“They who have put out the people’s eyes, reproach them of their blindness.”
— attributed to John Milton, 1642
The McGill University Health Centre has made headlines again, after failing to observe basic standards of decency in its response to a very sick person. Coroner Jacques Ramsay’s recent report details how Kimberly Gloade, a Mi’kmaq woman, was asked to pay a fee (over $1000!) for an emergency room visit in February 2016 because she did not have her Medicare card. Unable to pay, Gloade left, sentenced to suffer for weeks until dying of liver cirrhosis at home.
The MUHC certainly bears responsibility for how horribly Gloade was treated. However, such behaviour is not unique. We know that people without health coverage are callously turned away at institutions across the city on a regular basis.
The ultimate fault lies with the Ministry of Health and Social Services, which annually resorts to an opaque process to determine the cost — not including physician fees — of an outpatient visit or a hospitalization at a particular institution. In cases where care is given to individuals without a valid Medicare card, the ministry then adds an exorbitant 200 per cent surcharge that the institution is supposed to recoup from the patient. For example, a hospitalization in the intensive care unit may cost the system $3,500 per day, but a “non-resident” of Quebec without Medicare coverage will be charged upward of $10,000. As a result, when a health-care institution submits its reports at the end of each fiscal year, its deficit is artificially inflated because of the fees being charged to people without insurance who are unable to pay. The pressure to balance hospital budgets results in aggressive institutional policies demanding payment up front, scapegoating marginalized groups.
New immigrants and those with precarious immigration status appear to be the intended targets; if not, then why does the government not exempt them?
The surcharge amounts to double discrimination against migrants (and their children) who don’t have health-care coverage because of discriminatory barriers to access that have been erected by the provincial government.
For example, unlike their counterparts in Ontario who receive provincial health coverage at birth, babies born in Quebec to parents without recognized immigration status are not covered by RAMQ.
Meanwhile, since 2001, landed immigrants, despite being permanent residents upon arrival in Quebec, have been forced to wait three months to obtain RAMQ coverage, a policy that has been condemned by the Quebec human rights commission.
Finally, people without status are not eligible for RAMQ coverage, even though many of them work or go to school, and are as integral a part of our communities as anyone else living here.
Gloade’s avoidable suffering and ultimate death show the disastrous impacts anti-migrant policies have on other marginalized groups, including individuals living on the street and Indigenous people. In the case of the latter, these impacts are exacerbated by the layers of systemic discrimination stemming from a history of genocide and ongoing colonialism.
These draconian policies systematically prevent people who are often the most in need from accessing dignified health care. Too many people have paid the price with their health and, in the most egregious cases, their lives. Political will to centre compassion and solidarity in our health-care system would ensure that cases like Gloade’s never happen again. Until then, we all bear some responsibility for allowing this revolting status quo to continue.
Health-care institutions should treat everyone based on need, not ability to pay. The opportunistic sanctuary-city motion recently adopted by the city of Montreal is sadly devoid of any substance. Building a genuine “solidarity city” is hard work, but can allow us to achieve health care for all. A modest first step is demanding an end to inhuman policies.
Nazila Bettache and Samir Shaheen-Hussain are Montreal hospital-based physicians and social-justice activists. This article has been co-signed by 25 other health care providers.