=e

PREDIC ARE

User fees ‘a tax on the sick’

Continued from page 3

vide coverage for services which the govern-
Ment has excluded from medicare.
Significantly, both have been proposed by
One of the chief economic influences on the
€tt government, the Fraser Institute.
The head of the Canadian Medical
lation dismisses extra-billing as any
threat to medicare, arguing that it only con-
Stitutes two per cent of total physicians’ bill-
INgs across the country. But even if that
Wgure is correct, it is still significant when it is
translated into dollars in each province.
Health and Welfare Canada statistics
show that extra-billing in Ontario, for exam-
Ple, takes an extra $49 million out of pa-
ints’ pockets’. In Alberta, it accounts fora
otal of $14.5 million.

What is worse, it begins the process of
‘eating two levels of care. As government
Testraint keeps fee schedules down, extra-
a grows and more and more doctors
pt out’? in order to extra-bill their pa-
“ents. The amount that is extra-billed also
8tOws over the years. Finally only those doc-
tors committed to the system are prepared to
Provide services at the listed fee.

; Extra-billing is currently prohibited by
“gislation in this province. But the Socreds
“vy substantial user fees for various services
and may, as is widely suspected, have impos-
€d the extra-billing ban in’ order to give
themselves the future option of levying a
Sovernment user fee for a visit to the doctor.

British Columbians now pay $8.50 a day
Or a stay in an acute-care hospital($10 per

Yn some maternity hospitals) and $10 for
ra emergency ward visit in addition to fees
Boe enlances, day surgery and other ser-

The charges are not a deterrent in the same
Way as doctors’ extra-billing although
Health Minister Monique Begin cites the
Fe of a parent not taking a child with a

“ver to an emergency ward because of the
€€ — which could have tragic consequences

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if the fever turned out to be a symtom of
meningitis.

But they are the most regressive form of
taxation since they impose the heaviest
burden on those with lower incomes.

Moreover, Dave Schreck, who is also an
economist and the general manager of
CU&C Health Services Society, notes that
they are economically wasteful since they
force each hospital to set up its own accoun-
ting department.

But for a government which does not sup-
port the idea of universal medicare funded
by general taxation and publicly ad-
ministered, that argument is immaterial.
Socred financing abounds with regressive
forms of taxation.

The federal government has targeted user
fees and extra-billing as the main threat to
medicare and has proposed to penalize pro-
vinces which allow them in a new Canada
Health Act, slated for introduction in Parlia-
ment in the fall session.

The Liberals’ support for universal
medicare —in fact, it has launched a publici-
ty campaign on “preserving universal
medicare’? — has strong election overtones
but the dispute is more than a clamor for
votes.

The federal government’s and Begin’s
defence of medicare draws heavily on the
recommendations of Justice Emmett Hall, a
man who headed the original 1964 royal
commission which proposed a universal
health services program, and who has head-
ed various commissions on updating the
system in the years since then.

Ina 1979report, Justice Hall recommend-
ed that physicians by prohibited from opting
out of medicare and extra-billing and also
urged that, as money became available, the
provinces discontinue user fees and
medicare premiums.

But since that report most provinces, run
by right wing Tory and Social Credit govern-
ments, and under pressure from business in-

terests, have shifted in the opposite direction
— forcing more and more health care costs
on to the sick in order to slash provincial
health budgets.

The ‘‘business first’? approach of those
governments was summed up by Alberta
Health Minister David Russel who said in
July: ‘‘There is a great philosophical dif-.
ference between a free enterprise Conser-
vative government and a socialistic Liberal
government.”’

Inan effort to deflect the federal criticism,
the provinces have in turn charged that the
federal government has reduced federal sup-
port for health care. If is a charge which has
some validity since, as a result of financing
program changes in 1977 and 1982, there
are, in fact, proportionately fewer federal
doliars going to the provinces for health care
than in 1977,

But that is mainly a problem of federal-
provincial financing and could be redressed
if the federal government were compelled to
live up to the recommendations of the 1981
task force which urged that federal support
be restored to 1977 levels. It certainly doesn’t
threaten the medicare system in the same
way as provincial budget-slashing and the
growing practice of. extra-billing and user
fees.

The battle lines have been clearly drawn
since at least two provinces, including B.C.,
have demonstrated that the principles of
universal accessibility to the best available
health care is distinctly secondary in deter-
mining budget priorities.

The first major skirmish with the federal

government came at the conference of .

health ministers Sept..7 and 8. Inevitably
there will be more before a draft Canada
Health Act is tabled inthe Commons.
But even before that, people in this pro-
vince will have a fight against Bill 24 which is
before the provincial legislature right now.
Certainly the future of medicare in 3h Cs

depends on its defeat.

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PRO-CHOICE
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The day will be marked by a general
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‘Saturday, Oct. 1 has been set asa ‘‘na- |)

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SEPT. 24 — YCL 60th anniversary
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See display ad-for details.

SEPT. 25 — Surrey Alternative
movement dinner and panel discus-
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RUSSIAN PEOPLE’S
HOME EVENTS
SEPT. 29 — Adult's basic conver-
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7:30 p.m., 600 Campbell Ave. For:
info. 526-5160, 278-8779, 298-1513.

OCT. 2 — Report-back with slides
on the Prague Peace Assembly.
1:30 p.m., 600 Campbell Ave. For
info. 420-5866 or 526-5160.

OCT. 1 — You are cordially invited
to a farewell party for Nick and
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OCT. 29 — Keep this date open for
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PACIFIC TRIBUNE—SEPTEMBER 21, 1983—Page 11