Far from Free: The Canadian Medical System

There is a notion of “free health care” in Canada. That is far from the reality for many, our system remains well beyond the reach of various demographics, particularly those living below the poverty line and the working poor. We do, indeed, have a more open and accessible health care system and there is much to be said about our system but all too often the costs of health are overlooked with the idealized notion that everything is free.

It is extremely frustrating for people with chronic health conditions to see medical professionals who suggest products and services without thought to cost. Much of what is suggested is unaffordable except to a select few. Some patients would rather not even hear about the options that could improve their quality of life than know they exist but that you cannot access them.

There are so many costs associated with our medical system it can quite overwhelming. Even before you get into a hospital, you have to pay for parking, and that alone is a deterrent to getting the help you need. Then when you see a doctor, they make suggestions without the knowledge of what it costs. Often, when one tries to talk to a medical professional about the barrier of affordability, they get responses of judgement and being told that they just aren’t prioritizing their health or don’t want to get better, neither the truth. The problem with “prioritizing your health” when you live in poverty is that there is no savings, whatever you use for medical issues is taken from other necessities like house, food, or medications; this leaves you stressed, with poor nutrition, and/or inadequate housing, all of which worsen chronic health conditions.

This disconnect between the reality of the financial abilities of patients and what doctors and specialist suggest needs to be improved. Poor health is not fixed by will alone, there needs to be services and products but there also needs to be affordability. For those who are working poor, the stress is increased because getting the proper medical care can actually cost them money; they have to take time off work to make appointments, losing money to see medical professionals who then expect them to pay for therapies and supports. Some don’t seek out the medical care they need because they know they can’t afford it.

One of the key tenets of accessibility is options. We need to have a medical system with options. Currently there is some government funding, but doctors have to fill out forms, which costs money, so we once again get stuck in a cycle of not having money to pay for what is needed. Doctors should be aware of the costs of what they are suggesting and know cheaper options.

Our health care has a lot of issues to address and affordability is one of the important topics, but it is very rarely discussed. Money is an uncomfortable topic; people don’t want to talk about living in poverty in case it affects the care they receive. Experiencing poverty bias is real and frustrating and keeps some from trusting or turning to medical professionals when in need of help.

Medical students should be taught that there are many intersecting identities that they will encounter: sexuality, gender, religion, income level, race, disability, etc. They should be given lessons and basic information about the various demographics of their patients and learn how to interact with those patients. Health care does not start and stop at the body, brain, and senses, we need to consider the entire person, their environment, and their financial limits.

It is estimated that one in 5 Canadian have precarious jobs. Not only does this affect one’s finances, it affects their health, their stress levels, their mental health. Being given medical solutions or suggestions that further stigmatize and stress people in poverty, or working poor, is not the answer. Being more mindful and respectful about finances and how that affects a person’s ability to access health care is one step we can take towards a future where patients aren’t offered hope only to have it snatched away when they see the price tag. Medical professionals becoming aware of the costs of therapies, medications, support, etc. is another step that is vital to bridging this gap. Doctors should ask patients whether their medical decisions will be reliant on what they can afford, and if that is the case, it should be marked in their chart.

There are ways we can work to support both patients and medical professionals in being more aware of the costs of our medical system and how that affects those in need. Poverty, unfortunately, is shamed, and many are not comfortable talking about it, but dialogue is vital. Thank you for reading this. Please continue this conversation where you can.

Discriminatory Customer Service on B.C. Transit

I have used mobility aids for over fifteen years. I have been using the transit system just as long. I have experienced a lot of discrimination as a passenger with a disability, I even founded my organization, Citizens for Accessible Neighbourhoods, in 2005 because of customer service issues with transit in Metro Vancouver. Today, I had one of the worst experiences ever. I had taken a bus from the ferry to downtown Victoria where I was catching a bus to Esquimalt. I was waiting at the bus stop and, as the bus was the second in the bay, it pulled up behind another bus. I was standing just off to the right of the front door of the bus and I said to the driver “I need the ramp”. She waved her hand and said “pole”. I repeated that I needed the ramp so she deployed the ramp without moving and, as predicted, the ramp was an inch from the light pole. I said I couldn’t use it there, I couldn’t get over the lips on the side of the ramp. I said that she needed to move the bus forward. I should not have been forced into instructing her. She glared at me and moved the bus forward, passing me where it was accessible, making myself and the growing crowd around me move forward. She deployed the ramp and I boarded. Frankly, it was humiliating having to advocate for accessibility as a growing crowd of people pushed on me and wanted to board, several people did offer words of comfort to me about the driver needing to do her job and why was she making it so difficult, but even with those thoughtful comments, the driver was making a sideshow out of what should have been a normal procedure. Finally I boarded the bus.

When we approached my stop, I stood up and moved to the front of the bus and the driver just sat there. I said “I need the ramp” and she reluctantly deployed it. As it was deploying, I said “I shouldn’t have to fight so hard to use the ramp” and she stopped the ramp halfway and just sat there. I was exhausted at this point and, honestly, extremely frustrated and angry and I didn’t want to say anything I would regret so I simply said “please deploy the ramp” and she did. As I was exiting the bus, her power play bothered me, it was so unnecessary of her to stop the deployment of the ramp as if she were going to trap me in the bus for speaking up for myself (and other passengers with disabilities). I said “a passenger shouldn’t have to fight to get the ramp deployed” and she said she didn’t know I needed it. I said I told her I needed it. She then said that “the ramps weren’t made for you, they were made for wheelchairs”. I replied that they are there for anyone who needs them and they shouldn’t have to fight for that right, they should ask and get the ramp deployed. She disagreed. I realized that no matter what I said she wasn’t going to change her mind so I continued on.

The BC Transit driver completely devalued me, she acted as if I was an aggravation and she’d only deal with me if forced. It was absolutely unacceptable and discriminatory service. There are people with disabilities who experience this type of rudeness and unwillingness to give them access to a service that is quite literally built into the bus, and never want to use transit again; I know because my organization receives calls and emails from concerned family and friends asking how to encourage them to try again. It is truly disheartening to see the same issues present in today’s transit system that were happening when I founded my organization fourteen years ago. It truly bothers me, and it should bother BC Transit, that there still drivers who demean and demoralize passengers with disabilities. Nobody who needs accessibility should have to fight for it. No one with a walker, who is unable to lift the walker onto the bus, should have to hear that the ramp is not for them and be told it is only for people with wheelchairs. No person should feel invalidated and minimized.

I expect BC Transit to make sure this employee knows that discriminating against customers on the basis of disability (or any other identity) is unacceptable.

I also expect that BC Transit will back up the talk with the driver by sending out a notice to all bus drivers reinforcing the right that if a passenger with disability (with or without a mobility aid) says they need the ramp, the ramp should be deployed. There should be no argument, there should be no shaming. and there should definitely not be service that makes them feel like they are a burden.

Image of person with walker

Affordable and Equitable Transit

The following is the speech I delivered to the Vancouver City Mayor and Council on January 16th, 2019. I was one of several speakers supporting the #AllOnBoard motion for free transit for all children and youth 0-18, a sliding scale pass system based on income for adults, an immediate end to the fare evasion ticketing of minors, and the introduction of community service as an alternative to ticketing for adults.

“I founded Citizens for Accessible Neighbourhoods in 2005 because of physical and attitudinal access on transit. For the past thirteen years CAN has advocated for, and worked with, TransLink to improve the accessibility of our system. As exciting as the progress of the physical accessibility of the system is, for many of our members, those improvements do not benefit them because of finances. All too often, unfortunately, financial accessibility is lost in conversations about access and yet, if one can’t afford the transit system, it doesn’t matter to them if it is physically accessible to them.

The majority of C.A.N.’s members are people with disabilities, and a significant portion live below the poverty line, on financial assistance, and transit is vital for them to access services, food banks, volunteering, the medical system, education, and employment, as well as to connecting to support and community.

There are no words to adequately describe what it is to live in poverty and to see a transit system everywhere you go and know you cannot afford it, that it is not for you. We have a transit system that could improve the lives of many, but they can’t access it, or, when they do access it, they do so by cutting into their resources for food, medications, medical needs and/or housing or at the possibility of a huge expense, like the tickets for fare evasion.

There is a weight to poverty. Every day you live under a burden of an enormous pressure stretching dollars, making desperate decisions and constantly juggling needs. Many of our members feel isolated and scared and they are losing hope at improving their lives or finding ways out of poverty or even figuring out a way to have a little less weight on their shoulders. Not having access to transit leads to isolation, depression and a disconnect from the community, worse yet, it can make people feel that no one cares about them and it reinforces the idea that people, once in poverty, are unable to break the cycle and work their way out. Even those of our members who do buy monthly bus passes, have to do so by making constant sacrifices and difficult decisions at the expense of essentials like: medications, groceries, medical appointments, proper seasonal clothing and more.

The current BC bus pass is $52 a month. For those of us on disability who paid $45 per year, just a few years ago, this $52 a month is a huge increase and one that forces us to decide between applying the money to transit or other necessities. I had to make this decision, I chose groceries, it was not an easy decision. I have a bus stop directly behind my unit and I can no longer access it. I‘ve lost my independence. I am fortunate, however, as my parents have a wheelchair accessible van. I have options, many do not. There are some who make this decision month by month and this is exhausting. There is a mental and emotional toll to continually juggling money. You can choose to help alleviate this weight.

AllOnBoard is asking for an inclusive and equitable approach to transit costs. This approach does not favour one demographic but speaks to income, it recognizes that many demographics, immigrants, families, people with disabilities, seniors and more are in need of more affordable transportation. It understands that transit is a vital need for those struggling to get by in Vancouver, one that opens up opportunities, allows people to access the community supports they need and to be a part of their community.

I thank you for allowing me this time to represent the voices of the members of Citizens for Accessible Neighbourhoods. I represent our members on federal disability who do not have access to the provincial bus pass program. I represent our members on provincial disability who had to use the increase in disability for medications, medical appointments, housing and/or food. I represent our members of various ages without disabilities who have financial limitations who need the equity offered by the #AllOnBoard motion, ensuring transportation costs are based on a sliding scale based on incomes. And I represent myself, who is currently without access to the transit system.

I also thank you for this time to speak on behalf of members of our community who feel isolated, unheard and pushed to the margins. With this vote, you have the opportunity to tell these people that they are seen, that their voices are being heard, that they are valued members of our community and they deserve transit they can afford so that they can access the supports, services, community and opportunities that exist in Vancouver and which will help enable them to live the lives they envision for themselves.

Supporting the #AllOnBoard motion is a step forward in recognizing the necessity of transit and the importance of a fair and equitable system that does not penalize poverty, and which better supports citizens in becoming active participants socially, economically, and politically within their communities.”

The mayor and council voted in favour of supporting the motion, with one councillor voting against. Vancouver is the third city to vote in favour of supporting the #AllOnBoard motion, following Port Moody and New West. Those of us involved will now move on to other cities/municipalities in the Lower Mainland.


For more information about #AllOnBoard, visit their website at https://www.allonboard.ca/

#AllOnBoard stands for affordable and accessible transit based on income in Metro Vancouver to ensure our communities can access public transit to live, work and thrive. 

We advocate for:

  • Free transit for all children and youth 0-18
  • Sliding scale monthly pass system based on income 

We advocate for an immediate end to the fare evasion ticketing of minors, and the introduction of community service and restorative justice options for adults as an alternative to fare evasion tickets. 

We also advocate for a social justice and poverty reduction mandate for Translink, non-stigmatizing affordability measures, fare evasion fines to be unlinked from ICBC and infrastructure expansion. 

Metro Vancouver has zero affordability measures based on income to ensure equitable acccess to our public transit system. We lag far behind many cities and municipalities across Canada, the US and beyond that offer affordability measures to ensure low-income folks can access the essential service of public transit. 

The result? Children, youth and adults that primarily lack access to any other form of transport in Metro Vancouver remain locked out of our transit system.

The time is now. Join in solidarity to make affordable transit a #1 issue in Metro Vancouver and ensure our whole communities can get on board.  

#AllOnBoard is a movement. The campaign consists of an alliance of  coalitions, organizations, community groups, advocates, unions and passionate communities and citizens from municipalities across Metro Vancouver coming together to ensure our entire communities can get on board.

#AllOnBoard stands for affordable and accessible transit based on income in Metro Vancouver to ensure our communities can access public transit to live, work and thrive.