The Current - Alberta opts for a public-private health-care system

Episode Date: November 24, 2025

Alberta says allowing doctors to work in the public system and bill patients privately will shorten wait times for everyone, while keeping costs down. But critics — including many Alberta doctors �� say the plan will make care worse for everyone.

This ascent isn't for everyone. You need grit to climb this high this often. You've got to be an underdog that always over-delivers. You've got to be 6,500 hospital staff, 1,000 doctors, all doing so much with so little. You've got to be Scarborough. Defined by our uphill battle and always striving towards new heights. And you can help us keep climbing.

Donate at lovescarbro.cairbo. This is a CBC podcast. Hello, I'm Matt Galloway, and this is the current podcast. The Premier of Alberta, Danielle Smith, says she has a fix for health care, a solution for those who are awaiting a painfully long time for hip or knee or cataract surgery. That fix, allowing patients to pay out-of-pocket for private care. She says letting doctors treat people willing to pay for quicker access while still seeing patients in the public system will improve care for everyone.

Here is part of the Premier's pitch made in a video released on social media. It's time to follow the lead of other high-performing health systems in Western Europe and Japan and build a modern, innovative, and 21st century health system that attracts and retains the best doctors working in the best facilities on Earth because health care shouldn't be about blind and outdated ideologies or politics. The reaction to the Premier's plan has been swift and divided, and the rest of the country is watching closely. Globe and Mail reporter Carrie Tate broke this story before the Premier's announcement with the leaked draft of the legislation. She's in Calgary. Carrie, good morning.

Good morning, Matt. What do we know thus far about how this plan would work? Well, what Alberta had plans to introduce, according to the draft legislation that the Globe obtained, is that it's creating three categories of doctors. One who would work just in the public system, as we know, but now, one just in the private system, and then a third category where doctors could toggle back and forth and bill both the government system, the public system, or bill privately. That's the big difference that right now there's no place else in Canada where doctors can work in both systems.

You have to opt in or opt out. I'd suggested in the introduction that this is around backlogs and wait times for surgery, but Matt Jones, the minister of hospital and surgical health services, said that this could possibly go beyond surgical activity. So how broad could this be? Well, the legislation or the draft amendments are written. So right now it would be wide open. And then the government would come in and put almost restrictions, I guess,

on their own system. So the framework is meant to be all-encompassing. And then the government reels it in. So what it looks like the government intends to do is implement, you know, the sweeping change and then reel it in. So it is limited to certain types of surgeries. Now, the video that the premier and the minister released came after the globe story. But we actually haven't seen legislation from the government yet. That is still to be tabled.

So we're really not sure. I guess the question is whether this would go, for example, to GPs, to family doctors, whether they would be able to move back and forth as well. And if people aren't able to get into see their GP, perhaps offer a faster path if you are willing to pay. From the information that we have right now, which is based on the amendments that the globe obtained and the video, the answer is no. But the amendments, the legislation, would create a pathway there where that is possible, up to the government to decide which boxes they want to check. You have reported on health care extensively in the province of Alberta for several years now. What is your sense as to why now?

Why is the Premier putting this forward now? I don't think the United Conservative Party hides that it believes in free enterprise. And it very much has argued for years that the health care system needs to be upended. We have not seen the party or the Premier float something as dramatic as this. Like there were no trial balloons around this idea. But this very much fits with the government and the Premier's belief. Do we know, I mean, people are watching this across the country. Do we know whether this approach would violate the Canada Health Act?

The critics, I think, are really quick to say this will or will likely violate it. I have to assume that the government has thought that through and that they are working on a way to thread that needle. but right now we really don't know. Right now we have draft amendments, which, you know, of course, we're still being polished and a video. And a video does not equate to legislation. So we're still waiting for, you know, the fine tuning.

In that fine tuning, just finally, what will you be looking for? Again, people are trying to figure out how far the Premier will go. We're going to talk about the objections in a moment. The details are still to be sorted out, but what are you going to be watching for? The Premier is going to have to thread a needle on protecting the public system if this is to win over critics and to have the system work that will this end up draining doctors, surgeons, from the public system to the benefit of private, or is there a way to actually balance this in like they pitch?

I guess we're going to have to see. We will wait and see. In the meantime, Carrie, thank you very much. We're going to talk more about some of those concerns in just a moment. I appreciate you being here this morning. Thanks for having me. Carrie Tate, a reporter for the Globe and Mail. She's in Calgary, and she broke that story, as we said, with the draft release before the premier officially announced it.

Dr. Brayden Manz is a kidney doctor, professor of health economics at the University of Calgary. Dr. Mans, good morning to you. Good morning. Thanks for having me. Thank you for being here. Your first blush on this was to say that these are your words. is definitely two-tiered medicine. Why did you react in that way? Well, this is definitely two-tiered medicine.

This is improving access for people who can pay. But unfortunately, the evidence from other countries that have this system say that it doesn't either shrink wait times in the public system or actually they go up because we're simply dealing with a scarce resource. And it's not just the surgeon. It's the anesthetist in the operating room teams who you need to do an operation. So when the Premier showed that, you know, somebody was coming off the list and somebody was coming on, well, unfortunately, the reality is when that person leaves the public wait list, they're taking their surgeon, their anesthetist, they're operating with them.

So it's not back in the public system to add that extra person on. So again, details are still to come, but she has said, the Premier has said, that there will be guardrails, that surgeons and the staff that support them still have to perform a set number of publicly funded, surgeries, that they would do any private work that they are engaged in on the evenings and on the weekends and on their own dime. What's the problem with that as you see it? Well, there's a couple of things. The government's announcements often talk about guardrails. And when they introduced chartered surgical facilities, which are taxpayer funded, but their private for-profit facilities where surgeries are done, they also talked about a lot of guardrails and that they would protect the public system. And as soon as those facilities opened and they didn't have enough

anesthetists, there was pushed back to the government and the government actually and ended up prioritizing the anesthetists to those chartered surgical facilities over the public facilities. So we don't have a good track record of actually standing by that. And physicians are independent contractors. They're not employees of the health care system. So it's actually really difficult to put restrictions on physicians. And that to you is, the key issue here that this is a story in some ways about scarce resources? This is a, I mean, we just have, because our system is run by governments, there's no long range planning, there's not good health workforce planning. So we have about half the physicians

that other countries do, that do operate this kind of system. And it's also important to remember that the UK, for instance, which is the best comparator. It has, it's kind of offering the additional services that patients can pay for, CTs, MRI, surgeries that Alberta's talk. about they've got more health care workers and physicians than we've got. But they haven't solved their wait time problem. And it's actually, it's not just a general wait time problem. What we're talking about is that some people wait a long time. It's the outliers that you hear about in the media. And others don't. We can talk about why that is, but this is not going to fix that. Can we talk about one of those people who's waiting? His name is Paul Ryan. He's

46. He waited two and a half years for hip replacement surgery in the province of Alberta and was asked if he would have paid to have the surgery done privately and sooner if that was an option. Have a listen to what he said. Yes, I would have 100%. It was that bad. My quality of life, I suffered every day. I was waking up angry, depressed. It was taking a real toll on my life. So I definitely would. At that point there, my wife and I both said we would have done anything. You can always make more money, but you can't get your health back. What would you say to somebody like, Paul, you can always make more money, but you can't get your health back? Yeah, so it seems like the problem that the premier is trying to solve is that it's it's currently not allowed to pay for

services that are provided within publicly funded health care in your own province but you can go to another province and get your hip surgery for $26,000 again the problem is that individual's been waiting for two and a half years that's because we don't have one wait list we have hundreds of wait list every surgeon has a wait list for the public hospital presumably he needed to be done in the hospital with the support of a hospital. We have a wait list for that same surgeon for the private for-profit chartered surgical facilities. And now we're going to have a third wait list, which is the one you can pay to get on. It's going to be very short.

It's going to be using the same resources. And so what's going to mean that actually we may have more outliers like that individual. Again, there are solutions to this central access and triage, a single waitlist for surgeries for some of the, you know, hernias. knee surgeries, those lower risk surgeries, and that will eliminate those outliers, and we'll really understand whether the waitlist, if we had a waitlist in a local region, whether that waitlist is too long. But do you think the system is working now as it exists right now? I mean, you talk about wait lists, in Beverly McLaughlin, when she was the Chief Justice of

the Canadian Supreme Court, famously said that access to a wait list is not access to health care. Do you think the system is working as it is right now? No, the system is not working as it is right now. But again, the problems that we have, not enough family doctors, long waits in the emergency room because we don't have enough hospital beds because we haven't planned to have the continuing care beds that we need, long surgical weights. The fix is actually becoming a more organized system, bringing doctors into the system, having a long-term health workforce plan. And governments simply don't do that when they're on a four-year cycle and they don't want to be seen as fighting with physicians. That's just not good for getting re-elected. So there are solutions, but this is like a solution to a problem that we don't have.

We've got problems, but it's not going to solve the problems we have. Do you think just finally, are we as a nation reluctant to have those big kind of gut check conversations about health care? Because it's so important to us, because it's wrapped up in our national identity. And I'm not saying that this is a solution or that this is the solution, but the people are reluctant to have kind of out-of-the-box conversations about how we might address the problem. if the system itself isn't working? Well, a couple of things. I think it's actually really difficult to understand how the system works. You know, when we started, in the 60s, we had, you know, the hospital and we had a couple of

treatments, we had the doctor, and it was kind of easy to understand how the system worked. And frankly, I don't, it's become so complicated and so many players have been added on that I don't think people fully understand, even physicians don't understand how the system works. So it's hard to float the solution to the problem that we actually have. But yeah, it is awkward to have the conversation. Really, what we're having, the conversation we should be having right now is if I can pay for my health care, is my relative priority in terms of receiving health care, am I more important than somebody who can't pay for health care? And the grand bargain with Medicare has always been equal access based on equal need.

And again, this is going to make that worse, that the people who stay in the public system are staying there because they can't have. afford to pay, and their health needs tend to be greater than people who can pay privately. So it's going to exacerbate that problem, and that's the awkward conversation you need to have. If you can pay, or should you get access to those resources, which I now can't have access to because I can't pay. Dr. Mans, good to speak with you. Thank you very much. You're welcome. Dr. Braden Manz is a professor of health economics at the University of Calgary.

This assent isn't for everyone. You need grit to climb this high this often You've got to be an underdog that always overdelivers You've got to be 6,500 hospital staff, 1,000 doctors All doing so much with so little You've got to be Scarborough Defined by our uphill battle And always striving towards new heights

And you can help us keep climbing Donate at lovescarbro.cairbo.ca. storm? You can take action to help protect your home from extreme weather. Discover prevention tips that can help you be climate ready at keep it intact.ca. Rosalie Watch is an economist and the associate director of research at the C.D. Howe Institute. She leads the health policy research initiative there. Rosalie, good morning to you. Good morning.

Premier says that this is going to, her proposal, is going to fix major issues, including doctor shortages, operating room, surgery, wait times. Do you see that happening? Well, I'd say that that's a pretty big sell and it'll certainly take time to see whether that's the case. But realistically, the devil is in the details and we don't yet have some of those details. So I wouldn't, I'm not confident about whether this will fix everything, but it is certainly unique in Canada. And it has potential to really change how health care is delivered in the province of Alberta, and if it works, I think the rest of the country will be watching to see how this goes.

Now, the rest of the country certainly is watching. Dr. Mann says this is two-tiered medicine, that if you can pay, you get to the front of the line, and if you can't, you remain in a public system. Well, I think that's certainly everyone's fear, but really, I think it really depends on what those restrictions the government might put on physicians as your first first, guest said right now it's kind of an open field, but the draft legislation does leave room for the government to restrict what services could be provided privately, you know, put limits on physicians where they have to provide a certain amount of care within the public system.

And so this isn't completely a free-for-all. The draft, as we've seen it so far, is wide open, but that doesn't mean that that's necessarily what's actually going to happen or what would happen over the long term. What do you make of Dr. Mann's final comment on that, though, that should we, we, as Canadians, be comfortable? That if you can pay, you get better care. And if you can't, then you will languish on a wait list. Should we be comfortable with that? I would say, whether we're comfortable with it or not, it already exists in this country. If you would like to get, say, a hip or knee replacement done privately, all you have to do is travel out of your province, which is, let's face it, additional time and cost.

because we're each insured provincially. So I'm not an insured patient in Alberta. I, someone that isn't an Alberta resident, could access private surgery in the province, but people that live there can't. So there's also an equality argument there should people that don't even live here be able to access a service that you can't.

How do we insure, again, to Dr. Mann's point, he believes a story about scarce resources, how do we ensure that this does not divert doctors and other resources away from a public system? I think that that's realistically a short-term concern. It's a real concern, but I think it's short-term. As the market adapts, when you think about it, this could be attractive to physicians.

It could draw physicians to the province to practice. You know, it might require investing in private sites of care and expand the total infrastructure for health care. So in a longer-term dynamic sense, the physician labor force can expand. Healthcare is pretty much the only industry where we talk about labor like it's a fixed quantity. But we broadly have a shortage of doctors and nurses and other health care workers in this country. If there's that shortage already, is it not inevitable that they will be drawn to a private system, perhaps where hours are more flexible, where there's more control, maybe they can make more money as well?

That is a possibility, but I think it's also, when you have a private system, they have an incentive to increase efficiency. And currently, a lot of services are not insured if they're delivered by a nurse or a nurse practitioner, but you can access those services privately. This all comes down to the technical definition of what is an insured service and what isn't. And so I guess what I'm saying is this could actually expand the number of providers that are able to provide different services within an existing family practice. Some primary care could be delivered by nurses and nurse practitioners, but it is a real thing. It's not just Canada. Globally, we are short on health care professionals.

So what that really means is the only way to actually improve care and access is to find new and more efficient ways of delivering care. And currently, I think, regardless of system, we could do a lot by just reducing administrative load and other things that take physicians away from patient care to open up those hours and providing an incentive for them to work on evenings and weekends. Really, the best way to expand access to care is to get the existing physicians to work more hours. That is a limited quantity, but over the last, 20, 30 years, we've seen that the number of hours that physicians actually spend with patients

has been consistently declining. So there's a lot more care we could get out of the existing physicians that we have. The country is watching and watching for the details, but also watching to see how this could play out, not just in the province of Alberta. Rosalie, we'll leave it there. Thank you for speaking with us. Thank you. Rosalie Wanch is an economist and an associate director of research at the C.D. Howe Institute, She leads the health policy research initiative there. You've been listening to the current podcast. My name is Matt Galloway.

Thanks for listening. I'll talk to you soon. For more CBC podcasts, go to cbc.ca.ca slash podcasts.