Medical Fee Cuts and a Bakery

breadPeople struggle to see how fee cuts could harm patients. It just does not make sense that the most vulnerable patients might be harmed by cuts.  This post attempts to explain the impact by using a parable. I hope it helps.

 

There once was a wealthy man with too many children to count. The kids filled a whole village. The only other grown-ups in the tiny village were a small group of bakers.  Each day, the wealthy man sent his children to buy bread at the village bakery. The bakers worked all night long so that the children would have fresh bread every morning. The wealthy man kept a tab at the bakery so that the children could pick whatever loaf they wanted, and he would pay for it all at the end of the month.

Every morning, the children showed up for fresh bread. Most of the kids picked rich, crusty bread. It was cheap, plentiful and delicious. Each baker’s loaf tasted slightly different. Each child had a favourite loaf and bought bread baked by the same baker each day.

But a few children could not eat the crusty bread. They were gluten intolerant. For these children, each baker made a few loaves of gluten-free bread. The special bread had a higher price because it cost more to make a loaf.

One day, the wealthy man fell on hard times. He had invested in wind machines that didn’t turn a profit. He had very little money left over to buy bread.

So, he told the bakers he could not pay extra for the gluten-free bread. The bakers complained. The children needed gluten free bread.  It required extra time and expense to bake it. The wealthy man would not listen. He said that the bakers sold lots of bread and were well paid. They had no right to charge more for the special bread.

What were the bakers to do? The children needed gluten free bread, but their father refused to pay for it.

The bakers talked and talked. Finally, they came up with a plan. They would keep making gluten free bread for their current customers. The bakers would make enough gluten-free bread to meet the needs of the children they currently served.

But the man continued to have more children, and the children continued to grow. The bakers made more and more crusty bread to feed the hungry children but kept making the same amount of gluten free bread as they had before.

It came about that some children who used to eat the crusty bread became gluten intolerant. On top of that, some of the new children ended up gluten intolerant from the start. But there was no more gluten free bread for them to eat.

The bakers pleaded with the wealthy man. They begged him to cover the costs of making more gluten free bread so that the bakers could offer it to the children. The man refused, and the children went hungry.

 

Doctors will do everything they can to mitigate the impact of fee cuts. They will keep caring for their patients as before. But do not be mistaken; fee cuts harm patients. The government has responsibility to pay for the care they’ve promised to provide. We need to hold politicians to their word. Arbitrarily cutting fees compromises patient care for those who need it most.

photo credit: cbc.ca

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14 Replies to “Medical Fee Cuts and a Bakery”

  1. What a perfect explanation. I truly enjoy reading your emails..keep them coming!

    The one thing that I have noticed as I read your and all the other media around this subject is that no one has yet to open the tier system discussion . It would appear to me that the government is trying to open the door on charging patients for more Healthcare and make the Doctors the bad guy for doing so.

    1. Thank you so much for reading and commenting, Dieneen! Comments from readers like you make the post far more meaningful for every single reader that comes along.

      I wish I knew what the government had planned. I fear they don’t have any plan at all beyond dealing with the debt.

      Thanks again for reading! If your email is a clue to your location, I might bump into you someday soon.

      Best regards,

      Shawn

  2. I have a feeling our paths will cross soon. We have mutual friends at SRHC and your name keeps coming up to me 😉 I look forward to it.

    Best regards,
    Dieneen

  3. Hi Shawn. This is how the squeeze begins and just gets worse. Is this not how Walmart functions? I hope the board of the OMA does not succumb! As to reconciliation payments this is ludicrous! The government of Deb Mathews and Kathleen Wynne will have to continue to decimate until they implode which will happen!!Let them fix the wait times ! I have patients waiting 2 years for back assessments and shoulder replacements and 1 year for hip and knee replacements. What are they going to do about that?

    1. Thanks for taking time to read and comment, Tim!

      As you say, it’s the most vulnerable, the patients referred to specialists, the complex patients, who end up most impacted by these arbitrary changes. I can only suppose that they try it because they think they can get away with it. I hope people take time to fully understand what the government is doing.

      Thanks again!

      Shawn

  4. Hi again, Dr Whatley,
    This especially hits home to me, being a Celiac patient practicing family medicine in Ontario!

    SO the father, who wasted his investments in wind machines has no money, so has to find ways of making it to provide all his children with equal access to bread again. Hmmm….next to impossible. I fear this leads to no other conclusion but a 2nd Tier to provide the money???

    We’re screwed!
    Great story, sad ending!
    Donna Mahoney, Woodbridge

    1. Oh no! I hope you didn’t find it inappropriate? I didn’t mean to poke fun at any patients.

      I’m so glad you asked, “So, what’s next?” That’s exactly where we need the conversation to go. Do we want more of the same? If everyone wants that, fine. We can build and provide more and more of what we have now. But we have to pay for it somehow. Or, could we learn something from Sweden, England, France, Germany, Switzerland or even Singapore? Is it possible that other smart people have figured out ways to provide universal care that respects patients, does not compromise on quality and delivers on wait time promises?

      I fear that “2nd Tier” risks oversimplifying the discussion and closes debate before it begins. I find it has the same reaction as asking whether we want to keep sailing or blast a hole in the hull. People panic and vote for sailing regardless of icebergs ahead.

      Thanks again for reading and commenting. I sure appreciate having people help out with this topic!

      Kind regards,

      Shawn

  5. Really nice parable Shawn. The paternalistic king is quite a nice analogy. Many of his children have grown up. They appreciate what the king has done. They realize the king can’t keep on paying for everything. Many of them are even WILLING to pay for their special bread, or at least pay the difference between the ordinary bread and the gluten free. The king won’t dream of it. That would make him less kingly. It would go against the principles of the bread kingdom. Why, if we did that soon eeryone would be paying for all their own bread and those that couldn’t afford it would starve. Some bakers might even start making REALLY special bread and get rich off those willing to pay for it. The fear of the possible bad outcomes paralyzes the king, despite the evidence of the real bad outcomes already facing him.

    This is what killed communism in Russia. Fear of change and failure to reform in the face of clear unsustainability meant that all the west had to do was sit and wait. Communist Russia drove itself straight into the ground with the fear that introduction of ANY capitalist or democratic reforms would lead them down a path to doom. They didn’t realize they were already on the path. The west just let them keep walking.

    1. Brilliant comment, Jon. You took the idea and made it so much better! I had only thought of trying to explain current headlines.

      I really appreciated your comments “…all the west had to do was sit and wait.” I wonder if that’s what we’re supposed to do here? It kills me to watch our beautiful system crumble because we refuse to try anything new. Sweden has managed to keep things extremely socialistic but still develop a layer of accountability by offering patients some choice and guaranteed wait times with a promise (as one example among many).

      Again, I really appreciated your comment! Brilliant!

      Highest regards,

      Shawn

  6. Shawn:
    Thanks for your great writing and parable.
    Your story ends with the baker stop making bread.
    Unfortunate the bakers in this province will keep subsidizing the bread.
    Are we close to the point to stop making bread ? Until then, nothing much is going to happen. The power to be knows the game plan WELL. Until we are willing to do something that affects (not harm) the patient, they will keep squeezing us. Get your fellow Board members to be on side and DO something.
    The majority is still waiting for OMA to act. I have been around for 40 years and this time seems different : the grass root member are realy angry and frustrated.

    Michael

    1. Great comment, Michael! You touched on a key issue. Docs keep working….hard. I agree, we fight a very knowledgable opponent. The OMA will come out with some impressive moves, but the scariest moves for politicians come from the grassroots. Politicians hate hearing about grassroots movements.

      I really appreciate you sharing your 40 year perspective. I think you’re right; this time it feels different. Nothing has happened that’s this tyrannical in Ontario to date.

      Thanks for taking time to read and comment!

      Kind regards,

      Shawn

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