Skip to main content

A patient prepares for treatment at Sunnybrook Hospital in Toronto. More than half of Canadians feel they will experience a serious medical error while in hospital and 74 per cent of nurses feel likewise.Tim Fraser/The Globe and Mail

Politics Insider delivers premium analysis and access to Canada's policymakers and politicians. Visit the Politics Insider homepage for insight available only to subscribers.

Earlier this month, Saskatchewan became the latest province to waive the 90-day wait period that family members of Canadian Armed Forces members had to endure before being eligible for basic health coverage.

It's a nice gesture in support of military families and it's hard to understand why some jurisdictions have not yet done so. The recalcitrance of Nova Scotia is most perplexing because it is home to a large contingent of sailors and soldiers; the laggardness of Nunavut and the North West Territories is a little more understandable because there is not a large military presence there.

The approximately 60,000 members of the military and 25,000 reservists fall under federal jurisdiction, so they depend on the Canadian Forces Health Services for care. But their families depend on civilian care, which is under provincial jurisdiction.

About 11,400 members of the Canadian Armed Forces are transferred between provinces each year. Their care is seamless, so it's only fair that spouses and children not be denied health coverage during these transitions either.

Most provinces and territories have recognized this and put rules in place to ensure that a military family moving, for example, from Ontario to Quebec, can immediately trade in their OHIP card for a Carte-Soleil.

What is a lot less clear is why all Canadians don't have this same benefit.

Medicare, Canada's publicly funded insurance program, is designed to ensure that all Canadians have access to medically necessary care regardless of ability to pay or where they live. This is spelled out in the five "principles" of the Canada Health Act: universality, accessibility, comprehensiveness, portability and public administration.

Portability means that Canadian citizens are entitled to medically necessary care, without prejudice, regardless of where they are in the country.

This fundamental principle of our most valued social program is violated every single day.

All provinces and territories have a waiting time – usually 90 days – before newly arrived residents are eligible for a provincial health card.

Ostensibly, this is to prevent "health tourism" – residents of one province sneaking into another to get better care.

These rules are legal – barely because they constitute a delay in care rather than a denial of care – but they are preposterous nonetheless.

There were about 312,000 "interprovincial migrants" last year, according to Statistics Canada. They were not all moving to get slightly better healthcare services.

And, if they were, so what?

The more restrictions you put on access to health, the more it stifles employee mobility and that's bad for the economy.

We should actually be encouraging Canadians to vote with their feet on medicare, not punishing them for it.

If cancer patients and their families want to move from New Brunswick to Quebec because drug coverage is better, that's fine because it corrects an injustice. If they want to move their elderly parents from Newfoundland and Labrador to Manitoba because homecare is better, all the power to them. If they want to travel from Alberta to B.C. because the wait time for surgery is shorter, that shouldn't be a problem.

Provinces should be ashamed of these differences and shamed into fixing them instead of hiding behind butt-covering rules.

Of course, moving for better care is, for the most part, an option that is open only to wealthier Canadians. But we should be drawing attention to variations in care and every opportunity and demanding they be fixed.

In fact, a key role of the federal government should be to ensure equity in access to care, and it should be using its financial clout to do so, i.e. imposing financial penalties on underperforming jurisdictions and on provinces that don't respect portability provisions of federal law. (The current Conservative government, unfortunately, has taken a hands-off approach to healthcare; but earlier Liberal governments were similarly laissez-faire on portability.)

The 90-day wait for new arrived residents is unnecessary. But it's only one part of the portability issue.

On a daily basis, there are border skirmishes, particularly along the Quebec-Ontario border. Ontario hospitals and doctors dread treating Quebec patients because the payments they receive are significant lower. In some cases, they demand up-front cash payments, which is a flagrant violation of the law.

In other parts of the country, such as along the Ontario-Manitoba border and between the Maritime provinces, there are more cordial agreements. (The Canadian Armed Forces also has agreements with provinces in case members of the military need care in the civilian system.)

But why do significant differences in care provision (and costs) even exist between provinces?

Medicare should be a national program, accessible equitably to all Canadians. The health cards we carry in our wallets should be accepted everywhere, no questions asked. That's what "portability" means.

It's up to the 14 different jurisdictions to make this a reality for all citizens – not just military families – rather than creating unnecessary and punitive barriers.

It's not enough to have principles in principle – you have to give them life.

André Picard is a health columnist for The Gobe and Mail.

Follow related authors and topics

Authors and topics you follow will be added to your personal news feed in Following.

Interact with The Globe