Institutional thinking?

The government's BC Progress Board is looking to review the funding of the province's healthcare system. And it's turning to a former Fraser Institute staffer - whose past reports have recommended privatizing public hospitals and opening the door to parallel private healthcare - for help, Public Eye has exclusively learned. New Democrat health services critic Adrian Dix has said the hiring is part of a government effort to privatize that system. But a progress board staffer said Cynthia Ramsay was simply the most qualified candidate who could do that work within the organization's budget. And Ms. Ramsay encouraged the critic to not pass judgement on her until the review is published.

The board was setup by the government in 2001 to advise the premier on how to "improve the province's economy and social wellbeing." As such, it's reviewing the "future sustainability of health care spending in B.C." and planning to directly award Ms. Ramsay a $25,000 contract as part of that project.

Under the government's procurement guidelines, contracts worth $25,000 or more must be put through a competitive bidding process unless certain conditions are met - such as only one contractor being qualified to do that work. And that's exactly what the progress board has said about Ms. Ramsay.

A notice of intent quietly posted on the province's procurement Website on Wednesday states her company Elm Consulting is "uniquely qualified" thanks to "previous research into public financing of health care in Canada (as presented to the Romanow Commission)..."

That research was among a number of peer-reviewed discussion papers released by the commission but not representing the commission's views.

Indeed, the commission's head concluded in 2004 that private medicine isn't the solution to Canada's healthcare problems.

"Many of the so-called 'new solutions' being proposed for health care - pay-as-you-go, user and facility fees, fast-track treatment for the lucky few, and wait-lists for everyone else - are not new at all," said former Saskatchewan premier Roy Romanow. "We've been there. They are old solutions that didn't work then, and were discarded for that reason."

But Ms. Ramsay, who is better known for being The Fraser Institute's former senior health economist between 1993 and 1998, has her own thoughts on how to cure Canada's healthcare system.

On Thursday she told Pubic Eye she has "never, ever recommended we don't have a publicly-funded system...So it's all how we can work within the publicly-funded system in order to improve efficiency and get better care and access for Canadians. It's the ultimate goal of any project I do."

That being said, most of Ms. Ramsay's cures have involved injecting a heavy dose of privatization into that system.

For example, in 2003, she co-authored The Rebirth of Medicare in Saskatchewan: Steps Toward an Accessible, High Quality, and Sustainable Health Care System with The Fraser Institute's then health policy analyst Nadeem Esmail.

That report recommended privatizing the province's hospitals because it would improve the "quality of service delivery and reduce expenditures for publicly insured health care."

It also suggested the government remove medical education subsidies, limit what services are funded by taxpayers and have citizens start savings accounts for their long-term care rather than have the government pick up the tab.

And those were just the recommendations that, according to the report, wouldn't violate the Canada Health Act.

Ms. Ramsay and Mr. Esmail advanced similar recommendations the following year in The Alberta Health Care Advantage: An Accessible, High Quality, and Sustainable System, another institute report.

That report also suggested removing "any and all restrictions on a parallel private health care system."

As for the paper Ms. Ramsay presented to the Romanow Commission, in it she stated, "There are few, if any, that can point to whether a publicly or privately funded health care system is better or worse for population health."

As a result, given the "struggles faced by Canada's health care system," she posed the following question: "Is there justification for mixed financing plans?"

So why did the BC Progress Board decide to directly award the contract to Elm Consulting?

We put that question to its senior analyst Joel Emes - who went to school with Ms. Ramsay and worked with her at The Fraser Institute, where he was a senior research economist.

"I did some searching for people and she seemed to be a good fit for what we were searching for. We spoke to some other people and we couldn't get anyone interested for the amount of money that was involved," he responded.

Mr. Dix questioned that rationale.

"Firstly, it's a waste of money because her views are already known - already published. Secondly, if the intent of the process is not to search for solutions but to arrive at certain ideological conclusions, then it's a particular waste of money," he stated.

But Ms. Ramsay - who said she doesn't write any of her reports with a "conclusion ahead of time" - encouraged Mr. Dix to look at "what's written rather than simply assuming what people are thinking."

And Mr. Emes - who disclosed his past relationship with Ms. Ramsey to the BC Progress Board's members - said, "We've never had any concern about potential bias or anything from a particular author."

The reason: the board - a group of past and present business leaders - vets its reports at all stages.

That, however, didn't seem to reassure the health critic.

"The government has consistently supported undermining the public healthcare system," he stated. "If you just look at the recommendations in her Saskatchewan report, I think we have someone in Ms. Ramsay who has very well-established views."

"And there's nothing wrong with having those views. But if this is just a setup process to drive a preordained conclusion against public healthcare, then the government shouldn't be doing that."

The following is a complete copy of the aforementioned notice of intent.


Notice of Intent #ON-001910
Report on Future Sustainability of Health Care Spending in B.C.

Notice is hereby given by the Ministry of Small Business, Technology and Economic Development (the "Ministry") of its intent to contract with Elm Consulting.

The contractor will work with BC Progress Board staff to produce a report on the future sustainability of health care spending in BC and what BC can learn from how health care is structured in other countries.

The maximum dollar value of the proposed contract is $30,000 ($25,000 in fees and up to $5,000 in expenses). The term of the proposed contract is expected to run from May, 2010 to March 31, 2011 although the project may be finished earlier. There is no option to renew as this contract is to produce a single report.

The Ministry has chosen not to call for vendor proposals because it believes that Elm Consulting is uniquely qualified to perform this work based on its previous research into public financing of health care in Canada (as presented to the Romanow Commission) and international health care systems, combined with its proven ability to write clearly and concisely in presenting complex ideas to a non-specialist audience.

Vendors wishing to object to this decision should submit in writing the reasons for their objection by 2:00 pm Thursday May 20, 2010 Pacific Time to Soledad Reeve by facsimile at (250) 387-7309 or email at, detailing specific reasons for their objections. A vendor's relevant experience and ability to provide the services described above for the same or better price will be a key aspect of the Ministry's considerations of such objections.

If justified, the Ministry of Small Business, Technology and Economic Development will convene a meeting with Ministry representatives and the vendors to receive vendor representations concerning this contract.


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