Alberta Bill 30 - Introducing For-Profit Medicine in Alberta

(This will likely be the first of several posts examining the 3 controversial bills the UCP introduced yesterday)

With respect to Bill 30, which will increase approval of private, for-profit clinics in Alberta, some thoughts...

There is a cap on certain procedures, like hip and knee replacements, that creates a bottle-neck beyond the limitations of a finite number of surgical facilities. Why is this in place? Why could the government not just remove the cap?

Could it be that the cap will simply accelerate the development of a two-tiered system?

Think for a moment about the private eye clinics in Alberta. They do laser surgery and other "cosmetic" (i.e. not medically necessary) surgeries, but they also do some procedures covered through public health. The public health procedures make the clinic less profit than those for which the patient pays directly. Which types of procedures do you suppose get scheduling priority? It seems obvious that the more lucrative procedures will get the lion's share of the available OR time. The lower paid procedures will fill in gaps, because it's better to have the facilities in use and making some money than standing idle. That is the way for-profit businesses work.

So, for hip and knee replacements in a private clinic, those that are covered by Alberta Health will be less profitable than other procedures performed at a private clinic. They will not get scheduled as quickly as more lucrative procedures. People in pain, and possessing sufficient means, will start asking if they can get their surgery moved up if they pay for it themselves.

The UCP will, at some point down the road, lift the barriers to patients paying for their own surgeries which are covered under the Canada Health Act, saying that the public wants this. Then people with money to pay will get their surgeries sooner, but those who cannot pay will get pushed further back down the line. And this will go on as more people decide to pay, or seek out insurance that will pay.

This would undermine the essence of the Canada Health Act which guarantees all Canadians access to equal health care, regardless of ability to pay.

This is a prediction. The cap keeps a hold on the maximum number of these procedures that can be billed through Alberta Health and therefore keeps these procedures at low priority status in private for-profit clinics. This will incentivize people with the means to pay out of pocket to demand to be able to do so. And it will leave people without the means to pay, further and further behind. And insurance companies will begin advertising products that promise to help those people who couldn't pay for it themselves obtain better access, so long as they pay monthly premiums.

You may be wondering why the UCP would want to see two-tiered medicine in Alberta. Apart from the support the UCP may be receiving from the insurance industry and for-profit health care interests, there is an historical component that contributes to the anti-medicare ideology.

The National Citizens Coalition was founded in 1967 by an insurance agent named Colin Brown. Brown was extremely opposed to the Canada Health Act, which was very new at the time. Obviously, universal health care impinged upon his industry's profitability. People no longer had to buy insurance to pay for any medical care they needed.

The NCC also opposed the Candian Wheat Board, unions, the mandatory long-form census, Liberals, restrictions on third-party election spending, and a number of other things.

In 1997, Stephen Harper resigned as a Member of Parliament for the Reform Party to become Vice-President of the NCC. He became president the following year and remained in that role until 2002, when he took over leadership of the Canadian Alliance Party. These grievances of the NCC clearly aligned with, or helped shape, Harper's political direction.

As PM, Stephen Harper sold the Canadian Wheat Board, discontinued the mandatory long-form census, changed election financing laws, and allowed the provinces great latitude in how the Canada Health Act was administered. This resulted in increased access to for-profit entities in the systems across the country.

Yes, Jason Kenney is not Stephen Harper. But he was Harper's protege. He served Harper for the duration of the CPC government. He has now hired Harper to consult and guide the UCP government's management of the province.

As Prime Minister, Stephen Harper was not able to eliminate the Canada Health Act. Messing with Canadians' health care is political suicide, even in Alberta. So he ignored it, and turned a blind eye to Premiers who were so inclined, as they whittled away at the public system. But installing a system that would be lucrative to the insurance industry and to for-profit health care providers has always been the plan.

Now, behind the scenes, the wheels are in motion.

Governments in Canada have been under intense pressure from lobbyists representing the insurance industry, the for-profit health care industry, and the pharmaceutical industry, since the Canada Health Act came into being. The Canada Health Act is viewed as depriving them of the opportunity to profit from the Canadian market.

The philosophy of the Canada Health Act is that no one should profit from the suffering of others. So the two sides hold diametrically opposing views. It is only when there are governments in place which are sympathetic to the for-profit interests that changes occur in their favour. And these must be undertaken with stealth because Canadians are extremely attached to their health care.

We are seeing stealth moves by the UCP. They are framing it as helping people get surgeries they need faster. They are trying to present it as a benefit. In the long run, however, it is liable to be the wedge that breaks the Canadian Health Act.