Ralph Klein bets the farm on Third Way

Docs divided on whether plan "fundamentally undermines" medicare

By Julia Cyboran

Alberta doctors will be able to work in both the public and private systems if Premier Ralph Klein's 'Third Way' becomes law. His recent policy proposal contends that letting doctors practise in both systems will make public healthcare better and more sustainable. The plan has the medical community fiercely divided.

"Doctors working in a public and private system and billing patients directly for health services fundamentally undermines universal healthcare," says Dr Tom Noseworthy, director of the University of Calgary's Centre for Health and Policy Studies. "I think this is an absolute no-no."

But other physicians think Premier Klein might just be on to something.

"The proposal's concept is to do things differently," says Dr Don Dick, president of the Alberta Orthopedic Society and one of the collaborators of the province's highly successful joint replacement pilot project (see "Alberta slashes wait times for joint replacements" Vol 3, No 3). Dr Cy Frank, who also worked on the wholly publicly-funded joint replacement project, agrees. "There are many good aspects, like putting patients first and looking at different models of care," he says. "But it all depends on how it's implemented."

So what's all the hoopla about? In a nutshell, the 10 point plan outlines how the province will provide Albertans with prompt access to quality healthcare that is both affordable and sustainable (see "Ralph Klein's 10 point proposal" right). "Of the 10 points presented, I think nine of them aren't contentious," says Alberta Medical Association (AMA) President Dr Tzu-Kuang Lee. "The AMA has given its conditional support because we don't know yet what all the details are."

NAGGING CONCERNS
Still, many stakeholders believe that the province needs to do more. "I think we need to define core services and what will be covered publicly," says Dr Dick. "When we know what they should be covering in an appropriate time and an appropriate manner the option for choice is out there."

But for Dr Noseworthy, talk of choice obscures the real issue — access. "They keep on saying people want choice. Do you think that people living on park benches want choice?" He says that at minimum Canadians look to medicare for equity. "These are worrisome times," Dr Noseworthy says. "All this is dangerous, particularly when there's a doctor shortage."

For its part, the AMA is concerned the plan fails to address one of Canada's biggest healthcare issues: wait times. "We're really disappointed that the government hasn't set care guarantees," says Dr Lee. Both the Mazankowski Report and the First Ministers meeting in 2004 suggested that wait time benchmarks should be part of all healthcare reforms.

Some fear that the parallel public-private system will only mean longer wait times. "There have been many studies done that show how this only increases wait time problems," says Sharon Sholzberg-Gray, president of the Canadian Healthcare Association, an umbrella group representing health organizations from across the country.

Only time will tell what will come of the proposal. The government is currently holding public consultations. Premier Klein has announced that he'll be stepping down in October 2007, leaving him less than two years to put his private healthcare legacy in motion — if the plan's legality can be established. "This places a very interesting onus on our brand new federal minority government," observes Dr Noseworthy. "If the feds aren't the keeper of medicare then who the hell is?"