State-Regulated Leisure

Alberta's Minister of Health Iris Evans wants to make Albertans healthier while reducing healthcare costs. She has been "thinking outside the box," Premier Klein said. The effort to cull new ideas should be commended. She reckons that a population with healthier living habits will cost less in the long run because fit people will visit doctors and hospitals less.

Generally speaking, it makes sense for the state to promote healthy living and to provide fitness incentives that will reduce costs. Evans envisages tax deductions for gym memberships, for recreational activities, and tax credits to healthy individuals, as determined by a doctor.

The practical application of these ideas raises significant questions, however. Fitness does not only happen in gymnasiums. We may include the use of swimming pools and skating rinks, and those who take dance lessons, judo, karate, fencing, etc... Dealing with fitness and recreational activities where one does not have to register is more problematic. Many Albertans love to hike, run, cycle, cross-country ski, and so on; and there are those who prefer the privacy of their home to do yoga, to use a wind-trainer, or a treadmill? How will the state keep track of these?

For the non-yuppie, fit citizen who does not require going to a gym, a clean bill of health from a doctor will qualify her for tax credits. Sounds good in principle, if we don't think about questions of age and genetic constitution, or how one objectively determines what a clean bill of health is. Will second opinions count?

More importantly, we may further pervert the already precarious relationship between Albertans and their doctors. The doctor-patient relationship is impaired by the fact that doctors profit from frequent visits from patients but are rewarded by a third party. The patient is likely to visit the doctor more when requested and to be less demanding of the care received because he or she is not paying directly. If Evans' proposed ideas are implemented, doctors will still depend on frequent patient visits to make more money, but patients will also depend on doctors to get tax credits. Given the symbiosis in pecuniary interest while a common third party is paying, it will increase the potential for significant abuse.

Many more healthy Albertans who normally would not go to a doctor very often will now have to go just to qualify for the tax credit. They will add to the already long lines at the doctor's office. The more so around the time when the paper work will be due to government for tax credit. If the expectation is that healthcare reforms should be reducing line ups, these ideas are bound to have the opposite effect.

The Minister has also come out in strong favor of mental health. What kind of incentives will Alberta offer to promote good mental health? Will we get tax credits for engaging in relaxing the symphony, the theater, or reading books? Will we get credits for a relaxing glass of wine or beer at the local watering hole? After all, the healthy benefits of these have been widely extolled. Necessarily, the state will have to decide which sport or leisure activities qualify for this scheme. Those decisions will benefit those with higher income and more time for leisure and sports. In other words, it will benefit those who are already healthier and fitter.

How, when, and to what extent will these activities be regulated, what amounts of money will it involve, and what levels of bureaucracy will be required to administer it? Will the cost of doling and administering the incentives be greater than the savings in healthcare?

The lines will need to be defined with some clarity. How far is the state prepared to go to promote health and wellness? Premier Klein announced that he was not in favor of a province wide ban on smoking because it would hurt businesses, and perhaps kill jobs. Unemployment likely does not promote wellness, but how does lung cancer become the superior collective choice to unemployment?

The Premier did not say that the choice to smoke is a private choice, and that the state should not be in the business of telling people what to do with their lives. He could have said that, but he did not. If mental health is a priority and individual choice does not have much of a place in the government's scheme, Ms. Evans should also be considering a province-wide ban on wallet-depleting, anxiety-causing casinos and VLTs (but like a ban on smoking, it would deprive the state of significant income).

The assumption that the state should provide economic incentives for people to have better health only makes sense because we accept the premise that the state should be in the business of caring for the bodies and minds of all its citizens. The moment that we placed comprehensive decisions about our health in the state?s hands, we did so at the greater expense of some personal freedom and autonomy. How much more of these do we wish to relinquish?

Considering how much of our lives and actions ties in to our health, where will the state?s involvement stop? Jean-Marc Fournier, Iris Evans' Quebec counterpart, declared this past week that the Quebec government may begin taxing junk food. Imagine for a moment all the questions that idea brings! One does not have to be an enemy of public health care to see the point. To what extent do we allow government to influence our choices and regulate more of our lives in search of an elusive standard of health for each of us?

The response from Albertans to Ms. Evans ought to be clear: "Thanks, but no thanks!" We do not want state-regulated leisure. If the Minister wants ideas on how to promote health and wellness, spend less money on healthcare and save money to the provincial treasury, she should go back and re-visit the Mazankowski Report's more substantive parts. It leaves room for her to practice her maternalistic approach, to keep the public system that most Albertans want, and to give some of us some autonomy in our lives: give us Medical Savings Accounts.