Looking for Solutions in Health Care for 2006 and Beyond

Our health care system needs to change to accommodate new demographics, new technologies and new pharmacologic advancement.

The roots of compassion and caring in health care should not change however, and it is with this in mind that the dialogue of change should be had surrounding health care.

How can we adapt to different needs that emerge as our population ages?

How can we  find sustainability in the midst of so many new advancements?

How can individuals become more empowered in serving their own health care needs?

What role does the individual have in enabling the  health care of others  beyond paying taxes?

Many questions like these need to be answered and if we are willing to look with open minds at the problems within our health care system, and beyond political posturing, then we can find new  solutions to take us further into this century. 





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Oil, Ageism, and Pharmacare

The complexity of health care never ceases to amaze me. It's like a contrarian puzzle--as more pieces are added, the more complicated it becomes with completion made impossible. To put it concisely, it is a "head banger".

Before I go any further, I'd like to take a moment to show my gratitude for the excellent contributors to this blog. Over the years I am continually appreciative of your insight, dedication to shining the light, and persistence.

More than ever, we need common sense voices to be heard above the din of political posturing and above the vocal groups with union backing.

Thank You!

The posts from the past few days on debt, end of life care, executive salaries, OMA-MOHLTC negotiations, inequality theories,  are all connected. The difficult issues surrounding these areas have developed in significant part from a single payer health care system that has been overcome by harsh realities of an aging population, a sluggish economy likely to go on for decades and attempts at political distraction.

First, Ontario has a debt of approximately 300 Billion and growing even as Premier Kathleen Wynne talks deficit reduction. Her calls for federal collaboration really mean, "give Ontario more money" but her Liberal party has not spent judiciously. You all know the various scandals and overspending from ehealth, to gas plant scandals to smart meters, to failed energy policy. Even the Canadian Medical Association has got into the act calling for a National Seniors Strategy aka more federal funding for health care. In fact, there is more federal money being transferred to Ontario but it can't go on.

The price of Canadian oil has dropped precipitously and while customers at the pump might be rejoicing, there will be an impact on federal coffers. We should be grateful that Canada, at least federally, is in a reasonable situation to withstand another economic shock but for political or health care leaders to think that the answer to medical service delivery issues is to go back to the federal pot is undisciplined and indulgent.

I note that Health Quality Ontario is calling for more palliative care support. I can't deny the need for this. How will it be paid for? As we add more layers of care whether it is patient navigators, preventative measures, more palliative care, caregiver support or more pharmacare, there needs to be an understanding that it all costs more...somewhere the tab gets tallied and somebody has to pay unless, of course, cuts can be made elsewhere.

Lo and behold, I am hearing more and more from people who tell me that their aging family member, friend or acquaintance is being denied care. It is typically a patient into their 80s or 90s whose family is told that the hospital bed or resources are finite and that spending on the dialysis or other life saving procedure would not be best use of the public resources. It is both stunning but predictable.

The patient whose family members are able to advocate for medical services that should be legally available to them survive to fight another day. Those who can't are denied care. I thought Ageism was illegal in Ontario but apparently it is being practiced on an ongoing basis led by physicians who believe they are doing the right thing by sacrificing the patient in the name of the system. Even though the courts have upheld the rights of families to determine when to cease life prolonging medical intervention, MDs are taking it upon themselves and their representative organizations are pushing to create a health care environment where some people's lives are seen as undeserving of resources. It is disconcerting to say the least.

The discrimination is occurring quietly but it speaks volumes of a society that is losing its values. The modern medical profession that was once considered a life saving and life preserving entity is now participating actively in denial of care and is in a serious conflict of interest as it is driven by politicians to control costs. This kind of comanagement is not ultimately helpful. It simply pushes costs further out, where they collect insurmountably.

The calls for poverty reduction, more money for social determinants of health, more palliative care, more, more, more go on and on. Today I read Dr Eric Hoskins, Ontario's current health minister, discussing the need for a National Pharmacare program touting the benefits of being able to negotiate better generic prices. I acknowledge the need for more ways to fund much needed medication but a National Pharmacare program cannot be had until a Hybrid system for medically necessary care is created. Tax payers and fee payers cannot continute to add more and more services that must be funded by a relatively smaller tax base. The reality of demographics stands in its way. A National Pharmacare dialogue is a clever distraction from what ails Ontario's health care system but let's be realistic about how it can be funded. Driving up debt at both provincial and federal levels is not the way to a properous country that can provide opportunity for  the next generation.

Oil, Ageism, Pharmacare...they are connected. In a complex world with our complex health care system, we can begin to take measures to create flexibility for patients and in funding of health care. It will require trade offs and a Hybrid medical system that combines a robust public system with private options. We have until 2025.




Reader Comments (177)

Thank goodness there are still some health care types who have not been swallowed by Groupthink:
December 16, 2014 | Unregistered CommenterMerrilee Fullerton
"The idea for moving away from fee-for-service came from integrated health systems, like Geisinger, Intermountain and Kaiser Permanente, who told Congress, as Weil paraphrased, “We are trying to do the right thing, we are trying to deliver high quality care, keeping people out of our expensive hospitals and institutions, but every time we achieve that goal, we lose money.”"
December 16, 2014 | Unregistered CommenterMerrilee Fullerton

Your post was thoughtful and informed. Sadly, we have moved passed it. We are now into the population based "good for all of us" ideology. We will established more committees and guidelines to help ration the pooled money. The marginalized will get get, the "herd" will be OK. Just don't get marginalized. We have been advised by all the experts, they know the right path for all of us, under their supervision. This can only be accomplished through a controlled monopoly.

This time, unlike the Germans in the 30's, we will concentrated on the old. They need to go faster.
December 16, 2014 | Unregistered CommentermovingforwardOntario

More and more at central is directed to improve the health of the population, at the cost of those who no longer contribute. This is not going well. The aged need to stop assuming they will get care. They should find their ice floe and go.
December 16, 2014 | Unregistered CommentermovingforwardOntario

The Minister has assured us, he will deal with this, All insured services are delivered in a timely and appropriate fashion.
December 16, 2014 | Unregistered CommentermovingforwardOntario
Nobody has moved past anything in health care change. The more things have changed, the worse the problems is a vicious cycle.

Population health can provide the biggest bang for the buck, hence my involvement on a Board of Health but it is not a legacy thing that politicians can unveil or cut ribbons for or take the first shovel of dirt on.

Politicians like photo ops---they are concrete and make it seem as though great things are being accomplished! LHINs, Hubs, etc all give the impression that there is a solution when we are really just chasing our tails
We are born, we grow up, and we die. That has not changed.What has changed is the socialization in which we do that. No longer your family, it is now the population control that deals with your life.
December 17, 2014 | Unregistered CommentermovingforwardOntario
"no longer your family"
Which is probably the biggest factor involved in social decay and dysfunction. Granted, there are many families that may be dysfunctional but they won't be helped by Ontario's policies on gambling and pot and soon prostitution.

The current Ontario government is looking to be your "surrogate" family although it has neither the resources or a meaningful moral compass. Bad combo.

The world has changed. The government now is your family. It will do what is best for you, in its view.
December 17, 2014 | Unregistered CommentermovingforwardOntario
Cost containment solutions to fiscal pressures may cause conflicting societal policy. Until there is immunity for participation physicians must have patient well being their primary concern.

Change the law and have all adherent to policy either vulnerable or, conversely, immune.
December 17, 2014 | Unregistered Commentereklimek
The laws will not change. Those in power will remain immune in that the power they hold they get from the queen, who gets it from God. God is immune.

Arguing for a system based on equalitarian rights, means each individual has rights and responibilities for which they are accountable. We are not there yet.
December 17, 2014 | Unregistered CommentermovingforwardOntario
The crown may be immune. We remain vulnerable.

(This is scanned with OCR and some formatting lost.)


CMPA Perspective Sept 2012 page 11

There are very few areas of healthcare that are not
confronted with some form of fiscal restraint. As
demands for healthcare services continue to
outpace resources in some areas, physicians are
tasked with managinq their wait-time lists and, on
occasion, with prioritizing patient procedures.
These decisions carry medico-legal implications
and mitigating these risks will benefit physicians
and patients.

Physicians have a duty of care to patients. This
duty may extend to resource allocation, and
ensuring patient care is not compromised. ln an
environment of constrained resources, or when
faced with an unexpected shortage of medication
or supplies, physicians should engage with
hospital officials or health authorities to request
resources to meet patient needs. This advocacy
work, if not handled professionally, may be
interpreted as a challenge to the leadership of the
hospital or health authority. To avoid this
perception, physicians should work with the
hospital administration and channel requests for
resources in writing, using a professional tone and
providing the facts to support the allocation of
necessary resources.

To reduce medico-legal exposure, physicians
should ensure that they meet the standard of care
of a reasonably competent physician in similar
circumstances. While the courts are willing to
consider the resources available to physicians
when assessing whether the standard of care was
met, physicians are still expected to do the best
they can within resource constraints.

Similarly, fiscal realities cannot supersede medical
judgment. Physicians should acknowledge the
financial pressures confronting the facilities and
hospitals in which they practise. However,
medical judgment should not be compromised
by cost considerations. For example, when
considering diagnostic tests, physicians may
consider alternative tests that would cost less but
still give the information needed to diagnose or
treat the patient.

Beyond direct patient care, physicians may also be
engaged in cost containment reviews to identify
short- or long-term solutions to fiscal pressures.
Physicians in leadership positions (chief of staff,
division, or department regularly asked to
contribute or to lead these program reviews. ln
this capacity, physicians become advocates for the
societal good. This dual responsibility, to an
individual patient and to society, may cause
conflicting imperatives for physicians.

Many Colleges have advanced codes of ethics
which provide direction to physicians in this regard.
For example, the College of Physicians and
Surgeons of New Brunswick acknowledges these
responsibilities, advancing that "the physician
should consider the well-being of other patients, of
society and of colleagues, as well as his/her own
well-being, but that of the patient being treated at
the time must be the physician's primary concern."
December 17, 2014 | Unregistered Commentereklimek

Providers will remain at risk, and the risk is growing, as more bodies are suggesting that standard of care discussions include care not provided in one's political jurisdiction. Thus, discussions about care with patients maysoon involve services provided in other jusisdiction.
December 17, 2014 | Unregistered CommentermovingforwardOntario
Although all the experts advised the powers that be, that age and health care wouldn't be a problem, it is beginning to overwhelm things. The end of life discussions need to be accelerated.

At some point, central will have to overtly say, no more public resources to maintain your life.
December 17, 2014 | Unregistered CommentermovingforwardOntario
First of all, "all the experts" most certainly did not advise government there would not be a problem.

Second, it is not beginning to overwhelm things.

"That problem is not impending. For me and my colleagues in neurology, that problem is here, it is now and it just keeps on getting worse from here on. It will spill over and it will not involve just me or this ministry; it will involve all of society."

Last, despite the CD Howe faith in "coordinated team-based primary care, giving patients comprehensive nonacute services from an organized group of practitioners such as doctors, nurses, dieticians and physiotherapists"

Please note - nonacute services - are not high cost high acuity services.

Trimming these will not save money.
December 17, 2014 | Unregistered Commentereklimek
The team concept in primary care as cost saving is a crock.
Someone needed to say that. There .
December 17, 2014 | Unregistered CommenterMerrilee Fullerton
None of this is going to save money. as long as you have a bottomless pot of money it will get spent. If you try to contain, those who control will disperse it first to their needs, causing more to fall into the marginal care areas.

If you want to save money, give the money to the patients, and let them keep money, if they don't spend it.

This is all about wealth redistribution. We are using health care as a social equalizer. The more we do this, the faster the aged need to go.
December 17, 2014 | Unregistered CommentermovingforwardOntario
Things are going to get worse as hospitals readjusted to Health System Funding Reform (HSFR) (FFS for hospitals).
December 17, 2014 | Unregistered CommentermovingforwardOntario
"We are using health care as a social equalizer"-mfO

But it is not an equalizer.
December 17, 2014 | Unregistered CommenterMerrilee Fullerton (realist)
We think it is. Our consultants have assured us it will equalize all. Biology is irrelevant. Inequality and chronic disease are social issues, not biological. Our consultants have assured us, if we can provide them sufficient funds, they can make the world fair.
December 17, 2014 | Unregistered CommentermovingforwardOntario
As the molecular differences become more apparent, it will be clearer that redistribution does not create health.
December 17, 2014 | Unregistered CommenterMerrilee Fullerton
Sharing resources to help sanitation , clean water and clean air might qualify as equalizers. Basic health care and emergency care are equalizers. But increasingly personalized medicine cannot be "redistributed". That is not the nature of newer scientific knowledge.
December 17, 2014 | Unregistered CommenterMerrilee Fullerton
Greetings from central

The ED will be transformed within 5 years. You will first be reviewed through your EHR, including your income status, and available wealth, home ownership, etc. All that confedential info will be passed to you team as they need it to design your treatment plan. The guidelines for your illnesses will be followed, and if possible, a discharge plan from the ED will be arranged following the guidelines. If however you are admitted, the guidelines will be followed to see whether you qualify for additional liberty, or are being admitted for watchful dying.
December 18, 2014 | Unregistered CommentermovingforwardOntario
"According to the C.D. Howe Institute, Ontario would need to increase provincial taxes by 70 per cent to finance its future health-care obligations on its own.

Luckily, Ms. Wynne has found part of the solution. Just blame Ottawa."
December 18, 2014 | Unregistered CommenterCanary in a Coal Mine
Expecting the EHR to make a difference is the problem. Its not the EHR.

"After more than five years and a $25 billion investment of federal money to move U.S. medical records out of paper files and into computers, doctors say the systems lack analytical functions, don’t allow them to share information with colleagues in other practices and require too much time to enter data.

They say the limitations are affecting patient care and that fixing the system will take years...."
December 18, 2014 | Unregistered Commentereklimek
EHR costs billions and billions and the more you know and can measure, the more care will have to be provided. Gigantic costs.
December 18, 2014 | Unregistered CommenterMerrilee Fullerton (realist)

At least it has been documented. An intention act occurred to eliminate files. One wonders, is this not also a privacy breach, and subject to review by the Privacy Commiseration? Was there permission to enter the private files of all those staff members?
December 19, 2014 | Unregistered CommentermovingforwardOntario
By 2020, highly centralized data collection with funds available just to guideline meeters, all other of guidelines, services not available.
December 19, 2014 | Unregistered CommentermovingforwardOntario
Speaking of advances in medicine. We now have a 6 hour window of opportunity.

" ... patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion of the anterior circulation have a benefit with respect to functional recovery when intra arterial treatment is administered within 6 hours after stroke onset. This treatment leads to a clinically significant increase in functional independence in daily life by 3 months, without an increase in mortality."

December 17, 2014DOI: 10.1056/NEJMoa1411587

All clinical and imaging secondary outcomes favored the intervention (Table 2, and Table S3 in the Supplementary Appendix). The NIHSS score after 5 to 7 days was, on average, 2.9 points (95% CI, 1.5 to 4.3) lower in the intervention group than in the control group.
December 19, 2014 | Unregistered Commentereklimek
Coming to Ontario:

NHS A & E has its worst week ever...
December 19, 2014 | Unregistered CommenterMerrilee Fullerton (realist)
It's interesting that the NHS measures patients waiting for a bed (trolley waits) as measured in hours. Ontario's are often measured in days.

"Trolley waits - that is waits of four hours or more for a bed once a decision to admit a patient into hospital from A&E is made - topped 10,000 for the first time.

That compares to under 4,000 for the same week last year.

Delays getting patients out of hospital once they are ready for discharge are also much higher than average."
December 19, 2014 | Unregistered CommenterMerrilee Fullerton (realist)
Will a national pharmacare program make things fair???

The Health Minister appears to think so.

It's been my experience the more government makes things "fair", the less fair it is for everyone.

Someone must think that a national pharmacare program will keep patients out of hospital...good luck with that. I can't get people to understand we have both too much drug use and insufficient drug use at the same time.
Found one shift in the city periphery.
Having my own problems with my health and yes, you don't want to be in the margins (though the margins are looking like thoroughfares to me).
December 19, 2014 | Unregistered CommenterOutPatientPharmD
I agree with you and good to hear from you. Sorry to hear of your health problems. Hopefully, you are getting what you need.
I see that Ontario has had a credit rating downgrade yesterday.

Kiss it good bye OMA?

"Difficult trade offs" is right.
Pharmacare could easily be another black hole for tax $.
Merry Christmas everyone and best wishes for a happy, healthy and prosperous 2015.
I cannot express enough the enjoyment I get from reading this blog and all of your comments and insights. Never give up, things may someday change for the better.
December 23, 2014 | Unregistered CommenterConnie LHINgus
Thanks Connie. There is a glimmer!
I am grateful to you all for your enlightening posts and persistence!

Merry Christmas, Happy Holidays & Best Wishes to all of you for a Happy and Healthy 2015!
December 23, 2014 | Unregistered CommenterMerrilee Fullerton
As we move into the new year, and central shuts until mid january, be grateful for where we are positioned.

A strong majority government with 4 more years of control, and things to get done.

A good relationship with the developing new federal majority government.

The realization that closed government appointed committes are the best way to govern.

A firm commitment to the status quo so that stabilization exists as the tax resources are consumed.

Recognition that spending resources are better than not spending resources. We can grow our way ahead.
December 23, 2014 | Unregistered CommentermovingforwardOntario
Old Norwegian saying , in response to Connie..." No matter how bad things get, things can get worse"....Old a russian saying " Expect the worst and you will never been disappointed".

I wish you all well, a merry Christmas and a happy new year...then we get the government's offer to the OMA revealed....and then the faeces will hit the fan.
December 23, 2014 | Unregistered CommenterAndris
I was recently talking with an individual involved in helping to create more long term care spaces with a combined community and provincial funding effort. The spaces were almost doubled in number at the new facility compared to the pre existing one.
I was told that the entire long term care facility was built so that EVERY floor could be turned into closed dementia floors.

With Ontario anticipated to move from 100,000 people in the over 90 yr old age group this year to 300,000 plus in this group in 2036, suffice it to say that more closed wards will be necessary.....I'm just not convinced that all the other frail elderly will "Age at Home" even with "wearables" that the expert consultants are hanging there hats on. The public wants to believe but the writing on the wall is getting bigger and bigger.
A frightening scenario.

Humans like to organize top down; nature self organizes and evolves bottom up.

Top down organizations become increasingly complex, the more complex, the more organization is required, the more management, the more anticipates a massive, horrifying, inefficient and oppressive Orwellian Kafkaesque closed ward hospital system resembling Bedlam.

There is no way that the idealized 'Age at Home' system that the government's pointy headed "experts" thought up will work out.

At present my wife is increasingly occupied by her ailing almost bed ridden (#hip) , cognitively challenged deaf 92 mother, blind in one eye...." cared" for be her older second husband with unfolding dementia ( who refuses to see doctors lest he looses his driving licence), who forgot to administer her glaucoma meds amongst other meds...who treats the CCAC staff , with its disjointed teams which can only provide budget limited home care ( they live in a condo) rudely and the more effective and expensive private home care workers who are treated just as rudely with episodes of aggression....he drove the Veterans Affairs social workers away in near tears...a couple that have refused over the years to move to
retirement living facilities.

How average , financially tight, families will cope as the age/ dementia problem mushrooms I just don't will those who don't have familes , with no loved ones overseeing them, cope?

Elder abuse will explode, their pockets will be picked by fraudsters, their assets stripped officially by governments to cover costs or unofficially by charlatans specializing in defrauding the elderly cognitively challenged.

The future looks increasingly of the government " solutions" will be their end of life pathways which one suspects will look much like the Liverpool end of life pathway.

The exits from the closed ward Bedlam's will likely be manned by very busy end of life pathway committees.
December 26, 2014 | Unregistered CommenterAndris
Greetings from central:

Just a brief summary of key points for the next 3 years.

The Premier has assured us no deficit by 2017.

The MOH has assured us there are no issues his office can't resolved promptly and fairly.

Now in the practical world.

Look forward to the most top down autocratic government you have ever experienced. All committees are now just government appointees, paid by governmnet funds. All recommendations are now self surviving ( give us the money and we will fix it).This governmnet is a buttoned down autocratic, non open system. Only officially approved speak is allowed.

All political efforts are designed to elect a federal liberal governmnet, as it will assist in the deficit issue.

OMA deal will be a flat-lined. Thus over the next 4 years most MDs are see real tax home income loss. Most new MDs will be salaried.They will do as they are told. The MOH will imposed the deal.

Big big push on the need for quality of life, not quantity. Those whose quality of life is poor need to be identified and worked on.

Big push to get at the inheritance available for the elderly. More of their health care services will be drawn from their available estates.

Meanwhile, the gas plant scandal, and others, are expanding, forcing more clamping down on speech.
December 27, 2014 | Unregistered CommentermovingforwardOntario
Ayn pointed out that the goal of such ' liberals' is to smuggle us all into welfare statism by means of single, concrete, specific measures, enlarging the power of government a step at a time, never permitting these steps to be summed up into principles, never permitting the direction to be identified or the basic issue to be named.

Statism will come, she pointed out , not by vote or violence, but by a slow a long process of evasion and epistemological corruption, leading to a fait accompli.

As MFO pints out we have the most top down autocratic government in modern history, determined to stamp its statist will on the is also a fact that this may well be also the most corrupt government in Ontario's modern history as demonstrated by the gas plant may also likely that this is the most incompetent government in ontario's modern history.

With Incompetent, incapable, corrupt and self serving top down autocrats at the wheel of an intellectually and fiscally bankrupt Ontario utilizing force to impose its policies and to gain its goals.... there can only be one ending.

The " smuggling" stage in Ontario is almost over, the liberal mask is about to slip off, the civil rights of the medical profession are to be violated , the state will demand, will insist, that they sacrifice themselves for the supposed common good of the collective....ideally the government would prefer that the profession agrees to be enslaved, that it will be willing to co manage its own enslavement.

The health care system of the Soviet Union was built on the same top down collectivist principles and the Soviet population suffered the consequences ....the citizenry of Ontario will experience much the same.
December 27, 2014 | Unregistered CommenterAndris
"Top down organizations become increasingly complex, the more complex, the more organization is required, the more management, the more bureaucracy."-Andris

So true.

As for bleak, I don't think so.

What is becoming increasingly clear is all the prevention aimed at reducing heart disease and cancer propels people into advanced age with supports that are inadequate and no treatment for the dementias or frailty that they inhabit.

I suggest it is time for the State (and MDs) to stop poking and prodding and insisting that their moral judgemental "right" is the only righteousness.

Is it perhaps time to let people "be" well before they reach the Age of No Treatment and No Intervention (we won't call it DNR we'll call it dying "naturally"!!!!)

No, I'm not suggesting that we stop treating people. I suggest that as a society we should stop insisting that some bad habits are worse than others...mainly it seems that the visible "bad" habits are the ones the State and the do-gooders insist we focus on.

Now, who is the Liberal?
December 27, 2014 | Unregistered CommenterMerrilee Fullerton (realist)
Realist, having attended that recent OMA emergency meeting and having an insight into governmental intentions, I am full of pessimism.

The quotation( attributed to so many now) , that governments will do the right thing only after having exhausted every other alternative.

The powers that be in Ontario are ingenious in regard to their capacity to discover and impose so many alternatives to the " right thing".

Medicine and health care was very much bottom up over the centuries until the modern day powers that be decided that it should be " improved" by becoming a top down dictatorial has to wonder how a bottom up health care system would have adapted to modern day changes and how it would have evolved as a consequence?

One suspects it would have looked completely unlike to what is about to be imposed.
December 27, 2014 | Unregistered CommenterAndris
Cntral will imposed its will. Healthcare now belongs to the politicians, not the doctors. They will do as told.
December 27, 2014 | Unregistered CommentermovingforwardOntario
In nature, a bottom up entity, each form of life interacts with the environment and , if succesful, reproduces and passes on its genes.

Those who can't successfully reproduce disappear, their genes disappear and are lost to history never to be seen again.

In business, in an environment of supply and demand, entities either succeed and evolve further or fail, become bankrupt to again vanish from history, never to be seen again.

Where governments , in particular with statist/ collectivist governments, are concerned nature's laws are ignored....bad and unworkable ideas are imposed whether or not they are in harmony with their environments....if they fail to flourish, they are nevertheless preserved and propped with further " investments".

Worse, failed ideas of the past can get resurrected by governments, the graves dug up, the ideological corpses dragged out with lipstick and make up applied to make them look more appealing to the uninformed.

The powers that be have rediscovered that failed top down socialist totalitarian health care dinosaur that failed so miserably in the Soviet block and have decided to resurrect it and impose it contrary to evidence, deliberately eradicating a bottom up system that evidence indicated had worked so well but which the powers that be had decided required some "improvement" seems that it was guilty of being too effective and too productive ....better, the pointy headed decided, a less effective and productive system that fit a budget.

Procrustes , a hotelier, fit his clients to his beds....those who were too short were stretched on a rack until they did fit...the too long had their feet and lower legs cut off until they fitted.

We are too have our lower legs amputated to fit the government's budgetary bed...then , one day, they will complain that we don't walk.
December 27, 2014 | Unregistered CommenterAndris
All will be fine. The plan is good. 95% of the trench workers will take their pay and be happy with the orders.
December 27, 2014 | Unregistered CommentermovingforwardOntario

Far to pessimistic. The overwhelming majority of workers appreciate the direction, guidelines, and lack of need for critical thinking afforded by centrals' leadership.
December 28, 2014 | Unregistered CommentermovingforwardOntario
With the OMA contract resolution, and the, in essence freeze, the newt result is most physicians( and their employees) end up with a 3% reduction in take home pay. As health is such a major component of Ontario's GDP, the anticipated 2.5% increase for 2015 is unlikely.
December 28, 2014 | Unregistered CommentermovingforwardOntario

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