Rx for high Alberta health care costs: Not what the doctors ordered!

Alberta ponders how to increase physician productivity – house calls? Below: Health Minister Fred Horne, Alberta Medical Association President Linda Slocombe.

Alberta Health Minister Fred Horne’s musings he just might join Ontario Premier Dalton McGuinty in declaring war on physicians’ fees is proof the chickens continue to come home to roost for those foolish enough to assume the polls were right and the Wildrose Party would win the April 23 Alberta election.

It was journalists, bloggers, pollsters and certain far-right politicians who had to eat crow instead of chicken after last month’s epic polling fail, but it may turn out as the henhouse dust settles it was another class of customer entirely who really has to pay for this historic miscalculation.

At any rate, in the lead-up to the 2012 provincial election, the province’s most powerful labour union – the Alberta Medical Association, whose 7,200 members are budgeted to collect nearly $3.5 billion in “compensation and development” in Alberta’s 2012-13 budget – did no favours for the then-still-shaky Progressive Conservative government led by Premier Alison Redford.

Who can forget the docs’ repeated calls for a judge-led inquiry into physician intimidation in Alberta’s health care system even as it became excruciatingly uncomfortable for the Redford Government when the far-right Wildrose Party seemed to be rolling into power?

The physicians’ union – once virtually an official branch of the Progressive Conservative Association of Alberta, as Ms. Redford’s party is officially known – jumped onto that bandwagon with enthusiasm.

There was that expensive – and possibly illegal – AMA newspaper advertising campaign, designed to embarrass Ms. Redford’s Tories in the weeks leading up to voting day, no doubt prompted by dreams of a profitable new world of privatized medical services.

Then came AMA President Dr. Linda Slocombe’s drop-dead letter to Elections Alberta, telling the agency the union’s Board of Directors would be proceeding with the campaign to hold the government to account for such things as intimidation in the heath care system, availability of family physicians and access to health care information.

There are times when this kind of thing looks courageous, but one of them is not when everyone assumes the party you’re attacking is going to lose office anyway and its leader may not even hang onto her own Legislative seat.

Like lots of well-paced groups in Alberta who thought it wouldn’t hurt to be on the right side of a new Wildrose government, this must have seemed to the AMA like a good idea at the time. “We view it as a legitimate expression of free speech,” Dr. Slocombe told a Calgary Herald reporter at the time. “The AMA is a non-partisan organization and we’re trying to put health care first.”

Well, you know what, that’s not likely the way they’re going to remember those ads nowadays in the office of the premier – who happens to still be Alison Redford, Progressive Conservative MLA for Calgary-Elbow.

So along comes Mr. McGuinty, Ms. Redford’s counterpart in the cash-strapped province of Ontario who has also recently come through a stressful election campaign, with a call to other provinces to form a united front on how much Canadians’ provincial public health care systems are prepared to pay their docs. (Which right now is about 20 per cent of the total health budget, in Alberta’s case.) He’s thinking, presumably, that they can’t all pack up and move to the United States.

And, guess what, Mr. Horne was right in there – if not quite “ready, aye, ready,” at least prepared to talk about it.

Now, as the Herald reported yesterday, Alberta’s signed a two-year deal with the docs, retroactive to last year, to raise their fees by 2.5 per cent a year. After that, though, it sounds like all bets are off. Or, as Mr. Horne put it: “That said, it’s a short-term agreement. We have to be discussing these things.” (Emphasis added.)

Mr. Horne’s comments were nuanced, naturally, as befits the man’s style. But between the lines it’s pretty clear Alberta will be coming after the docs both for a slowdown in fee increases and increases in their productivity – or what more conventional, and weaker, trade unions might call a “speed-up.”

The health critic for the Wildrose Party – which normally calls for less spending cuts on everything except tax breaks for billionaires and oil companies – was quick to defend physicians’ high salaries. But the degree of sympathy from Calgary-Fish Creek MLA Heather Forsyth (margin of victory: 38 votes) is probably a lot less valuable to the AMA than it might have seemed before it turned out the main Opposition party would only have 17 MLAs.

Physicians’ organizations were quick to squawk too, with the Canadian Medical Association protesting that thoughts of adopting “a broken model that excludes true collaboration are wrong-headed.” True enough, but where are these guys when a regular trade union is getting its chops busted?

Don’t expect Mr. Horne to go after Alberta’s doctors quite as aggressively as Mr. McGuinty might like. The AMA is still the most effective union in the province – right up there with the Alberta Bar Association and the NHL Players Association – and physicians and Progressive Conservatives continue to have class interest and economic worldview in common.

Still, given what happened not so long ago, Mr. Horne and Ms. Redford may well conclude that a nice sharp crack across the doctors’ knuckles early in the government’s mandate might have a salutary effect the next time there’s a tightly contested provincial election on the horizon.

The AMA might also want to consider just quietly settling their dispute with Elections Alberta when it comes up, rather than fighting it all the way to the Supreme Court or whatever it was they had in mind back in those heady days of April.

This post also appears on Rabble.ca.

3 Comments on "Rx for high Alberta health care costs: Not what the doctors ordered!"

  1. Mark Roseman says:

    Frankly, if the gov't agreed to cut out half the middle management in AHS and add some actual accountability and transparency in there and in fact the whole system, the doctors might well agree to some reductions in billing rates.

    A more positive and less frustrating working environment would certainly be worth paying for. But with all the shit that docs have had to put up with from the system in this province for so long, I don't see any motivation to make any concessions.

  2. Nordic says:

    The Alberta Medical Association as labour union? You may need a doc to remove your tongue from your cheek. How many labour unions are stupid enough to willingly negotiate a contract based on “piece work,” which the docs call “fee for service?”

    If you ever needed evidence that universities focus too much on specialization, all you need to do is look at HOW the AMA wants its members to be paid, not how much. Evidently the mini-docs are never exposed to any labour history.

  3. Brian McAlpine says:

    Is ANYBODY reading this blog?
    Is there a blog a little more active?

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