How Hard Can It Be?

Why does it feel like health care is rocket science in Alberta?

The latest move by the province to go back to the "good ol' days" of health regions...errrrr... operational districts is a fascinating one.  Fascinating because it's making everyone wonder why we are where we are.  Seven years ago, the province dissolved all of the health regions into the AHS superboard to "save money."  And now we're going back to the way things were to "save money."  How in the heck is that supposed to happen?

Let me try to dissect this whole situation.  Keep in mind, I'm not a professional and I wasn't a fly on the wall during the closed-door meetings between the province and the individual health regions, then later AHS.  What I am good at, though, is optics and what it looks like from an outsider's perspective.  So here goes nothing.

The decision to dissolve the boards into the AHS superboard was seemingly two-fold.

One surrounded money.  Each board had its own agenda and its own needs.  Some were more outspoken than others.  I do remember covering old Calgary Health Region meetings where the main message always seemed to be "we need more money."  It became a bit of a contest, because you had each region pounding its chest saying it needed more money, and who was the province going to listen to?  Likely the board with the loudest voice (aka the most voters).  So you saw Calgary and Edmonton get the brunt of the attention.  It created divisions with the more rural regions.  So after the bickering (and if memory serves me right, even heated words between certain higher-ups), the province decided enough was enough and got rid of the boards, because frankly, if you get one board, you'll be able to spend the cash as needed without it getting hyper-politicized.

Two surrounded doctors.  Right in the midst of the first big boom in Alberta, family doctors were at a premium.  You couldn't get enough of them.  So it became a fight amongst the different regions over resources (not just with doctors, but with nurses and support staff as well).  The rural guys were saying "we need help attracting family doctors to our area because the big cities are stealing them all away" while the big city guys were saying "we need all the doctors we can get because of the population base."  Even that got politicized.  Creating the superboard would allow for a handful of people to make the "right decisions" to support each community and region properly without political bias.

But a funny thing happened (note the hint of sarcasm on the word "funny").  AHS was created, but some decisions were made and some failed.  So in an attempt to buffer themselves from taking the heat for bad decisions, layers of management were built in.  The "fall guys".  The fall guys had fall guys.  And the fall guys' fall guys had fall guys.  Instead of looking at ways to save money (which, remember, was the original intent of AHS), more money was being spent.  If I remember the quote correctly, it cost Alberta $8-billion to run health care ten years ago.  Today, it costs $17-billion.  That's just a tad more than inflation plus population growth, if my math is correct.

Look at the doctor situation.  Did AHS actually fix the shortage?  Did we attract and maintain more doctors?  (I actually don't know the answer, although judging by the issues we've seen, I'd say if we did, we didn't keep up with population growth).  So instead of attacking the real issue (doctor shortage), we created alternate ways of getting health care.  You used to have two options: family doctors (for non-emergency stuff) and emergency rooms (emergency stuff).  Because you didn't have enough family doctors, people were going into the emergency rooms for minor stuff (I once saw an older gentleman in the waiting room who was complaining about a hangnail, not a word of a lie).  So the province, in trying to fix the backlog in the ER's, created primary care networks and family care clinics.  And the province was never really clear on how each was supposed to work.  Where do you go when you have a cough or cold?  What about a pain in your back?  You've created extra steps for people in trying to find simple care.  So they're going to default back to what they know: the emergency room.  And we're suddenly back at square one.

Meantime, you have a superboard that hasn't been overly-super.  You've had firings and controversies and everything you don't want out of that group.  They have been tasked with managing an entire system and knowing what is going on in every corner of the province.  Yet, they didn't.  They tried to blanket solution for each region and it didn't work.  Will family care clinics work better in Grande Prairie than family doctors?  What do the people of Lethbridge gravitate towards?  Do we have enough infrastructure in Calgary to have a bigger hospital or should we go after primary care networks?  The board just always seemed to be finding ways to start open heart surgery when all the taxpayers had was mild chest congestion.  All people want is to be able to see a doctor when they have the sniffles.

You used to be able to do that in every community in this province.  And thanks to amalgamation and centralization, you have to go to the big cities to get most things checked out.  So now the big cities are having to deal with not only their regular workloads, but also the workloads of the smaller communities.  They had a doctor shortage in Brooks a few years ago and a woman went into labour.  She was 60-ish minutes from Medicine Hat and 90-ish minutes from Calgary.  Guess who gave birth in an ambulance on the side of a highway?  Even today, look at all the news surrounding EMS and ambulances being logjammed at city hospitals.

You also have the issue of specialists upon specialists.  Whatever happened to a "general practitioner"?  Someone who could check you over and make sure you're not dying.  I've heard stories of something simple like a broken arm going to three different doctors.  All because they "didn't do that kind of thing" or "you have to see this type of doctor."

And now we're going back to health regions.  What I hope comes out of it is that the province will listen to all of the local concerns and that we won't re-develop the over-political, under-productive ways of the past.  What I hope is that each region will be able to utilize a provincial strategy on recruiting and retaining doctors, nurses and staff, so that everyone has proper access to health care.  Each region has its own unique needs (distances between facilities, population bases, etc).  The province will need to treat them all differently because what works well in Fort McMurray might not work in Fort Macleod.  That being said, understand that ALL Albertans deserve the same level and access of care, whether they be in a rural or urban setting.

But most importantly I hope the province finally shows Albertans what they should expect from this new/old governance model.  Explain to us what each level of governance is going to control, even if that means showing a flow chart of where the managers and assistant managers are supposed to be, and how that compares to the number of doctors and nurses.  Then we can actually say there's fat to be trimmed.  Because right now, we know it's there, we just can't seem to differentiate between the meat and the fat.  And beyond that, it's time to communicate with Albertans about how they should be accessing health care.  Eliminate the question of "should I be going to the ER for this or to the family care clinic?"  Explain to people what the issues are and help them understand the navigation of the system.  Things have become so complicated and that's why everything ranging from expense scandals and patients waiting for hours for care are falling through the cracks.

I know it sounds silly, but "keep it simple stupid" really comes to mind here.  I know health care isn't simple, nor should it be.  But it's up to the province and the health authorities to make it as easy as possible for the patients.  Whether that be to understand where their taxpayer dollars are going, or how to get rid of that ugly rash.

Where Do We Go From Here?

I'll never claim to be an economist or even someone who has an absolute 100% knowledge on everything economics in this province. My understanding is pretty basic.  I did take a year of university accounting where I learned about micro- and macro-economics among other things.  Unfortunately, I'm good with numbers but horrible with theories.  So I ended up in radio. Makes a lot of sense...

I digress. The current state of Alberta's economy has more than a few people perplexed. How did we get in this mess? Where did we go wrong? Where do we go from here? Just a few questions that are being tossed around. And frankly, does anyone really know the answers to all of these questions? Let's face it, you could ask each political party what their definition of "asset", "liability" or "debt" is and you'd probably get different answers. I'm not accusing anyone of cooking their books, but over the last few years, it sure feels like you're not getting straight answers (or at least answers that make a lick of sense). So I'm here to try to simplify the issues as much as I can.

Let's assume that this $7-billion "problem" is the real number (although I'm still curious as to whether that's the real number or not as I haven't seen the books and I don't know if this includes the credit card debt that we've accumulated over the last few years).  Anyways...it's a $7-billion problem.  We could argue until the cows come home on why we're in this mess, etc.  But I'm not interested in the past anymore.  Tell me how to fix it.  And as far as I can see, there's four ways we could fix it (with household comparisons):

#1. More debt (aka "Where's my Mastercard?")
We all know this won't go over well with many, especially fiscal conservatives who believe this should be a last resort.  Which is kind of weird given we're in a province where EVERYONE seems to have second and third mortgages to pay for all the toys (house, vehicles, boats, summer cottages, motorcycles, etc).  The one bad thing about credit card debt is that you have those outrageous interest payments.  And we all know it's really easy to get lazy and just throw in the minimum payment each month.  However, we're doing this anyways (I believe that number is anywhere from $3-billion to $5-billion, depending on who you ask).  An extra $7-billion on the credit card might not be the best option, but maybe we can put a little bit of on the card and hope it doesn't get rejected.

#2. Cut spending (aka "No more cake or allowance")
There's been some interesting developments on this one that I don't think are getting as much play as they could.  Interim Wildrose leader Heather Forsyth has said that there aren't $7-billion worth of cuts to be made.  Premier Jim Prentice says he could fire everyone employed by the province and it wouldn't equal the $7-billion problem.  So where does this leave us?  We could "cut the fat" (like many want at AHS, and it sounds like something Prentice is priming for eventually), which would, in my estimation, be nothing more than window dressing and good for the optics.  But the #1 expense for any organization (including government) is salaries and benefits.  And do you really think for a second that the worker groups and unions are going to be happy about this?  And really, neither should you because we can't be cutting employees (you know, doctors, nurses, teachers, support), especially when the overwhelming majority of people think we need MORE doctors, nurses, teachers and support.  I've even seen Wildrose candidates campaigning on getting more supports, which costs money (weird from someone who is supposed to be a fiscal conservative).  Needless to say, as much as some of you believe that cutting spending is going to answer all of our problems, you're living in a dream world.  I know opposition parties like to say that the PC's "don't have a revenue problem, they have a spending problem."  But when you have a laundry list of wants and needs from the electorate, as well as employees, you can't help but feel like the problem might be a bit self-fulfilling.

#3. More taxes (aka "NOOOOOOOOOOOOOOOOOOOOOOO!")
I reckon this one will fly like a lead balloon.  But there are more than a few ways you could look at this one.  We've heard everything from replacing the flat tax with a progressive tax regime (aka go after the big companies), health care premiums (which I'm still torn on), a PST (gasp!), and even a small gas tax.  The interesting thought with the PST or gas tax that was brought up by one person was if you made either one 3%, you could say 1% goes to education, 1% goes to health and 1% goes to infrastructure.  As a farm kid, I don't like the gas tax idea only because you're being penalized for living out in the sticks and needing groceries all of a sudden gets even more expensive.  Admittedly, I haven't done the full math on the flat tax but from what I can see, we have wiggle room to make it work without losing the "Alberta Advantage".  And making the rich guys pay a little more?  Sounds great.  Except for when you're looking for donations to your party come pre-election time.  Yikes.  And remember that comment that the PC's "don't have a revenue problem, they have a spending problem."  Well, they must have at least a little bit of a revenue problem.  Because some groups keep claiming that spending "shouldn't be on the roller-coaster ride provided by the price of oil."  Government doesn't have a ton of options when it comes to revenue.  So...there's that.

#4. Heritage Savings Trust Fund (aka "Remember that secret bank account we created when you were a kid?")
This one has me a little perplexed and intrigued all at the same time.  Admittedly, I don't know the process in how or even if we could liquidate assets.  But I did a little reading and it appears the value of that thing sits at $17.2-billion.  Here's my question: is this not referred to by many as the "rainy day fund"?  That would lead to a follow-up question: what is your definition of a "rainy day"?  That would lead to a third question: is this not a "rainy day"?  And if it wasn't set up for a rainy day and was set up more as being "for our grandkids' grandkids", at what point does it constitute our grandkids' grandkids' era?  Is there a "best before" date on the fund?  Is there a "can't open until 2030" sticker on the fund?  Now, I understand that the value of this fund hasn't dipped below $11-billion since the '90's, so taking the full $7-billion would be uncharted territory.  But what would be stopping us from utilizing some of the Heritage Savings Trust Fund to soften the blow so that we're not forcing something else down the taxpayers' throat?  Buys the government a little bit of time to maybe look into some other options (ie the above three options) and come up with a scheme on how to build the fund back up over time.  And who knows, maybe diving into that fund now might actually help us avoid creating a PST that lasts into the days of our grandkids' grandkids, who will be shaking their fists at us, wondering why we tied their hands "back in the day."  That'd be a legacy, now wouldn't it?

I'd imagine the Prentice government is going to introduce some hybrid of all four options (assuming they don't find an extra $7-billion sitting under the couch cushions).  Here's my bold prediction though: they'll introduce their solution and then call an election.  It will be their dare to the other parties: "let's see you do better."  And Albertans will be left in a tricky predicament.  Ultimately, you want to choose the party that presents the best plan to get us out of these turbulent times.  But what happens if that party is the one that steered us into these turbulent times in the first place?  Do you pick the second-best plan?  Or do you give them one last chance?