terminations of such pregnancies may have been induced by their campaign. Gideon Koren, MD. Motherisk Program. Hospital for Sick Children. Toronto, Ont.
economics. However, I do know containing alcohol puts the fetus something of arithmetic. Baltzan's at risk." This is false information, conclusion that since health care because no research to date has spending has not increased as a documented evidence that after a portion of the gross domestic single drink or a few drinks there product over the last 10 years is a risk to the fetus." 2 "there is as much money left over At the Motherisk Program in now as there was then" is patently Toronto we deal with scores of false. frightened women who would be Ten years ago Canada did not ready to terminate their pregnanhave a cumulative federal deficit cy if we told them that the few approaching $500 billion. Servic- drinks they had had before realizing the federal debt has become ing they were pregnant were terathe single greatest expenditure on togenic. the federal ledger, sucking up dolThe Manitoba physicians lars that should have been avail- should probably sponsor a study able as transfer payments to the to find out how many unjustified provinces. terminations of such pregnancies Dr. Lager presents the case may have been induced by their for more fiscal responsibility on campaign. the part of patients. Since most provincial governments lack the Gideon Koren, MD intestinal fortitude to pursue such Motherisk Program an agenda (at a paltry $5 per Hospital for Sick Children emergency visit, neither does the Toronto, Ont. government of Quebec) it is point- References less to argue the merits of such a strategy at this time. 1. Rosett HL, Weiner L: Alcohol and the Fetus, Oxford U Pr, New York, 1984 Like it or not, provincial govLouis H. Lager, MD ernments have politically deter- 2. Abel EL: Fetal Alcohol Syndrome, Med Economics, Oradell, NJ, 1990 1529 Victoria Ave. mined that they have a choice: Windsor, Ont. they can either raise taxes or cut (or reduce the rate of growth of) [The Manitoba Medical Associathe cost of medical services. If tion responds.] [The author responds.] physicians wish to avoid the latter I must take exception to some of it is up to them to credibly defend On May 30, 1991, the Child the comments made by Dr. Balt- the status quo. Health Committee of the Manitozan. His first complaint, that I ba Medical Association launched misrepresented the true purpose Brian Goldman, MD an awareness campaign about the of the 1986 strike, is utter non- Contributing editor, CMAJ risks of drinking alcohol during sense. I am well aware that some pregnancy. A 30-second commerOntario physicians rationalized cial with a clear message to the the strike as a fight to retain the public regarding the potential right of private practice. However, Drinking and pregnancy dangers of drinking during pregthe only issue that truly mattered nancy was produced in conjuncto the public was the cost of in- I n the Aug. 1, 1991, issue of tion with a local television station CMAJ (145: 235) was the and broadcast daily for a 10-week sured services. Newsbrief "Campaign by period in English, French and By the way, the right to private practice has never been taken Manitoba MDs highlights risk of Cree by local television stations. away, provided the physician has drinking during pregnancy." The commercial highlighted opted out of the provincial health These physicians should be the following points: (a) drinking insurance plan and the patient is commended for identifying fetal alcohol during pregnancy may willing to pay the fee in total. alcohol syndrome (FAS) as of high cause physical, mental and behaThe gist of Baltzan's second priority in preventive medicine. vioural abnormalities in the baby, comment, that I display ignorance However, their commercial is (b) there is no known safe of economic matters, is partially quoted as claiming that "regard- amount, (c) all forms of alcohol correct. I am not an expert in less of age or race, any drink (e.g., liquor, wine and beer) can returned each year to the patient if his or her medical costs are below the cap. Equal access and universality would continue, and costs to OHIP would also be largely capped, which should lead to less taxation. Therefore, instead of trying to pay for our flawed medicare system by increasing taxation why not look for an alternative method? Capping the gross income of physicians is very unfair in a free enterprise system, especially since we are the only group singled out for this injustice. We can scrape by on $400 000, but if the work is justified the physician should be paid in full. Capping physicians' fees will only lead to stretched out consultations, tests and procedures. Medicare's equation includes government (two tiers), patients and caregivers. Each must bear responsibility to make it work, not only the physicians. My two-tier system offers more fairness to all.
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LE 15 DECEMBRE 1991
