It is the great equalizer in politics. And it will help determine who wins Alberta’s upcoming election. Say hello to healthcare reform.
Just a couple of words—but they encapsulate a decades-long tale of failed dreams, frustrated ambitions and enough political deaths to fill a graveyard.
Danielle Smith, though, is undaunted. Soon after becoming premier, she launched an aggressive strategy that included firing the board of Alberta Health Services, replacing the remaining 11 members with an official administrator (Dr. John Cowell) and promising massive changes to the healthcare system. She said she wanted, among other things, to improve ambulance service, reduce wait times in emergency rooms and clear up surgical backlogs. All areas that cried out for improvements.
Smith is arguably the most divisive, combative and controversial premier in Alberta history, but when it comes to overhauling, improving or fixing the healthcare system, her strategy doesn’t look particularly new. The fact is Alberta premiers have struggled over the years to improve the healthcare system as it gobbled up billions of public dollars but continued to see wait times grow.
Premier Ralph Klein kicked off a never-ending merry-go-round of symposiums, conferences and summits on reform. He held a healthcare summit in 1994 and another in 1999. In 2000 his government commissioned the Mazankowski Report on healthcare reform, which in turn spawned more government-led reports, including one on delisting services, another on new ways of funding healthcare and yet another on innovation.
In 2005 the province spent $1.3-million to invite healthcare experts from all over the world to a symposium in Alberta to learn the “best practices” in other countries. The government heard from so many differing people with differing viewpoints that there were as many “solutions” as there were opinions.
At the time, Klein promised to ignite a “firestorm” of controversy through “un-Canadian” challenges to the Canada Health Act. These would usher in a “Third Way” of healthcare that included private, for-profit hospitals. Klein’s plan fell apart under public pressure, but his rhetoric poisoned the well of public trust for anyone in government who dared talk about healthcare reform.
But talk they did. Under Premier Alison Redford, the government launched a series of public-consultative “workshops” that grew from an advisory committee on health. In 2013 Redford was so fed up with the system she fired the board members of AHS and replaced them with an official administrator, Dr. John Cowell.
Smith has acknowledged that Albertans will be passing judgment on her healthcare reform in the election.
Sound familiar? This isn’t just a vague sense of déjà vu; it is history repeating itself.
To add a bizarre twist, in 2013 Smith was leader of the opposition Wildrose party—and she labelled Redford’s actions to fire the board and hire Cowell as a “cosmetic change,” not a strategy for real reform.
Indeed, Redford’s plan didn’t solve healthcare problems. No premier has done that. We’re living with the proof today.
But then again nobody has found a way to substantially improve the healthcare system anywhere in Canada. Instead, premiers from every province routinely demand ever more money from Ottawa to help keep provincial systems from collapsing. But more money doesn’t always mean better service. The pandemic revealed the fragility of our health system.
The threat is both Gordian knot and sword of Damocles. Healthcare is, among other things, a complicated jumble of public funding and private delivery that pits groups such as the Raging Grannies and Friends of Medicare against Conservative governments. The system is expensive, but hack away too deeply to reduce costs and find “efficiencies” and you risk bringing down the sword. Or even suggest you might want to start cutting, and watch as you bring down the wrath of the electorate. Klein’s aggressive prescription for change included suggestions of private hospitals, a notion so toxically unpopular that federal Conservatives blamed Klein in part for their 2004 electoral loss to Paul Martin’s Liberals.
Smith, for her part, has created controversy by pushing “health spending accounts,” where the government would give Albertans a few hundred dollars to spend on services. Critics say this would open the door to patients having to pay out of pocket for care (an idea Smith’s past comments suggest she supports). And it reignited a debate over private vs. public care.
Smith has acknowledged Albertans will be passing judgment on her healthcare reform in the upcoming election. “Help is on the way,” she promised in November, echoing Jason Kenney’s 2019 election pledge, “Help is on the way and hope is on the horizon.” Kenney won the election but was forced to resign in 2022 after he, among other things, tripped himself up over his leadership failures during the pandemic. Healthcare is the great leveller in politics. It’s a truth premiers ignore at their peril.
Graham Thomson is a political analyst, member of the Legislature Press Gallery and former Edmonton Journal political columnist.
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