The animosity created by Alberta Health Minister, Shandro and felt by physicians is a direct result of Canadian society’s placement of health as one of its paramount values. The establishment of universal health care for all citizens is an implicit reflection of good health as one of society’s most valued requirements.

In a way, this has become a classic example of the mismatch that Canada’s acclaimed global economics leader, Mark Carney, in his recent book: Value(s) Building a Better World For All, makes between the severely limited definition currently evoked by market economics on “value” versus the actual “values” important to society and human satisfaction.

Carney uses the example of the widely accepted (but as he makes clear, not necessarily infallible and in fact dangerous) usage of value as solely determined by the “market”. This gives the company Amazon a market value of trillions of dollars while giving the Amazon rain forests essentially no value until the forests are levelled and land planted in soya. This monetary “value” may be very far off from societal “values” for which no accounting ledger would even have a column, nor any way of placing a dollar value on.

Similarly for health ministers now, doctor’s incomes have become a “liability”, a negative item in the budgetary ledger of “wealth creation”.  As Carney points out, this vision of “wealth” concerns itself only with “money” capital (which preferentially benefits the already wealthy), essentially ignoring “social” capital (which favors instead and benefits the general societal good).

Providing subsidies for oil extraction or pipelines have “value”.  Health costs on the other hand have negative value and horrors, might require increased taxes. There is no column in this ledger for society’s values. What is the “value” assigned to a family’s relief or grief from an ill child’s outcome from severe illness. How does this ledger value the human cost of depression on the individual or his neighbors.

Society has stated throughout history that it places high values on its physicians. Kings, rulers and governments throughout time placed great values on the knowledge and compassion of this noble profession. How then, has Shandro shown such contempt and such attempted public humiliation for doctors? He sees them solely as a budgetary liability. There is no accounting for the values inherent in society’s high estimation.

The public too has been led astray by this paradox. It is easy for Shandro to humiliate doctors by publishing their incomes. Yes, they earn well. Horrors again, we may have to pay taxes for this. Yet, the public willingly expect to pay for a dentist, lawyer, plumber, etc. out of its own pocket. They’re worth it.

Canadian society values doctors more than say lawyers; it made this explicit by establishing universal health care. Yet, they should earn less? They have less value than a lawyer? Something seems inherently wrong with this picture.

The recent rejection of Shandro’s package is no surprise. How can society place such a high value on doctors, saying their services are a basic right for all citizens and therefore paid for through the common purse – and yes, they must work no matter how Shandro victimizes them. Yet doctors can’t address any humiliation he places on them and uniquely compared to any other essential service, they can’t seek binding arbitration. His law, his word is unchallengeable.

Is this really in accord with how society “values” physicians?

- Terry Fridhandler M.D.C.M., F.R.C.P. (Retired)

Editor’s note: The views, perspectives and opinions in this article are solely the author’s and do not necessarily represent those of the AMA.

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