Michael Rachlis MD

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

9 February 2013, 8:50 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.

Hear my interview with Matt Galloway

31 October 2012, 6:08 PM

Hear my interview with CBC’s Matt Galloway on Toronto’s Metro Morning.

Let's have that Adult Conversation about Medicare

14 October 2012, 11:32 PM

I have an op ed in today’s Toronto Star replying to Globe columnist Jeffrey Simpson, former Bank of Canada Governor David Dodge, and others who say Canadians are too immature for the adult conversation we need to have about medicare. Simpson’s new book “Condition Critical: Why Canada’s health-care system needs to be dragged into the 21st century” is better than most centre-right critiques of medicare. But, his analysis is superficial and he omits key facts. He doesn’t seem to have heard of the quality agenda in health care and as result his analysis of the wait list issue is wholly inadequate. He hardly mentions public sector options to reduce wait times. Like others he fails to note either the Queensway surgicentre, North America’s largest out of hospital surgical facility, or Winnipeg’s Pan am Clinic. (You can read more about these innovative centres in a 2007 paper I co-authored.) And he implies support for user fees ten times before he dismisses them near the end of the book.

So let’s start the grown up conversation about medicare with public sector solutions. To quote Tommy Douglas, “It’s not too late to make a better world.”

Good news about Medicare

10 November 2010, 1:21 AM

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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Canadian H1N1 vaccine rollout hits a pothole

2 November 2009, 4:52 PM

I did interviews with nine CBC morning shows today on the troubled roll out of the H1N1 vaccine. Canadians are rightfully enraged at the chaos of last week’s H1N1 vaccine clinics. There must be a better way to run a vaccine program. There are two main reasons why the vaccine roll out looks like rush hour at a Mexican bus terminal.

... read full post »

Filed under Ontario health care, Wait Times

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