Alberta Premier Danielle Smith is charging into 2024 with a mandate to take on Alberta’s bloated, intractable healthcare bureaucracy and her success or failure could impact how healthcare is managed across the country. Rest assured every premier in Canada is watching Smith closely on this file.Let’s face it. Canada’s healthcare system stinks and no province is an exception. Costs go up every year while access goes down. People are dying on waiting lists and the lists are only getting longer. Citizens are finally realizing the vaunted reputation of Canada’s healthcare system is a myth.Still, defenders of the status quo fight tooth and nail when anybody even speaks of reforming the system, much less acts on reforms. Unions, bureaucrats and assorted socialist activists refuse to accept that the system is broken and are doing everything possible to keep anybody from fixing it.As more and more Canadians find themselves or their loved ones suffering under the broken system, the appetite for change is finally growing. Danielle Smith is the first premier to truly stick her neck out on the issue and her battle is just beginning.Smith began by cutting from the top with Alberta’s massive healthcare management bureaucracy. Shortly after becaming Alberta’s premier, her government fired Chief Medical Officer Dr. Deena Hinshaw. Then they fired the entire Alberta Health Services (AHS) board. Finally, they fired Dr. Verna Yiu from her position of CEO at AHS. The NDP, unions and the rest of the usual suspects were apoplectic. Legacy media members and activists alike rallied in the 2023 spring election to ensure Smith didn’t win. They failed, Smith won, and now she has a real mandate to reform. Since the election, Smith has split AHS into several different entities. Ostensibly this is to allow for more specialized policies in different aspects of healthcare and there is some merit to that. More importantly though and more likely is the organization was split because it makes it harder for bureaucrats to put up an organized front in hindering reforms.Premier Smith warned when she won the last election that she won’t let herself be slow-rolled by the bureaucracy. It appears AHS managers didn’t get the message as they have been dragging their heels on mandates to improve service. One simple mandate for example was with ambulance services. Tens of thousands of trips are made yearly using fully-equipped ambulances crewed by paramedics to transport non-emergency patients. It is a terrible waste of resources and it ties up highly-trained workers and highly-specialized equipment without need. The mandate was handed down for AHS to seek private contractors to take over some of the role of non-emergency patient transports. It is a simple, common-sense solution to a large problem.Instead of taking the mandate seriously though, AHS bureaucrats devised a ridiculous set of conditions and created a number of barriers for any private contractors seeking the contracts. They are moving as slowly as possible and continue to find excuses not to approve applications. Meanwhile, Alberta has been hitting situations where regions have run out of ambulance service including on New Year’s Eve of this year in major cities.Premier Smith has had enough and is laying down the law. In a recent interview she made no bones about it in saying, “That’s what our focus is. It’s firing the managers who we have paid to solve these problems and they’ve allowed the problems to perpetuate and they’ve done nothing about them.”It’s bold, it’s to the point and it’s unequivocal. Managers had better prove they are getting things done or they will be fired. That’s not an unreasonable expectation in the private sector and it shouldn’t be with healthcare bureaucrats either.The usual suspects have gone wild of course. They are claiming Smith has overstepped her role or mandate and that she hasn’t the right to make such demands. I call BS. Danielle Smith was elected as Alberta’s premier to do exactly this sort of thing. If an elected premier can’t call the shots with the largest public bureaucracy in the province, who can or should? Union heads? Activists? The leader of the opposition? The tail has been wagging the dog for too long at all levels of government. In Calgary’s city hall, it was almost nauseating watching the elected councillors being called on the carpet for questioning senior bureaucrats and city managers in the last few years. If the elected officials don’t hold the bureaucrats to account, nobody will. In fact, nobody has for years and look at where it got us.Shaking up the Canadian healthcare system has been considered political blasphemy for too long. The system is failing and thankfully, Premier Smith is willing to break away from dogma, become an apostate and get the job done.The battle of wills is just beginning and I am betting on Smith winning it. When Smith wins and healthcare begins to improve in Alberta, rest assured the other premiers too cowardly to stick their necks out will follow. Alberta is lucky to be in a province with a premier willing to lead. Her actions and tenacity will benefit us all within and even outside of Alberta. And it’s about time.