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FEDERAL LIBERALS OPENED DOOR FOR KLEIN'S BILL 11
By Doug Meggison, Edmonton
(This article is from the April 1-15/2000 issue of People's Voice, Canada's leading communist newspaper. Articles can be reprinted free if the source is credited. Subscription rates in Canada: $25/year, or $12 low income rate; for U.S. readers - $25 US per year; other overseas readers - $25 US or $35 CDN per year. Send to: People's Voice, 706 Clark Drive, Vancouver, Canada, V5L 3J1.)
SEVERAL RECENT STUDIES knock the stuffing out of the Alberta Government's justifications for Bill 11, which proposes to allow Regional Health Authorities to contract out any hospital procedures, including surgeries which require overnight stays.
The New Democratic Party characterizes the Bill as a plan to shovel public money into private pockets, and to ultimately destroy Medicare. The provincial Liberal Party, despite the milquetoast federal Liberal Minister of Health, Alan Rock, has been forced to take a principled stand by the huge public support for the New Democrat position (albeit not the NDP). The Communist Party plans to coordinate a door to door mail drop of an anti-privatization leaflet in the Edmonton riding of the associate minister of Health who is leading Premier Klein's "Truth Squad" for the Bill.
A new study by the University of Alberta's Medicare Economics Group (MEG) argues that the bill is a culmination of changes to medicare that the Klein government negotiated with the federal Liberals several years ago. This is, by implication, one reason why Ottawa has been fighting Bill 11 with one (or both) hands tied behind its back.
The study's author, Dr. Richard Plain, shows that the furore over Bill 11 can be traced back to 1994-95, when the "provincial government reached an understanding with the Alberta Medical Association and various medical entrepreneurs which led to the development of a new private public hybrid model for the Alberta health care system." (p. iii)
On May 17, 1996, the Alberta and Federal Governments signed off on twelve principles. One of these, Principle 11, sets out that physicians may receive both public (medicare) and private (out of pocket) payments for medically required publicly insured services. The example of cataract surgery with "add-ons" is used.
Dr. Plain argues that Principle 11 should be deleted in its entirety, and a number of the other principles amended. Without Principle 11 in the background, the current Bill 11 could not likely go forward.
Principle 11 also asserts that where the public system is not providing a service in a timely fashion, but still within a medically acceptable time frame, an individual may purchase the service outside of medicare insurance.
The study effectively uses the example of existing private for-profit MRI facilities in Alberta as an example of how queue jumping occurs today. Bill 11 purports to prohibit queue jumping, but the text of the Bill means that "bakeesh" (or bribery) is to be prohibited, not private purchase of a diagnostic service which is normally provided within medicare.
Dr. Plain shows that the word "timeliness" confuses matters and has probably led to a legal violation of the Canada Health Act, despite whatever Bill 11 may produce: "The normal linkage between medically required services and publicly insured services should remain invariant with respect to time or else medicare, as we currently understand it will be destroyed." (p.57)
A health care economist, Dr. Plain repeatedly shows that the private competitive market fails when dealing with "patients," and will lead to monopoly price gouging in the absence of strong regulatory controls, which the Alberta Tories apparently have no intention to provide. Still, he recommends that if contracting out must occur, then all contracts must be available for public inspection. Proposing for-profit clinics should have to prove their case economically in advance.
He argues that criteria used by Regional Health Authorities should be on a detailed standardized provincial basis; otherwise seventeen systems could come into existence. "Report cards" should be issued on private clinic performances, and all of the services contracted out (e.g. laundry and day surgeries), he says, should be brought under the same new legislation and regulations.
In any event, private hospitals under whatever name ("approved surgical facility") should be banned, he says, because of inevitable and structural market failure, and the consequential violation of the "comprehensive" and "accessible" principles of the Canada Health Act.
The study shows that the Alberta government is committed to the privatization of sectors of medicare for non-provable ideological reasons. The government has carried out no research to prove the case that privatization works by reducing waiting lines or costs. Dr. Plain argues that nothing should go forward without appropriate research. The thrust of his paper is that the logical, ethical and empirical case cannot be made for contracting out overnight-stay surgeries.
Meanwhile, public opposition grows, much of it coordinated by the "Friends of Medicare" group, whose tireless spokesperson Christine Burdett has been seen on national media. The group has an excellent website with links to other organizations and studies at <www.savemedicare.org>.
Klein is likely to bring back Bill 11 for second reading in early April. Meanwhile, his government is assessing the effect of having distributed a full text of the Bill to over a million Alberta households.
However, with the lineup of opponents growing to include the Alberta Medical Association, Klein may face a large loss of seats come general election time if he bulldogs ahead.
The ruling class may be ferocious, but they can make mistakes. Savaging medicare may be possible for the Klein regime, but a well organized resistance to stop the Tories is gaining strength daily.
(The Privatization and the Commercialization of Public Hospital Based Medical Services Within the Province of Alberta: AN ECONOMIC OVERVIEW from a public interest perspective, March 2000, Medicare Economics Group, Department of Economics, University of Alberta, 65 pp., download from Internet free at www.meg.ab.ca)
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