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Monique Keiran: Health-care premiums serve a purpose

Within days of the recent iPhone 7 release, Apple sent system fixes to all fans who had just purchased the device. Even then, it wasn’t immediately clear the update corrected all the problems.

Within days of the recent iPhone 7 release, Apple sent system fixes to all fans who had just purchased the device. Even then, it wasn’t immediately clear the update corrected all the problems.

The new federal public-service payroll system serves as an even bigger cautionary tale about pushing processes and systems through before they’re ready.

The rush to launch the Phoenix payroll system last February has meant tens of thousands of federal employees have been overpaid, had their pay delayed or haven’t been paid at all since.

If Phoenix doesn’t rise from its ashes in the next five weeks, the next tax season will be a costly headache for Revenue Canada, as it tries to sort out who actually owes what in taxes.

The people who haven’t been paid for months will continue to feel Phoenix’s failings long after it is fixed and money owed is settled. When a person guts her savings and misses payments on loans and mortgages, implications abound for retirement and beyond.

No, being cautious or slow about committing to new products or technologies isn’t exciting or cool, but it can bring its own rewards.

Despite the frustration, time, expense and so on, the two years that passed between the first proposal put forward for Greater Victoria wastewater treatment and the recent recommendations by the independent Core Area Waste Water Treatment Project Board yielded some benefits.

We now have a better design for a sewage plant, better technology, a higher level of treatment for less cost to taxpayers, and a somewhat better deal for Esquimalt.

British Columbia is the last province where residents still pay premiums for provincial health care. As noted elsewhere in these pages, even the premier agrees the system needs to change. Lagging in the switch to using tax revenues to pay for health care means B.C. can learn from other provinces’ experiences.

In Alberta and most other provinces, health care is now paid for out of undesignated provincial tax revenues. Many of these provinces now find a growing disconnect between health-care services and residents’ awareness of the cost of those services.

By charging premiums every month, B.C. at least reinforces the idea among those who pay the premiums that publicly funded health care does cost. Doctors might not hand us bills for prescriptions written and blood pressure measured when we leave their offices, but basic health care is expensive — far more expensive than what our premiums cover, in fact.

Ontario has overcome this disconnect in part by creating a designated “health care tax” for residents who earn more than a certain amount each year. To counter the burden on individuals — many of whose employers had previously paid their workers’ health-care premiums as part of company benefits packages — Ontario also implemented a payroll tax for medium and large businesses. Small businesses with payrolls under a threshold amount are exempt.

Funding health care solely from income- and payroll-tax revenues might jeopardize B.C.’s much-ballyhooed status as one of the lowest-taxed provinces in Canada. The former Alberta government paid a steep price for floating the concept of designated health surtaxes.

When Jim Prentice proposed adding a health-care levy to individual Albertans’ tax bills on top of what they already paid, he started the end of the Alberta Conservative Party’s decades-long hold on power in that province.

Provinces that have stopped billing for premiums have also experienced gradual deterioration of their records. Regular premium-driven communication with residents keeps health-care administration data up to date on resident addresses, demographics, family status and eligibility for coverage. Data quality quickly muddies without that mandatory communication.

Poor-quality data open those provinces up to risk. Privacy breaches occur every time personal and health-care information is sent to residents at out-of-date addresses.

Health-care and medical fraud — both intentional and inadvertent — becomes easier and more frequent. This increases health-care costs further, and requires investigations and audits, adding additional layers of expense.

As discussed in these pages, no easy options to a premium-based system exist, but B.C. certainly can benefit from the mistakes, successes and experiences of other jurisdictions as it plans future payment methods for its Medical Services Plan.

keiran_monique@rocketmail.com