Jan. 12, 2005
 Toronto Star

Klein sees an opening

THOMAS WALKOM

Ralph Klein has thrown down the gauntlet. The Alberta premier has long been
hankering to scale back and privatize medicare. Yesterday, he served notice
that he's going ahead.

In a speech to the Calgary Canadian Club, Klein said that while his plans
might violate the Canada Health Act, the federal law governing medicare,
they wouldn't "necessarily" do so.

Rather than break the law, he said, he intends to bend it — in his words,
to "test the boundaries."

While the usually blunt premier remained deliberately vague on specifics,
his speech — particularly in the context of Klein's earlier musings on
medicare — gives a pretty clear idea of where he wants to go.

First, he wants to reduce the scope of medicare. That, presumably, is what
he meant when he talked about devising a "third way" between a system where
money determines treatment and one "that tries to provide all services to
all people."

It's long been the Klein government's position that medicare is too
extensive. Gary Mar, at the time Klein's health minister, made that point
last May when he told an Ottawa think tank that Alberta planned to "go back
to the original intent of medicare."

What was that original intent? For Mar, it was to create a system where no
one was denied necessary health care because of poverty.

In fact, that was not the original intent of Canadian medicare. It is the
intent of a U.S program called Medicaid that is aimed specifically at the
very poor.

But when Canada designed its national publicly funded health insurance
program in the mid-1960s, it made the conscious choice to do something far
more ambitious — provide all medically necessary physician and hospital
health services, not just to the poor but to all.

Ironically, the very scope of Canadian medicare, and the consequent
economies of scale, created the conditions for its success.

It proved cheaper overall than the U.S. health-care system (while providing
better results) and far less ramshackle than the British two-tier
arrangement (which permits a full-scale private system).

So when Klein spoke of turning his back on a system that "tries to provide
all services to all people" he was, in fact, taking direct aim at the very
core of Canadian medicare.

Second, Klein said he wants to give Alberta's regional health authorities
more leeway to "try new ideas, encourage competition and choice and see
what works and what doesn't."

On the face of it, there is nothing extraordinary about that. Who can fault
innovation?

But within the context of the Klein government's approach to health, words
such as "new ideas" and "choice" mean something both more specific and more
daring.

To understand just what requires a little history. In late 2001, an
advisory panel personally chosen by Klein and operating under the
chairmanship of former federal Conservative finance minister Don
Mazankowski produced a report on medicare. The panel itself was relatively
broad and some of its ideas sound.

But the essence of the Mazankowski report constituted a fourfold attack on
medicare, to wit:

 Patients should be charged out of pocket for medicare — either through
user fees or some other kind of mechanism;

Medicare should be scaled back to so-called essential services;

 As much of medicare as possible — including services no longer deemed
"essential" — should be privatized;

 The government should encourage innovation in order to achieve the first
three aims.

These recommendations were echoed in a second report done by a legislative
committee. It recommended Albertans be levied user fees whenever they go to
a doctor or hospital.

Klein deemed this second report so controversial that he kept it secret for
18 months.

When Klein praised the Mazankowski report yesterday as the country's "best
report on health-care reform," he wasn't just being polite. He was
signalling that, for him at least, these notions are still very much alive.

And when he said to the province's regional health authorities, "If you've
got a good idea, you've got our permission to try," he wasn't just talking
about letting hospitals charge parking fees. He was signalling his
determination to encourage profound change.

If, indeed, Klein does use his last tour in office to take apart medicare
in Alberta, who will stop him? The premier bets — probably correctly — that
it won't be the federal Liberal government of Prime Minister Paul Martin.

If he runs afoul of the Canada Health Act, Klein said yesterday, he's quite
prepared to take advantage of the so-called dispute resolution system
Martin's predecessor, Jean Chrétien, put in place in order to delay any
potential federal action.

And while the Alberta premier didn't bother mentioning it, he has another
ace up his sleeve. That's Martin's decision last fall to formally endorse
the concept of so-called asymmetrical federalism in the health field. The
Prime Minister did so during a gruesome first ministers meeting in order to
appease Quebec.

But at the time, Klein's government quietly won a key concession: If Ottawa
was willing to let Quebec go its own way in health without financial
penalties, it would have to grant Alberta the same privilege.

In effect, Klein has served notice that he'll be taking advantage of this
concession. He is planning to go his own way. Medicare be damned.