By Sandra Azocar, December 21, 2020
As 2020 winds down, I look back with appreciation at everything that Alberta’s public services have accomplished to keep Albertans healthy and safe. When this year began, we could not have imagined the challenges we would face with a global pandemic and the impact it would have on the people of Alberta. We had to adapt quickly, and the resolve, professionalism and commitment shown by health care workers and all essential workers to maintaining vital services was truly impressive.
While COVID-19 continues to impact our day-to-day reality, many of us have been reflecting on the critical importance of our public health care system. As we look around the world at various countries’ responses to this unprecedented health crisis, It has become especially timely that we fortify our commitment to a system based not on profit, but instead on the shared belief that health care is a human right. Unfortunately in this province, during one of the worst health crises we have ever faced, our government has doubled down on their efforts to undermine and erode our public health care. Instead of seeing greater support for our health care system and the workers who keep it going, we are seeing this crisis being leveraged to usher in legislation and initiatives that only serve to pave the way for ever more privatization of our health care.
2020 has been an excruciatingly long year, and trying to capture the measures that have been taken by this government makes this year even more painful to deal with. I tried hard to look at redeeming actions so as to provide a balance account, but when these actions deny people their human rights and the supports they need, it is hard to accept.
If you recall, in May of 2019 The UCP appointed Janice MacKinnon to chair the Blue Ribbon Panel, and to look into our province’s expenditures. The panel was given a very narrow mandate to examine expenses but not revenues, and was tasked with recommending a path to a balanced budget by the year 2022-23, without raising taxes. The panel released its report on September 3, and the recommendations included massive cuts to public services, which served to directly inform the UCP's future policies and financial planning.
In the area of health care, the panel recommended "transformational change in the way health care services are delivered and health care professionals are compensated." Most concerning was the recommendation that the government expand the role of private health care in Alberta. The recommendation that the province look at the “use of alternative service delivery for day procedures and other services that do not have to be delivered in hospitals and could be delivered in private or not-for-profit facilities,” was and it still is the wrong and irresponsible direction to take. Private health care maximizes price and cost as well as waste, so it systematically erodes global cost control, which is one of the essential strengths of any public health system.
Then, in February, 2020, the government released the $2 million Ernst & Young (EY), review of Alberta Health Services, with a focus on economics and finding efficiencies in the health care system. With these reports in hand, the world and Alberta was hit by the COVID-19 pandemic.
In March, at the start of the pandemic, the government pushed through Budget 2020, based on unrealistic forecasts for oil prices and subsequent unfeasible estimations for government revenue. Considering the economic impact that a pandemic would have on all Canadians, it was clear that what this government needed to do was to push the reset button, and go back to the drawing board for Budget 2020.
Following the release of this budget, this government continued with their legislative agenda by passing a series of grab-bag omnibus bills which prevented the opposition from properly reviewing and debating the bills. Among these bills was Bill 30: Health Statutes Amendment Act, which put Alberta on track to create a market entry point for private health care companies. This omnibus bill made sweeping changes to Albertans’ health care, including repealing or changing 9 pieces of existing health legislation.
The changes contained in this bill have the potential to turn over our resources, health care dollars and staff to private corporations. The bill itself followed several of the recommendations made in the EY performance review of Alberta Health Services (AHS).
Highlights of Bill 30 include:
- The Health Care Protection Act would be renamed to the Health Facilities Act, and would lower the bar for the approval of new private clinics and private surgical facilities. The current Health Care Protection Act (formally known as the infamous Bill 11) resulted from hundreds of thousands of Albertans standing up and protesting against then-Premier Klein’s ongoing attempts to establish a parallel private health care system in Alberta.
- Under the guise of ‘choice’ non-physician corporations would be able to employ doctors — corporations whose ultimate goal is profit.
- The number of public members appointed by the minister to sit on regulatory colleges would be doubled, enabling the government to stack councils with their supporters.
This bill is a destructive piece of legislation intended to erode the public delivery of health care by establishing and encouraging a market for much greater corporate involvement by enabling private companies to receive public funding for publicly funded services (and then directly subcontracting/employing physicians) and cross-subsidizing private-pay (uninsured) services. It sets the stage for the potentially significant shift to for-profit delivery of acute care, diagnostic imaging, labs, and primary and community care services.
Shortly after this bill was passed, this government moved to establish a "Health Contracting Secretariat," whose focus is on building the health care delivery market and reducing barriers to market entry for larger corporate players. The Request for Proposals indicated that this secretariat would be used to build internal markets for outsourcing surgeries and imaging (getting public and private sectors to compete on price per procedure, purchaser/provider split, etc), and entrenching private sector actors.
Private surgical facilities
Since early in their mandate, the UCP has been touting their Alberta Surgical Initiative. Despite the COVID-19 pandemic, Health Minister Tyler Shandro has doubled down on looking to the private sector rather than expanding surgical capacity within the public sector. The pandemic has since forced AHS to cancel non-urgent surgical procedures from March 18 to May 4, leaving a backlog of about 25,000 surgeries. By September, 88% of that backlog had been eliminated according to the government, and health facilities were doing about 85% of the volume of surgeries they did prior to the pandemic. Shandro himself identified that Alberta recovered faster than other provinces in part by ramping up summer surgeries, working on the weekend and hiring more staff—a sure indicator that these public solutions could reduce wait times and surgical backlogs even in non-pandemic times.
Two issues here that need to be highlighted as the government pursues the contracting out of our surgeries to private corporations:
- The volumes guaranteed to entice players into the market will likely have to be here to stay post-COVID. Contracting out the simple stuff will throw off the case mix in public hospitals—there are only so many day procedures and low acuity patients they can send to for-profit facilities within the current regulatory structure.
- They will need to allow more complex/higher acuity surgeries within private facilities in order to guarantee sufficient volumes to encourage players to enter the market—and that’s what the for- profits will tell the government.
While this government has spoken non-stop about the financial unsustainability of our health care, and the need for fiscal restraint, what is not shared with Albertans is how much contracting out our public health care will ultimately cost to the citizens of this province, nor any comparators of how much it would cost to instead increase in-hospital capacity or build public infrastructure in the interest of the public good.
Once the legislative framework for this privatization starts taking shape, we start to see who really intends to profit from our health care. Through a story released by the CBC in August, we learned about lengths that this government will go to in order to push their privatization agenda on Albertans. A new private orthopedic surgical facility—the largest ever in Alberta—has been proposed on the site of Ericksen Nissan, next to the Royal Alexandra Hospital in Edmonton, and has already gained the Minister of Health’s “tentative political support.”
5 orthopedic surgeons, the Principal Advisor for the Minister of Health, lobbyists, and representatives from Ericksen Nissan have all come together, hired an architect and have had ongoing ready access to the Minister of Health. This deal shows unequivocally how ideologically driven health care delivery objectives are mixing with political influence and interference in this province. Behind closed doors, away from any public accountability, scrutiny, or oversight, the Minister of Health has given ready access to those who seek to profit from the poor health of Albertans.
Under the proposed terms of this backroom deal, the $200+ million, 5-7 story private surgical facility would be tasked with performing all insured minor surgeries, while the public system would be left with the more complex cases. This deal ensures that the government—meaning every single Albertan—would assume all risk if this privatization experiment does not work out. Albertans must remember that when the same type of “business model” was tried at the Health Resource Centre in Calgary they went bankrupt, leaving Albertans on the hook for millions of dollars and over 900 surgeries to be brought back under the public system. Those leading the project for the new private facility intend to make the contract so tight that if any other government is elected it would be prohibitively expensive to cancel. They also propose that they will be ‘saving’ money by hiring non-unionized staff, creating risk of underpaid and overworked staff, and poorer health outcomes for patients.
Ideologues, like Minister Shandro and Premier Kenney, insist that contracting out is benign, because services are still paid for with public money. This is far from true. Contracting out surgical facilities is more accurately described as a corporate subsidy, and it is about the most nonsensical way to use public money that you could think of if you tried. Past attempts to privatize surgeries in this province and across Canada have shown that private delivery of surgical services costs more than public delivery, and contracting out means that the public loses our right to see what we are paying for services from private suppliers, and are denied any input on how to provide or change services.
This project is not about shortening wait lists, providing better care, or improving the health care system; it is about the privatization of our health care. Systemic changes are needed to address Alberta's health care issues, but they must be in line with the vision of improving on the solid foundation that we already have within our public system, and improving our existing public capacity. Unfortunately, as we have seen, that this government is not interested in public solutions, because that would mean this government would have to truly believe in the value of public health care.
Privatization of lab services
As one of their first moves as government, prior to even being sworn-in, the UCP announced that the $590 million laboratory hub project would be put on hold until they had the opportunity to “review the project.” Very soon after this announcement, then-Premier elect Jason Kenney claimed that the project would “do nothing to improve patient services,” a claim which is both inaccurate, and patently disrespectful to laboratory workers and the vital work they do for Albertans. Reporting from the Edmonton Journal showed that our current lab system is outdated and overwrought, and without a plan in its stead, this halt to what was to be a major expansion for our public medical laboratory services puts Albertans’ health care in jeopardy.
Through subsequent news reports, Albertans learned that physicians had been instructed not to buy any new equipment that couldn’t be moved or would be too expensive to move to the new facility: “As ‘shoestring inventors,’ laboratorians have been repairing outdated machines by cannibalizing parts from other broken ones.” Minister Shandro responded that AHS is responsible for making equipment purchasing decisions. But while politicians and government agencies play the blame game, Albertans are still waiting to hear how and when this important service will be delivered.
In October 2019, the existing leadership of Alberta Public Laboratories was suddenly removed and the name quietly changed to Alberta Precision Laboratories. The name change and the removal of the word ‘public’ signaled the inevitable move towards privatization in Alberta's medical labs, following the recommendations made in the Blue Ribbon Panel. Unsurprisingly, EY’s AHS Review also recommended that the province contract out our medical laboratory services. Prior to Alberta’s COVID-19 outbreak, the government had already sent out a Request for Proposals, and we were well on our way to putting this integral part of our health care up for grabs to the highest bidder.
This pandemic has shone a light on the impact of publicly delivered and funded lab services in providing the capacity for timely and effective diagnoses for those impacted by COVID-19. To date, Alberta's labs have administered over 2.6 million tests and have tested over 1.6 million Albertans, exceeding the number of tests administered per capita than almost any other jurisdiction in Canada, thanks to the excellence of our lab professionals. Dr. Deena Hinshaw, Alberta's Chief Medical Officer, credited the province's centralized public lab, Alberta Precision Laboratories (APL), as the primary factor in our ability to test so effectively. Our lab, in spite of years of neglect from consecutive provincial governments, has responded admirably to this unprecedented health crisis, and will no doubt be pivotal to seeing Alberta through this crisis and beyond.
For years, many Albertans, including front-line laboratory workers and pathologists, have opposed the privatization of our laboratory services. And now more than ever, Albertans are witnessing firsthand the direct link between the lab and their health. Private, for-profit contracts remove the ability of the public to provide ongoing input to improve the system, and they minimize public oversight over the quality of services. Rather than transferring Alberta’s public health dollars to private investors by contracting out our medical labs, we should learn from the COVID-19 crisis and invest in improving and expanding our public medical laboratory system that has proved so invaluable during this challenging time.
It is when a system is under stress that we see the cracks. COVID-19’s toll on Alberta’s continuing care system has exposed many of the long standing issues wrought by decades of privatization, and the inequity created by perpetual cost-cutting. Seniors in continuing care facilities count for over half of all COVID deaths in Alberta, and the numbers continue to rise. As of December 18, a total of 815 Albertans have died of COVID-19 to date, 488 of whom were residents in continuing care facilities. What we are seeing now was decades in the making.
For decades FOM and seniors’ advocacy groups have been sounding the alarm over the issues in our seniors care. We have repeatedly called on governments to get profits out of seniors' care, and to enact patient-staff ratios to deal with the unsustainable workloads which lead to burnout for the staff, and degrade the quality of care and attention for seniors in care. We have called for an end to the privatization of seniors’ care and to the subsidization of the building of privately owned and operated supportive living facilities. Yet over decades we have seen a drop in funding such that staff do not only provide personal care but are also tasked with housekeeping duties, creating a real danger of cross contamination, now more than ever. It has become a race to the bottom when it comes to providing quality care for seniors and more offloading of costs and care to seniors and their families.
On July 9th, 2019, without a media release or formal statement, Health Minister Shandro announced on Twitter that the Affordable Supportive Living Initiative (ASLI) will continue under the UCP was made with a photo op at the Silverado Seniors Village, owned by Park Place Seniors Living. The ASLI program allows the government to provide up to 50% of funding for construction costs, followed by operational costs to run these facilities
The EY review made recommendations that would perpetuate the existing crisis in our seniors’ care, including the sale of Carewest and Capital Care to private providers as a one-time revenue source. The report suggested that Alberta could see estimated savings “in the hundreds of millions of dollars” through the sale of the two public care providers, but the public has yet to see any real numbers to back this up, nor any consideration of the potential impacts the sale would have on working and living conditions at these sites.
Besides the further privatization of continuing care, the report recommended that AHS convert Long Term Care (LTC) beds into Designated Supportive Living (DSL) beds—in other words, reassess those individuals needing 24 hours care for ‘unscheduled’ medical needs to lower levels of care—is equally specious. This change would mean that residents would be considered to have lower staffing needs, and would remove Registered Nursing from seniors’ care. Staffing has been a long overlooked issue in our continuing care system: LTC in Alberta rarely meets benchmark criteria for minimally acceptable care, and private facilities have the greatest average deficits below minimal care. These deficits put patient health at risk every day, and as we have seen during a health care crisis like COVID-19, this risk surges.
While AHS provides funding to seniors’ facilities for staffing, including health care aides, licensed practical nurses, registered nurses etc, no strings are attached to this funding to ensure that 100% of it is spent on staff. The current funding structure creates incentive for both non-profits and especially for-profit providers to pursue a low-wage strategy for their staff, where many are treated unequal in pay benefits and workplace rights in comparison to those of similar education and experience working at public facilities. This lack of accountability and transparency are a disastrous mismanagement of public dollars.
For decades, calls from advocates, workers, and families, for action to address the crisis in our continuing care system have gone unheeded. Now, we are seeing the impacts of our governments' inaction unfold in the devastating effects of the COVID-19 pandemic. In May the Alberta government announced that they would be committing an additional $170 million for AHS-contracted continuing care facilities, to offset the loss of ‘revenues’ that have resulted from this pandemic. Although the government said there would be a “requirement to report on the use of these funds,” and that facilities will need to “return money not spent on COVID-related purposes,” there was absolutely no indication that this reporting will be made public.
In August, 2020, Health Minister Tyler Shandro doubled down on this privatization path and introduced a ‘new approach’ to building more seniors’ care facilities. He indicated that the first part of this approach would involve opening a mere one-month long bidding process to corporate and non-profit organizations who can identify “underutilized space” in existing buildings that can be converted into new publicly-funded, privately-delivered continuing care beds. As of now, the government is uncertain how many new beds this program will secure, how many additional staff will be needed, or how much this will cost the public.
It is beyond comprehension as to why this government refuses to learn from the ongoing public health emergency that is COVID-19, despite the glaring light it has cast onto the long-existing cracks and weaknesses in our seniors’ care system. We have provided for-profit operators over $200 million in public funding since this pandemic started, and it appears the government is content to continue to subsidize a system that is truly in crisis. Once this pandemic is over, it is imperative that we do not return to the same old structure of continuing care that allows corporations and their shareholders to profit massively at the expense of Alberta’s seniors. It will not be enough for us to return to normal, because in Alberta’s continuing care, our normal is woefully flawed. Even when the public health emergency orders are lifted, and the brunt of the threat of COVID-19 has passed, the devastating toll that it has taken on our seniors should serve as a harrowing reminder of the failure of our seniors care system. This health crisis must serve as a grim, yet timely indicator to our government that we need an immediate re-evaluation of how we are providing seniors’ care in this province—and that means bringing seniors care under the public umbrella, full stop.
War on front-line workers
Over the past several months we have seen Health Minister Tyler Shandro opt to engage in a very public dispute with Alberta’s physicians, rather than to return to the bargaining table. With the introduction and passing of Bill 21: the Ensuring Fiscal Sustainability Act, Minister Shandro announced that his government would be terminating the long-standing contract between the Alberta government and the Alberta Medical Association (AMA), and, as per the MacKinnon Report, using “legislative options” to make changes to physician compensation. The government implemented a new physician funding framework as of March 31, 2020, and physicians were encouraged to move to a Clinical Alternative Relation Plan (ARP) payment model. This decision to unilaterally end its long-standing master agreement with Alberta’s doctors represents a dangerous precedent in the manner in which this government is willing to push forward their agenda.
As part of the new physician funding framework, they also outlined 11 consultation proposals that will not only negatively impact the financial bottom line for family physicians, but also for Albertans themselves. Some of changes included:
- Seniors' Driver Medical Exams that are now to be paid out-of-pocket, as will referrals for diagnostic imaging from practitioners like chiropractors, audiologists and physiotherapists;
- Physicians will no longer be able to submit good faith claims for patients who can't provide ID, a change that disproportionately impacts vulnerable Albertans, and individuals experiencing homelessness in particular;
- An end to clinical stipends, impacting rural care especially.
These proposed changes would alter the rates at which doctors can bill, including cutting funding for complex care plans, and restricting doctor pay for 25-minute visits to the same as for 15-minute visits. Alberta doctors are anticipating that they will have to close their practices or even leave the province due to the changes imposed by this government. This bill also limits the number of physicians allowed to practice in a given area of the province, as well as the number of physicians allowed per practice type or specialty. Family doctors in particular, and especially rural doctors, have expressed worry about the impacts this would have on their ability to provide the care that their patients need. The Alberta Medical Association has called the proposed changes "troubling."
In April, 2020, the AMA filed a statement of claim against the government, holding that the government violated doctors' charter rights by passing legislation that gives political leaders the power to unilaterally end their deal. And, in the last few months we have seen doctors coming together to advocate for themselves, their patients and our health care system. Doctors know that this change will threaten the viability of community and primary medical practices across the province which form the backbone of health care for patients. This very public dispute has created stress and uncertainty for those that rely on our health care system, and it will mean that patients without good, comprehensive primary care will ultimately be forced to higher cost areas of our health care system such as emergency departments and admissions to hospitals
In fairness, some of the changes were deferred during this pandemic, but they were not overturned. While the Minister has since “suspended” provisions related to the amount of time that physicians can see patients, and has put changes to some stipends on pause, the government has nevertheless continued forward in imposing their previously announced plan for physician billing. These changes have resulted in a number of doctors handing in their notice to resign from their hospital privileges, in some cases leaving rural communities without obstetrical and ER services. A number of primary care clinics have also closed their doors as a direct result of the governments’ funding changes to the Schedule of Medical Benefit Claim fees.
With a targeted attack against the physicians who provide our primary care, our government decided to make use of this health crisis to tout a corporate relationship with Babylon-Telus’ virtual care platform, rather than supporting doctors within the public system to utilize public online platforms. There continues to be lingering questions regarding the data and privacy compliance of this platform, which was created by a third party and which has access to our health care information through Netcare.
Meanwhile, negotiations with nurses and other health care professionals have also been “temporarily” suspended, though there has been no assurance that this government will not follow through with proposed cuts to front line workers once the pandemic is over. In October, 2020 the government announced that, as part of AHS’ implementation of the EY review, they would be outsourcing thousands of health care positions to private vendors, including 2,000 laboratory jobs, 4,000 housekeeping jobs, 3,000 food service jobs, and 400 laundry jobs. All those Albertans who are continuing to work tirelessly to keep our health facilities clean and safe during this pandemic, will likely be on the way out after the threat has passed.
Then, on October 26, front-line hospital workers across the province walked off the job in a a wildcat strike, to defend their jobs and the public health care system that keeps Albertans safe and healthy. Friends of Medicare was proud to join them on the picket lines, as our province's vital health care workers made it clear to this government that they will not sit idly by while attempt are made to contract out this essential work.
This government declared war on the front line health care workers of this province when they announced they were cutting over 11,000 good health care jobs at a time when Albertans are already struggling. Even in the face of a global pandemic, while health care workers have proven themselves as the first line of defense in the province’s pandemic response, this government merely paused the layoffs of an estimated 16,000 health care workers province-wide. The plan to contract out and privatize their jobs is an insult to workers, and a betrayal of the patients who depend on them.
Let’s seize the moment to work for systemic change!
As Albertans continue to navigate one of the worst health crises that we have ever experienced, we find ourselves in an unprecedented political moment. As we end 2020, a year that has challenged our entire society, we have also been provided with an opportunity to reassess our priorities as individuals, communities, and members of a society at large. More than ever, we have been empowered to act collectively for the well being of everyone, a collectivism that embodies the caring and compassion that is necessary to advance society in the interest of the public good.
This is not the first health care crisis that Alberta has seen, and it will not be the last. We have a responsibility to ensure that once the dust of this particular health care crisis has settled, our vital public health care system is not left to be squandered and privatized. Rather than seeking out short-term solutions in the interest of fiscal balance, it is imperative that our government must instead learn the difficult lessons of this pandemic and commit to putting the interests of Albertans first.
Our province will soon find ourselves in a moment when we will have to make critical financial decisions, and Albertans will be looking for leadership and demanding a real commitment to our public health care. Once we emerge from this pandemic, the political will to expand our public health care will be more crucial than ever. As has been made abundantly clear in 2020, profit has no place in health care, full stop.
On behalf of the staff and board of Friends of Medicare, I’d like to wish you all a safe and happy holiday season. As we reflect on the challenges of the past year, and consider the challenges undoubtedly yet to come, we invite you to join us in what will undoubtedly be a fight to protect our public health care from the perils of privatization. In this strange and uncertain new year, let us resolve to stand up for our vital public health care system when it needs us most.
Friends of Medicare