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Fight with doctors won’t cure what ails the system

The province’s ongoing dispute with its doctors – about two-thirds of whom recently rejected a new pay schedule negotiated with the Ontario Medical Association (OMA) – means Ontarians shouldn’t hold their breath waiting for improvements to the health care system.

While the government has dumped ever-growing amounts into some aspects of the system – essentially paying off public sector workers in exchange for votes – it’s been simultaneously squeezing doctors, who aren’t unionized and can’t be counted on at the ballot box.

At $11.5 billion, payments to doctors account for about a fifth of Ontario’s health care budget. That’s significant, but there’s been downward pressure on these costs of late.

Ontario is not alone in that regard, as other provinces have done the same kind of squeezing with their doctors. A new report this week shows physician related costs rose 3.7 per cent last year to $25 billion Canada-wide, but payments to individual doctors did not – the increased spending can be traced to growth in demand (population, new doctors).

Not government employees, doctors are instead typically self-employed, receiving gross payments – an average of $339,000 in 2015 – from which they have to pay for staff, office costs, equipment and other facets of their practices. Clearly, the problems go well beyond payments to doctors.

Spending on health care increases annually, though in recent years not as quickly as in the past. The growth is unsustainable – the file already accounts for more than 40 per cent of the budget – but hasn’t led to commensurate improvements in the system. In fact, by one metric, wait times, it keeps getting worse.

Studies by groups as diverse as the Wait Times Alliance (made up of doctors’ organizations) and the Fraser Institute (a corporate-interest advocate) show waiting times for medically necessary treatment reached 18.3 weeks in 2015, almost double the 9.3 weeks seen in 1993.

Recent battles with doctors and debates over wait times inevitably raise the issue of private health care – letting doctors offer services outside the blanket of the single-payer, universal health care system Canada has adopted. That in turn leads to comparisons with the situation in the U.S.

The U.S. system works as it does not so much because of private practices, but because of private insurance. Costs are high, the bureaucracy unwieldy, and many people are denied access to treatments, even if they’re insured.

Here, it’s the universality of the system that matters. Everyone has health coverage. One’s income is not a barrier as it is in the U.S., but access is limited because demand outstrips the supply of health care personnel and equipment.

Advocates of U.S.-style health care revel in every delay in our system – every additional day that somebody’s mother has to wait for a knee or hip replacement, the case for a speedier alternative grows stronger. It’s the wait-time argument that is driving much of today’s debate on the future of health care. Americans, we’re told, have quick and easy access to medical tests and treatments. Canadians, on the other hand, have long waiting times for even basic services. They have millions of uninsured citizens who can’t afford health care, while we have a universal system.

Cost is indeed a big issue. Certainly Canadians pay an indirect price for health care: the system consumes more than one tax dollar in five, and spending is rising exponentially. Such increases are not sustainable. Still, Americans spend more on health care. The service is better … for those who can afford it. Not a system we want to emulate fully.

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