Don Braid: Smith’s health spending accounts aim to prepare public for private payment

This Prime Minister Has Been a Professional Talker for So Long We Often Know What She Really Wants, Which May Be Very Different From What She’s Saying Now

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Premier Danielle Smith has fanned many fires during her media days. Now she’s trying to stomp one with her apparent retirement on health spending accounts.

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First, she said that people would pay for their visits to family doctors with these accounts. The government would give them an upfront payment of $375, presumably to anyone with an Alberta health card.

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But Smith went much further than that. She hinted that private accounts would eventually be the ONLY method of paying family physicians.

“My opinion is that the entire budget for family physicians should be paid for from health savings accounts,” she said in June 2021, in an article written for the School of Public Policy at the Institute. University of Calgary.

“If the government were funding the account at $375 a year, that’s equivalent to 10 visits to a GP, so there can be no argument that it would compromise access on an ability-to-pay basis.”

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Well, sorry, there is an argument. Many people need much more care when they are seriously ill. The accounts would also discriminate against low-income people who cannot afford to add their own funds to the account.

A GP calls the plan ‘myopic and knee-jerk, without due consideration of the wide range of issues a family doctor deals with’.

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Smith suggested Albertans put their own money on top of the government’s $375, ask their employers to pay even more, and even fundraise for their personal accounts.

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She threw those ideas around before anyone dreamed she would be prime minister. But she still pushes the accounts in her mandate letter to Health Minister Jason Copping, directing him to “work to establish health spending accounts.”

The Prime Minister now says people could only use their accounts for services that are not covered by public health insurance – physiotherapy, medication, whatever.

An excerpt from Premier Danielle Smith's article at the U of C School of Public Policy.
An excerpt from Premier Danielle Smith’s article at the U of C School of Public Policy.

Doctor visits are no longer part of the plan. She lambastes NDP Leader Rachel Notley for twisting the truth, as Notley pretty much points out what Smith herself said.

This prime minister has been a professional conversationalist for so long that we often know what she really wants, which may be very different from what she says now.

And the purpose of these savings accounts is to prepare the public for widespread private payment. This is clear from his own words.

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Smith told the U of C newspaper: “Once people get used to the concept of paying for more things themselves, then we can change the conversation about health care.”

She argued that the system “must shift the burden of payment from taxpayers to individuals, their employers and their insurance companies.”

Even more surprising, Smith calls for a “proper” global health insurance system with deductibles or co-payments.

“If we establish the principle of health spending accounts, we can also establish co-payments,” she wrote.

“I can also guarantee you that if the government creates this structure, businesses and non-profit organizations will intensify.

“Employers will make matching contributions to health spending accounts. Non-profit organizations will be created to make charitable contributions to the health spending accounts of low-income people so that they can obtain a wider range of health services.

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“Because that’s the character of Albertans. We take care of each other. This is what we do.

In my experience, Albertans have always demanded a better system, but never one that made them pay out of pocket.

Premier Danielle Smith celebrates her victory in the Medicine Hat by-election on Nov. 8.
Premier Danielle Smith celebrates her victory in the Medicine Hat by-election on Nov. 8. Photo by Jeff McIntosh/The Canadian Press

Smith is playing with far more dangerous political explosives than former prime minister Ralph Klein detonated in 2005, when he introduced the Third Way, a plan that would have allowed people to pay for enhanced surgeries and skip Queues.

The uproar was so furious that Klein had to abandon the plan, but not before tossing a liberal health policy document on a page of the teenage legislature and shouting “I don’t need that shit!”

Smith’s broader plans would inevitably violate the Canada Health Act. A single public compensation system is at the very heart of the law. Because Alberta is complying, Ottawa will pay the province $5.3 billion this year, or 21.5% of the health budget.

Smith now says anything she does would comply with federal law. But she consistently voices her opposition to many federal policies and actions, claiming the right to reverse them.

This begs the question: would she use her impending sovereignty law for health care?

Don Braid’s column appears regularly in the Herald.

Twitter: @DonBraid

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