Warning signs are here
June 23, 2026
Hard-working families in Alberta need to understand what the American two-tier healthcare system actually looks like, because the direction the UCP government is taking resembles the early stages of that model. In large parts of the United States, a small number of large corporations own hospitals, clinics, labs, surgical centres, pharmacies, insurance companies, and physician groups. They control the entire chain of care, from the first appointment to the final bill. When the same corporation owns both the insurance plan and the hospital, it sets the prices, decides which treatments are covered, and keeps all revenue inside the same organization.
Insurance companies employ physicians whose job is to review claims and find reasons to deny coverage, even when the attending doctor has prescribed the treatment. Millions of Americans have no insurance because the fees are too high, and some die because they cannot afford care. Even those with employer plans pay hundreds of dollars a month in premiums, plus deductibles that can reach several thousand dollars before insurance pays anything. A single emergency can bankrupt a family. Despite these costs, the American system delivers no better outcomes. On a per capita basis, it costs roughly twice as much as Canada’s public system, with much of the money going to corporate overhead and administrative departments dedicated to denying claims.
Alberta is now moving in this direction. The UCP government spent years pushing down public sector physician income through technical billing changes that reduced earnings for the same work. Family doctors were hit the hardest. After suppressing public pay, the government is introducing a dual practice model that allows physicians to work in both the public and private systems. Dual practice drawing doctors into the private tier is a reasonable and evidence supported prediction based on what has happened in other countries. It is not yet a proven outcome in Alberta, but the pattern is well documented elsewhere. When a private tier offers higher earnings, physicians tend to shift more of their time toward it, leaving fewer hours available in the public system.
Readers should also understand that some of these statements describe systemic incentives rather than literal rules. In both the American system and in any emerging two tier structure, outcomes are shaped by how organizations respond to financial pressures, not by explicit instructions written into legislation. These are structural truths about how healthcare markets behave.
Middle class families need to understand that two-tier healthcare does not protect them. It exposes them. It turns them into customers in a marketplace where corporations decide what care they receive, how long they wait, and how much they pay. The American system did not appear overnight. It was built step by step, through the same kinds of policy choices Alberta is now making. The efficient public system chipped away bit by bit over the last 46 years by those wanting a piece of the healthcare financial pie.
Ken Riley,
Bassano