Albertans concerned about the preservation of public health care should not be overly reassured by the statement issued yesterday by Premier Danielle Smith and Health Minister Adriana LaGrange in response to a plan by a Calgary medical clinic to make patients pay up to $4,800 a year for timely access to a physician.
The communique may have been drafted in response to a statement for media from Health Canada indicating it believes the scheme by the Marda Loop Medical Clinic to make patients pay a membership fee would violate the Canada Health Act.
But the Alberta statement is slippery and offers no meaningful indication the Smith Government intends to change its permissive approach to the continued erosion of public health care in Alberta.
Nevertheless, the controversy over the plan by the clinic puts the United Conservative Party Government in an uncomfortable and potentially embarrassing spot that it obviously takes seriously enough to make an explicit effort to defuse, albeit without really changing anything.
Last week, patients of the clinic received an email from Dr. Sally Talbot-Jones promising “to significantly improve our services to you and your loved ones” but in fact announcing that if they wanted to continue to be able to see her promptly they were going to have to pay substantial “membership fees” starting Aug. 1.
When the story about Dr. Talbot-Jones’s “transformative healthcare initiative” broke Monday, the controversy was immediate. Health Canada issued its statement to media yesterday, saying “the Government of Canada does not support a two-tiered health-care system where patients may choose, or be required, to pay membership fees to access insured primary care services at clinics, or to gain expedited access to those services.”
Importantly, Health Canada said it had informed Alberta Health officials that in its view “the ability for patients to purchase preferential access is contrary to the Canada Health Act.”
However, since other clinics only for fee-paying members have been allowed to operate in Alberta, it’s quite possible that this interpretation of the act could be disputed in court, and it’s not yet clear if the federal government will be willing or have the time remaining to amend the Canada Health Act to specifically close the loophole.
Still, if you think the Smith Government would be prepared, say, to use its Sovereignty Act to introduce two-tier health care into Alberta, as much as Premier Smith might privately wish she could do just such a thing given her history of advocating for private health services, it would be politically risky in the extreme to do so.
Given that risk, the provincial strategy is more likely to be to try to sound as reasonable as possible in hopes of not goading the Trudeau Government into amending the act while continuing to look the other way as fee-based clinics continue to operate. In its story, the CBC cited an academic paper that indicates at least 83 private payment only clinics are operating in six Canadian provinces, including 14 in Alberta.
That would leave the task of challenging the application of the Canada Health Act to Dr. Talbot-Jones or someone like her, since the temptation to try to use this legal loophole is likely to prove irresistible to many more clinics.
Which brings us back to yesterday’s statement by Ms. Smith and Ms. LaGrange.
While they begin by saying they expect physicians to follow the law, including the Canada Health Act, their statement soon moves into the no-laws-were-broken defence so familiar to observers of Alberta politics.
A paragraph expounds on all the legal ways Alberta physicians and clinics operate – services that might include “non-medically required surgery, nutrition and acupuncture services, medical notes and fertility treatments.” (And abortions, it should be added, if Ms. LaGrange ever gets her way.)
“The Audit and Compliance Assurance Unit of Alberta Health has evaluated instances where private clinics operate this way, charging membership fees in Alberta,” it continues. “Historically, all evaluations have confirmed that these clinics are operating in compliance with the act.” (Emphasis added.)
Health Canada, it adds, has so far not identified a problem with these clinics – which, if true and if the Health Canada statement is also accurate, suggests a significant number of clinics have been quietly operating illegally in Alberta for some time while the provincial government either looked the other way or failed to ask the right questions.
Alberta only recently became aware of Dr. Talbot-Jones’s plans, the statement continues.
“Alberta’s government would be extremely concerned if this clinic was charging fees for services that are insured and offering accelerated access to a family physician at the expense of other patients needing to wait longer,” the statement says. “We have directed Alberta Health to investigate this specific clinic to ensure compliance with all legislation. If any non-compliance with relevant legislation is found, we will take appropriate action.” (Emphasis added.)
In other words, if you need a translation, we’re not admitting anything improper is going on; we’d like the problem to go away as soon as possible; and we intend to do as little as possible.
“Albertans do not pay out of pocket for insured health services such as seeing a family doctor or visiting a hospital,” the concluded, “that will not change.” This statement, while definitive, does not respond to the question raised by the Marda Loop Clinic’s plan.
According to the researchers at Simon Fraser University in B.C. and Dalhousie University in Nova Scotia whose paper was cited by the CBC, clinics requiring membership fees, that bundle public primary care with wellness services, and corporatization of family medicine “should all be the subject of robust investigation by both provincial policy makers and provincial physician regulatory colleges.”
And that, dear readers, is precisely what Ms. Smith and Ms. LaGrange so obviously hope to avoid.
Isn’t this what we were warned would happen if Smith was elected?
The only transformative thing I can see from the email is the big fee for services that previously had no fee. It seems those that pay the fee are promised preferential access, which must mean those who don’t get reduced access. If that is really not the case and the clinic needs to explain exactly what it is doing and not just to the Alberta government that seems to accept whatever they will say. Personally I don’t think you can hide behind a few vitamins and a health consultation for paying thousands. I don’t think this is what this is really about.
If the UCP continues to pretend this is all fine and does nothing or drags its feet here, it will seriously hurt them politically. The Feds will eventually need to put an end to this and if it comes to that they will end up looking good politically.
I have a hard time believing even the UCP doesn’t actually get all this. If so, that narrowly won recent election has really gone to their heads and is being badly misinterpreted by them.
What else should or could be expected from a group of individuals that believe that human greed in the form of a complete faith and reliance on the religion of market dynamics as the solution for what ails, generally and specifically, locally and globally. There are not enough converts that are sufficiently greedy enough, one supposes. Beyond that trivial observation and the overlooked fact that the same market dynamics do not deliver as promised is the more general and specific problem of intellectual dishonesty, using such tactics as creeping normalcy and versions of the ‘sorites paradox’ (where inattention and a lack of awareness regarding the appearance of impeccable reasoning using premises that appear impeccable yield falsehoods) as a means of arriving at an ideological nirvana that is nothing but a mirage.
For all those individuals that are paying even the slightest attention, it is interesting to note the use of lingchi as a metaphor for ‘creeping normalcy’ where:
“Susan Sontag and Georges Bataille were interested in this form of torture due to the relationship between pain and ecstasy, but many people in business and other industries refer to this type of torture when speaking of creeping normalcy. Creeping normalcy is the idea that slow change is not perceived as being as negative as one large change and that large institutional shifts may occur invisibly in this way.”
There is much to consider in that short paragraph (for example, as both a metaphorical and literal exemplar of bondage, discipline, domination, submission, sadism, and masochism and their normalized practical applications in the overall capitalist economic framework and its daily operation) and its application to the current situational dynamics surrounding and regarding healthcare commodification mania and the exploitative orgasmic feeding frenzy that it portends.
Slippery slope? This is an effin skating rink and only a few have the skates.
You’re not alone Albertans, Ontario has them too. Looking up and down the Canadian Taxpayers Federation and Fraser Institute websites I was unable to find any reference to membership fees for medical access or “surveys” supporting them.
… ‘I was unable to find any reference to membership fees for medical access or “surveys” supporting them’….. so far.
Smith as she continues to behave in slippery ways is nothing new. She will get away with what she can. Just recently with her investigation with the ethics Commissioner on a conflict of interest with the Pawlowski case and prosecutors. Her restaurant owned by her husband and herself as she broadcasted which was put on sale just days after the announcement. The only reason I believe is because of clawback of funding from the Fed’s otherwise she has a blind eye . Smith and her caucus cannot be trusted. Her intrust is not for Albertan’s
The hemorrhaging of public health care in Alberta continues amidst the talk from the UCP. If you think that the UCP will do anything to stop the further privatization of health care, you haven’t been paying attention. What you can expect from this corporate government is more rhetoric about choice, freedom and private investment, as if that will solve the problem. In fact, it will do the exact opposite and blow up the public health care system in the province, if not Canada.
It will be interesting to see what happens now, if anything, with the federal cabinet shuffle.
Surely if the federal government comes down hard on this slippery-slopeism, Danielle Smith will be delighted to pitch this as the reason Alberta should become a sovereign nation forthwith. Dr. T-J could become the patron saint of les souverainistes. Vive l’Alberta libre!
Consequences are about to slap Albertans silly.
I hope even Albertans might not swallow “we need to separate from Canada so we can have for-profit health care.”
Erasers help and court proceedings,before we know it ,we are here
Indeed a robust investigation should be done to make sure the slope gets at least reduced, if not eliminated and private services like hair transplants and other cosmetic or non-essential medical repayments do not effectively become prerequisite—along with clinic fees—to getting ordinary, needed healthcare anywhere in Canada.
There are plenty of so-called “wellness” or “holistic” clinics in BC which make their bread and butter from private or employee insurance plans, auto insurance and, the big one, workers’ compensation boards. Naturally these clinics have medical doctors—at least one to supervise “technicians”—on hand. But, with the doctor shortage, they too are usually booked. They even advertise “no walk-ins.”
BC naturally compares differently with most other provinces owing to our generally geriatric profile. (The median age on my little Island, for example, is 61 years of age—the average is more like 71). But we also have a nominal socialist party governing the province which actually supports universal public healthcare. However, in-migration from everywhere times our older-age profile —plus Covid (many doctors on the cusp of retirement decided to stay on to help weather the pandemic, then went ahead and retired after it settled down a couple years later; the effect was the illusion that the shortage of doctors was sudden when, Covid subtracted, the trend was ongoing)—has been challenging. Wait times for an appointment have gotten much longer (it takes a month on my Islanders-only clinic, for example, where one resident doctor—new from the Maritimes—is occasionally spelled by a locum from another island. We are 1300 souls here—but nobody has to pay a club fee even though chiro and physio are available under the same roof).
BC doctors got about a six-figure pay-raise recently from the billing authority: it allows them to spend more time seeing patients and to delegate the considerable administrative duty to hired hands. Less immediately, the better pay also attracts doctors from elsewhere to come and enjoy life on the Left Coast—like so many Albertans in general have. Of course there’s an ethical question about “stealing” doctors (and nurses) away from other jurisdictions which really need them to stay, but I’ve personally met a number of doctors who where going to “retire” to BC from elsewhere in the country anyway—that is, continue to practice here well into their 70s—even 80s (told ya: we’re an older profile than other Canadian jurisdictions).
Offsetting that is boosted nurse and doctor training in BC—the question of course being whether they will eventually relieve the dearth of general practitioners, opt instead for specialization, or practice outside the province or country. I wouldn’t expect most of them to opt for Alberta—at least not until the healthcare environment and political atmosphere there has cleared—and who knows when that will be…
Best advice: don’t get sick.
“…it would be politically risky…” How so? The UCP was given a majority, and are opposed by a weak-kneed NDP. What’s the risk? They will remain in power no matter what for the next four fucking years. Who can stop them now?
I tend to agree. I just don’t think the True Believers care enough about public health care to turn against the UCP so either apathy sets in or they wholeheartedly jump on the privatization bandwagon. If the comments in the major news services can be believed there are no shortage of brain dead morons in this province that are now all-in for private for profit health care. Indeed, we are all f**ked.
weak-kneed opposition? What does that mean
Seems this has been happening on the down-low for quite some time. Sure do hope the feds close this loophole. I am very pessimistic for the future of Canada’s health care system, even without blatant attempts to privatize it. Canadians seem incredibly determined to avoid talking or thinking about how to change the system to accommodate the changing needs of an aging society. As a society, we are coasting by on the investments of our grandparents and the inheritance of our grandchildren.
IMO there will be no need for a doctor to pay for the legal costs of challenging the feds in court if they do so, there will be no shortage of money from members of the owning class seeking to emulate America’s situation (Americans pay the highest health care costs in the developed world by far and have some of the poorest results).
This is one of Climenhaga’s best explainer type of posts.
Needs to be shared widely across all social media platforms.
Blurb on CBC Radio Calgary this AM mentioned 30+ such clinics in PQ.
I’m sure the UCP are all talk, if they say they oppose this clinic now. Their real intentions are private for profit healthcare in Alberta, and their hero, Ralph Klein felt the same way.
Hello DJC and fellow commenters,
Like pretty well everyone else here, I condemn charging fees to patients who, if they pay the fee, become customers.
At the same time, the disrespectful decision by the Alberta government to unilaterally end the agreement with the ?Alberta Medical Association?, along with the Alberta government’s miserly financial treatment of health workers, including doctors, is despicable.
For example, the Alberta government agreeing to pay Telus almost double the fee paid to doctors practising in their own clinics is shocking.
The current policy choice to pay for-profit providers of medical services or slower service at a higher cost is also unacceptable. This is the conclusion of the Centre for Canadian Policy Alternatives.
I think that the public will have to put pressure on the Alberta government to treat doctors and other health professionals along with the support staff, including cleaning staff, with respect and pay them fairly if anything is to change.
Unfortunately, there are misguided people who believe that “choice” should be available to them on the public purse so they can jump the queue and go to private clinics.
I saw the effects of “choice” in the U S when an acquaintance was billed approximately $380,000 for medical care when she and her daughter were in an auto collision in the mid-1990s. This was the cost after the hospital where she worked provided some discounted and free services, and insurance paid some of the costs. I think that this amount is about $700,000 in current Canadian dollars.
Now that it’s becoming clear that the auto insurance industry is engineering a backlash against the UCP’s sudden rate ceiling, after Jason Kenney lifted it few years ago, by denying policies for Albertans because they are high-risk clients, I suspect that the UCP will take off the cap and rates will plow that much higher. So much for the UCP leading the Alberta will affordibility policies. And now medical clinics are looking to add their own user fees into the mix and the UCP intends to look the other way for … reasons.
The interesting thing to note among that those dumbest monkeys called UCP Voters is that they are of the belief that (maybe) it’s time for the real cost of health care to be borne by the user? Getting a broken leg mended shouldn’t be free, otherwise you’re going to keep breaking your legs, right? Fees are a deterence for stupid behaviour, so nobody moves, nobody gets hurt, and nobody pays. And a few more things … don’t get cancer, a heart attack, or get pregnant, because those things are pretty expensive, too.
Back in the day … maybe the 1880s … people mended their own broken limbs. A couple of wooden splints and a lot of whiskey, a cane, and you were as good as new in a couple of months. A women would give birth and get back in the kitchen they next day. Yeah, those bygone days of sod huts, water-borne diseases, and high infant mortality … those days weren’t so bad. People today are soft and entitled, but a rising body count and a few more cripples in the streets will toughen everyone up.
I keep wondering when doctors will admit that they are paid as piece workers. It’s a pay structure workers fought against but when Medicare came in doctors wanted to be paid by patient. It’s high time we restructure payments so doctors are on salary. I don’t know why the doctors’ associations aren’t pushing for salaries.
I cannot believe after the wait times and lack of access to doctors that patients / the public are NOT willing to try a new healthcare model. The existing one is broken. How do we know a hybrid approach doesn’t work if we don’t test it? I think we need to be clear on what is being solved for with a hybrid system before we criticize it. Doctors are paid a fee for their services (per patient interaction) instead of earning income linked to making patients better. Why don’t we talk about a pay for performance model aligned to measurably improving patient health. Accountability sounds revolutionary in AHS to me…
I remember Albertans falling for the lies from Ralph Kleins gang that privatizing the electrical transmission system will give Albertans cheaper electrical bills. When that and other promises fail, the government conveniently blames the Liberals for some made up BS (Alberta Beef BS of course) and the people go away happy. It seems that as long as someone none conservative can blame someone else, the followers are happy. Short term memories are encouraged by conservative governments.