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“They who have put out the people’s eyes, reproach them of their blindness.”

— attributed to John Milton, 1642

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The McGill University Health Centre has made headlines again, after failing to observe basic standards of decency in its response to a very sick person. Coroner Jacques Ramsay’s recent report details how Kimberly Gloade, a Mi’kmaq woman, was asked to pay a fee (over $1000!) for an emergency room visit in February 2016 because she did not have her Medicare card. Unable to pay, Gloade left, sentenced to suffer for weeks until dying of liver cirrhosis at home.

The MUHC certainly bears responsibility for how horribly Gloade was treated. However, such behaviour is not unique. We know that people without health coverage are callously turned away at institutions across the city on a regular basis.

The ultimate fault lies with the Ministry of Health and Social Services, which annually resorts to an opaque process to determine the cost — not including physician fees — of an outpatient visit or a hospitalization at a particular institution. In cases where care is given to individuals without a valid Medicare card, the ministry then adds an exorbitant 200 per cent surcharge that the institution is supposed to recoup from the patient. For example, a hospitalization in the intensive care unit may cost the system $3,500 per day, but a “non-resident” of Quebec without Medicare coverage will be charged upward of $10,000. As a result, when a health-care institution submits its reports at the end of each fiscal year, its deficit is artificially inflated because of the fees being charged to people without insurance who are unable to pay. The pressure to balance hospital budgets results in aggressive institutional policies demanding payment up front, scapegoating marginalized groups.