Smith declines to disavow comments urging out-of-pocket payments for health care

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EDMONTON — Premier Danielle Smith is declining to say whether she stands by or is disavowing earlier comments she made proposing Albertans pay out-of-pocket for medically insured services as a way to keep the health-care system sustainable.

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Smith has declined four times over the past nine days to say whether she stands by a policy paper she wrote in 2021, which urges Albertans to begin paying for services covered by medicare, including visits to a family doctor.

Smith’s United Conservative Party government has committed not to delist any current medically insured services or to having Albertans pay for services or prescriptions currently covered by medicare.

At a news conference Monday, Smith, when asked again where she stands philosophically on Albertans paying out-of-pocket, pointed to a long-term health funding deal for Alberta recently signed with Ottawa.

“I believe actions speak louder than anything,” said Smith.

“One of the first things I’ve done as premier is signing a 10-year, $24-billion health-care agreement with the federal government, where we jointly agree to uphold the principles of the Canada Health Act.

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“One of those main principles is no one pays out-of-pocket for a family doctor, and no one pays for hospital services. That’s in writing.”

The reporter was not allowed to challenge the answer, as Smith has instituted a rule that she is asked one question per reporter per news conference with no follow-ups.

The Opposition NDP said Albertans need to know what Smith believes, given she is seeking a four-year mandate in an election campaign set to begin next week with voters going to the polls May 29.

“Danielle Smith wants Albertans to pay to see their doctor,” NDP health critic David Shepherd said in a statement.

“She has published a detailed plan and described it on the record many times. Smith had many opportunities to disavow this plan, but she refused.

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“When we proposed universal coverage for prescription birth control, Smith said Albertans should pay out-of-pocket for private health insurance.”

Smith, in turn, said the NDP needs to explain why it continued the government practice of charging $40 a day for addiction treatment beds when it was in power from 2015 to 2019.

“(NDP Leader Rachel Notley) needs to answer for whether or not she’ll bring that back because she certainly didn’t remove it when she had the chance,” said Smith.

Smith has faced questions, even from supporters, on where she stands on paying for medicare.

On April 15, on her Corus radio call-in show, Smith was asked three times about her views.

A self-described party supporter named Jeff called in to say he’s OK with out-of-pocket payments but doesn’t know where Smith stands.

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“I’m really confused,” the caller told Smith. “It seems to be changing all the time.”

Another listener said he didn’t believe Smith had changed his views, saying in a text message read aloud by host Wayne Nelson: “Let me ask you directly: do you now categorically reject what you wrote in that (policy) paper? Yes or no?”

Smith declined to answer and pointed both questioners to his proposal to create health spending accounts. The accounts would give Albertans $300 in seed money with incentives to help them grow the funds to pay for non-insured medical services like therapists and dentists.

When Nelson asked Smith where she stands, Smith said she was taking her marching orders from her caucus and party membership.

“It’s a very grassroots process, and I can tell you there is not a single UCP cabinet member, caucus member or (party) member that I have talked to that says they want to make people pay for a family doctor,” said Smith.

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Health spending accounts are the fulcrum of the debate.

Smith has pledged to bring in the accounts but only for non-medically necessary services.

However, in the 2021 policy paper she wrote for the University of Calgary before she re-entered politics, and in interviews she did around that time, Smith described health spending accounts as a gateway to get public buy-in to discuss a new way of funding health care, including services currently paid for by the public purse.

“Once people get used to the concept of paying out-of-pocket for more things themselves, then we can change the conversation on health care,” Smith wrote at the time.

“Instead of asking what services will the government delist, we would instead be asking what services are paid for directly by the government and what services are paid for out of your health spending account.”

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She added: “My view is that the entire budget for general practitioners should be paid for from health spending accounts.”

Smith wrote that from health spending accounts, the government could move to broader reforms like co-pays and deductibles based on income for things like surgeries.

In a statement late Monday, Smith’s office said in an email that many of her positions on different issues have “evolved and changed.”

“On this specific issue, the premier has been clear that Albertans will not be paying out-of-pocket to see a family doctor or for a hospital visit — including surgeries.”

This report by The Canadian Press was first published April 24, 2023.