Bill 11
After announcing his intentions to allow private health care in Alberta many months ago, including a province-wide TV address paid for by the government, Klein has finally shown the actual bill he intends to pass. He also intends to send every Albertan their own copy of the bill, along with a helpful propagandapamphlet and a volly of TV ads, at a cost of $1.2 million to Alberta taxpayers.
Klein neglects to mention that Alberta spends the least percapita on health care in the country, and then insists that our public health system is in need of ``innovative new methods of funding''. My "innovative" method would be to increase public funding to exceed 1993 levels (currently health funding is at 93% of 1993levels) and move away from the current system of paying doctors on a per-patient-visit basis. Repeatedly ranked as the numberone concern of Albertans, the Health Care system received little increase in funding (especially considering the overwhelming debt loads of many of the Health Authorities) in the latestprovincial budget. This budget also includes ``an overall 15% cut in provincial income taxes'', mostly due to the introduction of a flat tax rate in 2001, which means most of the claimed $852 million in tax savings will be seen only by the wealthiest Albertans in tax brackets above $30 000 and $60 000 dollars. Why are taxes being cut instead of health care funding being increased? Moreover, why do Albertans suffer with the least spending per capita on health care (as well as high privatecosts) when they enjoy one of the strongest economies in thecountry?
Called ``The Health Care Protection Act'', to steer attention awayfrom its real intent, Bill 11 contains the following "highlights":
1. It gives the Health Minister numerous powers, such as the abilityto change what is an insured service and determine the terms oflicenses for each surgical facility, and gives these powers whileexempting the Minister from responsibility: ``No decision made by theMinister in the exercise or purported exercise of a power or thecarrying out or purported carrying out of a duty under this Act may bequestioned or reviewed in any court by application for judicial reviewor otherwise, and no order may be made or process entered orproceedings taken in any court, whether by way of injunction,declaratory judgment, prohibition, quo warranto or otherwise, toquestion, review, prohibit or restrain the Minister.'' This gives theHealth Minister total control of the Health Care system, with nopossibility of consequences if he does something ethically, morally orlegally wrong.
2. ``The Lieutenant Governor in Council may make regulations (b)governing the rates that may be charged (i) for enhanced medical goodsand services and non-medical goods and services that are provided to aperson who receives an insured surgical service at a public hospitalor a designated surgical facility, '' These clauses would easily allow"approved surgical facilities" to charge "facility fees", much likecataract (among other) surgeries now (infact, ``The Gimbel Eye Centre in Calgary and Edmonton is believed to have grossed $12 million last year, much of it from facility fees.'')
3. Throughout the document, reference is made to ``insured services'' and the fact that Alberta Health will continue to cover such ``insured services''. Nowhere is it defined exactly what will continue or not continue to be an ``insured service'', nor does there appear to be any defined review process for de-insuring services, besides the Health Minister simply changing them (again, without recourse). What is covered under Alberta Health today may change moments after this Bill is enacted.
4. There are allowances for "enhanced medical care"; this reads to me as though the ``approved surgical facility'' will simply provide some basic minimum procedure (covered by Alberta Health), while at the same time recommending to the patient some enhancement to that procedure and charge them whatever they like for it (this is happening currently with cataractsurgery: a better procedure is recommended by most of the doctors, yet it is not fully covered by Alberta Health and costs around an extra $750 per eye). If it turns out later that these fees were charged in error in some manner, it is up to the all-powerful Health Minister to recover those fees through civil court action and only reimburse the patient if the Minister happens to recover thefees!
5. The Health Minister can change the agreements with the individual facilities at any time: ``25(1) (j) authorizing the Minister to amend designations under Part 2 or to add, remove or vary a term or condition to which such a designation is subject;''
6. ``The Lieutenant Governor in Council may make regulations ... g) regarding whether a particular medical good or service is or is not an enhanced medical good or service or whether a particular good or service is or is not a medical good or service;''. This appears to allow for easy de-insuring of services and amending what exactly an insured service entails, raising further fears that currently insured services won't stay that way for long.
The biggest claim made in the highlights section, and the first clause of the bill, is that there will be no allowance for private hospitals. The only difference between a "private hospital" and the "approved surgical facilities" is that a hospital can provide emergency services, which likely aren't profitable anyway. Much mention is made about the fact that private surgical facilities will not be allowed to charge for "insured services", but no mention is made as to the process of changing what these "insured services" are; the Health Minister merely needs to issue a decree changing what is insured. There are also many clauses allowing for "enhanced" service to be offered at additional cost to the patient. Patients should be able to fully trust their doctor, and not have to wonder if they are being recommended something merely because it isn't covered and means more money for the doctor's clinic.
Klein repeatedly claims that private facilities will reduce waiting lists and allow for more surgeries, but fails to elaborate on how he envisions this occurring without additional funding for the public sector (which he claims will be paying for all these additional surgeries). Where will the additional funding for regulating these private surgeries come from? From a Medical Post article, ``Dr. Richard Plain (PhD), a health economist at the University of Alberta in Edmonton, said an increase in private services would not improve access or reduce waiting lists...'' Dr. Plain's assertion is backed up by the example of privatized cataract surgery in Alberta.
Klein seems to base his entire argument for allowing private hospitals on the assumption that private is automatically more efficient, which has been shown by many studies (examples here and here and here) to be exactly the opposite for health care. Klein, of course, spent minutes and minutes looking for studies to support his case, and includes one (out of the four he found) from 21 years ago which concludes that in some cases the higher administration costs of private facilities don't result in higher total costs. There has been no research looking into the costs of private procedures currently available in Alberta.
Quite apart from the economic arguments, however, is the increased influence that companies providing health care products would have in the diagnosis of patients as well as increased distrust of doctors; it would be naive to assume that doctors won't receive benefits (monetary or otherwise) for recommending one treatment/sugery/hospital over another (think of drug prescriptions now: how often does a doctor prescribe a generic drug vs. a specific brand name?), and this would allow increasing influence by corporate interests in doctors' offices (much like we are seeing in education, with things like Pepsi'sdeal with the University of Calgary, Coke's similar potential deal with McGill or YNN's deal to show "news" and advertisements in K-12 classrooms in exchange for money). Come on down to the Nike orthopedic clinic! Have your baby aborted at the Gerber Baby Emporium! Get your lungs treated at the Benson and Hedges Lung Cancer Centre!
This is already happening with cataract surgery in Alberta, where doctors push patients to pay for a ``better'' but uninsured option, at increased cost to them. Further, as health care becomes more and more a commodity rather than a public service, individuals must look out for their own interests and therefore become less trusting of doctors ("Is this really the best procedure for me? Is it being recommended for ulterior motives?"). This commoditizing of health care also means that the customers must become more educated about what they are getting and why; this isn't always possible or practical for the average user of medical treatment -- doctors spend year and years in school for good reason.
Premier Klein claims that his plan will result in better, more comprehensive health coverage for Albertans than a fully-public system, but fails to provide any compelling evidence that this is the case. There is, however, evidence -- including Albertan cataract clinics -- pointing to the fact that such a system will be more costly. Besides economic disadvantages, privatization of health care means it becomes less and less a public service and more and more a consumer item, which is bad for all involved (except medical corporations). I challenge Klein to instead simply increase public funding to the per-capita levels of the other leading provinces.