Braid: What’s really behind Smith’s health spending accounts

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Premier Danielle Smith lit a lot of fires in her media days. Now she’s trying to stamp one out with her apparent pushback on health spending bills.

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First, she said people would use these bills to pay for their GP visits. The government would give them an initial payment of $375, presumably to everyone who has an Alberta Health card.

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But Smith went much further than that. She even suggested that the private accounts would eventually be the ONLY way GPs would be paid.

“My view is that the entire budget for family practitioners should be paid for out of health care savings accounts,” she said in June 2021 in a paper written for the University of Calgary’s school of public policy.

“If the government funded the bill at $375 a year, that’s the equivalent of 10 trips to a GP, so there can be no argument that it would impair access based on ability to pay.”

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Well, sorry, there is an argument. Many people need much more care in times of serious illness. The accounts would also discriminate against people with lower incomes who do not have the means to add their own funds to the account.

One GP called the plan “short-sighted and knee-jerk, without proper consideration of the wide range of concerns that a GP has to deal with.”

Smith suggested Albertans put their own money on top of the government’s $375, get their employers to chip in even more, and even fundraise for their personal accounts.

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She threw out these ideas before anyone dreamed she would become prime minister. But she is still pushing the bills in her mandate letter to Health Secretary Jason Copping, ordering him to “work to produce bills for health spending.”

The prime minister now says people can only use their accounts for services not covered by public health insurance. Physiotherapy, medication, whatever.

There is no longer talk of doctor visits being part of the plan. She has NDP Leader Rachel Notley twist the truth while Notley pretty much points out what Smith himself said.

This prime minister has been a professional talker for so long that we often know what she really wants, which may be quite different from what she says now.

And the purpose of these savings accounts is to groom the public for widespread private payment. It’s clear from her own words.

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Smith said in the U of C paper, “Once people get used to the concept of paying out of pocket for more things, then we can change the conversation about health care.”

She argued that the system should “shift the burden of payment away from taxpayers and onto private individuals, their employers and their insurance companies.”

Even more surprisingly, Smith calls for a “proper” overall health insurance system with deductibles or co-pays.

“If we establish the principle of Health Spending Accounts, we can also establish co-payments,” she wrote.

“I can also guarantee you that if the government creates this structure, business and non-profit enterprises will increase.

“Employers will make matching contributions to Health Spending Accounts. Non-profit organizations will be established to make charitable contributions to the Health Spending Accounts of low-income earners so they can get a broader range of health services.

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“Because that is the character of Albertans. We take care of each other. That’s what we do.”

In my experience, Albertans have always demanded a better system, but never one that makes them pay out of pocket.

Smith is playing with political explosives far more dangerous than what former premier Ralph Klein detonated in 2005 when he introduced the Third Way, a plan that would have allowed people to pay for upgraded surgeries and jump rope.

The uproar was so furious that Klein had to abandon the plan, but not before throwing a liberal health policy document at a teenage lawmaker sheet and yelling “I don’t need that shit!”

Smith’s larger plans would inevitably violate the Canada Health Act. A single public payment system is at the heart of the Act. Because Alberta complies, Ottawa will deliver $5.3 billion to the province this year, 21.5 percent of the health care budget.

Smith now says anything she does will comply with federal law. But she constantly voices opposition to many federal policies and actions, asserting the right to overturn them.

This begs the question: would she use her looming Sovereignty Act for health care?

Don Braid’s column appears regularly in the Herald.

Twitter: @DonBraid