Michael Rachlis MD

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At the University of Toronto with the Globe's Jeffrey Simpson

9 February 2013, 3:50 PM

I was on a panel at Hart House University of Toronto on Thursday February 7th with the Globe and Mail’s National Columnist Jeffrey Simpson — the topic was the sustainability of the Ontario health care system. My slide presentation available at the Publications page, concludes that health care spending is not “wildly out of control” and we need very little new money to ensure we hardly wait at all for needed health care. You can also find a picture at the publications page.

Mr. Simpson’s new book Condition Critical outlines the problems with our health system — long waits, mediocre quality, relatively high costs. His main recommendation is more for profit competition within our public financed system.

In general, Simpson toes pretty close to the conventional centre/right line:

      *     Health Care costs are wildly out of control

      *     The baby boomers will really deep six Medicare
      *     The only alternatives are to either cut real services or use more private care and finance
      *     We need an “adult conversation” to reduce our expectations and make us see the need for private involvement

Even when confronted with examples of how we could eliminate waits for care — patient co-production, high functioning teams, shared care with specialized services — Mr. Simpson doesn’t believe these really could be the norm. He doesn’t think providers, especially doctors will change the way they do their work.

I understand Mr. Simpson’s skepticism. We’ve known about these innovations for a long time. Change is hard anywhere at anytime. But, it’s been really hard to change Canada’s health care delivery system. But, I like to think that Canada could have a world class health care system if we wanted one.

I found Mr. Simpson reminded me of John Ralston Saul’s descriptions of Canada’s elite in his 2008 book “The Fair Country”. Saul refers to the “Colonial Mind” — that the Canadian elites tend to have a colonial view of insignificance within the Empire (British originally, US now) and to be focussed on the outside world for validation. I find folks like Jeffrey Simpson to have a cynical view of the Canadian potential. He can’t or doesn’t want to clarify whether he is saying we can’t do something — like eliminating wait lists with process improvement — or rather that up until recently there has been little effective implementation of these innovations.

Perhaps he is correct. But I don’t like the way he dismisses the notion that we should aspire to health care excellence with a quick knowing shrug, “tried that, too hard, let’s move on (to private care).” Let’s all prove him wrong.

Speech to Quebec Medical Association Annual Meeting April 20

22 April 2012, 8:05 PM

You can read Montrael Gazette articles prior to and after my speech to the QMA annual meeting in Montreal. You can also get a copy of my presentation here (MS PowerPoint, 3.89MB).

Filed under Health Care Expenditures, Interviews, Meetings, Presentations

Canada's Health System needs Innovation

19 April 2012, 8:50 AM

Read an article in today’s Montreal Gazette about my presentation tomorrow at the Quebec Medical Association annual meeting.

Filed under Health Care Expenditures, Interviews, Meetings, Presentations

Good news about Medicare

9 November 2010, 8:21 PM

I have an op ed in today’s Toronto Star on Medicare’s good run. The Canadian Institute for Health Information released their annual health spending numbers two weeks ago. Health care costs have decreased their share of the economy or Gross Domestic Product (GDP) slightly in 2010 - from 11.9% in 2009 to 11.7% after shooting up from 10.7% in 2008. It turns out that almost the entire increase in 2009 was due to shrinkage in the economy not increased spending.

The graph below summarizes the Canadian spending data and indicates what the results would have been for 2009 and 2010 with 1998-2008 rates of economic growth. I have put together a few slides which summarize the new data for Canada and Ontario. Please use them and distribute them.

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U of M Faculty of Medicine convocation

16 May 2010, 12:00 AM

On May 13, 2010, my Alma Mater, the University of Manitoba granted me an honorary degree (LLD, honoris causa) at the Faculty of Medicine convocation. You can read a copy of my address to the graduates here. In doing some research for my speech, I discovered that 2010 marks the 100th anniversary of Tommy Douglas’s arrival in Canada from Scotland. His family settled in Winnipeg.

Here is a picture of me with my companions at a dinner at the Manitoba Club on May 12th. Grant Mitchell is an old friend and Winnipeg lawyer extraordinaire. Evelyn is one of the world’s most knowledgeable persons on health and social policy for the elderly and was an important mentor to me in medical school. Joel Kettner is Manitoba’s chief public health officer and an old friend from medical school student politics.

Front row from left: Me, Professor Emeritus Evelyn Shapiro, Dr. Joel Kettner

Back row from left: Grant Mitchell, University of Manitoba President Dr. David Barnard, Dean of Medicine Dr. Dean Sandham.

Filed under Presentations, Travel

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