Can Jim Bradley explain why he "stood up and said 'I hate doctors'"?

The following story by Michael Valpy (Globe and Mail, Jan. 5, 1991) gives an interesting overview of the tenuous relationship between doctors and the Liberal bullies of the David Peterson Ontario government. It’s hard to believe that a cocky Liberal like St. Catharines MPP Jim Bradley, as outlined in this story, would say that he hates doctors. Why would he say that? Does Liberal Jim Bradley still hate doctors? Even today, in 2007, Bradley’s Liberals are still forcing patients to the States for treatment that Bradley’s healthcare monopoly fails to deliver at home: maybe Bradley hates patients too? Maybe if Bradley and his Liberals had actually listened to doctors, not attacked them in the 1980’s, then our present healthcare shortages may have been averted.

It was certainly the height of gauche hypocrisy for Bradley to have spoken at the memorial service of Suzanne Aucoin (St. Catharines Standard, Nov.17, 2007) when he said "She spotted deficiencies in the health-care system and brought them to everyone's attention." The utter smarminess of this Liberal! Jim Bradley, over his 30 years in office, had a lot to with these "deficiencies" in the first place.

He's a proud supporter of the very system whose deficiencies let Aucoin down, that denied her funding, that forced her to the States for treatment - because it was unavailable in Jim Bradley's single-payer, no-choice monopoly system! Aucoin got her treatment where it was available - in the States, whose system Liberals like Jim Bradley love to deride, and where Jim Bradley's Liberals still force patients to because they can't receive care here in Ontario. How convenient to preach the merits of Ontario medicare while utilizing the American system to cover Ontario's systemic inadequacies.

Many Ontarians have suffered due to Jim Bradley's Liberal handiwork. Valpy's story is an account about how the Liberals cavalierly treated the medical profession in the 80's.
We have to wonder ... how much different are they now? I say they're still the same, they've more subtly ingratiated themselves into a position where they appear as outsiders to the problems which they set in motion years earlier.

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“HEALING THYSELF , Physicians want government to discuss a concept called utilization management. It may help contain health-care costs - and get doctors out of the doghouse Ontario MDs seek to mend rupture with province.

By Michael Valpy
In September, when Ontario's new government surprised everyone including itself by getting elected, there was immediate speculation about who would be named attorney-general. The wisdom emanating from the designated experts on the election-night television panels was that it must be someone who could deal with the Law Society of Upper Canada, who could work with the legal profession and have the respect of the bar. It also should be noted that a substantial number of those invited by TV stations to sit on these expert panels were lawyers.

Not doctors.

No doctors were to be seen offering political analyses to the public or speculating on the identity of the next health minister - this in a province where $13.9-billion, a third of Ontario's budget, is expended on health care (compared to $950-million for the combined ministries of the attorney-general and solicitor-general).

No doctors, at a time when health care, one of the few remaining national assets universally valued by Canadians, is deemed to be in crisis.

And no concerns raised by the TV pundits about whether Ontario's titularly socialist government would appoint a health minister who could work with the doctors. No one cared.

This makes a statement about the comparative political weight doctors and lawyers wield in Canada. It also is evidence that the doctors and the Ontario Medical Association are still, to put it mildly, in the doghouse.

A search through two years' of newspaper files turns up a surprising number of plaintive pleas from the OMA to be allowed to "work with government," to be accepted as being "onside with government" in trying to control health-care costs and more effectively manage the system. All these entreaties appear to have fallen on deaf ears - both political and news media.

Ontario's doctors have been out in the cold politically since their disastrous 26-day strike in 1986 in protest against the then-Liberal government's Health Care Accessibility Act, which banned extra-billing. Their strike had no public support. After its collapse, a number of doctors further fouled the profession's nest by continuing to bill in excess of government-approved fees in defiance of the law. The OMA, in addition, initiated a constitutional challenge both to the Ontario legislation and to the Canada Health Act.

The doctors failed to recognize the fundamental political axiom that, if no one with influence supports your cause, government has carte blanche to do terrible things to you - and end up looking good in the process. The doctors believed their strike to be about professional freedom; the public thought it was about greed.

Recently, in interviews, Dr. Ted Boadway, the OMA's director of health policy, and Dr. David Peachy, the OMA's director of professional affairs, talked about the previous Ontario government's scorched earth policy on the OMA and the medical profession. The Liberals, they said, assumed a "messianic mania" to "save" medicare from the doctors.

"It was (former Liberal health minister) Murray Elston's policy to take no prisoners," said Dr. Boadway. "If he could have exterminated us, he would have. Jim Bradley (the former environment minister) stood up and said: 'I hate doctors.' The Liberals acquired a perverse delight in attacking us." [passage red-bolded by me for emphasis]

Said Dr. Peachy: "There never was a relationship with Elinor Caplan (the last Liberal health minister). She was unrelateable to. Her ministry was the least consultative I've ever seen. Amendments to regulations we'd learn about the day before (they were promulgated), sometimes the day after."

The fallout from the strike and the Ontario government's retribution has been devastating to the profession, the OMA officials said. Surveys of doctors have shown they feel rejected by their communities and in turn have rejected their communities.

Last April, the OMA abandoned its legal challenges. "The times have changed and we have changed," said OMA president Dr. Carole Guzman. "This system of medicare is what the public wants . . . and we are willing to work with that system."

But no peace doves were released at Queen's Park. Requests from the OMA to meet with the government continued to engender no response. "We've told the government: 'We're onside, we'll work with you.' But the government has never called," said Dr. Boadway.
And, so far, neither has Ontario's now-ruling New Democrats.

In mid-December, however, after some frantic messages sent to Queen's Park indicating the OMA's enthusiasm for a meeting, the association did receive a letter from Frances Lankin, chairwoman of Cabinet's management board, suggesting everyone should get together in the new year.

"There is a lot of anxiety about the first contact and we want to start out on the right foot," said Dr. Boadway. "We don't know what conventional view they may have of the ugly OMA or whether they're still worried about being slam-dunked by us."

The OMA has a number of reasons for being eager to reopen communications.

It wants to strengthen its credibility with Ontario's 24,000 doctors. The OMA has image problems trying to appear as the tough and powerful vehicle of the medical profession. It does not compare well to, say, the Law Society of Upper Canada.

It wants to get negotiations going with government toward a new fee schedule. It wants the government to deliver on Premier Bob Rae's unofficial promise to give the doctors the instrument of binding arbitration to resolve fee disputes.

The association also believes it has an important message to bring to the New Democrats - a message that it can get the medical profession behind major economies in the cost of health care: "Everyone has been looking for a new platform and we think we've found it," he said. The platform is utilization management - what Dr. Boadway describes as "clinical guidelines without the cookbook approach, leading to better care . . . and showing you can be efficient and also save money".

It is not a strikingly new idea. But until now it has been on the periphery of the debate over costs. The OMA wants to bring it to centre stage.

Essentially, its thesis is that the costs of new technology and new treatment procedures are grossly under-assessed before they are introduced into hospitals and doctors' offices. And it is these new technologies and procedures that have become major items driving health- care costs. This is held to be true about health care in Canada as well as elsewhere in the industrialized world. Most of the fat in these systems has been squeezed out, Dr. Boadway said, yet costs continue to rise - and they all seem to be rising on the same slope.

Utilization management is an attempt to assess whether a proposed new procedure or piece of equipment is really better than what it is replacing - almost always at far greater cost.

Prof. Adam Linton of the University of Western Ontario's medical school and epidemiologist David Naylor of Toronto's Sunnybrook Health Sciences Centre limned the dimensions of the problem in a recent article in the New England Journal of Medicine. "The system in Ontario," they wrote, "has failed to stem the tide of drugs and devices of questionable usefulness. . . . The same lack of assessment and control is evident for novel or more intensive applications of established techniques or equipment.

"Furthermore, accepted practice patterns are rarely scrutinized, in part because there are no formal criteria for assessing the indications for a host of medical and surgical tests and procedures. . . ."

The two doctors also point out that these new technologies are marketed aggressively by manufacturers - and often by medical specialists - as life-saving devices and treatments, leaving hospitals and the provincial ministry of health obviously reluctant not to find the money somewhere to pay for them.

Hospitals and doctors, indeed, have a practical reason for going along with the new technologies: they fear their insurers might reduce coverage unless they accept them.

Drs. Linton and Naylor cite one case where a diagnostic drug was introduced universally into the Ontario health-care system even though it lacked satisfactory epidemiological evaluation and despite the existence of data from Britain that said total conversion to the drug in that country might save 15 lives a year but at a cost exceeding $2-million each.

The drug, known as a low-osmolarity contrast medium (LOCM), is injected into the body for such procedures as kidney X-rays and angiography. It causes less discomfort generally to patients than traditional contrast mediums and, in some cases, could prevent death from adverse reactions to other chemicals.

Drs. Linton and Naylor argue that if Ontario had opted for selective use of the drug only for those patients known to be at high risk from other mediums, the cost to the health-care system would have been a fraction of the $35-million spent for conversion (which was about $35- million).

In an interview, Dr. Linton said probably not a month goes by without "something out there being swept into use without proper evaluation of cost and application." And while there is no adequate way of calculating how much total extra cost is being imposed on the health-care system, Dr. Linton said, the cost of new technologies is increasing astronomically.

The development of sound clinical guidelines on what should or should not be accepted into the health-care system is a thorny issue. The OMA and Dr. Linton (one of the association's most active members) believes that doctors will support utilization management only if the guidelines are flexible, supportable and related to quality of care - which is what Dr. Boadway means when he says guidelines "without the cookbook approach".

Dr. Linton suggested three categories. Where the evaluation of a technology is supported by hard science, then a usage-standard can be set. Where the science is reasonably good, then a guideline - with some flexibility - can be written. Where the science is very soft, then options, or "optimal practice patterns", can be drawn up.

The OMA believes the best chance of selling guidelines to the profession is if the OMA draws them up itself along the lines suggested by Dr. Linton. Any attempt to impose guidelines on doctors from outside will be branded a totally intolerable intrusion into professionalism.

The first step is getting government to listen to what they have to say."
(Globe and Mail, Jan.5, 1991)
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And Jim Bradley today, in 2007, has the audacity to talk about "deficiencies', as if he had no role whatsoever in creating them. Un-flicking-real.