Sunday, November 11, 2007

Can McGuinty's Liberals be held negligently liable for the suffering of Ontario patients?

Since McGuinty's Liberals were re-elected on Oct. 10, 2007 , there have been a number of news stories about our doctor shortage. How can we have a doctor shortage in 2007, after four glorious years basking in Ontario's Liberal Shining Path Of Light? Is this problem new?

Here's a thread of healthcare letters and related topics, from the National Post, starting in Oct. 2003, which can shine some light on the healthcare debate.

Let's remember, when McGuinty's Liberals were newly elected in Ontario (Oct. 3, 2003), Chretien was still Prime Minister, and Paul Martin was still the annointed PM-in-waiting. Quebec's Chaoulli decision was two years in the future. Michael Moore's Sicko was yet to be propagated.

As you read these letters and opinions, and as you see the time fly by, it's astounding at how thick-headed the "status-quo" was and still is, and how many patients have suffered in our healthcare monopoly since these letters were written.

Ontario's Liberal government must have known, or should have known, that its restrictive health monopoly would cause harm to Ontario citizens.


I'll start with a National Post Editorial from Oct 25, 2003:

Losing our doctors, risking our health

More and more, Canadians are finding, the doctor is out. Since 1993, the number of physicians in Canada has declined 5%, while the general population has risen nearly 13%.
At 2.1 doctors per 1,000 residents, as the Organization for Economic Co-operation and Development reported last week, Canada has one-third fewer doctors per capita than the average among industrialized countries -- and only slightly more than half as many as France, Germany and the United States. In our largest metropolitan areas, this has led to so many doctors capping their patient lists that finding a family practitioner in one's own neighbourhood can be next to impossible. And in many of our smallest centres, there are no doctors at all.
The principal cause of this shortfall is easy to discern. In the early 1990s, federal and provincial health ministers sought to reduce the number of students admitted to medical schools, encouraged older doctors to retire early and limited the number of foreign-trained docs entering the country. The theory was that fewer physicians would result in lower medicare billings and fewer hospital admissions, thus producing savings to public treasuries -- as though doctors control who gets sick and how many seek treatment.

Then there is the exodus of doctors to the United States. Upwards of 300 Canadian doctors move southward each year. Some go for the higher pay and lower taxes. But many doctors are also migrating out of frustration with the inability to practise up-to-date medicine in Canada. In earlier reports, in fact, the OECD revealed that Canada ranks among the worst-developed nations for access to high-tech diagnostic and treatment equipment. Hungary has more MRIs, the Czech Republic more CT scanners. Only a handful of OECD members have fewer lithotripters that use shockwaves to break up kidney stones. As a result, we have far too many risky kidney operations as a substitute.

And as the Fraser Institute pointed out again this week, waiting lists grow longer each year. Nearly 900,000 Canadians are currently waiting for diagnosis or treatment for what ails them. Waits lengthened in 2003 to an average of 17.7 weeks nationally for all procedures, up from 16.5 weeks the year before. More troubling still, Fraser found that specialists now believe "over 90% of waiting times are ... beyond clinically reasonable times." Hundreds die annually waiting for treatment that would come much faster in other nations; thousands more live with severe pain or disability.

The problem, contrary to popular wisdom, is not insufficient tax dollars in the system: Canadian public health care spending has actually risen by 35% in inflation-adjusted, per-capita terms since 1993. Some of this money went to buy new diagnostic machines and to hire new specialist doctors. Most, though, went to higher wages for unionized health care workers. And any additional public money will likely go in the same direction. Because of the monolithic structure of our single-payer medicare system, health care workers can hold it hostage. Politicians, who cannot bear the wrath of voters over hospital strikes, will always capitulate.

We are not knocking the nurses, technicians, aids and orderlies who change our bandages and refresh our linens: The only reason Canada's health system has continued for so long to produce acceptable health outcomes, such as high recovery rates and longevity, is the hard work and innovation of these caregivers. But a way has to be found to infuse the system with more money for new equipment and more doctors.

Governments have proven themselves hopeless at getting the money to where it will do the most good, so the task should be left to the rest of us. By freeing patients to buy extra care, or faster care, our health system will receive the market signals so vital to determining the balance between supply and demand. Private spending will also increase the amount of money in the system as a whole, thus permitting governments to redirect the amount they spend to the needy patients who need it most.

Until Ottawa and the provinces permit private spending on primary health care, new monies will be directed away from new doctors and badly needed technological upgrades, and Canadians won't receive the world-class level of health care they deserve."


"Bitter medicine for Canadians" by dr. Joseph Berger (National Post, Oct.27, 2008):

"Re: Losing Our Doctors, Risking Our Health Care, editorial, Oct. 25.

Your editorial clearly expresses the concerns Canadians have with decreases in the proportion of doctors, our falling behind much- poorer countries in terms of advanced medical diagnostic equipment, and the necessity for introducing a private, alternative health care system. But you finished off an otherwise excellent summary with an unwarranted and unjustifiable assumption that without changes, "Canadians won't receive the world-class level of health care they deserve."

As a collective entity, Canadians don't deserve better health care. Over the past two decades, they have consistently rejected, and continue to reject, private alternatives. Through the representatives they elect, Canadians have collectively stuck with a socialist monopoly system that everywhere else has always been associated with deteriorating standards of care, deteriorating motivation of care-givers and less-than-adequate medical equipment.

It is not "Ottawa and the provinces" who need to change their outlook radically, it is the majority of Canadians who need to think differently if they indeed want to have a world-class level of health care. Through their votes, they are saying the status quo is what they want. Not even the new leader of the federal Progressive Conservative party could bring himself to advocate the acceptance of a private, alternative health care system.

Dr. Joseph Berger, president, Ontario District Branch, American Psychiatric Association, Toronto."


"Second-class health care" by Dr. Joseph Berger (National Post, Jun 24, 2004):

"As a recent past chairman of two large medical groups (Toronto branch of Ontario Medical Association and Ontario branch of American Psychiatric Association), I take strong exception to the comments by Dr. Sunvil V. Patel, president of the Canadian Medical Association. Most doctors that I know are not members of the CMA.
It does not represent my views, nor the views of most sensible physicians I know.
Most rational physicians do not believe that the rapidly deteriorating Canadian health care system can be saved by having more money poured into it, or by it remaining restricted exclusively to the socialist public-funding model."


"Doctor shortage" by Dr. Joseph Berger (National Post, Jan 29, 2005):

"How ironic that the source for the article MD Shortage Critical (Jan. 27) is Michael Decter, chairman of the Health Council of Canada. Many doctors remember Mr. Decter as being the deputy health minister in Bob Rae's NDP government in Ontario, which reduced the number of available training positions for doctors and whose policies drove doctors from this province.


"Seeking a fair deal for Ontario" by Premier of Ontario Dalton McGuinty (National Post, Apr. 6, 2005)

"Ontario is the heart of Canada. And Canada is the soul of Ontario. We don't have a monopoly on patriotism. Yet no group identifies more closely with Canada than Ontarians.
Ontario and Canada need each other -- and if we work together in three areas in particular, we can prosper together.
The first area is medicare -- a Canadian idea that's not only one of our defining characteristics, it's absolutely central to Ontario's future prosperity because it's also one of our greatest competitive economic advantages. Only a strong Canada led by a strong central government can preserve medicare and preserve this advantage.
The second area is immigration, a powerful driver of economic growth in Ontario. With populations ageing and skills shortages growing, jurisdictions the world over are in a race to attract the best and brightest the globe has to offer. Canada's estimable reputation in the world has given Ontario a lead in this race. The combination of a Canadian passport and an Ontario job has proved to be a powerful magnet for immigrants.
A third area is the need to develop our greatest asset -- our people. The most important thing we can do to attract good jobs and investment in the 21st century is to invest in our future prosperity. In a world where automation is replacing rote work, where communication technology makes global outsourcing possible, and where there will always be another place where people will settle for lower pay and lower standards, there is only one way to build a thriving, sustainable economy: build the world's best- educated, most highly skilled workforce.
Investing in our people and our future prosperity is absolutely essential, and it is in this context that I've been writing and talking about the $23-billion gap -- the difference between what Ontario gives the federal government in taxes and what we get back every year. Put another way, $23-billion is the amount Ontarians give to the federal government for distribution in the rest of the country.
We're proud to be Canada's economic engine. We're proud to contribute to social programs across the country. But to share wealth, we must first create wealth. And the gap has grown so much over the last ten years -- from $2-billion to $23-billion -- it now compromises our ability to invest in Ontario's future prosperity -- the prosperity our country depends on.
We want Ontario to lead the nation in health care reform. That's why our agreement with our doctors will encourage new ways of practising, with family health teams that prevent, as well as treat, illness. But it's difficult to fund reforms, as well as maintain services, when Ontario ranks ninth out of 10 provinces in federal funding for health care.
We want Ontario to continue to be a magnet for new Canadians, and indeed, over the past three years we've attracted 57% of the country's immigrants. It's difficult to leverage all that talent into jobs and investment, however, when you receive only 34% of federal funding for their settlement.
Is that fair to these new Canadians? And is it the smart thing for Canada to do?
We want to build the best-educated, highly skilled workforce in North America. In his recently released solid report on post- secondary education, former Ontario premier Bob Rae concluded we need to invest another $1.3-billion in our universities, just to bring our funding up to the national average. Right now, we rank tenth out of 10 provinces when it comes to university funding.
Do any of these situations make sense when we're sending $23- billion to the federal government to support higher levels of funding in other provinces?
Of course they don't.
That's why we need to narrow this gap and invest more in our future so we can generate the wealth our people deserve and our country depends on.
I know that some in the federal government are a little taken aback by my insistence that Ontario be treated fairly. Some believe it is unseemly for an Ontario premier to even raise this issue -- as if Ontario's role in Confederation is only to supply fairness, never to seek it.
I see it differently. My responsibility, as the person privileged to serve Ontarians as their Premier, is to advance any cause, make any claim and demand any concession that helps strengthen my province and my country.
I want to be able to look our hardworking health care professionals, our students and faculty, and new Ontarians right in the eye. I can't do that unless I'm satisfied that I've done all I can on their behalf. So I'll continue writing and talking about the $23-billion gap.Ontario is the heart of Canada. Let's make sure that heart is strong enough to face the challenges -- and vibrant enough to seize all the opportunities -- of the 21st century."


"Canada doesn't stop at Ontario's borders", by Colin Gosselin (National Post, Apr 7, 2005):

"Re: Seeking A Fair Deal For Ontario, Dalton McGuinty, April 6.

Despite what the Premier seems to believe, Ontarians are not more Canadian than those in the rest of the country. And while I know it can be really hard to tell at times in this great federation of ours, brace yourself, Mr. McGuinty: Ontario is not Canada.
Just as Canadian as you. Colin Gosselin, Edmonton."


"McGuinty misguided", Dr. Joseph Berger (National Post, Apr 9, 2005)

"Re: Seeking A Fair Deal For Ontario, Dalton McGuinty, April 6.

As a physician I was profoundly offended by the whining drivel offered by the Premier of Ontario. The problem is not that the federal government isn't passing enough money to Ontario; it's that Mr. McGuinty remains committed to an obsolete socialist system that interferes with the emergence of any really significant improvements in health care. As Ontario's Premier, he has the opportunity to show leadership by encouraging the development of a parallel alternative private health care system which is the only thing that will improve medical care."


Private health care already ... near” by David Saul, MD (National Post, Apr.11, 2005)

"Re: McGuinty Misguided, Letter, April 9.

Dr. Joseph Berger, claims the only way to improve medical care in Ontario is for Premier McGuinty to "encourage the development of a parallel alternative private health care system."
While I agree there are many faults in the present health care delivery system, there is already an alternative system in place, where Ontarians can arrange next-day investigative procedures, such as MRI and CT scans. They can also arrange almost next-day service for hip and knee replacement, as well. They need only make a trip across the border to the United States. And all it takes is cash, which is exactly what would come to pass if Premier McGuinty allowed a private alternative to our present health care system. The only difference would be the drive."


"U.S. health care better than ours", by Dr. Joseph Berger (National Post, Apr 21, 2005):

"Re: Confessions of An American MD, Philip Alper, April 19.

Dr. Alper expresses many of the same complaints about government- managed care that I have heard from American colleagues at meetings I attend as Ontario representative to the Assembly of the American Psychiatric Association.
However, when comparisons are made between the American and Canadian health care systems, there are three vital areas that have been maintained in the United States but have been lost in the Canadian socialist system. They are promptness, excellence and choice. For both U.S. patients and physicians, advanced examination and treatment are available almost immediately while waiting lists here are an abomination.
Under the highly competitive U.S. system, standards of excellence remain in many areas of medicine while the Canadian socialist system encourages mediocrity. And in the United States, both patients and physicians have choice in terms of whether or not they participate in the managed care system. In Canada, our health system imposes enormous restrictions on both patients and physicians."


"Canada needs shared care" by John G. Kelton (National Post, Apr 25, 2005):

"John G. Kelton, MD, is dean, Faculty of Health Sciences, including the Michael G. DeGroote School of Medicine, and vice-president, McMaster University, Hamilton.

The Canadian health care system is a house slowly burning down. An occasional shower of sparks flies as another wall falls in, but it's mostly a slow, relentless burn. Many Canadians can't find a family physician. For those with doctors, referral to a specialist starts with a wait, and then you line up for surgery. And the lines are getting longer. Our emergency departments are backed up because our hospitals are overflowing.
The delays and barriers to care have moved past inconvenience and now contribute to unnecessary deaths, as shown by a recent medical study that reported more deaths among Canadian heart attack patients compared with Americans. Yet, options and solutions do exist. It is true that we don't have enough physicians, but other health professionals can also deliver quality care. Unfortunately, barriers prevent patients from accessing other health caregivers. The problem is further compounded by the complexity of our health care system. Yes, it is underfunded. Yes, we're behind most developed countries in availability of cutting-edge medical equipment and yes, discussions about models of care delivery quickly collapse into politics, ideology and turf battles.
The solution is not one big revolution, but many small evolutions. Even the much anticipated Romanow report proved disappointing. Rather than serving as a catalyst for change, its central theme was more of the same, just add money. One recommendation, now being implemented, is for a national body to study the waiting times for procedures such as hip surgery or cataract operations. This is simply bad policy. Deterioration of health care will continue. However, it will be well-studied.
And yet, a deteriorating system offers the greatest opportunity for dramatic change. Many small and by themselves minor changes can, in their totality, transform the entire system. For example, two provinces, Alberta and Quebec, are tentatively experimenting with alternative delivery systems.
A burning house needs firefighters and their equipment. But others can also help put out the flames. Our universities train many different types of health care professionals. Better education has given these individuals greater skills. Yet, their ability to use these health care skills remains restricted. For example, in Ontario, if a patient with an eye infection sees an optometrist, that patient cannot be given a prescription for the needed medication. It is illegal. Instead, the patient must go to his or her family physician or the local emergency department for evaluation and the prescription. But, in the United States and many other provinces of Canada, the optometrist is permitted to prescribe the appropriate medication. Good care is received and an unneeded trip to the family physician or emergency room is avoided.
In other countries, health care can be provided by nurse practitioners, some of whom specialize in diabetic care, or hypertensive care, or cancer care. But across Canada, this practice is limited and will only occur under the supervision of a physician. Other examples abound. In Canada, pharmacists dispense medications. But, in the United States, they can give vaccines and other treatments. Medical studies consistently show that skilled health professionals (sometimes nurses, sometimes optometrists, sometimes pharmacists) can provide care in a safe, effective and high-quality fashion. Physicians then are freed up to care for others.
If these models of shared care work, why not implement them in Canada? The answer is three words: "scope of practice." These represent a series of broad rules and regulations developed by the various professional bodies and government officials. These rules were developed with the best of intentions to ensure Canadians receive good care. But these rules also restrict who can provide specific types of care. Cynics might say that certain health care professional bodies have a vested interest in protecting their memberships. But, when I talk to health care professionals across the country, I hear a growing interest in change. There are just not enough anesthetists, family physicians, surgeons, midwives (or virtually any health professional) to go around.
It would be too simplistic to think that Canada's health care problems could be easily fixed by merely broadening the scope of practice. But this would be a logical first step. Perhaps, more symbolically, such a step would also be a signal that we're not stuck on the past. Canadians are ready for real changes in health care."


"Don't 'play' doctor" by David Saul (National Post, Apr 27, 2005):

"Re: Canada Needs Shared Care, John Kelton, April 25.

Dr. Kelton, dean of the medical school at McMaster, in Hamilton, Ont., suggests one solution to the present health care crisis is to have health care provided through a shared system. Under this system doctors would share duties with nurse practitioners, optometrists, pharmacists and other health care providers.
Houston, we have a problem here. These allied health workers are not medical doctors, but will be acting as if they were. They also will not have to go to university, med school or residency for a minimum of nine years -- like real doctors -- to work in the clinic and see patients.
This slippery slope of allowing non-MDs to provide MD services threatens the entire health care system. Part of the Ontario Health Ministry's mandate for primary care reform has already begun positioning nurse practitioners to work as members of the "health care delivery team," allowing them to independently assess patients, establish a working diagnosis, order any laboratory or diagnostic testing and prescribe medications.
Soon, the Health Ministry will simply do away with family doctors and replace them with nurse practitioners, medical assistants, pharmacists and maybe even naturopaths, because they will all work at a substantially reduced cost compared to the MD.
As dean of a medical school Dr. Kelton knows only too well the amount of education and training necessary to produce a fully functioning MD. Let doctors stick to medicine, nurses to nursing, optometrists to eye exams, pharmacists to filling prescriptions. We have better solutions for improving health care delivery."


"Private health care is no threat" by Dr. Joseph Berger (National Post, Jun 9, 2005):

"Re: Medicare Future At Stake, June 8.

Exaggerated comments by people such as Mike McBane, spokesperson for something called the Canadian Health Coalition, has delayed Canada keeping up with the rest of the world when it comes to health care. The public universally accessible service is not in any way threatened by the development of a parallel private system -- other perhaps than the possible raising of its standards by the presence of competition."


"A vote against medicare" by Dr. Joseph Berger (National Post, Aug 12, 2005):

"Re: A Vote For Medicare, letter to the editor, Aug. 10.

Doctors have been listening very carefully to what our patients say. What they have been telling us is that they are absolutely horrified with the endless waits in emergency rooms on stretchers. They are fed up with the long delays in obtaining consultations with specialists. And our patients know that better functioning, better equipped, more effective and more responsive systems exist in many other countries where there is a private, alternative system."


"We need a safety valve" by Ruth Collins-Nakai, MD, president of the Canadian Medical Association (National Post, Aug 22, 2005):

"Every day, in every region of Canada, doctors are helping Canadians -- finding cures, easing pain, bettering lives and listening.
Last week, doctors from across the country took some time away from their patients to meet at the Canadian Medical Association (CMA) General Council in Edmonton. Although away from their clinics, the doctors still had their patients in mind as they discussed how to make the Canadian health care system even better. Amid heart- wrenching stories of frustration and worry, doctors spoke passionately about how the system was failing their patients, and how they needed to put the interests of those patients first.
Politicians also stress the need for ready access. What does it mean when Canada's doctors talk about putting patients first? For the only truly national organization representing 62,000 doctors, it means this: Our patients must have access to the care they need when they need it. It also means that patients' access to care must be based on medical need, not the ability to pay. Period.
Day after day, in every part of Canada, physicians deal with the human consequences of political gamesmanship. We see, with our own eyes, the terrible price being paid by ordinary Canadians who deserve more but are getting less and less. The CMA supports what our patients tell us: they need a "safety valve." They need a way to deal with their pain and suffering when, and only when, the public system fails to provide care within a medically acceptable wait time benchmark.
Some suggest this is a new and radical idea. It isn't. The CMA first proposed this concept three years ago when Roy Romanow, was leading his Commission on the Future of Health Care in Canada. Senator Michael Kirby proposed a similar care guarantee in his six- volume Report on the Health of Canadians -- The Federal Role. Most recently, the Supreme Court of Canada ruled that it was unconstitutional to restrict access to care in the private sector when the public system fails to provide timely care. Indeed, four Canadian provinces -- Newfoundland and Labrador, Nova Scotia, New Brunswick and Saskatchewan -- already permit parallel private health insurance.
In essence, what the CMA is proposing reflects what the highest court in the land is already saying. Most significantly, it is what our patients are saying. Canadians have a right to medical services when they need them. This is a fundamental right and a key characteristic of what it means to be Canadian. It is also something the CMA strongly supports in principle and our members support in practice.
Our ongoing commitment to building a strong public system shone through as general council delegates passed resolutions calling on governments to establish and implement wait time benchmarks and to address the critical shortage of health care providers to ensure Canadians get the medical attention they need, when they need it. The national crisis that is our worsening shortage of doctors, nurses and other health care professionals threatens to undermine any and all steps we can take to renew the system. Governments must move now to address this issue.
Canada's doctors will continue to work to ensure the public system has the resources needed to provide care to all Canadians. We will not let governments off the hook. We will also continue to push for a Canada-wide health access fund to make sure Canadians can get the care they need, when they need it. The creation of such a fund would obviate the need for supplementary private health insurance.
Most importantly, Canadians can trust that their doctors are in their corner speaking out for their patients. Within the next six months, the CMA will provide Canadians with a report on the best way to give patients access to the "safety valve" they are demanding. The report hasn't been written yet -- but two important principles will guide it.
One, access to care must be based on medical need, not on the ability to pay. Two, no Canadian should have to pay out of pocket to access medically necessary care.
Putting patients first is not a slogan for doctors. Ensuring timely access to care is not a slogan for doctors. It is our mission and our life's work. It is at the core of the oath we took when we joined the profession.
Canada's physicians will not shy away from the difficult questions and problems facing the future of health care -- even if some politicians think we should. Our patients deserve better and we plan to make sure they get it."


" 'Safety valve' won't fix health care" by Dr. Joseph Berger (National Post, Aug 24, 2005):

"Re: We Need A Safety Valve, Ruth Collins-Nakai, Aug. 22.

I am not a member of the Canadian Medical Association. Therefore the wishy-washy nonsense its bureaucrats requested their president, Dr. Collins-Nakai, to sign does not represent my views.
I am appalled by such rubbish as "medically acceptable wait time benchmarks" or the utter stupidity of the idea of a "Canada-wide health access fund [that would] obviate the need for supplementary private health insurance."
It is not "Canada's doctors" who have "to work to ensure the public system has the resources needed to provide care." It is the general public who have to demand that of their elected public officials.
What doctors can do is offer the options and the standards of excellence that simply may not be available or affordable in a general system that tries to guarantee at least a basic minimum standard for everyone. Therefore, those higher standards and greater options may have to be privately paid for -- as their equivalents are in every other area of life.
The CMA states that all patients want is a "safety valve." I and many of my colleagues believe Canadians want far more than that."


"Cutting back on doctors never a good idea", Dr. Joseph Berger (National Post, Aug 31, 2006):

"Re: Prescription: More Doctors, editorial, Aug. 30.

To whom was cutting back on the number of doctors a good idea?
Certainly not to me and many of my medical colleagues who fiercely opposed the stupidity of the Peterson Liberal and Rae NDP governments of Ontario, which pushed forward these ideas.
We warned our appeasement-minded colleagues in the OMA and CMA as well as the general public about the likely long-term consequences of their proposals.
Who were "we"? For the most part, we were doctors of British origin and we were supported by doctors of eastern European origin, all of us having experienced the disaster that a socialist government-controlled system produces. Britain today, since Margaret Thatcher, has a thriving private system, alongside a decaying, over- regulated, bureaucratically obese public system.
Lesson to be learned: Cutting back on doctors is never a good idea. There are always geographic areas that are under-serviced, new techniques that require new expertise, more research that needs to be done."


"In praise of user fees" editorial (National Post, Feb 6, 2007):

"Now that federal Health Minister Tony Clement has admitted the obvious -- that Ottawa cannot ensure Canadians will receive medical treatment within guaranteed wait times -- can we all please stop pretending that the status quo public health care monopoly is sustainable?
Granted, Mr. Clement did not confess that the Conservative government would never be able to arrive at wait-time guarantees. He still holds out hope that a deal with the provinces can be worked out someday. But on the weekend, he admitted that he would not be able to reach such an agreement before the next election.
A more fruitful approach for Mr. Clememt and his provincial counterparts would be to consider Quebec's new health legislation as a model for reform.
Bill 33, adopted in December, permits Quebec's health clinics to bill medicare for certain treatments, while also allowing patients to be charged private user fees for supplies and uninsured tests. Clinics can also offer enhanced recovery rooms, extra tests or superior medical appliances for an additional fee. Before the Canada Health Act was passed in 1984, many provinces sanctioned such "extra billing," and wait times were considerably shorter than they are now.
Predictably, unions and friends of medicare are up in arms. In Thursday's edition of Montreal's Gazette, a group of five dozen sociologists, activists, lawyers, political scientists and health professionals signed an open letter charging that "private clinics that charge patients for access to insured services damage the publicly funded health care system of Quebec."
Not necessarily. In the 1990s, when Alberta was permitting tax- paid cataract surgeries to be performed in for-profit clinics, those in a hurry paid extra to have it done outside the plodding public system. As a result, the competition drained patients from public wait lists and spurred public hospitals to improve their own cataract procedures. Wait times for public eye surgeries went from 24 months to three.
Also, when provinces still permitted doctors to "balance bill" or "extra bill" for office expenses, telephone consultations or medical supplies used during physicals, doctors' office and emergency room visits were less frequent. After it became entirely cost-free to see a doctor or visit an emergency ward, usage spiked by between 10% and 20%. The pattern reflects basic microeconomics: Make something free and people will consume too much of it. That's why our emergency rooms are full of people with minor scrapes and back aches, as well as seniors who are merely lonely, confused or depressed.
Of course, wait times are caused by a complex mix of factors, such as expensive new technologies and an ageing patient population. But any time a decision carries no personal consequences, people tend to make their choices casually. Permitting user fees at clinics and even hospitals would help cut down on unnecessary visits and help shorten waits for all."


MD: user fees aren't the answer” By Dr. David Saul (National Post, Feb 10, 2007):

"Re: In praise of user fees, Feb. 6.

The only thing your editorial board got right was that "wait times are caused by expensive new technologies and an ageing patient population." Perhaps you should go sit in any emergency department, where you will find them full of very sick people and patients being wheeled in with acute major trauma. Using the new initiatives in Quebec of "nickel and diming" sick patients as a model for Canada is wrong. Quebec's health system is the lowest funded in the country and Quebec docs are paid, guess what -- the lowest in Canada.
Doctors were allowed to "extra bill" patients from the 1970s into the 1980s, to make up the short-fall due to provincial health ministries suddenly and unilaterally dropping the payments to doctors from 90% to 70% of provincial Medical Association billing rates. Numerous studies also point to "user fees" causing increased health care costs as patients wait until the late stages of illnesses before seeking treatment, when earlier diagnosis and treatment would have been cheaper in the long run.
The health care system we have in place in Canada may not always fulfill the needs and desires of the public, but after 30 years in practice, I see it working more than adequately and I sure don't want to start talking money with my patients. The next time you are sick, I'm you sure won't want to either."


“We deserve better health care”, By Roman Bobak (National Post, Feb 13, 2007):

"Re: MD: User Fees Aren't The Answer, letter to the editor, Feb. 10.

Dr. David Saul has gall to offer up his sugar-coated placebo that our health care system works "more than adequately." Thanks for that underwhelming reassurance, but I'd seek a second opinion. It is shameful that despite 40 years' worth of various incantations of Tommy Douglas's pipe dream promises; and despite $34-billion worth of government health care spending last year in Ontario, people still die on waiting lists.
Regardless of Dr. Saul's aversion to "talking money" with potential patients, consumers should be able to pay for services currently protected from competition under OHIP's monopoly. For the public good, consumer choice in health care should no longer be banned, accursed and
derided. It should be reclaimed as every individual's intrinsic right."


"Building hospitals will break the bank by Dr. David Saul (National Post, Apr 26, 2007)

"Re: Why doctors are leaving Canada, editorial, April 16, and resulting letters.

What seems strangely to be missing from this one-sided debate on health care in Canada, foreign vs. home-trained doctors and the doctor shortage is the money issue. I'm not talking about fee for- service or that doctors make more money in the U.S. than in Canada. It has to do with hospital budgets, which consume 50% of the total health care expenditure. Check any hospital in Canada and you will find that the wards are full, with no empty beds; the operating room daily schedules are solid, with a few emergencies "squeezed in"; and the out-patient procedures are over-booked with patients waiting in the hallways.
Surgeons need operating rooms and internists require hospital beds to perform the work they were trained to do. There is no more room in the existing hospital system to allow for more surgeons or internists to practise medicine in this country. Letting more doctors work in primary-care "family medicine" is not the answer either, as most of this work can be adequately performed by trained nurse practitioners in primary care reform group health care centres.
Provincial and federal health ministers are aware of these issues, but also are cognizant that doubling hospital space will "break the bank" of the health care budget. Canadians, therefore, have a choice: Work with the system we have, which doesn't cost anyone a cent, or pay substantially more in taxes for an expanded hospital-based public system, or pay personal health insurance, U.S.- style, for new private hospitals. I vote for the status quo."


"Health truths (II)” by Dr. David Saul (National Post, Jul 14, 2007):

"Re: Health Truths, letter, July 13.

Forget whether Canada has the best health system in the world. What matters to Canadians is that the system will work when they need it, for life-threatening emergencies and cancer treatments. Letters regularly printed in the National Post highlight mistakes, backlogs and inadequacies of the health care system. Where are the thank-you letters that I and many of my colleagues receive daily from our patients?
In my practice of 30 years, it is very rare to hear patients complain about how the system failed them. The doctors, nurses and support staff, who are the backbone of the system, bust their asses day in and day out to provide the best medical care we can. We wouldn't mind a hug once in a while, too, instead of the bad- mouthing."


"Should doctors be paid in hugs?" by R. Bobak, National Post (Jul 16, 2007):

"Re: Health Truths (II), Letter To The Editor, July 14.

It's unfortunate that letter-writer Dr. David Saul complains that he and many others "busts their asses day in and day out" and get no respect. Not only does personal reward and respect come from the knowledge of a job well done, but so should your compensation.
If Dr. Saul has a problem with anything, it should be with the sicko Canadian health care monopoly which he so champions. If health care workers want to get paid with hugs rather than money, it might be prudent to leave the examination-room doors wide open."


Willing to bet on U.S. health care” by Dr. Leonard Hamm (National Post, Sep 26, 2007):

"Re: Doctor Defends Canadian Health Care, letter to the editor, Sept. 22.

Dr. David Saul thinks that the U.S. health care system is a "horror." However, one must consider the flip-side of such a horror: As someone who practised medicine in Canada during the dawn of socialized medicine, I can tell you that when you don't place any expectation on the patient -- when care is "free" -- it removes most of the incentive for the patient to assume control over his care and retards any efforts by the medical system to educate the public about personal health care.
Fortunately for Dr. Saul, he "knows where to do the research and find the world's expert opinions," which is a veiled way of saying that he can wend his way quickly through the system using his influence. Pity the average Canadian who may not have the same advantages.
Dr. Leonard Hamm, Point Roberts, Wash."


"Validating failed health policies" by Jack Sands (National Post, Sep 21, 2007):

"Re: The Coming Health Revolution, editorial, Sept. 19.

Did anyone expect Roy Romanow, a dyed-in-the-wool socialist, to recommend substantive changes to our dysfunctional socialized health care system? In setting up the Health Council of Canada, he did precisely what the Liberal government that appointed him intended; he validated their failed policies and took them off the hook for making any politically messy changes."


"The coming health revolution" editorial (National Post, Sep 19, 2007):

"A few years from now, when Canada finally joins every other free nation on Earth by permitting citizens to pay for their own health needs with their own money, we will look back and say: Why did that take so long? We have known for years that the financial burden of our single-payer health system is unsustainable. How come forward- thinking politicians of the Mulroney, Chretien and Martin eras didn't lay the groundwork for a European-style health model that combined private options with a robust system of universal care?
Historians will point to a number of factors: inertia, well- oiled propaganda campaigns orchestrated by public unions and their supporters, our pathetic dependence on medicare as a crutch of Canadian identity. But another less known factor is a sheaf of paper: the final report of the Royal Commission on the Future of Health Care in Canada --better known as the Romanow Report, after its one-man brain trust, former Saskatchewan premier Roy Romanow.
Released in December, 2002, the Romanow Report arrived at an important juncture. By 2002, a critical mass of Canadians were beginning to agitate for change, and reform advocates hoped that politicians finally
would break the taboo against discussion of a European-style mixed public-private system. Instead, Mr. Romanow advocated throwing more money and bureaucracy at the status quo, repackaging the old wine of our government health monopoly in fancy new bottles with grandiose labels such as "Canadian Health Covenant," "Health Council of Canada" and "Canada Health Transfer."
In Ottawa, the report gave relieved politicians cover to continue sticking their heads in the sand -- which is what just about all of them did. It is fair to say that Mr. Romanow single-handedly set back the cause of real health reform in this country by at least five years.
But thanks to long waiting lists, and provincial budgets groaning under the growing cost of Canada's Soviet-style public health monopoly, the winds of reform are starting to blow once again. Two years ago, in the case of Chaoulli vs. Quebec, the Supreme Court of Canada ruled that Quebecers facing health-threatening queues in the public system can't be denied access to private care. A vibrant network of private health clinics has sprung up in Montreal, Toronto, Vancouver and elsewhere. The new president of the Canadian Medical Association, Dr. Brian Day, founded the Cambie Surgery Centre in Vancouver, the first private multi-specialty surgical centre in Canada.
Perhaps the most telling sign that things have changed came courtesy of the Toronto Star. Last Friday, the left-leaning newspaper sought to goad its readers into righteous fury with a front-page story reporting that Liberal MP Belinda Stronach recently had sought treatment for breast cancer at a U.S. medical clinic. Ms. Stronach, who's become a political punching bag in recent years for a variety of unrelated reasons, clearly was being set up for a cascade of abuse and accusations of hypocrisy.
But that cascade never came. Instead, Star readers told the newspaper's editors to butt out. "Far from outrage, early reaction seems to be heavily on Stronach's side," a Star writer reported in a follow-up article. "Star readers, responding in a Web forum, were largely saying yesterday that it was no one's business where the Magna executive decided to pay for her own treatment outside Canada's medicare system. The Star's 'Speak Out' forum received comments such as: 'Good for Belinda,' and 'There's no issue,' and 'Please, please, please, leave her alone.' At least a couple of readers questioned the Star's judgment in making this front-page news."
All of this shows that Canadians are ahead of their politicians on health care. Ordinary people are ready for real reform -- it's the politicians who are mired in Trudeau-era dogmas.
We expect proof of this to emerge soon. As the National Post reported on its front page yesterday, Dr. Albert Schumacher, a former president of the Canadian and Ontario medical associations, has kicked off a cross-country series of town-hall fora in which citizens will get a chance to discuss their opinions on our health system. In February, Dr. Schumacher will release his report. One hopes it will get the same careful attention in the country's health ministries as did Mr. Romanow's.
Dr. Schumacher, whose tour is sponsored by the right-of-centre National Citizens Coalition, makes no secret of his frustration with Canada's stultified health-care debate. "One of the difficulties until now is that politicians will immediately cast any spokesperson for debate and discussion as pro-American, pro-private, two-tier health care," he says. "Everybody's afraid to talk about it. The politicians won't touch it with a 10-foot pole."
Slowly, inexorably, that is changing. Our politicians can ignore the will of the people on a subject as crucial as health care for only so long. Eventually, common sense--and the cause of individual freedom-- will prevail."


Doctor defends Canadian health careDr. David Saul (National Post, Sep 22, 2007):

"Re: Coming Health Revolution, editorial, Sept. 19.

Your editorial states, "in a few years Canadians will be permitted to pay for their own health needs with their own money," and "the winds of reform are starting to blow against Canada's Soviet-style public health monopoly" and that "ordinary people are ready for real reform." Wanna bet?
Your editorial writers, and most Canadians, have no idea what a simple medical visit to any doctor, clinic or emergency clinic in the United States entails. A decision on what your private health insurance plan covers and how much your co-pay will be has to be decided before any medical issues are discussed. I don't think Canadians are chomping at the bit for this horror.
As Dr. Irfan Dhalla wrote in the July 3 Canadian Medical Association Journal, "despite ever-increasing expenditures, increases in overall spending on health care in Canada are sustainable for the foreseeable future."
But back to your editorial. If I were Belinda Stronach and I had a potentially life threatening illness -- and unlimited funds -- I also would search out the world experts to possibly save my life. But, I'm not Belinda Stronach, I'm just an MD in Toronto who knows where to do the research to find the world's expert opinions, without leaving home. Her example of U.S. interventional treatment of her breast cancer does not support your argument against Canadian health care. It was wrong for the Post to bring it up."


Belinda Stronach (a Liberal MP once touted as a possible PM of the country), who acted as the Great Liberal Defender of Canadian medicare for everyone, became the Great Liberal Pretender when it involved her own health: typical do as I say, not as I do... the standard motto for the medicare-pushing hypocrites of the left.

Saul wants cover up and not ask questions about why such a high-level pro-medicare politcian couldn't even get proper health treatment in Canada? Well, where does that leave the rest of us, who have no choice (by law) but to suffer in the no-choice healthcare monopoly so favoured and espoused by the ilk of Stronach and Saul and the Smitherman?

And what's with Saul's cryptic claim that he "knows where to do the research" to obtain expert opinions "without leaving home"? What's that mean? Does Saul, who coyly claims he's "just an MD in Toronto" have special treatment insights that Stronach's doctors (or other doctors, or other ill Ontarians) are not aware of? Did Saul try to help Stronach? Or, is he doubting her reasoning for obtaining her treatment in the States?

The circumstances that Stronach faced in Canada are indeed grounds for an investigation into our health monopoly. Saul would be wrong to try to cover it up.

And with this we flew through four years of Medicare discourse (and there will be more), and really, what has changed? Doctor shortages, patients forced to shuffle off to Buffalo and beyond for health's like nothing in this post mattered much to the Liberal authoritarians and their medicarista sycophants.

How many more Ontarians will have to suffer for Jim Bradley's, Dalton McGuinty's and George Smitherman's failing Liberal social experiment? Ontario health minister George Smitherman, who already admitted that the Province can't "do it all" when it came to healthcare (St. Catharines Standard, Aug.11, 2005), nevertheless still obstructs Ontarians, by law, from the choice of looking after ourselves.

Shouldn't Smitherman and his Liberal government be held negligently liable for the suffering of Ontario patients?

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