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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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Sunday
Mar162014

Hospital Mergers and Transformation-Who Should Pay?

 

With permission from ELB, I introduce our first Guest Journal Entry:

Even Donald Trump would say that this is "huuuuuge".

Money woes disrupt Scarborough-Rouge Valley hospital merger
A $3-million grant from the province falls well short of what Scarborough Hospital and Rouge Valley Health System say they need to cover upfront merger costs

http://www.thestar.com/news/gta/2014/03/15/money_woes_disrupt_scarboroughrouge_valley_hospital_merger.html

In short, the hospitals believe that the integration would cost about $30M. The Minister of Health and Long-Term Care offered $3M. The same Minister who just bailed out Thunder Bay on Friday to the tune of $14M.
http://news.ontario.ca/mohltc/en/2014/03/new-health-investments-in-thunder-bay.html

Honestly, if you were looking for transformation, wouldn't the Scarborough-Rouge Valley merger look borderline orgasmic? And from a political perspective, without doing the formal research I am confident in saying that there are more seats in GTA East than Northwestern Ontario. Heck there are less the 250,000 people in the whole region. That fits on one Scarborough RT train - or at least feels (and smells) like it!

But I digress.

So mfO, riddle me this one: since when is Scarborough on the margins and Thunder Bay is at the core? Or does this officially mark the beginning of silly season?

And finally, a similar merger happened not too long ago in GTA West, i.e., Trillium Health Partners (Credit Valley Hospital, Mississauga Hospital, and Queensway Health Centre). There must have been some government support for this transformation: either from the Ministry or the LHIN.

Can someone explain why Central is not giddy with excitement and tripping ll over themselves to make this happen?

Questions:

■ Does Central think that this is nothing but a cynical hospital cash grab?

■ Are there not enough Liberal seats to maintain or win or is GTA East hardened PC territory?

■ The Liberals had the chance to support this and hesitated. Which party jump out on Monday morning and declare that if elected they will support this?

Would love to see the Minister's briefing note on this one.

That's enough for now.

Discuss.

Reader Comments (215)

ELB

It is the beginning of the walk away. Keep away from all issues since the best we get is a minority government and we don't need to own all this mess.
March 16, 2014 | Unregistered CommentermovingforwardOntario
I see the Ontario Ombudsman is wading into the MUSH sector without the H...shouldn't the OO also be involved at the Hospital level?

from Twitter:
‏"@Ont_Ombudsman
The MUS (municipalities, universities + school boards) receives over $30 billion from provincial coffers. The 39 yr free ride soon ending."
"It's the beginning of the walk away"...

Interesting comment. It seems like Ontario wants to dictate the centrally controlled system but now it doesn't want to pay for it. How can it be both?
This would be a merger of a merger as those hospital corporations were formed in the late 1990's by the infamous HSRC.

We looked at the cost benefit of merging in the mid 2000's and found that the merged hospitals of the time were costing 15% more to operate than there predecessor single sights.

It sounds good to say you can eliminate duplicate CEOs VPs etc. but it saves nothing. You have ended up paying the "super" executives more than the predecessors, the organizations gets to big to manage so you bring in more middle management for oversight and the senior execs lose touch with the ground allowing other inefficiencies to slip in. When everyone cries they do not have enough staff, you believe them because you are too far removed and so you approve increases. This leads to budget issues and then you bring in efficiency experts. And so it goes.

Bottom line, I have not seen hard evidence that mergers save money and are usually nothing more than empire building.

I much prefer the Magna approach to business unit sizing.
March 16, 2014 | Unregistered CommenterConnie LHINgus
The LHINs didn't really work to unlink Central from cost cutting and rationing decisions. The trail was easy to follow back to the politicians.

If Central government decision-makers push savings based on transformation (the savings never really materialize or if they do, they are quickly consumed by some other new necessity) then how do hospitals who have signed accountability agreements fund the additional upfront costs of tens of millions of dollars?

And we know the transformations don't typically result in long term savings overall. There is always some other factor that comes in to play to drive up costs.

If ultimately the only way to control costs is to ration, then how do we educate patients on this and their need to be informed about their choices that they should have.

Coming soon is the BC Challenge to prohibition of private health options.

I also not that there are plenty of other "social entitlement" areas that allow people to pay for upgrades etc.:

http://www.theglobeandmail.com/globe-debate/ideas-lab/would-you-pay-extra-for-better-healthcare-and-faster-highways-take-our-test/article17480453/
Connie,

Astute observations. If you look more deeply at the mergers, there are costs don't seem to be noticed by those riding on the Happy Health Care Bus. If we hang around long enough we see the history. The young "Health Leaders" think they are inventing something new. Not.

"We looked at the cost benefit of merging in the mid 2000's and found that the merged hospitals of the time were costing 15% more to operate than there predecessor single sights."
R

The seams are unravelling and no one wants to be found to blame. Under 5 years left unless go way up.
March 16, 2014 | Unregistered CommentermovingforwardOntario
When we create more complexity and create bigger health care kingdoms it costs more and there is more entrenchment and less flexibility.

Through all the efforts to coordinate care, costs are being driven up and the system is becoming more brittle.

The complexity cannot really be coordinated. There must be movement at the links...and I don't mean Health Links...they are another bogus attempt to appease MDs with money that will flow to the followers. It all costs more.
"The seams are unravelling and no one wants to be found to blame. Under 5 years left unless go way up. "-mfO

It is definitely a charade that will come back to haunt us.
If we prepared now for 2025 by starting to understand how a Hybrid system like Australia's could evolve here, then we could manage when the huge surge of need hits us by 2020. If we take another five years to see the reality, it will be too late to meet the demand that is coming.

Paul Martin's "Fix for a Generation" has turned out to be an expensive delay of the inevitable. It reminds me a bit of the bail outs for the big automakers....
[Dr. F - thanks for the opportunity to be first guest blogger on your site!]

<<It is the beginning of the walk away.>> - mfO

Well summarized. But what are the implications? Can LHINs walk away from their Ministry-LHIN accountability agreements? Can health service providers "walk away" from theirs?

I don't think so.

Being in power means ... well ... being in power. I think we all know what has to be done. Let's get at it.

We hear that the OHA and the ONA are going to arbitration - despite best efforts at negotiation. It will be interesting to see if the arbitration results mirror the 2011 experience.

mfO believes if will be held at 0%. I do not share that belief. Only time will tell.

There will be some degree of synchronicity with the writ. Do the parties want an election before, during or after the results of arbitration.

Finally, how will this all affect negotiations with the OMA?

Enough for today. My head is starting to hurt.
March 16, 2014 | Unregistered CommenterExecutive Lead Blogger
I am disappointed by the approach of the OMA to go along with the government steam roller that has short term sight only. It's a mistake. Too many big egos looking to feel important and conciliatory by doing what they believe is correct for their own self-interests. Unfortunate. What happened to leadership with character?
Connie

Great comment.

I wonder if this merger and request for increased funding has to do with the case costing funding model central is mandating? http://healthydebate.ca/2012/02/topic/cost-of-care/ontario-hospital-funding-confusion
http://www.igi-global.com/chapter/implementation-of-case-costing-with-ontario-case-costing-initiative-occi/78690
March 16, 2014 | Unregistered CommenterOutpatientPharmD
"We hear that the OHA and the ONA are going to arbitration - despite best efforts at negotiation. It will be interesting to see if the arbitration results mirror the 2011 experience."-ELB

How will this affect the OMA?

Here's how I think it will play out:
The OHA and the ONA will be dealt with through arbitration and come out better than they would have had they rolled over.

OMA will roll over believing it is doing the noble thing. It is not. It is perpetuating a sinking boat to the detriment of all aboard including patients.
Thanks ELB!
and if government thinks it can save costs by moving more care to the community, think again:

http://thehealthcareblog.com/blog/2014/03/14/can-hospitals-survive-part-ii/
OHA and ONA arbitration

This process used to always make me chuckle. If you are unable to freely negotiate an agreement, then HLDA legislation mandated binding arbitration.

There is no incentive on behalf of ONA to agree to a 0% settlement. They have nothing to lose by not agreeing since they automatically go to arb. Our cadre of bleeding heart arbitrators believe there is no ability to pay argument on behalf of the OHA. They know that ultimately hospitals are funded by the government and the gov't has an unlimited ability to pay. They either increase taxes or shift funds. Therefore arbitrators always give the nurses an increase. So it is a no lose proposition for the nurses. OHA won't give us what we want, let's go to arb then. If for some reason the arb provides a low increase, the union blames the arbitrator and is absolved of bad bargaining. Not a bad gig if you can get it. OHA is in a no win situation also.

In bargaining, there has to be a "hammer" at the end of the process to incentivize realistic bargaining. Therefore, if there is no deal, you have a strike or lockout at the end and your members feel the pressure of no income.

I have often said that the real financial problems began in hospitals after a 1989 arbitration award giving the nurses a 30% increase -- BOOM! The cost of the system just went up by a third. Because you know, right after the nurses got it, everyone else lined up, CUPE, OPSEU representing support mad lab and X-ray workers. Then the doctors. Oh and then a recession happened. Since approximately 70% of a hospitals budget is wages and benefits! the system could not handle it and it never recovered.

Bad system to resolve contract disputes.
March 16, 2014 | Unregistered CommenterConnie LHINgus
Good summary Connie.I had forgotten about the 1989 arbitration. A 30% increase...based on what?
It is just politics, but things are piling up.

1. ONA and OMA contracts are due. Expect an overall no increase in net take home for most. Some will do well, but the top is being reached and "selective" realignments are coming. Certain groups are being targeted based on the consultants recommendations (OMA and ONA members).
2. 5-15% decline in CDN dollar but most supply costs are in USD (most supplies are US derived.
3. Huge infrastructure costs due to ice storm, and hard winter. In case you haven't noticed the roads have taken huge hist this winter and will need new not budgeted for capital costs.
4. Fuel is in short supply and is calculated in USD.
5.The overall population has aged another year.
6. Overall civil servant pension funds are underfunded.
7. Pronouncements have been made that no new middle class taxes will occur.
8. Despite claims, manufacturing continues to go down.
9. Despite media claims, Ontario has one of the worst run, publicly funded, system in the OECD (stop comparing against the US, which has it's own unique, non publicly funded issues).
10. deficit will rise
11. A rediscussion of GTA transit is going to occur.
12. Despite the new tax rate on the "rich", not enough revenue has been found.
13. More guidelines are coming, allowing further guideline given restrictions.
14. Case costing funding isn't working as revenues are short, forcing hospitals to draw from other programs.
15. 0% increase to hospitals for 2014-15.

It may be time to allow the election,chose to lose, and walk away to return in the next cycle.

Who would want ownership of this?
March 16, 2014 | Unregistered CommentermovingforwardOntario
Is this true here?

"The physician practice losses, euphemistically called “physician investments”, are compounded by rising payments for physicians taking night or weekend call in ER’s and ICU’s, medical directorships and other forms of physician subsidy. Income subsidies to physicians have become hospitals’ fastest growing expense. Today, hospitals’ most urgent cost management challenge is to reduce physician subsidies that serve no strategic purpose."
March 16, 2014 | Unregistered Commentereklimek
If I recall, the ONA increase was a "catch up" based on supposed lost ground during the high inflation early/mid 1980s. Remember those days.
March 16, 2014 | Unregistered CommenterConnie LHINgus
DrK

One of the systems faster growing costs, are physician subsidies not related to direct patient care, but to management roles. How many physician leaders must the LHINs hire?
March 16, 2014 | Unregistered CommentermovingforwardOntario
eklimek,
I'm hearing grumblings of discontent as salaried specialists (and family physicians) are off at network meetings and conferences but not available to take call or do deliveries (of babies). It makes for resentful colleagues who are not part of the physician leadership cartel.

So how is the productivity of salaried "physician leaders" measured? Just wondering?
The "physician leader" concept appears to be part of the optical arrangement that makes it appear MDs are part of the solution. The reality is a more complex system is being created that requires more people to do more bureaucratic work and be paid for non-provision. This kind of "leadership" will make negligible difference in controlling costs of care or to the rising costs of social entitlements.
Dr K,

I don't think it is true to the extent in the article. If I recall, the MoH acted to eliminate hospital paid stipends and incentives related to getting doctors to "work" more on behalf of the hospital. Things like on call rosters etc. this was through the HOC process. If you were found topping up, HOC would be cut.

The largest cost subsidy came with the introduction of Hospitalists. Their OHIP billings typically only offset 30-40% of their salary. Best case was to recoup 50%.

The best deal for hospitals was when FPs took call and maybe received some token on call pay in addition to the ridiculously low fees for seeing PTA in hospital. The MoH I and the OMA in their penny pinching shortsighted ways never addressed the value of FPs taking call and a result became the much more costly Hospitalist model.

Only other subsidies I am award of are chief and dept head stipends and other employed physician positions here in Ontario. Anything else would be double dipping
March 16, 2014 | Unregistered CommenterConnie LHINgus
Connie:

There are lots of subsidies through the LHIN structure.
March 17, 2014 | Unregistered CommentermovingforwardOntario
As for funding, it will be a traumatic year. Budget is based on the successful transition to HBAM funding, and early rumours are it is not going well. Big places can struggle through, little places can't.
March 17, 2014 | Unregistered CommentermovingforwardOntario
Regarding the Sarborough mergers.

Numerous hospitals were given instructions to merge with costs that were partially known and entirely speculative outcomes were based on future community services that never materialized. Now Scarborough says it won't because it costs too much? Pull my other leg please.

When did costs suddenly become a problem? If I recall the Toronto Grace was to be closed but saved during a byelection. Gees, if a gas plant can be moved with zero planning or concern for costs, what's this about a merger for $30 million being too much?

What is the back story to this? It isn't about the money.
March 17, 2014 | Unregistered Commentereklimek
DrK

This money was the transition money to discuss mergers, not complete it. do you really want this discussion going on preelection?
March 17, 2014 | Unregistered CommentermovingforwardOntario
http://www.thewhig.com/2014/03/17/five-things-the-conservatives-can-do-to-stop-the-bleeding



OPINIONS AND OBSERVATIONS
Five things the Conservatives can do to stop the bleeding

By Stephen Skyvington

Monday, March 17, 2014 2:47:13 EDT PM


Canadian Prime Minister Stephen Harper participates in a question and answer session with the BC Chamber of Commerce in Vancouver, on Wednesday. Carmine Marinelli/QMI Agency

Canadian Prime Minister Stephen Harper participates in a question and answer session with the BC Chamber of Commerce in Vancouver, on Wednesday. Carmine Marinelli/QMI Agency






Stephen Harper's Conservative Party is in trouble — deep. But all is not lost. Here are five things the Conservatives can do to stop the bleeding and position themselves to win the next election, expected sometime in 2015 . . .

1. Stop obsessing over Justin Trudeau.

I've said it before and I'll say it again. Stephen Harper's Conservatives need to get over their almost pathological obsession with Justin Trudeau. From almost the moment he was elected leader of the Liberal Party of Canada, Trudeau has faced a barrage of shots — mostly of the “cheap” variety — from the Conservatives. But, as former Harper adviser Tom Flanagan pointed out, it's difficult to attack somebody who's held in higher esteem than you are.

That said, there is a way that the Conservatives can exploit Trudeau's weaknesses to their advantage. They simply need to let the man speak. Every time the Liberals' very young and very inexperienced leader opens his mouth, we're reminded not so much of his father but, rather, his mother. Whether it's a stupid joke about Russia invading Ukraine because of the humiliation suffered by their hockey team at the Olympics, or his “admiration” for Chinese dictators, Justin Trudeau is quite capable of making himself look foolish without anyone else's help.

Harper's gang needs to learn to get out of the way and let Trudeau shoot himself in the foot.

2. Don't be so damn partisan all the time.

The prime minister has proven himself to be a magnificent campaigner over the past decade. Unfortunately, he appears to have a hard time accepting the fact that once you actually win an election, the campaign is over and it's time to govern. As a result of this, the Harper Conservatives have managed to poison parliament by engaging in a particularly nasty form of partisanship — the sort rarely seen in Canadian politics.

Case in point: A Canadian delegation recently travelled to Ukraine, shortly after the Russians invaded that country. The eight-member group was led by Foreign Affairs Minister John Baird, and included two Conservative backbench MPs and a Conservative senator, along with four representatives of the Ukrainian Canadian community. So far, so good. However, when the two opposition parties asked to send one representative each, they were turned down by the government.

Again, a dumb move.

3. Share their story with Canadians — it's a good one.

The average Canadian could be forgiven for thinking the Harper Government was incompetent, or mired in scandal, or running our economy into the ground. In fact, none of these things are the case — although you wouldn't know it based on what we hear from the Harper Conservatives themselves.

The prime minister and his team have actually proven to be excellent managers of our tax dollars, for the most part, and have provided our country with the kind of stable, dependable leadership we need — especially following the worldwide economic meltdown in 2008. So why isn't any of this being reflected in the latest polling numbers, which show Justin Trudeau's Liberals with a slight lead? I believe it's mainly because Harper's advisers have chosen to run ads attacking Justin Trudeau instead of using that air time to tell their own story — which, as I've suggested elsewhere, is a good one.

The Conservatives need to change their message track and change it fast. What they're doing now clearly isn't working.

4. Dispense with the Fair Elections Act.

Rarely have we witnessed, in Canada, so blatant an attempt to manipulate the electoral process as with the introduction of the Fair Elections Act — or, as we like to call it around here, the Unfair Elections Act.

It's bad enough the Harper Conservatives have already re-jigged many riding boundaries — even going so far as to create new ridings in vote-rich provinces — that will inevitably favour the re-election of a Harper government. What I find much more irksome is the rewriting of the rules which will make it even harder for Canadians to cast their ballot — all under the guise of preventing voter fraud. The only fraud here is the one being perpetrated by the Conservative Party upon innocent Canadians.

The prime minister would be wise to kill the bill, or table it, or appoint a blue-ribbon panel to study it to death — anything to ensure the Fair Elections Act doesn't see the light of day before the next election.

5. Convince Stephen Harper it's time.

Stephen Harper has been one of the finest Canadian prime ministers of the last 50 years. A lot of people have trouble acknowledging that — just as they have trouble admitting that Jean Chrétien was also a tremendous leader — but it's true. Harper obviously loves the job, is good at the job, and wants to continue doing the job for as long as possible.

Sadly for the prime minister, his “best before date” is fast approaching. In spite of this, there is a way to turn this apparent negative into a positive. If Stephen Harper were to announce this coming June that he's accomplished everything he set out to do, and that it's now time for someone else to take over — someone like Saskatchewan Premier Brad Wall, for example — the Conservatives could win another majority.

But if Harper puts his own interests ahead of those of his party instead, then I'm afraid 2015 will unhappily usher in the Trudeau 2.0 era.

And that won't be good for any of us.


Stephen Skyvington is the President of PoliTrain Inc. He can be heard every Saturday at 1 p.m. on CFRB Newstalk Radio 1010. Follow him on Twitter @SSkyvington.
March 17, 2014 | Unregistered CommenterStephen Skyvington
Fee deals: How much can governments afford?
WRITTEN BY COLIN LESLIE ON MARCH 11, 2014 FOR THE MEDICAL POST
Read more articles on: fee deal • editorial
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Our national fee deal survey and forecast is a to return to this periodic editorial series examining how fee deals are made. This time, as we examine the basic issues that come up in every master agreement negotiation, we look at how doctors might think about the overall affordability of doctor services.

For this particular editorial I’m going to describe my thinking as we went through the process of gathering the data in our fee deal survey summaries on pages 24 and 25.

My first take came from thinking about what happened to Ontario doctors as they tried to negotiate the fee deal that should have begun April 1, 2012, and instead saw the provincial government impose significant fee cuts.

While it is true the government also clamped down on its public sector healthcare employees such as nurses, individual nurses on salary in unions did not see their take-home pay go down. However, many doctors did because of the unique financial compensation system physicians have with the province.

So that struck me as a “dick move”—as Dan Savage, a personal relationships advice podcaster and columnist I like, calls it when one partner has behaved in a morally questionable manner toward another in a relationship.

But then Ontario’s doctors were not the only ones to see high-handed behaviour in recent years.

As well as the usual tough negotiating in some jurisdictions, in recent years the provincial governments in both Nova Scotia and New Brunswick told their respective medical associations that their negotiated deals would be suspended or amended, and zero or more moderate increases applied.

So, this sucks, right? One could be forgiven for thinking the leaders of our provincial governments are either bad planners or we have a crappy political class, or an unlikely-to-happen-calamity struck the finances of the provinces.

I’m not an economist, but I think the fact that these “dick moves” came in the years after the 2008/09 worldwide economic meltdown is telling.

But do provinces, in exceptional circumstances, have the right to do things like this?

Well, in a democracy, that is for the voters to decide—though doctors certainly have a right to marshal as many forces of protest as they choose.

But it is interesting to note that some provinces didn’t take such extreme measures with their fee agreements.

As for the situation now, it is hard to know how valid the provinces’ claims of tough times are (our summary boxes do provide some data). Certainly health-care economists continue to argue the mega-trend we have seen in recent decades—health-care costs rising faster than GDP—means overall Canadian physicians should expect only moderate increases in the coming years.

This, of course, is not to say that many individual doctors and some whole specialties don’t deserve to be much better paid. Many doctors are underpaid in Canada.

Rand Formula
Ontario Progressive Conservative Leader Tim Hudak, who for several years embraced the “right to work” policies that have been controversial in some U.S. states, recently did an about-face on killing the Rand Formula (which, in Canadian labour law, makes union dues mandatory regardless of the worker’s union status). This means, of course, that doctors who are not members of the Ontario Medical Association will continue to have to pay OMA dues even if there is a change in government.

As well, as part of the 2012 negotiations, the OMA and the Ontario health ministry entered into a “representation rights” agreement where the ministry acknowledged that it is required to negotiate and consult with Ontario doctors, through the OMA, with respect to physician compensation. The agreement recognized the OMA as the exclusive representative of doctors and stated that, going forward, the ministry must negotiate doctor compensation in physician service agreements.

So I am going to toss out my own view here on this—but please, we’re happy to run counter views on the opinion page at right in future issues.

I get that there are problems with how the provincial medical associations perform as fee negotiators. But, unless I’m missing something, I think it is questionable for small groups of specialists to negotiate separately.

Yes, there are clearly times when some doctors feel the main body of their medical association doesn’t get the unique challenges they face. And surely they are right sometimes. But medical associations are the vehicle by which your colleagues have input into the complex process of determining how much various types of doctors are compensated.

I think Canadian doctors are best served in the long run by maintaining a united front.

That said, determining relative compensation for different types of doctors cannot simply be about workload, education length and overhead. It is always going to be a political process because it has to include competitiveness, as the provinces—and indeed the U.S. and other countries—try to recruit certain types of doctors.

If we are again in a period of health-care spending restraint, well, let us hope the provincial governments are more sophisticated than they were last time there was restraint in the early 1990s, when they mostly imposed across-the-board cuts. That is how dummies cut health-care costs.

As Alberta Medical Association president Dr. Allan Garbutt said in our cover story: “So they (the provinces) are going to try to squeeze costs and that is undeniable. What we really want is that they squeeze costs smartly.”

Amen. Even in times of restraint, governments should be increasing spending on some parts of the health system.

It is easy and cheap to simply diss politicians. Instead we should ask ourselves how we, in the physician-interests community, can improve the thinking and planning of our political class around health-care issues.
March 17, 2014 | Unregistered CommenterStephen Skyvington
http://www.theglobeandmail.com/globe-debate/the-real-problem-facing-ontarios-factories-markets-are-moving-south/article17521075/#dashboard/follows/

Quiet, subtle, no ranting or raving. True. The world is shifting, and Ontario is not well placed. This is going to get worse. Central will protect itself, but things are tightening up.
March 17, 2014 | Unregistered CommentermovingforwardOntario
The budget, in June, will be a real shock, for those who understand budgets, It will be painted as good, but underneath, look for the lead poisoning risks,
March 17, 2014 | Unregistered CommentermovingforwardOntario
Very good articles, but a little bit of a momentum buzzkill from the previous posts.

Oh well.

<<Budget is based on the successful transition to HBAM funding, and early rumours are it is not going well.>> - mfO

Early rumours? Darn thing hasn't worked properly since day one. What was the first clue?

Can we talk about the HBAM a bit? Does anyone really know how it works? And can it be audited (i.e., deconstructed are reconstructed)? Truly, I don't think anyone has a total handle on it.

I was wondering, mfO if you could confirm the following story - or at least correct it for everyone. Word has it that the American originator of the HBAM only wanted to license its use to the Central. Yes, I said American - the original HBAM is in use in New York State, I believe.

However Central wanted to buy it off him and that did not fly. So Central took the version of the HBAM left by the American after the contract was over and has been using that version (with some home court favourable modifications) every since.

In short, Central replace one black box with another black box.

Good move.
March 17, 2014 | Unregistered CommenterExecutive Lead Blogger
Ah yes, the budget, accountability and all that...

I hear the AG is checking out Ontario's vaccine program and it may not be pretty...just hearing...
ELB,
HBAM was supposed to be new, made in Ontario!
And we've had the discussion comparing Ontario debt to California's debt but from a per capita stand point, Ontario seems much worse.

All the theories of efficiency finding in health care transformation don't seem to be holding true in real life.

http://www.torontosun.com/2014/03/17/ontarios-debt-size-nearly-double-californias-study
ELB:

THat story about HBAM is roughly correct.

AS for the upcoming budget:

We are promised:
1. Control of the deficit and debt
2. Infrastructure costs for ice storm and harsh winter
3. Infrastructure for transit
4. Contract resolution for numerous unions - including the OMA and ONA.
5. No increase in taxes or fees for the middle class
6. Jobs
March 18, 2014 | Unregistered CommentermovingforwardOntario
"We are promised.."..

Sounds famililar.
The sclerotic government of the unrejuvenated Wynne Liberal party is no longer a catalyst for change and can't muster enough courage to address the problems it faces.

Arguably neither opposition party has the charisma to gain office, but who thinks charisma is required for leadership? What seems lacking is a principled platform, straight forward and honest, that all agree will be painful but necessary.

The absnet political party in Ontario is the party that insists community and social problems are the responsibility of the people without mortgaging our childrens future to fund government. The current deficit financing of government services and waste, is not the major election question. It is the only election issue. It has tendrils that strangle all other considerations and efforts by society to provide for the needy.
March 18, 2014 | Unregistered Commentereklimek
"The current deficit financing of government services and waste, is not the major election question. It is the only election issue. It has tendrils that strangle all other considerations and efforts by society to provide for the needy."-eklimek

I agree. However, the public is so financially illiterate it does not understand or hears only the loud advocates who call for more spending....

How can the public be informed? Do they want to be informed?
From "Asking Whether Leaders Are Born or Made Is the Wrong Question" (Harvard Business Review Blog Network) :

"Unfortunately, we often choose our leaders based on traits such as extraversion, charisma, and intelligence (or perceived intelligence). And then we wonder why their performance does not live up to our expectations."
R:

The public is not illiterate. They enjoy the free things.
March 18, 2014 | Unregistered CommentermovingforwardOntario
Health literacy and financial literacy are quite different from general literacy. I suggest the Canadian public is lacking in both. I do my part to inform and educate.

I see now that Poloz is saying the current demographics are contributing to Canada's sluggish economy...You heard it here years ago folks.
R

We all agree. Things are slowing, the world is shifting, and we all like "free" stuff, that really isn't free. A wall will be hit. Ontario is not well placed. The 2014 deficit budget is not a wise decision.
March 18, 2014 | Unregistered CommentermovingforwardOntario
<<"Unfortunately, we often choose our leaders based on traits such as extraversion, charisma, and intelligence (or perceived intelligence). >> - Dr. F.

Ah, perceived intelligence...my forté.
March 18, 2014 | Unregistered CommenterExecutive Lead Blogger
" Leadership is a combination of courage and wisdom neither of which is of much use without the other".

Our political system doesn't seem to generate the like...a Lincoln , un photogenic , pockmarked and gaunt , could never be elected in the modern era....perhaps the Ancient Athenian lottery system would be more effective....or a monkey throwing dung at a telephone directory.
March 18, 2014 | Unregistered CommenterAndris
Andris, I don't like your last option.
But we have leaders, who are out to do "good". Difficulty is "good" costs, and where are we to get the revenue? Two philosophies - find it before you do "good", or do "good" and it will be found. Those approaches have consequences that that current leaders wont announce. Either some people don't get good things done in time, or burden the next generation with debt.
March 19, 2014 | Unregistered CommentermovingforwardOntario
R

I tend to agree that the public is intentionally supporting the defecit government. It is much the same as any group voting to sacrifice anothers priorities. The majority declares it in society's selfinterest. Its not much different than a group voting how the dinner bill will be paid. It goes on some elses credit card and the others walk away.
March 19, 2014 | Unregistered Commentereklimek

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