Navigation
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. 

 

 

 

 

Login
« B.C. Courts will bring into Focus the Hard Questions about Canada’s Health Care System | Main | The Tentative Ontario Doctors' Deal-What it means to you »
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)

Looks like the Feds have gained intervenor status in the upcoming Cambie Surgical Centre court case. Here we have the Federal health minister spreading misinformation and others fear mongering about Canadians going bankrupt due to private insurance premiums.

Add in a doctor shortage for good measure and we're back to the hysterics of the US gun control debate right in out own backyard when any serious attempt to discuss a hybrid health care system is made.

http://www.cbc.ca/news/thenational/feds-gear-up-for-battle-against-private-health-care-1.3740740
August 30, 2016 | Unregistered CommenterCanary in a Coal Mine
Status or knowledge of any pending or active CPSO complaints against Hoskins? Behavior unbecoming of a physician, speaking of the profession and colleagues in a manner that diminishes the profession, are these not slam dunks? I recall some rumblings about a complaint on this forum late last year?
August 30, 2016 | Unregistered Commenterdocinthepark
The CPSO is the policing arm of the MOH so good luck with that one. Why do you think there have been no charges laid by the OPP in any of the numerous LIberal scandals. The OPP are the police for the state.
August 30, 2016 | Unregistered CommenterCanary in a Coal Mine
I pushed the CPSO to take both Hoskins and deputy minister Bell to the committee that decides if there will be a hearing.

Unfortunately, they were able to use the I'm acting as a politician not a doctor defence and no further action was undertaken.

The usual disgraceful CPSO performance.
August 30, 2016 | Unregistered CommenterStephen Skyvington
"Looks like the Feds have gained intervenor status in the upcoming Cambie Surgical Centre court case."
They will put on a soft effort...for show.
Same as they have done for Pharmacare.
Same as they have done for Health Accord.
They've spent their billions on other things.
Selfie anyone?
" Maybe through this or similar changes, Canada might reflect its status as one of the best countries in the world as opposed to a socialist country with rationed healthcare."
August 30, 2016 | Unregistered CommenterMerrilee Fullerton
No hybrid system will be allowed.
August 31, 2016 | Unregistered CommenterMovingforwardOntario
"No hybrid system will be allowed"....no life boats will be allowed on the Titanic...no auxiliary ships will be allowed to follow the Titanic.
August 31, 2016 | Unregistered CommenterAndris
Dare anyone suggest that we are creating an environment rife for a Canadian health system disruptor like Amazon, AirBnB or Uber?
August 31, 2016 | Unregistered CommenterExecutive Lead Blogger
So I gather the health system can't be reorganized or improved from the outside. As for legal challenges, your replies tell me the CPSO, OPP or Federal court system cannot be relied on to enforce corruption even if it's obvious.

We then wait patiently for total collapse from the inside out, if not the health system's inherent weakness, it will be the debt bubble that takes down the provinces- the voting population has no one to blame but themselves.

As for the hourly rate of a physician in Ontario, can you say stagflation? I get the sense the CODs are afraid they won't be able to make payments on their mansions and luxury cars and they're right. Many of these specialists at least in my city have pretty offices with the latest finishes and furnishings. Time to own that worldwide this is a dangerous economic climate, and you can't expect anything sustainable from a government up to it's eyeballs in debt. Look to Europe for a preview of what's to come here, BritishColum-exit, Queb-exit, they won't want to pay for this.

Should've taken the 2.5% while we had the chance...
August 31, 2016 | Unregistered Commenterdocinthepark
<<Should've taken the 2.5% while we had the chance...>> - DITP

Let's be honest, because I am way too daft to understand the black, white and whole-lot-of-gray in this entire issue.

Was it really only about the money?

I thought it was about the co-management concept and the secretive nature of the negotiations.
August 31, 2016 | Unregistered CommenterExecutive Lead Blogger
Taking the 2.5% meant you own the rationing.

Currently, central owns it.
August 31, 2016 | Unregistered CommenterMovingforwardOntario
Kicking the can down the road another 4 years was clearly not an option for the majority of non academic practicing physicians.

Expecting the physicians to shoulder the burden of fiscal restraint without an equivalent contribution from the rest of the public sector was also a nonstarter.

There was no upside to signing the deal - Repeat - no upside unless one has a vested interest.

Bring on the billing caps, fee reductions , patient volume discounts and Hoskins, Wynne will own them in 2018 and lets see what access and waiting lists look like in 2 years.

Any money saved will not go to underpaid specialists and FD/ER docs. It will be used to fund growth in population and utilization. Of course, expect further cuts once those projections are exceeded.
August 31, 2016 | Unregistered CommenterERDOC
Rejecting the tPSa was not about then money for the section of Neurology. We aren't high rollers and wouldn't be with ratification, so no lure there. Rejection was about the nonfinancial issues, transparency. co-ownership rationing, infrastructure, and I won't gone on.
August 31, 2016 | Unregistered CommenterEklimek
For most docs in the trenches this was not about money but rather about not owning rationing and that will remain the case.

I'm still prepared to let the politician Hoskins dish out what he wants for the next 18 months but in return I'll do everything in my power to ensure Bill 210 does not see the light of day.

On election day the docs will be bloodied but their fingerprints won't be on Bill 210 and more importantly hopefully Bill 210 won't see the light of day.

For many it is now personal with Hoskins,.....it is time to end his political career.
August 31, 2016 | Unregistered CommenterCanary in a Coal Mine
CICM, ditto
August 31, 2016 | Unregistered CommenterMerrilee Fullerton
ELB,
The rejection of the deal was in response to unreasonable rationing and damaging "comanagement" and sneaky behaviour.
August 31, 2016 | Unregistered CommenterMerrilee Fullerton
Ditp

The system is not corrupt. It is just the system we built. Not perfect, needs some adjusting. Problem is it is hard to get consensus what to change it into.
August 31, 2016 | Unregistered CommenterMovingforwardOntario
ELB,
As one of my colleagues said, "There is no app for appy"
However, there is room for empowering patients in their own care through mhealth and virtual health and modern communication technologies beyond gov't provision. How to create that innovation?
August 31, 2016 | Unregistered CommenterMerrilee Fullerton
<<How to create that innovation>> - Dr. F

Unabashedly disrupt.

Now is the time.

Can it get any worse?
August 31, 2016 | Unregistered CommenterExecutive Lead Blogger
"On election day the docs will be bloodied but their fingerprints won't be on Bill 210 and more importantly hopefully Bill 210 won't see the light of day.

For many it is now personal with Hoskins,.....it is time to end his political career."-CICM

If the libs were reelected following the McGuinty era, anything is possible. I can foresee Hoskins making a run for Premier and the dumb vote will have his back. The GTA is not frustrated enough and life moves on. We do not have thr general public's attention and despite claims from the CODs, the coalition does not have the support of GPs across the board, note the lack of endorsement from the SGFP and substantial MD voter apathy rates.

If our profession can't hold Hoskins accountable within our own channels and are relying on the Democratic process to straighten things out, we're sitting ducks.

Central controls the RA and subsequently, the books of our businesses and our livelihoods, for this reason bill 210 can and in my opinion will sail through the majority government and we have no recourse. Ultimately physicians will follow the money, and the MOH knows this, be happy you even have an RA coming in this month. Hence my comments about taking the 2.5%, it was their best offer and it has passed. We don't make the rules, we are in the lowly position to either play the game, or head home empty handed.
August 31, 2016 | Unregistered Commenterdocinthepark
Ditp

The public likes what exists, and will continue to vote in, any party that can keep "free" in place, regardless of how cumbersome and slow it is.

The majority of ontario population is getting what it wants from the free system. Those who aren't go to press, and frequently raise sufficient empathy to get what they want.
August 31, 2016 | Unregistered CommenterMovingforwardOntario
First of all there was no 2.5% raise as the Hoskins propaganda machine keeps on regurgitating...growing the pot at 2.5% whilst those consumming from the pot are growing faster means less...but not less for all...some who feed from the pot have their portion of the feed guaranteed , which means that those others with no guarantees have even less.

There is a Chinese military strategy that advises one to swallow one's blood and teeth when faced by an adversary when he holds the advantage...to back off....but never forget...six months latter when the adversary comes out of the bar into the alley blind drunk, one waits in the shadows with a base ball bat at the ready.
August 31, 2016 | Unregistered CommenterAndris
DITP,
I think you should review the tPSA again. That was not a 2.5% raise in fact it was likely to be a 0.6% cut and would have meant that physicians co-owned the rationing.

The SGFP gave a pro vs con neutral assessment and we still don't know the breakdown of the vote but I can tell you I don't know one FP who voted yes. Even my non-academic FHT colleagues voted no. I think you would find that of the FPs who voted the large majority excluding students and residents did not support the deal.

Maybe someday the OMA will actually release the breakdown.
August 31, 2016 | Unregistered CommenterCanary in a Coal Mine
I don't interpret the 2.5% to be a raise and acknowledge that it's spin. Just saying that to expect anything more than what they offered is wishful thinking looking at the balance sheet of the province, and accepting the reality we are up against a majority government. To stand outside of Queens park with a megaphone knowing this is the case only furthers the stereotype that M.D.s aren't good with their finances.

As a medical community we have to reexamine our priorities and fiscal expectations in the context of the broader world economy and where things are going. From there we can have a more sustainable plan B at the bargaining table. If we can't at least acknowledge the liberal's philosophical stance (which takes this reality into account) there's nothing further to discuss or negotiate and this is the reason right now for the large divide between doctors and the MOH. The anger and arguments everyone has about ehealth and billions wasted in other areas is also a dead end given that it can't be policed.

Pay cuts and freezes will be the norm (losses relative to inflation guaranteed) and unless you can influence the bank of Canada or federal reserve, the glory days are over, judging from Japan's experience possibly flat for 20-30 years. We can squabble about who's ranked where in doctor billings comparing with other provinces, but the entire ship is sinking, doesn't matter which cabin you're hiding in.
August 31, 2016 | Unregistered Commenterdocinthepark
It will all be fine. We will transform the system through integrated health care teams. Paid for by reducing the physicians pot of money,while putting more doctors into the pool.

The plan is good. Love it,or leave.
August 31, 2016 | Unregistered CommenterMovingforwardOntario
Agreed that we are facing a global deflation, that our province and country is being run by drunken sailors running up massive unpayable debts in our names, with monies spent on unproductive, wealth destroying ideological wet dreams.

Agreed that our provincial monopolystic, monopsonic health care Titanic is sinking and that the medical profession thinks that it is locked in its cabins.

This Health care system is not one that the medical profession conceived, it did not design it, did not construct it, did not manage it and is certainly not responsible for its buoyancy.

The powers that be won't look for alternatives, look and hopefully learn from the world's more effective and efficient hybrid public/ private systems, until its own construct hits rock bottom.

Their public health care vessels could have auxiliary private vessels sailing nearby ....allowing auxiliary private vessels to float next to their own public vessels is certainly ideologically unpalatable to them at present....but it is the answer to their problems.
August 31, 2016 | Unregistered CommenterAndris
It will all be fine,once all the doctors have their incomes reduced and join the "Community".

Come join us,at the maypole dance in celebration.
August 31, 2016 | Unregistered CommenterMovingforwardOntario
All will be fine. Soon,each patient will be assigned a "care manager", to assure their journey through health care services, are kind and gentle. Central will assure you are not stressed as we provide all your health care needs.
September 1, 2016 | Unregistered CommenterMovingforwardOntario
All will be fine. Soon,each patient will be assigned a "care manager", to assure their journey through health care services, are kind and gentle. Central will assure you are not stressed as we provide all your health care needs.
September 1, 2016 | Unregistered CommenterMovingforwardOntario
Just drink the kool aid and all will be fine, so sayeth the Rev. Jim Jones.
September 1, 2016 | Unregistered CommenterStephen Skyvington
" A pig with two owners soon dies" ( old English saying) ....god help the LHIN clients who are to be looked after by a team overseen by a manager...
September 1, 2016 | Unregistered CommenterAndris
docinthepark,
It's unfortunate that pain often drives change. Ontario MDs need to rise up for their patients. There are plenty of better ranked systems to consider. Plenty of options available yet the "there's nothing we can do" is a pathetic response from some MDs. Shockingly innocent.
September 1, 2016 | Unregistered CommenterMerrilee Fullerton
It's a response I hear from MDs under 45 typically.
September 1, 2016 | Unregistered CommenterMerrilee Fullerton
There is nothing you can do. Central owns control. The population needs exceeds individuals wants.
September 1, 2016 | Unregistered CommenterMovingforwardOntario
central is losing a byelection tonight

referendum on Kathleen Wynne and her ship of fools
September 1, 2016 | Unregistered CommenterStephen Skyvington
Still a majority, with lots of time to rearrange the system.

The plan is good.
September 1, 2016 | Unregistered CommenterMovingforwardOntario
Dr F., my view comes not from a place of innocence, but from acceptance for how things are and what's across the negotiating table. If we are to generalize about what generation is doing what, many of the over 45s I've seen are the ones who sipped the Kool aid and joined the alphabet soup by merging their mega practices into the team models. They are as much to blame for this predicament we are all in.
September 1, 2016 | Unregistered Commenterdocinthepark
It will all be fine. The consultants have assured us.
September 1, 2016 | Unregistered CommenterMovingforwardOntario
The status quo is not sustainable. The government continues on the wrong path and accepting this deal would have prolonged the pain. There may be no more money but so what.? Get rid of single payer , and at least we will have a system that will respond to the laws of supply and demand.

The growth in private healthcare will provide more jobs, more care, more OR time and more tax revenue. That money can be reinvested in our hospitals and public system.
September 1, 2016 | Unregistered CommenterERDOC
Central has been advised it is sustainable by its consultants (many OMA members). There will be NO overt private money allowed. All know,however,lots of covert leakage is going on,and expanding. Those with resources are improving their health options,those without are getting declining care. Central is actually driving the expanding inequity.
September 1, 2016 | Unregistered CommenterMovingforwardOntario
It needs to be understood, central's advisers (including members of the OMA), have agreed social justice is the way of the future. MDs incomes will be reduced for the good of the population,and they will be made to be team members. Personal MD autonomy is gone for the good of us "all".

It seems many do not get how advanced this transformation is. Central will determine your value,and need for health care services, as it deems appropriate.

Trust us,we are here to help.We know what is needed.
September 1, 2016 | Unregistered CommenterMovingforwardOntario
nice humiliating defeat last night in SRR

wynne has won her last election

done like dinner
September 2, 2016 | Unregistered CommenterStephen Skyvington
Stephen, your enthusiasm may be short lived. Reality is that we have a majority government who has 2 years wreak havoc , unchecked. They can lose every by election and the outcome is the same.

Should the Tories be elected in 2018 (and they have a long road ahead including their leadership crisis), they might be inheriting a train wreck.
September 2, 2016 | Unregistered Commenterdocinthepark
True enough...the government has the time to change the facts on the ground...it still has time to run the medical care vessel onto the rocks and to drown its occupants.

One advantage would be that an incoming government could cry crocodile tears, attribute the sinking of the vessel, quite rightly, to the incompetent captain and pilot...and then go about and design an evidence based health care system to the benefit of all.
September 2, 2016 | Unregistered CommenterAndris
<<One advantage would be that an incoming government could cry crocodile tears, attribute the sinking of the vessel, quite rightly, to the incompetent captain and pilot...and then go about and design an evidence based health care system to the benefit of all.>> - Andris

You had me up until "captain and pilot". You lost me at the point where you turned the corner at Utopia and then monkeys flew out of my butt.

Sorry but history has shown that none of the three provincial political parties have a monopoly on or the capacity to design a health care system to "the benefit of all".

The system you suggest will have to come from a broad-based apolitical coalition of health system providers and patients who are prepared to relinquish whatever historically acquired superiority they believe they have in order to create a comprehensive evidence based equitable system of care for the common good.

We need to find an acceptable leader who can instigate and support this kind of groundswell healthcare historical hierarchical mutiny.

No names instantly pop into mind...anyone?
September 2, 2016 | Unregistered CommenterExecutive Lead Blogger
ELB...it is an unfortunate fact that the general public needs scapegoats when one of its revered sacred cows collapses....the government has been busy setting up the medical profession as its scapegoat for the ills of the health care system and who would be blamed if it went to ruin.

The captain in this case is the Premier and the Pilot, Hoskins...in my opinion they will have to be held responsible if, or rather , when this Ontario Health care vessel runs into the rocks...the public will demand heads....and the heads will have to be theirs and not that of the medical profession who cannot be held for the course that the supposedly experienced medical master mariner Hoskins chose to follow in such dangerous waters.

The ship's captain and pilot are jointly responsible for the manouvering of their vessel in such turbid waters....if it ends up on the rocks then it is their heads that will have to roll.

As for being " utopian" ....it may well be that out of the pending health care chaos there will be even more chaos, worse chaos as opposed to hoped for order with its hoped for evidence based hybrid health care system ....if the survivors try recreate the structure that failed so miserably then the consequences will be the same...as stated previously politicians will do the right thing only after having exhausted every other alternative, and there are so many more wrong solutions that they haven't tried as yet.

Obama had the opportunity of creating an evidence based health care system and , instead, ended up with a shambolic pig's breakfast.
September 2, 2016 | Unregistered CommenterAndris
<<...politicians will do the right thing only after having exhausted every other alternative, and there are so many more wrong solutions that they haven't tried as yet>> - Andris.

You are so right, it is painful, Andris!

From Steve Paikin's blog posted this morning regarding the Liberal defeat to the PCs in the Scarborough byelection:

<<...in a statement released last night, the Premier admitted the result was “disappointing and gives me cause for reflection.” While Wynne has been focused on trying to run a truly transformational government...she also acknowledged in her statement that she may have got tripped up on the more basic things people expect from their governments, such as affordable electricity rates>>

It is entirely likely that the Wynne Liberals will face defeat in 2018 as did the Harper Conservative government did in 2015. The result was based primarily on change and hope as opposed to fear and loathing. It also helped that a charismatic yet untried leader was presented against a self-proclaimed stiff policy wonk.

Unfortunately, we have no such option in Ontario. As previously said, I strongly believe that leadership is going to have to come from outside the formal political arena to galvanize the health care enterprise to a point where none of the parties will be able to get in the way of the necessary change.

Waiting...
September 2, 2016 | Unregistered CommenterExecutive Lead Blogger

PostPost a New Comment

Enter your information below to add a new comment.
Author Email (optional):
Author URL (optional):
Post:
 
All HTML will be escaped. Hyperlinks will be created for URLs automatically.