Health care has long been a point of pride for Canadians, since Tommy Douglas brought medicare into Saskatchewan as premier in 1962 and former prime minister Lester B. Pearson adopted the program federally in 1965.
When United Conservative Party Leader Danielle Smith was accused by her political opponents of wanting to “sell off hospitals,” Albertans took notice.
Last week, a UCP news conference that included Smith was interrupted by protestors chanting “Hospitals are not for sale.”
On May 10, Calgary-Mountain View NDP candidate Kathleen Ganley made a claim about Smith’s “values” that lean toward privatization of hospitals, that has since been repeated by the Alberta NDP in press conferences and election advertisements.
“(Smith) has attacked our public health care, where she has talked about why it’s good to have to pay for a visit to a family doctor, where she’s talked about why it’s good to sell off our hospitals to private companies,” Ganley said at the May 10 press conference.
“Ultimately, she will govern based on those values. And I think that Albertans deserve to know that because these are not the values of Albertans.”
Does Smith plan to sell off hospitals in the province? Let’s look at the claim.
Transforming Alberta Health Services
In a speech titled “Transforming Alberta Health Services” as part of the “Freedom Talk” series on the weekend of October 2021, Smith said, “Health care reform is one of the issues that I feel so passionately about.”
She outlined a three-part plan, building on a paper published by the University of Calgary’s School for Public Policy in June 2021, that included a health spending account, more free market fundamentals and a separation of powers.
Hinting at a current lack of accountability, Smith proposed the government to split the roles of purchaser, provider and auditor — roles that currently sit with departments within AHS.
Under the split roles, Smith would have AHS become a contractor running hospitals and other health services, billing to the Alberta Health Care Insurance Plan.
“Then we would have the Alberta Health Quality Council do us an auditor function and tell us whether or not Alberta Health Services should continue running the (Peter) Lougheed Hospital or the Rocky View Hospital or South (Health) Campus, or any of the 100 hospitals that they currently run in majority in the province. And if they can’t meet the terms that we want them to, we can do an RFP,” Smith said in October 2021.
“And then the Alberta health insurance can give a different contract to a different group of doctors and a different group of patients and a different entity to run all of our hospitals.”
Smith made no mention of what would happen to the physical health-care facilities or equipment as part of that June 2021 plan.
But she later suggested such a change could be put in place rapidly.
“You could pass legislation that immediately separates Alberta health insurance from Alberta Health Services, from Alberta Health Quality Council, immediately that could take place next week and you don’t have to change anything. And then the contracting process would develop over time,” she said in October 2021.
“Once doctors and surgical teams and hospital administrators and local communities realize, ‘Hey, we can do this,’ then they’d hire a business manager and then develop a proposal.”
Putting thoughts on paper
While Smith does not directly talk about putting hospitals up for sale, she does say the contracts to run hospitals could go to the open market.
Citing the mechanisms that already allow private surgical centres, Smith suggested the High River Hospital could divorce itself from AHS and charter directly to Alberta health insurance on a per-procedure basis.
That speech came five months after the University of Calgary’s School of Public Policy published a paper proposing changes to government-provided services like health care and education. The paper included sections from several Albertans, including Smith.
In the paper, she talks about the health spending accounts to “shift the burden of payment away from taxpayers and toward private individuals, their employers and their insurance companies.”
Smith suggested that more services — like those from general practitioner physicians — could be paid entirely from the health spending accounts and, after a time, establishing copayments.
Since being elected UCP leader, Smith has publicly backed down from the idea of health spending accounts and copayments.
In the policy paper, she also suggested charter and private hospitals could be established, with charter hospitals being privately delivered on public dollars and private hospitals “can receive contracts for publicly-paid services as well as serve paid customers (foreign clients on a pay-for-service basis to remain in compliance with the Canada Health Act).”
Complying with the Canada Health Act
Complying with the Canada Health Act while expanding privately-operated medical procedures has been something the UCP government has been trying to balance, going back to the Alberta Surgical Initiative of 2019.
A recent study by the Parkland Institute showed the number of contracted surgical procedures has increased by 48 per cent since 2019, while surgeries in AHS facilities were down by 12 per cent — despite those provincial facilities operating at around 70 per cent of capacity.
“There’s nothing in the Canada Health Act that explicitly prohibits private delivery of health services,” Lorian Hardcastle, an assistant professor in health law at the University of Calgary, told Global News. “The only reference in the act to public is that the health-care system must be publicly administered.
“That said, the legislation does talk about access to care.”
Hardcastle said there are three issues that surround contracting out health services: access to care, increased cost to the public due to private profit concerns, and quality of care.
“Unlike the public system — which doesn’t need to include a profit margin — these facilities are only lucrative to those who operate them, if there is that built-in profit margin in terms of what the government is paying for health services.”
The Parkland study showed a 61 per cent increase in payments to contracted surgical facilities in four years, despite the 48 per cent bump in procedures.
That study also showed that patients seeking hip and knee replacements were well below the federal wait time benchmark.
“To the extent that the current premier still wants to pursue that goal of private delivery, I think this report sounds the alarm that potentially this could be problematic for the public health-care system,” Hardcastle said.
The health law professor also said allowing a further corporatization of health-care services like hospitals isn’t likely to help with recruitment.
“Many doctors remain deeply committed to the public health care system and they believe the evidence that single payer health care system – one that relies primarily on public delivery – is the most effective model,” Hardcastle said.
“I would be concerned that doctors who hold those beliefs would be disincentivized in coming to a province that’s seen as one that’s embracing privatization and corporatization.”
Running on her record
This election period, Smith said to look at her six-month record as premier for how she would treat the health-care system if granted another term.
“I can confirm that under a UCP government, with our health-care guarantee, no one will ever pay out of pocket for a family doctor or for hospital services,” Smith said on May 11.
When pressed to address her comments made in October 2021 before she was an elected official, the UCP leader said her party would contract out surgeries “that make sense.”
She added they “will not privatize the hospitals that are under the umbrella of Alberta Health Services.”
Smith pointed to the confidence she gathered from the work done in the first 90 days of Dr. John Cowell as AHS administrator and Mauro Chies as AHS CEO.
“If we need to continue doing some contracting out of services that can be done in charge of surgical centres, we will consider doing that. But I think that people should feel a lot of confidence in what they see at Alberta Health Services.”
At the October 2021 talk that had Smith take questions from health-care professionals in the audience, Smith said she almost ran on the health spending accounts as leader of the Wildrose Party in 2012, “but we thought it would be too complicated to explain to the public, and we thought it would be perceived that we were trying to privatize the health care system.
“I was a coward back in 2012 because we didn’t run on it either. But I think with the passage of time in ten years, I think it absolutely is a political winner,” she said in 2021.
The policy declaration that came out of the 2022 UCP AGM that saw Smith get elected as leader also had some direction from party members.
One was to have a health-care system that “blends public, non-profit and private sector provisions” and would “give Albertans the choice of privately-funded, privately delivered health services to address excessive wait times and to make the publicly-funded system more accountable.”
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