Health care

(Yet another) attempt to soften us up for privatization?

The Alberta government budgeted nearly $13 billion for health care in 2009. That’s a lot of money – but the figure seems less frightening when you realize that the relative cost of health care in Alberta is actually declining compared to our ability to pay.

As a proportion of provincial GDP (our collective provincial income), spending on health care has actually been falling since the early 1990s – from 5 per cent of GDP back then to 4 per cent today.

Despite this fact – and despite the fact that Alberta's population has grown by more than 400,000 in the past five years – the provincial government now says that we spend too much on health care and that cuts are necessary.

Bad-mouthing Medicare

Since 2008, then health minister Ron Liepert has gone so far as to say that Alberta needs to consider moving away from a “single payer” public system. Translation: he wants to open the door to for-profit health insurance and a two-tier system.

Former finance minister Iris Evan is also on record describing Alberta’s health care system as a financial “black hole.”

Friends of Medicare Executive Director David Eggen says it’s starting to look like the government is deliberately under-funding the health care system in order to create a crisis in quality, which, in turn, will make it easier for them to convince Albertans that privatization is necessary and even desirable.

A system under attack

When you consider all the cuts and changes that have been made over the past 18 months – and the comments that have been made by prominent government members and health officials – it starts to become apparent that Eggen has a point:

• Eliminated health boards
  A year and a half ago, the provincial government collapsed Alberta’s nine health regions into one “superboard”, now called Alberta Health Services (AHS). Then health minister Liepert said centralization was needed to streamline operations and reduce costs. Instead, the new superboard structure has created chaos – and costs overruns are substantially higher than they were under the old nine-region system.

• System-wide hiring freeze
  The head of AHS, Steven Duckett, has admitted that his top priority is cutting costs. In order to do this, he has imposed a system-wide hiring freeze and he has begun the process of eliminating vacant positions. He has admitted that he’s particularly interested in dramatically reducing the number of Registered Nurses (RNs) working in the province.

• Low morale, heavy workload
  Duckett has also tried to force health care workers – particularly nurses – to work full-time hours when they would prefer part-time. He says this would reduce the amount of over-time being paid – but the real result has been plummeting morale and more and more nurses simply leaving the profession. This, in turn, increases the stress and workload of those who remain.

• 3% buget cut
  In fall 2009, AHS announced a system-wide budget cut of three per cent – even though Alberta’s population has continued to grow and provincial finances have continued to improve. The cuts led AHS to declare about 350 acute care hospital beds will be closed in Edmonton and Calgary – that’s equivalent to closing one big-city hospital full of beds.

• Nurses leaving
  The hiring freeze means that only a handful of young nurses graduating from Alberta schools are getting jobs in the province. The rest are being forced either to leave their profession and find other work in Alberta or leave the province to find work in their field. Provinces like Manitoba are proving all too happy to take these under-appreciated professionals who have been trained largely at the expense of Alberta taxpayers.

• Cancelled surgeries and diagnostics
  Taken together, the hiring freeze, the elimination of positions and the imposition of across-the-board budget cuts have led hospitals to cancel or postpone thousands of surgeries and significantly reduce the number of diagnostic procedures performed. Staffing shortages are rampant and remaining staff are working under increasing stress. The results for patients have been predictable: long and increasing wait times for almost everything, including emergency room visits and even cancer surgeries.

Broken promises

In addition to across-the-board measures, the provincial government and AHS have also launched targeted attacks on specific programs, services and facilities:

• Long-term care beds
  During the 2008 election, the provincial government explicitly promised to create more long-term care beds for seniors – but they’ve been closing them by the hundreds instead and moving people into so-called “assisted living” facilities. These facilities are run by profit-seeking corporations that offer very little real medical care while charging residents significantly more than they paid in public facilities. The province’s bottom line ends up looking a little fatter – but only because costs are being downloaded onto the shoulders of patients and their families. Seniors end up paying more and getting much, much less.

• Seniors’ prescription drugs
  The provincial government has also eliminated universality for seniors’ prescription drugs. As a result, thousands of middle-income seniors are having to dig much deeper in order to pay for the medications they need.

• “Boutique Clinics”
  The government is also actively encouraging the proliferation of for-profit “boutique clinics,” where for an annual fee (usually $3,000 or more), the wealthy can receive privileged, fast-tracked health services. These clinics are popping up like weeds in Alberta’s major cities, drawing crucial health professionals away from the public system.

• New hospitals
  The province has also failed to live up to its promises on new hospital construction. Officials from the city of Grande Prairie have recently been told their growing community will not be getting a new hospital, even though they were promised one. Similar promises have been broken in Sherwood Park and Fort McMurray (where the local MLA, Guy Boutilier, was actually thrown out of the government caucus for complaining that promised funding for a new long-term care hospital had never materialized). At the same time, AHS has made it clear that it intends to downgrade dozens of rural hospitals to glorified walk-in clinics.

• Alberta Hospital Edmonton
  Perhaps one of AHS’s most notorious recent decisions involves Alberta’s premier care facility for the mentally ill, Alberta Hospital Edmonton (AHE). The government has long promised to renovate and expand the aging facility. But in August, instead of announcing the promised funds for renovation, AHS revealed that Alberta Hospital would be closed completely and its more than 240 patients moved out into “the community.” Public outrage and strong opposition from health professionals who work at AHE has stalled the plan for the time being. But Stephen Duckett and other AHS officials have made it clear that their preference is still to dismantle and disperse the people, the programs and the expertise that it has taken decades assemble and nurture. If that happens, the province will be doing exactly what mental health advocates have been warning against: they will be essentially abandoning people with mental illness to a broader system that has few real places for them.

Great Transformation or Great Destruction?

The truly frightening part of this whole situation is that everything that has happened over the past year has been the result of the government cutting overall provincial spending by about $500 million.

What happens when they attempt to reduce spending by four times that amount – as they have said they plan to do in the provincial budget for 2010?

The United Nurses of Alberta estimates that the 3 per cent cut to AHS’s budget in 2009 will result in the loss of  about 3,000 full-time equivalents (which translates into about 5,000 staff out of a system with 90,000 employees). Another round of even deeper cuts will mean that thousands of additional health care workers will also lose their jobs.

At the same time, the number of acute care hospital beds in Alberta is already down from 14,733 in 1988 when we had a population of about 2.4 million to 6,800 beds in June 2009 when we had a population of 3.6 million. With more and deeper cuts expected in 2010, Albertans could see the number of beds drop below 6,000 even as our population continues to grow. If that happens, Alberta - Canada’s wealthiest province - would also be the province with the lowest number of acute care hospital beds per capita — a dubious distinction, indeed.

Looking at the big picture, then, one thing is becoming clear: The “great transformation” that Stephen Duckett and then health minister Ron Liepert have talked about recently is, in reality, shaping up to be the “great destruction” of Alberta’s health care system.