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.

Idealism and expediency fight to win debates in politics. Money flows to concentrated interests. Collectives apply concentrated pressure. They advance their interests and force a diffuse group to pay for it.

Is this how it should be?

Western democracy was set up to divide power, to avoid tyranny. It should protect diversity.

Politicians should represent the small groups in society, not just the majority. Representative democracy needs a constitution and the rule of law.

These days, majority parties often ignore minority voices and pass laws because they can. It is mob rule, just as the Greeks warned.

So throw them out. Elect new people. That works for scandals and broken promises. It does not work so well for healthcare.

Medical services take decades to build. Rewriting plans with every election creates chaos.

Patients lose out. They get left in hallways. Patients fill the auditorium and gymnasium at our local hospital right now.

The Ontario Health Insurance Plan began as an insurance plan. Regular insurance plans hold reserves. They pool risk. Ontario has no reserve. It has $300 billion of debt. OHIP runs by using money now that our children will pay back later.

Who thought that government could run a $50 billion insurance plan in the first place?

Government is not designed for the job. Even if it had the skills and structure, most politicians could not resist the temptation of votes for patient care.

In the sea of misaligned incentives and waves of popular opinion, healthcare is like driftwood, smashed against the rocks of budget deficits and sucked back to the ocean of competing interests. No wonder some doctors just say No to everything.

Political Survival

Life is messy. Survival often demands that we shake hands with those we do not like or trust.

We should never compromise our principles, but sometimes we have to hold our noses. And of course, others have to hold their noses around us, too.

We work in an imperfect system that needs our help. We can dream of a world where Wonder Woman fights Ares. Or we can get to work in our real world full of grey.

We should examine each step for what it is, not for what came before it. We will never move anywhere, if we demand that each step offers complete redress for all that came before.

Moving forward means we must test each move and accept that many more will follow.

Survival in medical politics requires vision and a million tiny steps towards it. Heroic acts only save the world in movies.

Photo credit: digitalspy.com

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7 Replies to “Political Survival in Medicare”

  1. Sir Shawn,

    Timely article! I saw WW this past weekend and I must say, I took a totally different message from it and how it applies to our situation.

    I saw a movie about a woman who left the safety and security of her home and family to fight for a principle she believed in–which was a black and white belief in the world. Diana (now I feel like a geek, but here it goes) came to realize this by the end of the film that despite being told again and again that she was wrong, there is no god of war, she found out that she was actually right…and wrong. She indeed defeated Aries, but came to realize that the evil in men is their own creation and that through conviction and adherence to the principles of justice and righteousness the eternal battle can be one or at least should be fought. Believe in your abilities and don’t listen to the noise of the naysayers, even if they label you as odd or out of touch. Right is right and will prevail.

    I will leave the reader to draw upon the parallels between this tale and the parties currently fighting for the correct path and narrative of how to deal with this government’s icy outstretched hand of can offer of “peace in our time”.

  2. Well done Shawn,

    I see just as much of a parallel between our situation and the unnecessary conflict of WWI. An armistice was signed to prevent further pointless bloodshed. Continuing conflict simply for the purposes of conflict is counterproductive. There is no more to gain by engaging in strike or job action for BA when a framework, endorsed by the Board, 50% of whom are new and 50% of whom are established, is right in front of us, ready for the taking. It provides for a fair process and allows us to get back to work caring for patients without sacrificing any of our principles.

    1. Darren, a comparison to the Armistice at the end of WWI is not particularly apt here. The Treaty of Versailles was the cause of an even bloodier and preventable WWII. Its lopsided emphasis on German reparations and denials of German sovereignty created economic chaos and destruction. It was fertile soil for the twisted genius of public manipulation and big lies. We hope this BIA is not the treaty of Versailles. Curiously the post war doctrine of Mutually Assured Destruction, as mad as it was, actually kept the general peace for quite a long time. I am hoping that the BIA is our A-bomb and will keep us from being assaulted again. In order for it to be that, it has to be maximally potent. This agreement is better than anything we have had in the past but that is not to say it is the bomb!

      1. That’s right Ernest. Terrible comparison to aspire to, but sadly correct.

        Instead of a railcar, are we going to sign this on Wynne’s big rubber duck?

  3. I am impressed with you and the rest of the board for reaching this Binding Arbitration Framework Agreement. I intend to vote in favor of the agreement. I see it as bringing more fairness to the table.

  4. Great article. I think some of the apprehension is not necessarily with BAF but rather trusting the OMA as our representative. Even though some of the players have changed a lot of MDs feel the game is still the same.
    The OMA pushed a flawed deal in 2012 that threw some groups under the bus and gave themselves exclusive representation rights in perpetuity . This BAF solidifies the OMA as our exclusive representation and even has within it the clause that the membership cannot vote to change our representation unless the OMA AND the Government agree. That, along with the history and the relativity clause has a number of groups having doubts about this BAF.
    After 2012 and the last summers failed referendum (for which the OMA pushed hard including Robocalls etc) this is vote is more about trust in OMA as our representatives than the BAF

  5. As we vote on an agreement binding on our profession “for ever” and not binding on the government …OPSEU public servant members ( 36,000 ) are voting on a 4 year extension with a number of improvements and NO DEMANDS FOR CONCESSIONS…wage increases July 1 2017 1.5%; January 1 2019 1% ; July 1 2019 1% ; January 2020 1%; July 1 2020 1%; January 1 2021 1%; July 1 2021 1%…..7.5%!

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