Alberta: Get Rich or Die Trying

Science: 1, Ideology: 10000

This must be making Harper's and Clements' blood boil. A BC Supreme Court judge has granted BC's safe injection site, Insite, a permanent exemption under the Controlled Drugs and Substances Act. Indeed, Justice Ian Pitfield ruled that allowing addicts to inject their illegal drugs in a safe, medically supervised environment--rather than on the street--is a matter of pragmatic healthcare. As a result of this decision, the federal government will have one year to reform the laws against possession and trafficking to accommodate safe injection sites or have them become null and void as unconstitutional. Finally, it looks like there will be no more periods of uncertainty and frustration for  the users and  staff of Insite as Harper and Clement play politics--pondering whether or not to grace the site with another tenuous exemption.

F*ck ya. It is really nice to see pragmatism and sound science win out over ideology and fear-mongering in the never-ending struggle to see sound drug policy in Canada!

Check out these previous posts, for more background on Insite and the Harper government's anti-science attitude.

Squirmy John McCain and other things that make me smile

Well it's Friday and I happen to be in a particularly good mood. So instead of listing something that makes me angry about Edmonton, Alberta or Canada today, I've decided to go positive. Here's a few things that made me happy this week and one that made me smile ear-to-ear.

First off, Alberta Sustainable Resource Development releases it's land use framework and surprisingly, it doesn't suck. Looks like Teddy Morton is good for something after all, despite an unsavory past in the 'Calgary School.' I just hope that implementation of the land-use framework goes smoothly, but as they say, the devil is in the details and we are still awaiting those. Ken Chapman offers a run down here also check out this article from the Journal.

Second, the federal government announced that the Prime Minister will offer an formal apology to survivors of the residential school system. As Little Miss Brightside points out, this is a big step (if only symbolic) towards addressing the injustices faced by aboriginal peoples since colonization. Props to Harper for stepping up to the plate, especially when past governments have been reluctant to do so.

Third, Health Canada and Alberta Health and Wellness are finally going to seriously investigate the unusually high instance of rare diseases in Ft. Chipewyan, Alberta. After years of bumbling and denial (as outlined nicely by this CBC timeline), it appears the AB government might actually be willing to put two and two and three together. I just hope the provincial and federal health bodies actually take steps to mitigate these health problems. Check out Straight Outta Edmonton for more background on this.

Finally, Ellen Degeneres takes on John McCain over same sex marriage. It takes a lot of guts to do what she did and her remarks are both poignant and convincing. Watch McCain squirm (if only this was a couple years ago and it was Klein up there), and start your weekend off right.

How's that for positive thinking, jk?

And then there was one

By now, you've probably heard about the Alberta government's decision to amalgamate the province's nine regional health authorities into one mega-super-board. As I'm not a health policy expert (per se), I find my reaction - like most of the reaction I've seen - is pretty mixed. So rather than providing you with either a resounding denouncement or endorsement of the plan, here are a few thoughts:

• I know this is being billed as an 'overwhelming' change, at least by Liepert. But I for one fail to see how this is going to revolutionize health delivery in Alberta. Liepert argues that amalgamation will significantly reduce administrative costs, but they only account for 3.5% of the health budget. This likely means that Liepert and former Deep Sixer Ed Stelmach still have other possibly more privatizationey (yes, that's a word) changes in mind. Indeed, the amalgamation is being referred to as only phase one of the plans and Charlotte Robb, the woman appointed the new CEO of the superboard until yesterday was president of a for-profit medical services company (DynaLife).

• Did anyone hear any solid rational for this change? I know Liepert says that it's going to reduce costs, but why? Did anyone see any evidence, studies of the success of previous amalgamations under Klein, international comparisons of best practices? Just wondering. I thought that neocons liked decentralization because it allowed them to take apart large unwieldy bureaucracies like super-mega-health boards. Moreover, it seems like the move yesterday came really fast. It was only the day before yesterday that Stelmach was promising that the Liepert would announce details within the next month, but then BANG! all of a sudden we have this major change effective immediately.  It would be nice to know that this change was based in well grounded policy research rather than fly-by-the-seat-of -your-pants  ideological(?) beliefs. I'm not so sure we have that in this case.

• I'm generally a believer in the notion that it's important to keep power closest to the people affected by it, so I for one would have liked to see the province have made a more genuine effort to give local elected health region boards a chance to work. However, Klein scrapped that idea almost as quickly as he implemented it, realizing that adding another layer of elected official into Alberta's political milieu might make for public criticism or open and honest discussion of problems in the system. It is unfortunate but largely unsurprising that the RHAs didn't function well in their previous form, given that board members were somewhat unaccountable and generally appointed on the basis of their closeness to the PC party.

• It's been suggested by a few people as well, that this latest quick move has also come out of a desire to quash dissent from board members and CEOs, and that the comments made by Calgary Health CEO Jack Davis during the last election were simply too much for Stelmach to handle.

And there you have it, the AGRDT-healthcare-revolution-analysis-post. Unfortunately, the other two-thirds of the main contributors to this blog are traveling today for May-long (must be nice), so this is probably all the analysis you're going to get from us on this issue for the time-being. For other views on the issue, you can check out Daveberta, today's Edmonton Journal editorial, Don Bell's take,  and Rick Bell's "analysis". In addition, today's Edmonton Journal has several stories on the subject, linked to from their front page.

A storm brewing on the health care horizon?

The Edmonton Journal's Archie Maclean has an interesting preview of (Alberta's new Health minister) Ron Liepert's plans for the upcoming legislative session. If you're at all skeptical about the role of the private sector in the delivery of public services, this article is pretty disconcerting.

His appointment of cabinet muscleman Ron Liepert to the health portfolio is an indication that he is intent on spending some of his political capital to make the changes happen.

Liepert says the timing and political will were never quite right to make the necessary reforms. It's different now.

"We've got a new caucus, we have a premier with a pretty darn strong mandate and if we start making these changes very soon in the term, we have four years to get it done," Liepert said in an interview. "And I don't think we're left with any choice. We need to make some significant changes to how we deliver health care in Alberta."

Liepert says the template for his changes is the government debt-busting reforms that went on in 1990s.

"Albertans bought into it," Liepert says. "They acknowledged that there would be some pain. They were prepared to share in some of that pain and I would hope that we are now at the same kind of juncture when it comes to health care."

To summarize: Stelmach thinks it's time to make huge changes to health care, and judging by his appointment of Ron 'I won't take no for an answer' Liepert to the portfolio, he anticipates the changes aren't going to be very popular (see this earlier AGRDT post for more on that). Liepert even goes so far as to say that his plans for health care are going to be modeled on the major cuts Albertans saw under Klein during the 1990s, "as Albertans bought into it" then, so they should now too, right?

Well that's the big question isn't it? On the one hand, Albertans (and Canadians) for that matter have heard time and time again that there health care system is broken and unsustainable and needs to be fixed. In that way, they're primed for big changes as long as they're framed in the language of inevitability. On the other hand, the economic climate in Alberta today is a lot different than it was in the 1990s. It seems unlikely that Albertans are going to sit back and watch the price of caring for their parents and grandparents skyrocket as services are delisted and privatization becomes more common, while the government continues to post record-breaking surpluses. One cannot underestimate the power of the $22.7 billion boogeyman Klein inherited when he took office, but perhaps a more relevant lesson for Liepert and his reforms is the disaster that was the 'Third Way', which Klein tried to introduce as his final legacy project.

Ultimately, the political success of Liepert's reforms are going to be based on two things: the specific tools he uses to reduce costs and the strength of Alberta's economy. If Liepert chooses to cut costs mainly through the use of P3s and a reform of the health region administrative system, it may not be enough to get Albertans really worked up. However, if he starts going after more controversial reforms like de-listing services or adding in a user-pays fee structure he's going to have a lot more public resistance on his hands. One thing working in everyone's favor is the necessity that Alberta increase the number of doctors, nurses and other health care professionals working in the province. This objective will stem a repeat of the more controversial features of the 1990s budget cuts and could lead to less vocal opposition from health care workers.   The other factor, the strength of Alberta's economy, plays into the equation because it impacts how successfully Liepert will be able to sell the need for reform. If the US does enter it's seemingly inevitable recession, Alberta's oil sector (a.k.a. its entire economy) could be looking at a major slump. While this development may be bad news for the government as a whole, it will help Liepert make his case more effectively.

In any case, it will be interesting to see if Liepert is as ideological and heavy-handed on the health file as he was in education. Reading this story in which Liepert muses about the halcyon days of Alberta circa 1992, I'm not optimistic.