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Friday, 17 April, 2009

Debate on Alberta health insurance overhaul boils over

Alberta Health Minister Ron Liepert (left) made a big splash this week -- even by his infamous "Rockin' Ron" standards -- when he declared that because the province's healthcare costs are growing at an unsustainable rate, some medical services currently covered by the public insurance plan would have to be "de-listed." [Calgary Herald]

Mr Liepert said the government may establish a panel to make recommendations on "what is medically necessary, what is essential, what needs to be covered, what doesn't need to be covered."

"We, 3.5 million Albertans, can't afford to cover what we've got right now," he said. [Calgary Sun]

"Keep in mind that in a lot of the services that we offer, many of them are outside the Canada Health Act," Premier Ed Stelmach said. "I'm not saying that we have to look at all the services, but we're going to have to ensure that we preserve our public health-care system for the future."

The Tories' assertion is supported by new research published in a new report from the University of Calgary's School of Public Policy, by Lakehead University's Livio Di Matteo and researcher Rosanna Di Matteo. Growth in government health expenditures continues to outstrip growth in GDP and (by a factor of nearly two) growth in government revenues. "Clearly, the set of policies that guided health care spending over the period 1997-2007 is not sustainable." [The Fiscal Sustainability of Alberta's Public Health Care System (PDF)]

Anti-privatization politicians and activists were upset to hear Mr Liepert's plans. "Mr Liepert laid his cards on the table today," Dave Eggen, the executive director of the group Friends of Medicare, told the Calgary Herald. "He wants to get away with as much as he can in terms of privatizing and delisting."

Even within Mr Stelmach's own party some doubt has arisen as to whether delisting is a feasible political move. [Calgary Herald]

Mr Liepert has defended the need for a review. "If we stay with the status quo, we will have exactly what they say this government is trying to do, and that is more private health care because we won’t be able to continue to afford to provide what we are today," he said in the legislature. [Health Edition]

Reporters encountered a frustrated Liepert at the legislature. "I don't want you going out there spreading fear, which is what you do," he told journalists, and then walked away without taking any more questions. [Edmonton Sun]

The delisting controversy began earlier in the week when Mr Liepert announced on Tuesday that the province would cease coverage for sex reassignment surgeries, a change which would save the province $700,000 per year. [CBC News] By Wednesday, at least 20 human rights complaints had been filed by transgendered Albertans. [CBC News] Similar human rights complaints against the government of Ontario led that province to reinstate coverage for sex reassignment surgeries last year.

But Mr Liepert has pressed on, undeterred. He told the Calgary Sun that the ideal future structure of Alberta's healthcare system should be a public insurance plan for basic care and private supplementary insurance, provided by companies like Blue Cross, to cover other care. He'd like to see a cross between the American and Canadian models. "There's got to be something between their system and our system that works," he said.

On Wednesday, Mr Liepert announced that the price of Blue Cross individual insurance would triple, going from its current monthly rate of $20.50 to $41 on July 1, and then to $63.50 on the following July 1. [Edmonton Journal]

Today, Mr Liepert's office was besieged by protesters angry over potential cuts. [CHQR News]

Given the divisive issue that health insurance privatization is in Canada, combined with Mr Liepert's unapologetic attitude, penchant for tough talk, and his reformist drive, Alberta's situation is sure to be among the defining issues of Canadian health policy over the next few years.

Posted by David Elkins and others at 5:17 PM

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1 comments:

  1. Ron, Sam, et al,

    let's look at this summation:

    'Mr Liepert's unapologetic attitude, penchant for tough talk, and his reformist drive'

    RE: the unapologetic attitude

    the condemnation of the press about "spreading fear" companions well with the fear that fuels an unapologetic stance.

    RE: penchant for tough talk

    Ron, let's hope this really means you are following the tested and true D.A.D.S. ( disclosure, analysis, dissemination of results, sanctions).
    Tough talk, without DADS is playing the ostrich.
    Tough talk with DADS occurs at the point of (S) Sanctions and ( key) has strength of argument because of the quality of the (A) analytical stage.

    RE: reformist drive

    Now here lies the passion and energy to do something new.

    And what would that be?

    Look closely at the age-old practice and public expectation that where the governors state change is required they do two things:
    create a block and a challenge at the same time

    The "blocking" part is going well but the "challenge" part is not well thought out.
    This may be because, historically, this block/challenge process has the cart "before" the horse ( that is action "precedes" analysis , selection of alternatives and susbsequent timely revisions )

    No time like the present for the "reformist" part of your drive, ron,to do a new thing.

    And what would that be?

    A paradigm shift in your own thinking, Ron.
    Answer this question ( quickly, before analysis)

    Q- if there were 2 patients in a hospital.... and admission rates doubled every day.... and on the 30th day the hospital was full...what day was the hospital "half" full?

    Quickly now...what did you say... the 15th day?
    interesting...... that is what most people say when they do not switch their thinking from "logical" to "deductive".

    The actual answer...look closely... is "the 29th day "
    ( remember, doubles every day)

    This leaves NO time to "plan" or "provide" change that requires huge restructuring.
    You are IN the ? 15th day and all you can do is re-shuffle the cards you have.

    How is that done?

    Answer:

    This is the problem the entire publicly funded health service in Canada faces:

    1. the failure of change agents to think analytically
    2. the impact of geometric growth and the exponential function

    What to do?

    Well, you see the problem...and your response to it is to erect a "huge" STOP sign... and the private sector options are "wolfing" at the door. ( I'm slipping in the saliva)

    Ron, what if you START something new emerging from the publicly funded structure that still fulfils the tenets of the Canada Health Act?

    What is that?

    RE: direct patient care

    1.fund the day-to-day "NON-medical determinants of health " activities which take up the most time but(key) cost the least.
    Don't you know it would cost the patient less to pay for "per visit" medical treatments than it costs for them for the non-medical IADL?????????

    [If you think you are going broke.... look at them!!!]

    2. enter a mezzanine financing relationship with the private sector where the responsibilities for delivery and payment for secondary, tertiary and quaternary care services rendered are phased ......with QA monitoring and public input and reporting included in the assessment of each phase.

    Trust me , Ron, the lowest costs in primary care are linked to "instrumental" events impacting the patient ( and now provided only by the private sector with geometric growth in cost )

    This means that both you and the patient outside of hospital are experiencing the same impact of exponential growth in costs.
    KEY: Their only respite is to become more ill so the public purse can kick in.

    Oh, no! Now what!

    Steps:

    1.Put all primary care into the community with medical health service "attractively"salaried.... and non-medical service funded through the patient.
    Make it more profitable/valuable for the patient to be "well" ....and watch the primary care hospital beds close.

    2. Let a larger community control exist over the " coordination" of this service provision and you will see how the "exponential function" kicks in again to cover administration costs in "clusters".

    KEY: Make the exponential function work FOR you... not against you.

    SUMMARY

    Do a pilot, Ron... call it the Community Healthcare Access Program (CHAP). Create a circular independent loop in clusters that includes the patient. Release control and responsibility for service to a selection of clusters that teach each other excellence.....but (key) maintain control over "coordination" as a central event.

    P.S. ( KEY ) Use "analytical thinking" only to capture the references to phasing ...and the divisions of primary, secondary, tertiary and quaternary care.... and central coordination benefits.

    - 30 -
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