As a physician, the decision-making of the provincial government has become of particular interest to me over the past few weeks. The Ministry of Health and Long-Term Care (MOHLTC) announced they are imposing unilateral cuts to physician fees for the 2nd time since 2012. In addition to the additional cuts across the board to all specialties, they are imposing a ceiling of total physician compensation over a 3-year period. If an aging population and an increasing number of users causes utilization of services to increase above the artificial ceiling, the government will clawback that amount from all physicians after the 3rd year. Let that sink in. A public sector group being forced to compensate for increased public demand.
So why now? Well it’s no mystery the province’s finances are in tatters, and they are looking for easy cuts wherever possible. Physicians are a convenient target right now. Public opinion is generally that physicians are well-compensated, and the government feels they can cut physician compensation without affecting voter confidence. I’ll get to why this is a huge miscalculation later on.
What drives government behaviour? It sounds crass, but quite simply it’s the next election. We are mere months into the term the new Liberal majority government, and all parties are already strategizing for October 2018. This is no secret to anyone with any experience in politics at any level. The goal is to be able to maximize voter confidence and approval come the next election. This is why cuts are made early in a government’s term. Get them over with now, and by the time the next election rolls around, no one will remember they even happened.
This brings me to health care in Ontario. Interestingly, polling numbers show that health care is at a 10-year low in terms of its importance to voters. Which may surprise many, given the general state of angst many have about our health care system. ER wait times, inadequate access to mental health services, underfunding of long-term care and home care, lack of access to family doctors, etc. Anyone working in the system knows that we are on the brink of collapse in many crucial areas. It won’t be pretty. The fact the public is largely unaware of this is a testament to health care workers who work tirelessly to fill system-created gaps.
From the government’s perspective, they know that the two main issues for voters are jobs and the economy. Health care is a distant 3rd, and the government is taking advantage of this. In addition to the cuts across the board to physicians, they have removed financial incentives for physicians to take on new patients. Regardless of the rationale for this decision, the projected result is obvious. Fewer physicians will set up practices in Ontario (as was seen through the 90s and early 2000s), and the number of patients without a family physician will increase. This will push more patients to walk-in clinics and ERs, which the government is fully aware of, hence why they reduced the amount paid for walk-in visits on evenings and weekends. They know demand will be higher there with fewer family physicians accessible. Wait times for specialists will also steadily grow with fewer specialists being attracted to the province.
My prediction is that the quality of our health care system will continue to decline because of underfunding until the middle-to-end of the 3rd year of the Liberals’ 4-year term. By then, strategic spending will be well publicized in a few key areas, the majority of the public will be under the impression that health care is on the rise, and the voter seduction will begin. Without any urgency demanded by the public in the interim, this path will be quite predictable. If there is no political risk to continuing along their current trajectory, the government has no incentive to deviate from their plan. Silence from the public is music to their ears.
But what of the next three years? Is the public really content to sit back and be manipulated like this? Millions of Ontarians will struggle in the health care system for the next three years, simply because the government knows that average Joe Voter isn’t outraged enough about the health care system to do anything.
I’m not asking for sympathy for cuts to physician fees. But what I want the public to understand is that sometime in the next three years, someone close to you will likely feel the impact of these cuts, either through limited access to a family doctor or a specialist. The ONLY way that you can have any impact on this is to let your MPP know how you feel. Let them know that your memory is better than they give you credit for. Any impact on the health care you receive as a tax payer, you will remember in four years. Tell them to get back to the table with doctors and other health professionals, and come up with actual solutions to our health care woes, not just short-term band-Aid proposals. (Here’s an article from former OMA president Dr. Scott Wooder that explains the type of “interest-based, mutual gains bargaining” that the public should be demanding government participate in).
Health care is merely an accounting item to politicians right now. Let them know that it needs to be far more than that. Email, call, or write your MPP and tell them your personal story of why health care is a priority for you. Otherwise we know exactly where we’ll be in four years.