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It was all in the name of cost-cutting. And yet, cost creep soon set in again.

This year the government will spend $20.6 billion on health care, in a budget with total spending close to $55 billion.

After Kenney took office in May, the MacKinnon report established that Alberta spends more per capita than any other province.

Kenney’s changes won’t be a Klein-era demolition derby. But on the level of the entire system, they may eventually reach even deeper.

His first key target is compensation for doctors and nurses, which MacKinnon identified as a major reason for Alberta’s high spending.

There’s already legislation that allows the government to essentially abrogate its pay agreement with doctors.

Health Minister Tyler Shandro said in a statement: “Our payments to physicians are out of line with other provinces: average fee-for-service payment per physician is more than $100,000 higher than comparable provinces, and per capita spending on physician services is 19 per cent higher than the national average.”

Major labor conflict is inevitable. Doctors will have less time to spend with patients — if the doctors stick around. During Klein’s time, many prized specialists left for prestigious posts in the U.S.

The tide, once it begins to flow, is very difficult to reverse. It took nearly a decade to start winning back doctors. This alarming cycle could repeat itself very quickly.

On top of all this, the government is also conducting a complete review of AHS structure and management, as well as programs, services and policies. The report from Ernst and Young is due by Dec. 31.