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That five-year plan: Why Ed Stelmach and his Conservatives can't fix Alberta's health care mess

Alberta Health Minister Gene Zwozdesky

A Velvet Fog rolled over Edmonton yesterday, but it failed to obscure the health care shambles that dogs the Conservative government of Alberta Premier Ed Stelmach.

Health Minister Gene Zwozdesky -- known as the Velvet Fog for his normally mellifluous ways -- waved a "five-year health action plan" at a hastily arranged news conference in hopes of diverting attention from Monday's embarrassing leak of a political strategy to foist privatized health care on Alberta after the next election.

We'll leave it to the mainstream press to provide the details of today's meaningless document, which was rushed into print days ahead of schedule to cover up the government's latest embarrassment.

The trouble with the Conservative plan rattled off by an uncharacteristically nervous Zwozdesky and a rattled looking Dr. Chris Eagle, the new CEO of Albert Health Services, is that it's unlikely to mean much if the Conservatives manage to get re-elected.

"These five-year plans are good for about a year and a half, when the next election is," said a blunt spoken NDP Leader Brian Mason after the lunch-hour newser. "Anything they promise today will be meaningless in the future. … You can't trust them, and you particularly can’t trust them on health care."

Liberal Leader Dr. David Swann, himself a physician, cut to the chase about the problems with health care delivery in Alberta: "This structure simply cannot work. … We need a new organizational structure."

The structure Swann was talking about is barely two and half years old. But the fact is, Stelmach's Conservatives contributed significantly to Alberta’s current health care crisis when they eliminated the province’s nine regional health authorities in May 2008.

From the moment they announced the disastrous decision to roll the regions plus the Alberta Cancer Board, the addictions commission and the mental health board into a single entity, the Alberta Tories touted the alleged cost savings of amalgamating health services in a huge centralized bureaucracy. They still do, although to date few savings have materialized.

While it is true some duplication was eliminated, for example among traditionally over-paid top executive positions, Albertans can see clearly now that that there are also huge dis-economies of scale in the central-planning approach to health care foisted on an unwilling Alberta by former health minister Ron Liepert.

As blogger Ken Chapman recently commented, "a lot of good work and service capacity was lost in the process, especially in the Capital Region."

It is likely that Liepert cooked up this tragic plan -- tragic because Albertans are literally dying needlessly while they wait in emergency wards because of it -- for all the wrong reasons.

Of course, he's never said why he really did it, but it is reasonable to conclude that the political need to be seen to be doing something, the desire to break the political power of the Calgary Health Region's sometimes outspoken leadership and the urge to mess up health care delivery just enough to open the door to privatization all played a role in creating this disaster.

The acerbic and undiplomatic Liepert compounded the problem by hiring the similarly acerbic and undiplomatic Australian economist Stephen Duckett to head the giant new health care enterprise.

In all of this, Liepert had Stelmach's complete support.

When Liepert became a lightning rod for Albertans' anger at the growing crisis in health care, the premier replaced him with the more-sensible and diplomatic Zwozdesky. But, really, by then it was too late.

When Duckett embarrassed the government on Nov. 19 with his notorious Cookie Walk, he was fired at a cost to taxpayers of $680,000. But that decision came far too late to mean anything.

For all these reasons -- history, hubris, ideology -- Alberta's Conservatives under Stelmach's leadership simply cannot fix this crisis.

This would not be so bad if an opposition party were waiting in the wings with the convictions and vision to restore health regions with enough administrative tweaks to solve the overabundance of independence that Stelmach's Conservatives were clumsily trying to address.

Instead, alas, the most likely successful challenger is the far-right-wing Wildrose Alliance, a party that proposes a solution sure to make the situation even worse -- the chaotic reintroduction local hospital boards throughout Alberta.

Of course, under former Fraser Institute apparatchik Danielle Smith, the Wildrose Alliance is a party deeply committed to "free-market solutions." The Alliance leadership knows well that the introduction of hundreds of hospital boards will ease the transition to a much-higher degree of privatization in the system.

It also knows that unenforceable legislative limits on waiting times for Emergency Rooms -- a dangerous policy foolishly backed by Legislative Opposition parties that should know better -- will help achieve the same ends.

What Alberta really needs is a return to health regions, a structure that sensibly balances economies of scale with unique regional needs.

The Conservatives have made much of the fact medical services were not delivered in identical ways in all regions, as if this were some sort of disadvantage to the party's rural heartland in particular. In fact, the population-based funding system in use for a time in Alberta made sense as a way to balance the different needs of different regions.

Think about the needs of the population in the old Northern Lights Region based in Fort McMurray, which is biased toward young people and young people’s health problems, and that of the former Palliser Health Region in Medicine Hat, weighted toward an older population and its needs.

Different blends of health services for different populations makes sense. It can deliver better service at a lower cost. It also responds more quickly to changing needs. This is why, of course, health regions remain the favoured way to deliver health services elsewhere in Canada.

A centralized province-wide health board, by contrast, simply can't respond as effectively as a region could. Got an Emergency Room problem in Lethbridge or Red Deer? Well, they’re still working on a provincial admissions policy in Edmonton… And so we find ourselves in our present fix.

Even needed short-term solutions, such as opening more continuing care beds to ease the crunch in emergency departments, take longer when they must be solved by a bloated super board.

That's a large part of why, in fact, rural Alberta liked regional health boards. As William Munsey of New Sarepta, an Alberta Party board member, recently pointed out on his blog, rural Albertans are not naïve about what they need from government or unprogressive in their core values.

Obviously, they realize the quality of their local health services will decline under the centralized model being provided by the Conservatives, and that it will all but disappear under the privatized approach favoured by the Wildrose Alliance.

The profound wish of Albertans in every part of the province is to see this crisis solved and our province return to the world-class medical services we had just a few years ago.

The promise that Zwozdesky trotted out yesterday is for more of the same. If this keeps up, Stelmach's Conservatives are going to find themselves on life support!

This post also appears on David Climenhaga's blog, Alberta Diary.

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