Health Minister’s ‘what would Tommy do?’ rationale misses mark

By Robert Matas
Globe and Mail
Dec. 28, 2011

“I’m not certain Tommy Douglas had in mind free parking when he talked about universal publicly funded health care,” Health Minister Mike de Jong says in a year-end interview in the Vancouver Sun.

Tommy Douglas is a library in Burnaby, a collegiate in Saskatoon, a street in Côte Saint-Luc and a townhouse development in Toronto. Corner Gas fans know the politician who introduced universal publicly financed medicare to Canada as the advocate for free coffee refills.

“You’re not in Toronto any more, Lacey, with your grande-mocha-dappo-loppa-frappochinos,” Brent said during an episode in the first season. “This is Saskatchewan. Tommy Douglas fought the federal government for free refills on coffee.”

And now Health Minister Mike de Jong is mocking the suggestion that Mr. Douglas’s legacy could stand for something more: free parking at hospitals. His comments came in response to a question about an editorial in the Canadian Medical Association Journal by Rajendra Kale. The editorial proposed free parking as an important step for patient-centred health care.

The editorial maintained that parking fees amount to a user fee in disguise. The fees may interfere with a clinical consultation, compelling a patient to cut short a visit in order to avoid a parking ticket or additional charges. The impact is felt especially by patients undergoing regular dialysis or chemotherapy and parents with sick children.

Hospital administrators and politicians say the money – about one per cent of hospitals’ net revenues – is a valuable source of funds for health care. But the fees are an additional source of stress for patients and are, for all practical purposes, a barrier to health care, the editorial says.

Mr. Douglas did not make speeches about parking fees but he spoke about medicare. He responded to the most common criticisms during a special session of the Saskatchewan legislature in October, 1961, when his government brought in the Medical Care Insurance Act.

Health-care services “should be the inalienable right of every citizen of a good society,” Mr. Douglas said. Measuring medical care just in dollars was “sheer nonsense,” he said. “When we’re talking about medical care, we’re talking about our sense of values. Do we think human life is important? Do we think that the best medical care which is available is something to which people are entitled, by virtue of belonging to a civilized community?”

As for paying the bills, Mr. Douglas said around two-thirds of the cost ought to be raised by taxes related to ability to pay. Flat taxes that bear no relationship to ability to pay should be kept as small as possible, he said. Requiring a means test to qualify for health care was humiliating, he said.

He believed that most people were willing to pay for medicare, providing the cost was spread equitably on the basis of ability to pay. “The only ones who are likely to oppose it are those who fear that they will have to help those less fortunate than themselves,” he said.

No one should be exempt from paying, he said. “Even if we could finance the plan without a per-capita tax, I personally would strongly advise against it,” Mr. Douglas said. “There is a psychological value in people paying something for their [medical] cards. It is something which they have bought; it entitles them to certain services. We should have the constant realization that if those services are abused and costs get out of hand, then of course the cost of the medical care is bound to go up.”

By invoking Mr. Douglas, Mr. de Jong has set a new benchmark for medical care in B.C. He could now be expected to ask, “what would Tommy do?” when confronting any health-care issue.

Based on that measure, Mr. de Jong was mistaken in using Mr. Douglas to back up his views on parking fees. Mr. Douglas appears to have indicated that the charges, as an unavoidable part of health care, should be paid through taxation, not user fees.