It is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.Macbeth
Over the past week, the Smith government has released mandate letters for most of its Cabinet Ministers, including the major portfolios that will handle controversial issues: Health, Finance & Justice. I can only imagine the flurry of activity that has taken place in the Premier’s office and Executive Council over the past few weeks to produce these pages and pages of bullet points.
But here’s the thing: it’s the middle of November, and the provincial election is at the end of May.
If we think just about the big ticket items, there’s the Sovereignty Act (whatever it will look like), something to ‘protect’ those who choose to be unvaccinated, measures to address affordability, and decisions on whether to move forward with a provincial police force, provincial revenue collection and a provincial pension plan. Oh, and the healthcare system is crumbling as we speak.
All of these are both controversial and (with the exception of human rights and vaccination status) highly complex. And only one of them (health care) is urgent. (OK, maybe two: some of the measures around affordability are at least a year late).
For whatever reason, the Smith government has decided that the best way to spend the next five months is in a flurry of activity, reigniting arguments about policing and pension plans, parsing clauses of the Constitution and debating the merits of centralization versus decentralization in health system governance. She has sent missives in all directions, calling for an arena deal for Calgary, or a train to Banff, or …
All of this at the point in the election cycle when governments are normally coasting toward the finish line, making happy spending announcements and generally trying to avoid pissing people off.
Instead, Smith has opted for sound and fury. Perhaps it is intended to distract us from the rapidly dwindling number of available ICU beds in the province. Perhaps the plan is to hold referendums on policing, pensions and tax collection alongside the provincial election, in the hope that it will motivate the base to show up. Perhaps the Premier really thinks that government can move this swiftly and not screw up.
(Perhaps the flurry of activity is intended to confuse us about what this government really is. Yesterday, I admitted to Duane Bratt that he was probably right and there wasn’t really a pivot. Today, we’ve changed sides and he thinks the Health letter is a pivot, and I’m not so sure. It’s dizzying.)
To be fair, many of the letters are filled with bullet points that direct Minister to keep their department doing things that their department is already doing. (You know, like when you add an item that’s already finished to your to-do list so you feel like you’re getting somewhere.)
But when we focus on the big picture, what we’re left with is this:
The government will devote much of its time and political capital (such as it is) over the next five months to talking about Alberta’s place in confederation, including the controversial issues of a provincial police force, a provincial pension plan and provincial tax collection.
For variety, it will pass some kind of legislation to prevent ‘discrimination’ against the unvaccinated.
Smith has absolutely no clue what to do about the crisis in health care, and she is setting Health Minister Jason Copping and Alberta Health Services up for failure.
The Mess in Health
In the page of bullet points in the Health Minister’s mandate letter, only one has the potential to affect the government’s political fortunes. It’s the third bullet point: “Take immediate tangible steps to have AHS improve EMS response times, decrease surgical backlogs and cut emergency room wait times.” This is the item that requires urgent and immediate action. Like, yesterday.
But it’s buried below two other bullets:
Develop a series of reforms to the healthcare system that restore decision making authority to the local level, incentivize regional innovation and competition to provide increased medical services and surgeries, and that attracts health care professionals domestically and internationally.
Assess the effectiveness of our health care institutions including the HQCA and AHS and develop a plan to improve health care delivery and health care outcomes while managing costs. This includes mechanisms to support local decision making within AHS and supporting our frontline health care workers.
These are not small tasks, and even if they could be accomplished in the coming month or two, they will not save the system from the tsunami of COVID and influenza that is washing over it. And there is absolutely no evidence to support the idea that the reason the system is buckling is excessive centralization or other governance issues. Ontario’s health system is relatively decentralized. And the situation there is as bad if not worse than what we see in Alberta.
I’m not a health policy expert and I’m the wrong kind of Doctor, but it’s pretty evident to anyone paying attention that the most proximate cause of the current crisis is … COVID. (For a fuller picture, CTV data journalist Kyra Markov has a great thread on Twitter). For most of this year, there have been at least 600 COVID cases in Alberta hospitals, and we’re now up over 1000 again. And health care workers are exhausted and increasingly incapacitated by COVID. (The WCB data on public sector workers’ claims for this year is eyeopening). And now there’s an influenza epidemic that’s hitting children especially hard.
It seems safe to assume that there are no quick fixes that will produce more doctors, nurses and EMS workers. The system is at capacity, and changing that capacity is a long-term undertaking. The only thing that will take pressure off the system is to reduce the number of people who need it over the next several weeks and months.
And if there’s one thing that’s clear about this government, it’s that it will not take the actions that are required to address the situation: a full-throated endorsement of vaccinating kids (and adults) for flu and COVID and a requirement that everyone wear masks indoors for the next several weeks. Today, the new CMOH issued a statement that downplayed the situation (“ho-hum, it’s flu season”) and encouraged mask wearing, while hastening to add that “Albertans should be supported regardless of their choice to mask or not.”
Five months isn’t a lot of time for a government to move forward an ambitious policy agenda. But it’s plenty of time to push a health care system teetering on the brink over the edge.
We see this again and again in health care ... when in doubt go after the governance of the system. But it's never really the governance that is the issue, it's the organization and delivery of care. But you can't change that without taking on very powerful interests in the system (witness SK's failed attempt to LEAN the SK health care system) whereas governance changes are fully within the purview of the government. This is the kind of stuff what drives us health policy wonks absolutely nuts.
Excellent article!