Where the parties stand on health care: What we know and what we don’t

2019 UNA Election Bulletin

UNA remains committed to its promise to the parties that we will publish their responses without editing. If we receive submissions from any of these parties at a later date, we will post them along with the responses on this webpage.

With a provincial election looming, United Nurses of Alberta wrote to the leaders of all political parties with seats in the Alberta Legislature in mid-January asking them to respond to five questions about issues of urgent importance to nurses. We requested their responses of about 300 words to each question by mid-February. The questions are included in a special UNA Election Bulletin that is being mailed to all members.

UNA received responses from only two of the five parties we contacted – the governing New Democratic Party and the Alberta Liberals.

Regrettably, the United Conservative Party, Alberta Party, and Freedom Conservative Party chose not to disclose their platform policies on these issues to UNA members. Despite several entreaties, some well after the deadline date, UNA had received no response from the UCP, the Alberta Party or the FCP by press time.

UNA remains committed to its promise to the parties that we will publish their responses without editing. If we receive submissions from any of these parties at a later date, we will post them along with the responses on this webpage.

LINKS

This section includes links to materials relevant to the 2019 Alberta General Election.

The online version of the information from the 2019 Election Bulletin distributed to all UNA members in the Spring 2019 edition of UNA NewsBulletin will resume below this section.  

PDF copy of UNA’s 2019 Election Bulletin

Alberta needs to look forward, not back, AFL President says

AFL 12-point plan for Alberta’s economy

Video of AFL President Gil McGowan on the future of Alberta’s economy

AFL slides on the Alberta economy

There’s only one election issue, energy transformation: AFL President’s Calgary Herald op-ed

On the world stage, Canadian oil majors promote carbon tax  

The questions we asked:

Question: Health care funding cuts: Several Alberta political leaders have floated the idea of health care funding cuts. In the context of the widely perceived need to balance Alberta’s budget, what is your party’s position on cuts in funding to Alberta’s health care system? In the event your party supports cuts, what are the areas within the health care system where you would anticipate reducing funding?

 Question: Protection of front-line nursing: Studies from multiple jurisdictions suggest higher ratios of Registered Nurses in health care lower costs and improve patient outcomes. Is your party prepared to take measures to increase or maintain the percentage of RNs in the health care system? If so, what approach would you take?

Question: Private sector role in public health care: Some Alberta political parties have advocated a bigger role for private-sector health delivery in Alberta. What is your party’s position on a larger role for the private sector in our public health care system? Specifically, what services do you think would be appropriate for an expanded private-sector role?

Question: Capital projects and plans: During the past four years, several significant health care capital projects have been announced, including a new cancer centre in Calgary and a new hospital in South Edmonton. In addition, some projects have been placed on the province’s list of priorities, for example, expansion of the Red Deer Regional Hospital. Will your party commit to proceeding with these projects?

Question: Labour relations: The current government enacted changes to the Alberta Labour Code that included features such as first-contract arbitration that have long been standard operating procedure in most other Canadian jurisdictions. Would your party leave this legislation in place?

RESPONSES 

Alberta New Democratic Party

Health Care Funding Cuts

Our Canadian health care system isn’t a right. It’s a choice.

It’s a choice we as Albertans and Canadians have made together. And we have to continue to make this choice every day.

The Alberta NDP has always chosen to fight for universal public health care. We fundamentally believe that whether an Albertan has a fur coat, or no coat at all, they deserve the same health care services.

Nurses are on the front lines, providing quality care, and we are committed to ensuring that nurses have more support to do their jobs effectively – not less.

We are against cuts to the health care system. When we were elected, one of the first choices we made was to cancel the catastrophic cuts the previous Conservative government had planned for Alberta’s health care system. We also cancelled the Conservatives’ unfair health care premiums.

With a growing and aging population, we need continue to take a measured approach to delivering health care services in the right place, at the right time, with the right health care provider. 

Our government won’t make the kind of reckless cuts others are proposing – upward of 20% of our budget, firing 4,000 nurses to fund a $700 million tax break for the rich. With a growing and aging population, even a funding freeze would be a massive cut to the health care services that families count on. A freeze would mean not being able to staff new health care builds like the Calgary Cancer Centre, the new Grande Prairie Hospital, or the new South Edmonton Hospital.

As we get closer to the election, we will have more to say about our plan to invest in health care for Albertans. In the meantime, you can trust the choice we’ve made is that we will continue fighting to protect and improve Alberta’s public health care system.

Protection of front-line nursing

As nurses, you are there when Alberta families need you most, from the first days of a baby’s life, to some of the darkest and most anxious hours of a person’s life.  

That’s why Rachel Notley’s NDP will always be there to defend you, your patients, your jobs and our public health care system.

When we were first elected, we not only inherited an economy in free-fall, we inherited run-down schools, overstressed hospitals, and a major, province-wide infrastructure deficit.

To deal with the downturn, our opponents urged us to respond in the same way they had for years: firing thousands of nurses, cutting hospital funding, and cancelling construction projects.

We said no. Instead, we stabilized health care funding and had the backs of our health care workers. Numbers from CARNA’s annual reports show that from 2014-2017, there was an increase of 1,209 nurses registered with CARNA.

That’s in stark contrast to previous conservative governments when faced with an economic downturn. In 1993, under Ralph Klein, 3,000 full time nurses were fired. The UCP Leader, Jason Kenney is no stranger to Klein’s cuts. He was there, as the head of the Canadian Taxpayers Federation, saying Klein’s reckless cuts didn’t go far enough and weren’t done fast enough. The best predictor of future behaviour is past behaviour. 

At the Alberta NDP convention, under Rachel Notley, our members voted on a resolution to establish safe staffing ratios for health care workers in Alberta. Meanwhile at the UCP Convention, Jason Kenney’s members voted in favour of two-tier American-style health care.

Rachel Notley’s NDP values the work nurses perform and know that the best way to protect front-line nursing is to ensure stable funding for health care and to avoid reckless cuts. Nurses should be at the bedside, not in the unemployment line. That’s why we will continue fighting to protect and improving front-line nursing in Alberta.

Private sector role in public health care

When Rachel Notley’s NDP came to office and learned about the deal cooked up by the previous Tory government to sell off the lab system to an Australian company, we knew we had to do something. By the end of our first summer in office, we had put a stop to that dangerous and irresponsible experiment in privatization. We do not believe that the delivery of health care services should be sold off to those whose interests are to profit from it. 

We also had to make decisions around the delivery of continuing care throughout the province. We knew we had to develop a better supportive living program that would make funding decisions based on need, not profit, and as a result, we are currently rolling out the new Building Communities of Care capital program. We will announce more details on our commitment to long term care closer to the election.

Jason Kenney and the UCP have been clear that their plan for health care is to move towards an American-style, two-tier model. They would ensure that the wealthy receive priority access to health care services, while slashing funding to the public health care services regular Albertans rely on.

As our record over the last four years demonstrates, a re-elected NDP government will continue investing in public health care services and stop reckless privatization experiments. 

Capital projects and plans

Rachel Notley’s NDP is proud to have made badly needed investments in public health care, so that our hospitals and health centres are there when patients and families need them.

During the boom years, Calgarians were told that they urgently needed a new cancer centre because the Tom Baker Cancer Centre had reached capacity. Consecutive Conservative Premiers from Ralph Klein to Jim Prentice kept breaking promises of getting a new cancer centre built.

Under Rachel Notley, the Calgary Cancer Centre is finally under construction. In January, 30 per cent of the project’s total concrete had been poured. This project will provide quicker care for cancer patients in the region.

We are committed to finishing this project – and ensuring there are enough doctors, Registered Nurses and other allied health professionals to actually treat the patients who need life-saving cancer treatment.

We’re are diligently planning for the new hospital in South Edmonton. The last time an acute care hospital was built in Edmonton was in 1988 – over 30 years ago. Since that time the population has almost doubled.

We are committed to finishing this project.

After we talked to and listened to the community and the Red Deer NDP MLAs last year, we invested $1 million to update the needs assessment and business plan for the Red Deer Regional Hospital expansion. Upon reviewing the initial findings of that assessment in early February, Rachel Notley committed that, if re-elected, she would build the much-needed expansion of the Red Deer Regional Hospital. 

Labour relations

In addition to fighting for better hospitals and improved health care, Rachel Notley’s NDP is also fighting for better, safer and stronger workplaces.

In the past, Conservative governments introduced Bill 9 and Bill 10, two bills designed by the old government to fundamentally undercut your pensions and your future. At the time, Rachel Notley, as an opposition member, led a filibuster that delayed and eventually killed the bills’ attacks on working people, their pensions and their unions.

As government, we introduced and passed legislation that ensures you have joint governance of your pension plan. We believe that when pensions receive contributions from both the employer and employee, they should be jointly governed by employer and employee.

We’ve also created mandatory safety committees through the Occupational Health and Safety Act. We’ve added first contract arbitration into the Labour Code. We’ve improved leave provisions to help people care for loved ones who are sick without worrying about being fired, and we’ve improved measures to support and protect women fleeing domestic violence.

Jason Kenney and the UCP have previously stated that, if elected, they will undo every piece of legislation that we’ve passed during their “Summer of Repeal.” This would be devastating, and a huge step backwards for workers in the province.

Rachel Notley’s NDP will continue to work with you, as a partner, to improve labour relations in Alberta.

 

Alberta Liberal Party

Health care funding cuts

All health services (whether publicly or privately funded) need to be evaluated in relation to quality, access and cost-effectiveness, not only for internal shifting of resources for evidence-based outcomes but also for consideration of opportunity costs in other areas. As health care spending approaches 50 per cent of the provincial budget, there is clearly a need to examine:

Management roles and responsibilities with a view to optimizing their important role in relation to essential front-line services. Management salaries and benefits also need to be examined in comparison to other jurisdictions.

Management of chronic conditions (our costliest area of medical management), which is clearly not optimal and where a stronger and better coordinated team approach is needed. This may require a shift of funding to some degree.

Long-term care costs can be minimized with greater investment in homecare and community services, especially to those who are isolated and vulnerable.

Investment in prevention, which continues to be inadequate for an advanced society with evidence of achievable cost savings through screening and early intervention (both physical and mental conditions) and recognition that meeting basic needs results in dramatic reduction in the use of health care services. Team-based primary care standards and accountability are long overdue, and will ultimately reduce cost, suffering and premature deaths.

Investment in health education (including mental health, lifestyle, diet and activity) and partnership with research community has proven effective in many jurisdictions but requires new levels of collaboration especially in regards to reducing risk of drug and alcohol addiction.

Better use of operating rooms, including hours of operation and turnaround times.

Protection of front-line nursing

There is clearly a need to examine the question of each profession (especially nurses and doctors) optimizing its scope of practice with respect to each of the following areas of service delivery: emergency services, acute care, maternity care, long-term care and community care. Our goal is to move to full scope of practice for all health care professionals, including nurses, to ensure both quality and sustainability of our system. Cost-effectiveness is part of the measure needed, and research should provide a basis for making these critical decisions about the balance of professionals with limited resources.

Private sector role in public health care

Public funding has been demonstrated to provide the most affordable and equitable health care and the Alberta Liberals support this fundamental value inherent in Medicare. We are committed to one publicly-funded medical system for all. We also recognize that financial means must not determine access to equal health care. Some support services such as laundry, procurement, transportation, and food preparation as well as infrastructure could benefit from competitive bidding processes, including carefully managed Public/Private Partnerships (P3), and we are open to such indirect health services involving private investment.

Capital projects and plans

The Alberta Liberals would honour all previously-announced health care capital projects, ensuring that each involves a fair and open bidding process where construction has yet to begin. We’ve been vocal advocates for a new cancer centre in Calgary and other urgently needed health care facilities in both Edmonton and Red Deer, and are strongly committed to their prompt completion.

The Alberta Liberals would also enact transparency legislation for public-private partnerships (P3s). In each instance, where the use of a P3 is being considered, the legislation would require the undertaking of a detailed risk and value for money analysis to determine if the P3 delivery method creates the best value. More broadly, we’d ensure that information is publicly available on all capital projects so that Albertans can have confidence that their tax dollars are being spent in the most efficient way possible.

Lastly, and most importantly, infrastructure is just infrastructure without the necessary staffing complement. The Alberta Liberals would ensure that any new health care facilities have adequate operational funding and are properly staffed to be able to meet the needs of the populations they serve. 

Labour relations

On the whole, the Alberta Liberals supported both Bill 17, the Fair and Family-Friendly Workplaces Act (which made numerous amendments to the Employment Standards Code and the Labour Relations Code), and Bill 30, An Act to Protect the Health and Well-Being of Working Albertans (which amended the Workers’ Compensation Act and the Occupational Health and Safety Act). After decades of Conservative rule, Alberta had some of the most regressive labour laws in the country, and many of the changes were justified to help restore balance.

That said, Bill 17 did represent a massive policy shift, and the Alberta Liberals believe that it would have benefitted from a stakeholder consultation period of longer than five weeks. Now that the legislative changes are in full effect, it’s become apparent that the Employment Standards Code changes around statutory holiday pay are problematic for many small businesses, who’ve seen their overall costs increase dramatically under the NDP. This is one item that we’d revisit.

The Alberta Liberals would also amend the Employment Standards Code to prohibit employers from skimming tips that are intended for servers and other hospitality staff.

We’d also amend the Employment Standards Code overtime and rest period exemptions for waged, non-family employees of farms and ranches, which currently entitles them to only four days of rest for every 28 days of work.

With respect to the Workers’ Compensation Act, we’d amend section 13.2(8) to increase the length of the appeal period for WCB claimants to four years from the current two years. Many Canadian jurisdictions don’t impose any sort of limit on the WCB appeal period, yet in Alberta we stubbornly insist on squeezing claimants at a time when they and their families are most vulnerable. This is patently wrong, and really only benefits the WCB by reducing its liability.

Where major parties stand on health care funding and fiscal policy

 When it comes to understanding the positions of the major political parties in Alberta on health care and public services, there’s a lot of noise and distraction, and frequently too few facts.

With an election call inevitable soon, it’s important to try to cut through some of the confusion to get a hint of what the parties’ true positions are likely to be – even if they’re not saying much just yet.

Based on what we know from public statements by the parties, here’s a quick breakdown of where the parties now vying for your attention and your vote stand.

Public health care

Alberta Party: The party’s 2019-20 “shadow budget” proposed cuts of nearly $1 billion form heath care spending. The party has said it would develop strategies for mental health, long-term care and chronic conditions. It says it is in favour of private facilities playing a bigger role in long-term care.

Alberta Liberals: Liberals have called for increased emphasis on mental health and preventative care, social determinants of health, and long-term and continuing care. The party supports private-sector provision of long-term and continuing care, but not what it has called core health services, such as lab services. A more detailed statement from the Alberta Liberal Party is available in this Election Bulletin.

New Democratic Party: The Alberta NDP is unequivocally opposed to cuts to Alberta’s health care budget. With Alberta’s population aging and growing, the NDP advocates what it calls a measured approach to delivering health care services in the right place, at the right time, with the right provider. It has showed some commitment to maintaining a public-sector role in long-term care, and party members have voted to support a national pharmacare program. A more detailed statement from the Alberta NDP is available in this Election Bulletin.

United Conservative Party: UCP members in convention have voted to support U.S.-style two-tier health care, and at least one candidate is now on record musing publicly in support of the concept. The party officially supports publicly funded health care, but as kept the door open to private delivery of more of those services. It has been critical of the Government’s decision to stop privatization of hospital laundry services.

 

Public services

Alberta Party: The party’s shadow budget proses cuts in provincial revenues of more than $3 billion and funding cuts of $2.9 billion. It has said it would budget for population growth but not inflation, focusing on “front line” ministries.

Alberta Liberals: Party policies say little about fiscal matters beyond support for a progressive taxation system.

New Democratic Party: During its first term in office, the NDP has focused maintaining public services, but with an emphasis on bringing the budget back into balance and reducing debt over time. There has been little discussion of how revenues could be increased to meet inflation and population growth.

United Conservative Party: The UCP has campaigned on bringing back the “flat tax,” providing a major tax break for the wealthy and transferring the cost of public services to middle- and lower-income earners. It also promises corporate tax cuts and significant fiscal austerity. The combined impact of these policies would be a loss of about $1.5 billion to the provincial budget. In the past, party leaders has talked about cuts to public sector salaries.

 

NOTES

Alberta’s fiscal situation

In its February 27 third-quarter fiscal update, the provincial government reported significant progress controlling health costs while increasing the health budget annually by about 3 per cent to account for increases in population and inflation. This compares to increases of about 6 per cent annually during the previous government’s term.

The government said it is on track to achieve its commitment to build 2,000 long-term care and dementia spaces. This Alberta government focused on bending the increases in costs and on new agreements with pharmacists and negotiating better prices for generic drugs.

Delivery matters 

Private solutions to the delivery of public health care is a frequent theme in the Canadian political debate about how best to finance and manage public health. International research suggests strongly that because of their profit-motivated organization, in particular their need to generate 15 to 20 per cent in profits, private hospitals and clinics are more expensive to operate than public facilities. In other words, private facilities are profit maximizers, not cost minimizers. Research suggests U.S. hospitals may cost as much as 20 per cent more to operate than their Canadian counterparts.

Research by the Edmonton-based Parkland Institute also indicates inferior quality of care is a frequent outcome of private operation of health facilities. “For-profit companies are more likely to deliver poorer quality care, or cost more, or simply be a much riskier choice for governments and, ultimately, patients,” Parkland said in a 2012 report.

The experiment with a private hip and knee surgical clinic in Calgary in the first decade of the century resulted in higher costs per surgery, a cost and delivery crisis caused by the bankruptcy of the private hospital operator, and lack of transparency and accountability throughout, the Parkland study concluded.

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