Buzz speaks out
On health care and socialist revolutions
Dear Ralph Klein and Gary Mar:
Me and the boys were completely wrong about you guys. We thought you were one-time liberals who saw the conservative light. It turns out you were nothing more than socialists in banker’s clothing.
I’m exaggerating a little. Only columnists and television pundits actually think a single decision can define a politician’s ideology. It’s just that your decision to turn Alberta’s doctors into salaried employees makes you look more like power crazy central planning socialists than free-market neo-conservatives.
We were convinced that all your boasting about revolutions in health care was nothing more than a political Chinook blowing hot air across the prairies. Then you blow our pants off by announcing you want to put half of Alberta’s doctors on a set salary by 2004. That is revolutionary all right – I just don’t think you realize what kind of revolution it is.
In the last eight years, you have made a name for yourselves as Canada’s top-notch conservative government, but turning small businesses (which is what doctors are) into salaried civil servants sounds more like a communist revolution than a conservative one.
Some of the boys were so shocked they couldn’t eat Mitzy’s showroom muffins. It’s difficult to understand what you hope to accomplish by luring 5,000 hard-working small businessfolk into the bureaucratic life of extended coffee breaks and endless paperwork. What happened to all those years of chanting that smaller government is better and there is nothing the private sector can’t do better than the public sector?
The doctor as small business system has its warts, but it also has a built-in carrot that ensures doctors are as efficient as possible when seeing patients (The Bay Street boys like to call it productivity, as if they somehow invented it). When folks are lining up in growing numbers to see doctors of all types, why on earth would you take those incentives away?
Me and the boys put our political heads together and came up with a few unsatisfying reasons for your excursion into central planning.
A corps of doctors under contract with the government will help a little with the tricky problem of budgeting how much you will have to pay doctors in a given year, but it won’t solve it. However, it certainly gives you and your bureaucrat masters a lot more control over the doctors. Now you can hire and fire doctors as the price of oil goes up and down. It may be one way to bring the doctor’s guild to its knees, but it’s hardly reassuring for us folks out here in the field.
You don’t have enough information to decide how many doctors your need to hire and where they should work. The Mazankowski report made it clear that there isn’t enough information to figure out who is doing what, when, where and why, and how much it costs. Great socialist central planning experiments need that kind of information to succeed. It doesn’t exist in health care or any other area of human endeavour. Saint Ronald Reagan aside, that’s why communism failed.
The salaried doctor will cost as much as 30 per cent more per doctor for less service than your freelance business doctor. You would have to pay them what they could earn as an independent businessman and deliver benefits, holiday pay and a pension plan. I mean, it’s all well and good to deliver more in-depth health care, but you are going to lose some serious productivity here.
I realize that the rest of your revolution is supposed to limit patient demands, but it will never create enough slack to save money. This is health care, my friends – people will continue to line up to see the doctor until it is either too expensive or the line is too long.
There are places and times when having a doctor on a salary makes sense, but the doctor has to have the right motivation. When you turn half of them into employees, it stops being a lifestyle choice and you run into problems. Just ask the Brits. Salaried doctors have been part of the British National Health Service for generations, and their system is in as much trouble as Canada’s. Many fingers point to the lack of efficiency created by doctor bureaucrats as the source of the problem.
More than all this, I would worry about your reputation as the great conservative hope. One central planning exercise such as this could wipe out years of hard work at the drop of a requisition form signed in triplicate for an eight-volume policy and procedure manual.
Viva la revolucion,
Buzz Angus
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