Ontario’s Ministry of Health, headed by Elinor Caplan, has initiated the numerical registration of every man, woman and child in the province. Preceded by a flurry of news reports describing the fraudulent use of Ontario Health Insurance Plan (OHIP) cards. Mrs. Caplan unveiled her plan to assign individual plastic health I.D. cards to replace the current “family system” now in use.
Incorrectly dubbed a “Smart Card” by the media, the Caplan card bears only slight resemblance to its American counterpart. True “Smart Cards,” used in some American states, have a microchip embedded in the surface. They permit, among other things, instant electronic funds transfer so that store clerks can debit a customer’s bank account for the price of a purchase made.
Within two or three years the Ministry of Health intends to incorporate microchip technology into its new plastic card.
By mid-April, every Ontario household had received application forms for the Caplan card. The cards themselves are being issued as The Interim goes to press. Mrs. Caplan has made it clear – no card, no health care. Those objecting to the Minister’s unique registration system can always pay for medical services in cash. Paying from $550 to $1,200 a day for hospitalization guarantees the public will accept an offer they can’t afford to refuse.
Heavy –handed tactics aside, the arrival of the Caplan card signals an end to the Peterson government’s token recognition of the family unit as a unique entity. Despite the fact that, whenever possible, family physicians prefer to treat the family as a whole, individual I.D. cards pave the way for teenagers to take their card (and their bodies) elsewhere.
Due mainly to the privacy offered by the Caplan card, parents will no longer be able to monitor their children’s health care, says Maurice Jones, the Ministry’s Media Information Officer. Instead of family members sharing the same file, each member will be assigned his or her own. Since each file is confidential, parents will no longer have access to their child’s health-care history.
When asked if more young women would have freer access to clinical services such as birth control and abortion, Jones told The Interim, “Certainly, that’s going to be the case [and] some Moms and Dads won’t like it.”
Mom and Dad may not “like it” but Mom and Dad will no longer be informed if their 14-year-old is being treated for a sexually transmitted disease (STD), has obtained diet or birth control pills, or is being treated for depression. Citing a need for absolute patient confidentiality, Caplan has placed an obstacle between parent and child – the physician. As a government employee, he must adhere to the provincial Privacy Act and, in a sense, become the guardian of the file.
Collection of individuals?
Pro-life and pro-family groups see the switch from “family-based” cards to an individual system as an attack on the integrity of the family unit.
In Hamilton, family physician and past-president of Canadian Physicians for Life Dr. Carmelo Scime, expressed concern for the Minister’s treatment of families. Physicians will be torn between treating the family as a whole or as a collection of individuals, Dr. Scime said. Speaking for him self, “I will be placed in a questionable position of compromise, in that attempting to build up a family practice, I see the government of the day attacking that very unit.”
Dr. David Flaherty, a law professor at the University of Western Ontario specializes in privacy issues. He takes a dim view of the Caplan I.D. number. In a telephone interview, Dr. Flaherty expressed his lack of faith in the Privacy Act’s guarantee that the Caplan card will be used only for Ministry of Health purposes. Using the Social Insurance Number (SIN) as an example, he explained that it was originally created – back in 1964 – to control Canada Pension Plan (CPP) disbursements. Despite fears that the SIN could become a national numbering system, it was implemented at the federal level, then at the provincial. Today SINs are used in data bases nationwide. By law, banking institutions are now required to obtain a client’s SIN before they can open his account. In an article that appeared in the Globe and Mail (March 17, 1990), Dr. Falherty cited credit information as “one area where abuse of the social insurance number is widespread.”
Flaherty sees the Caplan card as a threat to individual privacy. Like the SIN, the potential for misuse is real. Although the Privacy Act specifies that the government can only use collected information for its intended purpose, the Act does not cover the private sector. Simply by requiring the health I.D. card number on a job or credit application, the private sector can use the card number for its own purposes.
What can be done? Ministry spokesman Jones says the paper OHIP card will be valid for another 12 to 18 months. Once 80 per cent of the province has received cards, the Ministry of Health will phase out family cards.
Those who return the Ministry’s application form – and receive their card – will be subject to “the perfect tracking device,” says Flaherty. His advice? Boycott the card. Do not return the application form.