Taking the flak

Issue: BCMJ, vol. 44, No. 6, July August 2002, Page 284 Editorials

So where do we go from here? The current duo of health ministers have come to realize that they are as unable to control the economic drivers of health care costs as the past six or seven incumbents. I’m sure that informing the decision-makers that they shouldn’t agree to pay the McEachern arbitration award because they were broke was difficult for the new economic advisers. However, the two new ministers of health had been given a mandate to not only manage the biggest, most expensive ministry in government but to also play a vital role in helping to guide BC back onto firm economic ground. How could they look like prudent fiscal managers if they just paid the doctors what some chief justice said they deserved? The recommendation of the government’s health economics advisers apparently created a millisecond of indecision before the health ministers went to cabinet with a recommendation to fly in the face of reason and overturn the chief justice’s decision. At least it seemed that way, because our fresh new legislators’ now obviously poorly considered decision appeared so soon after Mr McEachern’s. We are all aware of the fallout from that decision, and I’m sure there will be substantially more before this whole debacle has been settled to the satisfaction of BC’s battle-hardened doctors. 

I understand this government’s economic dilemma is, at least publicly, the driving force behind their decision-making and public obstinacy. However, it makes little sense that they decided to take on the docs in such a public manner—unless, in fact, all they wanted was the appearance of being forced into a bitter conflict that they knew they couldn’t win. I think this government realized long before they were elected that the salvation of publicly funded health care could not come from a chronically empty public purse. To many observers, it has been clear for years that the survival of our much-loved but poorly understood medical system is likely dependent on the partial participation of private corporate investors.

Our recent dispute conveniently provides BC’s politicians with a reason to announce that they have been forced to privatize portions of the medical system in order to pay for the doctors’ demands. The hook for the public will be that with the addition of private funds into the health care funding equation, the economic climate will improve for doctors, ensuring a future supply of happy physicians. In addition, much more money will be available to invest in new technologies, state-of-the-art facilities, and the absolute necessity to expand access to medical training. I expect most people will see the common sense behind the decision. 

I don’t know if the above will happen now or some time in the future, but if the Canadian public expects to have reasonable access to health care in the future, it is essential that these politically unpalatable decisions are seen as expedient and clearly articulated as government policy. If doctors have to take some of the heavy fire in order for the politicians to make these decisions, where do I buy my flak jacket?


James A. Wilson, MD. Taking the flak. BCMJ, Vol. 44, No. 6, July, August, 2002, Page(s) 284 - Editorials.

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