Mr. Speaker:

When shall the said bill be read a third time? By leave, now?

Now.

Mr. Speaker:

By unanimous consent, Mr. Churchill, seconded by Mr. Nowlan, moves-

Mr. Martin (Essex East):

No.

Mr. Churchill:

There is no amendment.

Mr. Martin (Essex East):

No.

Mr. Speaker:

Next sitting of the house?

Mr. Martin (Essex East):

Next sitting of the house.

Mr. Speaker:

Next sitting of the house.

It being five o'clock the house will now proceed to the consideration of private members' business as listed on today's order paper, namely notices of motions and public bills.

Mr. M. W. Martin (Timmins) moved:

That in the opinion of this house, the government should give consideration to the advisability of introducing a comprehensive system of national health insurance, more particularly to give consideration to the advisability of: (a) amending the Hospital Insurance and Diagnostic Services Act to provide benefits on behalf of patients in tuberculosis sanitaria and patients confined to mental institutions: (b) introducing legislation to provide medical, dental and optical insurance.

He said: Mr. Speaker, I am highly pleased once more to have the opportunity of bringing this matter before the House of Commons. Either I or other members of my party over the years have consistently raised this matter year after year. It is pleasing that, as a result, at least to some extent, of the continual pressure that has been brought to bear by the party to which I belong, we now find that more and more across the country the public are becoming aware of this problem and of the necessity of embarking on some sort of scheme such as that suggested in this resolution.

If we follow this subject in our newspapers we also find that the urgency is increasing as well. The resolution deals with the bringing of tuberculosis patients under the Hospital Insurance and Diagnostic Services Act. We

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find that tuberculosis incidence in this country is not only on the increase as far as actual cases are concerned but that, in addition, tuberculosis germs seem to be developing a resistance to the drugs in current use. There is a need for greater research in this field if we do not wish to find that we are slipping in our control of the dread disease tuberculosis in this country. It also contains the idea of bringing mental patients within the confines of our hospital insurance act. It is probably not necessary but I think it might be worth while to remind the house once more that our hospital insurance act is only 50 per cent an act, because 50 per cent of the hospital beds in this country are still taken up by mental patients who do not come under the provisions of this act. This is one of the things this government has failed or neglected to do, in spite of what they said when they were members of the opposition some five years ago.

At the moment, we have a royal commission which is sitting and hearing briefs presented by the various interested groups. It is rather interesting, Mr. Speaker, to check the score in connection with this matter and ascertain who is supporting the idea of national health insurance and who is opposed to it. For example, amongst the people who are supporting this idea we find the 85,000 members of the civil service federation; the 400,000 members of the Canadian Federation of Agriculture, and the one and a quarter million members of the Canadian Labour Congress. These three organizations alone represent a total of approximately 1,735,000 people. So far as I am aware at the moment, and I have followed this matter very closely, we find on the opposition side the 150,000 businessmen in the Canadian Chamber of Commerce; the Metropolitan Life Insurance Company and the Great West Life Insurance Company-possibly they were speaking for other insurance companies, I do not know. I did read excerpts from the brief they presented to this commission. We can add to this number, certainly, the majority of the doctors represented by their organizations across the country, although not all. There is some controversy so far as the doctors themselves are concerned, and some of them favour the idea while others do not.

In the limited time at our disposal, Mr. Speaker, I should like to deal with some of the reasons for embarking upon this suggested program. I will not speak too long because I am sure there are other interested members who would like to say something on this very important subject. Many of these reasons have been repeated many times in this house, so I do not believe there is any necessity for going into them again. They are a matter of

record and have been set forth on more than one occasion. From time to time, however, new evidence is presented and I think this should be added to what is already on the record.

For example, I have here an article from the Windsor Star of March 19, 1962, which is entitled, "Health Good; Costs High, Almost Everyone Sad." This article reads in part:

Everyone is unhappy with the nationalized British health service-except, perhaps the patients.

The doctors, the nurses and the druggists are unhappy.

The drug companies are unhappy-the health

service has taken a lot of old remedies off its lists as less effective than other medicines.

The dentists and the opticians are unhappy because they complain they are not making enough money-

But a spokesman for the ministry of health emphasized today that despite the tribulations of the scheme, most of them due to the government policy of refusing pay increases, the state of the nation's health was never better.

When the health plan was introduced in 1948 the British death rate was 12.8 per thousand. In 1960, the last year for which statistics are available, it was 11.6 per thousand, an improvement of nearly ten per cent.

I should like also to put on the record a few remarks made by Kenneth O. Bardwell, federal government electronics engineer. This gentleman was the only individual who presented a brief to the royal commission looking into health insurance. According to this report, he spent approximately six months in preparing this brief. I quote from the article:

As a Canadian-"I flinch each time some foreign news medium carries a deservedly disparaging article on suffering brought about by medical costs to uninsured or under-insured Canadians."

As the husband of a multiple sclerosis sufferer- "I have spent months of evenings at a local hospital and have met many people whose worst problem is not their illness but the cost of it."

He goes on to criticize the doctors, and he said:

Their spokesmen tell us no Canadian suffers through inability to pay... that there is something essential about our right to be unable to pay the doctor or druggist.

Then, the article goes on:

He attacked voluntary health agencies. Many of them are self-perpetuating and can be relied upon to oppose any national plan, he said. Often they duplicate resources but will not allow their facilities to be used by a person suffering from another disease.

As I have said, Mr. Speaker, these are the views expressed by people who favour the implementation of a national health insurance plan. Now, in order to be fair, I should like to refer to some of the reasons advanced by persons who are opposed to this plan. We have the submission of the Canadian Chamber of Commerce which states that socialized medicine is not only undesirable but would

damage the freedom of Canadians and the already burdened Canadian economy. Then, they go on to say:

Income tax regulations should be amended to provide some measure of assistance in mitigating catastrophic illness expenses faced by normally self-supporting persons.

I wonder just how much income tax adjustment would be necessary to offset, to use their own words, the catastrophic costs of illness. In my opinion, the argument seems to be without merit whatever. We also have a reference to the representations made by the two insurance companies to which I referred earlier, the Metropolitan Life and the Great West Life. In a joint brief to the commission currently considering Canada's health needs, these two companies indicated their opposition to any government controlled national health insurance plan. Some of their reasons for their opposition are as follows:

The right to choose the proper plan from a very wide range designed to meet every type of need-or to reject them all.

Freedom to select the insurer and the method of financing.

The opportunity to reap benefits accruing from competition between insurers.

Then, they spoil their whole argument by their reply to a question asked by one of the members of the commission, and I quote the article as follows:

In reply to the commission, David E. Kilgour, president of Great West Life agreed some employers require a proportion of new employees to join schemes they operate jointly with insurance companies.

"And you call that voluntary?" asked commission member Dr. O. J. Firestone.

It seems obvious that the interest of these two companies is not the health and welfare of the public but the fact that they would like to run a very profitable business involving the nation's health. We have also complaints from doctors, and we find that most of these complaints are based more on theory than they are on actual fact. If the facts are given, they are very carefully slanted a certain way so that only one side of the picture is seen. For example, I should like to refer to a report appearing in the Globe and Mail of March 19, 1962. The headline reads, "Figures Suggest Third of Doctors Leave U.K." The article reads in part:

Figures suggesting that one third of all doctors trained in British and Irish medical schools emigrate after they have qualified have been published in the British Medical Journal.

Then, the article goes on to say:

-there are no records to show the number of medical students from overseas who come here for their training. A number undoubtedly do arrive and most of them intend, from the start, to return to practise in their homelands.

I do not know why it is said these figures could not be found because I had no difficulty

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in finding the figures. I found them in a matter of 20 minutes. We find, for example, that in 1961 out of 12,314 students in British medical schools 2,193 were foreign students. So, the information was not difficult to find.

In addition to that I recall that just a matter of a year or two ago I placed on record in this house the report of a royal commission which sat in Britain, which looked into this matter very completely, and into the opinions expressed by the medical profession in regard to health insurance. One of these opinions was that it would drive doctors out of that field and result in a shortage of doctors. However, the conclusion arrived at by the royal commission was that by 1961 medical schools in Britain would have to cut down by at least 10 per cent the number of students entering them in order to avoid widespread unemployment among doctors in Britain. These are not my words, they are the words of the royal commission and, as I said, I placed them on record in this house a matter of a year or two ago.

Another complaint frequently made with regard to a health insurance plan is that it would interfere with the relationship between doctor and patient. It is never explained very clearly how this would come about, but I am just suspicious enough to wonder if that is not the interference about which at least a number of members of the medical profession are concerned. For example, within the last month or two I saw a report of a case where officers of the income tax division of the Department of National Revenue told a magistrate that a certain doctor had failed to report a total of $51,891.55 from 1953 to 1960. It was stated that, over the years included in the charge, the doctor had been deliberately keeping two sets of books, one set for the auditing firm which compiled his income tax return and one for himself in which he accurately recorded his true income. Certainly such a thing could never happen, or would be much more difficult to accomplish, were a health plan implemented. Indeed I cannot help wondering if that is not one of the major fears with regard to interference.

I also wonder what kind of wonderful relationship would be built up between doctor and patient in the light of another report, which reads as follows:

About 100 Toronto doctors who have turned their new accounts over to a firm for collection will come under the scrutiny of the Ontario college of physicians and surgeons-

The doctors turn all their bookkeeping and billing over to Professional Services Associates of Wilson ave., who buy the doctors' bills at a 14 per cent discount.

P.S.A. then sends the bill on a printed note headed with "Dear patient" and signed, "Cordially,

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your doctor". It does not mention the fact the doctor has sold the account at a discounted rate to the agency.

As I say, I do not know what wonderful doctor-patient relationship can be built up under circumstances such as those.

I should like to give another example of something which, in my opinion, is the wrong way to build up a proper doctor-patient relationship. I quote from the Camp Borden Citizen of February 7, 1962, where there is an advertisement headed as follows: Dr. John B. Scott Dentist

Circled Pine Shopping Centre, Camp Borden, Ontario

Due to the increasingly large number-

Mr, Speaker:

I am not sure what the hon. member proposes to read, but while I did not comment on his argument which seemed to be a bit remote from the resolution involving as it did criticism of the medical profession and its accounting, I think he should not bring names of individuals into the debate on this resolution. It really has nothing to do with the medical profession in general but has to do with the establishment of public services. I may have misapprehended what the hon. member was going to do, but I am sure he will not mind my indicating my view.

Mr. Martin (Timmins):

I would like to apologize for using the name. It was not my intention to use this doctor's name. The advertisement reads as follows:

Due to the increasingly large number of delinquent accounts in this office it has become necessary to enforce the following policy with regard to dental treatment. Effective immediately all dental treatment performed in the office... in Camp Borden will be on a cash basis only as treatment is rendered. This does not apply to treatment of an emergency nature which if necessary will be allowed thirty days for payment. Will those who now have dental appointments and who feel that they will be unable to comply with the above condition please phone the dental office and cancel the appointments.

Please do not ask for treatment on any other basis as this cannot any longer be considered.

I think that points to a very deplorable condition in our country today.

I see my time is just about up but I should like to close with one final complaint which is often expressed whenever one speaks of health insurance. Immediately the hue and cry is raised about the terrible expenses involved. Well, Mr. Speaker, I should like to point out to the house that when a health insurance plan is implemented it does not create very much of a new expense. It may transfer expenses, which are now paid in certain ways, to some other way, but we must keep in mind the fact that health insurance, protecting and maintaining the

health of our citizens, costs a lot of money whether it is handled privately or publicly, semi-privately or semi-publicly, or whatever manner it is handled under the myriad of plans we have at the present time.

It will still cost money but there is no additional new expense involved by handling this thing publicly, trying to do it efficiently, and trying to ensure that the health of the nation is not based on the size of one's pocketbook.

Mr. McDonald (Hamillon South):

May I

ask the hon. member a question?

Mr. Martin (Timmins):

Certainly.

Mr. McDonald (Hamilton South):

In his

proposal would he maintain that the cost of this plan be taken out of general revenues or be met by contributions of the citizens of this country?

Mr. Martin (Timmins):

I am glad the hon. member asked that question. I do not believe in the policy of a health insurance plan paid for completely out of the public treasury. It promotes the theory that I object to so much in our society today, the theory that you can get something for nothing. There is no such thing as something for nothing in this country and it is about time the people were told so. I believe the plan should be based on a premium that can be afforded by practically the whole of society. If that premium is not sufficient, then the balance can be taken up in various other ways; but I believe that everyone who has health insurance should pay a premium so that he realizes that what he is getting he is paying for.

Hon. Paul Martin (Essex East):

Mr. Speaker, the Minister of National Health and Welfare is in his seat. In view of the limitation of time, if I thought that by giving way to him we could have from him a statement of policy on this important medical care insurance proposal I would readily give way. But I would not give way unless I had been assured by the minister that he is prepared now to announce something that the government said four and a half years ago it was prepared to give the Canadian people.

Mr. Pascoe:

Twenty two years.