Taxpayers shouldn’t cover expenses of surgery queue-jumpers

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This article was published 26/08/2022 (1462 days ago), so information in it may no longer be current.

Opponents of two-tier medicine should be careful what they wish for when demanding the Manitoba government reimburse people who paid for their own surgery out-of-province.

Now that the Stefanson government has announced it will send a limited number of patients outside Manitoba for hip and knee surgery to help reduce wait times, some who have already paid out of their own pocket are demanding taxpayers pick up the tab.

The Manitoba Liberal party, which is normally opposed to people “jumping the queue” by paying directly for medical care, says the province should reimburse those who have paid for their surgery in places such as Mexico and Calgary.

There’s nothing wrong with people using their own after-tax dollars to pay for health-care services. However, doing so is not allowed in most circumstances in Canada, although there are some exceptions. The Canada Health Act, for the most part, prohibits provinces from allowing patients to pay directly for “medically necessary” services, such as hip and knee replacements. For some reason, the federal government turns a blind eye to that rule when people cross provincial boundaries. You can travel to Calgary to pay for hip, knee or cataract surgery, but you can’t legally buy it in your own province (unless it’s at a clinic where the physician has opted out of the province’s health insurance scheme). Welcome to the weird and wacky world of Canadian medicare.

The argument in favour of prohibiting people from paying directly for medical services is mostly a philosophical one: people should not be allowed to get care based on the size of their wallet. It should be based on need only, as determined by government and paid for by government, proponents of Canada’s universal, single-payer medicare system argue.

So why, then, would those same proponents of medicare demand that people who use their own money to get hip and knee surgery in Calgary or Mexico be reimbursed for their procedures? Those who travelled outside the province without government approval and paid directly for surgical services jumped the queue. They got medical treatment based on the size of their bank accounts. And now they want taxpayers to pay for it.

Meanwhile, those who can’t afford it, or don’t have the means to borrow the tens of thousands of dollars required to get surgery outside the province, have to wait months, or years, for surgery.

Two-tier medicine opponents can’t have it both ways; they can’t argue everyone should suffer on the same government wait list and also demand taxpayers reimburse people who got quicker service by going outside of the province.

If government were to start reimbursing everyone who sought medical treatment outside Manitoba, it would open the floodgates to thousands of people sending bills to government for all manner of procedures. That’s why Manitoba Health has traditionally had a policy of reimbursing patients for medical services outside the province only if they was pre-approved. There have been exceptions to that rule, but that’s been the standing order for decades.

What the Stefanson government announced this week was an interim measure to reduce the backlog caused by the COVID-19 pandemic. The plan is to select a limited number of patients who apply to have their procedures done outside the province. Patients will be selected based on pre-determined criteria in consultation with their physicians. Not everyone who applies will be accepted. It’s a stop-gap measure expected to last only two or three years, or until the backlog is cleared. It doesn’t mean everyone who has already paid for a medical procedure with their own money should get reimbursed by taxpayers.

People should be free to use their after-tax dollars to buy medical services, whether it’s for surgery, diagnostic testing or any other procedure (as it is in most countries around the world with universal health care). They should also be allowed to do so in their own province. It’s dreadful that people have to sneak off to other provinces or countries to get basic medical care when they should be able to get it at home. But if they are going to buy medical services outside the government health insurance program, they should be prepared to pay for it themselves. Taxpayers shouldn’t have to pick up the tab.

tom.brodbeck@freepress.mb.ca