Is multi-tiered health care the solution?

by James Urquhart

19 August 2011

Two-tiered healthcare, rather than being a repudiation of Canadian ideals, might be one of the few solutions capable of maintaining them, Urquhart argues. (Photo supplied).

One of the things that we feel a great deal of pride about, as Canadians, is our ability to access health services without having to pay at the “point of sale.” While we often take this for granted, when we stop to think about it we soon come to realize that we have it better than most when it comes to health care. Yet, like any other service, someone has to eventually pick up the bill.

Traditionally, health care has been financially supported by federal funds, with our contribution coming from a percentage of the taxes we pay. The problem is that health care is expensive, and drastically affects the federal budget tabled by the government each year. Last year, the Conservative government gave 129 billion dollars to the various provinces in transfer payments for health care, and ran a 56 billion dollar deficit.

It has been clear for at least a decade that the health care situation is pretty grave in Canada—as costs continue to soar—and it’s also clear that we need a new solution to this problem. Many have offered possible answers, but the problem continues to worsen. One proposed solution—a multi-tiered health care system—is not a novel idea (in fact it is currently practiced to some extent in BC and Alberta), but I think that it is an idea worth revisiting as a possible solution to the growing cost of health care.

Of course, this is not a grand solution to the problem; I certainly realize that it would have to be part of a group of ideas working as a unit to solve our health care dilemma. This being said, if we did have tiered health care in this country, in conjunction with other measures, it is reasonable to think that we might be able to fix the holes in our health care infrastructure. Consider this scenario: suppose we charged Canadians who make more than X dollars per year (a figure determined by Statistics Canada and economic theorists) an amount of money to access health care on the basis of their income (as well as other factors including debt load, number of children, etc.).

At first, this may seem pretty radical, and I’m sure it would create a great deal of controversy. In addition, many would likely label whatever government attempted to pass this legislation as unconstitutional and un-Canadian. However, although unpopular, these measures would not be unconstitutional, and not necessarily un-Canadian. Notwithstanding the resistance that this measure would certainly face, something needs to be done about the problem Canadian provinces are currently facing, and I believe that tiered health care could certainly be part of the solution to that problem. The obvious advantage to a tiered health care system is that it creates a flow of capital that would otherwise not exist, while continuing to protect those who cannot afford to pay for privatized health care.

Creating this type of tiered health care system also does not run afoul of the Canada Health Act, because it still provides all Canadian citizens, who are insured, with health care. The difference between our current practices and this proposed change is that citizens who make over a certain amount of money would have to pay to be insured. One of the most obvious problems with a tiered health care system is that each province regulates its own system. As I mentioned above, some provinces already employ this measure (although some charge all citizens in their province, regardless of their income level). It would be problematic to get all provinces across the country to agree to pass this type of legislation.

It would also be problematic to control the amount that each province would charge those citizens who do fall above the income cut-off. Another obvious issue would be getting people to support this type of measure. After all, governments are elected by the constituents of various areas of the country—if citizens disagree with your policies and procedures, it’s very easy for them to elect another candidate.

I’m not trying to undermine the history and tradition of Canadian health care in this article. In fact, this is one of the things that makes me most proud of being Canadian. I am also not trying to suggest that what I have proposed in this article is an all-encompassing solution to the health care problem. What I am trying to bring to the attention of the reader is a serious problem for our economy, and readers need to think critically about a solution.

I too would like to have free health care for everyone, all of the time. Unfortunately, as the old saying goes, “money does not grow on trees,” so we must think about this, and similar problems, to find sensible solutions to real issues. So, while a tiered health care system is not a solution in and of itself, I do think that it would go a long way to creating some much needed capital for the struggling health care system.

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Is multi-tiered health care the solution?

by James Urquhart

19 August 2011