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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Ontario Election 2014

I must admit that it is somewhat mindboggling how the Liberals might still be in power June 13....but it will be Friday The 13th by the time the scandal-riddled-Liberals limp over the finish line with a little bit of doping from the Unions. If they manage a minority then let them wear their mud a little longer. If they manage a majority then the unwitting public is in for a big painful surprise as credit rating agencies begin to flex their muscles. The Liberals won't be looking very fresh at that point.

For the PCs, a win  will be a double-edged sword. The loud mouth unions will be out in full force at every turn. If the garbage truck is late, it will be Tim Hudak's fault. If a storm knocks out the electrical grid, that will be Hudak's fault too and if the growing ranks of people with acute on chronic disease show up in droves at the ER, that will be Tim's fault too...

It almost makes me think that a couple more years of the Wynne government would be worthwhile only if it is to show what a terrible muddle she and her big spending government have created. The downside is that Ontario will be driven further into debt and further hardship for Ontarians will be the result and I have difficulty supporting that.

What is striking in this election is the level of disengagement of the electorate. Advance poll numbers were down by about 6%..and with the first game of the FIFA World Cup on the tele I expect many areas of Toronto and Ottawa will have low voter turn-out numbers.

What kind of society do we create when the Union propaganda successfully deceives and the self-indulgence weakens the electorate?

What kind of society believes that the best election platforms are the ones that promise it goodies without any trade-offs?

Somehow, a culture of complacent, non-voters has been created. Their usual excuse is that it doesn't matter which party takes over, the result is the same. Why bother? 

How wrong they are.

I hope you manage(d) to vote today or in the advance polls and I thank you for your ongoing support!


Reader Comments (496)

As I finish my scotch and watch the results in disbelief, I think it is only fitting the Libs are left to deal with the mess they created.

Also I cannot believe what I am seeing. Hudak has been a disaster and let's hope for a change. I think immigration into the GTA/905 has changed ON politics
June 12, 2014 | Unregistered CommenterConnie LHINgus

Those coming into Ontario, can't fathom the generous programs and will support the party that keeps it coming.
June 12, 2014 | Unregistered CommentermovingforwardOntario
Four more years of back room deals, union pandering, and big dollar projects gone awry. It appears that only a credit downgrade will bring some fiscal discipline to the province.

The unions will be expecting big payback for delivering this majority to Wynn.
June 12, 2014 | Unregistered CommenterCanary in a Coal Mine
Four years of stability and no election.

The only question: will the ratings groups cut rating, pushing up interest rates, increasing deficit, require more cuts (as yet undiscussed).
June 13, 2014 | Unregistered CommentermovingforwardOntario
Greetings from the bunker:

Just moving the chairs back upstairs, taking care of some of the stains on the floor.

Won't be back for 4 years,

So where are we, and what to judge in 4 years, the major ones:

1. Province divided into three tribes, with virtually no chance of cooperation.
2. An ongoing lists of past (and future?) scandals that will play out over the next 4 years, that will affect the majority government, hampering them governing.
3. Taxes will rise, and, discretionary personal funds will decline.
4. Assurances that 4 years in the future, the number of public service positions will be kept as is, with proportional growth to the population.
5. Deficit gone by 2017-18.
6. All Ontarians will have secure pension minimums by 2017-18.
7. Non public sector employment will be up by 2017.
8. All Ontarians will have access to primary care by 2017.
9. Wait times down.
10. End of life directives available to be followed.
June 13, 2014 | Unregistered CommentermovingforwardOntario
I like the cartoon in NP of McWynnie holding up her arms in triumph " THANKS (suckers) ".

The citizenry of Ontario have made their decision and will have to live with the consequences---- no more compassion for them as the unpleasant consequences unfold---they turned a blind eye to corruption and incompetence---they will now get more of the same.

The voters chose , what they saw as the easy way out, the least demanding option.

" Taking the path of least resistance is what makes both man and rivers crooked" ( Old a Russian Proverb).
June 13, 2014 | Unregistered CommenterAndris
The sun rose and shone on Ontario today. No catastrophic event occurred. A sovereign state exists today and will tomorrow fashioned by the democratic process. The three party system has again permitted a minority of the electorate to endow the power of a minority unto a political party.

Jefferson would be appalled - "Democracy is nothing more than mob rule, where 51% of the people may take away the rights of the other 49%."
June 13, 2014 | Unregistered Commentereklimek
Here's my take for what it's worth on the election.

1. Ontarioans do not like confrontation. Live and let live. With the PCs in power it is certain that the public service unions would have gone on strike (i.e. teachers, police, nurses) no matter what Hudak did. With the Libs, some labour peace is likely. (I personally think not but the Ontario voters have been duped).

2. In our small pharmacy, even the dye hard Liberals (and Harper haters) were not going to vote Lib but PC. But not our newer immigrant. Why? Because she is used to corrupt governments and think it is the norm, and the Liberal corruption has not touched them per se….AND economically things are still pretty good. No one is starving, living without electricity and you can see a doc for free. What's not to like?

3. At a deeper level, we are becoming tribal. Without the unifying vision of a civilization based on Judeo-Christian values, I think we break up into tribes. And the Liberals know how to exploit this.

Sigh. Glad we are finally selling the pharmacy. My kids already know the future is out West.
June 13, 2014 | Unregistered CommenterOutpatientPharmD
"Sigh. Glad we are finally selling the pharmacy. My kids already know the future is out West."-OpPD

I hope the sale goes smoothly.
My "recently graduated from university son" told me that he could move out west or to the US should Ontario become increasingly hostile to business or high earners.

But it's not that easy. The West has its cycles of booms and busts and the US has its own economic pitfalls.

How to explain to someone young that while they need to be interested in their future, there is much to be accomplished by staying and attempting to improve the future for us all....but maybe that is wasted effort.

The Wynne Win makes it apparent that Ontarians want to be cared for. They want the state to tell them that all will be well and their jobs will be secure and that they will be taken care of from cradle to grave including while on the 401. It doesn't always work that way.

I am reminded of the Trudeau era when the population was young and our leaders spent us into the ground. It took decades to lift Canada out of the financial pit that had been dug but does the populace even care? It appears not.

Eventually what happens is a new group of leaders is elected to clean up the mess but then they are blamed for the austerity measures, the public tires of it and then brings back in the big spenders. It appears to be cyclic and we're not at the bottom of the cycle yet...believers abound...and that's not necessarily bad for NOW, but it will be a problem LATER.

It's tough to watch but maybe Wynne has some backbone unlike McGuinty who put his tail between his legs and ran away when the teachers turned on him.

The next four years will be very interesting. Perhaps smooth talking Wynne has the electorate hypnotized...We'll see.

The world goes on. If it gets worse financially, the poor will rebel, and punish the remaining rich. If it gets better, all will remain happy.
June 13, 2014 | Unregistered CommentermovingforwardOntario
The poor will rebel, the innocent rich will get punished and the politicians who created the mess will get reelected.
June 13, 2014 | Unregistered CommenterAndris
Of course, health care hasn't even been on the radar but is the biggest issue that is very real for many people. The funding available largely depends on how the Wynne Liberals choose to deal with debt.

I'm glad I'm not just starting out.
Starting out.

Assured good salary with benefits.

Set hours with defined guidelines.

Government committees that defined acceptable care.

Seems like a nice life.

A government promising to do "good".


The plan is good.
June 14, 2014 | Unregistered CommentermovingforwardOntario
Over time, dealing with the next 4 years.

The biggest promise on the agenda is the ORPP (Ontario retirement Pension Plan). It is important, and something needs to be present that allows reasonable assurance of long term stability.

Can take two routes, establish a voluntary Ontario system, or mandatory Ontario system. There are other options, but a majority government means they are off the books. The cynics would say this is a means of the government finding access to more funds, and a way of getting the middle class to pay twice for old age security. It is both. Currently, and if nothing changed, those who did not save enough are eligible for Ontario's social top up system, supported by general taxation they have paid for decades. Now they will be taxed more, to keep them above that minimal level, but will see no tax reduction. Thus, they will be being taxed twice, for one entitlement.
Will the fund be truly at arms length? No. A new agency will be established, with costs off the new tax, and the new agency will be targeted to invest in Ontario projects.
How it could be solved? Merely take, one fifth f Ontario tax paid under 150,000 per person, and put it in an Ontario RPP. That way, the double taxation doesn't occur, and is transparent to the tax payer and small business. Since these individuals no longer would need social assistance at retirement, in theory, those currently supplemented services could be reduced.
Where we will be in 4 years. Fixed mandated ORPP, drawing an additional 3.8% from all under 90,000 a year. Fund used for Tradition capital bulls. The government could do "good", it won't.
June 14, 2014 | Unregistered CommentermovingforwardOntario
"Seems like a nice life"

For those in the FHNOT clinics life is very good. Their patients though are not very happy and more and more of our never ending FFS business is patients from these clinics who cannot access timely care. It is now routine for an annual health exam to be booked 9 to 12 months in advance at these clinics in our region.

So we have these capitation clinics solely doing physicals and chronic disease management if the patients can get at all, but the acute and sub-acute care more and more is seen by the WICs and ERs. The money is good in the FHNOTs but one's clinical skills must get rusty pretty quickly.

In the upcoming contract negotiations I'd support a 1:1 fee negation for any FHNOT clinic patient seen in a WIC or as a CTAS 4 or 5 in the emergency department. That would put an end to the problem pretty fast.
June 14, 2014 | Unregistered CommenterCanary in a Coal Mine
So Mfo it will be the public service with most earning over $90K a year (teachers, fire fighters, police, NPs, etc.) financing the ORPP of those in the private sector who have no pensions and certainly will not be earning $90K per annum on average.

The unions will demand and get salary increases to cover the increased pension tax but the private sector will fall further behind as they will not be able to recoup the payroll tax through wage increases.

The best thing about the Liberal majority is they are now going to have to deal with the huge fiscal problems they have created. Add in $1.50 per litre gas this summer and a global slowdown due to China's slowing economy and the electorate is not going to like the medicine that eventually will be required to fix Ontario.

We'll see how many of these entitlement programs are actually carried out after the credit rating downgrade this fall.
June 14, 2014 | Unregistered CommenterCanary in a Coal Mine

If 60% of the FHNOT are doing scheduled wellness clinics, with good pay and no stress, who in their right mind would support a change that says physicians actually get paid to treat disease. Central has been told, by the consultants, wellness equals no treatment costs, long term
June 14, 2014 | Unregistered CommentermovingforwardOntario
“We’re on high alert that S&P will downgrade Ontario,” said Aubrey Basdeo head of Canadian fixed-income in Toronto at BlackRock Inc., the world’s biggest money manager. “She’s front-loading the deficit or the total debt in anticipation future years will benefit from stronger growth. They’re just looking at the raw numbers and they’re seeing a deteriorating financial balance sheet.”
June 14, 2014 | Unregistered CommenterCanary in a Coal Mine

Those with pension plans will NOT contribute to ORPP. thus , civil servants will not pay the 3.8%. The tax will only apply to those without existing pension plans,
June 14, 2014 | Unregistered CommentermovingforwardOntario
Will the provincial pension be voluntary or mandatory?

If the latter then we will have the situation where those taxpayers in the private sector will be matching 1:1 pension contributions made by the public sector AND making up for any shortfalls should the fund under perform in any particular year which has been the case lately.

In addition on top of the public sector pension tax those of us in the private sector may have a mandatory additional 3.8% payroll tax in order to offer pension supplements to those who did not save enough in the first place. And will the taxpayer also have to bail out this fund should it under perform?

It would seem that the premier has not considered the fact at a certain point taxpayers can move or go underground. I would contend that for many of us that tipping point will arrive with this new potential tax.
June 14, 2014 | Unregistered CommenterCanary in a Coal Mine
It will be mandatory given the majority government. It is a supplemental income source for the government to pay for capital projects.
June 14, 2014 | Unregistered CommentermovingforwardOntario
It will be mandatory given the majority government. It is a supplemental income source for the government to pay for capital projects.
June 14, 2014 | Unregistered CommentermovingforwardOntario
"More money for FHNOT Teams".

In the UK a tree surgeon surgeon, recently, accidentally cut his forearm to the bone with his chainsaw…he turned away from two UK FHNOT clinics because he was not registered there….eventually he managed to reach his own FHNOT where he was registered, but was turned away, although bleeding onto the floor, because they were "too busy"…he eventually reached Boots, a pharmacy much like Shoppers' Drug Mart , where he purchased bandages etc., and patched himself up..then he got his wife to drive him to a hospital 10 miles away , where he was treated and sutured.

Great working in those clinics, good pay, good hours, vacation pay and pensions….not so good if one is a patient.
June 14, 2014 | Unregistered CommenterAndris
In light of the recent comments about FHNOTs, I am still trying to figure out what the heck the Premier meant when she introduced the 24/7 access to primary care campaign promise by 2018.

Does anyone have a clue? mfO are you able to shed some light on this, please?
June 14, 2014 | Unregistered CommenterExecutive Lead Blogger
The equivalents of LHINs and FHT's seem to encourage ' jobsworths' as employees.
June 15, 2014 | Unregistered CommenterAndris
Ontario is following the British NHS's policies regarding FPs which pioneered FHNOTs, and one can anticipate the same consequences.

The number of FPs dropped as the work loads, including box ticking to measure 'quality', increased---fewer FPs are in the pipeline with practices/ clinics collapsing and closing ---those who would have gone into Family Practice are transferring to hospital employment, anywhere other than family practice---in a panic the Government is now trying to reverse the deterioration by decreasing the box ticking requirements , but it looks as if they acted too late, Family medicine in the UK is now in a state of collapse, as it will be here.

Promising 24/7 access to primary care indicates that the government will have to stretch the definition of primary providers---there are not enough medical doctor primary care providers to be on call 24/7---if they did try to make them work 24/7 (as I did in my first year in my present community in '72) then the exodus would begin---hiring far more expensive and less capable/ efficient and effective NPs ,as the NHS did in the UK and then scrapped because of expense and of medical,disasters, is a politically correct non solution which will , inevitably, be introduced with the same result.
June 15, 2014 | Unregistered CommenterAndris
The infiltration of first care providers by non MDs is generating internal problems. The number of misdiagnoses discovered late in the chain of referral is troubling. This is particularly problematic in time-dependent intervention where delay leads to poorer outcome. A domino effect of delay is developing.

One may expect that some of these cases will become precedents establishing scope-of-practice liability within the "team".

The ER is challenged with flow of referrals from outlying communities. Where once a referral to the "centre of excellence" was expected, it has now become a flow "up stream" from the urgent care or cottage hospital to ER and then to trauma centre. This arises from a lack of expertise locally and the unwillingness of the "centre of excellence" to accept referral from inexperienced clinicians with unstable patients.
June 15, 2014 | Unregistered Commentereklimek
There will never be an investigation or study regarding the effectiveness of non medical doctor primary care providers----one recalls the introduction of birthing units at our hospital , university trained midwives ( who could not compare with the previous generation of midwives that I worked with) with aseptic routine thrown out of the window--- unmasked family members were present in the birthing unit with its duvet and piped in music--- there was a sudden spike of neonatal infections---an investigation was ordered with the instruction NOT to look at the birthing units.

Speaking of the new fangled midwives and home deliveries--- the disasters ( and the statistics) end up in the laps of the OBGYN and hospital paediatricians who have them tossed into their laps.

The disasters of the non medical primary care deliverers and of the non alternative and non complimentary never end up as a statistic in their column--- they end up in ours---one wonders where the negative outcomes of Iridologists and reflexologists are recorded? Of course they aren't.
June 15, 2014 | Unregistered CommenterAndris

The primary level is designed now for quick, and cheaper - no good. It works for 95% of care. 24/7 for quick and cheap. The corner convience store for health. Doesnt need to be good for you - just convenient. The sick need to go to EDs.

Remember the 24/7 is for access. Not quality, or accessible. Just access.
June 15, 2014 | Unregistered CommentermovingforwardOntario
Greetings from central:

What a glorious day:

$ more years of stability, and walking into new revenue sources. hasn't happened in a long term. Taxes increases for all over $150,000 per year, and the new ORPP adds lots of revenue.

The pension plan is good. Now all with any money will be forced to cover their way, pushing them out of the top up available if you have no resources. Governments now dictate that the pubic can not be trusts ed and must contribution at least 15% of all income to mandated pension plans. The financial people love it too!
June 16, 2014 | Unregistered CommentermovingforwardOntario

If and when employers must match the 1.9% contributions of the employees, you can expect the employers to reduce their number of employees if possible. Jobs will be lost.

It all looks so good on paper and sounds so good coming from the smooth talkers. The reality will be different.

We can expect Ontario's productivity to fall further. Pensions are guaranteed for all! Why work? Why produce more? Why try harder?

Don't get me wrong. I believe we need to provide for the vulnerable and help those people who have met unfortunate circumstances in their lives but there are other ways to do it....and when we are all so comfortable that the state will care for us you have to know that nothing much of any long term "wellness" will come from it.

Just squish into your easy chair in front of the soccer, football, hockey or whatever, lose your money on internet poker and lean back...somebody else is going to take care of you...Kathleen Wynne said so.
and from the Medical Post:

"Quebec physicians recently agreed to defer a negotiated salary increase, as requested by the province's new Liberal government, to help get the province out from under a $175–billion debtload."

But the plan is good, and the voters support it. All is well in the world, for now.
June 16, 2014 | Unregistered CommentermovingforwardOntario

So, of the publicly funded system, Canada is the worse by quite a bit. Expensive, slow, and poor quality. we can't even get the two out of three right - cheap, good, or fast. We get all three wrong!!

Leave the US out - it's on its own. We are the worst. Number 1 in something. Worst performing publicly funded system!
June 16, 2014 | Unregistered CommentermovingforwardOntario
Ha! mfO...great minds think alike...didn't see your post before I posted mine!

10th, 9th, 8th out of 11 in most indices except for cost-related problems where we ranked 5th! Yippee!

Just we both watch the evidence. The evidence continues to be, despite the shortfalls of the Commonwealth Fund,(which is designed to shame the USA), Canada gets hit by the objective review. The worst publicly funded system as part of the review. High cost, poor performance, slow uptake of technology.

This is DESPITE massive infusion of funds. This isn't a FFS issue, this isn't a absence of knowledge about what can be delivered, this is poor management. Highest management costs of the 10 systems evaluated.

Funny thing is, in a decade, the US will catch up, making Canada the worst.

How's that OMA contract going? Ya think a 0.25% overall increase will be handled well?
June 16, 2014 | Unregistered CommentermovingforwardOntario
So we are't cheap, we aren't fast, and we have poor quality. But we BELIEVE and we are happy we believe!! Just stay away from the margins of sick, you don't get the best.
June 16, 2014 | Unregistered CommentermovingforwardOntario
"Funny thing is, in a decade, the US will catch up, making Canada the worst." mfO

Ha ha...I want to laugh but I get this queasy feeling...
"This isn't a FFS issue, this isn't a absence of knowledge about what can be delivered, this is poor management. Highest management costs of the 10 systems evaluated."-mfO

But the people in charge of the system changes ARE the high paid managers, consultants and experts! No wonder they blame it on FFS!

You keep getting it!.. This is strictly a political agenda. It is not based on evidence or facts. It is based on BELIEF. I believe my efforts are worth my salary because I believe, despite the evidence, it works. I BELIEVE. The facts, using outside consultants (the Commonwealth Fund) are wrong. We must believe.
June 16, 2014 | Unregistered CommentermovingforwardOntario
So. You are in school and get the worst grade in class. Do you accept it, or blame the teacher?

Where are we? Is it us, or is it the teacher? Who cares, it is free! We have the worst free care system in the world! Good for us. Number one.

Our performance statement. The best of the worst. Free, but poor quality, and proud of the free!
June 16, 2014 | Unregistered CommentermovingforwardOntario

The patients don't even know they are getting bad care. It's free and that is all they need or want to know. The propaganda and brainwashing is extensive.
June 17, 2014 | Unregistered CommenterOutpatientPharmD

Everyone knows that. It is free, therefore it is good. Meanwhile, we pay for "excellence" but get mediocre. Ahh, to be on the sunshine list!
June 17, 2014 | Unregistered CommentermovingforwardOntario

It is interesting that the OECD report has made none of the major news sources this AM. We have an objective, evidence based, report by an independent third party that goes unreported?
June 17, 2014 | Unregistered CommentermovingforwardOntario
So if our funding boosts have only served to worsen things, what are the steps that need to occur to fix things?

Getting to be of the age that likely will need more access to health care, one becomes concerned about entering a system where one is a "cost centre".
June 17, 2014 | Unregistered CommentermovingforwardOntario
The media, the profession and the government are all in denial---they have all come to believe the " best in health care system in the world" propaganda line---the cognitive dissonance causes their brains to hurt.

As stated before, they expect us to practice evidence based medicine in a non evidence based health care system.
June 17, 2014 | Unregistered CommenterAndris
"Our performance statement. The best of the worst. Free, but poor quality, and proud of the free! "

Worth repeating.

Maybe we should add that it also funds many layers of consultants, data analysts, MD "leaders", professors, health economists and all of their staff in order to measure and monitor the often inaccessible, poor quality care!

Talk about entrenchment. Public has limited knowledge of all things medical and is unable to be informed. Journalists also get perks from perpetuating the status quo. They get paid on the speaking and town hall circuit and get union support. Heck, Danielle Martin got a cool $50,000 from Unifor for her US health care system bashing. Wow....and the band played on.
For your reading pleasure:

"Despite Ontario’s mounting public debt, laggard economic performance, new status as a have not province, general lack of competitiveness, as well as a government marked by scandals and charges of corruption, the opposition parties were unable to convince the electorate of the need for change. In the face of such abundant fodder, this also represents a notable failure on the part of the opposition parties. Like Argentina, Ontario’s economic decline has spilled over to pervade its institutions with an inability to articulate and effect change."

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