Ontario has a $300 billion debt (Ontario Debt Clock). Let’s ignore how we got there.
Everyone calls for system change. Everyone. Even Medicare zealots want change.
Wynne got a majority government. Let’s ignore how she got it (bought it?).
Wouldn’t this be a great opportunity for real change? Might this be a great time to solve problems with access, quality and service for patients?
Instead, Wynne and Hoskins use their majority government to attack doctors, again. Because they can.
Change Requires Different, Not More
We could buy a better system by changing the way we spend taxes. Dozens of people have written about it. High needs patients, system integration and acuity modifiers for older, sicker patients offer a few critical places to start.
Fee increases vs. Population increases
Doctors do NOT ask for higher fees. Doctor do NOT want more money for doing the same work. They offered 0% fee increases for two years. 0%! They just don’t want more cuts. They already agreed to cuts in 2012 and 2013.
Doctors want the government to pay for growth.
NOT growth in doctors’ fees. Growth in patient volumes. New babies need care. Immigrants and an aging population increase the volume of services required in Ontario. New doctors provide that care. Or current doctors work harder. Hoskins refuses to pay for it. He calls it a raise to pay doctors’ fees for seeing more patients.
When is a cut not a raise?
What would you call the following?
- You ask your staff to work more for less pay. Is that a cut?
- You pay hospitals the same to see more patients. Is that a cut?
- What if you pay your staff 10% more to do 20% more work? Is that a cut?
- What if you cut the budget, underfund growth and slash-or-cancel programs for new graduates, unattached patients, continuing education, hospital on-call and more? Is that a cut?
Democracy and Law
What kind of government creates a state monopoly, then makes it illegal for 35,000 professionals to work outside the monopoly, then slashes the fees it pays for services provided?
Is this democracy? Is it something else?
Wynne Attacks Doctors and Punishes Patients
Politicians attack who they can and coddle who they must. All that matters is immediate public sentiment. Do voters believe doctors have enough?
- Who cares if doctors hire staff and pay overhead?
- Who cares about student debt?
- Who cares about 12 years of university?
- Who cares if it takes decades to catch up to friends who chose a different career.
- You chose that career!
- Who cares about job stress — everyone is stressed.
- Doctors earn $250 thousand dollars after overhead!
Jealousy: wanting what other people have while being ignorant of the sacrifice required to get it.
Fees drive physician behaviour. Voters don’t see that. Even the most altruistic doctor spends less time with you as a patient if she can only bill OHIP $33 for the visit. What happens if you need 45 minutes? You get less service or cannot find a physician at all.
What Next?
Doctors will keep seeing patients. They will grumble, but life will go on.
Eventually one of the last two state healthcare monopolies — North Korea and Canada — will wake up and admit that government monopolies hurt patients. They harm patients because they run out of money and get sloppy with management. Every other country in the world has admitted it. Even Sweden believes state monopolies harm patients. Communist Cuba used to stand with us. Now it’s just us and North Korea.
Dark Times Call for Great Leaders
We look to great leaders for direction in tough times. Maybe Wynne and Hoskins might quote a hero:
“There is no such thing as an absolutely hopeless situation.”
Vladimir Lenin in reference to capitalism
photo credit: cp24.com
What I don’t understand is why there is such a fee disparity between specialists in Ontario.
Ophthalmologists and radiologists, because of lucky technological advancements, have skyrocketed their incomes.
Family docs, for all of the violin-playing of shortages, are still the biggest target in cuts and are not rewarded for thinking and communicating, but for doing.
Pathologists aren’t even paid on the fee schedule. They are controlled by hospitals. Their work is not valued as patient care work but as the operation of the “laboratory machine”, spitting out “results”. Not ten years ago pathologists were paid less than family doctors, and it wasn’t until a bunch of poor women got harmed from pathologist incompetence (poor pay = poor recruitment = bad medicine) that the incomes were increased to what they are now.
Why is the OMA whining about physician overhead costs when certain fields are seriously overbilling while others are not? I mean, 40% overhead on a million billed is still 600,000 dollars – why should anyone feel sympathy for that? There has to be some balance. Why are the high billers so powerful in that they can resist cuts time and time again?
Thanks so much for commenting!
You raise a very important point about relativity. Everyone agrees there’s a problem. No one knows how best to fix it. This makes us less likely to oppose cuts on principle if they seem to result in an end we agree with.
We need to oppose unilateral cuts regardless. We should fight egregious process even if we tend to support the outcome.
As for some specialists appearing to earn much more than others, we should tread carefully. Many specialties, like ophthalmology, purchase $200,000-$300,000 of equipment just to open a practice. Furthermore, we need to correlate hours/effort/acuity from total earnings.
In the end, economists and historians tell us that no country has ever been able to fix prices without creating waste, or more often, scarcity. Only Canada and North Korea march and sing about price fixing and rationing. We need a solid public system. We need to care for those who cannot care for themselves. But we also need some accountability in the public system. Monopolies always treat patients and customers with disdain.
Thanks again for reading and commenting!!
Shawn
Thanks so much for creating a great collection on this issue! I hope readers get a chance to check out your site http://www.ontariosdoctors.com/.
Best
Shawn