Almost 50% of couples divorce, but 90% never fight about money, according to a new study.
Government has fought with doctors for almost 50 years now, and it looks like all they do is argue over money. This assumption is reasonable, and wrong.
Money is a Distraction
Most grownups pay attention to their accounts. They limit debt and make payments on time. They know that money runs out.
Government takes a different approach. In part, government does not need to worry; it can always raise taxes. But voters will not tolerate anything. Taxes run out, too.
When doctors and government fight about money, observers often miss an important point: Government does not really need to worry about the money it spends on doctors. It could just buy peace and then tax it all back.
Politicians could give doctors a raise, and then remove a tax benefit, like incorporation, or create a new tariff on medical practices. Government does not need to care about money the way individuals do. Money is secondary.
More Important Than Money
Most governments — especially the current Liberal government in Ontario — care about control, first. Governments always have.
The current government wants to define access and promote guidelines for care. It wants to give orders. Government uses money to get control.
The government is merely a servant―merely a temporary servant; it cannot be its prerogative to determine what is right and what is wrong, and decide who is a patriot and who isn’t. Its function is to obey orders, not originate them.
— Mark Twain
Medical associations tend to focus on minutiae about spending and accept vague concepts mixed with broad generalities for everything else. They almost miss the point entirely.
When government holds power to take back what it gave, discussions with government must pivot around control, not money.
With government hegemony, every detail about control becomes crucial. Doctors cannot trust hand waving about partnership or co-management.
Little Rebellion
Politicians, like regular people, often hold grudges and lust after power. Thomas Jefferson said that rebellion works like medicine to keep the government healthy.
I hold it that a little rebellion now and then is a good thing, and as necessary in the political world as storms in the physical. Unsuccessful rebellions indeed generally establish the encroachments on the rights of the people which have produced them. An observation of this truth should render honest republican governors so mild in their punishment of rebellions, as not to discourage them too much. It is a medicine necessary for the sound health of government.
— Thomas Jefferson
Is our government sick because doctors refuse to give it a little necessary rebellion?
Government wants ‘efficient technicians’. It wants quiet, thoughtful workers who follow guidelines. It wants willing partners to implement change.
Individuals who exercise professional judgment are much harder to govern. Organic care networks, that expand and collapse depending on patient need, resist bureaucratization.
Governments want efficient technicians, not human beings, because human beings become dangerous to governments…
— Jiddu Krishnamurti
Politicians tell us that there is no more money for healthcare. And in many ways, doctors have already given away all the important levers of control.
Maybe it’s time to stop fighting about money and discuss “a little rebellion” instead?
Yes it is about control, but it is also about money. We need a certain amount of money to keep our practices (especially private practices) viable. I for one have reduced staff and eliminated some insured services from my practice because I cant afford them anymore. Where do the patients go? Not to anyone in OHIP. This is government cutbacks in action. Now Quebec is clamping down on extra fees charged for meds and supplies in some clinics for procedures. What will be the response? Those clinics will stop offering those services. Yes we need a revolution and it should be about extra billing. Government doesn’t want to spend another dime? Fine, but someone has to pay because physicians are tapped out. It is about money eventually. What government doesn’t realize or want to accept is that the more government is involved, the less services will be available. We cant all work for academic health centres seeing half a dozen patients an afternoon with salaries and paid academic days. Very few doctors get those gigs. The rest of us struggle every day to pay rent and salaries and supplies. A dexon suture costs about $11.30 and the whole tray fee is less than that. We need a revolution and it has to be about our cost of doing business that relentlessly increases at a rate much higher than general inflation. This increase has absolutely nothing to do with increased utilization, that’s another can of worms we are expected to swallow.
Great comment, Ernest!
I was hoping someone would take up this line of thinking. I agree that on a practical level, specific fees can make or break a doctor’s ability to provide a service. My concern is that we seem quick to give away control as long as government offers higher fees.
It’s interesting how you end your comment. You raise the point about control over extra billing (I prefer the term ‘balanced billing’ as described before the media twisted it).
As you say so well, perhaps we have something like Janus, with two faces. We risk suffering at the hands of the other face, when we focus on only one at a time.
As always, thanks so much for reading and sharing such a thoughtful comment!
Cheers
Shawn
Well spoken! Government controls by taxing what it needs from anyone who does anything and then offering the carrot to those do its bidding. The twisted irony is that a people who recoil from the idea of being told what to do continue to swoon over leaders whose governments will control whoever they can.
I love it: “…people who recoil from the idea of being told what to do continue to swoon over leaders whose governments will control whoever they can.”
Voters have started to wake up, I think. The wanton arrogance of certain leaders would not survive a ballot right now. I worry that the same leaders will offer enough carrots to win another election in 2018.
Thanks so much for sharing this!
Cheers
Shawn