Doug Firby, Columnist, Troy Media Corporation
Spiralling health care costs are the bane of every provincial government. And, as Alberta is learning for the second time this decade, taking bold action to bring those costs to heel is only guaranteed to deliver political grief.
Facing its first deficit since the 1990s, Alberta's Conservative government brought down a provincial budget in April that cut funding for chiropractic procedures and sex change operations. Those cuts were clearly just a warm-up.
Gambling that fiscal belt-tightening would sell, Health Minister Ron Leipert declared Alberta would consider creating an expert panel to review which medical services must be covered under the Health Care Act and which are prospects for delisting.
“What's covered under the Canada Health Act, we're not dealing with,” he said, in an apparent bid to blunt criticism. “We're talking about a whole bunch of stuff that's outside the Canada Health Act.”
This came on the heels of a December initiative by Liepert to overhaul the Blue Cross drug plan. Unfortunately, his proposed deductible-based pharmaceutical program would have cost middle and high income seniors as much as several thousand dollars a year.
Meanwhile, dozens of health programs and grants, including youth suicide prevention, were chopped from Alberta Health and placed under review with the province's medical superboard, a body created last year when the province folded together semi-autonomous regional boards.
The net effect of these cuts has been to unleash a new round of fury from opposition parties, seniors, supporters of public health care and aboriginal communities, who are most deeply hurt by the imminent loss of critical social programs.
“As a senior living on a 10-year-old pension and a wife on disability pension, I simply cannot see how I will be able to remain in Alberta,” wrote Charles R on a local chat board. “This province and its heartless bunch of politicians . . . has gotten too expensive for us and we plan on moving east very soon."
Another wag, noting the government's recent investment in the largest drilling company operating in the province, sarcastically quipped: “Precsion Drilling $280 Million gift one day, Take-Away $20 million from The Seniors next day!”
Such sharp attacks are a bitter pill for Alberta, which built a reputation as a cost-cutter hero under maverick premier Ralph Klein. And although his successor, Ed Stelmach, has taken a more moderate tone, the province still fancies itself a leader in fiscal prudence, especially around health care. Its Conservative government was, after all, the regime that dared to blow up Calgary's largest hospital a decade ago on the promise of something better – a promise most consider largely unfulfilled.
In fact, in spite of its efforts, health care costs continue to escalate at rates comparable to other provinces, with no leveling off in sight.
As costs go up, the service continues to erode. The system's reputation suffered another black eye when a local newspaper columnist wrote inexcruciating detail about the 14-hour wait his wife experienced when she went to a local ER complaining of advanced intestinal blockage. Wrote the columnist: “Today we're in your world, Health Minister Ron Liepert, and it's hell.”
Worse, in a moment of hubris in 2008 just weeks before the onset of the recession, the Tories eliminated health care premiums for Albertans – cutting off a $1.5-billion revenue stream that they'd surely love to have back today. It's even appealed for $700 million in grant from the cash-strapped federal government. Good luck.
As for its own cost-cutting, the province has found itself backpedaling furiously. Last week, it rewrote the Blue Cross plan, switching to income-based premiums and drug copayments that exempts low-in-come seniors while charging wealthier retirees more. Liepert admitted he had received “a lot of feedback from seniors.”
The province also partially backed down on the sex-change funding cut, agreeing to pay for procedures in which individuals are on a waiting list. This was no doubt motivated by a Supreme Court decision several years ago that forced Ontario to do the same thing.
All of this has a powerful sense of déjà vu. Early this decade, the province commissioned former deputy prime minister Don Mazankowski to review Alberta's health system. His sweeping recommendations included the establishment of an expert panel to review funding for services that aren't considered medically necessary.
In 2003, the advisory panel suggested reducing or eliminating funding in several areas, triggering a protracted debate on whether province was actually opening the door to a full two-tiered health care system.
In spite of its posturing, the Klein government eventually lost its nerve in the face of overwhelmingly negative polling. Most of the recommendations were simply ignored, and the “Maz” report now collects dust on a shelf in Edmonton.
Liepert has tried to soft-pedal this latest run at reform. But, as the opposition builds, it's hard to see how this second leap into the breech will enjoy much more success than the last one – especially if it threatens to put the government itself on life support.
Doug Firby, former Editorial Pages Editor of the Calgary Herald, is Alberta columnist for Troy Media Corporation.
