This article originally appeared in the Western Standard.
By Shawn Whatley, May 29, 2023
Fighting an election over healthcare seems stacked in Rachel Notley’s favour. Voters come primed to accept what Notley says. She need not justify her ideas or prove how she will pay for them. Her promises sound familiar to voters, and familiarity feels safe.
For example, Notley has promised $10,000 signing bonuses for added healthcare workers, a tidal wave of 10,000 new trainees and forty Family Health Teams filled with health professionals from all over the world.
NDP ideas about Medicare sound familiar, because Medicare was originally built on NDP ideas.
For the most part, medicare still runs on the NDP thinking that caused our healthcare crisis in the first place.
Consider three common themes.
Every healthcare problem has a government solution. No matter how big or small your concern, you should call government first.
Voters have seen decades of headlines on healthcare. Every article calls on government to do something. No one ever calls for government to do less or to let people innovate themselves.
This makes Notley’s promise of seven medical students for Southern Alberta seem rational. But pause for a moment. If communities need the premier’s office to promise the placement of seven students, then Alberta has far bigger problems to solve. Alberta will need a very big and very strong government indeed.
Here’s another. Every healthcare problem comes from a lack of inputs at some level. Whether it be funding, doctors, nurses, or hospitals beds, every problem can be fixed by simply adding more of what we lack.
Doctors and nurses call for more every day: more services, more funding, more government help. No question, shortages exist and more almost always helps. But in part, calls for more are common, because they are the only messages that get through. Doctors never call for updated purchasing systems, supply chain resilience, or more thoughtful management. No one would know what they meant. So, doctors just call for more; it’s what medicare understands.
Notley loves hearing calls for more. Not only is she eager to offer more, it means no one will ask her about outcomes. No need to talk about performance or wait time guarantees. Just promise more. Campaigns built on inputs never run out of new things to promise. Inputs offer the answer to everything. Besides, spending may not fix everything but it never hurts.
Last one. When all else fails, government should tell people what to do.
For example, consider clinic appointments. Notley promises clinics will stay open in the evening. Patients want more appointments, and Notley will deliver. However, promises like that cannot be met with incentives or suggestions. They require direction, even command.
When faced with healthcare frustrations, governments often wield the power of law, contract, and regulation. The most obvious examples come from Quebec, such as legislation to ban part-time family practice, or $5,000 fines for family doctors who refuse to work in the emergency department. But Quebec is an outlier. Most governments wield power hidden in contract minutiae, regulatory changes, or policy documents. It can be hard to see from the outside, but it animates how the whole system runs.
Medicare lives on NDP ideas, and medicare has been in crisis since the late 1970s. Many voters miss the irony. More socialist thinking cannot solve problems created by socialism in the first place.
Danielle Smith has chosen to swim against the familiar, and talk about something different. She believes voters will see through Notley’s bluster. But Smith is taking a risk by raising fresh ideas. Faced with a healthcare crisis, familiar always seems wise even when it is not.
Medicare does not fail for lack of funding, lack of control, or lack of government solutions. It fails precisely because governments try to fix, fund, and control every little problem, right down to placing seven medical students in a small community.
Prime Minister Paul Martin promised a “fix for a generation” — a 10-year, $41-billion health accord in 2004. It came with detailed “strings attached” defining performance and accountability. It made doctors and nurses richer but did little to nothing for patients. Prime Minister Justin Trudeau did almost the same thing with his own $46-billion, 10-year, strings-attached deal this spring.
Canadian governments seem convinced that, given enough accountability, we can spend our way out of our healthcare crisis. It has not worked yet, but at least it is familiar.
NDP ideas caused our healthcare crisis. Even so, many voters keep supporting Notley as she waves and points at all the things she plans for government. Hand waving works for flagging down help with a flat tire, but having caught attention, flagging does nothing more.
Elections depend on attracting attention. Fixing healthcare requires something more. Notley’s ideas sounds familiar because they have been tried and found wanting for decades. Let’s hope voters can see through them.
Shawn Whatley MD is past President of the Ontario Medical Association, a Munk Senior Fellow in Health Policy and a physician leader with experience in emergency medicine and primary care. In 2021 he published “When Politics Comes Before Patients: Why and How Canadian Medicare is Failing.”