Monday, November 29, 2010

Alberta Health Services Works - Part II

Last week, I commented on how Alberta Health Services works in how it has served its function for government. Today, I argue that Alberta Health Services actually works in so far as how it serves its function for patients. However I will be clear, the Capital Health Authority also worked and would have been more effective.

My primary arguments revolve around the experience of my family and my father-in-law. Unfortunately, my father-in-law suffered an injury a few weeks ago and has been under the fantastic care of the medical professionals at the University of Alberta hospital since it happened. Day after day and shift after shift, we have experienced the care of a cadre of professional, competent and compassionate doctors, nurses and other capable healthcare professionals. Unequivocally, I can say that we are blessed to have available to us a world-class outstanding free medicare system. It is first class care that achieves incredible outcomes day-after-day patient-after-patient.

Unfortunately, that system is stretched to the maximum of its capacity and it relies far too greatly on the exceptional drive, dedication and unwavering commitment of its professional public servants. Accessing the system may be difficult and the time required to wait for care is extreme - but once you get the care, you know that it is the best possible care that money can buy, and then some. And that is why I feel obliged as a citizen of Alberta to speak out and defend that system. I will not allow our healthcare system to be jeopardised by cumbersome bureaucracy or by petty politics. We need to speak out about protecting the fantastic care we have available while voicing our concerns and worries in a respectful constructive manner.

I worry about people that need to have access to the system and cannot access it in a timely manner and I worry about what will happen when any more stress gets placed on an already burdened system.

We need to move beyond cookies and promises and look at what is really required to solve the problems and deliver the service that Albertans deserve. It starts by supporting and funding the system appropriately, and it is continued by supporting and listening to the people who are at the heart of healthcare delivery.

People like Raj Sherman, frankly.

Thursday, November 25, 2010

Alberta Health Services Works - Part I

Yesterday, it was confirmed. Alberta Health Services Works. It has done what it was designed to do.

Many Albertans in May of 2008, asked why the province chose to dismantle nine regional health authorities, a provincial cancer board, a mental health board, an effective and well-branded provincial addictions board and regional ambulance services into one large, kludgy and unmanageable provincial health authority. The purpose of that exercise became clear with the dismissal of AHS CEO Dr Stephen Duckett.

I'm not necessarily going to disagree with today's decision by the AHS board, but I will be adamant that it is about much more than a bloody cookie. There were many reasons why Dr Duckett had overextended his time here and why he needed to leave.

But none of those really account for why Duckett was fired and what the role of AHS is. Duckett was fired because healthcare became a political minefield for the Conservatives and they needed to be seen to be doing something. AHS was designed to be the fallguy when this point came.

Prior to AHS, the government figured it couldn't achieve meaningful reform in healthcare because it couldn't compel those pesky regional authorities to get on board with the changes it envisioned. Look at the problems caused when the Calgary or Palliser Health Authorities stood up on their hind legs. With a single health authority the government could exert enough influence to affect the changes it needed while maintaining the appearance of arms-length and having the scapegoat in place in case anything should go wrong.

There is no doubt in the tone and commentary provided by AHS Chair Ken Hughes yesterday that the decision to oust Duckett was made by government. Hughes stated explicity that the board was beholden to the Minister of Health and that the Minister made his wishes clear - that Duckett would take the fall.

A number of board members have now resigned from the AHS board. Their resignations are clear signals that the board is not independent from the minister and that these board members resent the lack of authority the board actually has.

We must now turn our attention on to Bill 17 - the Alberta Health Act, because it is calling for greater control and power to rest in the hands of the minister and cabinet and it also introduces another fall guy for the government to use when the need arises.

Don't worry too much about the Sherman amendment... Kill the Bill.

Monday, November 01, 2010

Bill 17: De-democratizing healthcare

My time lately has been consumed by two grad courses, an active full-time job and home and family commitments. But one emergent and urgent issue has forced me to tend to my oft-neglected blog. (Yes, Minister Zwozdesky, I do consider healthcare to be urgent.)

If I was at all surprised about the contents of Bill 17, the new Alberta Health Act, it was in how accurate my predictions for it were. While it is being positioned by government as sticking up for Albertans through a "health charter", "health advocate" and improved "public input," it is actually much more about removing power from Albertans and placing it at the cabinet table. Let's look at those three concepts and how Bill 17 is positioned to improve the power of cabinet.

Section 2 of the bill calls on the Minister to "establish a Health Charter to guide the actions of regional health authorities, provincial health boards, operators, health providers, professional colleges, Albertans, and any other persons specified in the regulations." Sounds great. Let's develop a document that outlines the rights of patients and responsibilities of the players in the system. While it is called a charter to make us think that it has some sort of higher power status like the Canadian Charter of Rights and Freedoms (part of our constitution), Bill 17 allows it to be changed by the whim of Cabinet. Section 12(c) allows the Cabinet to make regulations "respecting the establishment and review of the Health Charter." This means that your sacred Health Charter can be changed by an "Order in Council" at a roughly bi-weekly private meeting.

"Relax," you say, "the Health Charter will be enforced by the Health Advocate." But section 6(1) of the act ensures that the Advocate reports to the Minister of Health as opposed to the legislature and section 12(f) allows the Cabinet to "make regulations respecting the powers and duties of the Health Advocate." So, while the position of the Health Advocate may be valuable within itself, he or she will be under the strict control of Cabinet.

This type of act is considered enabling legislation, because it lacks restrictive clauses and enables the Cabinet and Health Minister to govern the system by regulation. Section 12 contains 11 areas for which Cabinet can enact regulations. Section 13 allows the Minister of Health to make regulations "respecting the designation of other persons as health providers" and "respecting the roles and responsibilities of (regional health authorities, provincial health boards and professional colleges)." Previously, making changes to the roles and responsibilities of regional health authorities, provincial health boards and professional colleges would mean changing legislation and having those changes approved by the democratically elected legislative assembly. With Bill 17, those changes can be made at the whim of the Minister of Health (no need to worry any longer about the pesky College of Physicians and Surgeons).

Perhaps we need not worry, perhaps we should trust the discretion of Cabinet and the Minister of Health (you do know that Ron Liepert could be reappointed as Health Minister, right?). After all, Bill 17 assures us that regulations can only be made if "the Minister has published a notice of the proposed regulation on the public website" and a "time period during which members of the public and stakeholders may submit comments, has expired" and that time period "must not end until at least 30 days after the Minister gives notice." BUT, Bill 17 also says the Minister has to pass on to Cabinet the changes which he or she considers appropriate. It also says that Cabinet may or may not make changes to the regulation, whether or not such changes are referred to in the Minister's report. Furthermore, the time period for submission of comments can be changed if in the Minister's opinion, "the urgency of the situation requires it, the proposed regulation clarifies the intent, or the proposed regulation is of a minor or technical nature." Oh and by the way, "no regulation made (by Cabinet or the Minister) is invalid as a result of non-compliance" with the Public Input section of the Act.

In the off chance that this argument is too wordy or technical, what all of this means is that the Minister has to seek Public Input, unless he doesn't want to, and Cabinet has to change regulations after listening to the Public Input, unless they don't want to.

The big intent behind Bill 17 is to remove governance of our health care system from the control of our democratically elected legislative assembly and place it neatly under the thumb of Cabinet - and done all in the name of seeking Public Input and protecting patients.

No Thanks!

Call your MLA today and demand they return democracy to our healthcare system.

Tuesday, July 20, 2010

Meet an Alberta Progressive: Sherry McKibben

One of the primary objectives of this series of podcasts, Meet an Alberta Progressive, is to demonstrate that progressives are a diverse group of people with diverse backgrounds, but to help us all to think about where our commonalities might lie.

Speakers are asked to provide a brief biography, some statements on why they love Alberta, what it means to be a progressive, the hopes they have for Alberta and what quality of life looks like.

Today, I bring you Sherry McKibben. Sherry is a social worker by profession and has been active in the social services and non-profit sector for many years. She has been the Executive Director for three Edmonton area non-profits including HIV Edmonton and the Boyle McCauley Health Centre. She has also served as city councillor in Edmonton Ward 3 and as President for the Alberta New Democrats.

Please, meet Sherry McKibben.

- music in the podcast is CC licensed by _ghost.
- photo courtesy

Tuesday, July 13, 2010

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

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

Thursday, July 08, 2010

Meet an Alberta Progressive: Chima Nkemdirim

The Alberta Liberal party placed an advertisement Wednesday inviting other progressive parties to talk about opportunities for cooperation. I spent a great amount of time campaigning in 2004 in Edmonton Glenora when a high profile NDP candidate and a high profile Liberal candidate took on a Progressive Conservative incumbent. One of the most overwhelming messages I heard on the doorsteps was a desire for the two progressive parties to get their acts together and to focus on the bigger struggle of doing what's right for the province.

Ultimately there is a great deal of unrest with how politics is being done in Alberta and people are looking for alternatives. Many people are supporting the Wildrose Alliance Party for that reason alone (regardless of their ideological bend or policies). Others, like me, are a little more lost. I feel that party politics is part of the problem and I hope we can move past partisinship. That's what I like about the Liberal ad and what I disliked about the NDP response.

The left wing has a branding problem in Alberta. So many Albertans have adopted "conservative" as part of their identity, regardless of politics and can not bring themselves to support the Liberals or the NDP purely because of their names. Dave Cournoyer has shown that both parties have become stagnant.

Progressives need to transcend labels and partisanship and begin talking about issues and hopes and dreams for the province.

At the last Reboot Alberta conference I started talking to people about who they were, why they were there, what it meant to be a progressive, why they loved Alberta and what their hopes were for making the province a better place. I recorded those conversations with the hopes of providing my blog followers with a look at who these people are. This summer I plan to share those profiles with you. With the Liberals starting the discussion, I think its a good time to start releasing these conversations.

Today I want to introduce you to Chima Nkendirim.

Chima is a Calgary lawyer and spokesperson for the recently revived Alberta Party. In today's podcast he discusses his inner geek, what it means to be a progressive and what hopes he holds for Alberta.


Photo courtesy of Facebook.

Tuesday, June 29, 2010

Katz and Copps: Why Edmonton should be concerned.

Darryl Katz looking to take over the lease on Copps Coliseum says something incredibly important about his plans for Edmonton's Arena District, but not in the way that most are speculating. A fair amount of speculation on the matter relates to how the Katz group may be using this as a veiled threat to help secure support for the Oilers new arena.

I'm a little less skeptical.

I'm more of the mindset that Daryl Katz is an incredibly smart businessman and he legitimately sees value in operating sports and entertainment venues. The Katz Group, in connection with the Edmonton Oilers organization, has been incredibly successful at building both the Oilers and Rexall brands. Rexall Place is well regarded as one of the most successful concert venues in North America. There is no doubt that they would do well to expand such a successful entertainment operation (and Rexall pharmacies brand no doubt) into a new market.

So what should these mean to Edmontonians and the quest for the Edmonton Arena District?

It means that operating an arena is a valuable business venture and a smart financial investment. Katz is moving to purchase Copps and other venues in Hamilton because he believes he can make money there.

I tend to agree. Entertainment is a solid market and running a sports entertainment complex is a viable business. It is a good investment that will pay off for the investor.

Which is precisely why I am opposed to using public funds for the project.

Public money is collected for a reason, to provide programs and services for the collective good of society and to meet public needs. It is not a pot to help private investments become more profitable. Katz will do very well to create a Canadian corporation similar to AEG and he will make a lot of money off of it - he doesn't need our help doing it.

I am all in favour of the Edmonton Arena District, its ability to improve downtown and the positive impact it will have on the city. But let's get it done without public investment.

Friday, June 11, 2010

Fraser Institute is Flat Wrong

Earlier this year, I wrote about the Manning Centre for Democracy’s conference on Alberta’s future. What I didn’t discuss in that post was how I spent an hour in the afternoon in the foyer outside the conference room talking about education with Fraser Institute economist Peter Cowley. Cowley is the author of the Fraser report cards on education and is trotted about as their educational expert, although he has no credentials in the field. The useless and over-normalised ranking of Alberta's high schools appeared in the Calgary Herald last weekend. Along with an exceptionally well-written and referenced (especially given the rotten assignment) article from Sarah McGinnis, the feature included a fallacious and ignorant editorial from Cowley.
Most of the fallacies in his argument can be accounted by the fact that he is an economist from BC and not an educator in Alberta. What is most reprehensible is that I pointed out these fallacies to him in January and he chose to ignore them and propogate the myths.

Fallacy Number One: "there is no provision for the routine expansion of successful operations." For 10 years, educational partners in Alberta have been engaged in a process specifically designed to expand successful operations called the Alberta Initiative for School Improvement. It is a highly successful model that is based on collaboration between a number of stakeholder organisations, including the ATA. It is the exact opposite of competition and it is having profound impacts on learning in Alberta that would not be possible under Fraser's preferred models for education.

Fallacy Two: "professional autonomy in the classroom inhibits the adoption of more effective teaching practice." Once again, this is completely opposite from the truth. As a teacher I had many strategies for delivering curriculum. Some of them were safe, tried and true. Others were innovative, off-the-wall and risky. Some of the practices I tried worked and others did not, but it was because of professional autonomy that I felt I could try them out, evaluate their effectiveness and adjust my practice accordingly. Without autonomy, I would have continued to deliver the safe, tried and true methods day-in and day-out.

Fallacy Three: "professional autonomy limits the principal's role as head teacher and mentor, making classroom level improvements more difficult to establish." Autonomy means that I, as an educated professional, can choose which practices I will use in my classroom. If my principal wants me to use a different strategy he would need to make the case for it. He needs to convince me of its merits and we would have to engage in academic discourse over its pedagogical value. As a result of this collegial environment, we have better educational outcomes for students. The alternative is that the principal comes in and dictates practice without discussion and without debate over what is best for the individual students in the individual classrooms (this is mentorship?).

Fallacy Number Four: "limitations on hours of work make it difficult for individual schools to extend the school timetable." Interestingly, in Alberta, the school jurisdictions with the most flexible timetables are the same jurisdictions that have hours of work clauses in their collective agreements. These agreements simply mean that the boards must achieve such changes in consultation with teachers. In many cases, the flexibility that allows for these innovations is because of these clauses. By spelling out the number of hours of assignable and instructional time for a teacher, it becomes easier to allocate those hours outside of the traditional teaching day.

Fallacy Number Five: there is "no evidence that any BC teacher had ever lost his right to teach due to incompetence." I don't have expertise in the BC education system and so will not comment on that aspect, but this is not the case in Alberta. Until last year teacher competency was enforced by the Council on Alberta Teaching Standards, who have removed certificates from teachers deemed to be not competent. Alberta's teachers are committed to upholding the honour and integrity of the profession, they have enforced professional conduct for decades and last year took over the role of policing competency as well.

Simply put, Cowley is an economist from British Columbia who has made no significant efforts to truly understand the education system in Alberta. He is advocating a tired mantra of privatisation and using falsehoods and data manipulation to advance his cause. I'm less dissapointed in him than I am in the Calgary Herald for publishing the tripe.

Thursday, June 03, 2010

Inspiring Education report comes with risks

Inspiring Education came out with its long anticipated report yesterday and the initial response is quite positive. The primary vision is reflected in the three-Es for an educated Albertan: Engaged Thinker, Ethical Citizen and Entrepreneurial Spirit. But a number of themes quickly emerge as being dominant in the report:

  • a shift in student outcomes from content to competencies;
  • a shift in the role of teachers from knowledge authority to architect of learning;
  • changes to the roles, responsibilities and makeup of governance teams;
  • moves away from testing students as a form of accountability;
  • education that is focussed on the needs of individual learners.

Taken at face value for the relatively vague statements they are, these are all great moves for our education system and will be beneficial for our students.

Generally speaking it is a great report and it is, more than anything else, inspirational. But there are a lot of pitfalls hidden between the lines of the 52 page document.

The first and by far biggest issue for Education Minister Dave Hancock will be managing the expectations of the over 4000 voices who participated in the process and the many stakeholders in the education system. There are a lot of generalisations and ambiguities contained within the report, most of which are positive and easy for people to rally around. This of course means that anyone can take their individual vision, bias or agenda and tuck it into this safe little wrapper called Inspiring Education. Consequently, there will be a lot of people ticked off because their vision – which they believe was included in Inspiring Education – is not being realised.

The second big issue for Hancock is essentially part of the first issue and that is funding. The document contains some pretty big ideas and monumental shifts in direction for the large ship that is Alberta’s Education system. Like changing the course of any big ship, achieving these changes is going to take a whole lot of fuel and a whole lot of time. Government cannot continue to underfund education while purporting to follow a vision for an innovative, responsive, learner-centred public education system. This is simply something that the citizens of Alberta must hold the government to account on. It is an ambitious vision, but education is worth every penny that we invest on it and the government needs to be willing to spend that money regardless of the price of oil.

There are a lot of issues encapsulated in this idea of a learner centred education system, even though there is little doubt that it is the ideal system. The reason we have a factory model of education currently in place is because it’s cheap. When teachers talk about the need to reduce class size, it is because they know they can do much more for each child if they only had more time to spend with each individual. If the entire system is going to be based on individualised instruction and individual needs we are going to need a whole lot more teachers. An associated risk is the notion that technology will be some silver bullet that can be used to fix everything. Teachers will tell you that technology takes time – there is time associated with learning the technology, there is time associated with assessing its validity and usefulness and there is time associated with implementing it. And yet, technology will not be able to replicate the role of teachers as architects of learning. Teachers will still need to spend time with students, assessing their needs, determining outcomes and strategies for learning and assessing that learning. Similarly, teachers will still need to spend time away from students focussing on planning, marking and professional development. Added time means the need for more teachers and that will cost money.

The final big risk is related to this idea of governance. I wholeheartedly agree that the governance model needs to be strongly reconsidered. Community is the reason for public education and the community needs to play a larger role in the governance of their schools. My sense is, this needs to happen at the local level as close to the classrooms as possible. The recent angst in Edmonton over school closures is a prime illustration of why we need to change the system of governance. One of the biggest reasons that Edmonton ended up in this situation is because of a disconnect between the decisions made (albeit decades ago) in urban planning by city hall and the ones made in school placement by education governors. In Finland, the schools are governed by the town councils – I’m not suggesting that is the model that should be used here, but it has a number of advantages that should be taken into consideration. The risk here is that people already perceive this to be an attack on school boards and on local elections. That should not be a concern. What needs to be created is a new model where schools are given more autonomy to make decisions, based on the needs of the students in the school, in consultation with the local community – and the governance model should facilitate that.

I want to end by reiterating my statements at the beginning of this post. Inspiring Education is a good document evolving from some very valuable and authentic work. There are risks that need to be managed, but that is not necessarily a criticism of the report or the process. To borrow some language from the Minister, we are all looking forward to some transformational change that is focussed on the best interests of students. In the end a strong effective public education system is the best investment we can make for the province of Alberta.

Monday, February 08, 2010

Manning Centre misses opportunity

In his book Don't Think of an Elephant, George Lakoff provides a metaphor for conservatives as the strict father figure, where as liberals are the nurturant parent. Upon first reading I have to admit I didn't completely buy the metaphors as a way to collectively describe the baskets of conservative and liberal viewpoints.

While I am loath to pigeonhole myself and others using simplistic labels, I am definitely more likely to be described as a liberal than a conservative. So when I found myself at this past weekend's Conference on Alberta's Future, hosted by the Manning Centre for Democracy, I was excited to get a sense of what the vision for our future looked like through the eyes of conservatives.

It really was a shame then that I left without hearing the big picture vision.

Please don't get me wrong, I appreciate the opportunity that I was given to be there and I applaud Preston Manning and the centre for putting the event on. No matter what your political stripe is, it's important to encourage civic engagement and discussions on big picture ideas. I just felt like the vision, a sense of what the ideal Alberta looks like, wasn't delivered. In fact the session titled "Vision for the Future of Alberta" ended up being an election style debate between PC MLA Kyle Fawcett and WAP leader Danielle Smith over who can do a better job pandering to oil and gas interests. Interestingly the first speaker to mention "Quality of Life" was former Liberal MLA Mike Percy, well into the second day.

What I learned most from the weekend, I learned by comparing this event to my experiences at the Reboot event I attended in Red Deer in November. What I learned is that Lakoff's view of conservative ideology as the strict father figure holds some truth.

That conclusion comes not necessarily from what was said, rather it comes from how the event was conducted.

In the leadup to the Reboot conference, delegates were asked about what topics they wanted to discuss at the event. At breakfast on the first full day we were given dot stickers with which we could vote on the suggested topics to determine what would be discussed. From that point on people picked the tables they wanted to be at and discussion ensued.

The day before the Alberta's future conference, I was emailed an agenda filled with predetermined subjects and preselected speakers. I applaud the organizers for bringing in challenging speakers like Percy and Pembina Institute's Marlo Raynolds, but in the end very little time was given to hearing from delegates. After 30 minutes per topic focussed on the speaker, there was a mere 20 minutes provided for discussion and it was based on whether you agreed or disagreed with the speaker. In essence, the entire topic was dominated by the agenda set forward by the speakers.

By the way, I would use the word "experts" instead of speakers, but the men who presented on Health and Education in Alberta are economists (one of whom is from BC). Hardly experts in the field.

The intent of the event was not to bring concerned citizens together and provide them with an opportunity to share their vision for what might be possible in Alberta in 25 years. From what I could tell, the intent was to bring people in one room to get them on-message as far as what the Conservative playbook should look like over the next few years (oh yeah, and so Manning could unofficially, yet overtly, place his support in the WAP camp). I heard a lot about the need for greater privatization, freer markets, smaller government, decreased spending and robust growth in the oil and gas sector, but to what end? What is the Alberta that we will create by implementing these ideologies?

In what can only be summed up with "Whaaaaa?" the day concluded with a presentation of the summaries of the table discussions, where the group voted on them. I would love to tell you what we were voting on, but I hadn't a bloody clue. Somehow without knowing what was being discussed at any other table but mine, I was supposed to endorse these documents as accurate representations of the discussion... and at the same time endorse them to be "taken forward to Albertans," whatever the eff that means. These votes garnered a weaker turnout than the last provincial election!

I decided to abstain from the votes, not that it mattered since father knows best anyway.

In the end I think these tweets summed up the strict father feeling best:
  • @ChrisLaBossiere - I can't help but feel I wasn't being asked for my opinion or ideas as much as being polled or herded through someone elses. #projectab
  • @djkelly: ORDER! ORDER! (The most overheard phrase at #projectab)
I guess my ultimate conclusion is this - as we think about how we need to reengage people and reinvent our democracy, will the strict fatherhood model really provide us with the change we are hoping for?

If you are interested in other progressive takes on this conference read:

For some more conservative views on the event try:

Tuesday, January 26, 2010

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?