Last Thursday, Tyler Shandro advised Albertans that the promised United Conservative Party review of Alberta Health Services is rolling ahead.
Well, he did once tell us that things tend to happen in due course.
This is pretty much the first we’ve heard from Alberta’s baby-faced health minister since he famously demonstrated he doesn’t yet understand how to stay in a message box without sounding like a dope.
Judging from his resume, Mr. Shandro is a bright guy, so he’ll probably figure it out. For now, though, it looks as if the UCP brain trust didn’t trust him enough to let him loose where there are TV cameras around, so his announcement took the form of a terse statement encouraging Albertans, the more the better, to visit the Alberta Health Services review website and offer their uninformed opinions.
The notion that, as the UCP has claimed in the past, the so-called performance review of AHS “will identify ways to deliver better results for Albertans and find efficiencies across the health system” is almost certainly a delusion.
Even done properly, a $2-million performance review of the operations of a $15.2-billion public health care agency with well over 100,000 employees that has to be done in four months is unlikely to produce much of value.
Since Ernst & Young’s effort cannot produce meaningful results, as a glance at the landing page for submissions also makes clear, the simplest explanation is that this is designed to provide a bit of faux democratic cover so the UCP can do what it plans to do anyway.
This is most likely to introduce as much privatization into our public health care system as it can get away with, pick a fight with health care unions, and find ways to have more low-skill, low-cost workers delivering care. The results will be bad for the system, bad for anyone who has to use it, but good for a few well-connected folks’ bank balances. In other words, pretty much standard Conservative operating procedure in this province.
My advice, not likely to be listened to by the government, is to pay attention to the respected Canadian Institute of Health Information’s comparative study of Canadian health systems and leave AHS the heck alone.
As has been stated here before, CIHI’s researchers found AHS has the lowest administrative costs in health care in Canada – 3.3 per cent of total spending, compared with a national average of 4.5 per cent.
What CIHI’s analysis means is that AHS has already saved “something in the range of $200 million that we could find in administrative savings” that Premier Jason Kenney promised he could recover based on costs cut by less efficient health systems. In other words, the premier’s prediction is wildly optimistic and based on a phoney diagnosis that won’t work because there’s not much fat left to cut at AHS.
As AHS President and CEO Verna Yiu observed in a letter to the Medicine Hat News last spring, delegates to the 18th International Congress on Integrated Care in Utrecht “ranked AHS second in the world” – behind only the Netherlands – “as the health system from which the most could be learned.”
With the exception of the past four years, Alberta’s health care system was in chaos for most of the preceding four decades. Whether the creation of health regions under Conservative premier Ralph Klein, the later reduction in the number of those health regions, and the establishment of AHS under premier Ed Stelmach were the right or the wrong things to do doesn’t really matter at this point.
What matters is that the system, which was actually running so smoothly under the steady hand of NDP health minister Sarah Hoffman that it ceased to be a top-of-mind issue for most Alberta voters, simply may not be able to take another major reorganization of any kind without catastrophic results.
Of course, as is now well understood thanks to the work of author Naomi Klein and others, neoliberalism thrives on catastrophic emergencies, as they provide the opportunity to open the door to more of the “solutions” that caused the crisis in the first place.
If one doesn’t come along by happenstance, market ideologues like Mr. Kenney are always happy to try to gin one up.
This, I’m afraid, is why it’s a mistake to characterize Conservative mismanagement as incompetence. It’s a feature, not a bug.
Memories of Conservative health care chaos past
Speaking of Conservative health care chaos, AHS and CIHI, I was reminded last week of the way Fred Horne, health minister under Conservative premiers Alison Redford and Dave Hancock, used to run things.
Who now remembers Janet Davidson, the high-billing consultant Mr. Horne appointed in 2013 as sole administrator to run Alberta Health Services after he fired the entire Alberta Health Service Board for insisting they had to live by legal contracts to pay executive bonuses?
Ms. Davidson, a former Registered Nurse and CIHI Board chair, has now been named interim director of the Nova Scotia Health Authority, taking over on Sept. 3. Interestingly, it appears she’ll be paid considerably less than she got as the sole AHS administrator, the one-woman regime set up by Mr. Horne to untangle the mess he and his Conservative predecessors had created.
It turned out, naturally, that AHS Board chair Stephen Lockwood was right, and a contract really is a contract. The bonuses were quietly paid during Ms. Davidson’s tenure, although AHS didn’t have a board again until the NDP came to power.
Mr. Horne now has gigs in the corporate sector as the board chair of a national health care procurement corporation, as a senior advisor to an Ottawa-based lobbying firm and a think tank, and in the public sector as an adjunct professor at the University of Alberta. This is living proof that, as they say en français … plus ça change, plus c’est la même chose.
Oh, poop! Here comes the train down the tracks and we elected Snidely Whiplash to save us from the painful competency shown by a much maligned NDP government. With all the remaining problems, my nearest hospital has had bed bugs in the doctors’ lounge, among other things, much remains undone and is likely to be ignored for the next few years.
My sympathies to the many doctors and nurses I deal with (you meet nice people when you have a chronic condition) who will be at the centre of the assault on collective bargaining.
The PCs stayed in power for a long time in large part by striking a grand bargain with Albertans. It was that they would deliver a reasonable level of services and keep taxes low. All of this was of course partly funded by resource royalties, so when oil and gas prices were high, it worked well, when they were low, they had troubles. Will Mr. Kenney be as lucky as Lougheed or Klein who enjoyed mostly periods of extended resource price increases? I have my doubts.
Mr. Kenney of course brought in an out of province expert to head his panel to recommend cuts, perhaps on the theory voters will not take their anger out on him, but instead on the woman who makes the recommendations. We’ll see how that works out for him. I don’t think she is well versed in Alberta’s grand bargain, after all she comes from a province with a sales tax, so she has been instructed not to look at the revenue side. She seemed to close a lot of rural hospitals in her province and the party she part of in government hasn’t governed in over a decade. It seems a lot of rural voters there have never forgiven this. I suppose we will soon see if Mr. Kenney is brave or foolish enough to cut rural hospitals as part of his plan to reduce health care spending. This was something even Mr. Klein largely left alone.
The PC dynasty came to an abrupt end here in Alberta, I think in part because it learned nothing and forgot nothing. Waiting for resource prices to increase to bail you out is like playing in a casino, you may have a good winning streak, but you will eventually lose. The Harper Conservatives seem to not have figured out that it was the unpopularity of their excessive austerity that in part did them in. In their haste to balance the budget, they forgot about or maybe just didn’t care that real people suffered from their cuts to government services. Mr. Ford in Ontario is learning how poorly delivered austerity can quickly destroy a governments popularity and he started by making a bad financial situation worse – by getting rid of the revenue stream from the carbon cap and trade system, for ideological reasons. Likewise, here in Alberta, Mr. Kenney seems determined to first dig a deeper hole, by getting rid of a revenue stream to finance major transportation/infrastructure projects (the carbon tax) and lowering tax rates for large corporations, certainly in the later case for ideological reasons.
I think instead of the grand bargain Alberta voters expect of low taxes and a reasonable level of services, we will end up with lower taxes and a poorer level of government services. I have a feeling voters are not going to like this and feel they were sold something else in the UCP election promises.
Again, all the while, the 3 biggest Alberta Health care expenses are: physician’s fees, rural health care and pharmaceuticals. Will the UCPers take on the doctors, cut back rural health care where most of their votes were or take on their Big Pharma corporate friends? Not sanguinously likely…..another right wing neoliberal Alberta farcical train wreck.
Albertan, I basically agree with your analysis, but I am not so sure that rural hospitals are all that safe. Rural voters will stay loyal to the UCP no matter what the government does, so from Mr. Kenney’s perspective, why not kick them in the slats? DJC
It would certainly be interesting to watch the fireworks if Kenney chose to close go that route. I expect he would only close one or two, to see how well it flew.
If I remember correctly, in the weeks leading up to the election Jason Kenney’s personal approval rating was lower than that of the UCP’s, and I can certainly see that happening in rural areas. In spite of Kenney’s attempts to pass himself on as the next Ralph Klein, he really gives off an ultimate city slicker vibe, and he might not be able to weather what rural Albertan’s would view as a betrayal.
Sara Hoffman and the NDP made over $150 million in cuts to pharmacist services while lying and demonizing us to the public. We are not Big Pharma! We get a maximum 7% markup and on expensive biologics we lose money dispensing them. But sadly we’re an easy target, and patient care has suffered as a result of the cuts. Yet we did not withold services and still provide many of them for free.
My Aunt has dementia and is on a fixed income. She is a public care facility. By law the price per year was allowed to go up by 2.5% per year. However, for some reason they are changing the annual increase from July to October. Instead of waiting a year to do this increase or even prorate this amount they are raising the amount by 5% within 3 months in the same year. They are doing this in the middle of an economic collapse due to a pandemic. For many seniors on a fixed income this is a huge change to their monthly budgets. This needs to be overturned immediately.