Over the years of blogging and writing about health care I've talked a lot about context. That is because without context we cannot fully understand how decision making happens in health policy or the impact of those decisions.
As a disclaimer before I go on:
I will neither lose or gain from the current negotiations. As a retired MD, or physician in transition as I prefer to call it, I will see no monetary gain or loss from the resulting contract. I have no vested interest in supporting the OMA or Ontario's physicians other than to be a potential receiver of care down the road. I have no interest in supporting the Liberal government either as I have seen them dig Ontario tax payers deep into debt while promising many things they could not afford.
You may not like it but let's confront some realities so we can get on with the solutions.
1. Health care IS political. Government has made it that way. It is not MDs who have done this. In Ontario in 2004, the Commitment to the Future of Medicare Act or "Bill 8" was passed. Then MOHLTC Minister George Smitherman talked about strengthening and restoring confidence in our public health care system.The government made it illegal for physicians to provide necessary medical care outside of the publicly insured program. Hefty fines would result and even jail time was considered.
The good times in Ontario were expected to go on for a long time judging from the stance the Liberals took on health care. Either that or the lack of affordability they had created would become someone else's problem once they vacated office most likely within 12 years of taking power.
The Ontario Liberal government had poured money by the bucketful into health care. It dumped money into eHealth, team care, and new models of primary care such as Family Health Teams and Community Health Centres. When a hospital went overbudget to meet demand, money was thrown at it. When patients were being sent to the US because of lack of capacity in Ontario hospitals, Mr Smitherman threw money at that too and the voices of physicians were quieted.
But the good times didn't last and in 2008 the Great Recession hit. The Liberals were stuck. Debt was mounting and all their promises on health care were becoming unaffordable. Almost a decade of flat out spending doubled the debt and drove Ontario to annual budget deficits that were mounting every year. Credit rating agencies were and are biting at the Liberals' heels.
Despite the unaffordability of what the Liberals have created, they continue to insist that it is perfectly sustainable. If only providers would continue to do more with less. If only physicians would agree to absorb all the costs of the hundreds of thousands of new patients needing care in the system over the coming years.
Supporters of this approach claim that the system is sustainable. More efficiencies, more team care, more electronic health records, Big Data, wearables, more prevention, better lifestyles will create some kind of health care nirvana. I've got news. They don't. They all cost even more.
The politicians won't tell you that. They will not tell you that the system we have created is unaffordable because it would potentially cost them their jobs and their power. They will not tell you that we need to move to a Hybrid health care system because of the risk to their own power and careers.
2. The Ontario Medical Association will also not tell you that the health care system as we know it is unsustainable. They insist that government provide more dollars for more patient care for a number of reasons including the aging population with more complexity and the growing population both of patients and physicians.
The OMA can't tell you that a Hybrid health care system is needed because they are joined at the hip with the Ontario government. The OMA depends on the government for its existence. Legislation exists to require the OMA to be the representative body of Ontario physicians. Ontario physicians must pay annual dues to the OMA.
The government has the power to change this which creates a huge conflict of interest for OMA Board members. If they do not support the government and its agenda, the OMA could cease to exist effectively. It becomes the fiduciary duty of the OMA Board members to support the organization not necessarily the best interests of the public or physicians. The OMA cannot come out in support of a Hybrid health care system that all other better performing health care systems of other countries have. Instead, it must insist that the government provide more funding to the health system even when it is clear that this is an untenable position.
3. The Public is unaware of the challenges facing a single payer system. The government won't discuss the challenges ahead other than to speak of fiscal responsibility. The public needs to know that our ability to fund more and more health care on the backs of a shrinking tax base is unlikely. The new advances in science and technology such as genomics, epigenetics, organ regeneration, cancer as a chronic disease, stem cell treatments, new expensive medications that will prolong life or save the lives patients with rare diseases are here. They cost huge amounts of dollars. They cannot be funded by holding the line of physician income for the next thirty years or longer.
The challenges ahead in health care in Ontario are too great to ever be carried by physicians. The coming costs of care will not be offset by freezing or cutting physician wages. A Hybrid model of health care is needed. The sooner we can all be honest about this we can get on with finding the way forward. In the meantime, the negotiating game continues to the detriment of us all.
We have until 2020-2025 to create the beginnings of a Hybrid health care system like many other countries with systems that provide better access, more care, and even pharmacare. Let's stop the political posturing, look reality straight in the eye and get on with it.