Hot! User fees and higher taxes won’t solve health crisis: coalition ‘Illness is not something we can tax’

MontrealGazette.com – Health
August 24, 2010.   By CHARLIE FIDELMAN, The Gazette

The Canadian Medical Association’s annual report card on health released yesterday is biased toward user fees as a solution to rising costs, says a provincial coalition of health advocates.

An Ipsos Reid poll on behalf of the CMA found that people want quality health care regardless of their income, said Marie-Eve Rancourt of the Coalition Against User Fees and Privatization. But when it comes to offsetting spiralling costs, Rancourt noted that the poll suggested two unsavoury options: higher taxes or user fees.

About 60 per cent of Canadians surveyed -74 per cent in Quebec -chose to avoid more taxes and go with pay-as-you-go fees to cover health services.

These results are in stark contrast to a Leger Marketing provincial poll in May, Rancourt said, showing 72 per cent of respondents were against the “ticket moderateur” of $25 per doctor’s visit proposed when the 2010-’11 budget was tabled.

So who is actually in favour of user fees in the CMA poll? The relatively young, healthy and wealthy, Rancourt said: “They are 35 to 55 years old, with a high income of more than $100,000, healthy and with pension plans. The perfect profile of someone willing to pay user fees.”

What about pregnant women, those with childhood illnesses, cancer and chronic diseases like diabetes that need close monitoring in clinics and hospitals? Rancourt asked. “Are the pro-fees willing to have people pay out of pocket each time? I don’t think so. It’s inhumane,” she said. “Illness is not something we can tax.”

Chris Schwartz, community organizer with Project Genesis, said his Cote des Neiges grassroots group is categorically against fees for medical appointments.

“User fees will make the sick even sicker,” Schwartz said. “We see people coming in who are living in poverty, and they are telling us that it will imperil their ability to access health care.”

Antonia Maioni, director of the McGill Institute for the Study of Canada and an expert in public health policy, said that Canadians are right to be concerned that as health care costs rise, so will their out-of-pocket expenses.

“That’s the fastest-growing segment of health costs, the part that’s not public,” Maioni said.

There were two related items in Quebec’s budget: user fees and a flat health tax. User fees for medical appointments are on hold for now, Maioni said, but Quebecers are already paying the health tax, levied as of June at $25 per adult. That “health contribution” is to go up to $200 by 2012.

“So we got what people said they didn’t want -a flat tax,” Maioni said.

User fees are not the best trade-off in organizing a health system, she added. “(When) you impose user fees, you are imposing a cost on access, which may have repercussions on health and equity. Certain people can afford to pay and others will be put off,” she said. “You have to think very carefully before you start playing around with those kinds of levers.”

Maioni also cautioned against blaming the tide of aging baby boomers or the so-called silver tsunami of seniors for the wheezing health system’s ills.

“There’s a debate in the scientific community about that. We’ve been told by the media and politicians that it’s the time bomb that’s about to go off. But what we know is that it’s not that someone gets aged, per se, that leads to a problem. It’s the intensity of use and the cost of technology that drives costs.”

But neurologist Howard Chertkow, director of the Bloomfield Centre for Research in Aging at the Montreal Jewish General Hospital, said that as boomers become seniors, they are going to develop the chronic diseases of aging -such as dementia and Alzheimer’s -“that are going to overwhelm our system. The numbers are shocking.”

“I don’t think the health care system is prepared to deal with aging, or diseases of aging or increased longevity of the elderly, even though demographers have been saying this is coming for years,” Chertkow said, noting there are fewer geriatricians today than a decade ago.

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