‘Nuke and Rebuild’: Will Premier Smith’s Plan to Reform Alberta’s Health System Work?

The South Health Campus hospital in Calgary in a file photo. (Jeff McIntosh/The Canadian Press)

The firing of Alberta’s health board and appointment of a sole administrator by Premier Danielle Smith is seen by some as a welcome sign of a much-needed overhaul to the province’s health system, while others say putting such a weighty task on the shoulders of just one person could be a recipe for failure.

Dr. John Cowell, who had a previous stint as Alberta Health Services administrator, has been charged with improving emergency medical service response times, decreasing emergency room wait times, reducing wait times for surgeries, and developing long-term reforms through consultation with front-line workers.

Susan Martinuk, a researcher and author of “Patients at Risk: Exposing Canada’s Health-Care Crisis,” believes Smith is on the right track.

“She has listed the major problems—like we all have—without giving solutions. Sometimes nuke and rebuild works. Sometimes it doesn’t. The best thing is that it is change! That is what is needed,” Martinuk told The Epoch Times in an email.

“First, do what is necessary for patients on the waitlists to get treatment. Payments should reward hospitals for treating patients. Current global budgets encourage hospitals to treat fewer patients.”

Dr. Herb Emery, former research director and program director of health policy at the University of Calgary’s School of Public Policy, believes the task is too great for one man.

“It doesn’t matter who Smith appoints, and I have no clue why Cowell would agree to do it. He can’t possibly succeed,” Emery said in an interview.

“Dr. Cowell may prove me wrong and fix everything, but I have never seen someone set up to fail so badly as Dr. Cowell. If he can pull this off then he will be a legendary hero in Alberta and Canada, rather than another guy who did his best and got burned by the health-care dragon.”

Cowell, who will have two staffers working with him, has said he expects to begin seeing results in six months.

The time frame and scale of the health-care system impede Cowell’s chances, says Emery, currently a professor of economics at the University of New Brunswick.

“The system is too big and heterogeneous for any single body, let alone person, to operate and manage it. Any time you make a major change in an organization, you need 12 to 18 months for the new structures to even be operationally functional,” he said.

“To make this big a structural change in the final year of a mandate, where re-election and continuity of the new structure is not assured, means it will be really hard to get buy-in from the overwhelming number of groups of stakeholders, care providers, and voters over the next year. People who don’t like the way things are going can lay down tools, not participate in the effort needed to ‘fix things,’ or even campaign against the ‘fixes.’”

‘More Than Cautiously Optimistic’

For his part, Cowell thinks the structure of his role and existing investments in health care give him a good chance.

“[I’m] more than cautiously optimistic we’re going to see real results. Six months is as much time as you need, and you couldn’t do it in less to see meaningful change. But I think the winning conditions are now in place,” he said at the press conference announcing his appointment.

“The fundamental changes are so well organized and so thought through that all we really need to do is accelerate it. … We’ve got a chance here because the supply side is far more robust than the demand side is demanding.”

During Cowell’s career, he was CEO of the Health Quality Council of Alberta, president and CEO of Alberta’s Workers’ Compensation Board, and for more than 30 years was a clinical professor at the University of Calgary’s Department of Community Health Services.

In February, the 78-year-old fractured his knee during a bicycle accident. He was taken by ambulance to emergency and later to surgery, and spent eight days in hospital.

“I don’t recommend you try it, but it’s one heck of a good way to find out what you’re up against,” he said at the press conference.

Ian Madsen, senior policy analyst with the Frontier Centre for Public Policy, believes more fundamental changes are required.

“I am not sure that rearranging or restructuring administration of the health bureaucracy will change much,” Madsen said by email.

“Ideally, the whole system would be scrapped, individual Albertans would be given health insurance credit and buy their own private insurance coverage. The hospitals, clinics, diagnostic firms, and physician practices would all be private sector and all procedure prices would be fully publicized and competitive. Various entities’ names above could go public and raise capital, if their current funding is insufficient,” Madsen said of the changes he believes are needed for a thorough revamping of the system.

“If similar things can be accomplished within the current system, I would be pleasantly surprised.”