Quebec Premier Francois Legault says he wants to charge unvaccinated adults in his province “a significant amount” because of the extra burden they place on the healthcare system.
Before I explain why I think this is a bad idea, Legault is 100% correct about the core issue here: the unvaxxed are disproportionately soaking up healthcare resources.
I’ll meet him one step further: he’s also right about the politics. It’s hard to ignore the growing frustration and even anger from those who have (mostly) adhered to public health orders and dutifully lined up for their shots, only for the pandemic to keep dragging on. And on. And on.
The inescapable fact is that unvaccinated adults are more likely to be infected with COVID-19, and importantly, much more likely to get sick enough to need healthcare. (About 60 to 70 per cent more likely, according to Dr. Bonnie Henry today.) And at the risk of sounding like wishing for ponies, it would be so much simpler if everyone got vaccinated and drove down the collective risk – and more to the point here, the cost.
Now, the inevitable disclaimer: before I get accused of being a recusant, I’m triple-vaxxed. I wouldn’t add “and proud of it,” because that’s a bizarre thing to take pride in. Ideally it’s a given, like brushing your teeth twice a day.
All that said – and yeah, it’s a lot – it’s still a bad idea.
First, it’s not clear this fee would be legal. The Canada Health Act explicitly states provinces and territories may not add a surcharge to access medically necessary physician or surgical-dental services. If a province decided to add a user fee (or an unvax tax), they’re no longer entitled to the full Canada Health Transfer.
In short, Ottawa could slow the money tap. Whether they would actually do that to any non-Alberta province, much less Quebec, is an open question. But the province would be wide open to a legal challenge from a private citizen, and while I’m not a constitutional lawyer, they likely have a case.
For its part, Quebec will likely counter their fee is not charging for healthcare, but a more general tax. Some argue that some high-risk activities, like smoking or drinking alcohol, already carry a surcharge, in that they’re taxed up the wazoo, and a fee on the unvaccinated is basically the same principle.
I’ll be honest here: that’s a more compelling argument. The money from “sin taxes” goes into general revenue, yes, but it’s easy to argue they (indirectly) help fund treatment for cancer and liver disease.
Setting aside the thorny issue of addiction, buying cigarettes or unsafe amounts of booze is something you have to actually go and do. You’re taxing the purchase. But a healthcare fee for not doing something – like not getting your daily steps in – strikes me as an overreach beyond what I’m comfortable with.
Second, there’s an obvious slippery slope here. Whatever its other flaws, Canada’s universal public healthcare system treats everyone the same, and not like a private insurance company, entitled to charge you more or even deny coverage, based on your history and lifestyle.
If you’ve ever applied for life insurance, you’ve been through this. Your premiums aren’t one size fits all – pay $X for this level of coverage – but the opposite. And it’s not just underlying health conditions you can’t control, like a family history of heart disease or glaucoma. Your assessment also takes into account entirely voluntary activities like certain sports, motorcycle riding, or (in my case) SCUBA diving.
In other words, your body and lifestyle determine what you pay – or even whether you can be insured at all.
Canada’s healthcare system and its legal underpinnings explicitly forbid the provinces from doing this. And again, no matter how angry you are with your unvaccinated aunt and her Facebook theories, not being vaccinated is ultimately an unhealthy lifestyle choice.
Here’s the thing: whatever you think of the unvaccinated, the basic fact remains it’s not illegal. They might be making a bad decision – actually, strike that, they are very much making a bad decision – but crucially, they’re not breaking the law. You may argue it should be against the law, but this province can’t even stomach mandatory vaccination for its own public school teachers, much less across the board.
I would never suggest that just because there’s a slippery slope, falling all the way down is inevitable – we’re often smarter than that. But it’s hard not to be nervous about provinces deciding they can tax citizens for making bad decisions. We don’t even do that for illegal bad decisions, like drunk drivers after a car accident, or gang members losing a gunfight. In all cases, they receive medical care, and I would never argue they shouldn’t. Universal means universal, even for the assholes.
So while we’re still a ways off from taxing Steve from accounting for having two Big Macs again for lunch, the basic objections remain the same: it’s probably not legal, and undermines the very principle of universal healthcare.
Maclean Kay is Editor-in-Chief of The Orca