Moving Beyond the Status Quo:
Alberta's "Working" Prescription for Health Care Reform
Executive Summary
Many experts have diagnosed medicare in Canada as an ailing system in need of treatment. Commission after commission has agreed that the health care system, under pressures of an expanding and aging population, and of growing demands for new technologies and prescription drugs, cannot be sustained by endless additions of public funds. Notwithstanding the economically compelling arguments in favour of market solutions, no consensus has been reached on the most effective treatment for medicare. Because monopolistic, state-funded, and state-delivered health care is said to be symbolically important to the Canadian electorate, governments have been hesitant to act at all for fear of political repercussions. Indeed, discussions of reform have been derailed by the twin fears that privatization is downright un-Canadian, and that the unrestrained pursuit of more public funding—rather than being the harbinger of a coming disaster—can somehow stave it off. Given the degree of resistance to changes in attitudes among the Canadian public on this issue, politicians are faced with a major problem: how is it possible to move beyond the status quo in order to save Canada's ailing health care system? Must the breakdown in the publicly- funded system be complete before anything realistic is done?
To answer this question, it is useful to examine the situation in Alberta, where modest but still unprecedented reforms have taken place under the leadership of Premier Ralph Klein. Despite threats that any such restructuring attempts would be political suicide, Premier Klein and his Tories emerged from their third straight election stronger than they went into it. Of course the premier's strong personal appeal and the province's prosperous economy had a lot to do with the Conservatives' victory, but our data also indicate that Alberta's "working prescription" has succeeded in moving health care a few steps beyond the status quo and has improved the popular perception of the overall system. Even though the same remedy may have different effects on different people suffering from the same condition, an examination of the effects of this prescription on Albertans can provide insights for other governments contemplating similar changes.
Understanding public perceptions is essential to creating effective policy reform in a democracy. This is especially true for such an emotional issue as health policy. Our analysis uses data from a series of public opinion surveys—the Alberta Advantage Surveys of 1995, 1996, 1999 and 2000—to trace the impact of the policies of the Klein government during a period of restructuring in health care. In doing so, this Public Policy Source aims to describe how changes to Alberta's health care system have been achieved without severe and adverse political repercussions, and indeed with improvements in overall perceptions among Albertans regarding health care. It also shows that many citizens recognize that an underperforming health care system is a result of factors other than allegedly insufficient expenditures from the public purse. These findings suggest that perhaps Canadian citizens more generally are capable of thinking outside the highly constraining box of health care orthodoxy. Accordingly, there are reasons to expect that with the appropriate prescription, it is possible to treat our ailing system and move beyond the status quo elsewhere in Canada as well.
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