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Conservative mismanagement of Alberta's health-care system is a feature not a bug

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Alberta Minister of Health Tyler Shandro tours the Stollery’s new pediatric intensive care unit. Photo: Government of Alberta/Flickr

Last Thursday, Alberta Health Minister Tyler Shandro advised Albertans that the promised United Conservative Party review of Alberta Health Services (AHS) is rolling ahead.

Well, he did once tell us that things tend to happen in due course.

This is pretty much the first we've heard from Alberta's baby-faced health minister since he famously demonstrated he doesn't yet understand how to stay in a message box.

Judging from his resume, Shandro is a bright guy, so he'll probably figure it out. For now, though, it looks as if the UCP brain trust didn't trust him enough to let him loose where there are TV cameras around, so his announcement took the form of a terse statement encouraging Albertans, the more the better, to visit the AHS review website and offer their uninformed opinions.

The notion that, as the UCP has claimed in the past, the so-called performance review of AHS "will identify ways to deliver better results for Albertans and find efficiencies across the health system" is almost certainly a delusion.

Even done properly, a $2-million performance review of the operations of a $15.2-billion public health-care agency with well over 100,000 employees that has to be done in four months is unlikely to produce much of value.

Since Ernst & Young's effort cannot produce meaningful results, as a glance at the landing page for submissions also makes clear, the simplest explanation is that this is designed to provide a bit of faux democratic cover so the UCP can do what it plans to do anyway.

This is most likely to introduce as much privatization into our public health-care system as it can get away with, pick a fight with health-care unions, and find ways to have more low-skill, low-cost workers delivering care. The results will be bad for the system, bad for anyone who has to use it, but good for a few well-connected folks' bank balances. In other words, pretty much standard conservative operating procedure in this province.

My advice, not likely to be listened to by the government, is to pay attention to the respected Canadian Institute of Health Information's (CIHI) comparative study of Canadian health systems and leave AHS the heck alone.

As has been stated here before, CIHI's researchers found AHS has the lowest administrative costs in health care in Canada -- 3.3 per cent of total spending, compared with a national average of 4.5 per cent.

What CIHI's analysis means is that AHS has already saved "something in the range of $200 million that we could find in administrative savings" that Premier Jason Kenney promised he could recover based on costs cut by less efficient health systems. In other words, the premier's prediction is wildly optimistic and based on a phoney diagnosis that won't work because there's not much fat left to cut at AHS.

As AHS President and CEO Verna Yiu observed in a letter to the Medicine Hat News last spring, delegates to the 18th International Congress on Integrated Care in Utrecht "ranked AHS second in the world" -- behind only the Netherlands -- "as the health system from which the most could be learned."

With the exception of the past four years, Alberta's health-care system was in chaos for most of the preceding four decades. Whether the creation of health regions under conservative premier Ralph Klein, the later reduction in the number of those health regions, and the establishment of AHS under premier Ed Stelmach were the right or the wrong things to do doesn't really matter at this point.

What matters is that the system, which was actually running so smoothly under the steady hand of NDP health minister Sarah Hoffman that it ceased to be a top-of-mind issue for most Alberta voters, simply may not be able to take another major reorganization of any kind without catastrophic results.

Of course, as is now well understood thanks to the work of author Naomi Klein and others, neoliberalism thrives on catastrophic emergencies, as they provide the opportunity to open the door to more of the "solutions" that caused the crisis in the first place.

If one doesn't come along by happenstance, market ideologues like Kenney are always happy to try to gin one up.

This, I'm afraid, is why it's a mistake to characterize conservative mismanagement as incompetence. It's a feature, not a bug.

Memories of conservative health-care chaos past

Speaking of conservative health-care chaos, AHS and CIHI, I was reminded last week of the way Fred Horne, health minister under conservative premiers Alison Redford and Dave Hancock, used to run things.

Who now remembers Janet Davidson, the high-billing consultant Horne appointed in 2013 as sole administrator to run Alberta Health Services after he fired the entire Alberta Health Service Board for insisting they had to live by legal contracts to pay executive bonuses?

Davidson, a former registered nurse and CIHI board chair, has now been named interim director of the Nova Scotia Health Authority, taking over on September 3. Interestingly, it appears she'll be paid considerably less than she got as the sole AHS administrator, the one-woman regime set up by Horne to untangle the mess he and his conservative predecessors had created.

It turned out, naturally, that AHS board chair Stephen Lockwood was right, and a contract really is a contract. The bonuses were quietly paid during Davidson's tenure, although AHS didn't have a board again until the NDP came to power.

Horne now has gigs in the corporate sector as the board chair of a national health-care procurement corporation, as a senior adviser to an Ottawa-based lobbying firm and a think-tank, and in the public sector as an adjunct professor at the University of Alberta. This is living proof that, as they say en français … plus ça change, plus c'est la même chose.

David Climenhaga, author of the Alberta Diary blog, is a journalist, author, journalism teacher, poet and trade union communicator who has worked in senior writing and editing positions with The Globe and Mail and the Calgary Herald. This post also appears on David Climenhaga's blog, AlbertaPolitics.ca.

Photo: Government of Alberta/Flickr

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