Health care worker, wearing a mask and gloves, holding a needle up.
Health care worker, wearing a mask and gloves, holding a needle up. Credit: Nenad Stojkovic / Flickr Credit: Nenad Stojkovic / Flickr

Right-wing think tanks like SecondStreet work hard to undermine the universal health care system in Canada. Their strategic ‘information’ often omits important back stories like Conservative governments under-funding and under-staffing the public system in order to create backlogs. That, in turn, allows them to proclaim the only remedy is to divert funds from the public to the private, for-profit system.

The United Conservative Party (UCP) agenda is an excellent example of how Conservative governments effectively transition public health care into a market economy.

In a recent interview, Dr. Luanne Metz, Head of the Division of Neurology at the Hotchkiss Brain Institute at the University of Calgary, summarized it this way, “If you can pay for it, you get it. And, if you can’t pay for it, you don’t get it.”

Yet, the UCP deny they are privatizing medical care. They claim that it’s public money and publicly paid for care that Albertans are receiving. However, their policies tell a different story, one that includes a private tier of health care that they have been developing and building. Eventually, everything will be in place to complete the conversion to privatization.

The UCP enacted legislation that allows them to pay corporations for medical services usually rendered by physicians and dentists. In fact, many Albertans may be unaware that they don’t actually have a health care provider who is responsible for them and their health records. Truth is, it could be a corporation that holds those health records.

Metz says, “Even before they [UCP] did that, they had puppet doctors and dentists who could run medical programs in a different province and never ever set foot there. As long as they get privileges there, they could be the physician of record.”

The contracting out of health services means everything becomes secretive. That includes the contracts themselves as well as the deliverables and outcomes at any kind of quality level. Even the Health Quality Council of Alberta can’t get data from them. Worst of all, these undisclosed contracts are unvoidable.

These cloak and dagger tactics are the vehicle by which the provincial government transfers public resources to a given company. These resources are not necessarily part of the contract but they enable the corporation to carry out contractual obligations. This is how public money is used to build corporate assets.

Metz cites plans to construct of a $200 million private orthopedic surgery facility on land currently owned by the Ericksen Nissan dealership close to the Royal Alexandra Hospital in Edmonton.

It’s unclear how the five to seven-story building will be financed, built and operated. However, reports have suggested the project will be a joint venture between the Ericksen family and a private company, associated with the Royal Alexandra Hospital Foundation Social Enterprise Company, which hopes to generate revenue through for-profit investment. Space will be leased to non-hospital orthopedic surgeons.  

Non-emergency surgeries, performed up to 23 hours a day, would be under contract to the provincial government. However, for-profit surgeons have a long history of accepting easier cases while diverting difficult cases to the public system.

The contract would also make it prohibitively expensive for any future government to shut down the private facility that will be serviced by non-unionized staff.

It’s clear Alberta Health Services will be shut out of all discussions and decisions until the plan has garnered sufficient support, from the UPC and civil servants, essentially making it a done deal.

Metz believes that the UCP will use the appearance of public funding as the means to convince Albertans that this private orthopedic surgery clinic is not yet another step towards privatized health care.

The gaslighting includes comparing these private orthopedic surgeons to family doctor practices and claiming that it’s no different from what the government has always been doing.

However, the government doesn’t pay a penny towards the operations or the cost of running doctor’s offices. And, as Metz points out, there are no secrets because, “It’s all public because we know what the fee schedule is and what patients get for each fee.”

Dental offices, although not funded publicly, are also being targeted in Alberta. Corporations swoop in when a retiring dentist is ready to sell their practice. These companies willingly pay top dollar to purchase patients.

Then, they lock retiring dentists into what’s known as the ‘golden handcuffs.’ The dentist agrees to work another two to three years, while meeting corporate driven quotas.

This corporatization of dentistry is changing the way dentists are trained. The corporate agenda doesn’t facilitate the mentoring of new dentists because the retiring dentist’s quota-driven work schedule is too demanding. The tradition of sharing dental knowledge and techniques has been eradicated.

These corporations are quick to guarantee that the original staff will be kept on. But once the corporation takes over, hours of operation generally extend to include more evenings and weekends. Undesirable shifts are then assigned to the more senior, experienced, and expensive staff. The old guard are force out and replaced with less experienced, less expensive staff.

The dental practice essentially shifts gear from patient-centred to corporate-focused. Everything done within the practice comes down to cutting costs in order to grow the bottom line.

That includes purchasing cheaper materials, hiring dentists with less experience, and enforcing quotas. To meet quotas, dentists are encouraged to avoid referring patients to specialists. Dentists may also push for non-essential work be done before it’s really necessary.

Metz says the key to avoiding what she refers to as ‘Walmart dentistry,’ is to find out who owns patient charts. Dentists who are responsible for patient charts and who can take clients with them to new practices are not corporate dentists. Other than that, it’s impossible to differentiate between a private dental practice and a corporate one.

Corporate dental offices have been known to simply disappear without notice. This usually happens when they fail to generate enough income and head office closes them down.

Metz notes that these midnight flights also happened in optometry. They often go unnoticed due to non-disclosure agreements that are built into corporate contracts. Corporate optometrists across Canada include Lenscrafters, Walmart, Costco and franchisors like Pearle and Kanda.

While the College of Physicians ensures patient rights, there’s no College of Corporations to ensure that they don’t close unprofitable offices leaving patients in limbo and without records.

Lethbridge Family Physician Dorcas Kennedy stated in the same interview, “These corporations have a fiduciary responsibility to their shareholders. So, the whole relationship has changed.”

Corporations don’t care if the patient is getting adequate care. They only care that they’re making a profit. Patients and the health care system come second to profits and shareholder dividends.

Kennedy says that two years ago, “The provincial government tried to take over the College of Physicians and Surgeons as being a governance of Alberta Health Care. The government wanted the ability to tell physicians where they could work, how they can work, what they’ll be responsible for. They decimated the Alberta Medical Association and left it without governance.”

There’s no contract to honour because the UCP ripped it up and replaced it with Bill 30, The Health Care Statutes Amendment Act, that states the government doesn’t have to honour any future contract.

In the two years since the UCP implemented changes to physician rules and fees, 33 Lethbridge doctors either retired or left the system. That means over 45,000 unattached patients are without access to a doctor or a walk-in clinic.

Walk-in clinics had been run out of the doctor’s offices. Since doctors are now limited to 50 lines or submits a day, they’re unable to bill for any services over and above that. Without the ability to bill for walk-in services, physicians can’t pay their overhead. That put an end to walk-in clinics.

This impossible situation made it easier for Kenney to introduce virtual medicine. Make no mistake, virtual medicine is corporate medicine. Telus Health and Shoppers Drug Mart provide virtual services across Canada. However, physicians accessed through these services could be located literally anywhere in the world.

Virtual doctors can book appointments, book follow-up visits, book referrals, and bill. But they can’t examine patients.

A surgeon in Alberta could get a patient referral from a virtual doctor who has never examined the patient. The surgeon still has a professional responsibility to the patient, but the corporate physician has none. In fact, virtual doctors often tell their patients, if it gets worse, go to emergency. Emergency is the new walk-in clinic and triage center for non-existent family practices.

Telus Health holds the contract, either directly or indirectly, for all Electronic Medical Records (EMRs) in Alberta. They are able to bill more for each service than family physicians creating a financial impetus for Telus Health to have the rights to all EMRs in Alberta.

Metz draws particular attention to the corporatization of the Alberta lab system. In 2019, the NDP was breaking ground for a publicly run province-wide lab system. Then, the UCP were elected and squashed the deal with Alberta Public Labs.

Instead,  the UCP awarded the contract to DynaLIFE at a potential cost of $480,000 million annually. However, DynaLIFE does not have to service communities unable meet corporate quotas. Those tend to be rural communities.

DynaLIFE grew out of DynaCare with headquarters in Brampton, Ontario⁠—although this is glossed over on the DynaCare site. Both companies are now a division of the Laboratory Corporation of America.

This untenable situation has motivated Metz to run as the New Democratic Party (NDP) candidate for Calgary⁠—Varsity in the next provincial election.

According to Metz, “The NDP do not support all the things they’re (the UCP) trying to do in privatization. We’re more than a year out from an election probably, and yet, that promise that we will support a publicly funded, publicly delivered health care system is already out there as a promise.”

Metz believes you need to have people in government who understand how this complex system works in order to really understand it on many levels.

“I’ve had senior leadership roles in the University in Alberta Health Services and so I’ve seen how things work,” said, Metz. “And, I know all the people, all going up to the top because I’ve seen them at all their different levels. I do know people in all parts of it. And, I know enough that every little thing you do is like flapping the butterfly wings and it has the impact somewhere else.”

Metz reminds those in Alberta that the health care system needed help even before the UCP began destroying it. She cites long wait lists as a classically Canadian example. But she knows there are ways to lessen the wait.

“There are proven strategies to do that. We’ve done it before and we’ve been successful. But the system is like turning an ocean cruiser⁠—it’s very, very slow and it should be able to be faster. It should be nimbler and we need to have the right incentives to fix the problems without wait times because the worse the wait times are, the more support there is for private health care,” says Metz.

She went on to say, “People shouldn’t be waiting that long in pain. We should have fixed that. We can. We know how. We just have to make it a priority to do it. That’s actually cheaper for the health care system.”

Metz echoes NDP calls for pharmacare, dental care, vision care, and better mental health care. She believes partnering federally will bring much needed funding for these investments which produce overall cost savings very quickly.

“Primary care is the backbone of the whole system. Every dollar you invest in improving primary care, you get, apparently, ten dollars back in benefits to your health system. And yet, it hasn’t really been pushed,” maintains Metz.

She admits that doctor’s shoulder some of the responsibility too noting that physicians often get set in their ways and aren’t eager to change. Metz envisions working with doctors to foster improvements that meet community needs. She says, “We’ve done so many pilot studies that we know how it can be done. But we have to make it so that it’s not only good for patients but fits with a transition plan for physicians to want to be in those practices.”

Doreen Nicoll

Doreen Nicoll is weary of the perpetual misinformation and skewed facts that continue to concentrate wealth, power and decision making in the hands of a few to the detriment of the many. As a freelance...