Dr. Merrilee Fullerton on Healthcare

http://www.torontosun.com/Comment/2008/01/06/4755278-sun.html

From the CMA:

Get ready for long-term-care crunch, CMA warns

By Patrick Sullivan

With Canada's population aging rapidly, concern is growing at the CMA over how this growing army of seniors will be cared for, and who will care for them.

That was one of the main messages delivered by President-Elect Robert Ouellet when he made the CMA's annual pre-budget submission to the House of Commons Standing Committee on Finance in December. His presentation followed an earlier written brief that included recommendations in seven areas, from providing debt relief for medical students to mitigating the impact of the GST on physicians and introducing a pan-Canadian catastrophic drug pan.

Ouellet, a Quebec radiologist, warned that action is needed quickly because seniors will account for a quarter of Canada's population by 2031, up from 13% now.

"These people will need care," said Ouellet, "and long-term care cannot and should not be financed on the same pay-as-you-go basis as medical and hospital insurance."

The CMA suggested that Ottawa consider options in which taxes on funds invested to meet someone's future long-term-care needs are either pre-paid or deferred. For instance, Ottawa has just introduced a Registered Disability Savings Plan that allows parents or guardians to contribute to a lifetime maximum of $200,000 to provide future care for a disabled relative. "This approach could have more general applicability to long-term care," the brief states (www.cma.ca).

The CMA also called for:

- Changes in the Canada Student Loans program to help improve access to quality care: Ouellet said the current policy means interest on medical students' loans begin accruing as soon as they leave medical school, even though they face up to seven years of additional postgraduate specialty training before being licensed. "This policy affects both the kind of specialty physicians-in-training choose and, ultimately, where they decide to practise." He asked the federal government to extend interest-free status on Canada Student Loans to eligible students pursuing postgraduate training in the health professions.

- More use of information technology to improve care - and access to it: Ouellet argued that a nationwide rollout of the electronic health record could provide annual savings of $6.1 billion by, for example, reducing duplicate testing and cutting the number of adverse drug reactions. In the process, wait times could be reduced. "The federal government could invest directly in the automation of physician offices by introducing dedicated tax credits or by accelerating capital cost allowances," he stated.

- Moves to make GST regulations fair to physicians: Ouellet described the GST's application to medical practices as a "consumption tax placed on producers of vital services" that costs the health care system $150 million a year. He said physicians should be buying the most modern diagnostic equipment, but applying the GST to such purchases adds $25,000 to the cost of a $500,000 machine. "The result of this misalignment of tax policy and health policy is that most diagnostic imaging equipment used by radiologists is more than 30 years old," said Ouellet, who called for "zero rating" of all publicly funded health services.

His presentation was well received, drawing numerous questions from MPs both during and after the session. As a part of a comprehensive pre-budget strategy, the CMA will continue to lobby on these issues prior to delivery of the next federal budget, which is expected in late February.

also waiting for the Castonguay Commission report sometime this January.

http://www.alumni.hbs.edu/bulletin/2007/december/ideas_opinion.html

The editorial from the SUN does address one of the key issues in avoidance of responsiblity - no one owns the problems. this is intentional.

The Government wants to be a Funder only but the MOHLTC wants to be both the funder and the manager (part of the daily conflict on interst issues that occur at central). Becuase the MOHLTC can't openly say its wants to run the system , they transfer that to the hsopital Boards most of which are closed shops who just do want the adminstration tell them is need, and since the CEOS etc are employees of the Minister, the Minister still gets to dictate what goes on.

The issues at BCH aren't new or different. They are driven solely by an underfunded system where the "woner" (the MOHLTC) refuses to openly acknowledge that theis is a "rationing" system not a "care" system. The collusion that occurs is that which always occurs in monopoly driven systems.

probably an accurate depiction mfO. Thanks.

Thanks for your most interesting comment on my blog.

It became the focal point for a new post, around which we are now having a lively discussion.

Thanks Joanne...

Bloggers unite!

https://www.blogger.com/comment.g?blogID=20283843&postID=6934146274757038889

oops

Here is Joanne's blog:

http://jojourn.blogspot.com/

Who is this Joanne? She sounds just like me....and she isn't just in case anyone thinks that I've taken a new identity....good for her...our centrally planned and centrally managed health care system resembles the Emperors' clothes that weren't....it takes only one little boy to point out that the Emperor is completely starkers...the whispers go through the crowd [pre blogging era]....and soon the whole crowd points to the nakedness of the health care Emperor...he's naked, completely and utterly naked....and soon the whole crowd will be howling its derision.

The Health Care Coalition will be making some brilliant announcement concerning BCH tomorrow...this is the crowd that cost the hospital over $12 million in over runs...also the crowd that wants to have only one tier...this in an 8+ tier health care society...how on earth would they get it down to just one?

Andris asked, "Who is this Joanne?"

Just an ordinary citizen who has had enough of too much government, complicit MSM, and a Health Care system that clearly has significant challenges.

What puzzles me is why George Smitherman would discount the opinions of the HCC when you would think he would be trying to curry their favour.

That the HCC criticizes the government is quite appropriate...but to blame the government for the delay, cost over runs and the smaller facility is just plain wrong...anti-3 P activists delayed the building by two years as I recall...during which time frame the price of cement and steel went through the roof so cut backs from approximately 730 beds were made because of the consequent $12,000,000+ increased costs just to remain within budget...we can thank the activists for the smaller hospital with less bed capacity...of course, the MOHLTC refused to cover the costs of the beds that it was then designed for.

Pledges from the Sikh community are at risk...I believe that it pledged some $100,000,000....the community is very competitive and one senses that some pledged in excess of what they could afford...it should not come as a surprise if some took the present difficulties as an excuse not to honour their pledges...but we should wait and see.

As for the PMH site...it is a rat infested, asbestos polluted site...it could not be opened for a dog shelter since it is so way off code...first thing would be to flatten it and clear it from contamination...with an economic recession looming whether there will be any governmental monies left to build a facility in the next 10 years is questionable.

http://www.thestar.com/News/Ontario/article/291543

I do wonder sometimes how the OHC (Ontario Health Coalition) says this stuff with a straight face.

Talk about ideology running amok!

In any case, perhaps they think it is better to go without. One wonders about their motives...yes indeed.

Thanks for the insight, Andris and Realist. So am I correct then in concluding that the OHC is basically an advocacy group for unionized, public healthcare? (i.e. worried about their own jobs & unions?)

Yes, that appears to be the case Joanne.

Same with the Canadian Health Coalition and Doctors for Medicare.

If you look at the sponsors for the various meetings/conferences they have, it is almost all unions and a smattering of government sponsorship.

But there are other groups emerging.

Such as the Canadian Health Care Concensus Group...

http://www.aims.ca/inside_chccg.asp?cmPageID=377

Claude Castonguay, the Father of Medicare in Quebec, is due to have a report from the Castonguay Commission any time soon. Even he understands the necessity of private provision along with public provision.

Will be interesting to watch for.
Can't find any news on it yet.

Also, Dr. Brian Day is addressing the Economic Club in Toronto on the 15th. I can't be there but would be interesting. Something more to report on!

and as far as Smitherman's response to the OHC's statements recently about the Brampton P3...well, this time I agree with him.

The OHC seem to becoming quite strident and the pitch of their whining is getting a little unbearable and extreme.

I suppose there is a market for that too.

how Sweden is using private/public health care arrangements:

http://www.iedm.org/main/documentation_transcript_en.php?documentation_id=66

Thanks for the links & info. So do you see the Swedish model as one for Ontario to consider?

The Swedish model has had to change in the last decade to allow more private provision and it also has user fees.

No system is completely transferable to Canada but we could take what has worked. I think that privatization in Sweden probably did not go far enough...ie the ineffective or inefficient providers were not weeded out since most is government funded.

But take a look at what Jacques Chaoulli has to say in the following link about Switzerland. It makes alot of sense.

Of course , we cannot change the Canadian system upside down. That will never happen. But we certainly do need more competition and more innovation...and I believe this can only be achieved with some increased element of private delivery all the while keeping a public stream intact.

http://www.fcpp.org/main/publication_detail.php?PubID=2006

and to come full circle back to Brampton's issue under the microscope of private/public partnership, here is some background info on P3s:

http://www.iedm.org/uploaded/pdf/hospfinal.pdf

Wish you luck with the joust but remember:

1. We control 45 BILLION dollars and that buys lots of influence not to change.
2. We don't want any one looking inside and finding out what we've been doing and who's been non competitively getting the money.
3. The public love this system.
4. As soon as you use "private" money, we fet to use the US system as the bogeyman. It always works with the public.
5. We know what's best for you - trust us.

"We control 45 BILLION dollars and that buys lots of influence not to change."

The MOHLTC must be broken into smaller subunits. It is entirely inappropriate for any one Ministry to be this large and in control of this much tax spending and remain unacountable.

It might be time to have a second look at the books for financing BCH especially since the Liberals historically run to the the OHC for favourable quotes. Something doesn't pass the smell test when Smitherman is so negative on the OHC's report.



QUEEN'S PARK
Queries raised about new hospital deserve answers


MURRAY CAMPBELL

mcampbell@globeandmail.com


January 8, 2008

The bluster is starting to wear a bit thin.

For years, the Ontario government has denied that it is involved in unholy matrimony in working with the private sector to build hospitals.

It has argued that using private bucks for bricks and mortar does not mean any loss of public control of the health system or that any corners are cut in the provision of services or facilities.

But a report released yesterday casts doubt on these claims,....

http://www.theglobeandmail.com/servlet/story/LAC.20080108.CAMPBELL08/TPStory/TPComment/Politics/

45 Billion buys a lot of friends, and also means a lot of deals go on amongst friends.

Need more surgery! Ohh guess that can only be done by licensed places so only they can get the money. Want to get a license - Ohh I guess we have to review that by our committee made up of memebers who already have licenses.

Come on guys- we're not changing our system.

This site is a goldmine of information!

Thanks so much. I've learned a lot and feel that I've found a valuable resource here.

Thanks Joanne...there is much to tell

and pass it on!

I have to ask:

What is so unholy about the government working with the private sector in health care? Private donations already keep our hospitals afloat.

Who does he think he is kidding?

And anyway, with same sex marriage is alive and well in Canada, I'm not sure there is any unholy matrimony...let us get on with finding long term solutions.

Now if the TStar could only get a grip on reality and stop pandering to the unions.

http://www.thestar.com/comment/article/291820

Sure, open the books and have a look.

The interesting part about the OHC's fuss is that nobody knows even how many bureaucrats there are working in health care...and we spend oodles and oodles of public cash on health care often while more transparency is needed.

Do we hear the OHC or the CHC or Doctors for Medicare clamouring for accountability then? I've never heard it if they have.

So I am left to ask "why now on P3s"? and the only reason that I can come up with is that these union backed groups are clearly bent on preserving the status quo, no matter how many people suffer or how many people can't get care....because it serves their purpose of dues collection and power control.

You can imagine that if 90% of Ontario's hospitals are over 40 years old, they are all coming due..and often retro fitting old spaces for new hi-tech equipment is just plain ghastly expensive.

What would the OHC have government do? Bankrupt itself trying to pay for all the necessary infrastructure on its own? Not great for credit ratings.

R:

You're getting it.

Let's see - we control 45 Billion dollars of tax resources. We like our jobs and its just tax money. No one can figure out how it all works.

Should we change the system? NO

$45 billion is at stake and OHC asks how $650 million was spent, by whom, on what?

What about the other $44.35 billion?

Good point eklimek.

http://www.nupge.ca/news_2008/n09ja08b.htm

unions

The MOHLTC is accountable and recently passed its accountability audit when the public awarded it another 4 years of authority.

The books of where the money goes is published and freely availble through the Ontario Public Bookstore.

The logic of why the money was sent in the fashion it is spent is not quite as available.

Reality is no one cares any more - it's how we do business - we take the tax money and give back to those who need it, a great benefit. The public LOVES free reasonable health care.

Ontario Health Care Lite - Love it or Leave.

Or as the Minister now says "who cares about what they think"

"The MOHLTC is accountable and recently passed its accountability audit when the public awarded it another 4 years of authority." - mfo

Reading this sort of statement, it is apparent that a general approval has been mistaken for a line by line review. Reelection does not absolve errors.

The analogy is a bit like the comfort given to a naughty child. We still love you, but not the things you do. It does not mean you can carry on as before.

Some one before me quoted Stan Lee when Peter Parker's Uncle said, "With great power comes responsibility". Maybe the Minister should read more ...... comics.

THis post belongs in quite a few places but fits here since it is part of the whole Brampton issue. Staffing problems are likely to worsen and will have an impact in many areas including budgets.

Frustration brewing among family physicians across Canada SHERYL UBELACKER

The Canadian Press

January 9, 2008 at 5:16 AM EST

Faced with an aging population requiring increasingly complex care,
overwhelmed Canadian doctors are feeling more and more frustrated by their
inability to properly serve their patients' health needs, a national survey
of physicians reports.

In the survey of more than 20,000 doctors and doctors-in-training from
across the country, 75 per cent reported that inadequate funding of the
health-care system and an undersupply of physicians and other health
professionals, along with paperwork and bureaucracy, are curtailing the
amount and level of care they want to provide patients.

While that attitude was expressed by all the specialties, it is perhaps most
pronounced among family physicians, simply because of their number and the
nature of their practice, said Calvin Gutkin, executive director and CEO of
the College of Family Physicians of Canada.

Almost half of Canada's roughly 60,000 doctors are family practitioners, and
it's usually the specialty seen most often by patients, he said.

"I think the frustration remains related to just the capacity within the
family medicine community to address all of the needs of the population,"
said Dr. Gutkin, whose organization conducts the triennial survey jointly
with the Canadian Medical Association and the Royal College of Physicians
and Surgeons of Canada.

"Physicians in most communities across the country are doing their best to
try to see as many patients as they can," he said. "But still many of them
have had to ... limit the number of new patients they can take. And we have
community after community with patients who are unable to access a family
physician for themselves or for their families.

"And the family physicians themselves are aware of this and are very
frustrated by this."

In fact, an estimated four million to five million Canadians do not have a
family doctor, and physician groups lay the blame in part on a woefully
understaffed health-care system.

CMA president Brian Day said the survey shows that about 4,000 doctors plan
to retire in the next two years and medical school graduates will barely
cover that loss. As well, 35 per cent of physicians surveyed said they plan
to slow down and cut back on their practice.

To bring Canada's health system up to global standards, the country would
immediately need to add 26,000 doctors, Dr. Day said from Vancouver. "That's
not going to happen."

Besides further increasing medical school openings, Dr. Day said, government
should make certification easier for the 1,500 doctors trained outside the
country each year.

Louise Samson, president of the RCPSC, said more specialists are also needed
to meet the growing needs of the patient population, which is getting older,
living longer and beset by more complex health issues as a result.

As a radiologist in Montreal, Dr. Samson sees first-hand the long wait
patients have for MRIs and CT scans because there are not enough technicians
to perform the tests or radiologists to interpret the results.

"Despite government investments to achieve reduced wait times in priority
areas such as cancer treatment, heart procedures, diagnostic imaging, joint
replacements and sight restoration, the survey reveals that progress has
been quite uneven," she said.

The survey also showed that only about a quarter of doctors are using
electronic records to enter and retrieve patient information.

Although progress is being made in electronic record-keeping, secure and
reliable systems are not widely in place, Dr. Gutkin said, leaving most
doctors to deal with far less efficient means of storing and sharing patient
information.

The doctors' groups are calling on the federal, provincial and territorial
governments to:

Continue to address the education, training, recruitment and retention of
physicians to ensure a sustainable work force that is ready to meet the
changing health needs of Canadians;

Implement a co-ordinated, Canada-wide approach to educating, training,
recruiting and retaining enough physicians to meet the needs of an aging
population.

MOHLTC propaganda

http://ogov.newswire.ca/getorg_e.html?okey=61237

57 news releases disseminated in this period.
Monday, August 13, 2007 - Saturday, September 8, 2007

16 news releases disseminated in this period.
Thursday, November 15, 2007 - Monday, December 31, 2007