Your editorial Fee Cuts Are Good Medicine (May 28) correctly notes that the benefits of new technologies should not all automatically accrue to their users. Even so, consider that innovations allowing lives to be saved by reopening blocked heart vessels require great technical skill. Providing them on a 24-hour basis is even more demanding. When cardiologists compare themselves with heart surgeons, who typically earn more, with less middle-of-the-night work, they do not feel overpaid. So unless a fair mechanism to look at relative value is used (something medical associations typically have decried), any solution will be arbitrary.
Looking for fairness is even more important as our population ages. Typically, current fees undervalue complex care, leaving older adults especially poorly served. Despite evidence that they are best managed by people with specialized geriatric expertise, in most provinces, fees for many no-value-added procedures dwarf what is paid for a geriatric assessment. Unsurprisingly, many training positions in geriatric medicine go unfilled. It is time to look at both what’s fair and what’s needed. Reshaping physician fees will require skilled operators.
Kenneth Rockwood, geriatrician, Halifax
To suggest that there have been no improvements to patient access to care or services just isn’t true. For example, there are now more than 2.1 million Ontarians who have access to a family doctor; more than eight million patients are benefitting from electronic medical records; wait times are down for several key surgeries; and more than 40 per cent of doctors are working on weekends. Let’s not forget that in the 1990s, governments made cuts to services and decreased medical school enrolment, which resulted in increased wait times and decreased access to care. It would be disappointing if we head down that road again.
Ontario’s doctors agree that efficiencies can and must be found. That is why we have worked with the government to reduce fees in certain areas and realign investments. The OMA remains committed to working with the government to transform Ontario’s health-care system. We need to engage doctors in a meaningful way, not force things on them.
Doug Weir, president, Ontario Medical Association
Doctors are at the mercy of the government, with none of the other perks that public sector workers receive. They don’t receive pensions, paid vacation time, seniority, yearly raises, employment insurance or any other benefits. And many physicians carry huge loans from their long and expensive training. You probably forget that physicians also had to absorb Ontario’s recent harmonized sales tax on rent and all supplies and services, which they cannot recoup like other businesses.
Anyone who believes that physicians will just accept this with smiles on their faces and continue to provide reliable and excellent service to their patients should ask themselves the question: “What would I do if my employer cut my wages?”
Marilyn Sinclair, Maple, Ont.
Reading Tim Kiladze’s article about investment bubbles ( Your Brain On Bubbles – Focus, May 26) makes me think that people often overlook the difference between investment and speculation. An investor provides capital for an enterprise that produces something of value, in the expectation of sharing in future profits. A speculator, by contrast, buys an asset with the hope that he will be able to sell it later for a higher price.
With speculation, no value is added to the asset, and the higher price is due solely to the belief that another speculator will pay an even higher price. Speculation does not create wealth – it just moves it around, and the only people who are sure to benefit are those who pick up the crumbs: brokers, traders, executives and lawyers. The stock market pretends to be about investment, but since most of the money to be made is based on share price rather than dividends, it’s really about speculation.
Mik Bickis, Saskatoon
The role of prisons
I can only conclude that Doug Saunders and I have very different views on the purpose of prisons ( Hurt The Criminal Or Hurt The Crime? – May 26).
I consider prisons to be part of the justice system. As such the primary and essential objective of prisons is justice. (Not vengeance – justice.) Prisons do not exist for rehabilitation nor for vengeance nor even for the protection of society. Rather, prisons exist to exact justice – to punish offenders in a manner appropriate to the injury they have caused.
Of course, the goals of rehabilitation and the protection of society are both valuable also. To the extent that these goals do not conflict or interfere with the primary function of prisons, these goals should be pursued, but there should be no mistake that the primary function of a prison is to punish. The family of someone who has been murdered, or a woman who has been raped, or people who have been defrauded our of their savings deserve justice. Prisons exist to provide this to the extent possible.
Jeff Breukelman, Richmond Hill, Ont.
Ice that violence
Re Hockey, Fighting And What It Means To Be A Man (May 28):
I’ve just returned from Spain, a country that celebrates both love and brutality in its culture – think flamenco dancing and bull fighting. But otherwise, Spaniards are a gentle people, much like Canadians. Perhaps societies like ours need such acts to celebrate love and provide a cathartic outlet for violence.
The Spaniards keep violence in the bullring, however, and keep it out of soccer. Grace, skill and beauty make that sport the joy that it is to watch. Could we not rise to this level of sophistication and remove violence from hockey? We would get better suited players and preserve the stars we create instead of losing them to senseless injury.
Robert Graham, Claremont, Ont.
Michael Adams’s analysis neglects the money-worshipping aspect of pro hockey marketing, directed at the lowest common denominator of human passion at the expense of decency, social norms and a host of other valuable societal imperatives.
Leadership is badly needed here from the National Hockey League. We need an equivalent to Don Cherry on the other side of the issue.
Elie Mikhael Nasrallah, Ottawa
As a celebrant who prides myself on performing deeply meaningful wedding ceremonies, I’ve watched wedding reality television with dismay and worried about its trickle-down effect. All too often, it’s just about the “bling.” The Globe’s wonderful article on The Simple Wife (Globe Style – May 26) was a very welcome reset: the turning way from showy to a more truthful bridal aesthetic.
The day that marks the first steps into marriage is incredibly powerful and important. It should feel true and honest. It’s the couple’s emotional bond that holds them together in the long term, not the size of the dessert table at the wedding reception.
Michele Davidson, Vancouver
Mary Lou Quinlan recommends that we jot down our worries on a slip of paper and place it in what she calls a God Box ( Pack Up Your Troubles – Life, May 28). This may be a viable alternative to pharmaceuticals. For a few hundred years, Jews have been placing notes in the crevasses of Jerusalem’s Western Wall and look how worry-free we are.
Farley Helfant, Toronto