Smart kids learn to distract and stay out of trouble. They know Mom won’t bother about overdue homework, as long as she stays stressed about something else.
Politicians do the same. They distract voters with new handouts, or even better, stoke anxiety about Zika, Global Warming or some other ominous event.
Just do not let voters ask about things that government can impact, like patient wait times.
How to Gain Control
If government wants to shape society, instead of just serving it, politicians need the power to tell people what to do. They need new laws. They need policies and legislation to make their ideas come alive.
There are different kinds of laws. For example,
Restrictive laws tell us what we cannot do: Do not litter.
Positive laws tell us what to do: Pick up your litter.
Other laws grant rights or authority: for example, the right for me to search your purse.
Medicare started as a government medical insurance program. Now, government wants Medicare to be a managed care program. It wants to tell doctors what care they can provide, and patients what care they can get.
Government needs positive laws to manage medical care.
It needs laws like Bill 119 that lets government access personal health information electronically.
It needs laws like Bill 210 (new number this fall) that gives government broad authority to enforce directives and inspect the clinics of health service providers.
Government used restrictive laws to prohibit any competition to their own insurance plan. They made it illegal for patients to have private insurance for medically necessary care. Now, it needs positive laws to tell doctors and patients what to do.
But positive laws do not work. You cannot tell knowledge workers how to think.
Relationship and Ownership
Doctors advocate for their patients and resist people telling them how to practice medicine. Patients love it; administrators and bureaucrats do not.
Only doctors can fundamentally change quality and efficiency. And doctors resist change by fiat.
The basis of quality in medical care is the doctor-patient relationship. Strong relationships impact quality more than new programs or technology.
Patients get high quality care, when doctors and nurses know each patient. Patients know this, and they do not want bureaucrats prescribing care in the guise of quality and efficiency.
The basis of efficiency is ownership. Efficiency disappears when no one cares about expenses. Providers in efficient clinics have a vested interest in the clinic’s success.
But even patients care about efficiency. Patients resist driving around for dozens of tests and appointments, spending their time and money to get ‘free care’. Patients support efficiency to the extent that care impacts their time, money and effort.
Relationships drive quality, and ownership drives efficiency.
Distract Doctors
Government must distract doctors to gain control. It must turn our attention away from patients in front of us and toward some other worthy cause, like sustainability or co-management.
Governments cannot gain control when doctors own and operate their own clinics. Government must attract doctors into state funded clinics (at great cost) and make life unpleasant for doctors everywhere else.
Government continues to undermine ownership by slashing fees for services that doctors can provide more efficiently outside of government run facilities.
The current Ontario government has a clear idea of what it wants. Will it be able to distract doctors and gain control?
photo credit: www.dailymail.co.uk
It goes back to being elected. Politicians make promises to get themselves elected. This works for a while. Then promises like “free” Medicare come into conflict with promises of balanced budgets. You can fill in the blanks over the last 40 years and see how we have come to this point in
Ontario and Canadian healthcare. Scapegoats are needed to deflect from government failures until after the next election. Then the story repeats itself.
Good point, Gerry. We elect politicians to give us what we want instead of electing people we can trust to run the country well.
I think most people who know healthcare can see that this cannot go on. But no one wants to say it. Instead, we look for scapegoats.
Thanks for reading and sharing a comment!
Best regards,
Shawn
George Orwell has nothing on the Ontario Liberals. The question is why isnt the OMA and CMA and the OCFP saying anything? The answer of course is they know who butters their bread. We need a public campaign to point out the warts in these 2 outrageous bills. Our social media people should spend time and effort on public facebook and twitter campaigns. And why doesnt the OMA have the people on board in-house to set up and run such campaigns. Its got to be cheaper than Navigator.
“And why doesnt the OMA have the people on board in-house to set up and run such campaigns? ” The OMA has people on board to run anti-smog campaigns. As you said concerning bread butterers, the OMA has to be careful how much they criticize government initiatives and the government itself. It seems that at this point in time, Physician Grassroots is better able to deal with calling the government out.
You both have hit an important theme, Gerry and Ernest. Those who know cannot speak. The OMA spends much time hand-wringing about how our action/inaction now will impact the ministry’s willingness to agree with our requests later. It feels very much like when I worked in hospital administration. The first rule was: never embarrass the Ministry of Health.
Great comments!
In another vein, you are right that government is executing a long game of wresting healthcare out of doctors private clinics without the expense of compensating them for outright seizure. But the very fact that this is a long, well thought out campaign provides a clue as to who is doing it. Back in 2004 I saw a long term plan to force all doctors into government controlled clinic via a series of steps including FHOs and FHTs and community health clinics with the end game of all physicians working in government run facilities run by Nurse/Administrators. The extends across government and shows that the real promoters of this scheme are the people who would benefit the most – the health care bureaucracy. They are the real enemy.
Another brilliant comment, Ernest! There must be some truth in this, despite passionate denials. I just met with an old acquaintance from the MOH who insisted that the MOH has NO DESIRE to tell doctors what to do. I smiled and said, “Most of us do not feel that way.”
Leave the Doctors with an umbrella control who knows and can manage the shared resources available to accomplish the public health goals. SHARE should be the new political song. Stop the drain on MD funds, pay for support staff invested in what they are worth, preventative teams working together to maximize the effectiveness of the MD training!
Thanks Elly!
You raise an interesting point: should docs be focused on public health goals, or individual patient health goals? I agree that public health is important. How is medicine different from public health?
Thanks for reading and sharing a comment!
Shawn