Social Policy in Ontario

Don’t have private insurance? You’re still paying for others who do — you deserve better care

Posted on November 23, 2024 in Health Policy Context

Source: TheStar.com — Authors: Danyaal Raza

TheStar.com – Opinion/Contributors
Nov. 22, 2024.   By Danyaal Raza, Contributor

Health care in Canada is universal for only two things, doctors and hospitals. For everything else, from psychology to prescription drugs, care depends on your private insurance or ability to pay.

If you’re one of a shrinking number with a good job and benefits, you’re in luck and can probably see a psychologist or physiotherapist without worrying too much about your bank balance.

If you’re not, you may be surprised to know you’re still helping to pay for the private insurance of others.

This is possible because private workplace insurance is extensively subsidized by the federal government, and all provincial governments except Quebec. Poorly understood, in part because of complicated tax policy, public subsidization occurs through an income tax exemption. Specifically, on an employer’s contribution to private health insurance premiums.

This year alone, the federal government projects nearly $4 billion in lost public investments because of employer-provided private health insurance. Despite this eye-popping number, this multibillion-dollar subsidy is still an underestimate; it doesn’t consider further public subsidies from provincial governments to private insurance.

These billions of dollars are paid for by everyone, whether they have private insurance or not. It is a cruel irony that though everyone pays, the wealthier you are, the more likely it is you have job-linked private insurance. Conversely, if you’re among the growing number of precarious and working poor in Canada, you’re paying for the care of the wealthiest.

Yet, the private insurance industry often portrays itself as a “pressure relief valve.” They have vigorously opposed an “interpretation letter” from the federal government, nearly two years delayed, that would clamp down on private-pay virtual care. They are also continuing to fight against public pharmacare.

It doesn’t have to be this way.

What if instead, $4 billion of public subsidies to private insurance were used to support universal pharmacare, beyond diabetes and contraceptive care? Or support high-quality virtual care that doesn’t depend on workplace benefits? What would that look like?

Virtual care has rightly become a mainstream health-care tool. When used properly, it is effective, safe, and enhances access to care. Yet, there has also been an explosion in paywalls, even “work-walls,” especially by for-profit virtual care companies. Health-care workers, already in shortage, are being locked behind these gates. Yet their care is being subsidized by everyone else, while the federal government delays a decision that would make sure everyone has access.

Robust universal pharmacare also has the potential to be transformative. Though we are still in the early stages of covering diabetes and contraceptive care, we must act quickly to not only implement this program but expand it to cover all essential medications. The $4 billion a year would go a long way here.

The private insurance industry can’t have it both ways. If arguments of a “pressure relief valve” are to be taken at face value, then it’s also fair to end billions of dollars in public subsidies.

If not, then let’s have an open and transparent conversation about what’s at stake, who benefits, and who does not.

Canada’s health-care system is far from perfect. But its founding principle of universal coverage is sound. Rather than tear it down, we must build it up. It’s not just good public policy, it’s also the right thing to do. We’re stronger when we’re in it together.

Dr. Danyaal Raza is a family physician at St. Michael’s Hospital, Unity Health Toronto and past chair of Canadian Doctors for Medicare.

https://www.thestar.com/opinion/contributors/dont-have-private-insurance-youre-still-paying-for-others-who-do-you-deserve-better-care/article_5bccebb0-a6a3-11ef-8972-0ff796bd9f89.html?source=newsletter&utm_content=a02&utm_source=ts_nl&utm_medium=email&utm_email=0C810E7AE4E7C3CEB3816076F6F9881B&utm_campaign=top_5737

Tags: budget, featured, Health, ideology, jurisdiction, pharmaceutical, tax

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