Quebec’s health-care disparity
“Trade wars are good, and easy to win.” —
Donald Trump “Trade wars aren’t good or easy to win even if you know what you’re trying to accomplish and have a clear strategy for getting there.”
— Paul Krugman Donald Trump has imposed tariffs on steel and aluminum, and threatens to do so on automobiles and perhaps even uranium.
Canada has now brought in $16.6 billion in reciprocal tariffs on American imports.
There will generally be no winners, but there could be one exception — namely resolution at last of Quebec’s lack of full participation in the portable Canadian health system. Let me explain.
Strained relations with the U.S. have tended to unite Canadians from all regions and across party lines. Many have reacted by boycotting U.S.-products in stores. Some have cancelled plans to visit American tourist destinations.
Yet this poses distinct problems for those from Quebec, especially if they have pre-existing conditions and do not qualify for unrestricted travel health insurance.
The Canada Health Act (CHA) was passed unanimously in 1984. Quebec has agreed to portable hospital benefits, but has refused to sign the Reciprocal Medical Billing (RMB) agreement. This permits physicians treating out-of-province patients to bill their own province at hostprovince rates, which then turns around and collects from the home province of the patient.
Quebec alone has refused to sign the RMB agreement. It pays only its own fees; until recently they were the lowest in Canada. Hence, few Canadian MDs accept a Quebec medicare card.
Most Quebec patients when receiving medical care outside their own province are billed directly by the treating physicians, pay out-of-pocket, and later receive reimbursement from the Quebec government. Canadians visiting Quebec must also pay the treating physician directly, which may deter some from travelling to that province.
Nonportable medical benefits affect Quebecers who become unexpectedly ill while on vacation or business in another province or territory, those who move permanently to another part of Canada, and for the first three months are “covered” by a Quebec health card, and those in border areas such as Gatineau who require emergency or specialty services in Ottawa.
For over 30 years, Quebec has refused to obey the CHA, partially because of the previous disparity between fees paid by Quebec and those of most other provinces. No federal politician has attempted to enforce this portion of the CHA.
As I stated in an article in Le Soleil (June 30), Quebec Premier Philippe Couillard could easily resolve this problem.
A few months ago, his family physicians and specialists received significant fee increases.
Gross incomes of Quebec family physicians are roughly 112 per cent that of the average across Canada; it is 123 per cent for medical specialists, 110 per cent for surgical specialists, and 98 per cent for cardiologists.
In the past, Quebec was fearful of antagonizing its own physicians if it were seen to be paying them less for services than their counterparts in other provinces. Now, there is no longer any excuse for the Quebec government to refuse to pay other Canadian MDs at host-province rates; it should therefore sign the RMB agreement as soon as possible.
However, if the Quebec government still refused to participate, another option would be for Ottawa to pay Canadian doctors directly for all persons treated out-ofprovince. Doctors do receive direct payment for federal prisoners and until a few years ago did for members of the RCMP.
Couillard now has no real excuse for not signing the RMB agreement. A year ago, he stated that Quebec desired to “participate in an even stronger way in the Canadian federation.”
He would leave a permanent legacy by ensuring that his fellow Quebecers finally received the fully portable health benefits enjoyed everywhere by other Canadians. It might also increase tourism to Quebec from other Canadians.
As the Saint John Telegraph-Journal stated in an editorial (July 18), “There continue to be many barriers to trade within Canada. If eliminated, they could increase the sum of internal trade, helping to make up what we lose with the Americans.
“But for this to happen, provinces will have to see themselves as the guardians of a single region and more as part of a national solution.”
Freer interprovincial trade entails that all Canadians have fully portable health benefits. I therefore urge Premier Brian Gallant to add this topic to the agenda of the Council of the Federation meeting, now occurring in St. Andrews, N.B.