Leading up to the last election, the NDP made a lot of noise about a long history of Danielle Smith supporting privatization of healthcare, leading the UCP to make some pretty firm guarantees about healthcare, and to accuse the NDP of “lying” about their healthcare plans.

“The UCP is committed, to all Albertans, that under no circumstances will any Albertan ever have to pay out of pocket for access to their family doctor” –Danielle Smith, April 2023

Yesterday, news broke about a primary care clinic that is now asking patients to pay up to $4800 per year for a ‘membership’ to access primary care, and limiting appointment spots for ‘non-members’ to one day per week.

This means that existing patients of the clinic have a choice: Pay $400/month to get on the VIP members list, be relegated to the list of patients that only gets any care one day per week (presumably with much longer waits for appointment times), or go find a different doctor. (Noting that family doctors are hard to find, and even if you find one, if this model is permitted to exist, there’s no reason to think that other doctors wouldn’t follow suit.)

The Canada Health Act framework means that doctors can’t charge patients directly for publicly insured services. This type of model undermines that statute, according to Health Law expert Lorian Hardcastle.

However, attempts to circumvent that prohibition with membership models aren’t completely new. Historically, there have been specialty clinics that charge membership fees, where insured and uninsured services are ‘intermingled’. While Health Canada has worked to apply pressure to ensure that the provision of publicly-insured services isn’t contingent on a ‘member’ paying for the basket of uninsured services, enforcement has been limited. Many of these clinics have walked (and arguably edged across) a fine line in terms of what the paid ‘membership’ gets patients.

That said, for a primary care clinic to shift to a membership model on this scale appears to be new. Up until now, a relative handful of clinics targeting the wealthy, surreptitiously facilitating ‘queue-jumping’ for paid members, have gone under the radar, but as access to family doctors declines, clinics actually telling an existing patient base “Pay or go to the back of the line” doesn’t appear to have happened before.

We have found no authoritative legal commentaries on whether giving preference to paid members for insured services is actually illegal, or if it successfully exploits a loophole within the Canada Health Act framework. However, NDP health critic Dr. Luanne Metz points out that “in real life that simply won’t work for people who need to see their family doctor right away on a regular basis.” On the ground, there’s no question that people who can’t pay the membership fee will end up having primary care needs go unaddressed because of the restriction of resources available to them.

Less than two months after the UCP won an election promising, unambiguously, that no Albertan will ever have to pay to see their family doctor, Albertans are getting emails from their family doctors saying that they’ll now have to pay. And what’s the UCP’s response?

So far, radio silence from official channels, aside from a generic statement from the Ministry’s press secretary reaffirming support for the principles of the Canada Health Act and promising to ensure that all laws are followed. Nothing from the Premier or the Health Minister directly addressing the issue.

However, from less official channels, the UCP response is to attack the NDP. Shortly after the story broke, a UCP propaganda Twitter account called “NDP Lie Detector”, which identifies itself as being operated by UCP “caucus staff”, released an attack ad under the header “NDP still lying about health care”, taking short out-of-context clips from the NDP press conference and cutting it together with cynical reaction clips from popular entertainment sources like Seinfeld.

There’s no lie here: This primary care clinic is now asking patients to pay to access their family doctor – precisely what the NDP warned us during the election campaign might be coming, and precisely what Danielle Smith promised no Albertan would ever have to do.

And the UCP’s immediate response is to defend the clinic’s approach, by attacking the NDP for calling it out.

UPDATE, July 25 at 4:45pm:

Health Canada has weighed in on the issue, asserting categorically that separate charges to purchase preferential access to insured services is contrary to the Canada Health Act. They’ve written to Alberta officials about it.

Healthcare is directly regulated Provincially, but if the Province permits the practice, it could result in health transfer payments being clawed back, as has occurred for other private health services across the country.

Still no word from the Premier or Health Minister.

FURTHER UPDATE, July 25 at 11:10pm:

Finally, LaGrange and Smith have spoken up, through a verbose “joint statement“, explaining at length that all the private clinics they’ve investigated before were compliant, but they’ll investigate this one, and if there’s a breach of any relevant statute, they’ll take action.

“We recently became aware of a clinic advertising services that are covered by the provincial health care insurance plan and these advertisements suggest these services would be available to a membership [sic] following the payment of fees. Alberta’s government would be extremely concerned if this clinic was charging fees for services that are insured and offering accelerated access to a family physician at the expense of other patients needing to wait longer.”

However, the UCP caucus staff Twitter post calling the NDP liars for drawing attention to this clinic…remains up.