While the separation question is understandably taking up most of Alberta’s bandwidth, the other nine ballot questions could also drastically change the province.
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Question 8 is a perfect example. It wants to change the Constitution so a province can opt out of a federal program while still getting federal transfers for things such as health care and education. The Canada Health Act, which is what establishes Canada’s universal health-care system, would be an example of federal legislation that “intrudes on provincial jurisdiction.”
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If the provincial government pursued this constitutional amendment, there’d be nothing stopping it from creating a health-care system that violates several tenets of universal health care while still getting the $7 billion in health transfers from Ottawa.For starters, the act only sets out funding and payment regulations. Provinces have wide latitude to experiment with how health care is administered, so long as the system isn’t run for a profit, is universal, avoids long waiting periods for new arrivals (so you can move without losing your health care) and gets audited annually. Ontario has almost all its hospitals run by not-for-profit boards rather than a government agency, and clinics can be privately run but publicly funded to whatever extent the province desires.
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It’s hard to see how the act restricts provincial control over health care, unless the provincial government disagrees with universal access or prioritizing need over income for critical services.
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A province could easily introduce significantly more market-based delivery mechanisms without violating the act, so long as it copies Europe. The “Bismarck” model involves sickness funds made up of compulsory insurance from not-for-profit providers, which is regulated to act like a public health provider. The government supplements the sickness fund to ensure universal access without crushing medical debt.
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So long as the sickness fund is regulated by a public body with the same universal principles, Alberta could allow not-for-profit insurers to compete with one another to feed into a provincial sickness fund. That wouldn’t require opting out of the Canada Health Act.
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Introducing more for-profit private insurance into Alberta would violate the act — if the Alberta government wanted to do that, Question 8 would be a necessary first step. But in addition to such a move going against the government’s pledge to protect the public health-care system, introducing for-profit care would be a disaster.
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The United States is one of the few developed countries where for-profit providers dominate health care. The Commonwealth Fund repeatedly ranks the U.S. last, or near last, in health administration, efficiency, equity and overall health outcomes. The U.S. doesn’t even have the lowest wait times among the OECD for GPs or specialists, being beaten by countries such as Germany, Switzerland and the United Kingdom. This is despite the United States paying twice as much per capita as comparable countries, a quarter of which is due to administrative overhead from for-profit insurers.
