Wildrose and the art of being vague

Kim Campbell once said that an election is no time to debate serious issues. There is no better example of this axiom than the current Wildrose election campaign in Alberta. Frankly, the four main planks in the Danielle Smith's election platform raise more questions than the answer and set a new standard for vagueness and political double speak. And if you are one of the undecided voters in Alberta, then questioning what Smith and the Wildrose really stand for and what their promises mean is the most important thing you can do before you vote on Monday.

I reside in Alberta but have never voted for the Progressive Conservatives. Nor have I voted for the Conservative Party of Canada. What follows are a series of comments on Wildrose promises.

1) Healthcare

A core Wildrose promise is to restructure healthcare in Alberta. They will do so in two key ways, first by dismantling Alberta Health Services (AHS) and second by allowing Albertans to seek health care outside of the public system if the public system is unable to deliver care in a timely matter.

Smith is on record saying she wants to "blow up" AHS and reinstate regional health boards across the province. Smith argues that AHS is dysfunctional and unaccountable and must be torn down. Yet just four years ago the Stelmach used the same arguments - that the regional health boards were government dysfunctional, unaccountable and unable to meet budget requirements - to do away with those same regional health boards and centralize health care management in a single board.

Specifically, Smith wants to fully decentralize health care management in the province. According to the Wildrose website, the party will "gradually decentralize the delivery of health care to locally managed and integrated hospitals, Primary Care Networks, family physicians, specialty centres, long-term care facilities and other health services....Solutions lie in empowering local decision-makers to determine the course of health care delivery based on the individual needs of local patients."

In short,  Wildrose will eliminate provincial management of health care resources and allow doctors and patients to manage it on a case by case basis. Each hospital and primary care centre will become self-managed.

First, healthcare management in Alberta has undergone major structural changes over the last four years. The Stelmach government destabilized healthcare with the elimination of regional health boards and the creation of Alberta Health Services. AHS certainly isn't perfect; it is still trying to find its way as an organization and requires time to do so. Would healthcare in Alberta be best served by fully dismantling AHS and introducing more instability and more uncertainty? To quote Andre Picard, health columnist at the Globe & Mail, "This kind of constant revamping of the management structure has interfered terribly with the stuff that matters: delivering quality care...Instead of fiddling with management structures, we need to fix our fundamental approach to delivering care – to put the emphasis on managing chronic disease and caring for people in the community and take it away from the outmoded approach of providing all acute care in institutions." (G&M, April 19, 2012).

AHS isn't perfect but blowing it up isn't the answer to improving stability, consistency and faith in Alberta's healthcare system. Smith hasn't proven that her proposal is any better than what we currently have and she has done little to expand on her ideas on healthcare.

A second Wildrose healthcare promise is to allow a mixture of public and private healthcare delivery. Alberta already has a mixed system. In fact, the vast majority of healthcare in Alberta is already delivered by private operators who work under a publicly managed system. Public healthcare is based on private operators billing and working under public management. More than 99% of doctors choose to work in this system.

So what exactly is Smith and the Wildrose promising? Or is Wildrose simply being disingenuous for promising something that already exists but few Albertans and Canadians are actually aware of?

In my opinion, the key to answering those questions is the Wildrose promise to allow patients to choose public, non-profit or private healthcare providers. In short, to encourage patient choice in the healthcare system. Decentralizing  and essentially eliminating public management of healthcare only makes sense if you plan to allow doctors to opt out of the current publicly-managed system entirely and operate with true independence. This is likely what Smith and the Wildrose really means by private healthcare providers. Like many of Wildrose's ideas this one isn't new or innovative; it is a return to healhcare circa 1960.

There are several problems with Smith's promises. First, as an economist Smith knows that demand for healthcare services is nearly unlimited yet supply of healthcare services is, for all intents, fixed in the short term. There is no way to quickly increase the supply of doctors, nurses, and technicians. It is not just a question of money or training but also of professional accreditation, which is tightly controlled. Thus, there is no way to increase the number of doctors working "privately" without decreasing the number that work in the "public" system, meaning they accept public healthcare management.

Smith's plan, assuming there is actually a well-thought out plan, is to pay for healthcare services in the private market out of the public purse. Exactly how is Smith going to control the cost of those services is unknown unless she also plans to introduce further price controls (this maybe what Smith means when she says she wants to emulate healthcare in Europe, which strictly controls what doctors can charge for services).  But she can't have it both ways. If Wildrose plans to allow doctors to opt out of Medicare they cannot simultaneously plan to control prices in the private market.

The Wildrose promise to pay for healthcare in the private market is more vapour than substance. What is likely to happen is that the Wildrose will cap what the public purse will pay for those services and allow doctors to extra bill patients. If a doctor who opts out of Medicare in Alberta, assuming Wildrose allows that, then Smith cannot limit what that doctor can demand for payment of services. Currently doctors really don't have a choice but to accept public management.

The other promise that Wildrose makes is to allow Alberta patients to seek timely healthcare in other provinces or in the United States. In essence, Smith is looking to reduce demand for healthcare services in Alberta by exporting that demand to BC, Saskatchewan and the US. This isn't a solution that BC or Saskatchewan will happily agree too.