Health care on the agenda

First ministers must come to grips with need for improvement, new revenues

Prime Minister Justin Trudeau and the premiers are in Montreal Friday for a first ministers meeting. They need to act on a couple of issues: providing portable medical benefits for Quebecers and overall health reform.

In his recent fall economic statement, Finance Minister Bill Morneau announced that the deficit for this year would be $18.1 billion — over three times what was initially promised. By 2023-24, the total debt would be $765 billion. Normally, in “good times” the government is expected to pay down debt. Now with the closure of General Motors in Oshawa and the drop in oil prices, these numbers will be much worse.

Meanwhile, Ontario has a debt of $347 billion and a deficit of $14.5 billion.

Health now consumes nearly half of most provincial budgets, yet Ottawa contributes only slightly over 20 per cent. There is no point in provinces demanding increased health transfer payments from Ottawa. Instead, they must look for new revenue to support health delivery and to provide fair remuneration to physicians, nurses, and other health professionals.

One potential source of this is medical tourism. And when premiers and federal officials talk about how to diversify international trade, that should be on their agenda.

One thing Canada can do less expensively than the United States is deliver health care. A knee or hip replacement costs US$60,000 to $80,000 in Boston or New York City, but only about C$20,000 at a private clinic near Montreal.

Encouraging expansion of hospitals across Canada with operating rooms devoted to elective surgery such as joint replacements on American, Chinese, and other foreign patients, would bring in much-needed revenue, and provide employment for orthopedic surgeons and for other health professionals.

More controversial is whether to amend the Canada Health Act so as to permit a limited amount of privatization for residents of Canada. Ottawa remains intransigent about doing so. Federal Health Minister Ginette Petitpas Taylor has criticized Quebec for allowing patients to pay out-ofpocket for care in their own province. Paradoxically, she turns a blind eye when Quebec residents require medical care in another province and are often required to pay directly and await partial reimbursement.

If interprovincial barriers are to be improved so as to promote tourism and trade, all Canadians must be assured that if they visit another part of the country on business or vacation, they will have fully portable medical benefits.

This is supposedly guaranteed by the CHA but ignored by Quebec.

When cutting expenditures, Doug Ford was forced to defer establishment of an $83.5-million French university in Toronto. New Quebec Premier Francois Legault expressed “disappointment” at Ford’s decision. However, he overlooked one chronic problem that his own province has created:

Such a university would likely attract a number of students from Quebec. While living in Ontario, they would lack complete medical coverage thanks to Quebec’s continued refusal to sign the Reciprocal Medical Billing Agreement (RMBA). Quebec students already pay extra non-refundable fees when visiting the University of Ottawa Health Services.

Legault should stop chiding Ford on this issue unless he is willing to sign the RMBA. If he still refuses, Ottawa should pay physicians directly for treating out-of-province patients.

Each provincial medical association should poll its members and ascertain which MDs have worked in European and other countries with blended public/private health care systems. Those with first-hand knowledge could be invited to participate in town hall meetings across each province, and field questions concerning the pros and cons of health delivery in each country. This would educate the public, media, and politicians.

We should be open-minded and learn from countries with more efficient systems, shorter wait-times, and high rates of patient and physician satisfaction.

This week’s meeting should not degenerate into just another “photoop.” Trudeau and the other premiers should strongly encourage Legault to sign the RMBA. They should also set up a committee to study modernizing and amending the CHA with a view to eventually permitting a blended public/private health delivery system. Such health reform would continue to ensure universal coverage, but might also provide for greater fiscal sustainability.

Ottawa physician Charles S. Shaver was born in Montreal. He graduated from Princeton University and Johns Hopkins School of Medicine, and returned to Canada in 1970. He is chair of the Section on General Internal Medicine of the Ontario Medical Association. The views here are his own.