On February 20, 2019—not quite two months before the provincial election—the leader of the UCP stood before the assembled media next to a large placard upon which was printed a simple pledge:

To sparse applause from staffers, Kenney solemnly signed the placard.

It was simple, direct, straightforward: the perfect gimmick to reassure any voters who favour the return of a right-wing provincial government but fearfully recall the Ralph Klein era of gutting health care funding and blowing up hospitals in the 1990s.

The stunt was designed to be as subtle as a billboard, easily read at a distance: a UCP government would not go after Albertans’ health care, full stop.

More than a year and a half later, that placard is probably in a landfill somewhere (though hopefully they at least recycled it).

Now, six months into a public health crisis, Alberta has the country’s highest per-capita rate of active COVID-19 cases. A July poll suggested 98% of the province’s doctors have no confidence in Health Minister Tyler Shandro (who declined to be interviewed for this story). And it appears many physicians are choosing to make less money in another province in order to escape this government.

It’s been quite the ride. But in the chaotic madhouse of 2020, it’s easy to lose track of all the threads. There are two in particular that are key to understanding what the UCP is doing on health care: privatization, and the war on the Alberta Medical Association (AMA).

Despite the importance of our public health-care system to Canadians’ identity, we don’t actually have a public health-care system—at least, not how we think.

Most of our health care is delivered through the private sector, including most family doctors, whose individual or group practices are set up as corporations. When we think of our “public health care,” what we’re usually thinking of is single-payer health care—that is, the government picks up the tab.

The Canada Health Act compels provinces to pay for an approved list of treatment categories deemed “medically necessary.” (Most dental care and pharmacare is paid for by private insurance or out-of-pocket for reasons based more in historical political fights than any actual logic.)

The UCP’s stated approach is to minimize the public aspect of health care, maintaining coverage as the Act requires, but maximizing the privatization of delivery and services.

That the UCP—a party firmly in the Reform-Canadian Alliance-Wildrose tradition, further right of any Progressive Conservative government, even Ralph Klein’s—would put its faith in for-profit business is unsurprising, particularly as it’s dominated by one man, Jason Kenney, whose own views on public health care are well documented.

Less than a month before the 2000 federal election, the Globe and Mail ran a story with the headline “Alliance supports two-tier health care” that quoted campaign co-chair Kenney saying the Canadian Alliance party would maintain health care funding, but support the expansion of private health care.

Kenney later published a response arguing that the headline was unfair, but the damage was done: the story caused a shift in the polls, the Liberals won a third straight majority, and many in the Alliance blamed Kenney for the loss—though his comments were in line with the UCP’s stance on private health care today.

In 2018, Kenney was caught on video being a little more candid. Speaking at the Whitecourt Chamber of Commerce, Kenney argued that private health care is faster and more efficient than public health care. But he offered no evidence beyond his own opinion, suggesting public health workers waste time and money taking coffee breaks and sanitizing equipment.

The comments were widely panned by health experts, who said Kenney, a philosophy major with no medical experience, didn’t know what he was talking about. But they hinted at a stereotypical view of public employees as lazy and (ironically) overpaid, perhaps foreshadowing his government’s conflict with the AMA.

One year to the day after Kenney signed that novelty-sized health-care guarantee, the Alberta government unilaterally terminated its contract with the province’s doctors, escalating a difficult relationship into open hostility.

The next day, February 21, a woman in her fifties returned from a Pacific cruise to her home in the Calgary health zone. She didn’t know it, and she would not isolate herself for another week, but that woman would prove to be the first case of COVID-19 in the province, marking the beginning of a massive public health crisis.

Undoubtedly the UCP would have preferred better timing for their fight with the AMA, given the optics of battling doctors during a pandemic. But it hasn’t seemed to temper their tone. The unilateral moves made by the UCP against physicians suggest a view of the profession not as partners to work with but a problem to work around—or, better yet, fix.

Family physicians in Alberta are paid on a fee-for-service basis, which involves a complex set of value rules: a flat amount per patient, plus additional fees based on factors like duration or complexity of the visit. Because family doctors’ practices are private businesses, those fees go towards overhead and staff pay, not simply their personal compensation.

Those fees are a significant chunk of Alberta’s total health-care spending—which altogether is 43% of provincial expenditures—and the UCP sees it as primed for cost reductions. Undercutting the AMA, which is the bargaining arm of the profession, is a way to ensure the government gets what it wants rather than having to give up ground in negotiations.

Physician fees are certainly fair game for review—some provinces have moved away from the fee-for-service model—but the dictatorial approach the UCP has taken may be unprecedented, especially during a health crisis.

In July, AMA president Dr. Christine Molnar described Shandro's behaviour as “disrespectful, misleading and, frankly, baffling.”

“At every turn, government—particularly the minister—has shown the intention to objectify, diminish and disempower physicians in this province,” said Dr. Molnar. “Their actions speak loudly.”

Before the election, Kenney retold a story he says informs his views on health care: his father, brought to an emergency room for an infection, sat in a waiting room for over 12 hours before receiving treatment. “They didn’t even really get test results back by the time he passed away.”

It’s a sad story, one that too many Canadians can relate to.

Without a doubt, our health care system is flawed. But where Kenney sees inefficiencies best solved by the profit-incentivized private sector, others see a system struggling to hold together after decades of uneven and insufficient funding.

There is a difference between streamlining a system and squeezing every ounce of profit out of it. There is always a cost to cuts, and determining whether the cost is worth it depends on whether your focus is patients or profits.

This is precisely the dynamic that has played out in Alberta’s long-term care facilities.

A 2013 study by the University of Alberta’s Parkland Institute found that “for-profit elder care is inferior to care provided publicly or by a not-for-profit agency.” In May, AHS had to take over control of a private Calgary seniors' home with a COVID-19 outbreak that repeatedly failed to meet acceptable standards of care.

And in eastern Ontario, 83% of COVID-19 deaths in long-term care have been in for-profit facilities—an ominous number considering that the vast majority of Canada’s total COVID-19 deaths have been in long-term care.

All of this seems to make a strong case not for further privatization but for reinvestment in public health care.

But the fight over private versus public delivery within a single-payer system is the wrong one to be having, according to Jason Sutherland, a professor in the Centre for Health Services and Policy Research at the University of British Columbia.

“The question of whether health care should be delivered publicly or privately has no clear answer,” he said, at least according to evidence about health outcomes and overall cost.

Sutherland proposes a different question, “Should we be expanding the role of the public funder into mental health and social care?”

Sutherland advocates for a more holistic approach to health-care policy, such as bringing mental health, dental, vision and pharmacare under the single-payer umbrella. Only 67% of Canadians have some form of supplementary private health care to cover those services—the rest pay out of pocket or, worse, go without care.

The result is increased public costs resulting from that lack of care, whether in the form of emergency-room visits, other public health care, or the costs associated with untreated mental illness, such as homelessness or inflated police budgets.

“If one were to focus on what the health care programs are trying to achieve, one might say: Why do we have [separate] ministries of health and ministries of social care?” Sutherland said. “Why wouldn’t we look at people’s food security, housing, mental health and physical health all together?”

“These seem to be artificial boundaries.”

Protestations that Alberta can’t afford increased health-care spending are akin to cries that the province can’t afford anything right now. And the same reply applies: it’s our choice.

Alberta is the only province that chooses to forego revenue from a sales tax; our inadequate physical and social infrastructure is the cost of maintaining ludicrously low taxes (which we cut nevertheless) despite the highest average income in Canada; and we continue to tie our economic recovery to the fossil fuel industry, which was a bad idea 20 years ago and an even worse one now.

There is more than one path forward, and any attempt by the UCP to justify aggressive moves on health care by pointing to empty public coffers and a broken economy is disingenuous.

Their hand may be forced by circumstance, but they are choosing the direction in which it moves.

Taylor Lambert is the Alberta politics writer for The Sprawl.