Both sides in health de­bate use ham­mers, not scalpels

Edmonton Journal - - FRONT PAGE - KEITH GEREIN Com­men­tary

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.

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