Paper written by Alberta Premier Danielle Smith sparks debate over Health Spending Accounts

Alberta Premier Danielle Smith is doubling back on a plan she outlined last year in which Albertans would pay for family doctor visits through Health Spending Accounts (HSA).

Smith’s comments, made in a 2021 University of Calgary School of Public Policy paper, resurfaced on social media over the weekend.

In her paper, she proposed a provincial healthcare system in which “the entire budget for general practitioners should be paid for from Health Spending Accounts.”


“If the government funded the account at $375 a year, that’s the equivalent of 10 trips to a [general practitioner], so there can be no argument that this would compromise access on the basis of ability to pay,” Smith wrote.

She added, however, under her supposed system “no one is denied care when they need it and no one should face bankruptcy because of medical bills. Full stop.”

NDP Leader Rachel Notley accused the premier of attempting to “dismantle public healthcare.”

In several tweets over the weekend, Notley attacked Smith’s ideas, adding families “are struggling so much to make ends meet as it is.”

“They should not have to pay out of pocket to see a family doctor … yet that is exactly what Danielle Smith is proposing,” she tweeted.

Smith took to Twitter as well, saying she is “committed to public health care” and that HSAs are a “bonus” meant to pay for things not covered by Alberta Health Services (AHS).

“@RachelNotley knows this, but she doesn’t care about the truth. She’d rather spin than give real feedback on how to improve our current system,” Smith said Sunday.

Videos circulating online, apparently taken from a summer livestream on Smith’s page — a members-only crowdfunding website — show clips of the premier referencing her 2021 paper.

In one clip shared by Notley Monday morning, Smith says the healthcare system needs more money, but not in the form of taxes.

“That’s what the beauty of the Health Spending Account is all about, is that not only would we seed it with a bit of money, but then we would give you the incentive to put more money in for your own medical needs, get your employer to put money in, raise money to put money in, get family members to donate money in,” Smith said in the video.

“Because I recognize we’re going to need more dollars as we go forward, but I don’t think that you want to put more tax dollars in a general pot of money to give to the head of AHS to have them make decisions about whether or not you get medical treatment. I think we need to create a mechanism where you could put more money in your own account for your own health needs and your family’s health needs, and that’s one way that we can avoid the excessive growth that we’ve seen in health care.”

Notley criticized Smith’s ideas.

“Danielle Smith has decided Albertans need to start paying for their healthcare. Or they can hit up grandma and grandpa… Or they can fundraise… Let’s be clear about what this really is — a complete dismantling of public healthcare as we know it,” Notley said.

Several people reacted to Smith’s resurfaced comments online.

Anne N. writes this system would “break” people like them.

“If this is truly the case, I am screwed. As a cancer patient, Dr.’s are the norm, this appt here, that there. This will break us in a heartbeat.”

Another user says, “This is absolutely ridiculous. It goes against the philosophy of having universal health coverage that is – based on need, & free at point of delivery. The reality is that some families require more visits to the doctor, while others require less.”

Gabriel Fabreau writes, “~1 specialist appt gobbles up the entire $380 health spending account, or 1 ER visit, 1/10 of a surgery, 1 month of common meds I often prescribe, 1/100 of some chemotherapies, 1/8 a day in hospital, 1/20th of a day in ICU.”

This is the second time comments Smith made on her page have resurfaced online, with previous remarks about Russia’s invasion of Ukraine prompting an apology.

In a statement to CityNews, the premier’s office says the NDP’s suggestions are “not true.”

“Premier Smith has committed to introducing Health Savings Accounts to help Albertans afford healthcare costs that are not covered by our publicly funded health system, and that they currently pay out of pocket or through private insurance,” said Rebbeca Polak, press secretary to the premier’s office.

“The government will be ensuring Albertans have access to more health services and will not be delisting any that are currently provided.”

-With files from Logan Stein

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