Commentary  The case for medicare

International students should be able to buy into Quebec’s provincial health plan

Canadians, in general, believe in medicare. In a 2008 poll conducted by Ipsos Reid on behalf of the Dominion Institute and Citizenship and Immigration Canada, the public considered the Canadian health care system one of the top ten defining national characteristics of Canada, along with the maple leaf, hockey, and peacekeeping. Observing this faith in medicare, I can’t help but ask – if it’s so good, why don’t international students have access to it?

Medicare works because it focuses on two major goals: equity and cost control. Medicare achieves equity by providing the same basic plan to everyone who enrolls, and cost control by creating one governmental agency that pays for everyone’s health care, since when there’s only one buyer but many sellers, the buyer tends to control the prices. However, in Canada, health coverage for international students does not meet these goals, since they typically must obtain their insurance from a private monopoly designated by their university.

Quebec makes for a good example of this. When international students come to Quebec, the provincial government requires that they have some form of health insurance that is valid in Quebec. Students from France, Denmark, Luxembourg, Norway, Portugal, and Sweden can obtain Quebec medicare due to bilateral agreements. However, all other international students must buy private insurance, and each university establishes one company as a monopoly for this service.

Many Quebec universities, including Université Laval, Université de Montréal, Université de Sherbrooke, and the entire Université du Québec system are part of a consortium that grants a monopoly on international student health insurance to Desjardins Securité financière. Bizarrely, different members of the consortium appear to charge different rates for the same plan. For example, UQAM’s web site lists the cost of one year of health insurance as $1,265, while UdeM’s, lists the costs as only $720.

McGill and Concordia are not members. Instead, they have contracts with Blue Cross. Again, even though the two plans (and even the insurance claim forms) are largely the same, international students pay different rates at each school – $750 for Concordia, but only $591 for McGill. Bishop’s University uses Expert Travel Financial Security (ETFS), which charges $787.20.

These private insurance plans generally mimic the public plan as set out by la Régie de l’assurance maladie du Québec (RAMQ), with some differences. For example, Blue Cross has been denying trans people prescription drug coverage for hormones since at least September 2010, even though RAMQ covers hormones.

International students also face some additional disadvantages due to having private rather than public insurance coverage. RAMQ will cover prescription drugs at the pharmacy, while private plans require submitting a formal claim – and waiting weeks for reimbursement. Furthermore, since international students cannot obtain a health card, many of them lack any form of Canadian government-issued ID, which can sometimes cause complications even when doing something simple, like picking up a package from the post office.

These issues only disappear once an international student graduates, decides to stay in Quebec, applies for a post-graduate work permit from Immigration Canada, submits another application to RAMQ, and then waits three months for RAMQ to start providing coverage.

All these different rules clearly undermine the principles of equity and cost control. Why should an international student at UQAM pay over twice as much as an international student at McGill? And why should an international student, as compared with a Quebec student, have a different set of benefits? And why bother having multiple bureaucracies when one alone can do the job more efficiently?

The solution is for the Quebec government to allow international students to buy into medicare. International students would have to pay a premium to RAMQ, particularly since their families have not been paying taxes to fund the public health care system. These premiums would also provide additional revenue for RAMQ and likely decrease per capita health costs, since students tend to be in their late teens or twenties – typically healthier age groups than the population at large.

SSMU, PGSS, and the McGill administration should lobby the Quebec government to expand access of Quebec medicare to international students, for the good of both international students and Quebec society as a whole.

Quinn Albaugh is a B.A. candidate in Political Science (Honours). They can be reached at