Transcript: Show #74 | Oct 13, 1996

The opening sequence rolls.

In animation, the title "Fourth Reading" spins against a red background.

Then, snippets from the current episode play.

Steve says THIS WEEK,
THE POLITICS OF HEALTHCARE.

Lesley Bell is in her forties, with long wavy red hair with bangs in a half-do. She wears a white blazer over a floral blouse and a pair of pendant earrings.

She says WHAT WE CURRENTLY SEE
IS THE CONTINUATION
OF POWER AND POLITICS
OF THE PAST.
WE HAVE THE O.M.A. OFF
NEGOTIATING WITH THE
GOVERNMENT'S NEGOTIATING
TEAM ON A FEE FOR SERVICE.
IT'S A COMPLETELY PERVERSE
INCENTIVE THAT REWARDS
THE WRONG BEHAVIOUR.

A fast clip shows images of The Toronto Hospital facilities.

Steve says WHO'S WINNING
AND WHO'S LOSING IN
THE SCRAMBLE FOR SHRINKING
HEALTHCARE DOLLARS?

Steve, Ruth, and Richard sit with another panellist and two guests around a table in the shape of a number 4.

Steve is in his mid-thirties, clean-shaven, with short curly brown hair.

He's wearing a dark gray polo T-shirt and dark gray blazer.

Ruth Grier is in her sixties, with short white hair.

Richard Mahoney is in his late forties, clean-shaven, with short white hair.

Steve says DOCTORS.
SUCCESSIVE ONTARIO
GOVERNMENTS HAVE FOUND
THEY CAN'T LIVE WITH THEM,
THEY CAN'T LIVE WITHOUT THEM.
THE PROSPECT OF DOCTORS
ABANDONING EMERGENCY WARDS
HAS TERRIFIED MANY A
HEALTH MINISTER AND HIS
OR HER PREMIER, ALTHOUGH
THE JURY'S OUT AS TO WHETHER
DOCTORS' STRIKES ACTUALLY GET
THE PHYSICIANS WHAT THEY WANT.
AFTERNOON, EVERYBODY.
I'M STEVE PAIKIN AN
WELCOME TO 4TH READING.
AS THE MIKE HARRIS
GOVERNMENT PRESIDES
OVER RESTRUCTURING OF
THE HEALTHCARE SYSTEM,
OBSTETRICIANS,
ORTHOPAEDIC SURGEONS,
AND EVEN YOUR GOOD
OLD-FASHIONED FAMILY DOCTOR,
WELL, THEY'RE ALL
THREATENING TO DENY
THEIR SERVICES UNLESS
THE GOVERNMENT
PUTS MORE MONEY
IN THEIR POCKETS.
HEALTH MINISTER JIM WILSON
HAS ALREADY SAID
HE'LL FIND THAT MONEY
FOR THEM FROM OTHER
PARTS OF THE SYSTEM.
SOME WILL COME FROM
RECENTLY ANNOUNCED
HOSPITAL SHUTDOWNS IN
SUDBURY AND THUNDER BAY,
OR THE 15 MORE EXPECTED
IN METRO TORONTO ALONE.
MEANTIME, THOUSANDS
OF NURSES
ARE EXPECTED TO
BE LAID OFF.
IN A MOMENT, WE'LL
ASK TWO KEY PLAYERS
IN THE SYSTEM WHY SOME
FOLKS ARE BEING CUT,
WHILE OTHERS
REWARDED IN THE SCRAMBLE
FOR SHRINKING
HEALTHCARE DOLLARS.
LET'S LOOK NOW AT SOME
RECENT DEVELOPMENTS.

A fast clip from the legislature rolls with the caption "Jim Wilson. Minister of Health."

Jim is in his mid-forties, clean-shaven and with short thinning straight blond hair. He wears a soft gray suit, white shirt, patterned tie and a red ribbon on his lapel.

He says HEALTHCARE IS NOT THE
BRICKS AND MORTAR.
BUILDINGS DON'T CURE
PEOPLE, PEOPLE DO.

Steve says REACTION TO THE
RECENT HOSPITAL CLOSURES
IN SUDBURY AND
THUNDER BAY,
AND NURSE LAYOFFS IN
TORONTO WAS LOUD
AND PASSIONATE.

The caption changes to "Lyn McLeod. Liberal Leader."

Lyn is in her mid-fifties, with short wavy gray hair. She wears glasses, a blue blazer over a white blouse and a silver brooch.

She says MINISTER, THIS HAS
EVERYTHING TO DO WITH
THE CUTS YOU AND MIKE
HARRIS AND JIM WILSON
HAVE MADE TO
HOSPITAL BUDGETS.
IT HAS EVERYTHING TO DO
WITH STARVING COMMUNITY
HOSPITALS TO THE POINT
WHERE THEY HAVE TO CLOSE.
AND IF THEY DON'T
DO IT VOLUNTARILY,
YOUR MINISTER'S
HATCHET MEN COME IN
AND DO IT TO THEM.

Steve says MARK ROCHON HAS
BEEN CALLED WORSE
THAN A HATCHET MAN.
IT'S SOMETHING HE'S
GETTING USED TO AS HEAD OF
THE COMMISSION RESPONSIBLE
FOR CLOSING HOSPITALS.

Mark is in his early-forties, clean-shaven and with short straight brown hair. He wears a white shirt and a patterned tie.

He says THIS ISN'T JUST ABOUT
HOSPITAL RESTRUCTURING
AND HOSPITAL CLOSURES,
WE'RE TALKING ABOUT
FUNDAMENTALLY CHANGING THE
WAY IN WHICH SERVICES
ARE PROVIDED TO PEOPLE
WHO LIVE IN ONTARIO.
AND THAT MEANS
IN THE SHORT RUN,
WE'LL CLOSE SOME
HOSPITALS AND CONSOLIDATE
CAPACITY WHERE IT
MAKES SENSE.

Steve says SURPRISINGLY,
HE'S GOT THE SUPPORT
OF THE ONTARIO HOSPITAL
ASSOCIATION AND MANY
OF ITS MEMBER HOSPITALS.

The caption changes to "David McKinnon. Ontario Hospital Association."

David is in his late forties, clean-shaven and with short slightly wavy gray hair. He wears glasses, a black suit, white shirt and patterned tie.

He says THERE ARE HUGE
POSSIBILITIES IN USING
THE SAME TECHNOLOGIES
THAT BANKS AND OTHERS USE
TO SHARE INFORMATION TO MAKE
SURE PEOPLE HAVE FASTER
ACCESS TO THE BEST MEDICAL
KNOWLEDGE IN THE WORLD
VIA COMMUNICATIONS
LINKS AND NOT IN TERMS
OF THEIR PHYSICAL
PRESENCE ON SITE.

The caption changes to "Scott Rowand. Wellesley-Central Hospital."

Scott is in his mid-forties, with short receding straight blond hair and a moustache. He wears a gray suit, pale gray shirt and printed tie.

He says WE NEED TO RESTRUCTURE
THE INDUSTRY.
WE'VE BEEN LEADING
RESTRUCTURING
BY RESTRUCTURING
OURSELVES.
CERTAINLY, THE COMMISSION
AND THE COMMISSIONERS
HAVE ALL BEEN SAYING
THEIR PREFERENCE
IS FOR VOLUNTARY
SOLUTIONS, RATHER THAN
IMPOSED SOLUTIONS.
THAT'S WHAT WE'VE
TRIED TO DO.

Steve says ROCHON ALSO HAS
THE PUBLIC SUPPORT OF
THE ONTARIO MEDICAL
ASSOCIATION WHICH
REPRESENTS DOCTORS
IN ONTARIO.

The caption changes to "Gerry Rowland. Ontario Medical Association."

Gerry is in his late forties, with short wavy red hair and a graying beard. He wears a pale gray suit, white shirt and printed tie.

He says WE UNDERSTAND THE
NEED FOR REFORMS
IN THE HEALTHCARE SYSTEM.
DOCTORS ARE WILLING TO
PARTICIPATE ACTIVELY
IN THOSE REFORMS IN ORDER TO
ASSURE THAT THEY ARE DONE
IN THE APPROPRIATE WAY,
AND THAT THE SYSTEM
IS STILL ABLE TO MEET THE
NEEDS OF THE PEOPLE
IN ONTARIO.
THAT'S WHERE WE HAVE
TO DIRECT OUR EFFORTS.

Steve says BUT BEHIND
CLOSED DOORS,
THE O.M.A. HAVE BEEN ENGAGED
IN TOUGH NEGOTIATIONS
WITH THE GOVERNMENT
AFTER OBSTETRICIANS
AND ORTHOPAEDIC
SURGEONS THREATENED
TO WITHDRAW SERVICES.
THAT THREAT CAME AFTER THE
GOVERNMENT TRIED TO END
SUBSIDIES FOR MALPRACTICE
INSURANCE AND CLAW BACK
DOCTORS' INCOMES.

Jim says AS WE SEE THE DOCTORS COME
OUT OF THE HOSPITAL SIDE
OF THE LEDGER, AS WE
REDUCE ADMINISTRATION
AND WASTE THERE AND REINVEST
THOSE DOLLARS IN PHYSICIAN
SERVICES, BUT WE WANT TO
DO IT STRATEGICALLY
TO HELP SOLVE PROBLEMS,
NOT SIMPLY THROW MONEY
AND COMPOUND PROBLEMS
THAT ARE HISTORIC.

The caption changes to "Lesley Bell. Ontario Nurse’s Association."

Lesley says WELL, I MEAN, WE HAVE OUR
OWN NEGOTIATING TABLE.
WE HAVEN'T BEEN INVITED TO
PLAY WITH WHAT I FONDLY
REFER TO AS THE BOYS.
THEY PLAY IN THEIR
OWN LITTLE CIRCLE.
THAT'S ONE OF THE
PROBLEMS WITH HEALTHCARE.
YOU CAN'T KEEP THE DOCTORS
AND WHAT THEY DO
TO THE SYSTEM IN A
SEPARATE BOX AND DEAL
WITH THEM SEPARATELY FROM
THE REST OF THE SYSTEM.

Steve says OKAY, JUST BEFORE WE GET TO
OUR DISCUSSION HERE
IN THE STUDIO, LET'S TAKE A
LOOK INSIDE OUR FACT FILE
TO GET SOME HARD
NUMBERS ON THIS TOPIC.

A slate appears with the caption "Fact File. Health care: 17.7 billion dollars. Hospital cuts: 1.3 billion dollars. Nurses’ layoffs: 5,000. Nurse: 43,000 dollars. Orthopaedic surgeon: 128,000 dollars. Obstetrician: 121,000 dollars. Family doctor: 74,000 dollars."

Steve says THOSE FIGURES,
INCIDENTALLY,
COURTESY THE ONTARIO
MINISTRY OF HEALTH,
THE ONTARIO NURSES'
ASSOCIATION,
AND THE ONTARIO
MEDICAL ASSOCIATION.
OKAY, LET'S
GET TO IT.
HERE TO TALK ABOUT THE VERY
POLITICAL BATTLES
ONGOING IN OUR HEALTHCARE
SYSTEM ARE TWO
OF THE KEY PLAYERS.
DOCTOR ROBIN RICHARDS IS
PRESIDENT OF THE ONTARIO
ORTHOPAEDIC ASSOCIATION.

Robin is in his forties, clean-shaven and with short wavy brown hair. He wears glasses, a blue suit, striped shirt and paisley tie.

Steve says LESLEY BELL, WHOM WE JUST
SAW IN THE BACKGROUND
PIECE, CHIEF EXECUTIVE
OFFICER OF THE ONTARIO
NURSES' ASSOCIATION.
THANK YOU BOTH FOR
BEING HERE TODAY.
WE APPRECIATE IT.
AND HERE TO JOIN IN
OUR DISCUSSION
ARE THREE FAMILIAR FACES.
THEY ARE RUTH GRIER, WHO
HERSELF IS A FORMER HEALTH
MINISTER IN THE PROVINCE OF
ONTARIO, AND RICK MAHONEY,
THE FORMER PRESIDENT OF
THE ONTARIO LIBERAL PARTY,
AND LAWYER WITH FRASER
AND BEATTY IN OTTAWA,
AND HUGH SEGAL, SENIOR
TORY GOVERNMENT ADVISOR.

Hugh is in his mid-forties, with short straight brown hair. He wears glasses, a blue suit, striped shirt, blue V-neck sweater and patterned tie.

Steve says
OKAY, LET'S GET
STARTED.
DOCTOR, LET'S
GO TO YOU FIRST.
CAN DOCTORS
ONLY DO BETTER?
CAN THEY ONLY GET
THE MONEY THEY WANT
IF IT'S A ZERO
SUM GAME?
YOU HAVE TO TAKE
IT FROM SOMEBODY ELSE.

The caption changes to "Doctor Robin Richards. Ontario Orthopaedic Association."

Robin says NO, THERE'S
MANY CHOICES.
I THINK MANY OF US IN THE
HEALTHCARE WANT THE SAME THING,
WHICH IS A STABLE
AND SUSTAINABLE SYSTEM.
AND I THINK THE REAL
QUESTION IS WHETHER
YOU CAN SACRIFICE OUR
HEALTHCARE SYSTEM
ON THE ALTAR OF
DEFICIT CONTROL.
THE MINISTER HAS MANY
CHOICES OPEN TO HIM.
UTILIZATION CONTROLS, A
TIGHTER DEFINITION OF WHAT -

Steve says WHAT
DOES THAT MEAN?
UTILIZATION CONTROLS?
WHAT DOES THAT MEAN?

Robin says WELL, FOR INSTANCE NOW,
DOUBLE DOCTORING.
EVERYBODY AGREES THAT
DOUBLE DOCTORING IS BAD.
YOU GO SEE A DOCTOR
AT A WALK-IN CLINIC,
AND YOU CAN GO SEE YOUR
OWN DOCTOR THE NEXT DAY
FOR THE SAME CONDITION.

Steve says SORRY, HOW DO
YOU PREVENT THAT?

Robin says YOU HAVE TO MAKE RULES.
YOU HAVE TO NARROW
THE DEFINITION
OF WHAT CAN BE
FUNDED.
CURRENTLY, THERE
ARE NO RULES.
IF YOU WANT TO
TAKE THE TIME,
YOU CAN GO SEE AN
ORTHOPAEDIC SURGEON
TEN TIMES FOR THE
SAME CONDITION,
AND THE PUBLIC
PURSE PAYS FOR IT.

Steve says YOU'RE A FORMER
HEALTH MINISTER.
CAN YOU IMAGINE THE PUBLIC
STANDING FOR AN END
TO DOUBLE DOCTORING,
EVEN IF IT IS
THE REASONABLE

The caption changes to "Ruth Grier. Former N.D.P Cabinet Minister."

Ruth says THING TO DO?
YES, I CAN.
I THINK THAT THE SUGGESTION
OF EACH PATIENT BEING
ROSTERED WITH A
PRIMARY CARE PROVIDER
WHICH IS THE ENTRY
POINT INTO THE SYSTEM,
IS THE WAY TO DO IT.
AND I THINK MOST OF THE
GENERAL PRACTITIONERS
AGREE WITH THAT, AS DO THE
NURSES' ASSOCIATION.
SO THAT EVERYBODY
IN THE PROVINCE
WOULD REGISTER WITH A
PHYSICIAN OF THEIR CHOICE.
AND IF THEY WENT
TO SOMEBODY ELSE,
THEN THE PRACTICE WITH
WHICH THEY WERE REGISTERED
WOULD BE DISCOUNTED FOR
THE COST OF THEM
GOING SOMEWHERE ELSE.
THERE WOULD BE A REAL
INCENTIVE FROM THE PROVIDER
AND ON THE PATIENT, AND
A DEVELOPMENT OF A REAL
RELATIONSHIP THAT WOULD
ALLOW THEM TO TALK ABOUT
PREVENTION AND LIFESTYLES
AND A BROADER RANGE
OF THINGS THAN MERELY THE
HANGNAIL THAT HAS BROUGHT
THEM TO THE DOCTOR'S
OFFICE IN THE FIRST PLACE.

Steve says OKAY, I WOULD LOVE TO PICK
UP ON THAT MORE IN JUST
A FEW MINUTES, BUT I WANT
TO GET TO LESLEY HERE
ON THE NOTION ABOUT
THIS ZERO SUM GAME
IN THE HEALTHCARE SYSTEM.
DO YOU FEEL RIGHT NOW
EVERYBODY IS WORRIED ABOUT
THE DOCTORS AND NO ONE
CARES ABOUT THE NURSES?

Lesley says THAT'S CERTAINLY HOW
OUR MEMBERS FEEL.
THE 322 NURSES AT THE
TORONTO HOSPITAL
THAT WERE LAID
OFF LAST WEEK.
I WAS AT A MEETING WITH
THEM ON TUESDAY
WHERE THERE WERE 200
VERY ANGRY NURSES.
NURSES ARE 31 YEARS
EXPERIENCE
GOT LAYOFF NOTICES.
AND IT'S A RESULT OF
THE FUNDING CUTS BASED
ON GOVERNMENT POLICY.
AND WHAT WE HEAR THE
MINISTER SAYING
IS WITH THE DOWNSIZING
IN HOSPITALS,
AND THE CLOSURE
OF HOSPITALS,
WE'LL SEE IF THERE'S
MONEY THERE WE CAN
THEN GIVE TO
THE PHYSICIANS.

Steve says I WANT TO UNDERSTAND
HOW THIS WORKS
ACTUALLY IN THE O.R.
THERE'S A NURSE, WHOSE
COLLEAGUE HAS PROBABLY
BEEN LAID OFF, AND THERE'S
A DOCTOR, BESIDE, WHOSE,
YOU KNOW, THE NURSE IS
PROBABLY PRETTY UPSET
WITH BECAUSE JIM
WILSON SEEMS TO HAVE
THE EAR OF HIS GROUP.
IS THIS GOING TO
AFFECT PATIENT CARE?
IT IS ALREADY AFFECTING
PATIENT CARE?

Lesley says WELL IT CERTAINLY PUTS A
STRAIN ON RELATIONSHIPS.
I THINK WE HAVE TO
RECOGNIZE PEOPLE
ARE PROFESSIONALS AND THEY
ARE THERE TO DO A JOB.
SO ONE WOULD HOPE
THAT DOESN'T HAPPEN.
BUT THERE'S CERTAINLY
LOTS OF BARBS AND ARROWS
BEING THROWN BACK AND FORTH
ACROSS THE OPERATING TABLE
AS WHOSE RIGHT IT IS TO
THE SLICE OF THE PIE.
WHETHER THAT AFFECTS
PATIENT CARE,
I DON'T THINK SO.

Steve says WE'RE REALLY TALKING WINNERS
AND LOSERS HERE, HUGH.
DON'T YOU SEE
IT THAT WAY?

The caption changes to "Hugh Segal. Progressive Conservative Advisor."

Hugh says WE BETTER NOT BE BECAUSE
THE PUBLIC WON'T STAND
FOR A CONTEXT IN WHICH
THE HEALTHCARE SYSTEM
IS BEING MANAGED BY ANY
GOVERNMENT, LIBERAL,
PROGRESSIVE CONSERVATIVE
OR NDP IN TERMS
OF WINNERS AND LOSERS.
THE PUBLIC EXPECTS THE
HEALTHCARE SYSTEM
TO BE MANAGED BY THE
PROFESSIONALS WITHIN IT,
AND BY THE GOVERNMENT
OF THE DAY,
AND THE CONTEXT OF
THE PUBLIC INTEREST.
THAT'S THE NATURE OF
OUR HEALTHCARE SYSTEM.
AND ANY GOVERNMENT
THAT FORGETS THAT,
REGARDLESS OF
ITS AFFILIATION,
WILL PAY A
HUGE PRICE.
I WOULD ARGUE, FOR
EXAMPLE, THE TORIES
ARE OFF A LITTLE IN TERMS
OF THEIR PUBLIC OPINION
STANDING, JUST A BIT,
STILL WELL AHEAD.
MY BET IT'S ALL ABOUT
HEALTH BECAUSE THAT'S
WHERE THE HIGHEST LEVEL OF
PUBLIC ANXIETY ALWAYS IS.
NOW, IN A PERIOD OF CHANGE,
WHEN YOU ARE TRYING TO DO
SOME RESTRUCTURING, TRYING
TO DEAL WITH REFORMS
THAT ARE NECESSARY, MOVE TO
A PRIMARY CARE SYSTEM,
ACCEPT THE FACT
PREVIOUS GOVERNMENT,
AND I GIVE THEM
CREDIT FOR THIS,
FLAT LINED THE GROWTH
LEVEL IN HEALTH BECAUSE
IT WAS GOING TO EAT UP
EVERYTHING IN THE BUDGET,
YOU'RE GOING TO HAVE
SOME REAL TENSIONS,
YOU'RE GOING TO HAVE
SOME REAL PRESSURES.
AS THE O.M.A. HAS PRESSURES
WITHIN ITS OWN ORGANIZATION
BETWEEN PHYSICIANS WHO
FEEL THEY'RE NOT GETTING
THE RIGHT ALLOCATION.

Steve says YOU TELL ME WHAT PEOPLE
SHOULD INFER HERE, OKAY?
JIM WILSON AND THE PREMIER,
THE HEALTH MINISTER AND
THE PREMIER HAVE A MEETING
WITH THE DOCTORS' GROUPS.
YOU KNOW THE DOCTORS
EMERGE FROM THE MEETING
AND EVERYBODY IS NOW
SUDDENLY SAYING OKAY,
WE'RE GOING TO FIND
YOU SOME MONEY.
THE DOCTORS PUT
PRESSURE ON,
THEY APPEAR TO BE HAVING
SOME KINDS OF MINOR VICTORIES,
AND THE NURSES ARE
SAYING, WAIT A SECOND,
WE'RE STILL
GETTING LAID OFF.
WHAT CONCLUSIONS
WOULD YOU DRAW?

The caption changes to "Richard Mahoney. Former Ontario’s Liberal Party President."

Richard says WELL, THE CONCLUSION
THAT WOULD BE DRAWN
IS THERE IS OBVIOUSLY SOME
DEAL BETWEEN THE DOCTORS
AND THE HEALTH MINISTER.
AND WHERE I THINK THE
MINISTER IS BEING WRONG-HEADED
THERE IS IF
HE THINKS FOR A MINUTE
IN TERMS OF NEGOTIATIONS
THAT NURSES,
AND PHYSIOTHERAPISTS, AND
ANY OTHER CARE PROVIDERS
WE HAVE WON'T BE NEXT
IN LINE SAYING, HEY,
WAIT A MINUTE, YOU
PROMISED MORE MONEY
TO DOCTORS,
WHAT ABOUT US?
WE'VE ACTUALLY BEEN LIVING
UNDER SOCIAL CONTRACT,
WE'VE BEEN LIVING
WITH LESS WAGES,
WHY CAN'T WE ACTUALLY GET
MORE MONEY OUT OF THE SYSTEM?
WHERE I THINK HUGH'S RIGHT,
IF THE TORIES ARE OFF
A LITTLE BIT IT'S PROBABLY
BECAUSE OF THE NATURE
OF FEAR IN TERMS OF A
CHANGING SYSTEM.
WHERE I THINK THEY'VE
ACTUALLY ALREADY GOT
IT WRONG - I'M ON A
HOSPITAL BOARD IN OTTAWA.
WHAT IS DRIVING THE SYSTEM
IS COST REDUCTION ALONE,
NOT CARE IMPROVEMENT.
AND MAYBE WE'LL GET,
HOPEFULLY HUGH'S RIGHT,
HOPEFULLY WE'LL GET TO
A POINT WHERE THE CARE,
AND WHAT IS BEST FOR
PATIENTS IS THE ANSWER.
BUT WE'RE NOT
THERE NOW.

Steve says LET ME PURSUE THAT
WITH YOU BECAUSE YOU'VE
JUST RELEASED THIS HUGE
DOCUMENT ABOUT HOW
YOU BELIEVE NURSES ARE NOT
BEING LISTENED TO ENOUGH,
AND NOW IF NURSES HAD A
GREATER SAY YOU COULD
FIGURE OUT HOW TO GET RID
OF A LOT OF THE WASTE
AND DUPLICATION AND SAVE
US A LOT OF MONEY.
AND A LOT OF WHAT'S
HAPPENING RIGHT NOW
WOULDN'T NECESSARILY
HAVE TO HAPPEN.
GIVE ME ONE NEW
IDEA TO SAVE MONEY.

Lesley says ONE NEW IDEA TO
SAVE MONEY.
WE TALK ABOUT INTEGRATED
DELIVERY SYSTEMS.

Steve says WHAT DOES THAT MEAN,
INTEGRATED DELIVERY?

Lesley says WHAT IT MEANS IS YOU
BRING ALL THE COMPONENTS
OF HEALTHCARE TOGETHER:
ACUTE CARE, LONG TERM
CARE AND PRIMARY CARE.
A LOT OF THE THINGS
RUTH SAID FALL INTO
AN INTEGRATED
DELIVERY SYSTEM.
IT'S TIME TO MAKE THE
PUBLIC MORE ACCOUNTABLE
FOR THEIR OWN
CARE, BUT ALSO,
WE'VE GOT TO START LOOKING
AT CONSOLIDATIONS OF HOSPITALS.
YOU DON'T NEED 230
HOSPITALS RUNNING
AT 50 PERCENT CAPACITY.
WE NEED TO START SHUTTING
DOWN SOME OF THOSE HOSPITALS.
BUT THAT DOESN'T MEAN
SHUTTING DOWN HOSPITALS
AND SHUTTING DOWN
INCREASING BED
NUMBERS AS WELL.
SO YOU CAN ELIMINATE M.I.S.
DEPARTMENTS AND FINANCE
DEPARTMENTS, THOSE KINDS
OF DUPLICATIONS
NEED TO BE ELIMINATED.

Steve says AND THE PROBLEM IS, ROBIN,
YOU'RE AT ST. MIKE'S
IN DOWNTOWN TORONTO.

Robin says YES, THAT'S RIGHT.

Steve says LONG PROUD HISTORY OF GOOD
SERVICE TO THE COMMUNITY,
AND SO ON.
BUT HOSPITALS IN THIS CITY,
WHAT ARE THERE 44 OF THEM
IN METRO TORONTO, THE
KIND OF INTERNECINE
WARFARE THAT'S HAPPENING
OUT THERE AS ONE TRIES
TO STAVE OFF, TRIES TO
SECURE ITS OWN SURVIVAL,
HOPEFULLY THEY SAY AT
THE EXPENSE OF OTHERS,
IS INCREDIBLE OUT
THERE RIGHT NOW.
WOULD YOU NOT AGREE?

Robin says WELL, THERE PERHAPS NEEDS
TO BE SOME RESTRUCTURING.
EVERYBODY AGREES
ON THAT.
AND WE'VE LIVED WITH
CHANGE OVER THE YEARS.
LENGTH OF STAY
HAS SHORTENED.
WE'VE LIVED WITH CUTBACKS
IN HOSPITAL BEDS,
CUTBACKS IN O.R. TIME.
AND IT'S A FACT MANY
HOSPITALS ARE NOT
RUNNING AT FULL CAPACITY.
SO IF SOME MONEY CAN BE
SAVED BY RESTRUCTURING
AND AMALGAMATING
HOSPITALS THAT MAKES
A LOT OF SENSE TO
MOST OF US.

Steve says INCLUDING
SAINT MIKE'S.

Robin says IT'S A PAINFUL PROCESS.
I'VE NO IDEA WHAT'S
GOING TO HAPPEN
AT SAINT MICHAEL'S
HOSPITAL.
THAT'S UP TO THE
RESTRUCTURING COMMISSION.

Ruth says HOW CAN YOU SAY THAT IF
THE MONEY HAD TO BE SAVED,
HOW CAN YOU THEN GO ON TO
SAY THAT MONEY OUGHT
TO BE GIVEN TO DOCTORS TO
INCREASE THEIR INCOMES,
WHEN THEY ARE ALREADY
ONE OF THE HIGHEST PAID
PROFESSIONS IN
THE PROVINCE.

Robin says LET'S CORRECT SOME
MISINFORMATION HERE.
THE DOCTORS
NEVER SAID THAT.
THE MINISTER SAID THAT.

Ruth says THE DOCTORS HAVE
ASKED FOR MORE MONEY.

Robin says NO, WE HAVE NOT.
WE HAVE NOT.
THE FIRST THING THE
MINISTER DID WAS TAKE
THE AGREEMENT THAT
WE NEGOTIATED
WITH YOUR GOVERNMENT
AND HE RIPPED IT UP.
SO HE TOOK WHAT WAS A
STABLE AND SUSTAINABLE
SYSTEM AND TORE
UP THE AGREEMENT.
THEN HE SAID THAT WE SHOULD
WORK HARDER AND
HARDER FOR LESS AND LESS.
THAT HE WAS NOT GOING
TO PAY ANY MORE
FOR THE INCREASING AGE
OR INCREASING NUMBER
OF POPULATIONS.
HE WAS GOING TO FIX THE
AMOUNT HE PAID PHYSICIANS
SO THAT OVER THE TERM
OF HIS GOVERNMENT,
WE WERE GOING TO WORK
HARDER AND HARDER
FOR LESS AND LESS.
AND OUR GROUP HAS
DECIDED THAT IS
AN UNACCEPTABLE
SITUATION.

Hugh says CAN I JUST CORRECT
THE DOCTOR ON SOMETHING
WITH RESPECT.
PART OF THAT AGREEMENT
THAT YOU SAID WAS TORN UP
IMPLIED THAT EXCESS
UTILIZATION BY THE PHYSICIANS
BEYOND THE LEVELS
THEY HAD AGREED TO,
WOULD BE REPAID
BY THE PHYSICIANS.
THE PHYSICIANS DID NOT
WANT TO REPAY THAT.
THEY EXPECTED THE NEW
TORY GOVERNMENT TO TURN
THE LEAF AND SAY EVERYBODY
ELSE HAS TO FACE
SOME CUTS, BUT NOT
SOME PHYSICIANS.
AND THE TORY GOVERNMENT
SAID, NO, ACTUALLY,
WHAT YOU HAVE TO REPAY
YOU DO WANT TO REPAY.
THE O.M.A. DIDN'T
WANT TO DO THAT.
THAT'S WHY WE'RE
FACING THE FRACTURE
WE FACED SOME TIME AGO.

Robin says WE COULD TALK ABOUT ALL THE
OTHER PARTS OF THE AGREEMENT.

Hugh says FAIR ENOUGH.

Robin says THAT HAD TO DO WITH
UTILIZATION CONTROL AND ALL
THE OTHER THINGS THAT WE'VE
TALKED ABOUT THAT WERE
NOT FULFILLED, AS WELL.
SO THE SHOE'S
ON BOTH FEET.

Hugh says THE SHOE'S
ON BOTH SIDES.

Richard says THE REASON WHY I THINK
WILSON MADE THAT
COMMITMENT THAT ROBIN
SAYS THEY DIDN'T SEEK
WAS BECAUSE WHAT BILL 26
DID - BY THE WAY, BILL 26 -

Steve says THE BIG
JUMBO OMNIBUS BILL
FROM LAST CHRISTMAS.

Richard says WHICH TOOK AWAY WHAT
THE NDP HAD DONE,
WHICH MADE THE ONTARIO
MEDICAL ASSOCIATION
THE BARGAINING
AGENT, EFFECTIVELY,
FOR DOCTORS ACROSS
THE PROVINCE.
IT REMOVED THE O.M.A.'S
ABILITY TO DO THAT.
THAT INCITED DOCTORS WHO
ACTUALLY THOUGHT THEY HAD
GOT A SYSTEM WHICH NOW
WAS WORKABLE AND WHICH
THEY COULD ACTUALLY
TALK TO THE GOVERNMENT.
DOCTORS WERE ANGRY.
JUSTIFIABLY SO
IN MY VIEW.
WILSON, IN REACTION TO
THAT ANGER HAD TO SORT
OF OFFER UP SOMETHING.
HIS OFFER WAS, WHEN I GET
SAVINGS ON THE HEALTHCARE
SYSTEM, I'LL GIVE
THEM TO YOU GUYS.
THAT'S WHY I THINK
HE DID WHAT HE DID.

Lesley says BUT I THINK WHAT
YOU'VE GOT TO RECOGNIZE
IS WHAT'S WRONG WITH THIS
IS THE POLICY INTENSIVES.
FEE FOR SERVICE IS A
BIZARRE INCENTIVE.
IT REWARDS VOLUME.
PHYSICIANS HAVE TO CHURN
OUT MORE AND MORE AND MORE.
THEY COMPLAIN ABOUT THEIR
QUALITY OF WORK LIFE.
I UNDERSTAND THEIR
FRUSTRATION AND THEIR ANGER.
BUT QUITE FRANKLY, I MEAN,
YOU'VE POINTED OUT THAT
NURSES ARE BEING LAID OFF.
WHAT YOU HAVEN'T POINTED
OUT IS WE ALSO HAVE
A 20 PERCENT ROLL BACK
ON THE TABLE WITH
THE ONTARIO HOSPITAL
ASSOCIATION.
SO NOT ONLY ARE
WE BEING LAID OFF,
WE'RE LOOKING AT 20
PERCENT ROLL BACK.
THAT TAKES US BACK
TO 1974 IN WAGES.

Steve says ROBIN, I DON'T WANT TO
BE TOO CUTE ABOUT THIS,
BUT I DO HAVE A RELEASE HERE
FROM THE O.M.A. WHICH SAYS,
IN FACT, "RESOLVING
THE CLAWBACKS AND BILLING
THRESHOLD ISSUES WILL BE A
TOP PRIORITY FOR THE O.M.A.
IF WE'RE TO AVERT A
SERVICE DISRUPTION."
I MEAN THAT SOUNDS LIKE
YOU GUYS WANT MORE MONEY.
I'M SAYING YOU'RE WRONG
TO WANT MORE MONEY,
BUT IT SOUNDS LIKE YOU'RE
TRYING TO BE A LITTLE
BIT CUTE IN GETTING
AROUND THAT.

Robin says WELL, THERE'S A LOT OF
THINGS THAT NEED TO BE DONE.
IF YOU'RE GOING
TO LAY OFF NURSES,
THE PATIENTS HAVE TO BE
LOOKED AFTER SOMEWHERE.
SO ONE WOULD ASSUME THE
PATIENTS HAVEN'T GONE AWAY,
AND I CAN TELL
YOU THEY HAVEN'T.
I MEAN I CAME HERE FROM
THE OPERATING ROOM.
IF YOU'RE GOING
TO CLOSE BEDS,
YOU NEED TO PROVIDE
AN INTEGRATED SYSTEM.
THERE'S MANY THINGS THAT
NEED TO BE ADDRESSED.
THE DEFINITION OF A
MEDICALLY NECESSARY SERVICE.
CO-INSURANCE AND CO-PAYMENT
WAS USED TO KEEP
THE DRUG PLAN ALIVE.
THERE'S MANY
ALTERNATIVES.
WE SHOULDN'T HAVE TUNNEL
VISION THAT THERE'S
ONLY SO MUCH MONEY AND
THERE'S NO SOLUTIONS,
THERE'S MANY SOLUTIONS.
AND THE MINISTER HAS NOT
ALLOWED ANY DISCUSSION
OF THESE THINGS.

Ruth says BUT HOW DO WE GET
TO THOSE DISCUSSIONS IS,
I THINK, WHAT WE ALL HAVE
WRESTLED WITH, NURSES,
O.M.A., AND ME AS MINISTER.
HOW DO WE GET EVERYBODY
AROUND THE TABLE.
NOW YOU HAVE THE
DOCTORS MEETING
WITH THE PREMIER, MEETING
WITH THE MINISTER,
AND NEGOTIATING FOR
DOCTORS ALL ABOUT MONEY.
YOU DON'T HAVE THEM
NEGOTIATING HOW DO
WE GET TO CREATING A
SYSTEM BECAUSE WE ALWAYS
TALK IN THIS PROVINCE ABOUT
OUR HEALTHCARE SYSTEM.
WE DON'T HAVE A SYSTEM.
A SYSTEM IS INTEGRATED
AND WORKS AS A WHOLE.
WE HAVE HOSPITALS,
WE HAVE PHYSICIANS,
WE HAVE THE OTHER
PROFESSIONS.
AND UNTIL WE GET TO SOME
DEFINITION OF A SYSTEM,
AND A WAY OF FORCING SOME
OF THE POWER STRUCTURES
TO CHANGE TO GIVE
US A SYSTEM.

Steve says WHAT DOES
THAT MEAN?
SOME OF THE
POWERS TO CHANGE?

Ruth says IT MEANS PERHAPS YOU HAVE
TO LOOK AT A GREATER
SHARING OF POWER BETWEEN
THE PHYSICIANS AND OTHER
PROFESSIONS, AND BETWEEN
THE HOSPITALS
AND NON-INSTITUTIONAL CARE.

Lesley says LET'S GET BACK TO
ROBIN'S POINT INITIALLY
WHEN HE TALKS ABOUT
DOUBLE DOCTORING.
WHAT WE NEED TO BE
LOOKING AT IS THE RIGHT
PROVIDER PROVIDING
THE RIGHT SERVICE.
YOU DON'T NEED A
PHYSICIAN FOR EVERYTHING.
YOU CAN LOOK AT NURSES.
YOU CAN LOOK AT
NURSE PRACTITIONERS.
YOU NEED APPROPRIATE
REFERRALS.
WHAT THE SYSTEM NOW
DOES IS REWARD REFERRAL
AFTER REFERRAL
AFTER REFERRAL.
YOU DON'T NEED AN
ORTHOPAEDIC SURGEON
TO LOOK AT A HANGNAIL.
I'M NOT SUGGESTING
THAT HAPPENS,
BUT THERE ARE EXTREMES
WITHIN THE SYSTEM
THAT NEED TO BE
ADDRESSED.

Hugh says THERE ARE A
LOT OF CONSTRAINTS,
JUST IN DEFENCE
OF THE PHYSICIANS,
AND LET'S DEAL WITH WHAT WE
REFER TO EUPHEMISTICALLY
AS THE ORTHOPODS
FOR A MOMENT.

Robin says ORTHOPAEDIST IS
THE CORRECT WORD.

Hugh says THANK YOU
VERY MUCH.
ORTHOPOD IS NOT
IN THE DICTIONARY.

Hugh says THANK YOU
VERY MUCH.
I STAND CORRECTED.
THEY HAVE TO DEAL
WITH A LOT OF TRAUMA.
THEY'RE CALLED
OUT LATE AT NIGHT,
AND THEY'RE CALLED
ON WEEKENDS.
THERE'S NOT A LOT OF YOUNG
PEOPLE COMING ALONG
TO TAKE THEIR PLACE TO
TRY AND DIMINISH
THEIR WORKLOADS.
THERE'S NOT A LOT OF
PHYSICIANS BEING LET
INTO THE PROVINCE
WITH THOSE SKILLS.
SO THEIR LIFESTYLE,
AS A PARTICULAR GROUP,
HAS DIMINISHED, AND
THEY HAVEN'T SEEN
ANY SIGNIFICANT
INCREASE IN INCOME,
AND THEY'RE ONLY
HUMAN BEINGS.
AND WE HAVE TO HAVE A
SYSTEM WHERE ALL
THE PLAYERS FEEL AS IF
THEY ARE BEING TREATED
RELATIVELY FAIRLY.

Steve says WOULD YOU NOT
BE FURIOUS, I MEAN,
IN FAIRNESS YOU CAN
UNDERSTAND THEIR POSITION
ON THIS IN A SENSE, WOULD
YOU NOT BE FURIOUS
IF EVERY TIME YOU DID
A JOB FOR WHOMEVER,
YOU SUBMITTED A BILL AND
YOU ONLY GOT PAID 90 PERCENT
OF WHAT YOU HAD AGREED
YOU SHOULD BE PAID.

Hugh says IF I WERE FURIOUS
ABOUT THAT,
MY POSITION WOULD BE I
DON'T WANT TO GET PAID
AND LESLEY'S MADE THIS
POINT, ON PIECEWORK ANYMORE.
I AM A PROFESSIONAL.
I HAVE A BACKGROUND.
I HAVE A RANGE
OF EXPERIENCE.
I HAVE A CERTAIN
TECHNICAL BACKGROUND.
I'D LIKE TO HAVE AN
APPROPRIATE SALARY AND
BENEFIT PACKAGE SO I CAN
LIVE A NORMAL LIFE AND
DO SO IN A FASHION WHERE I
KNOW THE STATE DOESN'T
PAY MORE EVERY TIME
I SEE SOMEONE.
IN FACT, MY INCENTIVES
ARE TO MANAGE THE CARE
IN A FASHION WHERE WE'RE
NOT RUNNING UP THE BILL.

Ruth says HUGH, YOU
COME FROM KINGSTON,
WHERE THE ACADEMIC HEALTH
SCIENCE CENTRE AT QUEENS
AND THE FIVE KINGSTON
HOSPITALS NEGOTIATED
WITH OUR GOVERNMENT FOR
AN AGREEMENT THAT
IN FACT DID JUST THAT.
SO HAS THE HOSPITAL
FOR SICK CHILDREN.
IT'S POSSIBLE,
IT'S THERE.

Hugh says AND THE RESTRUCTURING
COMMISSION IS HEADED
BY DUNCAN SINCLAIR, WHO WAS
THE DEAN OF HEALTH SCIENCES
AT QUEEN'S, WHO WAS VERY
MUCH INVOLVED ON BEHALF
OF THE SOUTHEASTERN
ONTARIO HEALTH SCIENCE
CENTRE NEGOTIATING
THIS PRECISE APPROACH.
WHICH I THINK IS PROFOUNDLY
HOPEFUL FOR EVERYONE.

Richard says AND I AGREE WITH EVERYTHING
THAT WAS JUST SAID ABOUT
HOW WE CAN MAKE A BETTER
HEALTHCARE SYSTEM EXCEPT
FOR ONE THING, THERE IS NO
EVIDENCE YET IN WHAT
THE RESTRUCTURING COMMISSION
HAS DONE IN THUNDER BAY,
OR SUDBURY, WHAT IT'S
STARTING TO DO IN OTTAWA,
THAT WE'RE GOING
DOWN THAT ROAD.

Lesley says ABSOLUTELY.

Richard says IF IT WAS, I WOULD ACTUALLY
BE PREPARED TO KIND
OF SIT BACK A LITTLE BIT
AND SAY, ALL RIGHT,
HOSPITALS ARE GOING
TO HAVE TO CLOSE,
THERE'S GOING TO
BE PAIN THERE,
WE'RE GOING TO HAVE A
BETTER SYSTEM IN THE END.

Robin says WE SHOULD KEEP IN
MIND THE RESTRUCTURING
COMMISSION IS DEALING
WITH HOSPITALS.
I WOULDN'T SLAM THE
FEE-FOR-SERVICE SYSTEM
WITHOUT PUTTING
SOMETHING IN ITS PLACE.
THE FEE-FOR-SERVICE SYSTEM
HAS SERVED THE PATIENTS
OF THIS PROVINCE VERY
WELL OVER THE YEARS.

Steve says HAS IT?
THAT'S NOT WHAT
I'M HEARING.

Robin says WE SHARE COMMON GROUND
WITH THE NURSES IN THAT
WE ARE PATIENT
CARE ADVOCATES.
I'M THE FELLOW THERE IN
THE MIDDLE OF THE NIGHT
TRYING TO GET THE CASE
DONE, TRYING TO GET INTO
THE OPERATING ROOM WHERE
THERE'S NOT ENOUGH BED.
TRYING TO GET THE PATIENT
INTO THE HOSPITAL WHEN
THE BEDS ARE BEING
CLOSED.
AND I WOULDN'T SLAM THE
FEE-FOR-SERVICE SYSTEM
WITHOUT OFFERING
ALTERNATIVES.

Steve says THAT'S A GOOD POINT.
IS HE GOING TO COME IN IN
THE MIDDLE OF THE NIGHT
AT 3 A.M. TO DO AN OPERATION,
OR TO TACKLE SOME KIND
OF EMERGENCY IF YOU DON'T
GIVE HIM A FEE TO DO IT?

Hugh says WELL, LET ME DEAL
WITH ONE POINT -

Steve says HANG ON,
ANSWER THAT PART.

Hugh says THE ANSWER IS IF THE
OVERALL COMPENSATION
ISN'T FAIR, HE'S GOING
TO HAVE A POWERFUL
DISINCENTIVE LIKE
ANYONE ELSE.
BUT I THINK THE POINT THE
PHYSICIAN MADE ABOUT
MORE MONEY IN THE SYSTEM
IS SOMETHING WE DO
HAVE TO TAKE A LOOK AT.
WHEN ROBERT BOURASSA WAS
ELECTED THE SECOND TIME
AS PREMIER OF QUEBEC, HE ASKED
A MIXED GROUP OF PEOPLE,
INCLUDING NURSES AND
BUSINESS PEOPLE AND OTHERS
ABOUT HOW YOU CAN PRESERVE
UNIVERSAL ACCESS
TO THE HEALTHCARE SYSTEM,
POINT OF CONTACT,
GET MORE MONEY INTO IT
WITHOUT BRINGING
IN PRIVATE MEDICINE.
THEY MADE A RECOMMENDATION
WHICH WASN'T ACTED UPON,
TO HAVE EVERY MEDICAL
SERVICE TREATED AS A
T5, A TAXABLE BENEFIT,
WITH A CEILING,
SO CATASTROPHIC COSTS WOULD
NOT PRODUCE A HUGE RECEIPT
THAT YOU COULDN'T HANDLE
AT THE END OF THE YEAR.
WEALTHY PEOPLE WOULD HAVE
TO PAY MORE INCOME TAX
WHEN THEY ADDED THAT TO
THEIR INCOME TAX FORM.
STUDENTS, LOW
INCOME PEOPLE,
SENIOR CITIZENS AND OTHERS
WOULD PAY ALMOST NOTHING.
YOU'D PUT MORE MONEY
INTO THE SYSTEM,
BUT AT THE POINT
OF CONTACT,
EVERYBODY IS TREATED
EQUALLY WITHOUT
REGARD TO WEALTH.
THERE ARE SOME
CREATIVE SOLUTIONS,
WE HAVE TO BE
LOOKING FOR THOSE,
AND THE PHYSICIAN
IS CORRECT.

Ruth says THE RESTRUCTURING
COMMISSION,
AS THE DOCTOR HAS SAID,
IS NOT SET UP TO DO THAT,
AND IN FACT, WORKS AGAINST
WHAT DOCTOR SINCLAIR
WAS DOING IN KINGSTON
BECAUSE IT'S ONLY LOOKING AT
A LITTLE PIECE OF THE PIE,
AS OPPOSED TO LOOKING
AT PROFESSIONAL SALARIES,
OTHER PROFESSIONS,
AND HOW TO DO IT.

Hugh says THAT'S
FAIR CRITICISM.

Ruth says I THINK THE MINISTER
HAS TRIED TO DISTANCE HIMSELF
FROM THE
HOSPITAL CLOSINGS,
AND IN SO DOING HAS HIVED
OFF THAT BIT OF IT,
AND HAS PREVENTED,
NOT, YOU KNOW,
RELIEVED HIMSELF OF THE
RESPONSIBILITY
OF TRYING TO DO
MORE THAN THAT.
AND THAT'S VERY SAD.
THERE'S NO LEADING
OF THE DEBATE.

Steve says LET ME LEAD A DEBATE
HERE ABOUT STRIKES BECAUSE
THE JURY, I THINK THE
JURY'S OUT AS TO WHETHER
A DOCTORS' STRIKE IS A
GOOD THING OR A BAD THING
FOR THE PROVINCE.
CERTAINLY, WELL, IN '86,
THE DOCTORS WENT
ON STRIKE, OR SOME OF
THEM DID ANYWAY,
AND THE LIBERAL GOVERNMENT
KIND OF LAUGHED
ALL THE WAY TO THE
BANK ON IT.
THEY WON THE
POLITICAL FIGHT,
AND THEY SAVED A LOT OF
MONEY BECAUSE
A LOT OF DOCTORS
DIDN'T DO BILLING.
SO WHAT'S THE
LATEST ON A STRIKE?

Robin says WELL, I DON'T THINK THERE'S
ANY POPULAR STRIKES.
IT'S LIKE ASKING IF
THERE'S ANY POPULAR
CHILD MOLESTERS.
BUT WHAT ARE WE
SUPPOSED TO DO?
I'VE WRITTEN THE MINISTER
21 LETTERS, YOU KNOW.
I'VE GOTTEN TWO
RESPONSES.
AFTER 15 MONTHS WE FINALLY
HAVE A NEGOTIATION GOING ON.
SO DOCTORS HAVE VERY
LIMITED ABILITY.
WHAT ELSE CAN WE DO?

Steve says BUT I NOTE ON THURSDAY OF
THIS WEEK THAT IT'S
NOW FAMILY DOCTORS WHO HAVE
SAID THROUGH THE O.M.A.
THAT THEY'RE NOT GOING
TO TAKE NEW PATIENTS
AFTER NOVEMBER 1ST.

Robin says THAT'S TELLING YOU
SOMETHING IF MORE AND
MORE PROVIDERS ARE MUTUALLY
AGREEING THE SITUATION
IS UNACCEPTABLE, I THINK
THAT'S A PRETTY
STRONG MESSAGE.

Hugh says SURELY THAT APPLIES
THERE'S NO SUBSTANCE
TO THE NOTION THERE'S SOME
SECRET DEAL BETWEEN
THE GOVERNMENT AND PHYSICIANS
IF THEY ARE CONTINUING
TO PUT OUT RELEASES
UPPING THE STAKES.
THE TRUTH IS THE GOVERNMENT
THE TRYING TO FIND A WAY
TO KEEP THE PARTICIPANTS
IN THE SYSTEM,
THAT'S ALWAYS THE
PROBLEM IN POLITICS,
WHAT'S URGENT TAKES
PRECEDENT OVER
WHAT'S IMPORTANT.
YOU DO HAVE TO DEAL WITH
THE SHORT-TERM PROBLEMS
SO YOU GET THE TIME TO
MAKE SOME OF THE MORE
SYSTEMIC REFORMS.
AND THIS MINISTER IS FACING
NO LESS A CHALLENGE
IN THAT REGARD THAN ALL
HIS PREDECESSORS.

Steve says WOULD HE FEAR A DOCTOR
STRIKE RIGHT NOW?

Hugh says I DON'T THINK ANY
RESPONSIBLE MINISTER
OF THE CROWN, CERTAINLY
I WOULD HOPE NOT,
WOULD HAVE ANY INTEREST IN
A DOCTORS' STRIKE EVER.

Steve says ALTHOUGH, YOU KNOW WHAT, IN
1986 WHEN IT HAPPENED
TO THE LIBERALS, I MEAN,
UTILIZATION OF THE SYSTEM
WENT DOWN, THEY SAVE -
THE TAXPAYERS, I GUESS,
SAVED MONEY, AND I DON'T
THINK ANYBODY DIED.
AND YOU KNOW AT
THE END OF THE DAY,
SOME VERY CYNICAL PEOPLE
SAID THIS WAS VERY -

Ruth says YOU DON'T KNOW
THAT, STEVE.
A DOCTORS' STRIKE
IS NOT ACCEPTABLE.

Robin says YOU CAN'T
COMPARE 1986 TO 1996.
THEY ARE A DECADE APART.
1986 STRIKE WAS
ABOUT EXTRA BILLING.
I NEVER EXTRA
BILLED MYSELF.
THIS STRIKE, THIS ACTION,
IS ABOUT A STABLE
AND SUSTAINABLE SYSTEM.

Lesley says IT'S
ABOUT A CLAWBACK,
WITH ALL DUE
RESPECT, ROBIN.
I MEAN, LET'S BE
REALISTIC HERE.
THERE ARE PROBLEMS.
PHYSICIANS HAVE THE RIGHT
TO WITHDRAW SERVICES.
NURSES ARE
ESSENTIAL SERVICES,
WE DON'T HAVE THE
RIGHT TO STRIKE.
WE'RE THE ONES THAT
ARE THERE AT MIDNIGHT.
BUT WE GO BECAUSE WE'RE
PAID A DECENT SALARY
TO DO A JOB.
WHAT I SUGGEST
PHYSICIANS, TOO,
SHOULD BE PAID
APPROPRIATELY,
AND THEY SHOULD BE
EXPECTED TO BE
ON THE JOB DELIVERING
ESSENTIAL SERVICES AS WELL.
A STRIKE WILL AFFECT
PATIENT CARE,
THERE'S NO QUESTION.
WHAT WILL HAPPEN?
THE NURSES WILL PULL
TOGETHER JUST AS THEY
DID IN 1986, BUT THERE
WILL BE PATIENT IMPACT,
AND THAT'S WRONG.

Robin says WELL, BELIEVE
ME, I'M AN ACADEMIC
ORTHOPAEDIC SURGEON.
THE LAST THING I WANT
TO BE DOING RIGHT NOW
IS ORGANIZING A
JOB ACTION.
AND IF THERE WAS ANY
OTHER WAY TO DO IT
I WOULDN'T BE DOING
IT, BELIEVE ME.

Ruth says CAN WE GO TO
WHAT COULD BE DONE?
I MEAN, HAS THE O.M.A. TAKEN
A POSITION ON THE PAPER
CALLED DIALOGUE THAT THE
NURSES PUT OUT THAT
TALKED ABOUT AN
INTEGRATED SYSTEM.
WHAT IS THE O.M.A. DOING TO
TRY TO MOVE TO A GENUINE
REFORM OF THE SYSTEM
THAT WILL DO SOME
OF THE THINGS WE'VE
TALKED ABOUT?

Robin says WELL, I'M A
HOSPITAL-BASED PHYSICIAN,
I'M NOT AN EXPERT IN
PRIMARY CARE REFORM,
BUT THE O.M.A. HAS A
POSITION ON THAT,
AND THAT'S BEEN
PUBLICIZED, AND THERE ARE
PILOT PROJECTS GOING ON.
BUT I'M NOT AN EXPERT IN
THAT PARTICULAR ASPECT -
YOU KNOW WHAT SHE'S
GETTING AT HERE.

Steve says SHE'S SAYING DOCTORS
HAVE TRADITIONALLY BEEN
UNWILLING TO SHARE POWER,
AND THAT'S PART
OF THE PROBLEM.

Robin says I DON'T THINK
THAT'S FAIR.
I REALLY DON'T
THINK THAT'S FAIR.
I AGREE WITH YOU THAT THERE
HAS TO BE INTEGRATION
OF THE SYSTEM.
YOU TALK ABOUT INCOMES.
I STARTED WORKING WHEN
I WAS 33 YEARS OLD,
SO LET'S LOOK AT
LIFETIME INCOME.
JUST DON'T TAKE A YEAR, A
SNAPSHOT OF SOMEONE'S LIFE.
AND THE NURSES ARE
THERE ALL NIGHT,
I KNOW THEY'RE
THERE ALL NIGHT,
I'M THERE ALL NIGHT,
TOO, AND I HAVE TO WORK
THE WHOLE NEXT DAY.
SO I MEAN LET'S
NOT BE UNFAIR.
I THINK THERE'S A LOT OF
COMMON GROUND BETWEEN
DOCTORS AND NURSES, AND IT
WOULD BE WRONG TO TRY
AND SPLIT THEM APART.
I MEAN, WE'RE PRETTY MUCH
SAYING THE SAME THING.

Steve says OKAY, ON
THAT HOPEFUL NOTE,
THE CLOCK HAS RUN OUT.
I'M AFRAID I'VE GOT TO
SAY THANK YOU TO ROBIN
RICHARDS FROM THE
ORTHOPAEDIC -
NOT ORTHOPODS,
ORTHOPAEDIC ASSOCIATION,
AND LESLEY BELL FROM THE
NURSES' ASSOCIATION,
THANKS SO MUCH.
YOU THREE, SEE YOU
AGAIN NEXT TIME.
OKAY, YOUR INPUT INTO
OUR PROGRAM IS ALWAYS
APPRECIATED, SO WRITE
TO US IF YOU WOULD AT:
A slate appears with a caption that reads "4th Reading. Box 200, Station Q, Toronto, Ontario. M4T 2T1."

Steve says OR
IN CYBERSPACE AT:

Another slate appears. It reads "4th Reading. Internet address: fourth_reading@tvo.org."

Steve says THANKS FOR WATCHING.
I'M STEVE PAIKIN.
SEE YOU NEXT WEEKEND.

Music plays and the end credits roll, as Steve and the rest continue the conversation.

A production of TVOntario. Copyright 1996, The Ontario Educational Communications Authority.

Watch: Show #74