By Ray Rivers
April 29, 2016
BURLINGTON, ON
I recall a doctor once complaining to me that his father, also a doctor, used to make ten times the average worker’s salary while he only made five. We all know that doctors generally make good money, which is why we were instructed by our parents to become doctors and why we’ve told our children to do the same.
The medical association will point out that American doctors are even better rewarded in that wasteful multiple-payer system south of the border. Of course some sports athletes, pop musicians, film actors and even senior bankers now make more. Except we don’t pay any of those people out of a public purse. And public financing is the issue behind the Ontario Government’s efforts to trim back potentially out-of-date medical billings.
Most of Ontario’s doctors work on a piece-work basis, charging OHIP for every patient who goes through their turnstile. And how they get remunerated depends on a highly complicated fee schedule, which gets negotiated between the doctors’ union, their medical association and your government, the health insurer. So how did one eye doctor bill $6.6 million in one year, when the average billing is more like three or four hundred thousand dollars?
In the absence of more detailed information one can only speculate – but it might be that the procedures that doctor used can now be performed more rapidly and efficiently than when the billing rate was set. That would allow more patients through the turnstile and into the cash register. And in that case the Minister has a valid point that the rates need to be revised downwards to better reflect the real cost of that medical service.
In the absence of a competitive market for medical services, value is determined by how long it takes, what kind of hardware is needed and how much skill is required. But even in the US, with a more competitive insurance model, services are priced in a similar fashion. So that is what Ontario’s Minister of Health, Eric Hoskins, who is a doctor himself, is trying to do – ensure that we get value for our medical buck by updating the fee schedule.
Of course that doesn’t resolve the issue of how much doctors should be making. My accountant keeps telling me to look at the net, after tax income, not the gross. So if society feels anyone, be they doctors, bankers or sports celebrities, are bring home too much dough, there is a solution. Just tax it back as we used to do in the 50’s and 60’s. And doing that within reasonable limits will also reduce the growing gap between the rich and poor, which everyone claims to deplore.
Trickle-down economics, as ridiculous a term as that sounds, was the rationale that allowed conservative-minded governments to redistribute income from the poor to the rich. Ronald Reagan was the perfect anti-Robin Hood. Canada’s income gap got a new life following the tax reforms brought in by former PM Brian Mulroney and his Bill C-139, which he ironically termed tax simplification.
Ontario’s Minister of Health Erik Hoskins, also a doctor, puts the province’s argument forward – the doctor’s lobby has always been effective.
Mulroney virtually dismantled our progressive taxation system, reducing rate classes to only three from the previous ten. He raised the tax rate for the lowest class from 6 to 17 percent and lowered the highest to 29 percent from 34. This placed more of the tax burden on the middle and lower classes. This huge shift in the tax burden also underlay the poor economic performance that plagued his government and the enormous structural deficit that Mulroney created and ran in every single year of his administration.
Our new PM’s first budget has attempted to address that inequality by lowering taxes for middle and lower incomes, and shifting more of the burden back to the wealthy through a new higher tax bracket. And that has brought out the trickle-down crowd once again. Stomping their feet as they hit the pavement in places like the National Post, warning of imminent doom unless the rich, once again, get more money. It’s as if ignorance, greed and stupidity have no bounds.
Ray Rivers writes weekly on both federal and provincial politics, applying his more than 25 years as a federal bureaucrat to his thinking. Rivers was a candidate for provincial office in Burlington where he ran as a Liberal against Cam Jackson in 1995, the year Mike Harris and the Common Sense Revolution swept the province. Rivers is no longer active with any political party. You can tweet him at @rayzrivers
Background links:
Health Minister’s Announcement – Doctor’s Salaries – Pay Cuts – Physician Remuneration – CD Howe Perspective –
US Doctor Income – $6.6 Million Doctor – Historical Taxation Policies – Harper’s Taxes – Trudeau’s Taxes –
How Much is Too Much – The Trickle-Down Crowd –
Ray, if you suspected so much, why did you feel it was OK to perpetuate this Liberal lie?? To me that is the real question you should be asking yourself while your looking into the mirror. We should not blindly follow any party or leader without first understanding what they are truly saying and always demanding Transparency, Accountability and Responsibility. The Tory’s did not do this and certainly Wynne’s Liberals are just as bad, perhaps worse, as they toted they would be better than Harper’s autocratic party.
As for IM Gouged; you benign mole is considered outside the OHIP fee schedule (ie., it’s cosmetic) and hence any Doctor can extra bill (Dermatologist are notorious). I remove these in my office under the OHIP fee schedule (and there still is a OHIP fee) for around $20 that is billed to OHIP.
Great comments all – Thanks D. Duck for such a lengthy and thoughtful response. I suspected as much about the $6.6 million billing, multiple doctors under one billing number.
I recently went to a dermatologist to have a small mole removed. He wanted $400 for 5 seconds of work which is the equivalent of $4,800 per hour. The slogan on the podium of the minister in the above picture would need to be “The Money First” to more accurately describe the present conditions.
Canada / Ontario – a proud history of medical innovation.
If a highly educated medical professional can discover a method to conduct a medical procedure in less time than what was established by a government bureaucrat – AND as long as the patient is being given the care required – then it is called progress.
A doctor curing 100 patients in the time the government suggests should be spent on 10 is doing taxpayers a service. Especially while wait times grow in this province.
Instead of penalizing doctors for efficiency – why doesn’t the government take those savings and invest in children challenged with autism?
Ray:
1) it was not a single ophthalmologist that billed 6.6million in a year. It was a group practice of 14 opthalmologists under one OHIP billing number that billed this amount. This is common in many subspecialties to use a common group OHIP number. So again, Hoskins has lied to the general public, which was pointed out to him but Hoskins now sighted ‘privacy’ of this Physician and their billing number though he certainly did not believe in privacy when he opened his uninformed mouth. I worked in a group of 8 specialists under a single OHIP billing number.
2) Hoskins has also said that Physicians in Ontario are the highest paid in Canada. The CIHI (CDN institute for Health information) recently released that Family Physicians in Ontario are the lowest paid in the country. Another lie by Hoskins to perpetuate his gov’t growing divide btw the general public and the Physicians. The ‘blame them not us’ political tactics.
3) Healthcare funding is under provincial jurisdiction and this liberal gov’t has run it into the ground. They have wasted billions on e-health, ornge helicopter, LHINS, CCAC, health care premiums, Cancer Care Ontario (CCO), etc. The MOHLTC has almost 10x the number of health care bureaucrats/administrators than does most European countries who have a mixed funded healthcare as quoted by the recent OECD reports (Nov/15). On top of this fiscal mismanagement, you have a gov’t blaming the healthcare professionals for being the evil spawns that created this. Funny, how the Burlington Post did not run with the Hamilton Spectator report on the HHS and JBG administrative over costs. How about the number of Full time RNs that have been laid off to be replaced by cheaper less educated/experienced PT/Casual RPNs. Listen to the ONA’s radio advertisements as they are correct.
4) This is also the gov’t (CCO agency of the MOHLTC) that won’t release the number of patients who have died or relapsed because they did not get their stem cell transplantation in a timely fashion (see last Saturday Toronto Star and today’s Star). The same gov’t is now paying almost 5x the amount for USA treatments though still having the patient/family pay for their 2-3 month living costs while receive this USA treatment. Nice transparency.
5) some facts (OHIP schedule without the 7% kickback to the govt):
– cataract sx cost $397 (per eye)………..and you can see/read/drive again and perhaps work in your retirement yrs
– Lasik sx cost $2000 (per eye)………..and you don’t need glasses
– vaginal delivery cost $500………..and you get a tax payer who votes Liberal (Cesarean cost $580 and is a Tory)
– quality bred golden retriever puppy cost greater than $1500………..and they have litters…..and are very cute
– Pap smear cost $6.75…………though CCO wants to limit this to every 3yrs
– knee replacement cost $619………and you can golf pain free and continue going to work and paying taxes
– appendix cost $336………and you live to go back to work and pay taxes
6) Wonder why in the Toronto Star it was only senior Oncologists talking………because hospitals have gag orders on Doctors for saying or doing anything that maybe deleterious to the hospitals. Physicians no longer can advocate for their patients. If you talk, you are labelled ‘disruptive’ and may loose your hospital privileges.
7) I work 70-80hrs per week. I don’t seek patients out, they are referred to me in my office or to the hospital when they have an emergency. Volume and long hours away from my family generates my income (which is Hoskins spouted avg of $350K gross). If I don’t work, I don’t get paid. I use to have 7 staff in our group practice and now we only have 4 staff due to increased overhead (a third of my gross income goes to increasing O/H + Hoskins unilateral 7% clawback made us lay off staff). If I am sick……..I don’t get paid and I have no sick leave. I have no pension or benefits (do you know the cost of drugs now a days???? Thank goodness for Costco!!) nor do I have paid holidays. I am like any other self-employed Canadian. If you work hard and long you will do well (maybe really well) but if you only work 30-40hrs per week you will just do OK and sometimes that is fine.
8) Hoskins is a ‘Community Medicine’ Physician. He is not an ‘Internist’ as he likes to pontificate. He certainly has no people skills or insight into human nature. Healthcare is easy too fix. Just listen to the front line healthcare workers (patients, RNs, community care workers, Physicians, Hospital employees). There are millions/billions of dollars to be saved. Don’t let self righteous political ego(s) over ride common sense. And, as anyone can see, common sense is missing from this provincial govt and its Minister of Health.
PS: Prime Minister Trudeau liberal govt will increase Canada’s debt another $150billion in half the time that Harper’s govt did. Why……..because it’s 2016.