Perhaps the most troublesome and outdated aspect of the act is the fiscal punishment it allows the federal government to mete out if patients con-tribute to the cost of their own medical care. In order to comply with the Canada Health Act, the B.C. Medical Services Plan (MSP) prohibits such payments for some (not all) medical care. MSP does so because other-wise the federal government can claw back its fiscal transfers to B.C. under the Canada Health Act, to punish the province if patients pay directly (instead of indirectly, through their taxes) even a small part of the cost of their own care.
In other insurance contexts, such payments are known as deductibles or copayments. Such direct payments are soundly based in both economic analysis and common sense. Allowing the users of any service to believe that it is "free" is a virtual guarantee that the service will be overused, and will be used needlessly by some. The statement in the guest editorial that "there is no evidence at all that user fees reduce the unnecessary uses of health services" implies that medical insurance is somehow exempt from the economic realities that apply to other types of insurance, and to virtually all other goods and services that are offered "free" to the user.
Imagine what would happen if that approach were used in the field of car insurance. Suppose ICBC announced that from now on, all car owners will have "free" collision insurance. Any damage, no matter who caused it, will be repaired "free of charge;" no more $300 deductibles to worry about. Does anyone seriously think that eliminating car insurance deductibles would not increase the number of claims? Of course, ICBC could limit the amount it spent on repairs by announcing at the same time that ICBC has taken over all of the auto body repair shops in the province, and is limiting their budgets to cap the number of repairs done each year.
While this might allow ICBC to balance its budget, it would render the "free" auto body repair illusory; people in need of new fenders would have to get on a waiting list.
Change "ICBC" to "MSP" in this example for a snapshot of how provincially funded medical insurance, with its promise of "free" care and government-run hospitals, operate.
The Supreme Court of Canada recognized in the Chaoulli case in 2005 that provinces use waiting lists to ration health care. Rationing reduces the amount spent by government health insurance plans. While limiting the supply of health care reduces governments' costs, it does nothing to ensure timely care for those suffering, and sometimes dying, on wait-lists.
Surely there is a better system than this, one might ask. There is. Canada is alone among developed nations in prohibiting its residents from paying for even a portion of the cost of medical care that is notionally covered by provincial government plans. Given that medical costs now consume over 40 per cent of B.C.'s annual budget, expanding government-funded health insurance is unrealistic. The Canada Health Act's ban on user fees does nothing to reduce this enormous cost.
Some low-income individuals need financial assistance to obtain necessary care; MSP premiums are already subsidized or waived for hundreds of thousands of British Columbians. There is no reason user fees could not be subject to a similar approach.
Another flawed premise in the guest editorial is the spectre of a "risk" that "medicare would soon become a public program serving the lower tiers of the income spectrum." Why should that be characterized as a "risk?" Should government-funded programs not be directed at those in "the lower tiers of the income spectrum?" In an era of increasingly scarce government resources, surely those who need government assistance to cover medical costs should receive financial assistance (which is what medical insurance is) ahead of those who, like most of us, can afford to pay at least some of those costs ourselves.
We already do so in areas where government-funded health care is not "universal." Two obvious examples are the costs of dental care and prescription medications, most of which are paid for by private insurance (often under extended benefit plans arranged by employers) or by patients directly. Low-income individuals can get government assistance to cover such costs.
In European countries, typically about 10 per cent of the population makes the choice to buy private medical insurance. In Quebec, under the Chaoulli decision, residents have already been found to have a constitutional right to obtain private medical insurance or pay for timely care themselves. The sky has not fallen in Quebec since that decision was made in 2005. Whether that right applies in B.C. is about to be decided in a recently commenced court challenge to MSP's ban on user fees.
The Canada Health Act is in large part a throwback to the early 1980s, when ever-increasing government spending and the creation of huge unfunded liabilities passed for sound public policy. If the fiscal crises of the past few years have taught us any-thing, it is that we need to rethink the financial models, and the ways we run so-called "entitlement programs," which led to the enormous government debts that we and our children will have to repay. With health care costs expected to consume over half of provincial budgets in the foresee-able future, the Canada Health Act should certainly not be exempt from such "tinkering."
Kieran Bridge is a lawyer who has specialized in Canadian and international health care and health insurance issues for more than 20 years.
Original Article
Source: vancouver sun
Author: Kieran Bridge
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