Roman-Ow! And Portability

Winter 2002 CSANews Issue 45  |  Posted date : Apr 12, 2007.Back to list

I have taken my kids to Disneyland, I must travel on business, I have gone to the U.S. to shop for a day and I have taken a week's vacation in another country. I have also been lucky enough to take a short cruise, to visit my grandparents' birthplaces in England and Ireland and to visit New Zealand where we have relatives. It has taken me almost 60 years to do these things (and a lot of frequent flyer points), and I believe that these travels reflect the simple desires of many Canadians.

My involvement with the Canadian Snowbird Association began when provincial governments decided to break our laws and to contravene the Portability section of the Canada Health Act. Governments, in their inherent stupidity, used to pay whatever bills they received for health care performed outside Canada. The Canada Health Act required them to pay only the amount that would have been paid for the same medical services in the patient's province of residence. The government paid more, and a lot more; they just routinely paid the bills they received, no matter how outrageous. It did not take long for U.S. health care providers to figure out what was going on ­ they had found a "gravy train." Not many people really knew what was going on, at the time, but provincial governments knew something was wrong (after several years of abuse) when they started adding up the payments for out-of-country care. It was hundreds of millions of dollars a year.

In reality, it was fraud, and the main culprits were the drug and alcohol rehabilitation "centers" in the United States. Did you know that a few doctors in Canada were often paid a finder's fee (I have heard rumours of $10,000 fees) for referring a patient to one of these luxury centers? The center would actually send a limousine to pick up the poor drug addict and drive them to the center in the U.S. where he or she could live in the lap of luxury for a few weeks, at our government's expense. In the early 90's there was often talk, inside government, of suing these centers and the few offending doctors to get our money back. My guess is that any settlement would be well in excess of one billion dollars, and we could surely buy the odd MRI or CAT machine for that amount.

I am getting a little off track, here, because I wanted to talk about real medical expenses for travelling Canadians, not the fraud that invaded the system. The best way is to give you some cost estimates for a typical stay in a U.S. hospital. Let's look at an appendix attack requiring 7 days of hospitalization.

As seen on the table on the following page, the provincial governments finally realized that they had erroneously been paying Cost #2 for several years, when they were only required to pay Cost #3 as outlined in the Canada Health Act. In their haste to remedy the situation, most provinces instituted the flat fees we now see of $75, $100 and $400 per day in hospital plus a very low level for doctor and diagnostic fees. This was in total breach of the Portability Section of the CHA! They should be paying Cost #3.

The CSA had high hopes that Mr. Romanow would address the Portability issue, as it had been intended, by the original framers of the CHA. It was of such importance to them that they had it implemented as one of the five Pillars of our whole Medicare system.

Cost #1 - Total amount of bills received from the U.S. health care providers: ($26,500 US) $41,075

Cost #2 - Total amount paid by your Government Health Insurance Plan prior to cutbacks:
$41,075

Cost #3 - Total estimated amount that should be paid under the terms of the CHA:
$12,500

Cost #4 - Total estimated amount NOW paid by your Government Health Insurance Plan:
$ 2,850

Cost #5 - Roman-Ow's solution:
$ 0

Now Romanow wants to throw it out and pay nothing for medical services outside of Canada. If the Romanow Commission had been true to the founding principles of our world renowned medical system, he would have strongly recommended that our federal and provincial governments pay Cost #3. This is the fair cost, the honest cost, the legally required cost and the only one that will give all Canadian travellers at least some freedom to follow their dreams.
We all know that we must buy additional private insurance when we travel and we have no quarrel with doing exactly that. The argument will be made that we are one of a very few countries that pay for any portion of medical services outside the country. This is true, but is this not one of the reasons our medical system is world renowned, in the first place?

When the provincial governments "gutted" health care benefits for travellers, they were overreacting to their own incompetence in paying fraudulent medical charges AND in paying far more than the Canada Health Act required them to pay for normal medical bills. The federal government is also to blame as they were under-funding our whole medical system, both then and now. Romanow should have pointed these simple facts out to his readers. If you remove one pillar from a building, it will very often fall down; portability is our freedom, our uniqueness and a critical component of our future and I hope our governments will realize, in the many discussions to come, that the Romanow Report, in at least this one area, is very wrong.

As I am really supposed to be writing an insurance article, I will simply point out that your, and my, cost of private medical insurance is directly related to the above factors. But of course our politicians may not hear our cries for help, as they have government travel insurance at Cost #2 provided to them for free, for life.