Smokers may be forced to pay higher Medical Services Plan premiums to reflect the heavier burden they put on B.C.'s health care system, Health Minister Mike de Jong says.
He offered no details, calling it a concept under consideration at this point.
"It's something I'm seriously looking at," de Jong said in an interview after floating the idea in a panel discussion at the Union of B.C. Municipalities convention.
An MSP surcharge on smokers would be a new stick to persuade smokers to quit, on top of existing taxes on cigarettes and a growing plethora of restrictions on where tobacco addicts can light up.
"I think smokers would be upset to be singled out," de Jong said. "But we want them to be upset because they are engaged in a behaviour that is costing the rest of society billions of dollars.
"These are controversial steps. If you're a non-smoker, they're less controversial."
A higher MSP premium on smokers could help raise extra money for the embattled health system, de Jong added.
The minister warned the government plans to carve money out of existing health spending to fund new initiatives to prevent chronic illness and reduce long-term costs.
B.C. already spends nearly $100 million a year on health promotion and disease prevention.
Victoria's latest move is to fully fund nicotine patches and other smoking cessation aids.
Smokers will no longer have the excuse of not being able to afford to pay for help to quit smoking, de Jong said, adding the $15 million required will come from other parts of the health budget.
"We think it's a good investment," he said.
Smokers make up just 14 per cent of the B.C. population – the lowest rate in Canada – but de Jong said cutting that to 12 or 10 per cent would still save billions of dollars.
The province intends to go considerably further in promoting prevention and primary care, de Jong said, in areas ranging from weight loss and exercise to salt avoidance and the risks of sugary drinks.
But there's no new money to pay for such initiatives, he said, so cash must come out of existing health care spending in other areas.
De Jong wouldn't say what types of programs may be cut to raise more for prevention, but said he expects the choices will be difficult.
"The transition is not going to be easy," he said.
B.C.'s health budget has climbed from $4.8 billion in 1990, when it made up 32 per cent of all government spending, to $16 billion now or 45 per cent.
"We keep plundering other budgets to feed an insatiable appetite in health care," de Jong said. "We are going to have to live within our means in health care and actually shift the emphasis."