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Canada’s government-run national health system, often held before Americans as a model method of delivering medical care, has been gradually falling to pieces in recent years, and last week it received what many fear will prove the knock-out blow.

That blow came from Alberta where the provincial Conservative government of Premier Ralph Klein is defying federal laws intended to safeguard the system against private medical practice. Klein unveiled a plan to institute a controversial “two-tier system” in his province – meaning two levels of medical care, one run by the government and delivered without fee, the other delivered privately with a fee attached.

This would end in Alberta the utopian socialist vision that inspired the institution of state medicine in Canada four decades ago, wherein rich and poor alike were to get the same level of care. But it was a vision increasingly belied by reality, because the rich could acquire the best care simply by traveling to the United States.

This they have been doing in ever larger numbers because waiting times for surgical and other specialist services in Canada can run to as much as two years, and people sometimes die waiting for them. One of the central causes for this was the exodus of doctors to the U.S. where their income would wildly exceed what they could earn in Canada.

Klein’s plan instantly created a crisis for the newly elected Conservative federal government of Prime Minister Stephen Harper who had pledged to uphold and defend the national system if elected.

Harper had good reason to make this pledge. He had lost the 2004 federal election because Klein announced, about a week before the vote, that he was about to disclose a separate medical plan for his province. The Liberals spread the story that the two Alberta Conservatives – Klein and Harper – were conspiring to destroy state medicine in Canada, and many voters bought the story.

Something else gave credence to that thesis. Before he began his movement to unite Canada’s conservative parties, Harper had lent his name to a group of disgruntled conservatives in Alberta who had urged Klein to build a “firewall” between the province and the national government. One of their proposals: To establish private medical care in Alberta.

Harper now finds himself in a triply unenviable role. He must be torchbearer for the hated feds against his own province. He must lead the Conservative government at Ottawa against the Conservative government in Alberta. And though a thoroughgoing fiscal conservative, he must champion the cause of state medicine.

Two factors, however, will ease to a degree his discomfort. One is the fact that Quebec, too, is establishing a somewhat more modest private medical system, so Harper must deal with two renegade provinces, not just his own. But Quebec’s plan differs substantially from Alberta’s. For instance, where Quebec doctors would have to choose whether to work in the private system or the state system, Alberta doctors would be encouraged to work in both, in fact be required to devote a proportion of their time to delivering services under the state system.

Second, Harper can make a show of resisting Klein by imposing the maximum penalties, provided under the Canada Health Act, the statute under which the federal system operates. But those penalties amount to a few million dollars, a trivial sum to a province which this year forecasts a surplus of $10 billion, created entirely by royalties and other revenues from the province’s gas reserves and the enormous heavy oil development in its tar sands.

It’s historically noteworthy that the deathblow to state medicine in Canada should come from Alberta. It was Alberta that most fiercely resisted its institution in the first place. The advent of government-administered medicine came in 1947 in Saskatchewan where Canada’s first socialist government instituted hospital insurance. When it later pioneered full medical care, this set off a doctors’ strike.

It also incited Ottawa to invade health care, a provincial jurisdiction, by offering to bankroll 50 percent of the cost to any province that joined its proposed National Health Plan. Alberta refused, and a chin-to-chin confrontation followed. During this it became obvious that, while Alberta might opt out of the plan, it was going to have to pay its share anyway. So Alberta reluctantly joined. In short, state medicine came to the province through federal blackmail.

That was in 1966. Now, exactly 40 years later, it is Alberta that leads the movement that could doom a program it never wanted. Ironic, eh? Or maybe fitting.



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