Is American-style health care on the horizon in Alberta?
That thought was on some people’s minds over the weekend as Premier Jason Kenney’s governing United Conservative Party passed a controversial health policy at the party’s virtual AGM.
Fifty-two per cent of the party’s membership voted in favour of supporting “the option of a privately funded and privately managed health-care system.”
The phrase “privately funded health-care system” is bound to set off alarm bells for many Albertans, especially as Kenney’s government continues to slash the budget of the public sector, with doctors leaving the province en masse and the government announcing cuts of about 11,000 health-care jobs last week. This follows the passing of an omnibus bill this summer that opens up Alberta’s health system for even more private influence.
WATCH: Alberta cutting 11,000 health jobs. Story continues below.
But is this latest policy directive a green light for a complete overhaul of the province’s public health-care system? Not quite, says University of Calgary associate professor Lorian Hardcastle who specializes in health-care policy and law. But the policy is still cause for concern, if you value the current system.
Here’s what you need to know.
What did the UCP vote on this weekend?
The party held its annual general meeting this weekend virtually over Zoom, which allowed members to gather and vote on various proposals it would adopt for future policies and election platforms.
One was the option to support privately funded, privately delivered health care. Hardcastle says the policy directive means the government supports the idea of creating alternative health-care channels in the private space — something proponents are calling a “private tier system.”
“Under this proposal, individuals would be able to pay out of pocket, or to take out private health insurance, in order to pay for the cost of the services,” she said. “In essence, we would be taking an area of the health-care system that is entirely publicly funded and we would be introducing private funding into those services.”
So that’s American-style health care, right?
Not so fast. Hardcastle noted that nowhere in the policy or any communications from Kenney and the government did they indicate they plan on ditching the public system. Rather, if put into effect, this policy could create two streams of health care in the province — one private, and one public.
“There would still be that universal system, you could just, in parallel to that, buy quicker access,” she said. “It’s very similar to education — we have a universal public education system, but you can pay if you want to go to private school.”
She said it’s difficult to make direct comparisons with other countries, because every situation is different. The UCP proposal is more in line with the United Kingdom or Australia, for example, than the fully private American system.
Public health care is still there, but Albertans might be able to pay to access better or faster services, and medical professionals can choose which system to work in.
Why is that still concerning if you value public health care?
Hardcastle says the directive opens the door for inequity in health care, where those with more money have faster and better access to important services.
“There’s already a link between wealth and health, where those who are wealthier already tend to be healthier,” she said. “And so if we allow those healthier people to buy quicker access to care, then that just exacerbates those inequities between the health status of the wealthy and the poor.”
There would still be that universal system, you could just, in parallel to that, buy quicker access.University of Calgary associate professor Lorian Hardcastle
She says a private system could pull doctors and other expertise away from the public system if they can make more money on the private side. She pointed to issues with other private tier health systems, like in Australia and the U.K., where governments have had to step in and regulate where and how doctors work.
“So the concern isn’t that there won’t be a public health-care system, it’s just what will the quality of that system be? And how will the parallel private system negatively affect it?” she said.
Can they actually do this?
Hardcastle says she’s been fielding countless questions in the days since the vote regarding possible legal barriers to the UCP actually doing this.
She says “there really isn’t a lot to legally prevent this.”
Many people pointed to measures in the Canada Health Act as a possible barrier to the UCP implementing this directive, she said. But nothing in the act stops provinces from implementing policies like this, according to Hardcastle.
“The Canada Health Act, it also doesn’t prohibit a province from having private financing and health care,” she said. “What it does do, though, is that if a province decides to have privately financed health care, their transfer payments from the federal government might be subject to deductions.”
Hardcastle said many people have asked about a recent precedent-setting case in the B.C. Supreme Court, which ruled against privately delivered health services.
But that case determined provinces can limit private health care, not that they can’t support it themselves.
“So in essence, B.C. wanted to limit private health care and that decision was upheld by the courts,” she said. “But if Alberta adopted this, they would not want to have those limits. And so the B.C. case doesn’t bar them from having a parallel privately funded health-care system.”
What did Kenney say about it?
Regardless of a shift to private health care in Alberta, the policy directive does go against Kenney’s much-publicized “public health guarantee,” which he made following the 2019 election, pledging to keep the public health system intact.
On Sunday, Kenney’s press secretary Christine Myatt issued a statement noting that the government does not plan to enact policies passed this weekend immediately, and the government will continue to govern on its 2019 mandate.
“Policy resolutions passed this weekend will help inform the development of the 2023 electoral platform.”
During a radio interview Monday, Kenney said his party made an “unqualified commitment” to publicly funded, universally accessible medicare.
“That is not the U.S. system,” Kenney said.
He argued that the policy directive is about giving Albertans “more choice” in how they access health care.
“There should be more choices and more options,” he said.
What happens next?
While Hardcastle says private insurance is “a ways off” in Alberta because a whole industry would have to form, the UCP could start repealing specific laws that prevent the delivery of private health care in the province.
“Alberta law limits, for example, private insurance for publicly insured services. Alberta law also limits what’s called extra billing, in which doctors both bill the government for seeing you and then charge you on top of that,” she said. “So really, the big thing would be to make those changes to Alberta’s legislation where it limits private finance.”
She said Kenney and the UCP will also have to be prepared to negotiate with the federal government on the issues of federal health funding and transfer payments.
“Sometimes those conversations happen before the fact; sometimes those conversations happen after the fact,” she said. “So Alberta could plow ahead and then later see what the financial consequences would be if they wanted to.”