Hear, hear.

Mr. E. G. HANSELL (Macleod):

May I thank my leader in particular, and the house in general, for their kind felicitations.

Mr. SPEAKER:

I have the honour to inform the house that I have received the following communication:

Ottawa, May 14, 1948.

Sir: I have the honour to inform you that

the Right Hon. Thibaudeau Rinfret, Chief Justice of Canada, acting as deputy of His Excellency the Governor General, will proceed to the Senate Chamber on Friday, May 14, at 5.45 p.m. for the purpose of giving the royal assent to certain bills.

I have the honour to be,

Sir,

Your obedient servant,

J. F. Delaute,

Assistant Secretary to the Governor General.

Right Hon. W. L. MACKENZIE KING (Prime Minister):

Mr. Speaker, I should like to make a statement to the house on government policy with respect to health services and health insurance.

From time to time, there have been inquiries in this house and outside as to when the government intends to proceed to implement the specific proposals placed before the dominion-provincial conference in 1945 for the development, by stages, of a nation-wide health program leading up to and ultimately including

health insurance. I am now in a position to give hon. members the desired information. I wish, however, in so doing, to place the health program in its proper perspective in relation to the government's larger and basic aim of securing for the people of Canada a national minimum of social security and human welfare.

Before the outbreak of war in 1939 considerable progress in social legislation had been made in Canada. A substantial measure of social security had been provided by the dominion through the creation of the Department of Labour and other federal labour legislation, and through the establishment of annuities, of pensions for the aged and the blind and for disabled veterans and veterans' dependents; and by the provinces through provincial departments of labour and labour legislation including workmen's compensation and through enactments related to widows' and mothers' allowances, maternity benefits, child welfare, sickness and hospitalization.

In all this, there had, however, been relatively little co-ordination of social security measures and no approach to a nation-wide plan. Even before the war it had become increasingly apparent that if there were to be an avoidance of conflict between the provinces and the Dominion on questions of jurisdiction, and unnecessary duplication of social services with consequent waste of public money, what was required was a comprehensive scheme of social insurance which, by satisfactorily combining provincial and federal services, would constitute a charter of social security for the whole of Canada.

Since the outbreak of war, there has been a tremendous advance in social security legislation. Far-reaching measures such as unemployment insurance, family allowances, floors under farm and fish prices, increase of pensions and allowances for the aged, the blind, the war veterans and their dependents, have been enacted in the federal fields, while legislation, varying greatly in degree and kind, respecting health services and hospitalization, maternity benefits, and the like has been enacted by the provinces. Notwithstanding this great advance in social services, little advance has been made towards an integration of federal and provincial activities which would combine existing social insurance measures and health services in

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a comprehensive constructive, efficient and effective nation-wide plan.

The government's policy of bringing into being a comprehensive scheme of social insurance which would co-ordinate provincial and federal activities, and which would include the establishment of a nation-wide system of health insurance was set out specifically in the speech from the throne at the opening of the session of January, 1943. A select committee of this house was thereafter appointed to examine and report upon the most practicable measures to give effect to the policy.

In the course of the general election campaign of 1945, after enumerating some of the social legislation already enacted, I stated that the government's program looked beyond these achievements to the early establishment of other great social measures. I said specifically: "The government is prepared to support a national scheme of contributory old age pensions on a basis more generous than that of the existing pensions. The government also believes that a substantial improvement in national health could be achieved through dominion-provincial co-operation. We have accordingly pledged ourselves to support a measure for federal assistance in a nation-wide system of health insurance, to include assistance to the provinces for preventive medicine. If the present government is returned to office, we shall proceed with these measures as soon as agreements with the provinces can be concluded."

Specific proposals regarding contributory old-age pensions and a nation-wide system of health insurance were made to the provinces at a conference which met in August, 1945, within two months after elections. As hon. members know, it has unfortunately thus far not proved possible to secure agreement with all the provinces.

The government has reached the conclusion that lack of agreement with certain provinces should no longer be allowed to stand in the way of a further immediate advance in the field of public health. We have accordingly decided to proceed with a substantial health program at the present session.

An important feature of the government's health program of August, 1945, was the proposal of a planning and organization grant to the provinces. This grant was designed to assist the provinces in developing their planning and organization for the improvement of existing health services, for the development of new programs that might be needed, and for the detailed planning of hospital and medical care insurance.

In addition to the planning and organization grant, the government also proposed a series

[Mr. Mackenzie King.l

of grants for the development and improvement of existing provincial health services. Grants were to be made available for the following purposes:

(a) General public health services. .

(b) Tuberculosis control.

(c) Mental health care.

(d) Venereal disease control.

(e) Prevention and control of crippling conditions in children.

(f) Blindness prevention and control.

(g) Professional training.

(h) Public health research.

In addition to these proposed health service grants, the government offered, in the 1945 proposals, to make financial assistance available 'through low-interest loans for the construction of needed hospitals throughout the country.

All these grants were regarded as essential steps in the development of adequate health services for the people of Canada, regardless of whether or not health insurance was eventually to be introduced. It was 'recognized, however, that the proposed grants would have the added advantage of being fundamental prerequisites of a nation-wide system of health insurance.

Although the introduction of these health grants was postponed, in 1946, the Department of National Health and Welfare has continued to give constant attention to the planning of health services. Studies have been carried out by the division of the health insurance studies which was established in 1945 to lay plans for the eventual introduction of health insurance. The research division of the department has also been actively engaged in this field. From time to time, specialists of outstanding ability have been asked to undertake more specific assignments. As a result of the subsequent research, certain modifications have been made, in the 1945 proposals.

I come now to the announcement of the health measures which it is proposed to take at the present session of parliament. These measures also represent first stages in the development of a comprehensive health insurance plan for all Canada. Parliament will be asked in the supplementary estimates to m-ake the necessary provision for the proposed health program.

The Minister of National Health and Welfare plans to arrange an early meeting with the appropriate technical officers of the various provincial health departments and the Dominion Council of Health to work out with

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them the detailed arrangements of the proposed health grants, and, in particular, the conditions to be attached to their adminstra-tion.

The specific proposals are as follows:

Health survey grant. The government proposes to make available immediately to all the provinces a health survey grant replacing the health and planning organization grant of $625,000 on the basis outlined to the provinces in August, 1945, as amended by the statement I made when the conference reconvened in November of the same year. The amendment was to the effect that the grants were not to be conditional upon the provinces undertaking to enter a health insurance plan.

The non-recurring grant of $625,000 is to be divided as follows: There will be a flat grant of $5,000 to each province; the balance is to be divided between the provinces on the basis of population, with the proviso that in no case shall the provincial grant amount to less than $15,000.

The purpose of this grant is to assist the provinces in setting up the machinery which will be necessary to ensure the most effective use of the other health grants now being proposed, and in planning the extension of hospital accommodation, and the proper organization of hospital and medical care insurance. Adequate safeguards will of course be provided to ensure that the provinces report in an approved manner on the expenditure of the funds and on the results of the studies undertaken.

Health grants. For the following specific purposes, annual grants will be made available to all the provinces along the lines of the proposals first outlined in August, 1945, and later amended.

1. General public health. A grant of 35 cents per capita is proposed for the purpose of strengthening the general public health services in those areas where the provincial authorities themselves most keenly recognize the need. In succeeding years the grant will increase by 5 cents per capita, and will finally reach a peak at a rate of 50 cents per capita. These public health grants will continue from year to year, with the initial commitment amounting to approximately $4,404,000 for a full year. In order to qualify for the grants, the provinces will of course be required to maintain at least their present level of expenditures in this field. This same safeguard will be attached to all the other grants it is proposed to make.

2. Tuberculosis control. To permit an accelerated and intensified effort directed towards the eradication of tuberculosis in Canada, the dominion government will ask parliament to make available to the provinces an annual grant beginning at $3 million and rising over a period of years to $4 million annually. The details of this grant, including the allocation of funds between the provinces, will be on the basis recommended at the time of the 1945-46 conference. The purpose of the grant will be to assist the provinces in the drive which they will now be expected to make to obtain control over tuberculosis, and to extend progressively the areas of free treatment to the maximum possible extent.

3. Mental health care. Parliament will be asked to make provision for a similar grant to the provinces for similar purposes for mental health care amounting initially to $4 million per annum and rising over a period of years to a maximum of $7 million per annum. The seriousness of the problem of mental illness can best be illustrated by reference to the fact that between one-third and one-half of all the hospital beds in Canada today are occupied by patients suffering from mental illness.

4. Venereal disease control. In accordance with the proposals made in August, 1945, the dominion government proposes to ask parliament to make available an amount of $500,000 annually to assist the provinces in extending and intensifying their present efforts in the control of venereal disease. Since the grants currently being made to the provinces for venereal disease control amount to $225,000 annually, the net increase under this heading will be $275,000 annually. The terms and conditions attaching to the use of this grant will be similar to those outlined in August, 1945.

5. Crippled children's grant. Very few of the provinces have at the present time an adequately developed program for the prevention, control and treatment of crippling conditions in children. To assist the provinces in the establishment of a program in this field, and in the development of a rehabilitation and training program for crippled children, the government is proposing to ask parliament to make available the sum of $500,000 annually, to be divided on a per capita basis between the various provinces.

6. Professional training. In order to meet the need for larger numbers of professional personnel in the public health and related health fields, the dominion government will seek appropriations to make available to the provinces an amount of $500,000 annually. It will be noted that this is twice the amount

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originally suggested in the 1945 proposals. The purpose of this grant will be to assist in making available the public health personnel which will be required in the development of an enlarged public health program in all fields. The grant will also be available to assist in developing and training the personnel required for the operation of constantly expanding hospital services.

7. Public health research. The dominion government will ask parliament to make available to the provinces, as originally suggested in the 1945 proposals, grants for the stimulation and development of public health research. It is considered, however, that a larger amount of money than was originally proposed is justified by the expanding requirements of the field. Consequently, though the grant will be $100,000 for the first year, as originally proposed, it will thereafter be increased by $100,000 annually until $500,000 is reached. This grant is an indication of the importance the government attaches to the development of a progressive health program.

8. Control of cancer. In addition to the grants which were originally outlined in the 1945 proposals, the dominion government is now proposing an annual grant to the provinces amounting to a maximum of $3,500,000 to assist in the development and provision of the most active possible diagnostic and treatment services for the control of the dread scourge of cancer.

First steps in the development of a plan of active control were taken a year ago in the establishment of the National Cancer Insti- ' tute, the function of which is to stimulate the development of an intensive research program in the cancer field. But research alone is not enough. More cancer clinics, more diagnostic and treatment centres are needed, if this dreadful malady is to be brought under control. The dominion government proposes to share with the provinces, on a fifty-fifty basis, the costs of any approved program for the control or treatment of cancer which the provinces may undertake. The grant will be divided on a per capita basis between the provinces.

Hon. members will note that the grants which I have thus far mentioned, with the exception of the cancer grant, correspond fairly closely with the original proposals made by the government to the provinces in August, 1945.

Hospital Construction. Before health insurance can be established on an adequate basis, another development is essential. At the present time there is a tremendous shortage of hospital beds in Canada. If, as the first stage in health insurance, hospital insurance were

now to be introduced on a contributory basis, the demand that would arise for hospital accommodation simply could not be met. This situation was recognized in August, 1945, when the dominion government offered to make available low-interest loans to assist the provinces in increasing hospital accommodation. Since 1945 the situation has not improved. The shortage still remains, amounting now to an estimated 60,000 beds of all kinds.

It is felt that the provision of low-interest loans would not at this time be a sufficient inducement to hospital construction on the scale required. Consequently, the government will seek an appropriation for outright grants towards the construction of additional hospital accommodation. These grants will amount to $1,000 per bed for active treatment beds and $1,500 per bed for chronic or convalescent beds. Analysis of the figures relating to existing shortages clearly demonstrates that the shortage of chronic or convalescent beds in Canada is most acute. As a result of this shortage, our hospitals are congested to an unreasonable degree with persons not requiring active hospital care, but perfectly capable of being treated in chronic or convalescent beds. By placing a premium on the provision for chronic or convalescent beds, which are cheaper to provide and cheaper to maintain, the congestion in active treatment units should be considerably reduced.

The proposed hospital construction grants represent, of course, only a portion of the total costs of hospital construction. The balance will have to be met by provincial grants and by local funds from other sources. One condition which it is proposed to attach to hospital construction grants is that the province shall match the dominion contribution or better it, and that the dominion contribution shall not in any case exceed one-third of the total cost per bed in any project.

The government hopes that the provinces and local communities will take the fullest possible advantage of these grants, in order that, with the least possible delay, the deficiency which now exists in hospital accommodation may be overcome. The government accordingly is prepared to recommend the appropriation throughout the next five years of the substantial sum of $13 million annually for hospital construction grants.

If the hospital construction grants are fully utilized, they will make possible provision for over 40,000 additional hospital beds in Canada. At the end of the first five-year period, the situation should be reviewed. If the hopes and expectations for the first five years are fulfilled, it is estimated that, for the sue-

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ceeding five-year period, it should be possible to reduce the annual commitment for hospital construction by approximately half.

It is estimated that the expenditure for the entire health program of which I have just given particulars, will require an appropriation by parliament over the next five years of some $30 million a year.

No doubt it will seem to hon. members that in presenting this health program to parliament the government is pursuing a policy which over the years will involve the expenditure of considerable sums of money. That is apparent. But what these expenditures may mean in the preservation of health, in the saving of human life, to say nothing of the lessening of human suffering and misery and not infrequently despair, is beyond calculation.

In commending the acceptance of this program to hon. members, I should like to remind them of the emphasis which, in the interest of the nation, all parliaments, over the years, have placed upon the conservation of the country's natural resources, and rightly so. A country depleted of its natural resources soon becomes a wilderness, a waste. But of all a nation's resources, its human resources are unquestionably the most precious. The preservation in health and strength of its population is surely the best of all guarantees of a nation's power, of its progress and of its prosperity. Our greatest national asset is the health and well-being of our people.

Mr. JOHN BRACKEN (Leader of the Opposition):

Mr. Speaker, you have permitted the Prime Minister, in the middle of the session, to come forward with a statement of new policy. I presume you will give some of us on this side an opportunity to make brief observations with respect to what he has had to say.

I am sure the house has listened with interest to what the Prime Minister has said about certain aspects of the social security program. I am sure, too, that members have welcomed many parts of the proposal. I have no doubt that all are glad to see that at last the government has been forced by public opinion-

Oh, oh.

Mr. BRACKEN:

I am sure the people will be glad to see that the government has been forced by public opinion to come forward with a better balanced program than the piecemeal type of program to which they have gradually added from time to time in the past.

Obviously we cannot discuss the details of this new program now. This is the first we have heard of it, However, in regard to one of the features of it, particularly, I wish to 5849-250

compliment the Prime Minister. I refer to the financial aid which the government proposes to give in the construction of hospitals. I think that is one of the weakest links in our present social security program.

Judging from what the Prime Minister has had to say, I gather that he must have been reading the social security program which was approved and passed at the last annual meeting of the Progressive Conservative party, because many aspects of the program announced today are in exact conformity with what was passed about a month ago by that convention.

Mr. MacNICOL:

Almost word for word.

Oh, oh.

Mr. BRACKEN:

I am interested to know that what I am saying has the approval of so many hon. members opposite. This party has long urged a more comprehensive social security program than we now have. The hon. member for Lanark (Mr. Blair) has several times advanced the very proposal that the Prime Minister brought forward with respect to hospitalization.

Since the Prime Minister has been permitted to read this new statement of policy, I think I ought to be allowed to read the skeleton statement of policy approved by our party a month ago and announced at that time.

Mr. CRUICKSHANK:

It will still be a skeleton.

Mr. BRACKEN:

Mr. Speaker, we listened with some interest and with order to what the Prime Minister had to say and I ask only the same concession for myself.

I said that our party has long urged a comprehensive social security program based on two things: more generous financial

assistance by the dominion, and administration by the provinces. I will ask the privilege only of reading what I had to say in my address to our annual convention, and then the resolution that was passed at that time respecting the very matters the Prime Minister has raised today. This is what I had to say on April 20:

We will implement a social security program that will provide against the hazards of health and accident, as well as sickness and unemployment. We will provide old age pensions at an earlier age and on a more generous scale. We will carry out these policies, not alone by government grants as at present-we will supplement them by a contributory system to which all wall make a small payment in their earning years, thus making possible a real pension on a higher basis in the place of the present "means test" gratuity basis on which it is now paid.

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Following that address and the discussions which ensued the following statement of policy was agreed upon:

The Progressive Conservative party proposes a contributory "four-in-one" social security program available to every Canadian irrespective of occupation to provide the following benefits:

(1) Retirement pensions at age sixty-five without the means test; (2) Accident and sickness benefits; (3) Health insurance; (4) Extended unemployment insurance benefits.

Under this program citizens will by contributions made during their working years be enabled to provide protection against the hazards of sickness, accident and unemployment and be enabled to retire in decency and comfort at age sixty-five.

It is intended that this "four-in-one" social security program w'ill be established in collaboration with and be administered by the provinces.

Enabling legislation will be enacted with permissive power to the provinces to adopt the plan, thus avoiding the necessity of constitutional amendments or an immediate over-all dominion-provincial agreement.

Until the contributory plan becomes fully operative the dominion will pay at least 75 per cent of a retirement pension of $40 per month.

Family allowances on a uniform basis, regardless of the number of children in the family.

In co-operation with the provinces a national health program will be established including promotion of improved nutritional standards and effective preventive health services to assist research and control of cancer, arthritis and other diseases and to provide assistance for the construction of hospitals, health and recreational centres.

Naturally, Mr. Speaker, we have had no opportunity to study the details of the program announced today by the Prime Minister, proposals that have been advanced to us without previous notice, and therefore without opportunity for debate. However, we shall study these proposals to see whether they provide a sufficiently wide social security program and to see whether the means of implementing that program are of a practical and effective character.

There are one or two questions I should like to direct to the Prime Minister, if he is in a position to answer them today. The first one is this. If this legislation is ready, why was it not announced in the speech from the throne? That is what the speech is for. It gives an opportunity for the announcement of public policy. When a policy is announced in that speech, the house is given an opportunity to discuss it. But now in the middle of the session a new program is brought forward.

The next question is this. Has the Prime Minister consulted any or all of the prov-

inces with respect to this program? If so, what indication has he had from it or them as to its acceptance?

I have one other observation to make before I sit down. In his opening remarks the Prime Minister referred to a statement of policy announced in 1945 with respect to social security, a program which he and others said at that time and since was to be dependent upon approval by all the provinces. Now he comes forward and says, "We have not the approval of all the provinces, but we are going forward without that approval."

I just wish to add this. Anything which the government is doing today, could have been done long before this time; this requirement of having the approval of all the provinces has been but an excuse for delay. The evidence of it is in the very announcement we have had today from the Prime Minister.

Mr. M. J. COLDWELL (Rosetown-Biggar):

The announcement made this afternoon, Mr. Speaker, by the Prime Minister (Mr. Mackenzie King), has taken the house by surprise, for the reason given by the Leader of the Opposition (Mr. Bracken), namely, that no announcement of this proposal was made in the speech from the throne; therefore it was unexpected. But while it is a surprise, it is none the less welcome. The view that has always been taken by the party with which I am associated' is that no matter what government is in power, if it brings down legislation which will lay the foundations of a proper social security system, in this country, we welcome it.

I regard the announcement made this afternoon by the Liberal party, through its leader, as but a beginning or foundation, of a more adequate national social security plan. My hon. friends of the Progressive Conservative party tell us what they might have done under their program adopted a month ago. But I care not what government is in power; as long as' they bring down legislation that will be helpful to the people, we shall welcome it and support it.

I believe, of course, that this legislation has been popularized to a large extent because four years ago, the people of my own province elected a C.C.F. government. In that province there has been brought into existence the widest plan of health insurance that exists in this country. We welcome the Prime Minister's proposal to assist in the building of hospitals. In my own province the provision of hospital beds has presented difficulties. During the past four years the number of beds has been practically doubled, and still the accommodation is inadequate.

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One thing that struck me in connection with the research proposals suggested by the government was that the amount worked out-I made a rough calculation when the Prime Minister gave the figure-to about one cent per head of the population of the country. Many of the amounts mentioned this afternoon seemed to me to be pitifully small. We welcome the proposals, however, as the beginning of a program of health insurance and other social security measures for our people.

I want to express approval particularly of the assistance that is to be given in the fight against cancer and tuberculosis, for assistance to crippled children and for treatment of the mentally ill. Those are worthwhile proposals.

It is fortunate that we live in a democracy where from time to time there are by-elections and provincial elections. I have noticed that, for some uncanny reason, exceedingly interesting proposals are often made just about the time these events occur. Of course, I am not suggesting for a moment that any such event provided the occasion for the announcement which was made this afternoon. As a matter of fact, in preparing to take some part in these by-elections I have been reading the pronouncements of the Liberal party, beginning with 1919, on this very subject. While today's announcements may interfere with some of the speeches I thought of making, I am glad indeed that the Prime Minister, before he retires from the high office which he has indicated: he is to relinquish within a short time, has placed before the House of Commons these proposals looking to measures of health insurance and social security which were foreshadowed when he was elected leader of the Liberal party in 1919.

Mr. ROWE:

Thirty years ago.

We have had to wait a long time, but I hope that the foundations now being laid will be regarded merely as such, and that, whoever succeeds the Prime Minister in the high office he now' occupies-no matter from which quarter of the house his successor may come within the next two or three years -will build upon those foundations a great structure of social security and health insurance for the people of Canada.

Mr. SOLON E. LOW (Peace River): I am sure, Mr. Speaker, that you will allow me a moment or two in which to comment on the important announcement which the Prime Minister (Mr. Mackenzie King) has just made.

I do not believe that the Prime Minister could leave a better monument to the long years of service he has given to this country as leader of the Liberal party than the foundations of a progressive health security program. I listened with close attention to the announcement he made, and I certainly want to congratulate the government on the step they have taken.

About the only other thing that, might have been done to go along with this program- bringing it down to a simple phrase-would be to extend it just a little further. However, Mr. Speaker, we look upon it as an important step forward. Like the hon. member for Rosetown-Biggar (Mr. Coldwell), I should like to see more elections in this country!

We approve heartily the principle of grants to the provinces. Since 1936 Alberta has pioneered and been in the forefront in health security measures, and on that point I take issue with the hon. member for Rosetown-Biggar. Our province has certainly led the way; and I think the Minister of National Health and Welfare (Mr. Martin) will agree that Alberta now is in a splendid position to make full use of the grants announced this afternoon.