Star Editorial: Finding money to fix medicare

[Are Be]

But what about an MRI machine next to a X-ray machine in a medical arts building, etc.? Why such a freak out over that? Why is a private blood lab and X-ray lab OK, but a 100% OHIP funded private MRI or CAT scan lab is flat out not worth considering?

 

[afransen TO]

Ok, I'll say this: I see no problem with private, for profit companies operating diagnostic equipment if and only if the service is also provided by not-for-profit institutions like hospitals, the private providers are paid PRECISELY what the public providers are, and those employed by these private clinics meet all the guidelines of the public system (ie, they must all be qualified). In the long run, I don't think any private company can survive on this, but we could at least have a clause in the contract with these firms that if they go bankrupt or they wish to discontinue service, they must sell the equipment to the government.

 

[Are Be]

March 11, 2004
Smitherman tackles health care spending
By CHRISTINA BLIZZARD -- Queen's Park Bureau

Health is at a crossroads in this province and a number of critical negotiations are happening right now that will affect how you will be cared for in future - whether it's in a hospital or by your doctor.

Proposed legislation that's causing a big buzz around here is known as Bill 8, aimed at bringing accountability to the system. And fair enough, as you can understand the uphill battle Health Minister George Smitherman is facing, trying to get health costs under control.

A couple of weeks ago, he took on hospitals, pledging to crack the whip on those that continue to run deficits.

Now that the Ontario Hospital Association has seen his proposed law, they're warning that Smitherman's hardline approach will take communities out of decision-making in local hospitals.

"The OHA is in support of moving in the direction of performance agreements, but we believe they should be negotiated," said OHA president Hilary Short.

"The bill fundamentally undermines hospital governance because it gives the minister the ability to impose an accountability agreement on a hospital," she said.

If there is a disagreement between the hospital and the minister about the kind of service that is being provided, there is a 60-day period of discussion to resolve it.

"At the end of the day, he or she can impose that agreement on the hospital. We believe that diminishes the community voice in health care," Short said.

The minister can bypass the board and deal directly with the hospital CEO. And, in the event the hospital doesn't meet the performance guidelines, the ministry can claw back 10% of the CEO's salary and fine the hospital $25,000.

"We understand the need for performance agreements and accountability," Short said, but added that there needs to be a fundamental change in the way hospitals are funded.

Then there are are the doctors.

The Ontario Medical Association (OMA) is locked in contract talks with the government.

One of the most sensitive areas is that of primary care reform. The Coalition of Family Physicians, a large splinter group of family doctors, is worried that the new family health groups the government is proposing will hurt patient care.

Scarborough family physician Dr. Doug Marks, who heads the group, likens what is going on now to what happened to Britain when that country moved to a National Health Service, that forced patients onto rosters.

"They don't have any proof to say that kind of practice is going to provide better care or better access to care. I am part of a group of seven and we provide more service in our group that what they offer on these new contracts," he said.

Meanwhile, a source within the OMA acknowledges the minister has made some major concessions to Bill 8 to meet its concerns. Two sticking points remain, however. First, the bill gives the general manager of OHIP the unilateral right to take back money from a doctor if wrongdoing is suspected.

The OMA says this could be done on a summary basis, with the doctor having no recourse. The OMA considers that as a basic infringement on the right to be presumed innocent. It's also concerned the government wants to restrict "block billing," for uninsured services. Right now, services such as camp medicals or examinations that are required by employers are not covered by OHIP. Some doctors are offering families a voluntary flat rate for such fees.

The OMA says it was unaware there were complaints about the practice and points out that such issues are regulated by the College of Physicians and Surgeons of Ontario (CPSO) anyway.

"We hadn't heard from the government before they introduced this bill that there was a problem," the source said.

"Certainly, if there was a problem we would have addressed it at the table, with the regulators - the CPSO.

"That said, the minister and the ministry definitely went to great lengths to change this bill, and we acknowledge that."

Ontarians universally agree that we have some of the best doctors in the world. Our nurses are saints. Most patients say that when they really need them, our hospitals are better than they expect. Health care takes almost half the provincial budget. If Smitherman doesn't act soon, it will gobble up the other half. That's the fine line he is walking.

No wonder the health ministry is often called the graveyard of political careers. It's no win and no one gets out alive.
Christina can be reached by e-mail at christina.blizzard@tor.sunpub.com. Or visit her home page.
Letters to the editor should be sent to editor@tor.sunpub.com.

(To print this page, make sure the left and right margins under your Page Setup are set to no more than 0.15 inches. Best viewed at 800x600 resolution or above.)
This site is updated by 5:30 a.m. ET each day and includes stories and columns from the day's print edition of the Sun. Use these links to find the Sun stories you are looking for. For updated news, sports, business and entertainment updates around the clock, we invite you to use the links from our CANOE network. If you are having difficulty viewing this page, please contact Tim Kraan, Managing Editor, Canoe.ca &nbsp &nbsp &nbsp &nbsp


News / Money / Life / Showbiz / Sports / Editorial / Columnists
Sun Media: Calgary Sun / Ottawa Sun / Edmonton Sun / London Free Press / Winnipeg Sun

 

[Are Be]

William Thorsell

By WILLIAM THORSELL
From Monday's Globe and Mail

UPDATED AT 12:58 AM EST &nbsp &nbsp &nbsp &nbsp Monday, Mar. 15, 2004

Advertisement

When the same problem recurs and deepens, and when vigorous efforts to fix it repeatedly fail, it is time to ask what the nature of the problem really is. Is there something wrong within Canada's health-care system that we can fix, and so keep the system pretty much as it is? Or do we have to look at significant changes to the system itself?

Roy Romanow's commission on health care concluded that we could fix the status quo with some new procedures and more public money. Canada's premiers seem to agree, with particular emphasis on the money — federal money. Three weeks ago they emerged from a confab and said: "We state today as premiers of Canada that without real reform to health-care delivery and without the affordable and sustainable financial base that can only be provided by the federal government, the health-care system as we know it will not survive the decade."

That's pretty dramatic and quite probably true, because neither major internal reform, nor significant new federal funding is likely to occur over the next 10 years. The nature of health-care delivery is deeply embedded in professions and bureaucracies. And Ottawa's capacity to divert even more public resources to medicare from other programs and from the wealthier provinces is clearly limited.

It is time to review the nature of the problem itself. Canada is one of the few nations in the world that insists on a monopoly public payer for basic medical services. And Canada is one of the few nations that effectively prohibits privately owned hospitals and clinics to serve individual health-care needs.

The insistence on a monopoly public payer means that all the financial demands for basic insured care fall on government budgets. Ergo, we can only spend as much on basic health care as governments can afford. We have placed an official, legal cap on basic health-care spending for individuals, a true rarity in the democratic West.

It has predictable consequences. Because health care ranks so high in people's preferences, medicare claims a bigger share of public spending every year, starving other major priorities of resources even as it puts upward pressure on tax rates.

Ten years ago, health care consumed about 40 per cent of Ontario's public-program spending. Now it's 46 per cent, as health spending has risen by 8 per cent annually over the past four years. That's typical of all the provinces.

You wonder why schools, universities, cities and highways are tawdry and second rate? Love that medicare. And the premiers warn that medicare itself is heading for the wall unless we divert even more public spending to the beast.

The problem isn't the stinginess of the monopoly payer. The problem is the system of monopoly pay.

The related issue of reform and innovation derives from the same root: the effective state monopoly on the provision of basic health services (with the exception of most doctors, who remain private professionals contracted to the state).

Enormous bureaucratic systems, webbed by professional and union interests, are fundamentally hostile to significant reform, as legions of health ministers have learned. The problem is not the inertia of the state monopoly administration, it is the monopoly itself.

Yet we say we will fix the monopoly-money problem in good part by reforming the monopoly-administration problem. It doesn't compute.

"The health-care system as we know it will not survive the decade," say the premiers. The implication is that it will either deteriorate beyond recognition, taking most other public programs down with it in a desperate effort to find more funding. Or the monopolistic constraints on pay and delivery will go, allowing far more resources to flow into a system that allows for far more diversity in delivering services.

Behind all the rhetoric, that's really what the premiers are saying. We have a choice; let's start honestly making it.

William Thorsell is director and CEO of the Royal Ontario Museum.



© 2004 Bell Globemedia Publishing Inc. All Rights Reserved.

 

[rbtaylor]

Are Be, I can tell you've never actually been in charge of a corporate budget or been in a management position.

When to outsource:
- It's cheaper (on a per client basis) to outsource as the company specializes in product X, has higher volume with similar quality and can do it cheaper. Generally not done with core competency due to loss of control.

- You want to get ahead of competitors in the market quickly and are willing to pay a long term hit for market share.

- You cannot afford the startup costs but are willing to pay a higher fee long term. The outsourced agent can borrow at a lower interest rate than you, so it ends up cheaper in the long term.

- You can bill out your time at a rate higher than what the outsourced solution would cost, so your time is better spent in a specialized area (not normally true with businesses of any size).


The Canadian government can borrow money at a rate lower than nearly any multi-national. We have the expertise to operate and maintain the devices. We do need help in design, manufacture and installation (much larger target market than just Canada -- so we can benefit from those savings).

Canada outsourcing health care at this point is a little bit like Royal Bank outsourcing their home mortgage market to CIBC.

 

[Are Be]

You cannot afford the startup costs but are willing to pay a higher fee long term. The outsourced agent can borrow at a lower interest rate than you, so it ends up cheaper in the long term.

Well, there you have it, a very good reason to allow private companies to run MRI and CAT scan clinics.

 

[afransen TO]

Are Be,

The government can borrow at a lower cost than any private health provider. Please try to read, and stop playing stupid.

 

[Are Be]

But it is FREE - costs the government NOTHING - if private investors pay for MRI machines, just like they pay for X-ray manchines.

Regardless of the interest rate, no money is less than any money.

 

[cdl42]

It's the Are Be medicare sale-a-thon!

Buy now! Pay later!!!

 

[afransen TO]

Are Be, so these private companies will provide their services for free?

 

[Are Be]

No, only the capital: the machinery, building, etc., but will get paid, by OHIP, in accordance with OHIP's price structure. Zero cost to the taxpayer to buy and maintain the machines! Just like a blood lab or an X-ray clinic.

 

[afransen TO]

You realise that once these private companies are providing these services, they will force up their fees with OHIP once we become reliant.

 

[Are Be]

No, I do not see that at all.
Have private X-ray clinics boosted fees?
And if they have, have the boosted fees nonetheless result in more X-ray machines for Ontario?
Why can't we have an MRI or CAT scan machine next to an X-ray machine and a blood lab? We already have the regulatory framework.

 

[Are Be]

Let's cure monopoly mania

By WILLIAM THORSELL

UPDATED AT 10:59 PM EST &nbsp &nbsp &nbsp &nbsp Monday, Mar. 22, 2004

Advertisement

Monopoly government control of health-care spending and provision of basic services is headed for a dead end. The monopoly payer won't have enough money to meet consumer demands, even if governments continue to bleed other public programs to death and hike various taxes.

And the forces arrayed against productive reform in health-care delivery by that same monopoly provider are too strong to generate meaningful savings from "process redesign."

So what do we do to avoid what Canada's premiers warn will be "the end of medicare as we know it" in a decade? The word "monopoly" contains the key to the solution, as it so often does.

We need to break the state monopoly on paying for health care and in providing the services that consumers demand.

How do we do this while retaining the core virtue of the current system -- good basic care for everyone as a matter of right? Happily, considerable thought has gone into this. In November, 2002, the Atlantic Institute for Market Studies (AIMS) published a cheeky yet sensible document called "Definitely not the Romanow Report," just two days before Roy Romanow came down so firmly for the unsustainable status quo.

AIMS starts by recommending "free-standing, specialized, not-for-profit and for-profit clinics based on French or Norwegian models, selling services to medicare on a fee-for-service basis, similar to Toronto's Shouldice clinic and the so-called Klein clinics in Alberta." Oh, scandal! The Shouldice is a privately-owned facility of international renown that specializes in hernia repairs. It is wonderful (according to The New Yorker magazine). And it would be illegal were it not provided for under a grandfathering arrangement.

Alberta Premier Ralph Klein got into awful trouble with the Ottawa monopolists when he permitted private clinics to provide cataract surgery to his citizens, without personal cost, through medicare. The feds insisted that these procedures had to be done in state hospitals only, lest sacred principles be despoiled.

Why would you oppose the provision of excellent health care through a private clinic, fully paid by medicare, if the quality of that service was very good? And why would you oppose it if the cost to medicare was the same -- or less? Irrational fear? Suspicion?

It is the latter. We can't get to first base on such a simple, intelligent proposal because we suspect the second base will be a killer. Herein lies the problem in keeping medicare alive and well: We have no faith in ourselves.

We think that breaking the monopoly will break the dam, and that the core value of medicare -- universal access to good basic health services -- will be lost of we allow any distinction in the quality of care provided. It's a soviet disease.

Clouded by this suspicion, we underestimate ourselves, and we underestimate the threat to health care and other public programs in hewing so desperately to the box canyon of the status quo.

The AIMS report goes on to make many more sensible recommendations, consistent with medicare's core values, but addressing its obvious weaknesses, too. Perhaps Premier Klein will have the guts and means to lead the way in showing how to save medicare by changing it in coming months.

Adapt or die. Learn or expire. Listen or crumble. Medicare is too important to starve in aspic.

William Thorsell is director and CEO of the Royal Ontario Museum.



© 2004 Bell Globemedia Publishing Inc. All Rights Reserved.

 

[afransen TO]

The current buzzword seems to be unsustainability.

Unfortunately, it has yet to be demonstrated that medicare is unsustainable. Until such a time, I will have to argue that public health care is inherently more efficient, which is borne out in the statistics.

We spend much less than the Americans, per capita, and yet we manage to provide medical care for everyone. Also, administration in the US hovers at 10% of health care costs (that's an astonishing amount for an economy of the USA's size). Canada's cost to administer the system is around 2 - 3% or less.

That 7% difference multiplied by what Canada spends on health care, something in the $80 billion range (no?)... that's a lot of money.

What I say is, fund medicare at a level at least comparable to the USA, institute primary care facilities across the country, as well as any other logical reforms and give it 10 years and see how things work out. If the system is still broken then, go ahead and privatise.