From: daniel@redwood.ppc.ubc.ca (Daniel Ouellet)
Subject: Re: Opting Out
Organization: University of B.C. Pulp & Paper Centre
Date: Tue, 29 Sep 1992 17:01:44 GMT

In article <1992Sep29.004740.28412@mikejag.wimsey.bc.ca>, brent@mikejag.wimsey.bc.ca (Brent Kennedy) writes:
|> In article <1992Sep28.164605.1618@unixg.ubc.ca> daniel@redwood.ppc.ubc.ca (Daniel Ouellet) writes:

[stuff deleted]
 
|> >
|> >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."  ??

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.

|> 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 ?

|> 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

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 ?

|> 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

Are you talking about the 'decreesing fee' system ? I don't understand you here .

|> 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.

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 ?
  
|> >
|> >"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.

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.

-- 
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Daniel Ouellet, Research Associate
Pulp and Paper Centre, University of British Columbia
2385 East Mall, Vancouver, BC, Canada V6T 1Z4
Tel:(604)822-8240   Fax:(604)822-8563   Email: daniel@ppc.ubc.ca
Newsgroups: bc.general