Alberta Premier Danielle Smith at Tuesday’s news conference in Calgary (Photo: Chris Schwarz, Alberta Newsroom/Flickr).

What did Alberta Premier Danielle Smith mean Tuesday in Calgary when she said of her plans for health care that “we’re just going to keep on making … incremental changes; I can’t stop doing reform because the federal government doesn’t want to partner with us”?

Canadian Prime Minister Justin Trudeau (Photo: Justin Trudeau/Flickr).

Here’s my translation: “I won’t stop trying to privatize health care a bit at a time just because the federal government opposes privatization, but I still want them to pony up the cash.”

Ms. Smith is the noisiest member of a group of premiers who would like the federal Liberals, committed to supporting public health care through funding tools like the Canada Health Act, to pay for the Conservative plan to dismantle Canada’s most widely supported public institution through stealthy but relentless privatization. 

A key message she would obviously like us all to take onboard is that Ottawa is being unreasonable and interfering with provincial jurisdiction by insisting money it provides for health care from Canadians’ federal taxes through the Canada Health Transfer be used as voters obviously intended when they elected Prime Minister Justin Trudeau’s Liberals. 

That is, to keep health care public. 

National Health Coalition Policy Director Stephen Staples (Photo: David J. Climenhaga).

The UCP position sounds a bit like calling a good Samaritan a creep because he offers to buy a hobo a sandwich but is reluctant to pay for a shot of gin to go with it. 

To re-state the obvious, the Canada Health Transfer is intended to uphold the principles of the Canada Health Act

The purpose of the Canada Health Act is to “provide comparable treatment for all Canadians, regardless of where they live.”

The type of health care “reforms” promoted by Ms. Smith and the United Conservative Party, and by other Conservative premiers, undermine the principle of comparative treatment for all Canadians, including within their own provinces. 

Under the circumstances, Ottawa can hardly be faulted for insisting on some accountability from the provinces about how federal health care money is spent before it hands over the cash.

This is the issue at the heart of the ongoing battle between Ottawa and the provinces over increases to the Canada Health Transfer that almost everyone acknowledges are needed. 

Stephen ‘Steve’ Harper, one of the authors of the notorious Firewall manifesto (Photo: Unattributed/

Ottawa is saying, in short, that it won’t fork over billions to the provinces to make health care better if Conservative leaders insist on doing things to make it worse.

“The provinces have a lot of latitude to make changes in their health-care system but they have to stay within the lane of the Canada Health Act and our national medicare system if they want to receive federal money,” explained Stephen Staples, national policy director of the Canadian Health Coalition, in an interview with Global News. 

Conservative political leaders, of course, dispute the argument that privatization of medical services will make things worse – we’ve all heard the “publicly financed, privately delivered” promise. The evidence suggests, though, that it is not particularly credible.

Be that as it may, our democratically elected federal government is not being unreasonable by insisting it won’t bankroll policies it believes would be harmful to suit a group of provincial politicians devoted to its removal from office. 

Which leads us back to Ms. Smith’s suggestion her UCP Government might be prepared to go ahead and carry out its “reforms” to health care whether or not the feds approve, with or without a funding deal with Ottawa.

Firewall Letter signatory Ted Morton, once Alberta’s finance minister (Photo: David J. Climenhaga).

Some reporters at her Calgary news conference clearly interpreted what Ms. Smith was saying as meaning she might indeed be prepared to move ahead with big changes to the public health care system even if that meant the federal government stopped the payment of Canada Health Transfer funds to Alberta

But it’s not clear – probably intentionally – whether that’s what she actually meant. 

When she says it would be great if the federal government “comes to the table with more funding support, but we’re not going to stop with the reforms that we’re doing,” she certainly won’t mind if opponents of public health care interpret that as meaning she wants to take the advice of the notorious 2001 Firewall Letter that Alberta should pull right out of the Canadian national public health care system.

But when she provides only examples of reforms that stay within the Canada Health Act’s lane, as Mr. Staples put it, she also won’t be upset if the rest of us interpret that as meaning there’s nothing for us to worry about. 

The Firewall Letter was the separatist manifesto penned 22 years ago by half dozen far-right ivory tower ideologues at the University of Calgary, including the young Stephen Harper, later prime minister, and the not-so-young Ted Morton, the worst premier Alberta never had. When they mailed it to premier Ralph Klein, he wisely trashed it. 

Among its list of bad ideas, most of which cropped up in Ms. Smith’s campaign last year to lead the UCP, was this: “Resume provincial responsibility for health-care policy. If Ottawa objects to provincial policy, fight in the courts. If we lose, we can afford the financial penalties that Ottawa may try to impose under the Canada Health Act.” (Emphasis added.) 

In real life, the implications of actually doing this could be pretty severe, among them transition to full-blown U.S.-style privatization, with the requirement for everyone to have high-cost and health-condition-limited private health insurance or risk bankruptcy or death. As in the United States, the cost to taxpayers would ultimately end up being higher than those of our current single-payer system of health insurance. 

But based on what she’s been saying for years, in and out of politics, none of that would particularly trouble Premier Smith. 

On the other hand, she’s smart enough to understand the impact it would have on her support in the polling booth. 

So for the time being, we can expect the UCP to keep doing the dance of the seven veils as they try to figure out how to get someone else to bring them the metaphorical head of public health care on a platter.

The Liberals, particularly considering the threat of the NDP abandoning their confidence and supply agreement, are not likely to help them out.

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  1. Smiths vague comments about incremental changes and reforms don’t really provide much information. I believe either Smith is just making this up as she goes along and doesn’t really have a plan yet or realizes the plan might not go over well with the voters so she doesn’t want to reveal it yet. Maybe it is even a bit of both, a half baked plan with controversial aspects.

    Smith seems to be the kind of person who has a new idea every minute, however quality control and implementation may not be her strong points. She seems itching for a fight with the Feds, but I suspect her advisors have told her that her Alberta Sovereignty Act … is a weak tool, more for political show than to stand up well under actual use, so she is avoiding using it.

    The Feds don’t seem to be itching for a fight, nor scared of her Sovereignty Act, but they seem quite insistent that additional health care funds will come with accountability as to how they are used and there needs to be better measurement and coordination of outcomes.

    The other premiers, most of them conservative, seem to have formed some sort of resistance to the Federal Government and only want money with no strings attached. We will see how well this resistance holds up. Last time a bunch of conservatives tried to gang up on the Feds, it did not go well and they lost their court case on the carbon tax.

    Perhaps Smith feels she has the luxury of having enough surplus funds to try fix some of the health care problems herself. Indeed an argument could be made that a province with a 12 billion or so surplus (however long that will last) should not be running to the Feds for more money while sending out $100/mo. payments to select individuals, some of whom make well over $100,000 per year, while not sending payments to many people who make much less.

    I suspect despite the typical sabre rattling, Smith really does not want to get into a battle with the Feds on health care before the upcoming provincial election. More privatizing health care would not be a politically winning issue for her and if the Feds actually withheld funds, that could blow a big hole in her plans for whatever surplus we can still expect in 2023 with oil prices well down from their 2022 peak. So, hence the vague comments. Whatever she is thinking of, she is probably mostly saving it for after the provincial election.

  2. While it might look like Danielle Smith is tempering her rhetoric, at very least (or at very most?) at what would seem the behest of her caucus members with their regard of the approaching general election, remaining dug-in on “we’re not going to stop with the [healthcare] reforms that we’re doing” doesn’t put paid to her losing ways when it comes to the general electorate’s prerogative.

    Christmas mincemeat must be getting a tad stale by now, but not so much that it can’t be likened to what Rachel Notley will make of such an ambiguous and suspect campaign position as Smith’s ‘don’t-worry-it’s-only-incremental’ dismantling of a struggling healthcare system her UCP has been responsible for during these last three and a half years. It’s been so ugly that this particular issue has risen like cream to the top of the milk-can, the top priority of a large majority of Albertans which must therefore include many citizens of the right-wing persuasion.

    How does her promise of incremental “reform” of healthcare work? How does ‘don’t-worry-we’re-only-dismantling-healthcare’ win votes, especially without the federal funding-condition which requires Smith’s reforms comply with the Canada Health Act? Well, opinion polls strongly suggest it won’t work.

    The more Smith says “incremental,” the more it looks like she thinks the electorate will come around and eventually approve these changes, despite their unworkable economics and blinkered psephology, and since the thing won’t be ready to fledge by the fast approaching scheduled May 29 election date, the prospect of an extended term seems more likely. Compounding each other, delaying the general election while inflicting the death of a thousand cuts incrementally upon healthcare appears doomed in terms of what is politic and winning, even in May 2024.

    ‘Unbuild it and they will come’ —but it’ll very likely be voters’ choices coming to reoccupy government offices whenever the next election is held.

    More and more it appears that Smith’s purpose is not to keep power but, rather, to irreparably wreck the public enterprise.

  3. Back the 90s, the Mulroney government was concerned over the growth of the budget deficit. But a matter of some concern was the use of federal transfer funds by the provinces for a variety of purposes, including healthcare. For one thing, the percentage of the federal budget that made up the transfer was growing fast. And there was, as there had been with previous governments, a deep mistrust of what the provinces will do with the funding. The rationale for the Mulroney government to cap transfers to BC, AB, and ON concerned that they had the fastest growing populations, and the least trust concerning the expected use of those funds. Or, as a commentator at the time said, “Are they going to build hospital with the funds or are they going to pave a highway?”

    The cap was brought down and stayed in place since the Mulroney years. Chretien pointed to, during the 1993 election campaign, that there was a $15B healthcare deficit in federal funding because of the CON transfer caps. Of course, once the Liberals got in, those caps were never removed, and were extended over other areas. The resulting greater off-loaded of funding onto the provinces, with no expectation that would recover the resulting growing funding and social deficit. Harper maintained that course, to the point where he also refused to meet with the premiers over the matter. And now we come to PMJT, who has actually agreed to put something on the table, provided that the provinces agree to oversight and actually agree to spend the funding on the prescribed programs.

    Since Alberta lives in a bizarre world of where taxes are theft, they refuse to actually assure stable funding for anything, and they blame Ottawa for everything, does anyone in their right mind believe that the UCP can be trusted with any funds from Ottawa? The pipeline to no where should be enough to put any notion of trusting them with any federal funds.

  4. All these pseudo conservatives and Reformers want to do is privatize public healthcare in Alberta, and in Canada. They do it with cuts to the public healthcare system, so that it gets weakened, and therefore, they have the excuse to privatize it. Danielle Smith wants to continue doing what Ralph Klein started, and we will be no better off. Lives will be put at risk from this foolishness.

  5. Great explanation. This is what I suspected when the health ministers got together and walked away with no deal. They interviewed the federal health minister and he indicated all was going well during the meeting and things were agreed to until they walked out of closed doors and the premiers balked at the feds for unreasonable terms. Just like noted, it sounded to me like the Conservative premiers want to privatize all of health care and the feds want no part of US style pay to get to the front of the line health care.

  6. Yet another example, along with Scott Moe and now Doug Ford (promising more business to for-profit clinics)–we need to revise the division of powers. Health care is a national priority and should be a federal responsibility.

    Yeah, I know. It ain’t gonna happen any time soon. But we can start pulling the Overton window back toward the left.

  7. Both Alberta and Ontario diverted billions of dollars earmarked for covid into something-that-wasn’t-covid-but-definitely-wasn’t-the-Premier’s-drinking-fund. While I generally dislike the Federal government, they have a point on this one – withholding and dispensing funds is their only real leverage to improve health care for Canadians.

    Policy suggestion – all provincial politicians, and their immediate family members, should be restricted from seeking healthcare anywhere outside their jurisdiction. If our Premiers didn’t know they can afford to leave Canada and seek health care elsewhere, they would be much less likely to intentionally undermine the delivery of health care in their home provinces.

    Policy suggestion – people involved in administering health care should have some skin in the game. There should be a connection between how much money they make and how good of a job they do. Their expenses should be periodically audited, so that they know that corruption could ruin their careers. They, and their direct relatives, should be restricted to only the health care they have jurisdiction over (as common sense dictates, a person responsible for health care in, say, the NWT, could still be medivaced to Alberta, but would have to follow the same triage process as a regular citizen of the NWT).

  8. What healthcare scope should the government provide vs what healthcare should be a personal choice. Something that needs to be discussed and won’t be discussed because of partisan bs. Just get the feds out of it and allow the provinces to go their own way. Then people can vote with their feet. Rather than have big government force feed everyone the scope that helps them get elected in jurisdictions 3000km away.

    1. It’s only a personal choice if access is UNIVERSAL. That’s literally, LITERALLY the entire point of universal health care. Folks can’t choose to look after themselves if they can’t afford to do so and the suggestion that they can is both laughable and criminal. Look no further to Canada’s hopeless dental and pharmacare market for plenty of evidence of that. Pretty hilariously ironic to see this blogs resident carnival barker call anyone else partisan, but here we are and you are you. No one is listening.

  9. Belated comment.

    Nice NDP-colour jacket Danielle’s wearing there in your lead photo. Unawareness of reality seems to be her prime characteristic, beyond babbling out loud whatever stupidity enters her febrile mind.

    I see Fat Dougald was promoting private health clinics in Ontari-ario on Jan 13. And here in my home province of dear old Nova Scotia, we are dealing with a small town PC premier who’s lost the plot as well. So damn dumb yet thinks he’s bright, and couldn’t martial hundreds of public servants minds to come up with a climate plan that made any sense after three tries — hence we are now about to pay the carbon tax for his incompetence.

    In fact, if there’s one thing that distinguishes most provinces, it’s the Mutt and Jeff-level brainpower of provincial conservatives’ inability to do anything that makes much sense on any issue, but particularly on healthcare. I wouldn’t give ’em any more federal trandfer money until they show thoughtful plans to revitalize their healthcare systems, and sign binding deals that any extra money they receive be applied ONLY to publicly-funded healthcare. No bullsh!t or prevarication allowed.

    And to add absurdity and complete nonsense to the fat already in the fire, we have that “enlightened” dope Poilievre stoking idiocy against the First Nations. I really don’t think he could properly manage a Sobey’s store given the opportunity. A corner convenience store, maybe, but unlikely. Not enough real life experience, and the kind of warped mind that Sam Bankman Fried of crypto ripoff fame would applaud.

    That’s not to say the Federal government’s brainpower, if converted to dynamite and set off then expelled through the nose, would be enough to blow through a tissue. They can’t even regulate the airlines or the cellphone/network providers decently. If you want to fleece consumers with lack of official consumer protections, I’ve said for 25 years now, Canada’s the place to set up shop and coin money on the sly and quiet. Even the Americans have a consumer lemon-car law in virtually all states. Not here.

    Crap governance at all levels is our national bane. It just goes to show how incredibly incompetent the PC-led provincial governments are, because they’re obviously far worse even than the feds. And frankly, I’m none too impressed with the BC NDP twits either, in case you wonder.

    1. Bill: I chose those two photos for a reason. Ms. Smith is clearly now channeling Ms. Notley, or at least channeling Ms. Notley’s fashion choices. Since Ms. Notley, if you judge her by her policies, is basically a traditional Alberta Progressive Conservative, this is probably not a bad look for Ms. Smith to adopt. DJC

  10. Very premature article. It doesn’t appear to be a concern at all now, since the PM and all 10 Premiers have all now announced of a pending 10-Year Federal Healthcare Funding agreement.
    They’ll all make themselves look good, congratulate one another and spread the good news once it’s all official. Especially current Premier Smith.

  11. I’d sure like to find a link to McMaster University’s study (2010?) that I considered the definitive meta data (200K sites) comparison of for profit and not for profit delivery of healthcare services. The not-for-profit sites were consistently more cost effective (i.e. more surgeries per dollar) and better patient outcomes (+5 months in life expectancy). These are the two metrics that matter the most in my eyes, not enriching unscrupulous friends of Conservatives politicians. Any chance you could locate this Mr Climenhaga?

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