Thanks Paul! At least you are honest.

Alberta should reform health care in nudge, nudge, way

By Paul Stanway, For The Calgary Herald September 21, 2010 8:32 AM

A devastating report last week from the Organization for Economic Co-operation and Development (OECD) delivered a very clear opinion on the state of Canadian health care; our vaunted medicare system is one sick puppy.
The world's leading public policy think-tank concluded that across the country health-care costs are gobbling up provincial budgets at an unsustainable rate, while rationing and waiting lists have become "endemic" as governments dither over reforming what we are told is the crowning glory of Canadian liberal democracy.
But of course we already know this. Umpteen reports, studies and commissions have told our federal and provincial governments essentially the same thing: we're paying more and more for health care without significantly improving access to services.
The problem is an antiquated and politicized delivery system, which was designed five decades ago in simpler times and for a smaller, less demanding population. It has struggled to keep pace with medical advances and changing demographics, and it takes no genius to figure out it's not going to respond well to tighter government budgets and the greying of the boomers.
So how have governments responded to these challenges?
Well, in Canada's largest provinces they've adopted a "nudge, nudge, wink, wink" approach, allowing the private sector to quietly supplement the ailing public system. While the governments of those provinces trumpet their undying support of public health care, private clinics are now fairly commonplace in Quebec, Ontario, and British Columbia.
And then there's Alberta, which has adopted a "tell it like it is" approach in the vain hope of an adult debate that would recognize the problems and create a public consensus supporting reform.
And why not? It worked with the fiscal crisis of the early '90s. The Klein government was upfront with Albertans and was widely supported in taking strong action to eliminate the deficit. It was understandable the government would assume the same approach would work with health care.
It didn't. Several clumsy attempts to generate support for health care reforms were successfully derailed by vested interests within the health system and by political and media opposition outside. In the end Ralph just threw his hands in the air and gave up.
But the problems didn't go away and the Stelmach government took a run at them from a new direction. It would re-organize and streamline the administration of health care, as a first step toward modernizing delivery.
That made sense. Nine sets of administration -- with boatloads of executives making huge salaries -- had failed to make the improvements Albertans want. Heck, they had trouble agreeing on the time of day or living within a budget.
Former health minister Ron Liepert was given the daunting task of taking a weed-whacker to this expensive health care undergrowth, and he succeeded in reforming public health administration at near warp speed. Predictably, he was demonized for his efforts -- but I would hazard a guess that few Albertans would actually support the notion that an overfed bureaucracy is the first requirement of an effective public health system.
Fast forward to a new health minister, Gene Zwozdesky, who has been given the task of continuing the overhaul -- albeit with a lighter touch. On the heels of the public consultations released last week by the province, Zwoz's next step is to create a legislative framework for a health system that can better meet evolving demands and put the needs of the patient -- you and me -- at the front of the line.
Because the reality -- as opposed to media myth -- is that Alberta's misnamed Health Care Protection Act is the most restrictive legislation in the country. What it protects is the system, not the needs of the patient: a system in which access is often plugged, and in which customer service is often an alien concept.
Let's get one thing straight. This is not about privatizing public health care. As the Klein government's investigations showed, the potential market for private health care in Alberta is too puny to attract medical entrepreneurs. Besides, if you want it and can afford it you can do a Danny Williams and head to the U.S.
But as the OECD report suggests, expanding the private delivery of public services -- the same system that allows you to see your doctor or go to a medicentre without reaching for your wallet -- has the potential to improve access and cuts costs.
Do you really care if the tech operating an MRI is a provincial employee? Would you care if your Alberta Health card was all you needed to get a hip replacement at a private clinic working on contract for Alberta Health?
Probably not, but this is Alberta. We're typecast as health care villains and any attempt to overhaul our health system is condemned as the end of civilization as we know it: "Americanstyle" privatization with old folks and babies being thrown to the wolves!
If enough Albertans buy that nonsense, it could derail yet another attempt at necessary reform. And as the OECD rightly points out, that really is the road to disaster.
Paul Stanway is an Alberta journalist and former director of communications fo Premier Ed Stelmach. His column runs every
Tuesday.
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