Category Archives: health care

WHAT’S THE STATUS OF THE PC’S 2012 MANDATE

So, you’re a former capital region mayor, who was popular as mayor, has good progressive credentials and now finds themselves on the inside of provincial government. You might be looking in the mirror today, thinking about the health portfolio and wondering how the world unfolded to put you where you are today. If this is you, then you’re not alone.

Sure, you might be Stephen Mandel, but you might also be Cathy Oleson, Ken Lemke or George Rogers, for that matter.

There is an important distinction however between Sherwood Park MLA Cathy Oleson and Health Minister Stephen Mandel. Oleson was elected to office by discussing her views on provincial healthcare (amongst other issues) with constituents as part of an election. In fact, Oleson had to discuss healthcare extensively with Sherwood Park constituents who were unhappy with not getting the hospital that they felt they had been promised – and still got elected.

The fact that Stephen Mandel was chosen by Premier Jim Prentice to be health minister over, say, Cathy Oleson, or any of 57 other PC MLAs raises an important question: what is the status of the mandate given to the Progressive Conservatives in the 2012 election?

That mandate was a progressive mandate. It is common knowledge that the PCs won the election because progressives all across the province, in ridings like Sherwood Park, coalesced around the PCs in an effort to defeat the lake-of-fire and anti-climate-change views that became emblematic of the Wildrose Party. Oleson, Lemke, Rogers, and most of the other PC MLAs were elected with that progressive mandate.

It is important to note that while the Alberta public has since come to reject Alison Redford, they haven’t necessarily rejected that mandate. Redford was tossed aside not because of her policy but because of her personal ethics (Indeed, it could be well argued that she would have been safer if she had stayed true to her original policy directions). In fact, a group of PC MLAs who were largely progressives and were instrumental in her downfall are all now on the outside of cabinet looking in.

In the days leading up to Redford’s resignation as premier, a group of10 rebel MLAs started clandestine meetings to discuss the growing spending controversies of the premier. They included Oleson and Lemke, but also included Janice Sarich, Matt Jeneroux, Moe Amery, Neil Brown, Jacquie Fenske, Mary Anne Jablonski, and David Xiao. Arguably, these people did more to bring down Redford than anyone else at that time. Most of them were very much elected on that progressive mandate.

I suspect that these MLAs were motivated by uneasiness amongst their constituents and growing disappointment with the Redford government. Not just disappointment over the spending controversies but also disappointment over the abandonment of the mandate that voters gave to the PCs in 2012.

So, does the appointment of outsiders like Mandel and Education Minister Gordon Dirks over these 10 MLAs speak to a rejection of the 2012 PC mandate or will the new Prentice government embrace that mandate that its caucus was elected on? Time will tell.

However, if Prentice wants to pursue a new direction then he needs to obtain it from the electorate. A set of by-elections may provide him with a limited new mandate, but then he has to fight those by-elections with a clear policy agenda and not just vague messages of change or accountability. Only then will he have the authority to change the policy directions given to government. If he doesn’t get that permission from voters, then he has an obligation to follow up on the commitments that got his MLAs elected.

Hotel stunt wins day one for Sherman

An election campaign is upon us and that means that each day will be filled with announcements, attacks, ideas, stunts and mistakes. It makes for an interesting time as Albertans spend 4 weeks discussing a wide variety of public policy issues (in theory). With so little surprise as to the day the campaign would start each party had a good opportunity to plan for it and ensure that they started with their best foot forward. For me, the strategies and the tactics are the most compelling thing to watch. There were no flubs, but which party and which happening was most notable on Day One?

My vote has to go to the Alberta Liberal party.

While the other parties held news conferences from the legislature with their leader surrounded by candidates attempting to set a narrative in motion, it was Raj Sherman who decided to do things a little differently. He launched his campaign from the Fairmont Hotel MacDonald of all places.

Dr Sherman started out with a stunt that reinforced the issue on which he is most knowledgeable and for which most Albertans describe as their top priority: healthcare. The message being delivered: a night in acute care is more costly than a night in the most expensive hotel in Edmonton. Point well delivered and well punctuated.

Albertans are finally starting to realise and accept generally that the biggest problem with our healthcare system is the waiting times for extended care beds for seniors. Unfortunately, these people who do not require acute care treatment (what most of us consider to be a general hospital bed), are stuck in acute care beds until the longterm care spaces open up. The log jam here is clogging the hallways down to and out the emergency room doors.

Emergency wards are full of people who are ready to be moved to acute care, but have to wait and the waiting rooms are full of people waiting to see a doctor in the emergency ward. Unfortunately, a good number of the people waiting to be seen in Emergency are being attended to by paramedics and the stress gets passed on to our ambulatory system.

Dr Sherman delivered a solid blow on day one by effectively showing that a little bit of money spent on seniors long term care will save money in all other parts of the system while simultaneously fixing some of the biggest problems.

Your Alberta Health Act: Opening Doors for Private Healthcare.

“We’d be a lot better off if we had funding follow the patient”

The comment hung in the air, a pinata, colorful, attention seeking, begging for a reaction.

I figured I would have to swing at it, or at least give it a poke.

I tapped the edge, “Hmmm, really? What makes you say that?”

“Competition. If you make the clinics compete for funding, then they will have to find efficiencies,” replied my tablemate as I chewed on my cookie waiting for MLA Fred Horne to get the evening started.

About 80 Edmonton and area citizens came to the public consultation on the Alberta Health Act on this warm June evening. I came because I wanted to help ensure that high quality accessible health care is available for all Albertans when they need it. After having a brief discussion with my tablemate, I was glad that I came to balance his perspective.

I value medicare: free, accessible, effective, outstanding, public medicare.

Unfortunately, medicare in Alberta is once again at risk. The Conservatives are introducing a bill in the fall sitting of the legislature which will create a brand new Alberta Health Act and while they say it is needed to “facilitate current and future health system initiatives,” they are being quite guarded about what those initiatives might be.

The purpose of the legislation emerged as the evening progressed, evident by the types of questions that were being asked and the answers that were already filled in. Progressive Conservatives in Alberta have tried numerous times over the years to bring in private delivery of health care. Their challenge has always been in bringing in the enabling legislation. Its not like you can just open up the hospital doors and lay out a welcome mat for private investors. The legislative framework must be in place and policies for monitoring the operators must be enacted. Much like the doomed Bill 11, this upcoming piece of legislation will attempt to enable private delivery of healthcare and place fences around the process.

There were a few things from the consultation process that make me think that the new Health Act will be used to introduce private for-profit health care.

One of the topics of discussion was on the principles that should be included in the legislation. The report of the Minister’s Advisory Committee on Health assures us that the principles of the Canada Health Act will be incorporated into the new Alberta Health Act, including the addition of some made in Alberta principles. However, while the Canada Health Act incorporates explicitly the principle of “public administration,” our discussion paper says the Alberta Health Act will integrate, “what these principles have come to mean to Canadians – a publicly funded health system that is accessible to all regardless of ability to pay.” These weasel words clearly leave out public administration, suggesting that it is not a principle that matters to Canadians and that the new legislation will enable private for-profit providers. 

Another topic of discussion was around the concept of a patient charter. A patient charter outlines the rights and responsibilities of patients. The discussion paper calls for a “full and transparent discussion around what it can be used for, including issues of accountability and liability.” There are a number of pitfalls here, the most significant of which is the possibility that patients could be denied service if they don’t live up to their responsibilities, including “making healthy choices” (ask Americans what they think about ‘pre-existing conditions’). However, that is not the thesis of my argument. My argument is that this concept of a patients charter is being used to enable private health care delivery. The reason we would need a charter is so that the government can regulate the activity of service providers. Interestingly, concepts such as “being ensured of privacy of information” and “having timely and reasonable access to information” are already protected within public institutions through the Freedom of Information and Protection of Privacy Act. This charter is not about placing regulations on public institutions like Alberta Health Services it is about regulating private service providers.

A third discussion had to do with “ensuring ongoing citizen engagement in the development of legislation, regulation and policy.” I summed this up as governance and argued that the government has already completely failed on this matter. The most effective forms of governance are distributed to local communities, because decision makers in individual communities are more closely aware of the circumstances and contexts of the community, thus they are in the best position to make informed decisions. I argued that the PCs missed on governance with two epic fails: removing democratically elected health boards and amalgamating heath regions into AHS. This discussion was really about testing the waters in Alberta about private governance. The PCs need answers to the question, “what decisions can be made without public consultation and public accountability and what types of public input is minimally necessary for those decisions that need it.”

The final question was blatant: “What changes are you open to? What assurances are important?” Here the government was looking for data on the specific issues of private delivery – what can we get away with politically? I have to respect Horne and the PCs for finally realizing that they cannot afford to get health care reform wrong again. Albertans care too deeply and a misstep here may spell the end of their reign. With this consultation process the PCs are attempting to get a very specific reading on Albertans’ appetites for changes.

Shockingly, before we broke up into our discussion groups my table mate from the start of the evening revealed something very telling about his views on medicare. He essentially asked, why shouldn’t someone who can afford better treatment get it – after all that’s how the rest of our world works.

For people like me, who want to defend public medicare – we need to mobilize and get the message out. Otherwise, the government will end up believing that the true sentiment of Albertans is that of my tablemate’s and the concept of universal public healthcare will be in jeopardy.

You can still have your say by visiting http://yourhealthact.alberta.ca.

For a further glimpse into why private delivery will not benefit us, see this post.

Time to put private health delivery to bed.

There seems to be one demon that lingers that Albertans have to fight off time and time again. At least this time it appears that our premier is actually standing up to the demon, instead of opening the door like our last premier did – and now the opposition is on board too. Somehow, whenever the issue of “wait times” arises, we must again exorcise the neo-con ideologies of competition and privatization in health care.

Albertans have been abundantly clear that they don’t want private insurance and they don’t want two tier healthcare, but this spectre of fee-for-services and private operators in the public system won’t go away.

The general principle is this. The government sets a rate that they will pay for a given procedure, the customer (who cease to be patients in this model) chooses where they will get the procedure done and the single payer (government) pays for the service. The typical neo-con reasoning behind this concept is that the service providers will compete for the funding that patients bring and will strive for efficiencies in the system – bringing down costs and boosting innovation.

The flaw however is the exact thing that is supposed to make the system work – profit motive.

Let’s start this discussion with a little formula: Profit = Revenue – Expenses. In order for private interests to want to be a part of the system (and don’t kid yourself – they really, REALLY do) there has to be a profit available to them. And if the goal of reform is to bring down costs, then that profit has to be made within the current funds available. There are two ways that that profit can be realised while maintaining the cost of the system – increase revenue or decrease expenses. I will discuss the drawbacks of both of these situations independently.

Let’s consider some ways that private health maintenance organizations (HMOs) can increase their shares of revenue within the system.

First, they can see more people in a shorter amount of time. The theory works well… in the delivery of cheeseburgers. McDonald’s does great business by getting people in and out quickly, but is that how you want your healthcare delivered? Do you really want to be put in to the loving care of a company whose primary interest is making profit, desperately trying to get you in, diagnosed and treated as quickly as possible? The fast food model simply doesn’t compute for health care. It is likely to result in missed diagnoses or haphazard care.

Alternately, GloboHealthCorp could increase their revenue stream by competing for your return business. Sure, they may strive for top-quality service and positive customer experiences, but the best way for them to ensure you come back to see them is to keep you sick. After all, planned obsolescence worked well to drive up profits for the big four car companies. This strategy would stand in direct opposition to real strategies that control costs, like preventative care.

Finally, revenue could be generated by making unnecessary referrals and ordering useless diagnostics. Imagine, a Quickicare(TM) general practitioner sends you to see a Quickicare(TM) specialist who orders you a Quickicare(TM) MRI, which determines that your hangnail is just untreatable and the technician asks you to go back to your GP next week for further tests.

But what about using the profit motive and competitive market forces to drive down costs?

Since the single largest expense in any service based industry will be related to people, the best way to minimize costs is to cut staffing. This can be done by cutting staffing levels or staff compensation. Once again these types of solutions simply do not fit when applied to healthcare. Decreased levels of staff will result in overworked doctors and nurses delivering lower quality care or increased wait times. And decreasing staff compensation will drive away the best employees and decrease quality of service. This would be akin to the dollar-store model of healthcare, selling cheap quality products at the cheapest possible price.

Of course, lowering costs not related to employees could mean lowering building, maintenance, technology or drug costs – but the effects would be the same with minimal gains. Finally, efficiencies could be found by minimizing administrative costs, but I would suggest that those types of savings can similarly be made in the public system through responsible reform.

Ultimately, it comes down to this. When you are at your sickest and needing help, do you want the agency providing your health care to be motivated by your health or motivated by their profit?