There is nothing that bureaucracy cannot make worse
Bureaucracy begats bureaucracy, building its own demand and transforming people into managers designed to meet bureaucratic needs. A bureaucracy designed to serve patients ends up serving its creators instead and protects those who work inside. Economist William Niskanen offered a definition of bureaucracies in his book Bureaucracy and Representative Government. Roughly speaking, he says, 1)…
Offer a small step to solving overconsumption and waste
Twenty-eight countries have universal healthcare. Twenty-two of them have some form of cost sharing. User fees offer one example. User fees work best as a small, flat fee paid at the point of service. Even a few dollars discourage (rational) people from booking an appointment for what they asked twice previously. User fees shorten the line…
When it comes to fixing health care, governance matters more than policy
Few voters had first-hand experience with hallway medicine or Canada’s world-famous wait times before the pandemic. Lockdowns changed everything. Health policy failure moved from fear-filled headlines into a tangible crisis everyone could feel. Failure begs for better, or even new policy, to fill gaps. Planners and policy writers jump to offer solutions: surgicenters, funding reallocation,…
Patients suffer if society reshapes the medical mind and how doctors process information
A medical mind is precious and fragile: hard to create, easy to corrupt. Doctors invest over 10,000 hours learning how to diagnose and treat. The medical mind exists to help patients and should serve no other purpose. But it is easily corrupted and distracted from its primary purpose. If patient care matters, we must protect…
Government, medical professionals, and public-sector unions each hold veto power over any innovation
The Honorable Monique Begin wrote in 2009, “When it comes to moving health care practices forward efficiently, Canada is a country of perpetual pilot projects.” Governments need “financial control” and remain “leery” of committing to programs. Pilot programs are easy to shut down “to avoid criticism” or if “budget priorities shift.” At first glance, we…
Canada rations care with wait times, limited investment in technology, and by using family doctors as “gatekeepers” to service
Doctors frustrate governments. They think too little about how much health care costs and too much about their patients who need help. The government of Ontario and the Ontario Medical Association arrived at a mediated Proposed Physicians Services Agreement (PPSA) this month. Doctors started to vote on it yesterday, with voting ending on March 27.…
Pandemic chaos and fear turned some otherwise rational doctors into dictators
Leadership carries a high risk for bossiness. Some medical Chiefs gain humility from caring for sick complex patients. It shapes their approach to leadership. Unfortunately, many forget their failures. Others never learned in the first place. Many Chiefs of Staff have never seen sick patients at all. But as chief, they see all the medical…
The world is watching Canada. Trudeau must separate his blend of public health and authoritarianism
Public health doctors created vaccination mandates and vaccine passports. Doctors tabled the ideas. Politicians docilely followed doctors’ advice and turned it into policy. Ideas shaped the policy and policy formed a protest. Public policy made the truckers’ Freedom Convoy a reality. Prime Minister Justin Trudeau’s response turned the protest into a global movement. The historic…
If you attack, slander, dismiss or silence your enemy: You. Will. Lose
Anyone who serves the public learns how to manage upset customers. When someone says you hurt them, do not argue. Listen. Apologize. When people are angry, upset, or heartbroken, you must stay silent. Offer support. There is no other rational response. Of course, listening has limits. Threats, yelling, or swearing must end the conversation, with…
Medicare struggles from funding thrown at the same tired ideas rooted in similar political traditions
Liberalism works when you are healthy but fails when you fall ill. Classical liberalism emphasizes autonomy, individual freedom, and free markets. These ideas have fuelled centuries of wealth and prosperity. Modern liberalism, in contrast, pursues central decision-making and equality of outcome. Despite similar names and obvious differences, neither type of liberalism provides arguments for everything…
Bureaucracy begats bureaucracy, building its own demand and transforming people into managers designed to meet bureaucratic needs. A bureaucracy designed to serve patients ends up serving its creators instead and protects those who work inside. Economist William Niskanen offered a definition of bureaucracies in his book Bureaucracy and Representative Government. Roughly speaking, he says, 1)…
