From: brent@mikejag.wimsey.bc.ca (Brent Kennedy)
Subject: Re: Opting Out
Organization: mikejag (mike) is a private system in Vancouver, BC, Canada
Date: Thu, 1 Oct 1992 05:09:16 GMT

In article <1992Sep29.170144.1363@unixg.ubc.ca> daniel@redwood.ppc.ubc.ca (Daniel Ouellet) writes:
> 
>I would feel bad, just as anyone would. If this were to happen however, I would strongly
>question the sense of ethics of that practitioner. I am also wondering if this could be considered
>a violation of their oath. Anyway, this is not my point. The hypothetical situation you describe is an
>extrapolation based on how the government proposes to implement the 'global cap'. It is indeed a
>plausible situation, and it is precisely why I think the global cap is introduced, as I said, in a clumsy
>way. Nobody has to work for free. You should recognize however that this situation is not likely to 
>occur under what I called a 'decreasing fee' system, as  someone gets something for every hour
>worked under that system.

Well if "Nobody has to work for free", as you tell me, then I have to ask why
should anyone have to work for progressively less and less money??  It seems
to me that the union members get paid overtime for working extra hours, not
less money.  As for the 'ethics of that practitioner", you said yourself he
has a right to be paid, so what happened to that right??  As for the true
ethics here, the code of ethics for doctors in Canada states that they have
the right to refuse care to anyone, with no explanation needed, provided that
it is not an emergency situation, in which they may not refuse care for any
reason.   Would you keep working for your employer is he phones you up
tomorrow and says that the money for the rest of this year has run out, but
he'd still really like you to keep working??   Sorry, but the excuse that
'health care is different' just won't cut it either.  Doctors spend a minimum
of 10 years and up to 18 years in post-secondary education, work anywhere from
50 to 100 hours a week, have the responsibility for peoples lives, for which
they often get sued for, have absolutley no benifit package, and for that
matter they even ironically enough have to pay for their own health care
insurance.  The problem of just how much society is willing to spend on health
care is a difficult one, but it has nothing to do with whether doctors should
be paid for their services or not.  Unfortunately everyone sees these as the
same issue.  Justice Hall stated when he started our socialized health care
system that it should never be used against doctors that they don't have any
easy way to 'strike' to enforce their contract demands, and that negotiations
with them must be done in a fair and equitable manner.  Justice Seaton threw
all that away and on the word of one wonderful Robert Evans decided to control
the health care budget by slashing doctors salaries, while nicely avoiding the
problem that we are really facing now, of just how much are we willing to
spend on health care.
>
>|> Controlling health care means that everyone must be responsible for their use
>|> of the health care system.  That means patients and doctors.  Right now there
>|> is no mechanism in place for patients to have any part of the responsibility.
>|> If you want to go to your GP weekly to complain about your hang-nail you can.
>|> If you go to the emergency every few months for basic common cold symptoms, it
>
>Right, but it seems that the only way to control how people use the system is to introduce user fees,
>which hits poor people harder (relative to richer people for which this fee would be a drop in the ocean).
>Any other idea on how to introduce a form of control in the system ?

This is again returning to the central issue of how much do we spend on health
care, and how do we ration it.  One of the problems with the arguement that
'you can't charge poor people user fees' is that it ignores the problem that
poor people abuse the health care system too, and they are in fact often some
of the worst abusers.  You can't cut them off health care beacuse of this, but
the issue has to be considered.  The ultimate solution for this problem has
yet to be found, it if even exists.  No matter what system you adopt, someone
won't agree with it.  The most interesting development in health care in the
last 20 years has been Oregon's new state run system.  They came up with a
list of over 700 conditions and treatements, and then weighed the necessity of
the treatment with  the cost to the system and the system's ability to pay.
The cut off came out somewhere in the 500's.  ie the first 500 and something
conditions are paid for by the state.  Conditions outside of that are the
individuals problem to pay for, or have 3rd party insurance to cover.  Many
Canadians immediately throw this idea away as it forces the user to pay for
some items, but should all the things we do now be offered to everyone??
Liver transplants cost well over a quarter of a million dollars, use over 100
units of blood, and require hospital stays measured in months.   Should we
pay for this as a society, and if so who should be eleigible for these
transplants??  Heart transplants could be similarly argued.  The same amount
of money could go a lot farther in other programs, so where is the limit??
Rationing of health care is a reality, the problem is how do we do this?? 
It is being done right now, but in a completely unregulated way.  And through
all of this we have to find some way to make people responsible for their own
care.  Should we continually pay for the IV drug abuser who gets serious
infections and eats up tens of thousands to hundreds of thousands of dollars
fo health care funding on each admission??  These are the very patients that
have no money to pay for health care, yet as soon as they are discharged they
once again find money for their drug habit.  Then we can discuss the single
mother who can't work as she must care for her children.  Of course we must
pay for her care and her childrens.  But what do we do when she comes into our
clinics smoking and smelling of alcohol?  Is it our responsiblity as a society
to pay for her once again as, 'the poor would be hit hardest by user fees'??
No, to answer your question, I don't have the solution.  The point many
doctors are making today is society has some hard choices to make and we have
to start making them, and stop sticking band-aids on our ailing system.

>
>Mind you, but my pay check is about the same as that of Joe Blo who sweeps the floor in the pulp mill, and 
>certainly much less than that of John Doe who watches the display of the control system in the comfort 
>of the control room. It seems to me that there are better places to take the money from in this case. As
>for the medical system, well, how much does a nurse get ?

Well if you are as well paid as the guy who sweeps the floor you're doing
pretty well for a research centre. How about the longshoremen foremen who are
making $80,000 to over $100,000 a year working 35 to 40 hours a week, is this
"fair"??

>
>
>I'm not sure I made myself clear on this point. What I meant by a 'political decision' was a decision
>taken to implement a policy put forward by an elected government. The decision to limit the costs of
>health care is political. They could have chosen to eliminate welfare to limit government expenses.
>They chose health care and doctors. As long as our government's decision is not against the Charter
>of Rights or other laws, this is fine with me. So I ask again, why would a single person be given more
>power on that issue than the government we elected ?

I'll refer you back to my earlier comments.  Once again you are confusing the
health care budget issue and the doctors pay as the same issue, which they are
clearly not.   Try applying your reasoning to the civil servants and imagine
how well they would take a pay cut on the next contract if it was a 'political
decision to limit government expenses'.
>  
>|> This pension plan had a lot of controversy surrounding it.  The bottom line
>|> was that the government signed to pay it, and the doctors accepted it, ie it
>|> was a legal contract.
>
>Sure, everything was 'legal'. My point was however that our former Premier had a pretty elastic sense
>of ethics and that we can question the reasons that brought him to take that decision.  Do you really
>think it makes sense to give a gold plated pension plan to some of the most wealthy people in our
>society when we face spiralling deficits and lack resources in all social programs ? Please open your
>eyes and give up that 'bottom line' argument.

Well please open your eyes yourself a do a little bloody math.  It's real
simple punch 25 million into your calculator and divide it by around 6200
doctors.  Now look at what you  get.  If you can invest $4000 somewhere and
end up with enough money to pay somebody a pension for a few years you are
either in the wrong line of work or involved with organized crime.  There was
nothing 'gold-plated' about this plan.  It was a stupid plan from the start
and I can't believe the doctors voted for it. It was a one time only pay in
with no chance for the doctors to contribute their own money.  They gave up
several percentage points in their total 3 year raise to get the pension plan.
The point isn't to start talking about all the wonderful places the money
could have been spent.  The point is exactly as the head of the BC Fed. of
Labour said -- you don't change a contract once it's signed because 'you don't
like it'.  You can renegotiate it, you can go into the following years
negotiations with the pre-condition that it will now be scrapped, but you
don't just rip up the contract.  As for your comment 'the most wealthy people
in our society', try taking the average blue collar workers salary over
his/her lifetime and seeing what they averaged per hour.  Then take a doctors
take home pay before taxes (NOT their gross billings) and divide it out over
their hours worked.  Remember to take into account the 100+ hour weeks for
all those years of medical school and residency.  Never mind paying overtime
rate for all those sleepness nights on call.  Don't forget the $3000 + in
tuition per year.  Then there's the fact that one mistake and their career can
be over, the might get AIDS or Hep B.  Let me know what you come up with.  I
think you'll find that if anybody should give more money to the social
programs maybe it should be the blue-collar worker.

-- 
#     Brent Kennedy	      | The disease of "Trauma" is responsible for   #
#                             | more years of potential life lost than any   #
# brent@mikejag.wimsey.bc.ca  | other disease, yet it's also the most        #
#		              | preventable, does that make any sense??      #
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