The world woke to an unfamiliar place on Friday. Journalists spun like Alice down a rabbit hole.
What’s going on? How did this happen in a modern Europe?
They were quick to explain it: xenophobia, racism, hate, and just plain stupidity.
Megan McArdle, of Bloomberg and the Atlantic, wrote,
“Journalists and academics seemed to feel that they had not made it sufficiently clear that people who oppose open borders are a bunch of racist rubes who couldn’t count to 20 with their shoes on, and hence will believe any daft thing they’re told.”
Rex Murphy, never shy of touching the wart on Grandma’s nose, saw the vote as a rebuke to Western elites. Maybe Britons didn’t like elites in Brussels passing laws that Britons must follow?
Brexit & Doctors
Doctors in Ontario face a similar divide. Our leader elites cannot explain how the plebes could disagree with them. Health Minister Hoskins attributes greed to dismiss working doctors’ anger at Hoskins’ bumbling mismanagement. Perhaps docs are just scared and confused, surely it cannot have anything to do with Bill 210.
Dismissive Reductionism
It is easy to dismiss your opponent as motivated by emotion, not reason or argument.
Whether we point to nefarious motives that deserve opprobrium, or humble motives that warrant sympathy, we reduce our opponent’s position to emotion to avoid debate.
We use reductionism to dismiss.
Dismissive reductionism attempts a condescending escape from facing real argument.
It leaves those, who have been dismissed as emotional, to prove that they do not have said emotion, or to prove that, yes, they do deserve to feel their emotional label.
Either way, the discussion is all about emotions.
As every schoolboy knows, emotions mean nothing in a contest. You play to win. Crybabies lose.
Eventually, people catch on. They see elites using the same old dismissive reductionism. At some point, citizens demand a vote.
Pay Attention, Politicians
Deputy Health Minister Bell and Health Minister Hoskins should take note. Regular working doctors cannot be dismissed as angry rubes forever, no matter how much the Deputy and Minister think they know about doctors.
Bell and Hoskins’ past lives a celebrity doctors – one in a world class teaching hospital, the other as global humanitarian – do not qualify them to say much of anything about what it’s like to run an office, in Ontario, on narrow margins.
Deputy Bell loves telling stories about his months working as a GP, 40 years ago. I won a math contest in high school. That doesn’t make me a mathematician.
The Western elites regret ever letting regular people vote on such an important issue, as leaving the EU. How could the plebeians know what’s good for them?
Prime Minister Cameron resigned after the Brexit vote, an honourable move. If only health politics followed this standard.
Doctors have legitimate arguments about the imbroglio in Ontario. Docs cannot be ignored with dismissive reductionism. Doctors will attack in the provincial by-elections, and then, do whatever they can to support voters who are sick of Premier Wynne, in the 2018 election. Will doctors target provincial medical associations next?
photo credit: news.nationalpost.com
Here’s hoping!
Bill 210 does NOT apply to almost all physicians in Ontario. It does NOT apply to “Regular working doctors…”.
The history of health care in Ontario and Canada says that everything has to start somewhere. It is only a matter of a short time before most doctors are ‘brought into the fold’ of Bill 210 unless the Liberals are turfed. Even then, if you believe the new ruling party will get right on reversing all of the horrible things done to health care in Ontario, you are dreaming in technicolour. They will just do what ruling parties do…blame their predecessors for the ugly state of things…
Thanks for responding to Perry, Paul.
Perry, you make a good point. Right now, many Family Docs and most specialists will not feel any immediate change with Bill 210. But for most family doctors, Bill 210 will radically change the face of the doctor-patient relationship. Now, we have bureaucrats overseeing how and when doctors see their patients, as well as a thousand other office details. The next step is a similar Bill for consultants: get them to bid on bundled services in a geographic region. Well populated areas will have more competition, and lower remuneration, for services. This is not complete conjecture….
How much government control do we want? What works best for patients? Has service ever been better when government provided it?
Thanks so much for sharing your thoughts!
Shawn
Bill 210 does NOT change the face of the physician-patient relationship. Take a look at section 1 of the Bill. The Bill applies to not for profit entities ONLY. I doubt that there are many physicians associated with not for profit entities. And, if there are some, all they have to do is consult a lawyer who specializes in business law. Problem solved.
Thanks again, Perry. Your comments echo what others have said. I will share two large sections on an analysis written by a dual qualified MD-JD. I think he makes a good argument. Please take a careful look at the second section pasted below. Pretty concerning!
What They Say:
Doctors should not be worried about Bill 210 because it does not apply to them.
What The Legislation Actually Says:
The legislation applies to “health service providers”. This term is essentially defined as: hospitals, psychiatric facilities, jails, the University of Ottawa Heart Institute, long-term care facilities, community health centres (“CHC”), family health teams (“FHT”), nurse practitioner-led clinics, Aboriginal health access centres, hospices, physiotherapists in clinic settings, persons or entities providing primary care nursing services, maternal care, or inter-professional primary care programs and services, and other persons or entities who may be included in subsequent regulations.
The legislation does not currently apply directly to individual physicians, dentists, chiropodists, or optometrists.
The government may be technically correct in maintaining that the legislation does not apply directly to doctors. However, the legislation does apply to almost every type of healthcare organization in which doctors may practice. Thus, most physicians, through individual contracts with their own healthcare organizations, will inevitably be at least indirectly subject to its provisions.
Moreover, the legislation specifically applies to: “persons providing inter-professional primary care services.” It is unclear to me how the government will attempt to construe that provision in practice. One arguable interpretation could apply that term to any physician or group of physicians who work with a nurse. If so, there will be very few doctors who will escape the legislation’s direct application.
Finally, the legislation will apply directly to any other persons or entities whom the government may decide to name by regulation. The government has left the door open to unilaterally expanding the legislation’s direct application.
NEXT SECTION PASTED BELOW:
What They Say: The legislation is not about controlling doctors; rather, it ensures accountability.
What The Legislation Actually Says: The legislation actually says that:
· The MOH may issue operational or policy directives or province-wide standards to the LHINs who must comply
· As stated above, the LHINs may conduct operational or peer reviews of health service providers, the MOH may appoint supervisors to take control of the LHINs’ Boards or may appoint supervisors to direct and oversee health service providers
· The LHINs can issue policy or operational directives to health service providers who must comply
· The LHINs may unilaterally impose funding terms on health service providers under “Service Accountability Agreements”
· The LHINs are granted broad powers to investigate the quality of care and treatment provided by health service providers
· There is no requirement for the LHINs newly-mandated professional advisory committees to include physicians or any other healthcare providers
· The LHINs may essentially exclude the public, including physicians, from their meetings
· “Prescribed entities” (unclear how this will be defined – will this include new entities or expensive outside consultants?) will be required to report to the LHINs respecting:
o physician resource issues such as opening and closing practices
o transitions and changes to practices, retirements and change of practice locations
o policies for accepting and discharging patients
o practice profiles, wait-times, coverage for after-hours services, and
o vacations, leaves, and other absences
These are strikingly broad powers. The MOH, directly or indirectly through the LHINs, will have the power to issue directives and policies, set province-wide standards, establish funding terms, investigate, audit, direct, oversee, and collect data concerning health service providers.
Again, it is unclear how the government will use the legislation.
Strictly interpreted, the legislation may, in reality, allow the MOH to ultimately dictate terms of employment to physicians, either directly or indirectly through agreements between individual physicians and health service providers who are subject to the legislation. Physicians, now generally considered to be independent contractors, may become in some respects simply contractors.
Also of concern, the legislation appears to eschew partnering with front line healthcare workers to develop creative, practical, and sustainable healthcare solutions, in favour of investing bureaucrats with wide-ranging decision-making powers.
As drafted, the legislation may potentially allow the MOH to establish any number of standards or metrics that would affect primary care and specialty practice throughout the province. The MOH could potentially mandate minimum daily work hours and after-hours service, minimum overnight call, minimum patients seen per day, minimum and maximum roster sizes, minimum new patients rostered per month, minimum number of next day appointments, minimum requirements for hospitalist and ER coverage, and minimum scores on patient satisfaction surveys. The potential list goes on.
One has only to review the recently-created New Graduates Entry Program for a clue as to the metrics currently of interest to the MOH.
Physicians should be more concerned with the Physician Services Budgets for Fiscal Years 14/15 and 15/16, whether OHIP billings by physicians will exceed the Budgets, and whether the difference will be recovered from physicians in Fiscal 16/17. The Ontario Government is committed to balancing the Ontario Budget before the election in 2018 and is cost shifting the cost of Medicare to physicians and health facilities.
Like the UK, we doctors are a fragmented bunch, too diverse to really drive in a direction that benefits us all. The old maxim that there is strength in numbers and more numbers = more strength, breaks down in our case. We would be much better off with smaller bargaining units united under one overarching union. None of our units are dispensable and so each has a power equivalent to the whole. And yet those among us that us on the front-line would call ‘elites’, argue from their salaried ivory tower, insulted from the work or starve imperative that the rest of us live with every day, that we are overpaid and privileged to serve an increasingly hostile master.
Accepting from the outset that any negotiated agreement has to be a zero-sum game gives away our greatest leverage. We should negotiate by specialty or sub-group and negotiate for our value not for how much of slice of the pie the government is offering.
“Free healthcare” is not free – it is subsidized by the lost wages of those who are impressed into service of an unsustainable system. We need
All great points, Ernest. Thanks for sharing them.
I, too, have wondered whether we would be more effective dividing the now 41,000 members of the OMA, 29,000 working docs (approximately). As long as government holds all the power and we have nowhere else to work, I wonder whether any organization of physicians will substantially improve our lot.
Thanks again – I always love reading your thoughts!
Cheers
Shawn