shawn whatley md

In case you missed my op ed. It’s available on the NP website also.

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Albertans re-elected Danielle Smith’s United Conservative Party with a majority last week. Smith now offers a chance to change the way we think about health care — a radically conservative vision. What might that include?

Many conservatives trumpet out-of-pocket payments as the embodiment of conservative health-care policy. Danielle Smith’s critics inflamed fears of patient payment central in their campaign attacks.

One month before the election, Smith took out-of-pocket payments off her campaign table.

“I believe actions speak louder than anything,” said Smith. “One of the first things I’ve done as premier is sign a 10-year, $24-billion health-care agreement with the federal government, where we jointly agree to uphold the principles of the Canada Health Act.

“One of those main principles is no one pays out-of-pocket for a family doctor, and no one pays for hospital services. That’s in writing.”

Smith’s pledge of allegiance to the Act sounds like other conservatives who have caved before her. True, Smith might govern health care like other “conservative” governments. But her pledge need not bind her. A big opportunity lies at the heart of her pledge, if she has the courage to chase it.

The “accessibility” principle of the Canada Health Act bans out-of-pocket payments: “charges made to insured persons.” Out-of-pocket charges disqualify provinces for federal health transfer payments.

The accessibility principle is the only reason the CHA exists. The first four principles — public administration, comprehensiveness, universality, and portability — come from the Medical Care Act, 1966.

Many conservatives bristle at the Canada Health Act, precisely because of its ban on patient out-of-pocket payments. That is partly right but mostly wrong. Yes, the CHA prohibits federal transfer payments to provinces which allow user fees for medical services. But no, that is not why Canadian medicare suffers.

Conservatives bristle at the wrong end of the bill. Conservatives fume at federal overreach on access but forget the CHA’s first principle, public administration. Continue reading “‘Noses in fingers out’ – How Danielle Smith could transform healthcare (repost)”

Albertans will elect Rachel Notley or Danielle Smith on Monday. Healthcare always ranks as a top concern for voters, but it usually falls to almost last place as a concern that will change someone’s vote. But healthcare could be the determining factor in who wins on Monday.

I wrote this piece for the Western Standard today. I thought I’d share it, in case you miss it in your  news feeds.

Please forgive me for posting so little! Most of my writing goes elsewhere lately. Shoot me a private email if you have strong opinions about reposts vs fresh content.

Thanks for taking a look!

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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. Continue reading “Rachel Notley’s empty healthcare promises: we’ve seen them all before”

If we could double the number of doctors in Canada, would papers print headlines about private, for-profit care? Would union leaders clutch their pearls and complain about the collapse of medicare?

Community physicians, although heavily regulated, still have the privilege of paying their own rent, heat, hydro, phone bills, and so on.

The Canadian Revenue Agency views most physicians as ‘independent contractors’ – that is, private businesses. (A few docs are salaried; many more wish they were.)

The End is Near

We have just come through a golden age (3 weeks) of peak public interest in medical politics and policy.

In mid-January, Premier Ford announced a 3-step plan to expand services outside hospitals. Patients will have increased access to publicly funded MRIs, CT scans, and minor procedures. By 2024, Ford hopes to see publicly funded hip and knee surgeries offered in non-hospital facilities.

The establishment had a fit.

I joined the enthusiasm (minus the fit) and have written furiously. Here are the results.

Ford Promises Private, For-Profit Care

The National Post published the first op ed. It feels newsy and light. It tries to put Ford’s announcement in context.

Note: headlines are designed to grab attention, not summarize content. Editors write better headlines than authors.

Ford’s Health Plan Will Be Good for Patients, if He Can Get It Past the Unions.

The Hub published the second article, which tackles the unspoken heart of health policy in Canada.

Do we have public administration of health insurance or do we have public management of medicine?

Do we have public health insurance or do we have a public health-maintenance organization?

Ford’s Health Reforms Are a Return to Medicare’s Original Purpose

Finally, the Financial Post published an op ed about disrupting hospital funding. Ford’s plan could succeed where decades of attempts at activity-based funding has failed.

Ford’s Health-Care Plan: Disruptive Innovation, not Privatization

I have another op ed out soon on that-which-must-not-be-named in Canadian healthcare: profit and privatization. Canadians find discussion about profit off-putting, if not immoral.

However, medicare is not a volunteer effort. Everyone profits.  The piece should cause some controversy (I hope) – really excited about it.

Please discuss Ford’s announcement with anyone interested. It seems more profoundly misunderstood than I realized.

Thanks so much! Looking forward to your comments.

PS. The original title was “The End is Near”. I thought people would see the joke in it. Some did not. So I changed it to a question – less humour, more clarity.