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Hike in premiums, balance billing
threaten entire medicare system

The increases in hospital charges
and medical premiums, and threats
by doctors that they will “balance
bill’’ if they don’t get the increases
they want have sparked new wamn-
ings about the danger to the medi-
care system — and an urgent call

Health minister Rafe Mair an-
nounced May 29 — after “flying a
kite” in April about possible in-
creases — that medical insurance

remiums would rise 15 percent Ju-
ly land hospital charges would rise
from the current $4 to $5.50 a day
for basic charges and to $8.50 from
$6.50 a day for extended care. Both
medical premiums and hospital
charges are also to be indexed to the
cost of living in future.

Two days later, the B.C. Medi-
cal Association, representing the
province’s doctors, revealed their
demand for a 30 percent increase in
fee schedules — and gave notice
that patients would be individually
billed for whatever the government

_ didn’t give them.

NDP health critic Dennis Cocke
denounced the increases as “‘irre-

‘sponsible and inflationary” and

warned that if they were imposed,
together with balance billing by
doctors, “‘medicare will start going
down the tube.”’

The Communist Party had ear-
lier warned that the government ‘‘is
undermining the health care system
and forcing people to pay more and
more of the costs themselves.’? The
doctors aggravated the problem,
ibe CP said, and urged a public
outcry “‘against any ‘incr i
health care costs.’’ i ee

David Schreck, director of
CU&C Health Service Society said
that the increases were at best, re-
gressive, and, at worst, ‘taxes on
the sick.”

_ Schreck pointed out that seven
of the country’s 10 provinces have
already abolished medical insur-
ance premiums. “‘Ironically,’’ he
added, ‘‘thé provinces which main-
tain premiums are the three richest
provinces — Alberta, Ontario and
British Columbia.”’

And the province which has just
increased them — B.C. — hasa $1
billion budget surplus.

Cocke pointed to that surplus in
his address to the B.C. Medical As-
sociation convention last weekend,
charging that the government
spends at least $250 million less on
health care than it should. More-
over, he said, Victoria is diverting
federal monies, received under the
block funding agreement worked

Teachers oppose bill ©

Continued from page 1

cluding Bill 29 which limits index-
ing while offering teachers some in-
creases in government contribu-
tions.

The BCTF delegation put the
teachers squarely behind labor’s
demand for withdrawal of pension
bills, altering an earlier ambiguous
stand in which some of the ex-
ecutive members of the pensions
committee, with little reference to.
the membership, had sought to
conclude an agreement which

would have limited indexing in
return for higher government con-

tributions,

That position was put to the an-
nual general meeting in 1978 which
referred it to the next. year’s
meeting. There, a slightly amended

version, which limited contribu-

See a

tions rather than payments, was
adopted..

At the 1980 meeting, however,
the teachers voted to re-affirm the
long standing BCTF position call-
ing for pensions fully indexed to in-
creases in the cost of living.

The BCTF said that it was
prepared to sit down with the
government to negotiate how full
indexing can be continued,
together with increased govern-
ment contributions to pension
funds. ;

The teachers pointed out that the
unfunded liability — the expected
shortfall in funds based on an-
ticipated pensions to retired
members — in the pension fund for
teachers is in large part the result of
government failing to match
teachers’ contributions.

out in 1977 with Ottawa, to areas
other than health.

To make up for the budget chis-
elling, Schreck noted, the govern-
ment is upping the premiums and
the hospital charges, which, he
charged, are both regressive forms
of taxation.’

“Since premiums are the same
for everyone, from the working
poor on up, those on low incomes
end up paying a higher proportion
of their income for health care — if
they can afford it at all,’’ he said.
_ He added that increased prem-
iums lead to a breakdown in the
medicare system since many people
who can’t afford it, have no medi-
cal insurance coverage and those
that do, pay for it through regress-
ive taxes — which are contrary to
the intent of the 1971 legislation es-
tablishing universal medicare.

Significantly, for the first time
Mair referred to the hospital
charges and medical premiums as
“user-pay fees’? — indicating that
the government is moving sharply
away from the original concept of
universal medicare. Under the en-
abling legislation, user fees are sup-
posed to be severely restricted so as
Not to limit access to health care.

Both the New Democratic Party
and the Communist Party have
called for the abolition of hospital
charges and medical insurance
premiums for just that reason —
they are regressive and are contrary
to the principle of universal health

' Care,

Another threat to medicare has
been seen in the doctors’ threat —
voiced on several earlier occasions
but confirmed at the BCMA con-
vention — to bill patients for the
difference between the fee schedule
set by doctors and the amount
agreed to in negotiations with the
government.

Although most of those in health
care acknowledge that doctors are
entitled to an increase, there is de-
termined opposition to the notion
that doctors hold their patients up
for ransom in demanding an extra
fee — and introducing yet another
user charge into the medicare sys-
tem. (

Cocke told the Tribune Monday
that heiggends to ‘‘scream his lungs
out in total opposition”’ to balance

billing, warning that if the doctors
are allowed to charge a small extra
amount now, it would be five times
that amount within five years.

‘The medicare system will fade
away into the sunset — it will just
be.a fond memory,”’ he warned.

Both Cocke and Schreck noted
that the doctors were doing ‘‘a lot
of posturing before the negotia-
tions with the government’’ al-
though Schreck emphasized that
the doctors were putting unreason-
able demands before the govern-
ment which could not possibly win
any public sympathy.

As a result, he said, ‘“‘they’re
strengthening the hand of the gov-
ernment which wants to destroy
medicare and would turn the public
against the doctors to wreck the
system.”

If the government allows the
doctors to bill the patients for any
amount not negotiated, it would
further undermine medicare, he
said.

Balance billing is specifically
prohibited by legislation in Quebec
and, more recently, in Alberta,
where if doctors are not satisfied
with the government fee schedule,
they must ‘‘opt out’’ completely
from the medicare system and bill
their patients for the entire fee for
services.

_ Inastatement June 3, B.C. Fed-

eration of Labor president, Jim
Kinnaird strongly criticized health
minister Rafe Mair for his handling
of medicare. “‘Doctors are calling
for huge fee increases, balance-bill-
ing, and extra billing,”’ said Kin-
naird, ‘‘and the person supposedly
in charge of the system has an ado-
lescent snit and won’t even talk to
the doctors. It’s an irresponsible
performance.”

Kinnaird repeated his call for the
government to get to the bargain-
ing table, and to conclude an agree-
ment satisfactory to the people of
B.C. ‘‘All citizens, and especially
working people and the poor,
stand to lose if this government of
the rich stands by and lets the medi-
care system be dismantled.”

The Federation president also
claimed that the medicare issue

clearly shows the government’s in-.

creasing isolation from the com-
munity.

LRT plans
crash to

standstill

The deafening silence heard in
Greater Vancouver about the pro-
spects for a quick start on rapid
transit, is the noise from the head
on collision between the Greater
Vancouver Regional District’s
$570 million light rapid transit pro-
ject and the spending priorities of
the Socred government.

The GVRD’s high capacity
rapid transit study — detailed en-
gineering plans for the whole LRT
system — has been finished for five
months and final submissions from
municipalities are due this month.

. But with the Socred gov’t, and the

NPA majority on Vancouver city
council, promoting several other
grandiose projects instead, the
GVRD seems to be resigning itself
to more delay.

_ Port Moody mayor and GVRD
transportation committee - chair-
man Ian Young admitted to the
Tribune this week that the GVRD
board of directors, once
unanimous in their determination
to get the LRT project moving, are
now divided. ‘‘There is a
divergence of opinion on the
board,’’ he said, ‘‘Some directors
have told me they want to move

cautiously and upgrade the existing |

bus system first.’’

The root cause of the divisions is
fear over the costs of the project
and the attitude of the provincial
government which must approve
the funding for the project if and
when it is included in the Urban
Transit Authority’s capital budget.

The current signs from Victoria
are admittedly ‘‘ominous’’, Young
said, ‘vith the minister responsible,
Bill Vander Zalm, making
statements about monorails along
Highway 1 as an alternative to
LRT, and with the province
already having committed over a
billion dollars to the Annacis Island
crossing, B.C. Place, the Trade and
Convention Centre, and Transpo
’86, complete with its ‘‘people
mover’? — a $60 million monorail
system for downtown Vancouver.

But Young still feels that the pro-
vince will be forced to back the.
LRT project. “‘It is either more An-
nacis crossings LRT. The op-
tions are disappearing,” he said.

Part of the answer to the funding
problem has been from Edmon-
ton, where an LRT system has been
operating since 1978 and has borne
out what advocates of LRT have
contended — that the windfall pro-
fits from rezoning and land de-
velopment along the LRT route, if

_ taxed, can pay a significant portion

of the costs.

Developers in Edmonton have
invested far more than the total
costs of LRT in new high rise, con-
dominium and shopping centre
complexes all along the LRT route,
especially in the downtown area.
Every block along the 19 block
stretch of LRT line on Jasper Ave.,
for example, has seen at least one
new office tower int = =<50

_ oe yee.

Outside of the downtown core, a
zoning freeze has protected
residential areas, but ‘‘many
developers have been quietly ac-
quiring land,”’ one Edmonton city
planner reported, ‘“We’ll see a
flurry of development in the
two years.”

Among the projects currently
planned alongtheLR ‘inejs a'318

acre shopping centre} office.com-
plex, hotel and ho complex at
the north east terminus of the route
at Clareview.

PACIFIC TRIBUNE—JUNE 6, 1980—Page 3