Twenty-nine thousand doctors, two bargaining committees, a premier, a health minister, a finance minister and myriad Ontarians following this drama all found themselves asking the same question late yesterday afternoon:
With the news that fully 63 per cent of Ontario’s doctors opted to reject the tentative agreement unveiled five weeks ago by the province and the Ontario Medical Association, we are all in quite uncharted territory and with plenty of questions. (Turnout, incidentally, was 55 per cent).
All the players tried to put the best shine on yesterday’s developments. But you couldn’t help but think that there are some very upset and disappointed people wondering what happens next.
Let’s start with the Ontario government, which had desperately hoped to have this agreement ratified for two big reasons. First, the agreement would have given the finance minister four years of much greater cost certainty, ensuring his hopes for a cherished balanced budget next year remain intact. But second, and equally as important, a ratified agreement would have taken one of the government’s most worrisome political issues off the front pages ̶ a major sigh of relief with an election coming in the spring of 2018.
The OMA’s leadership must also be wondering what’s next for its inner circle. How could it have misread the mood of the province’s doctors so badly? This deal wasn’t narrowly rejected. It was overwhelmingly rejected. Does the OMA brass still feel it has the membership’s confidence? Can it continue to represent the doctors at the bargaining table when the parties return there, or should its leadership resign, having clearly missed the mark on this one?
The initial response was one of perseverance, not disappearance.
“As president of the OMA, I am personally committed to rebuilding trust, and to reuniting and re-engaging our membership,” offered Dr. Virginia Walley, who reiterated to Matt Galloway on CBC Radio this morning that she wasn’t entertaining any thoughts of resignation.
Re-establishing trust will take some doing. Apparently, the straw that broke the camel’s back and led to a rejected agreement is the firm sense among the majority of doctors who voted that health-care funding in Ontario is being starved. They may have grumbled loudly when their incomes were unilaterally cut back by the Liberals. But they’ve drawn a line in the sand now that they feel their patients are suffering, due to an inadequately resourced system.
On this point the government would say: we do spend north of $50 billion annually on health care in Ontario. For more on this debate, read my recent post on whether the system truly is inadequately resourced or just poorly managed.
Clearly the majority of doctors didn’t believe the “trust us” claims of the OMA and the government, when both sides said doctors would “co-manage” the health-care system going forward. The much-vaunted “seat at the table” promised by the government left many doctors unimpressed.
“My six-year-old currently has a seat at the table, but I'm still the one making the decisions,” points out Dr. Nadia Alam, one of the leaders of Concerned Ontario Doctors, which lobbied hard to have the pact rejected. “This hierarchy, this power imbalance is currently what makes negotiations with the government so difficult for physicians.”
But if the doctors were looking for an olive branch from the province ̶ something that might constructively reignite negotiations ̶ they sure didn’t find it in this statement from health minister Eric Hoskins, himself a medical doctor.
“The result is regrettable and will require all parties to reflect carefully on next steps during the coming weeks,” he said yesterday. “The government will be guided by the need to secure a stable and predictable budget to meet the demands of population growth and an aging society, as well as to ensure fair compensation for all physicians and for family doctors in particular.”
Note what is first on that list of what will guide the government’s priorities.
For their parts, both opposition parties offered nothing constructive in their responses. Actually, what they did offer was worse than not constructive. It was downright mischievous. Both the PCs and NDP urged the government to consider allowing the issue of binding arbitration back into the discussions, even though it’s a virtual certainty that if either of them were in government, they’d be no more inclined than the Liberals have been to offer it.
The Liberals won’t go for binding arbitration because there is ample history with police officers, firefighters, heck, even millionaire baseball players, that arbitrators land on settlements management thinks are too rich and unaffordable. Ironically, for two consecutive elections in 2011 and 2014, the Tories campaigned on fixing “a broken arbitration system” that offers too-rich settlements. And yet for some reason, the Tories want to put the province’s most expensive labour agreement ̶ nearly $12 billion in physician compensation annually ̶ to that very same broken system.
If either opposition party were so convinced of the worthiness of binding arbitration as a means of settling this dispute, they’d surely have gone on record today promising to offer it should either of them form the next government. The fact that neither of them has done so speaks volumes.
Math is math, and Ontario’s fiscal reality will be the same for whichever party forms the next government. No party at Queen’s Park will risk allowing this dispute to go to binding arbitration, thus potentially putting the province’s books out of balance to fund an agreement that could cost billions more.
Dr. Alam emailed this to me last night: “(PC Leader) Patrick Brown believes docs should be treated like all other essential workers, including having the right to binding arbitration. As you've already pointed out, that is not an outright promise but it's certainly more positive than what the Liberal government has offered to date.”
Radiologist David Jacobs, who like Alam has been a constant presence on Twitter, also acknowledges: “There have been no hard guarantees by any party,” regarding promising binding arbitration in future. “The PCs are leaning towards it, but there is a measure of caution.”
These doctors are right to be cautious. Parties can favour binding arbitration while in opposition. But things tend to look different once opposition parties become government. “Favouring” is quite different from committing to doing something, and we have yet to hear either opposition party commit to binding arbitration.
Most observers seem to agree that the only way binding arbitration will be introduced is if the OMA’s court challenge succeeds in forcing it upon government. Otherwise, forget it.
Which gets back to our original question: now what, indeed?
We’ll tackle that question tomorrow.
Get Current Affairs & Documentaries email updates in your inbox every morning.