Doctors’ pay model wasn’t always broken

While doctors weren’t happy with Medicare at first, they eventually approved of the pay model.

Doctors when on strike in Saskatchewan when Medicare was first enacted in 1962.

Saskatchewan doctors complained that they would be turned into civil servants, unable to follow their own judgment about what was best for their patients. The day Medicare was enacted, 90 per cent of the province’s doctors went on strike.

Supporters of doctors strike. image: Canadian Dimension

Months later, much of the support for the doctor’s strike had dissipated. After the government made some amendments to the Act, including one amendment allowed doctors to practice outside the plan, doctors returned to work.

 Saskatchewan became as model for what was become universal health care for all of Canada.

The familiar pay system for doctors -fee-for-service- was born. It worked well for decades. Doctors are paid for each body that walks through the door, regardless whether the patient has a cold or some complex medical problem.

Doctors liked the system because they were independent business operators. No nanny state told them how to run their practice.

Now that pay model isn’t working for anyone: not for doctors and not for patients. With real estate prices going through the roof, with expensive medical diagnostic tools, and the rising cost of wages for staff and the price of utilities, doctors struggle to make ends meet.

Doctors now identify fee-for-service as the path to minimum wages.

Alicia Pawluk became a doctor in 2018 and treats patients at a clinic in Victoria. She says under the current system, the take-home income of a family doctor is comparable to minimum wage.

“The average physician graduates with about $200,000 of debt. Minimum wage is not going to be able to cover the sort of payments that we need to make,” said Pawluk.

Another Victoria physician, Dr. Jennifer Lush, says she works 70-hour weeks and struggles with work-life balance. Half the hours Lush puts in are unpaid because they are spent doing paperwork.

“The minute my kids are tucked in bed, I’m pulling out my computer and I start charting. Often I will chart until two or three in the morning,”

Given that almost one million British Columbians don’t have a family doctor, it’s surprising to learn that there is no shortage of doctors in B.C.  Data compiled by the Canadian Institute for Health Information shows B.C. had 134 family physicians per 100,000 people in 2020, the third-highest in the country. The number of doctors trained in family medicine grew 11.2 per cent between 2016 and 2020.

However, the number of British Columbians without a family doctor is the highest in Canada on a per capita basis. There are two reasons: the population of B.C. is growing and fewer doctors are willing to slave away at the fee-for-service model.

British Columbia has about 6,800 family doctors by training, but less than half of them are practicing traditional family medicine.

New graduates are choosing more hospital-based work instead and specialized practice, which provide a predictable income, team supports, a vacation and maternity leave.

Doctors no longer detest being employed by the state. With improved working conditions, who can blame them?

The solution is to build provincial clinics and hire doctors to operate them. It’s expensive but so is a pay model that no longer serves British Colombians.  

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Albertans to receive the highest carbon gift

The carbon gift is not a lump of coal. Albertans will receive the highest carbon tax rebate of any of the four provinces who have opted out of the federal plan. A family of four will receive an average tax credit of $888, compared to families in the other holdout provinces of Ontario, Manitoba and Saskatchewan who can claim a credit of $448, $486 and $809, respectively.

imge: Pinterest

Let’s call it a gift, not a rebate because most Albertans will receive more back than they pay in the so-called carbon tax. According to calculations by economists Jennifer Winter and Trevor Tombe at the University of Calgary, 80 per cent of Alberta households will get more back from the credit than they will pay in increased costs (Globe and Mail, Dec. 19, 2019).

And can we really call it a carbon tax when it isn’t really isn’t? Taxes are collected by governments to pay for health care, roads, education and so on. The goal of the carbon transfer is to reduce fossil fuel consumption, not to collect taxes. Let’s call it a carbon transfer. Money is just collected and redistributed.

The names given to the carbon transfer and carbon gift are politically motivated.  Conservatives prefer to call it a tax because it suits their political agenda of characterizing the fed’s actions to reduce fossil fuel consumption as a tax grab. The feds like calling the carbon gift “climate action incentive payments” because they like to pretend that we will meet carbon reduction targets.

And the federal Liberals are not rewarding Albertans for shutting them out of the province in the last election. The carbon gift is higher there because it covers a longer period of time than the other provinces and because Albertans spend more on fossil fuels.

You might wonder who’s paying for the carbon gift if it’s revenue neutral. Who is paying more than they receive?  It turns out that businesses are.

For struggling businesses, the carbon transfer seems unfair. But the holdout provinces are responsible for that: if they had devised their own carbon transfer system, the one proposed by the feds wouldn’t be in place. All provinces are free to create their own systems. Presumably, they could devise a system where taxpayers end up giving a carbon gift to small businesses. By refusing to create their own plan, they are accepting the fed’s by default.

B.C.’s carbon transfer is a model for the rest of Canada to follow. Businesses are not hurt –in fact they receive a reduction in taxes, as do personal taxpayers. Introduced in 2008, it has reduced per-capita emissions by 12 per cent and contrary to what conservatives claim, it hasn’t hurt the economy.

B.C.’ carbon transfer is also a model for conservatives because it was introduced by the BC Liberals, a conservative government. If the BC Liberals could introduce a carbon transfer and get re-elected, any conservative government could.

Pricing carbon is an easy sell to voters because most Canadians agree on pricing pollution, led by BC (84%) and trailing in Alberta where it’s still a majority (69%). And if there is no net cost to taxpayers, what’s not to like?

Pipeline approval won’t help the Liberals

If the federal Liberals were as popular as the Trans Mountain pipeline, they would win the upcoming election in a landslide.

image: City News, Edmonton

The problem for the Liberals is that the pipeline is most popular where voters are least likely to vote Liberal and least popular where voters traditionally vote Liberal.

According to an Angus Reid poll, the strongest support for the pipeline is in Alberta and Saskatchewan, 85 and 71 percent respectively (ArmchairMayor.ca, June 21, 2019). That’s where Liberal support is weak. Only a total of five seats were won by the Liberals in the combined provinces. Meanwhile in Quebec, 40 percent disapprove. That’s where the Liberals won 40 seats.

While support for the pipeline in B.C. is 54 per cent, that average doesn’t reflect the difference of opinion between the Lower Mainland and the Interior. People in the Interior generally support the pipeline because of jobs and financial incentives offered by Trans Mountain. An informal poll by Kamloops This Week showed 80 per cent approval. The Lower Mainland opposes the pipeline because of potential spills.

Conservatives are placed in the awkward position of approving of the pipeline while disapproving the Liberals. Cathy McLeod, Conservative MP for Kamloops-Thompson-Cariboo, doubted the government’s ability to finish the job:

“I’m not all that optimistic that this government can get it done,” McLeod told Kamloops This Week. Her statement aligns with the Angus Reid poll where 40 percent of respondents didn’t think the pipeline would be built.

Another perceived hurdle is Bill C-69, passed by the Senate last week, which critics say will ensure that the pipeline will never be built.

Bill C-69 imposes more requirements for consulting affected Indigenous communities, widens public participation in the review process and requires climate change to be considered in the building of any development.

The Alberta-based Pembina Institute is cautiously positive of Bill C-69:

“This bill was never about individual projects, but rather a reform of the entire decision-making and assessment process. It is about creating tools and processes to ensure natural resource development decisions, whether about a mine or a dam or a pipeline, are made in a fair way (press release, June 14, 2019) “

If pipelines don’t determine how people vote, what does? Pollster Michael Adams has noticed something new in the way people view immigrants. Twenty years ago, anti-immigrant sentiment was evenly distributed among all three major parties. That’s changed, say Michael Adams, Ron Inglehart, and David Jamison in their article:

“Conservative supporters are more likely to agree with statements strongly hostile to immigration. For example, 50 per cent of Conservatives strongly or somewhat agree that “Overall, there is too much immigration. It threatens the purity of the country.” Fewer than a third of New Democrats (31 per cent) and Liberal supporters (24 per cent) share this belief. This relative concentration of xenophobic sentiment in one party is a new phenomenon in Canada (Globe and Mail, June 14, 2019).”

The researchers are careful to point out that the Conservative Party is not anti-immigrant: they just attract people who are.

Researchers call this the “authoritarian reflex,” a reaction caused by uncertainty and characterized by increased hostility toward “the other,” regardless of whether they are “deviants” in society or foreigners.

The contagion of populism that has been animated by the authoritarian reflex in the U.S. has spilled over into Canada. It will determine the way people vote in way not seen in recent history.

 

Canadians support carbon pricing

Canadians, including business groups, support Trudeau’s proposed carbon-pricing plan announced Tuesday. So why are some politicians opposed? The short answer is politics, although games are being played by both sides.

image: Werner Antweiler

Recent polling from Environics Research shows that nine out of ten Canadians are concerned about climate change. And a majority support carbon pricing except in Alberta and Saskatchewan. Tony Coulson from Environics Research says:

“For many Canadians, it appears their concern about the consequences of climate change is strong enough that they’re willing to bear some cost to help stop it (Globe and Mail October 16, 2108).”

The feds say that they will collect carbon taxes from those provinces that don’t have a carbon-pricing plan and return the money directly to citizens of those provinces. Depending on how little fossils fuels they burn, they could get more back in rebates than they spend on the added carbon tax.

Opposition parties are calling it a vote-buying tactic in time for the next election.

Those opposing carbon pricing include Ontario Premier Ford. During his Alberta visit to bolster Jason Kenney, leader of Alberta’s United Conservative Party, Ford tweeted:

“I am proud to say that Ontario will stand with Albertans who oppose this unfair and burdensome tax on families and businesses.”

The Ontario Premier has allied himself with Saskatchewan Premier Scott Moe in opposing the federal tax plan. Manitoba also recently cancelled its planned carbon tax.

Carbon taxes are directly on the sources of carbon: 70 per cent of them from burning fossil fuels to heat our homes, generate electricity and for transportation.

Ford claims that carbon taxes take money out of the pockets of taxpayers. Not necessarily. A revenue neutral carbon tax such as the one that B.C. has doesn’t. Sure, we pay more for gasoline but receive an equal reduction in taxes elsewhere. As demonstrated in B.C., carbon pricing reduces greenhouse gases and doesn’t harm the economy.

If Ford wanted to take a conservative approach, it would be our carbon tax. A progressive approach would be to take the carbon taxes and directly invest them into sources of renewable energy.

Canadian businesses also support carbon pricing. The business-backed C.D. Howe Institute has recently come out in favour of carbon-pricing. The institute understands both the necessity and practicality of carbon taxes. C.D. Howe policy analyst Tracy Snoddon says:

“The politics of carbon pricing may have changed but the climate change challenge and Canada’s emissions reduction targets under the Paris agreement have not. The economics are also unchanged – carbon pricing continues to be the most cost-effective option for achieving emissions reductions across the country (Globe and Mail October 18, 2108).”

It’s disappointing to see politicians use the future of our planet as a political football.

Canadians want government action. For the first time in polling history, Canadians say that individual action is not working that governments need to step in.  “A slim majority now feels that voluntary action is not enough to address the challenges we face,” says Coulson.

Canadians are waking up to the fact that individual actions, like changing to energy efficient light bulbs, is not working. Only legislated policies will collectively accomplish what we individually wish for.

 

The bitter side of honey

Becoming bee friendly is a good first step for the city. Now Kamloops needs to become honey friendly.

Bee City Canada

Canadian and American consumers are getting stung with fake honey. Much of comes from China, the world’s largest honey producer but you wouldn’t know it. Chinese honey is being laundered.

The label rarely says “made in China.” Instead, it will show the country of origin as being from countries like Indonesia, Malaysia, and Taiwan: suspiciously, places that ordinarily don’t produce much honey.

An investigation by the Globe and Mail found that Chinese producers export cheap and often contaminated honey to countries mislabelled as molasses, fructose or glucose syrup so customs officials don’t become suspicious.

The Chinese honey is filtered to remove any soil or pollen that would identify the county of origin and exported to countries around the world.

Worse still, the Chinese honey may be contaminated with antibiotics and adulterated with sugar:

“Most honey comes from China, where beekeepers are notorious for keeping their bees healthy with antibiotics banned in North America because they seep into honey and contaminate it; packers there learn to mask the acrid notes of poor quality product by mixing in sugar or corn-based syrups to fake good taste.”

The importation of fake and imported honey leaves a bitter taste in the mouth of Neil Specht. The Saskatchewan honey producer has seen the price of honey drop from $2.43 to $1.11 a pound last year due to the flood of imported honey into Canada.

“There are few, if any, honey producers that can operate at $1.11 per pound,” Specht told Walrus magazine. “I would suspect the costs of production for most are in the $1.60 to $1.65 range.”

Specht had a bumper crop last year, more than 500,000 pounds, and he’s not sure what to do with it. He could sell it at a loss or keep it in hopes that prices will improve. He normally sells his honey to the Western Canadian co-operative Bee Maid.

Consumer confusion over labelling doesn’t help. When buyers see “Canada No. 1” on a label, they think it’s produced in Canada. But that is just an indication of grade, not country of origin. Fine print may reveal the true source.

Canadian honey producers are understandingly upset. Manitoba bee keeper Allan Campbell alleges that Canada’s largest honey packer, Billy Bee, is marketing their honey as pure Canadian while as much as one-half of the contents may imported. Spokespeople for Billy Bee deny this, insisting that their honey is eighty-five per cent Canadian. Billy Bee brand is a blend of Canadian and Argentine honeys while their Natural Honey Farms brand contains honey from China.

It’s well and good for Kamloops to promote healthy ecosystems for bees; they pollinate much of the food we eat. However, the honey they produce is worth protecting as well. I don’t mean just the honey bought at Kamloops’ Farmers Markets, which I would think is pure Canadian, but also the honey sold on grocery store shelves.

The bee-friendly brand is cute but the hard work is lobbying governments to remove deceptive labelling so that it’s clear what consumers are buying in bee-friendly Kamloops.

Why carbon storage won’t save us

Politicians can be expected to act irrationally during election years. By that measure, Saskatchewan Premier Brad Wall is acting as expected.

A rational, albeit flawed, argument is that Saskatchewan can produce clean electricity from dirty coal by capturing the carbon and selling it. It’s the equivalent of selling your garbage.

Carbon capture holds promise to rescue Premier Wall from a problem of geography. Unlike B.C., Saskatchewan has few hydro dams and lots of coal. In promoting carbon capture, Wall attempts to position himself both as a climate defender and friend of Big Coal.

At first glance carbon capture seems magical. The technology works some of the time and Cenovus Energy of Calgary agreed to buy the carbon dioxide from Saskpower. The plan is for Cenovus to buy all of the CO2 produced by the Boundary Dam generating/capture site, a total of one Mega tonnes a year. Cenovus use some of the CO2 to pressurize old oil wells near Weyburn, forcing the remains up to the surface and some would be simply be stored in underground caverns.

Irrationality number one: CO2 would be captured, then used to recover more fossil fuels which would be burned to produce more CO2.

Then there’s Wall’s obstinate posturing in advance of the meeting of the premiers with Prime Minister Justin Trudeau for talks on a national climate strategy on March 3. The feds hope to have a deal in place for a minimum carbon price that would allow provinces to use their own mechanisms to achieve the pricing. They aim to have a deal with a minimum of $15/tonne in six months.

Wall flatly rejects a broad-based carbon tax: “I’ve already made it clear … that if we’re re-elected, our government will not be pursuing any tax increases or new taxes, and neither would we support any new national taxes.”

Irrationality number two: The Saskatchewan premier doesn’t want a level playing field. He wants other provinces to pay for carbon pricing so his province would have a competitive advantage. Alberta has plans for a price of $30/tonne. “I don’t want a level playing field for our province. I want this to be the most competitive place that it possibly can be … and that does not include a new carbon tax, especially now, given the state of the economy.”

That leads to the third irrationality. My question is this: “If your carbon capture technology works so well, premier, why worry about pricing carbon that you won’t produce?” Carbon in the ground won’t cost producers anything.

The embarrassing answer is that the technology doesn’t work that well. When the plant is working properly, it captures 90 per cent of the carbon dioxide but, in fact, because of mechanical issues, the facility has only operates 45 per cent of the time. It works so poorly that Saskpower has to pay penalties to Cenovus for not supplying enough CO2 as specified in their contract.

The problem is not unique to Saskatchewan. There are only 15 such sites in the world. China has abandoned theirs. The costly, complicated technology is wishful thinking. Its chief product is political irrationality in election years.