LETTERS * CORRESPONDANCE

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Health care in Ontario In "OMA agreement signals cooperation with government, disagreement among doctors" (Can Med Assoc J 1991; 145: 145, 147) Dr. Brian Goldman says: "In 1986, Ontario physicians went on strike to protest the provincial ban on extra-billing, and that job

action severely damaged their credibility." Nobody who is familiar with the situation in Ontario could possibly agree with Goldman's conclusion. The purpose of the strike by Ontario physicians was not simply to get the ban on extra-billing removed or, more accurately, to retain the civil liberty of private practice; it was also a demand that patients who attended the physicians responsible for -

For prescribing information see page 1642

extra-billing be reimbursed up to the level of the payment schedule by the government. Although people could understand the principle of a strike for the right of private practice the coupling of the demand for reimbursement led them to believe that this principle was a smokescreen for greed. This is what damaged the doctors' credibility. I said this at the time in a CBC radio editorial, and it caused some Ontario physicians to condemn me for lack of support. On the other hand, my conversations with many members of the Toronto media and the federal government indicated that the position of the Ontario physicians would have been credible and supportable had they simply presented the public with one demand: the right to private practice. Goldman couples his political ignorance with economic ignorance. He says "Canada spends more than $50 billion on health care each year; without controls on increases in spending, there soon won't be any money left over for other priority items such as education and social assistance." In the past 10 years health care spending has not increased as a portion of the gross domestic product. Therefore there is as much money left over now as there was then. This might change in 1991 with the recession, but apart from this the principle has been true.

provincial government Dr. Goldman omits a very important aspect, namely the patient's role in the equation. In addition, as many others do, he treats our medicare system as if it were made of cement. Medicare is too open-ended and very flawed. It is like letting children loose in a candy store with no limits to their desires. Many patients assume no financial responsibility for their health care costs. The best example of patient-driven costs is the torrent of patients that surges through emergency departments. Many of the problems are trivial, and perhaps in the "old days" they were managed by a telephone call to the family doctor. The present medicare system prevails through ever increasing taxation borne chiefly by employers and also through general taxes. Unfortunately, the federal ministry of health is unable to accept that other systems are possible. Here is an alternative, twotier system. Tier one would cap medical benefits received by patients up to a certain level for drugs and costs relating to caregiver and hospital services. Tier two kicks in above this level. It would be operated on insurance principles, and in Ontario the Ontario Health Insurance Plan (OHIP) would act as the insurance carrier. The premium and deductibles for some services and prostheses would be paid for by the patient. Those people who have Marc A. Baltzan, MD irresponsible lifestyles (e.g., alco200-366 Third Ave. S users of street drugs, pregholics, Saskatoon, Sask. nant teenagers, patients with sexually transmitted diseases) would In commenting on the new agree- pay more through the deductibles ment between the Ontario Medi- and other measures. A certain percal Association (OMA) and the centage of the premium could be CAN MED ASSOC J 1991; 145 (12)

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Health care in Ontario.

LETTERS * CORRESPONDANCE We will consider for publication only letters submitted in duplicate, printed in letterquality type without prDportional spa...
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