Tuesday, July 12, 2005

Health of a Province

Well, as much fun as it will no doubt be over the next week to watch Paul Martin dance around Klein's health reforms, I suppose it's only fair to examine them and see just how scary they really are.

In typical Klein fashion, everything is very vague:

The two politicians stressed that the discussion paper was only a starting point meant to encourage industry and public feedback.

"Nothing is cast in stone," Evans said. "We put the paper out to be consultative with Albertans."

So, presumably, a lot will depend on the public backlash or support these proposals receive. It also means that Klein may be leaving his successor with a huge hot potato. My hunch is that Jim Dinning is probably the least happy person in Alberta over these proposed reforms.

As for the reforms themselves, here are the highlights:

1. Allowing patients to pay extra to upgrade their hospital rooms or surgical procedures; for example, by paying extra to get a better hip replacement than is medically necessary.

2. Possibly tying how much a person pays for medications to how much money they earn.

3. Implementing an Electronic Health Record for all Albertans

(Note: by and large, I pulled those four points from news stories because the only official report I could find had such specifics as "Taking serious action on wellness" for its 12 points. I'm not sure I've ever seen a more vague report on health care...or anything. If anyone has a link for the full report, I'd love to see it.)

As much as I hate to do it, I'm actually going to give Klein some credit. A lot of theserecommendationss sound good. Yeah, I'm surprised to be typing those words. Electronic health records make a lot of sense. Tying medication costs to someone's income would (presumably) help lower income Albertans. And allowing someone to splurge for a first class room is hardly a two tiered system.

However, I think once you start to allow people to get private delivery of medical procedures, you're into a two tiered system. Klein and Evans said that there would not be private delivery of necessaryy" procedures so it really comes down to where they draw the line at necessaryy". Either way, you're dancing with two tiered health care, even if it isn't anything new (Quebec has been doing this for years).

Friends of medicare also raised the concern that this could lead to doctors pressuring patients to get these "bonus" procedures since they'd be cashing in on them. I'm not sure if that's a major concern, but it's worth keeping in mind.

Bottom line: These reforms in themselves aren't profoundly scary. A lot of them actually sound good and Klein deserves some credit for trying to do something with health care. However, I really don't like having two tiers, even if it is only for hip and knee replacements and I hope there's enough public backlash against that to force Ralph to back down.


  • Basing how much people pay for medecine based on income is actually an attack on universality.

    High income users should be paying more through their taxes for services, not up front.

    If high income earners are paying more up front for services, they will of course resist higher taxes to pay for better healthcare for everyone.

    Though, I expect that's Klein's idea.

    By Anonymous Anonymous, at 11:49 p.m.  

  • Hey there! I saw this link and drew my blog from that. It's fairly massive to digest but it's the only thing I can find. Still is quite vague though. Link to Alberta Health

    By Blogger Canadian Perasma, at 12:50 a.m.  

  • One of the most interesting points in the vague list on the press release was the second from last, which was along the lines of "increase the number of health care providers in the province".

    So, what does that mean? Is that a quiet way of saying "increase the number of procedures that are provided by private clinics"?

    As CalgaryGrit says, the rest were pretty vague, and had insufficient detail for anyone to either get particularly excited or to get their knickers in too much of a twist.

    I'll call myself Anon37 (just for fun!)

    By Anonymous Anonymous, at 1:26 a.m.  

  • I might be a little cynical but I wonder if Klein's musings on health care are just a way to distracting people from the fact that he's caving in on same sex marriage. A lot of things he said are pretty vague and are not hugely different from things he's said in the past. If it is a cynical ploy, it seems to have worked, since the media is focusing on health care rather than same sex marriage.

    By Anonymous Anonymous, at 3:20 a.m.  

  • The Alberta government discussion paper contains several elements that have already been implemented in other parts of Canada, some as long as 10 years ago.

    Ontario consolidated all health professionals under one regulatory regime in 1995 or thereabouts. it streamlined costs and more importantly allowed for some procedures to be delivered by others who had previously not been able to deliver them; nurse practitioners have limited prescribing authority, for example.

    The bed upgrade is old hat and exists elsewhere. Providing premium services at a cost above the basic service is also consistent with the CHA.

    Other provinces have also already consolidated drug plans into one management system. By doing this Alberta would be able to expand the number of drugs covered, especially high cost drugs for MS and so forth and add new ones as they become available that are proven to be effective in reducing other medical costs like hospital stays, lab tests and physician visits.

    Making rich people pay more for drugs is a waste of energy. Make sure that generics are available as soon after approval by Health Canada as possible and make generic substitution mandatory if it isn't already.

    In other parts of Canada, this policy initiative would be greeted by a giant yawn.

    By Blogger Edward Hollett, at 10:07 a.m.  

  • I have to say that the few details he gives - like private rooms - really are a yawn because we already have a lot of that kind of thing here in Ontario. And the vagueness is the usual kind of nothing from a politician trying to look like he is doing something. I'm inclined to think C. Banana might be onto something.

    At the same time, at least he is venturing out with some discussion, and, looking at the press and the blogosphere, he has accomplished that. Since the SCC decision and the initial chattering and proclamations, there has been dangerously precious little discussion about healthcare. As we posted yesterday over at Cerberus, one of Martin's top 5 priorities should be coming up with a broadstrokes policy statement on where he will take us and our healthcare system. Everyone accepts that we don't need all of the detail now, but simply crying "no two-tier healthcare" is not enough. (It also reminds me too much of Stockwell Day during the 2000 debates, and we all know what happened to him!)

    By Blogger Ted Betts, at 10:28 a.m.  

  • Ohhh... so scary two-tier health care is okay, when it means making "the rich" pay more for the same services as everyone else?

    By Blogger deaner, at 12:43 p.m.  

  • CG:

    "3. Implementing an Electronic Health Record for all Albertans"

    Look for a company named HUMANA to set up a Mastercard-based platform of Medical Savings Accounts.

    Does anyone remember that Alberta Health Care Card scare a while bacK? Here, let me refresh your memories:

    Calgary Herald. Calgary, Alta.: Oct 5, 2004. pg. A.1.FRO

    Health-care fraud and identity theft are occurring because the Alberta government has failed to keep track of more than two million duplicate or replacement health-care cards, Auditor General Fred Dunn fears.

    One government worker is assigned to monitor the abuse.

    In his annual report released Monday, Dunn criticized Alberta Health and Wellness for making it too easy for people to obtain Alberta health cards, potentially putting thousands of them into the hands of fraudsters looking to bilk the system or use health numbers to steal identities.

    Dunn could not say how much money was being defrauded from the health system, but pointed out even if one per cent of the province's $8-billion annual health spending was affected, taxpayers were being cheated out of $80 million a year.

    "We are most concerned about this whole area," Dunn said. "This is potentially a very large amount of dollars.

    "We did not feel that there are adequate resources applied to this area and that is why we have directed them to increase those resources."

    The annual report featured some of the toughest language Dunn has directed at the Klein government since he took office in 2002.

    The report criticized $389,000 in consulting contracts to Health Minister Gary Mar's former aide, saying there was no proof any work was ever done.

    Dunn blasted the government for not taking precautions to protect tens of millions of oilsands royalties.

    Mar said he was unaware health cards might be used fraudulently, and pledged to tighten the requirements for getting a health number. He said his ministry would look into the allegations Dunn laid out about misuse.

    "We're going to be putting the time necessary to deal with the issue in the future rather than trying to spend all of our time rectifying past issues," Mar said.

    Dunn charged Alberta Health ignored its own warning in a report from 1998. The ministry's health-fraud watchdogs raised the spectre of U.S. citizens using Alberta health numbers.

    In some regions near the U.S. border there were double as many health numbers as there were residents.

    For Americans without health insurance, medical costs in the U.S. can be astronomical. Alberta health cards would be money in their pockets.

    No work had been done since to address this problem, Dunn said, so he had his team of forensic auditors investigate.

    Their findings, reported Monday, include:

    - One Albertan was issued 60 duplicate or replacement health cards, while 32,440 people had received five or more;

    - 123 municipalities had two to four health numbers for every person counted in the December 2003 census;

    - In 2002-2003, the lone Health ministry worker who investigates health-card abuse reviewed 105 cases and found 54 of the numbers were ineligible. That investigation division had been downsized since the 1998 report, from two full-time staff and a part-timer to one full-time worker;

    - In a three-year period, seven duplicate health cards for one personal number were used for 330 visits to 37 health-care providers in seven different parts of the province.

    Mar noted in many cases, people will move out of the province then return, needing another health number. Alternately, a father or mother may require duplicate health identifications for their children.

    Opposition critics were stunned by the statistics and the lack of government safeguards.

    "Absolutely scandalous -- they can find enough money to pay for 230 public (affairs) bureau spin doctors, but they can't find two clerks or three clerks who are needed to look at questionable registration cases," New Democrat MLA Raj Pannu said Monday.

    Dunn offered scathing rebuke of three annual private consulting contracts totalling $389,000 that Mar's department gave Kelley Charlebois, his former chief of staff.

    Dunn said the contracts were not publicly tendered, there were no written contracts and no indication Charlebois did any work. He highlighted that Charlebois billed the government $100 per hour for travel time.

    Dunn said his audit showed "no support in any of the three years that explained why the services needed to be contracted. Further, there was no documentation explaining why a competitive process was not used."

    Dunn said the department has good contracting procedures in place, but they were bypassed in Charlebois's case.

    While denying he had any involvement in Charlebois' contracts, Mar admitted some mistakes had been made by his department in how they had been handled.

    He said Charlebois played a key role in advising the department on efforts to shift from 17 health regions down to nine.

    "There is a tangible result, although there is no work product in terms of a paper. We didn't commission him to do a report. He was asked to put together advice on how to make this work."

    Calling on Mar to resign, Liberal Leader Ken Taft said Dunn's report shows the Klein government has reached new lows in cronyism and sloppiness.

    "Clearly, the minister's friend, Kelley Charlebois, has received hundreds of thousands of dollars in taxpayers' money without any proper accounting," Taft said.

    "We have to ask, 'What in the world is this guy doing?'"

    By Blogger AWGB, at 12:49 p.m.  

  • I suspect the Klein government will listen to the degree of opposition about action 8 of the plan, and then may delist more services as they look to "Consider a new health care assurance act". The fight to keep services on the public list will be the next front of the war to preserve quality care in Alberta.

    By Blogger Manatee, at 1:07 p.m.  

  • CG, what is your take on proposal number 8? This is one I am most concerened about. The rest are trivial .

    By Blogger Greg, at 1:08 p.m.  

  • Thanks for the link Perasma.

    Greg; It all depends on where they draw the line on "critical". I'm not too keen on having joint replacements seen as bonus procedures but that's not really any different than other provinces.

    By Blogger calgarygrit, at 2:18 p.m.  

  • deaner; Ideally, the med costs would be the same for everyone. It does seem kind of odd to have high income Albertans pay more for prescriptions than low income but since they can afford to pay that much, I guess it's harmless enough.

    But yeah, you are right that it is a little unfair.

    By Blogger calgarygrit, at 2:20 p.m.  

  • On the meds proposal, I have to respectfully disagree CG. And I find it very very odd coming from Ralphie-boy. Let's not forget that the rich are already paying more for their healthcare since we have - and should have - a progressive tax system. My view is: progressive on taxing income, universal open door on the provision of the government service.

    Maybe I'm inconsistent, but I don't have a problem with discriminating based on income when the government takes, which is kind of the backend of government, but I have more of a problem with discrimination on the other end when the government provides, which is more the face of government to its citizens. Something a bit unsavory about that to me. Besides which, from an administrative/bureaucratic viewpoint, since we already distinguish based on incomes in a fairly efficient manner on the income tax side, why build another bureaucratic regime to distinguish on the provision side?

    ~TB @ canadiancerberus.blogspot.com

    By Blogger Ted Betts, at 9:47 p.m.  

  • cerberus: I agree on the universality of service, but if you're paying drug costs out of pocket anyways, it's not so universal. and healthcare premiums are barely means tested; on a student income while racking up debt galore I still pay almost full premiums. so, I like means-testing drug costs if the drugs aren't free and are necessary to one's health.

    By Blogger matt, at 12:46 a.m.  

  • Cerebus and Pole:

    On the meds proposal - One point that I'm surprised no one has mentioned on this is that it's not actually double dipping because we DON'T have a progressive tax system. In Alberta, the rich pay the same as the poor, a flat 10% tax on income over $15,000. So I don't see any problem with making them pay more for meds from that perspective.

    By Anonymous Anonymous, at 12:41 p.m.  

  • This comment has been removed by a blog administrator.

    By Blogger Manatee, at 3:08 p.m.  

  • I can't believe I'm not hearing more outrage that the report had nothing to say on eliminating premiums (at least I didn't see anything about them). For a province that has been musing about eliminating income tax in the not to distant future, you would think it would be on the table.

    By Blogger Manatee, at 3:36 p.m.  

  • One point that I'm surprised no one has mentioned on this is that it's not actually double dipping because we DON'T have a progressive tax system. In Alberta, the rich pay the same as the poor, a flat 10% tax on income over $15,000.

    Umm, no. Under a single-rate income tax (with or without a exemption threshold), the rich still pay more. For example, a person making $100,000 per year would pay $8,500, a person making $20,000 would pay $500, and a person making $15,000 or less would pay nothing.

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