There is a common thread that ties together the United Kingdom’s vote to leave the European Union, the American Presidential election, which surprised many folks and the overwhelming decision by Ontario’s doctors to reject a proposed Physician Service Agreement between the Ontario Medical Association and the Government of Ontario.
The tie that binds all three results together is not the superficial similarity of a majority voting contrary to the wishes of the establishment. That would be a wonderfully simple view of the world that would let the OMA leadership (including me) off the hook. “We couldn’t expect anything different, look around that world and see people reject authority”. We need to look deeper or the OMA will not learn and will be doomed to repeat the same old mistakes.
The common element between the three elections is that people who proposed positive actions defeated people who warned that voting for the other side would send us all to hell in a handbasket.
People voted for hopeful change
I don’t have a deep understanding of the twists and turns of the Brexit campaigns. The Economist, June 20 2016, has laid out a summary of the main arguments for the Leave and the Stay campaigns. The Leave side made strong positive arguments. Immigration, complex regulations made in foreign capitals, jobs and the economy would all improve if the UK left the EU. It doesn’t matter for the purpose of my argument if those assertions are true or false, the point is that they speak of a positive result. The Stay side’s best arguments were that leaving would lead to a ruined economy. There is no mention of the positive things that would accrue to the UK if they stayed. There were no positive arguments.
A similar thing occurred in the American election. Mr Trump talked positively about policy. Again, forgetting for a moment the practicality of the policies, he spoke about building a wall, bringing jobs back home and re-building the Military. If Trump was elected foreign powers would fear and respect the United States of America. Make America Great Again.
Ms Clinton’s main arguments were all about Mr Trump’s unsuitablity. He was a buffoon. His perceived misogyny, racism and intolerance of foreigners were all she talked about. “A man who can be provoked on Twitter should not be given the Nuclear Codes.” It’s a good line, but it’s not enough.
I know she had dense volumes of policy papers—somewhere, but that’s not the message she got out. She talked negative. She got crushed in the Electoral College.
Anyone who thinks that her win in the popular vote is significant doesn’t understand power. “Winning isn’t everything, it’s the only thing.”-Red Sanders UCLA
What happened to the OMA during the recent vote on the tentative PSA? I’m afraid that the OMA leadership lost their way.
There were plenty of problems with the content of the agreement, there were plenty of problems with the negotiations process and there were plenty of problems with the ratification process, but the vote was won and lost during the 6 week ‘campaign’.
The OMA forgot to articulate the positive changes that would result from a ratified PSA. We should have focused on primary care enhancements, relativity, fee modernization, which would have including lowering some overvalued fees and increasing some undervalued fees. We should have talked about the leadership opportunities for physicians in health care transformation. We should have focused on our patients.
Instead we talked about the dire consequences of the status quo. “If we don’t agree to this contract we will be worse off.” It’s not a catchy slogan and worse it’s not a good reason to support something.
I’ve gone back and re-read an essay I posted on this site called “I Vote Yes”. I Vote Yes It does lay out positive reasons for voting in favour of the proposed deal. Later on, I changed my tone and spoke about the bad things that would happen if we turned down the tentative deal. I originally said that we needed to talk, that we needed to trust and that our patient’s need a relationship between doctors and government. Somehow, somewhere I switched my message to a darker place.
The No side did much better. Turn this down and we can negotiate something better. It almost didn’t matter what the ‘better’ meant. The fewer details the better.
No sold hope, Yes sold fear. Guess who won?
I’m not naive enough to think that the results would have been different with a different message. The margin of victory was too large for me to think that. But the Yes side had no chance with such a negative message.
Next time a decision is sent to OMA members, the OMA should forget about using fear of the alternative as a reason for Doctors to support something. Tell them the facts and let them make up their own minds.
Scott Douglas Wooder, MD
I almost didn’t publish this piece. I’m not trying to criticise others, I’m trying to learn through self reflection. I publish it because I personally made major errors in the tPSA process that I hope I can learn from.