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Project Saviour: Primary Care SPIN

Clarifying the Magnitude of the Disaster

It's crucial to first understand the shocking scale of the disaster vis-a-vis the primary care situation in BC.

After extensive data analysis, we've unfortunately reached a startling conclusion. Deteriorating access to primary health services and resulting adverse health outcomes may, in fact, cost us votes.

I don't need to tell you how unprecedented this is.

We've always been able to rely on the lack of credible political opponents to ignore healthcare. We know the Liberals would never put a nickel towards it or invest in any public services, so they are no threat. And the Greens nobody takes seriously. Even if people don't like what we're doing, who would do better?

In the past, this strategy has proven effective again and again. Data from the Liberal Party of Canada confirms that without a credible left-wing opposition, the promise of progressive policies is sufficient, but there's no need whatsoever to deliver on them.

New data suggests a seismic change in this electoral calculus. No, people will still not vote Liberal or Green because of healthcare. The sky isn't falling. But they may fail to show up and vote for us. It's time to act.

Secondary Implementation Details

The best SPIN has some (loose) connection to the proposed solutions, in this case, changes to the healthcare system.

We had our interns scour the internet for reasonable solutions. They found this one, which seems as good as any other.

Briefly (details not really important):

• adjust fees and costs to match value to incentivize providers to deliver the best care at what would still be the lowest cost
• incorporate accountability around service levels when structuring agreements with large providers
• invest in shared infrastructure to reduce costs globally, but that would be uneconomical without widespread adoption

SPIN Goals

As always, the foundational goal is to maximize Positive Publicity Placements (PPP) per dollar.

The desired primary messaging is: "Oh, thank goodness for the NDP, protectors of public healthcare!"

Secondary messaging: "The big bad Liberals would never do anything of the sort!"

Avoid At All Costs

During the implementation of this SPIN, we must be careful to always avoid admitting that:

• primary care failures happened on our watch
• delivering healthcare is our responsibility
• chronic underfunding was a factor
• we were warned for years
• this crisis was predictable
• there's money available whenever we need it (c.f. COVID-19, LNG, financial crises)

Blaming the Usual Suspects

Unfortunately, the current situation has ruled out the possibility of assigning blame to the usual scapegoats we've relied on in the past.

Greedy physicians. Even specialists are on board for addressing primary care problems based on how it impacts their practices, patients, and their own families. They're even willing to sacrifice some of their own fee increases.

Federal politicians. We've tried the shortfall-of-federal-transfer-payments strategy, but it's not gaining traction. There's been too much data seeping through. People know how bad a value the shiny UPCC's are, given how much they cost to provide a lower volume of service that's no better than any other walk-in clinic. And even comparisons to other provinces! Who is leaking all this internal data? We didn't build these expensive internal dashboards just so information could find its way to the public!

BC Liberals. Unfortunately, we've already used up our entire supply of "blame the previous government" credits.

Strategy Overview

We've identified what we believe are three effective strategies. These strategies preclude us from taking any responsibility for causing the problem in the first place and maximize our brand leverage to repurpose previous failures into inspired solutions.

SPIN #1: COVID

Thank goodness for COVID-19, the gift that keeps on giving.

Leveraging COVID-19 will remind people of our brilliant handling of the pandemic. It builds on how happy everyone is now that COVID-19 has disappeared. Fortunately, we reduced surveillance and stopped frequently releasing statistics that might imply otherwise.

Tying primary care reform to COVID-19 allows us to showcase our initiatives as an agile response to an unprecedented one-off event. It was clearly not our fault or something we could predict. It's all about adapting to the novel post-COVID reality, not based on any existing shortcomings. We're living in a different world. That's why we have to change.

We can emphasize that because long-COVID is so widespread (that's a stroke of luck!), people are presenting with more long-term chronic physical health conditions, as well as mental health problems. Remember, all of this is because of COVID-19. This was never the situation before.

Remind everyone that these types of problems are exactly the things that walk-in clinics and telehealth platforms don't handle well, and that longitudinal family doctors excel at. So — entirely because of COVID — we're now making a timely and unprecedented investment in full-service family practice.

Remember, it's all about adapting to an entirely brand new situation we could have never predicted in advance.

SPIN #2: Infrastructure

The catastrophic failure of the UPCC's on so many levels has been a difficult one to SPIN our way out of. Luckily, we found a way.

We'll turn over full control to independent family doctors, leasing them the facilities at a low cost. We'll also arrange facility subsidies to offset the costs of primary care physicians offering longitudinal care in other settings.

We can easily claim that was the plan all along. To address the short-term crisis, we needed to invest in physical healthcare infrastructure. Nobody other than government could justify the capital required to do so. But of course, the plan was always to let doctors do what they do best. Not a bad piece of revisionist history, and we've gotten away with far more blatant lies in the past.

Of course, the lease agreements will stipulate continued use of the present UPCC facilities as backdrops for future government announcements to ensure our PPP/$ is maximized.

SPIN #3: Public Health Defenders

Disincentivizing low-value primary care by reducing fees to encourage physicians to resume the high-value care provided in longitudinal family practice is just common sense.

The challenge is to justify that we were paying doctors doing episodic care the same as those doing longitudinal care, thereby reducing overall productivity in the system. Plus, we set things up so that we drove more and more doctors to settings where they could provide less helpful care, even though that's not what they wanted to do.

Honestly, it sounds pretty stupid of us when you put it that way.

We've decided the best approach is to claim ignorance and blame everything on the evil companies who so callously took advantage of unintentional loopholes in the system.

We need to stop their heinous efforts to privatize our precious universal healthcare system at the expense of hard-working British Columbians.

If we all dress like Tommy Douglas, they should buy it.

Unfortunately, Telus will be pissed at us. But that's nothing a few sole-source, no-bid contracts won't fix. We could pay them to provide communications infrastructure and other health IT tools to the entire medical community. The margins aren't as high for them as selling them piecemeal, but they'll make up for it in volume. Plus, the ambiguous nature of the contacts should make it easy enough to pad them with a few extra billion dollars. We've already got a team working on that.

This is a work of satire, though I'd be fine if it turned out true.