Deck the Halls With Poison Ivy: Tyler Shandro’s Rash Approach To Health Care Reform

poison ivy

Festive jingles brightened every nook and cranny of Calgary, it seemed, during the recent Yuletide stretch.

My house was no exception.

Practically vibrating with excitement and anticipation on Christmas Eve, my nine-year-old son belted out one carol after another.

His Christmas mix didn’t include restful, time-honoured melodies of yore. 911 Song, set to the tune of Jingle Bells, went something like this:

Dashing through the snow, on a pair of broken skis
Over the hills we go, crashing into trees!
The snow is turning red, I think I’m almost dead,
I woke up in the hospital with stitches in my head, oh!
9-1-1, 9-1-1, Santa Claus is dead!

That gem led on to a gleeful rendition of Deck the Halls With Poison Ivy, followed by Grandma Got Run Over By a Reindeer, all delivered at 110 decibels.  A Silent Night was not in the cards, musically or literally.

My ears were still ringing as 2020, fresh and clear-eyed, took over from a worn-out 2019.

It struck me that Alberta’s pediatricians and family doctors might relate to poor old Grandma., seeing as they got run over by a health minister just before Christmas.  They were caught every bit as flat-footed as the old lady trampled by those reindeer.  After all, they’d had reason to feel secure: Premier Jason Kenney publicly guaranteed that his government would not cut access to care.

But it turns out his “guarantee” wasn’t worth the over-sized placard upon which it was stenciled.  Without meaningful consultation with doctors, Minister of Health Tyler Shandro plans to take a machete to front-line care, effective February 1, 2020.

Without doubt, Alberta’s sprawling health care superstructure chews up far too much money; and despite all that dough, its performance isn’t stellar.  Serious renovations are needed.

But Minister Shandro’s ham-fisted opening moves put me in mind of Ronald Reagan’s famous observation: “The most terrifying words in the English language are: I’m from the government and I’m here to help.”

I channeled my dismay into an open letter to Minister Shandro a couple of weeks ago and dropped it in the public square.

It created a bit of a stir – meaning it got noticed by more than the usual nine people who read my stuff.

And wonder of wonders, it caught the attention of the minister.  He didn’t respond to me, naturally, but offered this up on Twitter:

 

Tyler Shandro (@shandro)
2019-12-19, 12:25 PM

This is a myth that our proposal to remove the first complex modifier would result in $60,000 reduction for family physicians. Just isn’t true. The modifier is $18.48. That would mean over 3,200 patients needing that complex modifier per year for that doctor.

It’s reasonable, in light of that rejoinder, to wonder whether Minister Shandro is properly briefed as to what is contained in his own ministry’s “Insured Services Consultation”.  (To deem it “consultation”, mind you, is to murder the term.)

The $60,000 figure I quoted in my letter was drawn from a careful analysis by the Alberta Medical Association.  It incorporates the eleven ways in which Alberta Health is trimming doctors’ pay – not just the first (very important) one which cuts the premium paid to doctors for spending additional time with complicated patients.  (Of the estimated $360 million in cuts across all eleven metrics, more than 70% will fall on the shoulders of primary care physicians).

I wonder whether Minister Shandro is aware that good family doctors form the spine of the health care system: without them it cannot stand.  One might just as well remove the trunk from an oak and expect the collapsed mess of branches to carry on as a tree.

I wonder if he is aware that his poorly conceived cuts to complex care will drive conscientious family doctors to provide a turnstile model of care – precisely the sort of care of which we need less, the kind of care that will drive costs up, not down, as patients are compelled to book multiple appointments to attend to their needs; or are forced, after losing their medical home, to  seek care in emergency departments already tasked beyond their breaking points.

Unsurprisingly, folks like NDP MLA David Shepherd, genetically opposed to all things UCP, co-opted my letter to bludgeon the government for its wrongheadedness.  (The steady drumbeat of doom and gloom that emanates from Shepherd, ex-premier Rachel Notley and Alberta Federation of Labour boss Gil McGowan in response to every single UCP government policy and initiative could be set to the thrum of Prism’s Armageddon.)

My admission to voting for the United Conservative Party sparked considerable scorn, of course.  “Imbecile”, “ignoramus”, and “moron” were among the gentler descriptors that came my way.  According to some keyboard geniuses, I’ve repented in sackcloth and ashes, consumed by bitter regret for my vote.

What bunk.  For those brainiacs, here’s a partial refresher in Democracy 101: It’s perfectly normal and healthy to disagree on issues – vehemently, even – with a government that one generally supports.  Dissent doesn’t imply utter disavowal of the party’s governing philosophy and all of its policies.

It’s a good thing my wife doesn’t adhere to the dubious logic of my critics: our marriage would have lasted five minutes.

I’m an ardent disciple of free enterprise.  I voted for the UCP purposefully, my eyes wide open to its visible blemishes.  Despite my angst at the ill-considered fumbling of the health care file I harbour no regret for my vote – not yet, at any rate.

I have never been – nor can I ever be – a socialist.  I could no more vote for Rachel Notley than I could hopscotch my way to the moon.

Socialism has oodles to say about dividing up the pie, but nothing to offer as to how the pie is created.  The tried-and-true recipe for pie – and for more and better pies – is supplied by capitalism.

It is capitalism, not socialism, that has pulled billions of people out of poverty around the globe.

It is capitalism, not socialism, that fuels the prosperity that underpins good government and healthy society.

Which is not to say that unbridled capitalism is the path to utopia.  As economist and author Arthur C. Brooks noted in a recent Munk debate: “I will not tell you that we need no regulations. I will not say that we do not need reform. I will not tell you that capitalism is perfect.”

Healthy capitalism is compassionate capitalism.  It’s a capitalism that invests heavily in people, in their education, opportunities, and well-being.

Compassionate capitalism recognizes the wisdom and morality in building and maintaining a robust social safety net.  Quality health care for all citizens, regardless of means, constitutes much of that netting.

Many of us, in ideologically polarized times, can feel politically homeless – stuck in the middle with “clowns to the left” and “jokers to the right”, as the ‘70’s Stealers Wheel pop hit put it neatly.

But in Alberta the jokers to the right are far more aligned with sensible capitalism (at least they purport to be – the jury remains out) than are the clowns to the left.

Notley’s just-expired NDP administration spent like drunken sailors as the public debt grew by leaps and bounds, while shamelessly pumping up employment numbers by stuffing the civil service with gobs of employees feeding expensively at the public trough.  As to how it was all be paid for in the end, they had as much of a clue as did  Peter, Paul, and Mary back in the day: “The answer, my friend, is blowin’ in the wind.”

It’s important to emphasize that it wasn’t just Notley’s accidental turn in power that landed us in our current financial pickle.  Far from it.  We have a long history of fiscal profligacy in Alberta, enabled, sadly, by serial “conservative” governments.  We currently dispense from the public purse $2000 more per citizen each year than any other jurisdiction in Canada.

We have a spending problem, not a revenue problem.

So yes: I voted for Jason Kenney to restore some semblance of sanity to the books.

The uneven performance of his UCP government to this point is a bit of a surprise, given Mr. Kenney’s prior track record as one of the shining stars of federal cabinet during Stephen Harper’s long run as Prime Minister.  But running an entire province is more complicated and demanding than running a cabinet portfolio.

Mere mention of “blue-ribbon panels” and “war rooms” suggests glittering competence and well-planned action; but panels populated with the wrong kind of experts and war rooms stocked with incompetent bumblers who can’t even come up with a logo (!) are likely to cause more harm than good.

General George Custer convened a war room too, I’ll bet, to advise him prior to the Battle of the Little Bighorn; look how that turned out.

I dearly hope Kenney’s administration rights itself before too much damage is done.  It had best happen soon, before negative momentum sends his government crashing downhill on broken skis.

Minister Shandro commissioned an accounting firm to review the operations of Alberta Health Services; Ernst & Young is scheduled to deliver its report later this month.  According to Mr. Shandro, more than 30,000 AHS employees and physicians have been consulted in the process.

I suppose I’ll have to take him at his word.  But colour me skeptical, if by “consultation” he’s alluding to another iteration of the sort contained in his “Insured Services Consultation”- a.k.a “I’ll tell you what’s going to happen”.

Why he didn’t wait until after delivery of the Ernst & Young analysis to consider revisions to physician remuneration, if indeed doctors were consulted so widely, is a mystery.

Minister Shandro has gotten some things right.  For instance, his initiative to reduce interminable surgical wait times – by contracting with private surgery clinics to deliver publicly-funded surgeries – is a solid step in the right direction.  He took plenty of flak for that from the NDP, “Friends” of Medicare, and a host of others, all of whom blithely ignored the “publicly-funded” bit and blathered on nonsensically about “U.S.-style healthcare”.  They conveniently forgot that the Notley government (wisely) did exactly the same thing – Minister Shandro is simply doing more of it.

It’s a good move.  But more can be done to harness the power of free enterprise.

There’s a peculiar and entrenched Canadian mindset that abhors the idea that any of our fellow citizens should enjoy superior health care to our own – even if it means we’d all be better off.  We’d rather be equally miserable.

It’s time we rid ourselves of that affliction.

Whether people realize it or not, we already live with a two-tier healthcare system.  Those with means don’t wait six months to see a specialist, or eight months for a hernia repair, or more than a year for a knee replacement.  They take themselves and their money south to the U.S. to access immediate, quality care when they need it, so they can get on with their productive lives.

Surely it would be better to keep that capital here, to bend its power toward the betterment of health care for everyone.  There are ways to achieve that, scenarios which don’t compromise the sacrosanct principle of quality health care for all, but rather enhance it by wiping away wait times that can only be described as immoral; scenarios in which everybody wins: patients, physicians, and the public purse.

All we need to make it happen is what we already have in spades: innovative Albertan thinking and iron Albertan will.

Let the rest of Canada carry on being “equally miserable”, if they wish.

But we can do better.

Let’s make it happen, already.

9 Replies to “Deck the Halls With Poison Ivy: Tyler Shandro’s Rash Approach To Health Care Reform”

  1. Excellent analysis. Yes we have a spending problem. Alberta spends the most on healthcare per capita but achieves middle of the road results. But we also have a revenue problem. Alberta voters put the UCP in power to get pipelines so that the engine of our economy could move out of first gear. I don’t see how that will happen without separation. Central and Eastern Canada have spoken loudly that they want our money but will not allow us to earn it. Time to go.

      1. How is it not feasible? Slovakia separated from the Czechs and the world didn’t end. There are a lot of other examples. What matters is what is best for the people living in the land. Our two main industries, oil and cattle, are despised by climate alarmists who are supported by leftists who comprise 65 – 70% of Canadian voters. That will mean constant attacks on Albertans. I see no realistic alternative but would like to hear your thoughts.

  2. Interesting comments on the free market. Hernando de Soto (an economist who I admire) stated: I am not a die-hard capitalist. I do not view capitalism as a credo. Much more important to me are freedom, compassion for the poor, respect for the social contract, and equal opportunity. But for the moment, to achieve those goals, capitalism is the only game in town. It is the only system we know that provides us with the tools required to create massive surplus value.

  3. Dr. Les:

    I have really enjoyed your analysis, especially the fact that Mr. Shepherd won’t be mentioning your disagreements with him any time soon.

    We are indeed in a fiscal mess far more due to spending (open and hidden) than insufficient taxation, and it is harming our healthcare system.

    For example, today I was on Danielle Smith to talk about how placing Estrogenic Hormone Replacement behind a prescription (instead of just informing one’s doctor one is taking it) barrier is costing us tens of millions of dollars in visits-for-refills for a very-low-complication / very-high-efficacy form of medicine.

    https://omny.fm/shows/danielle-smith/not-everyone-supports-banning-adult-conversion-the?in_playlist=danielle-smith!podcast

    I have an advantage though, being an expert in that particular therapy. Generally, I’m a lay person, but I’m sure frontline workers (and other patient advocates) see rot in other places.

    I also think some of the response from the bureaucracy has been sabotage for sabotage’s sake. Imagine first letting go many front-line nurses… and THEN limiting the overtime hours of the remainder… (which will probably then require more-expensive interventions to deal with more-complex issues, as you write) all to produce savings of 2.8%

    I would say it’s not just the Honourable Mr. Shandro working to put blood on the floor in this particularly ill-thought-out surgery.

    I hope you reach out to me, and we can talk about systemic fixes and what we’ve learned from other single-payer systems that do this better.

    Thank you for your time.

    Valerie Keefe – Candidate, Freedom Conservative Leadership.

    1. Valerie, Thank you for your thoughtful comments. I agree with you 100% re the ludicrous situation with respect to mandating a visit to a physician for med refills…. just one of many inefficiencies that have infested our medical care delivery system. Feel free to contact me via FB messenger…. my facebook profile is J Edward Les. Thanks.

Leave a Reply to Jody Terpstra Cancel reply

Your email address will not be published.