Can Justin Trudeau redeem himself? The image of his new government has been severely tarnished. The choice of Steven Guilbault as Minister of the Environment alienated many people, including Alberta Premier Jason Kenney and even Opposition leader Rachel Notley. The 11th hour decision to appeal the ruling of the Human Rights Tribunal and further delay compensation for 50-100,000 children has angered Indigenous persons across Canada. Jagmeet Singh termed this action a “betrayal.”
Trudeau must demonstrate in concrete actions, not platitudes, his support for national unity. Might a first step be ensuring that all Canadians – including Quebecers – enjoy fully portable health benefits across Canada?
Of note is that his new health minister, Jean-Yves Duclos, graduated from the University of Alberta in 1988. As an economist, he must realize that nearly 60 per cent of the funding for the university comes from the Alberta government, and much of its revenue is dependent on the energy sector. In addition, he has written much about “equity.” Surely he must be aware that his fellow Quebecers are treated like “second-class citizens” when they become unexpectedly ill in another province or territory, or require treatment by a physician within three months after a permanent move to another part of Canada.
Saskatchewan, is now the epicenter of the pandemic in Canada. In October it had a record 156 COVID-19 deaths and more residents per capita in ICU beds than any other province at any point in the pandemic. The Canadian Armed Forces have been sent in and by Oct. 31, at least 24 patients had been transferred to ICUs in Ontario. CMA President Dr. Katharine Smart termed this a “deep crisis.”
In June, Manitoba suddenly had the highest rate of new cases in North America. It sought assistance from the Canadian Armed Forces, requested surplus vaccines from the United States, and transferred 51 patients to Ontario, two to Saskatchewan, and two to Alberta.
Alberta, like Saskatchewan, eliminated most public health restrictions in early summer, and also requested the CAF to assist in its own surge. Ontario offered to accept ICU patients but so far none have been transferred.
The portability provisions of the Canada Health Act make this all possible. For example, the Ottawa Hospital receives – above their global budget from the Ontario Ministry of Health – for all out-of-province patients a daily ICU rate of $4,848. This is ultimately reimbursed by the home province or territory of the patient.
Because of the Reciprocal Medical Billing Agreement (RMBA) – signed by all territories and provinces and most provinces – physicians can bill OHIP or their own provincial health plan, receive their normal fee, and their own ministry of health then collects from that of the patient. This is required by Section 11 of the Canada Health Act, which was passed unanimously in 1984; thus all Quebec MPs voted for it.
Yet Quebec has continued to ignore this portion of the CHA. Its patients must usually pay the MD directly and after many weeks receive partial reimbursement from their own province. Over many decades, all federal health ministers have been reluctant to force Quebec to obey the Act.
Jean-Yves Duclos is symbolically from Quebec City. As a lasting legacy to his fellow Quebecers, he should strongly encourage Christian Dubé, Quebec Minister of Health and Social Services, to sign the RMBA.
Should a new variant emerge, and a surge of severe cases occur in Quebec, fully portable physician benefits would facilitate transfer of patients to hospitals in Ontario and other provinces. In addition, Quebecers would enjoy accessible medical care across Canada when travelling on business or visiting friends and relatives.
By finally being granted the same portable health benefits enjoyed by other Canadians, Quebecers would now have even more to lose if the separatist movement were ever to regain strength in the future.
With the approach of the holiday season, I therefore urge Trudeau to include this issue in his mandate letter to Jean-Yves Duclos,- a symbolic but concrete action that would benefit his constituents and promote national unity. In addition, hopefully Duclos will recall the years he spent as an undergraduate in Edmonton receiving an education that was partially subsidized by the natural resources of the province and will show his appreciation by urging Guilbault to adopt a fair, balanced approach to his new cabinet post.
As a Toronto Star editorial concluded, “Trudeau has now set the table for his third term in office. As usual, he scores high on symbolism, but the record is still to be written on substance.”
Ottawa physician Dr. Charles S. Shaver was born in Montreal. He is past-chair of the Section on General Internal Medicine of the Ontario Medical Association.