Sick about Two-Tiered Health Care

By Raymond D. Cohen

This editorial is X-rated! It’s X-rated both because of editorial content, and because it deals with a dirty question -- the emergence of an "official" double-tiered health care system in Canada.

Official, I say, because in fact there has long been a two-tiered system in place -- of sorts. Those of us with hepatitis C, multiple sclerosis or any of a myriad of other conditions know full well that, but for adequate private health plans, medical service is often available only to those with the cash in hand to pay for it -- and, paradoxically, that frequently excludes those who are most likely to need such services: people with
disabilities. This particularly applies to the costs of some vital medications (see "Effecting Change" by Linda Villeneuve, p. 60).

The range war waging between Ottawa and the provinces in recent times has focused a lot of attention on the whole issue of medicare. The big question for some of us is just how vulnerable people with disabilities being caught in the crossfire may become.

This issue is much more relevant to people with disabilities than to the general public. In terms of patient visits, chronic care represents a much higher portion of our health care system than acute care. People with disabilities have a vested interest in this, the part of the health care system which should receive the lion’s share of the money in dispute.

So, along comes Alberta and ups the ante. Let’s put in place private clinics which allow overnight stays -- in effect, mini-hospitals -- that too may be accessible only to those with the fiscal wherewithal to use them. The others may wail at the wall -- or attend the increasingly inadequate services in place to serve everybody.

Alberta is not alone at this, simply the most blatant. It seems that scams commonly circumvent protective measures in various provinces. For instance, some physicians will conduct inexpensive procedures under the guise of much more expensive ones -- and collect payment accordingly. Somehow, losing money in one area provides justification for grabbing it from another.

Now we have the blame game. Consider the recent media war between Ontario and Ottawa. The dollars spent by both sides on that skirmish could have been better directed... towards health care, for example.

This whole development in the financing of health care causes me to think back to the earliest days of medicare. Back then, I worked as a psychiatric youth worker in a Montreal hospital emergency room. Late one evening, the crisis phone rang... the obviously disturbed voice from an obviously disturbed youth boomed through the receiver: "I need help and I want it now!" The voice then became disturbingly specific. "If I come down there, will you [provide me with sexual services of an unspecified nature]?" the voice wanted to know.

I turned to the psychiatrist on call at the next desk over from mine. "Hey doc, there’s a guy on the phone who wants to know if you’ll [provide sexual services of an unspecified nature] on him if he comes down here."

"Well, I dunno," said the good doctor... "Does he have his medicare card?"

Despite such questionable beginnings, medicare has served Canadians well for many years. It has been a guarantee that help is accessible regardless of income, or the province or territory in which you reside.

These days, due in no small part to media depiction, many individuals believe that our health care safety net has a lot more holes in it. This feeds into the acceptability of a two-tiered health care system -- at least by those who can afford it.

When Ottawa cut back on its health-related transfer payments to the provinces, each province was left to decide where it, in turn, would cut. The health care industry was instantly out dollars. And if the health care industry is unable to collect from the traditional source -- the government -- it is inevitably going to turn to consumers directly. Those who can afford to pay, that is.

Clearly, the government is responsible for the increased development of a two-tiered system -- at both federal and provincial levels. Sure, the federal cutbacks had major impact, but it was the provinces that decided WHERE that impact would land. Likewise, when the federal government re-opens the tap this fall to address the medicare issue, as is expected, it’ll be the provinces that decide where potentially hundreds of millions of dollars will fall. This is an important issue -- one that people with disabilities would be well advised to monitor.

In the meantime, hang tight, try NOT to get sick, drink plenty of fluids -- and make sure you call your province’s minister of health in the morning. You may want to impress upon the good minister just where you feel those transfer dollars should be transferred!