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Medical Reform Group Letter to Dennis Timbrell

The Honourable Dennis Timbrell, Minister of Health,
Queen's Park, Toronto

Dear Mr. Timbrell:

There have, in recent months, been several physician and physician associated organizations which have been campaigning to mobilize doctors to secure higher incomes within the present fee for service medical scheme. Specifically, it has been suggested that physicians be allowed to bill patients directly for the difference between O.H.I.P. fees and what they would like to charge the patient. The Medical Reform Group represents a group of doctors who believe that significant changes are necessary to improve the quality of health care services in Canada. The following represents the position of the Medical Reform Group with regard to physician reimbursement and present efforts to increase fee for service payments to doctors.

Both federal and provincial governments have in the past embraced the principle of universal health care. The provincial insurance plans can be seen as the beginning of an attempt to put this principle into practice. Provincial health insurance, although in Ontario still financed by a regressive tax, is without doubt less inhumane than the system which preceded it. Allowing physicians to charge what they like on top of O.H.I.P. would be a step backwards and would increase the disparity in the varying quality of care which people of different incomes already receive.

There remain a myriad of ways in which those who can afford it secure better care. These include semi-private and private hospital coverage, private nursing care, access to physicians who charge outside of O.H.I.P., and access to drugs and dental care which many cannot afford. Private and public patients have certainly been very differently treated in the past, and this has been one of the ugliest aspects of the health care delivery system. There is no doubt that were the proposed changes instituted, a disparity would once again be introduced between the care of those who could pay the doctor's extra fee and those who couldn't. The group that would suffer most would be the working poor whom many physicians would not hesitate to charge, but who can ill afford the added expense.

Permitting doctors to charge what they like would erode the already undermined principle of universal health care. Health care would then truly be a privilege and not a right. We would find such a change completely unacceptable, and we believe it would be equally disturbing to most people in Ontario.

We would now like to address the issue of increased incomes for physicians. Doctors as a group make far more than the median income for the population and thus represent a privileged group within the society. The present economic situation is one of high unemployment in the face of continuing inflation. Large groups within the labouring population have had to accept decreases in the effective buying power of what they are earning. Considering the position of relative material advantage in which doctors already find themselves, we feel it is selfish and socially irresponsible for physicians' groups to be agitating for higher incomes.

Despite all of the above, we would like to make it clear that there are aspects of the physician's lot which we too find unsatisfactory. Many doctors, motivated partially by cupidity but also by other factors, feel compelled to work excessively long hours. The medical profession has no paid holidays, no group dental coverage, no long term pension plan, no guaranteed sick pay. The absence of these constitutes a cause for worry and a financial burden which many others do not have to face. We would like to present an alternative solution to these problems certain aspects of which the Ontario government has already considered as possibilities in terms of future health care delivery planning.

We believe that all physicians should be on a salary which would provide a reasonable income, but certainly not the extravagant amount of money which many doctors now receive. For this salary they would be expected to work hours which are roughly equivalent to the rest of the working population. Fringe benefits such as those mentioned above would be provided for by a health care system which would be under public control and would be financed from the general tax pool. Under such a system physicians would receive fringe benefits, be provided with security, and be guaranteed a reasonable work week, all of which are at present lacking.

We would like to suggest that such a system could be best organized around community clinics democratically run by staff and community members. Community clinics have already been shown to meet with a high degree of patient acceptance and we believe they would be ultimately advantageous for the physician as well. There is little doubt that organization of health care along community clinic lines saves money. Clinics would be an ideal way of implementing a much needed decentralization of health care decision making and delivery.

Excessive physician incomes, while inappropriate, constitute a minor contribution to total health care costs. Up to now, government strategy for cutting health care costs has consisted of a commendable resistance to increasing physician incomes, and a nearsighted reduction in essential hospital services with no provision for outpatient alternatives. We suggest that there are other aspects of the health care system which could more fruitfully be subjected to scrutiny. These include drug costs, pharmaceutical industry advertising and profits, dental care delivery, and the medical technology industry.

In conclusion, we would like to emphasize that the present campaign for higher incomes does not have the support of all Ontario physicians. We of the Medical Reform Group feel that to undercut the concept of provincial or national health insurance covering all medical costs would be extremely undesirable. Further, we believe that putting physicians on salary would improve the quality of care for the public and would ultimately be more satisfactory for physicians as well. We think that such a change in financing of medical practitioners could be best undertaken within the setting of the community clinic as the basic unit of organization of health care delivery. Finally, with regard to cutting health care costs, there are certain areas of exploitation and waste which, previously overlooked, should be examined.

Medical Reform Group

Health critic,
New Democratic Party Health critic,
Liberal Party Editor,
Globe and Mail Editor,
Toronto Star Editor,
Toronto Sun
Ontario Federation of Labour

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