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LOOK OUT, CANADA. AMERICA'S LITTLE SHOP OF HORRORS COMES FOR YOUR HEALTHCARE.

Updated: Sep 20, 2023

Healthcare funding based on past lifestyle choices would turn into a bureaucratic nightmare. Life is a pre-existing condition.


POLONIUS. My lord, I will use them according to their desert.

HAMLET. God’s bodikin, man, better. Use every man after his desert, and who should scape whipping? Use them after your own honour and dignity. The less they deserve, the more merit is in your bounty. Take them in.

Canada is renowned for its universal healthcare system.


Dominators (lawmakers) and compliors (citizens), agree on a first principle: healthcare is a fundamental right, not a privilege.


Our first principle is not held highly in every country. In the United States, for instance, owning a gun is a constitutional right, not a privilege. There, healthcare is a privilege. Let's keep America out of our principles.


All levels of Canadian government ought to address healthcare sustainability.


However, dreaming up healthcare funding policies based on the often risky lifestyle choices we made yesterday or maybe twenty years ago is a fundamentally flawed concept. A very bad idea. Here are a few reasons why.


1. Infringing upon the Canadian Charter of Rights and Freedoms would lead to lawsuits:


The Canadian Charter of Rights and Freedoms guarantees every citizen equal protection under the law. To determine health-coverage costs, a bureaucrat's evaluating the eligibility of individuals for the risks they took and the choices they made would be, again bureaucratically speaking, crazy-making. Where are we? Well, we're at too many martinis, too much red wine, too much weight-lifting, too much weight, too many clown rodeos, too much mountain biking, too much rich food, too many chocolates, too many painkillers, too many births, too many children, too many additives, too many football injuries, too many falls, too many car accidents – there’s simply no end to the too manys some officious person might try to mine, hoping to find harmful past lifestyle choices to refuse us our health coverage. Those pesky, risky, youthful indulgences, indulgences which MAY have impacted our health today, would be sucked up like blood and guts by a voracious, institutional Audrey. An insurance company or government’s digging around to find lifestyle disqualifications for anyone's healthcare coverage undermines the fundamental principles of equality and non-discrimination embedded in the Charter.


Audrey and Seymour in Little Shop of Horrors ©Pittsburg Post Gazette


We know you're thinking about the obesity epidemic. And the smoker. And the diabetic. You don't walk the walk, though. And what about that skin cancer on your arm. In the world of lifestyle disqualification, your medicare insurer wouldn't pay your doctor, clinic, or hospital for your treatment. You would be stuck with an outrageous bill (thanks, insurance companies). Why stuck? Look at your skin. You're clearly guilty of too much sun tanning. Welcome to the world of past-lifestyle disqualification for healthcare coverage.


2. Complexity and subjectivity of assessments would be costly and too often could be dangerously wrong:


Determining the influence of past lifestyle choices on an individual's current health status is a complex and highly subjective endeavor. Health outcomes are influenced by a multitude of factors, including genetics, environment, education, degree(s) of poverty, cultural habits, and access to healthcare. Determining health conditions based only on past lifestyle choices is guess-work, anecdotal, and/or subjective. All of which would inevitably lead to political disputes, legal challenges, and increased administrative burdens within the healthcare system. If a government-funded physician determines that your past lifestyle is a factor in your current illness, that physician had better not be wrong. Forthcoming lawsuits will be greater in number than incoming shrimp boats.


3. Stigmatization and social division would marginalize the already marginalized:


A healthcare system based on past lifestyle choices would foster a culture of stigmatization and social division. Individuals who are penalized for their past choices will face discrimination or judgment, keeping them from seeking present-day healthcare services. This bias could create an uncomfortable, even a cruel and an un-Canadian society, where those who are perceived to be "healthy" receive preferential treatment, while those who are smokers, or fatties, or drinkers, or mentally ill, or just plain old – those arguably most in need of medical assistance – are further marginalized, leading to greater disparities in health and social outcomes.


4. Societies should adopt preventative measures over punitive measures, because the latter have unexpectedly discouraging outcomes. Select policies and laws would be better tools in the fight against unhealthy lifestyles:


Shaming otherwise law-abiding citizens is not the "healthiest" route for systemic wellness. Instead of shaming citizens, lawmakers and policy-makers have the authority to pass relevant laws and bylaws to handle today's problems. Yo, governments! Use your authority. You've done it before. No smoking inside the building; No single-use plastic within the city. No drinking while driving. No adding gobs of sugar to soft drinks. (No more aspartame.) No skiing on the dark side of the mountain. No lead in gasoline. Whatever is safe or unsafe, say it out loud. Make a rule. Policies/bylaws/laws arrest dangerous lifestyle/cultural behaviours. It is, after all, the job of governments to keep Canadians safe. Now. Forget yesterday. Yesterday's choices, whatever they were, do not compel us to adopt today or tomorrow's healthier lifestyles. Discriminatory shaming has a discouraging outcome. We, the guilty ones, may be too ashamed to seek early intervention or to make positive changes in our lives because of the fear of financial and social consequences. But, listen here, law-abiding citizens obey the law. Good corporate citizens obey the law (and the law of the marketplace). Why don't the laws of Canada, provinces and territories restrict fat, salt and sugar content in junk foods? A voluntary code doesn't seem to be effective enough. To keep consumers safe, food corporations need commandments, not suggestions.


5. Erosion of trust in healthcare providers would lead to an unhappy citizenry:


While encouraging healthy lifestyles and addressing healthcare sustainability are valid goals, healthcare coverage based on past lifestyle choices is a bad idea, especially for Canada. What would help? Reigning in the double-dipping of medical specialists, funding small, primary-care clinics designed to handle the load of some elective surgeries and non-catastrophic injuries and illnesses, and finally, treating family physicians with institutional respect. Individual patients cannot solve institutional problems. Building affordable housing and paying for the caregiving of the mentally ill is a better solution for social well being than shaming people for falling on hard times.


Patients must have enough trust in their healthcare providers and in the healthcare system to seek timely care and follow medical advice. To say it again: Introducing punitive measures based on past lifestyle choices erodes the trust between doctor and patient. Patients may be hesitant to disclose to their physicians their health history or lifestyle habits, fearing potential political, social, and/or monetary repercussions. Failure to disclose can hinder accurate diagnosis and treatment. A nervous repressed individual and a targeted doctor (who, having insufficient information, orders a wrong treatment) are going to be equally unhappy with the healthcare system. Can't you just smell the lawsuits?


6. Administrative and legal complexities would be a nightmare; insurance costs would skyrocket:


As stated, implementing a healthcare coverage system based on past lifestyle choices would introduce significant administrative complexities and legal challenges. Determining eligibility, managing disputes, and addressing privacy concerns would require extensive resources and could divert attention and resources away from providing essential healthcare services.


If provincial healthcare will not cover treatment for your skin cancer, try signing up for private healthcare insurance. Insurance companies, only too glad to lend a hand to the uncover-able, would hike their insurance rates to the moon. Note to the wise: Don't get found out for your past sins: In a tattletale culture, you must keep mum on your medical history. Policies based on we-know-what-you-did-last-summer would attack equality, fairness, and accessibility, and decimate the principles which underpin Canada's universal healthcare system and give profitable insurance companies utter pleasure as they rub together their Scrooge-y fingers. If, from protected Canada, you travel to other countries and you're old or have a traceable "pre-existing condition" but of course you'll need extra insurance coverage: Ha! You'll soon get what I mean about enormous insurance costs.


Instead of punitive measures, efforts should be directed at promoting education, encouraging preventative measures (starting today), and giving equitable access to all citizens within the healthcare system. By focusing on collaboration, education, analysis, and research, Canada can achieve the goal of having a (mostly) healthy, contented populace. There is no good reason to resort to blatant discrimination in the hope of saving the system some money, which, when all is said and done, might only cost taxpayers more in legal bills when the government is sued, as it surely would be.


6. Snitching would be a dangerous social route

Using past lifestyle choices to regulate Canada's healthcare funding is a fool's metric. Once we start sliding down the nightmare slope of determining a person's just dessert, it's all over for us. There will be eager bureaucrats, and some doctors, who will accept the challenge. Snitches walk among us. To try to save a doubtful buck in healthcare services, they will not be able to stop themselves from hunting us down. Social media will find more victims to shame; but in the days of the snitch, the victims won't get paid medical treatment. An unhappy country would be the inevitable outcome.

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