Mr. Martin (Essex East):

Can the minister

give us that assurance?

Mr. Gathers:

What kind of horse trade is that?

Mr. Martin (Essex East):

Somebody asked, "What kind of horse trade is that?" We are going to have an election very soon and as this is going to be one of the issues in the election it would be very interesting to have a statement of policy from the government. The

Minister of National Health and Welfare now has an opportunity to state that policy.

Mr. Monteilh (Perth):

I would be very happy to listen to you, Paul.

Mr. Martin (Essex East):

Mr. Speaker, it is evident that the government has no policy with regard to this matter. All we can do, therefore, is to try and urge the government to give consideration, even at this late date, to matters about which it said it had such an intense interest over a year and a quarter ago.

In discussing this resolution introduced by the hon. member for Timmins we will perhaps want to recall the circumstances of the statement made by the Prime Minister in 1958 with regard to the kind of program the government had in connection with health insurance. It will also be interesting to recall the position taken by hon. gentlemen opposite with regard to paragraph (a) of this resolution, which calls for:

(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;

With regard to the former provision, the Canadian people were led to believe that once this government came into office it would provide, in co-operation with the provinces, a system of medical care insurance. With regard to this matter no progress at all has been made by this government. A year and a quarter ago, following the national Liberal rally which was held in this city and at which was discussed a proposal in the field of medical care insurance put forward by the members attending that rally, the Prime Minister one day, anticipating that discussion, rose in this house and announced the appointment of a royal commission to inquire into the whole matter of medical care insurance. He said he was not in a position then to give the personnel of the royal commission, but the house could be assured that the government was going to appoint the members of that commission with dispatch and the study was going to take place immediately. The implication left was that action would be forthcoming from the government.

What are the facts? The royal commission personnel were not designated until March, some 4J months after the announcement of the royal commission by the Prime Minister. The chief justice of Saskatchewan was selected as chairman of the royal commission, but a long interval elapsed between his appointment and the appointment of other members of the commission. The royal commission is now on tour; it was on tour with

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many other royal commissions of this government, such as the recent Bladen commission, about which, by the way, no action was taken by the government in last night's budget.

The royal commission on health services under the direction of Chief Justice Hall has gone from one end of Canada to the other listening to representations from the Canadian Dental Association, the nurses association, and so on. But what we ought to note is that this is another device by this government to postpone consideration of something which it told the Canadian people, when it last appealed to them, it was prepared to undertake.

We will be told by the Prime Minister during the course of the coming election campaign, make no mistake about it, "We are giving consideration to this whole question of medical care insurance. Have we not appointed a royal commission? Do we not now have in existence in this country a group of men under the chairmanship of the chief justice of the province of Saskatchewan who are examining this problem?" The Prime Minister will seek to convey to the Canadian people the great interest of this government in this particular problem, when the fact is that this royal commission, like so many other devices of this government, is nothing but a technique to divert the people from recalling the promise made by this government with regard to medical care insurance, the matter that in principle is now proposed in the resolution introduced by the hon. member for Timmins.

I say that the device of the Hall commission is nothing more than the well known technique of the present Prime Minister to convey to the people of Canada something which is not in accord with the facts and is not in accord with what he told the people of Canada he and his government would do. Yet he talks about having fulfilled his promises, telling the young Conservatives last Saturday night, "We have fulfilled all our promises; did not Peter Newman say so?"

Mr. Macdonnell:

Would the hon. member permit a question? Will the Prime Minister in the course of these discussions not be able to say that this government has spent many tens of millions of dollars in redeeming promises of the previous government?

Mr. Martin (Essex East):

The hon. gentleman asks, "Will this government not be able to say that it has been doing a great deal in other fields?" I am not talking about other fields right now, nor has this resolution anything to do with other fields. This resolution has to do with medical care insurance and I am now dealing with a promise made to the

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Canadian people by this government. I am pointing out that this government has resorted to its well known technique of introducing a red herring, a diversionary tactic, by the appointment of a royal commission; and there is no one who should deplore that more than the hon. member for Greenwood, for whom I have the greatest respect and who I know regards a political promise as something that should be observed.

Let us examine another promise made by this government which arises out of this resolution. The Minister of National Health and Welfare will recall how the present Minister of Finance in particular urged upon the previous administration an amendment to the Hospital Insurance and Diagnostic Services Act to provide for the inclusion under the act of patients suffering from tuberculosis and mental illness.

In response to that request it was indicated that, following a conference held with the provinces it was agreed by the latter that, as the great percentage of tuberculosis and mental illness costs were borne by the provinces, and since the Hospital Insurance and Diagnostic Services Act was intended to provide assistance to individuals and not to relieve provincial governments of their accepted obligations, it was not valid to argue that these two particular illnesses should be included in the Hospital Insurance and Diagnostic Services Act. But that was what the present government urged when in opposition; they urged that mental illness and tuberculosis should be included in the act. How they can resist this resolution in the face of that stand is very difficult indeed to appreciate.

Mr. Martin (Timmins):

Would the hon.

member permit a question? Can I take it from his remarks that the Liberal party is still of the opinion that they held at the time the present government was urging this change?

Mr. Martin (Essex East):

If my hon. friend will recall what I said about this matter two years ago he will appreciate that the situation has changed considerably.

Oh, oh.

Mr. Martin (Essex East):

Well, it has. Hon. gentlemen laugh, but their laughter only indicates their lack of comprehension of the facts. The financial situation between the federal government and the provinces has changed greatly. The province of Ontario has entered this field. The province of Ontario is now imposing a 25 cent contribution with regard to tuberculosis patients. The situation is altogether different. But the federal government, notwithstanding that fact, continues to take a

position which they urged earlier should have been taken by the previous administration. This government now, because of that fact and because of the promises made by the Prime Minister, again, with regard to this matter, cannot resist the inclusion of mental illness and tuberculosis in the Hospital Insurance and Diagnostic Services Act.

That is another promise which has gone unfulfilled. In spite of that, the Prime Minister went before the young Conservatives in Ottawa last Saturday and said, "Look at all the promises we have fulfilled", forgetting that here are two, among many others, which he and his government have not even touched.

He is already out making more.

Mr. Martin (Essex East):

Somebody says he is out making more, and I suppose that is true. What we must remember is that this subject is one which is of the greatest interest to the Canadian people. They do expect governments on a senior level to take some action with regard to medical care costs.

The Canadian people now have a hospital insurance scheme which runs across this country and which is proving its worth. They are now expecting governments at both senior levels to take action with regard to this matter. We in the Liberal party, having taken the initiative with regard to hospital insurance, having placed that act on the statute books of this country, having obtained the consent of the required number of provinces, which was a fact just before the change of government, can now say that we are prepared to embark on a further stage, in light of the fact that we have placed the Hospital Insurance and Diagnostic Services Act on the statute books.

Here again we find the Prime Minister boasting about what he and his government have done in the field of social welfare. Let it not be forgotten that the additional expenditures in that field which the Prime Minister mentioned on Saturday night included the moneys paid out of the unemployment insurance fund. It was those disbursements which caused the present social welfare expenditures to reach the level indicated by the Prime Minister. The right hon. gentleman forgot, of course, that the moneys paid into the unemployment insurance fund do not represent moneys under the control of the federal government but are moneys paid in by the employers and employees, the main contributors to the fund.

We believe the time has come when the government of Canada, in co-operation with the provinces, should provide a system of responsible medical care insurance so that no individual in this country shall go without

such care on the mere ground of financial incapacity. We have put forward in our contributory old age scheme a plan which meets part of this objective. With regard to the discussion which is particularly current in the United States, with regard to medical care for the aged, we say that not only should we provide financial assistance to the aged but we should also be making provision for the payment of their medical expenditures. Under our contributory plan, which could be put into effect under the present amendment to the British North America Act, we would provide for the medical care of the aged who are not now provided for under provincial or municipal arrangements. There are over a million people now receiving pensions from the federal government under the old age security scheme. There is also a lesser number-though it is considerable-receiving payments under the old age assistance plan, Many of these people cannot meet their medical care costs. Under the contributory plan which we have put forward, such individuals would be covered.

There is another aspect of this problem which was not touched on by the hon. gentleman, and it concerns sickness insurance which should be built into a medical care insurance plan. An individual who is out of work because his employers lack work to give him can draw unemployment insurance benefits if he is qualified to do so; but if such person loses work because of illness he cannot qualify for unemployment insurance benefits. We feel this is one aspect of the problem which should be taken care of. Indeed, I have a resolution on the order paper referring to this very matter. It is one of the reforms which will have come about and which is part of the social security program already announced by the leader of the Liberal party. Under that plan we guarantee to individuals an ability to meet the cost of medical care, as has been stated by the Leader of the Opposition in speeches which have been made during the past few weeks from one end of Canada to the other, and which will be increasingly made.

We have indicated that we recognize the importance of the doctor-patient relationship. The doctor must be free to use the form of treatment he believes in the circumstances, and the patient must be free to consult the doctor of his choice. There is no suggestion of interfering in any way with the traditional doctor-patient relationship which must prevail. We recognize the contribution which has been made by the medical profession. We recognize the contribution being made in the field of medical research. What we want to do, while preserving the integrity of the medical profession, is to bring to a

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maximum number of people in our country the opportunity of sharing in the discoveries of medical science. That is the idea behind the plan which we have put forward-a plan which would create a scheme which would attract an increasing number of able people to the practice and study of medicine.

We recognize that the plan will require machinery, that it will require administration. We recognize the position of the doctor with regard to his income. Where there is collaboration between the medical profession and the provincial and federal governments with regard to this plan, there need be no difficulty in working out some kind of program which would guarantee the security which we feel, in this day and age, individuals living in a country such as ours should have, without in any way interfering with freedoms which we recognize as part of our tradition and without in any way interfering with constitutional arrangements which we believe are implicit in the British North America Act. We feel that those who can afford to do so should pay a small part of their doctors' bills up to a low annual maximum. This, we believe, would afford the safeguard against the making of unreasonable demands for attention.

We do believe that to postpone this problem, as the government is doing, is to place the whole question in jeopardy. All the information now being gathered by the royal commission on health services is valuable, no one questions that. But all that material is now available to the government in the Department of National Health and Welfare. All the submissions being made by the labour bodies, by the federation of agriculture, by the various business organizations, the Canadian Manufacturers' Association, the chambers of commerce, the Canadian Medical Association, the dental association and similar bodies are familiar to the minister. His department has that information and it should not be difficult for him and his advisors to recommend to his colleagues the kind of program which should be put forward for acceptance by the Canadian people. The government has let four years elapse without taking any concrete steps in this field, as it failed to take any concrete steps in the field of a contributory pension scheme that would provide a basic national pension of $75 a month. We now have fifteen minutes left in which to discuss this matter. I call upon the minister to deal with this question and outline the program of the government.

Mr. Speaker:

Order. I am sorry to interrupt the hon. member but his time has expired.

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Mr. G. C. Fairfield (Porlage-Neepawa):

Mr. Speaker, I do not wish to take up too much of the time of the house. I do not intend to advance arguments relating to anything other than that part of the motion which calls upon the government to give consideration to the advisability of introducing a comprehensive system of national health insurance.

Hon. members of the opposition must realize that there has been appointed a royal commission to carefully examine existing health services throughout the nation and to recommend in what way these services may be improved. The hon. member for Essex East has stated that this information is already available to the Minister of National Health and Welfare. Having assisted with the briefs of some of the medical associations I can tell the hon. gentleman that the information is very voluminous. This matter should not be rushed into as was done when the United Kingdom government established national health insurance, which has led to the medical crisis that presently exists there, whether or not the hon. member for Timmins agrees with that statement.

I wish to talk about the supply of doctors we could make available under any plan this government might recommend as a result of the information gleaned from the investigation of the royal commission on health services. I do not know whether hon. members realize that in Canada we have the capability of graduating about 900 doctors per year. During the past few years only 800 students have graduated yearly from medical schools. It will be understood that many of these graduates come from the United States, Jamaica and other foreign lands and of course do not remain in Canada. I do not know what the people of Canada would have done since 1945 if it had not been for immigrant professionals from Europe and England. Since that time some 4,500 immigrant doctors came to Canada and helped out in this pinch.

The hon. member for Timmins said this question should be approached properly and sensibly. I feel it should be approached not only from the point of view of health services but also from the point of view of Great Britain being the only country in the free world which has a national health insurance scheme.

In the March 26, issue of V.S. News and World Report there is a splendid article with the provocative title "Disappearing Doctors: New Crisis in Britain" which examines the scheme in the United Kingdom. The shortage of recruits to the medical profession is not new knowledge to us. It may be to the Canadian Manufacturers' Association, the farm unions and other groups; but this condition

has been known to the Canadian medical profession and this government, if to no one else, for some time. For the past five years it has been a certainty that the number of people going into medicine is decreasing from year to year. In Great Britain with a population of approximately 50 million there are approximately 1,600 graduates per year in the medical field. The entire tenor of the article represents a gloomy forecast. We do not wish to encounter the same difficulty experienced in the United Kingdom.

Mr. Martin (Timmins):

Will the hon. member permit a question? Does he mean there are only 1,600 graduates out of the 12,000 students?

Mr. Fairfield:

It will be understood that a student spends eight years in the study of medicine. I am not a good mathematician but 12,000 students must be divided by eight years. There are roughly 1,600 graduates a year in Great Britain and 800 a year in Canada. In Canada there are probably 6,000 to 6,500 students in medicine but only 800 graduate each year from the eight year course of study.

Let me read an excerpt from the article to which I referred:

Why is British medicine under nationalization said to be in "a mess"? Why are hundreds of young doctors deserting socialized medicine to practise in countries free of government control?

The answers that you get from independent authorities are: Working conditions imposed by the government as a monopoly employer of doctors are proving to be more and more intolerable. One result has been a decline in the number of people choosing medicine as a career. Among those who study medicine, a steadily increasing number are refusing to work here.

Mr. Marlin (Timmins):

Would the hon. gentleman permit another question? Would the hon. gentleman not agree that the present unrest in Great Britain is not confined to the medical profession but arises as a result of the government wage freeze?

Mr. Fairfield:

Mr. Speaker, this motion is confined to a specific recommendation. I will not yield1 to the temptation of engaging in a discussion of doctor-patient relationships and other facets of this subject. I shall confine my remarks strictly to the question of the introduction of legislation to establish a comprehensive system of national health insurance as referred to in the terms of the motion.

I have spoken to many medical doctors who have emigrated to Canada from the United Kingdom. A great many resident surgeons and interns in hospitals in Great Britain are from India and other former colonial nations who are now taking over the actual practice of medicine in the hospitals in that country.

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Lord Taylor, a socialist spokesman on medical problems in the House of Lords, is reported in this article to have said:

I cannot honestly recommend you to go Into such hospitals as a casualty. In many cases, there is no casualty officer. A house surgeon will have to leave the operating theater when he can treat you. His experience will he far less than that of your general medical practitioner. When he comes, he will probably not he a British graduate, and he may well have difficulty in understanding what you say. This is at a time when speed and efficiency may be literally lifesaving.

These are important facets of this question. Speaking politically they could perhaps be ignored. But this government intends to study the question thoroughly. It must be approached on a reasonable basis. We wish to avoid the crisis that has arisen in the United Kingdom.

I have spoken to many practitioners who left the United Kingdom and came to Canada. They speak of the vast number of patients who daily appear in the office of the ordinary general practitioner. With sometimes as many as 60 or 80 patients a day the patients receive little care. This is quite understandable because a doctor has only a limited time to devote to his patients. It was said that all those patients with a similar complaint are asked to stand up and they are given pink pills. I use that merely as an illustration.

This type of treatment has created a demand among ordinary citizens for private practitioners. As a result of this a great number of doctors who previously worked under the national health scheme have established a private practice and dissociated themselves from the scheme. This has created a still greater shortage in the medical profession. This is having a snowball effect and it will continue to do so, according to the investigations overseas. I quote from this article as follows:

General practitioners, most of whom are burdened with a steadily increasing work load, are being forced to give less and less time to their patients.

Dr. Seale, who is a Harvard-trained medical economist in Great Britain, predicts that this growing shortage of doctors and the increasing demands for medical care will eventually force into private practice more and more of those doctors who are burdened with this type of practice. Whether or not this can be swallowed holus-bolus, I do not know. One quotation here is very interesting. It evidently comes from the same type of official and need not be taken as gospel. However, this man had this to say:

"If we had a chance to do It again," one high ranking official says, "I think that we would favour some form of compulsory medical insurance, supplemented by tax funds together with subsidies to hospitals to keep down costs. We would also act to limit the cost of drugs. In short, the state would insure that everyone had access to medical

government payroll."

You may say it is a very great political expedient to go to the country and say, "We are going to make all doctors work for a salary, as they do in the United Kingdom, of about $6,700 a year; there would be no time limit to the amount that they work; there is no such thing as a 40 hour work week; and they will be happy with it". I can warn you now that they are not happy with it in the United Kingdom and they have not been happy with it. The results are now coming to the fore in that unfortunate kingdom. The end of the article is particularly worthy of note, and I quote it as follows:

Whatever is done, one thing is clear in Britain: After 14 years of socialized medicine, a growing number of experts are coming to the conclusion that something is wrong with the system-and they are speaking out for the first time.

The alarm bell has been touched off by the realization that Britain is the only advanced industrial nation that is losing many of its best young physicians through emigration at a time when there is an acute shortage of doctors at home.

I therefore must warn not only our own government but the members of the opposition that if they go ahead without the concurrence of the doctors and, roughshod, push them into some form of compulsory work, they will bring about the same results as those now being observed in the United Kingdom.

Mr. Winch:

I should like to ask the hon. member a question. In view of what he said, will the hon. member in this House of Commons, as a worthy member of the medical profession, recite for us the Hippocratic oath?