ABLEnews Extra

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                         Holes in the Safety Net

Toronto--When Canadians count the many ways their centralized
health system is superior to the United States, the first item on
their list is universality: Everyone is covered, fair, square,
and free.

But in fact, with the cost of Canada's health system rocketing
higher every day, some holes are being poked in the universal
safety net these days.

This month, the province of Ontario began notifying thousands o
immigrants and foreign students that their health coverage was
cancelled.

All of the formerly insured are in the country legally, and those
who work pay full Canadian taxes; most now will have to purchase
private insurance out of their often-meager incomes.

Provinces also are imposing three-month waiting periods before
new residents can be covered by the national health plan. They
are also limiting coverage for Canadians abroad and reducing the
services covered by the system requiring Canadians to pay for
treatments, such as vasectomy reversals, that once cost them
nothing.

The net effect, experts say, will be a system offering the
essentials of health care for 'real' Canadians only, with
everyone paying extra for extra services.

"These are not cracks in the dyke. These are shifts in what the
dyke is for," said Jane Fulton, a health care expert at the
University of Ottowa. "The bureaucrats have targeted a vulnerable
and less skilled group because they are the least likely to make
a fuss."

The cutbacks, made in response to large budget deficits in most
of Canada's semiautonomous provinces, offer a warning to
Americans as Congress debates reform of the US system.

A Canadian-style program of national health insurance has some
support on Capitol Hill, but some Canadian experts say the
erosion of their system shows the risk of entangling health care
with politics. When budget deficits get too high, health care is
one of the targets.

"The whole government budget is one big envelope, and the whole
budget deficit is one big obligation," said Brian Ferguson,
associate professor of economics at the University of Guelph.
"They'll cut whatever is easiest to cut, and that's health care
and education."

Under the Canadian system, residents pay nothing our of pocket
for visits to doctors and hospitals, and they can choose their
own doctor or hospital at will.

The fees, set by negotiation between the government and the
practitioners are paid out of taxpayer dollars. About half of the
$50 billion spent on health in Canada every year is funded by the
provinces, another quarter comes from the federal government.
Within federal guidelines, the provinces operate their own health
systems.

That gives them latitude to choose what and whom to cover. The
province of Alberta, for instance, will pay up to $410 a day for
a traveling Canadian who must seek emergency care in a foreign
hospital, while the neighboring province of British Columbia pays
only $54.

Adult residents of Manitoba can have their eyes checked for free
by an optometrist once every two years, while those in
Saskatchewan to the east must pay. Foreign students enrolled in
Alberta are covered, those in Manitoba are not.

Canada's 28-year-old health system is the second-most-expensive
in the world on a per-capita basis, after that of the United
States.

In recent months, to control rapidly rising costs, provinces have
reduced the number of medical treatments that are covered under
their health plans. Ontario, for instance, earlier this year
decided to stop paying for in-vitro fertilization treatments,
routine circumcisions, and vasectomy reversals, and senior
citizens in Nova Scotia must pay for some drugs that were covered
before.

The idea, officials say, is to create a cost-effective system
that treats basic illnesses.

"If you've got an unattractive wart and you're 45 and going
through a midlife crisis, is that a medical condition?" asked
Robert Harvey, executive director of insured benefits for
Manitoba, which recently dropped coverage for wart removal.
"We're heading for a lot more efficiencies. The system is
becoming more accountable."

The decision by Ontario to drop coverage for some immigrants,
however, raises the question: accountable to whom?

The move, effective June 1, affects about 60,000 people and will
save the provincial government $21 million a year. Immigrants
with permanent-resident status will continue to be covered but
those with temporary authorizations to work and their families
are being dropped from the plan. Many of these people are
domestic workers, and many earn relatively low incomes.

Canada has one of the most liberal immigration policies in the
world, allowing some 250,000 people to enter legally each year,
equivalent to nearly 1 percent of the country's population.

Some of the new arrivals rely on Canada's generous welfare
system, but many others find full-time work.

"It's extortion to make temporary workers pay into the tax base
and then deny us access to benefits paid from that tax base,"
domestic worker Monica Anderson wrote in the Toronto Star.

Ontario officials say, essentially, it is tough luck for those
outside Canada's "universal" health system.

"The rationale is to protect our health care," said Paul
Kilbertus, spokesman for the Ontario Health Ministry.

"These are people we have no obligation to provide health care
to. It is something we can no longer afford," he said.

[Canada's Vaunted Health Care System Limiting Coverage, Reducing
Services, Anne Swardson, Washington Post, 4/19/94}

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