Third Way

[Guest squeegy80]

Hey guys,

 

I was going to post this in the Calgary forum, but I'd love to get feedback from U of A students and anyone else in the know about the new Alberta health care developments.

 

I just want to get some discussion going about this Third Way plan that's coming into effect. I don't know that much about it since I'm not in Alberta yet, but I've been keeping an eye on it recently as it seems like a pretty big deal in looking towards the future of healthcare in Alberta. I heard that in a few months they're planning to define what services are going to be included in the Third Way as part of the publicly-funded health system.

 

From everything I've read about the Third Way, I get a worried feeling in my gut that this is tactfully named plot to begin an overall increase in privatization. I remember the recent debate on the forums about the Quebec ruling, which naturally turned into a general debate about private vs. public health care. From this debate and pretty much everything else I've ever heard, I feel there are basically no major advantages to an increase in privatization except for rich patients and business- and insurance-people who would benefit from the private clinics. There would be an increased need for physicians and health care workers, there would be worse medical treatment in the private clinics due to profit-making cuts in costs, and there would be unequality in treatment with longer waitlists for publicly-funded care. This is just to name some of the major points.

 

Anyways, I don't want yet another private vs. public debate here, but I'd just like to get some feedback as to whether the Third Way is as potentially scary as I've made it out to be in my head.

 

Thanks,

squeegy

[Guest Jochi1543]

Do you have a link describing what the Third Way is?8o

[Guest scrubbed]

www.health.gov.ab.ca/abou...al_REV.pdf

 

That should do.

 

Here's an article from cbc.ca

 

C B C . C A N e w s - F u l l S t o r y :

--------------------------------------------------------------------------------

 

 

Klein launches 'third way' health-care changes

Last Updated Tue, 12 Jul 2005 18:16:54 EDT

CBC News

Albertans who are willing to pay will be able to get upgraded hospital rooms and surgeries such as hip replacements under the province's long-awaited "third way" health-care strategy.

 

 

INDEPTH: Health Care

 

 

Alberta Premier Ralph Klein says the time has come to 'move from ideas to action' to change the health-care system.

Alberta Premier Ralph Klein and provincial Health Minister Iris Evans on Tuesday unveiled the direction the province would like to take health care, including a mix of private and public options.

 

Klein first proposed his "third way" health-care system in January, but was vague on details at the time.

 

The "Getting on with better health care" discussion paper released Tuesday lists 12 main areas for changes that include:

 

Allowing patients to pay extra to upgrade their hospital rooms or surgical procedures – for example, by paying extra to get a better hip replacement than is medically necessary.

Possibly tying how much a person pays for medications to how much money they earn.

Allowing the use of secondary insurance to cover treatments from podiatrists and chiropractors.

 

"We need change in the system," Klein said.

 

 

'The things that are medically necessary will be provided'

 

While the paper lists changes meant to speed up "access" to some medical procedures, both Klein and Evans refused to directly say whether people would be able to pay to get faster hip or knee replacements, heart surgery or cancer treatments.

 

"It's not intended to fast-track the system," Evans said of allowing people to pay to get access to surgeries. "It's intended to provide people the choice."

 

Evans stressed that the public system will still pay for basic services, but the ideas under discussion will allow patients more options in the care they receive.

 

"The things that are medically necessary will be provided."

 

'Nothing has been cast in stone'

 

The two politicians stressed that the discussion paper was only a starting point meant to encourage industry and public feedback.

 

"Nothing is cast in stone," Evans said. "We put the paper out to be consultative with Albertans."

 

At several points during the news conference, Klein reacted angrily to questions from reporters as they pressed for details.

 

When asked why the provincial system had to be changed at all, he snapped: "Do you think that $9.1 billion is peanuts? Nine point one billion dollars – that's what we're spending on health care in this province."

 

Klein first proposed his "third way" in January, saying incorporating both public and private models was the best way to deliver care, while staying within the Canada Health Act.

 

 

FROM JAN. 12, 2005: Klein pitches 'third way' healthcare

 

He did say then that he would give the province's nine regional health authorities latitude to deal with problems such as long waiting lists. But he maintained that he would not pave the way for a U.S.-style system.

 

"It's not going to happen," he said then, describing the U.S. private system as expensive and non-inclusive.

 

Klein has moved away from trying to transform the Canada Health Act, but he said he would take any disagreements about the proposals to a federal-provincial dispute panel. The province already pays for private centres such as the Grace Clinic in Calgary, which performs orthopedic surgeries.

 

Klein's "unshackling" of health authorities isn't a radical departure, according to Jack Davis, CEO of the Calgary Health Region. He said his authority already contracts out a number of jobs, including long-term care, home care and diagnostics.

 

The premier created a stir in last year's federal election when he announced that after the vote he would declare radical changes to the health-care system. Prime Minister Paul Martin used the claim as ammunition against federal Conservative Leader Stephen Harper.

[Guest UTMed07]

The "third way" is a euphemism for "privatize."

 

Whether it is scary is a question of whether you believe the evidence that suggests privatization is a waste of money.

Personally, I don't think much is really going to change... at least not quickly. Generally, things don't change quickly... that is how things are. This article in the CMAJ, points out that a number of provinces never had laws forbidding private insurance and you don't see lots of private care 'cause other things are barriers to it (e.g. laws that state doctors cannot work privately and bill the government).

 

I think the deputy minister of health in BC has an interesting perspective on this. He compares how delays in the judicial system are dealt with compared to the supreme court's proposal for health care. I don't think things are going in the right direction... but I think the pendulum will swing back in the other direction again.

[Guest UWOMED2005]

So far, what I've seen them suggest in the media about this "Third Way" suggests it's a whole lot more PR and little real change rather than a fundamental change in healthcare delivery.

 

The example that's been repeatedly cited here in Alberta is offering patients the choice to pay for an upgrade on a hip arthroplasty to the Birmingham hip* If it is just that, is that really different from the current situation? Patients in emerg can pay for a fiberglass cast. Patients can pay for a private room overnight. Maybe this isn't different from the current situation at all?

 

But of course, I'm basing this opinion on what Klein has released in press releases. . . I wouldn't be shocked if the final implementation was more insidious.

 

* I'll let an ortho resident get into the details about Birmingham hips, but my understanding is they're not so much an "upgrade" as used for a different indication (ie younger patients who need their hips for longer)

[Guest marbledust]

So far, what I've seen them suggest in the media about this "Third Way" suggests it's a whole lot more PR and little real change rather than a fundamental change in healthcare delivery.

 

Ah...I see you are well on your way to understanding Alberta politics very nicely for a recent newcomer

[Guest UWOMED2005]

Yeah - I'm still new to this. Paid a lot of attention to the news clips, but get the sense I'm going to have to do more in-depth research if I want a reasonably informed opinion.

 

What's your take marble? You've been here longer. . .

[Guest scrubbed]

Hey UCMED2007 (UWOMED 2005),

 

The Third Way was featured in an article in Macleans. Effectively, aside from the hip transplant issue, there really wasn't too much of note, though some did raise concerns.

 

July 20, 2005

 

What's Ralph up to?

 

Alberta's latest batch of health care reforms is less than meets the eye

 

BRIAN BERGMAN

 

When it comes to health care reform, Ralph Klein has always talked loudly while wielding a very small stick. The results never quite matched his fiery rhetoric. Last week, it was déjà vu all over again. Just six months after the premier delivered a much-hyped speech about finding a "third way" in health care -- something between the survival-of-the-richest U.S. system and Canada's publicly funded monopoly -- Klein unveiled his latest round of reforms. Critics and supporters alike found themselves underwhelmed.

 

Federal Health Minister Ujjal Dosanjh, who rarely passes up an opportunity to demonize the Alberta premier as the champion of privatization, sounded pleasantly surprised. Dosanjh said he found nothing objectionable in Klein's 12-point program. Meanwhile, those who advocate a far more vigorous role for the private sector in health care expressed dismay that they'd been misled, yet again. "What we needed was a visionary politician," groused Nadeem Esmail, senior health policy analyst at the Vancouver-based Fraser Institute. "What we got was a reaffirmation of the status quo."

 

There is much to admire in the list of initiatives unveiled by Klein and his health minister, Iris Evans. Among other things, Canada's richest province is moving to aggressively recruit primary physicians, extend drug coverage to more Albertans and set fixed limits on how long patients must wait before receiving specific surgeries and services. But the only truly controversial proposal is to allow patients to pay out of pocket for what the policy describes as "enhanced medical goods and services beyond what doctors decide is medically necessary." At a jam-packed news conference in Calgary, Klein seemed eager to highlight that initiative, pointing it out even before reporters asked him about it. "Uh, item eight," said the premier in his inimitable fashion, "calls for providing choices in paying for supplementary health services. This will be controversial itself. I don't know if this will violate the Canada Health Act or not. We don't think it will."

 

One could sense a stir in the room. This was, after all, the man who almost singlehandedly torpedoed federal Conservative Leader Stephen Harper's chances of becoming prime minister when he mused, during last year's federal election, about introducing health care change that might contravene the Canada Health Act. (In the end, Klein did nothing more radical than throw hundreds of millions of dollars into the health portfolio.) "Isn't that two-tier health care?" demanded one scribe.

 

"I don't think it's two-tier," shrugged Klein, before conceding, "I guess it's subjective."

 

The jury is out on just how contentious "item eight" might prove to be. The only example of an "enhanced service" Klein and Evans could come up with was a surgical procedure known as Birmingham hip resurfacing, named for the English city where it was pioneered. It's far less invasive, but more expensive, than standard hip replacement. But it leaves patients with greater flexibility because less of the thigh bone is removed. Still in the experimental phase in Canada, the technique is considered best suited for active people under the age of 55, in large measure because it would allow for a full hip replacement operation if needed later in life. Under the Alberta proposal, anyone could have this procedure as long as they were willing to bear the costs themselves, either directly or through private insurance.

 

Most experts feel that "item eight" doesn't challenge the Canada Health Act because it applies to an enhanced, rather than a medically necessary service. But for some, it raises troubling questions all the same. Tom Noseworthy, director of the Centre for Health and Policy Studies at the University of Calgary, wonders what happens if doctors someday want the Birmingham procedure deemed a mandated operation, at least for certain patients. How likely is it the province will want to go along and bear the full cost? "What the government's done," says Noseworthy, a former ICU physician and hospital CEO, "is place a potentially necessary service into the private domain. And if they do that for all medical innovations coming on stream, it means only people who can afford to pay for them will benefit."

 

Another concern is queue-jumping. While Klein and Evans insisted patients who paid for enhanced services would not be fast-tracked, critics suggest that's very hard to police. Michael Rachlis, a Toronto-based physician and independent health policy analyst, points out that many doctors now work simultaneously in public hospitals and private clinics -- so there is often an inherent financial incentive to do the more expensive procedures first.

 

All the same, both Rachlis and Noseworthy say the proposals announced last week are far less radical than Klein's previous sabre-rattling would have suggested. "I think the defenders of medicare in Alberta have been very successful in making their case," says Rachlis. "While I honestly believe Mr. Klein has been trying to make the health system more private, he's also a good reader of public opinion. So every time he's come to the brink of actually doing something, he's balked for very good political reasons."

 

In fact, Noseworthy suggests "item eight" may simply be Klein's final "thumbing of his nose at the feds" before his widely expected departure from public life, perhaps as early as this fall. If so, the heavy lifting on health reform will be left to a successor -- or to other provinces. "The real boldness," says Noseworthy, "is in Quebec, where they have been playing fast and fancy with this stuff for a while, sometimes in complete and flagrant violation of the Canada Health Act." That trend could well accelerate, depending on how the Quebec government responds to the Supreme Court of Canada ruling last month which said that unless waiting lists in the province are dramatically reduced, private insurance plans must be allowed to fill the void.

 

But it's not just Quebec and Alberta that are wrestling with these issues. While the spotlight was on Klein last week, a private clinic in Toronto announced it would be offering cancer patients direct access to the new wave of high-priced drugs that the public system, in Ontario anyway, is unwilling to fund. These include medications such as the lauded breast cancer drug Herceptin, which can cost as much as $45,000 a year. It has been approved for direct use in some provinces, most recently B.C., but not in Ontario.

 

For all of that, Klein's latest pronouncements certainly left some feeling like they had lost a champion. The Fraser Institute's Esmail argues Klein said all the right things when he launched his "third way" initiative. "Many Canadians still believe there are only two ways to do health care -- the Canadian way or the American," says Esmail. "But it's simply not true. Of the 30 most developed nations in the world, 28 of them, including Canada, have universal health care programs. Only the U.S. and Mexico do not. And of those 28 nations, fully 27 say that if you want to pay for your own services with your hard-earned dollars when the government program is unwilling or unable to meet your needs in a timely fashion, you can do so."

 

Canada, Esmail says, is the only exception, the recent rash of private clinics and opting-out arrangements notwithstanding. And he held out high hopes that Klein, who once led a successful crusade to eliminate Alberta's debt, could have taken a similarly "visionary approach" to revamping health care. Then again, Esmail cannot be entirely surprised that the premier proved not to be his man. With retirement in the offing, Klein's crusading days are clearly over.

 

To comment, email letters@macleans.ca

 

Copyright by Rogers Media Inc.

May not be reprinted or republished without permission.

 

 

This story can be found at:

www.macleans.ca/topstorie...485_109485

[Guest marbledust]

What's your take marble? You've been here longer

 

Sorry I somehow overlooked this thread for the past few days...too busy reading Harry Potter in my "free" time :lol

 

I gotta be honest, I haven't been paying that much attention to it. I am quite ashamed to admit that, seeing how it will have many consequences for me and my future. Most of what I have picked up has come from listening to the right-wing radio shows on QR77 (don't ask...my partner has developed a strange obsession for talk radio--it drives him (and me) crazy) yet he persists...need incentive to LEAVE Alberta? Listen to the lunatics on QR77

 

I agree with you that it seems to be more talk than anything else--something Klein and his cronies are very good at (ah my political stripes are showing through). I'm skeptical that the plan will come to fruition, but I guess we will see. The part that is sending off the alarm bells in my head is the provision to pay for "advanced services." My biggest concern is that "basic services" will deteriorate to the point that everybody needs to shell out extra money for basic comfort and a reasonable standard of care. I mean, are you going to be able to pay for an "upgrade" to your hospital meals? It's crazy...

 

The plan to tie perscirption costs through the provincial extended insurance (Blue Cross) to income also bothers me. Mainly because I can see them turning it into something akin to the health premiums scam--you need to have a very low income to actually benefit from the premuim assistance program, and people with "higher low incomes" (ie still below the poverty line) suffer with little or no subsidy. I think the cutoffs for eligibilty for a premuim subsidy is something ridiculous like $15,000-$16,000. Anything above that, and you are on your own. I just don't see how many people will afford perscriptions, which will of course, just further burden the system.

 

That my superficial, and largerly uninformed, opinion. I think I have become to jaded to even care anymore....

[Guest cracked30]

Well,

 

I am concerned with all this focus on hips and knees. Lets not forget that osteoarthritis of the hip and knee tends to be a disease of middle class, former athletes who want to walk the full 18 holes.

 

Yet, in Ontario, we deny autistic children treatment after age six because it costs too much. Or we deny a dying cancer patient a last chance at a couple more years because they, the new drugs, cost "society" too much.

 

Public health care has become politicized and we, as doctors, are letting it happen. We are letting PhD health policy epidemiologists define and direct our care. These people who have never spoken with a patient face to face in their life.

 

Hips and knees are not life saving surgeries, people should have to absorb costs themselves and not get a new cadillac, or this year's trip to Florida. Use the money for the children and the dying. That's the right thing to do.

[Guest UWOMED2005]

QR77. Is that a talk radio show on the AM band? About 630?

 

I remember listening to that station for 3 hours on a trip back from Edmonton and being absolutely enthralled by it. There was some interview with some nutjob 20 yr old Harvard law student who wrote some book about how we were all corrupt and were going to hell. The callers were hilarious! I never would have thought such people existed. . .

 

I would have thought evolution would have weeded such people out by virture of them not being able to figure out how to breathe.

 

PS - cracked. . . what's your take on the Birmingham hip?

[Guest marbledust]

The callers were hilarious! I never would have thought such people existed. . .

 

Don't tell my partner this--but I have secretly become as addicted to it as he is. Yeah, the callers and show hosts are absolutely halarious. Some comic relief at the end of the day is a good thing

[Guest UTMed07]

I am concerned with all this focus on hips and knees. Lets not forget that osteoarthritis of the hip and knee tends to be a disease of middle class, former athletes who want to walk the full 18 holes.

 

Yet, in Ontario, we deny autistic children treatment after age six because it costs too much. Or we deny a dying cancer patient a last chance at a couple more years because they, the new drugs, cost "society" too much.

The upper-middle class yuppies is where the votes and power is... if they don't get their hip they raise hell. It isn't coincidence that the Quebec/Supreme Court case was about a hip.

 

I think you're right about autistic children... but they are a very small minority. Also, I imagine the people that have a child that is autistic-- are probably so burdened by taking care of 'em it is hard to find the energy to fight the political battle.

 

Any case, I don't think private insurance is the way to go. In the US it is the sickest people that have to fight with their insurance company. Most disgusting about the system is that the uninsured get gouged... it is just like with the pharma. The larger companies/insurers can negogiate a better price. As a single person big pharma tells you to take a hike--that's untamed capitalism.

Don't tell my partner this--but I have secretly become as addicted to it as he is.

I think the scary thing is people believe the stuff. I have surmised this from my visits to small town USA... where rabid hate-filled talk radio is the only thing on the dial. In the US they even have a term of people that believe the stuff -- "ditto monkey." Any case, I understand the appeal. I like "monkey mail" on Bartcop. There is something ego-boosting about listening to a half-wit trying to make a point.

[Guest cracked30]

I guess my point is not that private insurance is the way to go. I was lamenting at the politics in medicine, and that doctors are ignored and marginalized by health policy makers. The current, much ballyhoo'd, LHIN's (local health integration networks) that are being set up in Ontario will not allow an MD on the board. That's not an official policy, just a rumour, but as the boards are being announced, there is a conspicuous lack of the letters MD behind anyone's name.