Reading Between the Lines on Bill 30

It looks like chaos out there: a global health-care crisis in the form of the COVID-19 pandemic and a local, made-in-Alberta health-care crisis have combined forces to conduct an assault on multiple fronts. The list is long and growing:

• the ongoing battle between Health Minister Tyler Shandro and the Alberta Medical Association, prompting a steady exodus of physicians from rural hospitals and family practices
• whistleblower reports of clandestine lobbying of the Health Ministry to secure approval for a private, for-profit surgical hospital
• privatizing community diagnostic laboratories
• the promotion of third-party virtual health apps
• drive-through mask distribution
• consolidating EMS services
• contracting out “under-utilized spaces” in continuing care facilities to for-profit developers
• the Cambie legal decision 
• fears of Americanized, two-tier care

This whirlwind of developments, decisions and emergent scandals feels chaotic, incoherent and incompetent. Many Albertans feel the United Conservative government has no plan for health care and are anxiously bracing themselves for cuts.

But if we consider the big picture, the reality is far more concerning: this government does have a plan for our health care and it is one that will serve corporate interests instead of the public interest. Zooming in on the UCP’s health omnibus bill (Bill 30: Health Statutes Amendments Act) provides crucial pieces in the puzzle of the UCP privatization agenda.

Over the next number of weeks, this blog series will examine the specific manifestations of this agenda for surgical wait times, continuing care/elder care, and the politics of physician relations. This series supplements the excellent report into the privatization of home care, telehealth and lab services by Alison McIntosh that was released on September 21.

In this first installment, I will offer a breakdown of Bill 30:

• the changes it enacts to existing health-care legislation,
• implications for accountability, transparency, sustainability, quality of care and equality of care
• consequences for universality as wide-reaching corporate influence is invited into the system

Bill 30, introduced in the Alberta Legislature on July 6, 2020, enacts 11 amendments to nine pieces of health-care legislation in the cumbersome omnibus style preferred by Harperite conservatives: multiple small, highly specific changes make it more difficult to pin down and anticipate their effects. In Bill 30, some of these changes are minor, even benign. Some are more far-reaching, and the cumulative effect has the potential to set in motion a wholesale transformation of health care in this province.

The bill makes changes to a number of health professional associations, including two bodies tasked with oversight, regulation and approvals processes: the College of Physicians and Surgeons of Alberta (CPSA) and the Health Quality Council of Alberta (HQCA). Specifically, the make-up of the bodies will be re-balanced, with a new requirement for 50 per cent “public” participation. While this may sound like a win for accountability to Albertans, hang on. “Public” members are appointed by the government, and the UCP government has demonstrated many times that its appointments are partisan and nepotistic.

By stacking the HQCA and the CPSA with party faithful, their claim to objectivity and neutrality is severely eroded. Under Bill 30, the HQCA will also report directly to the Health minister, a move that undermines their political autonomy. For the CPSA, the erosion of non-partisanship may influence its increased role in approving “chartered” or “non-hospital”–private –surgical facilities. Meanwhile, political appointees will also be placed on the Hospital Privileges Appeal Board that is tasked with adjudicating physician grievances with hospitals.

These functions are at risk of becoming increasingly politicized, especially in the current climate where relations between physicians, the AMA and the Ministry of Health are incredibly strained. In a follow-up to the “tearing-up” of physicians’ collective agreement via Bill 21, Bill 30 enables more doctors to sign direct contracts with the government (called an ARP) –bypassing the need for the Health minister to return to the bargaining table in good faith.

More insidiously, it allows for a new type of contract between the government and corporations. Under this clause, private corporations can now make agreements to directly bill Alberta Health for publicly funded medical services and operate primary or community care clinics, essentially acting as an administrator that would sub-contract physicians. This means instead of having a collective agreement with Alberta Health, doctors would be bound to employee contracts with say, Telus or Loblaw’s (or their subsidiary companies). This raises questions about the transparency of not only billings (will more corporate-owned clinics adopt the “hybrid” model based on membership fees?) but also accountability. Unlike the arbitrarily cancelled doctors’ contract, these corporate agreements would be “iron-clad.” Concerns have already been raised about potentially prohibitive penalties that would dissuade future governments from cancelling such arrangements.

Bill 30 also further blurs the line between public funding and delivery, entrenching the framework for contracting out publicly funded surgical procedures established by the misnamed Healthcare Protection Act (Klein’s Bill 11) and expanding its scope. “Chartered surgical facilities” are so broadly defined that the minister can alter the parameters to suit a potential investor after an RFP is accepted. It also permits publicly insured and uninsured procedures to take place in the same facility, thereby enabling upselling and extra-billing. This despite the fact there is little to no evidence to suggest private surgeries offer any benefit to the public health-care system. In fact, it’s just the opposite: past experience and a recent B.C. Supreme Court ruling confirm that surgical facilities of this kind have significant adverse effects on wait times, costs and accessibility. The complexities of for-profit surgical initiatives will be explored in part two of this blog series.

As the Ministry of Health continues to antagonize doctors (mandating the disclosure of gross billings via a “sunshine list,” issuing instructions to the AMA on closing practice notice, mandating work in high-need areas), those with integrity and a true desire to put patients’ interests first are increasingly unwilling to remain in Alberta; those who remain may be persuaded to contract to corporate clinic franchises, private surgical hospitals or exclusive clinics. What Bill 30 represents, at its foundation, is an unprecedented transfer of power from physicians to corporate investors, and Albertans may pay the price in reduced access to primary care.

As health policy analyst Andrew Longhurst points out, “Bill 30 is a decisive shift to greater for-profit involvement in the provision of publicly funded health-care services. In essence, it further develops a legislative framework that will enable the erosion of publicly delivered surgeries and other acute care services (including laboratory, diagnostic imaging, nursing and rehabilitation services) from the public to the private sector.”

While its objective to create a “business-friendly” health-care sector may have anticipated a win for the Cambie corporation – a blueprint for a full parallel private system, ready to roll out with a ruling in their favour – neither the ruling nor the narrow interpretation of the Canada Health Act will prevent a slow corporatization of Alberta’s health-care services. Meanwhile, Premier Kenney’s oft-cited “public healthcare guarantee” remains intact by technicality: by maintaining public funding for insured health-care services, Kenney is breaking no promises by opening the door to for-profit delivery of those services. Bill 30, meanwhile, surpasses Klein’s attempt at a “third way,” and will surely “go down as one of the biggest moves towards investor-driven, for-profit healthcare, in the history of Medicare.”

Albertans’ health is open for business.