LETTER: An argument in favour of out-of-country OHIP coverage

SooToday received the following letter to the editor from Dave James, who has also forwarded it to the provincial government:

My name is Dave James. Until recently I was a long time resident of Sault Ste. Marie, but now reside at my cottage seven nmonths and in Florida five months. I am almost 74 years old.

My purpose in writing is to point out what I think to be some glaring misrepresentation of the facts regarding the proposal to eliminate out-of-country coverage and to highlight the unfairness of the current status and its proposed elimination.

The Canada Health Act provides that emergency health services while out of the country will be paid at the amount that would have been paid for similar services rendered in the province. In 1994 when the government followed British Columbia’s lead in reducing the level of payment for medical emergencies out of country, we were promised that OHIP would pay the equivalent of what it paid in Ontario.

It is my understanding from what I have read that B.C. continues to pay what it would have covered in B.C. Ontario has failed to live up to the Act or the promise for many years.

The following shows the fees a Brampton hospital would charge an Ontario resident not eligible for OHIP, but which would be paid for by OHIP for someone who is eligible, and the corresponding fees now paid if out of country:

If John takes his daughter, Annie, to watch his son, Adam, play hockey in Brampton on Saturday, April 27 and she suffers a medical emergency, that emergency will be fully covered. If he takes Annie to Detroit on Sunday to watch Adam play, and the emergency happens that day instead, OHIP will pay only $50 for an emergency room visit, or $200 a day, for a standard hospital room but the actual fees charged in Michigan will far exceed Brampton’s rate of $1,000 or $2,000.  

And if this emergency should happen after Oct. 1, the government proposes to pay NOTHING. Hayley Chazen, a spokesperson for Christine Elliott is quoted as saying, “Our proposal….. is part of our government’s commitment to ensure tax dollars are spent more responsibly and that we are protecting the services that matter most to Ontario families." 

All of us believe that our health services matter the most and that includes an emergency occurring out of country.

PC MPP Robin Martin is quoted as saying, “We want to maximize value we get for people and we think this is not an effective use of our resources.”

MPPs should understand that our health tax monies used for the purpose of reimbursing for medical emergencies is, next to prevention, the most effective use of “our resources” regardless of where that emergency takes place.

An article in the Toronto Sun reports that, “A spokesman for Christine Elliott said in a statement that this change is about fixing a program that costs taxpayers, due to high administrative costs while not providing much coverage.” 

No, the proposed change is about eliminating an entitlement, not fixing a program. The coverage is far less than legislation provides and administration costs could be pared. So, fixing the program means reducing the administrative cost and providing the much higher benefit we have already paid for and are entitled to.

When you reduce or deny coverage to TAXPAYERS and their families that they should have under the Canada Health Act and glibly state things like Martin (“They need to get adequate travel insurance to be covered.”) you are exhibiting a complete disregard for those taxpayers and showing a clear lack of understanding of the insurance industry, an understanding one should have to make decisions of this nature.

One can be denied insurance or forced to pay more because he hasn’t been off a prescription drug for 90 or more days or because he spent one night in the hospital in the last six months (regardless of the reason). One can buy insurance at age 55 for $455 but at age 74, it costs $1,056.  

A smaller deductible or pre-existing condition will drive each of these numbers up substantially. Some cannot buy insurance over age 80. The cost of insurance is also governed by the length of stay out of country. NONE OF THE FOREGOING ARE FACTORS IN OHIP COVERAGE WHICH WE HAVE ALREADY PAID FOR. Many of these factors will be taken into consideration when a family is planning a trip to Disney, the golf courses or the beach in Florida during spring break.

The government’s suggestion that this elimination impacts only 0.5 per cent of the population is highly misleading because it only refers to the 88,000 who make claims, but most people do not make claims. So, hundreds of thousands (perhaps millions) of us will be forced to buy yet more insurance – the government is offloading onto us the cost of even more of the health care we’ve already paid for. The only people not forced to do so will be those who have 100-per-cent coverage guaranteed through their employer, regardless of this change.

Who has that kind of coverage? Predominantly those associated with various levels of government; elected, working or retired and paid for by us.

I am one who whole-heartedly supports efforts to put this province in a situation where it can begin to unburden future generations with the tremendous debt placed on us by the Liberals. Saddling a family with hefty medical emergency bills because they forgot to purchase insurance, or the claim was rejected by their insurance company, or they were denied coverage because of a pre-existing condition is not the way to tackle the debt; and ignoring the fact that we have paid for the coverage through taxes and health premiums but just happen to be in another place when the emergency occurs is also not the way to do it.

I was employed for a Canadian company that had a plant in Michigan. Our company sickness and accident benefits exceeded the Worker’s Compensation benefits in Michigan. The word among the employees was “if I get hurt in here, drag me out onto the street so I can collect company benefits instead.” 

It is far more difficult to get dragged back to Ontario to deal with a medical emergency. It is unconscionable for the government to rely on that fact.

Respectfully submitted,

David J. James