Thursday, August 21, 2008

CMA chief: Accept the reality of private health care.

The CMA again hires someone who will serve those interested in making our system more of a for profit enterprise very well. There just does not seem enough support for purely non-profit medical care in Canada among doctors to elect a president who is interested in fortifying and advancing the public system. Of course our system has never been in any sense socialist in that the in-puts into the system such as drugs, medical instruments, medical infrastructure, etc. have always been loci of profit rather than non-profit for the most part. This for-profit structure is simply being extended into ancillary services e.g. meals in hospitals, janitorial and housekeeping services, etc. At the same time as medical costs increase there is a trend to unload costs from the taxpayer at large onto the individual. This will make medical care depend more and more upon income and provide more room for private insurers. This is the reality not only in medical care but in every area. In transportation we are returning to a medieval system--toll roads. This ensure profit not just in building the road but in its operation aas well. Similarly in health care we are changing to a situation where there are not only profits from the in-puts but from the oepration of the system as well. This is from the Globe and Mail.

Accept the reality of private health care: CMA chief
'I'm not ashamed,' Ouellet says
August 20, 2008
LAVAL, QUE. -- The natural next step for Canada's health system is allowing more private delivery, which will give patients more choice, and better access to care, the new president of the Canadian Medical Association says.
"My whole career has been about resolving access issues. This is my battle horse," said Robert Ouellet, who takes over today as president of the CMA.
"Private delivery is an accepted practice everywhere in the world and it's time Canada accepted this reality."
A radiologist by training, Dr. Ouellet, 62, owns and operates five medical imaging clinics in suburban Montreal. He is an unabashed promoter of private-sector delivery of medical care and keen to introduce more competition into Canada's health-care system, and he knows this will make him a lightning rod for criticism.

"I've never hidden what I do. I'm not ashamed of it. In fact, I'm quite proud," he said in an interview in his spartan office in suburban Laval.
"And let me remind you that the people who elected me know what I think and what I stand for."
The CMA president is elected by general council, which includes representatives from each province and from groups representing medical specialists.
The presidency is assumed annually by a member from a different province, and this year it's Quebec's turn.
Two years ago, when Brian Day, an orthopedic surgeon who operates a private surgical facility in Vancouver, became president-elect of the CMA, which represents Canada's 67,000 physicians, residents and medical students, there was a huge outcry that the profession was abandoning medicare and embracing the "Darth Vader" of the health system.
In the end, Dr. Day spent his term speaking passionately about improving access and reducing waiting times, issues that resonated with the public. "Darth Vader was actually a good guy. He went from the dark side to the good side," he joked yesterday.
Practically, Dr. Day concentrated on a largely arcane issue, replacing block funding of hospitals with so-called patient-focused funding. His efforts, while not spectacular in the way his critics anticipated, were quite successful, with a number of provinces now testing alternatives to block funding, which could ultimately give patients a lot more control over how their health dollars are spent.
Dr. Ouellet said he plans to continue in this vein, but to speak much more openly about the need to "transform the system."
Yesterday, symbolically, he presented the first motion to the 141st annual meeting of the CMA, calling on the organization to "develop a blueprint and timeline for transformational change in
Canadian health care to bring about patient-focused care" by February, 2009.
While largely unknown outside Quebec, Dr. Ouellet has been a pioneer in the health field and, more specifically, in the delivery of private care.
In 1987, he and colleagues from Cité de la santé hospital opened Canada's first private computed tomography scan clinic. Long before the private-public debate, this was momentous, but sparked little outcry.
"It was such a necessary service that there wasn't much debate," Dr. Ouellet recalled.
In fact, he stumbled into private practice. As head of radiology at the hospital, he was pushing for a CT scanner but was told that it would take between two and three years for the government to process the request.
Outraged, Dr. Ouellet and others in the department bought the CT scanner and contracted their services to the hospital. The workers compensation board and provincial automobile insurance board also signed contracts.
"Rather than wait six months for a scan at a hospital, we provided them in a couple of days," Dr. Ouellet said. It took five years for the hospital to get a CT scanner, which speaks volumes, he said.
Later, Dr. Ouellet and colleagues opened an axial tomography clinic, an MRI clinic and two diagnostic radiology clinics, all private.
Much of their business comes from the publicly funded system, but patients can pay themselves or use private insurance.
Each clinic has a price list at the door, as required by law. At the MRI clinic, it reads: "Brain $650. Pelvis $735, Hip (each) $650."
Dr. Ouellet said this is called consumer choice. "Patients want this, and they demand it," he said.
But Dr. Ouellet also stressed that private delivery of care is appropriate in only some areas.
"I'm not touting privatization of the whole health system. Nobody wants an American-style health system, least of all the CMA," he said. "We must have a universal health system but it has to be accessible and responsive."
In fact, Dr. Ouellet would like to expand one aspect of medicare - coverage of essential prescription drugs.
He said a national pharmacare program is long overdue and easily doable. "Pharmacare exists in Quebec. Why not everywhere else?"
What Dr. Ouellet finds attractive about Quebec's approach is that it's a mixed private-public model. In fact, provincial legislation makes drug insurance mandatory. The system also includes premiums, co-payments and deductibles.
"The system isn't perfect, but it's working. It shows the benefits of a good private-public mix."
Dr. Ouellet knows that his views will make him a lightning rod for criticism.
But he vows he won't back down. To emphasize the point, he reaches into his back pocket, pulls out his wallet and carefully extracts a small newspaper clipping.
"You are the best person to get things moving and your actions could trigger a domino effect," he reads, a smile stretching across his face. "Don't be afraid to make bold proposals and express yourself as frankly as possible."
The words are from the morning's horoscope.
"I'm an Aquarius: A sign that always looks to the future."

No comments: