Third way health care

Yesterdays announcement of the ‘third way’ health care reform platform by the Alberta Government has been described as timid, ineffective, and vague by some. For others it represents the thin slice of the wedge between private and public health care, threatening to undermine the public system. Is it possible both could be true? Yes. Is this an example of harmful neoliberal policy disguised with a smile? I think so… and I fear that this may be revealed more clearly in future announcements in areas such as delisting of services.

Much of the platform is little more than titles of future announcements and promises of consultation, and it is clear that yesterdays announcement will not cause the second-tier to dwarf or undermine the public tier overnight. After all, according to the Premier, these things take time. What is also clear is that the government failed to make any changes that will greatly decrease wait times. Although wait lists in Alberta are not substandard, it remains Alberta’s largest health care concern. There are some positives coming out of yesterdays announcement. For example, changes to the waitlist registry may not decrease wait times, but it will make important information more readily available to patients. New strategies involving booster shots and child immunization are welcomed, but hardly revolutionary. Action 9, addressing and exploring solutions to the spiraling cost of drugs, and the poor pharmaceutical coverage of Albertans (27% have zero coverage) will certainly be welcomed- though it appears the Government may have already decided on their solution. Rather than exploring higher drug prices for those with higher income, why not eliminate health care premiums and make the tax system more fair. Regardless, initiatives such as these provide the smile typical of ‘third way’ politics.

The devil within the details can be found in Action 8 of the Governments 12 step program. As far as I could see, there was no mention of eliminating the Health Care premium Albertans are currently forced to pay. Currently, Alberta is one of few jurisdictions in the country that pays for some (but not all) chiropractic services. Rather than expansion to increase coverage under the public system, the Government will allow Albertans to “use secondary insurance to help pay for podiatry and chiropractic services beyond what’s covered by Alberta health care” and allow people to “choose enhanced medical goods and services beyond what doctors decide is medically necessary.” The government says this is about providing choice, but it is also an expansion of the role of for-profit health care. Any expansion of for-profit care may contribute to the undermining of the public system. For example, will the availability of the Birmingham Hip through a user-pays system impede the availability of the same procedure in the public sphere. Will the Government be committed to making quality the goal of the universal system? It has also raised concerns over a potential conflict of interest for doctors. According to Friends of Medicare coordinator Harvey Voogd, “The patient will not know whether the physician is recommending enhanced medical care because it is in the doctor’s financial self interest or because it is the best treatment.” Finally, this expansion of the private tier is all occurring as the Government reexamines which health services will be covered by public insurance, and which will be covered by private. This is an important area in which the Government can demonstrate it’s commitment to quality public medicare, or not.

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4 Comments

  1. O'Smiley said,

    Wednesday, 13 July 2005 at 10:51 am

    The third way is definitely a mixed bag. I would say that the majority of the items are beneficial. Just glancing over the Alberta health page, all but Action 8 looks promising.

    Action 8 will definitely be the kicker. The big question is why is the universal coverage not the best? Cost plays a big role. As I said in a previous article, healthcare is expensive, and it makes some sense that if a procedure works fine and is economical, should it not be the choice of basic health coverage?

    That of course leads to the Supreme Court Ruling: if someone can pay for better than the basic should they not be allowed to? Unfortunately this then may lead to a possible decline in the quality coverage in the public system rather than persevering in developing the public system into the best it can be.

    It’s really tough to say yes or no on this issue.

  2. Manatee said,

    Wednesday, 13 July 2005 at 11:38 am

    Well, it pretty clearly doesn’t do anything to strenghthen the public system from future attacks from for-profit ideologues. I see in the morning paper that the Justice Minister is preparing to tell caucus what that damn SC ruling means for Alberta. There is a chance that the SC ruling may not apply the same way, since wait times are not as out of hand in Alberta (I think).

    The more I think about it the more I fear that delisting and an increased role for private insurance are just around the corner. That would not be good news for universal, comprehensive, public health care.

  3. O'Smiley said,

    Wednesday, 13 July 2005 at 12:02 pm

    The SC ruling must apply the same way across the country. To limit the ruling in one jurisdiction based on circumstance would contradict its judgment that this is a charter of rights issue. Whether waiting times are long or short the judgment is the same.

    As far as I can see it private healthcare must be allowed in one form or another or the notwithstanding claus must be envoked to stop it.

  4. Manatee said,

    Wednesday, 13 July 2005 at 2:20 pm

    We need Gnomes legal opinion.

    But is the section 7 being violated in Alberta? Obviously I don’t think so (but I disagreed with the Chaoulli ruling and didn’t think it was being violated in Quebec). But even given the Chaoulli president, if wait times are shorter then some threshold (not described by the SC) then isn’t there a case that there is no need for private health insurance?

    The majority wrote “The evidence shows that, in the case of certain surgical procedures, the delays that are the necessary result of waiting lists increase the patient’s risk of mortality or the risk that his or her injuries will become irreparable.” “Where lack of timely health care can result in death, the s. 7 protection of life is engaged; where it can result in serious psychological and physical suffering, the s. 7 protection of security of the person is triggered.”

    The ruling was about timely health care. Do shorter ALberta waiting lists make a difference? The dissenting opinion encourages me to think it may: “There is no “societal consensus” about what this non‑legal standard means or how to achieve it. It will be very difficult for those designing and implementing a health plan to predict when judges will think its provisions cross the line from what is “reasonable” into the forbidden territory of what is “unreasonable”.”


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