Here’s what’s behind the big raise offered to B.C. doctors. True North https://tnc.news/2022/11/06/whatley-bc-doctors/
I wrote this for True North News. I wanted to share it with readers here, too.
The headlines (including mine) use dollar signs for attention. But the BC offer pivots on control, not money.
Here’s what’s behind the big raise offered to B.C. doctors
Family doctors in British Columbia seem to have struck gold this week. The province offered a $135,000, 54% raise in return for a change from fee-for-service to a rostered – or what’s known as capitation-style –practice. This means average total billings for an individual physician will increase from $250,000 to $385,000.
Dr. Ramneek Dosanjh, President of Doctors B.C., called the six-figure offer a “seismic shift” and a “new dawn” in the physician-government relationship.
Governments rarely offer such raises. It reminds us of the British Labour Party’s push to build the National Health Service in 1948. British doctors had long opposed state medicine. But overnight, they did an about-face and embraced it. Aneurin Bevan, Minister of Health, was asked how he got the doctors to flip. He said by “stuffing their mouths with gold.” Continue reading “BC Stuffs GPs’ Mouths with Gold: $135,000 raise”
Time to move beyond rights. Healthcare is an obligation. Photo credit Wbur.org
“In the animal kingdom, the rule is eat or be eaten; in the human kingdom, define or be defined.”
Dr. Thomas Szasz
Defining healthcare sparks endless debate, especially in America. Canada seems to have settled on rights, with socialized medicine. The Romanow Report declared that, “Canadians view medicare as a moral enterprise, not a business venture.”
However, the right to stand in line for promised care is itself immoral. In the 2005 Supreme Court of Canada Chaoulli case, Chief Justice Beverly McLaughlin famously said, “Access to a waitlist is not access to health care.”
Rights
Defenders of rights form a crowd of dignitaries.
Earlier this year, President Biden said, “Health care should be a right, not a privilege, for all Americans.”
Former President Obama celebrated the seventh anniversary of his Affordable Care Act by saying, “We finally declared that in America, health care is not a privilege for a few, but a right for everybody.”
Pope Francis said health “is not a consumer good, but rather a universal right, and therefore access to healthcare services cannot be a privilege.” Francis moves the right upstream, which begs the question whether healthcare actually delivers health.
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, declared that “Health is a fundamental human right.”
Rights-talk appeals to natural rights. It assumes they are self-evident. Rights also touch on negative and positive rights: the right to be left alone vs the right to demand something from your neighbour.
Jeremy Bentham, 19th century philosopher, said only the state can confer rights through law. Natural rights confuse the existence of a want with the means of fulfilling it. Bentham called rights “nonsense on stilts.” Those who admire Bentham’s collectivism usually ignore his “nonsense.”
Privilege
By default, those who refuse to pledge allegiance to healthcare rights must be apologists of privilege. However, it is hard to find many saying so explicitly.
Media accused President Trump of calling healthcare a privilege. He said state care was like giving a “bozo with zero experience a management position.”
In 2017, Miss USA was asked onstage whether Affordable Care was a right or a privilege. Caught off guard, she called it a privilege related to her employment — clearly the wrong answer. Media had a fit.
Misplaced Privilege
Privilege, if it existed at all in healthcare, used to lie with the medical profession, not patients. Doctors used to control their own profession.
Bureaus and bureaucrats create bureaucracy. Together, they build their own demand and transform people into managers designed to meet bureaucratic needs.
A bureau designed to serve patients ends up serving its creators, while protecting those who work inside.
William Niskanen, economist, offered a definition. Roughly speaking, 1) bureaus contain people who do not earn income from the difference between revenues and cost, and 2) bureau revenue does not come from the sale of output per unit rate.
Squeamish About Saying “Bureaucrat”
Many people refuse to discuss bureaus, bureaucrats, or bureaucracy for fear of causing offence. The managerial and chattering classes see talk of bureau-anything as impolite, ill-defined, or perhaps unhinged.
This tactic is old. See Orwell’s, 1984. Control language; control the masses.
Forcing a word out of fashion does not remove the reality it described. Changing labels creates an endless need for new labels. Relabelling bureaucracy as management or administration does not escape the need to debate the concept.
We need bureaucracy, just like we need surgery. Surgery saves lives when nothing else will do. At the same time, there is nothing that surgery cannot make worse.
The Need for Bureaucracy
As organizations grow, they build bureaus and bureaucracy to decrease risk. Bureaucracy exists to slow things down and make us think twice.
For example, hospitals create communications departments to decrease the likelihood of bad press. Government funding relies foremost on keeping funders happy. Bad press about patient care trumps concern over care itself.
Every element of service creates its own demand for bureaucratic process.
Forms, checklists, and audits.
Computer passwords, authentication, password expiry, and mandatory sign-off.
HR credentialing… the list is endless.
Room always exists for more bureaucracy, with its imprimatur of orderliness and excellence.
The Value of Bureaucracy
Organizations and governments build teams of professional managers (bureaucrats) at significant cost.
Teams struggle to justify their own expense. They cannot point to profit or improved patient care. Given fiscal austerity, ballooning bureaucratic budgets make managers cringe in anticipation of scrutiny.
