SPECIAL EPISODE: Starting pistol/Yiu's out

This is a Strategist special episode. My name is Zain Velji. With me, as always, Corey Hogan, Stephen Carter. Guys, look at us. We're dressed in very different ways. Very,

Very, very different ways, yeah. I'm

I'm wearing a winter coat indoors.

Stephen Carter's wearing flannel, and Corey's wearing a tie. My mountain

mountain man shirt. My mountain man

man stuff. Yeah, there you go. In case

case I have to go outside.

It's going to be great. Should we tell people what this is, Corey?

I think they know it's a podcast.

Yeah. It's a podcast for 70-some people now. So as of recording, this is a podcast for 70-some people. We promised nothing. Let's be clear. We promised nothing. But we said sometimes we might do special episodes. We might do special experimental conversations with things that we find intriguing. Well, I think there's one happening right now, just this afternoon, just earlier this morning, I should say, Alberta News. Corey, Dr. Verna, you out as president and CEO of Alberta Health Services.

Yeah, seems fairly abrupt, especially given that her contract was just renewed a year ago for two years. And there has been confirmation of severance, which is generally confirmation of somebody got fired. Or got quit. Guys,

I think I'm the expert in this field.

carter carter will let you take it from here please yeah

yeah i mean generally speaking when you don't want to leave and they want you to leave they will often offer you a significant amount of money to enhance your experience of leaving which

which is why we went with a patreon we're trying to get the war chest to get steven to leave

leave big enough to bring in grenier that's what i'm told yeah fucking

uh carter i'm gonna get you to comment on this uh what did you you make of this is this just a casual letting go of an executive or is this something more something deeper where are you thinking and where are you going with this i

i don't think there's anything casual about letting go the ceo of alberta health services talk to folks

might not be in alberta about the gravity of this what

ahs is the consolidated model like why is this important now many

many other provinces have health regions and alberta used to have a health region system as well. We started off with dozens of health regions, and then we wound up with eight.

I think it was eight, might have been seven. And then Ron Leipert, who many may know as an MP from Calgary West, was the health minister when he was in MLA. And he squished them all together into one health region that was designed to make things more efficient. And I'm not sure that it has made things more efficient. But nonetheless, instead of having multiple health regions, We have but one. And so when we when we're talking about, you know, the CEO, the president of Alberta Health Services being fired, we are talking about literally the person who is responsible for delivering all health services, all publicly delivered health services across the entire province. So it's a big deal. It's a big deal. This person is really second only to the deputy minister of health and in many ways, much more powerful than the deputy minister of health, because they are actually delivering the frontline health services that, you know, everybody across Canada has come to expect from the services. services.

Corey, before we get into what it politically could mean or what it does mean from what we read thus far, anything to add to what Carter said about the role and its structure and its importance overall to government? And I guess I say government because health is such a big line item in

in our overall provincial budget as well. It's by far the biggest. It's not even close. Carter's right. There's nothing casual about letting go of the CEO of AHS. It's probably probably the most impactful public sector job in the entire province. I say that without a sense of hyperbole. AHS, because of the way it was constructed, and because it is the one health authority for Alberta, it is one of the biggest employers in the country. It has hundreds of thousands of employees. It is deeply involved in the operation of our healthcare system. I disagree with Carter. I think, by and large, it is very efficiently run, and it has proven It's proven its efficiencies time and time again. And I think a lot of where Alberta had fewer stumbles at the start of COVID have to do with the fact that we were able to marshal resources like ventilators more readily through a central health authority. So, you know, it's done the thing it's supposed to do. Now, the thing it's supposed to do, however, is drive efficiencies in the system, and we are seeing in COVID times that running in a system incredibly lean under like Six Sigma-style protocols

is not necessarily all great because if you run it lean, you don't have the slack, and when you need the slack, it isn't there. But one of the things that I think that we've got to throw on the table very quickly is it's very unlikely this is about – well, in my opinion, I'm sure there will be all sorts of stories leaking out. But if I fall on my fucking face here, it's only in front of 74 people, right? The

least important 74, I'd say. Thank you for subscribing.

78 right now. Oh, man. Going

Going up as we talk.

talk. As we speak, yeah.

Alberta, they said, probably has a lot more to do with where Alberta is planning to go with health care. And certainly you saw some lines dripped out by the Minister of Health, Jason Copping, on that. He said, hey,

hey, change of leadership, not us. you know don't look at me waving hands he said but but this will speed up government plans to revamp the health care system and those plans do include contracting more publicly funded surgeries to private facilities in

his words in an effort to cut wait lists uh but you know frankly this is more about private delivery and health care now you can get into the arguments for and against and we've talked on this pod about the fact that health care is not is

is not um it's not as public as people think, I think, in their hearts when they wear their Canadian flags on their backpacks, go around Europe and think about our socialized medicine. The reality is different and messy and complex. And health care is a big bucket that includes everything from chronic care to, you know, getting your prescriptions filled for birth control to I broke my leg and, you know, everything in between and beyond. So but this does seem to be a signal change is a common and there is reason to at least suspect that Dr. Yu was not necessarily on board with that change.

Carter, do you read it the same way?

I do. I mean, there's been other signals as well. There's been other pieces of the puzzle that have been described, like how many intensive care units are we supposed to have? How are we supposed to deploy our frontline services, our frontline doctors in emergency and all of that? And ultimately, that's the big choices. We have been making choices that move us away from hospitalization.

uh but then you see governments push back against that i mean they the cancer center has been recently constructed in the south calgary hospital both of those are examples of big investments in health care that were kind of questioned at the time how much health care do we need to have in hospitals when it's so much more expensive to deliver health care in hospitals and there's been debates around the ideology or the philosophies of health care for for a number of years. You know, I'm a big believer in primary care, right? The more primary, the easier primary care is to deliver, the better off the healthcare system is. But then, you know, you get hit by a car and you don't need primary care. So you think differently about the system, depending what it is, the thing that you're looking for, and how you're experiencing the system. So it is hard. And it's not just us as consumers of the system that are thinking that way. It's also the people inside the system so if you ask because it is such a diverse thing right you will run into people who talk only about the long-term um you know long-term housing issues around home around around uh you

you know aging in place and those types of things those people are talking about the same system as as when we have to take our kids into the children's hospital with a cough it is all the same system and depending on how you know it is really the blind men describing the elephant elephant um problem because it really does matter which section of the of the system you're interacting with hogan

hogan i i mean carter is exactly right and and there are a lot of views about health care and and good people can disagree about what makes a good health care system does tend to be very personal depends on what you've had to deal with in the past but what i think we need to underline here is that in all likelihood this is a bit of a starting pistol in terms of additional changes in healthcare. The CEO of AHS has an important job. You can imagine that being deeply tied to the idea of contracting out Alberta Health Services activities, and more to come. And by the way, like the government has not been shy about wanting to have more private delivery of healthcare. This is in some ways something that was in train in 2020. And then COVID hit and sensible views prevailed that said this is not the time to dramatically overhaul healthcare. But there's been contracting out of services such as laundry. There's been contracting out conversations around, you know, testing, going

going the opposite way of what the NDP created of Alberta Public Labs, which became Alberta Precision Labs, which in itself is a signal, I think is fair to say, about where we're all going with this. so uh people shouldn't see it just as a staffing issue it's not it's never just a staffing issue with a role of this seniority and when you consider the context and the fact that this contract was renewed as recently as a year ago yeah i'm sure there were some some raw situations around covet 19 but this is going to have a significant ripple throughout health care and you know stay frosty if you don't like it and if you do i mean i'm sure you're just rubbing your hands with Lee.

Carter, I got to ask you about this to what Corey just said, the wisdom

of this government doing this so

so openly, not being shy about it to what Corey said and doing it on the heels of a pandemic. Is this wise? From like a wisdom perspective? I know it's ideology. And I know it's what they believe. But talk to me about the political wisdom of trying to do this right now.

was struggling with that. Because you know, we have an election within in the next year or thereabouts, depending on, you know, there's I think there's three windows for an election. We're supposed to have it in, I think, late April, mid-April of 2023, you

you know, so a year from now. But do

do you want an election that's going to be combated over health care and health care delivery and everything that that means? So the public-private debate, I think, has been a total disaster in Canada, right? Because we fight over the idea of public delivery or private delivery. And the truth of the matter is that so much of the system is already private. I think it's the wrong question. I think the question really should be, do we have the access that we desire, right? Do we have the access and do we have the fullness of the coverage? You know what the Trudeau liberals are talking about with with pharma care and dental care? Do we have something that is comprehensive enough to actually matter? So comprehensiveness and access, I think, are far two better questions to be asking. But I don't get to set the questions. The people of Alberta, the people of Canada have taken it upon themselves to argue that private care is in some fashion a lesser form of care. And it is one of those signals to different groups within the political system. If you signal that you are moving towards private care, then one side of the spectrum moves towards you and another side of the spectrum moves away from you. And which side of the spectrum is larger? larger i

mean i don't i don't have the polling right now but if for the longest time um private

private was seen to be a problem you know ralph klein tried a big privatization ralph klein when when he was king ralph in alberta tried a private privatization model and he was uh he had to pull it i think it was called bill 13 as i recall it was a uh one of those lucky number scenarios so So he's, you know, this could be a very good play for the Jason Kenney government. And let's be clear, it is a play by the Jason Kenney government, not the board. Despite Minister Copping's denial, this would never have been done without the approval of those above.

Do you feel like, Corey, that the UCP can successfully change the question here using Carter's terminology, terminology, that this can actually be a more nuanced question between the raw, raw public and the yes, private, to the more nuanced of private delivery and the access and comprehensiveness questions, which we perhaps don't ask enough versus the more binary lines that this conversation usually falls on?

Yeah, well, your first question was, is this a bad time to try to do this? And I'm not sure it is a bad time. And this leads into the answer of the question you just asked me. I don't think it's necessarily a bad time because COVID has given us a bit of health care fatigue and also identified a number of challenges in terms of we've had months of reporting of being at capacity for ICUs, beyond capacity for ICUs, at capacity for hospitals, beyond capacity for hospitals. And that will fundamentally get people asking questions. So if you're the UCP, and you want to go in and make some big changes, you can frame it as Yeah, we want to create additional capacity still publicly funded, but we're looking for other ways we can deliver it novel forms of delivery that will allow us to have slack for challenges like this. Now, is it all a lot of bullshit, by and large, but you know, it becomes a healthcare challenge, it becomes the problem that you're going to try to solve. One of the things that right-wing crusaders on privatization of health care have often run into is people are, by and large, pretty happy with their health care. They're happy with their individual, you know, they might gripe about components, but they like their health care providers. And so when people start to rock the boat, when they try to do it through contract negotiations, through outsourcing, any of those things, people say, whoa, slow the fuck down. I've got health care access right now. Yes, I understand there are problems getting my knee surgery, but I generally like my primary care. if you have it, all of those things. But now the UCP has been presented with a problem to solve based on the last 12 months. And that is an opportunity if you're on a bit of a crusade to change the healthcare system. I agree with everything Stephen said about the real questions are about, you know, access and coverage. But I also think we have to acknowledge that arguments about access and coverage have often been the thin edge of the wedge to bigger changes that that actually damage access and coverage. So people will say, yeah, no, I mean, really, this is just about giving more access and filling it open. But it's a bit Orwellian because that additional access is access for some, you know, and then the access suffers for others. And that's the anxiety about two-tier health care. If the rich can just pay for better health care, then everybody else is sort of in a system that may be bled out by people who are less interested in funding it properly. And so the suggestion that we all have the same health care, doesn't matter if you're a billionaire or a pauper, is one of those fundamental things that might not be in the Canada Health Act in those words, but is a feeling that Canadians carry very heavily. And so it's going to be interesting to see where this goes. Carter,

Carter, I've got a question for you. Before I go into what should staunch defenders of the public health care system do overall, let me actually pare that down. What should staunch defenders of the public health healthcare system do today?

If they buy into Corey's argument that this is a starting pistol, that there's today, all that happened is that a CEO got fired. Okay. And

And you're now reading the tea leaves. Now, of course, there's more that this government has telegraphed, has put on paper, has put in a throne speech. I get it. But the action that happened today was this, that a CEO whose contract was recently extended less than a year ago, was fired.

What's the role of an an organization, whether it be political, let's just throw out the Alberta NDP, whether it be a union, the HSAA or others, whether it be a, you know, an organization that cares about public delivery of the public system, what are they doing, Carter, today? What would you advise them from a strategy perspective today? And then we'll zoom out to what does this mean for their broader plans? But what would you do today when you saw this?

Well, if I were the unions, I'd get ready, right?

right? I'd get ready for some sort of battle of some sort. I wouldn't start the battle before I i knew what the battle was about uh wait and see what's going to unfold but you know get get ready batten down the hatches you know understand what your messaging is get some polling into the field um see what canadians are or what albertans are concerned about if i was the ndp i'd be careful um the ndp were recently government and uh are hoping to become government again in the future i know i for one paid for my private mri when i separated my shoulder mountain biking because i I was outside and that was during an NDP government because the NDP didn't take action on the two tiers that we have that exist in radiology and tests. So they didn't take action on that. So they're somewhat susceptible to having been part of the issue in the past. I think that they need to think about where they want the health care system to go as as opposed to just simply criticizing where the UCP are taking it. I was on the radio this morning and I said, you know, this is the time for the NDP to be behaving as the government in waiting instead of just simply the opposition. And this is a great opportunity to remind them of that. This is actually a time for you guys to be talking about what you would do in government, not

not just critiquing what the UCP's action has been today.

just hope one of the 74 patrons is uh patrons

patrons it's patrons and it's 79 i imagine by now no

no it's i feel

feel like that we

we are just oh my goodness oh my

we are on fire

evening rush cory uh cory groups that that uh more broadly right whether it could be a political party or just groups unions staunch defenders of public health care what are they doing today from a strategy communications perspective when they see this this well i

i guess i would say for the start i hope that today wasn't the first time they thought about where this was all going the ucp government even before they were the ucp government when they were just the united conservative opposition you remember their big health care guarantee a

a united conservative government is committed to maintaining or increasing health spending and will maintain a universally accessible publicly funded health care system this was their guarantee well the words they didn't say were very telling there right and and it was the publicly delivered component that was most obviously missing and just the choice of words laid into this this has been a long time coming so uh it's time to dust off those plans make sure that you're activating the phone trees i hope you've been building the list that you've been building over the past bit and saying okay we're now on and applying pressure to the board on these important decisions that are going to be made around the hiring now no board's going to like that and they're going to say that's not necessarily appropriate or whatnot not but this is this is choice one so make your voice heard so i'm

i'm clear you would suggest advocacy to the ahs board on their new hire

hire is that correct for fucking sure i would i would be looking at how the hire was being done and i would be leaning in and saying we want commitments that this is somebody who is committed to a public health care system and and getting a little bit noisy about it now they're never going to say yes we heard you and we're going to fight that but you can rattle a few and you can make them feel like okay we've at least got to consider whether this this individual has a background supporting public health care or not, or else things get extra noisy. And even if you're just starting to nudge it more back in that direction, that's a moderate win, but it's a win to consider in this particular context.

Carter, any tactics you would consider right now if you're a staunch defender of the public health care system? Corey threw out one around advocacy to the board regarding the new CEO. Anything that else comes to mind short

Well, he also mentioned list building.

And, you know, list building is super important. You know, you have to have people ready to go. I mean, we're watching the ATA do their ditch the draft stuff. I mean, all of that is hinged on having lists of people that will actually take action for you. And I do think, you know, even when we were mentioning how big the protests were, you know, like how big the political gathering for the UCP would have been in relation to big protests. I do think that the Bill 13 protests of the mid-1990s, mid to late 1990s, were some of the biggest protests that we've seen in Alberta

Alberta history. This could be a major rallying point for both the unions and the NDP as they move forward. Just get your list. Don't launch something that fizzles, right? This is the big problem with all of this stuff is if you don't have everything ready, if you don't have all the things in place, then you launch it and it goes and no one and then all of a sudden kenny's got a free pass yeah

yeah you're actually signaling the opposite when you when you take a swing at somebody and you miss so badly and your pants fall around your ankles in the process right which is what we've seen on a couple of these initiatives lately by opponents so it's the old it's a version of if you come at the king you best not miss and if if you're trying to show that you are strong and that the public is with you and you stand up and nobody's behind you well guess what you've actually just signaled here year you were better off not making any move whatsoever so back to lists the question i think that groups like let's just say the ahsaa maybe even the ndp need to ask is can you get 100 000 people to tell the ahs board the next ceo needs to support public delivery of health care can you get shock and awe numbers going here and you probably want to do your list building in two stages if you're not 100 sure one is get them on your list see how big that list is send it to the ceo now Now, that's actually very difficult to do because that two-step process people are less likely to do. And you might just need to kind of cross your fingers and go, but you better have a sense you can do it before you do it if you're taking an action like that.

Where are you guys, and now that we're into like campaign strategy, where are you guys involving physicians and nurses and others who are part of the healthcare system in the mix? We've seen a lot of them during the pandemic. I shouldn't say go rogue, but they've been their own brand, right? They've been their own thing, many of them, that they're known to the media. They're speaking out on COVID. Many of them have been the emergency infectious disease. Where are you kind of bringing in the influencer that is the doctor, that is the nurse, that is the person that's delivering this? Carter, you want to give a go at this first?

Well, first of all, I'm not treating doctors the same. Doctors aren't the same. There are subsegments of the doctor. Amongst

Amongst each other. Yeah,

Yeah, there's like 18 different groups or something along those lines in the AMA. Those groups all have competing interests. So some of those groups are going to be on the side of, yeah, fire her and bring in more private delivery. We love that. Orthopedic surgeons were the ones I had. Or specialists or

whatever. Yeah, I mean, I still remember the guy who I ran into in Edmonton when I was there, Dr. Dick. You'll never forget that name, especially given the way he spoke to me. so yeah I mean the doctors have a different agenda and so you'll find different subsets of the agenda that that you got to go in and and pull around right so I think that that's that's part of it and but the nurses they should all be on board you know this you know this could be really bad for them.

Corey same question for you what are you doing with with doctors nurses those key personnel that kind of usher in a sense of trust authority empathy whatever it is depending on who you are in the audience, how are you using them right now?

Well, obviously, when you rank the trust of various actors within Alberta, healthcare professionals very high, doctors very high, nurses very high. And so they are, in some ways, troops that people will be fighting over. And their mobilization will matter a lot for this issue. And, of course, one of the interesting things about changes to the healthcare system more generally, I can tell you, is government tends to win round one because they can come out in a big way and they can communicate and frame it using the bully pulpit that exists but then people interact with their doctors and their nurses and other health care professionals and rounds two three four and five go to the other guys uh so if you are the government what you want to do is be trying to change that dynamic by bringing first of all the government will try to do this very quickly because that's the way you're you're most likely to be able to do it you're not going to drag this out over six months i assume uh if there's dramatic changes coming uh or certainly that wouldn't be a recommended course of action but uh on the flip side playing

playing for time makes an awful lot of sense for for opponents of major changes as well for those very reasons but all

all of that equation gets broken if you change the side that doctors and nurses are on so if you're the government reaching out and trying to find a few validators on that that, okay,

okay, but again, see my point about it's your doctor and your nurse, so you actually need to get the bulk of them. And playing a game internally is something that is probably a sensible tactic. But to be frank, Zane, I don't think they're going to be able to dramatically move healthcare professionals on these matters, because healthcare professionals have spent their entire careers thinking about these issues.

Carter, last question for both of you, which is what advice do you have for the Kenney government?

Many people are laying what happened today at their feet that this was an ideological move. Of course, this wasn't the board, so to speak, although it was the board. What advice do you have for them in terms of their game plan here with this perhaps being chapter one of it?

I'm going to pick up on where Corey was. Go fast. Go

Go fast. You know, you've got limited time anyways before the end of your government. If you think this is popular, then you've got to push it in. You've got to make it actually happen. And I'm I'm not sure that it's popular, but they are, so they should move. This isn't going to be available to them. I mean, just taking the pain of it without actually moving it, that's

Corey, anything else to add on advice for this government?

I think that's exactly right. But I guess I would add to it, you

you better really want to do this because this could be a giant effing fight. fight. And the UCP government has actually done a pretty good job of closing fights in the past six to 12 months, I would say, finding labor peace, reversing their positions on, to a lesser extent, the curriculum, but they've pulled the most contentious parts of the curriculum, the eastern slopes, they've backed away from asterisk, have they really? Sure. But they've diffused the matters is my point, not whether they've like, you know, faithfully walked away away from it.

To pick another fight on health care at this point in the election cycle is weird, right? Because you might find this is coming to a head just as you're heading to the polls. And is this the ballot question you want if you're the UCP? We say all of the time, if the ballot, in fact, just last episode, I was saying one of my criticisms of the NDP in 2019 is they made the ballot question about oil and gas, because that plays to a UCP strength. You make the ballot question about health care, that plays to an NDP strength.

We're going to leave it there. Our first of our special episodes of The Strategist. Look at this, Carter. Just one second.

We've increased, while we've been on this for the 27 minutes, we've increased our number of Patreons by 10%.

So I'll see you guys here same time, same place tomorrow.

I can't make this a habit, Carter. We can't make it. Unless, of course, something else happens tomorrow. Then we're here. Then we're here. No one knows. We'll leave it there. That's a wrap on our special episode of The Strategist. My name is Zane Belger with me as always, Stephen Carter, Corey Hogan, and we'll see you next time.