact that I personally agree with the purpose and purport of the amendment. It seems to me that it is in effect an exercise in futility to adopt a resolution and then a bill, winding up with an act, if that process is dependent upon a report from a body other than parliament. It seems to me that it is the responsibility of parliament and the government to gather whatever information they require prior to passing an act, and I am not sure of the propriety of any act of this parliament being
July 12, 1966

dependent upon the opinion of any other body, even one of the eminence of the Economic Council of Canada.
[DOT] (6:50 p.m.)


Maurice Rinfret: Order. With regard to the relevancy of the amendment now before the committee, it seems to the Chair that the amendment goes beyond the provisions of the resolution. Therefore it would appear irrelevant to the resolution and as such the amendment would be out of order. May I also suggest that the amendment fails on other grounds in that it is declaratory of principle and is in the nature of a reasoned amendment. The authority for this ruling is to be found at page 798 of May's seventeenth edition, chapter XXIX, headed "Expenditure: Financial Resolutions. Procedure in Committee of the Whole House on Expenditure." The paragraph headed "Scope of Debate on Resolution" reads as follows:
Debate in committee on a financial resolution is confined to the terms of the resolution itself and must not be extended to the related bill.
The next section, headed "Procedure on Amendments", says:
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-
On these grounds I regret that I must declare this amendment out of order.


Mr. Davis:: Mr. Chairman, first I should like to congratulate the minister and the government for bringing forward this very important measure at this time. I should particularly like to congratulate the minister because I think that in the relatively short time he has held this office he has done a remarkable job.


Some hon. Members:: Hear, hear.


John (Jack) Davis: A great many people in this country have been talking about medicare for a long time and have often been very glib about the subject. It is one which involves several jurisdictions, not the least of which is the provincial jurisdiction, and action in this connection tends to tread on many toes. The minister has effectively carried out his negotiations with the provinces. As a result of his efforts the provincial governments know where the federal government stands in this respect, and I am quite sure that the medical
Health and Welfare
profession and many other people associated with the provision of health care in this country now have a much better idea of where we are heading than has ever been the case in the past. I am quite sure they have a much better idea, for example, than had the professional people in the province of Saskatchewan a few years ago when the previous Saskatchewan government's medicare plan was brought in there.
I want to concentrate briefly on some of the financial aspects of this plan, but first I would say that medicare, in the sense of this resolution and later the bill, rounds out the number of vital health care services which we badly need in this country. We had the health grants legislation back in the late 1940's. We had hospital insurance brought in by federal legislation in 1957. It has been eminently successful. One fact attesting to this is that close to 100 per cent, of the order of 99 per cent, of all Canadians are now covered in respect of hospital insurance.
We have had passed more recently under the present minister the health resources plan which will help to provide many of the professional people and, more importantly in connection with the present legislation, the doctors who will be required to supply the needs of the country in respect of physicians' services.
Now we have the medicare legislation to provide for the paying of doctors' bills throughout the country. There is an old saying that goes something along these lines: A man or a woman is really well off when he or she is healthy, wealthy and wise. Personally I would rate good health ahead of being wealthy. I suggest that good health also precedes being wise, because I cannot imagine a child who is suffering from some disease learning very well and I cannot imagine an individual of more advanced years who is suffering from some ailment being very rational or wise. So I think that in the order of priorities we are dealing with something that is vital, something which heads the list. I would disagree at least to this extent with the hon. member for Red Deer who suggested that education should come ahead of health, because I believe that the reverse order is probably true. Certainly as a matter of emphasis I would put health well up the list. I would even put it ahead of wealth and wisdom in the priority of things.
The minister has passed over this matter rather lightly but I have heard other speakers say quite often that health is a matter of

July 12, 1966
Health and Welfare
provincial responsibility. I do not want to agree with that conclusion. Indeed, I have yet to be convinced that health is a subject which is totally a matter of provincial responsibility. I tend to believe the contrary. I believe that because health is so important it is something which is to the general advantage of Canada. I have not found a specific clause in the British North America Act, our constitution, which says that the nation must have little or nothing to do with health, and I notice that we have a federal Department of National Health and Welfare which has survived under two different administrations. Therefore I suggest that health is to a degree at least an important federal or national responsibility.
This legislation is essentially financial in character. It deals with money. It does not deal, at least in any great detail, with the administration of a medicare plan. The administration in its depth and detail will be a matter for the provinces. This measure says in effect that the government of Canada, the representatives of the people of Canada here in parliament assembled, will collect from all the people of Canada a given sum of money every year and will distribute it equally to all Canadians. The government here in Ottawa will remit to each provincial government a given sum of money which reflects the population in that province.
The formula is arrived at roughly in this way. The sum total of all doctors' bills is properly checked out, properly accounted. They are totalled, divided by the Canadian population and a certain figure is arrived at. The estimate for next year is of the order of $34 per capita. The total doctors' bill for Canada is $34 multiplied by 20 million, being the number of people in Canada. That is $680 million as the total bill for next year.
The federal government, as I understand it, under the proposed legislation will pay half that amount, half of $34 or $17 per person, to the provincial governments. Each province will receive its population figure times $17 for that year. The province from which I come, with a population approaching two million, would therefore receive two million times $17 or close to $34 million, or about 5 per cent of the total national cost of medicare or 10 per cent of the total federal tax collection for and expenditures on medicare. Some provinces might find their costs a little higher than $34 on the average, some less, but they will receive $17 per capita and will have a genuine incentive to average out at around the Canadian average figure.

[DOT] (7:00 pm.)
They will indeed have an incentive to cut the cost. In some of the provinces, such as Ontario and British Columbia, where hourly
wage rates, and other prices are higher, the figure may be above $34-maybe $36 or $40-but $17 per capita will come back to that province from the national treasury. This is a measure which, to some degree, spreads the wealth across the nation. It is a measure which collects from all of those who pay the federal income tax, the federal corporation tax, the federal sales tax, import duties and so on. It collects from those who can afford to pay and it redistributes the moneys on a per capita basis across the country. I therefore say it is a measure which, in some degree redistributes wealth across the nation.
That is as it should be, and I am quite convinced that the people of British Columbia, the people in my riding, who perhaps on the average are better off than the average Canadian, would go along with this legislation. They also recognize health care as being one of the top priority items in this country, if not the highest priority item. They are quite willing to pay according to their ability and to see these moneys distributed more in accordance with the needs of individual Canadians across the country, with the needs of those who are less fortunate, those who are ill, who suffer from accidents, and so on.
I would now like to say a word about rising costs, because a great deal of nonsense has been said about the extent of the increase of costs of medicare. We hear references to the fact that the bill for medicare in the United Kingdom has gone up five or six times since the end of world war II, since medicare was brought in by the Labour government in the late 1940's. This is true in dollar terms, but the cost of medical care, of physicians' services in this country has also gone up five or six times.
As I recall it, the national income of Canada at the end of world war II was around $12 billion; today it is over $50 billion. Our national income has gone up fivefold and the percentage of that income devoted to physicians' services has risen, not fallen. I therefore suggest that the total of all the bills collected by the physicians in this country has risen five or six times.
This is not wrong; this is as it should be. However, let us face the fact that in a country such as the United Kingdom an increase of
July 12. 1966

five or six times has its parallel in Canada which, so far at least, has not had a comprehensive prepaid medical care plan.
The Hall Commission found that, on the average, countries which were industrialized and enjoyed a reasonably high standard of living spent anywhere between 4.5 and 5.5 per cent of their national income on health services of different kinds. In 1961 the United Kingdom spent around 5 per cent, while we spent 5.4 per cent. It follows that without a comprehensive, prepaid medical care scheme we were devoting more of our national income to health care than were the people of the United Kingdom. Today our percentage is comparable to or higher than that of other nations such as west Germany, and the Scandinavian countries which have had such universal schemes in effect, not just for years but for decades. I would even venture to say that in the case of Germany this type of scheme has been in effect for nearly a century. We find that those countries were able to develop a medical profession which is among the best in the world and which performs services that are satisfactory to the people of those countries.
It is typical that as the income of the people rises, they spend more on medical services. So we should not be surprised to see the percentage devoted to medical care of physicians' services in this country rise over the next few years. However, there is a point beyond which, as people become more affluent, the percentage goes over a threshold so to speak. It begins to fall after people pass the $5,000 a year income level. By the time they get up to around $10,000 the share falls to 3 or 4 per cent. If all Canadians were suddenly propelled into the $10,000 a year income bracket, we would not be spending 5.5 to 6 per cent on health services, as we are currently doing, but a lesser amount. The prospect therefore is for an increase in percentage for some time, then a levelling off, then a decline in the payments.
I have noticed that the minister made some allowance for a sharp increase in the demand for physicians' services in the first year or two. This is in accordance with experience in other countries. Many people, 10 or 15 per cent of the population, are afraid of going to a doctor because of the bills they will encounter, or else they put off going to a doctor for so long that they never get to one at all. Under a medical care plan these people will be more inclined to go to a physician and have the benefit of his advice and his care.
Health and Welfare
There will therefore be an increase in the workload of the medical profession in this country. There is no point in trying to ignore this fact. The demand is there, the human factor is there, and surely as members of parliament will recognize, the need is there. If the medical profession is not adequately staffed today, and in some cases does not have adequate research facilities, hospital equipment and so on, then it is our responsibility to make sure that opportunities are given for training, the carrying on of research, and that the necessary facilities are provided for them. There will be a period of some difficulty; an increase in the workload is bound to cause some strain. But this is a type of strain which the great majority of the medical profession is not only prepared to accept, but is willing and anxious to meet to the best of its ability.
Not long ago I came across the brief of the Canadian Medical Association to the Hall Commission. It stated the following as the objectives of the doctors of Canada:
1.	The highest standard of medical services should be available to every resident of Canada.
2.	Insurance to prepay the costs of medical services should be available to all regardless of age, state of health or financial status.
3.	Certain individuals require assistance to pay medical services insurance costs.
4.	The efforts of organized medicine, governments, and all other interested bodies should be co-ordinated toward these ends.
These recommendations, which seem to fit amazingly well into the resolution we have before us-and I trust the legislation will be forthcoming-arise out of the predicament in which many individuals find themselves. You and I may well have experienced a situation such as this.
I wish to quote from a book which appeared some time ago written by Henry Richardson entitled "Economic and Financial Aspects of Social Security". It states:
Sickness is too uncertain and irregular in its onset and too variable in its severity for the cost to be met as it occurs out of the normal family budget. Provision can be made effectively only by saving, but many people do not make adequate savings individually, especially if their means are low, and young people may not have had time to save enough to pay for a severe and costly illness. Moreover, medical care is becoming increasingly costly because of the advances being made in scientific research and techniques. In consequence, the difficulty of paying direct for medical care has become much greater and will continue to increase. The remedy is for the risks of sickness to be pooled by the whole community and for medical needs to be met mainly by small regular payments from the family's annual budget.

July 12, 1966
Health and Welfare
I should now like to refer to some of the benefits. The Hall Commission considered this matter, but I am sure the Economic Council also, if the hon. member for Peace River had been successful, would not only have investigated expenditures but would also have looked into the benefits which would result from better and improved medical care. They would have dealt with facts of this nature. On the average, roughly 2 per cent of our working force is absent through illness all the time. These people who are off for extended periods of time, if they had continued to be productive and had better care, could have, increased our national income by about 4 per cent. Even if we had an increase of half of one per cent, if we could knock the incidence of illness down by about 10 per cent-a half of one per cent relative to 4 per cent-then we could more than offset any possible increase in the cost of medicare in this country. So the Economic Council, working out the benefits and costs, I am quite sure would come down on the side of an effective prepaid medical care scheme in this country. In other words, I feel a careful economic appraisal would result in a verdict in favour of the introduction of medical care.
[DOT] (7:10 p.m.)
I have referred to the fact that on a number of occasions the minister has underlined the fact that administration is by the provinces, that the details are up to the provinces. The provinces will receive their per capita payments annually. They will collect their own taxes and perhaps will collect premiums as well. The sum total of these revenues will pay the doctors' bills and the provinces will be responsible for the payment of those bills.
There are four important conditions which have been repeatedly stressed by the Prime Minister at federal-provincial conferences and by the minister on a number of occasions. These are conditions attached by the federal government before federal money will be available to the provinces. They are simple, but they are very important. The first concerns the scope of services available. All doctor's services should be available to all Canadians who rely on this type of support, that is all physicians' services must be available to those individuals participating in this plan. This is No. 1.
The second point is that there will be universal coverage, that is, universal in the sense of 90 per cent, originally, and 95 per cent after a period of years. I think that if

our experience in medicare parallels our experience in hospital insurance, this figure will move up toward 98 per cent or 99 per cent. The reasons will become more obvious as we gain experience with this program.
The third point is that the programs must be publicly administered by the provinces. Those provinces may have a variety of schemes. I think this is co-operative federalism working at its best. The federal government agrees to attach a minimum of strings to moneys of this kind, but the strings or conditions are vital to a successful scheme. They involve a minimum of federal direction and they involve a minimum of inconvenience to the provinces, as well as a maximum of flexibility to improve the efficiency of the scheme.
The provinces must take full responsibility themselves. As I understand it, what is meant by public administration is that there must be a minister of health in the province. He and his department must take full responsibility for the soundness of the schemes, whether there be one province-wide, government administered scheme such as presently exists in Saskatchewan, or a multiplicity of schemes which involves one substantial government plan and a variety of other plans. As I understand it, the condition attached is that these additional plans, which may be loosely referred to as private plans, must be in the nature of non-profit operations. They will be thoroughly scrutinized and, in a sense, licensed by the provincial authorities.
Obviously, the doctors' non-profit plans will qualify. I have not discussed this with the minister, but I believe some of the big insurance companies schemes would also qualify, if they are not making a profit? As I understand it, insurance companies have often used medical care insurance as a loss leader to attract attention of the community to their other services. If in fact, they are offering this type of service, I cannot see why they would not qualify as a non-profit operation.


Maurice Rinfret: I regret to interrupt the hon. member, but the time allotted for his speech has now expired.


John (Jack) Davis: I wonder if I could have one or two more minutes to conclude?


Maurice Rinfret: Is it agreed that the hon. member may have a minute or two more to complete his remarks?


Some hon. Members:: Agreed.
July 12, 1966


John (Jack) Davis: I was talking about the private carriers operating as non-profit organizations, in the economic and financial sense of the word. I think it is desirable, and in some provinces I would like to see what these other agencies can do. I should like to see what private insurance companies can do from the standpoint of a non-profit scheme. I noted that recently the London Life Insurance Company, for instance, took the contract for Physicians' Services for the civil service of Ontario away from P.S.I. They took it away from P.S.I. because they had lower costs; they were better organized and they used the latest data processing techniques. Because of their lower costs they made a more attractive bid to the government of Ontario.
I can envisage in this country the possibility of certain provinces having provincially run schemes, and other provinces with a variety of public and private agencies. This flexibility is desirable. If the private agencies are inefficient, they are going to lose out in competition; they are not going to quote the best prices and they are going to be ignored. In any case, I am prepared to take that chance. I think this is a flexible approach, and I believe it is a highly desirable one.
I should have liked to go on at length about the freedom of the individual to choose his doctor, to work wherever he wants in this country and still benefit under the plan. I should have liked even more to talk about the freedom of the doctor to accept any patient or to deny services to that patient. This is the program, as it is evolving, at least in so far as our federal stipulations are concerned. It does not interfere with the doctor in the way the program in the United Kingdom and some other countries does. It does not require a doctor to go to a certain area, to have a panel to serve. It does not limit his freedom in that important sense. He is in no way a civil servant. He is a professional, completely on his own, as he has always been. He may have fewer problems collecting his bills, but I cannot think of any great difficulties he is likely to encounter. Indeed in the remarks made by a number of my doctor friends, some of whom are very vocal and some even hostile, I find a situation similar to that which I encounter when I talk to some of our separatists: They have a problem, but they will not tell us what the solution is. They will not tell us how the constitution can be changed, but they have a problem. Many of those inside and outside the medical profession who are concerned
Health and Welfare
with these imaginary problems will also find that they will disappear when this legislation is implemented.


Lewis Mackenzie Brand: I have listened with a great deal of interest to many of those who have taken part in this debate. I have listened to the hon. member for Coast-Capilano assure the medical profession that they have nothing to fear, that they know exactly where they are going. I suggest to the hon. member that he get together with the Minister of National Health and Welfare to straighten out exactly what their views are, because I distinctly heard the minister say, in relation to the scope of the benefits, that the government was going to see that all the services provided by the physicians were insured services. He went further to say that they were going to insure the availability of physicians' services.
If hon. members do not believe that is a problem, then they do not know what went on in Saskatchewan just a few years ago, when an amendment was introduced to the medical care insurance act of that province which, by insuring the services of physicians, effectively denied physicians the opportunity to practise medicine properly. This is what the fight was all about; and if the minister does not know this yet, I think it is about time he looked into the situation a little more carefully, before making statements to the house.
[DOT] (7:20 p.m.)
I say at the outset, Mr. Chairman, that despite this mistake-and I hope it is that, which has been made by the Minister of National Health and Welfare-I concur wholeheartedly with the suggestion implicit in the resolution of federal contributions to help pay part of the costs of medical services incurred by provinces pursuant to any provincial medicare program.
I note, coming to another point, that there is nothing in this resolution which indicates whether or not there has been any change in the attitude of the government-and I have heard various views on this tonight-toward the four provisos that the minister previously indicated would be included in the medical care legislation. That change in attitude has to do with the provinces themselves. It is of the utmost importance, Mr. Chairman, to every province in Canada to know exactly the stand of the Canadian government as to which province will or will not be able to

July 12, 1966
Health and Welfare
participate in this shared cost program. Despite what the minister says, this is ambiguous.
My own province oi Saskatchewan has ol course met these four provisos, and we will welcome any additional moneys from the federal government. I am sure that that will allow the government to do away with the direct tax it presently has, and make this program free-if one puts those words in parenthesis-to the people of Saskatchewan.
While we are not so naive as to believe that medical care will be free, as suggested, we think that the distribution costs will be made on a more equitable basis, since it seems that the federal government's share of the cost can allow the Saskatchewan government to eliminate the direct tax it now imposes. I believe that this direct tax, which is easily paid by those in a position to do so, is not so easily paid by some who are neither within the ambit of social aid assistance, nor high enough on the income scale to permit payment of this tax without hardship.
Much has been said, however, by the minister and by members of the other parties as to what effect provision of medical care on a universally available basis will have on the health standards of Canadians. Much has been said about the supposed opposition of Canada's medical profession to the proposed implementation of universal medical care. I should like to discuss both these statements in some detail and clear up, if at all possible, many of the misunderstandings which have arisen regarding the stand of the medical profession.
Page 2, volume 2 of the Royal Commission on Health Services contains a quotation from the Canadian Medical Association brief submitted to the Royal Commission on Health Services in May, 1962. In this brief the C.N.A. said:
-insurance to prepay the costs of medical services should be available to all regardless of age, state of health or financial status.
Commenting on this statement the royal commission said, on the same page:
-it is clear that this policy intends that every Canadian will have or will be entitled to have prepaid coverage enabling each and every one to seek the services of a physician and to receive the services which in his physician's judgment are required.
I point out to the minister that you do not insure services, and I draw his attention to the famous statement made by the hon. member for Burnaby-Coquitlam in regard to insuring services when he was asked that question

during the medical care crisis in his province. He said that you cannot insure physicians' services because, as he said: "You can no more lead a horse to water and make it drink than you can take a doctor and make him practise medicine." Despite the fact that he had to eat those words later, I think the meaning is clear to us today.
It seems clear to me that this statement, which is supported by an overwhelming majority of Canadian doctors, is unequivocal and clearly indicates support for a program of prepaid medical care for every person in Canada. It should be noted that this brief was submitted to the royal commission prior to the culmination of the difficulties in Saskatchewan in July of 1962 when despite what is said by certain individuals and politicians, the battle was joined there, not because of opposition to prepaid medical care but because of opposition to what we sincerely believed was an attempt by a provincial government to control the medical profession. I know that there are those who take issue with me in this regard, and they are entitled to their interpretation. I think, on the other hand, conversely, that I too am entitled to my views on this matter.
You may wonder, Mr. Chairman, what application these remarks have to the resolution before the house, but I believe that it is essential to the understanding and application of the resolution that there be a clear knowledge of what pitfalls and stumbling blocks must be avoided by the government in order to bring in the proposed legislation in an atmosphere of reasoned understanding.
As I have said, many attempts have been made to claim that the doctors were opposed to prepaid medical care. I have heard on public platforms and in the news media deliberate distortions which indicated that doctors were opposed to this because the income tax would find out how much money they were making, or that they would make less money under a medical care scheme. I have even heard a prominent former member of this house claim that the doctors were afraid of prepaid medical care because the standard of medicine was so low in this country, and we did not want anybody else to find out about it.
What are the facts? I should like to refer briefly not to what socialist governments, not to what governments bent on welfare statism have done, but to what individuals and doctors have done to bring about programs of prepaid medical care.
July 12, 1966



In 1929 the medical profession pioneered in Saskatchewan the free treatment of tuberculosis. Sanitoriums were set up under a system of private enterprise, with the municipalities supporting the scheme on a per capita basis. In 1931 the profession co-operated with the government, establishing diagnostic and therapeutic cancer clinics available to all at a modest fee. This fee was eliminated by the way under the Liberal government of Saskatchewan prior to the socialists gaining power in 1944.
For many years our country areas were serviced by a local tax-supported municipal scheme. This was pioneered by a citizen of Saskatchewan, Mr. Matthew Anderson, reeve of the municipality of McKillop, in Bulyea, and as a result of his singlehanded action and laudable persistence, an act respecting medical and hospital services in municipalities was assented to in the Legislature of Saskatchewan on April 1, 1939. It may be of interest to some of my friends on the left to know that this included hospital care, medical care and necessary medicines and appliances furnished upon prescription. It seems to me that no mention is ever made by those of socialistic persuasion of the very effective and useful efforts of this private citizen, who operated in a milieu of private enterprise to see that the rural areas were very well served indeed.
A great need still remained in our cities and large towns. To fill this gap the medical profession of Saskatchewan between 1934 and 1938 organized several voluntary non-profit prepaid medical care plans. Much was said during the medicare struggle to the effect that these doctor-sponsored plans were making a great deal of money at the expense of the people of Saskatchewan, despite the fact that they were incorporated under the cooperative assistance act of Saskatchewan, were completely non-profit, and were owned completely by those who took out membership in them.
Despite what we had in this field, there were still gaps in medical care, particularly with those low-income groups who did not qualify for social aid and still could not afford the low premiums of the voluntary plans. So it was that in 1941 the Saskatchewan College of Physicians and Surgeons, in co-operation with the government of the day, set up a continuing committee to consider a universally available province-wide health insurance scheme. Despite these overtures by the medical profession, nothing was done, and
Health and Welfare
in 1944 the C.C.F. government came into power in Saskatchewan. The medical profession offered its co-operation to this government and as a result, in 1944, medical coverage for old age pensioners, the blind, and indigent widows with families was established.
[DOT] (7:30 p.m.)
At the outset this plan was subsidized up to 60 per cent by the medical profession. Hospitalization in that province is a matter of record. Our profession continued to press for an extension of the proposed health insurance scheme. Many meetings were held with the minister of health and with the premier of the province, now the hon. member for Burnaby-Coquitlam; but it was not until 1950, if I remember correctly, that he gave up his cabinet post and Hon. T. J. Bentley took over as minister of health. Following this, the college received a letter stating that no further discussions or negotiations would be held at that time. That was the situation in Saskatchewan. We never hear this from the other side of the fence at all.
We felt they were waiting to find-if I may use this word; it appears in the resolution before us-an expedient time to introduce a bill into the Saskatchewan legislature. I do not know how many hon. members know what "expedient" means, but I took the trouble to look it up. Here, in the Concise Oxford Dictionary, it says "politic rather than just". I leave this to the imaginations of hon. members.
The hon. member for Burnaby-Coquitlam said the reason they did not bring in a program was that they did not have the money. I accept this view; it is perhaps correct. But this does seem to fly in the face of the contention expressed today by members in that corner of the house that medical care really does not cost any more money, since you are merely taking the amount presently being spent and distributing it among the whole citizenry, giving more equitable coverage.
However, our voluntary plans went on. They covered almost 40 per cent of our population. Taking this percentage along with municipal coverage, coverage of old age pensioners, the blind, widows, mothers' allowances, workmen's compensation, cancer clinics and so on, only 10 per cent of our population had no assistance with their medical bills.
That is interesting, I would think. What happened next? Well, into this improbable

July 12. 1966
Health and Welfare
situation, medicare was introduced. I shall not take the time of the committee now by telling the long and dolorous story of what happened over the next few years. Certainly the lack of communication between the medical profession and the government of Saskatchewan was very like the failure of communication surrounding the "Seven Days" crisis within the C.B.C. Nobody seemed able to get together with anybody else, and I think the reasons were the same as those which the hon. member for York East mentioned the other day when he was discussing the "Seven Days" affair-it was management, rather than the other group, which was causing the trouble.
Eventually a commission under Dr. W. P. Thompson was set up to study not only the question of a medical care plan as originally proposed, but the entire health needs of the province of Saskatchewan. The commission continued its hearings on into 1961. A campaign was mounted against the doctors, and people were made to believe they were against a medical care scheme. The government was re-elected. Hon. members know the rest of the story.
But it was in 1961 that the Canadian Medical Association approached the then prime minister of Canada, the present Leader of the Opposition, and urged him to set up a Royal Commission on Health Services. This has been said before, but it is worthy of repetition: It is as a result of this commission on health services under the chairmanship of Mr. Justice Emmett Hall that the present resolution is before us today.
I have mentioned previously the effect of insuring physicians' services and the iniquitous type of legislation which was brought in in Saskatchewan. A large number of doctors withdrew their services. We did not go on strike. If we did, the Labour members who sit on my left may wonder how we could have a strike and continue to work.
Nevertheless, medical care continues in Saskatchewan. I am not claiming that all the blame was on one side. Most of it was, but not all of it. The doctors themselves, under great emotion, said and did things which they should not have done; but I still believe, and they still believe, that our stand was basically a correct one and I should not like to see a repetition of these tragic events in any other area of Canada.
As a result of this attempt to insure the services of physicians, much was said about

the deterioration of medical care under a medical care scheme. The Hall Commission and the present Minister of National Health and Welfare seem to feel that implementation of a medical care plan will not affect the quality of care, nor will it be a burden on the present facilities, and indeed the Hall Commission on page 9, volume 2, of its report, states as follows:
We can hope therefore that the introduction of universal insurance in Canada will reduce our present losses to the United States, and will result in Canada becoming self-sufficient as the new medical schools are established and existing schools expanded.
I mentioned earlier what happened in Saskatchewan. I think it is worth mentioning again, however briefly-I was thinking of the medical school at the University of Saskatchewan-that instead of producing more graduates, we produced fewer. In the three year period from 1957 to 1959, a total of 289 new entrants was recorded in Saskatchewan and 121 of these were graduates of Canadian schools, for a percentage of 42. During the three year period 1963 to 1965, there was a total of 399 new entrants, 91 of whom were Canadian. This is a percentage of 22.8, a substantial decrease. We are experiencing a steady loss of Canadian graduates; instead of getting more, we are getting less.
I wholeheartedly agree with the remarks of the hon. member for Simcoe East about the loss of Canadian doctors. I think this is a serious matter. The total number of doctors in our province has, of course, increased-due to the greatly increasing numbers of doctors from Pakistan, the United Kingdom, Taiwan, India, North Korea and the Philippines. I am disturbed, not because I question the qualifications of these doctors, but why should we take doctors from countries which themselves face an acute shortage of qualified physicians? We must do something about producing doctors ourselves. It is easy to say that everything will be lovely in a few years time-"Wouldn't it be luverly?"
I am glad hon. members opposite think so, and I hope they are right. It is true that in Saskatchewan there has been an 11 per cent increase in the number of doctors following medicare, but still we do not have enough. The ratio is about one to 1,007, well below the national average and significantly below British Columbia's ratio of one to 758, and Ontario's one to 776. If the ratio is bad in Saskatchewan, what will happen in the Maritimes where the ratio is between one to
July 12, 1966

758S
1,000 and one to 1,300, and in Newfoundland where it is one to 1,991?
These figures refute the contention that the introduction of medical care will solve all our problems. Should I remind the minister again of his statement in Halifax, where he said it would take 20 years to increase our dentist population by 5 per cent? Yet on the basis of the figures I have given this committee the minister apparently feels that without difficulty we can increase the doctor population by between 10 per cent and 15 per cent in one year. I know it cannot be done. I should like to hear what the hon. gentleman has in his mind.
I would remind hon. members briefly of the priorities suggested. Perhaps I may quote again from the Report of the Royal Commission on Health Services, where the following statements are made on page 1 of volume 2:
We consider quality as the most essential element in health services and every aspect of the programs must be constantly directed to that end.
Not just a second thought, to fill in the gap between organizational methods and the payment of physicians.
[DOT] (7:40 p.m.)
A few lines further on they say:
Quality depends primarily on the supply, availability, knowledge, skill, and dedication of professionally qualified personnel, secondly on the facilities at their disposal and thirdly on the organization of the services.
Those are your priorities, first supply, second facilities, third organization. The hon. member for Burnaby-Coquitlam agrees with me because as reported in Hansard of April 6, 1965, at page 50 he said:
There are some provinces who have an adequate number of doctors in ratio to their population and who, very quickly, could qualify for medical care . . . Some provinces would take longer to qualify.
You bet your sweet little life they are going to take longer to qualify. We in this profession will provide the knowledge, the skill and the dedication, and the health resources fund will go a little way to providing the facilities. But what is the minister going to do about the supply of doctors? What about the manpower policy-


Maurice Rinfret: Order. I regret to interrupt the hon. member but the time allotted to him has expired.


Some hon. Members:: Continue.


Maurice Rinfret: Is it agreed that the hon. member may continue?


Some hon. Members:: Agreed.
Health and Welfare


Lewis Mackenzie Brand: I thank hon. members for the courtesy of allowing me to continue, and I shall finish in another couple of minutes. I want to remind the minister about the manpower policy recommended in the Hall Commission report. What is the government doing about that recommendation that urges the Association of Canadian Medical Colleges to set up departments of general practice in the teaching hospitals, and chairs of general practice in the faculties of medicine?
What are we doing to ensure the continuing training of the general practitioner? I have heard conflicting views on whether this is a provincial or federal responsibility, views expressed from the opposite side of the chamber. Personally I think that once you step into this field you have a responsibility to provide that. The minister throws his hands in the air. Is that what he feels about this situation? Is that the way he is going to treat this serious problem? I sincerely hope not. I trust from a medical point of view it was more of a tic than a demonstration of anything else.
At page 259 the Hall report stated:
In a world of specialists it has become important to review and re-define the role of the general practitioner-
I ask the minister to peruse the Hall Commission's statement in this respect at a quieter time.
It is axiomatic, and I am sure the minister would agree with this, that inseparable links to quality are the freedom of the health profession and the freedom of the public as potential patients. I am glad the minister spelled this out, although somewhat in a blurred fashion; but I am sure he agrees with the Hall report that these freedoms must be spelled out in the legislation and be safeguarded through organizational arrangements and mutual respect.
When I was speaking in the house on the health estimates I suggested that the government should reconsider its inflexible attitude toward those provinces which wish to proceed with medical care in a manner of their own choosing, since such care is primarily a provincial responsibility. No matter how the minister and the government may look at the matter, if they are intending to prescribe the manner in which medical care shall be carried out they are infringing on an area of provincial responsibility, in other words poaching on preserves where they have no right.

July 12. 196E
Health and Welfare
I believe each citizen o 1 Canada has a right to obtain benefits for which he has paid, through the increased burden of taxation which is already beginning to kill the spirit of enterprise that should be an integral part of a young and robust nation such as ours. I would urge the government not to deny any citizen of Canada his right to a share of the tax moneys merely because provinces do not live up to the guidelines proposed by the federal government. Surely it is in the spirit of the Hall report to allow such provincial freedom of choice. Include the non-profit prepaid plans, as has been said, and you go a long way because you have trans-Canada plans which can fit in and allow portability.
Finally, the minister should remember that one of the priorities proposed in the Hall report was the free spirit of co-operation among all those who participate in such a plan. Medicare, dominion-wide, can be a success, but it should not be so at the expense of the rights and freedoms of the patient and practitioner alike.
This has been a stormy session and is almost coming to a close, but let us not add to the storm. Mr. Chairman, may I conclude by quoting from a letter written by Washington to Madison on November 5, 1786, which is taken from the Writings of Washington, volume 29, page 51:
No morn ever dawned more favourably than ours did; and no day was ever more clouded than the present! Wisdom and good examples are necessary at this time to rescue the political machine from the impending storm.


Mr. Slanbury:: Mr. Chairman, I take pride in being permitted to participate in this debate on the principles of the government's national medical care insurance plan. I am concerned that there are so few in the chamber tonight to listen to and take part in the debate, which is surely one of the most historic that will occur during this session.
I am proud to subscribe to the principles enunciated in the resolution and by the Minister of National Health and Welfare. As this is a time for stating one's position on the principle of the plan, I have been somewhat disappointed by the remarks from the official opposition, and to this point I am not yet sure whether it is in favour of this proposal in principle, or against it. I have the greatest of respect for the two hon. members who have spoken on behalf of the official opposition. I respect the concerns they have expressed on behalf of their learned profession, which is so intimately affected by this plan, but I am left

in a bit of a quandary as to the position of the political party they support.
I recall that in the recent election one of the planks in the platform of the Progressive Conservative party was stated in this way, and I quote from the Toronto Daily Star of November 6, 1965:
The Progressive Conservative party will institute a system of medicare, based on a universal, comprehensive program of medical and health services for every Canadian, as outlined in the Hall Commission report.
Well, Mr. Chairman, that seems to be what is before us in this resolution; but on the basis of what has been said by official opposition spokesmen in this debate I am not sure whether that is still the policy of the Progressive Conservative party.
I note that the government of Ontario has not taken issue with the principles put forward by the federal government. I refer to a Canadian Press dispatch from Toronto which appeared in the Ottawa Citizen of February 3, 1966, the first paragraph of which says:
Ontario did not say at the Ottawa meeting of provincial health ministers early in the week that the province disagrees with federal government proposals for a national scheme of medical care insurance, Health Minister Matthew Dymond told the legislature Wednesday.


An hon. Member:: We are 80 per cent covered now.


Mr. Stanbury:: Some hon. members undoubtedly feel that the Ontario plan has seeds of perfection in it, but the Globe and Mail, which is hardly a Liberal organ-


Eric Alfred Winkler: Are you opposed to it? That is the question.


Robert Douglas George Stanbury: -said on January 29, 1966 that:
The government scheme-
Referring to the Ontario government scheme.
[DOT] (7:50 p.m.)
-is likely to attract most of the high-users, because these must pay premium rates with the private non-profit plans that will continue to operate. If the Government scheme, as intended, remains actuarially sound, then these high-risk cases-who are frequently least able to pay-could eventually find themselves paying higher premiums than those in the private plans. If this inequity develops, it could only be corrected by bringing all under the government plan, or by subsidizing the plan from general revenue.
Until the plan has been in operation for some time it cannot be known, either, if the proposed low-income subsidies will be sufficient to ensure that nobody is prevented by poverty from obtaining coverage.
July 12, 1966


Eric Alfred Winkler: That is right.


Robert Douglas George Stanbury: This is the Ontario plan which the premier ol Ontario suggests can be brought within the federal proposal, but which is hardly perfect under present conditions even in the judgment of the Toronto Globe and Mail.


Eric Alfred Winkler: Is the hon. member opposed to that plan?


Robert Douglas George Stanbury: I am a supporter of a plan in the terms of the Hall Commission report, the kind of plan which meets the four standards set down by the Prime Minister of Canada as warranting the use of federal funds for its support.


Eric Alfred Winkler: But you did not answer my question: Are you in favour of the plan or not?


Robert Douglas George Stanbury: I am not in favour of the Ontario plan as it stands today. I feel it has many weaknesses and should conform to the four principles which have been outlined.


Eric Alfred Winkler: May I ask one more question.


Robert Douglas George Stanbury: Are you in favour of the present Ontario plan?


Eric Alfred Winkler: Would the hon. member admit that those who require services receive them, regardless of the price of the premium?


Robert Douglas George Stanbury: Mr. Chairman, I presume from what the hon. member says that he is fully in favour of the Ontario plan.


Eric Alfred Winkler: That's for sure.


Robert Douglas George Stanbury: Therefore he has no objection to the private insurers retaining all the group coverage and the government having the high-risk coverage to look after.


Eric Alfred Winkler: So long as the people who need the coverage get it, I am in favour of it.


Herman Maxwell Batten: Order. The hon. gentleman is interfering, now.


Robert Douglas George Stanbury: No matter whether or not it is at the expense of the public and to the benefit of the insurers, apparently.


Eric Alfred Winkler: That is a pretty weak answer.


Robert Douglas George Stanbury: The chief argument of the official opposition up until this point appears to suggest that they approve of medicare, but on the never-never plan. Their chief objection seems to be a lack of manpower. I should 23033-480
Health and Welfare
like to refer to a remark made by Sir Hugh Linstead, president of the International Pharmaceutical Association when he appeared in Canada recently. This appears in the Hamilton Spectator of June 9 last. He said:
I know of no country. Including the United States, where medical resources are sufficient for the population.
He added:
All countries have to ration medical aid.
He suggested that medical facilities should be given with regard to need rather than to the ability of people to pay.
Surely that is the simple answer to the concern expressed by my hon. friends in the official opposition; that is, that you must surely provide medical services strictly on the basis of need and on no other basis. According to the Hall Commission, the only way that can be done is by a universal scheme.
The Prime Minister has been accused, I think by the hon. member for Red Deer, of political blackmail because he set down certain principles to which provincial plans should conform if federal funds were to be devoted to their support. I suggest these principles are perfectly reasonable and necessary. When he announced this policy in Toronto the Prime Minister said:
We cannot impose policies and programs on provinces in respect of matters within their jurisdiction. And we will have to be increasingly careful in participating in joint federal-provincial programs in which all provinces do not participate.
On the other hand, we will not forgo our right to make grants to provinces to help them in programs such as medicare which are provincially-administered; and our right to relate such grants to the acceptance of certain principles which, in our view, justify the expenditure of federal funds for provincially-administered schemes.
It is then for the provinces to decide whether they wish to co-operate on this basis.
Mr. Chairman, I do not call that political blackmail. I agree with the Winnipeg Free Press which terms this approach an ingenious one. It is one, Mr. Chairman, which ensures that federal initiative will bring about as soon as possible the kind of national health service insurance plan which will be in the interest of all Canadians.


Eric Alfred Winkler: By compulsion or choice?


Robert Douglas George Stanbury: By choice of provincial governments.
On this principle of universality with which my hon. friends apparently take issue, I think I can quote no authority which might

July 12, 1966
Health and Welfare
appeal to them more than Sir Winston Churchill who, when speaking more than 50 years ago, spoke of social insurance in its various forms as spreading the risks of life, and bringing "the magic of averages" to the help of the poor. This program will bring the magic of averages to the help of all Canadians. This program is being welcomed across the country. The Kingston Whig Standard of May 19 commented:
Whatever the plan chosen by each province, Canada is now about to take a great and too-long-delayed step in social welfare. It can be taken for granted that the whole country will be covered by satisfactory medical insurance within the next year or two.
Well, Mr. Chairman, I am proud as a member of the Liberal party that I have had a part in bringing about this plan. I am proud that we now have a government which is prepared finally to bring such a plan to fruition.
Hon. members will be aware of my particular interest in education. I am grateful that education shares with health a position in the consideration of this government as a matter of top priority. No former government has invested so much in education, or shown such constructive concern in this other field of primarily provincial jurisdiction but of such vital national importance.
Mr. Justice Emmett Hall, the chairman of the Royal Commission on Health Services, has laid to rest the argument made by some hon. members, that because of the demands made on governments by education we should put off indefinitely a national medicare insurance plan. Mr. Justice Hall declared in Ottawa last November:
"There cannot and must not be any question of conflict or of priority between the needs of better education and good health."
He pointed out that medicare calls for an annual expenditure of about $600 million, of which half would be raised by the federal government and half by the provinces. He said that in 1961, according to estimates made by the Hall Commission, Canadians spent $383 million for physicians' services and $72 million for the administrative cost of private health insurance plans, and that these figures have no doubt increased since 1961; so that the actual increase to the public as a whole should not be above $100 million annually. It might be pointed out as well that last year there was an estimated loss to our economy through illness of $1,630 million. A great deal of this loss might well have been prevented
[Mr. Stanbury.l
had there been an adequate medical insurance plan in existence.
[DOT] (8:00 p.m.)
An editorial in the Toronto Star of December 1, 1965 came to this conclusion:
If public health and higher education are thought of as investments rather than as burdens, the question is not whether Canada can afford to have medicare and increased aid to universities but whether it can afford not to have them.
During this session the government has committed massive funds to both health and education. We have observed some memorable legislation. We have had the Canada Students Loan Plan extension measure, Which gave an injection of new funds to education; we have had the Canada Assistance Plan, which will supplement the Canada Pension Plan passed during the last session; we have had the government's announcement of vastly increased support for higher education, some of which has already been committed and more to be negotiated with the provinces in the fall. Recently we have had the health resources fund which laid the groundwork for the national medical care insurance plan, which we now have before us tonight.
I suggest that this resolution carries out the injunction of the Hall Commission report, which proposed that "as a nation we should now take the necessary legislative, organizational and financial decisions to make all the fruits of the health sciences available to all our residents, without hindrance of any kind".
Surely our people are the most valuable of Canada's resources, and their freedom and opportunity are surely the most sacred trust of government. The twin foundations of individual freedom and opportunity are our citizens' health and education-freedom from the catastrophes of illness and ignorance, both largely beyond individual control, and opportunity to live in good health and to pursue the abilities of the individual to the best advantage of his family and his country.
I am proud that the government which I support is moving forward strongly and resolutely with the construction of both these foundations of our individual freedom and opportunity-freedom from illness and opportunity to learn-and that these are being ranked foremost among our responsibilities to the Canadian people, not only of today but of tomorrow.


Walter Gilbert Dinsdale: Mr. Chairman, the hon. member who has just taken his seat posed a number of questions in regard to the stand taken by the opposition on this important
July 12. 1966



matter. I discerned a somewhat reserved reference to our stand. Let me assure him at the outset that a program of medicare for all citizens of Canada has long been one of the prime objectives of the Conservative party. Surely it is not necessary to press this particular point, because in the course of remarks that have already been made by spokesmen on this side we have demonstrated beyond a shadow of a doubt what our actual position is.
It should be remembered by all hon. members of the committee that what we are adopting by this resolution is largely the result of an excellent study that took place as a result of the initiative of the former Conservative government. The report that emerged from the Royal Commission on Health Services, better known as the Hall report, charted the course of comprehensive health care which, over the next few years, will ensure that Canada has one of the most progressive programs to take care of all her citizens of any country in the world.
It is not necessary to reiterate many of the statements made tonight and this afternoon. We are concerned about this health problem because, as has been indicated by several speakers, it is one of the major problems that Canada has had to face. The previous speaker mentioned the high cost of illness, amounting to between one billion and two billion dollars per annum. He also referred to the tremendous loss in terms of man days, amounting to $100 million per year. I merely repeat his observations at this time to underline the fact that we are dealing with a most important matter.
The amazing thing about this program is that it has taken years to develop. The minister in introducing his resolution took bows on behalf of his party for its initiative. He has been in this house about the same length of time as I have, and I am sure he will agree that activity in this field in the early 1950's was conspicuous by its absence. When the hospital insurance program was brought down in 1957 it remained for us to amend it in 1958, in order to make it possible for that step forward in health services to be made.
The minister now wants to ensure that we have a comprehensive health insurance program on the statute books by July 1, 1967, so the government can take all the credit derived therefrom. We certainly agree that the principle as outlined by the minister in his statement should be implemented as
23033-480*
Health and Welfare
quickly as possible. I scarcely believe, however, that on the basis of past performance, at least during the 15 years I have been in this house, we are going to have a comprehensive and absolutely complete program in operation as early as the beginning of our 100th birthday.
[DOT] (8:10 p.m.)
I say this because, as everyone knows, and it has been reiterated several times, the type of medical insurance program that will be finally implemented in Canada will depend upon provincial initiative. I think the minister would agree with that. As a matter of fact the medical insurance programs that are operating at the present time in some of the provinces-indeed most of the provinces have some form of medical insurance -have been entirely to the credit of the provincial governments, and as I read the comments on the government's proposed scheme it seems to me that some of the provinces are going to jealously guard and protect the programs that they have already charted in this important field. This seems to be the case being made by the province of Alberta, for example. My own province of Manitoba has indicated that it does not agree with the program being enunciated by the federal government, and certainly the province of Ontario has uttered similar reservations.


Allan Joseph MacEachen: Mr. Chairman, has my hon. friend read the speech made by the minister of health in the legislature of his province, stating that the government of which he is a member will be ready to participate in a national program on July 1, 1967?


Walter Gilbert Dinsdale: Yes, Mr. Chairman. The minister of health of the province of Manitoba is a personal friend of mine and I have not only read his speeches, I can assure the minister, but I have had personal conversations with him. I think the sort of response that Manitoba through its minister of health has made on this matter is typical of the progressive administration of that province. It is not going to take second place in this matter. At the same time he has on behalf of his government made certain reservations in this regard, as has the Premier of Manitoba, Mr. Roblin.
I am merely raising this point to indicate to the minister that while the target date of July 1 is a worthy and laudable objective, I hope he will continue his consultation with

July 12. 1966
Health and Welfare
the provinces so that the scheme contemplated by the federal government-we have not yet seen the bill so we do not know what the details might be; our discussion is preliminary to the introduction of the legislation-to be inaugurated next year will be carried out with a minimum of friction. I think it would be disastrous for social legislation of this kind if we were to enter into a period of provincial-federal bickering which has marked so much of the progress of the present Liberal administration in Ottawa during the past three years.
Here is a place where co-operative federalism, or consultative federalism might be used to the maximum advantage in order to ensure that the conflicting viewpoints of the provinces might be reconciled with the co-ordinating function of the federal government in so far as it is humanly possible to do so. While Manitoba has always taken a reasonable viewpoint in these matters-and I think that Manitoba, in the federal scheme of things, has established a reputation for being reasonable and moderate in all things-I believe the minister will agree that the position of the province of Alberta is a little more difficult and is something with which he will have to come to grips before the program can be implemented.
I am not going to deal with the principles that have been enunciated by the government in this regard, but I should like to make a few suggestions, which perhaps have already been incorporated in the bill to come before the house. It seems to me that if we are to come to grips with the problem of medicare on a comprehensive basis, we have to deal with three fundamental aspects of this question, the preventive, the therapeutic and the restorative. In medicine as well as in any other field of human activity, an ounce of prevention is better than a pound of cure. I think the minister will agree that so far as health services are concerned the educational function is the basic function in providing an adequate basis for the prevention of illness and disease. This is the priority that the government of Manitoba has constantly repeated in its representations on this matter.
When we come to the therapeutic aspect we must take into consideration that adequate therapy involves the treatment of the whole patient. I am not an expert or authority on these matters-we have already had some well qualified medical practitioners participating in this discussion-but I noticed a

little cartoon in the week end newspaper which pointed out one of the difficulties of the practice of medicine at the present time. The cartoon depicted a group of doctors surrounding a patient, and one doctor was saying to the others, "Do you know, that was a very difficult situation. I was almost one half inch out of the area of my specialization." In other words, the science of medicine, the science of medical therapy has advanced to such a state of specialization today that sometimes we fail to take into consideration the fact, and it is a basic fact, that in any illness or disease the whole person is involved.
This brings me, Mr. Chairman, to an important aspect of illness which is not covered in any of the existing health schemes operating in any of the provinces, and that is an adequate approach to the problems of mental illness. It is becoming increasingly recognized by the authorities in the field that when a person is ill, the whole person is suffering from the illness, and the psychosomatic branch of medical science is only now emerging as perhaps one of the encouraging new developments in the field. Mr. Justice Hall in his excellent report makes a strong bid for the inclusion of adequate mental health care in any program of health insurance that will be brought before this parliament. He said there must be the removal of all discrimination in the distinctions made between physical and mental illness.
I trust that in the proposals to be brought forward by the minister and the government adequate consideration will be given to this fundamental aspect of therapy, even though it cannot be implemented on a comprehensive basis at this stage because the final initiative, as I have indicated, will rest with the provincial governments. I know several provincial governments are interested in this aspect and I trust that the legislation will make it possible for the provinces which are ready to move forward to seize the initiative in this regard.
[DOT] (8:20 p.m.)
There is just one other point which I should like to make. I do not want to speak at length because many of the points have already been covered and repetition at this stage should be avoided at all costs. However I do want to repeat that the Royal Commission on Health Services in outlining the health charter for this nation emphasized, as many of the provincial governments and many speakers in this debate have done, the
July 12, 1966

necessity for taking priorities into consideration. We are living in a day and age of specialization, and if we are going to have a co-ordinated program-and the essential function of the federal government is that of co-ordination-we must provide, as the Hall Royal Commission has pointed out, for a health planning council so that we can avoid the hit or miss approach to the problem which has existed hitherto.
We must also expand the existing medical resources council which could perhaps be described as a health sciences resources council. All sorts of new disciplines have emerged in recent years in the field of health care.
The role of the social scientist has become increasingly important as has the role of the social worker. I wonder how many hospitals today are adequately equipped with social scientists, psychologists, sociologists and social workers so that the whole person and his problem can come under treatment? I would venture to say there are very few hospitals adequately staffed in this way. The advent of our national health program will immensely aggravate the problem. The program will create the need for proper hospital planning, specially trained architects and administrators to handle the specialized problems arising in modern hospital care, as well as statisticians to compile the data necessary in order to diagnose the problem adequately and then to treat it.
We heartily endorse this scheme. I also wish to express my admiration for the government's belief that this program can be launched successfully by July 1 of 1967. Many long years have been wasted. I hope, Mr. Chairman, that this is not a piece of legislation put forward in the spirit of the 60 days of decision. I am sure the minister appreciates the fact that before the program that he contemplates and that is recommended by the Royal Commission is initiated, much more careful consideration and consultation with the provinces in whose hands rests the initiative will be necessary.


Stanley Howard Knowles: We of the New Democratic Party, Mr. Chairman, welcome this resolution. We are happy to vote for it and we hope the legislation which is forecast will commend itself to the house to the point that hon. members will realize that we should go as far as we can with it before we rise for the summer recess. As we get into a discussion of the details there will undoubtedly be some points on which we will have questions to
Health and Welfare
raise and suggestions to make, but as members who have asked for this legislation through the whole of our political experience, we do not intend at this time to indulge in any carping criticisms of this legislation. I am sure the minister and other hon. members on the government side will realize that we would be something other than human if we did not draw attention to the fact that through all the years we have been in parliament we in this party have been urging legislation to establish health insurance or medicare for our people. However, I will not take time tonight to refer to all the occasions on which we have raised this matter but rather, out of the generosity of my heart, I will admit that the Liberals were advocating health insurance before our party even came into being.


Allan Joseph MacEachen: That is the old 1919 line.


Stanley Howard Knowles: I hear my hon. friend the minister referring to 1919 which was before he and some other hon. members on that side of the House were born. However, I do think that in fairness to the Liberal party and out of respect for the important platform decision which that party made in 1919, the book which records that historic decision should at least be seen in this chamber on this historic day. I tried to find some way under our rules in which it could be placed on the table of the house, but I could not find any rule under which I could do so.


Allan Joseph MacEachen: By unanimous consent.


Stanley Howard Knowles: Is there unanimous consent for tabling this historic book which records the fact that in 1919 the Liberal party took a stand in favour of unemployment insurance, old age insurance and health insurance?


Some hon. Members:: Agreed.


Some hon. Members:: Hear, hear.


Stanley Howard Knowles: It is good to hear these hon. members who have been born since that day rejoicing in the fact that it has taken the Liberal party only 47 years to implement the plan that was drafted in 1919. It is good for the people of Canada that at last some action is being taken on this issue.
I may also say Mr. Chairman, that it is very interesting for us to hear our speeches coming back to us from the minister. It was really a delight this afternoon to hear all the arguments that we have used over the years to try to get the Liberals to move, now being used by the minister. He told us about the

July 12, 1966
Health and Welfare
social responsibility that rests upon Canada to provide for the health of our people. He told us that it would make good economic sense. We cannot object to these arguments because they are the arguments we have been using in this chamber for all the decades during which we have been here.
The minister also drew to our attention the fact that private insurance schemes fail to provide complete coverage for the people of Canada. He gave figures which showed that for all the good that might be said by some hon. members about private schemes, in the end there has to be a public scheme if all the people of Canada are to be covered. As I said, we are glad to hear the speeches we have made over the decades being pronounced in this house today by a minister of the crown advocating this legislation.
[DOT] (8:30 p.m.)
We have also heard another very important argument which we have used over the years, namely that a health insurance program does not involve an expenditure of new money to any great extent. What a health insurance program does is to redistribute the cost of medical care. This afternoon the minister gave us actual figures. He said that under the legislation it is anticipated that $680 million will be spent on medical care in the first year in which the plan was in effect. He pointed out, however, that even without this legislation we are spending $600 million for comparable services. After all, therefore, we are simply adding a total of $80 million to the amount of money the Canadian people are spending but we are distributing the cost by this legislation so that it will be borne by the people of Canada according to their ability to pay, but health care will go to the people of Canada according to their need.
This is a good. This is a great day. It is wonderful to have been alive in 1919 when medicare was proposed by the Liberals. It is wonderful still to be alive when it is put into effect 47 years later. I see the minister has borrowed the book and is looking it up. It is on page 205 of the report of the Liberal convention which met in Ottawa in August, 1919.


Mr. Macaluso:: Oh, yes, we know about it. The hon. member has drawn it to our attention so often.


Stanley Howard Knowles: My hon. friend across the way did not even know the book was in existence.


Joseph Angelo Macaluso: The hon. member referred to it so many times that I profited from his information. I learned about it four years ago, thank you.


Stanley Howard Knowles: You are more than welcome. As I was about to say, I wish to echo for a moment the question put by the hon. member for Burnaby-Coquitlam this afternoon. It is good to know we are going to get this legislation; but when, is still a question that this house must face. I want to say, as urgently as I can, that I think the House of Commons should go all the way with this legislation before it rises for a summer recess. I think the bill should be passed through all stages.
The Minister of National Health and Welfare suggested that at least he would like to go as far as second reading. This is almost all the way; it would be approval in principle by the House of Commons. I want to say that in view of the kind of discussion that has taken place here today, in view of the differences of opinion that exist, I think the country has a right to know where parliament stands. I do not see how the provinces in this country can make their plans during the summer months on the basis of the debate that has taken place today. The provinces can make their plans only after the legislation has been passed, or certainly has had second reading, so that approval in principle is clear.
I want to suggest to the members of this of the whole committee that in asking the government to go all the way with this legislation we are not asking for something new. Hon. members know that I have been on my feet on orders of the day, or on "late shows", as often as I could during this session to try to get a commitment out of the government. We got a commitment. On three or four occasions the Prime Minister and the Minister of National Health and Welfare indicated it was the desire of the government to deal in full with this medicare legislation before a summer recess. References can be found in Hansard for June 1, June 22, and in several other places. I have the various clippings from Hansard on my desk, as a matter of fact.
I submit, Mr. Chairman, that if we do not get the legislation through at this time or at least get it approved in principle on second reading, the chances are slim of medicare being in effect on July 1, 1967. If this measure is not considered until the fall, I suggest that the debate we have had here today indicates the second reading debate will be a long one. Before you know it, it will be

July 12, 1966

Christmas and the provinces will not be in a position to pass complementary legislation. The suggestion that the legislation should go to a committee for study is a plausible one. However, Mr. Chairman, as a result of the studies that have been given to this matter in the last half century, surely we are in a position to act. I think of the various reports we have had during the years, such as the Heagerty report, the Marsh report, and so on. I think of all the work that went into the preparation of the green books that were presented to the federal-provincial conference in 1945. I think of an actual bill that was laid on the table of this house in 1944 or 1945 by Hon. Ian Mackenzie, then minister of pensions and national health.
All of these studies have been updated by the studies into health grants and hospitalization, as well as many departmental studies. We took this matter up in the estimates committee a few years ago and a very exhaustive study of it was conducted by the members of this house. Now we have had the Hall report, and members in all parts of the house agree that this was a tremendous study. There have been federal-provincial conferences galore, and I suggest that basically parliament is in a position to make up its mind on this question. I hope we will do it now so that the target date of our 100th birthday can be met with respect to this important question.
I said that we are in full support of this legislation. Any suggestions or criticisms that we might make would be with respect to the details. There are one or two to which I want to refer briefly. I note that the wording the Prime Minister used last July regarding the scope of the services to be covered seemed to me to be a little broader than the wording used today by the minister. Last July the Prime Minister talked in terms of all the services that might be required. The minister today talked in terms of physicians' services of all kinds. Then, he said, he hoped, in the not too distant future, he will be in a position to enlarge on these services.
This strikes me as imposing a limitation, at least in spirit, that was not contained in the announcement the Prime Minister made last July. I should like to suggest this to the Minister of National Health and Welfare. He had a great deal to say during the debate on the Canada Assistance Plan about the fact that there is no ceiling on the assistance or the welfare services in which the federal government will participate. I suggest that he
Health and Welfare
should apply the same principle to this legislation. If a province wants to enlarge the range of insured services, the federal government should agree to that and should place no limitation on it, any more than it does on the assistance or the welfare services set out in the Canada Assistance Plan. I remind the minister also that on May 17 of this year, as recorded in Hansard at page 5213, he announced the government's decision to let medicare come into effect in any province that agreed to it without waiting for the majority of all provinces. We immediately approved of that stand, and we still approve of that position. It seems to me that consistent with that position, namely that a province that wants to come in can do so without waiting for the others, is the further position that if a province or two or three provinces want to go further than some of the others in the services that are to be insured, the federal government should go along with that position. We will develop this idea when we go into committee on the bill.
There is one other point that I think we will want to look at rather closely when we are considering the bill, and that is with respect to what is known as the third criterion. I refer to the one having to do with plans being provincially administered. Here, again, I detected a slight difference between the wording of last July and the wording of today. I was only slightly concerned when the minister spoke, but I was really quite exercised when the hon. member for Coast-Capilano spoke because he seemed to see in this wording a possibility of private carriers being included in the plan. I realize that the hon. member for Coast-Capilano does not speak for the government, but at least he has posed a question with which we will want to deal when we go into committee.
[DOT] (8:40 p.m.)
The time for this debate is limited and we are limited to 20 minutes, so I shall cut my remarks short. There are in fact just two more things I want to say, and I can say them briefly. In the course of this debate those who have been critical of this legislation have trotted out the word "priorities". They spoke about two other things that should come first. Last year when we were debating the Canada Pension Plan we had this same argument. People then were saying: We must establish priorities. Education and health were regarded by some speakers as matters that had priority over the Canada Pension Plan. Today, because we are dealing

July 12, 1966
Health and Welfare
with health, the people who were talking in this way are saying that education and pensions should take priority over health. I suppose if we had a bill to provide massive sums of money for education those same people would be saying that health and social security should have priority over education.
It seems to me, in a country that has a gross national product of $55 billion, in a country that has the affluence and the prospects of this country, that we do not need to talk about one or the other of these things. We have the money to provide social security, education, and health. Those who talk about priorities, as I see it, are attempting to slow down our work in this important field. I urge that we have the capacity to go along with all these important aspects of social welfare, and I hope that we shall do so without the kind of delay that we have had from the party opposite, which has taken 47 years to implement the three most important planks in its 1919 platform.
The other point I should like to make relates to the complaints that some people have made about the payments that will have to be made for medicare, even though it is clear that there will be no premium at the federal level, and even though it is clear that, for the most part, our medical services will be paid for out of general revenue. The point was made by an hon. member that this involves taxes, and that our people do not like taxes of any sort.
I know it is an old cliche, and it is an adage that everybody does not agree with, but I think it is true that taxes are the price we pay for civilization. I suggest if we must pay taxes for civilization, one of the aspects of civilization that is most worth paying for is the good health of our people. I urge that we do not keep finding these excuses for a slow-down with respect to this legislation, but that we recognize, as was said the other day by my leader, and as was subsequently said by others, that the best thing we can do to celebrate our one hundredth birthday, on July 1, 1967, is to have medicare in effect.
I urge therefore, Mr. Chairman, that this committee of the whole and this House of Commons act on this legislation in the light of its importance, that we get this resolution through, and that we proceed with the bill before we think of going home for a summer recess.


John Carr Munro: I could not help noting that the hon. member for Winnipeg North Centre kept referring to the Liberal platform policy

which had been announced back in 1919. It seems to me, ever since I have been here, since 1962, that that has been the permanent line adopted by the hon. member for Winnipeg North Centre. I would point out to him how tedious it is to hear the same line day in and day out, and how refreshing it would be to hear something novel and original.
I think it will be well, before the hon. member talks about how long it has taken some parties to implement their policies, to remember that the leader of his party for almost 20 years was premier of Saskatchewan, before he brought in medicare legislation in the early 1960's. It would be well for the hon. member for Winnipeg North Centre to bear that in mind before talking of how long it has taken other parties to implement their programs. I do not think it is pertinent to discuss what some political parties might have done or said 30 or 40 years ago. I think the point to remember is that now we have legislation before us, and that we should get on with it and put it into effect.
That brings me logically to the position taken by the official opposition. It seems that they would prefer to deal with the initial stages of the legislation now, and then deal with the remainder of it, namely, second reading, if I am stating their position correctly, later. I find this a very difficult position to comprehend, especially when one looks at the stages that this program has gone through in the last three years, to wind up in the resolution before us today.
We had the royal commission-and a good commission it was-set up by the Conservative government between 1958 and 1962. That commission reported two and a half years ago, and it came out with its second volume less than two years ago. Following the publication of these two reports-actually it would be more accurate to say that the second volume came out one and a half years ago-the government launched an intensive study of its recommendations. After that the government took the initiative and put forward proposals at a federal-provincial conference in July, one year ago. These were the proposals setting down the four criteria which have been referred to frequently today.
That shows progress, I would say, that no one should be ashamed of. These reports had to be studied, and they were studied intensely. Federal-provincial conferences were called, and the first one of real significance was over one year ago when the four criteria were laid down which are contained in the
July 12, 1966



bill we have coming before us, and which have been submitted in this resolution.
There is nothing novel about the matter. Members of this house have been aware of this legislation, and of its nature, for over one year. We all have been aware of the royal commission report for well over two years. Why it should take any further mulling over, or why it should need any further time for discussion over the recess is hard to understand.
I would think in view of the royal commission's findings, in view of the ample material there available for all to study, in view of the fact that the principal ingredients of this resolution were laid before a federal-provincial conference over a year ago-ingredients which have changed hardly at all and which are contained in this resolution, and in this proposed legislation-we should be able to complete this legislation within a day or two. I would urge that that course of action be adopted. We should then have done something which we could be proud of accomplishing prior to recess.
I think now, Mr. Chairman, it would be appropriate for me to deal with some of the principal objections taken to this legislation. The objection you often hear, although it has not been referred to too much in this house today, is the objection to there being any target date. It has been suggested that setting a target date is unnecessary and unrealistic. With this I do not agree. Without target date discussions can drift, and it can be years before any progress is made.
Another criticism that is most often repeated concerns the universality of application of these proposals, and of the compulsory element that flows from such application. As has been mentioned, the government put forward four basic principles which it felt were prerequisite to the federal government sharing the cost. It has been argued in some quarters that one or more of these criteria should be deleted. One of the principal criteria to which objection has been made is that provincial schemes should be universal in coverage. Opponents of medicare argue that this principle is repugnant to a free society-that it involves compulsion and is not in keeping with a democratic society.
[DOT] (8:50 p.m.)


Eric Alfred Winkler: Would the hon. member permit a question? I should like him to explain the statement he has made about universality and compulsion and tell us the exact 23033-481
Health and Welfare
position he takes. Are they similar, or is there a difference?


John Carr Munro: If the hon. member would listen to the remainder of my speech my position will become very clear.


Eric Alfred Winkler: It will be difficult, but I will try.


John Carr Munro: I suggest that universality is an essential ingredient of any real medicare program. It underlines the basic philosophy of the Royal Commission on Health Services; it is also an element common to many provincial health, social and educational programs now in operation in the public sector of the economy. Elementary education, for example, is now universal-compulsory, if you like-as are vaccination and pasteurization. Yet I do not hear any strenuous objection from the other side in regard to these progressive measures.


Eric Alfred Winkler: That is right; but you are not extracting a fee for those purposes.


John Carr Munro: At any rate, this is an objection I hope to deal with at some length. Amother objection one hears, and it has been raised by some medical associations, is that medicare will turn medical practitioners into civil servants. I do not believe this is so. A further objection-I heard it in this committee today-is that medicare will impose an intolerable burden on the economy, one which Canada is not ready to assume. I do not think that either the facts or the experiences of other nations bear this out.
A further criticism, and one which is related to the financial argument, is that medicare at this time is politically motivated and that it has been placed improperly on the list of priorities to the prejudice of other measures which are badly needed. Education is usually mentioned as a public need which has been forced to take second place to medicare.
The primary objection which seems to be worthy of mention is that medicare as presently envisaged by the federal government will severely prejudice the quality of medical services available to Canadians. This is an objection which the hon. member for Simcoe East stressed this afternoon. While I could not agree with many of his observations I felt his was a speech with real content, one which included many worthwhile suggestions.
I have outlined the principal objections here to the medicare proposals. I should like to deal particularly with the arguments of

July 12, 1966
Health and Welfare
those who object to universality. They feel it compromises freedom of choice-that it compels people to participate in the plan and is foreign to the tenets of democracy.
Surely it is necessary to introduce the principle of universality in any program which so closely affects the health and life of all Canadians. The voluntary approach would never result in everyone being covered. This is a proven fact. I should like to refer hon. members to some figures on this aspect of the subject. The very group which would not be covered by voluntary plans is often the group which fails to receive adequate and, all too often, essential medical care. Universality may lessen an individual's freedom from coercion, but for many, total freedom is enhanced; for many it is the key to the enjoyment of such fundamental rights as freedom from want and freedom from fear.
We talk of equal opportunity. How can we achieve this lofty goal when there are many who for lack of means do not receive adequate health care? How are these people physically able to participate fully in, and contribute to, society? How can they share in the opportunities afforded their more fortunate compatriots?


Eric Alfred Winkler: Can the hon. member indicate what he is reading from?


John Carr Munro: I am reading from my own notes which I have prepared.
Hon. members may be interested in the results of a study of the Alberta plan. Examination of this plan shows that it fails by a considerable margin to achieve universal coverage through the voluntary method. As of May 1, 1965 the Alberta medical plan covered 831,268 residents of the province, or 57.3 per cent of the population. Other plans offering equal benefits cover another 118,981, or 8.2 per cent. Thus, together, these two elements which form the basis of Alberta's plan provided coverage for only 65.5 per cent of the population of the province.


Eric Alfred Winkler: Would the hon. member permit a question at this point? I should like to ask him whether the people who need the service in the province of Alberta are getting it, and whether they are satisfied with it. That is the question which matters.


John Carr Munro: I would say that a very significant proportion of the people, a proportion in excess of 30 per cent, were without coverage as of May 1, 1965.


Eric Alfred Winkler: Do they all want it, or don't
they? Is it available to them if they need it? That is all I want to know.


John Carr Munro: Mr. Chairman, I would very much appreciate the opportunity to complete
my remarks.


Eric Alfred Winkler: I want some answers to these
questions.


An hon. Member:: Make a speech.


Eric Alfred Winkler: Yes, I will make a speech.


John Carr Munro: If the hon. member wishes to refute my contention I trust he will have the opportunity.


Eric Alfred Winkler: I do not want you to mislead the people of this country.


John Carr Munro: I do not think the hon. member should worry about people being misled by this side of the house.


Eric Alfred Winkler: You are good at doing it.


John Carr Munro: talking of those goods produced and distributed on the basis of the open market system, a system where the voluntary element is circumscribed only by the dictates of price. We are talking of something much more than services which someone provides because he can turn a profit. We are dealing with services where, for a variety of cogent reasons, such considerations do not apply.
To raise the criticism of lack of choice and, at the same time, to limit it to medical services-one area in the whole health services field-is quite incomprehensible. If this criticism has any validity, should it not be equally applicable to the whole spectrum of health services?
By insisting on universality the federal government has gone a long way toward ensuring that Canadians will pay the most reasonable rates for medical coverage. The risk will be spread among all the people. In this connection I should like to refer to a comparison of rates under different schemes.
Many critics of medicare advocate that coverage be provided by private insurance companies and that these companies be subsidized to provide coverage for those unable to pay their own way. They suggest that private companies could provide this service at a fraction of the cost of the federal proposal. The facts do not bear out this contention.
Figures show that private plans pay out considerably less revenue on claims than do public sponsored plans. The Hall Royal Commission figures show that retained moneys, that is, money not paid out in claims, for private plans range from 38 per cent to a low of 18.5 per cent for a prepaid plan. This covers direct administrative costs, acquisition of new members, commissions, taxes, reserves and profits. In Saskatchewan on the other hand the retention ratio, free of reserves and profits, was only 6.39 per cent in 1963 and 5.81 per cent in 1964. From this comparison it can be seen that there will be a heavy obligation on provincial administrations to have these plans publicly administered.
Another objection in the summary of criticisms is the fact that doctors would now be relegated to the role of civil servants. Such an allegation is set out in a draft letter that the Ontario Medical Association sent to doctors throughout the province, asking them to 23033-4811
Health and Welfare
sign it and send it their patients. I quote one paragraph from that letter:

Referring to the doctor who it is proposed should send out the letter.
-am deeply concerned about Mr. Pearson's proposal because a compulsory, government operated medicare plan could adversely affect our relationship. I would become virtually an employee of the government, and would not be free to care for you and your family in the same way I have done in the past.
Such an allegation is simply not correct. It presupposes that the doctor will not be able to choose his patients; that the patient will not be able to choose his or her physician; that the doctor will not be free to practise where he wishes; that the doctor's fees will be arbitrarily set and that doctors will not have the choice to practise in or out of any government sponsored program. These are the faulty assumptions inherent in the draft letter.
Any provincial scheme can be implemented and qualify within the four criteria and, at the same time, guarantee the preservation of all the above rights, rights which are repugnant to any employee-employer relationship. It has not been suggested by anyone at the federal or provincial level that the doctors would not have the freedom of choice of patient, or the patient freedom of choice of doctor. It has not been suggested that the method of payment to the doctor would be on other than a fee for service basis.
It has not been suggested by anyone that there be any regulations governing where a doctor can carry on his practice. In fact, it has been suggested in the Hall Commission report that the fee schedule would be determined through consultation between the government and the recognized associations representing the medical professionals. How then can it be said that the doctor becomes a government employee or civil servant? How then can it be said that the government is interfering with the doctor-patient relationship?
The third objection is that medicare would place-


Maurice Rinfret: Order. I regret to interrupt the hon. member but the time allotted to him has expired.


John Carr Munro: May I have a few more minutes?


Maurice Rinfret: Is this agreed?


Some hon. Members:: No.

July 12. 1966
Health and Welfare


Maurice Rinfret: I regret there does not appear to be unanimous consent.


Mr. Fulton:: Mr. Chairman, during the course of his introductory remarks this afternoon the minister made a request which the committee, I am quite sure, will comply with, that the proposal he has submitted will receive the constructive and conscientious attention of the house. I trust therefore that if the attention that members give to his proposal, and to the statement he made this afternoon, gives rise in turn to some difference of opinion and criticism, he and the government will give those contrary opinions and those criticisms the same degree and kind of attention that the minister bespoke for his own proposal.
I am quite sure that a statement which would receive universal acceptance is that a proposal that prepaid medical services be available to all Canadians is a valid and desirable objective, and a proper objective for government to seek to accomplish. But I suggest to you, Mr. Chairman, that we as members of parliament cannot be carried away by a mere statement of objective and that we are still entitled, and indeed required to examine any specific proposal laid before us by the government, in this and any other field, in the light of certain criteria.
The two criteria which I suggest apply most particularly and forcefully here, and which we are bound to bring to bear upon examination of this proposal are these: First, how does the proposal meet the test of economic realism? How does it fit in with any realistic assessment of the priorities-and I make no apology for using that word-to be allotted to government objectives and expenditures? I hope the government will not take the position that it must rush blindly after all objectives that occur to it, without trying to assign some priorities among them.
And second, how does the proposal in question meet the test of constitutional propriety? I use the reference to the constitution here not from the sense or point of view of strict legal application-the question of whether or not the legislation is ultra vires or inter vires-but rather use the words constitutional propriety in the sense of the proper relationship between the two levels of government in Canada, and applying to the proposed activities of the federal government the test of whether or not they involve an unjustifiable intrusion by it into a field which properly belongs to another level of government.
[The Deputy Chairman.]
I suggest most strongly, Mr. Chairman, that on the basis of an examination of the government's previous announcements in connection with its medicare program, and an analysis of the minister's statement this afternoon, the proposal he has placed before this committee, and will place before the house, has very serious deficiencies with respect to both the criteria that I have suggested should be applied.
Looking first at the matter of the economic realism of the proposal, I suggest to you, Mr. Chairman, and to members of the committee, that what is involved here, when a scheme such as the minister has in mind is in full flower, will present a major distortion of the economy and of any realistic scheme of priorities.
[DOT] (9:10 p.m.)
Mr. Chairman, all welfare schemes and projects are desirable; of course they are. Anything that will contribute to the betterment of our people, to the better care of our health, to our needs in old age, or any other aspect of our lives as Canadians, is desirable. But it seems to me that as a growing, developing young country we must assign priorities to the problems which confront us. We must bear in mind that the federal government is not responsible for all aspects of Canadian life or all the welfare of Canadians. Nor are the resources available to the government without limit; and therefore it is prudent and proper in the interest of Canadians to insist that the federal government bring a measure of judgment to bear with regard to what its programs will be and on what basis it intends to carry them out, as well as the priority assigned to them.
At the moment, on the basis of proposals and commitments made by the government, we are faced with a vast increase in commitments for expenditures in respect of security measures. In respect of the Canada Pension Plan-the cost of which I have yet to see authoritatively stated-the estimated cost is at least $600 million per annum. We are apparently about to be committed to a medicare plan which at its inception, on the basis of the statement made by the minister this afternoon, will cost $340 million per annum out of the federal treasury. Recently we have had the Bladen report on the needs of education in Canada, much of which has been approved in principle and in respect of which a commitment in principle has been given by the Prime Minister. If implemented in toto its cost can reach an astronomical amount; the
July 12, 1966

commitments given will probably amount to some $500 million per annum out of the federal treasury.
So that on the basis of just those three
commitments, in what I might describe generally as the field of welfare, at least $1,500 million-and I suggest closer to $2 million per annum-more has been committed to be raised by federal taxes and paid out of the federal treasury, than was the case just 18 months ago.
And that is in these three areas alone,
leaving aside other real responsibilities of the federal government in such important and vital areas as our responsibility in the field of anti-pollution and de-pollution of our water resources. These increased costs are on the basis of present estimates and I suggest, Mr. Chairman, that we are entitled on the basis of past experience to assume that the estimated costs are well below what they will in fact turn out to be.
My view is that the government has no right or reason to enter into welfare schemes oblivious of the economic consequences. It has to consider whether there will be sufficient funds available for investment in our economic development and whether we will have to place further reliance on foreign investors for Canadian development.
Is it not a strange situation that here we have a present Minister of Finance and a former minister of finance of this government vying for the leadership of the Liberal party on the basis of the question of foreign investment in Canadian development enterprise. Both of them are committed to allowing this increase in expenditure on this kind of measure, which at the same time is helping to reduce the capital available in the pockets of Canadians for investment and which cannot help but increase our dependence on foreign capital. There is no consistency or logic in the government's position. For a government, some of whose spokesmen are crusading to, "buy back the Canadian economy," this is an odd position indeed.
With respect to the estimated cost of this program alone we already have seen a considerable escalation in the estimate. The government originally estimated the per capita cost at $28 to be shared equally by the federal and provincial governments. I understand it now estimates it at $34, an increase of $6 per head. In other words, within six months the estimated cost of medicare has risen by over 20 per cent.
Health and Welfare
Even the recent figures I believe are overly optimistic. In this connection it is interesting to note the experience of the United Kingdom, with their national health service. Their estimated annual cost of $510 million for the first year turned out to be $1,206 million and has risen steadily to $3,754 million despite the imposition of certain service charges. I suggest that on the basis of that experience, and our own experience, the minister has probably very seriously underestimated both the initial and future annual costs of the medicare program.
I suggest to you, sir, that we should be devoting our energies and our resources to meet the priority needs of the Canadian people and that those priorities really lie in the development programs which would aid in the creation of new jobs. If we concentrated on those, we will eventually reach the position where we would be able to finance even a universal medicare scheme.
I suggest that we take very special consideration of these things and that if we do not the consequences will be disastrous indeed, and if we are to give priority to any form of social measure, I say the priority should be given to education. Even in the field of medicare itself that is where the priority should be given now. In the field of medical assistance we should be providing funds so that we can produce the doctors, teachers and nurses so that we can staff our medicare program.


Allan Joseph MacEachen: Would the hon. gentleman mind if I asked him to relate the matter of increased aid for old age pensioners to the problem of priorities.


Mr. Fullon:: Certainly. We are asking that those elder citizens who are not taken care of under the Canada Pension Plan, should be taken care of. That is where the priority should have been given. In the matter of priorities in this field I would ask the minister to approach this matter with a sense of realism, but apparently that is a hopeless request.


Allan Joseph MacEachen: Is my hon. friend now endorsing the $25 flat rate increase in the pension, in the light of the financial consequences?


Edmund Davie Fulton: Mr. Chairman, my colleague the hon. member for Perth, placed on the order paper of this house and brought forward for discussion toward the end of last

July 12, 1966
Health and Welfare
week a proposal in this matter which logically and realistically sets out our position in the matter of the $25 increase in the old age pension. I commend it for the consideration of the minister.
[DOT] (9:20 p.m.)
On the basis of arguments and considerations I have so far brought forward I submit with all earnestness that the federal government has no right in the first place, and has no reason in logic or in responsibility, to impose this scheme on the provinces as the minister intends to do. I submit, rather, that the approach by the federal government to the plan of prepaid medical services in Canada should be to offer to supplement provincial schemes where there are gaps in the present coverage. Because I believe in matching criticism with constructive proposals I should like to put before the committee and the government at this stage a brief statement of principles upon which I think the federal government's approach to medicare should be based. I will summarize them as follows.
Any plan for prepaid medical coverage to which the federal government contributes should not be on a universal and compulsory basis, but should be based on the following principles:
One, that medical services, at an adequate level, should be available to all Canadians on a prepaid basis.
Two, that this being a field primarily within provincial responsibility, the federal government should not seek to superimpose any national, universal or compulsory scheme on existing provincial schemes.
Three, that the role of the federal government should be to extend to the provinces financial assistance to enable them to establish provincial medicare programs whereby prepaid medical care is available to all citizens at a fixed premium, or cost, but not to compel contributions to or participation in a scheme by those who are now covered adequately, or who are able and prefer to provide medical care for themselves.
Four, that all schemes of prepaid medical care, to qualify for federal assistance, should preserve the voluntary doctor-patient relationship.
Five, that beyond federal participation in such uniform programs to ensure availability of standard coverage, the provinces should be left free to expand or enlarge medical care schemes as they and their voters see fit, while the federal government should concentrate its efforts in the vital fields of encouragement of,

and provision of resources for, training and research in medical, dental, nursing and other related occupations and facilities.
That, in my submission, Mr. Chairman, is a sound and realistic set of principles upon which federal participation in a program of medicare should be based. Such an approach would lead us to offer to the provinces help in a voluntary but universally available plan.
There are other statistics and considerations which argue this way as well. The 1964 survey on voluntary health insurance reported that more than 80 per cent of Canadians were covered then by some form of prepaid medical care. With the Ontario, Alberta and British Columbia plans now in effect, on the basis of some estimates this figure approaches 90 per cent, although I am told that a more realistic estimate is between 86 and 87 per cent. I have seen estimates that 12.8 million Canadians are now covered by adequate prepaid medical care plans.
The government, however, wishes to use a shotgun approach to the problem. In order to provide medical care for the approximately 10 per cent not now covered-and that is the gap we should be concentrating on-the government insists upon a new type of universal plan which will supersede private and corporate plans long in existence. On the basis of the minister's proposal, all private plans must be wiped out and this plan must be publicly administered. Let me ask him and the committee what is going to happen to some of the very adequate and excellent private plans now in existence, under which employees of companies in large numbers are covered? These individuals are covered by medical plans they like, the benefits of which they enjoy. They are perfectly adequate in coverage. Many of these plans are paid for by the employer without any contribution at all by the employee, as the result of agreements arrived at through the years of the process of collective bargaining. These plans are apparently to be wiped out by the minister's proposal, and there will be substituted some sort of universal plan which can only be paid for out of the tax purse, to which these employees will be contributing. This will deprive them of a benefit they have attained as a result of the process of years of collective bargaining.
I suggest the alternative Ontario Medical Services Insurance Plan or the British Columbia plan, which are universally acceptable and under which the provincial governments pay the premium for the lowest income
July 12, 1966

groups, effectively meet the government's objection to a voluntary scheme. They are universally available, and show that the government's fear that the most needy would not participate or benefit can be met without a compulsory program.
Indeed, Mr. Chairman, since the Hall Commission report is being quoted extensively, I think we should remind ourselves of what was said by the commission at page 3 of volume 1 of its report. These are the words used:
The commission believes that the individual's responsibility for his personal health and that of the members of his or her family is paramount to the extent of the individual's capacities.
Surely one can agree with the objective of adequate medical services for all Canadians without endorsing a comprehensive system of compulsory medical insurance.
These are some of the considerations which in my view indicate that the plan of the minister and the government is not economically realistic. As to the other criteria in relation to its constitutional propriety, again I find that there are very serious objections.


Maurice Rinfret: Order, please. I regret to interrupt the hon. member, but the time allotted to him has expired.


Some hon. Members:: Carry on.


Maurice Rinfret: Is it agreed that the hon. member may continue his speech?


Some hon. Members:: Agreed.


Edmund Davie Fulton: Mr. Chairman, I appreciate the committee's generosity and I will do my best not to abuse it, and to bring my remarks to a close very shortly.
It is, in my opinion, inescapable that the government must not take the position, as the minister has, that it will dictate to the provinces how they will run their medicare programs, if they want to obtain federal financial contribution. It is true that the minister this afternoon in his words recognized the constitutional fact of provincial jurisdiction. But this is what he said earlier in answer to my question as to whether provinces, which do not care to accept the federal criteria, would qualify for a fiscal equivalent:
I wish to state there is no provision for federal contributions to provinces which do not have medical care plans which conform to the four criteria . . . The medical care legislation will not require agreements between the federal and provincial governments; it will simply authorize payments from the consolidated revenue fund to any province which has a medical care plan as described in the federal legislation.
Health and Welfare
In other words, Mr. Chairman, most clearly what is being said is this: Here we are, boys, we have a lot of money in the federal treasury; it is there for you if you will be good and run your medical care programs the way we want you to run them, and not the way you think you should run them. This clearly indicates a heavy-handed use of the club of financial power to force provincial acceptance of federal dictation.
What is the difference between what the minister proposes there, and a proposal that the federal government has money in the treasury and will give it, say, to the province of Manitoba for education if that province will alter its school curriculum and provide for the teaching of French at all levels of their school system? Alternatively, what is the difference between the minister's proposal and the federal government saying to the province of Quebec that it will give that province money from the federal treasury if they will adopt a school system of the kind considered desirable by the people here in Ottawa?
This is nothing more than financial blackmail and it is totally and completely unacceptable.
The federal government makes the boast that what it is doing is co-operative federalism. This is not co-operative federalism: This is dictatorial federalism of the worst sort.
[DOT] (9:30 p.m.)
Mr. Chairman, there are many other objections that I could put forward on the grounds of constitutional impropriety, but as I wish to show the committee my appreciation of their courtesy in allowing me to finish my remarks, I will conclude simply by saying that the other criticisms are equally as valid as those I have already made.


Eric Alfred Winkler: Mr. Chairman, I am certainly very pleased to have this opportunity to participate in the debate, and I can assure you it is not by choice. Probably one might say it is because of provocation, which is not unusual in this house and perhaps is not unusual at this stage of a session. I viewed with a great deal of dismay the way in which the hon. member for Hamilton East entered the debate. I also viewed with tremendous apprehension some of the words that he spoke. The reason I say this is that he referred, as did many speakers this evening, to who was the father of legislation such as this.
If hon. members wish to go back to years gone by, I can recall on another occasion in

July 12. 1966
Health and Welfare
this house referring to the remarks of Bismarck that were made, not a few decades ago but many, many decades ago. He was certainly a hidebound conservative in European politics and was, I believe, the father of this and many other types of social measures that have been introduced into western social justice. But the thing that concerned me most so far as the hon. member for Hamilton East is concerned was the fact that at this stage in the debate he was allowed to inject certain thinking, in very carefully chosen words, in regard to what government policy is now and what their intentions are.
I say to the hon. member, who is a member of the legal profession, that he would be ostracized by his colleagues in that profession if he tried for one moment to impose this sort of dictatorial control over his friends in the legal profession. One of the things in this country that is becoming vitally serious is that people such as the hon. member and others in the legal profession are coming out and advocating such policies and supporting such socialistic plans as the one to which he paid lip service this evening, as did other hon. members. In view of this it is my opinion that we should socialize the lawyers quickly-and very quickly.


Some hon. Members:: Hear, hear.


Eric Alfred Winkler: I notice, Mr. Chairman, that I have a lot of support in this respect. I will be condemned for this, I know; but not being a lawyer I do not very much care. I happen to know the fees that lawyers charge, as do my hon. friends in the New Democratic Party and others. I know what fees the hon. member gets for his services and the fees other gentlemen in his profession are paid. I am a free enterpriser and wish to follow a free course, as other free human beings wish to do. It is interesting that we in Canada are now moving into this medicare plan when the people of England are starting to move out of it.


Thomas Clement (Tommy) Douglas: That is nonsense.


Eric Alfred Winkler: It is not nonsense at all, when you realize how many people in that country are today covered by private plans who were not covered by private plans two years ago. I have the figures here and can give them to the hon. member now. In England today over two million people are insured by private plans who were not insured before the medicare plan came into effect.


Some hon. Members:: Oh, oh.


An hon. Member:: They don't want to hear that.


Eric Alfred Winkler: I know they don't want to hear that. It is a peculiar thing, too, that the plan in effect in Alberta is a rather satisfactory one. I hesitate to say this because it is sometimes taken in the wrong way, but I went to work in this country for as little money as anyone in the depression days. I am not ashamed to admit that, nor to say that the family from which I came needed a great deal of the support that families get today; but my family did not receive that support. We would have had greater opportunities if this assistance had been available; I do not deny this for one moment.
But I say to you, Mr. Chairman, the house and the country that what we should be dealing with in a medicare bill is serving the needs of the people who need help the most. If the people do not choose to participate in such a program, it is not for us to cram it down their throats, if they are prepared to pay the tax out of which other people will be assisted. There is nothing charitable about that situation or the government bringing in such a plan.
The hon. member for Hamilton East also referred to a letter sent out by a doctor to his patients, or some distribution of this type of literature in the province of Ontario. I should like to ask the hon. member if he thinks that doctor or the Ontario Medical Association was lying, because that is what the hon. member implied. I should like him to deny that statement.


John Carr Munro: Mr. Chairman, I was reading from a paragraph of a letter that the Ontario Medical Association sent out to doctor members. The paragraph I quoted from was contained in a letter they sent to the medical profession, suggesting that they incorporate the particular paragraph in a letter they wished them to send to all their patients. I read the paragraph and after reading it said that the conclusions reached in the letter were faulty and incorrect. I pointed that out in my speech, if the hon. member was listening. I did not say the doctors were liars. The hon. member is now attempting to pervert my remarks.


Eric Alfred Winkler: You perverted your own remarks, but I will accept your explanation.
I would also make reference to the cost of plans which have been adopted by governments. I preface these remarks by referring to the speech delivered in this house not
July 12. 1966

many evenings ago by the right hon. Leader of the Opposition in which he explained the socialistic plans that were instituted and developed in the province of Saskatchewan. Since the medicare plan was adopted in Great Britain it is interesting to note that it has increased in cost by 500 per cent, and this is not unusual in a government instituted plan of this type.


John Carr Munro: Mr. Chairman, may I ask the hon. member a question now? Is he advocating, as I take it he is from his remarks in objecting to the universality of this plan, medicare with a means test?


Eric Alfred Winkler: My earlier statement was very clear in this respect. I am here as a member of parliament, representing and serving the people. I said before that I believe the duty of every member of parliament is to serve the people's greatest need now, if the need exists; and I know it exists in the case of some people in our society who cannot afford to pay for these things. But I do not understand why people should be forced to participate in a plan that is offered to them, when they already have a plan of their choice. I believe that this is a choice most people wish to make of their own volition. I am not supporting a means test at all. I spoke too often against the means test in connection with the type of social legislation the government are introducing in connection with old age pensions. I am against that sort of thing and will be against it forever.


John Carr Munro: Do you want a means test?


Eric Alfred Winkler: You cannot talk to me now the way you spoke earlier this evening. Mr. Chairman, if the hon. member will resume his seat I will carry on with my speech.
I should like to refer now to the province from which I come, and to the program in effect at the present time in Ontario. I would ask the minister to clarify his position in regard to universality and compulsory participation in such a scheme. Does he say that a province which has 90 per cent of its people enrolled in such a plan will be entitled to the money available through this particular scheme? Or is a province which has a 90 per cent enrolment going to be forced into the compulsory aspects of the scheme the minister has enunciated in this house?


David Lewis: Mr. Chairman, would the hon. member permit a question?
Health and Welfare
[DOT] (9:40 p.m.)


Eric Alfred Winkler: I should like to proceed by saying that I believe the Minister of National Health and Welfare-


David Lewis: Is the hon. member afraid of a question?


Eric Alfred Winkler: I am at a very high point in
my speech, if the hon. member does not mind.


David Lewis: Will the hon. member permit a question?


Eric Alfred Winkler: If the hon. member does not mind I should like to continue my statement. I am at a very high point of my speech, Mr. Chairman.


Herman Maxwell Batten: Order, please.


Eric Alfred Winkler: I am grateful to hon. members across the floor. I want to say this, Mr. Chairman, and it is a very serious point.


David Lewis: Is the hon. member at a low point now?


Eric Alfred Winkler: If the Minister of National Health and Welfare introduced this plan now because of the enrolment that is taking place in the largest province of this country-


Allan Joseph MacEachen: Which one?


Eric Alfred Winkler: If he did that, he is guilty of exactly the same fault, in my humble opinion, as the Minister of Agriculture in regard to the milk farmers, and as the Minister of Industry in regard to designated areas. When I was a child going to school we used to call it "dirty pool". I believe it is very significant that the Minister of National Health and Welfare is forcing this issue at this time because he is only pulling the rug from under the people who wish to serve those in greatest need.
I am not only referring to the province of Ontario. I believe that the province of Quebec is currently considering the same type of program. The province of Saskatchewan already has such a program, as have the provinces of Alberta and British Columbia.
What is the minister trying to do? If he is trying to impose a new set of ground rules to replace the satisfactory plans which are now in existence, then I suggest that the unparliamentary language I have used would apply.


David Lewis: May I ask the hon. member a question before he takes his seat? The hon.

July 12. 1966
Health and Welfare
member for Grey-Bruce stated, if I heard him correctly, that in Great Britain the cost of the medicare plan has increased by 500 per cent. May I ask the hon. member where he obtained that information, so that we may all be able to read it?


Eric Alfred Winkler: I made inquiries from a very authentic source and that was the information that was given to me this afternoon. May I also inform the hon. member that the research and the medical and surgical teaching has sadly deteriorated in the same period.


David Lewis: Can we be informed of this authentic source, Mr. Chairman? I am paying the hon. member the compliment of accepting his suggestion that his source is authentic, and I should like to share with him the information from this authentic source.


An hon. Member:: It is a Conservative source.


Eric Alfred Winkler: No, it is not a Conservative source. This information has come to me from a professor of medicine at the University of Western Ontario.


Thomas Clement (Tommy) Douglas: Now we know where it came from. This is a bit much. You did not consult him; you got this information in your mail.


Mrs. Maclnnis (Vancouver-Kingsway):: Having listened to the debate this afternoon and evening I can well understand why it has taken nearly 50 years to get the medicare resolution up to the present stage. Before hearing this debate I had no idea that there were so many hon. members in this house who have been talking across the country about the need for medicare and about the need of the sick people; that there have been so many people promising a national scheme of medicare for many years and who have then, on being faced with a good piece of legislation, spoken about the need for education and the need for legislation on this, that or the other thing, and then have mounted a sudden surprise attack stating that this legislation deprives the people of this country of their liberty.
I feel it is time that Canadians saw the way in which so many hon. members in the house are reacting to the legislation now before us and which the government has had the courage and foresight to present to the house. I hope that at this stage the government will not weaken or defer this measure, because I think that if the minister were to leave this matter at the resolution stage, the

summer recess will be used by many hon. members whom we have heard speaking in the house in order to prejudice certain groups of people in their own constituencies against this legislation.
I suggest, Mr. Chairman, that they will await the opportunity of having this matter referred to a committee in order to kill the legislation before it gets any further. I appeal to the government to go ahead with this matter. I can assure the minister that this measure will have the support not only of a sufficient number of us in this house to have it passed but also the support of the people of this country who have been waiting for medicare for such a long time.
We have heard many quotations from the Hall report, and I was very disappointed to hear the hon. member for Kamloops trying to enumerate a few minutes ago all the medical coverage that Canadians have under private schemes at the present time. The Hall report states quite clearly that after more than 35 years of endeavour on the part of voluntary groups and commercial insurance companies, only slightly more than one half of the population of Canada has any degree of voluntary insurance protection, and this for medical services alone. Of this number, the coverage held by nearly three million people is wholly inadequate. Over 7.5 million Canadians have no medical care insurance whatsoever. I think it is time we stopped talking in distorted terms regarding the medical coverage of Canadians.
The Hall report is an exceedingly worthwhile document and its findings have been beyond criticism or dispute. I think that sometimes we are forgetting why this legislation is being introduced at this time. It is simply being introduced because coverage of this kind is urgently needed in Canada. It has been abundantly proven over and over again that not only the small sections of the population about whom we have been hearing tonight, but wide ranges of Canadian citizens simply cannot afford the medical care they need.
We have been hearing about the exceedingly high cost of medicare. Let me remind the house of the cost of illness to our economy at the present time. In 1963, a hundred million man-days of labour have been lost because of illness, which amount to 3.8 per cent of the gross national product of that year, worth over $1.5 billion. If we assume a continued 3.8 per cent loss, the figure for the year 1965
July 12, 1966

reaches at least $2 billion, and that does not include the reduced productivity of those who continue to work while in poor health. Obviously not all of this is preventable, but even if only 10 per cent could be avoided through better health care and greater availability of physicians' services, the gain to our economy would at least be equal to $200 million. I think it is time we began to look at this matter in actual terms instead of bringing forward moss-backed ideas that should have died in the last century.
As I said, we have been considering this measure for approximately 50 years. Other countries of the world are away ahead of us. We have the example of the health plan in New Zealand which has been in existence since the 1930's, and the medicare plans which have been in existence in the Scandinavian countries for a long time. We have had the example of Great Britain and our own province of Saskatchewan. Let me ask these people who are so keenly eager to prove that Great Britain wishes to repudiate its medical plan whether it is not strange that in spite of all the true blue Tory governments which have governed that country since the introduction of the medicare plan, none of those Tory governments has repealed this legislation.


David Lewis: Or has amended it.
[DOT] (9:50 p.m.)


Winona Grace MacInnis: Or
even amended it. They did not dare do it because they knew that if they touched that legislation the common people of Britain would know exactly what to do with them. Let me point out that if the government can get this piece of legislation on the statute books, it will be an enduring memorial to them. It will not be touched by those people who are today making such a fuss from this side of the house. These people who have been complaining about it will never dare to touch it, knowing how needed it is and how popular it will be once the legislation is in effect.
The Hall report made it abundantly clear, too, that another allegation which has been made today is completely wrong. That report has made it abundantly clear that there is no comparison between the cost of administering these private plans and the cost of administering a properly run government medicare scheme. Indeed, the Hall report says that the decisions which Canadians have to make, assuming that they accept the claim of the health insurance industry that it can provide
Health and Welfare
universal coverage, which incidentally the Hall Commission does not accept, is whether they wish to pay $1,020 million for these services in 1971 as administered by the insurance industry, or $837 million for a program administered by governmental agencies.
It has been proven over and over again the public agencies are the ones which can run a medicare scheme more economically. All of us in this corner have been looking forward to getting this legislation before us because we hope, at long last, we are going to be able to turn health care from being a business for profit, as it has been under the private agencies, into a service for the people of Canada. The opponents of this measure say that the cost will go up, and that the Hall Commission estimates have not been high enough. Probably the cost will go up. Costs have gone up for other services and in other industries. Costs are steadily going up these days. I point this out, that if the cost of a public medicare scheme goes up, the cost for private schemes under private agencies will go up too. People who are today without medical service coverage will be just that much worse off than they were. I think there is no argument in saying that costs will go up.
There have been a number of pieces of evidence given concerning the benefits to the people of a publicly administered medicare scheme. I want to give just one single bit of evidence which was given to those of us who were in Vancouver attending the national conference of social workers a week or two ago. Professor Titmuss of the London School of Economics was referring to the benefits that had come to the British people as a result of the health services. He gave this illustration, that the incidence of cataract in people over 70 has declined by 30 per cent in 12 years in Great Britain. This is a disease that is tremendously prevalent among older people.
May I give one other example of what is happening? This may impress hon. members even more. The incidence of blindness is down 25 per cent in Great Britain over the last ten years.


Lewis Mackenzie Brand: May I ask the hon. lady a
question?


Winona Grace MacInnis: right.


Lewis Mackenzie Brand: Does the hon. lady honestly believe that as a result of medicare in Great Britain the incidence of cataract has improved? If this is the case, I am sure the

July 12, 1966
Health and Weljare
medical profession would be more than pleased to hear about this new discovery.


Winona Grace MacInnis: I am saying that a reputable person, Professor Titmuss, one of the best known authorities in Great Britain on social welfare measures, made the statement that during the last 12 years, during which time medicare was in force in Britain, one of the greatest triumphs had been the reduction of blindness by 25 per cent. He attributed this reduction to the fact that they had a national health service in Britain and people, for the first time, were able to go and get treatment for their blindness. They were able to get treatment for cataract on a large scale.
Let me point out that one of the difficulties we have encountered in Canada has been the fact that the business of providing medical services has been a private industry. The doctors, whether they wanted to or not, have not been in the position to give service to those who most needed it, the people in the lower income group. The hon. member who just asked me the question was this afternoon deploring the shortage of doctors. He said we would have to find ways and means of increasing the number of doctors. Of course we will. Let me point out, however, that the shortage of doctors occurred in Canada, not under a public medicare scheme but under a scheme where the doctors were private, individual businessmen. They have not been able to provide services to the people of this country where those services were required.


Lewis Mackenzie Brand: Will the hon. lady permit-


Winona Grace MacInnis: I
have just a minute left, and I am afraid I cannot get an extension of time. Although I have had to put into a shorter period of time than I would have liked the comments I desired to make, let me summarize by urging the government not to be deterred by comments heard from some on this side. The government should know that this measure is one of the most needed by the people of this country. They have been waiting for it and will welcome it more than anything else, with the possible exception of an increase in old age pensions. Once this measure is on the statute books, there is no chance in the world of its ever being repealed by this lot over here, if they should be in power again, or by any other government in this country. I urge the government and the minister to proceed now, before the summer recess.


Herman Maxwell Batten: Order. It being ten o'clock it is my duty pursuant to standing order 61A to interrupt these proceedings and forthwith put the question.
Resolution reported and concurred in.
Mr. MacEachen thereupon moved for leave to introduce 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.
Motion agreed to and bill read the first time.
[DOT] (10:00 p.m.)



BUSINESS OF THE HOUSE

Mr. Starr:: I wonder if someone on the government side could tell us what business we shall undertake tomorrow in this house?


Allan Joseph MacEachen: Mr. Speaker, the order of business for tomorrow is the income tax amendments; the National Arts Centre; Bill C-215, which is the dock workers bill; second reading of the medical care insurance bill-


Gordon Minto Churchill: No, no.


Allan Joseph MacEachen: -and a bill, standing in the name of the Minister of Trade and Commerce, to amend the Canadian Corporation for the 1967 world exhibition act. That is just a small item.


Gordon Minto Churchill: Mr. Chairman, I rise on a point of order. In the absence of the government house leader, the acting house leader has now announced additional business for the house which was not contemplated by the government house leader.
In numerous consultations that we have had with the government house leader within the last ten days, an attempt has been made to bring this session to a conclusion, and the arrangement has been that a limited number of bills be placed in front of us. The acting house leader has now placed something else in front of us which was not in that arrangement. This, I think, is breaking the word of the government house leader that he conveyed to us on this side of the house.


Michael Starr: Also the Prime Minister.



PROCEEDINGS ON ADJOURNMENT MOTION

[Stage Direction]
A motion to adjourn the house under provisional standing order 39A deemed to have been moved.
July 12, 1966

Louis Ralph (Bud) Sherman: It
has come to my attention in recent days, Mr. Speaker, that Canadian political and economic sovereignty may be suffering an infringement-indeed, a violation-as the result of United States government policy respecting trade with the government of Cuba; and I take this opportunity to direct a query in this area to the Minister of Trade and Commerce or, in his absence, the Minister of Industry.
I am informed on excellent authority, sir, that directives have gone out to the three United States owned flour mills in Canada namely, Robin Hood, Quaker and Pillsbury, forbidding them to mill Canadian wheat in Canada for sale to Cuba. The order is articulated under the Trading with the Enemy Act, and apparently carries with it the implied threat of severe penalties for any offender.
I would add that so far as I am aware, these are not new directives, and this is not a new situation. On the contrary, the situation would appear to be a chronic or permanent, one. It has been the subject of widespread suggestion and speculation before. It has come freshly to light as a result of the $800 million wheat agreement that has just been concluded between Canada and the Soviet union.
The directive forbidding these three United States owned flour mills from processing wheat bound for Cuba has sat, I am informed, on the desks of the Canadian offices of these companies for a considerable time. I re-emphasize that so far as I am aware there is nothing new at the level of the directive itself. What is new, apparently, is that despite all the recent furore over United States government guidelines for foreign subsidiaries of domestic U.S. firms, and despite the insistence of the Canadian government that those guidelines have been modified to meet the legitimate principles of Canadian sovereignty, there has been no new directive rescinding the old one. The old one is still in effect, and is being observed once again in connection with the new Canada-Russia wheat deal.
Under the terms of this Canada-Russia deal, the Russians have purchased, for delivery over the next three years, about 45 millions bushels of wheat in the form of flour, and no one has attempted to make any secret of the fact that more than two thirds of it is earmarked for Cuba. The flour is
Proceedings on Adjournment Motion shipped in 100-pound bags, and the total 45 million-bushel purchase represents an annual sale of 6.6 million of these 100 pound bags.
The Russians are in process right now of placing their orders for the processing of this flour with mills in Canada, both Canadian-owned and American-owned, and the situation as I understand it is that while both Canadian-owned mills and American-owned mills are bidding on the orders destined for shipment via the west coast to Russia, only the Canadian-owned companies are bidding on the orders destined for shipment via the east coast to Cuba. The American-owned mills in this country are not bidding on the Cuban orders-presumably because of the old directives from their head offices in the United states which prevent them from doing so.
Now, there are two concessions with respect to this situation that I want to make immediately. The first is that the situation in no way interferes with Canadian business. On the contrary, in fact, it is a beneficial situation as far as the Canadian mills are concerned. They have the whole Cuban market to themselves, with no competition from the American-owned mills.
The second is that I am fully sympathetic with the interests of the United States government and the United States people in their courageous fight at this time-in Southeast Asia, in the Caribbean, in Europe and elsewhere-to resist the forces of aggression in Communist and other forms that threaten the free world. And I can fully appreciate their legitimate desire to withhold, wherever possible, any goods or materials which might be construed by them to be of help and comfort to their enemies.
But I submit, Mr. Speaker, that there is a principle at stake here and it is in the undeniable interest of our Canadian sovereignty that it be respected. Hon. members on the government side will say perhaps that no Canadian business is being hurt here; so, they will ask, what harm is being done?
But I would ask them this: What would happen if all the flour mills in Canada were American-owned? Then, would not the logical result be a situation wherein Canada would find that she could not sell any of her flour, or at least could not sell any flour to Cuba?
I would ask hon. gentlemen opposite this: Is the present situation with respect to the American-owned mills in this country in keeping with the spirit of good corporate Canadian citizenship? Is it in accord, in their
7608	COMMONS
Proceedings on Adjournment Motion view, with the principles of citizenship as they feel they should apply to individuals who live here, and make their living here?
I say only this, Mr. Speaker. These American-owned firms are here, and we are glad to have them here. But presumably some benefits accrue to them as a result of their being here and it is therefore incumbent upon them to fulfil the same responsibilities of citizenship in this country as we expect of individual persons who live here and work here.
For my part I believe these United States firms, left to their own social and corporate philosophies, do fulfil those responsibilities most admirably. It is only when a different authority interferes that there is the danger of trouble. In this case, sir, I submit that an over-riding authority has interfered and in so doing has not only inhibited the potential of these American-owned citizens of Canada, but has infringed upon Canadian political and economic sovereignty as well. If this is the visible part, what of the invisible part? I would ask the government to give us assurances that this is not the tip of an iceberg.


Hon. Robert Winters (Minister of Trade and Commerce):: I am grateful to the hon. member for Winnipeg South for his remarks concerning a situation which would not, if it in fact exists, harmonize with good corporate Canadian citizenship.
[DOT] (10:10 p.m.)
When I learned of the hon. gentleman's question today we endeavoured to check with the companies concerned. We were able to communicate with most of them, and they said they have not received instructions not to sell any of this flour to Cuba. We propose to check with all of them and make sure of the facts in this regard.
The situation is as the hon. member represented it, that even if the American-owned companies were prevented from processing flour for Cuba, Canadian industry
DEBATES	July 12, 1366
would not lose because then Canadian-owned companies could process more of the wheat. In that way the Canadian economy will not suffer.
However, there is the question of the extension of extraterritoriality with which we were concerned in our meeting with the U.S. ministers earlier this year. Canadian ministers pressed our case very vigorously. We told them this was contrary to the best interests of Canada and totally incompatible with our concepts of Canadian sovereignty.
We told them we intended to take action to let Canadian companies know what we regarded to be good corporate Canadian citizenship. Hon. members know what the guiding principles are. We have set forth the principles under which we suggest that foreign and Canadian owned companies operate in all respects as good Canadian citizens.
We did leave it with the Americans, after pressing very vigorously, that if any cases came to our attention where there was any danger of infringement on Canadian sovereignty, we would bring them to their attention and pursue the matter, and if there is any evidence to that end, as a result of our approaches to these milling companies, we will certainly pursue it.
There have been one or two instances recently in which it was alleged that this sort of thing was happening. We took them up with the American authorities and we found out either it was not happening at all, or, if there was any shadow that it might be happening, appropriate action was taken to prevent it. I would like to assure the hon. member that this matter will be pursued along the lines I have mentioned, and I wish to thank him for bringing it to our attention.
Motion agreed to and the house adjourned at 10.14 p.m.

Wednesday, July 13, 1966