From: brent@mikejag.wimsey.bc.ca (Brent Kennedy)
Subject: Re: Opting Out
Organization: mikejag (mike) is a private system in Vancouver, BC, Canada
Date: Tue, 29 Sep 1992 00:47:40 GMT

In article <1992Sep28.164605.1618@unixg.ubc.ca> daniel@redwood.ppc.ubc.ca (Daniel Ouellet) writes:
>
>Boy, I sure made you steam with that one-liner, but that wasn't my intent.
>Well, O.K., but so what if doctors are self employed ? This isn't the only example of a government
>controled fee structure.  BC Tel is a private company but their rates are controled.

Yes their rates as a company are controlled, as are doctors.  The difference is
that with BC Tel they don't start taking a portion of the money paid out, back
from them at the end of the year.
>  
>
>I can understand that doctors are frustrated by the cap, but I have yet to hear of a better way to
>control the increasing costs of health care. If your solution is simply to increase taxes then I don't think
>we will be able to maintain our present health care system and other social programs very long. On the
>issue that government is taking money away from M.D.'s, we can look at things from a different
>perspective. To my knowledge, the cap doesn't represent a cut in salary. Now I do agree that the way
>this thing was introduced by the government is very, very clumsy and I would certainly not like to be
>put in the situation of our M.D.'s. It seems to me that a more thoughtful way to control expenses on that
>matter would be to introduce a "decreasing fee" system. For example, doctors would be paid $0.90 for
>every dollar they bill over $100,000, $0.80/dollar above $150,000, etc. Of course, this is more tedious
>to administer, which may explain why our bureaucrats came up with the proposed cap :^) . Now before I
>get flamed on this idea, please understand that I don't pretend this is the ideal way of solving the
>problem. I just tought of it as a constructive way to contribute to this debate. 

Well how would you feel if you phone your doctor next February and he/she says
"Sorry, but we've reached our limit of money, so you'll have to wait for
another 2 months before I can see you."  ??
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
doesn't cost you anything extra as an individual.  There isn't much money left
for research in anything, as I'm sure you're aware.  So what if we cut your
salary so that we have more money to do research on reducing pollution in the
pulp and paper industry??  It's certainly an important topic, but should you
have to pay for it out of your own salary??  Yes, the docotors are in effect
taking a pay cut.   The 'global cap', as it's referred to, is only being
increased in relation to the increasing total population in BC.  It does not
reflect the aging of our population, the increased usage by the public or any
new technologies.  The projection by the economists when this bill was brought
it was that doctors take-home pay (before taxes) would be one half of what it
is now within 6 to 7 years, at the present rate of use/abuse of the medical
system.  As for your other suggestion, that applies more to the cap of
$350,000 that was put on the total gross billings that any one doctor can
make.  The Ontario system was more similar to the one you suggest.  The
interesting thing here is that few doctors are complaining about this cap.
The few that it has affected are either working less days per year, or have
left the country.
>
>The issue is not that much to control M.D.'s salaries, but rather to control the cost of health care. Why
>would you go to arbitration, asking a single individual to take position for or against a political decision
>made by a democratically elected government ? 

No.  We're talking about negotiations between two groups on a contract.  The
government presents it's side, then the doctors present their side.  Then the
arbitrator decides on a fair deal for both sides.  This is NOT a political
decision, it is contract negotiations.
 
>
>"legally negociated" ? Isn't this the pension plan that was refused to them by our former Socred
>Finance Minister for lack of funds, and then finally granted to them after a meeting with Van Der Zalm ?
>Machiavelli was darn right when he said that people forget  (and I could add that they forget very fast).

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.

>

-- 
#     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??      #
Newsgroups: bc.general