Smith’s health-care guarantee goes against her own basic plans and convictions

Premier Danielle Smith needs Albertans to believe she didn’t mean many things she said in the past. Her voluble history is a serious danger to the UCP in the coming election campaign.

This forces her to govern against some of her own core beliefs. The most striking example came this week, when she announced the UCP’s “Public Health Care Guarantee.”

The question will be whether voters believe what she says now, or what she said before. It’s a toss-up, frankly, because she was so specific and passionate about her earlier prescription for user-pay health care.

On Tuesday, the premier said: “The UCP is committed to all Albertans that under no circumstances will any Albertan ever have to pay out of pocket for access to their family doctor or to get the medical treatment that they need.

“It means that a UCP government under my leadership will not delist any medical services or prescriptions now covered by Alberta health insurance, no exceptions.”

She repeated this several times, topping it with: “Rest assured, you will never use a credit card to pay for a public health care service. You will only ever need your Alberta health care card.”

To make the point, the premier stood beside a big sign showing the card most of us carry around.

Smith said the NDP is “lying to Albertans” and engaging in “fear and smear” when they accuse her of threatening universal public payment.

But Smith herself sowed some of that fear with great conviction, and not just in throwaway lines on talk radio.

She wrote it all down in a 2021 policy paper for the University of Calgary. Her full article was published along with those of other participants under the title Alberta’s Economic Future.

I wrote about this last November but it’s even more pertinent now, with her new promises and an election at stake.

Smith’s article outlines her belief that business has the solutions for society, that Alberta bureaucrats are lazy and incapable of reform, and — most crucially — that services should come with cost to Albertans.

Her section on “User Fees” starts with this declaration: “We can no longer afford universal social programs that are 100 per cent paid by taxpayers. That is the simple truth.

“Taxpayers do not want to throw more money at an inefficient system. Public servants don’t want to reform the system from within.

“The only option is to allow people to use more of their own money to pay their own way and use the power of innovation to deliver better services at a lower cost.”

She called for a patient-focused system “that has to shift the burden of payment away from taxpayers and toward private individuals, their employers and their insurance companies.”

Then she explains her plan to prepare the public, through health-care spending accounts starting with $375 per person per year.

“The benefit of a Health Spending Account is that it allows people the means to pay for services that are uncovered and largely preventive — massage therapy, physiotherapy, dietitians, prescriptions and so on,” Smith wrote.

Then came the real point: “But once people get used to the concept of paying out of pocket for more things themselves, then we can change the conversation on health care.

“Instead of asking, what services will the government delist, we would instead be asking what services are paid for directly by government, and what services are paid for out of your Health Spending Account?

“My view is that the entire budget for general practitioners should be paid for from Health Spending Accounts. If the government funded the account at $375 a year, that’s the equivalent of 10 trips to a GP, so there can be no argument that this would compromise access on the basis of ability to pay.”

There would be plenty of argument, actually, from people with serious illness or complex conditions.

The real point here is Smith’s health spending accounts would groom the public for private payment.

She now promises that the accounts would not be used for doctor’s visits, only for unlisted services.

But she has not abandoned the original idea. Health-care savings accounts are coming.

Originally, Smith envisaged people topping up accounts with their own cash, and companies and non-profits pitching in with contributions.

In her view, the effect of these accounts stretches to an overhaul of health insurance.

“If we establish the principle of Health Spending Accounts, then we can also establish copayments,” she says.

Albertans would face a deductible before receiving free care, on the same principle as your car insurance.

Now she promises that no Albertan will ever pay for anything. That’s not what she believes, unless she was making up everything in that U of C paper.

Politicians often govern against their own wishes for electoral reasons. They adjust to reality. Maybe voters will accept Smith’s big switch.

But rarely has a premier set down core beliefs and actions so vividly, and then promised the exact opposite 48 days before an election.