Headlines and photo ops follow drama. So Ontario teachers on the picket lines received lots of both.
Ontario's doctors, by contrast, signed a path-breaking deal with the provincial government. That triumph of government policy and common sense by doctors was a one-day media wonder, success being of less interest than failure. But the two-year deal between Ontario and its doctors signals across Canada that years of fat increases for physicians are over.
Ontario's disputatious teachers will resist any comparison. The government imposed a settlement on us, they'll argue, whereas the government negotiated one with the doctors. All we sought, union leaders will say, was a negotiated settlement.
Maybe, but the teachers unions, given their strong ideological tendencies, had been negotiating unsuccessfully with the government for a long time. Teachers, like doctors, had been munificently treated by Dalton McGuinty's government. But whereas the doctors understood Ontario's fiscal dilemma (a $14-billion deficit) and appreciated how generously they had been treated, the teachers' understanding seemed very grudging.
Ontario's deal with the Ontario Medical Association essentially freezes fees for two years. A whopping 81 per cent of physicians endorsed the agreement. If physicians create reforms within the system that save money, it will be spent helping new physicians enter the system. Doctors have pledged to reduce costs in other ways, such as eliminating unnecessary testing, doing more evidence-based drug prescribing and communicating electronically more often with patients – an area where Canada has the poorest record in the Western world, as underscored in a recent Commonwealth Fund report.
Before bands start marching, let's remember that the deal is only for two years. If in two years the OMA insists on "catch up" payments that shoot above inflation again, this period of restraint will have been for naught.
What's needed is an understanding by physicians, nurses and other unionized employees that Ontario is in tough fiscal shape (and will be for quite a while), that the health-care budget can't keep rising at 7 per cent a year (as it did from 2004 to 2011) and that the remuneration should rise at the rate of inflation over the next decade. That's what Ontario (and most other provinces) can afford; that's what would be fair to them. The OMA agreement is a first step toward accepting that reality.
Every province, of course, runs its own health-care system. But they do watch what happens in other provinces. Ontario, being the largest, is the one watched the most. So the precedent set by the OMA deal will be used by provinces when they sit down with their physicians, just as physicians elsewhere will have to be mindful of what their Ontario colleagues did.
Ontario is trying something never done in the history of medicare: to reduce annual budgetary outlays to only 2 per cent a year, and to keep them there for a prolonged period.
Nationally, health-care increases have dropped in the past two years to the 3-per-cent/3.5-per-cent range, down from 6 per cent to 7 per cent in the years after the 2002 Romanow report recommended spending huge additional sums to "buy change." That approach largely flopped. The new money bought peace with provider groups in the form of inflated wage settlements, and it bought time to keep things more or less on an even keel.
The money certainly didn't buy change; indeed, it inhibited change by making more money the easy answer to all challenges. Now that money is tight – and will remain so for years – more serious change is coming to health care, evidence of which is this new agreement with the OMA, changes to the scope of practice, the push for more community care, more bulk purchasing of drugs, and so on. These kinds of changes are haltingly under way across the country.
Medicare was supposed to be fixed by injections of large sums of new cash. The getting of wisdom is to stop believing in what didn't work before, and certainly won't work in the future. Maybe, just maybe, the OMA deal reflects some of the getting of wisdom.