Categories: Need to know

Ignatieff thinks again on health user fees

Facing Liberal revolt, he now opposes Quebec’s proposal

by macleans.ca on Thursday, April 15, 2010 11:53am - 56 Comments

Liberal Leader Michael Ignatieff has been quick lately to show he’s on-side with moves by Quebec’s provincial Liberal government. When Premier Jean Charest moved to force fully veiled Muslim women to remove their niqabs to get some provincial services, Ignatieff quickly voiced his approval. Similarly, he was fast to say he thought a Quebec plan to study imposing a $25 per medical visit charge, to be implemented through the income tax system, didn’t violate the Canada Health Act. But after a grassroots revolt in his party, Ignatieff now says, wait a minute, the Quebec idea would break the federal law against user fees.

Canadian Press

Tags: Canada

SpencBC

It is great to see Iggy distract from the Helena affair with his sharp politicking. Way to take the wind out of your sails there Iggy. What a disaster this guy is.

ex canuck

SpenceBC, you are cruel. It's not easy being leader of the Liberal Party of Canada, you know.
http://intensedebate.com/people/Thwim Thwim

Were you similarly saying Harper was a disaster when he about-faced on the anthem?

http://intensedebate.com/people/CTM Claudia Lemire

It is a completely different about – face!

Margaret

That first sentence doesn't even make any sense. The second and third aren't much better.

Plain Old Anon

This is a prime example of why it is difficult to attract good people into politics.

Margaret

I have no worries at all about how Ignatieff will administer the Canada Health Act. He's more in touch with the "little people" than Harper can ever hope to be.

ex canuck

Which little people are you talking about, Margaret?

SpencBC

She's among Iggy's "political class", you know, the people he invited to his think-fest. Us "little people were not invited, nor were the little liberal caucus members. Only non-Canadian intellectual elites.

Mark

Is a small user fee not a terrible idea? I don't have a problem with $25, but even if the fee was $5 or $10 (hardly onerous by anyone's standards), wouldn't it cut down on visits, or at least offset some costs? I'm sure there's an easy way to rebate these fees to to low-income earners, if this is a huge problem.

http://intensedebate.com/people/RunningGag RunningGag

I thought the point was to get people to go sooner so that things could be caught early (and cost less). If you start charging people user fees there are some that are going to wait as long as they can before going to see a doctor.
David Josephy

Mark, your question answers itself. A small user fee may be little deterrent, but it raises less money than it costs to administer, so what's the point? A large user fee would appear to raise money, but it really would deter people from seeing the doctor. If just one sick person hesitates to see the doctor, worried about the user fee – and then needs to be hospitalized, because his or her unattended condition gets worse – that will cost the medicare system more than can be raised by hundreds of user fee payments. And it puts the patient's health at risk. User fees stink, and we should be thankful that the Canada Health Act bans them. Shame on the Quebec government.
David

Tim

I think it quite interesting that the Ontario Liberal caucus is the group that is most upset about this. This might be a good chance for Charest and Ed Stelmach to gang up and turn the screws on Ontario domination of the Liberal Party and Canadian federation and crush the Canada Health Act
Steve M

How do we know that the extra costs of deterred people who end up getting worse won't be more than offet by the deterred people who get better all on their own? I don't know the anwer, but somebody must have studied this?

Chad

It's possible that something like that can work, but that doesn't mean it does when all is taken into account. First, there is the transactional cost. How do you pay? Setting up payment systems in doctor's offices and hospitals costs money. Setting up tax rebates for the poor costs money.

But even before that, they need to demonstrate that there is waste, where the waste is, and that this approach will reduce such waste taking into account the new transactional costs and costs of setting up the system (and studies). Cutting costs should never be the goal. Improving efficiency should. Even a perfect system costs money because people do get sick, need help, and need preventative checkups. Adding user fees to a perfect system would end up costing more, not less.

Supposing the problem is indeed unnecessary overuse. (How would you even measure that? How do you measure whether a checkup preventatively saved someone from a more expensive treatment later?) Is the overuse primarily by poor people? If so, then this system will do nothing since the poor get money back.

And speaking of the poor tax rebate on this, is that really saving the poor the expense? Suppose they start having health problems in August and have to pay hundreds of dollars for many trips? How does getting a tax rebate in June help pay their bills in August and September the year before? Instead, they may chose not to go to the doctor and lead to a more serious and expensive problem later.

Have they looked at all these problems and still determined this is a good direction to go? Perhaps it is. But I have yet to see any evidence they even bothered to look at the economics in a holistic sense and just came up with an idea to reduce immediate up front costs and reducing immediate up front usage of the health system. Where's the evidence it won't show up on the back end at much greater cost?

Oliver

In politics you never do the sensible thing first: you awkwardly punch then look at the reaction and adjust.

Then another government gets elected and you start over again….

SpencBC

Of course you li9ke it, your a "tax me….. tax me now", Liberal.
http://intensedebate.com/people/PolJunkie PolJunkie

U don't even have to be low-income to feel the brunt of this. A middle-income earner plagued with a chronic disease of some sort that requires frequent doctor visits would take a serious financial hit from such a measure.

More importantly, it is total right wing propaganda to suggest that mounting healthcare cost are due to needless medical visits. The issue here is an aging population that will require care. Those user fees are not the answer as they will not contain the growth.

http://intensedebate.com/people/Gaunilon Gaunilon

Ignatieff's got this Liberal leadership thing all wrong. You're supposed to sample public opinion first, and then come up with a completely hollow position that adheres to it like glue.
http://intensedebate.com/people/Thwim Thwim

You mean like Harper did on the Flag?

Steve M

Tee Cons said they would look at changing the words to the anthem. Then the public uproar made it quite clear that no study was necessary. Case closed. But they never said that they were definitely going to change it.

http://intensedebate.com/people/Thwim Thwim

You may want to revist your revisionist history of the Throne Speech and, you know, read it.

PrairieAnne

What's Michael Ignatieff doing in his spare time? Perhaps he should familiarize himself with his party and with the country he hopes to lead.
Margaret

No, you're supposed to spend $50 million on advertising around the Olympics, and get Duffy and Nancy Tory to shamelessly shill for you on TV — then you let people know what you think. After you're quite sure you're safe.

Do you ever see Harper speaking on any topic without using the blandest vocabulary possible, and without checking polls ad nauseam? Would you ever catch him talking without a bodyguard, Dimitri Soudas, the RCMP, and copious notes, plus forechecking the audience to make sure they like him?

Harper is gutless. Ignatieff has courage to spare, and he's honest. That's why he says things off the cuff sometimes – something you will NEVER, ever see Cowardly Harper do.

ex canuck

Margaret, do we conclude that you dislike Mr. Harper?

http://intensedebate.com/people/SamDavies SamDavies

It's pretty safe to say that there is no fan club membership card tucked away in her wallet! ;)

sbt

"Ignatieff has courage to spare, and he's honest. That's why he says things off the cuff sometimes"

It may be honest and courageous but it's also very stupid when you have to backtrack on a fairly regular basis.
SpencBC

She's among Iggy's "political class", you know, the people he invited to his think-fest. Us "little people were not invited, nor were the little liberal caucus members. Only non-Canadian intellectual elites.

http://intensedebate.com/people/SamDavies SamDavies

Is there an echo in this thread?

Oliver

I really like you Ignatieef, I really really do.
But you're making it very hard… Who cares if some of your MPs think it was abad idea for Charest to do this, it's a step in the right direction: progress towards making sure we don't go bankrupt paying for the health benefits of an aging population.

Come on, stick to your guns!

http://intensedebate.com/people/CTM Claudia Lemire

Never is going to happen, he loves to go with the flow!
Ron

Ignatieff is a coward. He sees this 'mechanism' proposed by Quebec as a means of subverting the Canada Health Act (an act his own party penned). Instead of having the "adult conversation" about Heath Care, he lets the provinces figure out how to do the "dirty work".

Then his own party decides to bury its collective head in the sand and decry this as an illegal user fee. It may well be. So, Mr. Ignatieff, would you care to open your "adult conversation" with a salvo suggesting that the Canada Health Act needs to be revised?

Or are you a coward… and planning to run away from that hot potato?

http://intensedebate.com/people/s_c_f s_c_f

This Ignatieff fellow is a man of unwavering principles.
http://intensedebate.com/people/s_c_f s_c_f

This Ignatieff fellow is beginning to understand the differences between a classical liberal, a modern liberal and a Liberal.

Plain Old Anon

Comment of the Day.

SpencBC

Correction "little people". She'll bitch about my typing if I don't issue a correction.

http://intensedebate.com/people/CTM Claudia Lemire

Oops, I had one of those already, hahaha …
http://intensedebate.com/people/SamDavies SamDavies

I dunno – the typing isn't so much the problem as your silly whining and your inferiority complex. There there…

SpencBC

Correction "like".
http://intensedebate.com/people/Open_Democracy Open_Democracy

With the rapid change in Canada's demography over the next 20 years, something is going to have to give if we're going to all have access to the type and quality of health care we now receive. If something politically unpopular and unpalatable (such as user fees) aren't adopted, we will all find that our provinces are unable to supply quality health care.

Unfortunately, all provinces have wasted so much money on nonsensical expenditures that they will be forced to tax us further in order to continue to fund necessary programs such as health care and education. That is the real crime against taxpayers.

We're rapidly approaching that big pile of doo doo.

http://viableopposition.blogspot.com/
http://intensedebate.com/people/danby danby

I am no fan of Harper, but Mr Ignatieff sometimes makes it hard to rally to the alternative.

http://intensedebate.com/people/Crit_Reasoning Crit_Reasoning

No kidding. Under Iggy's leadership, the LPC seems to be stuck in the high twenties/low thirties in the polls, no matter what happens.

http://intensedebate.com/people/danby danby

He seems unable to provide a supportable level of consistency, never mind galvanize people who are unhappy with Stephen Harper's Conservatives.

http://intensedebate.com/people/CTM Claudia Lemire

I wonder how he decides what to wear in the morning?

sbt

Ignatieff's problem is not deciding what to where in the morning. It's that he goes home and changes at lunch because someone told him his colours clash.

http://intensedebate.com/people/sea_n_mountains sea_n_mountains

does he ever Danby. Can this man or anyone in his office not think through the implications of varying positions before he expounds publicly on whatever light flashes most recently. Gawd.

http://thenonconformer.wordpress.com/ Quebecer

Time to get a new federal Liberal leader
addd

User fees I suppose would reduce visits to family doctors offices, but there is a ( government supported ) trend to capitation in this area so I don't think the doctors would mind. User fees aren't going to help much in a hospital.
Ron

What did his "Thinkers Conference" determine about Health Care? (other than its inherent un-sustainability). I find it funny the party cannot come up with a 'platform' on Health Care. When the leader decides to dip his toe into that pool, he gets immediately and harshly rebuffed.

Given that he himself stated that there needed to be an adult conversation about the state of Health Care, I find it funny he's not willing to concede that there are imperfections in the Canada Health Act. Instead, he tacitly supports its subversion by Quebec.

The issue isn't whether the user fees are a good or bad thing. The issue is that the Federal Liberals won't tell us what they really believe.
Tom Folkestone

God by the comments I can see that the National Post Reform party supporters have taken over here. Sad Macleans used to enjoy a spectrum of debate, non just jingoism.

jingo jango

Can't defend your party's position? probably cause its a pretty silly position.
Poker Face

Glad to see your constructive contributions here too. I think Charest's having to swallow a tough pill here with his budget. I have to say that the user fee caught me by surprise. (The QST was pretty much a done deal though.)

Ariadne

I don't care about the Liberal and Iggy's politics of shooting everything the other party thinks and does, but I agree, there should be user fees for physician's visit. There should also be mandatory fees for everytime a person visit the hospital's emergency unit for flus and other non emergency cases instead of going to a regular physician. User fees will also be more preferable than a health care going bankrupt. If one can afford to buy a beer why not a user fee to check one's health? There should be income cap for user fees, so for those who can ill afford will be able to visit the doctor without fear.
fuddle duddle

what a bunch of bull, if alberta or bc tried to charge $25 per visit the government would be all over them
http://battlelight.blogspot.com HitEleven

fuddle duddle, indeed you're right. Every party has been tiptoeing around this, except for the Liberals, who have been flip-flopping like fish in a boat.

Read more at http://battlelight.blogspot.com.
jayR

I tend to put off doctor visits as it is. There have also been times when I desperately did need to see a doctor but if there had been a user fee I could not have afforded even $5,00. I put off seeing a doctor because I had no way to get there or even for a bus ride there. User fees may seem easy for some but for others there is an extreme hardship involved.