Uneasy Alliance

One of the most notable elements of the just concluded Alberta Legislature session was that the various opposition parties put aside their (very significant) differences and teamed up for the collective goal of torturing the Tory government over its handling of healthcare.

Certainly called for and frequently entertaining, it also helped lift the veil on the contemptuous dismissal with which the government treats opposition.  Albertans saw how the government responds to legitimate criticism from Raj Sherman, one of their own with banishment and  a whisper campaign to try to destroy him.  The opposition alliance fulfilled the will of the people in expressing the disdain and distrust the government is now held in.

But we shouldn't let this brief concordance of intent and allied opposition to the Stelmach government obscure the very real differences between the opposition parties.  Danielle Smith has very helpfully provided an op-ed for the Calgary Herald where she makes it very clear that the Wildrose alliance's only real problem with the government's approach is that they aren't pushing privatization enough.

In Calgary, we've seen what private deliverers can do when the government gets them involved. Before AHS abruptly terminated their contract, the Health Resource Centre was performing hip and knee replacements at a fraction of the cost and in almost half the time as the public hospitals.
Former premier Ralph Klein, after leaving office, admitted his biggest regret during his 14 years as premier was caving to the special interest groups and letting them derail his plans to reform health care.
Clearly, Stelmach has learned nothing from his predecessor.
If this government won't do what is needed, it is time for a government that will.

Of course the Health Resource Centre she's rapturously praising here, was an expensive boondoggle that went bankrupt under the huge cost over-runs inherent in private healthcare.  Sunk under vast legal bills and gigantic executive compensation that even Alberta Health Services with its  infamously highly overpaid and top heavy administration found excessive, and when she complains that their contract was 'abruptly terminated' she means that despite the pleas of the supposedly 'free market' oriented Wildrose Alliance they weren't bailed out of the expensive hole that is the inevitable result of introducing the profit margin to healthcare delivery at even further huge cost to the Alberta public.  

Smith and I do agree though, that the Health Resource Centre is an excellent example of what private health delivery is capable of.

She also indulges in one of the popular hobby horse of the Canadian right by claiming that we should follow the example of Sweden in letting the private sector have more access to public health funding.  Of course, this is actually an example that in no way makes the point she thinks it does.

Sweden pays for about 85 per cent of health expenditures from public sources, in comparison to about 70 per cent in Canada. This includes public coverage not only for hospitals and physicians, but also for drugs and dental care (for kids up to the age of 20 it's free, and for adults it is subsidized).  While a sizable number of Canadians lack drug coverage, Swedes do not. Sweden also has generous sick leave coverage, great parental leave benefits for both mom and dad, a national child allowance until the child is 16 (with larger payments for more children), and even a pension system which counts time spent at home looking after the kids.
Oddly, Sweden has recently become the darling of Canadian commentators wishing to privatize how we fund and deliver health care. The picture they paint is often not recognizable to Swedes.
So, yes, for historical reasons, Swedes may pay user fees when they see the doctor or stay in hospital. These fees are capped and geared to income; computing them does add some administrative costs that Canada can avoid. But, in stark contrast to Canada, these patient fees account for only about four per cent of health-care costs in Sweden. They also have reference-based pricing to control pharmaceutical costs—the B.C. system, which Manitoba probably should adopt as well.
So, to be more like Sweden, we should probably be paying more of the bill publicly, not less.
In terms of delivery, Sweden began with publicly owned and operated hospitals, run by local governments (county councils). In Canada, by contrast, our "public" hospitals are not-for-profit private organizations, with considerably more managerial autonomy (although we do grant that attempts by provincial governments to induce "accountability" within regional health authorities may indeed be moving us closer to de facto public control.)
As the New Public Management movement confirms, publicly run institutions are often seen as cumbersome, and local officials may lack the skills to manage them. (On a visit to Sweden several years ago, one of us recalls complaints from hospital administrators that the county councillors kept coming in to count the sheets.)
Several years ago, some councils experimented with contracting out these services to private hospitals. Although reports are mixed, we note that Swedes were unhappy enough that some of the privatizations were reversed. In 2004, they banned further privatization of hospitals. Instead, the Swedes are seeking to move from the older focus on market-based mechanisms to approaches looking for greater co-operation among providers.

In fact the private sector experiments in Sweden were an unpopular failure, repudiated and rolled back the first opportunity Swedes had to vote on them.  Again, Smith and I agree, an excellent example of the real record of private health experiments, again, probably not in the way she intended.

The Wildrose Alliance joined the NDP and the Liberals in slamming the government purely for reasons of partisan gain, their opposition to the government's healthcare approach is simply that it doesn't go far enough down the road of privatization and this should be remembered.