Medicare is an active and effective form of redistributing wealth. Those who have benefited most from our nation’s wealth, and who in general have the good health to show for it, contribute to improving the health of those who have not. This is why Medicare is such a cornerstone of public policy in Canada, and a perennially popular one among the general public. It’s also why it faced such virulent resistance upon introduction and continues to be under persistent, recurrent attack in the face of the overwhelming evidence for its success.While Meili focuses largely on the practical point, I'd think his moral observation is the one which probably deserves additional emphasis. In effect, our health care system depends on the idea of basic health security: that a lack of money will never stand in the way of one's access to the treatment needed to deal with an immediate illness. But the same principle would seem to apply equally well to housing security, or income security, or all kinds of other basic prerequisites to individual and community health.
Those pressures and attacks will only continue to mount as income equality grows. The poor and disadvantaged use a disproportionately higher amount of hospitals, medications, and physician services. In Saskatoon, residents of the low-income neighbourhoods use thirty-five per cent more health care resources than middle and high-income residents, amounting to $179 million more per year in costs. This makes it clear that health care is not the only way in which we should redistribute wealth. Not only does failing to address this issue raise moral questions, such as how to explain our willingness to help people when they’re sick and dying but not to mobilize the resources to keep them healthy, but it also poses a risk to the political feasibility of Medicare. When we don’t cover pharmaceutical costs or dental services, we increase costs not only for individuals, but for the system...
A system as fair and compassionate as Medicare needs to reflect a society that is also compassionate and fair. If all the weight of dealing with the fallout of growing social inequality falls on the health care system, the cries of crisis will rise, and the commitment of those who are being asked to contribute more than they gain will continue to erode. Before long we will find ourselves in a situation where patients like Mrs. Peters or Brandon would be asked first not, “How can I help?” but “How will you pay?”
Of course, as Meili notes, the fact that we're investing less and less in those priorities (as the price of massive upper-end tax cuts) has been used by far too many commentators as an excuse to attack health care as well. But our commitment to Medicare serves to reflect how much we cherish exactly the type of compassionate values needed to support other steps beyond the health care system we have now. And we should be looking for additional opportunities to enhance individual security - rather than accepting the spin that all we can do is hope that any given social support will escape a budgetary axe for a few more years before making way for corporate interests.