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
Another excellent article by Shawn. I like to think that I am a pretty good writer but Shawn beats everyone hands down. Congratulations on your piece. I love your metaphor at the end. Gerry
Thank you so much, Gerry! I really appreciate your kind comment and that you took the time to read and then share it!
I rankle at the current treatment of doctors as much, or more, than others we interact with on social media. I just hope we get positive change and don’t give up too much in our demand for representation.
Kind regards,
Shawn
Shawn excellent article. Considering the motives and tactics of govt, forming a union would appear to be the only salvation for a high valued profession as physicians. Agreed it is a double edged sword and can cut both ways. If there is to be a change in a HC model to one that actually satisfies the needs of patients and docs and taxpayers….you have limited options. Govt seems to react only to pressure and overwhelming bad press. After all….it’s only about that next election win ….eh.
Hey Shawn
please clarify a bit…when you say “crush medicare” , whether you see that as a potential good thing (so that something better for all can rise out of that)? Or a bad thing (ie. a “Canadian catastrophe”)?
My thoughts and emotions go all over the map on this question. Wish we could change medicare without crushing it, but history shows there is no political guts for that.
Brilliant question, John! I wondered whether that ambiguity might slip by or open up a discussion. I’m glad you jumped on it!
Your last 2 lines capture my feelings, too: “My thoughts and emotions go all over the map on this question. Wish we could change medicare without crushing it, but history shows there is no political guts for that.”
Multiple studies place Canadian Medicare behind all healthcare systems in the developed world except the U.S. Of course, many are satisfied just as long as we get ranked higher than the American system (overall). I think Medicare must change or become an even bigger embarrassment.
Winkler said healthcare’s on a collision course. It will crumble without substantive change. Everyone agrees with that. A medical union would crush it quickly and leave a disaster in its wake, I think.
So, I hope for disruptive innovation, like Schumpeter originally described, as opposed to destruction. I think it becomes semantics, for me, to quibble over whether major change to Medicare would create something other than Medicare. For lovers of Medicare legislation, this isn’t semantics. But then, they love Medicare more than patient care.
I hope politicians, patients and providers start putting patient care ahead of an antique piece of legislation that was drafted when the average age in Canada was 25.
Great question! I sure appreciate you taking time to read and comment!!
Best
Shawn
“…they love Medicare more than patient care.
I hope politicians, patients and providers start putting patient care ahead of an antique piece of legislation that was drafted when the average age in Canada was 25.”
BRAVO!!
Thanks John!
The love of medicare which persists despite clear evidence that it is often not a helpful form of HC delivery.
There seems to be a uniquely Canadian delusion shared by patients and HC providers that medicare is THE BEST universal HC system in the world.
I was at a conference recently for groups representing rare cancers and rare chronic diseases. A lot of discussion focused on the lack of funding support for medications for these disorders. I happened to talk to a woman who was representing Rheumatological diseases who was pushing for more funding for biologics. I mentioned to this lady that in other countries such as the UK biologics are covered by the NHS (assuming there was approval for the treatment through NICE)
and she would be only pay 8 pounds per prescription. The woman just shook her head and said that was ridiculous the UK had a terrible HC system. Medicare was the best in the world. I gave up trying to talk to her.
Somehow pride in Medicare has become associated with national identity in Canada. I think this bizarre association will need to be untangled before substantive progress can be made on HC reform.
Thanks for all your thoughtful ( but not subversive) blogs Shawn
Great comment, Helen!
I have a close relative with a rare metabolic storage disease that OHIP does not pay to treat. Fortunately, a charitable society funds the medications.
We cannot argue rationally with people about ideas they arrived at by something other than reason.
Loved your sign-off! 😉
Best regards
Shawn
Hello,
Just rereading some of your excellent posts. “Disruptive innovation” as a method of tackling the woes of Medicare sits well with me.
I do think that a Hybrid system is the only way forward that is likely to produce improvements. Actually I would say that Canadian Medicare is already very much a”Hybrid” of public and private payment for medical care.It lacks the public funding of drugs,psychology,physio,extensive in home care etc which characterise most other western HC systems.
Perhaps emphasising that our system is already a “Hybrid” of public and private might soften the transition?
Best regards Shawn
and thank you for your continued work to make some sense of the current nonsensical Canadian HC system.
Well said, Helen. I agree, we have multiple tiers and many hybrid elements.
To your point, Yanik Labrie wrote a great piece about Why Dentists don’t have Wait Lists.
Thanks again for reading, commenting and encouraging!
Highest regards,
Shawn
Well said, Don!
I worry that all the work done to prevent government attacks might produce an equally strong but just as dictatorial force. We must move carefully. Society grows increasingly comfortable with laying down freedom in exchange for less responsibility. This risks equally totalitarian solutions in the face of oppression. We often see regimes exchange one dictator for another.
Unless physicians welcome the responsibility of managing healthcare, we waste time advocating for less control, less government regulation and micromanagement. Physicians might as well advocate for unionism and hope their new dictator is benevolent.
Thanks again for taking time to comment!!
Best,
Shawn