Throughout the pandemic, Alberta Health Minister Tyler Shandro’s War on Doctors has been held up as an example of what a government ought not to do in the midst of a pandemic when front-line medical workers of all sorts are risking their lives to keep us safe and well.
Yesterday, though, the United Conservative Party Government of Premier Jason Kenney had something to celebrate in that war: What appeared to be the unconditional surrender of the Alberta Medical Association bargaining committee.
Today, as it happens, is the first anniversary of the official declaration by the World Health Organization that COVID-19 had become a global pandemic.
In Alberta that day, there were 19 confirmed cases of COVID-19, the disease caused by what was then known as the novel coronavirus. There were 98 cases in all of Canada.
I wrote in this space that we shouldn’t feel too smug or confident about the low number of cases, or hesitate to take strong measures to suppress the virus and prevent our medical system from being overwhelmed.
I also argued “it is increasingly evident that whatever you say about the difficulty of fighting a new and aggressive disease like COVID-19, effective public health policy and neoliberal economic doctrine are incompatible. You can have one. You can have the other. You can’t have both.”
Based on what we know now, both these judgments seem sound.
We know this, of course, because our leaders, in their wisdom or lack of it, did the opposite, or as close to it as they could get away with, always with the goal in mind of restoring the worst of neoliberal economics as quickly as possible. And if that meant using the pandemic to implement the Shock Doctrine, so much the better.
Which brings us back to the War on Doctors.
It remains to be seen if Alberta’s doctors themselves will surrender, since a ratification vote must still be conducted. It seems likely, though, that they will give up and ratify, despite some complaining in the ranks on social media.
The terms of the tentative agreement are extremely unfavourable from the physicians’ perspective judging from the report of the CBC, which was leaked a copy of the deal.
The doctors’ agents – bargaining committee is a somewhat misleading term under the circumstances – obviously abandoned all hope of ever settling disputes with this government through binding arbitration, one of the key issues in the dispute from AMA members’ perspective, loudly voiced throughout the year.
So, the tentative agreement says, “the AMA acknowledges that the physician services budget is established by the minister in the minister’s sole discretion.”
Moreover, it continues, “the AMA further acknowledges that nothing in this agreement fetters the minister’s authority or discretion with respect to the physician services budget.”
If that’s not unconditional surrender, what is?
The agreement – that may not be quite the right term either, as it sounds as if the government simply scared the beejeepers out of the AMA negotiating committee and imposed its will – also contains a provision allowing the minister to withhold agreed-upon doctors’ pay if the government’s health-care cost-suppression strategies don’t work.
Alberta physicians were doubtless being sold hard on the one-sided deal in the AMA-members-only town hall meetings yesterday and last night. They will have been told that if they dare to keep pushing for better terms and the government somehow agrees, it can turn around and pass legislation to eliminate whatever gains they made.
Some docs could be heard on social media complaining that the government couldn’t be trusted to keep any agreement, but, really, with a deal like that, trusting them is not an issue. Permission to break the deal is written right into it.
Is there anything for the doctors at all? Well, it restores Physician and Family Support services to the AMA, and reinstates continuing medical education programs and liability insurance from the Canadian Medical Protective Association, which is popular with doctors.
With ratification, Mr. Shandro can move ahead with his campaign to send the entire War on Doctors down the Memory Hole in time for the next election. On Tuesday, he was already insisting “there was no fight with the Alberta Medical Association.”
Never mind that in April 2020, the AMA sued the government for $250 million in compensation for the way it arbitrarily tore up their last contract. The tentative agreement also includes an AMA promise to drop the suit.
And never mind that 98 per cent of the physicians who took part in a vote conducted in July by the AMA expressed no confidence in Mr. Shandro. The AMA’s president at the time, Dr. Christine Molnar, said in a news release that “Mr. Shandro’s words and actions have created a chaotic state in health care and have alienated most of the people responsible for actually delivering the care in the system.”
“It’s a toxic situation,” she added, “and physicians have clearly had enough of it.”
Even Postmedia political columnist Don Braid expressed his wonderment Tuesday at the way the government was denying that the very public fight had ever happened. “The great forgetting has already begun,” he lamented.
But unless the doctors surprise their bargaining committee and refuse to ratify the deal, by the time the next election rolls around in 2023, you can count on it that Postmedia too will have forgotten all about the War on Doctors.
While it may appear that the cozy relationship between Postmedia and the UCP is weakening, I wouldn’t say it’s over. Despite how many very expensive boondoggles, and other missteps the UCP are doing, Postmedia will still be championing the UCP, right before the next provincial election in Alberta. This will be quite evident, especially in the Sun newspapers. I also don’t think the battle with Covid-19 is over in Alberta. The complacency and inability to listen to the experts, is something the UCP has a history of doing. Double standards are also something the UCP has been doing for quite some time. I’d give it at least another month, if that, and we will be back to square one. Even more cases of Covid-19 will be present. We weren’t allowed to spend time with the ones we love over Christmas, because the UCP thought they knew better than the medical professionals, after they gave their recommendations in November. It’s likely that more restrictions will be happening at some point in the spring, or the summer, and will carry over beyond that. It’s also very Ralph Klein like when the UCP are treating medical professionals with such a low regard. Ralph Klein wanted private for profit health care in Alberta. This is precisely where the UCP are going. Why else would the UCP have Janice MacKinnon on their Blue Ribbon Panel? She was an NDP MLA in Saskatchewan, and had been responsible for closing down rural hospitals. She was basically copying Ralph Klein’s austerity, in Saskatchewan, and it seems like it is coming full circle in Alberta. More austerity from the UCP, and this will be the excuse for more privatization.
As one of the contributors to Don Braid’s column memorably says, “I wish this government, never happened…”
The UCP may feel like they have won the War That Never Was, but it may prove to be a very hollow victory. Will this suddenly stop the discontent that led to 98% of the province’s doctors voting non-confidence in Tyler Shandro? Will it stop the migration of rural doctors? Will it even be ratified, by doctors feeling like they have been sold out by the AMA?
Most chilling, perhaps, is the long term effect on the province’s ability to recruit doctors. Our existing doctors can hold their nose and accept the ‘deal’ (aka capitulation) in the hopes that a new government will treat them with the respect they deserve, but a doctor being courted by Barrhead Town Council to move to Canada from his/her home overseas is going to be very reluctant to move here in the hopes the UCP doesn’t get re-elected. Moving here and setting up a practice would cost a lot of money. Who would be stupid enough to bet a fortune on the outcome of an election? (Oh, sorry, make that what smart person would do it?)
I just have a word for both the doctors and the government – MONKEYS
It seems we are all locked in this neo-liberal cul de sac which will very likely not end without violence.
I use to believe in democracy and human decency but more and more I understand why history has periods of great violence. Without it humans cannot change. It is very discouraging but it seems that we are not the great species we think we are.
It should be noted that the Fukushima earthquake and nuclear disaster happened 10 years ago today. I mention that for no reason other than March being a bad news month, typically. We haven’t even arrived at the Ides yet.
I guess it shouldn’t have surprised me that a cashier for a major Ontario grocery retailer that has profited heavily from the Covid crisis was not wearing a mask in the store yesterday. She explained that she doesn’t have to wear a mask…because she is an antimasker/anti-vaxxer?
So many people seem to think the pandemic has been cancelled. What will happen if the new variants take hold here in Alberta, and the government’s cost-suppression strategy doesn’t work? Will we be looking at a Bolsonaro situation like in Brazil?
“Stop whining. How long are you going to keep crying about it?” Mr Bolsonaro said at an event. “How much longer will you stay at home and close everything? No one can stand it anymore. We regret the deaths, again, but we need a solution.”
Doesn’t that sound strangely familiar?
I would recommend the doctors tell the province to get stuffed. I would recommend the province bear in mind that doctors can live anywhere they want to. Everyone’s immigration policy makes room for doctors.
I see it completely differently – this is not a surrender, it is a counter-assault to further embarrass and discredit Shandro. I think the AMA negotiating committee has confidence that physicians will vote against the deal. If the docs give the deal a thumbs down then Shandro has failed yet again and he takes another massive political hit. Getting all docs to vote on the deal just brings attention to how much disdain the UCP holds for them, so this is a tactic by the AMA to enhance solidarity and embolden their resolve to get binding arbitration.
Anon, that is a brilliant interpretation. I really do hope you are right, and maybe you should consider a career in bargaining tactics!
I am already enjoying the imagining what you have described.
I sure hope you’re right.
Anyone care to live in a third world dictatorship? They begin with lies and distorted versions of reality.
Doctors stand up to them. Let these bullies follow through on threats to use embarrassment and maybe other barrel scraping tactics. They will only win if we let them. Albertans need you, appreciate you and understand your value.
When a party accepts corporate donations it is obligated to dance to the tune played by corporations. That means they are beholden to corporate demands which want privatized medicine. The pharmaceutical industries want private for profit health care and they own the AMA which in turn puts pressure on doctors who want to keep their license to practise medicine (and keep their high incomes from it). This was what happened in Saskatchewan from 1961 when the Medicare act was passed until July 1962 when they found that the NDP would not relent.
Doctors know that Medicare was very good for them both in simplicity of getting paid for their services and for having a sure source to their high incomes. With private insurance the insurance companies reject some of their diagnoses.
My dad experienced this in the 1950’s. In 1958 he was diagnosed as having diabetes and the doctor kept him in hospital and made him lose 25 pounds in three weeks. This ran up a big bill for the private insurance company to pay. In 1959 they refused to insure him any more. So he had no insurance until 1962 and had to pay his own doctor bills. This happens all the time in th US.
In the US medical insurance is tied to employment so when you are too ill to hold a job you are uninsured. This is a double edged sword because it keeps people tied to low wage jobs and insurance with high copays. That’s what Albertans are in for if the UCP gets away with it.
Our noeliberal-style provincial government has little interest in most citizens, and doesn’t care whether we have health care or not. My guess is that the rich seldom use publicly funded health care and do not care much about its quality and availability to other citizens. It seems likely that the government is attempting to encourage the average person to conclude that publicly-funded health care is undesirable. Most people do not think about the fact that, when everyone is responsible to pay for their own health care, you pay for every single visit and procedure, not just the occasional one that you can pay for to skip the queue. Paying a few hundred dollars occasionally for an MRI, for example, is very different from paying for everything every time. Citizens will feel the brunt of this cap on the amount available for health care in Alberta. Yes, it will upset doctors, and reasonably so, but citizens will then turn on doctors who can’t afford to keep their offices open when they aren’t being paid after the government maximum expenditure is reached. However, the government will avoid the wrath of citizens and cause us to turn on one another instead of the real culprits, who are the elected MLAs creating this situation.
Well put. From now on I will only get sick in the first 20 days of the month!
Dispute? What dispute! Usually, people at least have the good sense to wait until an agreement is signed before claiming there was never a serious conflict. Of course, most politicians (even conservative ones) in Alberta in the past had the good sense to avoid such a big conflict with doctors, one so big its is now regularly called the war on doctors. However, I suspect the words good sense and Shandro are not generally used together in a sentence.
I suspect doctors just wanted an agreement of some type and are hopeful that the government might stick to it this time. Of course, as you noted, this agreement gives the government a lot of leeway, so perhaps this is a moot point. I suppose it is more like a truce than a peace agreement. Both sides are tired of fighting and realize they are not gaining anything by it, but there is still no real agreement between them to end the conflict on a lasting basis.
So the Alberta government will proceed as it wants, but perhaps try to appear to be slightly more pleasant about it and the doctors will grudgingly accept this for now. Perhaps the truce will lead to something more lasting eventually, perhaps it will break down at some point in the future or perhaps it will just continue in its fragile state for some period of time, sort of like a cold war standoff. I suspect however, some doctors will also still do the only thing they can – vote with their feet.
Of course, they will have to carefully follow some rules about closing clinics and such. I wouldn’t be surprised if some doctors will suddenly get sick or just take a some extra days/weeks of vacation (after we are all able to travel again) when they hit those billing caps. The provincial government will grumble a bit, but what will they do, send the provincial police to Mauii to haul them back one by one? However, the voters who will find it harder to get an appointment to see a doctor will not be happy, truce or not. If some more sustainable agreement is not achieved eventually, all this unhappiness might come back against the provincial government to bite them, say in time for the next election.
Let’s say that doctors learn the cap (is that individual or collective?) is usually reached by the 20th day of the month. They book appointments only for the first 19 days of the month, out of an abundance of caution, with the rest of the month done day by day. You can phone in between 8 and 9 a.m. for a same-day appointment. Appointments will be limited, until the cap is reached. Then there are no more appointments that month. Please proceed to an emergency room with your concerns.
The emergency rooms and urgent care centres fill up with people who have non-urgent, non-emergencies. One city where I lived during the Klein years had a severe doctor shortage. People new to town had to get their prescriptions filled at the emergency room, usually in the wee hours of the morning when the crowds were down. There were no walk-in clinics, and pharmacists couldn’t refill prescriptions on an emergency basis. The other option was to drive five hours to a big city. Need to see an opthalmologist for a pre-existing condition? Go to the visiting optician at the Walmart for a referral, because GPs are not taking new patients, local opticians are not taking new patients, and the Walmart optician is outraged at the appalling care.
Here’s another one. You see a doctor, who is sending you for a referral, but by 3 p.m. that day, she/he has reached the billing cap for the month. Your referral does not does not proceed until the following month.
Or how about this? You are a senior with complex care needs. Your doctor decides that your case is too bothersome, because you will need care after the 20th day of the month, when the billing threshold has been reached. The doctor breaks up with you, and no one else will take you as a patient, because they all have the same issue with billing.
Walk-in clinics will face the same challenges.
Maybe the UCP, in its infinite wisdom, will cap billing for the year in September, instead of monthly, so patients would be doctorless heading into flu season every year. That would be interesting.
Big city people missed out on some of the antics in health care during the Klein gong show. Come on down; it’s your turn now.
Is this a good time to remind Albertans that most medical doctors overwhelmingly vote for Conservatives?
I wonder if this will change their voting habits in the future?
Is it really true that (nowadays) doctors mostly vote conservative? Do you have survey links ? Certainly, growing up in rural NS, most of my dad’s medical colleagues voted tory, but that was a kinder, gentler conservatism. They did not understand my dad’s socialist streak. But my impression now in AB, both from door knocking (paired with a doctor in one case) in the last election, and from talking to 30 years of undergrads, many of whom have done on to med school, is that if that was ever the case, it is not true any more. In 2019, nearly all the people who answered the door to me (in Calgary) and self-identified as doctors, nurses or teachers, planned to vote NDP. With engineers or anyone in the oil patch, it was a different story.
It’s Tyler’s turn to play dressup. Aren’t scrubs rationed in Alberta?
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