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Higher fees for individual doctors are a big driver of health care costs, but there is a second force at play. Every year, health care demand goes up due to population growth and aging. That means hiring more doctors to service the demand, and asking existing doctors to do more work. The new government will pay that cost, something the previous government said should just be sucked up within the reduced physician budget.

The government, quite reasonably, is talking about the increase in the total cost of paying doctors. The OMA is taking a narrower focus on the money that could be considered a raise for its members. That explains why the OMA’s request sounds modest, and why the government’s offer sounds more generous than it is.

There is not much doubt that Ontario doctors have been treated badly by the former government. After years of increasing the costs of physicians’ services by paying them incentives to work in teams, the Liberal government hit the brakes and shifted into reverse, high-handedly cutting fees with no real justification other than it wanted to pay less. It’s no wonder docs got mad, stayed mad and are holding out for total victory.

On the other side of the table, the cost of health care scares the heck out of government. It’s already the biggest expense in the budget and costs are difficult to control. Getting a deal it can live with gives government some measure of certainty.

Arbitration is a risk for both sides. The government has considerable motivation to settle. The OMA just doesn’t believe the offer is real. The only way to find out is to get that offer on paper and put it to their members. After all our doctors have been through, they deserve a say.

Randall Denley is an Ottawa political commentator and former Ontario PC candidate. Contact him at randalldenley1@gmail.com