Looking forward to your comments.
http://www.flickr.com/photos/7855449@N02/2780450986/in/set-72157606844282993/
Friday, December 03, 2010
Stairway to Brand Heaven and Hell
Here is a great representation about how citizens/people feel about their relationship to politics and to politicians these days. Everyone has a BRAND. How is your brand doing on this set of values? How would you rate the political parties in Alberta on these brand values?
Looking forward to your comments.
http://www.flickr.com/photos/7855449@N02/2780450986/in/set-72157606844282993/
H/T Sharon Matthias for the link and thanks to David Armano for the image.
Looking forward to your comments.
http://www.flickr.com/photos/7855449@N02/2780450986/in/set-72157606844282993/
Thursday, December 02, 2010
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.
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.
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.
Wednesday, December 01, 2010
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)
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)
Monday, November 29, 2010
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.
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.
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