Better medicare is Ontario’s answer
The provincial government and the Ontario Medical Association, the body that represents doctors in Ontario, are talking again. After months of turmoil and growing toxicity — both between the government and doctors, and within the OMA — this is good news.
The resumption of dialogue follows months of debate within Ontario’s physician community. The details of the saga are still being played out, but within the turbulence a disturbing theme has emerged: a desire amongst a small but vocal group of doctors to dismantle the fundamental principle of our health-care system, that our patients should be able to access care based on need, not on ability to pay.
Universal health care has been called “a sinking ship” by a GTA physician in an op-ed in another Toronto newspaper. Calls for user fees on top of what the government already pays us, and arguments to let rich Ontarians pay for faster services, undermine values shared by most doctors and patients.
Not to mention, they also fly in the face of the evidence. Besides violating the Canada Health Act and Ontario’s own laws, user fees and similar charges disproportionately impact those least able to pay, who also happen to be the Ontarians most in need of care.
Despite the very real challenges in our health-care system, private payment is not the answer to important system problems, such as wait times, access to primary care, and variations in outcomes for surgery or cancer treatment. The tired argument that we should move away from a system that provides universal care, on uniform terms and conditions, is easily debunked by looking at the evidence. It’s no surprise why: As wealthy patients leave the public system to jump the line for care, so do doctors, nurses and administrators. With fewer health-care workers left to care for those in a less lucrative public system, patients who are unable to pay for care will suffer the consequences, i.e., even longer wait times in the public system than we currently have.
For those looking for even more proof of the perils of private payment for doctors’ services, you don’t need to stray outside of Canada or even Ontario. As front-line physicians, we constantly struggle with barriers our patients face when accessing dental care, physiotherapy, psychotherapy and prescription drugs. In each of these cases, Ontario has a two-tier health care system, full of gaps created by inadequate public and inequitable private insurance.
All Ontario physicians experience the squeezing of hospital budgets, the overcrowding of emergency departments and the difficulties our patients experience accessing timely specialty care. But doctors should be advocates for evidence-informed solutions that will actually work. Team-based primary care across the province, centralized intake for specialty services, reductions in unnecessary and harmful tests and procedures would benefit all patients, physicians, and the system.
As the OMA and provincial government resume talks, both parties must put patient care ahead of political expediency or physician self-interest. They should, for example, build structures that allow for a medical profession engaged in health system stewardship and they should work together to open the door for the expansion of medicare to include universal access to prescription drugs.
Within a publicly funded health-care system that requires physicians to practice within that system, governments cannot act unilaterally when it comes to physician compensation. Instead, there must be a fair and independent binding arbitration system. The Ontario government has been too slow to recognize this, and the profession and OMA have been right to demand it.
But at the same time, if doctors take job action, or seek changes to the way or the amount we are paid, equitable access for our patients is not acceptable collateral damage.
Most of all, punishing patients with user fees and largely unaffordable private payment for physicians’ services must be off the table. Better medicare, rather than the elimination of medicare, is what Ontarians need and deserve.
Dr. Danyaal Raza is a family physician at St. Michael’s Hospital. Dr. Joel Lexchin is an emergency physician at the University Health Network. Both represent Ontario on the board of directors of Canadian Doctors for Medicare.