The true cost of charging for health care

If the Yukon government introduces premiums for health care, its employees will be virtually exempt.

If the Yukon government introduces premiums for health care, its employees will be virtually exempt.

On page 158 of the government’s collective agreement with the Public Service Alliance of Canada, there is a small but weighty paragraph:

“The parties have agreed that, should medicare premiums be reintroduced to the Yukon, the employer will pay 90 per cent of the cost of the employee medicare, as found in the 2000-2002 collective agreement.”

Yukoners who don’t work for government would be out of luck.

“Premiums are basically a tax on being sick,” said Yukon Anti-Poverty Coalition member Laurie MacFeeters on Thursday.

They don’t make sense economically, she added.

More than 20 years ago at Queens University, MacFeeters remembers words of wisdom from her economics professor.

“There’s not an economist in the country who’d support user fees for health care,” the prof told the class.

It would not accomplish what government hopes, said MacFeeters.

Users fees could actually cost the territory.

If there were 8 million people living in the Yukon, user fees might bring in some revenue, said coalition member Ross Findlater.

“But with only 30,000 Yukoners and the high administrative costs (that come with collecting user fees), they might not make any money,” he said.

The Anti-Poverty Coalition met with a government steering committee on Thursday morning to respond to a 260-page Yukon Health Care Review released in September.

In it, and in a mail-out survey regarding the review, there is a suggestion that user fees may be a solution to the Yukon’s soon-to-be “unaffordable” health-care crisis.

A one-line suggestion to implement user fees may sound like a good idea, but it’s not that simple, said MacFeeters.

Would the fees be based on a person’s income, or their assets?

How would income and assets be determined?

“Once you start looking at how it would work, you might realize, ‘Oh, it will cost more to administer than it will save,’” she said.

It makes more sense to cover health-care costs through income tax—that system is already established, added MacFeeters.

The health-care review is cost-focused, said Findlater.

But that’s not all there is to health care.

“The definition is fairly narrow in the review—they’re not looking at health in the broad sense,” he said.

There are plenty of social determinants that affect health, said Findlater, mentioning housing, justice, recreation and education.

If someone has no home, and no money for food, that may seem like a housing issue, said MacFeeters.

“But it’s really a health-care issue.”

And the review only examined the existing health-care system, said MacFeeters.

It didn’t address the need for better mental health services in the Yukon, for example, she said.

The survey is focused on finances, so that may end up being the focus of the subsequent report, said MacFeeters.

It doesn’t look at the big picture.

The survey is also vague, said MacFeeters.

The question, should Yukoners “pay an appropriate fee for some of the health services they use?” could mean anything, she said.

Someone might agree with this, thinking that people should pay for gym memberships, but not emergency room visits.

“What jumps to mind is so different for different people.

“They are asking, on a five-point scale, very big questions that are much more complex.”

The review and survey also regularly compare the Yukon to the provinces.

“But our goal should not be to be the very same as the provinces,” said Findlater.

“The goal should be to provide quality care to all Yukoners.”

And if the Yukon is doing something better than northern Ontario, it doesn’t mean the territory should change its model to be like them, said MacFeeters.

“If we’re serving our citizens better than other jurisdictions, then that’s good,” she said.

The review mentions equity, and that means, “everybody should be able to get the health care they need—and it isn’t tied to income,” said MacFeeters.

Charging for health care is a disincentive, she added.

It means testing people might have had done to catch illness before its full-blown may be delayed until its an emergency situation.

“And that costs more,” she said.

“If they are genuine about equity, then imposing fees is not going to fly,” said Findlater.

Contact Genesee Keevil at