Competence and Caring: When it Comes to Healthcare, How "PC" are the PCs?

Bruce Cameron is a pollster and political strategist who recently published a public opinion survey on the state of healthcare in Alberta for CBC

There's an old adage in political circles that you can win elections by ruling from the head or the heart, but rarely both. Typically elections in Canada are won primarily by appealing to rational economic arguments about good management or competence and secondarily about empathy and caring. A classic example is the contrast between the NDP in Ontario under Bob Rae, which was elected through an appeal to the hearts and not necessarily the minds of Ontario voters, compared to the relatively heartless but forcefully competent and decisive approach of Mike Harris and his Conservatives, who ultimately fared much better than the NDP in running Ontario.

Premier Stelmach and his advisers would do well to consider that old political adage when trying to navigate the tricky issues surrounding healthcare in Alberta. Political correctness calls for a great deal of caring and empathy when dealing with requests for healthcare funding, particularly for seniors who often need it most acutely. But if the existing budget challenges in Alberta make cuts to healthcare a more likely political option, the Stelmach government will need to substantially boost its perceived competence to carry out any cuts. So far they have failed on both accounts—competence and caring. This is not because the Premier is viewed as heartless (far from it, given his down-to-earth and genuine folksiness), but because his government has shown such political incompetence in dealing with the first of what will likely be many more healthcare funding skirmishes—the debacle in Fort McMurray.

To understand why healthcare is such an explosive issue in Alberta politics, look north to Fort McMurray. Long time local Progressive Conservative MLA Guy Boutilier publicly backed Lyle Oberg in the PC leadership race in 2007, with whom he now shares the dubious distinction of being publicly turfed from the Tory caucus. The irony and the importance should not be ignored: Lyle was tossed out by his own colleagues while Premier Klein kept a stately distance from the bloodshed. Guy was abruptly expelled from caucus this summer in a phone call directly from the Premier. Why? For having the audacity to stand up for his constituents in Fort McMurray. No “skeletons in the closet” from Guy. He aired the dirty laundry publicly. And the sword he chose to die on was a broken healthcare promise, made by Premier Stelmach, to build a much needed long-term care facility for seniors in the fast growing city.

To make matters worse, the Provincial Government recently followed up the muzzling of Guy Boutilier by announcing plans to spend $241 million over the next five years to expand the boundaries of Fort McMurray. As the Premier put it, the plan would “create new jobs for today and new homes for tomorrow.” He might have added that if any of these new 9,500 residents of Fort McMurray happen to grow old and need long-term care, the only option will be to ship them hundreds of kilometres to the south.

Kicking out Boutilier speaks volumes about the way the Stelmach government makes decisions and tries to enforce those decisions through party unity. Picture recently defeated PC candidate Dianne Colley Urquhart at a candidate’s forum telling the voters of Calgary Glenmore riding that she would remain true to her party’s policies even if it meant voting against the wishes of her constituents. The howls of outrage were visceral. But the Boutilier decision also highlights one of the most important battles going on in Alberta today – the struggle to take healthcare decision making out of the hands of political representatives in favour of decision making by healthcare administrators.

This is not the first time the Provincial Government has experimented with centralizing, decentralizing and now recentralizing healthcare decision-making. Alberta was originally a leader in decentralizing healthcare decision making in the 1990s when the Klein government established a series of elected and appointed regional health boards to balance local political interests with professional healthcare advice. But those changes met with stiff resistance by elected MLAs who feared that competing elected members of health boards would be making decisions on the issues of most importance to “their” voters.

Like many things the Stelmach government faces, underneath the monolithic conformity of massive conservative majority’s there is a lot of discontent brewing. Take for example a recent editorial on healthcare from the Mayerthorpe Freelancer, a weekly newspaper in the Whitecourt riding which the Progressive Conservatives have held since Peter Lougheed swept to power in the 1970s.

“The government is centralizing power to a degree that would have made one of the country’s greatest centralizers, Pierre Elliott Trudeau, pale by comparison. …… it is difficult to imagine how concentrating power back into a secretive, plodding ministry of health has improved care.”
Whitecourt is not exactly a hotbed of socialist dissent, so when the Premier’s ideas are likened to Pierre Elliott Trudeau's, the early warning systems and alarm bells should be going off among Stelmach’s inner circle! Even more damning, and perhaps a sign of things to come, is this comment from the same paper about the growing tendency of the government to curtail public input on a whole host of issues:
“It appears that the centralization of health services by Stelmach’s government has stripped the regions of the power to shape services to local needs and has muzzled the voice of the public to have a say in local health care.”
Muzzling a barking dog may prevent it from biting you, but as the locals say “you can't make it hunt”. And you never know when it might turn on you. If it does, Stelmach and his advisers best hope for equal parts caring and competence.