Last days of free market capitalism and the true believer

Being an unapologetic capitalist is not all that it’s cracked up to be.

John Hancock, senior counsellor at the World Trade Organization, was sweating profusely as he told his audience how capitalism was entering a more radical phase that would lead to further globalization of economies, massive dislocations, de-stabilization and perpetual turmoil. And that was the good part.

Speaking the Gardiner Museum last night as part of TVO’s Big Ideas series co-sponsored by the Literary Review of Canada, Hancock credits capitalism as having allowed the West to race ahead of the rest of world. In 1800 the richest economies were four times those of the poorest. By 1914 it was fifteen times. By 1950 it was 26 times. In 2000 it was 70 times.

Now countries like India and China are catching up at a torrid pace. Hancock says the Chinese economy is doubling in size every decade and India is not far behind.

Without once mentioning the impact of rising oil prices or the cost to the environment, Hancock says transportation costs have revolutionized the world economy to the point where it’s economic for countries to ship their garbage to foreign destinations. He says that Charlemagne would be “blown away” to walk into a Shoppers Drug Mart today and see the array of inexpensive products from around the world. This is the new utopia: cheap lighters made in Indonesia.

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Patient-based nonsense

Patient-based health care: Take away the phrase and the Minister of Health’s speeches would be little more than clean white sheets of paper.

There is an air of unreality when you see those trusted with stewardship of our health system using this phrase in new and unusual ways. It’s like somebody sent out a memo: this year is about patient-based care. Attach it to everything you do.

At last week’s Insight Conference on Continuous Quality Improvement in Health Care, Miin Alikhan, director of the Health Quality Branch of the Ministry of Health and Long Term Care, presented on the government funding “reforms,” including patient-based funding.

What is patient-based funding? It’s basically what they are moving the doctors away from — another version of fee for service although the exact mechanics are a bit unclear.

You don’t often associate funding reform with patient-based care. Evidently previous funding models didn’t apply to caring for patients.

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Maybe the LHIN CEO was referring to Grease, the musical

Bill MacLeod told an Insight conference last week that the deficit was Ontario’s burning platform, that the province was “this close” to being Greece. Generally speaking, it’s a bit more complicated to compare provinces to nations, but the CEO of the Mississauga Halton Local Health Integration Network may be more than just a little off in his comparison. In common parlance, you might call that remark a “whopper.”

The hysteria about deficits also applies to the Harper government, which is cutting services as if we were already Greece. That includes recent news of the termination of Statistics Canada’s Health Survey. Chop chop – who needs to know about the population health status of Canadians anyway? Heck, it’s only about effective planning.

Is our economic situation really that bad?

Money may be tight following the Ponzi schemes the financial services industry used to crash the world economy in 2008, but as far as borrowers go, Canada is actually in an enviable spot.

The September edition of the U.S. Institutional Investor magazine ranks countries by their credit rating. On the top of the 179 country list are such social democratic bastions as Norway and Sweden. Fourth on the list is Canada.

That’s right, our credit rating is fourth out of 179 countries. The U.S. is 10th. The UK is 14th. Germany, which is a big lender to Greece, comes in at 9th. Oh, and Greece, their credit rating places them in the 156th spot, just above countries like Afghanistan, North Korea and Somalia.

Fourth versus 156th.

The concept of a burning platform is to create a situation to force people to make a change.

The truth is Canadians are not standing on a burning platform. We are not Greece. We’re not even close to being Greece.

When Bill MacLeod says we are, you know he has another agenda to spur us into accepting decisions we may not like. Is this about democratic decision-making, or blatant manipulation?

You decide.

More managers to front line staff has an impact well beyond cost of salaries

Asking how the ratio of management to front line staff has changed at a public hospital seemed like a straight-forward question.

In this era of obsession with hyper-efficiency, you’d think the Ministry of Health, the Local Health Integration Networks and the hospital boards would be asking this question, and asking it regularly.

Doesn’t everyone want more live bodies actually delivering diagnostics, acute care and rehab?

To be fair the Ministry breaks down data by what they describe as “unit producing personnel” (UPP) and those whose “primary function is the management and or support of the operation of the functional centre” (MOS). Oddly the terms themselves suggest that managers don’t actually produce anything, which is much further than we would certainly go. (Note to managers reading this – are you really okay with these terms?)

If all this confuses you, apparently it does for hospitals too. There have been past complaints about the consistency and subsequent validity of such data. In our recent survey of the changing ratios of managers to front line staff, several hospitals opted (with our permission) to give us the UPP/MOS data instead of interpreting themselves who was in fact a manager.

Conducting what we thought was a basic freedom of information request, we received data in various formats and continually got the question: what is management?

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Are there more managers and fewer front line staff? At some hospitals, absolutely

Earlier this year we issued a freedom of information request to 20 sample hospitals where OPSEU represents health care workers to understand whether managers are in fact replacing front line health care workers.

Nine of 20 hospitals reported an increase in managers proportionate to front line staff over the past five years.

It’s a frequent complaint we hear.

While the requests were sent out in February, the information took much of the year to trickle in.

Resources are getting ever tighter in the hospital world – Ontario hospitals are experiencing no increase in their base budgets this year. How hospitals allocate their funding does matter.

Some hospitals actually reduced managers – at Kingston General Hospital, for example, managers dropped from 146 in 2008 to 125 in 2012. Staff has remained almost exactly the same over the past five years at 2,453. Other hospitals that dropped managers include the Chatham Kent Health Alliance, South Grey Bruce Health Care and the Windsor Regional Hospital.

Others show that our members were right.

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Employee engagement has substantial impact on reducing workplace stress – OHA study

Ontario hospitals could be paying a big price for not engaging their employees.

A new study from the Ontario Hospital Association suggests that “the quality of the work environment for staff and physicians is a key determinant of a high-performing health care organization.”

Written by workplace consultant Dr. Graham Lowe, The Relationship Between Employee Engagement and Human Capital Performance notes that “engaged employees are committed to their employer, satisfied with their work, and willing to give extra effort to achieve the organization’s goals.”

The study looks at data from small, teaching and community hospitals. The data links information from two tools — NRC Picker employee surveys and PwC Saratoga HR benchmarking project.

The evidence would suggest engaged employees are less inclined to experience workplace stress, suffer from fewer patient-handling injuries, and be less inclined to seek employment elsewhere.

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Briefs: Health Coalition Action Assembly November 17-18

The Ontario Health Coalition is holding its annual Action Assembly and Conference on the weekend of November 17-18 at the University of Toronto’s Hart House. The Action Assembly plans the Ontario Health Coalition’s actions and priorities for the coming year. It is also an opportunity for caregivers and patient advocates to network and share concerns. A block of rooms has been set aside at the unionized Bond Place Hotel on Dundas Square. To get the reduced rate of $84 per night, call 416-362-6061 or 1-800-268-9390 and tell them you are attending the Ontario Health Coalition conference. Watch for more details coming soon.

Briefs: Tax cuts don’t spur economic growth — study

The Ontario government has long believed that cutting corporate taxes will spur economic growth. A new six-decade study from the U.S. Congressional Research Services says that tax rates “have had little association with saving, investment or productivity growth.” The study did find that reductions of capital gains taxes and top marginal rates have led to greater income inequality. A story in The Atlantic notes that in the 1950s the top marginal rates were about three times what they are today, yet GDP growth was twice as fast in the 1950s as it was in the 2000s.

Briefs: Women with mental illness disproportionaley more likely to end up in jail

Women with mental illness are disproportionately more likely to find jail than health care help according to the associate chief of psychiatry at the Royal Ottawa Health Care Group. Speaking to the Ottawa Citizen editorial board, Dr. AG Ahmed says it is time to address that imbalance. According to the newspaper, an estimated 800 female inmates have some form of mental disorder in the federal corrections system. Dozens of women at Milton’s Vanier Centre – Ontario’s only correctional facility for women – have symptoms of mental illness that are so severe that they could benefit from being treated at a secure unit. While the Royal Ottawa maintains such a unit to treat men, the nearest for women is in Saskatchewan.

Vector Poll: Most Ontarians think McGuinty government is doing a poor job on major health priorities

Deb Matthews may want to get out more.

We’ve previously noted that Ontario’s Health Minister has made far fewer public speeches than her predecessors. The Ministry’s on-line speech archive lists two speeches for Matthews this year, one for last year. There have been a total of five press releases issued during the summer months (June to August), most dealing with basic alerts, such as reminding Ontarians to protect themselves from West Nile virus.

For a government intent on radically remaking the health system, there appears to be very little coming out of the Minister’s office. The effects are telling in a recent poll around the province’s long waited health action plan.

When the Local Health Integration Networks were formed, the province was charged with developing an overall health strategy. This was supposed to be the basis for the LHINs own integrated health service plans.

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