Category: Politics

Television host, Steve Paikin, spoke with Dr. Ved Tandan, Ontario Medical Association President, about the failed OMA MOH negotiations. Paikin asked what happens when government, the payor, makes unilateral cuts.

“Usually when these kinds of things break down, Dr. Tandan, the payee does something like withdraw services; like go to Queen’s Park with lab coats and protest signs and raise hell, etc., etc. What do the doctors have planned now?“

Tandan said, “The doctors of Ontario are going to do everything we can to minimize the impacts of these cuts. But make no mistake; there will be negative impacts.“

See The Agenda (11:38).

What Next?

A prominent pollster in Ontario told a large group of physicians that doctors need to learn how to play tough. They shouldn’t be so nice.

Ineffective action could be seen as inaction.

Physicians need to think about doctors who are working now, those who will follow, and all their patients. If doctors frame fee cuts as nothing but a personal nuisance, they miss the point. Current cuts drain physician funding for the next 15 years or more.

Time to Recovery

In 2012, doctors took a 5% fee cut. Inflation runs between 1.2-2% per year. The Wynne Liberals sliced off 2.65% this month with more to follow. Wynne promises 4% plus an unknown amount of claw backs as ‘reconciliation’ for growth in services.

5% + (2% x 2 years) +4% = 13%

Doctors will see 17% cuts, or more, to gross billings by 2017 including inflation. Physicians’ net income will drop well over 20%.

How long will it take to fees to recover? Even if we assume a 1% recovery per year, plus 2% inflation, it would take 17 years to recover with 3% raises per year, or 2034. How reasonable is it to expect 17 yrs of 3% raises? The core family practice code, A007, has almost flatlined.

 

Response vs. Vision

Doctors took a fairly measured, coordinated response so far. Articles, videos, social media and meetings with politicians offer peaceful protest. Should physicians ramp up their response? Should they march to Queen’s Park?

What do doctors want? They probably want the bottomless pit of reconciliation abolished. Docs likely want the indiscriminate program and fee cuts reversed. But do physicians have a vision for fundamental change?

Without system change, we can expect more cuts and tweaks in the future. Political pilot projects within the current framework will raise expectations and then disappoint with unsustainable costs. Four decades make it certain. Dr. Max Gammon, after studying the British National Health Service, said that in

“a bureaucratic system … increase in expenditure will be matched by fall in production ….”

It’s called Gammon’s Law, or the Theory of Bureaucratic Displacement.

Some doctors want protest but have little appetite for fundamental change. Protesting current cuts while asking for a return to the status quo prolongs the inevitable. If we protest, we need protest with vision. Are doctors willing to consider substantive system change? Is the public ready for it?

Or should doctors shut up and accept a >20% cut to net income?

photo credit: theagenda.tvo.org

Doctors take buses to protest outside parliament. Noisy physicians crash a local political meeting. Doctors hand out flyers at a shopping mall, scuffle with security and get on the evening news.

Grass roots activism sends chills into both sides of a political war. It’s messy and carries huge reputational risk. It might back fire. It’s often crude and unsophisticated.

Activism is not about riots, and doctors cannot strike. The occupy movement used professional demonstrators funded by partisan organizations to drive a political message. They did not grow on local individuals and families standing shoulder to shoulder against injustice.

Organizations prefer thoughtful, coordinated media-based campaigns. They show the other side that you can mount a sophisticated attack. Media campaigns often work very well.

But what if media has no interest in being convinced of your message? What if journalists fundamentally disagree with your position?

What if your audience cannot understand what you’re saying? What if a campaign drags on, year after year, same old thing?

What if the public doesn’t care?

Grassroots Activism – Features & Benefits

1. It gives people something to do. When citizens get oppressed, they go through shock, disbelief, anger and depression. But eventually, many of them will look for ways to fight back. They need something to do.

2. Grassroots activists welcome sacrifice. They volunteer. They believe in their cause. They use personal funds. They enlist their families into the movement.

3. It focuses an issue. It does not try to deliver a complex intellectual message. Activism sharpens discussion onto a single injustice. It’s gritty, emotive. It speaks to people’s hearts. This is wrong! You cannot treat people this way! Simple messages empower activists, recruit members and resonate with the public.

4. It’s time limited. Movements wrap up when they achieve success. People go back to their families, on with their lives. Movements that spawn reactionary organizations never hold public sympathy for long; they get old, stale.

5. Activism rests on the value of individuals. At its heart, activism relies on free people speaking out. A free and democratic society demands that people get active in the face of injustice. Leaders offer information and support but not control.

6. Grassroots activism does not worry about compromising political relationships or contracts. It puts truth before partnerships, justice before political control. Political leaders can join movements but do not define them.

7. Activism works when the courts cannot help. The law has limits. It’s shackled by process like any other political system and often impotent in the face of abhorrent oppression.

8. It is diverse. Everyone can join. I am Charlie enlisted millions who had never heard of the controversial French tabloid. People from every group in society can stand shoulder to shoulder against injustice. It’s not a strike but a social movement.

9. Grassroots activism works. Oppression persists when one group benefits from taking advantage of another. Entire systems survive on institutionalized trampling of particular groups. Such a system will not change on its own. It cannot. It needs to keep squeezing one group to stay alive. Only activism can challenge a dysfunctional system.

Imagine this:

A government signs an agreement with a group of workers. When the contract runs out, politicians decide they want to pay less for more work. They need the work done so politicians make it illegal for the labourers to work anywhere else, illegal to strike, and refuse to negotiate a new contract. The politicians cut pay with legislation. In fear, the workers make peace by signing a terrible 2 year contract.

Two years later, the politicians want to pay the workers even less. They say the workers are greedy. Politicians blame workers for finding tricky ways to make supplies even more expensive.

The politicians pretend to negotiate with the workers for a whole year but say the same thing in nearly 100 meetings. Finally, the politicians offer the workers a massive pay cut. They threaten, “Take it or we’ll legislate an even bigger cut!” On top of that, politicians promise to make workers pay for all the increasing costs of supplies and new projects.

The workers refuse. The government delivers their threat. The media yawns. Lawyers shrug with elbows bent and hold out empty hands, “I’m sorry, but there’s nothing we can do!“

If something like this happened, would it warrant outrage? What would you do about it?

[photo credit: cnn.com]

Journalists know that envy sells papers, and people can’t resist a bit of wealth porn (see Super Rich or Super Angry). But publishing doctors’ incomes also serves a deeper purpose. On average, doctors’ billings prove that some workers earn more than others. Physicians’ incomes demonstrate that income disparity exists, and publishing them presupposes the gap warrants discussion. Except for ardent capitalists, salacious CEO incomes give most of us pause. But is income disparity intrinsically bad?

Beyond envy and idle curiosity, income comparisons rest on the belief that all workers should earn a similar wage. Some people think that skilled workers who contribute more to production should be paid more. Marx disagreed. He saw factories automated to increase profits for owners while decreasing wages for labourers. He believed income disparity to be evidence of capitalist corruption, and many still agree with him.

We miss the point when we debate whether incomes are fair. If we accept the idea that wages should be set in comparison to other wages, we presuppose Marx was right. He believed that all work had intrinsic value that should determine wages. Capitalists believe that demand for a product or service should determine income. If a particular skill or service is in high demand, then wages for that skill will be high.

If we agree that all income disparity is inherently bad, we accept a core tenet of socialist ideology.  Our country grew strong on democratic capitalism. We did not become prosperous by pursuing socialism.

Prosperity allows us to create some socialized services. But we must not confuse socialized medicine with socialism.

Within socialized medicine, every worker labours for an income, for profit. Highly trained professionals earn more than those with less training and responsibility. Healthcare wouldn’t exist if it weren’t for intimate ties with industry to build, supply and service institutions. Socialized medicine is not the same as statewide socialism.

Income equality stands at the pulpit of socialized medicine to preach socialist ideology. Most people agree with helping those who cannot help themselves. But this does not require socialist economics. Socialism has been tried and failed repeatedly over the last 100 years. It refuses to die. If we accept the belief that all income disparity is bad, we lose the debate about doctors’ incomes before it begins.