Health Minister Adriana LaGrange in 2021, then the education minister, behind podium.
Health Minister Adriana LaGrange in 2021, when she was education minister. Credit: Chris Schwarz / Government of Alberta Credit: Chris Schwarz / Government of Alberta

The Alberta government has the power to outlaw fees like those about to be charged by a Calgary medical clinic for patients to get timely access to their physician. If Premier Danielle Smith wants anyone to believe her election claim no Albertan would ever have to pay up front to see a doctor, it’ll have to exercise it

And if the United Conservative Party won’t exercise the power to stop this dangerous practice, and another step toward true two-tier pay-to-play medicine in Alberta, then the NDP Opposition needs to do its job and introduce a private member’s bill that would force the government to reveal what it really thinks.

Patients of the Marda Loop Medical Clinic in Calgary were shocked last week when they received an email from their physician, Dr. Sally Talbot-Jones, saying that if they wanted to continue to be able to see her in a timely fashion, they were going to have to pony up significant “membership fees” ranging from $4,800 per year for a two-parent family membership to $2,200 annually for a single adult. 

Family membership for a single parent would cost $2,400 a year; for a couple with no children, $4,000 a year; and for child coverage by a single parent who couldn’t afford to pay the fee for herself, $500. 

The alternative, if they hope to continue to see Talbot-Jones, is to try to get seek an appointment on the one day a week she says she will continue to provide care to non-member patients. 

If this “transformative healthcare initiative,” as Talbot-Jones called her new approach to billing, is supposed to improve service for patients who can afford the fees, it obviously isn’t going to have that effect for those who don’t have enough income to pay.

As one Calgarian who had seen the letter wrote last week in the comment section of my blog, “if the province encourages this, and if enough doctors take up this idea, this is the end of public health care.”

And therein lies the rub. Since the practice appears on its face not to violate the Canada Health Act because patients would not be required to pay for medically necessary services listed by the province, the government can say no laws were broken and look away. 

Smith could even claim – and probably will – that patients can always find another doctor who doesn’t charge a membership fee. 

The problem with that, of course, is that given the national shortage of physicians, which seems to be particularly severe in Alberta thanks for former health minister Tyler Shandro’s 2020 War on Doctors, if nothing is done to nip this practice in the bud, it will become commonplace. It’s a matter of supply and demand, after all. 

While the government could argue on a technicality that no one who needs a medical service will be denied, if getting it requires an up-front fee to see a physician that you can’t afford, you have in effect been denied the treatment or at least been sent to the back of the line.

Indeed, it’s fair to say that the whole idea won’t work if everyone can afford to sign up. If the goal, as the clinic email states, is “to provide a more comprehensive, proactive healthcare service,” it would require service to get worse for those who can’t afford to pay. 

Alberta Health Minister Adriana LaGrange told the CBC yesterday that the government remains committed to the Canada Health Act. It isn’t, of course, but there’s not much it can do about it. In the meantime, it is in effect pleading the no-laws-were-broken defence.

LaGrange’s press secretary tried to sound more reassuring while saying the same thing: “The government will continue examine these cases to make sure all legislation is being followed.” In other words, the UCP is not going to do anything. 

In a statement sent to media, NDP Health Critic Luanne Metz, a physician, half-heartedly defended physicians who adopt such a billing scheme, saying “I primarily fault the provincial government for pushing these doctors into a situation where this is how they have to pay the bills.”

“I am very concerned that if the province approves these fees, then this revenue stream will be irresistibly attractive to other clinics as well,” she added, obviously accurately.

In the same statement, NDP Mental Health and Addictions Critic Janet Eremenko noted Smith’s claims during the election campaign that no Albertan would ever be asked to pay to see a family doctor. “That brings us to today, with Albertans being asked to pay to see their family doctor, exactly what Smith promised wouldn’t happen.”

The CBC noted in its story that there are other clinics in Alberta charging membership fees for patients to access service. 

This is true. There are at least four others, three in Calgary and one in Edmonton, and may be more. 

The case if the Marda Loop Medical Clinic, though, is the first that has come to public attention in which a family medicine clinic in Alberta that previously operated according to the conventional model is switching to membership payment for patients who want to continue to receive timely appointments and treatment. 

Model legislation to ban this practice would give physicians the ability to bill patients for memberships only if they opted out of receiving payment for approved medical treatments from public health insurance. 

The Alberta Medical Association, the Alberta physicians’ collective bargaining organization, did not respond to a query about this practice. The office of federal Health Minister Jean-Yves Duclos is aware of the situation and will try to determine if there is a breach of the Canada Health Act

David J. Climenhaga

David J. Climenhaga

David Climenhaga is a journalist and trade union communicator who has worked in senior writing and editing positions with the Globe and Mail and the Calgary Herald. He left journalism after the strike...