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 http://yourhealthact.alberta.ca.

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

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