The Perfect Gift

Posted on August 21, 2011 by susanonthesoapbox

What’s the perfect wedding gift for your little sister?  The one who’s been married twice and waited 10 years before she decided she was ready to take the plunge again?  I’ve been pondering this question for weeks and time is running out, the wedding is this Saturday.  It will take place in my back yard, ahem, tiny little garden.

Wedding day minus 5:  Bride and groom arrive at the airport.  Bride and I are so excited to see each other we walk into the men’s washroom and don’t realize our mistake until we spot that man by the urinal!  Bride is happy that the wedding preparations are well in hand.  Groom has a horrendous ear infection and is verging on comatose.

Wedding day minus 4:  Bride and Groom visit the Registry office and pick up a marriage license.  The clerk makes them promise not to spindle, fold or mutilate the license which he then shreds in the printer.

We stand in the back yard, ahem, my little garden, squinting at the sun trying to figure out how it will angle over the eaves so that we can settle on the perfect placement of the bride and groom.  We haven’t quite figured out how to pack 25 guests on to our tiny patio but are convinced it can be done.

Wedding day minus 3:  Groom cracks and we take him to the walk-in clinic—for his ears, not nerves.  He receives treatment, antibiotics and ear drops and is slowly recovering.  We go to the airport to pick up Mom and Dad.  They’re 84 and I am amazed yet again at how tiny and frail they look.  Our plan to rent a vehicle at the airport in order to pick up another sister and her children an hour later falls apart because there are absolutely no cars to rent other than the SUV for $199/day!  We take the folks home in a town car and leave the men with the family car to wait for my sister and her kids.

By now every spare bedroom is packed with relatives, everyone is talking at the same time, the children are laughing and the dog is exhausted from trying to keep an eye on us all.  The big question preoccupying us all is what to throw at the bride and groom after they’re wed—confetti?  No, it’s impossible to get out of the lawn, even with a shopvac.  Rice?  Doesn’t it expand in birds’ stomachs and make them explode?  If not rice, what about rice crispy squares—OK now you’re being silly.

Wedding day minus 2:  For some reason the soles of my father’s dress shoes fall apart and we’re off to the mall to buy extra wide shoes.  (My mother’s slippers also disintegrate—I have no idea why).  The skies opened that evening and hail stones pelt the back yard (ahem, garden) pulverizing the annuals.  The Groom’s two sisters and their families arrive and check into a nearby hotel.  Groom is on car duty picking up and dropping off assorted relatives.  Groom is a very patient man.

Wedding day minus 1:  My husband announces he’s put out his back hauling the Party Time china, cutlery and stemware into the house.  Luckily the Groom is fine.  Dad got stuck in the soaker tub—at 84 it’s a bit tricky hauling yourself out of there I guess.  I take the parents, one sister and her kids and my daughter to the Zoo (the real one, not our household) to get us out from underfoot while my husband and the Bride prepare the rehearsal dinner.   Not a moment too soon either as Dad is instructing my husband on how to make jamabalaya (this from the man who just recently figured out how to fry an egg).  The Zoo is delightful, but we lose Dad temporarily when he stops to take off his sweater and is swallowed up by the crowd.   Meanwhile the Groom makes yet another trip to the airport to pick up more nephews and girl friends.  Exhausted from the Zoo, we return to the madhouse.

Wedding day:  We set up the banquet table which spans the dining room and the living room.  I send everyone to the mall while I set out the Party Time china, stemware, cutlery and linens—everything looks terrific.  My husband and I pick up the Crave cupcake/wedding cake.  It’s gorgeous but huge.  A quiet calm descends upon the house as we all sneak off into our own little corners to get ready.

Finally the guests arrive, the Marriage Commissionaire is ready and we begin.  The Groom surprises everyone by getting down on one knee to propose “properly” to the Bride.  The women daub their eyes and the men are speechless at the sight of such gallantry.  The garden is warm and sunny, the old folks are sitting in chairs, the young ones are standing on the grass and everything goes off perfectly.

After the ceremony, everyone mills about getting acquainted.  I make a last minute check of the dining room and discover to my horror that the little bride and groom who were perched on top of the wedding cake have slid off…the brides’ head is resting on a ledge behind the sideboard, the little groom is clutching a headless torso but is none the worse for wear (well except for his thumbs which have also disappeared).  Oh my god!  How do we tell the bride?  My youngest daughter whips into action.  She has a glue gun at home and speeds off to her apartment to get it.

Meanwhile the Bride, blissfully unaware of the drama playing out in the next room, puts her arm around me and tells me that “everything is perfect, absolutely perfect!”  I have to tell her…so I gently lead her into the dining room to show her the carnage, and she bursts out laughing.  Soon my daughter is back, glue gun in hand and the little bride is back where she belongs, in the arms of the little groom who is up to his knees in chocolate icing.

The wedding dinner is perfect, the after party in the garden is perfect and by midnight everyone is unconscious in bed.

*****

So what’s the perfect wedding gift?  It’s something that I don’t have the power to give—it’s the gift of health.  In that tiny garden I counted 1 stroke, 2 cases of cancer, 1 pnemonia, 4 wonky gallbladders, 1 pancreatic cyst, 4 high blood pressures, 2 rheumatoid and 1 osteoarthritis plus innumerable minor ailments.  And that’s just on our side of the family.  As I watched the Bride speak her vows in a strong clear voice I realized that the only reason that my sister was here at all was because she had a wonderful doctor who recognized a potentially fatal disease and aggressively pushed her through the system before the illness could take her from us.

The “gift” of good health is an incredible thing.  It springs from a combination of genetics and environmental influences.  It can vapourize over night if the government lacks the wisdom to  manage its resources prudently and share them with all of the people fairly—not just those who can afford it.

My gift to my sister is my commitment to continue to fight for good healthcare for all of us.

Wedding day plus 1:  Everyone is heading home.  My parents are exhausted, but held up very well considering their age.  The sisters, their spouses, nieces, nephews, girlfriends and boyfriends have left or planning their escape.  We’re reclaiming the nooks and crannies of our home and poring over the wedding photographs.  It was all perfect!

Photobucket

Posted in General Health Care, Uncategorized | 5 Comments

Zwoz The Wizard of Oz – The Sequel

Posted on August 14, 2011 by susanonthesoapbox

If men are from Mars and women are from Venus then the Health Minister must be from Nix, one of the 4 moons orbiting the non-planet known as Pluto.  The Mars/Venus paradigm is supposed to help the sexes understand each other so we can actually get along.  Well guess what…it doesn’t work in the political context, not even when a tiny little group of women and men go to meet just one man.  Why?  Because that one man holds all the power and the normal rules of engagement do not apply.

Last week I described the WCPH meeting with Health Minister Zwozdesky.  What an eye-opening experience!  When the Zwoz wasn’t bobbing and weaving to avoid the sticky issues he filled the air with political rhetoric.  It was a one way communication with very few opportunities for WCPH to present its views.  Not surprising really, given the Zwoz’s intense need to control the meeting.  At one point he actually raised his hand and shushed one of our members in midsentence. (!!)  We were stunned.  A few minutes later he realized what he had done, patted her arm and said “I didn’t mean to cut you off”.  Nice touch, but way too late.

The meeting was over in 45 minutes and we piled into our cars to debrief at the Highlevel Diner (very nice diner by the way—great strawberry rhubarb pie).  We were unanimous in our view that the Zwoz was patronizing, dismissive and not even remotely interested in our perspective.

So why am I still fuming about this meeting?  Because after being blown off in person—he did it again by email!  (Please bear with me if I go off again into italics and !!! in random places in this post.)

The WCPH decided that the Zwoz needed to hear our feedback on the meeting.  So we sent a follow up letter.  Its tone was professional, measured and honest.  We expressed our disappointment that after 18 months of trying to meet with the health minister he did not allow us to voice our concerns about the new Alberta Health Act or the commercialization of seniors care.  Our frustration over the lack of transparency and accountability leapt off the page with the statement:  “If we had had the opportunity, we would have closed the meeting by saying that “Trust” is a huge issue between the citizens of Alberta and your government”.  In a last ditch effort to focus the Minister’s attention on our issues, we resubmitted an annotated agenda setting our concerns and asked the Minister for a well-considered response.

The Health Minister responded the very next day.  He said he was pleased to have met with the WCPH.  He regretted the fact he only had a ½ hour but as he pointed out before he was busy, busy, busy.*  Then he came to the heart of the matter and said:  “ I did listen carefully” to all of the WCPH points.  He and his 2 staff members took notes “So I have a different version of how our discussion went”.   In other words notwithstanding the unanimous view of the 7 WCPH members who attended the meeting and concluded that the Minister didn’t listen, cut them off and wouldn’t allow them explain their position, they were wrong!  Again!  Not only was the WCPH incapable of recognizing the good work Zwoz was doing on behalf of all Albertans in the area of healthcare and seniors care, WCPH couldn’t even figure out what was going on in a simple meeting.

What this boils down to is a variant of the classic “he said/she said” dilemma.  I listened, no you didn’t, yes I did, no you didn’t, ad infinitum.  In the Mars/Venus paradigm of male/female interaction you can learn how to overcome this stalemate.  The WCPH would say, you didn’t listen and we’re really annoyed about that and the Zwod would acknowledge the fact that we felt like we weren’t listened to (even if he believed otherwise) and would offer to have another meeting where we could review our issues again and presumably this time he would listen.

Unfortunately the Mars/Venus paradigm does not carry over into the Tory political cosmos.  In the PC universe the PC’s have all the power and the citizens have none, so it makes no difference whatsoever whether the Zwoz listened or not.  All he needs to do is grant the public a 45 minute audience, lecture them, throw in a few red herrings and he’s done.

This miserable experience has played out a thousand times with a thousand different citizen action groups and professional associations (including the nurses, the doctors and the teachers) for what feels like 100 years.  But it’s beginning to wear thin.  The public (trusting souls that we are) is waking up to the fact that it’s pointless to try to have meaningful dialogue with Zwoz and others like him whose raison d’etre is not to represent the best interests of the people but rather to run interference while the government moves ahead with its own agenda—be it privatization of public services or the sell-off of non-renewable resources at bargain basement prices.

So what do we do?  We’ll continue to “waste” our time talking to these guys—if for no other reason than to demonstrate that we’re not deceived by their smoke and mirrors public engagement process.  But the better audience for these discussions is other Albertans.  We will share our experiences and educate others, we will find the non-Tory candidates who say they will listen and really mean it, and we will work with them to reclaim the democratic process.**

Then the men from Mars and the women from Venus will pack these Nixonites back off to Nix where they belong.  There they can spend their golden years sitting around not listening to each other.

* The Health Minister said he’d respond in writing to our issues.  I’ll let you know if he does.

**I’d like to thank all of you who contributed in person and by email to this epiphany!


Posted in Alberta Health Care, Politics and Government | Tagged | 4 Comments

Zwoz: The Wizard of Oz

Posted on August 7, 2011 by susanonthesoapbox

It’s amazing what you can learn about a person in 45 minutes.  After 6 long months the Whitemud Citizen’s for Public Health (WCPH)* was granted an audience with the Health Minister, Mr. Zwozdesky.  It’s hard to describe the meeting, although the word bizarre springs to mind.

WCPH hoped to have a meaningful dialogue with the Minister about the new Alberta Health Act, the privatization of seniors care and transparency and accountability.  Instead we were treated to a dazzling demonstration of how the Zwoz keeps the public, the press and the opposition at bay when they ask a difficult question.  Here’s the Coles Notes version of Zwoz’s technique:  start with the political pulpit—describe something, anything, the government has done and hope that this deflects the troublesome question.  If that fails try the conjurer’s trick of misdirection “black is white, you must be mistaken” and as a last resort fall back on the Sgt Schultz response “I know nothing”.**

Here’s how Zwoz used the razzle dazzle technique to dance around our agenda:

The new Alberta Health Act:  We asked why the Act is peppered with phrases which open the door to increased privatization?  Why is the independence of the Health Advocate compromised by making him report directly to the Minister instead of the Legislature?  And why is the Minister given the power to make major changes to the Act by passing regulations instead of bringing these changes to the Legislature?

The Minister popped out of the political pulpit:  his government had made a 5 year funding commitment to ensure financial stability.  Yes, that was wonderful, but it’s not what we were talking about.  Unfazed he moved to misdirection suggesting that our concerns about privatization were based on “rumours” we’d picked up from the leaked paper which set out the transition to the new Alberta Health Act.

This was a shrewd move.  By raising the leaked paper first he was able to reshape it to his liking.  He said the reference to “privatization” (in fact the entire leaked paper) was simply a reflection of the public’s feedback and did not represent the government’s position at all.  Black is white. 

Sensing our scepticism (the leaked paper sets out a plan to roll 5 additional pieces of legislation into the new Alberta Health Act—hardly the kind of thing the public would dream up) Zwoz dropped back to the Sgt Schultz defence.  He was not in caucus the day the paper was presented and had nothing further to say.  Did a rogue government employee take the paper to caucus and get the Premier’s blessing without Zwoz’s knowledge or consent?  It doesn’t matter.  Zwoz knows nothing about it, so drop it and move on.

What about the Minister’s power to make substantial changes to the Act by passing regulations, thereby avoiding Legislative (public) scrutiny?  Zwoz assured us that his power only applied to minor regulatory changes;  substantive changes would continue to go before the Legislature.  Really?  Furthermore, the regulations would be published for all to see.  Lovely, published where and for how long?  Zwoz thought they’d be published for 30 days on the Health and Wellness website but he wasn’t sure.  As far as he was concerned the promise to “publish” a regulation granting him new powers was a fine example of openness and transparency.  The question of whether he should have those powers in the first place was irrelevant.  Black is white.

Privatization of seniors care:  WCPH turned to the government’s “aging in place” policy.  This policy will ensure that seniors get the level of care they need without having to move to a new residence every time the level of care increases.  Sounds fine in theory, but the government has reduced the number of public care facilities in favour of facilities run by for-profit companies.  We illustrated our concern with for-profit facilities by describing the appalling care a senior had received in the for-profit Touchmark facility after she’d left the public Good Samaritan facility.

Zwoz responded from the political pulpit.  He’d build 1100 “spaces” already.  Interesting, but not relevant.  He expressed surprise that the Good Samaritan had provided poor care.  It didn’t and we didn’t say that it did.  The culprit in this story was Touchmark, not Good Samaritan.  Brownie points for misdirection though.

He knew nothing of Touchmark (ah the Sgt Schultz gambit) and added that he was besieged by for-profit companies begging for more money, but he refused to give it to them.   I think he thought this would impress us, but it simply confirmed the fundamental problem with for-profit service providers.  If they can’t make their profit margins by government subsidies, they will raise fees and reduce costs by cutting services.  The result:  staff reductions and poorer quality of care.

Transparency and accountability:  We referred the Minister to a recent article by Frank Work, the Privacy Commissioner, in which Mr Work advised PC leadership candidates not to promise openness, transparency and accountability unless they really mean it, because the voters would actually call them on it if they failed to deliver.  What was his reaction?

Zwoz had two comments.  He wasn’t aware of Frank Work’s article.  Sgt Schultz again.  But when Mr Stelmach took office he swept away the closed opaque regime created by Mr Klein and created the open transparent government we see today.  Classic black is white. 

Okay, let’s discuss the government’s refusal to call a public inquiry and the impact this had on public trust.  Zwoz explained that public inquiries take years and cost millions of dollars, the Health Quality Council of Alberta had everything in hand and would issue progress reports in 3, 6, and 9 months.  Ann McLellan was an advisor, how could we doubt her integrity?  Think about this a moment.  Our question focused on the issue of public trust.  Zwod turned it into a question of time, cost and whether Ann McLellan was biased.  Nice piece of misdirection Mr Minister.

We were now 15 minutes past our allotted time (and ready to throw ourselves into the reflecting pool outside the Legislature).  We thanked the Health Minister for his time and asked to come back another day to continue the conversation.  He stopped short of saying are you kidding me?  Instead he pointed out that he was a very busy man.  This portfolio was the busiest he’d had in 18 years in government, busy, busy, busy.  Not to put too fine a point on it—we were done.

Mr Zwozdesky is not the Wizard of Oz.  He’s the MC at the Cirque du Soleil.  He’s so busy promoting the party line and the interests of the private sector that he doesn’t have the time nor the inclination to listen to Albertans.  But the WCPH and groups like it all across the province will not be distracted by the razzle dazzle of the performance even when we end up with front row seats.  There is serious work to be done.  If this group of politicians won’t address the issues raised by Albertans, there is someone else waiting in the wings who will.

* WCPH was originally formed by the citizens of Whitemud, but has expanded to include citizens across the province.  It’s a non-partisan group focussing on health services and seniors care.

**For the youngsters in the crowd, Sgt Schultz was a character in Hogan’s Heroes, a sitcom set in a German POW camp.  Schultz was an incompetent oaf who distanced himself from trouble with the classic phrase “I know nothing, I know nothing.” 

Posted in Alberta Health Care, Politics and Government | Tagged , | 10 Comments

Susan’s Eye–and the death of common sense

Posted on July 30, 2011 by susanonthesoapbox

Everyone knows that you shouldn’t put ear drops in your eye, right?  But what happens when your doctor prescribes ear drops for a nasty eye infection, then what do you do?

After 3 days of wondering why the tiny little muscles in my eye felt like they’d been doing bench presses I finally called my doctor.  She was out but another doctor in the clinic could see me right away.  Dr L performed the usual diagnostics, getting up close and personal to blind me with a penlight, poking and proding, and confirmed that I had an eye infection.  He prescribed drops.

Clutching the prescription (which I had not read) and 2 chocolate covered donuts I waited patiently outside of Timmy’s for my daughter Kelly to pick me up.  Without my contacts and in my useless coke bottle glasses I can’t see three feet ahead of me let alone to drive.  Kelly plucked me from the curb and we went to the Co-op pharmacy.  As I loitered behind the red line, ostensibly there to protect my privacy but really there to keep the hoi polloi from stampeding the pharmacist, I finally read the prescription.  “Instill 2 drops twice a day into the affected ear(s)”.  Ears???   

The pharmacist, a charming young woman, was convinced this was an error and called the doctor to sort it out.  Yes, I thought, it must be a mistake, the doctor was chatting with me when he entered the prescription into his computer and we all know that men are hopeless at multi-tasking.  But no, Dr L confirmed his original decision—he did indeed prescribe ear drops for my eye problem.  Hmmm.

The pharmacist gamely went about preparing the prescription while Kelly and I wandered through the deli picking up samosas for lunch and commenting on the old guy eating grapes straight out of the bag and putting it back.  Note to self:  never ever eat grapes without sterilizing them first.

Kelly and I were daring each other to stick an arm in the blood pressure cuff (it’s a machine, what if it won’t stop inflating and nips your arm right off) when the pharmacist called us over.  She carefully explained that she’d never heard of a doctor prescribing ear drops for an eye problem, she’d scoured the internet and found absolutely no examples of this usage, she warned me to be very careful because the Ph balance in ear drops is significantly stronger than what you’d find in eye drops, if I noticed any redness or irritation I should discontinue usage immediately.  All the while her eyes were saying “For god’s sake don’t put this stuff in your eye!”

Slightly unnerved I headed straight home and put that stuff in my eye.  When I regained consciousness…no, just kidding.  After 3 days of inflammation, oozing and goofy jokes from my co-workers—should I speak into your good eye?—I’d had enough.  I stopped using the drops and went to the Richmond Walk-In Clinic.  There I met the wonderful Dr K.  When I told him I’d been prescribed ear drops and actually used them for 3 days he looked at me as if I’d lost my mind.  He tossed the drops contemptuously into the trash and wrote out a new prescription for, you guessed it, eye drops for my eye problem.  I’m now on the mend.

Lessons learned:

  • The “white coat” syndrome is more powerful than gravity…you need to work very hard to overcome it when a situation is going off the rails.
  • Always read your prescription at the doctor’s office and make the doctor explain anything that doesn’t make sense.
  • Even if the explanation makes sense (sort of) pay close attention to your pharmacist, she may know more about medications and how they interact with your body than your physician.
  • When all else fails—use common sense and get a second opinion.

For heaven’s sake, everyone knows that you can’t treat an eye infection with ear drops!

Posted in General Health Care | 6 Comments

The Blue Moon And Its Impact on Oil Sands Development

Posted on July 24, 2011 by susanonthesoapbox

Once in a blue moon something remarkable happens in the world of politics—disparate opinions begin to align.  Last week the Federal government, the Alberta Federation of Labour, Greenpeace and Environmental Defence agreed with former Premier Peter Lougheed:  the pace oil sands development must slow down.

For the last 5 years Mr Lougheed has said that the frenetic pace of oil sands development has created a high cost economy and put Alberta on a collision course with the federal government.  Instead of proceeding with 60 projects at once, Mr Lougheed suggests developing no more than 5 or 10 underground bitumen recovery projects and 1 or 2 surface mining projects at any one time.  This measured approach would create pockets of time (admittedly not much) to examine and address the spin-off effects of oil sands development on the environment, the economy,  infrastructure and social services.

The suggestion makes good sense when you consider that the Alberta government appears to have learned nothing from the last boom-bust cycle.

Alberta had 75,000 oils sands related jobs in 2010.  This number will explode to 905,000 within 25 years.*  Alberta’s existing social services programs (think of healthcare and education) are in tatters.  The government’s ability to provide such services at the level required today, let alone meet the increased demand of the next boom, is utterly inadequate.

Premier Stelmach admits he can’t keep his pre-election promise to diversify the economy by keeping bitumen upgrading jobs in the province.  Bitumen production will double in the next 10 years but only 50% of that bitumen will be upgraded here in Alberta.**The government could insist that oil sands development come with “strings attached” and require industry to build on-site upgraders as part of the approval process.  But it is reluctant to do so.  Consequently the value adding jobs of upgrading, refining and petrochemical production will be created in China and India.

Alberta’s reputation for environmentally responsible development is tarnished—to the point where the federal government announced its own oil sands monitoring plan.  This plan calls for a slowdown in development in order to understand the results of monitoring of air, water, flora and fauna.

The federal government’s intervention in what is essentially the province’s right to develop its resources is the first step in the battle for control of the oils sands.  Alberta’s Energy Minister, Ron Liepert, is trying to outmanoeuvre the feds by creating the Super Energy Board (which consolidates the approval granting authority of the departments of Energy, Environment and Sustainable Development).  He hopes that quick approvals will create sufficient industry support to make feds go home.  However Mr Liepert’s “fast approval” solution is exactly what the feds are worried about—that Alberta is rushing approvals and not acting in an environmentally responsible manner.

The big question is will a slow down kill the golden goose?  Reducing the speed of development will certainly reduce job creation, royalty streams and corporate returns, however this reduction would be offset by tempering the negative side-effects of the boom (environmental degradation and an overheated economy).***

And that’s what everyone was talking about under the blue moon.  It’s time to look at oil sands development from the perspective of all Albertans, not just the oil companies.  Instead of a piecemeal approach to oil sands development we need a long term strategic plan.  The plan should consider the broader social and environmental impacts of development, not just its economic benefit.  The creation of such a plan requires input from industry, government and the public.  Let’s start the dialogue and do it right this time.

* Calgary Herald, July 19, 2011, A7

** Herald, July 19, 2011, A1

*** For an excellent review of the impact of the oil sands industry on Fort McMurray see a paper by Robert James Earley, Disconnect:  Assessing and Managing the Social Effects of Development in the Athabasca Oil Sands, University of Waterloo, 2003

Posted in Energy & Natural Resources, Politics and Government | Tagged , , | 3 Comments

Lessons Learned from the Americans

Posted on July 17, 2011 by susanonthesoapbox

I just returned from a business trip to Washington DC.  It was hot, sticky, confused and angry—hot and sticky because 200 years ago some bright light decided that the best place to locate the capital was in the middle of a subtropical swamp; confused and angry because Americans had finally realized that unless Obama and the Republicans agreed to increase the $14.3 trillion debt ceiling prior to Aug 2, the US would default on its Treasury bonds.  Alternatively it could meet its debt service obligation by chopping social security, old age pension payments and welfare cheques.  Talk about being between a rock and a hard place.

I’m not going to review the arguments in favour of raising the debt ceiling, holding the line or switching to Plan B.  Suffice it to say that this issue has been badly mishandled.  Moody’s and S&P placed the nation’s AAA bond rating on review for a possible downgrade, America’s economic health is now being discussed in the same breath as that of Greece, Ireland and Italy and Michele Bachmann has become the newest darling of the Tea Party.

Compare this to a situation closer to home.  It’s become blindingly obvious that Alberta cannot continue to use resource revenue to cover the 30% shortfall in the cost of public services.  The question is not will Alberta run out of cash but when.  One solution that has surfaced is raising taxes.  The Conservatives have said this is out of the question.  Sound familiar?

Is there anything we learn from the American experience that will help us work through this problem?  Let’s start with a few basic questions.

Didn’t Obama, Congress and the Senate see this coming?  Of course they did.  However anyone bold enough to raise the alarm was no doubt warned off.  Not only is this a complex problem it’s a political hot potato and politicians as a rule would rather keep their heads down and hope that the problem will somehow self correct.

Lesson #1:  A government owes it to its people to identify critical issues early and bring them into the political process for reasoned analysis and debate.  Well, guess what, the Premier’s Council did just that in its May 2011 Report on Economic Strategy, but the politicians, particularly the PC leadership hopefuls, are not eager to address the issue.

Once it became obvious that the debt crisis could not be ignored, how was it communicated to the population?  The government’s communication process is unclear, however international publications like The Economist carried the story for months, but it didn’t hit the mainstream media in the US until recently.  One might argue that the corporate owners of media outlets were simply trying to protect their political cronies, but it is more likely that the media needs time to understand a story of this complexity and reduce it to bite-sized pieces which will catch the attention of the audience.

Lesson #2:  The media relies on its overarching right to publish without state interference.  In return for this right, the media has an obligation to expend the intellectual horsepower necessary to understand and communicate a complex story accurately and effectively.  Or to put it more succinctly—the media must do its  job.  In Alberta’s case, the press gets a tick in the box.  The media presented the findings of the Premier’s Report (as well as countless other reports published by various think tanks) which suggested that increased taxation may be the solution to the 30% revenue shortfall and asked the politicians to comment.  The politicians ducked the question or suggested that it was premature.         

Who became engaged in the debt crisis story once it became public?  Was it just opportunistic politicians or did the general population call their politicians to account?  This is where the US experience gets really interesting.  Some segments of the population became engaged and others did not.  The level of engagement depended on two things; whether a potential downgrade of the national debt could impact their lives and whether they were represented by a national organization that could lobby effectively on their behalf.

Here’s an example.  AARP, a non profit organization for Americans 50 years and older, quickly recognized the potential outcomes of a poorly managed solution to the debt crisis.  In May it sponsored TV ads warning of cuts to Social Security and Medicare.  In June the ads turned derisive (why cut Social Security and Medicare but continue to sponsor pickle research and shrimps running on treadmills).  In July AARP representatives flooded the halls of Congress dropping off “I am NOT a pushover” buttons and reminding congressmen that AARP represents 50 million seniors which equates to 50 million votes.

At the other end of the spectrum is a segment of the population that is utterly disengaged.  The complacent group includes professionals and businessmen who are aware of the issue but don’t have the time or the inclination to give it much thought.  But then again the professional/business class can afford to be complacent.  They have access to decent medical care and certainly don’t expect to be dependent on social security or welfare any time soon.  They are confident that the politicians will come up with a solution in the next 2 weeks because the failure to do so is unthinkable.

This manana world view is a serious concern.  Had this group focused on the issue when it emerged and pressured their congressmen to address it a solution may have been found and the crisis averted.

Lesson #3:  No one can afford to be complacent in the face of a critical issue.  Do your research and make your voice heard, if not for your sake then for the sake of your children. 

Albertans, unlike their American neighbours, still have time to transition out of a bankrupt public service funding model to one that is more sustainable.  But we must start the dialogue now.  We must identify all of the options and analyse them in an unbiased, non-partisan way.  Should we reduce services by 30% so that the non-resource revenue stream will be sufficient?  Should we raise taxes?  Should we generate additional revenue through levies or user fees?  These are difficult questions which will require thoughtful analysis and ultimately buy-in by all Albertans.

Albertans have learned Lessons #1 and #2, now we need to focus on Lesson #3.  It’s time to set aside our complacency and find a solution to the revenue shortfall problem.  That’s the only way to  avoid our own version of a hot, sticky, confused and angry summer.

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Dr Patrick White (aka Rocky Balboa)

Posted on July 10, 2011 by susanonthesoapbox

Dr Patrick White is a very smart man.  He has to be.  He’s is the lead negotiator for the Alberta Medical Association (AMA) which is negotiating a new 3 year master agreement for physicians services with the Alberta Dept of Health and Wellness (AHW) and Alberta Health Services (AHS).  The process is called Negotiations 2011, but it feels more like Rocky I, II, III, IV, V, and VI.  Just when it looks like the AMA might win a round, the pummelling starts all over again.

Let me set the stage.

The Protagonists:  AMA (led by Dr White), the Dept of Health and Wellness (led by Health Minister Gene Zwozdesky) and Alberta Health Services (led by Dr Chris Eagle).  Note: Given that the AHS reports directly to Zwozdesky and is the government’s implementation arm, Dr Eagle and the AHS are merely window dressing in this exercise.

The Plot:  Replace the 8 year master agreement governing physician services which expired on Mar 31, 2011 with a new 3 year master agreement.

The Sub-Plot:  Stelmach and Zwozdesky are peeved with Alberta doctors who refuse to  shut up about the ER crisis, wait times, intimidation, retaliation and just about everything else that pops up in the media so it’s payback time.

Plot Twists: 

  • Zwozdesky threatens to cut 9 key programs which will immediately reduce doctors’ pay by $35,000 unless AMA agrees to sign a new agreement by Mar 31, 2011.  The AMA refuses to be blackmailed into signing.
  • The AMA and AHW/AHS sign a temporary 3 month Agreement in Principle based Zwozdesky’s offer of a pay package of 0% increases for the first 2 years and COLA* for year 3.  Zwozdesky assures the AMA that this offer is the “norm” for all public sector settlements.  Then the Government turns around and gives the AUPE a 4% increase plus 2 lump sum payments totally $3000.
  • Zwozdesky and Dr Chris Eagle attack Primary Care Networks (an AMA success story) casting doubt on whether funding will continue.
  • The Agreement in Principle expires on June 30—there is no new deal, just a transition plan to get to June 30, 2012, and then what…?

Negotiations 2011 started amicably in the fall of 2010, however by Feb 2011 Dr White knew he had a problem.  Luckily Dr White is not only a patient man, he’s also shrewd.  Instead of waiting to be batted around by Zwozdesky, Dr White went on the offensive (which must have been tricky given his close connection to the PC party).  He kicked off a comprehensive communication plan with three target audiences:  the AMA members who were updated on the status of the negotiations in real time, the public through the AMA website and the media, and the politicians who were inundated with emails and telephone calls from doctors and concerned citizens supporting the AMA’s position.

Dr White captured the Premier’s attention (and by default Zwozdesky’s) twice.  The first time was right after the Government announced the 4% pay hike for the AUPE (a shock to the AMA).  The second, when 6 sections of the AMA publicly supported the call for a public inquiry into allegations of intimidation.  In both cases it was in the Premier’s best interests to sooth Dr White’s ruffled feathers and get the AMA back in their corner where they couldn’t do much damage.  The AMA may have been unable to do much about the AUPE 4% pay hike and its applicability to the AMA negotiations;  however it refused to back down when it came to supporting the need for a public inquiry—much to the government’s chagrin.

Along the way we’ve learned some interesting things about the Premier and Minister Zwozdesky.  They are street fighters who are prepared to use bully boy tactics to force their opponent to concede—they had no intention of cutting funding to the 9 programs if the AMA didn’t sign the new agreement by Mar 31.  That was just a “negotiation tactic”.

This raises a more fundamental question.  Can the government be trusted?  What happened to negotiating in good faith?  A 0% increase is not the same as a 4% increase no matter how you cut it.  Threatening to cut funding to the PCN program (which the government’s own independent expert confirmed was an excellent program) is a cheap bullying tactic at a time when cool heads and thoughtful solutions are required.

The AMA has already conceded the 0% wage hike so why won’t it bow to the wishes of the politicians?  Because there are greater issues at stake.  Physicians want joint decision making power to identify and deliver healthcare reforms and improve access, quality and productivity.  Zwozdesky is adamant that they won’t get it.  He fought hard to ramrod changes to the Alberta Health Act through the House.  These changes deliver all the power over healthcare funding and delivery into his hands.  He’s not about to share that power with anyone, let alone the very people who know best how to use it.

But Dr White isn’t finished yet.  Recently he stepped into the maelstrom of politics and healthcare in the context of the PC’s leadership race.  He responded to a request from his friend PC leadership candidate Gary Mar who wanted help shaping his healthcare platform.  Dr White obliged by sending an email to all AMA members telling them about a phone-in townhall meeting at which they could present their views.  This created a furor among some AMA members who saw the email as a tacit endorsement of a particular leadership candidate.

But there’s another way of looking at it.  The Mar townhall meeting presented an opportunity for Alberta physicians to give direct feedback to the man who might one day be their boss, or more accurately, their boss’s boss.  In the business world this is akin to a union taking advantage of an opportunity to enlighten a prospective employer about the working conditions of his employees.  Surely a worthwhile exercise considering that Negotiation 2011 failed and, in Dr White’s words, he’s back to square one.**

However to make this a truly useful exercise, the AMA should set up a series of feedback sessions with all of the PC leadership candidates, not just Mr Mar, and lay out the AMA strategy for curing Alberta’s healthcare problems.  If the leadership hopefuls rebuff the AMA’s request they should be reminded that behind every doctor are hundreds of patients who are desperately seeking quality healthcare delivered in an efficient and timely manner.  We’re in the audience watching Rocky take his lumps and we’ll keep rooting for him until he hits the mat or wins the match.

*Cost of Living Adjustment

**Calgary Herald, on-line, July 1, 2011.

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Musings on Canada Day

Posted on July 2, 2011 by susanonthesoapbox

Have you ever wondered why the American Declaration of Independence reverberates phrases like:   “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness”…words that are so moving that the Declaration of Independence became the plot driver for an action/adventure movie starring Nicholas Cage?  And why the Canadian Constitution is so bland, stoically asserting that Parliament will “… make laws for the peace, order, and good government of Canada, in relation to all matters not coming within the classes of subjects by this Act assigned exclusively to the Legislatures of the provinces”.  The only part of this statute that grabs you is its nickname—POGG (Peace, Order, and Good Government).  Not even an over-the-hill actor like Harrison Ford would be willing to risk his life for POGG.

The reason Canada asserts bland support for “peace, order and good government” and the US demands the unalienable right to “Life, Liberty and the pursuit of Happiness” is found in history and is particularly evident this weekend when both countries celebrate their independence.

Canada Day is a birthday party—a festival of food and music, multi-cultural events, face painting and that Captain Canada guy.  Independence Day is an act of patriotism.  Yes, there is levity and backyard BBQ’s but there is also an element of solemnity which quickly turns to full throated patriotism when the high school marching band leads a procession of veterans from WW2, the Korean War, the Vietnam War and the wars in Afghanistan and Iraq down main street.  The crowd is hushed, the people remember.

Our independence day celebrations reflect our separate histories, specifically how and when each of us disengaged from Great Britain.   The Americans acted decisively.  On July 4, 1776 the US Continental Congress declared that the 13 American colonies were no longer part of the British Empire.  The relationship was unilaterally and irrevocably severed.  Not a surprising outcome given that the colonies had been at war with Britain for over a year.  At issue were Britain’s refusal to allow the colonists to trade with anyone but the British Empire (the increased cost and delays in acquiring essential goods from far flung ports was a continual source of aggravation) and the imposition of taxes on everything from official documents to essential goods like tea and cloth.

After fruitless attempts at resolution, the colonists reacted violently.  Britain sent troops and the War of Independence was off to a bloody start.  The British viewed the colonists as rebels and traitors.  The colonists saw the British as oppressors and invaders.  And the Declaration of Independence was conceived—in the cauldron of war.  It became the battle cry which mobilized the colonies, setting them firmly on the path to independence.

Contrast this with the Canadian experience almost 100 years later.  Unlike the Americans who literally fought their way to independence, Canadians inched toward independence one statute at a time.  As a result we were able to pry independence out of the grasp of a reluctant ruler.  Britain’s first concession was the passage of the British North America Act* in 1867.  The BNA Act united 3 provinces, New Brunswick, Nova Scotia and the province of Canada (which later became Ontario and Quebec) to form the Dominion of Canada.  PEI and Newfoundland opted out.  (Newfoundland, being the contrarian that it is, refused to join Confederation until 1949).

Over the course of the next 60 years Canada continued to negotiate the terms of its independence.  The process culminated with the Statute of Westminster, 1931 which formalized Canada’s independence.  Also along for the ride and adding to the weight of the negotiations were the Dominions of Australia, New Zealand, South Africa and, last but not least, Newfoundland.  Curiously, it wasn’t until 1949 that Canada felt its legal system was sufficiently mature to eliminate the final right of appeal to the British Privy Council.

The final act of independence occurred in 1982 when the Constitution was repatriated to Canada and Dominion Day became Canada Day.  The repatriation was a bit tricky because of the on-going tension between Quebec and the other provinces.  However Prime Minister Trudeau, ever the smooth operator, deftly neutralized the provinces’ objections by watering down the Chart of Rights.**  Yet another example of the Canadian willingness to compromise.

The Constitution, unlike the Declaration of Independence, is a complex instrument, contained not in a single document but in many documents which stretch back over hundreds of years.  It continues to evolve.  A recent example was the recognition of Nunavut.

So back to the words themselves.  Yes, the American Declaration of Independence stirs the heart and the Canadian Constitution is almost antiseptically neutral in tone.  Each document is a manifestation of its unique history.  Our history has led us inevitably to this place—a place of joyful celebration of Canada’s birthday (shared with the Duke and Duchess of Cambridge no less).  America’s history is more troubled and results in a more solemn celebration of the Fourth of July (also the name of a war movie, starring Tom Cruise).   

Be thankful we’re here.  Happy birthday Canada!

*The name of the BNA Act was changed in 1982 to the Constitution Act, 1867.

**Prime Minister Trudeau inserted the “notwithstanding” clause which allowed the provinces to opt out of certain obligations.

Posted in Politics and Government, Uncategorized | 2 Comments

Russian Stacking Dolls

Posted on June 26, 2011 by susanonthesoapbox

We’ve all seen Matryoshka dolls, those wooden Russian stacking dolls that open up to reveal a smaller doll nestled inside.  You keep opening the dolls one by one until eventually you find the smallest innermost doll—a baby doll carved from a single piece of wood, its delicate features carefully outlined by the artisan who crafted her.

For weeks I’ve been digging deeper and deeper into the policy documents which set the stage for the creation of the Ron Liepert’s energy superboard.  I’ve been trying to understand why Mr Liepert is convinced that another superboard, this one focused on managing Alberta’s energy resources, is critical to Alberta’s future.

The Matryoshka doll that is the energy superboard has been superbly crafted, beautiful in its intricacy and sleight of hand.  Open the first wooden doll and you’ll find a Mar 2010 document entitled Energizing Investment:  A Framework to Improve Alberta’s Natural Gas and Conventional Oil Competitiveness.  This study focuses on the relative competitiveness of Alberta’s conventional natural gas, unconventional natural gas (coal bed methane, shale, and tight gas) and conventional oil.  It excluded the oil sands because that sector was performing very well.

The study concluded that Alberta’s competitiveness is enhanced by its stable democracy, a skilled workforce, extensive infrastructure and abundant resources.  However, it warned our competitiveness is now under pressure due to increased competition from BC, Sask and the US.  Apparently, those jurisdictions have stepped up their efforts to attract oil and gas investment by policy and regulatory changes. 

Anyone who reads the trade publications will tell you that changing regulations is not the first thing to hit the radar screen in a discussion about competitiveness.  In an effort to appear credible, the May 2010 report acknowledged the negative impact of the global recession and the fundamental shift in the market which resulted in gas prices sinking from $12/Mcf to $4/Mcf.  However, once the government locked on to the bogie of regulatory complexity, it laid the first stepping stone on the path to the energy superboard.  The report suggested a need for increased collaboration, consistency and alignment within the regulatory system—a small “fix” which could have been achieved without creating a superboard but simply enhancing the existing “one window” approach to funnel applications through the process.*  But that’s not what happened.

Open the second wooden doll.  There you’ll find a Dec 2010 policy paper entitled Enhancing Assurance:  Report and Recommendations of the Regulatory Enhancement Task Force to the Minister of Energy.  A task force led by the deputy ministers of Energy, Environment and Sustainable Resource Development reviewed every single piece of legislation governing energy and recommended a Policy Development and Policy Assurance System to regulateoil and natural gas.  At this point the oil sands were put back in the mix, notwithstanding fact that they had been excluded from the Mar 2010 study.  This leads to the conclusion that the recommendations relating to the oil sands are based on speculation and conjecture, since no data was reviewed.

So what is a Policy Development and Policy Assurance System?  It’s billed as a system to enhance Alberta’s competitiveness by “improving” the regulatory system for oil and gas development.  Implied in this statement is the assumption that improving the regulatory system will vault Alberta to the front of the line and somehow offset the global factors which impact our competitiveness.  Oh if only it were so simple.

But let’s suspend disbelief for one second and assume that overhauling Alberta’s regulatory system will catapult Alberta into the top tier of competitive jurisdictions.  These regulations apply to air, water, land, mining, facilities authorizations, conservation and safety in connection with coal, oil, natural gas and oil sands extraction, abandonment and reclamation.  How does Ron Liepert intend to accomplish the gargantuan task of integrating and aligning all of the energy statutes?

Mr Liepert’s team assures us that this will be a straightforward exercise.  The regulatory functions previously performed by the departments of Environment, Sustainable Resources and Energy will not be changed but simply transferred to the department of Energy.  And all of the applications they used to review will go through the superboard—a beefed up Energy Resources Conservation Board (ERCB).

Sounds easy, but open the next Matryoshka doll.  Inside this doll you will find a May 2011 document entitled Enhancing Assurance: Developing an integrated energy resource regulator.  It identifies at least 9 major pieces of legislation that will be impacted** and more importantly creates a “to be determined later” category of issues too contentious or difficult to address now.  These include determining the right level of oversight (aka interference) the government should have with the superboard and creating a better public engagement process.  This latter point is particularly troublesome given that under the existing system environmentalists and land owners have three opportunities to present their views to three different departments but under the new system they will have only one opportunity to present their views to the beefed up ERCB.  No wonder Mr Liepert thinks integration will be a breeze, he intends to address the most contentious issues behind closed doors and away from public scrutiny.

OK, we’re down to the last Matryoshka doll and the most important question of all—if this exercise will have little or no impact on Alberta’s competitiveness, why embark on it in the first place?

Ah, the answer to that question is buried deep within the Dec 2010 document.  It recommends the creation of a Policy Management Office (PMO)*** which will report to the deputy ministers of Energy, Environment and Sustainable Resources.  The PMO’s job is to “integrate” energy policies and “interface” between policy development and the superboard.   The reason Mr Liepert wants the PMO is that the 3 ministries persist in creating policy which reflects their mandates and as a result conflict with each other to some degree.

Personally I think this is a good thing.  The diverse perspectives of Environment, Sustainable Resources and Energy should be clearly presented to the regulator who will weigh them in search of the solution that best serves the public interest.  Apparently this process didn’t satisfy Mr Liepert who has gained ascendancy in policy development and created the PMO to hammer off the “rough edges” of the conflicting policies created by the other ministries before sending the watered down policy to the superboard and thus ensuring that energy projects are approved.

Even Mr Liepert must know that he can’t influence global markets, so he’s working with what he’s got and he’s done a very skilful job of ensuring that when you open up the last wooden doll what you’ll find is not an intricately painted baby doll, but a rubber stamp.

*See the ERCB Upstream Oil & Gas Authorization and Consultation Requirements Guide

**Alberta Land Stewardship Act, Coal Conservation Act, Energy Resources Conservation Act, Environmental Protection and Enhancement Act, Oil and Gas Conservation Act, Oil Sands Conservation Act, Pipeline Act, Public Lands Act, Water Act.

*** It is interesting to note that the PMO was not referred to in the later May 2011 document which outlines the legislative changes required to create the superboard and is not disclosed by the government to stakeholders in public forums like the PPX Symposium.

Posted in Energy & Natural Resources, Politics and Government | Tagged | Leave a comment

The Full Monty

Posted on June 19, 2011 by susanonthesoapbox

Remember the movie The Full Monty.  It’s the story of 2 unemployed steelworkers from Sheffield.  They’re desperate for cash when they stumble upon a Chippendales type strip show and realize in an ill conceived flash of genius that they’ve found the solution to their cash flow problems—a male strip act.  All they need to do is recruit 4 more desperate men and they’re all set.  But there’s a snag.  The ladies won’t pay a penny to see this pathetic group of middle aged losers perform until Gaz, the ring leader, blurts out that their performance will feature “the full monty” (they’ll be as naked as the proverbial jaybird).  The tantalizing arc of the movie, both for the ladies and for the audience, is whether the men will actually go through with it.

How is The Full Monty relevant to healthcare—or anything else for that matter?  Well, aside from getting your attention, The Full Monty is a clear example of the principle of full disclosure and why when you commit to doing something, you’d better deliver or suffer a serious credibility blow.

On Feb 14, 2011, I joined the legions of citizens trying to pry a shred of information out of the government.  I FOIPed the Dept of Health and Wellness requesting all records relating to the private insurance options that were described in the leaked government policy presentation entitled Alberta’s Health Legislation:  Moving Forward.  On Mar 31, I received a letter politely informing me that a search had failed to retrieve any records relating to the subject.  Furthermore, the leaked presentation was a draft document and “AHW did not look at any private insurance options and no work was conducted regarding possible options.  This was a question being asked at the draft stage and the policy shift of considering private insurance options was excluded from the final document.” 

Given my cynical nature I wanted to compare the draft document with the final document to confirm that the private health insurance options had indeed fallen off the table.  On May 8 I FOIPed again.  This time I requested a copy of the “final document” referred to in the Mar 31 letter.

On June 2 I received a reply—“Unfortunately, access to all the information that you requested is refused under section 4(1)(q)…under the FOIP Act” because the final document “was created on behalf of the Minister of Health to be presented to the Alberta government caucus” and therefore was exempt from disclosure.

Now this is where it gets interesting (really it does—do I have to bring back the Sheffield lads?)  At this point the question we should be asking not what was in the final document.  We already have a rough idea of the answer.  It was the process to overhaul Alberta’s healthcare legislation by enacting the new Health Act and setting a time line to roll up 5 other pieces of healthcare legislation.  The real question is why should the public be denied access to background information which forms the foundation of government policy?

To answer that question let’s go back to first principles.  The FOIP Act gives Albertans access to all governmental records, with some limited exceptions.  These exceptions fall into 2 categories:  those where disclosure would result in harm to privacy, safety, law enforcement and intergovernmental relations (whether this last exception has merit is being tested right now with the Wikileaks) and those where the request would result in premature disclosure of the confidential deliberations of the Executive Council or its committees on “recommendations, policy considerations, draft legislation,” etc.  But this exception bears a time stamp—the protection from disclosure expires once the decision has been made public.

Apply these principles to my FOIP request.  The presentation contained background information which was presented by the Health Minister to the Alberta caucus.  A decision was made to pass the new Alberta Health Act.  This decision was made public.   The Premier and Minister Zwozdesky have repeatedly assured Albertans that they have no intention, now or in the future, of adopting  privatized insurance options.  Surely the justification for refusing disclosure is stale dated.  And yet the government response is “no disclosure, go away”.

So Mr Zwozdesky, it’s time to get up on the stage, turn up the footlights and deliver.  Albertans may not cheer with wild enthusiasm but at least they’ll have the full picture.

While we’re waiting for Mr Zwozdesky’s response here’s a glimpse of The Full Monty for your viewing pleasure.

Posted in Alberta Health Care, Politics and Government | Tagged , | 2 Comments