The Legault government proposes to impose a contribution to the financing of the public health insurance plan on people who have not been vaccinated for COVID-19. Their risk of using costly health services is higher than that of vaccinees. This practice is found in private health insurance plans. For example, insurance premiums will increase with the risky behavior of the insured. Regardless of the political, administrative or legal quibbles that disguise the Legault contribution, it remains a financial contribution by the insured linked to the exposure to a risk.
Quebec’s public and universal medical and hospital insurance plan is not a bric-a-brac that can be manipulated to meet the needs of a particular political moment, however dramatic it may be. One of the plan’s main objectives is to make medical and hospital services financially accessible. No service point fees are charged, no deductible is levied, no selection of members according to risk is applied, insurance premiums are non-existent. In short, the plan does not seek to link what insured persons pay to their state of health or behavior, nor to their ability to pay. The insured risk is collective, and the insurance is collective in both coverage and financing.
Prime Minister Legault’s proposal comes into play in this architecture for reasons that are foreign to him. There are other ways to promote the most universal and complete vaccination possible while respecting the basic requirements of the components of the Quebec health system. In a pandemic, vaccination is a weapon within the reach of public health. The vaccination operation must therefore be planned, organised, distributed and financed within the framework of the means made available to public health by the public administration. These means range from health promotion interventions to coercion. There is no need to fiddle with the smooth running of the public and universal health insurance system to promote or impose vaccination.
Requiring a contribution from those who have not been vaccinated to finance their own medical and hospital care amounts to imposing an insurance premium, albeit in disguise, for a specific risk that they run. This measure is in profound contradiction with the public and universal health insurance scheme as it was designed. In addition, Public Health has an arsenal of specific means to implement the policies, programs and interventions appropriate to the pandemic situation that afflicts us. Let her use it. No need to go elsewhere.
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