Justin Trudeau accuses Andrew Scheer of not mentioning his U.S. citizenship. However, apparently he never voted there, and allowed his passport to expire. Ironically, Trudeau and his entire family likely have and use fully portable Ontario health cards unlike his Papineau constituents. They are treated as “second-class citizens” outside Quebec as they must usually pay out-of-pocket to see an MD and face notices from institutions like the Montfort Hospital in Ottawa that specialists will refuse to see them unless it is a dire emergency.
Although health delivery is within provincial jurisdiction, Ottawa should have a role in facilitating access to care across Canada and in other countries. So far, Justin Trudeau and his health minister have failed to address both of these problem areas.
Granted, within Canada, hospital benefits are portable.
However, Quebec has refused to provide portable physician benefits. Thus, its residents on business or visiting friends and extended families in St. John’s, Ottawa, Toronto, Calgary, etc. must usually pay out-of-pocket to see a physician, and then await partial reimbursement – often at 30-50 per cent of the amount paid. Trudeau has done nothing to resolve this issue.
All Canadians also face inadequate hospital coverage outside the country for two reasons:
Hundreds of drugs have been placed on “back-order” for an indefinite period of time. This began about 2010, and is worsening. Physicians must then switch their patients to a similar drug which may have different side effects and reduced efficacy. Such a change would invalidate most travel insurance policies, if it occurred within three months of a vacation or business trip.
The median age in Newfoundland and Labrador is 45 years – the highest of any province. Yet this could impact far more than just “snowbirds.” Many younger persons have diabetes mellitus, hypertension, lipid disorders, or overt cardiac disease. They take multiple medications; some may be suddenly changed. In 2015, the prevalence of diabetes mellitus in Canada was second among G7 countries (the U.S. was No. 1). It is higher among First Nations persons, South Asians, Chinese, Filipinos, Hispanics and Afro-Canadians. Thus it is relevant to all major Canadian cities.
The Canada Health Act requires that outside of Canada, government insurance (not affected by a recent change in medications) must at least cover the cost of equivalent services in a patient’s home province.
Sadly, this occurs only for physician fees. Whereas most large hospitals receive as an “interprovincial rate” about $1,400-1,600 per day for a standard room and over $6,000 for one in the ICU, except for P.E.I. and the three territories, provinces have been reimbursing only token amounts.
For a community hospital, Newfoundland and Labrador pays up to $350 per day. British Columbia pays $75, and Alberta, Saskatchewan, Quebec, and New Brunswick pay $100. Ontario has been paying $200-400, but plans to cancel this after January 1.
Provinces urge persons to buy travel insurance, but many cannot qualify. The federal health minister has never imposed financial penalties for violations of portability.
If provinces were eventually forced to comply with the CHA. Using data from the Canadian Life and Health Insurance Association, I estimate that this would require an increase of one percent of the Canada Health Transfer. It seems affordable, considering that in the last fiscal year, Ottawa’s revenues rose by 6.7 per cent.
Trudeau’s massive blind spot includes a lack of empathy with Canadians (some quite young) who take medications for chronic illnesses. Many might like to travel outside Canada this winter and still have adequate health coverage. Voters disillusioned with Trudeau’s many broken promises and his inaction in ensuring portable health benefits have a choice on Oct. 21.
Which political leaders will offer solutions?
Charles S. Shaver, MD,
Ottawa, Ontario
