Transcript: Show #76 | Nov 03, 1996

(music plays)
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,
CRITICAL CONDITION.

A clip shows Gerry Rowland speaking in a press conference.

He says THERE IS A CRISIS IN
HEALTHCARE, AND IT'S A CRISIS
OF UNDERFUNDING.

Now, in another clip, a man says to the journalists
WE'LL TAKE THE WEEKEND TO
DECIDE WHAT THE NEXT STEPS
WILL BE.

A clip shows doctors in a demonstration.

Steve says SOME ONTARIO DOCTORS
BEGIN TURNING AWAY NEW
PATIENTS AND WANT THE
GOVERNMENT BACK TO THE
NEGOTIATING TABLE.

(music plays)

Steve and four guests sit around a table in the shape of a number 4.

Steve is in his early thirties, clean-shaven, with short curly brown hair. He's wearing a black blazer over a white shirt and floral tie.

He says A POLITICAL RULE OF THUMB IN
ONTARIO IS PEOPLE HERE LOVE
THEIR MEDICARE, AND
GOVERNMENTS TAMPER WITH IT
AT THEIR PERIL.
SOME FAMILY DOCTORS IN THE
PROVINCE HAVE BEGUN TURNING
AWAY NEW PATIENTS, AND THAT
IS AFTER PHYSICIANS TURNED
A RESOUNDING THUMBS DOWN TO
A DEAL NEGOTIATED WITH THE
TORY GOVERNMENT.
AFTERNOON, EVERYBODY, I'M
STEVE PAIKIN, AND WELCOME
TO THIS WEEK'S EDITION
OF 4th READING.
HOW IS THIS ALL
GOING TO AFFECT US?
WE'LL TALK TO THE MAN
CHARGED WITH TRYING TO MAKE A
FRACTIOUS PROFESSION HAPPY,
WHILE NEGOTIATING WITH A
GOVERNMENT BENT ON
HEALTHCARE REFORM.
A LOOK NOW AT WHY THE
DEAL WAS TURNED DOWN.

Now, a clip shows several men sitting at a long table. One of them holds a microphone.

A caption on screen reads "Dr. Gerry Rowland, President, Ontario Medical Association."

Rowland is in his mid-forties, with short light brown hair and a goatee. He wears a gray suit, white shirt and gray patterned tie.

He says WE HAVE REQUESTED THAT
THE GOVERNMENT RETURN TO
NEGOTIATIONS BEFORE NOVEMBER
8th, AND WE WILL RECOMMEND TO
THE DOCTORS OF ONTARIO THAT
NORMAL PRACTICE CONTINUE
UNTIL THAT TIME.

Now, another man speaks in the press conference.

The caption changes to "Dr. David Mendelssohn, Ontario Specialist Coalition."

Mendelssohn is in his late thirties, clean-shaven, with short brown hair. He wears a black suit, striped shirt and black tie.

He says THE HEALTHCARE NEEDS OF
ONTARIANS HAVE BEEN REDUCED
TO ALARMING LEVELS BECAUSE
OF CHRONIC UNDERFUNDING,
AND THE FAILURE OF
GOVERNMENT TO ADDRESS THE
EVER INCREASING PRESSURES
CAUSED BY AN AGING AND
EXPANDING POPULATION.
WE WOULD VERY MUCH LIKE AND
EXPECT AN EARLY MEETING
WITH THE PREMIER AND
MINISTER OF HEALTH TO
FACILITATE THE RESUMPTION
OF THESE NEGOTIATIONS.

Now, another clip shows doctors and nurses in a rally.

Steve says THE OMA'S DECISION
COMES AFTER WEEKS OF BITTER
INFIGHTING AMONG ONTARIO'S
DOCTORS AND GROWING THREATS
OF A DOCTORS' STRIKE.
JOB ACTION BY MANY OF
ONTARIO SPECIALISTS,
ORIGINALLY PLANNED FOR
OCTOBER 1st WAS AVERTED
AFTER THE PREMIER
PERSONALLY INTERVENED.
BUT DOCTORS LINED UP TO
DENOUNCE THE DEAL NEGOTIATED
BETWEEN THE OMA
AND THE GOVERNMENT.

Now, a clip shows people in an auditorium. Two men and two women sit at a long table on stage. One of the men speaks.

A caption reads "Dr. George Tawagi, Ob-Gyn Association."

Tawagi is in his forties, with short brown hair and a moustache. He wears a white shirt and a blue patterned tie under a lab coat.

He says WE CAN'T FUNCTION UNDER
THOSE CONDITIONS.
IT'S NOT BEING GREEDY.
THIS IS JUST
STATING THE OBVIOUS.

Now, a clip shows doctors at a hospital.

Steve says THE MOST CONTROVERSIAL
PROVISION WAS THE CONCESSION
ALLOWING THE GOVERNMENT
TO RESTRICT NEW DOCTORS
FROM SETTING UP PRACTICE
IN OVER SERVICED AREAS.

Now, another clip shows Dr. Sandro Galea speaking.

A caption reads "Dr. Sandro Galea, Professional Association of Interns and Residents."

Galea is in his mid-thirties, with short brown hair. He wears rounded glasses, a denim shirt and a creamy dotted tie.

He says THIS DEAL CONTAINS BILLING
RESTRICTIONS WHICH NOT ONLY
WON'T WORK IN TERMS OF
SOLVING THE UNDER SERVICED AREA
PROBLEM, THEY'RE ALSO GOING
TO DESTROY PEOPLE'S LIVES.

Now, a clip shows a doctor auscultating a kid.

She says OKAY, LISTEN
AROUND THE BACK.

Now, snippets show doctors performing different activities in a hospital.

Steve says THE DEAL REDUCED THE
CLAWBACK OF DOCTORS' PAY
FROM 10 PERCENT
TO 2.9 PERCENT.
IT ALSO RESTORED MALPRACTICE
INSURANCE SUBSIDIES CUT BY
THE GOVERNMENT, AND
LIFTED A CAP ON EARNINGS.

Now, a clip shows Jim Wilson speaking at Parliament.

Steve says AT THAT POINT, HEALTH
MINISTER JIM WILSON WARNED
THE DEAL WAS AS GOOD
AS IT WAS GOING TO GET.

A caption reads "Jim Wilson, Health Minister."

Wilson is in his mid-forties, clean-shaven, with receding light brown hair. He wears a light gray suit, white shirt and blue patterned tie.

He says I WANTED TO MAKE IT CLEAR IF
THE DOCTORS OF THE PROVINCE
THINK THERE IS A BETTER
DEAL AT THIS TIME FROM THE
GOVERNMENT, THERE ISN'T.

Steve says BUT PREMIER HARRIS
OFFERED THE PROMISE
OF MORE TALKS.

Now, a clip shows Premier Harris surrounded by journalists and microphones.

He says IT WOULD BE A GOOD
IDEA TO RATIFY IT.
AND I WOULD ENCOURAGE
THEM TO DO THAT.
AND IF THEY BELIEVE THAT
TURNING IT DOWN OR RATIFYING
IT MEANS THE END
OF NEGOTIATIONS,
IT'S ONLY THE BEGINNING.
IT'S JUST THE FIRST STEP.

Now, a clip shows Gerry Rowland speaking to the camera. He wears an olive green blazer over a light green shirt and patterned tie.

Steve says THE OMA RELEASED
THIS VIDEO LAST WEEK.
IT WAS TRYING TO PERSUADE
ITS MEMBERS TO ACCEPT THE DEAL.

Rowland says NOW I UNDERSTAND THERE IS
DISTRUST OF THIS PROCESS
AMONG SOME OF YOU.
BUT I BELIEVE WE FINALLY
HAVE NEGOTIATIONS
PROCEEDING IN THE
RIGHT DIRECTION.

Steve says THE GROUP
REPRESENTING ONTARIO'S
MEDICAL INTERNS AND
RESIDENTS RESPONDED WITH A
VIDEO OF THEIR OWN, URGING
DOCTORS TO REJECT THE DEAL.

Now, a new video shows Dr. Sandro Galea speaking.

He says THOSE OF YOU WHO ARE
CONSIDERED ABOUT THE
FINANCIAL ASPECTS OF THIS
AGREEMENT WILL ESSENTIALLY
HAVE TO DECIDE WHETHER ANY
OF THIS IS ENOUGH FOR YOU
TO SELL OUT YOUNG DOCTORS.

Steve says HEALTHCARE ANALYSTS
SAY THE DISPUTE BETWEEN
DOCTORS AND THE GOVERNMENT
IS PART OF A BROADER
RESTRUCTURING IN THE
HEALTHCARE SECTOR.

Now, a clip shows Michael Decter speaking.

A caption reads "Michael Decter, health policy analyst."

Decter is in his fifties, clean-shaven with short gray hair. He wears a black suit, white shirt and patterned tie.

He says DOCTORS AND HOSPITALS,
BETWEEN THEM, ACCOUNT FOR
PROBABLY 60-SOME PERCENT
OF THE TOTAL SPENDING.
SO THEY'RE THE
TWO BIGGEST ITEMS.
AND SO YES, NOT ONLY BECAUSE
OF REDUCTIONS, BUT TO PAY
FOR NEW DRUGS, TO PAY FOR
NEW PROCEDURES, YOU NEED TO
ESSENTIALLY RECYCLE MONEY
OUT OF THOSE TWO BIG
SPENDING CATEGORIES.

Now, a clip shows doctors in a hospital.

Steve says THE GOVERNMENT HAS
BUDGETED 17.7 BILLION DOLLARS
FOR HEALTHCARE THIS YEAR, BUT
WITH INCREASING COSTS AND
REDUCED TRANSFERS FROM
OTTAWA, IT SAYS IT NEEDS TO
RESTRUCTURE THE SYSTEM.

The clips end.

Back in studio, Steve says OKAY, WHERE DO THE DOCTORS AND
THE GOVERNMENT GO FROM HERE?
AND WHAT DOES IT
MEAN FOR PATIENTS?
HERE WITH SOME ANSWERS,
PRESUMABLY, IS GERRY ROWLAND.
HE IS THE PRESIDENT OF THE
ONTARIO MEDICAL ASSOCIATION.
WE WELCOME YOU.
THANKS FOR BEING HERE.

Gerry wears a light gray blazer over a white shirt and patterned tie.

He says THANK YOU.

Steve continues YOU KNOW
THESE GUYS.
HERE'S LESLIE NOBLE FILLING
IN FOR HUGH SEGAL TODAY.
LESLIE IS THE PRESIDENT
OF STRATEGY CORP.

Leslie is in her mid-thirties, with curvy long blond hair. She wears glasses and a beige blazer over a black turtleneck sweater.

Steve continues AND FROM THE OTTAWA LAW FIRM
OF FRASER AND BEATTY, HERE
IS RICK MAHONEY, FORMER
PRESIDENT OF THE LIBERAL
PARTY OF ONTARIO,

Rick is in his fifties, clean-shaven, with short gray hair. He wears a dark gray blazer, striped light blue shirt and patterned blue tie.

Steve says AND RUTH
GRIER, HERSELF, A FORMER
HEALTH MINISTER IN THE
GOVERNMENT OF BOB RAE.

Ruth is in her late fifties, with short gray hair. She's wearing a blue Mao jacket with a brooch and a coloured scarf.

Steve says OKAY, LET US START.
I DON'T WANT TO TALK
POLITICS AT ALL.
I WANT TO TALK
MEDICINE FOR A SECOND.
YOU'RE A FAMILY DOCTOR
FROM TILLSONBURG.
NOW, BEFORE YOU GOT INVOLVED
IN ALL THIS OMA STUFF,
WHAT WAS A TYPICAL DAY
LIKE FOR YOU AS A DOCTOR?

A caption reads "Gerry Rowland, president, Ontario Medical Association."

Gerry says WELL, A TYPICAL DAY AS A
DOCTOR BEGAN AROUND 7:30 IN
THE MORNING WITH HOSPITAL
ROUNDS, INTO MEDICAL RECORDS
FOR PAPERWORK FOR ABOUT AN
HOUR, AND THEN TO MY OFFICE
BY 9:30 WHERE I PRACTICED
FROM 9:30 'TIL NOON, AND
ONE 'TIL FIVE, THEN ONE
NIGHT A WEEK FROM SEVEN TO
NINE, AND THEN ONE NIGHT
A WEEK ALL NIGHT IN THE
EMERGENCY DEPARTMENT.
PLUS ONE WEEKEND A MONTH ON CALL
FOR THE EMERGENCY DEPARTMENT.

Steve says AND TYPICALLY YOU'D SEE
HOW MANY PEOPLE A DAY?
HOW MANY PATIENTS?

Gerry says IT VARIED.
I WORKED IN AN
UNDER SERVICED AREA.
TILLSONBURG IS UNDER SUPPLIED
WITH DOCTORS, SO WE CARRY A
SOMEWHAT HEAVIER
LOAD THAN SOME.
A TYPICAL DAY WOULD RANGE
AROUND 60 PATIENTS.

Steve says WHAT'S SO
BAD ABOUT THAT?
WE HEAR FROM DOCTORS
NOWADAYS THAT PRACTISING
MEDICINE IN ONTARIO IS
WORSE THAN IT'S EVER BEEN.
WHAT'S BAD ABOUT THE WAY
YOU'VE JUST DESCRIBED THINGS?

Gerry says WELL, YOU ASKED ME AT THAT
TIME WHAT WAS A TYPICAL DAY
WHEN I BEGAN.
IN THE PRESENT DAY CASE
PHYSICIANS ARE FACING
A MUCH HEAVIER LOAD.
IN THE UNDER SERVICED AREAS
THEY ARE BEING SUBJECT TO
MUCH GREATER DEMAND FROM
A POPULATION THAT IS NOW
OLDER, THEREFORE REQUIRING
MORE CARE, A LARGER
POPULATION BY SOME 700,000
SINCE '92, AND INCREASING
TECHNOLOGIES THAT HAVE
PUT UP THE COST, PLUS
INCREASING COSTS OF RUNNING
THE PRACTICE ITSELF IN
TERMS OF OVERHEADS WHICH
SUPPLY STAFF, WHICH SUPPLY
THE OTHER PEOPLE THAT HELP THE
PHYSICIAN LOOK AFTER PATIENTS.
PHYSICIANS ARE UNDER A
GREAT DEAL OF STRESS, BOTH
FINANCIAL AND OTHERWISE
BECAUSE THE EXPECTATIONS OF
THE PUBLIC HAVE ALSO RISEN.
THEY ARE EXPECTING MORE AND
BETTER CARE FOR LESS AND
LESS IN THE WAY OF
RESOURCES TO PROVIDE IT.
WHAT HAS RESULTED NOW IN
ONTARIO IS QUITE SIMPLY THAT THE
RESOURCES AVAILABLE TO CARE
FOR PATIENTS DON'T MATCH
THE DEMAND.
IN FACT, WE'RE WORKING WITH
ABOUT 138 MILLION DOLLARS LESS THAN
WE HAD IN 1992, AND 700,000
MORE PEOPLE TO CARE FOR.
SOMETHING NEEDS TO HAPPEN SO
THAT THE RESOURCES AVAILABLE TO
PHYSICIANS TO PROVIDE THAT
CARE MATCH THE DEMAND THE
PATIENTS HAVE.

Steve says RUTH I'D LIKE YOU TO TAKE
THE FIRST KICK AT THIS
BECAUSE THE ISSUES HAVEN'T
CHANGED AT ALL SINCE THE
TIME YOU WERE HEALTH
MINISTER A FEW YEARS AGO.
YOUR RESPONSE TO WHAT
YOU'VE JUST HEARD?

The caption changes to "Ruth Grier, former NDP Cabinet Minister."

Ruth says WELL, I THINK MY RESPONSE TO
WHAT I JUST HEARD IS THAT WHAT
ALSO HASN'T CHANGED IS THE
WAY IN WHICH MEDICINE IS
PRACTICED BY A
FAMILY PHYSICIAN.
THERE NEEDS TO BE A GREATER
INTEGRATION OF OTHER
PROFESSIONALS INTO THE
PRACTICE OF MEDICINE.
I DON'T KNOW WHETHER IN YOUR
PRACTICE, DOCTOR, YOU WORK
WITH NURSE PRACTITIONERS OR
MIDWIVES OR CHIROPRACTORS,
BUT THERE ARE MANY OF THE
PEOPLE WHO ARE NOW PUTTING
PRESSURE ON FAMILY DOCTORS
WHO PERHAPS COULD BE SEEN
BY SOMEBODY OTHER THAN THE
FAMILY DOCTOR IF THE WAY IN
WHICH DOCTORS WERE PAID WAS
SUCH THAT IT ENCOURAGED THAT
KIND OF TEAM AND
INTEGRATED APPROACH.

Steve says BUT HIS POINT, THAT PEOPLE
WANT MORE SERVICE, GOVERNMENTS
WANT TO PAY LESS FOR IT.
IS HE RIGHT ABOUT THAT?

Ruth says I THINK PEOPLE HAVE BEEN
ENCOURAGED TO WANT MORE
SERVICE BECAUSE THE WAY IN
WHICH DOCTORS ARE PAID UNDER
THE FEE-FOR-SERVICE SYSTEM,
THERE'S NO INCENTIVE FOR
THE PHYSICIAN TO SAY, LOOK,
DON'T BOTHER COMING TO ME,
WHY DON'T YOU GO TO THE
CHIROPRACTOR, HE CAN DEAL
WITH LOWER BACK PAIN
BETTER THAN I CAN.
SO WE PERHAPS AREN'T
HAVING THE RIGHT MIX OF
PROFESSIONALS TO PROVIDE
THE ADDITIONAL HEALTHCARE
THAT I AGREE AN AGING
POPULATION NEEDS.

The caption changes to "Richard Mahoney, former Ontario Liberal Party president."

Rick says THE GOVERNMENT, AND ALL
GOVERNMENTS, RUTH'S
GOVERNMENT BEFORE, AND THE
TORIES NOW, HAVE A PROBLEM.
THERE IS AN EXPECTATION
THAT YOU'VE TAGGED THAT IF
THERE IS SOMETHING WRONG
WITH ME, I'VE GOT A COLD,
IF I DON'T LIKE THE
ADVICE I GOT FROM MY LAST
PHYSICIAN, I'LL JUST GO TO
ANOTHER DOCTOR, I'LL GO TO
EMERGENCY, I'LL GO WHEREVER.
THERE'S AN EXPECTATION THAT
WE'LL GET FIXED.
AND SOMEHOW THE VARIOUS
PROFESSIONS, AS RUTH SAID,
AND THE GOVERNMENTS HAVE
TO BREAK THE BACK OF THAT
ISSUE IN ORDER TO GET
A SYSTEM THAT WORKS.
I THINK THE FEE FOR SERVICE,
RUTH MENTIONED THE FEE FOR
SERVICE SITUATION WE NOW
HAVE WHERE IF WE GO IN FOR
A PARTICULAR TREATMENT,
THERE'S A TARIFF LITERALLY
THAT DOCTORS CAN PROVIDE
FOR TREATING THAT PARTICULAR
ILLNESS, IS PROBABLY NOW AT
THE ROOT OF THE PROBLEM.
THE ROOT OF THE PROBLEM
IS PROBABLY THE PUBLIC'S
EXPECTATION, AND WE'LL
PROBABLY NEVER GET AWAY FROM
THAT HUGE DEMAND ON A
DOCTOR'S SERVICES UNTIL WE
FIND AN ALTERNATIVE
WAY TO PAY DOCTORS.

Steve says THE ROOT OF THE CURRENT
POLITICAL PROBLEM IS THAT
THE MEDICAL ASSOCIATION
AND THE PROVINCE ARE
NEGOTIATING, AND THEY DON'T
SEEM TO BE ABLE TO FIND
ENOUGH COMMON GROUND TO
KEEP THIS STUFF OUT
OF THE HEADLINES.
AND THE QUESTION, I
GUESS, FOR LESLIE IS,
YOUR GOVERNMENT NOW HAS THE
RESPONSIBILITY OF COMING UP
WITH AN AGREEMENT.
THREE OF THE LAST, WHAT,
I GUESS, THE LAST THREE
AGREEMENTS HAVE ALL BEEN
RIPPED UP UNILATERALLY BY
GOVERNMENT, TWO IN THE
LAST FIVE YEARS ALONE.
WHY SHOULD DOCTORS TRUST
GOVERNMENT TO MAKE A
DEAL NOWADAYS?

A caption reads "Leslie Noble, P.C Advisor."

Leslie says WELL, IT'S NOT JUST A QUESTION
OF TRUSTING GOVERNMENT.
I DON'T THINK DOCTORS HAVE
PARTICULARLY LIKED ANY OF
THE DEALS THEY'VE HAD,
AND THEY'VE BEEN PARTLY
RESPONSIBLE FOR PUTTING
ENORMOUS PRESSURE ON
VARIOUS HEALTH MINISTERS TO
CHANGE THE ELEMENTS OF THE DEAL.
SO THAT'S PART
OF THE PROBLEM.
I MEAN, I GUESS RICK
ADDRESSES THE PROBLEM AT
ITS SOURCE...
UTILIZATION MANAGEMENT.
IT'S NOT DOCTORS' FAULT
THAT PEOPLE DON'T HAVE ANY
CONCEPT OF WHAT IT COSTS
TO GO AND SEE A DOCTOR.
MEDICINE'S FREE.
THAT'S PART OF THE
SOCIALIZED MEDICINE SYSTEM
THAT WE HAVE.
WOULDN'T HAVE BEEN MY
CHOICE, PROBABLY WOULDN'T
HAVE BEEN THE DOCTORS' CHOICE,
BUT THE REALITY IS
SUCCESSIVE GOVERNMENTS,
TORY GOVERNMENTS INCLUDED,
HAVE DETERMINED PERHAPS
THAT'S THE BEST WAY TO
ENSURE EVERYBODY RECEIVES THE
CARE AND TREATMENT THEY NEED.

Steve says I ASSUME YOU'RE BEING
TONGUE IN CHEEK WHEN YOU SAY
MEDICINE IS FREE.
EMPLOYERS ARE PAYING
A HEALTH TAX FOR IT.

Leslie says PEOPLE'S PERCEPTION.
AS A CONSUMER, THEIR
PERCEPTION IS MEDICINE IS FREE.
THERE'S NO MARKET FORCE AT
PLAY THERE BECAUSE THEY
NEVER SEE THE BILL.
IT'S VERY DIFFICULT TO
CONVINCE PEOPLE THAT THERE'S
A CO-RELATION BETWEEN HIGH
TAXES AND HIGH MEDICAL COSTS.
PEOPLE WANT THE SECURITY TO
KNOW THAT THEIR HEALTHCARE
SYSTEM IS THERE FOR THEM.
AND ALL THREE PARTIES
REPRESENTED HERE WANT TO
ENSURE THAT AS WELL.
WE MAY DIFFER ON HOW YOU
GO ABOUT ACHIEVING THAT.

Rick interrupts and says I ALWAYS GET A
LITTLE NERVOUS WHEN I HEAR,
AT THE RISK OF BEING PARTISAN,
WHICH IS UNLIKE ME...

Steve says OH, RISK.
RISK AWAY.

Rick continues WHEN I HEAR TORIES OR
ANYONE ELSE TALKING ABOUT
SOCIALIZED MEDICINE BECAUSE,
LESLIE, WE DO HAVE A
CONSENSUS IN THIS COUNTRY
THAT A PUBLIC HEALTHCARE
SYSTEM IS THE WAY TO GO.
WHAT WE ARE NOW COMING AT
IS UP AGAINST ESSENTIALLY
A DEBATE OF LIMITS.
WE CAN'T GO ON WHERE
THAT EXPECTATION IS.
I DON'T THINK THE SOLUTION
IS GOING TO BE TO
DECONSTRUCT THE PUBLIC
HEALTHCARE SYSTEM.
IT'S GOING TO BE
TO IMPROVE IT.
FIND ALTERNATE WAYS TO
DELIVER SERVICES THROUGH
OTHER PRACTITIONERS, AS
RUTH SUGGESTED, AND FRANKLY
AN ALTERNATIVE WAY TO PAY
DOCTORS A FAIR WAGE FOR A
LIFESTYLE, WHICH Dr. ROWLAND
POINTS OUT, IS PRETTY ONEROUS.

Gerry says LET'S BE CLEAR, THE
FEE-FOR-SERVICE SYSTEM,
WHICH IS THE ONE MOST
PHYSICIANS PRACTICE UNDER
IN ONTARIO, NOT ALL, BUT
MOST AT THIS TIME, REWARDS
PHYSICIANS FOR LOOKING
AFTER THEIR PATIENTS.
THE PROBLEM WE'VE BUTTED
RIGHT UP AGAINST, AND IT'S
BEEN INCREASING TO THE
LEVEL WHERE NOW IT IS
INTOLERABLE, IS THE FACT
THERE ISN'T SUFFICIENT
FUNDING TO ALLOW PHYSICIANS
TO SATISFY THE NEEDS THAT
THEIR PATIENTS HAVE.
THAT CAN'T BE DONE.
WHILE ONE CAN TALK ABOUT A
VARIETY OF WAYS OF PAYING
PHYSICIANS, AND A VARIETY OF
PRACTITIONERS... AND I WOULD
REMIND YOU WE AT THE OMA
HAVE ALWAYS FAVOURED THE
INCLUSION IN AN APPROPRIATE
WAY OF OTHER MEMBERS OF
THE HEALTHCARE TEAM.
WE THINK IT'S VERY IMPORTANT
THOSE EFFICIENCIES BE REALIZED.
BUT THAT NEEDS TO BE DONE IN
A COMPREHENSIVE WAY, IN A
WELL THOUGHT OUT WAY, NOT
IN AN ARBITRARY, WE WILL
IMPOSE THIS ON YOU.
SECONDLY, CAPITATION HAS BEEN
SHOWN NOT TO BE AS EFFICIENT...

Steve says TAKE TEN SECONDS
AND SAY WHAT THAT IS.

Gerry says CAPITATION IS WHEN A
PHYSICIAN IS PAID A SET FEE
FOR TIME LIMIT, BE IT
MONTH, PER YEAR, TO GIVE
COMPLETE CARE TO A PATIENT,
AND IS PAID ON THE NUMBER
OF PATIENTS CARED FOR.
IT'S ALSO BEEN SHOWN IN
STUDY AFTER STUDY NOT TO BE
AS EFFICIENT, BOTH IN
HEALTHCARE WAYS, AND IN
FINANCIAL WAYS, AS THE
FEE FOR SERVICE MODE.
WHAT'S HAPPENING OUT THERE
RIGHT NOW IN ONTARIO IS WE
DON'T HAVE THE RESOURCES
TO MEET THE DEMAND.
SOMETHING NEEDS TO BE DONE
TO ADJUST THAT SO RESOURCES
DO MEET THE DEMAND.
I THINK THERE'S ROOM IN
THERE FOR PATIENTS TO TAKE
GREATER RESPONSIBILITY FOR
SOME SORT OF WAY OF THEM
SAYING DO I REALLY NEED
THIS MEDICAL CARE?
IS IT ABSOLUTELY NECESSARY I
GO TO THE EMERGENCY IN THE
MIDDLE OF THE NIGHT, OR CAN
I WAIT 'TIL MORNING, CAN
ALL THOSE THINGS HAPPEN.

Steve says LET ME ASK YOU THIS, THOUGH,
IF BUZZ HARGROVE HAD
NEGOTIATED A DEAL WITH
CHRYSLER, LET'S SAY, TAKEN
IT TO THE MEMBERSHIP, AND
THREE-QUARTERS OF THE
MEMBERSHIP HAD TURNED IT
DOWN, BOY OH, BOY WOULD
TONGUES BE WAGGING.
PEOPLE WOULD SAY, MAN,
IS THERE A BAD SPLIT
IN THIS MOVEMENT.
YOU JUST NEGOTIATED A
FRAMEWORK AGREEMENT WITH
GOVERNMENT, AND
THREE-QUARTERS OF THE
DOCTORS SAID THIS
WILL NOT PASS.
WHAT DOES THAT SAY TO YOU?

Gerry says LET ME PUT THAT IN
CONTEXT FOR YOU.
WHAT HAPPENED WAS WE TRIED
TO NEGOTIATE WITH THE
GOVERNMENT FOR
SOME 18 MONTHS.
FINALLY, OVER THE LAST EIGHT
WEEKS, WE GOT A COMMITMENT
TO MEANINGFUL NEGOTIATIONS.
THIS HAPPENED IN A MEETING
WITH THE PREMIER AND HEALTH
MINISTER ON SEPTEMBER 4th.
WE BEGAN NEGOTIATIONS
AS SOON AS THE GOVERNMENT
NAMED THEIR TEAM, WHICH
WAS SOME THREE WEEKS AGO.
WE HAVE BEEN NEGOTIATING
FOR THREE WEEKS,
NEGOTIATING INTENSIVELY.
THE PROFESSION TOLD US
THEY MUST SEE TANGIBLE,
MEASURABLE RESULTS
BY NOVEMBER 1st.
WHAT WAS BROUGHT BACK TO THE
PROFESSIONALS IS A PROGRESS
REPORT SAYING WE
HAVE COME THIS FAR.
ARE WE ON THE RIGHT TRACK?
DO YOU WANT US
TO GO FURTHER?

Steve says AND THEY'VE SAID NO.

Gerry says THE PROFESSIONS SAID
YOU'RE NOT QUITE ON THE
RIGHT TRACK, BUT AGAIN,
THEY ACKNOWLEDGED THAT
SIGNIFICANT PROGRESS
HAD BEEN MADE.
THEY INSISTED, VIRTUALLY
UNANIMOUSLY, THAT WE RETURN
TO THE NEGOTIATING TABLE
AND CONTINUE THE PROCESS.
WE'RE A DEMOCRATIC
ORGANIZATION.
OUR MEMBERS HAVE SPOKEN TO
US FROM THE GRASSROOTS,
INDICATED OUR DIRECTION,
AND WE WILL FOLLOW THAT.
WE'RE ASKING THE GOVERNMENT
TO COME BACK AND NEGOTIATE
WITH US AS WELL.

Ruth says ANOTHER WAY OF PHRASING WHAT
THE DOCTOR JUST SAID IS
THAT THE MEMBERSHIP SAID THERE
ARE SOME PARTS OF THE DEAL
WE LIKE, WE'LL CHERRY PICK
THOSE, AND PIECES WE DON'T
LIKE, WHICH WERE THE PIECES
THE GOVERNMENT LIKES,
GO BACK AND RENEGOTIATE.
I MEAN...

Steve says CAN'T DO THAT?

Ruth says IT'S NOT THE KIND OF
NEGOTIATIONS BUZZ HARGROVE
WOULD ENGAGE IN.

Steve says IT'S A SEAMLESS
WEB, IN OTHER WORDS.
YOU'VE GOT TO TAKE
IT OR LEAVE IT.

Ruth says YOU NEGOTIATE A DEAL.
I DON'T THINK ONE SIDE CAN
THEN SAY, OKAY, WE'LL TAKE
THIS AND THIS AND THIS, BUT
WE'LL REJECT THIS AND THIS
AND THIS AND EXPECT TO
GO BACK TO THE TABLE.

Steve says AND THE KEY ISSUE
HERE IS BILLING NUMBERS.
WHO CAN GET THEM AND WHERE.

Ruth says THERE'S
ANOTHER ISSUE, TOO.

Steve says THAT'S THE KEY ISSUE.

Gerry says LET'S TALK ABOUT
THE BILLING NUMBER.
ONE, WE AT THE TABLE WITH
THE GOVERNMENT SAID WE
DON'T THINK THIS WILL
FLY IN THE PROFESSION.
AND THE GOVERNMENT SAID
THERE'S NO DEAL UNLESS YOU
TAKE IT TO THE PROFESSION.
SO WE SAID FINE, WE'LL TAKE
IT OUT TO THE PROFESSION
AND LET YOU KNOW.
THE PROFESSION HAS SPOKEN.
76 PERCENT SAID NO
TO BILLING NUMBERS.
THAT'S PRETTY
CLEAR DIRECTION.
WE NOW WANT TO RETURN TO THE
TABLE WITH THE GOVERNMENT
AND SAY, OKAY THAT ONE
DIDN'T FLY, WE TOLD YOU
IT WOULDN'T, NOW LET'S GO
FORWARD AND SOLVE THE PROBLEM.
BECAUSE THE REAL PROBLEM
HERE AGAIN, AS I'VE SAID
BEFORE, THERE ISN'T
RESOURCES TO MEET THE
PATIENT DEMAND.

Steve says LET ME READ, WHICH I'M SURE
YOU LOVE, THIS EDITORIAL IN
THE GLOBE AND MAIL, WHICH
THEY SUGGEST IS THE NUB OF
THIS THING.
PHYSICIANS HAVE TO REALIZE
THAT THE OLD DAYS ARE OVER,
SAYS THE GOOD GREY
GLOBE.
THE TIME WHEN DOCTORS HAD
THE RIGHT TO SET UP SHOP
WHEREVER THEY PLEASED,
AND BEGIN BILLING THE
GOVERNMENT WHATEVER THEY
WANTED ARE FINISHED.
YOU AGREE WITH THAT?

Gerry says WE AGREE THAT THE
SYSTEM NEEDS REFORM.

Steve says THAT'S NOT
WHAT I ASKED YOU.
DO YOU AGREE WITH WHAT
THE GLOBE IS SAYING?

Gerry says I'LL GET TO IT.
WE AGREE THE SYSTEM
NEEDS REFORM.
WE KNOW THERE ARE UNDER
SERVICED AREAS THAT
ABSOLUTELY NEED PHYSICIANS.
WE ALSO KNOW THAT THERE ARE
AREAS OF OVER SERVICE AND
SOMETHING MUST BE
DONE TO ADDRESS THAT.
THAT CURE WILL
PROBABLY TAKE LONGER.
WHAT WE DO KNOW ALSO IS
ARBITRARILY RESTRICTING
BILLING NUMBERS WON'T WORK,
WON'T SATISFY EITHER NEED.
IT'S BEEN SHOWN IN STUDY
AFTER STUDY THAT IF YOU
FORCE PEOPLE TO GO TO
VARIOUS AREAS TO PRACTICE
MEDICINE, THEY EITHER LEAVE
THE PROVINCE OR THEY DON'T
PRACTICE WELL, OR
THEY AREN'T AT HOME.
WE WANT TO PROVIDE QUALITY
CARE TO THE PATIENTS.
WE'RE WILLING TO SIT DOWN
WITH THE GOVERNMENT, FIND
INNOVATIVE SOLUTIONS, AND
IN FACT WE ALREADY HAVE IN
COOPERATION WITH PAIRO AND
OTHER BODIES, FOUND SOME
SOLUTION THAT ARE
MAKING HEADWAYS.

Steve says RICK?

Rick says OR WHAT THEY DO, IF YOU
SAY OH, YOU WANT TO BE A
DOCTOR, HERE ARE THE
DIRECTIONS TO MOOSE FACTORY.
WHAT HAPPENS IS IF THE
DOCTOR GOES TO MOOSE
FACTORY, HE OR SHE WILL
LIVE OUT THEIR SENTENCE IN
MOOSE FACTORY UNTIL THEIR
FREEDOM OF MOBILITY IS
LIFTED, AND THEY'LL RETURN
TO OTTAWA OR TORONTO OR
LONDON, OR WHEREVER ELSE.
THE SECOND PROBLEM WITH
RESTRICTING THE WAY OUR
DOCTORS CAN PRACTICE...

Steve says SO YOU AGREE WITH
THE OMA ON THIS THEN?

Rick says I DO.

Steve says RESTRICTING BILLING
NUMBERS

Rick says IS WRONG.

Leslie says WHAT'S
THE SOLUTION THEN?

Rick says LET ME GET TO THAT, RIGHT
BRITISH COLUMBIA TRIED THIS
IN THE MID-'80s, AND THE
COURT OF APPEAL OF BRITISH
COLUMBIA SAID YOU CAN'T DO
THAT, IT'S AGAINST SECTION
6 AND SECTION 7 OF THE
CHARTER OF RIGHTS AND FREEDOMS.
WHICH IS FREEDOM OF
MOBILITY, SECTION 6, AND
LIFE LIBERTY AND SECURITY
OF THE PERSON, SECTION 7.
AND THE SUPREME COURT OF
CANADA SAID, THE COURT OF
APPEAL IS RIGHT, LEAVE
TO APPEAL IS DENIED.
SO YOU CAN'T DO IT.
THAT SCHEME WOULD PROBABLY
BE CHALLENGED IN ONTARIO,
AND WOULDN'T DO IT.
THE ONLY WAY THAT I CAN SEE
TO ADDRESS WHAT IS A REAL
PROBLEM, WHICH IS GETTING
DOCTORS INTO COMMUNITIES
LIKE TILLSONBURG WHERE THEY
ARE NOT NOW, IS THEY'VE
TRIED A NUMBER OF
INCENTIVES, SOME OF THAT
HAS WORKED.
THEY'VE OBVIOUSLY
GOT TO GO FURTHER.
I THINK CHANGING AWAY
FROM THE FEE FOR SERVICE
REGIMENT INTO AN ALTERNATE
WAY OF PAYING DOCTORS.
THE PROBLEM IS, YOU GO TO
ALEXANDRIA, ONTARIO, YOU
DON'T SEE AS MANY PATIENTS,
CAN'T BILL AS MUCH, SO YOUR
LIFESTYLE IS AFFECTED.

Steve says RICK, YOU COULD PAY
700,000 DOLLARS A YEAR AND THEY'RE
NOT GOING TO MOVE, AS YOU
POINTED OUT, THEY'RE NOT
GOING TO MOVE TO MOOSONEE.
THAT'S THE REALITY.

Leslie says SUCCESSIVE
GOVERNMENTS HAVE TRIED THAT.

Rick says WE'VE NEVER TRIED
AN ALTERNATE FINANCING SCHEME.
NEVER DONE THAT.
WE'VE GOT A FEE
FOR SERVICE.

Leslie says THE PROBLEM IS
THERE IS NO MARKET
FORCES AT PLAY HERE.
THERE'S NOTHING TO DRAW
ANYONE THERE ON THEIR OWN.
YOU COULD PAY THEM A TON
MONEY MORE, BUT AS LONG AS
THERE'S AN OPTION TO MAKE
JUST AS MUCH MONEY IN
ANOTHER LOCATION JUST BY
HANGING UP YOUR SHINGLE,
AND AS HORRIBLE AS THAT IS
TO ME, I DON'T THINK YOU'LL
FIND A STRONGER FREE
ENTERPRISE ADVOCATE THAN
ME AT THIS TABLE...

Rick says COME ON, YOU'RE A
CLOSET SOCIALIST.

Leslie laughs and says THAT'S ME, RICK.
BUT THE PROBLEM IS THERE IS
ABSOLUTELY ZERO FLEXIBILITY
IN THE CANADA HEALTH ACT TO
ALLOW ANY PRIVATE CAPITAL
WHATSOEVER INTO
THIS SYSTEM.
AND INSTEAD OF FEAR
MONGERING THE ISSUE,
CAN'T WE ALL AGREE THAT
THERE'S A PROBLEM HERE?
THAT WE ALL WANT TO MAKE
SURE THAT EVERYBODY HAS
EQUAL ACCESS?

Rick says WHO'S FEAR MONGERING?

Leslie says EVERY TIME WE BEGIN TO TALK
ABOUT PRIVATE CAPITAL,
MY FRIEND RICK HERE, DID IT
AT THE OUTSET OF THE SHOW.
I'M SCARED OF TORIES
THAT TALK ABOUT THIS.
UNTIL WE ALL AGREE THAT THE
CURRENT SOLUTIONS AREN'T
WORKING, THAT WE HAVE TO
FIND BETTER SOLUTIONS, THAT
THE MARKET FACTORS THAT
ORDINARILY WOULD BE AT PLAY
TO DRAW PEOPLE TO AREAS
WHERE THERE'S JOBS, AND
KEEP THEM AWAY FROM AREAS
WHERE THERE SHOULDN'T BE
JOBS, YOU'RE NOT GOING
TO HAVE A SOLUTION.

Ruth says LESLIE, HOW DO
UNDER SERVICED AREAS GET
TEACHERS, GET CLERGYMEN, GET
ENGINEERS, GET A WHOLE LOT
OF OTHER PROFESSIONALS?
BECAUSE A JOB IS THERE, AND
THERE IS A SALARY ATTACHED
TO THAT JOB.
AND IT EITHER IS AN
ATTRACTIVE ENOUGH SALARY,
OR IT ISN'T AN ATTRACTIVE
ENOUGH SALARY.

Leslie says BUT THERE'S ALSO
NOT THE SAME NUMBER
OF JOBS IN TORONTO.
IF THEY DON'T WANT TO TAKE A
JOB IN St. CATHARINES,
THEY CAN'T JUST GO AND
HANG UP THEIR TEACHER'S
SHINGLE IN TORONTO.
THEY HAVE TO FIND A JOB.
THAT'S DIFFERENT THAN
THE MEDICAL PROFESSION.

Ruth says I KNOW.
THAT'S THE WHOLE POINT.
WHY SHOULD PHYSICIANS BE
THE ONLY PROFESSION THAT
EMERGES FROM THEIR TRAINING
PERIOD WITH AN EXPECTATION
OF A PERMANENT SALARY
WHEREVER IN THE PROVINCE
THEY WOULD CHOOSE TO
SET UP THAT SHINGLE.

Leslie says I DON'T
DISAGREE WITH YOU.

Steve says LET'S HEAR
FROM GERRY ROWLAND.
WHAT'S THE ANSWER
TO THAT QUESTION?

Gerry says YOU NEED TO UNDERSTAND THAT
THE UNDER SERVICED AREA
PROBLEM IS NOT A FINANCIAL

Steve says IT'S A LIFESTYLE
ONE, ISN'T IT?

Gerry says IT'S VERY MUCH
A LIFESTYLE ONE.
AND THE OTHER PROBLEM IS
THAT IN ORDER TO LOCATE
PHYSICIANS IN UNDER SERVICED
AREAS, A GREAT MANY
PHYSICIANS ARE MARRIED
TO OTHER PROFESSIONALS.
THERE ARE LIFESTYLE
ISSUES INVOLVED.
I KNOW, I PRACTICE IN
AN UNDER SERVICED AREA.
YOU'RE ON CALL ALL THE TIME,
THE HOURS ARE LONG, IT'S
VERY DIFFICULT, YOU CAN'T GET
AWAY TO UPDATE YOUR EDUCATION.
YOU ASKED ARE THERE
OTHER SOLUTIONS?
YES, THERE ARE.
WE'VE STARTED THEM,
AND THEY ARE WORKING.
THEY HAVEN'T COMPLETELY
SOLVED THE PROBLEM, THAT'S
WHY WE'RE SAYING WE NEED TO
GO BACK TO THE TABLE AND
NEGOTIATE MORE OF THEM.
BUT WHAT THEY HAVE DONE SO
FAR, WE HAVE A LOCUM PROGRAM
GOING THROUGH THE OMA THAT
LETS DOCTORS IN ISOLATED
AREAS GET BACK-UP SO THEY
CAN GET OUT TO GO TO
FURTHER EDUCATION COURSES,
TAKE A BREAK FOR A WHILE,
REFRESH THEMSELVES, AND
GET BACK IN PRACTICE.
WE HAVE A CONTINUING MEDICAL
EDUCATION PROGRAM THAT DOES
THE SAME THING.
OUR SISTER ORGANIZATION,
PAIRO, HAS THE PAIRO
REGISTRY WHICH ENJOYS THE
SUPPORT OF ALL THE NORTHERN
COMMUNITIES AND...

Ruth says AND GOT
EIGHT DOCTORS.

They all talk at once.

Gerry says ALL OF THOSE ARE
WORKING RIGHT NOW,
AND THIS IS A LONG-TERM
PROBLEM THAT CAN'T BE SOLVED
WITH SHORT TERM GAINS.

Steve says LESLIE.

Leslie says IN MAY OF THIS
YEAR, 475 NEW DOCTORS
CAME INTO THE SYSTEM.
70 PERCENT OF THEM WENT
TO OVER SERVICED AREAS.

Steve says THAT CAN'T CONTINUE
IS WHAT YOU'RE SAYING.

Leslie says IT CAN'T CONTINUE.
AND I UNDERSTAND THAT THE
PROBLEM YOU'VE IDENTIFIED.
I WOULD LOVE TO KNOW THAT
ALL OF THESE EFFORTS ARE
GOING TO WORK.
BUT WE'VE BEEN TRYING
THEM SINCE 1969.
THEY HAVEN'T WORKED.
SO WHAT HAPPENS
WHEN THEY DON'T?

Gerry says LESLIE, WE HAVEN'T
BEEN TRYING THEM SINCE 1969.
WE'VE ONLY HAD THEM
FOR THREE YEARS.

Steve says RICK.

Rick says LESLIE, I AGREE
WITH WHAT YOU SAID.

Leslie says MANY SUCCESSIVE
GOVERNMENTS HAVE TRIED THIS.
WHAT'S THE
REAL SOLUTION?
WHAT HAPPENS AT THE END
OF THE DAY WHEN THOSE
THINGS DON'T WORK?
YOU JUST SAY, I'M SORRY,
YOU KNOW, EAR FALLS,
YOU DON'T HAVE
A DOCTOR?

Gerry says THE REAL SOLUTION
IS A LONG TERM SOLUTION.
THAT'S THE ONE
THAT WILL WORK.
AND IT INVOLVES A
GREAT MANY FACTORS.
YOU NEED TO TAKE PEOPLE
FROM THE SMALL COMMUNITIES,
EDUCATE THEM IN MEDICINE,
AND THOSE ARE THE PEOPLE WHO
WILL RETURN AND STAY.

Ruth says ALL OF
THAT IS IN PLACE.

Gerry says SHORT TERM, ONE-OFF,
ARBITRARY SOLUTIONS WON'T WORK.

Steve says MAHONEY'S BEEN TRYING TO GET
THE FLOOR HERE FOR A WHILE.
GO AHEAD.

Rick says LESLIE IS RIGHT.
IT IS A BIT OF AN
INTRACTABLE PROBLEM.
IT ISN'T WORKING.
WE DO HAVE UNDER SERVICED
COMMUNITIES.
BUT GIVEN THE VERY
INTELLIGENT POINT SHE MADE
ABOUT THAT, WHY ISN'T JIM
WILSON, THIS GREAT MINISTER
OF HEALTH, WHY ISN'T HE
EXPLORING ALTERNATIVE WAYS
OF COMPENSATING
PROFESSIONALS SO THAT THERE
IS NOT... YES, THERE'S SOME
LIFESTYLE DISINCENTIVES,
YES THERE'S SOME
PROFESSIONAL DISINCENTIVES
TO GOING TO MOOSE FACTORY.

Leslie says HE IS
EXPLORING THOSE.

Rick says NO, NO, HE'S DRIVING A
SOLUTION THAT'S FEE FOR SERVICE.
IT'S JUST GOING... WE'RE
GOING TO HAVE THE SAME
PROBLEM NEXT YEAR.

Steve says HANG ON,
RUTH'S TURN.

Ruth says THE DOCTOR AND HIS
ENUNCIATION OF ALL THE
THINGS THAT HAVE BEEN
TRIED, AND YES I KNOW
THEY'RE BEING TRIED, I
STARTED MANY OF THEM.
BY THEY'RE VERY EXPENSIVE.
TO GET DOCTORS TO GO TO EAR
FALLS UNDER THE KIND OF
INCENTIVE SCHEME THAT WE'VE
TALKED ABOUT, YOU'RE PAYING
THOSE DOCTORS A GREAT DEAL
IN TERMS OF THEIR VACATION
TIME, THEIR TIME FOR THE
UPGRADING OF THEIR SKILLS,
YOU KNOW, THE NEGOTIATIONS
WERE EXTREMELY EXPENSIVE
UNDER OUR GOVERNMENT.
AND I DON'T THINK IN THE
CURRENT CLIMATE THERE IS THE
MONEY TO DO THOSE KIND
OF INCENTIVE SCHEMES.
SO WE'RE BACK TO RICK'S
SOLUTION OF A DIFFERENT WAY
OF PAYING DOCTORS THAT
WILL ENCOURAGE A MORE
COMPREHENSIVE
PRACTICE OF MEDICINE.

Gerry says WHAT YOU'RE TALKING
ABOUT IS A POLITICAL
SOLUTION TO A
MEDICAL PROBLEM.
AND THE MEDICAL PROBLEM
IS WE NEED TO GET THE
RESOURCES TO THE PEOPLE,
BUT WE NEED ADEQUATE
RESOURCES IN
WHICH TO DO IT.
CONTINUALLY SCREWING DOWN
THE CAP ON MEDICAL SERVICES,
CONTINUING TO REDUCE THOSE
RESOURCES IS ONLY GOING TO
MAKE THAT WORSE.
AND THEN TO SUDDENLY SAY,
WELL, YOU HAVE TO GO HERE,
IT WON'T HAPPEN.
IT'S NOT A WAY
TO REACH SUCCESS.
WE NEED WELL THOUGHT OUT
COMPREHENSIVE SOLUTIONS.
WE NEED TO MOVE FORWARD.
AND THAT REQUIRES THE
COOPERATION OF THE
PHYSICIANS, THE COOPERATION
OF THE GOVERNMENT.
THAT REQUIRES NEGOTIATIONS.
THAT'S WHAT WE'VE
JUST ASKED FOR.
IT SEEMS
VERY SIMPLE.
THAT'S WHAT WE
HAVE TO DO.

Ruth says YOU KEEP TALKING ABOUT THE
RESOURCES FOR MEDICAL CARE.
I MEAN, WHAT YOU'RE REALLY
TALKING ABOUT IS HOW MUCH
DOCTORS ARE PAID.

Gerry says NO, WHAT I'M
TALKING ABOUT IS FINANCING
THE PROVISION OF
SERVICES TO PATIENTS.

Ruth says WHAT DOES
THAT MEAN?

Gerry says THAT MEANS DOCTORS NEED THE
RESOURCES TO BE ABLE TO
CARE FOR THE NUMBER OF
PATIENTS THEY'RE LOOKING AFTER.

Ruth says DOCTORS NEED
MORE MONEY.

Gerry says THAT
REQUIRES FUNDING.
IT REQUIRES A LOT
OF OTHER THINGS.
AND AS I'VE SAID, WE'RE
READY TO SIT DOWN AND WORK
OUT ALTERNATIVE SOLUTIONS.
WE'RE READY TO NEGOTIATE.
WE'RE READY TO WORK WITH THE
GOVERNMENT ON THIS ISSUE.

Ruth says STEVE, THERE WAS ONE
ELEMENT IN THIS WHOLE DEAL
THAT I'D BE VERY INTERESTED
IN HEARING THE DOCTOR TALK
A BIT MORE ABOUT, WHICH WAS
THE 25 MILLION THAT WAS TO
BE FOUND OUT OF THE
HEALTHCARE SYSTEM.
TO ME, THAT
SPELLED DELISTING.
AND I'D BE INTERESTED IN
WHAT YOUR MEMBERS' ATTITUDE
TO THAT WAS, AND WHAT ROLE
THAT PLAYED IN THE DECISION
THEY MADE TO TURN
THE DEAL DOWN.

Gerry says WELL, DELISTING, OR
MODERNIZATION OF THE FEE
SCHEDULE, CALL IT
WHAT YOU WILL...

Steve says THAT'S GREAT
DOUBLE SPEAK THERE.
MODERNIZATION OF
THE FEE SCHEDULE.

Rick says WHAT THAT MEANS
IS THERE WILL BE CERTAIN
SERVICES WHICH WITH NO LONGER
BE ON THE OHIP SCHEDULE.

Ruth says IT MEANS PATIENTS WILL PAY.

Steve says HANG ON, IN FAIRNESS,
WHO STARTED THAT?

Leslie says DAVID PETERSON.
AND THEN RUTH GRIER
HELPED IT OUT.

Leslie says 20 MILLION DOLLARS
WORTH OF DELISTING.

Ruth says I TOOK OFF A REMOVAL OF
TATTOOS, AND I MAKE NO
APOLOGIES FOR THAT.
HEALTHCARE SHOULD
NOT PAY FOR IT.

Steve says THAT'S NOT
ALL YOU TOOK OFF.

Leslie says THAT
SHOULD CONTINUE.
THE DOCTORS AND THE
GOVERNMENT SHOULD CONTINUE
TO WEED OUT THOSE TYPES
OF SERVICES THAT ARE NOT
MEDICALLY NECESSARILY
AND DELIST THEM.

Ruth says BUT DON'T FORGET, THAT'S A
WAY OF THE DOCTORS EARNING
MORE MONEY BECAUSE THEY CAN
THEN CHARGE THE PATIENTS
FOR THAT.
AND THAT CAN LEAD TO A VERY
SERIOUS EROSION OF THE
CANADA HEALTH ACT.

Leslie says I DON'T OBJECT TO
PAYING DOCTORS MORE MONEY IF
THAT'S WHAT'S REQUIRED TO
HAVE DOCTORS CONTINUING TO
PRACTICE IN THIS PROVINCE.

Steve says WE'RE IN THE
LAST MINUTE HERE.
ALL RIGHT, IN THE LAST
MINUTE HERE, CAN YOU
IMAGINE THAT PATIENTS WOULD BE
HAPPY TO START DIGGING INTO
THEIR POCKET TO PAY DOCTORS
FOR SERVICES WHICH ARE NOW
CURRENTLY COVERED BY OHIP?
WHY WOULD ANY PATIENT THINK
THAT WAS A GOOD THING?

Ruth says OR ANY MINISTER?

Gerry says I THINK YOU'VE PUT THE
FINGER RIGHT ON IT WHEN YOU
SAY THERE ARE SERVICES THAT
ARE NOT MEDICALLY NECESSARY.
WE AGREE THAT GOOD MEDICAL
CARE MUST BE AVAILABLE TO
ALL THE CITIZENS
OF ONTARIO.
WE THINK THERE ARE WAYS IN
WHICH WE CAN PROVIDE THAT,
BUT WE NEED THE
RESOURCES TO DO IT.
WITH RESPECT TO SHOULD
PATIENTS HAVE TO PAY FOR
CERTAIN SERVICES, WELL IF IT'S
A CONVENIENCE SERVICE THAT IS
NOT MEDICALLY NECESSARY, WHY
SHOULD SOCIETY PAY FOR IT?

Steve says IN OUR LAST
TEN SECONDS, ARE YOU
CONTINUING TO TAKE
NEW PATIENTS?

Gerry says YES.

Steve says AND YOU WILL CONTINUE
UNTIL THERE IS AN AGREEMENT
REACHED OR...?

Gerry says I'M THE PRESIDENT OF THE
ONTARIO MEDICAL ASSOCIATION.
AS THE PRESIDENT, I WILL
FOLLOW THE INSTRUCTION OF
COUNCIL WHICH WAS TO DELAY
ANY PRACTICE ADJUSTMENTS
UNTIL NOVEMBER 8th,
PENDING THE RESUMPTION
OF NEGOTIATIONS.

Steve says FAIR ENOUGH.
WE WISH ALL
OF YOU WELL.
THANKS VERY MUCH
FOR COMING IN TODAY.

Gerry says THANK YOU.

Steve says THAT'S Dr. GERRY ROWLAND
FROM THE ONTARIO
MEDICAL ASSOCIATION.
LESLIE NOBLE, THANKS
FOR PINCH-HITTING.
WE'LL SEE YOU TWO
AGAIN NEXT TIME.

Steve faces the screen and says WELL, THE TOPICS ON OUR
PROGRAM OFTEN CREATE A
LITTLE BIT OF CONTROVERSIES,
SO PLEASE LET US KNOW WHAT
YOUR VIEWS ARE ON THEM.
WRITE TO US, IF
YOU WOULD AT…

A slate reads "Fourth Reading. Box 200, Station Q, Toronto, Ontario. M4T 2T1."

Steve says OR IN CYBERSPACE…

A new slate reads "Internet address, fourth_reading@tvo.org."

Steve continues THANKS, EVERYBODY.
I'M STEVE PAIKIN.
SEE YOU NEXT TIME.

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

A production of TVOntario. Copyright 1995, The Ontario Educational Communications Authority.

Watch: Show #76