Before he became so unpopular with his own party, Alberta Premier Ralph Klein was busy challenging the status quo when it comes to delivering health care in his province. Klein talked about his “Third Way” — a way that some suggested might be in violation of the Canada Health Act. (Not that Alberta needs Ottawa’s financial help to provide its citizens with health care but still …)
Today, Prime Minister Harper released a letter he sent to Premier Klein in which he said,
“[Our] primary concern is the proposal that would allow doctors to practice in the publicly funded and the privately funded systems at the same time. Dual practice creates conflict of interest for physicians as there would be financial incentive for them to stream patients into the private portion of their practice. Furthermore, dual practice legitimizes queue-jumping as it provides an approved mechanism for patients to pay to seek treatment at the front of the line.”
[See the attachment below for the full three-page letter]
This topic came up in Question Period. Here is the exchange, as reprinted from the House of Commons “Blues”, between NDP Leader Jack Layton and Health Minister Tony Clement.
Hon. Jack Layton (Toronto—Danforth, NDP): Mr. Speaker, for 13 years the Liberals promised that they would protect public health care in this country. Of course then we saw provinces chipping away at our public health care system. One could think of Alberta. What did we get from the Liberals? We got a beating of the chest, we got the occasional letter and we got ever decreasing fines being called upon. It did absolutely nothing to stop the growth of for profit medicine and the deterioration of medicine in this country. Will the Prime Minister today give a clear indication that he is prepared to impose significant financial penalties when the Canada Health Act is broken?
Hon. Tony Clement (Minister of Health and Minister for the Federal Economic Development Initiative for Northern Ontario, CPC): Mr. Speaker, as this is my first opportunity to rise in the House, I wish to thank the people of Parry Sound—Muskoka for this immense privilege.
I want to assure the hon. member opposite that the government is committed to universally accessible, publicly funded health care that respects the five principles of the Canada Health Act. As the hon. member noted, there was a lot of rhetoric when the members opposite in the Liberal Party were government but not a lot of action. In fact, wait times doubled in the 13 years of the previous Liberal regime. Canadians voted for change. They will get greater accessibility–
The Speaker: The hon. member for Toronto—Danforth.
Hon. Jack Layton (Toronto—Danforth, NDP): Mr. Speaker, the Alberta plan would allow doctors to be both inside and outside of the health care system at the same time. In addition, there is a proposal to allow wealthy individuals to get their own health insurance and jump to the front of the line. This is what credit card medicine is all about. This is the beginning of the creation. We are now hearing the return of the catcall approach from both parties this morning. I have to say it is quite disappointing. I cannot hear myself ask a question. Canadians want to know whether or not the government is going to put a stop to the two tier system which is unfolding in Alberta.
Hon. Tony Clement (Minister of Health and Minister for the Federal Economic Development Initiative for Northern Ontario, CPC): Mr. Speaker, I am in agreement with the hon. member that in fact we have to have innovations in our health care system, but it has to be openly accessible and universally accessible within a publicly funded system. There is a lot of innovation that can occur within that mandate. The letter that the Prime Minister sent to the premier of Alberta makes it clear that our recommendation is that Alberta join other provinces in establishing wait time guarantees. That was our commitment to the people of Canada and there are many innovations that can occur within the Canada Health Act. That is our commitment to the people of Canada. That is our commitment to Albertans who are also people of Canada and voted in the election for change. We represent that change and we will follow through on that change.
Later, outside the House of Commons, in the foyer, Clement was asked by journalists about the matter:
Question: This letter to Alberta premier Ralph Klein, can you tell me a little bit about what message the government wanted to send in that letter?
Tony Clement: I think the letter to premier Klein accomplished several things. First of all, it was, the premier and the government of Alberta did ask for input, public input to their proposals and the prime minister being a fairly well-known Albertan, I think he wanted to get some points of view across. The letter indicates that there are many aspects of the Alberta proposals which are we think very progressive and very useful such as health human resource reform, making sure hospitals are doing appropriate procedures, some of the procedures could be done outside of the hospital settings, these kinds of things. He also indicated his disappointment that there were no specific wait time guarantees. As you know, this was a crucial element of our election campaign and it was also something that Albertans voted for, not just other Canadians. So that was put on the record. He then went through a series of concerns that we have with the proposals as they currently stand. Some of these, some of these concerns could be perhaps addressed in legislation. Some of the issues could be clarified through legislation but we did want to get our concerns on the record.
… I had indicated when the Alberta proposals came out that we would be studying the proposals and putting out our position. That is in fact what we have done and we have made it very clear that from our government's perspective, there are many innovations that can occur within the Canada Health Act. You don't have to go outside of the Canada Health Act to get useful reform and in fact, the government of Alberta was a trailblazer in for instance hip and knee replacement surgery, of acting within the Canada Health Act, within the public health system and reducing wait times quite considerably. So from our perspective, there is it is not an either/or. You can get innovation, you can reduc
e wait times, you can get to a wait times guarantee and still be within the Canada Health Act.
Question: It is either/or in terms of dual practice thing? Is it, you know, drop that and support everything else?
Clement: Well, I think we raised I think some very legitimate concerns about dual practice. If dual practice is done the wrong way, you can have a situation where there is queue jumping, where physicians are cherry-picking their patients, where we are actually draining resources out of rural Alberta into urban Alberta. So we put those on the record and we stand by those concerns.
Question: Do you know if the prime minister sent more letters to Quebec or B.C. like the one that you have sent to premier Klein?
Clement: Well, no, I think our position on Quebec was communicated through my self and through the prime minister's comments and obviously directly to premier Charest and minister Couillard. In terms of British Columbia, I can tell you that I met with premier Campbell. He gave me a little bit of a rundown on some of the things that he witnessed in his tour of some European jurisdictions, but we will wait and see. The only thing I have said on the record in terms of British Columbia is we are anxious to proceed with innovation in British Columbia as with other provinces and again within the same framework as we have indicated in Quebec and Alberta, that is the same way we would like to see things going in British Columbia.
Question: Does the letter actually say that the proposals are a violation of the Act? Did you express those concerns?
Tony Clement: It expresses some concerns. What the letter does indicate is that there are certain questions that have to be answered. Otherwise, our concerns remain in place and we are cognizant of the fact that the proposals themselves were fairly general. As they move towards legislation though, there is a chance to be more specific. So we wanted to put on the table the prime minister's, the government's concerns about the issues that we raised in the letter and obviously hoping that those concerns could be met and that in fact, we can work with the government of Alberta on our No. 1 objective which is wait times guarantees. We think that that is a necessary proposal for health care to be delivered well to the people of Canada. We think it is a popular proposal. We think Albertans are supportive of wait time guarantees just as other Canadians are, so that is something we have evidenced in the Throne speech as our top priority agenda.
Question: What happens if you don't get the reassurances that you would like from the Alberta government?
Clement: Well, that is a speculative question…. What I can indicate to you is the prime minister has made it very clear that any innovations can and should be within the Canada Health Act and our job as a national government is to enforce the Canada Health Act.
NDP Leader Jack Layton, who, it could be argued, decided last November that the Liberal record on health care was enough for his party to force the general election we had on January 23, also commented on Klein’s Third Way and Harper’s response.
Question: Mr. Layton, the prime minister sent off a letter to Alberta’s premier highlighting his concerns, in particular allowing doctors to work in both systems. I guess what’s your response about the letter that’s been sent ?
Jack Layton: Well, of course we saw letters being sent by Liberals to various provinces at different times and all kinds of chest beating. What we’re saying is that this is contrary to the Canada Health Act. The prime minister should make it crystal clear that if Alberta goes down this road there will be financial penalties and he’s got to take a firmer position. This is not a time to waffle on these questions. We’re in the process through the Alberta recommendations of breaking down our single payer fundamentally egalitarian system of medicare and allowing a system at two speeds. You get to the front of the line fast if you’ve got a big credit card credit limit. And it’s time for the prime minister to be very, very clear on this matter and the letter is only that, a letter.…..
Question: On the topic of Mr. Harper’s letter to Ralph Klein, what did you make of the tone? You’ve seen these letters before. Any surprise?
Layton: Well, we’ve seen many letters from federal governments of different parties when provinces contravene or threaten to contravene the Canada Health Act. The problem is we haven’t seen action. With the Liberals we usually saw beating of chests and fight of our lives and all kinds of rhetoric with penalties imposed that shrank by the year. What we want to see from Mr. Harper is a strong, proactive stand so that the Canada Health Act and its fundamental principles are protected, so that you can’t buy your way to the front of the line and leave others further behind, so that you can’t practise both inside the public health care system with its benefits and outside where you’re profiteering at the same time. That’s not the right way to go for Canada and the prime minister needs to be crystal clear that there will be penalties for any province that goes down that road.
Question: And he wasn’t about that, right?
Layton: No, he certainly wasn’t.
Question: Anything about the tone, the way he presented it to Ralph Klein? Does it encourage you, discourage you as his first sort of (inaudible)?
Layton: Well, let’s just say it wasn’t very robust. It was somewhat more timid than what we’ve seen with the Liberals in the past. The problem was that with the Liberals all that ever happened was a letter. Frankly these letters aren’t necessarily worth a great deal. It’s a question of whether you’re willing to stand up and say there will be penalties if you’re going to violate the rules.