Governance Transformation Essential for the OMA

 

Note: The following guest blog was was written by Dr. Paul Hacker and Dr. Lisa Salamon (pictured above).  While the opinions are theirs, I happen to share those opinions as well.

We, the co-chairs of the Ontario Medical Association’s Governance Transformation 2020 Task Force (GT20), welcome discussion and debate about the recommendations for change in our report, Better Together. These recommendations were made in response to the broad input from council delegates, members, board directors, senior OMA leadership and external stakeholders.

Recent reports about these recommendations have, unfortunately, included inaccurate statements leading to erroneous conclusions. The report, including a summaryand FAQ document, is available in the links or on the OMA website (here).

We would like to highlight for OMA members, the changes that we hope to see in 2021 if these recommendations are endorsed at the council meeting this week and receive final approval at Spring council in May 2020.

Members will directly ratify all negotiated Physician Services Agreements (PSAs)

Currently, council has the authority to ratify any negotiated PSA. In the future, this responsibility will rest with you, the member. Contrary to other reports, if these changes are passed, the OMA would introduce a new bylaw requiring member ratification that could not be overruled or ignored by the board of directors.

Fully informed members will directly vote for their president-elect and directors. Currently, members elect a small proportion of directors to the board, based on where you practice; other members and council elect the rest. In the future, members will vote for all directors, informed by a standardized profile generated by an independent third party.

Members are likely aware of their current role regarding the election of the president-elect: participation in a non-binding member poll while council makes the final selection. In the future, you will vote directly to choose your president-elect.

A collaborative general assembly will replace council

Council, governed by outdated parliamentary rules which promote factional disputes, will be replaced by a general assembly that still represents members through section, district and forum delegates, but seeks to work collaboratively to identify the priorities most important to members.

Members will be given new and enhanced opportunities to contribute to time-limited working groups. This ensures that the work of these groups is relevant to you and other members and uses the expertise found within the membership to help guide the OMA.

The OMA will become more nimble, able to respond to emerging issues effectively:

A streamlined governance structure will result in a more agile organization. Members should notice that communications are clearer, the OMA acts more decisively and that it advances solutions that make sense to members.

Both of us became involved with the OMA in 2016/17 because of frustration with the results we, as members, were seeing. As we got more involved, it became clear that the underperformance of the OMA was not due to a lack of effort. The OMA had stagnated under a governance structure that had grown out of date and was no longer responsive to its members. And in 2019, members told us nothing had changed.

We believe that it’s time for an upgrade. We invite and welcome all members to join us in this change.

Dr. Paul Hacker and Dr. Lisa Salamon are the co-chairs of the GT20 Task Force.

PATIENT SAFETY AND CONTINUITY OF CARE MUST COME FIRST

On October 22, an article by Shawn Jeffords, reprinted in HuffPost online, talked about the government’s call for feedback on letting nurses prescribe certain medications.

This is a critical issue and one in which I and the Ontario Medical Association (OMA) Board are actively involved.  For us, patient safety and continuity of care must come first. The ultimate goal of any scope of practice change should be to improve and enhance high quality patient care, not just to provide convenience.

In the summer and fall of 2018, the OMA shared our concerns directly with the College of Nurses.  We are now completing our submission to the Ontario government.

In short, we welcome and appreciate the value all health care providers bring to patients and the broader healthcare system. I personally have been strongly supportive of nurses in the past as there is simply no way I could look after patients without their help.  Both I and the OMA encourage collaborative, team-based, patient-centred delivery of health care. To that end, the OMA evaluates any changes in scope based on the OMA’s Set of Principles outlined below.

The ability to seamlessly share information is equally critical to the continuity of care for patients. Ideally this information would be shared through electronic health records, so this should be a consideration when looking at any changes to prescribing authority. A complete medical history, including all diagnoses and treatment information, is essential for any practitioner to effectively treat a patient.

OMA Set of Principles

OMA’s highly rigorous process for evaluating scope of practice changes involves using the following key principles. Scope changes should:

  • Be consistent with the knowledge, skill and judgment of the professionals involved
  • Be subject to a rigorous regulatory structure
  • Support a truly collaborative, team-based approach to care as opposed to parallel care
  • Not raise patient safety concerns
  • Be accompanied by system initiatives/supports to ensure that no health care provider is unreasonably burdened with complications arising from expanded scopes of practice from other professions
  • Be subject to stringent conflict of interest provisions
  • Be applied with consideration of current best practices and lessons learned from other jurisdictions
  • Be applied with consideration to cost effectiveness at a health system level
  • Promote inter-professional communication and information sharing
  • Promotes continuity of care
  • Promote positive relationship with patient
  • Should be subject to system evaluation to determine if leading to positive outcome.

To some, the above principles may seem overly onerous.  Others may view this as “turf protection”.  But the reality is that multiple studies have shown that the best care provided to patients is when continuity of care is maintained.  This does not mean that you must get a treatment from your family doctor, it means that your family doctor must be aware of what treatment has been given, so that it can be part of your medical record to inform future decisions made about your care.

Also, to be clear, there are many instances where the changes in scope of practice have been beneficial.  My own ophthalmologist has a collaborative relationship with three optometrists that provides continuity of care, and ensures patients get care in a timely manner.  These type of unique models (not just in ophthalmology) occur throughout Ontario, and must be supported.

The priority of every doctor in Ontario is the health and well-being of their patients. We care for more than 340,000 patients every day.  There is simply no substitute for a doctor.  In order to ensure our patients get the best care, it is important that policy decisions always focus on appropriate high quality health care.  It is this way that we can help to fix the health care system and solve critical issues like hallway medicine.

There Is No Substitute For a Doctor

Note: This blog was originally published on the OMA website.  It’s being reproduced here for those of you who do not access that site.  I have also added commentary on the report about the growth in physician numbers.

Every health care journey is different, but they all have one thing in common. They all involve a doctor. There is nothing pleasant about getting hurt or getting sick. But in Canada, there is something extremely comforting about knowing that doctors are there for us in our time of need.  Patients understand the value of doctors.  They understand that it takes a doctor to diagnose the problem, determine the appropriate course of care and follow them throughout treatment.

Doctors have a minimum of ten years of post secondary education before they enter the profession. They continue to enhance their skills throughout their practice through regular education programs. This training and expertise are what differentiates them from other health care providers. Many providers play a critical role as part of an integrated health care team, but it takes a doctor to identify – and often deliver – the continuum of care needed.

Ontario doctors are on the front lines of our health care system.  We care for 340,000 patients every day, and the health and well-being of those patients is our absolute number one priority.  We know what is working within our system, and we know what needs to be fixed.  We understand that changes being made to health care have to work for patients in real-life situations, and we understand better than anyone that cutting physician services means longer wait times and reduced access to care for our patients.

That last point is critical.  Ontario doctors carry a heavier workload than doctors in many other jurisdictions in the world.  We currently have 2.3 physicians in Ontario for every thousand people.  Europe has, on average 3.9 physicians for every thousand people, with countries such as Sweden and Germany up over 4 (source: World Health Organization’s Global Health Workforce Statistics).  Despite this heavier workload, and because of the dedication of Ontario’s doctors we still manage to provide the best possible care we can to our patients.

Not only do I want to preserve that, but I want to improve on that.  While I’m grateful to see the recent report that suggests the number of physicians is increasing faster than the general population, we still have a long way to go.  Europe also has many structural differences in how they deliver health care (some of which we should copy – a topic for another blog).  But even with those differences, they need more doctors per capita.

Research has shown that a high quality health care system needs strong physician leadership.  Specifically, physician leadership in terms of system design, governance, and implementation is vital.  A doctor-led system that focuses on integrated care provides better quality at lower cost, and this is what we need to build in Ontario.  The patient-centred system of the future, today.

Ontario doctors are willing to help build, and lead, the health care system that Ontarians deserve.  A system that will improve patient care and health outcomes and reduce wait times.  A system that will recognize and meet the needs of rural, Northern and underserved communities.  And a system that removes unnecessary administration and red tape to enable more efficient and effective delivery of care.  It takes a doctor to lead a patient throughout his or her health care journey, and it takes doctors to lead Ontario’s health care transformation.  Because ultimately, there is no substitute for a doctor.

My Experience With The Vaccine Hesitant

Dr. Samantha Hill

The following blog was written by Dr. Samantha Hill (pictured above), President Elect of the Ontario Medical Association.  The blog reflects her opinion and not that of the OMA.  It was published in the Medical Post, but is being republished here for those who do not have access to that site.

It’s an interesting experience, being yelled at by a room full of angry people.    It’s not something physicians encounter regularly.   Professional criticism is usually subtle: askew glances, rejected papers, absent promotions.  Decades of schooling had not prepared me to stand in a room full of people yelling “shame”.

On Monday, I (and others) deputed at the Toronto Board of Health on the merits of vaccination.  We were met by a large crowd of angry people.  I was heckled, jeered at, and even photographed for later attacks on social media.

The aggressive opposition was unexpected, especially when presenting on something as factually obvious as vaccines.   Among doctors, this isn’t a debate.  We KNOW the benefits outweigh the risks.  We know it more certainly than we know many other things in medicine.   Vaccines work.  Vaccines are safe.  Vaccines are vital to our communities’ well-being.

“Liar, you’re all just in it for the money”, someone yelled.   I was angry, defensive, and incredulous.  And above it all there was a sense of surrealism, surely this can’t be real?

But sitting in town hall for 5 hours listening to a crowd of passionate parents and advocates beg that they be allowed not to vaccinate their children I had time to work through some of that.  I had time to get past my perspective and reactions.  So I listened.  Prior to speaking (and being identified), I exchanged smiles with the mother nursing her infant to quiet them, with the mother patting her young daughter’s head while she colored quietly, with the two boys a little older than my eldest who after a few hours of sitting were getting antsy.  There were no smiles after I spoke.  But still, I listened.

A young lady, presented to the Board passionately about bodily autonomy, scholastic freedom, and freedom of choice. While I disagree with her stance entirely, I was, in an odd way, proud of this fierce young woman. She was clear and articulate and witty. I wanted to congratulate her on her activism, on her bravery, on questioning authority figures. I wanted to tell her how impressed I was, and how I was sure she was going to be successful in life, a voice for change, a voice for those who might need help finding their own. But that would have been inappropriate and likely unwelcome. And my heart broke a little, that I as a female physician couldn’t offer this mentorship and support, that in this critical space, doctors were neither trusted nor respected.

Another woman pleaded with the Board to find compassion for those gathered, who sought only to protect their young. And I wondered, how do you tell people who are so certain, that the actions we take that they oppose, are in fact borne out of compassion? Compassion for all the children at risk by being unvaccinated? Compassion for bereaved mothers of children now deceased from preventable infectious diseases? Compassion for cancer patients who are already fighting for their lives, that they not be subjected to yet another battle? It would be perceived as paternalistic and demeaning.  My heart broke a little more.

I heard people decry feeling silenced and coerced, being thought of as uneducated or uninformed. Mostly, though, I heard fear. Profound soul-shattering fear. The instinct to protect our young from a perceived threat is deep-seated; this is a fear that doesn’t allow for logic, or rationality.

Suspend your medical training, your knowledge for a moment. Imagine being cornered, feeling that the doctors and nurses were out to hurt your child, that the government was complicit and supporting them, that YOU were the last line of defense for your children from absolute inevitable severe harm. Imagine that for a moment.  Stay in that place.  Become uncomfortable.  In fact, the horror must be untenable.  I was a parent before I was President-Elect of the OMA. I would stand in front of a firing range for my children. My heart breaks entirely.

It’s an easy stance, being firmly on the side of science, insisting that population health supersedes individual choice.  In fact, I salute the Board of Health on taking a leadership stance on this issue.  It’s hard to hold a space of compassion for the “anti-vaxxers”, to remember that behind their hurtful words and upsetting actions, they are simply terrified and angry parents trying to do their best for their children.  But as I walked away from town hall on Monday, my broken heart demanded that I try.

 

 

 

 

 

 

 

Health System Reform Must Include Physicians

Wright

The following was written by Dr. Jim Wright (pictured above) and Dr. Adalsteinn Brown. I found the blog very thought provoking.  Reproduced at their request and with permission.  Opinions, are theirs.

Ontario has embarked on a bold experiment to transform care with a large focus on Ontario Health Teams or OHTs. At maturity, OHTs will be responsible for the full continuum of care within a community. As the Premier’s Council’s latest report suggests, OHTs should be able to provide an integrated experience for patients, an experience that takes advantage of the latest digital technologies to deliver care where and when patients need it, and that relentlessly improves against the quadruple aim goals of better population health, better cost, better patient experience and better provider experience.

This is a laudable vision and one that is long overdue in Ontario. Several health systems have already begun experimentation, implementation and even evaluation of these sorts of integrated models of care. And while no model of care is a panacea, there are some limited but encouraging signs from these other systems. The history of health system reform, however, in Ontario is one of largely excluding physicians from leadership. So, an important question for physicians in Ontario is how to respond to the OHT reforms. In this blog we consider this question and make some suggestions around the hows and whys of physician engagement in these reforms.

First off, it is important to state the obvious; Health system reform must include physicians. Physicians remain responsible, with their patients, for most decisions around care. It is hard to expect a system of care to change unless that reform engages and works with the physicians. Moreover, the importance of physician (and all clinicians) in reform is clear. One of us has argued previously that clinician engagement and leadership is one of the three must-haves for any health system undergoing reform and is more important than the typical Canadian paths to health system reform like regionalization, electronic medical record implementation, or compensation structures.

Perhaps as importantly, early evidence from the US and the Accountable Care Organization (ACO) experiment where communities of providers come together to take care of defined populations suggests physician leadership is key  to success. Those ACOs that had physician leadership (and particularly primary care leadership) tended to do better. A recent supplement to the New England Journal of Medicine focussed on how to build strong physician leadership in ACO type models.

The ACO experience is important because it is based on a model of risk or gain-sharing where ACOs become responsible for the care and the costs of that care. As care improves, prevention increases and patients are able to stay at home or in the community, ACOs share in these savings. In some models, they can also share in the losses. How should physicians engage with these sorts of models? With this question, it is important to parse carefully the evidence and the OHT model. The first conclusion is that individual physicians should not face risk or gain-sharing on their own patient populations. Although OHTs will manage hundreds of thousands of patients, individual practices will not be large enough to manage risk. One very ill patient could change the cost profile of an individual physician’s practice and we do not want to encourage reforms where physicians are punished for taking on the sickest and most vulnerable patients. Experience with other reform efforts suggests that these sorts of approaches can leave patients without necessary care.

If not risk or gain-sharing on their own patient populations, then should physicians face a pay-for-performance type system where they are encouraged to provide certain types of care or discouraged from other types of care? Again, the conclusion is no. Repeated Cochrane Collaboration reviews have showed a lack of evidence to support pay-for-performance. Although a number of Canadian provinces have implemented pay-for-performance schemes, these have tended to buy small amounts of change in process without impacting outcomes or larger goals like sustainability or equity. In addition, P4P shifts the activity from improving integration to one of compensation. Finally, P4P also inevitably focuses on the metrics rather than the goals of the reforms. Instead of focusing on improvements in the system, P4P often leads to arguing against the metrics.

So, if physicians should be engaged and should be part of OHTs, but should not face risk-sharing or pay-for-performance at an individual level, then how should they participate in OHTs? It is important to remember that OHTs are a new form of organization in Canadian healthcare. Physicians can and should be part of and help lead these organizations. But any incentives they face and any thoughts about risk and gain-sharing should reflect the success of the organization, not of an individual within that organization.

The alternative to gain/risk sharing is to view the improvement in the health of populations, improved quality of care and enhanced integration are incentive enough to encourage doctors to participate in OHTs and change their practice. Doctors want to do the right thing for their patients. Furthermore, enhanced integration will relieve the administrative burden for doctors, should improve their productivity, and most importantly, allow them to spend more time directly caring for patients. Any financial gains of OHTs instead of accruing to doctors could instead be invested in patient care, such as enhanced IT systems or patient navigators and spread out over necessary improvements (and increases in care).

This means that performance measurement and reporting is key. Performance indicators of what we want to achieve in this reform, grounded in the quadruple aim, will be critical. This will also help physicians see and stay focused on improvement. It also means that stronger financial management is key. Without such management, individual OHTs will not be able to prioritize investments in better care. Finally, it re-enforces the importance of physician engagement and leadership. Without it, we risk losing the connection between better system management (and improvement) and the decisions made at the front lines of care.

Although not all will agree, for doctors, health care reform should be all about improved care and integration for all and not about financial gain (and loss) for some.

James Wright is Chief, Economics, Policy & Research at the Ontario Medical Association

Adalsteinn Brown is Dean and Professor at the Dalla Lana School of Public Health, University of Toronto.

Ontario Health Teams A Good Start For System Transformation

The Ontario health care system is in distress.  Frontline health care workers like myself know this.  Many of the rules that we are forced to abide by are archaic and make no sense.  Outdated fax technology only flourishes in health care.  Hospitals are bursting at the seams.  Home care is proving woefully inadequate.  Sadly, patients are suffering from the consequences.  This is what 15 years of neglect and lack of foresight by the previous Ontario Liberal government has caused.

To fix the situation, the new Conservative government of Premier Doug Ford is proposing what has been called the most massive transformation of health care since Medicare. The first step is to form an agency– called Ontario Health – that will merge up to 20 different agencies into one.  Long-time fans of mine (all three of them) will know this is music to my ears.  It was step three in the seven-point plan I urged then-Premier Wynne to follow to fix health care back in 2017.  I can’t help but be pleased this is finally happening – and certainly expect a significant reduction in Ontario’s bloated bureaucracy as a result.

The second step is to form a number of “Ontario Health Teams”(OHTs).  The goal of these teams is to provide Integrated Care Delivery Systems (ICDS).  There’s a lot of bureaucratic verbiage in the documents released to date, but essentially the goal is to ensure that different health care providers (doctors/home care/hospitals, etc.) work seamlessly to deliver care to patients, as they move through the health care system.  I know, it sounds incredibly basic, and should be straightforward, but unfortunately, it just doesn’t happen as well as it should right now

Can OHTs work?  As always, the devil is in the details.  The first thing that is needed is the political will to transform the health care system.  This is clearly evident.  Health Minister Christine Elliott has been widely lauded as a very capable minister and truly has the ability to provide the political will necessary.  Dr. Reuben Devlin (the Chair of the Premier’s Council on Ending Hallway Medicine) is a strong leader as well.  Thankfully, the person who will have to do a lot of the bureaucratic heavy lifting is new Deputy Minister Helen Angus.  I’ve written about her before, and she certainly appears to be a very strong deputy minister.  I think she’ll do very well.

The next step is to ensure that similar models across the world are studied, and only the successful ones copied.  You see, the OHTs appear to be the Ontario version of something called Accountable Care Organizations (ACOs – I know, you have acronym overload by now).  The goal of ACOs is to provide an amount of funding to a geographic region, and to have all of the health care delivered to patients in that area paid for by that funding.  The OHTs however, appear to be taking a more cautious, pragmatic approach, and are only going to provide funding for outpatient services, and not include physicians’ services. They may evolve in the future, and it’s a smart move on the government’s part not to move too quickly.

Now, the reality is that only some ACOs worldwide actually meet the goals of simultaneously improving health care while reducing health care costs.  So it’s incumbent upon OHTs to reflect those effective models, and not the ones that have failed.  What do the successful models have in common?

First, it is essential to have strong physician leadershipin these models.  For too long, Ontario’s physicians have been blocked from providing advice to the government.  Physicians work on the front lines of health care delivery, and see the effects of bad policy every single day.  They have many ideas on how to transform health care for the better.  The previous Liberal government only viewed front line health care workers as eye candy for photo ops and nothing more. Thankfully, this seems to be changing, and it was refreshing to have Premier Ford’s Senior Advisor Greg Harrington come to visit us at the Ontario Medical Association head office last week (I can’t recall anyone from Kathleen Wynne’s office visiting us).  Governments co-operating with physicians can only help patient care.

Secondly, the mess that is Ontario’s IT infrastructure needs to get cleaned up quickly. You see in 2019, for seamless care to be provided to patients, hospitals need to talk quickly, securely and electronically with home care providers.  Doctors need to talk to pharmacies.  Nursing homes need to get doctors quickly.  In short, the relevant data has to follow the patient.  Projects like the one I was proud to spearhead in Georgian Bay have proven that we can save money and provide better health care at the same time.

These are challenging times in health care, but there is also a great opportunity.  By properly instituting OHTs, Ontario has a chance to finally start reversing its poor record of the past 15 years.  Done properly, this reform of health care could also be a lasting legacy for Premier Ford.

Let’s get it done right.

A Personal Journey Through Public and Private Health Care

Disclaimer:  The following blog was written by Dr. Darren Cargill (pictured below).  He asked that I put it up for him.  Dr. Cargill is a palliative care physician from Windsor, Ontario.  Opinions are his and his alone, and do not necessarily reflect my opinions, or those of the Ontario Medical Association.

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Recently, a series of articles in the Toronto Star claim that Ontario Premier Doug Ford is looking at “private” options to end hallway medicine.  This was, of course, immediately denied by Health Minister Christine Elliot who stated her government’s ongoing support for public health care.

To support this narrative, the Ontario NDP brought forward a leaked piece of draft legislation called the “Health Systems Efficiency Act”. This draft suggests that all 14 Local Health Integration Networks (LHINs) and many other agencies (Health Quality Ontario, eHealth, etc.) are to be rolled into one big Agency.  NDP Leader Andrea Horwath claims that this draft legislation is a signal that private health care is the real agenda for the Ford government.  Interesting times for health care in Ontario.

In Andre Picard’s book “Matters of Life and Death,” he eloquently outlines the history of Medicare in Canada, warts and all.  I think we can all agree with his comment “Canadians want care that is appropriate, timely, accessible, safe and affordable, from birth to death.”

So here is our story. In 2007, my wife was diagnosed with cancer. She received excellent care here in Windsor as well as at Western in London as part of her journey.  I can honestly say, that she would not be here today if not for that excellent care. I am indebted to our system for saving her.

Getting cancer at 29 is frightening.  When we wanted a second opinion to confirm the diagnosis and ensure that we were receiving the best possible care, we booked an appointment at Karmanos Cancer Centre in Detroit.  A second opinion in Ontario would have taken months. We got our appointment within days across the border. They confirmed that Windsor was giving us fantastic care.

At one point during her treatment, she needed an MRI.  The wait was many months in Ontario.  At first, she was ok to wait but as the days passed, the wait took its toll.  Eventually, we decided to go to Detroit and have the MRI done, with only a few days wait and near instantaneous access to the results.

When we needed help conceiving following chemotherapy, this too was not covered by our public system and we paid out of pocket for that.  We required help from physicians in both Windsor and Detroit. Today we have a son.  And he has a mother.

Neither system alone gave us what we needed. It was both.

We already have private health care in Canada.  Doctors’ offices are privately run businesses that rely on single-payer public funding to operate. We also have private care when we pay out of pocket for drugs, physiotherapy, psychotherapy, fertility treatments, and dental care.  Canadians already spend money out of pocket for health care so the fears around a “two-tiered” system are odd, to say the least. Two-tiered refers to the argument about equity, not public/private, in my humble opinion.

Many will claim I am a physician and had “the means” to avail myself of private care.  But for the record, I was less than 2 years into my career and still had over two hundred thousand dollars in debt from tuition gathering interest every day.  We had to ask family for loans to support us.

For me, the price was worth it.  I would have preferred to have all of our care provided in Canada, but the public system simply could not give us everything we needed.  I believe it was providence that we ended up in Windsor, a short drive away from a world class cancer centre and fertility experts in Detroit.  Ontario gave us most of what we needed and prevented catastrophic financial consequences but privately delivered care in Detroit helped to fill in the gaps.

Why couldn’t I have those options in Canada?

To be clear, I am not suggesting we adopt a US style for-profit system and I am not suggesting we abandon our public system. What I am suggesting is that we have a mature conversation about our system, it’s limitations and whether there is a way to supplement or augment our “good not great” publicly funded, single payer system with private options that could enhance the care we deliver. Can we make our system better through private innovation and efficiencies while preserving all the best parts of public Medicare?

I am asking for a conversation.

As a palliative care physician, I won’t benefit from privatization.  End of life care and symptom management for patients with life-limiting illness will remain publicly funded.  But end of life care does give us a great example of what a good conversation could look like.

In 2015 the Supreme Court of Canada’s Carter decision came down and we were required, as a nation, to address the issue of Medical Assistance In Dying (MAID). Previously, MAID was taboo and “verboten.”  We could not raise it with our patients or even discuss it. But a funny thing happened. Once this prohibition was raised, it got easier to discuss death and dying. Whether or not you support MAID or not, one thing is indisputable.  The conversation has been elevated.

In his book, Picard states “we talk endlessly about sustainability of Medicare but have no idea what we want to sustain.  Our Medicare model is a relic, frozen in time. Tommy Douglas’s role in shaping publicly funded health care is celebrated, mythologized even.  But we conveniently ignore that Medicare was designed to meet the needs of 1950s Canada.”

All on the first page of his chapter on Medicare.I couldn’t agree more.  And while we are at it, let’s stop tilting at wind mills.

I do not pretend to have all the answers.  I just know we need a mature conversation about public AND private health care.  Let’s not shut down the conversation out of fear-mongering and ignorance. To paraphrase former CPSO president David Rouselle: “let’s not repeat the same sterile conservations again.”