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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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Wednesday
Jun072017

Understand the Implications of the "Framework"

It is shocking to me that Ontario physicians would be encouraged by the OMA or any other group to be supporting a deal with so many MAJOR pitfalls for the profession and for Ontario patients as this one.

It is WORSE than the tPSA that was voted down not so long ago with such extraordinary upheaval.

Let me be more accurate, the pitfalls are not just potholes, they are huge sharp cliffs in this case. There is a trap being set for Ontario physicians and apparently not even our own leadership can see it. The Wynne government is using Ontario physicians as part of its campaign, offering them an election goodie right before the potential of a snap summer election which may come sooner than you think...The Wynne government, after cuts to care and causing so much upheaval, is trying to deliver Ontario MDs on a silver platter and the OMA is complicit.

I will post some of the information put out by Concerned Ontario Doctors and from DoctorsOntario after this plea to think critically about the serious and dangerous ramifications of this potential "framework" not only to physicians but to Ontario's patients.

There are really four areas of concern that jump out from this contract which are more than unsettling:

1. One of the Ontario Medical Association's own negotiators is linked through family to a very vocal activist group. This in itself should have been recognized as a potential conflict of interest. This is extremely relevant since this conflict of interest puts into question the motivation for at least several contentious aspects of this potential agreement.

2. Tying arbitration to economic conditions in Ontario is murky. Although the government will say that Ontario is doing better than most other provinces in Canada with its GDP growth, this is a relative comparison and in no way indicates an overall positive econonomic picture here.

Ontario has a huge debt burden that threatens credit ratings and as it sells off revenue generating entities like Hydro One, drives up energy costs, and makes it harder for businesses to thrive, the current government is creating greater challenges for the economy for years to come. In addition, an aging population will have an effect on productivity. This too will have an impact just as need for care begins to surge. Make no mistake, tying binding arbitration to the economy is a major flaw in this agreement.

3. "Perpetuity"--any contract that requires those involved to be bound in "perpetuity" should be looked at with a special lens. Physicians must be aware that binding arbitration that is flawed by being tied to the economy, which is a problem in itself, will now be linked to other requirements that will be in "perpetuity"....items that because of this deal cannot be renegotiated.This is a major downfall and should outweigh any positive in this agreement.

4. After four years without a contract and major cuts to patient services, and being treated disrespectfully, physicians must not accept the Wynne government's newest election ploy. The Wynne government is luring physicians and the OMA with promises of  binding arbitration but the binding arbitration described  is so badly flawed that it will result in serious ramifications for doctors and patients now and in the future.

It will result in an agreement silencing physicians without any recourse. Legal counsel has confirmed that No Strike and No Job Action becomes effective immediately upon ratification, not later. The Liberal government and the OMA negotiating team with Steven Barrett will have silenced physician voices forever thereafter.

Ontario physicians and the OMA are being duped.

 

 

Reader Comments (587)

Top down agricultural decision making.

Free food for all as determined by Central.

The majority of the population supports it.

More centralization coming post 1917.

Lenin.

Look at Venezuela post election/ referrendum 2017....history may not repeat itself , but it certainly rhymes....Ontario, here we come.
August 9, 2017 | Unregistered CommenterAndris
The majority of the population supports the 'perceived' healthcare that central has masqueraded to the masses. They would NOT support the reality of healthcare if they new the facts and the truth.
August 9, 2017 | Unregistered Commentergfraser
Perception is all that matters.That's how you get votes.
August 9, 2017 | Unregistered CommenterMovingforwardOntario
Once reality hits , it's too late...as Venezuelans are discovering today.

We resemble that proverbial fellow who fell off the Empire State Building and passed the 32nd floor saying " so far, so good".
August 9, 2017 | Unregistered CommenterAndris
With the OMA looking after its own corporate interests rather than those of the membership, and the CPSO and the now the CMA advocating for patients who is going to advocate for the lowly physician? Seems like we've been dropped by our own professional organizations funded by the very members they were meant to "serve".

Has the CMA been co-opted by social justice warrior physicians? It is time to cancel our CMA memberships and send a strong message to the CMA board that they work for the physicians of Canada and their mandate should be fist and foremost to protect and enhance our professional interests and needs. They should not be wasting members' hard earned funds on the SDOHs.


""The goal is to shift from a member association to a more widely focused “social enterprise”, says Avery. “This expands the idea that we’re not just stamping out disease, it is actually our objective to make the whole population healthier and more productive,” he said. “We need to expand beyond isolated medical interventions.” CMA will continue to be a not-for-profit organization.

Dr. Sarah Gander, vice chair of Canadian Doctors for Medicare, is pleased that the CMA will be taking this broader view of health care. “It’s nice to see the CMA recognizing that physicians have a powerful role in the social determinants of health,” she said."

http://cmajnews.com/2017/08/03/cma-adopts-patient-focus-cmaj-109-5464/
August 13, 2017 | Unregistered CommenterCanary in a Coal Mine
CICM:

MDs are no longer trained to treat and cure individual's needs. In Ontario, they are agents for social population good, at the expense of individual's desires for maximized "good life". You serve the government, not the patient.

Medically Assistance in Dying crossed the last line. Given that, incorporation MUST go, as civil servants serve the government, not corporations. Move to the dark side as quickly as you can, before the last table scraps are being brushed off the table.
August 13, 2017 | Unregistered CommenterMovingforwardOntario
"I worry that many doctors cannot process attacks from government anymore. They can think, but they cannot feel.

These proposals wipe out retirement, savings for children’s education and parental leave. It makes the extra cost and effort of incorporation a total waste.

Sometimes, governments tell voters something so outrageous, that people lose a frame of reference to check the facts. Small lies spark public protest. Big lies elicit shock but no action."

http://shawnwhatley.com/stealing/#more-5324
August 13, 2017 | Unregistered CommenterCanary in a Coal Mine
Unfortunately I am a person of principle and will not move to the dark side. The corrupt Queen can keep her stolen coin.

When the time comes I will leave the province in order to maintain professional autonomy.

The provinces west of here will remain friendly to free range physicians for the rest of my career.
August 13, 2017 | Unregistered CommenterCanary in a Coal Mine
The social justice warriors won't be satisfied until they achieve the Maoist goal of having impoverished 'barefoot ' doctors / widgets trudging from door to door , carrying the little red book, under the management of overseers , both under the just guidance of the Big Sister.

As noted they have penetrated the professions representative structures...god help us all, medical professionals and our patients, because no one else will.
August 13, 2017 | Unregistered CommenterAndris
Tis life. The sentence and economic environment has changed. Old white males are done in ontario. Even the OMA agrees.
August 13, 2017 | Unregistered CommenterMovingforwardOntario
Yes welcome to the new pink ghetto at least in primary care.
August 13, 2017 | Unregistered CommenterCanary in a Coal Mine
Business owners and physicians are looking to feel the love somewhere other than Ontario.

"I know that increasingly in academia, businesses are framed as the bad guy. While that may be the case in some situations, the majority of business owners are good law-abiding citizens who look after their employees. Wouldn’t it be nice if we were treated like the folks in West Virginia treat their businesses? I worry that many business owners are looking to feel the love somewhere else."

http://www.torontosun.com/2017/08/13/when-did-businesses-become-the-bad-guy
August 14, 2017 | Unregistered CommenterCanary in a Coal Mine
Business owners and physicians are looking to feel the love somewhere other than Ontario.

"I know that increasingly in academia, businesses are framed as the bad guy. While that may be the case in some situations, the majority of business owners are good law-abiding citizens who look after their employees. Wouldn’t it be nice if we were treated like the folks in West Virginia treat their businesses? I worry that many business owners are looking to feel the love somewhere else."

http://www.torontosun.com/2017/08/13/when-did-businesses-become-the-bad-guy
August 14, 2017 | Unregistered CommenterCanary in a Coal Mine
CICM

Professional autonomy will not survive in any jurisdiction.The world has shifted. Only the global elite (with capital) will remain autonomous. They will create more rules to strip autonomy away. Autonomy will remain for those whom deliver end of life care.

Plan your future without the availability of incorporation. That deal is done.

Next capital gains on housing sales, and inheritance taxes. Wealth must be transferred faster.
August 14, 2017 | Unregistered CommenterMovingforwardOntario
Autonomy may not survive in other jurisdictions but they are a lot further behind than Ontario in its erosion. We will relocate as is needed.
August 14, 2017 | Unregistered CommenterCanary in a Coal Mine
CICM

To the politicians, the lowest hanging fruit is identified: incorporation, inheritance, housing wealth. If it is not pursued now, it will be pursued later. Wealth accumulation in Canada, is not socially accepted anymore. All must be shared, fairly.
August 14, 2017 | Unregistered CommenterMovingforwardOntario
Needs to very clear. Social justice wins. As a result place no trust in ownership or inheritance. Done.

All inheritance will be taxed. All house ownership will be annually taxed. All wealth accumulative will be taxed.

Don't say the warnings of change were not discussed.
August 14, 2017 | Unregistered CommenterMovingforwardOntario
Mfo

Not sure where you are going. In Niagara we already pay hefty property taxes. How about Toronto bringing its "market value assessment" up to date?
August 14, 2017 | Unregistered CommenterEklimek
DrK:

Toronto, and the province, will go to a province determined assessment property tax basis. That will then be annually assessed for its "wealth" value, and taxed.
August 15, 2017 | Unregistered CommenterMovingforwardOntario
The incorporation issue, feeds into NAFTA, so it is a done deal. With that, and the OMA members sharing all conversations with the media, go to the "dark side" as quickly as you can. The deals are about to end.
August 15, 2017 | Unregistered CommenterMovingforwardOntario
I don't see any deals in primary care rather I see more and more attempts to enslave the profession and undermine professional autonomy and skills.

There is a pattern from the LHINs developing here of over-promise and under-deliver.
With much fanfare a new program is rolled out and we're told it will enhance services with all these allied health workers on hand. A year later patients and physicians are complaining and the docs start to abandon the program.

The latest is a province wide program to assist with back pain run by chiros and physios under the supervision of an ortho. I give it a year before we see that it offers little new to our patients but does employ a whole truck load of new allied health care workers.

I suspect that is the real reason behind these initiatives,....more Liberal votes.
August 15, 2017 | Unregistered CommenterCanary in a Coal Mine
The government knows votes are obtained by the illusion of improvement. New programs give that illusion.

If one walks through Queen's park, you can sense the struggle to maintain the authouritarian central power, at all costs. 2018 will be interesting. Anyone under 45 needs to seriously consider their future.
August 15, 2017 | Unregistered CommenterMovingforwardOntario
Of interest to you:

https://www.thestar.com/news/gta/2017/08/15/doctors-propose-plan-to-reveal-top-ohip-billers.html
August 15, 2017 | Unregistered CommenterMerrilee Fullerton
Excerpt:

"The 10 per cent of families (with families including, perhaps a little strangely, unattached individuals) that make the lowest incomes average $14,641 a year in income and pay $2,006 in tax. With income that low, maybe they shouldn’t pay any tax at all. But they do. Take 23.5 per cent of what they pay and you get $471 going to health care. Not necessarily their own health care, of course. It all goes into a government pot and comes out in services. On average, they probably consume health care worth more than $471 per year. But $471 is their contribution.

By contrast, average cash income in the top 10 per cent of families is $292,063, which generates $166,575 in tax payments, with 23.5 per cent of that, $39,123, going to health care. (Note that total taxes are more than half of the cash incomes of people in this income bracket — 57 per cent, to be exact.) Except in bad years, people at the top likely consume a lot less than $39,123 of health care services. In fact, increasingly they probably buy their own care from private sources. So a lot of their health care “spending” is for other people.

Of course, they get zero credit politically or culturally for their high average tax rates and big dollar contributions but instead are widely derided as oligarchs and rip-off artists, sometimes even by the very governments taking 57 per cent of their incomes. "
August 15, 2017 | Unregistered CommenterMerrilee Fullerton
R

And the well off are about to see more of their wealth redistributed. Inheritance taxes, wealth tax access annually based on capital/property value, and user fees for health for high incomes.
August 15, 2017 | Unregistered CommenterMovingforwardOntario
back to opioids

Drug Overdose Deaths Among Adolescents Aged 15–19 in the United States: 1999–2015

"The majority of drug overdose deaths for both sexes in 2015 were unintentional, although female deaths were more than twice as likely as male deaths to be suicides. Overdose death rates among those aged 15–19 were highest for opioid drugs, specifically heroin."

https://www.cdc.gov/nchs/products/databriefs/db282.htm
August 16, 2017 | Unregistered Commentereklimek
https://www.thestar.com/opinion/commentary/2014/12/15/be_careful_what_you_wish_for_on_doctors_billings.html

Dr Mark said go ahead and make docs' billings public three years ago. Guess the OMA is finally catching up.
August 16, 2017 | Unregistered CommenterStephen Skyvington
The OMA should also be describing how the relative scarcity of some specialists means that they need to be more productive. If there were 4 times as many Ophthalmologists the utilization costs associated per specialist would quite possibly be much less...divided amongst a larger pool if ophthalmologists.

The question really ought to be how do we service more patients..not how much an MD bills within the rules and laws.

A productive MD has incentive to serve more patients. In the context of a relative shortage , one could see that as helpful rather than a problem.
August 16, 2017 | Unregistered CommenterMerrilee Fullerton
https://www.thestar.com/opinion/commentary/2017/08/16/how-ontario-doctors-messed-up-on-secret-pay-hepburn.html

Overbilling, and 1/3 of all care "unnecessary". The OMA is burnt toast. Central has more to leak.
August 16, 2017 | Unregistered CommenterMovingforwardOntario
Which 1/3 of all care " unnecessary"?

I recall a study from BC that came to the same conclusion...not all tests are positive, but the non positive also provide useful information.

A negative pregnancy test might be regarded by a bean counter as having been unnecessary in retrospect....but it helps the practitioner to move in the right direction.
August 16, 2017 | Unregistered CommenterAndris
Then lets put a co-pay on the visits for primary care.

See how that goes over with the voters some of whom use the health care system whenever they break a nail or get a sniffle.
August 16, 2017 | Unregistered CommenterCanary in a Coal Mine
DrL

Many visits are for "social" reasons".THe system doesn't want to acknowledge the social work provided by MDs.

The OMA is dying under the pressure.
August 17, 2017 | Unregistered CommenterMovingforwardOntario
Nor does it want to acknowledge the ton of free work done by physicians especially wrt paper work.
August 17, 2017 | Unregistered CommenterCanary in a Coal Mine
One needs to clearly understand - this is simply about envy and wealth redistribution. If the OMA doesn't have a strategy to deal with those two, they are burnt toast.
August 17, 2017 | Unregistered CommenterMovingforwardOntario
Mfo...its confusing...they say that 1/3 of our office visits are " unnecessary"....are the " social problem" visits classified amongst the 1/3 unnecessary visits...they seemingly want us to do them, but at the same time not to do them?

The CMA , pushing their social determinants of health strategy , would encourage an increase and more emphasis on the " unnecessary" visits that the government doesn't want to acknowledge nor pay for.

Again....Machiavelli taught that there were only two causes for hatred...fear and envy....the government has been feeding that hatred with gusto and the only strategy that the OMA can think of countering it is by helping to impoverish the profession so to diminish the hatred....instead it is generating the contempt of all those who hate them.
August 17, 2017 | Unregistered CommenterAndris
DrL

Social visits don't count. They are unnecessary.But central wants more social visits. You guys/girls are screwed.

Central is going to make you widgets.

All billings will be out by end of year. Drive the envy to a frenzy.
August 17, 2017 | Unregistered CommenterMovingforwardOntario
There was no "secret pay".
August 17, 2017 | Unregistered CommenterMerrilee Fullerton
....all billings out by the end of the year?....the shame of being a low biller...I'll have to wear a brown paper bag on my head with holes in it ...have they no care for our feelings?
August 17, 2017 | Unregistered CommenterAndris
This has nothing to do with emotion.It is the public shaming of the privileged and the wealthy.
You will be humbled,and shamed. You have used your privilege and status to abuse the "oppressed". The improvement in life expectancy, and decreased morbidity do not contribute. You are "oppressors".You will be constrained.
August 17, 2017 | Unregistered CommenterMovingforwardOntario
This is just unacceptable to have these economic migrants flooding into Quebec and now Ontario from the USA. Even if the majority will be deported back to their countries of origin think of the cost of housing, feeding, and clothing them plus health care and a hearing. We could be just turning them back at the border or fixing the law in order to allow us to do so.

Where is the hundreds of millions going to come from to pay for all this not to mention the military and police resources this under-reported fiasco is sucking up at a time when we need these resources for more important security threats?

Could it be that the attack on small businesses by Morneau will raise additional funds to pay for this out of control migrant problem?. At some point this wilful blindness and lack of spine will backfire on the Liberals.

http://www.theglobeandmail.com/news/national/ontario-to-get-shelter-to-help-assist-with-influx-of-asylum-seekers/article36010444/
August 18, 2017 | Unregistered CommenterCanary in a Coal Mine
CICM

You'll just have to adjust to the new world, and pay the higher taxes to cover the social injustice in the world.
August 18, 2017 | Unregistered CommenterMovingforwardOntario
The Liberal Party wants to perceived as the party of compassion...for all....other than its MDs.

Each economic migrant that enters Canada and gets accepted is one more potential Liberal supporter....
August 18, 2017 | Unregistered CommenterAndris
DrK

It is the new future.
August 18, 2017 | Unregistered CommenterMovingforwardOntario
Steffens was an US reporter who visited the early Soviet Union and returned broadcasting widely "I've seen the future , and it works ".

Many believed him until they came to realize that it did not work....instead of a workers' and peasants' utopia the Soviets created a hell for all concerned apart from the hierarchy.

Sadly some still believe that collectivism/ statism works....and there is a generation coming up having been ' educated" in the Marxist academia that believe that this time they could do it right having neutered the potential saboteurs , the free range medical professionals.
August 18, 2017 | Unregistered CommenterAndris
We won't be able to depend on the media to report the real story....Walter Durante won the Pulitzer Price in 1932 having painted a pretty picture of the USSR...denying the negatives, the widespread famine and the mass starvation in Ukraine.

It was decades before the NYTimes itself reported that his reporting was amongst the worst to ever appear in its pages.

We have too many Durantes in our media that will follow his example of biased false news manufacturing to cover up the defects and disasters within the Ontario health care system and who are truly responsible.
August 18, 2017 | Unregistered CommenterAndris
Ontario is fine. Hospitals are balancing their budgets. All is fine.
August 18, 2017 | Unregistered CommenterMovingforwardOntario
Andris,
Long term care issues are being picked up by the media..but it is the providers being blamed again. Rightly so in some instances but it has been my experience that the environment good people find themselves in can sometimes cause them to behave in ways they would not normally behave.
Most of the time it's not the people who are the problem...it is the environment they find themselves working in.
August 18, 2017 | Unregistered CommenterMerrilee Fullerton

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