Liberals failed Canadians on health coverage
Disillusioned voters have a choice, Charles S. Shaver says.
Although health delivery is within provincial jurisdiction, Ottawa has a role in ensuring access to care in other parts of Canada and in other countries. However, the current Liberal government has failed to fulfil this role.
Within Canada, hospital benefits are fully portable. The Canada Health Act clearly states that treating physicians are to be paid at host province rates when treating an out-of-province patient. Quebec has refused to comply for 35 years, and no federal health minister has enforced the federal law. Hence, Quebecers who need medical care while on business or vacation within Canada or after a permanent move to another province or territory must pay out-of-pocket and await partial reimbursement.
Justin Trudeau recently asserted, “I’m very proud to be a Quebecer.” This is no longer true. In May 2018, after voting in Ottawa, he acknowledged that for several years he had been a legal resident of Ontario. Thus, he almost certainly has a fully portable Ontario health card. Might this explain why he has not defended the portability rights — guaranteed by Section 11 of the CHA — of his Papineau constituents? The number of affected persons greatly exceeds the few thousand jobs at SNC Lavalin that he was trying to protect a few months ago.
His constituents, and most Canadians, now face inadequate hospital coverage outside the country for two reasons:
Since 2010, and increasingly for a few months, hundreds of well-established drugs have been placed on “back-order” for an indefinite period of time. This forces physicians to switch patients to a similar drug which may have reduced efficacy and different side effects, and can invalidate most travel insurance policies. These often disallow a claim if a person’s drugs have changed within three months of travelling.
A change in mediations does not just affect “snowbirds” but many younger Canadians. In 2015 the prevalence of diabetes mellitus in Canada was second among G7 countries — exceeded only by the United States. It is especially high among First Nations persons and South Asians, Chinese, Blacks, Arabs, and Filipinos. Many of these persons take multiple medications for diabetes, hypertension, lipid disorders, or cardiac disease. Many of these drugs may become suddenly unavailable.
Unfortunately, the federal health minister has failed to enforce a different part of the CHA which would provide coverage despite a recent change in medications. It is to be made at the amount that would have been paid for care in that province. As a guideline, St. Paul’s Hospital in Vancouver receives $1600 for a standard room and $6219 for the ICU per day from a Canadian’s home province. Other reciprocal rates are $1973 and $6422 at Calgary Foothills Hospital, $1650 and $4933 at Montreal General Hospital, and $1450 and $6180 at QEII in Halifax.
Whereas all jurisdictions reimburse properly for physician fees outside Canada, only P.E.I. and the three territories pay correctly for hospital costs. The rest pay token amounts. For example, British Columbia pays only $75 per day and Alberta, Saskatchewan, Quebec, and New Brunswick pay $100.
Enforcing the CHA would likely cause provinces to demand additional funding.
What would be the cost? Using claims data from the Canadian Life and Health Insurance Association for British Columbia, Manitoba, Ontario, Quebec, and Nova Scotia, I estimate that the Canada Health Transfer would need to be increased by roughly one per cent. This is affordable, as in the last fiscal year, federal government revenues rose by 6.7 per cent.
On Sept. 19, at a town-hall meeting in Saskatoon, Trudeau claimed that he was working hard to make things better for his Papineau constituents. This is false, at least for health care access outside Quebec. Of interest is that some 40 per cent of Papineau residents are immigrants.
Voters disillusioned with Trudeau’s broken promises have a choice on Oct. 21. Andrew Scheer has pledged to increase the Canada Health Transfer, and also initiate targeted increases in health spending such as replacing MRI scanning equipment. Hopefully he will enforce the Canada Health Act for the benefit of Quebecers and other Canadians and provide any required additional funding. To remain affordable, if parts of it need to be changed after 35 years, then the Act should be amended and no longer just ignored.
Dr. Charles S. Shaver was born in Montreal. He graduated from Princeton University and Johns Hopkins School of Medicine. He is past-chair of the Section on General Internal Medicine of the Ontario Medical Association. The views here are his own.