Canadian Medical Association Journal 1996; 154: 1259-1260
© 1996 Canadian Medical Association (text and abstract/résumé)
L'Heureux, a past president, said doctors had a strong case and the CMA spent a large amount of time and money over several years trying to change the rules: it collected solid evidence that proved the tax is unfair to physicians and costs them millions of dollars annually that other professionals don't have to pay, and it delivered the information forcefully on Parliament Hill. Yet two governments -- one Conservative, one Liberal -- have refused to budge. "Where did we go wrong?" asked L'Heureux.
"In the end, you have to look at the objective," said Fry, a past president of the British Columbia Medical Association who was named to Prime Minister Jean Chrétien's cabinet in January. She said the GST "was a very difficult issue" politically because any changes made to appease one group would be a hard sell politically -- a government cannot be seen to favour one segment of society. Fry said other groups also claimed that the GST treated them unfairly, and to provide special treatment for one of them could have had a domino effect.
Does this mean the CMA was wasting its time and money pursuing the issue? "Not at all," said Dr. Bill Acker, chair of the Political Action Committee. "To me it simply shows how important it is to get our MD-MP Contact Program up and running so that we can get our message across in caucuses."
That program, launched last year, is designed to link a physician or physicians in each riding with their MP. In effect, the CMA wants to make lobbying a national effort by expanding it into ridings instead of concentrating all efforts on Parliament Hill. "You have to remember that Hedy Fry was speaking as a cabinet minister and when you get to that level of responsibility, you have to deliver a certain message," said Acker, who thinks MPs who are not in cabinet would deliver a different message.
Dr. Keith Martin, a Reform Party MP from British Columbia, said acquiring public support is the key to successful lobbying on issues like the GST. "You have to influence a broad spectrum of people, including politicians of all stripes, but public support is essential. Without public support, you won't get your message across."
He acknowledged that an issue like the GST made it difficult to gain this support because physicians who lobby on "money issues" seldom enjoy success.
Acker said the CMA's GST lobbying should continue "because this issue is far from decided and we have to keep hammering away on it." Even though the government hasn't responded to the CMA's concerns about the GST, he thinks positive results in areas such as registered retirement savings plans may be partially attributable to physicians' vocal reaction to the GST.
Fry, a family physician from Vancouver, said doctors should not concentrate all lobbying efforts on cabinet ministers: "Go for the broader reach if you want to be effective." For instance, an issue taken to a back-bench MP may not reach the prime minister or cabinet ministers directly, but there is a good chance it will be discussed during regular meetings of the national caucus, during which MPs can pressure ministers.
Léo Duguay, a former Progressive Conservative MP, said physicians used to think that political lobbying was "sleazy" and considered themselves above the fray. "It is essential that you participate because it is the only way to ensure that all sides in an argument are represented. The best way to counter bias is to ensure that all biases go on the table at the same time."
Physicians who attended the Feb. 29 workshop hoping to be inspired about the way federal politics works received little in the way of inspiration from Martin, an emergency physician. He said federal politics has left him feeling frustrated. "Why would a doctor, who is part of one of the most respected groups in society, seek to become part of the most reviled group?" he asked. "I sometimes ask that question myself."
Martin said physicians who want to affect public policy should cultivate relationships with the media, which will deliver messages to both politicians and the public. "It is the most powerful conduit," he said. "And we have to repeat our message 100 times before it will get through to the public."
Political viewpoints usually depend on which side of the House an MP sits, so it was no surprise that Fry had a much different perspective about Parliament Hill than Martin. Fry, the minister of state for multiculturalism and the status of women, argued that physicians should try to create change from the inside by seeking election. "Standing outside and lobbying is fine, but on the inside you can have a personal effect on change."
She said organized medicine, and particularly forums such as the CMA's General Council, are excellent finishing schools for would-be federal politicians. "I learned to think on my feet at General Council and that training has served me well in Parliament," she said. "Physicians generally must stand up and speak more loudly -- don't let the opportunity to lead change pass you by."
Another politician said his party is facing many of the same problems as health care. "We're also restructuring and downsizing," Jean Charest, the Progressive Conservative leader, said in an address during the CMA Leadership Conference that followed the lobbying workshop. He is in the midst of rebuilding a party that was decimated in the Tories' 1993 election meltdown.
Charest, the youngest-ever member of a Canadian cabinet, described the peaks and valleys of his political career and said physicians would be wise to realize that there are "things we can change and things we can't."
He said he was a wise choice to speak to physicians about change -- the theme of the 1996 Leadership Conference -- because few people live with as much change as politicians and he has seen more of it than most. Less than 3 years ago, Charest was a cabinet minister in a government that had a huge majority. Today, he leads a party that has two MPs.
It is probably a sign of the political times and the new emphasis being given to lobbying that the workshop attracted three times as many registrants as anticipated. "We are very pleased," said Acker. Organizers had hoped to have about 25 participants but attracted more than 80.
Acker said the high attendance is one sign of physicians' growing interest in the political system and ways they can influence it.