2010 Jun Speaking Notes - Presentation to Minister's Advisory Committee on Health Care (MACH)

Good morning. My name is Gil McGowan and I am the President of the Alberta Federation of Labour.

As most of you know, the AFL is Alberta's largest organization of labour unions. We represent 29 unions in the public and private sectors with a collective membership of more than 140,000 working Albertans.

As you probably also know, the AFL has played a central role in the fight to keep our health care system whole, and to keep it public.

With our partners in groups like Friends of Medicare, we fought against Bill 37 in the late 1990s.

In 2000, we fought against Bill 11- the provincial government's next attempt at expanding the role of private hospitals.

And in 2005 and 2006, we played a key role in the fight against the Third Way.

In all of these cases, the labour movement - through the AFL - marshalled its resources, mobilized its members and helped win the support of a clear majority of Albertans.

The ads, the town halls, the thousands of calls and letters to MLAs - we helped make those things happen. And we did it because we believe in our hearts, and in our guts, that public health care is worth fighting for.

All of these campaigns were instructive. They demonstrated that Albertans are passionately supportive of their public health care system. They demonstrated that Albertans are willing to pay for a top-notch public health services through their taxes. And they demonstrated that Albertans are deeply distrustful of, and opposed to, all efforts to weaken the system through privatization.

For our purposes this morning, I think it's particularly important that we look back on our province's experience with the so-called Third Way.

While we were preparing for this presentation, we dug up a document called "Removing Barriers" which was prepared by the government in 2005.

It was a summary of what the Third Way was all about - and it's worth reading if only to remind us that we've been here before.

According to the Removing Barriers document, the main goal of the Third Way was to pave the way for private insurance and for doctors to practice in both the public and private systems. Both of these changes were to be made by amending the Alberta Health Care Insurance Act and the Hospitals Act ... the same laws now under review by this committee.

Back in 2006, the people of Alberta heard this sales pitch and they made it clear that they weren't interested in buying.

They didn't want the government experimenting with private insurance. They didn't want the government to allow doctors to practice in both a public and private system or any other money-making scheme that would siphon resources from the public system to a for-profit one.

And the government was forced to back down.

So here we are, almost 4 years later.

The lesson from these earlier attempts at privatization should have been that the people of Alberta are not interested in more user fees, a parallel private system, or purchasing private insurance.

They are not interested in schemes that allow queue-jumping. And they're not fooled by loaded political buzzwords like "choice" and "flexibility."

What Albertans wanted then, and what they continue to want now, is a properly-funded public system that uses intelligent innovations within the public system to make sure people get the care they need, when they need it.

So what has the government learned from Bill 37, Bill 11 and the Third Way?

Well, they don't seem to understand what "no" means.

If anything, it appears the lesson the government has taken from all of these failed attempts at reform is not to accept that Albertans don't want more private health care, but rather that they should be just use new and better political "spins" to sell the idea.

That's why my organization is frankly suspicious of this committee and its work. Even some of your reassurances make us suspicious.

For example, this Committee has tried to reassure Albertans that we're not heading for a repeat of the Third Way by saying that whatever changes are made, the legislation that comes out the other end will be in compliance with the Canada Health Act.

With all due respect, this is perfect example of the political spin I was talking about - the kind of game-playing that makes Albertans more distrustful of the government's real intent, not less.

As all of you undoubtedly know, the Canada Health Act does not prevent private health services, private delivery, or private insurance.

The Canada Health Act does do is ensure that federal spending on health care supports publicly administered, comprehensive, universal, portable and accessible provincial health care insurance plans.

But the CHA is silent on whether there should or shouldn't be a parallel private system available to those who can afford to buy their way to the front of the line using US-style private insurance.

That means that restricting the growth of a parallel for-profit health care system is the role of provincial Legislatures, not the federal government through the Canada Health Act.

And what do the laws in Alberta say today? The good news, from our perspective, is that they actually do the job of protecting the integrity of the public system.

For example, in sections 6 and 7 of the Alberta Health Care Insurance Act physicians are allowed to either opt in or opt out of the public system. There is no law against a physician setting up a wholly private practice. But the Alberta Health Care Insurance Act contains some powerful disincentives for physicians to go "private" - most notably the prohibition on opted-out doctors from receiving subsidies from the public system.

In addition, section 26 of the Alberta Health Care Insurance Act outlaws contracts for private insurance for services that are covered in the public system, and private insurance is also not allowed to pay for all or part of fees charged by physicians who opt-out of the public system.

In other words, these are the laws that keep our system public. These laws, Alberta laws, are what keep the privatization monster at bay.

Unfortunately, they also happen to be the laws that this committee is proposing should be amalgamated, streamlined, and possibly relegated to regulation.

That's why we're worried.

We're worried because you're proposing to tinker with legislation governing opting-in, subsidization, and private insurance contained in the Alberta Health Care Insurance Act which are the only barrier to the creation of a private health care market.

We also worried because the legislative model you're proposing for the new "Alberta Health Act" is the model that the government used in the Drug Program Act.

As you know, the Drug Program Act is enabling legislation, which permits the Minister to establish a drug program for the purpose of providing funding for, or providing, drugs, services and approved drugs.

The Drug Program Act then permits the Minister to make regulations which will determine all of the details of the plan, including who is covered for what kind of drug coverage, amounts of co-payments and deductibles.

The Drug Program Act puts most of the power to decide the future of Albertans' drug coverage in the regulations, not the legislation or statute itself.

The key difference between a statute and a regulation - and I know this is obvious, but it bears repeating - is that a statute is approved by the Legislative Assembly following debate before it becomes law, while a regulation is not.

If the Drug Program Act is accepted as the model for the new Health Care Act, Alberta's health-care legislation will contain no details of the core health-care framework.

All details will be left to the Minister's discretion and will not subject to debate in the Legislative Assembly. Further, the Minister can change the regulations at any time without notice and without debate.

This model offers no assurances that delivery of insured services using public funding will be organized in a manner that preserves delivery of health care on a non-profit model; or appropriate standards for health and health services in Alberta will be established and enforced.

To us, it seems like a tool designed to ram privatization down the throats of Albertans. It seems to be a strategy aimed at giving the government the power to fundamentally change our health care system under the cover of night, because they haven't been able to do their dirty work successfully in the full light of day.

All of this is not to say that there aren't constructive changes that could be made to our various pieces of health care legislation.

For example, we could expand the services covered under the Alberta Health Care Insurance Act to include more services, such as eye care.

We could move all Health-Insurance related legislation into one piece of legislation, consolidating the Hospitals Act and the Health Care Insurance Act, setting out more services that are insured under our public plan.

We could beef up accreditation and inspection of non-hospital surgical facilities such as the now-bankrupt Health Resources Centre, so that they are subject to the same rules as a public hospital.

We could improve the standards in nursing and mental health care, which every reasonable person agrees would help to protect and better care for Alberta's most vulnerable citizens.

But there is no need to amalgamate all of the legislation, and there is even less need to structure our health care laws as enabling legislation. This committee appears to be breaking the things that don't need fixing while not even looking at the areas - like mental health and seniors' care - that are actually broken.

In conclusion, I want to be perfectly clear with this committee.

My purpose here this morning is to let you and the government know that we have a pretty clear idea of what you're up to.

In the language of that old Third Way document, it seems to us that your task is to remove barriers. And the barriers you seem intent on removing are the barriers that currently exist in legislation to private insurance and the introduction of a parallel, private health care system. Perhaps most disturbingly, you want to achieve these radical changes in a way that is profoundly undemocratic.

So please, tell the Minister, tell the cabinet, tell the Premier: if they go ahead with this attempt to structure our health laws against the wishes and best interests of Albertans, we in the labour movement will, once again, stand up for and with ordinary Albertans.

Tell them not to fix something if it's not broken.

And tell them to do what Albertans have been asking for from the beginning: and that is to improve the public system by focusing on reforms within the public system itself, not by constantly returning to discredited and dangerous privatization schemes.

Thank you.

Gil McGowan, President
Alberta Federation of Labour
Thursday, June 29, 2010

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