Thursday, December 13, 2007

Pseudo-doctors in Ontario's pretend health-system

Terence Corcoran wrote in “Ontario doctors sold out again”, (National Post, Nov.6, 2004):

"Throughout next week, Ontario's 20,000 doctors, members of the Ontario Medical Association union monopoly, will vote by phone on a new four-year agreement with the province. The OMA has a long history of selling out its members, stripping doctors of their freedom and sacrificing patient care at the altar of socialized medicine. This new union contract, reached in secrecy two months ago, sets new lows in undermining doctor and patient rights.

More than a decade ago, I wrote: "The Canadian health care system creeps relentlessly toward its ultimate destination, the Soviet model, a centrally planned monster run by commissars issuing directives in a futile attempt to control the uncontrollable. The end result of the Soviet system, extensively documented, is chaos and corruption and collapse." With the new OMA-government agreement, Ontario appears to be entering the second phase of that progression.

The agreement, which includes classic blunders of central planning to manipulate doctor behaviour (35% pay gains for docs who do what the government wants; 4% or even less for those who don't), further co-opts individual doctors into the OMA strategy, which seems mostly aimed at embedding OMA top brass deeper into the Ontario health care politburo. Forgive me for deploying old Soviet jargon, but nothing else does justice to the union's latest pact with the bureaucratic and political devils who manage the province's health care monopolies.

The worst highlight of the agreement is a one-page "letter of understanding regarding the improvement of drug therapy." From the moment it was leaked to the media more than a month ago (everything was going to be secret prior to the vote, until the leaks started), critics branded it a corrupting breach of medical ethics. Under the drug agreement, the OMA agrees that doctors will undertake to cut $150-million from their drug prescription costs by 2007. If the "savings" target is met, the doctors will get a $50-million bonus.

The $50-million bonus was immediately labelled a kickback by critics, and a breach of medical ethics. Doctors would be put in the position of cutting back on patient drug prescriptions -- a dubious objective in itself -- in return for a payment from the government. One anesthesiologist (among many doctors who appeared anonymously in media reports for fear of government and OMA retaliation), told The Toronto Star: "The government does not have the right to coerce me or try to buy me off into providing substandard care."

Alas, the OMA negotiators have agreed to take away that doctor's rights. Even more, it contemplates direct and constant government control over the prescriptions of each doctor. "It is agreed that the Parties will develop a Drug Utilization Review that will provide, where practical, direct, confidential feedback to physicians regarding their prescribing practices." The implications are vast and disturbing.

Remember that "the Parties" here are the OMA and the Minister of Health, George Smitherman. He co-signed the secret drug agreement, which means Mr. Smitherman and his staff (through the review) will begin collecting individual prescription information from each doctor on each patient, information the government does not now have access to. Doctor and patient prescription records remain confidential, even when paid by the provincial hospital insurance plan. The government would, under the agreement, begin monitoring doctors and patients through prescription information.

Even more perverse is that the kickback scheme is worth much more than the $50-million mentioned in the agreement. Thanks to information circulated by Dr. Arnold Aberman, professor of medicine and former dean of medicine at the University of Toronto, we learn that the scale of the kickback is $200-million, not $50-million.

In a widely circulated critique of the union contract and the drug side agreement, Dr. Aberman reports that the OMA's chief negotiator, Dr. Stewart Kennedy, told an information meeting that the value of the drug deal to doctors is actually $200-million. Dr. Kennedy said, and other officials confirm, that the original OMA agreement with the health minister was considered to be $150- million too rich for the government's finance and management board officials. To get around their objections, the OMA and health ministry officials "devised the drug deal to get the $150-million" from another area of Ontario's health spending, the $2.8-billion drug budget. If the doctors can save the drug budget $150-million, they can keep the money. Thinking they had a good thing going, they threw in another $50-million as a later bonus. It turns out, writes Dr. Aberman, "that the OMA is getting all of the $200-million ... Don't we all feel much better now -- knowing the OMA sold out our patients' interests for $200-million, not only $50-million."
Other parts of the overall four-year contract, reportedly worth more than $1-billion in new spending, take away more and more of doctors' freedoms. Payment schemes are clearly designed to draw doctors into salaried positions as members of "family health teams." As part of teams, family physicians will receive 35% wage increases; fee-for-service docs will receive increases of 4%. Most of the payment increases occur in later years of the contract.

The agreement is filled with clauses and conditions that will transfer more doctor powers and decisions to bureaucrats and committees. In hospitals, for example, the agreement calls for "comprehensive standardization of prodecures and products." A task force will begin planning for the development and use of a common provincial drug formulary for hospitals. It will also oversee "the selection and use of surgical devices."

Even if doctors should be foolish enough to approve the contract, it apparently is not binding on the government beyond two years. Two years into the contract, before any significant wage gains are in place, the government has the right to unilaterally reassess the contract. A legal opinion from Toronto lawyer Brian Shell to the Coalition of Family Physicians states that the four-year contract, as written, "amounts to [a] two-year low-increase arrangement, with little likelihood and certainly no certainty" that the three- and four-year increases will ever be paid.
The OMA has sold out its members in the past. Back in 1991, the OMA agreed to become a province-wide closed shop, making the OMA union a total monopoly, beyond anything Buzz Hargove could dream about. Any autoworker can quit GM and and work as a non-union worker somewhere else. Doctors have no such right, thanks to the OMA, which decided years ago to join the government health care dictatorship rather than fight it.

The OMA was also part of the central planning fiasco of the early 1990s that created the current doctor shortage. Back in 1993, the University of Toronto medical school agreed to be paid $10-million a year not to produce doctors. Enrollment at the medical school was cut 30%. The planning reason: Ontario had too many doctors. Foreign doctors were systematically kept out of the province. The OMA also agreed later to schemes that capped the annual revenue of specialists at $400,000, thus limiting the supply of specialists. Under the new contract, that cap will not be lifted until 2008, but more likely it will never be lifted.

Doctors in Ontario, and across Canada, are no longer bearers of noble principles aimed at the health and welfare of their patients. They are already indentured servants of bureaucrats, politicians and union bosses at the OMA. This is exactly as planned.

A federal-provincial health policy paper, written by two eminent members of the Canadian Institute for Advanced Research, Morris Barer and Greg Stoddart, concluded back in 1991 that doctors were no longer to be in charge of their destinies. "There is a continuing evolution from the view of physicians as private agents for their patients and their own interests, to the view of physicians as clinically skilled agents serving the collective goals of a publicly funded health care system."

The OMA union monopoly has offered its doctors a contract that further entrenches that trend. Let's hope, as patients, that Ontario doctors have the courage to turn it down."


2004 was a giddy year for the Liberals - they got their Commitment to the future of medicare act, they started the LHINs monster, they pretended their newly instituted multi billion dollar health tax was just a premium, and they paid off/settled with the OMA for four years.

Well, in 2008, the four years is up, and we'll see what McGuinty has to shell out to keep our doctors as vassals to the provincial overlords. The insiduousness of this system, the interdependence of all levels on the state, is shocking. And what do we have to show for it - shortages, wait-lists, line-ups, suffering , death, and , truly, no-one - they have made sure of it - can be held liable. The circle almost always points elsewhere up or down the line. You can't blame the doctors for organizing - Tommy Douglas set that puppy's tail wagging the minute the state began to socialize the insurance system, which has impacted every aspect of health delivery. It's always in the state's favour to fan the proletariat to blame doctors for their system's ills - but when you outlaw and remove the accountability which stems from a contractual payment relationship between doctor and patient, the state noses its way in as the monopoly payer, with good intentions, originally, of course, and then skews the market with its interventionist whims, acting really like the Soviet's central-planning fiasco.

Laura Callaghan (St. Catharines Standard, Dec.12, 2007) wrote in "Give alternate-care providers more responsibilities":
"The OMA also opposes changes to the scope of practice in the current legislation, which would allow them a larger role in providing health care within a hospital or community."
She asks "What will it take for the NHS to start focusing on displacing the demands of the OMA with the needs of the people of Niagara?" So, contract time is coming in 2008, the shortages, etc. are piling up...the time is ripe for some good old labour politics. "The needs of the people"...will be met by, what... by not giving them health-care payer/provider choices?!? By more monopolism?! Really, Laura?
The "needs of the people" will only be met by force-feeding patients more monopolistic Tommy Douglas single-payer-rearrrange-the-deck-chairs-while-the-ship-sinks crap? Really, Laura?!

It's sad it has come to this. What if a patient WANTS a qualified DOCTOR?

We aready have a pretend universal health system, with systemic problems directly associated with its inherent command-and-control structure: a bait-and-switch system that promises medicare, but can't deliver it; now, after McGuinty's Liberals cut coverage while increasing premiums (...mull that hypocrisy, that contradiction of so-called "universal healthcare" for a while...) the next thing on the list to try, in a desperate attempt to beat Ontario's dead horse of a single-payer system to life, is having pseudo-doctors in our pretend system!!
Isn't that just perfect?  So the OMA can be demonized again: lookit thare - dem docters is aginst cost-savings! Save the costs!!
It's Barer-Stoddart-style B.S. all over again, from another side. Get rid of doctors, but still pretend that you have the same system.
If I wanted a nurse practitioner, then I should get a qualified one. If I want a doctor, I should be able to get a doctor, not a reasonable facsimile of a doctor. Will these nurse practitioners have the professional liability to cover themselves for any medical negligence on their part caused to patients? Or, will that too be compromised by the state (against the patient, in favour of the nurses), by having limits on malpractice suits and awards? This is the very reason we need a private parallel health system, with its own facilities and organizational structure, where patient-accountable sanity prevails. When the monopoly is our only choice {therefore it is NOT "a choice" at all} it's the Callaghan's who have the upper hand, certainly not doctors, and least of all, patients.

As the saying goes, too many cooks in the kitchen spoil the broth.

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