Could the Pandemic Finally Bring Health Care Reform?

Andy Crooks
April 22, 2021
If a system always claims to be “at capacity”, announces it’s “nearing the breaking point” every time anything unexpected occurs, perennially frets about “staff burn-out”, and blames patients themselves for the crime of getting sick, then maybe it’s time to change the system. So it has been with Canada’s health care system and Covid-19. Whether there are 50 people in hospital or 500, it’s always too many, and we’re continually on the cusp of cancelled cancer treatments and delayed organ transplants. Seeing opportunity and hope in crisis, Andy Crooks envisions harnessing the efficiency and drive of the private sector to break the bureaucratic stranglehold and deliver world-class health care.

Could the Pandemic Finally Bring Health Care Reform?

Andy Crooks
April 22, 2021
If a system always claims to be “at capacity”, announces it’s “nearing the breaking point” every time anything unexpected occurs, perennially frets about “staff burn-out”, and blames patients themselves for the crime of getting sick, then maybe it’s time to change the system. So it has been with Canada’s health care system and Covid-19. Whether there are 50 people in hospital or 500, it’s always too many, and we’re continually on the cusp of cancelled cancer treatments and delayed organ transplants. Seeing opportunity and hope in crisis, Andy Crooks envisions harnessing the efficiency and drive of the private sector to break the bureaucratic stranglehold and deliver world-class health care.
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We meet for coffee in Calgary. It is the spring of 2026. Unmasked and cheerfully rubbing shoulders, we look back five years, to the spring of 2021. The turning point. In some ways, it seems like yesterday. Yet so much has happened, so much progress has been made.

In 2021 it became clear that the Covid-19 virus was beyond control. The promise of eradication was gone. By that fall, the pace of mutations even began outstripping the rate of vaccine development. People were reluctantly concluding that the virus would be a permanent feature of life.

Albertans looked ahead not to their normal lives, lived with freedom and vigour, but to a more severe annual flu season. This sad and worrisome new fact of life was creating a permanent strain on the hospital system, groaning increasingly under the weight of treating the many who continued to become infected.

While the virus appeared here to stay, the people would not accept permanent lockdowns; everyday life had to resume. We knew this but, at the time, we did not see the path forward. Yet things worked out better than anyone could have predicted, in ways that no one would have guessed.

Could crisis bring a brighter future? Launching an ultramodern – and privately-funded – dedicated Covid-19 clinic could be the first step in real health care reform.

It all begins with a brilliant yet simple idea, unveiled in the summer of 2021: a specialized clinic just for Covid-19 patients. It will be somewhat like the tuberculosis hospitals of a past age – but ultra-modern and sophisticated. The Government of Alberta announces the creation of two special hospitals for the province, to be designed, built and staffed entirely to deal with virus treatment.

But it is not going to come cheap. Alberta Health Services proposes a $500 million facility for Calgary and a similar one for Edmonton – a combined price tag of $1 billion. The Alberta government simply cannot afford it. The extraordinary budget deficits caused by the pandemic have all-but exhausted the province’s fiscal capacity.

Almost immediately, however, a group of investors step forward and offer to finance and build a private facility for a fraction of the cost – a private Covid-19 hospital. With utter predictability, the nurses’ union, the public service unions and even the College of Physicians and Surgeons all come out against the idea. They organize protests, but fortunately the ongoing social-distancing rules limit the numbers and mute the impact of their chanting and sign-waving. Meanwhile, their rancorous rhetoric on social media and in sympathetic outlets like the CBC also falls flat.

Albertans, it seems, are as tired of bitter partisanship as of the virus itself, and just want a solution. They are deeply concerned about the province’s strained fiscal capacity and have little remaining confidence in Alberta Health Services. Millions seem ready for a “made in Alberta” approach – something big, bold and different.

Applications for jobs in the new clinics greatly exceed the number of positions. Younger hospital staff prove eager to get out from under Alberta Health Services’ oppressive management structure. News media soon carry stories of happy and excited staff at the new hospital.

Operating costs are much lower than in the public system and, without the layers of Alberta Health Services management and oversight, administrative costs are dramatically lower. Freed of the public service pension burden, the private operator can offer generous salaries and benefits not merely to medical staff like nurses, but to janitors and other staff. Standard private-sector practices – such as contracting out maintenance, laundry and food services – are also applied, saving further costs, although strict Covid-19 safety protocols are of course applied to anyone who enters the facility. Among the numerous state-of-the-art design features and operating practices, sophisticated climate control systems cleanse and manage the airflow, making the virus clinics among the world’s safest environments.

No patient left behind: Focusing exclusively on Covid-19 would hold down the new clinic’s capital and operating costs and promote efficiency while relieving pressure on the main health-care system.

There is much more. Doctors love the state-of-the-art equipment and are pleased at the ease with which patients can be admitted. Patients and their families are thrilled with the ease of access, service levels and enhanced visitation. That is because the company and its staff view them as valued customers who keep the clinics in business, not as burdens and problems who “get in the way” or “strain the system’s capacity”.

The project attracts national attention; it is hailed as a Covid-19 treatment triumph.

At first, the Government of Alberta is the clinics’ only customer, with Alberta Health Services paying the per-patient-per-day rate. While the private sector has provided the hospitals’ financing, construction and operations, they are publicly funded facilities. To the patient, it is still “free” health care, and nobody is “turned away” because of poverty.

Publicly vs. privately run health care: The one regards too many patients and visitors as problems to be kept at arm’s length, the other sees them as valued customers to be welcomed.

But the owners do reserve half the beds for true private health care, serving paying customers. As the facilities grow, they begin accepting pay-as-you-go patients. The costs are so reasonable and the treatments so effective that demand surges. Specialized Covid-19 ambulance services begin feeding patients from across Western Canada to the new and growing facilities.

The insurance industry responds quickly. The first Covid-19 health care policy is made available within 60 days, and it sells well. Coverage includes the costs of private care in the new clinics. Albertans and Western Canadians are pleasantly surprised at the reasonable premiums. For the first time since the 1960s, they enjoy the same freedom of choice regarding their own health care that Europeans have had all along.

The investors are delighted. They earn a modest return on the government contract and generate substantial profits from the private patients.

Six months after their opening, the facilities expand to 125 beds each, and the recovery statistics are impressive. On the six-month anniversary, the ownership group announces an expansion of services beyond virus treatment. The new hospitals now offer eye surgery, MRI and X-ray diagnostics, and other treatments, all on a pay-as-you-go (or privately insured) basis.

The demand proves extraordinary. In contrast to the public system’s long, stressful – and often health-damaging – waits, service is almost instantaneous, prices remain reasonable, and people understand that their medical expenses are tax-deductible. Thanks to the choice exercised by these patients, waiting lists on the public side actually shrink slightly, while fewer Albertans feel they need to seek care in the U.S., boosting the local economy.

 The world is watching: In the author’s imagined future, the Cambie Surgery Centre (above) leaves unfriendly B.C. for welcoming Alberta, while Minnesota’s world-famous Mayo Clinic (below) opens a Canadian branch.

Following the Supreme Court of Canada’s 2005 decision (Chaoulli v. Quebec) permitting private health care in Quebec, a growing number of doctors had operated private facilities in Montreal. The Alberta clinics’ first service expansion uses the management expertise of these private care operators from Quebec. Until now, Alberta’s new Covid-plus clinic does not perform surgery. To fill that gap, the Cambie Surgery Centre of Vancouver announces its expansion into Alberta, to be housed in the new private hospitals. Construction on new wings of operating theatres and specialized surgery facilities begins.

Some of the more significant health care providers in the United States and Europe are also watching with interest. For decades they had regarded Canada as a potential market to be served, for they had been providing services to a significant number of Canadian “medical tourists” who came to them for a wide range of treatments that were either not provided in Canada or that imposed such punishing waiting times that the patient might die first. Now, the Mayo Clinic moves first, announcing its intention to build a world-class centre in Edmonton. Scripps and two other medical providers, one based in Spain and the other in Germany, make similar announcements shortly thereafter.

This flurry of innovation and change also means that the public, the media and the Alberta government can finally compare public and private costs and patient satisfaction. Alberta Health Services does not stand up well. With the competitive private-sector alternatives providing clear comparative data, the government and patients are finally empowered to demand better cost and performance standards of the public system.

As these improvements finally commence, everyone benefits. The added Covid-19 capacity has already allowed the public hospitals to resume regular services at full capacity. The competitive environment now drives improved service in the public hospitals. After 60-plus years of costs going up almost without interruption, Alberta Health Services is finally able to halt the climb and begin nudging costs back down without slashing service delivery. The organization begins by releasing entire levels of management. Private operators immediately hire the skilled and experienced staff.

As Alberta’s hybrid health care model emerges, Albertans are finally able to exercise the same free choice regarding their own health care as Europeans have had all along (pictured, a hospital in Switzerland).

Still, the private operators remain much more efficient, so Alberta’s Health Minister and Finance Minister begin openly discussing the sale of public hospitals to private operators. The proceeds, anticipated to be in the billions of dollars, would significantly reduce government debt. Studies show that Alberta could pay out all the union pension obligations, offer substantial severance packages, complete the sales and still be financially ahead. And billions more will be saved, year after year, thanks to the reduced operating costs of the privately operated but still publicly funded and universally accessible hospitals.

With each step, a hybrid model of health care is emerging, a blend of public and private. No one is left behind, and the new model is mutually supportive and complementary.

Meanwhile, the original dedicated Covid-19 hospital has become a world leader in the treatment of the virus. Covid-19 is still a serious problem, but the virus has proved to be treatable.

As the new private hospital relieves the virus stress points, the province focuses on contact tracing and testing. As hot spots are corralled, people begin to feel safe and comfortable, bolstered by the confidence that they will have easy and quick access to treatment if they are infected.

The province’s economy rebounds to an enviable “new normal”. Alberta is back! Seeing the province’s progress in the virus fight and the innovative ways it has been waged, employers begin flocking to Alberta as they once did during energy booms. Office vacancy rates in Calgary and Edmonton shrink at last.

The federal government, however, is not impressed – only resentful and feeling threatened. Every step of the way, it tries to block all of these health care reform ideas from being implemented. More than once, Ottawa threatens not merely to reduce but to cut all federal transfer payments for health care to Alberta. Albertans are not amused. Only a year earlier the Fraser Institute had released a report showing Alberta, though flat on its back economically, had once again contributed more to Ottawa than it received in federal transfers.

The rest of Canada gives nothing, only more griping about Alberta’s oil and natural gas industry. The equalization formula remains a totem for the general disdain that much of the rest of Canada feels for Alberta. But this time, Albertans and their government don’t back down. Instead, seeing the almost immediate benefits of private health care, they turn inwards and resolve to pursue health care reform come what may.

Spring 2026, happy days are here again: Alberta’s economy has come roaring back, masks are a distant memory, Covid-19 has faded to the background, health care waiting times have shrunk, service has improved and, after 60 years of rising costs, the system’s costs are finally under control.

The federal government and other provinces see this shift in public sentiment and, despite threats and bluster, ultimately decide to let things pass. They do not want to create a constitutional crisis. The Covid-19 virus and growing national debts have created instability around the world. Separatist movements are gaining traction and are moving to create new independent states in Scotland, Ireland, Catalonia and other places. The very idea of permanent national boundaries seems to be passing. So, Ottawa decides Alberta is best left alone – or its people might well decide to go it alone.

As our relaxed and convivial coffee visit in the spring of 2026 winds down, we realize that the Covid-19 pandemic of 2020-2021 had many unexpected consequences, and some of them were actually good. These included an improved and expanded role for private health care, significantly better private and public medical care, shortened waiting times for Albertans, greater freedom for individuals to use their personal resources as they see fit, diversification of the Alberta economy and a renewed environment of genuine federalism emphasizing provincial rights.

In 2021, no one would have guessed.

Andy Crooks is a retired Calgary lawyer and a movement conservative with leadership roles in constitutional law, tax policy, health care, addictions, fine art and parks.

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