No it’s not the Clint Eastwood movie; it is the cost of a premature birth. This is making the news in Canada and eliciting some of the usual ‘tsk tsk’ the evils of private insurance. Here is the brief version of the story: a Saskatchewan resident, Jennifer Huculak-Kimmel, went on vacation with her husband to Hawaii. She wisely purchased travel insurance; she was 24 weeks pregnant. However, she was told that she could get coverage since she was less than 36 weeks pregnant. Shortly, after arriving to their vacation spot, Ms. Huculak-Kimmel’s water broke resulting in the premature birth of Reece (who is now by all appearances a fine and thriving baby). Needless to say, a neo-natal unit is costly. The problem is that the private insurance company, Blue Cross, is refusing to pay citing a pre-existing condition. Now since Ms. Huculak-Kimmle was cleared by her doctor as being able to travel, what could be the pre-existing condition? Ms. Huculak-Kimmel did say she had had a bladder infection some time during her pregnancy but the doctor was not of the opinion that this should any problems (one would conclude especially one such as risk of premature birth which would have been considered by the doctor).

This case highlights several issues. The first is one that I feel compelled to note: Saskatchewan is the province responsible for Canada’s single payer health care insurance. Tommy Douglas became Premier and instituted (he cannot be thanked enough in my opinion) the province’s Hospital Services Plan in 1947. Then in 1961 the province adopted a comprehensive health insurance. This model was adopted by the federal government of Canada in 1966 as the Medical Care Act. This means, basically that if Ms. Huculak-Kimmel had given birth in Canada she would not face any cost nor any stress resulting from costs of care. Tommy Douglas was a preacher, and someone who cared about the poor and a socialist. He worked tirelessly for a fair society. If the single payer system adopted in Canada is called socialized medicine, it is by those who misunderstand the intent as well as the manner in which the Health Care Act (as it is now called) is framed. It can be broadly stated that the Health Care Act is based on the belief that rich and poor should have access to good health care regardless of their circumstances and that, furthermore, one could never predict what was going to happen. Case in point, Ms. Huculak-Kimmel was not at a high risk of delivering prematurely, but she did.
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And this brings up my other point: pre-existing condition: great loop-hole. But what does it mean? Is a pregnancy a pre-exiting condition? Ms. Huculak-Kimmel was cleared by her doctor. If something more is needed, then what is it? Obviously Blue Cross does not wish to pay the high cost—after all a million bucks hurts even the very rich. Is this a tactic to scare off the claimant into paying? It is an unfortunate event and Ms. Huculak-Kimmel has stated that she does not wish it on anybody. However, it is often a ploy used by insurance companies to deny many types of claims. This also highlights another issue about health care: we are all differently positioned on the spectrum of healthy to unhealthy. Some of us will be sicker than others from birth. In addition, as we age we will be prone to more illnesses. Yes pre-exiting conditions predispose us to possibly more health care use. However, the whole point of a single payer system is to make care available to everyone and not to discriminate based on disease (by the way it also more financially efficient). And this is a crucial point: we do not discriminate based on race or sex and so on (at least we claim we do not). Why should we discriminate based on illness? This may be the prerogative of private insurers but I do not believe that a society should be comfortable with this. The denial of Blue Cross sadly highlights the loop-holes of private insurance–that is not to say that this could not happen to a visitor to Canada. One must be a Canadian resident to get health care–so unlike Jack and Avery of the show 30Rock (Double-Edged Sword, 2011) whose cash was refused for the care involved in the delivery of their baby, visitors would have to pay for that care. Though, I would hope not a million dollars.