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Looking for Solutions in Health Care for 2006 and Beyond

Our health care system needs to change to accommodate new demographics, new technologies and new pharmacologic advancement.

The roots of compassion and caring in health care should not change however, and it is with this in mind that the dialogue of change should be had surrounding health care.

How can we adapt to different needs that emerge as our population ages?

How can we  find sustainability in the midst of so many new advancements?

How can individuals become more empowered in serving their own health care needs?

What role does the individual have in enabling the  health care of others  beyond paying taxes?

Many questions like these need to be answered and if we are willing to look with open minds at the problems within our health care system, and beyond political posturing, then we can find new  solutions to take us further into this century. 

 

 

 

 

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Sunday
Aug142016

Wynne's Dysfunctional Approach to Solving Ontario's Healthcare Challenges

**Please note that the original journal entry from August 14 has been modified to reflect the vote result from  August 15.

 

 “Abdication, Distraction, and Deflection.”

 Ontario’s doctors voted NO to the tentative Physician Services Agreement between the Ontario Medical Association and the Wynne government that would have doctors co-manage the Province’s ailing health care system. The results of the vote from August 14 were shared the following day. Of voting OMA members, 63.1% voted Against the Agreement, 36.9% voting For the Agreement. The rejection is indicative of the negative view of Wynne’s overall approach to healthcare in the Province – one of abdication and deflection.

Given that Ontario is at a pivot point in health care that will affect patients, physicians, and the province for many years to come, the vote result will be important.  Simply stated: it is a bad deal, indicative of Wynne’s overall

 Abdication

The Wynne government has demonstrated its abdication of responsibility to patients by limiting the physician services budget for patient care below what can conceivably meet patient demand.  Instead of dealing honestly with the surge in health care need due to our growing population, new advances in science and technology, and an aging population with all of its associated requirements the Ontario Liberals are using health care to balance their budget. They have used rationing of patient care to offset the burgeoning debt that they have created through mismanagement and wasteful spending.

The centrepiece of the Liberal government-OMA deal was Wynne’s design to use  Ontario’s doctors as its collaborative rationing tool through co-management of the Physician Services Budget. This would have bureaucrats and doctors, together, deciding on the healthcare cuts to meet the government’s scheduled budget targets. Obviously, neither the OMA nor the Liberal government appear to have the interests of patients at heart. If they did, they would not be resorting to rationing under the guise of “co-management” and “collaboration”.

 Distraction

The Liberal government-OMA deal included components to address Relativity (the relative difference in the OHIP fee codes of some MD specialities compared to lower fee codes of other specialities). Although some physicians believed this was a positive attribute, it will require Ontario’s physicians to be internally focussed on slicing and dicing their profession – rather than spending time and resources on providing input into major structural issues that afflict health care delivery.

While the OMA is distracted with Relativity, the Wynne government master plan is to bring in more bureaucratic management in the form of Bill 210, The Patients First Act. Doctors kept busy with co-managing the rationing of care allows the government to move forward with minimal resistance to its major expansion of powers that allow it to unilaterally impose accountability agreements. Individual freedom for both patients and providers is at risk with this legislation.

 Deflection

The Ontario Liberals are intent on deflecting blame for costs of their own debt and waste onto the Province’s health care system and its providers. It is harder and harder to provide publicly funded patient services when the government is spending approximately one billion dollars a month on servicing the massive debt it created over the past decade through waste and mismanagement. Consider what can be paid for with a billion dollars per month: the medical staff, operations and procedures, the equipment. With the deal and physicians given a co-management role, the Wynne government has found a deceptive way to deflect public criticism from government decision-making.  

 As a disturbing aside, thousands of physicians who oppose the government’s current rationing plan are not “dissidents” as some government spokespersons and media have referred to them. By branding physicians who perceive solutions differently from the government as non-collaborative the government is attempting to quiet dissenting voices and deflect attention from its own failed policies. It’s a ruse. Differing perspectives could be used to create a more respectful and compassionate plan for health care transformation. It is often at the interface of opposing views that the best solutions will be found. It would be wise for our political and association leaders to do more listening and less deflecting.

The Liberal government’s approach has created a dysfunctional healthcare system

The Wynne Liberal government’s deal with the OMA suggests this government is clueless on how to proceed with its healthcare challenges. Constraining the freedom of physicians in a command and control system where they cannot meet patient demand and then labelling this as being in the “public interest” is disingenuous at best.

This is not the way to create a leaner and more efficient health care system or a way to meet the growing demand for patient care. Instead of squeezing the breath out of our public health care system, as our population grows and ages Kathleen Wynne should be answering the question “How can we provide more care to more people?” If we want innovation and “modernization” of care, it will not be found in rationing or managing wait lists. More management and more bureaucracy are not what we need.

As this deal so clearly illustrated, Wynne’s healthcare legacy is an abdication of duty, deflection of responsibility and distraction from her government’s wasteful ways. Hardly inspiring. Hardly a vision. Ontario can do better – it must do better.  The vision of health care in the future cannot be about rationing care, denying care, and limiting the freedoms of providers and patients.  It must be about empowering patients and empowering providers including Ontario’s physicians in providing more services and more care, not less.

The rejection of the deal was the ethical and appropriate response to a poorly considered health care rationing master plan pushed by the Wynne Liberals. Ontario doctors have spoken with resounding support for patients. However, any celebration of the rejection of this deal should be dampened by the reality that there is much work ahead to be done to shore up Ontario’s hobbling healthcare system. Let’s start with the resignation of Dr. Eric Hoskins.

 

 

 

Reader Comments (290)

Trust us,we know what is best for you.

Accept the deal, you can trust our management.
August 14, 2016 | Unregistered CommenterMovingforwardOntario
With a yes vote ....the medical profession will have followed the government's instructions and form a circular firing squad.
August 14, 2016 | Unregistered CommenterAndris
Lot more NO side docs at the meeting today than YES side docs

Think the OMA is about to suffer a rather humiliating defeat.

I'm sure Navigator is working on the spin tonight before the results are released tomorrow.

Can't wait to see how the government tries to spin this.

The lip stick just won't stay on that damn pig any more!
August 14, 2016 | Unregistered CommenterStephen Skyvington
"It's not the voting that counts, but the counting" ...the proxies held by the OMA are the key.
August 14, 2016 | Unregistered CommenterAndris
One smoking gun was the "shall" or "should" deflection by Dr. Robot running the show...the question was asked many times, and it was continuously deflected. It turned Motion 1 from a "must" have binding arbitration going forward, to "should but dont really have to"..i.e. the OMA doesn't have to ask for it if the deal gets a "No"! as we go forward. A complete legal loophole created by the OMA's legal side..very disturbing (yet not surprising)...clearly the spirit of the motion was to guarantee BA after thsi tPSA, yet they got around it...
August 15, 2016 | Unregistered CommenterKsy11
Co-management, stewardship, rationing,all the same thing in a fixed pot. Need to decide who wants to tell the public the pot is empty.

Lots of envy between sections - elites versus the troops. Going to be hard to solve.

Almost 10 years of growth under 3%,whereas need greater than 5% 50 turn this around.

Government's current - increase taxes and fees, raise immigration, cuts services for those who can pay more.
August 15, 2016 | Unregistered CommenterMovingforwardOntario
The trouble is that lawyers can parse any phrase interpreting it in their favour...much like Clinton and his " is" definition.

It seems that we won't know the result for several days....in this era of computers one wonders why...perhaps it is to allow the OMA lawyers time to spin whatever the result it and come up with an OMA/ government friendly interpretation.
August 15, 2016 | Unregistered CommenterAndris
Given the delay in announcing the results for an "electronic" vote it is pretty clear the OMA and MOH cabal must be attempting to either find a fix for the NO side win, or is trying to come up with a plausible explanation as to how it happened despite the millions of dollars in membership dues given to all its lawyers and PR consultant firms.

I'm sure if it was a clear Yes majority we would have heard about it faster than DeGrasse can run the 100 m.

While I'm still doubtful the No side has prevailed, if this is the case the COD will have to start to collect additional voluntary donations in order to fight the next legal battle in this war.
August 15, 2016 | Unregistered CommenterCanary in a Coal Mine
Ksy11,
To be fair, I believe it was the judge who rewrote the motion...however, OMA legal could have provided more clarity more easily at the meeting.
At one point there was laughter at an explanation provided .

As for the delay, I believe there is an issue of a letter.
August 15, 2016 | Unregistered CommenterMerrilee Fullerton
Whoever heard of the result first, please post!
August 15, 2016 | Unregistered CommenterMerrilee Fullerton
Hears
August 15, 2016 | Unregistered CommenterMerrilee Fullerton
rejected
woo hoo
August 15, 2016 | Unregistered CommenterERDOC
The Minister knows what to do. Regrettably the OMA needed to be reminded of the same.

From my previous post.

"The sky is not falling. Negotiations carry on and government keeps its current plan and cuts us again, and again every year, for the next 2 years. That's the next election. May be my $2,000+ annual OMA dues could go to something meaningful? I let you reflect on how the money could be spent."

Why did this PSA not meet the smell test?

The day after the PSA was to be ratified you meet the first patient.

"Good morning Mrs. Smith, I am your doctor paid by the state, as your agent, for your care. I provide services, as you and I agreed, should be available in your care, to the best of my ability. When the state, by restrictive social policies, has deemed your care exceeds a fixed amount the excess will be deducted from my income. Should your care not be provided in a timely, or needed fashion, because of financial constraint, I will still advise you of alternatives I recognize as acceptable, by other medical/scientific groups not constrained by Ontario's social policies."
August 15, 2016 | Unregistered CommenterEklimek
Big shock to central.Not enough PARO or OMSA turned out.

Tactic if you are clever. Confirm OMA BOD was instructed tPSA could not be presented, except with its support, on Ministry directive. It becomes a failure of the Minister,not the OMA or MDs. Minister tried to manipulative the system and failed. He'll have to go,or be constantly challenged of his failure.Price of a "truce". The Minister.Don't lose the momentum.Follow through.
August 15, 2016 | Unregistered CommenterMovingforwardOntario
Two things to do,quickly.

1. Clearly,put the issue back on the Minister, if the BOD of the OMA was instructed,no support,no offer. If true,the Minster owns the failure, and needs to be gone. Followup.
2. Put out a clear message,before all the"co-management" advocates blame the greedy doctors. The message " the Proposed tPSA was an effort by the Ministry to distort the information available to the public,about how the government has capped the money available for each individuals care in Ontario.The tPSA was to cover up the MOHLTC failed management leading to unmonitored waste,rising waiting lists, and delayed access to needed technology.The OMA,collectively, recognized that, and through a tough process, democratically voted to expose this government's desire to hide its issues of budgetary restrict access to needed and wanted care. Appropriate management of health care services can only begin once the government is honest with the public, that its goal to to constrain needed health care because of budgetary issues, that the government can not solve within the current constricts of monopoly inadequate funding.
August 15, 2016 | Unregistered CommenterMovingforwardOntario
If the OMA can not grab this issue and own the control by Wednesday news cycle,it loses.

The "co-management"gurus are already aligning to blame the greedy doctors. Blame the unneeded health care restrictions.

You have until Wednesday to grab the upper hand.
August 15, 2016 | Unregistered CommenterMovingforwardOntario
Thanks for the quick notice ERDOC!
August 15, 2016 | Unregistered CommenterMerrilee Fullerton
http://www.cbc.ca/news/canada/toronto/doctors-vote-not-to-accept-ontario-s-proposed-fee-agreement-1.3722071

We all agree with the Minister,that until today tPSA the MOHLTC has made no effort to involves its MDs in management. The tPSA has been accessed by many competent individuals, and found to lacking to protect patients interests. As the Minister has confirmed, its first efforts are insufficient, and in light of the political distortion applied by the Minister,like many,we request he step aside to allow reasonable progress to occur.
August 15, 2016 | Unregistered CommenterMovingforwardOntario
Te OMA has until 5 PM Wednesday to cease this agenda. Beyound that, central wins.
August 15, 2016 | Unregistered CommenterMovingforwardOntario
Sigh.
The CBC says it is a "fee deal"...guess they didn't talk to Scott Wooder who called it a "process agreement" as I recollect.

It was a rationing deal.
Scott Wooder resigns from the OMA Negotiations Committee
Dr Eric Hoskins, Minister of Health and Long Term Care should resign. He has destroyed trust in government and the negotiations process.

Bring in the next shift.
DO NOT UNDERESTIMATE WHAT IS GOING ON. Central is not.
August 15, 2016 | Unregistered CommenterMovingforwardOntario
As we said earlier on this blog, although some disagreed, the students are out traveling around Europe recharging their batteries or else working a summer job and the last thing they are concerned about is OMA politics. Just think back to when you were a student. Most of us would not give a rat's ass about this stuff until possibly clerkship.

It is time for the COD to grab this bull by the horns before it gets spun as the 'greedy doctors'. Get the vote breakdown and provide that to the news media. Almost ever FHT doc I know on capitation voted no. New grads voted no. No one trusts this government nor the OMA. Trust has been lost and until there are some substantial high level resignations this struggle will continue against the OMA and MOH.

Finally Ontario physicians have awoken from their slumber.
August 15, 2016 | Unregistered CommenterCanary in a Coal Mine
I'm hearing of urgent LHIN meeting today.
August 16, 2016 | Unregistered CommenterMerrilee Fullerton
Any comments ELB?
August 16, 2016 | Unregistered CommenterMerrilee Fullerton
<<Any comments ELB?>> - Dr. F.

Failure to deliver on the OMA agreement will have a definitive negative cascadeing effect on all other government health-related initiatives. And since the health envelope is about half the entire magilla, this is a big deal.

The next initiative that immediately comes to mind is Bill 210, of course. It's primary feature: the blending of the CCACs with the LHINs. If you have to do A and B in order to achieve C, what happens if you get stuck at A?

[I'm trying hard to avoid using the spiraling down the toilet drain analogy...but there...I said it]

Let's go back almost two years to the Minister's mandate letter from the Premier:
https://www.ontario.ca/page/2014-mandate-letter-health-and-long-term-care

Half-way through the Minister's mandate, what have we done and who owns the accountability?

In the words of one of Canada's unofficial comedic poet laureates, Russell Peters, "Somebody's gonna get a hurt real bad".
August 16, 2016 | Unregistered CommenterExecutive Lead Blogger
As always, enlightening and entertaining ELB! Might as well enjoy the humour. There is enough strain.

Bill 210- The Patients First Act is a real nasty. It will not accomplish anything more than creating increased costs to the system with increased micromanagement. It's a sham.

It's like putting a pretty bow on a warthog. (Tired of using the lipstick on a pig analogy).
https://www.ontario.ca/page/2014-mandate-letter-health-and-long-term-care
"The most ridiculous comment was from Bob Hepburn in the Toronto Star, who likened the Mites to Donald Trump supporters. Because, of course, the first thing you think when you see two young, brown, ( and in one case Muslim) women is — “Gee, they must support Donald Trump!"
August 16, 2016 | Unregistered CommenterMerrilee Fullerton
Anyone know what Minister Hoskins had to say this afternoon around 3?
August 16, 2016 | Unregistered CommenterMerrilee Fullerton
Not what I ws led to believe....

"Many doctors who opposed the tentative deal complained that it resulted from some kind of backroom deal when they didn’t even know negotiations had resumed. Hoskins said the government didn’t try to hide the fact that talks had resumed.

“It was at the OMA’s insistence that those discussions be kept secret,” he said.

http://globalnews.ca/news/2885340/oma-wants-new-negotiating-mandate-after-doctors-reject-tentative-fee-deal/
August 16, 2016 | Unregistered CommenterEklimek
Fromthe posted above article;

"Hoskins said Tuesday that if 10 per cent over four years wasn’t a big enough fee increase, then doctors need to tell the government how much they really want."

10% fee increase.

The OMA has 24 hours left to take ownership, or the public will turn.

The Minister knows he is now not telling the truth. Is this "disruptive behavior".
August 16, 2016 | Unregistered CommenterMovingforwardOntario
Of course, at central, it has been pointed out the entire PSB (physician service budget),is the fee fund the all doctors draw from.To bad the doctors don't get that. The alphabet groups,and salaried slots are going to get hit.

The social agenda decision has determined the fee per capita per doctor will come down, over the next decade.About 30%. The pot,per doctor, is being reduced.
August 16, 2016 | Unregistered CommenterMovingforwardOntario
Mfo

There is no "social agenda". Let's call it for what it is. There is a wandering convoluted concoction of government opportunism that has no overarching strategy beyond attempting to seek re-election.

As we approach 2018 the government spin about the economy and policy success will become downright rosey. Within two years the "wynne" successes, labour peace and infrastructure funding will mask all concerns.

The good times will be manufactured, just in time for 2018. Deficit, what deficit?
August 16, 2016 | Unregistered CommenterEklimek
DrK:

There is "a social agenda". It is now a Social agenda., those who suffer must get more,those who succeed, must get less, It will come to a head.

Sorry but subsistence caribou in Manitoba, is not the equivalent of putting Canadian astronauts in space. We have,hopefully, moved on.

Sorry,no racism involved. The world has moved. Moose hunting as a means of life involvement, does not provide water purification, vaccinations,cellphone access, or paved roads.
August 16, 2016 | Unregistered CommenterMovingforwardOntario
The Liberal government is practicing the " Politics is the systematic organization of hatreds"...the politics of envy, the overly vilification of the perceived wealthy....the " social justice agenda " , the levelling of the medical profession, the taming of the OMA, fits nicely into their plan for reelection which, as we know, is the primary concern of such career politicians.

What could trip them up is the likelyhood of an implosion in health care system...the wheels started to fall off with the rebellion amongst the membership of the OMA....the OMA was supposed to deliver the membership hog tied ready for the BBQ and failed....Hoskins may have to dirty his own hands to hog tie it himself before Bill 210 can get implemented.
August 16, 2016 | Unregistered CommenterAndris
Getting Hoskins out of the picture will improve the chances of us agreeing to a new contract. The wounds inflicted are still fresh and the sooner he's gone, the sooner we will move on. It has become downright personal and the liberals would be smart to unload him ASAP.

The truth is they are out of ideas. They have spent Ontario into a fiscal mess. Growth greater than 2% is not coming. Healthcare cannot be fully funded.

Single payer is dead so make the bold changes and cut the dead weight out of the system. Ten times as many bureaucrats as Germany (per capita) says it all. Allow private competition and private funding.

We could add extra capacity to our system and perhaps Americans would come here for cheaper care. Imagine the extra revenue for hospitals, OR's fully operational, and money to invest in beds and nurses. Canadians who want same week MRI's can pay for it out of pocket or through private insurance. Currently money is flowing out of the country and this lost revenue = lost jobs = lost taxes.
August 16, 2016 | Unregistered CommenterERDOC
We need to slow down process and have this debated in the legislature which is the last things the Liberals want. Nothing happens until after Sept. 12 when Hoskins can repeat those lies in front of his colleagues and have them challenged instead of playing a game of hide and seek as he has been doing.

I want to see the guy stand and defend his bald face lies in the legislature.
August 16, 2016 | Unregistered CommenterCanary in a Coal Mine
Highest paid physician in the province Hoskins 7.8 million a year. USE IT.

Product produced - 6 billion a year in deficit.
August 17, 2016 | Unregistered CommenterMovingforwardOntario
Yes. Use it.

As mfO predicted...by Wednesday:

http://www.theglobeandmail.com/news/national/oma-leadership-warned-as-doctors-remain-divided-on-negotiations/article31440495/

Instead of greedy doctors Hoskins is deflecting by putting it on the OMA. Perhaps some of the leadership of COD is seen as sympathetic.

Interesting.

Again, The Wynne Liberal government deflects.

Hoskins needs to go.
August 17, 2016 | Unregistered CommenterMerrilee Fullerton
Ok so the coalition needs to arm itself with facts such as lower fees in Ontario.

Pick the most common specialty fees and compare them across the country. If we are indeed the highest than I guess we can't complain. If the numbers show us to be middle of the pack or lower than we have a good case. I suspect we are middle of the pack or lower after the clawback is factored in.

example
appendectomy
Ontario $336.60 (minus clawback)
Alberta $ 517
NB $384
BC $338
August 17, 2016 | Unregistered CommenterERDOC
Sadly, no action by the OMA explaining to the public why things happened. Central has seized ownership about the greedy doctors. No actions for years now. Should not have wasted the last 2 days re:grabbing ownership from Central.
August 17, 2016 | Unregistered CommenterMovingforwardOntario
The Coalition wrote to the OMA directors requesting the dissolution of its Negotistionx Committee and Negotiations Advisory Committee....it criticized the OMA's communication's strategy which Mfo pointed out had not taken the initiative and , if anything, still had its guns pointed at the Coalition, leaving the field the Ontario government to define recent events to the general public.
August 17, 2016 | Unregistered CommenterAndris
Some interesting comments from Paul Conte.

http://shawnwhatley.com/crisis-of-trust/#comments
August 17, 2016 | Unregistered CommenterCanary in a Coal Mine
https://pbs.twimg.com/media/CqHKD6aWEAADjyq.jpg:large

Please send the link to all your Liberal friends.
August 18, 2016 | Unregistered CommenterCanary in a Coal Mine
Sigh. Globe and Mail still doesn't understand.

The rejection of the deal was not about doctors wanting to be paid more. It was a rejection of government that wanted its doctors to ration care to a growing population.

http://www.theglobeandmail.com/opinion/editorials/ontario-and-the-doctors-prescription-for-a-budget-conflict/article31451348/
August 18, 2016 | Unregistered CommenterMerrilee Fullerton

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