Premier Dwight Ball described U.S. President Donald Trump’s decision to impose tariffs as “extremely troubling.” He hoped to discuss “a positive and mutually beneficial trade relationship.” He even offered Trump free tickets to “Come from Away.”
In the U.S.-Canada trade war, there will be no winners, one possible exception — namely the beginning of Quebec’s full participation in the portable Canadian health system.
Let me explain.
Strained relations with the U.S. have tended to unite Canadians from all regions and across party lines. Many have reacted by boycotting U.S.-products in grocery and other stores. Some have cancelled plans to visit New England, New York, and other tourist destinations and have urged their friends to instead visit another part of Canada. Sadly, this poses distinct problems for those from Quebec, especially if they have pre-existing conditions and do not qualify for unrestricted travel health insurance. It may for similar reasons deter some Canadians from visiting Quebec.
The Canada Health Act was passed in 1984. Among its five conditions for federal health transfers was portability. Quebec has agreed to portable hospital benefits, but has refused to sign the Reciprocal Medical Billing Agreement. This permits physicians treating out-of-province patients to bill their own province at host-province rates, which then collects from the home province of the patient. Quebec alone has refused to sign the RMB agreement. It pays only its own fees; until recently they were the lowest in Canada.
As a result, most Quebec patients when receiving medical care outside their own province find their health card refused; instead, they are billed directly by the treating physicians, pay out-of-pocket, and later receive reimbursement from the Quebec government. Canadians visiting Quebec must also usually pay the treating physician directly.
This affects those who become unexpectedly ill while on vacation or business in another province or territory, those who move permanently to another part of Canada, and for the first three months are “covered” by a Quebec health card, and those in border areas such as Gatineau who require emergency or specialty services in Ottawa.
For over 30 years, Quebec premiers have refused to obey the CHA, partially because of the previous disparity between fees paid by Quebec and those of most other provinces. No federal politician has attempted to enforce this portion of the CHA.
Quebec Premier Philippe Couillard could easily resolve this problem. After all, recently his family physicians were given a 14.7 per cent fee increase over the next 8 years and specialists a total of $2 billion in increased compensation over 10 years. Using RAMQ figures from 2016/17 and those from CIHI (Canadian Institute of Health Information) from 2015/16, gross incomes of Quebec family physicians are roughly 112 per cent that of the average across Canada; it is 123 per cent for medical specialists, 110 per cent for surgical specialists, and 98 per cent for cardiologists. In the past, Quebec was fearful of antagonizing its own physicians if it was seen to be paying them less for services than their counterparts in other provinces. Now, there is no longer any excuse for the Quebec government to refuse to pay other Canadian MDs at host-province rates; it should therefore sign the RMB agreement as soon as possible.
However, if the Quebec government still refused to participate, another option would be for Ottawa to pay Canadian doctors directly for all persons treated out-of-province. Although health lies within provincial jurisdiction, doctors do receive direct payment for federal prisoners and until a few years ago did for members of the RCMP. They are paid at rates in their own province through the IFHP for refugees.
Hopefully, the trade war will be resolved after the November U.S. election. In the meantime, it might spur Premier Couillard to leave a permanent legacy and also increase his support prior to the Oct. 1 Quebec provincial election. After three decades of federal and provincial political posturing, he should finally ensure that Quebec residents receive the fully portable health benefits enjoyed by all their fellow Canadians. It might also increase tourism to Quebec from other Canadians.
I asked Premier Brian Gallant to add this topic to the agenda of the recent Council of the Federation meeting in Saint Andrews, New Brunswick.
Charles S. Shaver, MD