Category: Politics

The strong steal from the weak: kings from nobles, Castro from Cubans, and Premier Wynne from Ontario’s doctors. English barons wrote the Magna Carta because King John acted like Premier Wynne, a law unto herself.

Magna Carta – “the greatest constitutional document of all times – the foundation of the freedom of the individual against the arbitrary authority of the despot”.

 In fairness, Wynne attacked because no law said she couldn’t. In fact, previous governments did the same thing in the 1990’s social contract years with clawbacks and caps that forced doctors to work for free.

A specialist asked me, “So government can cut us, we have no way to fight back and it’s illegal to bill outside of OHIP. Isn’t that Communism or something?“

Throughout history, governments have stolen power and property – usurped – from their citizens. Tyranny and usurpation still drive immigration. Most Canadians have relatives who fled political tyranny for freedom.

Canadian democracy stands on the rule of law. We answer to the law, not the capricious whims of monarchy or government. And where there is no law, Canadians behave by principles like honour your commitments, deal fairly and tell the truth.

Usurpation in Medicare

Medicare was once an insurance plan. Now it’s an example of government imposing itself on others. In the late 1960s, Medicare simply replaced a few large health insurance companies. Ostensibly, a national plan guaranteed coverage for all citizens and promised administrative savings.

In the glory days of Canadian Medicare, doctors worked and governments paid. But policy experts tickled political ears with whispers of a more robust social utopia, a full-blown, centrally controlled healthcare system.

Social designers had to wait for Medicare to become a national icon before they took control. By the 1980s politicians had what they needed and moved in. Doctors were pushed out and have been blamed for almost everything wrong in Medicare ever since.

How to Usurp and Get Away with It

Aside from a few historic exceptions, whenever doctors organize serious resistance, government pays them off. Docs always settle for less than they wanted; passion fades quickly. Myths about pendulums swinging or cycles of plenty and famine usually turn doctors back to their knitting. They hardly notice that fees are now only 50% of 1970 levels. Citizens tolerate usurpation in small slices over time.

Wynne got greedy and went for a big slice. Her plans cut over 20% from doctors’ net earning by 2017. Incomes have plummeted since 2012 such that by 2017 doctors will have lost 30% of their net in 2012 dollars. Wynne’s usurpation will fail.

Representation Rights

Doctors have had zero protection from usurpation by government for the last 45 years. They cannot strike. They cannot earn income practicing medicine outside OHIP.

For the first time in 4 decades of state healthcare, government acquiesced and promised in legislation to ‘negotiate’ before legislating fees. But even with representation rights, government ’negotiated’ for a whole year and then legislated what they had offered on day one of ‘negotiations’: a rigid cap on total spending for MD services.

How to Win Enemies

Many blame political oppression for terrorism. At the very least, tyranny and usurpation inflames hatred of government and its policies.

Medicare runs on doctors’ cooperation with government. Doctors will never riot or terrorize. But do politicians really believe that Medicare has any hope of survival when they treat physicians with disdain?

When government usurps too aggressively, it starts revolution. Wynne has created a small pack of doctors determined to revolutionize healthcare. Once committed to action, they will not distract easily.

Wynne gambled that doctors never fight back. But some do. I think she might have gambled wrong.

photo credit: magnacarta800th.com

Unions formed to fight bosses who demanded more work for less pay in unsafe conditions. Majority support allowed ruthless employers to dictate wages without negotiation. Labourers built unions to force entitled elites to listen, to back down.

Premier Wynne and Minister Hoskins swagger through parliament. They attack new physician graduates with impunity and slander established doctors without shame. Then they lie about it (see We Expect Honesty from Our Government). Many physicians cry out for a union to fight back.

Union versus Association

Unions bargain collectively. Union bosses fight every instance of oppression. But they also shield low performers, promote incompetence in the name of seniority and willingly kill their young to get higher wages for senior dues-payers. Unionists lust after bigger membership lists, more dues, more power.

Associations work to promote an industry and ideals supported by trade professionals. Associations acknowledge excellence and kick out members who underperform. Individual workers get help only if their case shows potential to harm other members; unique cases get ignored. Unions and associations usually share features; they overlap.

Ontario Medical Union

The government legislates all physicians to be dues paying members of the Ontario Medical Association. The Rand formula makes collective bargaining doable. Even libertarians have no appetite for negotiating separately with over 60 physician specialty groups.

Forced dues and collective bargaining feel like unionism. But government carries the clubs and demands collectivism.

Design

The OMA acts like a union in collective bargaining but was never designed to fight for individual physician rights. There’s no dispute resolution when collective bargaining fails, and no work grievance process. The government can cut as much as voters will allow during ‘negotiations’. And it can treat individual doctors however it likes in between. There are no union bosses around to help.

Over time, the OMA has increased representation for individual physicians and beefed up its legal department. It offers contract review and advice for individual compensation issues. However, it does not show up for every grievance in the way a union boss does for his members.

Even without a 25-30% cut to net income, MDs fume that politicians can mistreat doctors with no legal reprisal. It enrages doctors and fuels cries for unionism. But the current OMA does not have the legislative authority, constitutional structure or mandate to behave like a union. This frustrates physicians even more.

Medical Union = Demise of Medicare

A union of 27,000 physicians would crush Medicare. The Ontario physician services agreement is the largest labor contract in North America. If MDs were fully unionized with dispute resolution and job action, the economy could not produce enough taxes to support such a beast.

The only reason Medicare hobbles along is because politicians can deal unfairly with physicians when times get tough. They make unilateral cuts or massively curb access, like they did all through the 1990s and from 2012 – present.

Patients and physicians face uncertain and troubling times in Ontario. But crisis creates opportunity. Let’s hope physicians and patients get a meaningful voice in the change that follows. When money runs out, governments tend to increase control. Politicians could decide to become even more regressive – more totalitarian – in their management of nationalised industry.

Our toes grip the end of the healthcare diving board this spring. A splash will follow. Let’s hope it’s not a flop.

photo credit: theguardian.com

Organizations risk becoming irrelevant and detached from their members.

Wynne’s attack on doctors puts the Ontario Medical Association in a bad spot. Front line docs will resent government initially. But unless they see the OMA as their champion, physicians will eventually turn against their association.

Relativity grates on doctors every time they drive in to do a case at midnight or try to wake up a cushier specialty at 3 in the morning. Invariably, the cushy guys generate a much bigger income. Everyone knows it, but no one can fix it. Docs give it less attention when times are good.

Repeat failed contracts weaken the OMA. People forget the totalitarian approach government took in ‘negotiations’. Doctors just see failure. Physicians do not suffer fools lightly. MDs believe serving in leadership is half as hard as clinical practice. Many think they could do a better job if they were in leadership but just don’t have the interest or time to spare.

Disruptive technology pops up when the status quo gets too big, expensive and unwieldy. Personal computers took over when mainframes became more powerful than necessary and too hard to access.

Is the OMA risking a disruptive innovation?

The Ontario Coalition of Family Physicians formed after family practice nearly died in the 1990s. Many of the coalition members got on the OMA board and improved things for family practice in the early 2000s. They saved family practice from extinction.

Family doctors now face a 25-30% income cut by 2017 from 2012 levels. It’s not the OMA’s fault. Premier Wynne slashed doctors to finance Liberal debt and scandals. But doctors won’t remember that. They’ll just see that their collective bargaining agent didn’t come through for them.

Crucial Conversations

The OMA faces a critical juncture. It needs to ask some hard questions.

• Why does the OMA exist?
• Who does it serve?
• Where does it draw the line between serving members and partnering with government?
• Does the OMA take members for granted?
• Does the OMA resist change and avoid competition?
• What political philosophy does it espouse?
• How does OMA policy and bureaucracy help or hinder its mandate?
• What needs to change?
• Can the OMA improve member involvement and if so how?

The late Brenda Zimmerman inspired us to ask ‘wicked questions’ that include seeming opposites. For example, how can we increase services AND spend less? Love of wicked questions aside, we often struggle to hold onto more than one thing at a time.

OMA Mid-Life Crisis?

Billy Crystal played Mitch Robbins in the 1991 Movie, City Slickers. Mitch has a mid-life crisis and signs up for a cattle drive on a ranch in New Mexico to clear his head. An old cowboy, Curly Washburn, played by Jack Palance, offers Mitch some advice.

Curly: Do you know what the secret of life is?

[holds up one finger]

Curly: This.

Mitch: Your finger?

Curly: One thing. Just one thing. You stick to that and the rest don’t mean sh**.

Mitch: But, what is the “one thing?”

Curly: [smiles] That’s what *you* have to find out.

What is the OMA’s one thing?

Without member support, the OMA loses relevance. It can have the best leadership, policies and bureaucracy, but without support, it’s weak and lost. How can front line physicians help the OMA through to find its one thing, to continue being relevant, strong and connected?