The strong steal from the weak: kings from nobles, Castro from Cubans, and Premier Wynne from Ontario’s doctors. English barons wrote the Magna Carta because King John acted like Premier Wynne, a law unto herself.
Magna Carta – “the greatest constitutional document of all times – the foundation of the freedom of the individual against the arbitrary authority of the despot”.
In fairness, Wynne attacked because no law said she couldn’t. In fact, previous governments did the same thing in the 1990’s social contract years with clawbacks and caps that forced doctors to work for free.
A specialist asked me, “So government can cut us, we have no way to fight back and it’s illegal to bill outside of OHIP. Isn’t that Communism or something?“
Throughout history, governments have stolen power and property – usurped – from their citizens. Tyranny and usurpation still drive immigration. Most Canadians have relatives who fled political tyranny for freedom.
Canadian democracy stands on the rule of law. We answer to the law, not the capricious whims of monarchy or government. And where there is no law, Canadians behave by principles like honour your commitments, deal fairly and tell the truth.
Usurpation in Medicare
Medicare was once an insurance plan. Now it’s an example of government imposing itself on others. In the late 1960s, Medicare simply replaced a few large health insurance companies. Ostensibly, a national plan guaranteed coverage for all citizens and promised administrative savings.
In the glory days of Canadian Medicare, doctors worked and governments paid. But policy experts tickled political ears with whispers of a more robust social utopia, a full-blown, centrally controlled healthcare system.
Social designers had to wait for Medicare to become a national icon before they took control. By the 1980s politicians had what they needed and moved in. Doctors were pushed out and have been blamed for almost everything wrong in Medicare ever since.
How to Usurp and Get Away with It
Aside from a few historic exceptions, whenever doctors organize serious resistance, government pays them off. Docs always settle for less than they wanted; passion fades quickly. Myths about pendulums swinging or cycles of plenty and famine usually turn doctors back to their knitting. They hardly notice that fees are now only 50% of 1970 levels. Citizens tolerate usurpation in small slices over time.
Wynne got greedy and went for a big slice. Her plans cut over 20% from doctors’ net earning by 2017. Incomes have plummeted since 2012 such that by 2017 doctors will have lost 30% of their net in 2012 dollars. Wynne’s usurpation will fail.
Representation Rights
Doctors have had zero protection from usurpation by government for the last 45 years. They cannot strike. They cannot earn income practicing medicine outside OHIP.
For the first time in 4 decades of state healthcare, government acquiesced and promised in legislation to ‘negotiate’ before legislating fees. But even with representation rights, government ’negotiated’ for a whole year and then legislated what they had offered on day one of ‘negotiations’: a rigid cap on total spending for MD services.
How to Win Enemies
Many blame political oppression for terrorism. At the very least, tyranny and usurpation inflames hatred of government and its policies.
Medicare runs on doctors’ cooperation with government. Doctors will never riot or terrorize. But do politicians really believe that Medicare has any hope of survival when they treat physicians with disdain?
When government usurps too aggressively, it starts revolution. Wynne has created a small pack of doctors determined to revolutionize healthcare. Once committed to action, they will not distract easily.
Wynne gambled that doctors never fight back. But some do. I think she might have gambled wrong.
photo credit: magnacarta800th.com
you’re right on the mark there, shawn. our grassroots activism is slowly picking up the pace as well as support along the way!
however, i’m curious. what do you say to those docs who insist that “things are so much better than they used to be when every family doc was fee-for-service?” or, “i get paid a lot more now than i ever did before — i daren’t complain!” or, “i remember a decade ago when there were 20% fewer docs and we were paid 300% less than what we are now. we have made enormous gains. we should be grateful for our privileged position.”
i’ve only been in practice 5 years. i admit, i don’t know the entire history of medical politics in ontario. and i too hear the talk of pendulum swings etc etc. i’m still furious at the government’s bullying tactics. if the government were to negotiate fairly on equal grounds, i would not be as pissed off or disappointed by them as i am. but i also get frustrated at the complacency i see among fellow colleagues when i try to bring up healthcare reform — i almost feel as if i’m being patted on the head like a fussy child: “there, there, give it a few years and you’ll come around.”
would appreciate advice from people who’ve been arguing longer (and more articulately) than i have …
That is a brilliant question, Nadia! Thanks so much for taking time to read and share this. I hope some others attempt a response, too.
First, I think this needs a few posts to answer. Earlier posts on “Doctors’s guilt about income” and the Stockholm Syndrome come to mind. But your question needs even more.
When I respond to these familiar comments, I usually start by agreeing with the speaker. We DO have great jobs. We want to help people and have been able to find a career that lets us do it. Many patients still respect us. We probably won’t starve to death. I agree; we have privileged jobs!
Then, I talk about marginal patients. Even the most altruistic MD will not accept another medically complex patient when they feel overwhelmed already and worry about covering their overhead and home expenses. Thus, medically complex patients will go without care unless docs can manage to assume the responsibility without hurting themselves.
Established docs – usually the ones making the paternalistic comments you raised – often sit smug in their self-righteous support of government because their practices are already “full”. They already have enough complex patients.
Finally, I ask about fundamental values. It matters little if legislated cuts were 0.1% or 10%. I believe it’s the issue that they happen, not the size of the incision.
We could say so much more! These comments pop to mind first, but I’ll try to work on a more robust comment in a separate post.
Thanks again for reading, commenting and getting involved in change!
Highest regards,
Shawn
Nadia and Shawn,
Great to read your post Shawn excellent as always.
Although I am much more long in the tooth than you Nadia I empathise with your frustration at the complacency of many established physicians.
Having graduated in Scotland and worked in 4 other provinces before moving to Ontario 15 years ago I thought my observations on HC reform might be of interest to the OMA. My letters generally went unanswered or received the literary equivalent of your “pat on the head.” No reply from the political advocacy group – who wants a rude Scot interfering in polite chit chat with politicians.
Nadia you are right to be concerned about health care reform. No other western country has been so complacent about updating HC policy as Canada (most other countries cannot afford to let things slide in HC and other policy areas the way Canada does !!!)
Our lack of action over the years will have consequences – the “Winkler Collision Course” which Shawn refers to. Our HC system needs radical reform. Other countries have done this – Netherlands in 2006 for example – and survived.
Next a point that Shawn has made a number of times. If we want to be leaders in HC reform we need a plan. By which I mean we need Physicians who are policy experts to work on a new HC model for Ontario. We then need to agree as Ontario physicians to execute the HC plan, and to accept responsibility for it.
I would be happy to see my OMA money pay for this to happen (or pay additional money) otherwise we will be Rebels without a Clue.
– Sorry Shawn I may well have misinterpreted some of your previous comments. Still I will let this stand as MY comments even though they are very simplistic.
I think I hear the opening bars of The Internationale. I had better go…
Very best regards,
Helen
Thanks again, Helen! Comments always become the best part of any post if they spark discussion. I don’t think you misinterpreted anything.
Thinking over the ‘complacency’ of so many of our colleagues, I wonder whether some just feel overwhelmed at having to educate themselves about all the issues. Maybe they feel it’s easier to share a few platitudes, not because they are complacent; because they’re overwhelmed.
I like your suggestions about OMA developing a plan. While I agree with work and planning, I hold suspicions about social planning in general. Central, authoritarian elites – even if they are doctors – never come up with ideas that are anywhere near as smart as those that come from the thousands of docs working to solve problems everyday. We need some structure for sure. But I get worried about grand designs.
I also think we need to be smart enough to advocate for ideas that others end up believing are their own. As such, any ‘OMA plan’ won’t be as successful as a plan that OMA influences. Of course, I would love to think that we could fix everything if we only had enough power, but that’s the lie that motivated parties to put us into this mess in the first place.
Thanks again for commenting!
Best
Shawn
Hi Shawn.
Great critique!
I am sure you are quite correct in identifying “complacency” as “overwhelmed” in many instances.
Also your comment that problem solving is something that we all do every day so turning our (collective) attention to HC problems does make sense. Appointing a new dictator to replace the government would indeed be foolish. However I do have difficulty imagining collecting, coordinating, and collating the input from everyone into specific HC policy changes. The herding cats idiom comes to mind.
I think your idea of implanting good ideas into receptive vehicles and letting the recipients take the credit is excellent. OMA influenced HC planning by mind control – brilliant (but maybe a bit subversive)
Regards,
Helen
Thanks again, Helen!
I believe we will get more solutions – and more interesting ones! – if we loosen our iron grip on the front lines. Let doctors innovate on care provision. Of course, follow best evidence but let docs innovate to improve for patients.
If you know of ways to inject thoughts into others, let me know! I could use help with my teenagers. 🙂
Thanks again,
Shawn
Sorry. Mind control has been a dismal failure to date with my boys. I will let you know if there are any positive developments.
Cheers,
Helen
🙂