Take a firm stand against user fees

TheStar,com – Opinion/Editorial
Published On Sat Apr 03 2010

Canadians could be forgiven for feeling safely above the fray during the bitter U.S. health-care debate. Not so fast.

While the Americans are taking a slow step forward, Canadians may soon be taking a quick step backward from the universal health-care system they have spent decades building up and protecting.

The first salvo was launched by the Quebec government, which this week proposed a thinly disguised user fee that would punish patients for being sick. User fees hurt – and humiliate – low-income people who are more prone to illness and most sensitive to costs. No one should be made to feel that health care is a matter of charity, rather than a basic right that Canadians cherish.

That’s why user fees have been explicitly banned under the Canada Health Act from its inception. They are not fair; and they do not work.

In its latest budget, however, Quebec tries to skirt the prohibition on user fees “at the point of contact” between a patient and doctor. Instead, the fee would be paid through annual income tax filings (when hospital or doctor visits will be tabulated). Quebec boasts that this is a legitimate loophole in the Canada Health Act and has rather baldly suggested that other provinces may want to follow suit.

That makes Quebec’s moves a concern for all Canadians. Yet federal government officials have so far turned the other cheek, saying simply that the Canada Health Act must be respected. And federal Liberal Leader Michael Ignatieff has turned a blind eye, which suggests he is reluctant to ruffle feathers in Quebec even at the expense of the national interest of all Canadians – and Quebecers who deserve universal access. Ignatieff’s calculus is especially curious, given that the Canada Health Act was authored by a Liberal government (under Pierre Trudeau).

The Quebec government, Ottawa and the federal Liberals are all being too clever by half. The Quebec proposals are a political sleight of hand, a medical mistake and a social policy blunder. They will do nothing to prevent rising health-care costs, which are more a function of growing pharmaceutical expenses and persistent inefficiencies in the system. The idea that patients are somehow driving demand has long ago been discredited by health economists, who point to physicians as the gatekeepers of the system.

We have already had this debate in Canada. The Americans have just recently had their own debate. But it now appears this is a fight that must be waged again so that politicians can be reminded of the principle of universality that Canadians don’t want to see compromised.

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