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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
Aug142016

Wynne's Dysfunctional Approach to Solving Ontario's Healthcare Challenges

**Please note that the original journal entry from August 14 has been modified to reflect the vote result from  August 15.

 

 “Abdication, Distraction, and Deflection.”

 Ontario’s doctors voted NO to the tentative Physician Services Agreement between the Ontario Medical Association and the Wynne government that would have doctors co-manage the Province’s ailing health care system. The results of the vote from August 14 were shared the following day. Of voting OMA members, 63.1% voted Against the Agreement, 36.9% voting For the Agreement. The rejection is indicative of the negative view of Wynne’s overall approach to healthcare in the Province – one of abdication and deflection.

Given that Ontario is at a pivot point in health care that will affect patients, physicians, and the province for many years to come, the vote result will be important.  Simply stated: it is a bad deal, indicative of Wynne’s overall

 Abdication

The Wynne government has demonstrated its abdication of responsibility to patients by limiting the physician services budget for patient care below what can conceivably meet patient demand.  Instead of dealing honestly with the surge in health care need due to our growing population, new advances in science and technology, and an aging population with all of its associated requirements the Ontario Liberals are using health care to balance their budget. They have used rationing of patient care to offset the burgeoning debt that they have created through mismanagement and wasteful spending.

The centrepiece of the Liberal government-OMA deal was Wynne’s design to use  Ontario’s doctors as its collaborative rationing tool through co-management of the Physician Services Budget. This would have bureaucrats and doctors, together, deciding on the healthcare cuts to meet the government’s scheduled budget targets. Obviously, neither the OMA nor the Liberal government appear to have the interests of patients at heart. If they did, they would not be resorting to rationing under the guise of “co-management” and “collaboration”.

 Distraction

The Liberal government-OMA deal included components to address Relativity (the relative difference in the OHIP fee codes of some MD specialities compared to lower fee codes of other specialities). Although some physicians believed this was a positive attribute, it will require Ontario’s physicians to be internally focussed on slicing and dicing their profession – rather than spending time and resources on providing input into major structural issues that afflict health care delivery.

While the OMA is distracted with Relativity, the Wynne government master plan is to bring in more bureaucratic management in the form of Bill 210, The Patients First Act. Doctors kept busy with co-managing the rationing of care allows the government to move forward with minimal resistance to its major expansion of powers that allow it to unilaterally impose accountability agreements. Individual freedom for both patients and providers is at risk with this legislation.

 Deflection

The Ontario Liberals are intent on deflecting blame for costs of their own debt and waste onto the Province’s health care system and its providers. It is harder and harder to provide publicly funded patient services when the government is spending approximately one billion dollars a month on servicing the massive debt it created over the past decade through waste and mismanagement. Consider what can be paid for with a billion dollars per month: the medical staff, operations and procedures, the equipment. With the deal and physicians given a co-management role, the Wynne government has found a deceptive way to deflect public criticism from government decision-making.  

 As a disturbing aside, thousands of physicians who oppose the government’s current rationing plan are not “dissidents” as some government spokespersons and media have referred to them. By branding physicians who perceive solutions differently from the government as non-collaborative the government is attempting to quiet dissenting voices and deflect attention from its own failed policies. It’s a ruse. Differing perspectives could be used to create a more respectful and compassionate plan for health care transformation. It is often at the interface of opposing views that the best solutions will be found. It would be wise for our political and association leaders to do more listening and less deflecting.

The Liberal government’s approach has created a dysfunctional healthcare system

The Wynne Liberal government’s deal with the OMA suggests this government is clueless on how to proceed with its healthcare challenges. Constraining the freedom of physicians in a command and control system where they cannot meet patient demand and then labelling this as being in the “public interest” is disingenuous at best.

This is not the way to create a leaner and more efficient health care system or a way to meet the growing demand for patient care. Instead of squeezing the breath out of our public health care system, as our population grows and ages Kathleen Wynne should be answering the question “How can we provide more care to more people?” If we want innovation and “modernization” of care, it will not be found in rationing or managing wait lists. More management and more bureaucracy are not what we need.

As this deal so clearly illustrated, Wynne’s healthcare legacy is an abdication of duty, deflection of responsibility and distraction from her government’s wasteful ways. Hardly inspiring. Hardly a vision. Ontario can do better – it must do better.  The vision of health care in the future cannot be about rationing care, denying care, and limiting the freedoms of providers and patients.  It must be about empowering patients and empowering providers including Ontario’s physicians in providing more services and more care, not less.

The rejection of the deal was the ethical and appropriate response to a poorly considered health care rationing master plan pushed by the Wynne Liberals. Ontario doctors have spoken with resounding support for patients. However, any celebration of the rejection of this deal should be dampened by the reality that there is much work ahead to be done to shore up Ontario’s hobbling healthcare system. Let’s start with the resignation of Dr. Eric Hoskins.

 

 

 

Reader Comments (290)

The G&M wants to speak to its readership. Beating down the rich doctors is consistent. Why ideology trumps practicality is not within their scope. Exploaration of the rjected PSA is too nuanced for them. Consider the G&M as a sound bite trying to be relevant without deeper nderstanding.
August 18, 2016 | Unregistered CommenterEklimek
This article is worse. Put the docs on salary and make em into teachers.

Most doctors in private practice like to think of themselves as small-business operators rather than as gatekeepers to a vast network of publicly funded health services. That they are both creates all sorts of conflicts that, in a centrally planned system, can often only be resolved by government fiat. As long as we pay doctors principally on a fee-for-service basis, rather than turning them into salaried professionals, hard caps on overall compensation may be the only tool governments have to prevent patient churn and skyrocketing costs in coming years.

http://www.theglobeandmail.com/opinion/ontarios-doctors-dont-get-it-health-care-is-a-team-game/article31449722/
August 18, 2016 | Unregistered CommenterCanary in a Coal Mine
Where the heck is the OMA to counter all this media BS. Is it left up to the COD to do all the heavy lifting again to set the public record straight?

It is pretty clear the OMA has purposely remained quiet to allow the vacuum in official comments to be filled with nonsense from Hoskins and a misinformed and math challenged news media.

The OMA needs to be reformed asap if that is even possible.
August 18, 2016 | Unregistered CommenterCanary in a Coal Mine
As mfO correctly counselled, the OMA had a window of opportunity to gain control of the message and get in front of the Minister and the columnists.

It did not happen and - again as mfO pointed out - the OMA has lost control of the message and now must invest even more energy into trying to explain its position.

I suspect that the absence of a proactive media stance position could be attributed to the fact that the OMA thought it was going to carry the ratification vote.

Oops. Shouldn't have put all the eggs in that basket. Comprehensive plans should have been developed for both "yes" and "no" scenarios - that Communications 101, no?

It suggests a few things:

◘ That the Minister can now go on the record as saying that the "well-paid specialists" and other doctors have turned down over a billion dollar increase over the term of the agreement and that the government cannot afford to give them anymore. This resonates deeply with the population.

◘ That the OMA has pretty much "lost the room". It no longer has the benefit of widespread support of its members, there is no trust with the current negotiating process (including its representatives) and there is no well-formed public communication strategy outlining why the physicians turned down the agreement to counter the government's "greedy doctors" story.

In the absence of a new, four year-agreement before the Legislature returns in September, the government must be very concerned about the impact this will have on the passage and implementation of Bill 210: Patient's First Act.

If there is one thing that we have all witnessed and learned about healthcare in Ontario: we are challenged to undertake on big transformational change at a time. Trying to tackle two simultaneously is asking a heck of a lot...particularly given our current position in the electoral calendar...rapidly approaching one year of "change time" before one year of "campaigning time" is to begin.
August 18, 2016 | Unregistered CommenterExecutive Lead Blogger
Too bad about dropping the lead on this key issue.

The issue is the public funding can't keep up with the consumer demand.

One can argue, correctly, some MDs are overpaid, others underpaid, etc, the issue is the consumers are overconsuming on the free system. The idealists argue healthcare is a right, it is not in a solely publicly funded system. In a solely publicly funded system, it is a rationed responsiblity of the system to provide.

Central has deemed the monies to the doctors can be cut to keep things going on, and no one will notice. Bluntly, the doctors need to make their message clear: central has ordered more rationing in the healthcare system, we don't support that decison, but that is what has been decided. To date, nothing out from the OMA stating that. Yet central has clearly stated the doctors turned down a 10% fee increase, and the opportunity to comanage.
August 18, 2016 | Unregistered CommenterMovingforwardOntario
OMA lead lawyer and Media relations should be gone. This is abysmal.
"there is no well-formed public communication strategy outlining why the physicians turned down the agreement to counter the government's "greedy doctors" story."

What was the OMA thinking....or was the leadership so entangled in government tentacles that it could not act.

One wonders.

Lack of modern day advice perhaps is playing a role. MDs at OMA want to trust their advisors. Their advisors have failed. They should be gone.
The absence of arguement that may sway the public is a serious blow. It allows central to do nothing, since the "greedy" doctors just want more money. There is no counterarguement, and no chance of any significant action.

Sad to watch. So badly thought out.
August 18, 2016 | Unregistered CommenterMovingforwardOntario
Navigator was fired this morning along with the negotiating team, lawyers and advisory committee. More to come
August 18, 2016 | Unregistered CommenterStephen Skyvington
The OMA has now lost the initiative and is going to revisit the same game plan. More pulse takng of the profession, more meetings. The OMA meeting of November will be the first opportunity for fresh blood to both be spilled and infus ed into a medical society that has been deemed the representative of the profession by government. It has failed to bring the profession to an accord.

There should be no surprise here. It is not a union by structure or function.

What is the common shop floor of the membership? Doctors have in common 3 or 4 years of med ical school and a license by the CPSO. The majority of their training follows medical school, for all specialists at least, makng for dversity of interests and professional activity.

If government wants to make agreements it can Support the OMA and request it restructure itself as a union, or it can make numerous smaller spcialty specific deals. In which case it will need to address the Medical Dues Act.
August 18, 2016 | Unregistered CommenterEklimek
There will be no need for central to do anything. The absence of a campaign to seize the agenda after the vote has allowed central to own it by default. It doesn't need to do anything but feed the media, its position about greedy doctors and fess.

Any issues arise in the next two years, central will just slip some extra cash to any group of MDs capable of causing a "crisis. Very few can.There are strategies/tactics that can deal with this,but the OMA seems incapable of doing anything hard back against central.
August 18, 2016 | Unregistered CommenterMovingforwardOntario
OMA vote, Such a lost opportunity. Can:t get it back. The election won"t address the issue. Stay away from the growing margins.They are getting ugly.
August 19, 2016 | Unregistered CommenterMovingforwardOntario
Changing governments isn't going to solve the issue. How do you pay for all the health care services that can be provided? The public has been promised it all can be provided for "free", at point of care. The MDs have said it can't,and the rationing going on,is the responsibility of the politicians. The politicians don't want to own rationing. That's what the issue is. When you see your MD, because of resource issues, you will not receive best care, you will now get best rationed care. Who owns that decision?
August 19, 2016 | Unregistered CommenterMovingforwardOntario
Up coming in September, targeted funding drops to some of the sensitive MD supporters of central. Need to assure that the greedy doctors"story gets told by the right players,to the right source.Media will respond well.
August 19, 2016 | Unregistered CommenterMovingforwardOntario
"But it will require the co-operation of doctors, who, contrary to their self-image, are not free agents, but providers of a government-funded essential service." G&M

I think I herniated something upon reading this.

If health care providers are to be agents of social policy as providers of an government-funded essential service, but prohibited in doing so other than through government approved outlet and budget, then they must be immune from legal, disciplinary or other proceedings against them resulting from compliance in good faith with the policy.

Further, they shall not be required to disclose in any proceeding the information provided to them beyond that upon which compliance resulted. Failing this, health care providers will make every effort to impose the burden of compliance onto those immune from such actions. That is one reason I voted against the tentative PSA.

Ah, ... as usual ?.. singing to church choir with my ranting. I welcome anyone writing an op-ed and cribbing this post freely. Actually, I encourage it. I need tend my hernia.
August 19, 2016 | Unregistered CommenterEklimek
It is about ownership of the rationing. Central wants the MDs to own it; the MDs should refuse the ownership. The "team" is constructed by central, the "team" can own rationing.

Dear patient: We have, as a society,deemed your health options are determined on a monopoly pooled system.It has limited resources. When needed,for solely financial reasons, we will restrict services, and place you on the correct palliative care route.

You have elected this management system,and we appreciate your desire to move these agendas ahead.

On top of all of that, the physician pool, per capita,is being reduced.

Stay away from the margins,it is really disturbing.
August 19, 2016 | Unregistered CommenterMovingforwardOntario
It is over, the decisions have been made. Central will manage physician income alone, that is the consequence of the NO vote.

Expect a Hoskins-led execution of 'relativity'. Opthomolgy , radiology, cardiology are the priciple targets. Those 'temorary' FFS discounts will be made permanent. Entrance into FHT teams frozen. Fiscal thresholds reintroduced.

A little time, however, has been bought. Relativity reductions delayed until October 1, but that now is a drop dead date.
August 19, 2016 | Unregistered CommenterTragically an OHIPster
Pain drives change.
August 19, 2016 | Unregistered CommenterMerrilee Fullerton
Tragically the profession was going to be maltreated but he won't have a permission slip as he hoped he would have with a ' yes'...he will own the inevitable negative unintended consequences.

He will drive the morale of the rest of the profession to new lows....the lower the morale the greater will be the cost to all concerned....some deluded companies believe that investing in employee morale is the key for success....evidently Hoskins knows better, believeing that the key to success is the destruction of morale.

Hoskins will own the floundering health care system to come.
August 19, 2016 | Unregistered CommenterAndris
Drl:

We all will own it.
August 20, 2016 | Unregistered CommenterMovingforwardOntario
What becomes of Bill 210 ?
Is it too hot a political issue right now for the Liberals to ram it through? Or is it a done deal? In which case I will proceed with obtaining a spare office key, bank access card, and EMR password for my LHIN "supervisor"
August 20, 2016 | Unregistered Commenterdocinthepark
Bill 210 will continue to be referred to as a Patients First agenda by all the reporters who don't really grasp its nastiness.

See the article from Andrew Coyne to understand the lack of depth of understanding of health care complexities. His suggestions are madness and would reduce access to care further, drive up bureaucratic costs and diminish quality of care.

Shockingly ignorant suggestions from my broad perspective,
And scary because he has influence on the public and hence government. How did it happen that reporters drive the agenda. Argggh!

http://www.nationalpost.com/m/wp/full-comment/blog.html?b=news.nationalpost.com/full-comment/andrew-coyne-answer-to-soaring-health-care-costs-lies-in-changing-the-system-itself
August 20, 2016 | Unregistered CommenterMerrilee Fullerton
The actions of the OMA reminds one of the Costa Concordia where the captain deliberately guided his ship too close to shore and ran it up on the rocks...the captain and his officers immediately abandoned ship and vanished.

HMCS OMA was run onto the rocks and its captain and officers have flown off to Vancouver to the annual CMA boozeup.

HMS OMA has been deliberately left stranded on the rocks to be battered by the governmental waves....presumably it is hoped that those remaining on the ship will eventually appeal for them to return and take charge.

It could be that they hope that HMCS OMA , built in the pre RAND days with its quaint rules and regulations , will become so thoroughly wrecked that they would have to build a new vessel, " modernized" with government approval, more government friendly/ compliant , without those pesky rules that allowed the Coalition to thwart their grand plans.
August 20, 2016 | Unregistered CommenterAndris
One must really pity the young ones.Who would want to start their career looking ahead at the mess that is going on.Massive ideological social engineering going on. Must be very unsettling.
August 20, 2016 | Unregistered CommenterMovingforwardOntario
Mfo

It may be the attraction to the young is the ideolgcal social engineering,. Ask not what your country can do for you, ....
August 20, 2016 | Unregistered CommenterEklimek
I doubt they understand the impact of the Patients First Act.
August 20, 2016 | Unregistered CommenterMovingforwardOntario
mfO is likely correct. Few MDs have probably taken the time to see the damage and cost of the growing bureaucracy of the Patients First Act.
Life gets in the way. Hoskins has likely figured that into the equation. Give it a name that is unassailable and people believe in it. I find it disconcerting.

Anyway, a little more shiftiness by the Wynne Liberals and Minister Hoskins and the ship will flip. Public will say what happened?

http://m.torontosun.com/2016/08/20/why-doctors-killed-the-deal-between-the-wynne-government-and-the-oma
August 20, 2016 | Unregistered CommenterMerrilee Fullerton
Well written Realist....the government is determined to hang the inevitable negative consequences of the impending primary care reform around the neck of the medical profession like an albatross,
August 20, 2016 | Unregistered CommenterAndris
It will be Health Force Ontario,a centrally run,distribution system of health care workers as central sees fit. Services as determined by central,workers distributed by central. Accountability of volume per capita worker.
August 21, 2016 | Unregistered CommenterMovingforwardOntario
It is quite sad that there is one voice that remains silent....that of the OMA...it was thought at first that it was stunned by the No vote and would recover its voice and, sobered, speak up on behalf of its members.

It now seems that the silence is deliberate.

The OMA's silence implies acquiescence with the recurrent Hoskins mendaceous propaganda lines that are filling the media and airwaves....it's nice to see some contrary articles being published in the Sun, but the other papers are full of the Liberal spin....as the Star dies, the G&M and even the NP have picked up the Liberal cudgel, repeating the government's talking points and regurgitating them unexamined with no contradiction from the OMA.
August 21, 2016 | Unregistered CommenterAndris
Andris

You read too much into this. I think you mistake paralysis for acquiescence. The OMA is not a union with an organization and a dedicated mission. It is a medical society. It became more engaged as funding increased both through the RAND and the OntarioMD.

How much money and time was spent? Endless hours seeking input, paying for advice, buying advertising and appeasing internal groups.

Now that the effort has failed, there is no direction. No one in the OMA is able to step up and take a leadership role. It isn't structured to allow it and the recent effort by a small group to move ahead backfired. The remaining will keep their heads down until something changes.

Definitive leadership will wait until after November council.
August 21, 2016 | Unregistered Commentereklimek
Coming soon.Provider payments to central to pay for accountability.Pay for a license to practice, and payment for the required quality assurance programs run by the LHINs.Big industry being built.

A changing world.
August 21, 2016 | Unregistered CommenterMovingforwardOntario
August 19, 2016 comment above, "Are you just going to let me die?"

Here's what the good mayor said in 2013 after his first bout with esophageal cancer.

"We've got a terrific health-care system, " Mayor Macmillan said. "Those who need it the most get it the soonest and it certainly worked for me."

So my take is, it certainly worked for me until it didn't. The status quo can't handle the boomers' expectations. It's mathematically impossible. Between the Cambie lawsuit and all the complaints, it's two-tier this decade.
August 21, 2016 | Unregistered CommenterVera
Paralysis or acquiescence.

Pre RAND the lines were clear...the OMA and the membership on one side...the government and the ministry on the other.

Post RAND the lines became blurred, the increased revenue due to RANDing got the OMA 's head and into a costly real estate quagmire....it grew as an organization becoming dependent on the RANDed monies pouring in....the OMA became one of the best employers in Toronto in 2016 , treating its employees very well with benefits and pension...if only the OMA was making certain that their own membership would be as satisfied at their work.

Thanks to RAND and OntarioMD the organisation the OMA as a Corporation became absorbed by the MOHLTC , much like an amoeba consumming a paramecium ( nice video of process on U tube)!

" A servant with two masters has to lie to one"...the President dare not lie to the Government and dares not tell the truth to the membership and can no longer lie to it....she she remains silent.
August 21, 2016 | Unregistered CommenterAndris
I wish that I could down load down from U Tube ...Amoeba biology...Amoeba eating paramecia...the Government being the amoeba and the OMA and its membership the paramecium....the visual is great as is the commentary.
August 21, 2016 | Unregistered CommenterAndris
Excellent points made.

And here's a little into for context:

http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2016/0812


Ontario Liberals have wasted and mismanaged and taxed left and right. Now they are about to embark on a "fee" crusade to save us all from ourselves by reaching deeper into our pockets.

Caring? Compassionate? I think not.
Entitied? Entrenched? I think so.
August 21, 2016 | Unregistered CommenterMerrilee Fullerton
"Coming soon.Provider payments to central to pay for accountability.Pay for a license to practice, and payment for the required quality assurance programs run by the LHINs.Big industry being built.

A changing world" -mfo

Mfo, I split my week in 2 LHINs about an hour apart and my EMRs are not part of e-health. What is there to account for? I can see them enforcing FHT contract terms ,but those of us in the fee for service trenches buzzing around may be hard to swat.

You're implying the CPSO gets involved in the LHIN licensing, or do we buy our billing number from the LHIN/MOH? As angry as physicians are , this type of play is strike worthy- 63% no votes will swell to 90% in a hurry, time for a 1986 style shutdown, the MOH will bend within hours.
August 21, 2016 | Unregistered Commenterdocinthepark
LHIN involvement in provider remuneration, particularly FFS, has been overstated. FFS payment will continue to be dictated by the price seen in the Schedule of Benefits. There will definitely be a reintroduction of individual provider fiscal payment thresholds (as before, it will be a percentage reduction when limits have been exceeded). And as discussed previously, we will soon see a Hoskins-led version of relativity, driven almost exclusively by a detailed report on payment by specialty, currently sitting on his desk.

The situation is a little less clear for providers in the capitated payment models. While we will likely retain the age/sex based payment rates across the different models (really just FHN and FHO), we (well in this case it really is the LHIN's) will take increasing control over individual provider rosters. This will mean patient thresholds per provider, and the ability of the LHIN to 'auto-enroll' a certain percentage of high needs patients, per GP.
August 21, 2016 | Unregistered CommenterTragically an OHIPster
And none of it will make a difference. The demand will grow. Outcomes will not be any better...because the drivers of disease are mostly beyond family practice now
August 22, 2016 | Unregistered CommenterMerrilee Fullerton
Keep it all in perspective.

1. Massive and expensive effort to change to clean energy, to the point of the elimination of fossil fuels. Hugely expensive tax burden but is top agenda of central. Will be big trickle down cost.
2. Infrastructure costs/immigration. Lots of debt to be incurred,and lots of immigrants being allowed to Centrals advisers are confident the economy can be driven by short term debt increase,which gets corrected by new jobs created through immigration.
3.The above two,are cushioned by more health care provided from the fixed health care budget,solved by more accountability of the provider widgets.

Centrals prime agenda the immediate correction of the energy issue that occur with the banning of fossil fuel as an energy source.
August 22, 2016 | Unregistered CommenterMovingforwardOntario
<<And as discussed previously, we will soon see a Hoskins-led version of relativity, driven almost exclusively by a detailed report on payment by specialty, currently sitting on his desk.>> - Tragically an OHIPster

This is something we don't talk enough about but it another elephant in the room: the number of things that are sitting on this Minister's desk...and the amount of time he sits behind it.

I have heard several accounts that he does not log as much office time as his predecessor Ministers - hence the accumulation of material and - by extension - decision making. As a result, things are seriously backlogged and have frustrated stakeholders across the province who are waiting to obtain official "go-aheads" on various projects and initiatives.

Further, there are also some legendary interventions where the Minister has stepped in (and over) multiple decision-making bodies to intervene in local issues that would have been normally reserved for local administrative bodies. Such micromanagement is never a good thing.

Would like to get some validation (or rebuttal) of these actions from the field, if possible, please.
August 22, 2016 | Unregistered CommenterExecutive Lead Blogger
Micromanagement and political interference which even overshadows Smitherman. Yes.
August 22, 2016 | Unregistered CommenterMovingforwardOntario
Energy transformation in Ontario is running much much higher than expected. More energy infrastructure funds will be needed from federal central. Additionally costs transferred to users are higher than expected,and going to rise more. As they rise,harder to get to smaller population centres,as transportation lines are expensive to upgrade, thus,if put in, require greater subsidy.As those costs are filtered in, populations and industry will leave smaller population centres. Rates on urban single family dwellings will be going up further. Huge issue in infrastructure costs in the energy transformation plans. Time-frame, costs, and endpoints dates are misalignment, badly, now.

Infrastructure costs federally are shooting up,as small communities are getting hit by their remoteness, and political demands for more bailouts are rising (see Native populations,Newfoundland, New Brunswick, and now Northern Manitoba).Bailing,and long term support, is very expensive. Globalization is badly affected "distant" Canadian areas.It is accelerating.Only huge subsidies can bail these places out,but that draws the resources away from urban areas which can compete. Thus,infrastructure bailout debt will be increased.

Immigrant population are not settling, by and large,outside on Montreal, Toronto,or Vancouver, with over 20% actually just "parking" their wealth in Canada, rather than immigrating (Vancouver,and Toronto real estate).

MDs are targeted because of social justice agenda - yes,many issues of relativity must be addressed,but the pot need is expanding, far in excess of what central can offer, or planned for.The MDs pot is ,essentially, frozen. Too wealthy.

Stay away from the expanding margins - it is getting nasty, if you are on the expanding margin edge. Fortunately, the MAiD program is about to get more money. Properly provided, will released $100,000,000 of "assets".

The plan is good!.
August 22, 2016 | Unregistered CommenterMovingforwardOntario

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