Tackling two-tiered health care

In Canada, the higher a person’s income, the better the health care they can access.

And that’s just not right, says the Canadian Medical Association Journal.

We fully agree.

Although politicians in this country love to extol our “universal” health-care system — and Canadians are fond of boasting of its superiority compared to the U.S. system — the truth is there are gaping holes in the so-called safety net of publicly insured medical services coverage in Canada.

Access to everything from prescription drugs to mental health counselling, physiotherapy to home care, along with many more medical services, is effectively out of reach for Canadians in financially compromised situations.

That includes Canadians whose employers don’t provide health-care benefits and those in poverty, including families with children.

In a far-reaching, blunt editorial published on Monday, the CMAJ argued it’s past time for the federal and provincial governments to work together to tackle the “disturbing inequities” in Canada’s health-care system.

“The persistence of these disparities amounts to discrimination against Canada’s most disadvantaged populations,” the editorial said.

Without financial resources, many medically important services that are not, or not consistently, publicly insured — including dental care — are simply unaffordable for too many Canadians.

Poverty also imposes “insidious barriers” — like lack of mobility or even time — to access even “free” services, the CMAJ said.

“Tacit acceptance of such inequities should not be allowed to continue.”

As the CMAJ rightly reminds us, poverty increases health risks — and, in the long run, health-care costs — in multiple areas, from poor nutrition to trauma and substance abuse. Meanwhile, studies show that in 2017 Canada ranked last, among comparable countries, in spending on social programs.

“The effects of a fraying social safety net are pouring into the health-care sector,” the Canadian Medical Association Journal said.

The CMAJ editorial’s proposed solutions included instituting the universal guaranteed income as well as studying what other countries, such as New Zealand with its “well-being budget,” are doing to try to address the social determinants of health.

We’re not endorsing the CMAJ’s specific recommendations, per se.

What’s required is to, first, acknowledge the elephant in the room — the stark current inequities of Canada’s health-care system that are directly and indirectly related to financial means. Second, we need to have an urgent, purposeful — and open-minded — discussion about how to change that reality.

Otherwise, the rising costs of running our two-tiered health-care system will only continue to climb.