Tuesday, August 19, 2008

Meet the New Boss...

...same as the old boss, at the Canadian Medical Association anyway.

Dr Brian Day's tenure is coming to an end, and his welcome push back against Tony Clemont's hysterical and illogical attacks against harm reduction aside, he was and is the wrong choice as the President of the CMA due to his fervent support for heath care privatization.

Unfortunately his incoming replacement Dr. Robert Ouellet is another private clinic entrepreneur pushing for more 'competition' in Canada's healthcare system based on misinformation and discredited arguments.

You recently wrote in the CMAJ, “I don’t want to change the world, but at least, to have some little influence and to show that there are some solutions that we have, that are working.” What specifically would you like to accomplish with your influence?

Well, we have to look at what’s going on elsewhere because there are experiences in other countries -- I’m talking about the UK -- where they were at the same level as us with wait times five years ago but they’ve succeeded in getting rid of them. We’re a rich country and have wait times of nine months for surgery or more for hip replacement! We cannot accept that. I cannot accept that.

Nor should we accept it. Of course Ouellet ignores the long history of underfunding, deliberate policies of limiting medical school enrollment and yes, market tinkering that has led us to this point.

And his 'it's worked so well in Britain' argument ignores that their improvements came from major re-investment in the wholly public system while their simultaneous experiments with privatization were costly disasters.
Until recently, Britain has been like Canada. Our National Health Service, despite its problems, is doing a good job and improving. But its future has been put at risk by the introduction of market forces and profit-seeking providers.
I understand that some B.C. politicians and other private health care lobbyists are claiming that U.K. health care privatization is a success. Nothing could be further from the truth.
Britain recently introduced private hospitals, much like B.C.'s private surgical clinics, to carry out the cheap, less-risky operations on generally healthy patients. To put it crudely, they cherry-pick the profitable work and leave the NHS hospitals to care for less healthy people and all the other complex procedures.Yet operations in these private hospitals cost on average 11 per cent more than in public ones. And these profit-seeking companies are guaranteed a flow of funding. So if their contract specifies 5,000 patients a year and only 4,500 go there, the private hospital gets paid for the full 5,000.
The former chair of the British Medical Association, James Johnson, has said, "I see hospital services destabilized as a result of over-emphasis on the use of the independent sector. . . the money could often have been better spent making greater use of existing NHS capacity." While the incomes of private sector hospitals are guaranteed, public hospitals have been forced to compete, not just with the for-profit outfits, but with each other. To do that, the government introduced payment by results -- your politicians call this "patient focused funding."
The result has been a mess. The new system was supposed to introduce fiscal discipline, but in its first year the NHS overspent its budget for the first time in 60 years. Hospitals cut back on services to clear deficits, resulting in major backlashes against the Labour party government all over the country.
Payment By Results AKA Patient Focused Funding or as privatization proponents in Canada now refer to it, Activity Based Funding was a central pillar of Dr Day's crusade against the wholly public system and Ouelett waxes similarly rhapsodic about it, despite its long, world wide history of expensive failure. When a policy idea changes it's alias every few years, its usually to try to escape its own record.

Unfortunately the CMA appears to have abdicated it's leadership role in promoting the best healthcare possible for Canadians for another year by picking another market ideologue as their leader.

UPDATE: A Creative Revolution tells the story of An American in Canada, and reminds us exactly what we're being asked to give up.

UPDATE 2: It never fails, you pen scathing attacks on an outgoing and an incoming CMA President and then they offer you a whole bunch of new ammunition on the cover of the Globe and Mail the very next day. Actually that's only happened to me this once, but you get the idea.

Dr. Ouellet unashamedly promotes the massive transformation of Canadian healthcare into a market driven sector, but that's OK because he also believes in pharmacare subsidization of the drug industry and his horoscope tells him he's the best man for the job.

Meanwhile, outgoing CMA president Brian Day says 'that a large majority of Canadians - 68 per cent - want a major overhaul of the health system.' and that "It is time to act. Change is both necessary and inevitable." but fails to mention that Canadians continue to strongly resist private sector solutions no matter how carefully we're coached.
Dr. Day also bemoaned the fact that there is a reluctance to discuss and debate these issues publicly. "The private-public rhetoric on health care is a relic of tedious and tiresome propaganda. Those who argue against and demonize the private sector need a reality check,"
So parsing that, there should be more willingness to discuss and debate these issues publicly - unless you disagree with the elite consensus that we must move away from the public model and expand the market's role in health care, in which case you are just spouting 'tedious propaganda' and really should just shut up and do what you're told.

UPDATE 3: The push for more privatization of healthcare is class warfare:
But Danielle Martin, chair of Canadian Doctors for Medicare, argued that Ouellet's proposals would drain resources from the public system, which is already sorely lacking in nurses and physicians.
"There's no doubt that those kinds of proposals would increase access for people who can afford to pay for their own health care, but they would decrease access and wait times for everybody else," Martin said in an interview. "That's been the experience in Australia, where they implemented a private system alongside the public system.
In those areas where the amount of private activity was greatest, the wait times were the highest in the public system."

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