Is Premier Alison Redford’s bitter fight with the docs about money, or control?

Who’s in change here? Progressive Conservative MLAs get ready to supervise the work of an Alberta Health Services medical team while Alberta voters look on. Health officials, physicians and electors may not be exactly as illustrated. Below: AMA President Dr. Michael Giuffre; a space invader

Is the increasingly bitter fight between Alberta’s government and the province’s physicians just about money? It’s said here it’s more about who gets to control the health care system.

If you need evidence for this assertion, look no further than the fact just two and a half months ago Alberta Health Minister Fred Horne said he was going to impose a pay deal on the docs that would have seen their salaries keep on rising.

Premier Alison Redford is now traipsing around the province explaining that these same doctors are being paid too much – why, they get 20 to 29 per cent more than their counterparts anywhere else in Canada!

“Quite frankly, before I start asking Albertans to pay health care premiums, I want to make sure that we’re getting the best deal possible with our doctors,” Ms. Redford told supporters during a recent telephone town hall. “At the end of the day, I think that’s really where we start to save some money with respect to things like health care.”

This is the leader of the same government that just days ago was about to force the same supposedly overpaid physicians to accept an imposed agreement that included a 2.5-per-cent lump sum payment and cost-of-living increases in each of the next three years.

Naturally, the doctors didn’t think that was enough and screamed bloody murder when Mr. Horne moved to unilaterally impose the contract on them. But it still raises the question: If they were not paid enough in November, why is the same pay too much now?

For his part, Mr. Horne has since withdrawn that deal, denied he imposed anything, and returned to the bargaining table with the AMA, setting the stage for the current slanging match.

AMA President Dr. Michael Giuffre conceded on CBC radio yesterday that Ms. Redford’s percentages are essentially correct, but argued that the costs of hiring nurses, renting space and otherwise operating a medical business in boom-bust Alberta are also higher by roughly the same amount.

He couldn’t resist the highlighting the irony of the fact that back in November the Redford Government spent $130,000 of taxpayer money on radio ads to promote an imposed settlement that now seems to have become far too expensive.

Accusing the government of “slamming” and “vilifying” physicians, Dr. Giuffre assailed the premier’s “often-confusing and frequently misleading” comments about physician pay as alarming and not particularly helpful to the on-again negotiations with the docs. He suggested the government is unfairly demonizing physicians because it desperately wants to hold the line on a budget deficit burgeoning in the face of lower prices fetched by Alberta petroleum resources.

Of course, the bitterness between the government and the AMA may go back a little farther than that. Alert readers will recall that the AMA backed the wrong horse in the final days of last spring’s election campaign, when the association bought advertisements that assailed the government and all but called on voters to elect a Wildrose government. Rest assured Alberta’s PC elephant has not forgotten!

Still, if you consider for a moment that the government’s real cost-control fight with doctors may be about who is going to be the boss of the health care system, the emphasis on Alberta physician pay premiums over other provinces suddenly makes sense.

Look at this from the government’s perspective. If you cede control of the system to physicians, who obviously have a dog in the hunt, the chances you’ll ever get health care costs under control are, shall we say, diminished.

Not only are Alberta physicians generously paid, but the billing structure is highly advantageous to their financial health. So it should come as no surprise that in the background of this public fight over wages, Mr. Horne has been chatting with his counterpart in Ontario about ways to change the formula by which physicians are compensated.

But if the government proposes any change to the billing process, it is likely to be attacked by the AMA as dangerous to patients – and chances are good many Albertans will listen. Both the government and the AMA also know that if you asked the typical Albertan in the street whom he or she would rather have in control of the health care system – doctors or politicians – the answer is likely to overwhelmingly favour the docs.

Yet if the government can’t slow down the rate at which health system costs are rising, the PCs and Premier Redford are bound to come under increasing pressure from the Wildrose Party – which can promise without a shred of evidence or accountability that its privatization schemes will deliver fairer, cheaper, more efficient health care.

Ergo, the government’s simplistic but easy-to-sell attack on the AMA from its flank makes political sense while Ms. Redford’s brain trust tries to figure out how to wrest control of the system from physicians and put it in the hands of more easily controlled officials.

Come to think of it, this is what former premier Ed Stelmach was up to when his government created Alberta Health Services back in 2008, not that that worked out the way anyone expected.

Saying doctors are paid 20 to 29 per cent more is just easier to explain than making a complex case for restructuring the way routine health services are delivered to most Albertans, many of whom are focused on the complaint they can’t find a family doctor.

Even Albertans who understand that health care financing is a complex policy question may not connect the dots that this argument represents a strange flip-flop by the government from what it was saying just a few weeks ago.

With the AMA, whose members are not used to losing, darkly hinting that it may resort to legal action if the government won’t bow to its will, look for this fight to continue for some time yet.

But don’t be surprised if this doesn’t particularly displease Ms. Redford, Mr. Horne and Finance Minister Doug Horner.

After all, given its vocal position on the need for austerity, the Wildrose Party can hardly rush to the doctors’ defence and call for a big salary increase, and fighting with the docs at least makes it look as if the government is doing something to respond to the Opposition’s screams about the deficit.

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BudgetChoice.ca – a coercive push poll or the greatest thing since Space Invaders?

Scoffers may try to dismiss www.budgetchoice.ca, the government’s $57,000 online do-it-yourself deficit-elimination tool “as a particularly coercive push poll” intended to soften up voters for another round of cuts to the public service or maybe a tax increase, wrote commenter Tom Fuller after yesterday’s post.

“But I think it’s a stroke of genius turning the budgeting process into an on-line multi-player role-playing game,” Mr. Fuller went on. “Assuming my avatar (Chlorox, the Elf Warrior) I vote to cut services to children and seniors, and lay off everyone at Environment. For reducing expenditures by 23 per cent, I get 5,000 special bonus points, and can claim the magic axe of Steve West, lost for lo these many years. I haven’t had this much fun since I spilled the beer on my Atari and shorted out Space Invaders.”

My blogging colleague Dave Cournoyer apparently agrees, observing: “It simplifies the process, but it also works to demonstrate that with modest tax increases and minor cuts to the Legislative Assembly budget, and cuts to wasteful programs like Carbon Capture, the government could easily balance the budget without burning down the house. And I did all that as a Level 4 Dwarf with a Stockwell Day amulet. It earned me 430,000 Gold Katzs.”

Personally, I’m not a gamer, so I have no idea.

This post also appears on Rabble.ca.

6 Comments on "Is Premier Alison Redford’s bitter fight with the docs about money, or control?"

  1. jerrymacgp says:

    So Dr. Giuffre “…argued that the costs of hiring nurses, renting space and otherwise operating a medical business in boom-bust Alberta are also higher by roughly the same amount”, did he? Let’s be clear, physicians rarely hire nurses, except with the assistance of public funds through Primary Care Networks. They hire medical office assistants, who sit behind a desk wearing scrubs and perpetuate the illusion they are nurses, when they have no nursing credential (RN, RPN or LPN) whatsoever.

    Yes, overhead costs for Alberta physicians may be somewhat higher than in some provinces, but can they really say that office rental is 20-25% more dear in Red Deer or Peace River than in, say, Vancouver? Also, if overhead is such a concern, why don’t more docs move from expensive cities like Calgary to less expensive, under-served communities like Manning (where the clinic building is provided by AHS)?

  2. Alex P says:

    Why I will never be premier: I ran a $5.2 billion surplus by having a 2% sales tax, hiking income taxes and returning to health care premiums. Goodbye carbon capture.

    • ema says:

      I will never be Premier either! Rather than using the preferred ‘death by a thousand cuts’ method I simply used 3 quick selected ‘strokes’ to the Budget (using sales tax, income tax and generic drugs) and came up with a $4B surplus.
      However, I’m reminded of the quote about statistics (that what they show is revealing, but what they hide is vital) and using that sentiment want to know what fat is really hidden in the Budget. All these past years of PCs spending like there was no tomorrow, when they afforded monstrous $$$s to dubious projects, including hideous payouts to former MLAS and Klein, yet they want to say that there is no money now. I don’t buy it at all!

  3. reginald soso says:

    The Minister of Health was made an offer in advance of returning to meet with the AMA President, whereby he would have had all the ammunition necessary for settling this disgusting scene that has developed. He passed on said offer.
    Chosing instead to suck and whistle.
    Even Premier Redford could diagnose the mess at hand.
    Of course the therapeutics of Premier and Minister in treating problems they create ought to undergo some quality assurance—before the patient dies preferably.

  4. Doug C says:

    With all due respect, the doctors “screamed bloody murder” after the government reneged on an agreement in principle (which had been reached before the election) and subsequently imposed something completely different. As a unionist, one would think Mr. Climenhaga would be more sympathetic towards a group of people who–in addition to having their value and remuneration questioned–have been denied the opportunity to bargain in good faith.
    It also seems the result of a double standard to rail about the Fraser Institute’s ostensibly fallacious claim (against which Climenhaga provides little evidence) that public sector employees in Alberta make 10% more than their counterparts in the rest of the nation, but not to argue one bit against Redford’s figures about physician compensation.
    I’m equally baffled by Climenhaga’s assumption that the AMA’s media campaign leading up to the election were as the result of support for the Wild Rose Party. If there was any degree of partisan support or endorsement–either overt or suggested–I completely missed it.
    This post is lacking the balance, attention to detail, and fact that I’ve come to expect, and enjoy, from the author.

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