In its budget last week, the Charest government mounted an attack on the principle of universal access to healthcare: it wants to charges citizens for visits to hospitals. At the time they file income tax, someone with cancer, going for weekly treatments in Quebec would be dinged $25 for each visit. Over a 30-week period they would run up charges of $750, plus the annual fee.
The Canada Health Act embodies an idea. Healthcare should be available to all those who are sick and in need, not just to those who can pay for it.
The last time Medicare was challenged by user fees was when Ralph Klein was premier of Alberta. The federal Liberal government indicated it would withdraw one dollar for every dollar the Alberta government collected, as provided for under the Canada Health Act, and Klein backed down.
With Stephen Harper as prime minister, an avowed opponent of the federal spending power, and known proponent of privatization, the Charest government looks to get away with introducing user fees for Medicare.
The most surprising reaction came from the Liberal leader Michael Ignatieff. The day before thousands took to the streets in Quebec to protest the Charest budget, Ignatieff announced he supported the move by Charest, claiming it was designed to move people away from hospitals and over to clinics. Why he would hand over this issue to the Bloc and the NDP in Quebec is beyond understanding. With this misstep, he has put his leadership in jeopardy. A Liberal leader in danger of reducing his party standing in Quebec might as well stand down now.
In addition to projected user fees, the Quebec Liberal budget also introduced an annual medical services fee (rising to $200 by 2012) for each adult, separate from income tax. Individuals earning less than $15,000 are exempt. B.C. charges Medicare premiums, and do so Ontario. But in Ontario the fees are graduated, the more you earn the more you pay, with those with an individual taxable income of $200,600 and over, the highest bracket, paying $900 per tax year.
Charest pledges to give tax credits to help poorer citizens stuck with new and increased user fees. As always, some very low income people do not file income tax, and so will not be getting any credits. The budget contains additional regressive measures. It increases inequality by raising the regressive sales tax by two points. In addition to the new regressive health charge, it is hiking regressive hydro fees.
Astonishingly, because it overlooks what we have learned about the social determinants of health, the Charest healthcare plan will increase the cost of healthcare not reduce it. The best research shows that growing economic inequality causes incidence of ill health to increase. Less equal societies see social costs mount as violence (domestic and criminal), drug addiction, obesity, alcoholism, and diabetes all increase. Regressive tax measures make societies more unequal, and less healthy, causing healthcare costs to rise.
The World Health Organization showed that individual health improves with income. The lower down the income scale you are, the poorer your health. The new charges Charest proposes ignore the links between poverty and ill health, and the role inequality plays in poor health.
The Charest government overstates the financial problem with healthcare expenses. In a 2007 CCPA study senior economist Marc Lee shows primary healthcare costs can be contained. Despite the aging population, costs are rising not much more than GDP. What has happened is that the introduction of new technology such as MRI, and new procedures such as hip and knee replacements have been added onto existing budgets. New use of healthcare facilities does not represent waste in the system, so it cannot be eliminated by the deterrent cost of user fees.
People who fear user charges avoid seeing doctors. As a result illness goes untreated. Often things worsens, and by the time people do seek medical attention, it becomes more expensive. Experts conclude user fees cost more money than they take in, and create worsening health. It is called the zombie approach by respected researchers at UBC, because it keep coming back.
What we need is for someone to kill it again.
Duncan Cameron writes from Vancouver.
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