Some Musing About the "Moving Forward"Leaked Health Policy Document

The cut and thrust of politics is heating up in Alberta, especially over health care.  Now the discussion is moving towards the place it should about - the fixing of the system.  The leaked "Alberta's Health Legislation: Moving Forward" document has been the catalyst for the policy discussion.  It has been lead by Dr. David Swann, leader of the Official Opposition and the Liberal Party of Alberta and the recently rejected PC caucus member Dr. Raj Sherman.

The details of the debate are well documented in the main stream media so I will not repeat them here. The implications of the debate are what is interesting to me.  I want to talk about the threat of a Two-Tier system that involves private insurance, and if docs can operate on both side of that street. I also want to talk about delisting health service elements contained in the Moving Forward document too.

Swann is pressing Stelmach on if there will be a two-tier health care system in Alberta.  He wants a promise from Stelmach "in writing" he will not allow doctors to work in both the system, a public and private side, at the same time.  There is nothing stopping doctors from option out of Medicare now and working strictly in a private patient pay system.  There are lots of private sector elements in our health care system now.   Any talk of keeping private enterprise out of health care is futile.  That is all ready the case and it is working well.  It is working well because there is a single-payer for health services, the government.  If we allow private insurance to be purchased and to pay for medically necessary services we are into the feared and reviled two-tier system and the unnerving possibility of doctors playing both sides of the street and eroding the effectiveness of the public health care system.


THREATS OF A TWO-TIER HEALTH SYSTEM COMES AROUND AGAIN:
I do not expect Premier Stelmach to commit to writing that he will promise to not allow doctors to work in a private and public system at the same time...because there is no political will (today) to go to a two-tiered system.  That is now.  What about after the next election when the fear is major system changes will be imposed, including a private insurance possibility for health care.  That is what the government plan is according so some interpretations of the "Moving Forward" leaked document.

If it is of any comfort, I received a fund raising letter from the Progressive Conservative Party today signed by Ed Stelmach as Leader. In it he says "Your government (his government) firmly believes we can build a better (health care) system without moving towards a two-tier system with privatisation of health care."   Hardly a public statement since it is in a political party fund raising letter...but it is a commitment of sorts to the single-payer public health care system that we now have - and it is in writing.  But as Ralph Klein used to say when he "changed" his political mind for political purposes"That was then. This now."

It has a bullet about health providers working to full scope of practice.  That is a problem as Docs, Registered Nurses and Licensed Practical Nurses are all underutilized to some degree or other, due to the payment system that is used to pay docs.  More on that at some future time.  What Moving Forward talks about is providing health providers to opt-in and opt-out of the public health system as part of the new Health Act.  I have not reviewed the just past Act but know that doctors can to that now.  Why is it part of the "new" law?

The proposed policy shift in Moving Forward that is intended to bring "fairness" to this fictitious imbalance is to "Apply the same constraints to all health providers and allow government the flexibility to regulate health provider commitment in the public system."  That is very abstract language indeed and fairness to physicians is compared to the way midwives and pharmacists operate in a partially publicly and privately funded arrangement.  To meet the spirit and my sense of the intent to induce more fairness would mean we would need to make sure Midwives and Pharmacists would enjoy access to a fully funded public payer system for their areas of endeavour, including a fully funded drug program.  That way they and the docs would be on a level playing field under the current arrangements.I don't see that sense of providing fairness to druggists and midwives to be involved in the Moving Forward proposals at all. This framing for "fairness" to doctors to allow them to play both sides at the same time, if there were a public and private system, is disingenuous at best and intentionally misleading at worst.

DELISTING:
Then there is the delisting section entitled "Process to Establish Essential Services."  The issue is stated to be that there is  not a clear process to determine essential services and current services are not based on a "regular, rigorous and evidence-based process."  That used to be more true than it is today and some medical services have been delisted.  There was a full review of what process should be used to see if medical services should be in or out of the public system done by an Expert Panel Chaired by Dr. Bob Westbury.

We at Cambridge Strategies were involved assisting with that review and there was a Progress Report issued to the Alberta government in December 2002..   The Expert Panel was commissioned by then Minister of Health and Wellness, Gary Mar.  The mandate was "...to review the current basket of publicly funded health services and, on an ongoing basis, to review new health services to ensure that Alberta's publicly funded health services remain comprehensive and sustainable for the future, and provide the best value."

The idea was an expert panel would determine what services were to be publicly funded or not.  Those determinations of what service was in or out of  was also to be done in an open objective way using criteria established by the Expert Panel to determine what new diagnostics, treatments and drugs would be added to the system too.

The review and recommendations made by the Expert Panel were sound and soundly shelved by the Klein government.  The next phase of actually setting up the process and structures to do a thorough and detailed review of current funding, new services, priority setting and specific services review was never allow to happen.  This sense of intentionality and rationality over what health care services should or should not be covered by the goes back even further in Alberta.

Premier Don Getty set up The Premier's Commission of Future Health Care for Albertans that reported in December 1989.  In Recommendation #8.0 sand " THEREFORE WE RECOMMEND that the Government of Alberta, in consultation with health care practitioners and consumers, define with is considers to be basic insured services covered by the Alberta Health Care Insurance Plan."  I will be doing a series of comparisons with the new Alberta Health Act to the recommendations made over 20 years ago in the Premier's Commission on the Future of Health Care for Albertans to see what is same, similar new and missing.  The old Premier's Council  spent two years and made 21 Recommendations and 66 suggestions for action.  The current Minister's Advisory Council on Health represents some very good work too.  It made four Recommendations with a total 20 sub elements including 6 Principles.  A thorough review and comparison will take some time but I think it will be helpful and useful for Albertans to have.

Perhaps the Stelmach government should revisit these reports and finally to stimulate a public conversation about what medical services Albertan want to pay for as a society or as individuals, and how they want to proceed to reconcile and rationalize the differences.  The recent truncated public consultation over the past summer on the new Health Act was not a serious effort at effective citizen engagement.  Premier Stelmach recently said about the new Health Act in the Alberta Legislature "The one thing that all members should focus on is the Bill (Bill 17 the Alberta Health Act just passed awaiting Proclamation) that we've debated in the house that says very explicitly that Albertans will have a say in the future direction of health-care delivery ..."  Go to the link and read Section 14 and see if that provision satisfies your test of if it amounts to Albertans having a say in the future direction of health-care delivery.

There is more to be sceptical about in the Moving Forward document but this post is too long already. My advice is that Albertans better not suspend their critical thinking faculties about this and other public policy directions that may be lurking behind the confidential and closed doors of the government caucus.  Time to use the cracks that Raj Sherman has caused to happen and that is letting some light shine in on what is really happening.  Sunlight is still the best disinfectant.

Alberta Venture "The Right Call" Calls it a Day

I read with interest my latest edition of Alberta Venture and the wrap up column on business ethics "The Right Call" that has been shepherded by Fil Fraser since April 2008.  I got to participate as a contributor in a number of the issues and enjoyed the opportunity to consider some key ethical questions that industry faces these days.

I agree with the tag line on the contribution written by Fil alone in this edition "We Broke New Ground."  Ethics is a key concern of most people these days, in our dealings with business, politics, government and in relation to all our institutions.  It is hard to name an institution that has not betrayed our trust in one way or another in the past 15 years or so.  Albertans are measuring business and government on ethical terms these days.  This is especially true in terms industries who must justify their a social license to operate or governments to be seen as worthy of a citizen's consent to govern. Institutions are been evaluated by citizens too in terms of effectiveness, integrity, intent, accountability and transparency, as well as fulfilling their public service duty and mandate.

The list of fellow contributors is in the final column and I am proud to note most of them are friends of mine. Like all good things, it has come to an end. I encourage you to read the columns and especially the last one.   It has been fun so thanks to Fil Fraser and Ruth Kelly for making it happen.

For Alberta Being the Best in the World is NOT Good Enough

I have read the leaked Government of Alberta Power Point presentation "Alberta's Health Legislation: Moving Forward"  It is a document that begs a lot of questions and raises some legitimate suspicions about the political intent of the Stelmach government on just how secure is the future of publicly funded health care in Alberta.

Bill 17, the new Alberta Health Act is now passed with Closure invoked by the Stelmach government.  I expect to hear very little about it now. The government wants to shift our attention to the "Becoming the Best: Alberta's 5-Year Health Action Plan" and not have us dwell on any boogie-man fears of a secret strategy of privateers out to make our health care system the private property right of some insurance companies.

I have not yet read the Five Year Action Plan.  It was just released yesterday. But I will read it with great interest.  At first is sounds like a revision of the Olympics motto with words like  "more, faster, quicker, reduced, best" as the hooks. There is only one small mention of a wellness aspect and that is a 32% increase in child immunization rates...what ever that means.  We need much more attention to prevention and wellness in our health action planning.  Don't you think?

I know Minister Zwozdesky had some resistance getting this Action Plan through Cabinet. But all the publicity and pressure over Raj Sherman and the leak of  July strategy document I am sure that forced the hands of the foot-draggers in Cabinet.  After all what is the point of a five year stable funding commitment if you don't have a five year plan to be able to prove you are using the money wisely?

I will comment more on both document in future blogs.  Let me say for now, on the leaked "Alberta Health Legislation: Moving Forward" it is difficult to understand the document because it is terse and in bullets points.  There is not much narrative to help one really understand the integrity and intent of the policy approach being proposed.  Some stuff is very good and other stuff is veiled political framing of a privatization agenda.  Minister Zwozdesky says this is "not his document" and he rejected it because some elements were contrary to the Canada Health Act.  Go figure!

From that statement by Minister Zwozdesky, it is safe to conclude this government document is must then "belong" to former Health Minister Ron Liepert.  Is sure sounds like his free-market competitive Fraser Institute approach to health care. Given the clear comments from Minister Zwozdesky that he rejected the leaked "Moving Forward" document, we can hopefully conclude that the public health care system in Alberta is safe from ideologically driven privatization agenda - at lest for now..  That sense of safety for the public health system in Alberta only goes up to the next Cabinet shuffle, when ever that might be.  If Minister Liepert performs as badly in Energy as he did in Education and Health, a shuffle could be sooner than later.  Who replaces Gene Zwozdesky in the Health and Wellness portfolio will tell us a great deal about the integrity and true intent of the Stelmach government on the privatization of the public health care system in Alberta.

As for the Five Year Action Plan, at first blush is it all about targets, measures and percentage but almost entirely aimed at the acute care end of the spectrum. The care and compassion, respect for professionalism in the system is not readily apparent.  Fair enough but we also need a culture shift to include encouraging personal action on disease prevention, wellness and well-being too.  Albertans must take personal responsibility for their health care and that is about each of us taking steps in the areas of prevention, including lifestyle changes as necessary.  Health care is not just all about the system.  Much of it is about us, our values and attitudes.

I get put off when I see policy documents aspiring to be the "best."  Like in this document title: "Becoming the Best:Alberta's 5-Year Health Action Plan." Stating Alberta's goal to be the "best-performing publicly funded health system in Canada is to merely measure ourselves relative to others.  That is a mugs game and is more sloganeering than a soundly reasoned policy objective.  With all the wealth in Alberta and our highest per capita spending on health care we should already be the best in Canada...but on what measures?  Life expectancy and wait times are important but not very sophisticated outcome aspirations.

We know economic wealth translates into good health outcomes.  Given the enormous wealth and potential in Alberta we should have the aspiration to be the best health care system for the world, as well as the best in the world.  That better aspiration for Alberta to be the best health care system for the world can happen in terms of investment in other areas like prevention, teaching, research and innovation.  Now that is something to strive for in addition to value for tax money and, quality care and better access times...all of which are essential but not sufficient for live up to our potential.

To close let me invite you to watch this interesting video.  It is just over 4 minutes and shows how the wealth of a country is correlated to life expectancy.  Watch it and ask yourself why the Alberta government sets its health care sights so low and narrow given our potential.  (H/T to Kim Bater for the link)

Visit AlbertaVote.ca for a Wealth of Political Insight & Incite

It is great to see Duncan Wojtaszekback into political blogging, returning from a self-induced exile.  A visit to his new site www.albertavote.ca is a rigorous and thorough approach to "what ifs" based on a recent poll and the re-jigged constituency boundaries coming soon in Alberta.

His commentary and analysis of Edmonton Rutherford (Fred Horne) and Edmonton Meadowlark (Raj Sherman) is timely and telling.   Of course these are predictions based on assumption in a hypothetical election that is not now happening.  But what is interesting is the electoral implications of shifting public opinion.

Here is another post "Trying to Predict What Would Happen in Calgary"  all of which points to the growing volatility in the Alberta political landscape...but without any consideration yet of the potential impact of the emerging Alberta Party.  That will no doubt be part of future commentaries.

There is lots more from the imaginative mind of Duncan Wojtaszek...and I anticipate a lot more to come. Welcome back to blogging.  We have missed you.

Is There a Conspiracy to Discredit Raj Sherman?

I love politics and I think it is a force for good.  But sometimes I despair about the way politics is practiced and portrayed.  When politics is all about getting and keeping power it is becomes manipulative, intimidating and even corrupt.  That is politics at its lowest.  When politics is about exploring new ideas, sharing wisdom to protect and empower citizens, it is at its best.

This past two weeks politics in Alberta has been at its worst, at its best and is changing faster than most of us could imagine.  I am talking about the events around the courage of Dr. Raj Sherman to take a stand and expose some political truth about health care in Alberta.  There is now evidence of politically motivated reactions and tactics by anonymous forces who are intent on discrediting and even destroying Dr. Sherman.

Efforts to discredit Raj by questioning his mental and emotional state are an example of politics at its worst.  Dark forces are now challenging his professional capacity to practice medicine with anonymous innuendos.   Sherman is fighting back by talking openly about these perverse efforts against him.  That is the only way to defeat these dark forces.

Intimidation, threats and bullying is on-going from some segments of the PC government as they try to control messages and command loyalty.  I know I faced this myself when I publicly announced I was no longer going to stay as a member of the Progressive Conservative Party of Alberta.  Clients were told they would have more success in dealing with government if I was no longer involved in representing them.  Long time party supporters have been suddenly and unceremoniously removed from positions on boards because they were suddenly not “acceptable” to serve.  Why?  Because those individuals were simply publicly speaking truth to power.  Community based not-for profit agencies that rely on government funding to provide services to vulnerable citizens have been told to toe the line or there will be “consequences”- personally and organizationally. This is no way for those in authority to behave.

When this kind of coercion happens paranoia runs deep and creeps into your heart. Intimidation should not becomes “normal” in our political culture.  It must be stopped.  That can only happen by public exposure by those who are its victims.  Silence is compliance.   Speaking out against this kind of intimidation and coercion is exactly what Dr. Raj Sherman is doing now.  More reason to applaud him and value his courage.

When we feel threatened by powerful forces we can even start to question the integrity of our friends. That is what has happened in the recent highly publicized conversation between Fred Horne and Dr. P. J. White, who are both friends of Raj Sherman.   Many of us are friends of Raj Sherman and admire him for what he is doing.  We are also aware of the enormous stress Raj is facing as he stands up against some very powerful and entrenched political forces.   

With such intense feelings and threatening circumstances it is very easy to misinterpret good intentions…even of your friends.  Drawing a negative conclusion is easy and often justified as a survival strategy - but it also could be a wrong conclusion.  I think the wrong conclusions have been drawn around the actions and intent Fred Horne and P.J. White in sharing an authentic mutual concern for the well-being of Raj Sherman.

Some context is important in trying to better understand what is happening here.  Fred is the new Parliamentary Secretary for Health and Wellness.  Fred ran the new health act public consultation process this summer.  P.J. White is a psychiatrist and the newly elected President of the Alberta Medical Association.   In a cynical world it is easy to misinterpret the actions and intentions of Fred and P.J. as powerful people who may be part of a conspiracy to discredit Raj Sherman politically and professionally. 

The other, more realistic interpretation in my opinion and based on the personal characters of Fred and P.J., is they are simply sharing a genuine concern for the well-being of a mutual friend in a difficult time  In the vulnerable reality of Raj Sherman these days, one can hardly blame him for being paranoid about such a conversation taking place, even amongst good friends.  To see the erosion of the benefit of the doubt about the intent of friends, shows just how sad and dysfunctional our political culture has become these days.

I have a long standing friendship with Fred Horne.  I have a growing friendship with Raj Sherman and a deep respect for his character and courage.  I have recently met Dr. P.J. White, under other circumstances, but we share some personal values about politics.  I also admire P.J. for his personal and professional courage for standing up against the irrational political decision of Dr. Duckett and the AHS to close Alberta Hospital in Oliver.  He stopped the closure.

When the conversation Fred and P.J. had about the well-being of Raj Sherman became public and a focus in the media I called both Fred and P.J. to get some first-hand content and context on what was really going on here. I am certain from my personal knowledge of both gentlemen and our recent chats that the intent of the conversation between Fred Horne and P.J. White was motivated by a shared respect for Raj Sherman and a genuine concern for his overall well-being. 

But the record can and should be set straight.  I hope this blog post is a step in that direction.If there is a politically motivated conspiracy to discredit Raj Sherman based on innuendo about his mental state and capacity, Fred Horne and P.J. White are not part of it.  They, along with many others, and me included have reached out to personally and publicly support Raj.  We are all dismayed at how low some will stoop to sustain or gain political power at the expense of others.  

Raj Sherman has supporters – lots of them.  He has powerful enemies too – I expect many of them.   The big difference is the supporters are open and public while the enemies are anonymous and secretive.  So who should the public trust? Which narrative of Raj Sherman will "win" in the court of public opinion?  When seeking changes in political attitudes and culture, it is the court of public opinion that matters most.  What people come to believe becomes political reality.  In politics perception is reality…and that is not just a cliché.

Monday November 29^th will see a Point of Privilege presented in the Alberta Legislature asking if Fred Horne is part of a political conspiracy to discredit Dr. Raj Sherman.  I trust it will be debated in the spirit of supporting the political integrity, transparency, honesty and the accountability of our elected representatives.  I hope it is motivated by a desire to enhance our democracy and to regain some increased respect for the institution of the Alberta Legislature.  If this is not the case, it will only perpetuate the worst of our declining political culture.

I hope for better angels to prevail on all of our provincial politicians today.  I am no Pollyanna but I do believe the better angels will triumph.  That will only happen if the wisdom and good judgment of our elected representative overcomes the excessive partisanship that dominates our political culture these days. 

Albertans are not fools and we do not think our elected representatives should be either.  If there is a politically motivated whisper campaign to discredit and destroy Raj Sherman, it must stop NOW!  I hope the NDP Point of Privilege Motion being heard today is the start of a new direction in our political culture.  If it is merely another tactic in political gamesmanship, I will despair even deeper about the democratic deficit in this province. 

So, ladies and gentlemen of the Alberta Legislature, it is time to listen to your better angels….here and now…on this issue and the many other health care concerns of Albertans.  It is time to return to your task of serving the best interests of Albertans…not just personal or partisan power agendas.  Rest assured we will be watching and judging you.

   
UPDATE NOV 29 12:35 PM - I HAVE JUST BEEN ADVISED BY SOMEONE IN THE MAIN STEAM MEDIA THAT THE NDP HAVE WITHDRAWN THEIR POINT OR PRIVILEGE THAT WAS TO GO TODAY ON IF THERE WAS AN ANTI-SHERMAN CONSPIRACY TO DISCREDIT HIM.