Stand up to doctors Defending medicare has hit many crossroads during the
past 40 years and this latest decision by Ontario's physicians
may represent another of those defining moments
ROY J.
ROMANOW
The recent contract rejection by a majority of voting
doctors in Ontario sets the stage for a dramatic showdown that
may determine how the future of medicare is delivered in
Canada.
Initiating, renewing and strengthening medicare has hit
many critical crossroads during the past 40 years and this
latest decision by Ontario's doctors — made in defiance of a
deal that the OMA negotiating team had signed off with the
province — may represent another of these moments in time.
Why is this the case?
At its core, this contract was based on the need to
provide a more seamless continuum of care for Ontarians
through the judicious use of incentives.
The contract clearly aims to improve the accessibility
of medical care to rural and Northern Ontarians and provide
support to the many in need of family doctors.
Importantly, it also attempted to bring about the
centrepiece of a more cost-effective health care system —
primary care reform with an inter-disciplinary approach,
making better use of nurse practitioners and others.
As well, the deal aims to deal with prevention,
rewarding doctors for providing services to help people stop
smoking and screening for cancer.
It goes upstream to transform the behaviours that
contribute to obesity and diabetes.
In September, 2004, Prime Minister Paul Martin and the
other first ministers moved the medicare yardsticks forward
significantly.
Money should no longer be an obstacle to reform.
Determinants of health such as income, housing, and early
learning and care were emphasized.
Primary care's importance was confirmed. Some important
progress on accountability was accomplished.
While not perfect or complete, the first ministers
signed on to the fundamental changes envisioned by the royal
commission into the future of health care and endorsed by an
overwhelming majority of Canadians.
And while there is important work taking place in many
provinces, Ontario has clearly demonstrated the kind of bold
steps necessary to move forward.
New tax dollars must buy change and Ontario has moved
to do just that — to bring about more accountability with
hospitals, setting the stage for primary care reform and home
care, and generally committing to move money from more
expensive options to higher quality and less costly ones that
will produce better health outcomes for individuals.
But the boldest and most important of Ontario's
strategy for change, thus far, is this now-rejected contract
with the OMA.
That is why the current situation in Ontario may be one
of those critical junctures in the 40-year history of
medicare.
As often noted, history has a way of repeating itself.
Do we have another crossroads, with one pathway embracing the
status quo, and another boldly representing a better future?
In the early sixties, Tommy Douglas and his colleagues
combined a clarity of vision regarding health care with a
truly uncommon strength of purpose in staring down the doctors
in my province.
Most of the medical establishment clung tenaciously to
the status quo. We lived through a difficult and emotional
doctors' strike, which, in the short run, divided our
province.
But Douglas and his colleagues stayed the course. They
chose the untravelled and bumpy road to a better future.
Today, Canada has medicare.
In 1984, with extra-billing and user-fees running
rampant — a renewed attack on the core values of medicare —
political leaders were again put to the test. Prime minister
Pierre Trudeau and health minister Monique Begin responded by
implementing the Canada Health Act, banning these practices,
and enshrining the five principles that reflect Canadian core
values and govern medicare today.
Then, as now, a majority of doctors opposed the
legislation. Some provinces did, too. But when Trudeau asked
his health minister where the people stood, Begin replied,
"They are on side, Prime Minister." Trudeau's response was to
stay the course and the Canada Health Act passed with flying
colors.
In spite of the passage of the CHA, extra-billing
continued. In 1985, with the Peterson-Rae accord in place in
Ontario, the government stood up to the doctors and banned
extra-billing. They stood up for vision, values, change, and
public interest.
Perhaps Ontario provides the setting, once again, for a
similar drama with national implications.
Given the bold and transformational nature of the
Ontario/OMA contract, the fact that 41per cent of Ontario's
doctors voted in support of the deal should be seen as
encouraging.
This is especially true when the public perception is
that this substantial minority includes a good deal of the
younger physicians, those from rural areas, and those
associated with academic centres, where new doctors are being
trained.
While this remains a minority of doctors, albeit a
strong one, they are in line with a public that knows that the
status quo isn't working.
So Canadians should keep a watchful eye on what is
unfolding in Ontario.
The government has clearly embraced the kind of changes
and a longer view of things required to strengthen and sustain
the future of our most cherished social program. The
government sought, and legitimately believed it had attained,
an agreement with the doctors' leadership.
Douglas, Trudeau, Begin, and others have provided a
legacy of valuable lessons.
At this point in history, well over 80 per cent of
Canadians are onside, clear about their values and how they
are best expressed through medicare, waiting and hoping for
change.
The McGuinty government has an opportunity to write the
newest chapter to strengthen and preserve medicare. It won't
be easy. It never was. History needs to repeat itself for the
future of medicare.
Roy J. Romanow, P.C., is a former premier of
Saskatchewan and headed a Royal Commission on the Future of
Health Care in Canada.
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