Alberta Politics
Health Minister Tyler Shandro, at right, poses with two surgeons and a patient at a private Calgary eye-surgery clinic yesterday (Photo: Flickr/Government of Alberta).

Regardless of Tyler Shandro’s promises, private clinics won’t shorten surgical wait times — they’ll make them longer

Posted on December 11, 2019, 1:42 am
6 mins

Using private medical clinics to remedy long wait times for surgeries in Alberta’s public health care system, as the United Conservative Party Government says it expects to do, is about as likely to work as treating iron-poor blood by attaching blood-sucking leeches to patients’ arms and legs.

That is to say, the results are certain to be considerably different than those advertised, and not in a good way.

Alberta premier Ralph Klein in 2005, not necessarily the best example to follow when developing health care policy (Photo: Chuck Szmurlo, Creative Commons).

Pretty much everyone who’s been paying attention to the Canadian debate about public health care at any time during the past half century understands this — including, one presumes, the market-fundamentalist think tanks that cook up fatuous studies to support announcements like the one yesterday by Health Minister Tyler Shandro.

Assigning surgeries like cataract removal and joint replacements to private clinics will give more time and resources to public hospitals for life saving surgeries, Mr. Shandro claimed at a news conference at a private eye-surgery clinic in Calgary.

A day earlier, a spokesperson for Mr. Shandro was touting the questionable conclusions of an astonishingly well-timed press release by the Fraser Institute, the Vancouver-based purveyor of comforting fantasies about the ability of the private sector to solve all of society’s ills, including long surgical wait times.

The much publicized effort by the foreign-funded Vancouver think tank turned out to have been based on a survey answered by only 17 per cent of the medical specialists who were sent the questionnaire — presumably the 17 per cent who reckoned they had the most to gain from further privatization.

Be that as it may, Mr. Shandro told credulous reporters in Calgary that that by hooking up with private clinics the government figures Alberta will become the only province in Canada that meets surgical wait-time benchmarks.

We’ll see about that, I guess.

Researcher Seth Klein, no relation as far as anyone knows (Photo: David J. Climenhaga).

It didn’t actually work out all that well in the rectangular province next door, where the Saskatchewan Party government threw money at the wait-time problem for a spell in the early 2000s, successfully reducing average waits until the program ended in 2014. As soon as that happened, Saskatchewan’s surgical wait time lists went back to growing at about the same pace as Alberta’s, so it’s highly doubtful the use of private clinics was the foundation of Saskatchewan’s short-lived success.

Premier Jason Kenney used to tout the Saskatchewan results, although he forgot to mention Alberta’s experience with the same notion, and what happened when a private surgical clinic was allowed to do business in a former hospital in Calgary when Conservative Ralph Klein was premier and then went bankrupt on Conservative Ed Stelmach’s watch. Taxpayers ended up holding the bag to ensure the essential hip and knee surgeries the clinic had been contracted to perform continued to be available.

Latter-day United Conservatives like Messrs. Shandro and Kenney also always seem to forget that the surgeries done by that private clinic cost about $500 more per hip or knee than the same ones in a public facility in Calgary, throwing the cost saving claims of the private-sector approach into further doubt.

Bankruptcies notwithstanding, privatization and two-tier medicine don’t work very well reducing wait times, as researchers Seth Klein and Andrew Leyland showed for the Canadian Centre for Policy Alternatives in 2016. The principal reasons they identified:

  • There are only so many doctors and they can’t be in two places at the same time — so taking surgeons out of the public system to work for private clinics means those of us without the means to pay extra for private service will have to wait longer.
  • The business case for private clinics only works if there are long waits in the public system — so there’s actually an incentive for double-dipping doctors in private practice to prolong waits for their public-sector patients.
  • Letting clinics and physicians maintain their own wait lists is less efficient than assigning the first available surgeon.
  • When folks with money have institutionalized access to better quality care than the rest of us, they no longer have any stake in demanding the public system deliver quality care.

As the Saskatchewan experience suggests, Mr. Shandro’s plan might have a chance of working if the UCP Government is prepared to spend a lot of money to ensure wait lists for everyone are reduced.

Knowing everything you know now about how the UCP operates, how likely do you think that is?

18 Comments to: Regardless of Tyler Shandro’s promises, private clinics won’t shorten surgical wait times — they’ll make them longer

  1. Anonymous

    December 11th, 2019

    Now we know why the UCP did not bring forth its budget and other issues before the last federal election. If they did, Andrew Scheer and the CPC would have been wiped off the electoral map. They would have gotten far less seats. Here’s a clue from history. Around 2005, there was an up and coming federal election. Before that federal election, Alberta PC premier, Ralph Klein was touting some 3rd Way type of health care reform in Alberta. This included pursuing private for profit health care in Alberta, and also seeing how he could mess with the Canada Health Act. When Canadian voters got wind of this, Stephen Harper and the CPC were not elected to form government. Peter McKay responded and said that Ralph Klein should have his mouth duct taped shut. Tyler Shandro is proposing something that will not reduce wait times, not save any money, and will make a mess of our health care system even further. Private for profit will compromise quality of services, and focus on making a business wealthy. It’s all about the profit, and the other things take a back seat. Ralph Klein’s drastic cuts to health care, (as part of his massive, and destructive austerity policy to get Alberta “debt free”), were a precursor to allow private for profit health care to creep into Alberta. The UCP is apparently going down that same foolish path. Neoliberal policies, like what the Fraser Institute proposes, end up in failure. They include deregulation and privatization of essential services. Ralph Klein did this with other things, like with registries, road maintenance and utilities. His good friend, PC premier in Ontario, Mike Harris, also privatized and deregulated essential services, (by trying to mimic Ralph Klein, and by following the Fraser Institute’s bad policy recommendations, where Mike Harris is employed, or affiliated with). We all know how badly that turned out. The UCP are becoming as bad as a government can get. Nothing they do follows logic or common sense.

    Reply
  2. Just Me

    December 11th, 2019

    Of course all these bright and shiny new private clinics for every kind of aliment are just going to pop up all over the province, thanks to the “Invisible Hand” of the free-market, profit-motive, in addition to human-decency and charity.

    And…Jason Kenney is really 6’5″.

    Once the cost of moving into the private queue is found to be exorbitant, users will suffer the long wait times and demand better. Of course, the UCP zealots will just cut back more in healthcare services funding and make it easier to open up a private clinic. (A medical degree? In the end, isn’t that just more red tape and a barrier to competition?)

    Worse, the UCP will try out their genius of a voucher scheme on healthcare. Really, use it in the public or private tracks and we’ll foot the bill.

    And if you really want to get crazy, just call “faith-healing” a credible healthcare service. A half-hour of speaking-in-tongues and some splattered chicken blood and anything can be cured.

    Even Jason Kenney’s height-impairment.

    Reply
  3. Kang

    December 11th, 2019

    The other great problem with private provision of surgical services is treating complications resulting from the surgical procedure. Who pays for those? In the UCP/Con system complications from a private surgical procedure are treated in the public system at public expense. The private provider suffers no immediate financial consequences. When the incentive is to make money it is always the patient who pays in both monetary and often in health terms.

    Reply
  4. Scotty on Denman

    December 11th, 2019

    I wish Albertans could heed BC’s lesson: we had 16 years of BC Liberal government, led by ideological chauvinists whose market-solution nostrums, rationalized by exactly the same twaddle—because it came from mostly the same place, the Fraser Institute (whose former chairman recommended that commodifying atmospheric air, dollars per cubic inch, would clean up air pollution and reduce wait times for citizens with respiratory diseases—wait times for death, that is).

    This era was bad for BC then, and still affects us negatively even though now we have a new Green-Dipper government because of the BC Liberals’ quadrupling of the provincial debt, the gutting of public services, and the beggaring of public enterprises. Gutting public services was the only one of the three they couldn’t hide—but they made it so there was no way to complain about it—very like a Franz Kafka novel.

    And the BC Liberals said they would run the province efficiently —like a private business: it was a disaster that haunts us still and will for many years to come as we dig out from the BC Liberal wreckage.

    Why did we have the BC Liberals for so long if it was so bad? It was a combination of factors they gamed to the max: the opposition was wiped out in the BC Liberals’ first mandate and was shaky in the rebuild for about 13 of those 16 years; the BC Liberals immediately reorganized government upon taking power, effectively shutting down freedom-of-information, independent public watchdogs, accessibility and accountability so that the micro-managed cabinet could operate by stealth; the BC Liberals lied the whole time but we didn’t know even the half of it until it was too late to stop the near-bankrupting (BC Liberals’ intent) of public enterprises, the stashing of billions of dollars of debt into secret Crown Corp accounts (in order to look like they were balancing the annual budget), and the resultant quadrupling of the provincial debt (which is still forensically difficult to estimate, but very likely north of $100 billion—what a inheritance to bequeath our descendants!)

    The two-tier debate also raged here, too, quite in tune with the BC Liberals’ neo-right agenda to bust unions, privatize anything public, reward accomplices, and handcuff (sabotage) any remediation effort by subsequent, non-neo-right government. The neo-right promise of prosperity, accountability and fairness was complete, 100% bull. We’re sure sorry—except for the crony-insider remoras of the BC Liberal party—that we ever trucked with these saboteurs of the public apparatus. It monkey-wrenched public systems, racked up massive debt for us to pay, left the cupboards bare, and booby trapped any forensic evidence. The ploy depends on the difficulty to fix any of this within a single mandate, and to make citizens suffer when subsequent government parties attempt to repair the damage—that is, use that suffering to leverage the culprits’ return to power by effectively blaming the saviours for losses they didn’t cause. Citizens are the victims.

    Although it’s a little late for now to overturn the UCP’s reckless, ulteriorly motivated agenda, y’all have a respectable loyal opposition—which is a much better bulwark than BC had from 2001–2005 when we had absolutely no official opposition at all and the BC Liberals could quickly armour their sabotages before the opposition could rebuild. I hope you take advantage of this important asset.

    My recommendation is to assume—yes, even y’all who voted for the UCP—that it will do things covertly to anoint itself an unaccountable monarch able to favour whomever it likes that you’ll have a hard time getting rid of it, and it will lie about everything it does the whole way.

    Save yourselves! For the love of all that’s good, save yourselves!—okay, okay, don’t panic, just hang on to your hats and protect your public services and enterprises as best you can. You might not subscribe to NDP philosophy, but it is actually the loyal opposition for every, single citizen if Alberta between election campaign seasons, it will work for you no matter your partisanship or age or inclination to vote. Don’t let the UCP make every day an election campaign day so’s to hide what it’s doing and prevent the opposition from finding out on your behalf.

    Of course I’ll have to take all this back if the UCP revives the bitumen market. Good luck!

    Reply
    • David Climenhaga

      December 12th, 2019

      Market-based breathing solutions? The Fraser Institute didn’t really say that, did they? DJC

      Reply
  5. Ilikeit

    December 11th, 2019

    nothing better! We deserve our hegenomy!

    Reply
  6. Conrad Volk

    December 11th, 2019

    Shandro should be commended for pursuing the abolishment of medicare and the beginnings of Alberta opting out of the Canada Health Act, both of which are bankrupting our public sector. It’s time to move away from monopolistic health care and to a system that values patient choice and competition and better outcomes for all involved. This is the beginning of the end of Douglas’s legacy!

    Reply
    • CovKid

      December 12th, 2019

      Move back to the U.S. Of course, once your health benefits expire, you’ll be back here before the sun goes down.

      Reply
    • Anonymous

      December 12th, 2019

      Conrad Volk: The issue that Conservatives and their followers fail to get is the problem with corporate welfare is that eventually you will run out of other people’s money. Tyler Shandro should not be commended for anything and neither should the UCP. The only thing the UCP are succeeding at doing is copying the fiscal recklessness of the Alberta PCs, after Peter Lougheed left office. How do Americans deal without a public health care system? If they are not rich, they suffer and go broke. The UCP are excelling at two things. Running a dictatorship, (firing Lorne Gibson is proof enough), and supporting failed corporate welfare schemes.

      Reply
    • Kang

      December 12th, 2019

      Hey Dude! You old boomers should really settle down and get used to the idea of the old folks home and the fact your diapers will only be changed once a week in the nursing homes run by the UCP’s supporters.

      BTW Are you talking about the neo-Nazi legacy of Major C. H. Douglas of Social Credit fame or Tommy Douglas of CCF fame? Just FYI, medicare was brought in Federally by Mike Pearson after the NDP under Premier Lloyd implemented medicare in Saskatchewan and it grained huge public support in spite of the best efforts of the big American insurance companies to create FUD to stop it.

      Reply
    • Nicholas

      July 16th, 2020

      O_O
      It seriously irks me how many conservatives like yourself will twist how free markets work in ways someone who truly understands them would never say. So let me help you out. Dw, i’ll go slow.
      Monopolies are bad because of basic demand curves. This is literally the basics, ECON 101. Monopolies are bad because with full control of the supply, customers are forced to buy at the single sellers price. The REASON this is bad (the crucial reason you left out either because you have no economic comprehension or because you’re being characteristically dishonest) is because a single company has profit motive; that is, they will attempt to charge the highest price inflating the good above it’s market value by many times.
      You’ve proven with your comment that you either don’t understand this or have simply decided to lie about it’s impact to shill a false narrative. No competent economist (not even a dishonest ‘economist’ or ‘analyst’ at the fraser institute would describe nationalized health care as “monopolistic” and just leave it at that attempting to make some vague inaccurate argument by implication. That’s the mark of someone who doesn’t know what they’re talking about.

      Public health care doesn’t have profit motive anywhere near the same way private companies do.

      So then what embarassment of an argument do you have left?
      More “patient choice”?
      I could write just as much about you making more argument by implication while having no comprehension of the subject here as well.
      It should really bother you that you need to imply vaguely that something would be bad instead of actually having enough understanding of the subject to produce something of substance.
      If you actually reached a basic level of comprehension on this issue you might become quite ashamed of having spread BS for as long as you likely have. There are mountains of counterexamples both across the world and in Canada that show almost inarguably these UCP policies consistently would in no way produce “better outcomes for all involved”.
      The pittance of so called ‘successes’ for this UCP style policy are cherrypicked instances that ignored other events and variables that were much more likely all so whatever conservative moron was running at the time could feed it to their supporters knowing they wouldn’t verify those claims.
      If you want to better yourself and actually become capable of making real points on articles instead of being a garbage-rhetoric machine then learn:
      -what acceleration is (mathematically)
      -what elasticity of demand is (and how it’s uniquely relevant to health care)
      -what a claim is (the logic kind)
      -how a claim is properly substantiated
      -the steps to obtaining the most complete picture on an issue

      Good luck.
      Also “bankrupting our public sector” is a hilariously nonsensical thing to say.
      Trends on gov’t expenditure were pretty much linear towards immense deficit immediately before Notley took over. This isn’t even a cherrypicked fact. It was near-linear straight towards deficit long before she took and despite consistently climbing oil prices.

      (This is how cons con people into thinking she was responsible.) It takes time to undo policy. At the instant Notley was elected, trends were still linear towards heavy deficit as a result of conservative policy. This conaervative defixit trend came while oil was booming and providing massive amounts of extra revenue. Immediately after the election, oil prices crashed, significantly reducing gov revenue, and yet deficit trends stabilized following a stable parabolic curve towards surplus and bringing Alberta out of it’s deficit in Notley’s 2nd term that never came.

      Immediately after Kenny’s election up until COVID (that’s right, I’m not going to blame Kenny for covid related deficits even though I’m pretty sure someone as dishonest as you would) the trends reversed. In other words, deficit trends were stabilizing under notley during the worst oil prices, and then shot up again drastically under kenny despite massive cuts and gov layoffs.
      So what happened?
      A pitiable few percentage points of tax difference. That’s it.
      I say a “pitiable few” but this amounted to massive amounts of the gov revenue you pretend to care about (yet somehow know nothing about?).
      Public health care isn’t “bankrupting” shit.
      Incompetent conservative policy and taxation implementations are (by historical fact). This is mathematically provable. Everything you’ve said demonstrates complete lack of understanding of pretty much every relevant topic other than English.

      As a final note. There is really only one remotely half decent argument for privatization in health care actually supported by history. That is for innovation. Unfortunately, this comes at a cost of human lives. It essentially trades a vague future benefit for a better present. It also can be very easily butchered to the severe medical detriment of all citizens below a certain income threshold substantially lowering quality of care and exploding costs to absolutely unacceptable heights.
      To make this argument you would have to essentially do a study on historical medical advancements and rates of advancement between countries. You would then need to mathematically compare the detriment (the massive portion of lives lost due to a privatized system) to the benefit (theoretical/expected average amount of human lives saved in the future due to increased advancement rates per unit of time multipled by the theoretical difference in implementation date).
      Good luck making this argument as that’s nearly impossible to calculate let alone with anywhere near half decent accuracy and would rely on stupid assumptions like an average level of lives saved per innovation.
      This is the most realistic, plausible, actually-has-some-data-behind-it argument you could’ve made. It’s telling that instead of this one, you chose to regurgitate empty Kenny rhetoric that have always been based on nothing but nonetheless whip his zelots into a frenzy.

      Reply
  7. pogo

    December 11th, 2019

    I see a lot of very rich quasi service providers in the multi millions of thousands of dollars. Are our new overlords set against them? Not on your life! We could invent a penny worth cure for cancer and they would charge your life earnings! I’m sick of of our denial! Where are the realists? https://youtu.be/hS_x1A4LXCM

    Reply
  8. pogo

    December 11th, 2019

    your site sucks like 1998!

    Reply
  9. Jerrymacgp

    December 11th, 2019

    As you so clearly pointed out, there is a finite supply of surgeons, anesthetists, nurses, and all the other health professionals needs to run an ambulatory surgical programme or a hospital, and for every such professional who goes to work in a private clinic, that’s one fewer in the public system. So, public wait time should get longer.

    On top of that, private clinics will inevitably cherrypick the simplest, lowest-risk patients with the fewest co-morbidities, leaving the more complex & costly patients for the public system to look after. Since this also skews the cost-per-case curve to the right — i.e. more costly — the average costs in the public system ends up looking higher than the private, lending superficial credence to the notion that the private system is more efficient.

    Reply
  10. Dave

    December 12th, 2019

    Well it looks like another attempt to do what Klein tried a few times, but was not able to pull off – create increasing chaos and wait times in the public system by restricting funding and then increase funding to a parallel more private system.

    Of course, they don’t have wait times much in the US, but that is misleading – if you can’t pay, you often don’t even get in the line. They also spend more per capita on health care than we do and most other countries too, which also contradicts what Conservatives often like to say about private providers being more efficient and saving money. A patchwork system that does not cover a lot of people is not very efficient.

    I suspect most Albertans, regardless of the party they voted for in the last election will realize this is sort of thing is bs, just as they did when Klein tried it – better care for a few with a lot of cash and worse care for everyone else.

    Reply

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