Both sides in health debate use hammers, not scalpels

As a couple of contractors told me when I called them to fix my bumbling attempts at home improvement, it’s important to use “the right tool for the right job.”

Purely hypothetical examples might include the fact that a steak knife probably isn’t sufficient to unclog a drain, while using a nail gun to hang artwork is likely overkill.

The same principle can be applied in politics, especially when it comes to solving complex conundrums such as reducing health costs without damaging the timeliness or quality of services.

That’s a problem that requires precision instruments, the equivalent of a scalpel and tweezers.

Unfortunately, leaders on opposite sides of this increasingly bitter debate have so far decided to brandish only chainsaws and blowtorches.

While the government has pushed forward with demands for thousands of job cuts and wage rollbacks to address the cost issue, labour leaders are refusing to acknowledge there even is an issue, while also musing about the potential for a provincial general strike.

This is likely to get a whole lot worse before it gets better.

To be fair to the government, the issue of high costs is not an invented one.

Canadian Institute for Health Information statistics in recent years have consistently shown Alberta as the second highest among the provinces in per capita health spending — and that’s before you factor in that Alberta should have lower health demands because we have a younger population.

This is not a trend that developed overnight.

For the first decade of the 2000s, with the province swimming in resource revenue and growing rapidly in population, the health budget ballooned in a number of different ways: pay raises for workers, an expansion of beds and more services.

As a result, from 1999-2010, provincial spending on health increased by an average of roughly eight per cent annually.

Regrettably, in the decade that followed, when provincial income soured, there wasn’t an adequate cost correction to match. The NDP government took some steps down this path by limiting spending growth to less than three per cent annually and getting health unions to take pay freezes, but felt going further would risk stability of the system.

The UCP government, it seems, has no such fear.

Letters delivered to health unions suggest the UCP is planning to axe as many as 5,000 unionized health jobs over the next four years, and that number may be just the beginning.

Some of this will be accomplished by leaving vacant jobs unfilled, some through layoffs, and some by outsourcing more services to private companies — from linen and custodial work to medical testing to home-care nursing. It’s also possible we could see registered nurse positions filled by cheaper licensed practical nurses.

Cryptically, the letters also refer to “reconfiguring services” at smaller facilities and closing acute care beds, with no details provided.

While a trim to the health workforce was probably a foregone conclusion under the new government, the numbers offered in these letters are eye-popping. It’s hard to see how such a move doesn’t violate the spirit, if not the letter, of UCP promises not to hurt front-line care that is already overburdened in some sectors of the system.

In that vein, a figure of 5,000 job cuts is big enough that it makes you wonder if it’s a negotiating ploy to get union concessions, such as accepting wage rollbacks or toughening overtime provisions.

However, if the government is intent on such job reductions, then they need to do a much better job of selling it.

That includes offering credible research that the health services in question will be cheaper, faster and at least as reliable in private, for-profit hands, rather than just making an ideological assumption that it always works out that way.

After all, it’s not hard to find examples, including some in Alberta, where privatization of health care has performed poorly.

Moreover, the UCP needs to explain how it can still meet its promise of getting surgery wait times down to four months with fewer front-line staff and hospital beds.

That said, union leaders must rethink their approach, too, which at this point comes across as little more than a defence of the status quo.

Asked Monday what they would do to deal with high health costs, the presidents of both the United Nurses of Alberta and the Health Sciences Association of Alberta refused to even acknowledge the premise of the question.

At the same time, the Alberta Union of Provincial Employees has headed into arbitration hearings with senseless wage hike requests of between 6.5 and 7.85 per cent.

All this plays right into Premier Jason Kenney’s hands, as does increasing talk of labour groups organizing a general strike.

While some sort of labour action seems inevitable at this point, the chaos created by a mass walkout is sure to generate considerable anger, and Kenney is betting it won’t be him that bears the brunt of it.

Finding a fix to unsustainable health spending is not a problem unique to Alberta, but requires approaches that are careful, considered and based on the best evidence.

Unfortunately, the two sides negotiating this issue currently seem more intent on performing that surgery with sledgehammers instead of scalpels.