You’d think “universal” would mean exactly that. But in the context of Canadian health care, “universal” can mean something quite different, depending on your location.
Ontarians were reminded of this again last week, when the Progressive Conservative government announced that it was amending Ontario Regulation 552, part of the Health Insurance Act. Regulation 552 provided some payment for Ontario residents covered by OHIP who incur health-care related costs while travelling outside Canada. The Ford government noted that the maximum daily amounts had not been adjusted upward in 20 years and that the dollar values were wildly low compared to the actual costs of services.
Ontario would pay up to $400 a day, for instance, for a resident receiving a “high level of care” in a hospital bed abroad — think an intensive-care unit. Hey, $400 is $400. But according to a report published in 2010, in the United States, the average daily cost of an ICU bed was nearly 11 times that much. Your OHIP coverage won’t take you very far — you need either private insurance or an awful lot of cash if you get sick or injured outside Canada. The program wasn’t particularly popular: in 2018, the provincial auditor general reported that Ontario was paying only about $9 million a year for out-of-country coverage. Accounting for the currency exchange, that means the entire program was annually costing Ontario roughly as much as David Pastrnak costs the Boston Bruins for one season.
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The move was met with sharp criticism, of course. The Ford government has already taken some steps to lower health-care costs — recall its changes to the OHIP+ program — and this was seized upon as yet more proof of cruel conservative cuts. Thomas Walkom, writing in the Toronto Star, said it struck right at the heart of medicare. (I had not realized that the heart of medicare was a program worth one Pastrnak.) The editorialists at that same paper called the move “wrong and pointless.” The Canadian Snowbirds Association — the people who bail on our winters, not the Air Force squadron — put out a grumpy press release.
And then there was the Opposition. NDP health critic France Gélinas sent a letter to the federal health minister asking Ottawa to determine whether Ontario’s plan would violate the Canada Health Act. You’ll want to ask a lawyer about that, but my layman’s reading of the legislation suggests that it very well may — the act requires provinces to provide at least some coverage no matter where a fee is incurred. Ontario could probably get away with hacking the reimbursement rates down to $1 a day — Buck-a-Bandage? — but the NDP could well be right that the province can’t take it to zero.
There was also a tweet last week from Andrea Horwath, the leader of the Opposition: “Ontarians are Ontarians, even when they’re on a trip away. I believe the care you get should never depend on how much money you have. Taking away OHIP coverage every time Ontarians cross the border is a sneaky way to get us to pay for health care.”
Whoa, whoa. Hang on a minute. Does Horwath’s contention that “the care you get should never depend on how much money you have” suggest that an NDP government would make privately purchased travel insurance unnecessary? Would OHIP become fully portable under a Premier Horwath, covering all costs incurred, anywhere, by anyone insured under OHIP?
The answer, it turns out, is no, dear reader — she’s not saying that at all. A spokesperson for the provincial NDP told me by email that the party is “not advocating for any greater portability than what’s currently in place.” Okay, fair enough. I appreciate the clear and concise answer. But it’s too bad: I’d much rather see an opposition party offer up a genuinely contrary vision than simply warn people that what the government is proposing may contravene the Canada Health Act.
Again, it very well may. And if it does, then that’s a problem the Ford government is going to need to mull over. But lost amid the anger about Ford striking at the heart of medicare is a more fundamental question: What good is $400 a day toward your $5,000-a-day ICU bed? Why is that better than $200, or $15? What would the right number be? How much would it cost Ontario to provide that kind of coverage? Would it be worth it? Why shouldn’t people travelling abroad have to cover the full cost of that travel, with the trade-off being that they remain comprehensively covered at home?
These are interesting questions that no one is answering, because we’ve already fallen into a pattern familiar to our politics: any attempt to change the status quo is bad; therefore, the status quo must be good. That’s no way to run a province, but it is, sadly, the way the province has often been run.
It’s a shame. We’d be better governed if we took a broader view of what’s possible. On social media last week, I saw someone lament the fact that they’ll now have to get private insurance each and every time they duck across the border to run errands. I’m not sure why they wouldn’t already have insurance — one of those private plans that covers multiple trips. But the post made me wonder whether a better model for Ontario might be to extend full OHIP portability to anyone hospitalized within 24 hours of leaving Canada. Someone who’s crossing the border to buy cheaper groceries or struck down on the first day of a vacation would be covered. From their 25th hour on, they’d need private insurance.
To be clear, this isn’t a hill I wish to die on. There may well be reasons that this off-the-cuff suggestion is terrible or unworkable. Perhaps it even strikes at the heart of medicare. But I offer it anyway, as a hypothetical, the kind of thing we could consider if only someone in the legislature were to put it forward. Then we’d have something real to debate — because there’d be a genuine divergence of views on a matter of public interest. How refreshing would that be?