Rob Breakenridge: Must we turn health care into another Alberta-Ottawa fight?

NDP leader Naheed Nenshi has plenty to criticize about Danielle Smith's reforms without appealing to the federal government to be a white knight.

Alberta NDP leader Naheed Nenshi, via X.com

By: Rob Breakenridge

It’s been two years since Naheed Nenshi cruised to victory in the NDP leadership race sparked by Rachel Notley’s resignation. The subsequent 24 months have proven much more challenging, however.

Nenshi has not been the saviour or political rock star that many New Democrats were hoping for, and the grumbling has grown louder over underwhelming poll numbers and a perceived lack of political inroads.

However, whether it was Nenshi, Notley, or someone else, there’s still the unavoidable albatross for the Alberta NDP of having a Liberal federal government. The unpopularity of Justin Trudeau and the shock of a fourth successive Liberal win has allowed Danielle Smith and the UCP to keep the focus on Alberta’s relationship with Ottawa.

That hasn’t completely crowded out other issues, though. Health care, for example, remains a top priority for Albertans and folks don’t seem too thrilled with the government’s handling of this issue.

The UCP’s controversial health reforms represent a golden opportunity for Alberta’s opposition to change the political channel to the sort of domestic debates the UCP have otherwise tried to avoid. Instead, though, the NDP leader has made a dreadful miscalculation: He wants Mark Carney to step in.

Even if Albertans as a whole aren’t quite as obsessed with fighting Ottawa as the province’s ruling political class, inviting federal intrusion into an area of clear provincial jurisdiction — especially at this particular moment — is extremely ill-advised.

The issue at hand is Alberta’s “dual practice” health model, which the government is pressing ahead with. It will allow certain physicians to practise in both the public and private systems, with the expectation that they put in a minimum number of hours in the former. This, for now, won’t include family doctors and the Alberta government insists that emergency services, including cancer care, will remain exclusively in the public system.

It’s a modest step, but a provocative one. It does open up the door to faster access to certain procedures for those willing and able to pay.

It’s no surprise that the NDP is strongly opposed to all of this. And even if they can be reasonably faulted for a knee-jerk embrace of a failing health-care status quo, there is fertile ground here for them to portray themselves as the defenders and champions of the public health care system.

Instead, though, the NDP has decided to drag this issue back into the arena of Alberta-Ottawa relations. It’s not outside the realm of possibility that the UCP health reforms were designed to provoke a federal response. Either way, the opposition response must be music to the government’s ears.

The NDP are appealing for the feds to get involved. As Nenshi himself put it, “Today, I sent a letter to Prime Minister Carney, calling on the Government of Canada to intervene under the Canada Health Act and protect public health care in Alberta.”

This is a bizarre and counterproductive strategy around what would otherwise be an issue clearly in the NDP’s wheelhouse

For one thing, the possible federal “intervention” here would merely be the withholding of federal health transfers to Alberta. It’s hard to see how fewer dollars actually benefits health care.

Moreover, it would exacerbate the discrepancy between federal taxes collected in Alberta and the federal spending that comes back to the province. This “contribution” is already enough of a live-wire issue in the separation debate as it is.

The Canada Health Act is basically a set of principles and expectations that serve as the criteria for federal contributions to provincial health-care budgets. A violation of the Canada Health Act is not tantamount to a policy being somehow “illegal” and Ottawa doesn’t get to say “don’t do that.”

This is an issue that is unambiguously provincial jurisdiction. Inviting the feds to trample on that shifts the entire focus of the debate and further exposes what is already a glaring weakness for the NDP and its perceived unwillingness to stand up for Alberta.

It’s also a sad commentary on the state of the NDP that they seem doubtful of their ability to convince Albertans to oppose these reforms. Even in some fantasy scenario where the feds swoop in and force the UCP to submit, the NDP would get zero credit, anyway.

The NDP and other critics of the government have rightly noted that the UCP’s current policy direction is difficult to square with the rhetoric from the last provincial election.

Danielle Smith spoke many times on the campaign trail in 2023 about a commitment to upholding the principles of the Canada Health Act. One of their promises was a “Public Health Guarantee,” promising that no Albertan will ever have to pay for a doctor out of pocket.

Smith even accused the NDP of fearmongering on this issue and committed that under their plan, “no one can jump the queue” and “no one can pay out of pocket.”

Smith wouldn’t have made such promises in the first place if she didn’t think it was what Albertans wanted to hear. It’s up to Alberta’s opposition to highlight those broken promises and to highlight the potential risks of these new reforms. It probably also wouldn’t hurt to offer a credible alternative vision for how to address the many challenges in the health-care system.

Ottawa can still choose to wield the club of the Canada Health Act, but that should be a last resort. Provinces need the flexibility to explore different possible health-care-delivery models. Many of the same problems of delays and backlogs exist right across the country. An approach of “cooperative federalism” would respect that.

The voters still have the ultimate say, whether it be in Alberta or any other province. Let’s trust them, and respect the jurisdictional lines. It’s unfortunate that Alberta’s opposition isn’t willing to do so.

Rob Breakenridge is a Calgary-based podcaster and writer. He can be found at robbreakenridge.ca and and reached at rob.breakenridge@gmail.com

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