Martin Zelder Contributing Writer PAUL Martin’s tax reduction may have earned plaudits, but not his health budget. It’s “the end of the health-care system,” howled medicare detender Shirley Douglas. Premiers like Saskatchewan’s Roy Romanow moaned that the new $2.5 bullion CHST funding was “woetully inade quate.” Federal Health Minister Allan Rock was hardly reas suring when he noted: “Uts a short-term measure, nota ” Perhaps most at was Ontario Premier Mike Harris: “Clearly, theyre saving they can’t carry on with the status quo.” Harris is right: Subsrantive change fs necessary, but it is untikely to be forthcoming at the federal level. Given the current dismay, what's a dis- geunded province te do? Some may seriously consider what was previously unchink- able: opting out of medicare. Opting out of medicare means violating the Canada Health Act (CHA). Violating the CHA is treated as a mortal sin within the Canadian political papacy, purportedly ensuring eternal legal, financial, electoral, and moral damnation. in agtizali- ty, Violation is more on the order of a venial sin: a province, ac the maximum, would fose its anual CHST cash cranster, So, the question is: were a province to became a venial sinner and violate the CHA, what would be the price paid for absolution? The wages of sin for a recent fiscal year are considerable. For example, ii fiscal vear 1998-99) British Columbia's CHST cash transfer was $1.6 billion out of its total public health spending of $8.2 billion (19.7%), while Quebee’s transfer of $3.8 billion con- stituted a whopping 31% of its public health spending. But there are also signifi- cant rewards available to provinces willing to violate the CHA in a particular wav. Suppose a province decided to violate the “accessibility” criterion by charging a 25% coinsurance payment for each | 94 CHEY S10 , 5 spd, on Gotan sony cen “. use of provineialy insured services, up to a modest expenditure limit (above which, the province wouid toot the bil: Hit did se, the best available evidence, trom the renowned RAND Health lusurance Experment, implies thatthe province would reduce its public health spending by 19% with out impairing health out- comes for the vast majority of is citizens Haw much would cach province save if it institured this type of retoun? Hundreds of tmllions of dollags, in. most cases. Just as the CHST transfer is substan- tal, so too are the potential savings. If money were the only determinant of a province's decision making, under what circumstances would it choose to reform? It would choose to reform if its savings from reform exceeded its CHST wansfer. 2dr, Sspd, fully equipped This is not merely an abstract calvulation. For tiscal $998 99, both Alberta and Gnrie would have gained financially by opting out and instituting 25% coimsurance rates, Alberta would have gained $83 million, while Oarano would have gained S31 mullion. These gains could be used to shorten waiting lists. Furthermore, both British Columbia and Saskatchewan were close to gaining advantige by opting one for 1998-99, BC. would have fost only $55 intlion, and Saskatchewan $19 million, by opting out. With the veneral decline over time in CHST (Martin’s boost noavithstanding ), and rising health expenditures, it’s only a matter of time before B.C. and Saskatchewan gain, too. Why, then, don’t Alberta and Ontario opt ou? The obstacle, presumably, is that there are political costs to doing so. Were they to opt out, the electoral fortunes of the governing parties might be jeopardized. But, as a matter of logic, as the gain to ith budget opung out grows larger, if is more and more likely that it will eventually cunweigh the potengal cast of wlectoral reprisal Moreover, despite the CHST boost contained i Martin's budget, growing health costs make it increas- wily tikely that the opt-out aeulation will tilt in faveur of more and moce provinces over Une. Hence, 4 province intent on reforming its health care system can do so, if it is will- ing to pay the price in for- gone CHST transfers, and notential political opprabri- am. Some may call chat sin, but in a tame when the cur- rent health system forsakes so many who ace suffering, it might instead prove the most saindy compassion. — Martin Zelder is Director of health policy vescarch oat The — Fraser Institute, a Vancouver-based economic research organisn- tion, Details of the opting-ont calculations in this article can found at . Environmental acts awarded THE search is on for British Columbians whose contyi- butions to a healthy environ- ment deserve recognition, Environment, Lands and Parks Minister Joan Sawicki announced Feb. 15. Excellence in Stewardship has been added to the awards program this year to reward those who voluntarily work to pretect biodiversity on private land or in their local water- shed. Awards are given in each of the following, categories: B excellence in stewardship; Bi community or non-profit organization; André-Piolat school accepts individual citizen; business or industry; youth; & environmental education; B local government; communications or media. Those wishing to nominate an individual or organization for an award have until April 7 ts submit a nomination form. Forms for the awards are av: able at al! BC Environment regional offices or by contact- ing 250-387-9422, Nominations can be submitted through the Web site at . registration for full-time Kindergarten in French for the 2000-2001 school year. Register your chiid before Marsch 31, 2000! Your child must be at least 5 vears old by Dec. 31, 2000. We will also accept registration at the elementary levels. L’école André-Piolat accente les inscriptions a la matemelle a temps plein pour la rentrée scolaire 2000-2001. Inscrivez votre enfant avant le 31 mars 2000! Votre enfant doit étre agé de § ans au 31/12/2000. Nous acceptons aussi les inscriptions au niveau élémentaire. Conseil scolaire francophone de la C.-B. 2860-10991 Shelibridge Way, Richmond, C..8. V6X.3C6- Tél: 604-214-2600 | 1-888-715-2200 Teléc.: 604-214-9881 hitp:/tnww.csf.be.ca — info@esf. be.ca