The worst health care in Canada is federal
OTTAWA—Our nurses, doctors, and hospitals are facing a lack of funding support from provincial ministries of health. Ontario appears to be leading the pack for underfunding, but it’s a very close race across the country. Health-care systems are a bit like a house: if you don’t do the regular maintenance, fix the water leaks when they impact the foundation, replace the roof—that sort of thing—then you end up with a wildly expensive crisis. And here we are.
But there’s one system that is even worse: the federally funded and managed Non-Insured Health Benefits (NIHB) for status First Nations and Inuit. This is the health-insurance-like card that First Nations rely on. It covers expenses a bit like provincial health-care insurance, but it pays less than any of them. The icing on this cake is the reams of paperwork and faxes for the required advance approvals.
Inuit and northern First Nations rely on NIHB travel support because the federal government has neglected to build 24/7 health care in their communities. Even when there are nursing stations in some northern Ontario communities, nursing services may only be provided during the weekdays, and a doctor who flies in monthly at best.
So, travel turns out to be an essential piece of the health care system for First Nations and Inuit, but it’s stingy and mean travel support. Sometimes the patient gets notice of the flight out from the far north to a southern city’s specialist with barely an hour’s notice. Sometimes patients never get the notice of travel, and so they miss the appointment. Or the child gets covered to fly out for surgery, but not a parent. Or the patient who waited for medivac for weeks.
A list of the lack of parity across the board is both ludicrous and heartbreaking. If you were limited to NIHB for your health care, you would probably be furious. But who will be held accountable? Indigenous Services Canada (ISC) outsourced NIHB’s claims processing to Express Scripts. Is it an Express Scripts decision or an ISC decision? Who knows? It all lacks transparency and accountability.
I have received stern emails from ISC on prior NIHB columns, as apparently it’s the white god of health that shall not be critiqued. May I suggest that y’all be publicly accountable like the rest of the health-care sector?
I am not alone in critiquing this mess. Grand Chief Alvin Fiddler from Nishnawbe Aski Nation was at a rally at Sioux Lookout, Ont., where people came out to protest the poor and inequitable service from NIHB. Through a Facebook post, Fiddler, on June 8, referred to it as “the biggest barrier to better health care … causing great harm to our communities.”
The lack of health care called NIHB may just be the driving factor for the lower life expectancy of Indigenous Peoples, the higher rates of chronic disease, and virtually every disparity in our health outcomes today.
Indigenous Peoples deserve to be healthy. Do remember we’re in this era of reconciliation, when Canada says it will make reparations for all the harms done through residential schools, Indian hospitals, and worse. NIHB is currently not a reparation. Instead, the program requires atonement for its current inequity. Wait long enough and somebody might just sue for equity in health care. And that’s a case that no Justice Canada lawyer in their right mind should fight.
Abolish NIHB. It’s so beyond broken that it has no place in modern health care. Replace it with the federal government’s employee health-care insurance and include travel support that is publicly managed and accountable.
Rose LeMay is Tlingit from the West Coast and the CEO of the Indigenous Reconciliation Group. She writes twice a month about Indigenous inclusion and reconciliation. In Tlingit worldview, the stories are the knowledge system, sometimes told through myth and sometimes contradicting the myths told by others. But always with at least some truth.
The Hill Times