Public Values

"Streamlining" Medicare

Critics charge proposed Alberta Health Act a cover for privatization.

Local people have lost direct decision-making authority at each step of health care by Penney Kome

"People are saying, 'we need more doctors', not 'we need more legislation'," said Diana Gibson, research director for the Edmonton-based Parkland Institute. As the main invited speaker at a Calgary Council of Canadians meeting, she was responding to the latest proposal for a new Alberta Health Act. Putting People First released on September 16 by Alberta MLA Fred Horne, offers 15 recommendations for developing a new Act. This report is Phase Two of an entirely government-driven initiative.

NDP leader Brian Mason spoke at the meeting too. Emcee Ted Woynillowicz, from the Friends of Medicare, emphasized that he had invited representatives from Alberta Health Services, the Liberals and the Conservatives, but they had all declined. [Liberal leader David Swan later issued a short statement setting out changes Liberals want to see in health care.]

Albertans have seen almost 20 years of sweeping reorganizations of the health care system.

"Alberta eyes complete overhaul of health care," was the headline on The Globe & Mail. Media reports about Horne':;s report have tended to focus on two recommendations: for a Patient's Advocate and a Health Charter. These items stand out because they sound new and novel. Conversely, it's hard to make a headline from a clause that calls for public notice about changes in regulations.

Indeed, the Horne report seems to offer both more and less than meets the eye. Individual sentences seem to state the obvious. Yet, said Gibson, the difficulty is to know when the report is using code words. Take another look at words like "streamline" "standardize" and "consolidate," she suggested, because often these are code words for "lowest common denominator".

So, she said, is the proposed commitment to the Canada Health Act, because, "Our existing legislation goes well beyond the minimum standards in the CHA. If that's their target, our standards are heading lower."

"Right now, there are over 30 separate statutes and over 100 separate regulations that make up Alberta':;s health legislation," says the Horne report. Gibson agrees about the multiplicity, but says that those laws were enacted to protect the public.

For instance, the Health Protection Act resulted from public outrage over the Klein government's Bill 11. In 2000, Alberta citizens stormed the legislature banging pots and pans, to block passage of a Bill that clearly opened the door to privatization. The current legislation (a compromise) includes restrictions on private hospitals and hard-won legal safeguards for the public system.

Albertans have seen plenty of sweeping reorganizations of the health care system – almost 20 years of shake-ups and consolidation. In 1994, the province abolished 200 local (elected) health boards and replaced them with 17 regional boards, which in turn were replaced by nine boards and then, two years ago, by one Superboard.

Local people lost direct decision-making authority at every step of this process. To former Health Board members who were proud of their work, the idea of a single Patient':;s Advocate might seem like a scant consolation prize.

Promised efficiencies and cost savings are elusive, however. David Eggen of Friends of Medicare followed the money trail and reported, "In 2006-07 [Alberta Health Services] had a combined surplus of $47 million; in 2007-08, a deficit of $97 million; and in 2008-09 (the year the health authorities were amalgamated) the deficit was $343 million. What was the purpose of all this re-structuring if it ends up costing so much more money? Health outcomes, waiting times and access to beds have not improved..." The Calgary Herald similarly reported: "Patients get fewer benefits under Superboard".

Horne':;s report recommends basing the new Alberta Health Act on "principles" and giving the Minister and the department itself authority to set policy through regulations, in order to be flexible as technology helps health care evolve to more and more outpatient care. This kind of law is called "enabling legislation".

Gibson said that the problem with enabling legislation is that former laws can be demoted to regulations, "and regulations can be changed by fiat, that is, by Order in Council." Regulations govern, for instance, which procedures public health insurance will pay for.

Albertans were among the first in Canada to lose paid access to some health care services in the early 1990s, when Ralph Klein implemented his 20 percent across-the-board budget cuts. The government simply de-listed some services, such as physiotherapy (except for trauma), and decreed that patients should pay by other means – if not through private insurance, then out of their own pockets. "De-listing is expensive," said Gibson. "When vision care was de-listed, prices increased by 13 percent in one year."

Parkland Institute and Friends of Medicare propose saving public funds through a very different model of public health care, one that provides efficiency through team work. "The answer," said Gibson, "is to develop community hubs with doctors on salary, nurse practitioners, pharmacists on salary, social workers, all working as a team. Research shows it':;s a great model, and if done publicly it':;s the most cost-effective model there is."

"The NDP also conducted public hearings to find out what public wanted," said NDP leader Brian Mason. "Last fall, we held seven hearings around province and produced a report called What People Want. People want quality health care, to be treated well, in a nice place where they could get well. They want it to be affordable. They pay for it with their taxes and don':;t want to pay again...The problem with emergency rooms is that beds are occupied by people who need long term care, which backs up the whole health care system. We believe long term care is a critical piece we need to solve in order to repair health care in this province."

The Horne report does raise some important considerations. The medical system is indeed in transition from a hospital-based model to a more community-based approach, especially for older people, as the report says. And many Albertans will cheer the recommendation to recognize alternative health care practitioners. Some reports indicate that there may be enough public demand to persuade the government to reinstate partial payments to chiropractors, which ended last year.

But perhaps the most telling point in Putting People First is the repeated finding that most of the 1300 people who participated in hearings in 23 communities around the province do not want existing legislation tampered with. "[Albertans] want a clear picture about where the system is headed — and what it is expected to achieve — before legislation is put in place that goes beyond the Alberta Health Act," says the Horne report.

"Undoing Medicare: constant theme in Alberta politics," reads the headline on a Friends of Medicare timeline, which starts with Ernest Manning':;s fight against Medicare in 1967. Answering a question from the floor, Brian Mason explained that the motive is money. "Alberta spends $13 billion/year on health care," he said, "Canada spends $130 billion annually. Private health care companies look at that budget and drool, and keep putting pressure on governments to open up that market."

Penney Kome is an award-winning author and journalist who has published six books with major publishers. She is also the Editor of Straight Goods, where this article first appeared.

Posted: September 23, 2010

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