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second opinion

Danielle Smith, leader of the Alberta Wildrose Party (and, if the polls are to be believed, the premier-to-be), said that if her party forms the next government on April 23, it will allow a mix of public and private health-care delivery.


A mix of private and public health-care delivery – with public administration – is the norm in Canada. In fact, the vast majority of care is delivered by private providers, from independent physicians through to not-for-profit hospitals, and for-profit companies are increasingly providing everything from surgery to nursing-home care.

Yet, predictably, Ms. Smith's comments sparked an outcry.

Alberta NDP Leader Brian Mason said that medicare was "under attack" and "two-tier health care" was in the offing. The Friends of Medicare said that private health care is "like a zombie – it keeps coming back and back."

Patients care not a whit who delivers their care; they care about quality, accessibility and affordability. So too should governments.

We need to stop vilifying everyone – and politicians in particular – who states the obvious: that private care has a place in our health system. At the same time, we need to dispense with the tiresome stereotypes, good and bad, about private delivery of care.

Private providers do not magically deliver better care faster, nor do public providers operate in a hopelessly bureaucratic fashion. Private care is not always more expensive and more dangerous. Nor is not-for-profit care necessarily more efficient and humane.

Specialization, monitoring and accountability improve care. Standards are what matter.

There is nothing wrong with contracting out work. What is essential is that private providers be held to the same standards as not-for-profit and public providers. That has been the key to the success of private care provision in European countries: strict regulation.

It's important to understand the context of Ms. Smith's comments.

She's not advocating privatizing health-care delivery willy-nilly. Part of the Wildrose platform is the Alberta Patient Wait Time Guarantee, an initiative to reduce waits for 10 common surgical procedures. Ms. Smith said if guaranteed waiting times could not be met within the province, patients could seek the procedures from private clinics in Alberta or in other jurisdictions (Canadian or U.S.) and the province would pay.

This idea should be debated on its merits, namely: Are waiting times the most pressing issue today (not really) and is the $180-million a year this initiative will cost better spent elsewhere (undoubtedly). But we need to get beyond the knee-jerk "all private care is evil" rhetoric. The real issue is how to ensure the public-private mix that gives the best bang for the buck and enhances the underlying principle of medicare: equity.

One concern with the Wildrose approach is that well-heeled Albertans would jump the queue. This is a marginal concern. The wealthy already hop on planes and go to private clinics in B.C. or Montana. The purpose of medicare is to ensure all citizens get essential medical care that is of good quality and timely; it is not that everyone get identical care.

Alleviating wait times is a legitimate political choice – one embraced elsewhere – and Wildrose is being up-front about its intentions. But it is far from the most important issue.

What should be of much greater concern to citizens, in Alberta and other provinces, is what Wildrose (or the Progressive Conservatives, if they are re-elected) would do with the public administration side of the system.

In recent years, various PC governments have introduced regionalization, brutally at first, and then rejigged it confusedly on a number of occasions. The most recent incarnation is Alberta Health Services, a central body administering the whole health delivery system.

At one point, Wildrose was promising to blow up AHS, to decentralize anew. This kind of constant revamping of the management structure has interfered terribly with the stuff that matters: delivering quality care.

Instead of fiddling with management structures, we need to fix our fundamental approach to delivering care – to put the emphasis on managing chronic disease and caring for people in the community and take it away from the outmoded approach of providing all acute care in institutions.

Those are the meaty matters the leaders of Wildrose, the PCs, the NDP and Liberals should be debating during the Alberta campaign because they affect day-to-day health care for everyone.

Sadly, they don't get discussed because we are too busy tilting quixotically at windmills like privatization instead of slaying the real dragons in the health-care system.