didyouvoteforthis.ca  ·  A Public Ledger of UCP Fiscal Decisions
// Running total since 2019 $74B+ in confirmed cost, lost investment & transferred liability to Albertans See the receipts
A companion to The Receipts

Alberta voted for healthcare.
We got dismantling.

The full record of two UCP premiers' healthcare promises — from Jason Kenney's signed "Health Care Guarantee" of 2019 to Danielle Smith's "new day for health care" of 2023 — set against the public record of what Alberta's healthcare system actually looks like in 2026.

// The promise that opened the file

In 2019, Jason Kenney was photographed signing a pledge to "maintain a universally accessible, publicly funded health-care system." He called it the Health Care Guarantee.

It was the centerpiece of the UCP's 2019 election platform — a deliberate, photographed, signed promise designed to neutralize Albertans' historic anxiety about conservative governments and public healthcare. Kenney repeated the commitment throughout the campaign: "a universal, comprehensive health-care system is a core part of UCP policy." He guaranteed health spending would be maintained or increased. He guaranteed savings would be reallocated to the front lines. He guaranteed the public system.

In October 2020 — eighteen months later — the United Conservative Party's Annual General Meeting passed Policy 11, formally endorsing a "privately funded and privately managed health-care system" for Alberta. Neither Kenney nor Health Minister Tyler Shandro spoke during the debate or against the resolution. The Premier's office subsequently said the policy "won't have an actual impact in the province until the party's next term."

That party is in its next term. This is the public record of what the next term has looked like.

The page that follows documents two distinct UCP healthcare projects — Kenney's confrontation with the system in 2019–2022, and Smith's restructure of it from 2023 onward. The framing they shared was the same: the bureaucracy was bloated, the costs too high, the front lines starved. The record of what they did is below.

// 2019 · Signed and photographed
// Exhibit A · The Health Care Guarantee

The pledge Jason Kenney signed in front of cameras during the 2019 campaign

I will maintain a universally accessible, publicly funded health-care system.

— Jason Kenney, signed pledge during the 2019 Alberta general election campaign. Photographed and reproduced in mainstream news coverage. The official UCP platform titled the entire healthcare section "Health Care Guarantee."

Jason Kenney
// The state of the file in 2026
83,000+
On the surgical wait-listSept 2025; up from 71,500 in April 2023 (Alberta Surgical Initiative dashboard)
750,000
Without a family doctor2024 estimate, AMA / MAPS report; 2,471 physicians lost in five years
$109M
DynaLIFE failureAuditor General confirmed November 2025 (Conduct page)
2×
AHS board firedIn three years; one DM later held three jobs simultaneously

I. The Kenney file

2019—2022 · The signed Guarantee, the AGM resolution against it

Three actions, taken in sequence, that defined the gap between the Guarantee Kenney signed and what his government did with the system afterward.

Entry 01

The MacKinnon Panel — a sham, by its own internal documentation

// What was said

The MacKinnon Panel, struck by Kenney shortly after taking office, was framed as an independent expert review of Alberta's finances and public services. Janice MacKinnon — a former Saskatchewan finance minister with a documented record of hard cuts — was held up as a non-partisan voice. The panel's recommendations would, in the government's framing, guide responsible reductions to government spending, including healthcare.

// What the documentation showed

Subsequent research, including by the Alberta Federation of Labour, demonstrated that Kenney's office guided MacKinnon behind the scenes to ensure she stayed on script. The panel's final report contained data and analysis that government officials internally described, in their own words, as "horrible," "poor quality," and "highly inaccurate."

The panel did exactly what it was politically commissioned to do: it provided cover for cuts to public services, including healthcare. Per-person healthcare spending in Alberta subsequently fell by 3.6 per cent in 2021 — the largest single-year per-person healthcare cut in any Canadian province during a pandemic in which more than 4,500 Albertans died. (Source: Canadian Institute for Health Information.)

Sources Alberta Federation of Labour U of C Press · Blue Storm
Entry 02

Bill 21 — the only Canadian government to tear up a physician compensation agreement by law

// What was said

The Kenney government framed its dispute with the Alberta Medical Association as a fiscal necessity. Health Minister Tyler Shandro publicly described the move toward salaried Alternative Relationship Plans (ARPs), and away from fee-for-service, as a modernisation already underway in other provinces.

// What was on the public record

Bill 21 gave the Health Minister the authority to unilaterally terminate the province's compensation agreement with the AMA. Shandro invoked that authority in February 2020. No other Canadian province has ever passed legislation specifically to tear up a physician contract.

The fight that followed was characterised by Mount Royal University political scientist Lori Williams as part of a wider pattern in which the government was "going after front-line medical workers who are, at least in some cases, risking their lives for the health of Albertans." Shandro himself was subsequently filmed confronting a doctor in the doctor's own driveway over public comments about the dispute.

The result, by 2024: 2,471 physicians lost over five years and an estimated 600,000 to 750,000 Albertans without a regular family doctor — numbers documented by the AMA and Statistics Canada's Canadian Community Health Survey.

Sources CBC · Doctors fight AMA · Physician shortage
Entry 03

Policy 11 — the UCP membership voted, on the record, to dismantle the public system

// What the Premier signed in 2019
A universal, comprehensive health-care system is a core part of UCP policy.
— Jason Kenney, 2019 election campaign. Health Care Guarantee.
// What the UCP membership voted in 2020

At the United Conservative Party's October 2020 Annual General Meeting, delegates approved Policy 11, supporting a "privately funded and privately managed health-care system." The resolution explicitly contemplates Albertans paying out of pocket or through private insurance to access private delivery.

Neither Premier Kenney nor Health Minister Tyler Shandro spoke during the debate. Neither denounced the resolution. The Premier's office described the result as governing "the next platform" rather than the current term.

That next term arrived in 2023. The current term is being governed under it. The pledge Jason Kenney signed and the policy his party voted for cannot both be true descriptions of UCP healthcare policy.

Sources Global News · Policy 11 CBC · Opinion analysis

II. The Smith file

2023—Present · "A new day for health care"

Premier Smith opened her November 8, 2023 healthcare news conference with the words "Welcome to a new day for health care in Alberta." The "new day" was a plan to dismantle Alberta Health Services and replace it with four separate provincial agencies. What follows is what that day has produced.

Entry 04

"A new day for health care" — on the same patient population, with more administration

// What was promised
Welcome to a new day for health care in Alberta. We will put Albertans first in every health care decision and give our front-line experts the right space to properly care for Albertans.
— Premier Danielle Smith, November 8, 2023

The plan: split Alberta Health Services — an $17-billion delivery agency with 88,000 employees that 15 years earlier had itself been created by a Progressive Conservative government to replace nine regional health authorities — into four separate provincial agencies overseeing primary care, acute care, continuing care, and mental health and addiction.

// What was delivered

By the end of 2025, the legal restructure was complete. The same 88,000 employees were delivering the same care to the same patients. Roughly 16,000 health-care workers were administratively reassigned between agencies with no net job creation. Unions reported disruption, contract uncertainty, and increased administrative burden.

Health policy experts across Canada describe integrated health systems — the kind being dismantled — as the global "holy grail" for system performance. Steven Lewis, a national health-systems analyst, told CBC the only thing the restructure clearly achieves is removing AHS as a political shield for the government. "They rejig it, they own it," Lewis told CBC.

Total restructuring cost (government estimate): $85 million over two years. Total reported impact on doctors, nurses, beds, or operating rooms: zero. (See Receipt 08 on the front page.)

Sources CBC · Restructure analysis Alberta Politics · Climenhaga
Entry 05

The wait-list grew. The doctors left. The Premier called it "optimizing."

// What was promised

Smith's healthcare plan, in her own words, was to "put Albertans first" and produce "shorter wait times." The successor agency model was sold as the structural fix. Acute Care Alberta, Primary Care Alberta, Continuing Care Alberta, and Recovery Alberta would each have a "laser focus" on its area of responsibility.

In the December 2025 retrospective, Premier Smith told CBC the restructure is "pretty much done." "So now it's a matter of each one of those areas optimizing."

// What was measured

According to the Alberta Surgical Initiative dashboard, more than 83,000 Albertans were on a surgical wait-list as of September 2025 — the highest figure since January 2022, and rising steadily since April 2023 (when 71,500 were waiting).

The Auditor General has separately criticised the government's wait-list metrics as "not credible."

The Alberta Medical Association estimates 600,000 to 750,000 Albertans do not have a regular health care provider — rising to 800,000-950,000 once 204,000 new arrivals to the province are factored in. Alberta has lost 2,471 physicians over the past five years. Eighty-one per cent of Alberta physicians, in AMA surveys, report the system is getting worse. Seventy-nine per cent report support for physicians providing care has deteriorated.

Sources Globe & Mail · Wait-lists AMA · SOS letter CBC · Smith Q&A
Entry 06

Bill 11 and "activity-based funding" — the door quietly opened to private surgical centres

// What was said

The Smith government's mandate letters to the Health Minister and the Hospitals and Surgical Health Services Minister speak of "a competitive, activity-based funding model for insured surgical services to reduce wait times, improve patient experience and deliver better value for taxpayers."

The framing: this is not privatisation. It is modernisation. Multiple delivery models inside a single publicly-funded system, with public dollars following the procedure rather than the institution.

// What is happening on the ground

Funding for Alberta's chartered private surgical facilities is growing faster than funding for public hospitals, per Globe and Mail reporting in 2025. Private surgical centres are now formally classified as "equal partners" alongside Alberta Health Services and Catholic provider Covenant Health under the new acute-care model — a structural reversal from the previous model in which they were AHS contractors.

The Alberta Medical Association president told CBC the mandate letters "raise more questions than they answer." Public hospitals are losing operating-room staff — nurses, anaesthesiologists, respiratory therapists — to the chartered surgical facilities, with ORs closing as a result.

The Mentzelopoulos lawsuit, separately, alleges the former AHS chief executive was pressured to approve private surgical contracts of "significantly increased cost" compared to existing equivalents. (See the Conduct page for the full record on that allegation.)

Sources CBC · Mandate letters Globe & Mail · Private surgical

III. The physicians' SOS

Alberta Medical Association · Letters from the front line

The strongest witnesses on this page are not the Opposition NDP, not journalists, and not labour unions. They are the doctors themselves — the same physicians the Smith government is asking to help "optimize" the system.

Entry 07

"No answer to our SOS" — the doctors writing publicly to a Premier they cannot reach

// The Alberta Medical Association, on the record
Two fall 2023 stabilization proposals — and months of advocacy — were an SOS call to the Government of Alberta from Alberta's physicians. I'm sorry to say that there has been no answer.
— AMA President's Letter, 2024
// The numbers behind the letter
  • ♦ 81 per cent of Alberta physicians report the healthcare system is getting worse.
  • ♦ 79 per cent report support for physicians providing care has deteriorated.
  • ♦ 2,471 physicians have left Alberta over the past five years.
  • ♦ The healthcare budget fails to account even for population growth, let alone inflation, technology, aging, or increased patient complexity, per the AMA.
  • ♦ The Premier's office is described by the AMA as committed to "spending more on consultants and on the dismantling of the existing health care system" than on the front lines.

The voice on the page above is not the NDP. It is not the AFL. It is the College of Alberta's physicians, telling Albertans, in writing, that they cannot get the Premier's office to respond to two formal stabilisation proposals from 2023.

Sources AMA · President's Letter
// What this page is asking you to consider

A "Health Care Guarantee" is not a guarantee. It is a campaign artifact.

The piece of paper Jason Kenney signed in 2019 was meant to be the load-bearing wall of UCP credibility on healthcare. The point of signing it was to prove the rhetoric was real. The point of titling the platform section "Health Care Guarantee" was to make the promise verifiable. The promise was verifiable. It just was not kept.

The framing is the same in both eras. Kenney described the public system as bloated. Smith described it as broken. Both proposed a structural rethink as the cure. The Kenney rethink culminated in a per-capita spending cut during a pandemic, a shredded physicians' agreement, and a UCP membership vote endorsing a privately-funded private system. The Smith rethink culminated in 83,000 Albertans on a surgical wait-list, 750,000 without a family doctor, an Auditor General report on destroyed records (see Conduct), an active RCMP investigation into procurement (see Conduct), and an AMA SOS letter that is two years old and still unanswered.

It is possible to hold conservative views on the cost of public healthcare, on physician compensation, on activity-based funding, and on the role of private surgical facilities, and still recognise that the public record above is not the record the UCP asked Albertans to vote for. Alberta voted for the Health Care Guarantee. The receipt is on this page.