Stealing from Patients

Dunkirk opens with soldiers on a deserted street walking through a snowfall of leaflets. The city is empty.

One man catches a leaflet and flips it over. It’s a map of Dunkirk.

WE SURROUND YOU.

SURRENDER + SURVIVE!

Propaganda works: Hopeless soldiers give up. Emotion plays a role in every fight.

I worry that many doctors cannot process attacks from government anymore. They can think, but they cannot feel.

The feds propose:

  • 73% tax on retirement savings
  • 93% tax on inheritance
  • No income splitting, despite the risk that small businesses put on family members.

These proposals wipe out retirement, savings for children’s education and parental leave.  It makes the extra cost and effort of incorporation a total waste.

Sometimes, governments tell voters something so outrageous, that people lose a frame of reference to check the facts. Small lies spark public protest. Big lies elicit shock but no action. Continue reading “Stealing from Patients”

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Who Knows Best?

The dead of summer used to mean rest. Stand-ins covered talk radio. Politicians attended Canada-Day celebrations, and everyone hit pause on life.

Summer meant nothing happened in medical politics; you might as well go to the cottage.

Not anymore. Now, summer means no one is looking, so why not push through something doctors will hate. At this rate, summer will become the new fall, and we will all need vacations in September.

In an effort to pretend I’m ignoring medical politics, here are my rambling from a Muskoka chair.

Who Knows Best?

Mark Twain said,

“I would rather listen to a soldier who has been to war talk about war than listen to a poet who has never been to the Moon talk about the moon.”

Someone also said, “The eye sees what the mind knows.” Doctors see and know problems in clinical care. We must give doctors voice. Government cannot know enough to know, let alone solve, all the problems.

This raises Hayek’s knowledge problem. Every system contains more knowledge than any single person can know. No one can ever know the thousands of decisions people make inside a system. Continue reading “Who Knows Best?”

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Overpaid and Under-Performing

Please, make it stop!

Once again, government has attacked doctors. This time, the federal government took a turn.

Finance Minister Morneau said doctors were using a “loophole” in the tax code, breaking the law against loopholes.

He suggested doctors were cheating and not paying their fair share.

He promised public consultation before addressing the overpaid doctors.

The provincial government gave doctors the ability to incorporate in lieu of fee increases, just over 10 years ago. Most other provinces have had the ability to incorporate for much longer.

Doctors could finally build a pension and create self-financed benefits just like other incorporated businesses and salaried workers.

But the federal government needs money. Continue reading “Overpaid and Under-Performing”

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Can Doctors Rebuild a Working Relationship with Government?

Can a broken relationship be mended? When one party has done something really wrong, and the other has lashed back, can they reconcile?

Doctors in Ontario have been heckled in the legislature, slandered in the media and ignored for multiple pieces of legislation. Unexpected rounds of unilateral cuts have caused festering wounds. It makes caring for sicker patients with longer wait times almost unbearable.

Some doctors are so sick of feeling abused, they only want to mock the other side. A few prefer mutually assured destruction.

But most doctors just want to care for patients. Doctors want to be left alone to care for patients without worrying about the next crisis.

Can doctors find a way to rebuild a new relationship with government? Continue reading “Can Doctors Rebuild a Working Relationship with Government?”

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Patients Need Champions, Not Doormats

People love movies about underdogs. We like watching Harry Potter get picked on because we know that he fights back in the end.

Underdogs create great stories, but they do not stay under forever.

Medical schools look for students who seem able to care.

Do they have empathy? Are they lovers or fighters?

Journalism and law schools look for different things.

Med schools err on the side of sensitivity, even if it means that some gentle souls might burn out now and then. Better that than a class full of fighters and advocates.

It wasn’t always this way. In the olden days, good grades guaranteed a spot. Schools didn’t weed out the way they do now. Each class formed a cross-section of everyone who did well in school and wanted to become a doctor.

Medical school interviews changed all that. Doctors trained since 1990 have been selected for sensitivity. They have endured extensive psychosocial training. They have been selected and trained for professional deference. Continue reading “Patients Need Champions, Not Doormats”

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Equality, Relativity and Democracy

The World Record for solving a Rubik’s Cube is 4.73 seconds. My kids can do a 2×2 in under a minute. I have never solved a Rubik’s Cube.

Inequality has existed for as long as we have.

The Greeks developed philosophy, literature and architecture when Britain was filled with “…illiterate tribal peoples, living at a primitive level.”

The Chinese invented “…the compass, printing, paper, rudders and the porcelain plates that the West call ‘chinaware’…” centuries before Europeans (Wealth, Poverty and Politics, by T. Sowell).

Equality

Some use income to measure fairness and morality. High incomes indicate greed and oppression.

Economic egalitarians believe in equal economic outcomes, regardless of effort and circumstance.  Egalitarians oppose meritocracy. Continue reading “Equality, Relativity and Democracy”

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Change & The New OMA

People say that they hate change. But it’s not true.

We love babies, weddings and graduation. We love new homes and cars and retirement.

Everyone loves positive change that we control, but we get stressed when other people make us move.

So most of us avoid asking for change. We know it threatens people. Asking for change means we want something better, or different.

Change & The New OMA

The OMA started renovation this spring: a new group of Board members, a governance retreat/renewal and then a major strategy planning session. Now the hard work begins.

Change means we find new and better ways to act. It means we work in concert.

Kotter

Change interrupts usual workflow. We stop doing some things, start doing others and redefine ourselves in the process. Change is scary.  If it isn’t, it probably isn’t real change. Continue reading “Change & The New OMA”

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Political Survival in Medicare

Near the end of Wonder Woman, Steve, Diana’s romantic interest, steals a plane full of poison gas.

Warning: spoiler alert.

He blows up the plane, saves the world and dies a hero. Then Diana blows up Ares, saves the universe and grieves her loss, a tragic heroine.

It’s tempting to see life as a battle between good and evil.

Bad political parties make bad decisions, all the time, which is bad. We should fight them, all the time, because that is good.

If bad parties do something good, it probably isn’t good, because they are bad.  If we cannot see the bad in what they do, it is because they hid it, which is bad. So we should oppose them, which is good.

Healthcare is Political

After 50 years of state healthcare in Canada, some people can only see healthcare in black or white. They have watched governments twist healthcare left and right, with each election.

Politicians often twist it just to win elections. So some voters feel justified complaining about everything in healthcare, especially if they hate the party in power.

But no one is wrong about everything all of the time. Even a stopped clock is right two times each day. Continue reading “Political Survival in Medicare”

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Concerns About Binding Arbitration

A smart lawyer said he sees this all the time. People fight forever to get something. They sue. They protest. When they finally get what they want, they freeze.

There must be a trick. How could the other side agree? After abusing us for so long, how do we know this isn’t a trick?

Five years of fee cuts, unilateral actions, heckling and sloppy legislation have left doctors feeling abused. The relationship between doctors and government has been torn beyond easy repair.

Negotiators have started to mend a working relationship. They wrestled for months and finally got a framework each team could support.

The binding interest arbitration framework (BAF) represents months of debate and attempts to find common ground. They shaped a BAF that looks far better than many of us expected.

Some doctors wanted a framework that would guarantee a win in negotiations. They wanted a trigger that would be fun to pull. But neither side should want to go to arbitration. A negotiated agreement should always look more attractive than an arbitrated one, for both sides.

Concerns About Binding Arbitration

So after years of asking for it, doctors in Ontario have a BAF offer.  Some have serious concerns. Here are some of the things they tell me: Continue reading “Concerns About Binding Arbitration”

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Looking for Reasons to Oppose Binding Arbitration

Optimists see change as opportunity. Pessimists find change to be irritating, risky at best. Realists weigh change one case at a time.

Doctors face a paradigm shift in how they interact with government. Binding interest arbitration (BA) promises to fix a power imbalance between doctors and government. Many docs have wanted BA for years.

But will BA fix everything between doctors and government?

Are there reasons to vote against BA?

Reasons to Vote No

A few doctors believe that there are 4 insuperable reasons to vote against this contract. If you agree with these four, then you should vote No, too. Continue reading “Looking for Reasons to Oppose Binding Arbitration”

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