The Great Canadian Universal Healthcare Parking Fee Crisis

Recently one of our American readers (hi S.C.!) asked us to write about our Canadian universal healthcare system. It has sort of been in our news of late so I thought I would use the request to answer her questions and rant about our system.

We have a universal healthcare system whereby every Canadian citizen is covered and no one pays anything personally. It was created in the mid 1960’s after a long and arduous battle between those for it and those against it. It’s just a brilliant concept where, like any insurance program, you spread risk. Everyone contributes and you hope that it’s not your house that burns down (or you who gets sick) but if you do, you are covered. It is funded from general government revenues like income tax.

I remember when I first began working (many long years ago) I paid an OHIP Premium. The OHIP (Ontario Health Insurance Program) managed healthcare in my province and it was partially funded by the federal government, partially by the province and individuals contributed a small amount. It was mostly symbolic but eventually some government decided to appeal to voters by eliminating that minimal payment.

I am a huge believer in and supporter of our universal healthcare system, but not having people contribute to it or be aware of the cost of it, is just an inane concept. What it boils to is this; the costliest system that Canadians encounter on a regular basis, IS FREE and so for many people it has no value associated with it. Having a charge affixed to something equates to value for most people.

Healthcare is starting to use up an increasingly large part of our government’s resources. In Ontario it uses 40% of the budget and we spend $50 billion a year on healthcare for a population of 13 million. The percentage of the spending government devotes to healthcare grows each year. The federal government a decade ago signed a health accord and agreed to increase funding to the provinces by 7% each year, for the last decade. Now think about it. Has the economy been growing by 7%? Has your saving’s account been paying you 7% interest? Of course not. I believe the doubling time for a 7% increase is about a decade. So basically Canadians are spending double on healthcare what we spent a decade ago. Really? How do you think that’s going to work out?

Most Canadians have never seen a bill for healthcare or for their share of the cost of the system. If the system wasn’t already so overburdened with bureaucracy, I think that every time you leave the doctor’s office or hospital you should be presented with a statement that itemizes the cost for the treatment you received.

When I ran in the last provincial election as the Green Party candidate, there were several All Candidates Meetings where (mostly) older citizens expressed concern that they couldn’t afford the parking fees at hospitals, which have been rising quickly since it’s one of the few ways that hospitals can generate revenue. This topic is now regularly covered in the media, this crisis of healthcare parking. I can only shake my head. Our system has doubled how much money it requires in about a decade, and we think parking is a problem? TVO’s “The Agenda’ just did a show on healthcare where they demonstrated that 1 percent of the population uses 33% of the healthcare budget, and the next 4% uses a third … so essentially 5 percent of our population uses 2/3 of the healthcare budget.

http://tvo.org/video/programs/the-agenda-with-steve-paikin/high-care-high-cost-patients

(Just watch the first 2 minutes of this video.)

Half of the population uses only 2% of the healthcare spending. I am unbelievably grateful to be in that 2%. I am also incredibly grateful that the system has been there when members of my family have moved into the upper healthcare consumption percentage.

As our population gets older they use a much higher percentage of the healthcare system.

I know what you’re saying, “So Cam, you are being very negative about the whole enterprise and you’re not offering solutions.” That is correct. In Canada if you say we need to start charging people to use the system it’s anathema (the absolute worst thing you can suggest) to hardcore universal healthcare supporters. Somehow we have to convince Canadians that our healthcare system is a huge privilege, it’s not a right or a given. We have to start using it only when we actually need it. And we have to start being honest about the system. It’s not sustainable and no one will talk about it.

The deductible for my household insurance keeps going up and my agent keeps reminding me that insurance is for a catastrophic event. I believe that Canadians need to stop going to the doctor to get their blood pressure checked when they can buy their own machine for $50 and do it themselves. They need to stay out of the emergency ward when they have a cold.

Any politician who suggests we have to start being honest about the tsunami of a healthcare crisis that is coming will not be elected and this is proof to me of the deficiencies of democracy. When you’re honest with the electorate you don’t win. We aren’t even talking about rearranging the deckchairs on the Titanic, and it seems to me that would be a good starting point.

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11 Responses to “The Great Canadian Universal Healthcare Parking Fee Crisis”

  • In response to Susan, I’ve taken a special interest in fictional post-collapse healthcare systems (bet you never even knew this genre existed) from James Howard Kunstler’s back-to-basics World Made By Hand (mostly herbal medicine), to the dystopian futures depicted in the movies Elysium (quality healthcare available only to the elites) and The Road (strictly DIY). But the most realistic fictional future healthcare system I have come across so far (in my opinion) is the one depicted in one of John Michael Greer’s recent blog posts here:

    http://thearchdruidreport.blogspot.ca/2016/02/retrotopia-back-to-what-worked.html

    This is basically the system which prevailed in most of the developed economies about 100 years ago, where trade unions, businesses or public minded philanthropists would engage one or more physicians to provide medical services to a strictly defined population (members, employees, poor people in the parish and so on).

  • I guess my question is this. Should Canada go back to the same system the US has today. As in employer sponsored or privately paid for insurance? I am not trying to be argumentative. I’m genuinely trying to figure this out.

    Thanks

  • I agree with Cam and just about all the comments. I’m a family physician working in the Canadian healthcare system (although not for much longer – I’m cashing in my chips and heading out in June) and in case people are interested, here’s a list of the things which take up the most amount of time in my practice. These are just off the top of my head, I haven’t done a formal audit.

    Anxiety/stress/depression. Large amount of overlap between these, which often co-exist in the same person. I think statistics show that about 15-25% of the entire Canadian population is on a sleeping pill, a tranquillizer and/or a antidepressant. This is the elephant in the room which nobody ever talks about. I don’t believe that as a species, we evolved to be chronically anxious and depressed. It must be something to do with modern society.

    Drug abuse / drug seeking. Very difficult to differentiate genuine chronic pain from people who claim to have chronic pain to get the meds then sell them on the street. Lots of overlap between these two groups and the first anxious / depressed group.

    Routine visits for diabetes and blood pressure checks. Vey little value in these, in my view. People should eat less, exercise more, stop being obese and look after their own diabetes and blood pressure. By handing it over to me to look after it for them, it’s almost a way of absolving themselves from the responsibility of doing it.

    Demanding pointless things, e.g. “I have a cough, I want you to order a CT scan of my chest, but I’m not going to stop smoking”.

    Form filling. Endless, endless paperwork which takes me hours every day. Like the disability benefit forms (various flavours) which require me to certify that the applicant is too physically or psychologically sick to work, but they are still quite capable of doing their housework and DIY jobs and taking their benefit cheques down to the bank. Sometimes I have to ask them “what exactly is your disabling condition?” because from their medical chart, they don’t appear to have one.

    I could go on but I won’t, because there is a pile of paperwork still waiting to be done.

  • Hmmm, how did I miss this? I agree with you, and I also feel that it would be very hard to come up with a health care system that is sustainable when we live in a world of poor health! Has there ever been a time in history when there are so many pill popping sickies? I’m not stepping foot in a doctor’s office or hospital unless my arm falls off. DIY! Between the internet and medicinal plants the doctor has become nearly obsolete to me.

  • Wow! Thanks Cam for your post. It certainly has educated me on how a lot of Canadians think about their health care. I also think some of the comments were pretty good with solutions. Especially Marcia’s comment because it sounds like the same problem we have with Social Security. AKA after a someone reaches an income of $118,ooo per year they do not pay anymore into Social Security leaving higher income earners reaching that amount the first 3-4 months of every new year. I also liked the comparison of the car maintenance by Mark. So thanks again for this post.

    BTW-I didn’t get a notification of this until you mentioned it in your latest post. Don’t know why.

    S.C.

  • j:

    Charging user-fees just for basic access is a dangerous proposition; reduces ability to access services, creates stigmatizing class divisions.

    A far better approach is to charge for non-essential services and/or limit the number of “free” visits unless there’s a clear crippling diagnosis.

    For example, there’s no proof that a annual physicals, especially for the 18-65 group improve health outcomes. None; they shouldn’t be covered.

    There are also the horrible wasted “luxury” services that are covered now which either provide something non-essential to live or prolong suffering-> fertility treatments, sex change operations, transplants for seniors, chemo for terminally ill cancer patients.

    Anyone who wants coverage for the such luxury services or physicals should be able to buy their own private insurance.

  • Robert:

    There is no easy answer to this but you are right, but user fees are the 3rd rail of Canadian politics. Touch it and you light up like a torch with the glare of criticism and then the ashes of your political career blow away in the wind.

    How do between the needs of people who may not have $20 or $50 in cash on hand until their cheque comes in at the end of the month against the idiots who drag their child in to the ER everytime they have the sniffles? I don’t know but this is a problem that is not going to go away.

  • Neil:

    I am grateful for our universal healthcare and think it is part of what defines Canada. That said, the way it is set up cultivates abuse and overuse. Here’s a contra view: any other type of “insurance” coverge offers a claims-free discount. How about a periodic rebate to those who don’t go running in to the Doctor’s office for every little thing? Just like the idea of a token co-payment, it need not be a large sum… just an acknowledgement, and some reward for being reasonable and presumably living a geneally healthy life. And BTW, I also agree after every visit the patient should indeed get a statement to see what is being billed to the system

  • Marcia:

    I must say I am concerned with this thought of paying for our healthcare. The only reason why the costs are so much at this time is because the wealthy don’t have to pay taxes the way they once did. The divide between the rich and the poor is a huge concern in this province. I suggest you read the book by Alex Himelfarb “Tax is not a four letter Word” It is not the fault of the average citizen who uses our healthcare system and the need to judge the poor (pack of cigarettes)is a tactic of the 1%. The poor are always the scapegoats as they gut our social systems to line their pockets. I would also suggest you read the book “Harry’s Last Stand”. He is a 93 year old and grew up in the great depression in England and now lives in Belleville Ontario. He shows how the same things that happened back then are happening here in Canada now. We need to see this issue in it’s entirety. Maybe the best thing is to use our healthcare less but I hope payment will not be the answer since poverty is growing at an alarming rate.

  • Mark:

    Just think of how much auto insurance would cost if it was required to cover all preventative maintenance (oil changes, tires, wiper blades, etc…). Health insurance should be for catastrophic events, not day-to-day expenses (calling what we have today “insurance” is part of the problem).

  • Cam,

    You are perfectly right there is no value associated with healthcare because it is “free”.
    My wife works in an ICU dept and you would not believe the money spent to keep brain dead family members alive. If the family had to even pick up a token part of the bill for that I am sure that in many cases the plug would be pulled.
    Also Emergency room visits and clinic visits should have a charge say $50 or $100. I think that would cut down on a lot of spurious visits. For the low income earners they could be reimbursed at tax time or fill out a form but I think that they should also pay at least something, say the equivalent of a package of cigarettes.
    My understanding is that in the UK the heath care system will not go to extraordinary lengths to keep essentially dead people alive and we need the same thing here.
    There will always be stories of tragic events and circumstances where a cold and uncaring system should have helped some poor and underprivileged family but in the big picture it costs to much.
    I also believe that the system is very top heavy and is run poorly, unfortunately that is also a difficult problem to fix.

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Cam Mather and his wife Michelle live independently off the electricity grid using the sun and wind to power their home and their CSA. Cam is working towards the goal of making his home “zero-carbon” and with his extensive garden he aims to grow as much of his own food as possible. He is available to speak at conferences and other events and has motivated many people to integrate renewable energy into their lives, reduce their footprint on the planet and get started on the path to personal food, fuel and financial independence.
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