Since the Alberta government has the power to outlaw fees like those about to be charged by a Calgary medical clinic for patients to get timely access to their physician, it’ll have to exercise it if Premier Danielle Smith wants anyone to believe her election claim no Albertan would ever have to pay up front to see a doctor.
And if the United Conservative Party won’t exercise the power to stop this dangerous practice, which is another step toward true two-tier pay-to-play medicine in Alberta, then the NDP Opposition needs to do its job and introduce a private member’s bill that would force the government to reveal what it really thinks.
Patients of the Marda Loop Medical Clinic in Calgary were shocked last week when they received an email from their physician, Dr. Sally Talbot-Jones, saying that if they wanted to continue to be able to see her in a timely fashion, they were going to have to pony up significant “membership fees” ranging from $4,800 per year for a two-parent family membership to $2,200 annually for a single adult.
Family membership for a single parent would cost $2,400 a year; for a couple with no children, $4,000 a year; and for child coverage by a single parent who couldn’t afford to pay the fee for herself $500 .
The alternative, if they hope to continue to see Dr. Talbot-Jones, is to try to get seek an appointment on the one day a week she says she will continue to provide care to non-member patients.
If this “transformative healthcare initiative,” as Dr. Talbot-Jones called her new approach to billing is supposed to improve service for patients who can afford the fees, it obviously isn’t going to have that effect for those who don’t have enough income to pay.
As one Calgarian who had seen the letter wrote last week in the comment section of this blog, “if the province encourages this, and if enough doctors take up this idea, this is the end of public health care.”
And therein lies the rub. Since the practice appears on its face not to violate the Canada Health Act because patients would not be required to pay for medically necessary services listed by the province, the government can say no laws were broken and look away.
Ms. Smith could even claim – and probably will – that patients can always find another doctor who doesn’t charge a membership fee.
The problem with that, of course, is that given the national shortage of physicians, which seems to be particularly severe in Alberta thanks for former health minister Tyler Shandro’s 2020 War on Doctors, if nothing is done to nip this practice in the bud, it will become commonplace. It’s a matter of supply and demand, after all.
And while the government could argue on a technicality that no one who needs a medical service will be denied, if getting it requires an up-front fee to see a physician and you can’t afford the fee, you have in effect been denied the treatment or at least been sent to the back of the line.
Indeed, it’s fair to say that the whole idea won’t work if everyone can afford to sign up. If the goal, as the clinic email states, is “to provide a more comprehensive, proactive healthcare service,” it would require service to get worse for those who can’t afford to pay.
Alberta Health Minister Adriana LaGrange told the CBC yesterday that the government remains committed to the Canada Health Act. It doesn’t, of course, but there’s not much it can do about it. In the meantime, it is in effect pleading the no-laws-were-broken defence.
Ms. LaGrange’s press secretary tried to sound more reassuring while saying the same thing: “The government will continue examine these cases to make sure all legislation is being followed.” In other words, the UCP is not going to do anything.
In a statement sent to media, NDP Health Critic Luanne Metz, a physician, half-heartedly defended physicians who adopt such a billing scheme, saying “I primarily fault the provincial government for pushing these doctors into a situation where this is how they have to pay the bills.”
“I am very concerned that if the province approves these fees, then this revenue stream will be irresistibly attractive to other clinics as well,” she added, obviously accurately.
In the same statement, NDP Mental Health and Addictions Critic Janet Eremenko noted Ms. Smith’s claims during the election campaign that no Albertan would ever be asked to pay to see a family doctor. “That brings us to today, with Albertans being asked to pay to see their family doctor, exactly what Smith promised wouldn’t happen.”
The CBC noted in its story that there are other clinics in Alberta charging membership fees for patients to access service.
This is true. There are at least four others, three in Calgary and one in Edmonton, and may be more.
The case if the Marda Loop Medical Clinic, though, is the first that has come to public attention in which a family medicine clinic in Alberta that previously operated according to the conventional model is switching to membership payment for patients who want to continue to receive timely appointments and treatment.
Model legislation to ban this practice would give physicians the ability to bill patients for memberships only if they opted out of receiving payment for approved medical treatments from public health insurance.
The Alberta Medical Association, the Alberta physicians’ collective bargaining organization, did not respond to a query about this practice. The office of federal Health Minister Jean-Yves Duclos is aware of the situation and will try to determine if there is a breach of the Canada Health Act.
I’d feel a whole lot better if your article concluded with federal Health Minister Jean-Yves Duclos declaring that the Canada Health Act would be amended if this practice turns out to currently be legal.
Chompy: I’m pretty sure it’s legal. I wouldn’t rule this out, though, at the federal level as long as the Liberals remain in power. You could forget about it with a Conservative government, of course. DJC
This measure creates a two tier health care system, which I’m not sure is allowed under the Canadian Health Act.
People were warned about these phony conservatives and Reformers beforehand, and what they would be doing, if they were given the chance. They didn’t listen, and this is the results we will be seeing. The UCP’s full intent is to privatize healthcare in Alberta, which is what their hero, Ralph Klein wanted to do. Ralph Klein’s foolish healthcare policies cost Albertans their lives, and put other people’s lives at risk. The UCP will do the same. Anyone that has American relatives, or is American, would know how many people there go broke, because they can’t afford to pay out of their own pockets for healthcare. Why would anyone want that here in Alberta?
If we set up a picket line in front of the Marda Loop Medical Clinic, would the sidewalk of the 2100 bloc of 33rd Avenue sidewalk be declared Critical Infrastructure? Ironically, Calgary Currie voted for the NDP, Janet Eremenko.
Priority of care should only ever be decided on the severity & urgency of one’s condition, not the thickness of one’s wallet. This must be stopped, immediately.
Meanwhile, there is a series of articles published today in the British Medical Journal under the auspices of the Royal Society of Canada, assessing Canada’s response to the global COVID-19 pandemic. It is scathing on the failures of federalism to protect Canadians from this deadly scourge that has taken well over 53,000 lives. Link here:
https://www.bmj.com/canada-covid-series
I wonder what Danielle Smith would have had to say about this if Dr. Talbot-Jones had implemented this change before the election. I am sure the good doctor had a suspicion about how it would go down, so she waited until after the election.
Wow! Dani’s going to defend the indefensible! I can’t wait! https://youtu.be/CUj2AWEJnwQ
This long running program and its particular ideological monomania [the mythology and religion of ‘market determinism’ (and its application to ‘healthcare’: “Part of the reason health care doesn’t work (in Canada),” Smith told CSFN director, Jocelyn Bamford, “is because it’s being operated in this sort of top-down … public-funded, publicly delivered (model) …“We can have private delivery, public funding, stay within the Canada Health Act, and bring all of the principles that we know work in free enterprise to this most expensive service.”)
as the ‘truth’ and the only ‘sensible’ option along with the standard self interested pecuniary enrichment of private profit, i.e., human greed as the holy grail.] and its implementation/adoption requires the application of a few well known simple but effective techniques, for example:
1. Habituation: Using methods such as the thin edge of the wedge, where; minor changes are the prelude to major developments, using habit forming and a process of gradual adaptation to ‘change’ (beliefs) resulting in the normalization of the desired policy. That is, “But once people get used to the concept of paying out-of-pocket for more things themselves then we can change the conversation on health care,” . . . “The only option is to allow people to use more of their own money to pay their own way and use the power of innovation to deliver better services at a lower cost.”
2. ‘The Big Lie’: “in the big lie there is always a certain force of credibility; because the broad masses of a nation are always more easily corrupted in the deeper strata of their emotional nature than consciously or voluntarily; and thus in the primitive simplicity of their minds they more readily fall victims to the big lie than the small lie, since they themselves often tell small lies in little matters but would be ashamed to resort to large-scale falsehoods. It would never come into their heads to fabricate colossal untruths, and they would not believe that others could have the impudence to distort the truth so infamously. Even though the facts which prove this to be so may be brought clearly to their minds, they will still doubt and waver and will continue to think that there may be some other explanation”
“In the populist playbook, lying itself is glorified; it is an instrument of subversion, its purpose to demonstrate that the liar will stop at nothing to ‘serve the people’.”
“But rarely has a premier set down core beliefs and actions so vividly, and then promised the exact opposite 48 days before an election.”
Yet, according to the election results, a fairly large subset of the population should be very pleased with the results, even as, “More than half of Canadians say they can’t keep up with the cost of living, according to a new survey from the Angus Reid Institute. The survey also found that seven in ten Canadians report being stressed about money as inflation rates continue to grow.” Where apparently, predictably, and sadly consistent ideological tribal loyalties overide any underlying gnawing cognitive dissonance regarding the larger ‘reality’ and its negative spillovers. Noting that it has been bluntly and aptly stated that “(Neo-Randian) Libertarianism has always been a thinly veiled version of “f*ck you, I’ve got mine (and am going to keep it)” while pretending that (at the very least) that you’re not benefiting from society and standing on the backs of others.”, so maybe the above observations are not all that surprising.
Where did that last quote come from? It’s an admirable summary of the philosophy behind Rand’s writings.
In America, greed is celebrated. Perhaps Dr. Sally Talbot-Jones should leave the country if she is not able to make ends meet?
CTV ran a story on this yesterday as well (linked below). Things I found interesting in the story were:
1. The medical clinic has no details about the scheme on its website, which flies in the face of how delighted they were to make the announcement, as mentioned in their email.
2. The clinic, although presumably open, was not answering their phone when the CTV reporter called.
https://calgary.ctvnews.ca/alberta-government-checking-medical-clinic-offering-faster-physician-access-for-a-fee-1.6492427
David does present an interesting ‘what if’ scenario with his question ‘What if everybody signs up?’ The email from Marda DJC gave us the link to does not say anything about a limited number of memberships available, but Marda certainly does acknowledge that they currently have more demand than supply. If Marda does not limit the number of memberships it sells it will certainly have some very unhappy customers (no longer patients) annoyed that they forked out several thousand dollars and are still waiting for an appointment.
Here is another interesting what if: What if doctors in Danielle Smith’s rural heartland implement the same scheme?
Bob: That’s a good point about the fact there’s nothing about the membership scheme on the clinic website. Just to be clear, I was forwarded a copy of the email by someone and I made screenshots that would not identify the forwarder, then stitched them back together into a PDF to post on my site. I suppose the doctor could hire another physician if the model proves successful enough. Testimony of doctors who worked for the original membership-model clinics set up to exploit this gap in the Canada Health Act indicates they spent a lot of their time and effort scheduling unnecessary tests and selling unnecessary non-listed services to patients. DJC
And so it continues to begin; the end of publicly accessible, affordable health care in Canada.
Will the trend stop if enough UCP supporters can’t get treatment for Leopard Bites to their Faces?
This will put further pressure on emergency rooms, as people who cannot afford the fees are forced to seek timely treatment for urgent, but not urgent to their fee-charging doctors, in the public system. Sure, these patients can still pre-schedule appointments for prescription renewals, but what if they need anti-virals in a timely fashion for an infection? Sorry, not sorry, go to the nearest emergency room or urgent care centre. Viruses are still with us in post-reality Alberta, in case anyone wondered.
I very much doubt that single parents who cannot afford these fees can still somehow afford a $500 fee. Such faux compassion!
Would be a real shame if something happened to the building that houses her for profit , care denying practice.
Disgusting. Just think, we have 4 more years of this and worse.
This is so distressing- I kind of thought that America’s health care chaos (it isn’t really a system, at least one that anyone in their right mind would design) was an historical fluke of WWII and my countrymen’s surprising capacity for suffering if it means the poor/Blacks don’t get something. It’s a well-worn fact that American health care costs twice Canada’s for worse outcomes, but of course that means someone’s getting that money. I never quite appreciated that there would be constant pressure to open up that privatization trough in Canada, but I guess it makes sense – someone’s going to get rich. It’s not just the expense you know; even if you can afford it, your labour, time, and emotional energy will go into calling insurance companies, figuring out a bewildering array of choices, sorting out which clinic is covered by what plans. This will never happen at a good time, but often and usually during the lowest points of your life. Those of you who haven’t experienced private health care can’t imagine how draining it is, but it is certainly model capitalism- your money, labour and suffering will be someone else’s profit.
Here it comes … the full privatization of health care in Alberta, and of course the complete gutting of public health care, whether you like it or not. But what do Albertan’s expect when they vote in a corporate/right wing party year after year? $4800 for a family, and that’s just the start of things. Just wait till it’s in full swing, when you’ll be able to buy the “gold/platinum/etc plan*” on sale for only $1199 per MONTH! Limited memberships available, so hurry, won’t last long!!!
* Some conditions may apply, like co-payments, deductibles, non-coverable items, ceiling caps, pre-conditions etc etc. Isn’t this just great, making the 1% wealthier and more powerful at the expense of everyone else?
The Canada Health Act is a federal statute which can be amended by and act of parliament to prohibit this kind of slippery slope.
It could be sold to voters, too: “Do you want your healthcare system to be jeopardized like it is in Alberta? Do you Albertans want to protect your healthcare system?” It’s one of those rare cases where the federal and provincial sentiment might align.
Maybe the new federal health minister—whoever is picked in the cabinet shuffle—can summon Alberta’s leader of the Loyal Opposition to a meeting…
Well, maybe not, but let’s hope this plain thin-edge of the wedge is dealt with smartly forthwith. I can’t wait for the sovereignty flame to burn even brighter.
Scotty: The same thing happened last year in B.C. I don’t know if it was resolved or if the B.C. government did anything about it. https://www.timescolonist.com/local-news/another-greater-victoria-medical-clinic-charging-patients-a-monthly-fee-5805763 DJC
I’m not totally sure, but I do know the environment has changed substantially in BC since eleven months ago: the master agreement about doctors’ remuneration was settled (a large pay raise was agreed upon—and the hateful sur-fee was germane to that money issue before it was eventually settled) and Dr Brian Day’s appeal to the SCoC to allow private billing was dismissed.
It’s a good question, though, and I’m a check it out when the grandkids go back to Upper Canada (there’s the BC ones, too…).
Thnx.
Hello DJC and fellow commenters,
Here is a cbc article from 2016 about the Copeman clinics that charged a fee that sounds similar to the one that the clinic in Marda Loop is offering. The way the clinic was able to pass the costs of the membership-type fee on to the public is interesting. It seems to be that they billed ?customers? for tests, for example, paid for by the province and then the customers could claim them as tax deductions. According to the Copeman website I found, the clinics were re-branded. I don’t know if they still exist in Canada. Nonetheless, the cbc article shows how the membership-type fees could still be partially paid for by the public. I would suppose that other clinics operating in a similar way could still pass these costs on to the public. Here is a link to the cbc article from 2016.
https://www.cbc.ca/news/canada/calgary/private-healthcare-copeman-overtesting-billing-1.3589748
https://www.healthchoicesfirst.com/business/copeman-healthcare-calgary-alberta
Christine: I believe the former Copeman Clinic in Calgary is now operating as a Telus Health Clinic. DJC
Dr. Brian Day from B.C. started this in Alberta under Ralph Klein and he did nothing about it and I’m surprised that under these Reformers there hasn’t been a lot more of it. You can bet it will only get worse. Let’s hope the fools who supported them will be effected.
And then the UCP dispatches a release declaring that the clinic was in violation of the Canada Heath Act. (Well, well, well … there’s that Ottawa overreach again.) Of course, they also expect that Ottawa will take action, though that’s not how it’s supposed to work. Ottawa will fold their arms and remind Alberta that there is something called the Canada Health Act and it’s the provinces who are supposed to enforce it. But that would involve the AHS, and that would be overreach.
There will be lots of finger pointing and announcements of “It’s not my job” before long. And here we are …
Actually, Alberta Health Services can and will do nothing to address this, as governance over primary care clinics is not within their purview — except when the clinic is part of a Primary Care Network, and even then only as a member of the governing board of the PCN. Marda Loop clinic is a part of the Calgary West Central PCN, and it would be interesting to know if this matter has been discussed at the PCN’s Board of Directors.
https://www.cwcpcn.com/about/board-of-directors.cfm
If there is any action by the provincial government to put a stop to this, it will come from Alberta Health — i.e. the Ministry of Health.
Are you P.C. voters happy now?? Anyone who believes what comes out of smiths mouth is always a lie,,,or she says something,,then backtracks saying she DIDN’T say that,,,even when it’s been recorded….