Smith Just Exploded Alberta Health Care. What Comes Next?

Premier Danielle Smith's declaration last week that she intended to blow up Alberta’s health-care system came 25 years after then-Alberta premier Ralph Klein literally blew up the Calgary General Hospital.

Klein’s demolition on Oct. 4, 1998, involved tonnes of explosives to bring down a health-care icon the government had declared too old, inefficient and expensive. Ten years after its destruction, however, Calgary was still short of hospital beds and emergency room capacity.

On the other hand, Smith’s announced demolition will be much less dramatic but will involve a massive, long-run restructuring of the province’s system and thus affect every Albertan, for better or worse.

Both, though, are reminders of how Alberta Conservative governments have a tortured relationship with public health care.

From Klein to Smith, battling the public system

For years, Klein waged a war of sorts against the public system, blaming it for wasting too much money while he pushed for more private health care, including the possibility of private hospitals through his “third way” of health reform. In 2004, he told his caucus that his “un-Canadian plans” could “contravene the interpretation of the Canada Health Act” and “we ought to be ready for a firestorm” of protests.

Two years later, Klein’s “third way” ended along with his political career after his party members handed him a humiliating 55 per cent support in a leadership review.

But Klein’s health-care “legacy” lived on, with regular speculation over the years that succeeding Conservative governments were hell-bent on more private health care.

Smith says that’s nonsense and insists she is committed to the public health-care system.

However, there is a political context here impossible to ignore.

This isn’t just about Smith’s pre-premiership comments in which she, among other things, pitched the idea of contracting out the operation of hospitals to private bidders and suggested patients might pay out of pocket to see a doctor (ideas she subsequently disowned as premier).

This is about someone who has a record of attacking medical expertise where, as a radio talk-show host, she criticized pandemic restrictions and promoted quack treatments such as ivermectin and hydroxychloroquine.

During the 2022 United Conservative Party leadership race, Smith fired up support from her anti-mandate, socially conservative base by promising to wreak vengeance against Alberta Health Services for COVID restrictions. She also promised to amend the Alberta Human Rights Act to give official protection to the unvaccinated. On her first day as premier, Smith declared that the wilfully unvaccinated faced the most discrimination she had seen in her 50-year lifetime.

She dutifully fired the AHS board, got rid of Alberta’s chief medical officer, Dr. Deena Hinshaw, and began the process of undermining what she had called a “lawless” AHS.

This week, we saw just how AHS will be declawed. And how Smith will take more direct political control over health care in the province.

Rather than sitting on top of the pecking order, AHS will be relegated, in the words of Smith, to being just “Alberta Hospital Services,” where it will control acute care in hospitals but no longer control much of the health-care system.

Smith is setting up a system with four core health areas: acute care, primary care, continuing care, and mental health and addictions. All of them eventually reporting back to the premier’s office.

No one asked the nurses

Nobody is saying the current system is perfect, and Albertans rightfully complain about long wait times in the emergency rooms, long wait times for surgery and long wait times to get a family doctor.

But critics say Smith’s upheaval of the system is only going to make things worse.

She neglected to consult with some key stakeholders, including the United Nurses of Alberta, for example, which is a troublesome echo of how Smith imposed a seven-month-long moratorium on solar and wind projects without first consulting with the renewable industry that would be affected.

“This was an unprecedented change that came really without any notice and no consultation with any providers or patients that I’m aware of,” complained Dr. Tom Noseworthy, a health professor emeritus at the University of Calgary, in an appearance on CBC Radio’s Alberta at Noon last Thursday. A well-known expert in Alberta, Noseworthy has lived through decades of changes in Alberta’s health-care system.

He accused the government of issuing “falsifications” when trying to justify blowing up AHS. “To say that Alberta Health Services is management-heavy is a falsification,” said Noseworthy, who pointed out the organization actually has too few managers. He also took aim at allegations AHS is to blame for a shortage of family doctors.

NDP Leader Rachel Notley says Smith’s plan “has actually created a whole bunch of silos, which are going to create a whole bunch of confusion and chaos when it comes to the experience of Albertans.”

Despite Smith’s protests to the contrary about privatization, Notley suspects Smith will sell off continuing-care facilities still under AHS control to the private sector.

Take Back Alberta celebrates

It doesn’t help Smith’s protests that she has placed the surviving aspects of AHS under the control of Dr. Lyle Oberg, a controversial cabinet minister from the days of Ralph Klein who became an adviser to Smith when she was Wildrose Party leader a decade ago and has dabbled in the world of private health care since leaving politics.

The bottom line for Smith is political control. Besides punishing the “lawless” AHS, Smith has also introduced legislation to amend the Public Health Act so that she as premier will pretty much have ultimate control over how to deal with a public health emergency, like a pandemic, rather than leave it up to the chief medical officer.

Smith says her changes are simply aimed at improving the health-care system.

But it’s not as simple or harmless as that.

Giving us a peek behind the curtain was a tweet last week from David Parker, head of the socially conservative group Take Back Alberta. Parker formed the outspoken group during the pandemic to fight against restrictions and mandates. Along the way he helped kick out Jason Kenney as premier and install Smith as premier, and tirelessly pressed the government to punish AHS.

Parker’s tweet was a jubilant one-liner: “Alberta Health Services has been removed from power.”