How Danielle Smith Could Transform Healthcare

Commentary

The Albertans re-elected Danielle Smith’s United Conservative Party by a majority on May 29. Smith now offers an opportunity to change the way we think about healthcare – a radically conservative view. What does that mean?

Many conservatives trumpet cash payments as the epitome of conservative health care policies. Danielle Smith’s critics were incensed fears of patient payment at the center of their campaign attacks.

One month before the election, Smith taken cash payments from her campaign table.

“I believe actions speak louder than anything,” Smith said. “One of the first things I did as Prime Minister was to sign a $24 billion 10-year health care agreement with the federal government, where we jointly agree to uphold the principles of the Canada Health Act.

“One of those key principles is that no one pays out of pocket for a GP and no one pays for hospital services. That is in writing.”

Smith’s pledge of allegiance to the CHA sounds like other conservatives who have succumbed to her. It’s true that Smith could rule health care like other “conservative” governments, but her promise need not bind her. A great opportunity lies at the root of her promise, if she has the courage to pursue it.

The accessibility principle of the Canadian Health Act prohibits cash payments: “costs to insured persons.” Co-payments disqualify counties from federal health transfers.

The accessibility principle is the only reason why the CHA exists. The first four principles – public administration, inclusiveness, universality and transferability – come from the Medical Care Act of 1966.

Many conservatives are angry with the Canada Health Act precisely because of its ban on cash payments for patients. That is partly correct, but largely incorrect. Yes, the law prohibits federal transfer payments to counties that allow user fees for medical services. But no, that’s not why Canadian Medicare is suffering.

Conservatives are on the wrong side of the bill. While they are outraged by the federal reach on access, they forget the CHA’s first tenet: public administration.

Public administration, not payment, is key to Canadian health care. Medicare is not about whether patients pay for care with their Visa card or their health care card. Payment irritates voters, which matters to politicians. But payment for services is much less important to healthcare than the management of the care itself.

Herein lies the opportunity.

The Canada Health Act does not say that services should be administered by the government. It says that provincial governments must administer a “health insurance plan”. Provincial governments must manage payment for services, but they cannot manage the services themselves.

A health insurer is not the same as a healthcare organization. The federal Medical Care Act of 1966 nationalized Canada’s health insurance companies. Governments took control of the health insurance industry and insurance companies left the insurance industry. The insurance companies were never active in managed care.

Over the past 50 years, provincial governments have moved from health insurers to managed care organizations. Each province closely manages medical services and looks for ways to manage even more.

Most Conservative governments seem to ignore this on purpose. After being defeated in the out-of-pocket battle, the Conservatives shrug their shoulders and continue to manage like a Liberal or an NDP. They tweak and twist the levers of control, adjusting regulations, programming and funding allocations. Conservatives avoid (most) obvious progressive social policies, but it can be impossible to tell the difference in the clinic or at the bedside.

Conservatives could be (radically) different by refocusing on good governance. Good governance means good governance. And good governance means ‘nose in, fingers out’.

Governments, like boards of directors, need to know what’s going on (get your nose in), but they cause chaos when they get involved (fingers out). It has been difficult for Conservative governments to keep “nose in, fingers out” health care – impossible for Liberals and NDP.

Smith has the opportunity to change Canadian health care. She could refocus the government on governing and find all the ways to get the government out of her management.

Maybe this is asking too much.

Currently, provinces determine which medical services Canadians can access. Governments control the price, volume, quality and management of services. Provinces fund and oversee the training of health workers and shape labor relations. Doctors retain the privilege of managing the rent and maintenance of their clinics.

The government has so many things under control that it is difficult to imagine anything else.

Smith faces a difficult choice. She can take a conservative approach and do what most conservative parties have done. Or she can chart a new course to rediscover what good governance means. The question is, will Smith try?

© Troy Media

The views expressed in this article are the views of the author and do not necessarily reflect the views of The Epoch Times.