Double-dipping and wait times

Doctors are to blame for double-dipping but not for the long wait times in B.C.

image: Global news

Rosalia Guthrie of Salmon Arm found out the hard way about double-dipping. After waiting for 16 months, her surgeon’s secretary gave her the number of another clinic. To her surprise, she discovered that the other clinic was run by the same surgeon –and that she would have to pay.

Guthrie paid $500 to get in the door of the private clinic and another $3,850 for a written report. She didn’t have to pay for the actual surgery. That was covered by health care and only one-tenth of what she paid. The surgeon was paid $410.67 for the surgery done in a public hospital at UBC.

The surgeon did a number of things wrong. Double-dipping is illegal. That’s where doctors bill both the patient and the province for different aspects of the same treatment. And doctors are forbidden from charging patients for reports while advising patients on publicly-insured treatment. Also, the B.C. College of Physicians and Surgeons dictates that before referring patients to clinics, doctors must disclose if they have a financial interest. The surgeon did have a share in the clinic where Guthrie was treated and that wasn’t disclosed.

Doctors are not to blame for long wait times. That blame for that lies squarely at the feet of the government of British Columbia. The BC Liberals have failed to provide access to operating rooms for surgeons says Judy Darcy, the NDP spokesperson for health:

There are operating rooms that sit idle, MRIs that sit idle for many hours of the day. We need to invest in innovation to use our capacity to the maximum.”

If hospitals can’t provide operating room times for doctors, the province should build public clinics I argued earlier. There is no shortage of doctors; there is a shortage of operating rooms for them to work. In a survey done by the Royal College of Physicians and Surgeons, 208 fully trained specialists -16 per cent of those surveyed- were under-employed because “. . .there aren’t enough ORs.”

Some doctors contend that, while they may be doing something illegal, they are relieving patient suffering. Patients may lose their jobs while waiting or they may become addicted to pain-killing opioids.

Private clinics are expensive. Doctors can’t run them without charging patients. Dr. Ross Outerbridge, The founder of the Kamloops Surgical Centre, explains: “We factored in all the cost and a reasonable profit margin and that is what we charge the private patients.” But the whole realm of private clinics is unregulated. “I know that at other clinics, they overcharge,” says Dr. Outerbridge. ” I don’t personally agree with that – but it is very difficult, because nothing is being done about it.”

The BC Liberals have balanced the provincial budget by underfunding health care. British Columbia has the largest number of private clinics in Canada. While we are paying fewer taxes, we are likely paying more for health care when the cost of private clinics is factored in.

Yes, taxes would be higher but public clinics would be better than the illegal, unregulated, Wild West of bootleg medicine sold on the side of public medical practice.

 

 

The psychology of B.C. voters

At first glance, it looked like the split between interior and lower mainland voters was along the usual lines of social values.

   image: Macleans

Cities tend support liberal social values such as gay marriage, women’s rights, support of immigration, treatment for drug addicts, and poverty reduction. Rural dwellers support conservative values such as the integrity of the conventional family, individualism, and a no-nonsense approach to addiction.

An electoral map illustrates the divide between conservatives (BC Liberal) and progressives (NDP-Greens) with the interior coloured red and the coast and lower mainland orange and green.

This time the split was something else. Closer inspection of swing ridings indicates that something other than social values was at play. The south-east corner of B.C., including the Kootenays, is typically progressive. However Columbia River/Revelstoke swung from NDP to BC Liberal. It’s unlikely that those voters stopped being socially progressive. The Fraser Valley turned orange. It’s unlikely that the farming communities of the valley stopped being socially conservative.

There’s a close correlation between employment and how people voted. The lack of jobs creates a sense of uncertainty, whereas job growth creates optimism.  The interior has not recovered from jobs lost in the Great Recession of 2008. In 2016, the interior lost jobs while the lower mainland and Vancouver Island gained jobs. The Kootenay area was hard hit with a job loss of 2.3 per cent. The lower mainland had a job growth of 4.7 per cent while Vancouver Island had a growth of 2.6 per cent.

Shannon Daub, a director for the CCPA, believes he has the psychology of voters figured out. After talking to resource-sector workers for years, he has seen how government cutbacks in social services create insecurity. It erodes the social safety net and enforces the sense that governments can’t create jobs; that only the resource extraction industry can. And the notion of jobs in a green economy seems vague and remote.

Yet it was the BC Liberals that helped create that uncertainty in the first place. In the early 2000s, the BC Liberals cut public service jobs unevenly across the province with reductions to the interior being about twice that of the lower mainland in terms of percentage. In small communities, one of the top employers is often public service jobs. The loss of even a few well-paying jobs has a greater impact there than in urban areas where the economy is more diversified.

In addition to cuts in public services, the BC Liberals failed to restore jobs lost in the forestry sector to the pine-beetle disaster and deregulation of the industry. The government could have created jobs through value-added products, use of wood waste, and greater reforestation.

Rural B.C. voted for the BC Liberals despite the fact that the Clark government contributed to their uncertainty. Voters see resource-extraction jobs as their only hope and that’s just what the BC Liberals promised with pipelines and dam construction.

Also, energy corporations have been promoting resource-extraction jobs which offer hope. Enbridge has placed full-page ads in The Walrus and on TV Life’s moments, made possible by energy. My Facebook and Twitter feeds have regular ads from the Canadian Association of Petroleum Producers featuring a heartfelt discussion between a son and dad about cleaning up mining sites once they close.

TPP rises from the ashes

Rumours of the death of the TPP are greatly exaggerated. After President Trump announced U.S. withdrawal from the Trans-Pacific Partnership, I congratulated him: “Thank you, Mr. Trump, for killing the TPP.”

 image: WMAL radio

I now realize that Trump’s withdrawal from the TPP was not an indicator of leadership, but a sign of retreat from the international community. It’s just another indication of the degree of U.S. marginalization. Trump’s withdrawal from the Paris Agreement is yet another indicator that we must carry on without him.

Where the original TPP had a number of flaws, the new TPP can be negotiated to Canada’s advantage. Canada was disadvantaged in the first round because we were latecomers: we had to accept what had already been negotiated.

Canada is a trading nation and as such, we depend on fair trade agreements. As politicians like to do, I’ll list my five conditions for acceptance of the new TPP -dubbed TPP11 after the number of countries left to pick up the pieces.

Investor-state dispute settlement provisions (ISDS) should not be part of TPP11. This allows companies to seek damages from governments when local regulations interfere with profit-making.

When disputes arise, as they are bound to do, they should be settled in a transparent manner by judges, similar to the International Court, not in private between arbitrators as is now done with NAFTA.

Environmental standards should not be part of TPP11. Environmental damage is seen by industry as a cost of doing business -a price which indigenous peoples and future generations will pay. Environmental standards need to be negotiated by separate accords like the Paris Agreement.

Intellectual property and should be excluded as well. Artists and small software companies need protection, but too often concern for intellectual property masks large corporate interests such as Disney.

Exclude health regulations as well. They are an excuse for Big Pharma to extend the patent life of drugs that could be made cheaper with generics.

TPP11 will be a meeting of middle powers now that the U.S. is out, and China and Europe were never in. Canada can then negotiate from a position of strength when it comes to superpowers. Trump favours individual bilateral deals because he imagines an advantage over smaller countries. But if those smaller countries can form a block where there is an alternative to the bully-tactics of Trump.

The TTP11 would give Canada access to markets not previously available, says Hugh Stephens of the Canadian Global Affairs Institute. It will jump-start bilateral talks that were going nowhere, like those between Japan and Canada. With Japan in the TTP11, negotiations can proceed. And trade agreements under the umbrella of TPP11 can take place with other countries where Canada has no bilateral agreements such as Australia, New Zealand, Malaysia and Vietnam and Malaysia.

And in countries where Canada does have bilateral agreements, such as Mexico, Chile and Peru, the TTP11 can tie up loose ends.

Whereas Canada was a follower in the original TTP, we can be a leader in fair trade under TTP11. With the U.S. retreating into a fog of befuddlement, Canada needs to step up on the world stage.

 

 

Myths trace human migration

 

Ever since we came out of Africa, humans have carried myths to every corner of the globe. Cultural anthropologist Julien d’Huy traces their journey.

Cosmic Hunt as drawn 6,000 years ago in Spain

One myth, which d’Huy calls the Cosmic Hunt tells of a hunter who pursues an animal, which then turns into a constellation.

“As the Iroquois of the northeastern U.S. tell it, three hunters pursue a bear; the blood of the wounded animal colors the leaves of the autumnal forest. The bear then climbs a mountain and leaps into the sky. The hunters and the animal become the constellation Ursa Major. Among the Chukchi, a Siberian people, the constellation Orion is a hunter who pursues a reindeer, Cassiopeia. Among the Finno-Ugric tribes of Siberia, the pursued animal is an elk and takes the form of Ursa Major (Scientific American, December, 2016).”

Early humans from Asia carried the myth of the Cosmic Hunt across the Bering Strait to North America 28,000 and 13,000 years ago.

In turn, Asians got the myth from Europeans. In the cave paintings of Lascaux, France, a bison appears to be rising into the heavens. Black stains on the ground under the bison suggest the bloodstained autumn leaves of the hunted animal.

From Europe, the Cosmic Hunt traces back to Africa. While the story line is the same, the animal changes. In some parts of Africa it is a camel; in other parts a zebra, pig, or ungulate.

In another, the Polyphemus myth, a man gets trapped in a monster’s cave and escapes by hiding among the monster’s herd of animals.

In Homer’s Odyssey, the monster of the Polyphemus myth is one-eyed. Odysseus and his men are trapped in a cave by the monster and escape by clinging to the underbellies of the monster’s sheep which the monster has let out of the cave to graze.

The Polyphemus myth even traces the transition of humans to an agricultural way of life. Hunter-gatherers of Europe told the Polyphemus myth as a one-eyed dwarf monster, the master of beasts on a mountain.  After the ice age pushed humans into the Mediterranean 21,000 years ago, the one-eyed monster now lives in a shelter rather than in the wild.

In another French cave, the Polyphemus myth looks like humans are escaping the monster by hiding the anus of a bison rather than clinging to its underbelly. This is a similar version of the myth as told by some North American indigenous people.

I can’t help but wonder what myths survived from my indigenous European ancestors. Perhaps it’s this:

In the Greek telling of yet another cultural myth, Pygmalion makes an ivory statue of a woman and dresses her in fancy clothes and jewellery. After praying at the temple of the goddess of love, Aphrodite, he returns home to find that his ideal mate has been brought to life.

On CBC Radio’s Spark, Matt McMullen explained how his company is making hyper-realistic, anatomically-correct, poseable silicone sex dolls. Sexy robots have been turning up in our pop-culture, from Ex-Machina to Blade Runner, The Stepford Wives, and the HBO series Westworld.

The myth of an ideal mate, crafted to specification by men and made possible by technology, persists.

 

 

 

Fiction is not cultural appropriation

The fires of cultural appropriation were fanned recently when the editor of a small magazine published by The Writers’ Union of Canada wrote “I don’t believe in cultural appropriation.” Then he poured gasoline on the fire by promoting a “Cultural Appropriation Contest” in which the winner would the writer who appropriates culture the most: “. . . the Appropriation Prize for best book by an author who writes about people who aren’t even remotely like her or him.” He was forced to resign.

Credit: Illustration by Jon Foster

Fiction is not cultural appropriation because storytelling is not the property of any one culture. Fictional characters are, by nature, inventions of the storyteller. Writers may invent talking animals (Animal Farm) or wizards and magic (Harry Potter). In all cases they are fabrications, not cultural appropriations.

Cultural appropriation is not fiction. It is real. Grey Owl (aka Archibald Belaney) didn’t just write stories about indigenous North Americans –he completely assumed their identity. The British-born Belaney fabricated his persona after arriving in Canada in 1906. In 1925, he married a Mohawk Iroquois woman, 19-year-old Gertrude Bernard (aka Anahareo), who later encouraged him to write about his experiences.

Some indigenous writers claim that only they can fictionalize indigenous characters. But to what extent should a writer be indigenous? Prize-winning Canadian novelist Joseph Boyden wrote extensively about the indigenous experience. Boyden is primarily of Irish and Scottish ancestry but also claims Nipmuc and Ojibway heritage. How pure should an indigenous writer’s linage be to qualify?

A writer for APTN National News called out Boyden for faking his indigenous roots. I can understand calling out an author for not portraying authentic fictional characters. However, Boyden’s characters are authentic. I his novel, Three Day Road, he tells the story of two Cree soldiers serving in World War I, inspired by an Ojibwa sniper. Would Boyden’s story be more authentic if his pedigree were more indigenous?

Cultural appropriation is layered. An art gallery in Toronto recently cancelled an exhibit by a non-indigenous artist Amanda PL because her paintings carried elements of the indigenous artist Norval Morriseau. PL made no pretence at being indigenous. However, Morriseau himself has been accused of appropriating Christian symbols in his work. Author André Alexis finds a certain irony in the layers of appropriation upon appropriation:

“There are levels of irony at play in all this. To begin with Norval Morriseau was criticized for using sacred symbols in his work. He was accused of debasing them. There is a consistency, here, but how strange that some of the condemnation of PL would be a condemnation of Morriseau, too (Globe and Mail, May 14, 2017).”

If anything is appropriated, it is the entire volume of human storytelling from when early humans looked up at the constellations of the night sky and told of Ursa Major, or “great bear”. These tales are so ingrained that they can be used to trace ancient migrations of humans across the globe. Julien d’Huy explains in Scientific American:

“This research provides compelling new evidence that myths and folktales follow the movement of people around the globe. It reveals that certain tales probably date back to the Paleolithic period, when humans developed primitive stone tools, and spread together with early waves of migration out of Africa (September, 2016).”

The problem is doctor distribution, not shortage

The number of doctors in Canada is increasing faster than population growth says Dr. Michael Rachlis on CBC Radio’s The Current:

  photo: Nancy Bepple

“We’ve been increasing the number of physicians at about three per cent per year for the last 10 years and the population is only going up at one per cent per year.”

Another of the panellists on the program, Dr. Danielle Martin, author and VP at Women’s College Hospital, warns of a surplus of doctors:

“In fact you know in some parts of the healthcare system, people are worried about a glut and you hear stories of people coming out [of medical schools] and being unable to find a job.”

That’s certainly not the view from the streets of Kamloops. NDP candidate Nancy Bepple regularly visited lines of people lined up at a clinic to see a doctor. An estimated 30,000 Kamloopsians don’t have a family doctor (one-third of the population). In B.C. overall, it’s 15 per cent.

Why can’t people find doctors if there’s so many of them? Are they hiding?

Well, some of them have chosen to work for a salary rather than billing for each patient. They work exclusively in hospitals says Dr. Chris Pengilly of Victoria, another of the panellists. He calls them “hospitalists.”

They prefer to work only 40 hours a week. Who can blame them? And they are paid better. At $150 an hour, a hospitalist makes $300,000 a year with no overhead. After paying staff and rent, a family doctor would have to earn $400,000 a year, to take home that much; and work longer hours with less support.

The choice is obvious says Dr. Pengilly:

“So anybody coming out of medical school with a big student loan, which do you think they’re going to go for? A family physician [with] no time in hours a week or a hospitalist 40 hours a week and $300,000 with minimal expenses?”

Furthermore, hospitalists don’t want to work alone says Dr. Rachlis “Well, I say good for them that they’re looking to work in teams with other groups, with other physicians.”

One-half of Canada’s physicians focus on sports medicine or palliative care, says Dr. Martin:

“. . .they’re not practicing what we would think of as full scope full service cradle-to-grave primary care family medicine, and that is what those people who are lining up at Dr. Pengilly’s clinic and asking [for a primary caregiver].”

The current model is not working because doctors no longer want to work in the silos of a fee-for-service practice.

It’s ironic that the provincial government has created a hospital environment which doctors prefer to work but one that removes them from the general public.

The solution is obvious but the BC Liberals have been slow to implement it: Build walk-in clinics and hire doctors on a salary basis. Everyone, doctors and patients alike, will be happier.

It’s going to cost more because the government will own the clinics. But the alternative, privately-built clinics, is a failure. The reason that two walk-in clinics in North Kamloops closed their doors is because doctors don’t want to work for less in an environment where they don’t have the same support that hospitalists enjoy.

Canada’s internet remains flat, despite challenges

Canada remains a world-leader in keeping our internet equal for all. Challenges to tilt the internet in favour of special interests come from at home and abroad. Last month, Canada’s telecomm regulator ruled that all online data be treated equally.

The ruling comes after Videotron, a music streaming company, offered their wireless service to subscribers at no charge for data used. This practice, called “zero-rating,” is violation of net neutrality because content would be biased in favour of their service. Subscribers to other music streaming services would pay more. The Canadian Radio-television and Telecommunications Commission ruled the practice illegal.

In his ruling, the CRTC chair Jean-Pierre Blais suggested a less disingenuous tactic for Videotron:

“Rather than offering its subscribers selected content at different data-usage prices, Internet-service providers should be offering more data at lower prices,”

The ruling is a victory for the little-lobby-group-that-could, OpenMedia.ca (which I support financially).

“We just won again!,” they crowed in an email to me, “The Canadian Radio-television and Telecommunications Commission (CRTC) just decided in favour of historic Net Neutrality rules that prevent Big Telecom from unfairly manipulating data caps to discriminate against certain apps and services.”

Michael Geist, professor of Internet and E-commerce Law, was equally enthused but more muted in his response:

Most notably, Canadian consumers and creators will benefit in the long term from the Net-neutrality policies.”

Canada’s firm support of net neutrality extends beyond a level playing field. Without it, giant telcomms could start to collect browsing habits of unsuspecting customers and sell them to advertisers for the purpose of targeting specific demographics.

The concept of a flat internet is vital to free expression and innovation. In an earlier column, I argued that net neutrality is fundamental to democracy:

Canadians must stand on guard for a free and democratic internet.”

Net neutrality in the U.S. has been tilting back and forth. In 2014, the U.S. appeals court ruled that the internet was not a “common carrier.” A common carrier is like a telephone line, simply a conduit to carry information. If telephones weren’t a common carrier, telephone companies could make it easier for businesses to access your phone than your friends and family.

The designation of common carrier is vital to net neutrality. Without that designation, internet service providers could effectively suppress content by making it more costly to view.

Sensibly, President Obama restored the designation of common carrier in 2015.

Now President Trump’s appointees to the U.S. telecomm regulator, called the FCC, intend to overturn net-neutrality in the U.S.

Canada faces a mixture of faux worry and resistance from the U.S.  A Trump-appointed advisor to the FCC, Roslyn Layton, said “My biggest concern for Canada is that you continue to add regulation that deters the incentive to invest,” Her fake concern for Canada not believable. Many big U.S. giants such as Netflix oppose the Trump initiatives because they don’t want their subscribers paying more than competitive video-streaming. They fear that U.S. telcomms will do what Videotron tried to do and tilt the internet in favour of their own services.

I have a feeling that Layton’s real concern is that U.S. tech start-ups will move to Canada where innovative technologies still have unbiased access to the internet.