Front Burner - Danielle Smith vs. Alberta’s health care 'monopoly'

Episode Date: September 4, 2024

As part of Premier Danielle Smith’s plan to dismantle the provincial health authority, Alberta Health Services, the first of four new replacement agencies began operating this week.Last month, Smith also talked about transferring some hospitals away from AHS to third-party health services. And with a government grant, a private company is developing a business case for a health services “campus” in Airdrie.So why does Smith want to divide up the health care system when other provinces are struggling to unify theirs? What role does she see for private companies in the system? And is her vision of “competition” in health a solution or threat for Canadian care?CBC Calgary producer and writer Jason Markusoff is back to explain.For transcripts of Front Burner, please visit: https://www.cbc.ca/radio/frontburner/transcripts

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hi, I'm Allie Janes, in for Jamie Poisson. So that's Alberta Premier Daniel Smith last month, talking about transferring some hospitals away from Alberta health services and giving them to third parties, like a Catholic health service, saying it would create competition in a quote, monopoly. She made these comments at a town hall that was only for members of the United Conservative Party. So we just heard them

from clips like that one posted by the web series, The Breakdown. But this is far from the only way that Smith has been shaking up health care. Last November, she announced a plan to break the AHS into four separate agencies, the first of which, called Recovery Alberta, officially started operating on Sunday. At every step of this restructuring plan, there have been big outcries about the possibility of privatization. So why does Smith want to divide up the health care system when other places are struggling to unify theirs? Why has the AHS become

a political target in the province? And as Canadians' frustration with their health care grows, is Smith's vision of competition a solution or a mistake. Hello, Jason. It is always wonderful to have you. Hello, Ali. So great talking to you. So before we get into the details of how this whole healthcare shakeup works, I want to start with Premier Danielle Smith herself. So since she ran for the UCP leadership two years ago, what has her attitude towards Alberta Health Services seemed to be? She's really working well in sync with the attitude of her Unite Conservative base, the party that she had to woo to become leader and premier two years ago. This is all in the shadow, like so much of our lives of COVID-19 and the pandemic and the restrictions. Danielle Smith, like her base, really raged against the restrictions, mask mandates, vaccine rules, the idea that you could lose your job if you were in the healthcare

system and you were not vaccinated for COVID-19. These were really big sore points for people. And they felt that the healthcare establishment in Alberta was betraying their values of freedom, liberties, right to choose, right not to be vaccinated, right to choose various treatments. And so there was a real animus toward the healthcare establishment in Alberta. And when we're talking about the healthcare establishment in Alberta, in Alberta. And when we're talking about the healthcare establishment in Alberta, there is one. It is AHS. This was the first major province to go with this unified health super agency. Other provinces have regions or hospitals that are sort of self-contained. In Alberta, Alberta Health Services up until recently has been the monolith, basically running

everything in the public health care system. We're talking 113,000 staff, 8,700 physicians, 106 hospitals. Wow. And well, given that people blame them for so much that happened during COVID, people who disagreed with the COVID rules, it's become a big part of Danielle Smith's target. Am I right to say that she's targeted this as like a wasteful agency, that the setup of this is wasteful? Wasteful, monopolistic, too large, almost too large to succeed. I mean, she doesn't use those terms like refund too big to fail, but that's sort of

the subtext of what she says. She was very proud that one of her first moves was to fire the Alberta Health Services Board and put in her own administrator to try to reform things because she knew that that was the big applause line for her base. So this is a management problem. It is not a problem with our frontline workers. Our frontline workers need to be supported. And when it happens in a business, when they fail to meet targets

and they fail to meet direction, you change the management. To begin effective immediately, Dr. John Cowell will step up as the official administrator of Alberta Health Services. Dr. Cowell, as you will hear... People have, like everywhere in the country, frustrations with the public health care system, the frailties, the shortages, the wait times, the congestion, the closures. So she thought that by making decisive actions on healthcare, people would see her not just in her base, but broadly as trying to be reformist. So in that way,

she was trying to, by doing all these things like firing the board of Alberta Health Services, she was trying to appeal not just to her base that really dislikes AHS, but also the public who wants to see some kind of movement on healthcare. And so let's fast forward to last November when Smith announced this big reorganization of AHS. Tell me about what the pitch was and how this was supposed to make healthcare better in the province. So this wasn't something she had campaigned on or promised six months earlier in the election last May. But in November, Danielle Smith announced that she was going to dismantle Alberta Health Services, this super board that had been running Alberta Health for nearly two decades. It used to be a

bunch of regions, and then they merged into this big central unit. And now she was dismantling it, but not again as a region by region group, like one for Edmonton, one for Calgary, one for the rural north and whatnot. She was dividing it it, but not, again, as a region-by-region group, like one for Edmonton, one for Calgary, one for the rural north and whatnot. She was dividing it into functions, sections. Starting today, we're creating an integrated provincial health care delivery system that concentrates on four priority areas. We believe that by creating specialized organizations within one provincial system, we will enable each organization to look after one area of health

care only and avoid the scattered and uncoordinated approach of the more rigid, centralized structure that exists now. So there would be one for acute care, that's hospitals, one for continuing care, that's like nursing homes, long-term care facilities, one for primary care, medical clinics, and one for mental health and addiction services. So from one big AHS monolith to four agencies, and AHS would be reduced to running hospitals within the acute care wing. A big bold move, and the trend, as you said in your intro, is to consolidate. People have been looking at what Alberta Health Services did, and other provinces like Saskatchewan and some in the east have been consolidating their functions, moving everything into one big umbrella.

This sectoral change is new for the country. And the UCP even put out an ad that was supposed to illustrate how this would help, right? Yeah, this was an interesting ad. It showed a bunch of people in a very busy waiting room. It showed a bunch of people in a very busy waiting room. And the voiceover talks about, well, what if people aren't waiting in the same area for continuing care or addiction services or primary care? And as people leave, there's just one happy family left, and then they get to be seen by their medical practitioner. A refocused health care system in Alberta means some of the people in this waiting room won't have to be here. This family could have a practitioner to call their own.

These patients could have more continuing care options. This person could be accessing mental health treatment, leaving fewer people in urgent care who can now access more timely acute care. Giving every Albertan the care you need. It struck me as curious because, may I take things too literally, but if I'm in one medical clinic, I'm not waiting with somebody

who's looking for mental health services and somebody who's waiting for a nursing home and somebody who's waiting for ER. Right, those are already divided. Yeah, so it was, I think that the symbol was the idea that there's too much in one system and we have to ease it. But using this waiting room metaphor, it was interesting, I'll say.

How have critics responded to this? Because as I understand it, they've kind of, you know, said that this could lead to even more of the chaos that people have been complaining about. So what is their big concern here? Yeah, I mean, there aren't a whole bunch of screaming Beeman fans of AHS in the province. But what people are concerned, I mean, nobody is, you know, nobody is, I love my healthcare provider, right? They like their hospital, they may like the services, they've treated their doctors, whatnot. But the healthcare bureaucracy, nobody's Right. They like their hospital. They may like the services they've treated, their doctors, whatnot.

But the healthcare bureaucracy, nobody's wearing their t-shirt in the streets or doing the wave outside of a hospital. But there are concerns. There's going to be this lack of coordination. You know, this was an argument by the opposition NDP when this happened. What if you're a senior who needs mental health services and you're hospitalized? Are you going to have to trip through three or four different agencies before you finally get settled? The integration has had its advantages. You're all under one agency's roof as you transition from services. And I think that everybody who's had experiences

in healthcare has probably had some kind of case of this. I mean, like my father, for instance, was hospitalized during COVID and transitioned rather fluidly after a while to a nursing home. I think a lot of people had that experience. If that's being divided under multiple agencies, does something like that become more complex? Right. Like, do people fall through the cracks because it's not clear what agency they're supposed to be treated by, you mean? That's right, or agencies playing tug of war.

The other concern, of course, would be now you have instead of one president, one org chart, you have four org charts and then one transition council to oversee it. Is there duplication? consolidating and centralizing is you have efficiencies. You now have four procurement systems, four HR systems, four accounting payroll systems for cleaning services. There are a lot of people concerned that change will be at very least bumpy. They're saying there's going to be transition costs. This is going to be new. There are going to be a whole several thousands, tens of thousands of people who need new business cards, for instance, because they'll be in a new agency.

So there will be these inefficiencies and these costs. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization. Empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years.

I've talked to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income? That's not a typo. 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples. This is not the only shakeup we could be seeing in Alberta health care. A couple weeks ago, the UCP held this members-only town hall, and Smith said that she was considering transferring authority of some of the hospitals away from AHS and giving them to places like Covenant Health, which is this third-party Catholic healthcare provider.

And so why would you want to do that? Part of it is that, I mean, she was speaking to this crowd again, the United Conservative membership base that asks her questions about why are you still letting these AHS leaders run the show? There are all these problems with AHS. There are still frustrations within the UCP grassroots about COVID rules, about vaccines, and they really want to make sure that not only that nothing like this can ever happen again,

and that's set up in rights and freedoms and rules and laws, but also that the people who did this are weakened or disempowered or somehow sanctioned or punished or ostracized, basically. So part of this is showing her base that she can further weaken AHS, that they're not running the show at all like they used to. But part of it is that she's this advocate of competition. I mean, and she's been, you know, a longtime conservative advocate activist speaking for and doing work for Fraser Institute, being on their podcast.

To me, it doesn't really matter whether something is delivered by the public sector, the private sector, the nonprofit sector, the charitable sector. It's a matter of having that interplay between them and the competition so that they're constantly working on creating new innovations. So she has been interested in various models of public and private health care. Creating competition in the system to Premier Smith's argument will only improve it that AHS will be, you know, might be getting too fat and happy with the way it runs hospitals. And if other people show better ways of running it, like Covenant Health or some other new currently unused third-party operators, then AHS will face competition to shape up itself or they will lose some of their facilities to these other providers.

I mean, she said at that town hall that she wanted to use not just competition, but fear to motivate AHS to basically to deliver better service. When you're dealing with a monopoly, and they believe that they can deliver any type of care and there's no consequences, but you're going to continue to deliver bad service. And competition is one option. That's why we're offering chartered surgical centers

and why we're offering Covenant. But the other is the fear of having it taken away. That's going to be a very powerful competitive incentive for the managers to say, oh my goodness, if we continue to deliver terrible care in Drayton Valley, then somebody else is going to be chosen as the operator. What do you make of that? It was alarming to quite a few people.

I mean, even the fact that she's talking about this idea of just changing the entire system of not only whether AHS runs continuing care facilities or mental health and addiction services, but whether they run hospitals at all. Changing the system from being public. You know, her UCP base will be very excited to be putting fear into the heart of AHS executives, but the doctors who work for them, the nurses, the staff, the people who are receiving care at those hospitals and those specialty clinics, how will they feel? And then the question is, what are the consequences of the solution? One of the consequences that's widely feared and widely discussed is that Covenant Health is an organization that runs several hospitals, including two in Edmonton, one in Banff, several around the province.

But because they are a Catholic organization, they are allowed to not provide services that violate the doctrine of Catholic faith, including abortion services, including maid services, end of life decisions. So there are concerns about giving it over to them. And of course, there will be a concern from a lot of people with a conservative government. Is this a backdoor way to promote a pro-life, anti-abortion agenda? It doesn't seem to be that way. Danielle Smith is avowedly pro-choice herself. But certainly this is about, in her mind, weakening AHS and either making sure they perform or giving up their,

their what she calls a hospital monopoly. Another thing I saw a couple weeks back is that the city of Airdrie is looking at a quote-unquote campus that would group together a whole bunch of different healthcare services. And can you just tell me a bit more about what that campus would look like and why some people have been really concerned about this idea? So let's situate listeners. Airdrie is a small bedroom community north of Calgary, 80,000 people. It's actually the largest community in Alberta without a hospital. It's been growing rapidly. It's like nearly doubled in a couple decades or so. They have a small urgent care center right now, which is not serving their purposes. People are often told to go to Calgary. So there is a doctor and healthcare entrepreneur

in Airdrie who's pitched to the Smith government, the UCB government, a private campus which mixes an urgent care center with the primary care doctor's clinic. And right now, the government has offered money so they can develop a business case for this. It's being pitched by the private sector as a prototype for what other fast-growing communities can do for public health care activists and advocates. This is very disconcerting. This would be the first time an urgent care center, quasi-hospital, would be run by a for-profit organization that is very foreign to Alberta and the Canadian culture. You know, there's always these fears from progressives and

public health care advocates. Are we going toward more of a profit motivation model? Certainly the UCP and Daniel Smith, Premier Jason Kenney before her, have been shifting some surgeries, contracting out some surgeries to the private clinics, to private sector clinics, all being run by the single payer public system. So people aren't picking out their credit cards to have to pay for these services. a single payer public system. So people aren't picking out their credit cards to have to pay for these services. This would be a new thing, having a private company run an emergency or urgent care clinic. We'll see if it goes ahead, but Danielle Smith's interest in moving power away from AHS, experimenting with more privatization and competition, this seems like it could well be within her government's wheelhouse to pursue this option. You know, looking across some of the other healthcare policies under the UCP, I mean,

you kind of just touched on this, but I wonder if you see a pattern here. Like what kind of role does Smith seem to see for private companies in healthcare? She sees a lot of promise. They know that the idea that people paying for healthcare, the way healthcare is set up in the States puts a fear of privatization and private healthcare services in a lot of people's hearts. Daniel Smith sees a potential there. They see a potential to ease wait times with surgery by contracting out to the more efficient, potentially more cost-effective private sector. The question is what happens when it's just one single payer? If there are several competitors all for the same contract, all for the same public payer,

is that going to reduce things or is it going to create a bunch of inefficiencies, a bunch of problems? And just will people try and drum up business for themselves, inducing more demand for healthcare services by providing, you know, more costly diagnostics and billing the government, just jack up the needs of healthcare and the services provided? Are we just going to treat ourselves into near bankruptcy? You know, but the other part of this, I think why the public is not revolting about this, the public is not up in arms. First of all, nothing's really happened yet. There have been no, no major changes. As you said in the intro, the mental health and addiction services agency just started on September 1st.

So nothing major has happened. I think people are open-minded to try to change the healthcare system that people want to see something changed, something that something may have to give because right now the system is, you know, where there are ER shortages and closures in small communities all the time. It seemed like that was a constant all summer long as people go on, doctors go on vacation, ERs close. You know, people don't find that acceptable. Yeah. We saw a bunch of that in BC over the weekend, I think in the interior of BC, a bunch of ERs closed. Yeah, it's nationwide.

It's chronic. It's not just Alberta, but people see it in their own communities in Alberta and they think we need change. So what Danielle Smith is able to do with some of these announcements and plans is saying, I'm trying to change the system. I'm trying to do something.

And so far the public is letting her wait and see about what those changes are, how they take shape, and what outcomes they have. Right now, she can say, give it time to work. Politically, Jason, I'm wondering what you make of the timing of these changes to health care, and especially of the timing of Smith's recent comments threatening the AHS, essentially. Is there a reason that she'd want to deliver a win for the parts of her party that are, as you were talking about earlier, still really upset at the AHS over COVID right now? Yes.

In a couple months at the start of November, Danielle Smith and the UCP hold their annual general meeting, their convention. And there she has a leadership review. And like I said, her base is still very animated

by bitter memories and frustrations and layoffs and cuts and mask mandates with COVID. So she knows that criticizing AHS, threatening to weaken it, dismantle it, sanction it, put fear in AHS executives, shrink their mandate. That is good for the base. That has a lot of purchase in her base. I don't know if she's not using the, we're breaking it into four organizations. We're going to have a separate agency for continuing care as an applause line. But certainly we have sacked the AHS board and we're changing AHS as an applause line for her base.

And she's doing several things to entice her base, talking about new changes to the Bill of Rights, really fast-tracking a tax cut, potentially cutting services to pay for it. She is right now, from now until November, really focusing a lot of her attention on what the UCP grassroots want. And that as a group, based on their interest in COVID, is likely different from what the rest of the public in Alberta wants. They just want basic good healthcare, want basic schools to function well, want more infrastructure.

There are different interests, more niche interests from her UCB base, but she's going to be really focused on them because she knows that when the United Conservative grassroots don't like a leader, they turf them. They'll bounce them out. Jason Kenney during COVID or in the aftermath of the COVID pandemic. And so she knows that she needs to keep that group happy. And she has the comfort of being nearly three years away from a general election. She doesn't quite have to get to the general election and the general public yet. All right.

Jason, always wonderful to talk to you. Thank you so much for this. Thank you for having me on. All right, that is all for today. I'm Allie Janes. Thank you for listening to FrontBurner, and we will talk to you tomorrow.