Roadmap for reform or recipe for disaster?

In January 2002, Alberta Premier Ralph Klein and Health Minster Gary Mar promised they would implement all 44 recommendations put forward by the Premier's Advisory Council on Health - better known as the Mazankowski commission. Klein said the report would act as his government's "roadmap for reform."

How bad is the Mazankowski Report? Well, on one level, the report says many things that supporters of public health can agree with. For example, the council calls on the Alberta government to explore options to the current fee-for-service model for paying physicians. It also says we should pay more attention to preventing disease and promoting healthy lifestyles. And it says we should invest more in health education and research.

Many observers have pointed to these recommendations as proof that the Mazankowski report is not really that surprising or dangerous.

But the truth is that all of the Mazankowski report's talk about "healthy communities and healthy lifestyles" is just a sugar coating that has been applied to sweeten a bitter pill.

Like other Conservative governments, the Klein government in Alberta realizes that Medicare is extremely popular with the public - so they have avoided any direct references to eliminating or replacing the system. Instead, the Mazankowski report opts for vague language that seems deliberately designed to confuse people and blunt the real meaning of what is being said.

For example, instead of saying directly that many Medicare services should be de-listed, the report calls on the government to "re-define comprehensiveness." And instead of saying that patients should be made to pay out of their own pockets for health services, the report says that the government should "pursue alternative streams of revenue."

However, once you strip away all the vague and flowery language used by the Council, it's clear that the Mazankowski report is not just another bland analysis of the problems facing the health care system. Instead, it is a radical document that presents a relentlessly market-driven blueprint for reform. And it is a document which, if implemented, poses an enormous threat to the future of Medicare - not just in Alberta, but all across the country.

Given that Ralph Klein has embraced the Mazankowski report and is trying convince other Premiers to do the same, Canadians deserve to know what it's all about. Here is a summary of what the Mazankowski report really says - and why it's a danger to Medicare.

What exactly is Mazankowski proposing?

• De-listing Services - The Mazankowski commission is calling for the creation of an "expert panel" that would decide which health services should (and should not) be covered by Medicare. Given that the Klein government's top priority is cutting costs, there is no doubt that this panel will reduce the number of Medicare-insured services.

• Increasing Premiums - The Council says that the health care premiums paid by all Albertans should be increased to cover 20 percent of the total cost of Medicare in the province. Given that the premiums currently cover only about 10 percent of the cost, following the Council's recommendation would mean doubling premiums - from $816 per family to more than $1,600.

• Privatizing delivery - The Council also says that regional health authorities should be "encouraged" to hire more for-profit companies to deliver core medical services. In other words, more and more services will be handed over to the private sector. They're even talking about allowing profit-seeking corporations to own and administer hospitals.

• Make Patients Pay - Mazankowski says individuals should pay more for the health services they receive - especially if they're seriously ill and placing greater demands on the system. The Council makes a number of suggestions in this area including ideas like imposing "surcharges" on people who need more care or turning health care into a taxable benefit. Two other proposals put forward by the Council would involve the introduction of Medical Savings Accounts or Variable Health Care Premiums. Under both of these schemes, each Albertan would be given a set amount of money each year to cover their medical expenses. People who use up their accounts would have to pay for health services out of their own pockets.

• Electronic "debit cards" - The Council is also calling for the introduction of electronic debit-cards for health care. These cards would track how much health care individual Albertans "consume" - presumably with the goal of sending out statements and ultimately charging extra for services.

What's wrong with Mazankowski's plan for health care?

• Faulty Assumptions - Almost all the recommendations in the Mazankowski report are based on three faulty assumptions: first that health costs are out of control; second that patients are abusing the system and need to be "disciplined"; and third that privatization would save money and improve efficiency. However, there is simply no evidence to support any of these beliefs.

• Lack of Evidence - The truth is that Medicare costs are rising only gradually; patients are not over using the system; and privatization is no panacea. Neither the Mazankowski Commission nor the Alberta government has presented any evidence to support their core arguments. The fact that they provide no research or examples of successful private models of health care speaks volumes - it reminds us that no such evidence exists.

• Shifting Costs - The Mazankowski commission talks about the need to increase efficiency in the public system. But the recommendations aren't really about controlling costs - they're about shifting costs from the public system onto individuals. So, the Alberta government may succeed in reducing the amount of tax dollars spent on health. But individuals will pay much more - in the form of increased premiums, supplementary private insurance and charges for services that are no longer covered. This is a classic case of "robbing Peter to pay Paul."

• Penalizing the Sick - The real victims of the Mazankowski plan for reform will be those Albertans unfortunate enough to get sick or injured. Under the commission's schemes for Medical Saving Accounts or Variable Health Premiums, people with serious health conditions would quickly exhaust their accounts and be forced to dig deep into their own pockets. Even if government coverage kicks back when costs become "catastrophic," patients will still be on the hook for thousands of dollars. This is exactly the kind of scenario that Medicare was supposed to eliminate.

• Discouraging Necessary Treatment - Another big drawback of Medical Savings Accounts is that they give people a financial incentive to delay seeking medical attention. In many cases, people will put off seeing a doctor until their conditions worsen. When they finally do seek medical care, treatment will be more complicated and more expensive than if they had gone earlier. Significantly, the people who will face the biggest barriers will be the same people who need medical attention most - the poor and the elderly. The Mazankowski plan will punish these people - and favour the young, the healthy and the wealthy.

• Increased Costs for Business - In Alberta, many employers cover the cost of Medicare premiums for their employees. So, if the government doubles premium rates, they will also be adding a substantial cost to businesses in Alberta. This problem will be compounded if health services are de-listed: employers will then have to start forking over cash to cover the cost of private, supplementary insurance for their workers. Taken together, these changes will add up to a huge erosion of the so-called "Alberta Adavnatage" for businesses in the province.

• Violating the Canada Health Act - Both the Mazankowski Commission and the Alberta government have been careful to avoid the phrase "user fees" - which they know are prohibited under the section of the Canada Health Act guaranteeing access to necessary health services. But the "variable premiums" and surcharges for costly procedures that are being proposed are user fees in all but name. This is a clear violation of the Canada Health Act.

• Lack of Public Consultation - Unlike other commission being conducted into the future of health care (like the Romanow Commission at the national level and the Fyke Commission in Saskatchewan) the Mazankowski commission did not solicit input from the public before releasing its recommendations. Instead, the report was written by a small group of hand-picked academics and ex-politicians who the Premier knew would support privatization on ideological grounds.

• Conflict of Interest - One of the first questions to ask when assessing a new government plan is: "who benefits?" In the case of the Mazankowski report, the public clearly does not benefit. But private health companies and private insurance firms certainly do. Significantly, Mazankowski sits as a member of the Board for Great West Life Assurance, a company that sells supplementary health insurance. This is a blatant conflict of interest - and should have ruled Mazankowski out as a chairperson for the Council right from the beginning

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