Is Danielle Smith Going to Blow Up Alberta Health Care?

The premier who centralized the management of Alberta Health Services under a single administrator who answers only to her now says she wants to decentralize the provincewide public health agency “to enhance local decision-making authority.”

What’s wrong with this picture?

According to Danielle Smith’s mandate letter to Health Minister Adriana LaGrange, this will “create a more collaborative working environment for our health-care workers by incentivizing regional innovation and increasing our ability to attract and retain the health-care workers we need.”

How likely is this to work as advertised?

We don’t know yet, of course, whether this will be a full-blown catastrophic effort to drag Alberta Health Services back to a future that most resembles the 1950s south of the Medicine Line, or just some ideological window dressing to keep the UCP’s anti-vaccination, anti-public-health, anti-abortion, anti-everything base happy.

Probably a bit of both.

There’s not actually a lot to go on in the mandate letter. It’s mostly a repeat of the one she sent to her last health minister, Jason Copping, before the voters in Calgary Varsity released him back into the wild on May 29.

That is to say, it accurately identifies many of the problems causing the crisis in health care, and tells the minister to do something about them, which is easier said than done. It provides no hint, however, about how she might go about the task.

The letter also mentioned that $300 health spending account, one of Smith’s big promises in her UCP leadership campaign that hasn’t held up under scrutiny. “Working with the Minister of Technology and Innovation, who is lead, to explore the feasibility of creating an Alberta health spending account to support improved health outcomes for Albertans,” sounds more like face saving than a serious plan.

The Canadian Press called the Etch-A-Sketch outline of the UCP’s plans contained in the letter “the go-ahead to decentralize the entire health-care delivery system.”

If so, it’ll be a catastrophe. But that’s a big if.

There’s not much point asking either Smith or LaGrange about it — that would just be an invitation to more gaslighting. Indeed, speaking on a friendly right-wing radio station this week, LaGrange said “all of this will involve structures, and it’s too early to say what those will look like. I don’t want to presuppose where we will go, but rest assured, we are going to be making some change....”

Well, a bit of administrative decentralization would certainly provide political cover for a government that would clearly like to privatize public health services in a hurry, restrict access to reproductive health services, get revenge on public health officials for their response to COVID-19 and do some union-busting, all of which would be unpopular with significant parts of the public.

As for incentivizing regional innovation (other than ideological hobbyhorses like abortion services and vaccinations) or attracting and retaining the health-care workers Alberta desperately needs, real decentralization would have the opposite effect.

As everybody who knows anything about health care keeps saying over and over, yet another major restructuring of health care in Alberta is absolutely the last thing that a system already in crisis needs. Most likely, it would be an absolute catastrophe.

But Conservative provincial governments in Alberta have been constantly trying to reform health care for decades and about the only thing they’ve tried that’s actually worked was the creation of AHS, rolled out in 2009 under Progressive Conservative premier Ed Stelmach.

It had a bumpy start, but lo and behold, eventually it ended up with the lowest administrative costs for health care in Canada.

So of course the UCP has been asking ever since the party came to power, why not mess with it?

As Friends of Medicare director Chris Galloway put it in a news release after LaGrange’s letter landed, “This mandate letter is released at a time when Albertans are witnessing the UCP government’s health care privatization schemes fail before their eyes. Privatized food in hospitals is a disaster, privatized labs are failing to deliver, and privatized surgeries are only worsening wait times and reducing capacity.

As these privatization schemes continue to pull more workers from our public system, our health-care short staffing crisis is only getting worse with dozens of facilities across the province facing repeated temporary closures.”

And as NDP health critic David Shepherd observed, “this mandate letter basically provides a comprehensive list of all of the UCP’s failures in the health-care system.”

It’s pretty reasonable to expect that whatever the government does next, whether it’s the worst case or merely a less worse case, will have the same lack of success.

But most likely it will turn out that some things really are too big to dismantle — and that AHS is one of them.