In defence of refugees’ health (or why generosity is fair)

Refugees have one week to get their final prescription for insulin or get a much-needed prosthetic limb before having to figure out how to come up with the money to afford these things by themselves.

Refugees arrive in Canada after escaping desperate situations, often without having had access to a doctor (or the financial means to do so) for many years. This is why, since 1957, Canada has been providing temporary coverage of medical costs for refugee claimants through the Interim Federal Health Program (IFHP).

Coverage is basic—adequate but limited—although it does temporarily cover a number of pressing medical problems and disabilities that would otherwise greatly hinder a refugee’s ability to set themselves up and begin a new life in Canada: medication for diabetes or heart disease, for example, or getting a tooth pulled or a pair of glasses, or a prosthetic limb or wheelchair. That sort of thing.

It’s a show of generosity, yes, but it also makes good sense economically and socially. It’s a practical way of assisting a refugee’s integration into Canadian society, and keeps their medical issues from compounding, and thus adding extra burden on our health care system in the long run.

As of June 30, this will no longer be the case.

Citizenship and Immigration Minister Jason Kenney took a look at the IFHP coverage and concluded that it was unfair to the rest of Canadians. How so? Canadians, he said, should not pay for benefits for refugees that “are more generous than what they are entitled to themselves.” If Canadians don’t receive government-funded “supplemental health-care benefits,” he concluded, neither should refugees. Fair’s fair.

So Kenny amended the IFHP to limit medical coverage to refugees and protected persons. As of June 30, they will only receive coverage for “cases where there is a risk to public health or public safety.” A heart attack, by the way, is not a risk to public health. Neither is going into diabetic shock, or an abscessed tooth. Still, we are to celebrate: “Cost savings,” says Kenney, “are projected to be about $100 million over the next five years.”

There will, however, be no cost savings for refugees, who will now have to figure out how to afford prescription costs, or hospital visits for everything from medical emergencies to giving birth ($93.70 for less than 8 hours, $334.35 for one day, $668.70/day for multiple days, or $200.65/day for stay over 45 days). The vast majority of refugees are unable to find work and cannot yet afford medical expenses. They are especially unlikely to find a job if they have medical issues.

*

Changes to the IFHP will prove ruinous to many refugees. Not only will medical expenses be unaffordable to many, but with the processing time for permanent residency taking an average of 17 months, few will go unaffected. Some groups, however, will be dealt an even greater blow, thanks to another bill the Conservatives recently passed: Bill C-31, the “Protecting Canada’s Immigration System Act”:

If a refugee claimant has the misfortune of arriving in a group of two or more, and especially if they’ve done so by boat, then our Immigration Minister can now arbitrarily designate them an “irregular arrival,” (this is done to punish them for using a smuggler, a misdemeanor that is clearly waved by the UN Refugee Convention). After being detained for 15 days (initially Kenney wanted one year of mandatory detainment) they will have to wait five years before applying for permanent residency. Result: “irregular arrival” refugees have to subsist on so-called temporary IFHP coverage for a minimum of five years.

Who else? If a refugee claimant has the misfortune of arriving from a country that our Immigration Minister can now arbitrarily decide to designate a “safe” country (one from which the Minister thinks refugees shouldn’t be coming), then they won’t receive any IFHP coverage until being accepted as a protected person. (Countries that have made Kenney’s “safe” country list include Hungary, where the state is doing little to protected the discriminated Roma community; Mexico, a nation suffering from violent drug wars, and from whom Canada accepted 1,043 refugees in 2011; and El Salvador, where the homicide rate is so high that the nation celebrated one day in April when no one was killed for the first time in over three years.)

*

The changes to the IFHP go straight to the heart of what kind of society we want to have, and what kind of nation we want to be. Kenney has argued for “fairness,” and in that he and I agree. But what is fair?

Kenney has suggested that, unlike refugees, no Canadian receives supplemental benefits. This, quite frankly, is not true. Contrary to what the Conservatives would have you believe, not all Canadians receive the same health plan. Among the many Canadians who do receive supplemental benefits include those on welfare and those on disability insurance. The reason for this is the same reason we offer certain benefits to refugees: to compensate for disadvantage; to manufacture a level playing field; to manufacture a form of equality.

You see, there is an egalitarian intent at the core of the IFHP.

Most of us have been born into relative prosperity, all things considering. If we are born with a physical or mental disability, there are resources available to us. We have access to medical care, and the medical care is generally affordable. If we can’t afford something, many of us have a support network—family, friends, colleagues—willing to help us out.

These seemingly basic things are simply not the reality for most refugees. They often come from war-torn nations, or from years waiting in an underfunded refugee camp. They are often from marginalized communities and often economically impoverished, having left behind any money they might have had, not to mention their friends and family.

This, my dear Minister of Immigration, does not put them on an equal footing with the rest of us.

Rather than increase fairness, Kenney’s changes to the IFHP do the exact opposite, increasing the gap between the privileged and the under-privileged. Equal access to opportunity only works if everyone begins at the same place. And since we are born into different socio-economic classes—and with varying levels of health—equal access can’t happen unless we compensate and make adjustments. Unless we manufacture equality as best we can. This is how an egalitarian society works. Or at least, this is how it is supposed to work.

{side notes}

The following are examples of coverage with the changes to the IFHP, taken verbatim from the government’s own Citizen and Immigration Canada website. ([link no longer active—see this pdf). (That link no longer active—see this pdf, courtesy the College of Opticians of Alberta).

Heart Disease

Scenario: A patient is diagnosed with stable angina. The doctor prescribes aspirin and two other medications, and asks the patient to come in for follow-up visits. Heart disease does not pose a risk to public health and is not a condition of public safety concern. The prescribed medication is not covered.

Diabetes

Scenario: A patient is diagnosed with diabetes and is prescribed insulin. Diabetes does not pose a risk to public health and is not a condition of public safety concern. The prescribed medication is not covered.

Rheumatoid Arthritis

Scenario: A patient with rheumatoid arthritis is prescribed medication for pain. Rheumatoid arthritis is a condition deemed to require services and products of an urgent or essential nature, but arthritis does not pose a risk to public health and is not a condition of public safety concern. The prescribed medication is not covered.

Hip Osteoarthritis

Scenario: A patient has been having hip pain for several years and visits a doctor. After testing, the doctor tells the patient he has osteoarthritis and prescribes medication. The patient is identified as a candidate for hip replacement surgery. Hip replacement surgery is not considered urgent or essential. The prescribed medication is not covered. Hip replacement surgery is not covered.

Person Requiring Long-Term Care

Scenario: A man with advanced dementia is unable to look after himself and needs the services of a long-term care facility. He needs medication and regular assessment by a doctor. The assessment of the patient by a doctor is considered essential. However, long-term care will no longer be covered through the IFHP. The prescribed medication is not covered. The cost of the long-term care facility is not covered.

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2 comments

  1. Pingback: A big ol’ flip flop: Reversals to refugee health coverage « Bones for War
  2. Pingback: Mental health care for refugees? | Bones for War

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