Wednesday, November 7, 2007

Don't let myths get in the way of fixing OHIP

Here’s an bit from “Rx101:Fixing OHIP”, (Pulse Niagara, Nov.1,2007):

“ “The health system has really been battered by a couple of decades of policies that have favoured a short–term view,” observes Natalie Mehra, director of the Ontario Health Coalition, a public interest group which works to preserve the public health care system. The “roller coaster” of funding cuts and funding increases, she says, has “created all kinds of instability in the system and has really gotten in the way of good planning.”

The OHC feels the province needs to do more for young doctors and improve access for patients by enticing doctors locate throughout the province, instead of just in dense population centres. However, they point to one way the McGuinty government may be hurting healthcare in the guise of helping it.
“There is all kinds of privatization going on under the radar aided and led by this government,” Mehra says, noting that the migration of doctors to private clinics, such as sports medical centres, is partially to blame for the doctor shortage. “Those doctors should be working in the system providing actual care to people under OHIP,” she says. “Their university educations are hugely subsidized by the public. They ought to be working in the public interest.”
Whether or not McGuinty can save OHIP during the next four years depends on how closely he listens to recommendations made by both doctors and the public. For many, it’s imperative the government focuses on restoration of the province’s health care system so Ontario can once again be a leader in health care.
“The truth is, a lot of that is just regaining ground,” says Mehra of the myriad suggestions put forward. “I think in terms of priorities, let’s undo the worst of the damage and then we can start to build a more holistic, more effective and accessible health system.”"
The union-backed socialists want doctors to be forced to work for the government, because, after all, the state paid for their edumacashin, y’see; even though in many cases, it might NOT have. But who's counting? Force ‘em all, anyway – as they should be serving in The Glory That Is Tommy Douglas! The gobbledygook from Mehra is reminiscent of classic Bolshevik 'centralist 'planning; and purposefully ignores that the so-called ‘holistic, effective, accessible" health Nirvana didn’t materialize since 1966 for no reason other than Tommy’s medicare monopoly itself failed! There’s your “worst of the damage”! There’s not much else to blame but socialists whose agenda is authoritarian, no-patient-choice socialism. You want “restoration”? How about restoring the right of contract between a doctor and a patient? How about challenging and undoing OHIPs monopoly? There’s your problem! OHIP is just the Ontario Government Health Marketing Board, which limits healthy competition, and controls and price fixes the market through unaccountable, arbitrary taxation policies. And when its lacklustre bare-minimums are stretched, they simply transfer their burden -ie, the patients whom they failed- to the States for treatment. Socialists claim they speak for some "public interest", but "the truth is" more of the same old killer-socialism dressed up with the word reform isn't the answer. It's rearranging the deck chairs after the iceberg has been hit. The reform we need in Ontario is for a patient to be able to buy private insurance to pay for their care. A private parallel system must be phased in, sooner than later.

Here's what Dr. Colleen M. Flood and Meghan McMahon wrote in "Privatized medical care no cure for waiting lists" (Toronto, Sept.18, 2007 ):

"A constitutional challenge to Ontario legislation that prohibits the purchase of private health insurance for medically necessary health-care services (dubbed the "Ontario Chaoulli") was announced on Sept. 5.
It's another call for increased privatization, based on the misinformed notion that an expanded role for private insurance will remedy wait times in Canada.
Just last month, the outgoing president of the Canadian Medical Association, Dr. Colin McMillan, put forward Medicare Plus, the CMA's solution for sustaining our health-care system. It proposed expanding the role for private insurance and private payment, and allowing physicians to work for the public system and treat private patients, too.
After a stream of backlash from the Canadian Healthcare Association, the Registered Nurses Association of Ontario, Canadian Doctors for Medicare and others, the CMA responded by saying that it is time to examine the nature of the public versus private health-care debate.
Indeed it is. Will the CMA's recommendations make medicare better? The evidence says no.
Currently, Canadian regulations prevent doctors who are paid by public medicare from also providing medically necessary care for private payment. But doctors can "opt out" of the public system and "go private" (except in Ontario).
Why do we have this regulation? Because if we didn't, doctors would naturally want to spend much more of their time than they presently do treating private patients – as these patients often have easier conditions to treat and they (or their insurer) will pay more.
A doctor, like any normal person, will be attracted to working for more and doing less – who can blame them? So it is not surprising that some members of the CMA like the idea of Medicare Plus.
But from the public's perspective, and from the perspective of most patients, it's a bad idea. If you are a patient wealthy enough to pay privately or you have private insurance, then you may fare better under Medicare Plus. But lines for treatment in the public hospitals will grow longer and longer.
The CMA's recommendation also ignores the simple fact that, in the absence of an increase in the number of doctors (where will we get them from?), the introduction of a parallel private system must mean that the doctors we do have will be distributed between both public and private patients.
Private patients will pay more to have their medical needs met on a preferential basis, leaving public patients on ever-growing waiting lists. Evidence suggests that allowing doctors to practise in the public and private sectors will not, as Medicare Plus states, "improve access for the entire population."
Other countries that allow doctors to work on an unregulated basis in the public and private sectors – like New Zealand, the U.K., and Ireland – currently have, or have had, chronic problems with long waiting lists.
The evidence doesn't seem to indicate that having parallel private health insurance or "Medicare Plus" has cured waiting lists in these countries. Where waiting-lists have been wrestled down – as in the U.K. – it has been through a huge infusion of public money and improvements in the management of public hospitals. The cure has not come from more private money or private insurance.
And countries like France that appear to have a large private sector actually heavily regulate doctors who work privately – including the price they can charge and the amount of time they can spend treating private patients. So what looks on the surface to be "private" is not really: it's quasi-public because of such heavy regulation.
So we could follow the European route – and heavily regulate doctors who "go private" – or we can stick with the cleaner and simpler approach of requiring doctors who are paid by public medicare to be paid only by medicare but still allow doctors to "go private" if they are prepared to work completely within the private payment sector.
But we have to recognize that even with European-style regulation we would be embracing the idea that it's fine for folks with more money to jump queues and get preferential treatment from doctors.
This is in direct opposition to the principle of equity that has historically guided the Canadian medicare system, which was created in part to eliminate distinctions between the rich and poor in access to medically necessary health-care
Canada's health-care system needs reform – but reform based on the best available evidence and guided by Canadian values. On the issue of waiting times, for example, the Institute of Health Services and Policy Research – part of the Canadian Institutes of Health Research – funded research that helped establish the first-ever national benchmarks for waiting times in December 2005. CIHR-IHSPR is committed to providing evidence-based solutions that will improve the health-care system. Let us not make the mistake of misusing the wealth of evidence that strongly supports a public health-care system like Canadian medicare."

Why are medicaristas so afraid of 'Chaoulli type' challenges in other provinces, even referring them as 'copy cat' cases? Why is a supreme court challenge dismissed as "another call for increased privatization"? It's the failure of socialized medicare that brought the challenge to court! It would be wonderful to propagate the belief that Chaoulli and all others that may follow are frivolous. But they're not - they didn't occur in a vaccuum, they were years in the making, and they were created BY THE FAILED SYSTEM which the medicaristas espouse and continue to defend. Medicare should not be forced upon people, and medicare should not limit their freedom of choice to buy their own medical care -especially since the state botches up their promised care with esentially worthless, if not fraudulent, claims, that 'we're all covered'. Obviously, we HAVE a problem - a socialist wound inflicted upon Canada in 1969 by Tommy Douglas, which has festered in the dark for years, which has caused untold suffering and hardship upon many before before being slowly and eventually exposed and confronted in court. Canada can do a lot better by leaving socialism in the grave along with Tommy where it belongs. Medicaristas insinuate that medicare is about patients, but it's not about patients or healthcare at all, it's actually about instilling and enforcing their political power of socialism. It's about creating a forced dependence on the state by monopolizing our choices as individual consumers. And they get upset when their cozy, protected charade is exposed, when patients have the audacity to fight back, and when supreme courts, no less, are being asked to judge the absolute fairness of it all.

Here's a column, "Medicare myths" by Jeffrey Graham (National Post, Sept.14, 2007):

"Canada's health care system must be reformed to meet the needs of a changing world. These myths stand in the way.

The recent discussion of the inaugural address of Dr. Brian Day as President of the Canadian Medical Association reminds all of us how polarized and unhealthy the debate has become over the continuing urgent need for improvements in the Canadian health care system. It does not serve the public interest for those who oppose a consideration of all options -- public, private and mixed public- private -- to attempt to discredit the views of those who are open to change on the basis that advocates for change may benefit financially from such changes. If that fact was a basis for disqualification there could not be any debate on any public issue. The fact of the matter is that we all have a valuable perspective on matters of health and those who are directly involved in the system on a daily basis have tremendous insight from which we all can benefit.

Some of those who are unwilling to consider new approaches and nongovernmental solutions hide behind a number of unhelpful myths that make honest informed debate more difficult.

The first myth is that most Canadians want only the government to oversee the provision of medically necessary health services. The fact is that Canadians want accessible, timely and cost-efficient health care. For the most part, they do not care whether it is delivered by entities or individuals who are publicly employed or employed by private sector entities.

A second myth is that greater private-sector involvement in the delivery of health services is inconsistent with the Canada Health Act or related provincial laws. In fact, currently, governments deliver relatively few health care services directly. Most medical practitioners are part of the private sector. The majority of hospitals and long-term care institutions are private not-for- profit organizations with their own governance structures. Most diagnostic tests are carried out in private labs, and increasingly Canadians are benefiting from the tremendous inventiveness of the medical-device and drug sectors to reduce or avoid the need for institutional care. There are a complex series of federal and provincial statutes and regulations that define the roles and responsibilities of governments with respect to public health care insurance plans. However, there is nothing preventing governments from clarifying and refining the regulatory framework to ensure that new and innovative approaches to health care delivery can be introduced and implemented, including those that include private- sector participation.

The third myth is that governments alone have sufficient incentives to solve the current shortcomings of the health care system. If this were true, then the Supreme Court of Canada would never have been asked to express its views on whether Canadians should be free to pay for medically necessary services if the government is unwilling or unable to provide for them. In fact, the court has done Canadians a great service by making clear that governments can not prevent Canadians from paying for medically necessary services delivered in Canada with their own money if governments do not provide timely access. If governments were the exclusive answer, how could one justify the modest pace toward up- to-date access to electronic health records in a country that has every technological capability close at hand to make it a reality today?

The final myth is that governments themselves are not prepared to permit a parallel privately funded health care system to complement the public system. Recently, former senator Michael Kirby, in a report commissioned by the Ontario Ministry of Health and Long Term Care on Ontario's Wait Time Information System, noted that the Workplace Safety and Insurance Board in Ontario and similar bodies in every other province are able to obtain faster access than patients waiting in the publicly funded queue because WSIB patients are funded outside of time slots reserved for publicly funded patients. Surely there is an element of hypocrisy in some of the same governments insisting that a parallel private system would doom the public system to failure.

We do not have luxury of being able to bury our heads in the sand, insist upon rigid, dogmatic positions, or hide behind jurisdictional issues to postpone or frustrate an open and honest discussion of all options. We need leaders who understand how critical it is to the health of Canadians and the Canadian economy to update and adapt the health care system to changing realities so that we do not burden future generations with an unmanageable financial bill. We need leaders who understand that the literally billions of dollars we are spending on health care need to be treated as investments in the health of Canadians and the Canadian economy.

Finally, we need to seek creative solutions from all of our health care partners and providers recognizing that, at the end of the day, the current mix between public and private responsibilities is almost certainly going to change if we are truly interested in achieving the world's best health care system."

Or, we can listen to people like Mehra's group, who waltzed into St. Catharines city council earlier this year complaining about the P3 aspects of the city's still-yet-to-be-built-after-all-these-years hospital. St. Catharines desperately needs a hospital, but Tommy Douglas and his cult haven't built one since the 1960s -before medicare. Coincidence? They would be happy to squabble and delay this project on the basis of that old chestnut, the so-called public intetrest. But it's just their interest in socialism and anti-privatization that's key. It's not about patients suffering, it's about unionists protecting a failing monopoly. The bee in the socialist bonnet is the fact that we need to be able to attract private hospitals as well to compete where they can with the public ones. Then, the P3 haters can squabble and delay the public system to their heart's content, while a private hospital actually does get built.

Or, yes, we could just go to the States. Thanks, Tommy! You're the flickin' best!

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