Opinion: Independence would mean loss of portable health benefits

Premier Danielle Smith has estimated that startup costs for an independent Alberta would be about $400 billion.

On Oct. 19, a referendum will ask whether Alberta should remain in Canada. In Quebec, the PQ leader pledges to hold a third referendum on independence if he wins the October election. Anywhere from 18 to 30 per cent of people in both provinces favour separation.

However, like patients contemplating surgery, Albertans and Quebecers must be fully apprised of the multiple economic and other adverse effects of an amputation from Canada. David McLaughlin, a former cabinet secretary from Manitoba, has written about the side-effects of Brexit, with a 15-per-cent drop in imports and exports, a six- to eight-per-cent drop in GDP and a 12- to 18-per-cent decline in investment.

However, often overlooked would be the loss of portable health benefits in the rest of Canada.

If a province voted to become independent, many physicians, nurses, etc. would leave. Also, its remaining citizens would no longer be protected by the Canada Health Act of 1984. They would now be "non-residents of Canada" when seeking hospital or medical/surgical care in another part of Canada. Furthermore, after a permanent move, they would not have health coverage in their new province for three months.

Should Alberta or Quebec become independent, its residents would be billed directly by hospitals in other provinces. Hospitals require payment before elective surgery or discharge.

Consider these rates for "non-residents of Canada":

St. Paul's Hospital in Vancouver charges $1,355 for an emergency department visit, $4,690 daily for a standard room and $13,110 for an ICU bed. Vancouver General has a rate of $18,105 daily for the ICU.

An urgent-care visit at Victoria Hospital in Winnipeg is $1,452; a standard four-bed room costs $3,066 per day.

At Sunnybrook Hospital in Toronto, a standard room is $4,100 to $4,400, and an ICU bed $6,400 to $6,600 daily.

Alberta and Quebec currently pay a maximum of $100 daily for in-patient care outside the country. Creating new reciprocal health agreements between an independent province and each other province might take years. Meanwhile, travel insurance is often difficult to obtain, with caps on total coverage and exclusions for complications of previous illnesses such as diabetes, cardiac disease or cancer. If even the dose of a medication has changed within 60 to 90 days, the claim may be rejected. Most policies do not cover dangerous sports or activities, especially claims for injuries if under the influence of alcohol or illicit drugs.

Many Albertans originally came from other provinces — 44 per cent from Ontario, six per cent from the Atlantic provinces, and four to five per cent from B.C. If Alberta were to separate, many of its residents might still wish to return occasionally to their home province to visit friends and relatives. After independence, they might lose adequate health insurance coverage for an accident or an unexpected illness.

Sadly, Canadians experience long delays for procedures or elective surgery and must wait for hours in emergency departments. This should improve with the opening of new medical schools and expansion of existing ones, and fast-tracking the licensing of international MDs. Also required is greatly improved remuneration for front-line family physicians.

Prime Minister Mark Carney must actually build multiple pipelines within Canada. He must agree to repeal all of Danielle Smith's "bad bills." If he does, Albertans will prosper and hopefully wish to remain part of our nation rather than risk becoming U.S. President Donald Trump's "51st state."

Quebec and Alberta residents should recognize the advantage of remaining part of Canada, where everyone is entitled to portable health care — a benefit that will likely never be enjoyed by Americans.

Charles S. Shaver is a retired Ottawa physician, and former chair of the Ontario Medical Association's general internal medicine section.