Alberta's Next Election Could be Referendum on Private Care

The longstanding taboo against private sector involvement in health care is lifting

Speaking last month at the annual Canada Strong & Free Network (CSFN) conference in Ottawa, Alberta Premier Danielle Smith implored her fellow conservatives to “run towards” health care rather than away from it.

“Part of the reason health care doesn’t work (in Canada),” Smith told CSFN director, Jocelyn Bamford, “is because it’s being operated in this sort of top-down … public-funded, publicly delivered (model) …

“We can have private delivery, public funding, stay within the Canada Health Act, and bring all of the principles that we know work in free enterprise to this most expensive service.”

These were surprising words to hear from a conservative premier who will be up for re-election in less than two months — even if Smith was speaking on her "home turf" to a roomful of conservative movers and shakers.

After all, public health care has long been the third rail of Canadian politics. The mere suggestion of altering our single-payer, one-tier status quo to create more room for private-sector involvement in health care has been enough to bring down conservative politicians in the past.

Take, for instance, the hapless former Canadian Alliance leader Stockwell Day, who was so flummoxed by the Liberal narrative that he was a closet supporter of privatization that he resorted to holding up a sign reading “NO 2-TIER HEALTHCARE” during a televised leaders’ debate.

And Smith herself has had her fair share of blunders on the healthcare file. Her political comeback was nearly derailed last summer when comments she made on her podcast about cancer being “controllable” in its early stages were circulated on social media. She has also been criticized for her plan to give each Albertan a $300 health savings account for alternative services not covered by the public system — a policy that recalls the widely ridiculed "Dani-dollars" she once peddled as leader of the Wildrose Party.

But Smith’s comments also come at a time when the long-standing taboo against private-sector involvement in health care appears to be dissipating. Earlier this year, polling firm Ipsos found that nearly six in 10 Canadians now approve of the private delivery of publicly funded health services. A slightly higher proportion said they were in favour of fully private health care for those who can afford it; and nearly half were open to the introduction of new user fees and private health procedures.

These numbers floored even Ipsos head Darrell Bricker, a 30-year veteran of the polling business.

“This is the first time I can recall in which you actually got numbers like that, where you’d have a majority of Canadians saying they’re open to considering private methods of delivery,” Bricker told Global News.

The figures also underscore a shifting national policy landscape. In Ontario, home to nearly four in 10 Canadians, thousands of core surgical and diagnostic procedures are set to be offloaded to privately run, for-profit clinics. These procedures will include hip and knee replacements and cataract surgeries. In Quebec, where three-in-four residents approve of private health care, the Legault government has promised to build two private medical centres by 2025 — one in Montreal’s east end, the other in Quebec City.

But Alberta’s upcoming provincial election could mark the first time in the country’s history where private health care emerges as the central ballot question. Smith’s United Conservative Party (UCP) narrowly passed a resolution endorsing a two-tier system at its 2020 convention. Smith herself argued for the introduction of user fees and insurance co-pays in a 2021 paper she wrote for the University of Calgary’s School of Public Policy. With her recent comments about “running towards” health care, Smith appears to be digging her heels in favour of greater private-sector involvement in the system.

While the campaign has not officially started yet, it’s already clear that health care will be one of its top issues. The opposition Alberta NDP and hostile third parties have, in fact, telegraphed their forthcoming campaign strategy of using Smith’s own words on health care against her. For instance, a recent NDP radio ad features a snippet of Smith explaining her health spending account proposal last summer: "Get your employer to put money in, raise money to put money in, get family members to donate money in ….”

These sorts of pre-election attacks are, of course, nothing new. It’s nevertheless noteworthy that the Alberta NDP and their allies (among them public health-care unions) are casting themselves as the guardians of public health care at a time when Canadians are expressing an unprecedented level of openness to private delivery options. Whether these attacks stick to Smith and the UCP could be an indicator of the political palatability of private health care in Alberta and beyond.

After decades of being the ultimate electoral bogeyman, private health care is finally having its moment in Canada. Alberta’s upcoming election could determine its viability at the ballot box.

Rahim Mohamed is a Master’s student at the University of Calgary’s School of Public Policy. This article was published in the National Post on April 5th, 2023.