Albertans concerned about preserving public health care should not be overly reassured by Premier Danielle Smith and Health Minister Adriana LaGrange’s statement in response to a Calgary medical clinic’s plan to make patients pay up to $4,800 a year for timely access to a physician.
The communique may have been drafted in response to a statement for media from Health Canada indicating it believes the Marda Loop Medical Clinic’s scheme to make patients pay a membership fee would violate the Canada Health Act.
But the Alberta statement is slippery and offers no meaningful indication the Smith Government intends to change its permissive approach to public health care’s continuing erosion in Alberta.
Nevertheless, the controversy over the clinic’s plan puts the United Conservative Party Government in an uncomfortable and potentially embarrassing spot. It obviously takes that seriously enough to make an explicit effort to defuse it, albeit without really changing anything.
The membership fee controversy
Last week, patients from the clinic received an email from Dr. Sally Talbot-Jones promising “to significantly improve our services to you and your loved ones.” The email was in fact announcing that they were going to have to pay substantial “membership fees” starting August 1 if they wanted to continue to be able to see her promptly.
Controversy immediately followed when news of Talbot-Jones’s “transformative healthcare initiative” broke on July 24. Health Canada issued its statement to the media the following day.
“The Government of Canada does not support a two-tiered health-care system where patients may choose, or be required, to pay membership fees to access insured primary care services at clinics, or to gain expedited access to those services,” it read.
Importantly, Health Canada said it had informed Alberta Health officials that “the ability for patients to purchase preferential access is contrary to the Canada Health Act,” in its view.
The legal loophole
However, since other clinics only for fee-paying members have been allowed to operate in Alberta, it’s quite possible that this interpretation of the act could be disputed in court. It’s not yet clear if the federal government has the will or the time to amend the Canada Health Act to specifically close the loophole.
Still, it would be politically risky in the extreme for the Smith Government to, say, use its Sovereignty Act to introduce two-tier health care into Alberta. Of course, Premier Smith might privately wish she could do just such a thing, given her history of advocating for private health services.
The provincial strategy will more likely be to try to sound as reasonable as possible to avoid goading the Trudeau Government into amending the act. All while continuing to look the other way as fee-based clinics continue to operate.
In its story, the CBC cited an academic paper that finds at least 83 private-payment-only clinics operating in six Canadian provinces, including 14 in Alberta.
That would leave the task of challenging the application of the Canada Health Act to Talbot-Jones, or another doctor who can’t resist exploiting the legal loophole.
Premier and Health Minister look the other way
Which brings us back to yesterday’s statement by Smith and LaGrange.
They begin by saying they expect physicians to follow the law, including the Canada Health Act. But their statement soon moves into the no-laws-were-broken defence so familiar to observers of Alberta politics.
A paragraph expounds on all the legal ways Alberta physicians and clinics operate – services that might include “non-medically required surgery, nutrition, and acupuncture services, medical notes and fertility treatments” – and abortions, it should be added, if LaGrange ever gets her way.
“The Audit and Compliance Assurance Unit of Alberta Health has evaluated instances where private clinics operate this way, charging membership fees in Alberta,” it continues. “Historically, all evaluations have confirmed that these clinics are operating in compliance with the act.”
Health Canada, it adds, has so far not identified a problem with these clinics. If this is true, and if Health Canada’s statement is also accurate, it suggests that a significant number of clinics have been quietly operating illegally in Alberta for some time. The provincial government would either be looking the other way or failing to ask the right questions.
Alberta only recently became aware of Dr. Talbot-Jones’s plans, the statement continues.
“Alberta’s government would be extremely concerned if this clinic was charging fees for services that are insured and offering accelerated access to a family physician at the expense of other patients needing to wait longer,” the statement says. “We have directed Alberta Health to investigate this specific clinic to ensure compliance with all legislation. If any non-compliance with relevant legislation is found, we will take appropriate action.”
In other words, if you need a translation, we’re not admitting anything improper is going on. We’d like the problem to go away as soon as possible, and we intend to do as little as possible.
“Albertans do not pay out of pocket for insured health services such as seeing a family doctor or visiting a hospital,” the statement concluded, “that will not change.”
This statement, while definitive, does not respond to the question raised by the Marda Loop Clinic’s plan. Clinics are requiring membership fees, bundling public primary care with wellness services, and corporatizing of family medicine.
Researchers at Simon Fraser University in B.C. and Dalhousie University in Nova Scotia whose paper was cited by the CBC, state it clearly: these clinics “should all be the subject of robust investigation by both provincial policymakers and provincial physician regulatory colleges.”
And that, dear readers, is precisely what Smith and LaGrange so obviously hope to avoid.
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