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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)

Walley's emails (most recent outlining the OMA primary care "advisory group" as a pre response to their official bill 210 response) induce nausea in me instead of reassurance. Fellow doctors is this normal or should I start a PPI as next step in management?
September 2, 2016 | Unregistered Commenterdocinthepark
Every now and again strong characters, good or bad) rise to the occasion during crises...Churchill, De Gaulle ...or a Lenin ( " All I'm interested in is power and it is lying there in the streets, waiting to be picked up..." ) or a Trump?

The strong character in Ontario/ Canada is likely to be an unknown at present...most career politicians are midgets who flourish during the good and easy times and wilt during the bad...crises reveal the truly strong...and the strong will rise and take the reins ...the only problem is whether they will be good, capable, competent, persevering people of good character with a long view and who are seeking the truth or their ' strong' opposites.
September 2, 2016 | Unregistered CommenterAndris
Doc....is there a PPI/ benzodiazepine combo?

Psalm 64:2 " Hide me from the conspiracy of the wicked , from the plots of the evil doers" ( modern version).
September 2, 2016 | Unregistered CommenterAndris
BC
September 2, 2016 | Unregistered CommenterMerrilee Fullerton
Speaking of BC.


"The trial is expected to last four months. It could have nearly 200 witnesses, including six of the original eight plaintiffs. (The other two have died since the case was launched eight years ago.) While he is not named as a plaintiff himself, Dr. Day, as head of the private Cambie Surgery Centre, is leading the challenge against the B.C. Medicare Protection Act, which prohibits doctors from directly billing patients for care they have provided.

A variation of this issue was tested 11 years ago, when the Supreme Court of Canada ruled that a Quebec ban on private health care was unconstitutional. It is almost a certainty that this case will also end up in the hands of the country’s highest court.

The irony about all this is that if you talk to politicians privately, as I have, they nearly all admit that the kind of hybrid, public-private health-care system common in Europe is likely best for this country as well. France has the top one. The facts speak for themselves: The heaps of money that is spent on health care in Canada have little correlation with the quality of the care offered."

http://www.theglobeandmail.com/news/british-columbia/changing-canadas-health-care-system-is-a-life-long-fight/article31702370/
September 3, 2016 | Unregistered CommenterCanary in a Coal Mine
A brave political candidate with a true belief in two tier won't be able to stimulate change in the near to mid term. Aging population and the pride Canadians have in their socialized system equals the political kiss of death if a candidate even mentions two tier.
September 3, 2016 | Unregistered Commenterdocinthepark
DITP,

I agree that speaking out about instituting a hybrid system in Canada, much like speaking about gun control in the US, often is career ending/limiting for any politician. At some point though conditions in the system with wait times and lack of quality primary care will become so bad that the public parade for change will begin and only then will a politician get out in front of that parade. We are not there yet.

How far are we from that turning point? I'd say if nothing changes from a global financial standpoint then at least 5 to 10 years, however one cannot rule out another financial crisis in the next 24 months which will reset these time lines forward. Ontario is very vulnerable to any global financial shock given our massive sub-sovereign debt.

It is difficult to say what will be the catalyst (possibly a Trump win), but when that financial storm comes there will be rapid change forced on the economy from afar and as a result the health care system will have to change quickly to allow the necessary services to be delivered. The boomers won't have it any other way.

Just look at the talk recently of a "bail-in" policy for Canadian banks should one become insolvent. What do the central bankers know that we are not being told? Crazy talk or is the canary showing some signs of early respiratory weakness in his cage?
http://www.huffingtonpost.ca/2016/07/30/canadian-bank-bail-in_n_11270458.html

http://www.mcmillan.ca/Files/188014_Introduction%20of%20a%20Bail-in%20Regime.pdf
September 3, 2016 | Unregistered CommenterCanary in a Coal Mine
CICM, good points. Unfortunately for Canadian citizens, the health care system is "too big to fail". I don't forsee the boomers protesting with their walkers for change. Protest so they can pay for health care with the little disposable income they'll have left?
September 3, 2016 | Unregistered Commenterdocinthepark
The boomers are due to inherit from their parents the largest transfer of wealth this country has ever seen, assuming the government doesn't tax it away. They are no way near the walker stage of life ( the oldest boomer is only 67 years old right now) and they will resist the aging process every inch of the way.

No the boomers will be out protesting when their knees, hips, and lenses need replacement now, but the system can only promise a year down the road..
September 3, 2016 | Unregistered CommenterCanary in a Coal Mine
http://m.wealthprofessional.ca/infocus/home-equity/the-boomer-pension-shortfall-its-here-and-it-is-real-178619.aspx

CICM, assuming the wealth transfer happens, be assured it will be taxed. We're also due for a real estate correction, that should wipe most this fictitious wealth off the table and cause default on those home equity loans, most aren't smart enough to sell while the going is good.

Factors to consider that also disrupt any wealth accumulated- longer life expectancy and the rising cost of long term care. I expect the boomers to be a liability to the system and the future generations.
September 3, 2016 | Unregistered Commenterdocinthepark
We're long overdue for a real estate correction given the price to income ratio in Vancouver and Toronto is now 12 and 8.5 respectively. Historical norms have been 3 to 5 but I guess as long as the mainland Chinese money pours into these markets the prices will become more and more distorted and unaffordable for ordinary Canadians.

I think what might happen even if the boomers turn out to be less well off than expected is the public system quality will deteriorate to such a low level that even the younger ones will demand a second private option.

As mentioned here a month ago I had lunch with a nurse on a surgical ward in a U of Toronto teaching hospital (not on University Ave) who said the conditions at her hospital were so bad now that she had started to tell all friends and family to avoid the place. We are starting to see this trend in Mississauga Halton where people are driving to the new Oakville hospital instead of presenting to the local hospital where the quality of care has fallen substantially in the five years.

Maybe the tipping point will be the boomers spending time looking after their aging parents in these C. difficile infested public institutions with increasingly demoralized and disengaged staff that gets the hybrid system parade started.

There was a Macleans article a few years back on the expected wealth transfer to the boomers but increased life expectancy as you mention might wipe out a lot of the wealth transfer.
http://www.macleans.ca/society/life/the-inheritance-wars/

As for Helocs they are a very bad idea for a retired person on a fixed income. Lots of seniors going bankrupt after loaning their grandkids money for school tuition which the parents don't have. There really needs to be some guidelines for these unethical loans by banksters to 80 year olds on fixed incomes. Had one in my practice who lost his house after frittering away a half million on grandkids, trips, etc.
http://www.cbc.ca/news/business/seniors-going-bankrupt-in-soaring-numbers-1.3129176
September 3, 2016 | Unregistered CommenterCanary in a Coal Mine
....also , the retired guaranteeing the loans of the children.
September 4, 2016 | Unregistered CommenterAndris
Inheritance tax,
September 4, 2016 | Unregistered CommenterMovingforwardOntario
Inheritance tax,
September 4, 2016 | Unregistered CommenterMovingforwardOntario
The next generation might inherit squat....that would put the cat amongst the pigeons.
September 5, 2016 | Unregistered CommenterAndris
Noose closes by end of October with Bill 210 passing.
September 6, 2016 | Unregistered CommenterMovingforwardOntario
Noose closes by end of October with Bill 210 passing.
September 6, 2016 | Unregistered CommenterMovingforwardOntario
Why isn't the OMA in hand to hand combat over Bill 210?
Never mind.

On another note, argument against Hybrid care goes like this: "it will divert MDs in the public system to the private system and make waits longer"
This argument is a zombie argument.
The current government funded system is constrained by government 's ability to fund. That means that the current system diverts MD services to nowhere or elsewhere while ORs are facilities are inaccessible in a timely way.

http://www.theage.com.au/victoria/too-many-doctors-juggling-public-and-private-hospital-work-researcher-says-20160904-gr8hm8.html?utm_content=bufferd8281&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer
September 6, 2016 | Unregistered CommenterMerrilee Fullerton
"The masses never revolt of their own accord, and they never revolt merely because they are oppressed. Indeed, so long as they are not permitted to have standards of comparison, they never even become aware that they are oppressed."

George Orwell, 1984
September 6, 2016 | Unregistered Commenterdocinthepark
All will be fine,once the new performance matrices arrive. Number of widgets patient,each widget provider must process,or receive discounts on their billings.
September 6, 2016 | Unregistered CommenterMovingforwardOntario
DITP....interesting quote from Orwell...one notes that neither the government nor the OMA provide or invite comparisons between Ontario / Canada's health care systems with the top rated half dozen health care systems of the world, let alone discussing them.

Comparing Doctor patient ratios, Doctor health care bureaucrat ratios,health care bureaucrat patient ratios, comparison of workloads/ fees/ incomes/ benefits/ golden handshakes on retirement: pensions of all concerned....retirement ages of the medical profession/ health care bureaucrat/public servants/ other professionals .etc, would clarify matters in the minds of the medical profession and of the general public...the medical profession has no idea as to how badly they compare to their equivalents in the top rated countries....both the government and the OMA intend to treat the medical profession much like mushrooms...kept in the dark whilst feeding them faeces.
September 6, 2016 | Unregistered CommenterAndris
Big push to get Bill 210 through,setting up for the final management goals of performance matrices,and productivity standards. Health will be run like the public school system.
September 7, 2016 | Unregistered CommenterMovingforwardOntario
Treating health like the school system? Perhaps for the alphabet soup groups.

If they want us FFS comrades cranking through cases like widgets it's already happening, might only require a drive by at the open from the LHIN manager to see the line around the building the for our walk-ins.
September 7, 2016 | Unregistered Commenterdocinthepark
""If I want to take whatever money I have left after the government gets finished taxing me, and spend it on my mother's eyes, you're gonna tell me I can't do that?"

The answer from Canadian nationalists, who hold this country's one-payer system to be something holy, would be, 'Yes, sorry, my friend, but your mother needs to get in line like everyone else, and suffer for days in the hospital, for the good of us all.'"
September 7, 2016 | Unregistered CommenterMerrilee Fullerton (realist)
a slightly shortened version of my interview with dr brian day will appear in tomorrow's national post
September 7, 2016 | Unregistered CommenterStephen Skyvington
decision regarding treatment for pancreatic cancer

" ... he’ll participate in an appeal by phone before an OHIP panel of experts who are to consider options, including whether the province’s medical system should provide him with tumour removal surgery in Toronto or pay for the operation to be done by Martin’s team in Kentucky.

http://www.torontosun.com/2016/09/07/cancer-stricken-mayor-buoyed-by-good-news
September 8, 2016 | Unregistered Commentereklimek
Big news! The Liberals will reportedly prorogue the Legislature on Monday

https://www.thestar.com/news/queenspark/2016/09/08/wynne-to-prorogue-the-legislature-for-throne-speech-monday.html

Prorogation matters, because in essence it means shutting down the legislature. It's perfectly within the government's right, but it can be controversial: It kills any bills that are yet to be passed, stops committees from working and robs the opposition of its daily chance to hold the government to account in question period.
(Source: http://www.cbc.ca/news/canada/toronto/kathleen-wynne-prorogue-ontario-legislature-1.3507766)

Since Bill 210 had only passed first reading, it can easily be re-introduced with very little time loss. However, it appears that health is really not an issue at the moment -
taking a back seat to electricity rates...what the Liberals think contributed to their byelection loss last week in Scarborough.
September 8, 2016 | Unregistered CommenterExecutive Lead Blogger
ELB If Bill 210 gets resurrected can it be pushed through under Prorogue without the legislature be able to question it and vote on it?
September 8, 2016 | Unregistered CommenterAndris
Andris, I believe that the scenario you posit would not be possible in a parliamentary government, particularly as the Bill requires amendments to 19 existing Acts.

It appears that existing Bills will be brought forward and - if I understand it correctly (huge assumption) - the governing party would only have to re-introduce Bill 210 for a new first reading.

As the Bill had only gotten to first reading this would not represent a large delay given the current majority.
September 8, 2016 | Unregistered CommenterExecutive Lead Blogger

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