Category: Politics

Politicians confront impossible decisions. Do they fund education or healthcare? Do they fix poverty or illiteracy?

Our leaders live out Sophie’s Choice all the time, one child goes to die and the other lives.

At least that’s what you’re supposed to think.

Meryl Streep won an academy award as Sophie. She chose her son, Jan, for the children’s camp. Her daughter, Eva, went to the gas chambers. Watch the movie.

Healthcare versus Windmills

Premier Wynne and Health Minister Hoskins deserve an award, too. They insist that the only way to pay for teachers and nurses is to cut doctors.

They say doctors got a raise. That’s like saying school enrolment went up so we hired hundreds more teachers, which produced a raise for teachers.

Politicians repeat it so often; we must assume they think voters stupid enough to believe it.

Moral philosophy classes used to be taught using impossible moral dilemmas.

“Suppose a train is approaching 2 tracks and must choose one.

Your only daughter plays on one track, and a school bus full of children sits stalled across the tracks on the other line.

You control a switch to send the train down either track.

The train has no brakes.

Which track do you choose?”

Wynne and Hoskins face a dilemma: cut projects like Wind Turbines, or fund healthcare. But it’s not a moral dilemma. They face a personal dilemma, a challenge of integrity.

Do they admit bad decisions, or do they put a hard cap on healthcare?

Patients want to know. Will the system be there for me when I need it, as I get older? Patients can see that caps on spending won’t hurt immediately. They understand that it will take time.

Arbitration, Not Legislation

Doctors will not act against patients. They will always care for their own. But doctors will not accept more complex, elderly patients.

They cannot.

The province penalizes doctors for seeing more, providing more care. The province claws back doctors’ billing for seeing more patients. The province put a hard cap on medical spending.

We can do better than this. We can build a system that’s great for patients and fair for doctors and nurses. We need to start with patient needs at the center.

• What will the aging baby boomers need?
• How can we plan to meet their medical needs?
• Does cutting doctors now help us meet those needs?

Everyone makes mistakes. Politicians need a wide swath of grace. We’d all screw-up if we were in office. That’s why we elect politicians, not actors. We elect character, not panache.

It is government’s responsibility to get back to table and fix this mess. Get an agreement with doctors.

Doctors cannot strike. They can only take legal action as a proxy for job action. And doctors will do it. We have no other choice. It will take years to settle. Let’s hope it happens before cuts hurt patients. Let’s hope Premier Wynne wakes up and starts funding healthcare versus windmills.

photo credit: news.ontario.ca

Doctors want blood. They got hit again, and no one seems to care.

The Liberals cut 4.45% this year already, with more to come. But patients have not seen a change in service.

Patients will feel the rigid cap on spending in 3-4 years, long after Premier Wynne leaves for a new social agenda.

Doctors want action, now.

Doctors’ Action Plan

Many doctors ask, What can I do?

Buried in dozens of emails, I try to share this general message:

• Be bold.
• Take action.
• Accept risk.  
• Build alliances. 
• Inspire others.

Be Bold

Bold does not mean angry or stupid. Bold means not fearful or hesitant in the face of possible or actual danger.

Anger and stupidity blind us to danger. Boldness steps forward with eyes open. Doctors need to know what they are stepping into. Talk to others. Listen to stories about other fights with government. Know the danger. But do not hesitate.

Take Action

We are all different. Some people write. Others talk. Doctors need to find that kind of action most suited to their identity, their character.

Some doctors write research papers for fun. For them, writing a scathing academic analysis seems like a great ‘job action’.

We cannot expect all doctors to take the same action. It would feel odd. The first action should look different than the final action. Save some cards to play later.

Action does not mean harming patients or lying in the streets. Doctors cannot strike.

Accept Risk

Failure, even the thought of failure, immobilizes most doctors.

Activism does not come with a multiple choice test at the end. You cannot plan to get an A+.

You will stumble. You will make mistakes, offend others by accident and generally cause yourself pain.

There are no perfect messages or perfect ways to attract attention. Just get as much advice as you can, then be bold and take action.

Build Alliances

We achieve more together. Political parties, rock bands, churches and social movements rarely survive as one group. They divide and sub-divide.

We do not need to agree on everything. Alliances topple regimes. We need a strong alliance (union?) to fight tyranny.

Inspire Others

Pick 1 or 2 things that really bug you. Double-check your facts. Second guess your motives. Then make your simple message public.

People love authenticity; they cannot look away.

Use your message to inspire others. Don’t bother inspiring people you do not like. Inspire those close to you, people you’d want to see anyways.

 

Doctors are angry. Now we need to focus. Re-check our vision. Look for advice and partnerships. Then act boldly knowing that we will not be perfect.

No one can tell you what one thing you must do. The OMA can hire lawyers and expert media firms. They need our support, but real change comes as we convince one person at a time.

We can start with those closest to us.

Do you want your care capped?

Do you support a rigid limit on how much medical care patients get?

If not, why not help us pressure the Liberals to negotiate with Ontario’s doctors?

photo credit: telegraph.co.uk

 

Getting voted off the island is like being thrown under the bus, except more people do it to you.

The reality show, Survivor, gave votes to players so that the majority could send losers off the island, out of the show. Everyone got a secret ballot in the war of all against all.

Survivor is democracy in action, right?

Doctors and Democracy

When everyone votes directly on issues, we call it direct democracy. When we elect representatives – who are supposed to represent us, not their party – we call it representative democracy.

Voters send representatives to parliament to speak for all of us, doctors included. Politicians speak for everyone in their riding, not just the mob that funded their election campaign. Politicians are supposed to have ideas of their own and not just parrot their party leaders.

We elect politicians to speak for doctors and protect them like every other minority group in society.

Democratic Despotism

Over 150 years ago, Alex d’Tocqueville warned about democratic despotism. He described a kind of despotism that grew from a too fervent or uncritical devotion to the sovereignty of the people. Despotism arises when the majority democratically blesses a despot in trampling on the rights of others. (What Tocqueville foretold: a despotic democracy.)

Democracy fails when politicians ignore the rights and freedoms of minority groups.

Rights, Duties and Handouts

Do rights mean handouts, freebies? Do doctors have rights?

Everyone demands his right to publicly funded services. Most of the time, rights are just another way to take something that is not yours without calling it stealing.

Rights relate to our understanding of liberty. In his famous essay on liberty, Isaiah Berlin said that positive liberty assumes someone else provides for it. Positive rights (liberty) put duties on someone else to meet the demands of the rights in question.

If you demand the right to education or healthcare, then the government has the duty to pay for it.  (People used to talk about education and healthcare as privileges of citizenship.)

Positive rights demand handouts.

When doctors complain about government trampling their rights, they do not mean positive rights.

Berlin described a more basic kind of right: the right to be left alone, to not be attacked or have your property stolen.  Negative rights (liberty) let you form free associations and act according to your conscience. They include the right to live free of tyranny and oppression; the right to pursue and practice a career in the way you see best.

Negative rights demand the right to be left alone.

Mobs, Doctors and Democracy

The founders of Western democracy feared mobs like the Jacobins in the French Revolution. Advanced societies speak for minorities the mob would otherwise devour.

This means protecting the rights of the weak. But it also means protecting the rights of special people who develop rare genius, like Steve Jobs or Bill Gates. If we allowed mob rule, Jobs and Gates would have had their successes stolen by the majority, long before we got to enjoy their inventions.

Western democracies were designed to protect the rights and freedoms of all from the tyranny of the majority, and the state.

Doctors – Time to Fight?

Doctors have been voted off the island. They’ve been thrown under the bus while other groups get contracts –  teachers, nurses and police.

No one else gets cuts, four years in a row. Doctors are ignored by politicians and most of the media.

Is it right that:

• It is illegal to practice medicine outside of the provincial insurance plan?
• The Province of Ontario cut MD fees in 2012, 2013, 2014 and 2015?
• Premier Wynne will claw back fees doctors billed for seeing patients who needed care?
• Ontario blocked new doctors from practicing in the team models they were trained in, and expected to fill?
  • New docs were sent back to fee for service (FFS). Team care is to FFS as Tim Horton’s is to a private doughnut shop.
• The CPSO demands ‘effective referrals’ even if doctors believe it will not benefit their patient? The CPSO can take away their license for refusing.
• The CPSO restricts doctors’ right of association?
  • They demand MDs start doctor-patient relationships with all patients who walk through the door – if patients fall within the scope of a doctor’s training – even if doctors do not believe they will be able to meet patients’ demands and expectations.

Failed Democracy

Modern society requires you to fight for your rights. Doctors cannot depend on elected representatives. MPs do not know the issues and cannot (or do not want to) understand them. Medicare has grown up and changed.

Doctors, democracy has failed you. Stop expecting patients to care about fee cuts. Stand up and fight. Write letters. Challenge government usurpation of care. Prepare to fight. A lawsuit will not save you. Claw-backs are looming on top of the >25% loss in your net income since 2012.

If you plan to keep practicing in Ontario, all doctors will have to fight for their rights: to care for patients, to fair treatment by government, to free association and to free enterprise.  What are you prepared to do?