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Is Alberta Premier Alison Redford's bitter fight with the docs about money, or control?

Is the increasingly bitter fight between Alberta's government and the province's physicians just about money? It's said here it’s more about who gets to control the health care system.

If you need evidence for this assertion, look no further than the fact just two and a half months ago Alberta Health Minister Fred Horne said he was going to impose a pay deal on the docs that would have seen their salaries keep on rising.

Premier Alison Redford is now traipsing around the province explaining that these same doctors are being paid too much -- why, they get 20 to 29 per cent more than their counterparts anywhere else in Canada!

"Quite frankly, before I start asking Albertans to pay health care premiums, I want to make sure that we’re getting the best deal possible with our doctors," Redford told supporters during a recent telephone town hall. "At the end of the day, I think that's really where we start to save some money with respect to things like health care."

This is the leader of the same government that just days ago was about to force the same supposedly overpaid physicians to accept an imposed agreement that included a 2.5-per-cent lump sum payment and cost-of-living increases in each of the next three years.

Naturally, the doctors didn't think that was enough and screamed bloody murder when Horne moved to unilaterally impose the contract on them. But it still raises the question: If they were not paid enough in November, why is the same pay too much now?

For his part, Horne has since withdrawn that deal, denied he imposed anything, and returned to the bargaining table with the AMA, setting the stage for the current slanging match.

AMA President Dr. Michael Giuffre conceded on CBC radio yesterday that Redford's percentages are essentially correct, but argued that the costs of hiring nurses, renting space and otherwise operating a medical business in boom-bust Alberta are also higher by roughly the same amount.

He couldn't resist the highlighting the irony of the fact that back in November the Redford Government spent $130,000 of taxpayer money on radio ads to promote an imposed settlement that now seems to have become far too expensive.

Accusing the government of "slamming" and "vilifying" physicians, Giuffre assailed the premier’s "often-confusing and frequently misleading" comments about physician pay as alarming and not particularly helpful to the on-again negotiations with the docs. He suggested the government is unfairly demonizing physicians because it desperately wants to hold the line on a budget deficit burgeoning in the face of lower prices fetched by Alberta petroleum resources.

Of course, the bitterness between the government and the AMA may go back a little farther than that. Alert readers will recall that the AMA backed the wrong horse in the final days of last spring's election campaign, when the association bought advertisements that assailed the government and all but called on voters to elect a Wildrose government. Rest assured Alberta's PC elephant has not forgotten!

Still, if you consider for a moment that the government's real cost-control fight with doctors may be about who is going to be the boss of the health care system, the emphasis on Alberta physician pay premiums over other provinces suddenly makes sense.

Look at this from the government's perspective. If you cede control of the system to physicians, who obviously have a dog in the hunt, the chances you'll ever get health care costs under control are, shall we say, diminished.

Not only are Alberta physicians generously paid, but the billing structure is highly advantageous to their financial health. So it should come as no surprise that in the background of this public fight over wages, Horne has been chatting with his counterpart in Ontario about ways to change the formula by which physicians are compensated.

But if the government proposes any change to the billing process, it is likely to be attacked by the AMA as dangerous to patients -- and chances are good many Albertans will listen. Both the government and the AMA also know that if you asked the typical Albertan in the street whom he or she would rather have in control of the health care system -- doctors or politicians -- the answer is likely to overwhelmingly favour the docs.

Yet if the government can't slow down the rate at which health system costs are rising, the PCs and Premier Redford are bound to come under increasing pressure from the Wildrose Party -- which can promise without a shred of evidence or accountability that its privatization schemes will deliver fairer, cheaper, more efficient health care.

Ergo, the government's simplistic but easy-to-sell attack on the AMA from its flank makes political sense while Redford's brain trust tries to figure out how to wrest control of the system from physicians and put it in the hands of more easily controlled officials.

Come to think of it, this is what former premier Ed Stelmach was up to when his government created Alberta Health Services back in 2008, not that that worked out the way anyone expected.

Saying doctors are paid 20 to 29 per cent more is just easier to explain than making a complex case for restructuring the way routine health services are delivered to most Albertans, many of whom are focused on the complaint they can't find a family doctor.

Even Albertans who understand that health care financing is a complex policy question may not connect the dots that this argument represents a strange flip-flop by the government from what it was saying just a few weeks ago.

With the AMA, whose members are not used to losing, darkly hinting that it may resort to legal action if the government won’t bow to its will, look for this fight to continue for some time yet.

But don't be surprised if this doesn't particularly displease Redford, Horne and Finance Minister Doug Horner.

After all, given its vocal position on the need for austerity, the Wildrose Party can hardly rush to the doctors' defence and call for a big salary increase, and fighting with the docs at least makes it look as if the government is doing something to respond to the Opposition's screams about the deficit.

+ + +

BudgetChoice.ca -- a coercive push poll or the greatest thing since Space Invaders?

Scoffers may try to dismiss www.budgetchoice.ca, the government's $57,000 online do-it-yourself deficit-elimination tool "as a particularly coercive push poll" intended to soften up voters for another round of cuts to the public service or maybe a tax increase, wrote commenter Tom Fuller after yesterday's post.

"But I think it’s a stroke of genius turning the budgeting process into an on-line multi-player role-playing game," Fuller went on. "Assuming my avatar (Chlorox, the Elf Warrior) I vote to cut services to children and seniors, and lay off everyone at Environment. For reducing expenditures by 23 per cent, I get 5,000 special bonus points, and can claim the magic axe of Steve West, lost for lo these many years. I haven't had this much fun since I spilled the beer on my Atari and shorted out Space Invaders."

My blogging colleague Dave Cournoyer apparently agrees, observing: "It simplifies the process, but it also works to demonstrate that with modest tax increases and minor cuts to the Legislative Assembly budget, and cuts to wasteful programs like Carbon Capture, the government could easily balance the budget without burning down the house. And I did all that as a Level 4 Dwarf with a Stockwell Day amulet. It earned me 430,000 Gold Katzs."

Personally, I'm not a gamer, so I have no idea.

This post also appears on David Climenhaga's blog, Alberta Diary.

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