I thought this thought again this morning as I listened over the car radio to Premier Ed Stelmach’s astonishing confession of incompetence delivering H1N1 inoculations to Albertans. “We’re doing the best we can,” he complained through the ether. “Remember, we’re running a health system at the same time!”
Seeing this statement in black and white print really doesn’t do it justice. Lost in translation, but clear over CKUA’s rickety broadcast towers, was the petulant first-ministerial whine that translated as, “it’s not my fault!”
Was the premier really saying the government’s All-Union Institute of Health Materials and Services – whoops, I mean Alberta Health Services – is not capable of running its hospitals and performing routine tasks while engaging in a mass immunization program of an essentially healthy population?
Now, Alberta as a moribund late Soviet state has been a thought that’s been with me off and on since I moved back here in the 1980s, not long after complications from cirrhosis of the liver had brought an end to the short, unfortunate rule of Comrade Chernenko, as a matter of fact.
I mean, the place is a one party state. Every four years or so, the small portion of the population that can manage to rouse itself from its stupor trudges out and casts a ballot for the representative of the prevailing ideology. The press all says the exactly same thing. Industry is really dirty, and there’s truly totalitarian disregard for both the environment and the citizens who would protect it.
What’s more, Party apparatchiks are everywhere – you’ll be dealing with one if you want a license for your dog, let alone a building permit or a government contract. And, under Ed Stelmach, while the dominant ideology uses a slightly different terminology, the central planning orthodoxy remains essentially the same.
Soviet Alberta, in its most symbolic manifestation, is rendered incarnate in the form of Alberta Health Services, the massive centralized bureaucracy that manages all health issues, orders each swab and doles out every dose of Tamiflu, assigns every orderly and cancels elective surgeries in Black Diamond and Oyen from its nondescript headquarters bunker in the capital city.
One keeps waiting for an announcement of another success in fulfilling the objectives of the latest five-year plan.
Now, when this behemoth was created, the argument was put forward that it would save money by eliminating redundant administrative services. Alas, if there was one thing the real Soviet Union illustrated, it was that central planning really doesn’t work very well.
It turns out that if you just have one toilet paper factory for the entire state, a plan that might look pretty good on paper after a thorough study of usage over the past half century, things can get ugly real fast if you don’t pay attention to local trends – say, a washed out bridge on the only uncontaminated road into Chelyabinsk or a mass outbreak of intestinal distress at the end of the rail line in Vladivostok.
It turns out to be pretty much the same thing with health services in Alberta, which may be why those promised cost savings never materialized and centralization resulted instead in a billion-dollar-plus AHS deficit. It may even be why Alberta Health Services has trouble operating immunization clinics in Calgary and Olds at the same time.
This is no slam on public health insurance – merely an argument that public enterprises like any other kind work best when local conditions are kept in mind and decision makers are accountable to the people whose lives their policies affect.
Come to think of it, we didn’t have a bad system here in Alberta not so long ago, with locally run public health authorities that were overseen by boards made up of local people.
Alas, Mr. Stelmach and his inner circle hated that. Whatever their real plans for our health system were, local boards were certain to resist their worst ideas. It is generally acknowledged everywhere but in government propaganda and the media, which are pretty much the same thing, that the regional health authorities were shut down for political rather than practical reasons.
Which brings us to Mr. Stelmach’s worst nightmare – the smiling face of Wildrose Alliance Leader Danielle Smith.
Lately Ms. Smith has been advocating pushing health services back to the local level.
One fears that what she really has in mind is not a well-regulated, locally responsive public system but the lunatic chaos of the wide-open market.
Still, what an irony that the discredited central-planning orthodoxy of the Stelmach Tories could make such a vision appear alluring!