The Real Elephant in the Room: Health Care User Fees

The cost of Canada's supposedly universally accessible health care system is the "elephant in the room," many media quoted Quebec's Premier Jean Charest as saying at the Council of Canada meeting on Thursday. What wasn't reported as much was his proposal that user fees be instituted to defray the cost.

The CBC--reading from a press release from Charest's office, I presume--mentioned them prominently yesterday, but this morning Radio Canada, which hadn't, said that the premiers of British Columbia and Ontario dismissed the idea. They noted that studies show that user fees are counter productive since they discourage people from getting treatment when they need it and end up increasing costs. Canada's health care system is one of our "definiing" institutions, they and others added.

That's exactly the kind of response that Charest got last spring when his government proposed fees in Quebec. Doctors, citizens' groups, individuals: there was a great outpouring of condemnation for the idea. The result seems to be that Charest and friends have removed it from their immediate plans.

But here Charest is again, bringing up what health economist Robert Evans calls a "zombie" idea. It's possible that Charest is brandishing it in hopes that the outcry will be so loud that Stephen Harper won't dare cut health care funding to the provinces. There were those in Quebec, after all, who said that the idea was floated here only as a trial balloon and to make a sort of enrollment fee (not unlike ones in British Columbia and Ontario, as it happens) more easily accepted.

This is playing with fire, though. User fees are no solution to health care's problems, and opening up the Canada Health Act (which allows the feds to reduce payments to provinces who charge them) in order to make them legal would be a giant step toward a health system that is more inefficient, costly and profitable to private medical entrepeneurs.