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Alberta Politics

HappyJazzz said:
Well I didn't vote for it, mostly because I think party based democracy is a meme, but I did likely indirectly give them the idea for the policy.

Care to explain what part of introducing some competitive pressure to improve efficiency in healthcare is bad thing?
Click to expand...
Public healthcare is not a business and it takes a lack of undertstanding of the purpose of public services to think that they should be run as such.

There is efficiency to be gained, but there are means of achieving that within the existing structures.

This government has made it clear that they favour private healthcare so the above points are moot. Efficiency can only be judged if service levels are equal and the cost to consumers is unchanged and since private healthcare is motivated by profit over service, any improvement in the latter is a direct result in an increase of the former.
 
TAS said:
This also nicely outlines some of the concerns with Smith's recent actions on health care and police.

calgaryherald.com

Braid: Private companies running hospitals? All part of Smith campaign to soothe restless UCP base

Alberta Premier Danielle Smith pitches private hospital management to her UCP's restless base in advance of leadership review.
calgaryherald.com calgaryherald.com
Click to expand...
From the article:
Covenant is adept at shifting overflow to the two AHS hospitals, the University and Royal Alexandra. That increases pressure on their ERs from Edmontonians and northern rural transfers.

“In the only place where there’s already two hospital managers and a kind of competition, the results are actually worse,” says Dr. Paul Parks, president of the Alberta Medical Association.

Efficiency!
 
There are absolutely efficiencies to be gained in healthcare. @kcantor noted one (primary healthcare access) and the other is expanding long term care capacity to free up the extensive number of hospital beds occupied by elderly patients waiting for transfer. There are bureaucratic structures that could be refined as well, but for an organization that employs ~100,000 professionals, there's going to be substantial administrative overhead to keep it all moving in the same direction.

Otherwise, hospital healthcare ironically does work unbelievably efficient--our hospitals have been running at over 100% capacity in near perpetuity, average bed vacancy time for med/surg units is probably <100 mins, most units run the most bare minimum nurse-patient ratios and attendings manage three digit counts of patients. Hospital healthcare is held together by front line staff who work their freakin' arses off... seriously, I'd rather go work on a drilling rig in Wabasca before I'd work a hospital shift as a nurse.
 
Whattagame said:
Public healthcare is not a business and it takes a lack of undertstanding of the purpose of public services to think that they should be run as such.

There is efficiency to be gained, but there are means of achieving that within the existing structures.

This government has made it clear that they favour private healthcare so the above points are moot. Efficiency can only be judged if service levels are equal and the cost to consumers is unchanged and since private healthcare is motivated by profit over service, any improvement in the latter is a direct result in an increase of the former.
Click to expand...
It may not be a for-profit business (and it certainly shouldn't be IMO) but it has many of the same characteristics of other businesses.
These organizations have a budget, they have customers/users, employees with salaries and capital expenses, etc.
Buying equipment that goes unused is inefficient. Expending resources on a customer/user that didn't really need to be there is inefficient.
I'm not going to claim to have all the answers here, but I do think that there has to be some sort of mechanism to encourage efficiency.
Canada has treated healthcare budgets as sacrosanct and untouchable for too long, and it seems to have resulted in at least a lethargic bureaucracy.
Things can be done better, I'm sure of that. Whether or not competing hospital operators is the best way of doing that remains to be seen, but it is nice to see some serious attention on the issue.
 
kcantor said:
I suppose it depends on your priorities but public healthcare isn't necessarily best served by "improved efficiency" as much as by the delivery of quality health care. If improved efficiency doesn't result in the latter - or indeed compromised delivery of the latter - then it's foolishness personified.

If the goal is the provision of quality health care, perhaps less "introducing fear" and more listening to doctors and nurses and other health care providers is a better path? At this point in time, 650,000 Albertans don't even have a GP - the earliest and most efficient point in delivering quality health care. That's only going to get worse as Alberta experiences national and internation migration numbers at the fastest rate the province has ever had and none of them bring their own doctors or nursed or emergency rooms or hospitals with them...
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You aren't wrong about quality being important, I have no argument against that. But quality can be efficient too. Getting the diagnosis right the first time saves time for medical staff and patients/users alike.
Freeing the system of people/users that didn't need to be there in the first place helps medical staff provide better quality treatment to those that really need it.
And you're very spot on about the impact of Canada's record immigration and TFWs on these services too, the medical system is getting crushed along with much of Canada's other services and infrastructure.

Competitive hospital operators isn't the only solution to that of course, I think there needs to be increased focus on encouraging healthier lifestyle among people, so they don't need as much medical attention.
I'm also of the belief that Canada's "free" healthcare has given some people the impression that it can and should be used for anything, no matter how minor.

I've been fortunate enough to not have to deal with hospitals on a regular basis, and haven't since well before COVID, but there's no need for people with medicenter-tier issues to be clogging up an ER waiting room.
What's the solution there? Maybe it's token user fees to access hospitals directly. I'm also hopeful that the AI era may be helpful in helping take some initial diagnosis load off of more senior medical personnel too.

One thing is certain though, Canada's record population growth has meant there's really no time to mess around with finding solutions!
 
TAS said:
The public is learning more about these two initiatives from a reporter who attended a townhall meeting over a week ago on Aug. 17. That's a very poor way to announce policy directives.

The UCP and Premier Smith has established a poor relationship with with many hospital workers (doctors, nurses, support) as well as other key health stakeholders. Is this approach of fear and threats going to improve that relationship and increase the #of doctors we have? I can't imagine being in an environment like that.
We have troubling staffing issues. A man recently died several months after his cancer diagnosis and had never even seen an oncologist due to shortages.
Even Covenant Health has had to close departments in some of its hospitals for periods of time due to staffing issues.

I agree with you that I don't love party democracy in many respects and I find this particular government very heavily ideologically based in its decisions and is happy to hide info that is not supportive of its initiatives- such as the results of public survey on CPP, for one. They completely ignored the majority will of Edmonton and Calgary on municipal political parties.

This government just doesn't work well with so many of its partners in the province and even groups like the
Alberta Rural Munipalities Association, where their bread and butter support is, have outlined various concerns from inadequate funding, policing and well clean ups etc.

In terms of Danielle Smith, I don't trust or believe her many times. She distorts facts. Great communicator though.
Click to expand...

The primary reason why I don't like party-based democracy is that too many important issues end up turning into an us vs them bun-fight, which results in the actual problem either being obfuscated, ignored, or having potential solutions discarded just because it was "their" idea, and not "ours".

It does seem that the current provincial government is rolling out a lot of these ideas fairly fast, but I suppose that's being forced in part by decisions made by the federal government, so I can understand if there's some frustration on the part.of the province.

I will say that I think democracy is more effective the more local it is, so I do support initiatives that bring greater autonomy to the provinces.
 
HappyJazzz said:
It may not be a for-profit business (and it certainly shouldn't be IMO) but it has many of the same characteristics of other businesses.
These organizations have a budget, they have customers/users, employees with salaries and capital expenses, etc.
Buying equipment that goes unused is inefficient. Expending resources on a customer/user that didn't really need to be there is inefficient.
I'm not going to claim to have all the answers here, but I do think that there has to be some sort of mechanism to encourage efficiency.
Canada has treated healthcare budgets as sacrosanct and untouchable for too long, and it seems to have resulted in at least a lethargic bureaucracy.
Things can be done better, I'm sure of that. Whether or not competing hospital operators is the best way of doing that remains to be seen, but it is nice to see some serious attention on the issue.
Click to expand...
Publicly funded health care is very different from for-profit businesses and even from most other publicly funded and provided enterprises/services.

I’m old enough to remember the world’s first heart transplant and when most cancers led to a quick death and when people died of rare diseases without their ever being recognized. Not only do we expect access to all of the latest procedures and pharmaceuticals, we take them for granted. We fully expect artificial knees and hips and cataract surgery and organ transplants to be available for all of us almost “on demand”.

Health care is exponentially broader and more expensive than Tommy Douglas ever imagined not only in the aggregate but individually. Providing it and managing it along with continual advances in available medical care cannot be done by applying the types of management control that would be applied to a for profit business.

Health care is all about delivery, not cost control. If cost control is the primary objective, it can be achieved simply and quickly by not providing anything that wasn’t available in 1984 when the Canada Health Act was enacted. While that would result in tremendous efficiencies throughout the system, it would come at the expense of general public health and be financed by a reduction in life expectancy along with that reduction in the cost of health care.

As we’re already seeing that through the lack of access to timely primary care, perhaps that is indeed the road we’re on - reducing costs by reducing system demands by simply letting people die.

I for one don’t see the complete dismantling and restructuring of our health care system - including who owns and provides it - without a working model of what will replace it that is transparent and better supported by health care professionals than the current ideological path the Premier and her cohorts are setting us on.
 
@HappyJazzz - You're kind of exemplifying how the UCP playbook is supposed to work. You talk about non-emergencies clogging up ERs as an example of inefficiency. But this is the result of intentional underfunding and antagonism of medical professionals. You now have a severe lack of family doctors who would normally be looking at minor cases, so people are forced to go to the ER. And the ER is more clogged than it should be because of the chronic underfunding.

Then people cry "See! The system is broken!"

We will all pay more as a result, and if you want to see who wins look no further than the board of Covenant Health.
 
HappyJazzz said:
You aren't wrong about quality being important, I have no argument against that. But quality can be efficient too. Getting the diagnosis right the first time saves time for medical staff and patients/users alike.
Freeing the system of people/users that didn't need to be there in the first place helps medical staff provide better quality treatment to those that really need it.
And you're very spot on about the impact of Canada's record immigration and TFWs on these services too, the medical system is getting crushed along with much of Canada's other services and infrastructure.

Competitive hospital operators isn't the only solution to that of course, I think there needs to be increased focus on encouraging healthier lifestyle among people, so they don't need as much medical attention.
I'm also of the belief that Canada's "free" healthcare has given some people the impression that it can and should be used for anything, no matter how minor.

I've been fortunate enough to not have to deal with hospitals on a regular basis, and haven't since well before COVID, but there's no need for people with medicenter-tier issues to be clogging up an ER waiting room.
What's the solution there? Maybe it's token user fees to access hospitals directly. I'm also hopeful that the AI era may be helpful in helping take some initial diagnosis load off of more senior medical personnel too.

One thing is certain though, Canada's record population growth has meant there's really no time to mess around with finding solutions!
Click to expand...

@HappyJazzz
This episode of Real Talk nicely outlines the challenges/significant issues of a competitive model for health care.

 
"Why do people become socialist when they move to Calgary and Edmonton? I just don't get it," Smith quipped at a UCP town hall.

They don’t.

But when UCP policies drive urban voters to place their ballots elsewhere, that’s not because they’re socialist, it’s because they’re no longer UCP supporters.

And moving government ministries away from the seat of government surely can’t be a response that is anything but government by pettiness and spite. For better or worse, she is the Premier of the entire province, not just those pieces that voted for her.

 
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kcantor said:
"Why do people become socialist when they move to Calgary and Edmonton? I just don't get it," Smith quipped at a UCP town hall.

They don’t.

But when UCP policies drive urban voters to place their ballots elsewhere, that’s not because they’re socialist, it’s because they’re no longer UCP supporters.

And moving government ministries away from the seat of government surely can’t be a response that is anything but government by pettiness and spite. For better or worse, she is the Premier of the entire province, not just those pieces that voted for her.

Click to expand...
But moving those ministries further away must be more efficient. The tao of conservatism isn't an illusion, is it?

I believe it was on this site a while ago that I asked what people thought about the possibility of the UCP making moves to relocate the Capital away from Edmonton. I think that the consensus at the time was that it was a ludicrous thought.

With every passing day under this government, I'm not so sure.
 
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Whattagame said:
Public healthcare is not a business and it takes a lack of undertstanding of the purpose of public services to think that they should be run as such.

There is efficiency to be gained, but there are means of achieving that within the existing structures.

This government has made it clear that they favour private healthcare so the above points are moot. Efficiency can only be judged if service levels are equal and the cost to consumers is unchanged and since private healthcare is motivated by profit over service, any improvement in the latter is a direct result in an increase of the former.
Click to expand...

Competitive != Private, nor did I say I was endorsing a for-profit mechanism...
 
kcantor said:
Publicly funded health care is very different from for-profit businesses and even from most other publicly funded and provided enterprises/services.

I’m old enough to remember the world’s first heart transplant and when most cancers led to a quick death and when people died of rare diseases without their ever being recognized. Not only do we expect access to all of the latest procedures and pharmaceuticals, we take them for granted. We fully expect artificial knees and hips and cataract surgery and organ transplants to be available for all of us almost “on demand”.

Health care is exponentially broader and more expensive than Tommy Douglas ever imagined not only in the aggregate but individually. Providing it and managing it along with continual advances in available medical care cannot be done by applying the types of management control that would be applied to a for profit business.

Health care is all about delivery, not cost control. If cost control is the primary objective, it can be achieved simply and quickly by not providing anything that wasn’t available in 1984 when the Canada Health Act was enacted. While that would result in tremendous efficiencies throughout the system, it would come at the expense of general public health and be financed by a reduction in life expectancy along with that reduction in the cost of health care.

As we’re already seeing that through the lack of access to timely primary care, perhaps that is indeed the road we’re on - reducing costs by reducing system demands by simply letting people die.

I for one don’t see the complete dismantling and restructuring of our health care system - including who owns and provides it - without a working model of what will replace it that is transparent and better supported by health care professionals than the current ideological path the Premier and her cohorts are setting us on.
Click to expand...

And you're putting the for-profit words in my mouth too... Seems like there's a literacy problem on this forum?

While you are cynically correct in that simply letting people die is one way of reducing demand on the system, there are other ways of achieving reduced demand too, as I've already mentioned.

The best of course is not needing healthcare in the first place! A visit to your nearest costco or fast food joint will serve as a reminder as to how unfit many Canadians have become.
That lack of self-care will eventually end up requiring corrective measures, and I'm not sure that a public program should be footing the bill for that.

Frivolous use of the system is another significant problem. Should someone with a runny nose be taking ER resources away from people with broken bones?

As for primary care, that's probably the most difficult one to address with a booming population, and that's where I think the AI advances of late can be a real game changer.
What could be faster or more convenient than getting an online, on-demand initial consultation in the comfort of your own home?
 
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