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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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Main | Ontarians Should Be Very Wary of Bill 41- "The Patients First Act" »
Tuesday
Feb072017

Resignation of the OMA Executive-What Now?

So, the Executive of the Ontario Medical Association has resigned...sort of. The Executive is resigning to sit on the Board of Directors and then will go through an electoral process. At least that is what we are told currently.

This follows after a 55% non-confidence vote in the OMA Executive at a special meeting of the OMA Council but at which other motions failed to win the required two thirds majority to pass. These other motions if they had been successful would have led to the resignations at the individual executive level.

In the face of the quasi-win by the groups challenging the OMA's representative performance, there had been murmurings of requiring the OMA to hold another General Meeting of Council to address the non-confidence vote which had initially been arrogantly passed off by the OMA as a demonstration of support. Another General Meeting of Council would have been disastrous for the OMA. It managed to avoid that through this resignation process.

However, the OMA should know that this result was not the end of this non-confidence wrangling. It is just the beginning.

The Ontario Liberal government should also understand that the advocacy efforts of front-line physicians are not going away. These physicians are not dissidents as they have been labelled by some reporters. They are simply aware that the Liberal government's cuts to front line health care and patient care in Ontario will cause more and more hardship for patients as time goes on. It's not the 1990s anymore.

Fact is that we are up against the demographic wall made even more challenging due to a sluggish economy affected by the shift in aging--a double whammy. Instead of cuts to care, government ought to be planning how to allow more care for more people. Cuts do the exact opposite of what is needed. Even if the deficit is eliminated for 2018, growing health care need will not be eliminated. The pent-up demand for care will be even greater after 2018 due to the current Liberal cuts.

Physicians are becoming more vocal. Despite government-created positions for paid "Physician Leaders" to push through the government's self-serving and short-sighted version of transformation, many physicians see the negative impact of government's efforts to balance its budget on the backs of patient services.

Physicians I know and have known care deeply about their patients. They see that health care access is becoming more and more difficult. They want to continue to provide much needed services but they may differ on how those services can best be provided. We should be able to differ on the "How" and value different perspectives and approaches and still be united in providing quality patient care.

We must ask the "What if" questions.

What if the government is not forthcoming with more and more funding for care to adequately serve citizens who are dependent on it?

What if government providing  more funding leads to higher debt and greater interest payments resulting ultimately in fewer services?

Billions of dollars going to interest payments every month are one reason why Canada has fewer physicians and hospital beds per population than most developed countries and which results in lack of timely care, delayed diagnoses, and patient hardship--even death.

A couple years ago a fellow physician told me not to worry--all that was needed was a Liberal federal government and the money would flow. They were surprised to discover that the Trudeau Liberals are no health care saviours.

So what now?

I have no doubt that some of the former OMA Executive members will be re-elected to a new Executive. That will change nothing. Some new MDs may find themselves elected and in a position to create change from within the OMA but it is external factors beyond the OMA that have brought us to this point of upheaval. It is only by addressing external  structural health care system issues BEYOND the OMA that substantive, sustainable change can occur.

I'm hoping that a new OMA Executive will understand that their most important role is not to align with the government transformation flavour of the day. Instead, it is to give critical input on how more care for more patients can be realistically achieved while supporting our human providers who deliver that very necessary care.

We need to be asking the hard questions.

As always, thank you for your continued insights and thoughtful comments.

 

Reader Comments (712)

As DrK. Has put it, Ontario is formally Balkanized. It is going to get worse.
February 16, 2017 | Unregistered CommenterMovingforwardOntario
Typical MoHLTC. The announcements are made. The Photo op is produced. Next , ...


"The province should develop clear milestones; concrete objectives that
each LHIN is expected to achieve by the end of 2006 and at designated later
dates. "

http://www.wellesleyinstitute.com/wp-content/uploads/2011/11/LHINs_PCh_Paper2.pdf

But we never see follow up.
February 16, 2017 | Unregistered Commentereklimek
The system can not evolve until central controls doctors incomes, and hours worked. That is what is coming. Be prepared.
February 16, 2017 | Unregistered CommenterMovingforwardOntario
mfO,
No need to apologize. I thank you for your input and for giving the "heads up". We did predict this here.
The arrogance of the Ontario Liberals is shocking.
February 16, 2017 | Unregistered CommenterMerrilee Fullerton
The system CAN evolve without the government tromping on MDs. I would even suggest that for innovation to occur, government needs to loosen the stranglehold.
For anyone listening and lurking I want to be clear on that point.

I suggest that the "balkanization" of physicians in Ontario is due to poor insight and short term optics. This is not a longterm plan for sustainability. The surge in demand is and will be shocking.

The arrogance of the Liberals is concerning and yet many MDs still see themselves as "Liberals".
February 16, 2017 | Unregistered CommenterMerrilee Fullerton
R

The system can not change as it is set up. Unlimited demand, with no restraint of the patient end, and all the restrictions being placed on the providers.

You have to find new money, and put cost control on patients.
February 16, 2017 | Unregistered CommenterMovingforwardOntario
"Unlimited demand, with no restraint of the patient end, and all the restrictions being placed on the providers."

And, let's not forget, none of the liability for untoward outcome is shared by those in a position of authority that might actually be able to address the problem.

This is the major disconnect that is driving this top-down transformation. Crown immunity excuses hardships inflicted. If liability could be transferred upward, we would see an overnight attitudinal shift.
February 16, 2017 | Unregistered Commentereklimek
Put cost control on the patients, add new money, and legislate away crown immunity. Problem solved.
February 16, 2017 | Unregistered CommenterMovingforwardOntario
R:

I do wish to apologize if I'm seen as fanning the flames. I do not wish to do that. I have been involved with the system for decades, but am finding it tough to deal with the extreme ideological agenda being driven by central. There is no desire to find a common agenda. There is just a power agenda to maintain and seize more control, because central knows "what is best". As that goes on,more and more joining the marginalized.
February 16, 2017 | Unregistered CommenterMovingforwardOntario
MFO needs a playcation.

Let's send him or her to Washington so he or she can work for The Donald for a wee bit!

That should make Ontario look downright sane after MFO comes back . . .
February 16, 2017 | Unregistered CommenterStephen Skyvington
If he/she goes I volunteer to go along or act as a substitute. So far the essential elements of the prescription for fundamental change:

Patient cost control measures
Correction of fundamental shortage , and
Abolition of crown immunity for injury caused by willful blindness

All seem reasonable, nay ... essential .... to restoration of health care services in a province hampered by beaucratic inertia and political self interest. Maybe Kim Campbell was right. Some things are too important to be left to the electorate.
February 16, 2017 | Unregistered Commentereklimek
MrS.

Sadly, I find Ontario more extreme than the USA. There is an ideology of "command" and obey. I find the authoritarianism now overwhelming.

Please note, the Premier statements today at 4;30 PM do not assure negotiation. Central, behind closed doors, is not going to negotiate. If the OMA goes on, "good intent", it will be horribly surprised at the end point.

I prefer the solutions of DrK:

"Patient cost control measures
Correction of fundamental shortage , and
Abolition of crown immunity for injury caused by willful blindness"

Negotiate that "bad consequences" move from the CMPA arena, to the Minister whom enacted the legislation. Put ownership front and centre on the table. Start addressing the issues.

After that, the big issue: when patients make decisions that waste resources.

It is going to get nasty.
February 16, 2017 | Unregistered CommenterMovingforwardOntario
R:

One notes the"new"effort by central to "negotiate". It is b***s***.

Bring something new to the table.

1. Each patient accessing the system, has a responsibility for their care. Care utilization has a taxable component. If you do not access care, you get a tax credit, if you do, you are taxed on that. Tax rates will be reduced to make this nice balance, as best we can, tax neutral.

If you do not vaccinate, you pay more. if you are too fat, you pay. If you abuse your spouse,you pay.

2. MD fees for certain services WILL be reduced.
Some MD services are overfunded,some are underfunded.

3. System political decsions on resource allocation can be legally appealed so that, malfeasance,can be addressed. The "Crown" is vulnerable.

We all know the MOHLTC knows regional access to service is restricted, with the Minister's knowledge. The MOHLTC has the evidence that regionlization provides different health outcomes.
February 16, 2017 | Unregistered CommenterMovingforwardOntario
The OMA reminds one of a battered and abused dog who gets kicked and beaten with a stick, nevertheless it repeatedly reapproaches its master , when he speaks to it soothingly, with its tail between its legs , in the hope of " this time it will be different", only to get abused yet again.

The OMA is about to get sucked in yet one more time.
February 16, 2017 | Unregistered CommenterAndris
Please not the "right care, right place, right time" slogan again. It is tired.
He throws in "at an affordable price" too and wants a "system".
What is being created is a brittle unresponsive behemoth.
Patients need care.

And who determines "right care, right place, right time"?
You want government to determine that for each of us?
Are you sure?


https://beta.theglobeandmail.com/opinion/canada-must-address-the-problem-of-long-waits-for-medical-care/article34056251/
February 16, 2017 | Unregistered CommenterMerrilee Fullerton
"1. Each patient accessing the system, has a responsibility for their care. Care utilization has a taxable component. If you do not access care, you get a tax credit, if you do, you are taxed on that. Tax rates will be reduced to make this nice balance, as best we can, tax neutral. "

mfO, this won't work. People will potentially avoid seeking care resulting in more costs not less.
February 16, 2017 | Unregistered CommenterMerrilee Fullerton
R:

It can work. We have a system where no restraint exists because of free access. Some of this access is unwarranted because of the "freeness" of the system. The opoid crisis is a reflection of this. We need to be able to intervene, and mandate actions.

More and more,I lean to support DrKs point of actual accountability at the top. This "immunity" because power has been dispersed by "god" to the crown, needs to be revisited.
February 17, 2017 | Unregistered CommenterMovingforwardOntario
Any solution involving the tax system leads to more bureaucracy to enforce and account for it, and would likely lead to more paperwork and accounting fees for everyone.

Charge $15 copay to attend a GP's office and $25 to visit ER- suddenly those lineups out the door at walk in clinics disappear, leaving more time for mental health visits and preventive care. At that point the public may realize that picking up some nasal saline and vicks for their colds, polysporin for their finger cut, or bandage for their ankle sprain might be a better use of the 15 bucks. The extra $50-100 per hour in the doctor's pocket makes up for the lost A codes and everyone is happy. Don't give me that argument that it's a Canada Health Act Violation, it's the cost of a pack of cigarettes or two. Funny how all of a sudden everyone including the homeless and welfare recipients can afford the consult fees for a medical marijuana evaluation and the monthly cost of obtaining the bags of weed?

Employers should be responsible for the cost of the forms they ask us to fill out, it's private market so we should charge the full OMA uninsured rate to them. I personally short change myself on those fees cause I don't have the heart to stick it to my patients.
February 17, 2017 | Unregistered Commenterdocinthepark
MOHLTC/OMA negotiations 2017:

OMA: we propose inflation adjusting our fees and adding 2% per year for 4 years, a total of 8% ...

MOHLTC: sorry, there's no money for this. You are molesting patients, ripping off taxpayers, and the money is better spent elsewhere (see exhibits A/B/C in our powerpoint announcement to the public). We propose a 2% reduction in fees each year for 4 years, no inflation adjustment and increased funding to home care. If you don't agree to this it will be enforced in the next quarter anyway.

OMA: This is outrageous, we will proceed to have a meeting amongst ourselves and discuss possible strike action. Silence...

ARBITRATOR: I have weighed all of the factors and consequences of all outcomes, and in the public's best interest I have come up with a genius idea- we freeze the budget! 0% for four years, this satisfies a middle ground of what both parties want. Radiologists and specialists, you are billing too much, a joint committee of OMA and MOHLTC reps will be appointed to discuss what changes should be made to the schedule of benefits (which never happens)

Coles notes of the following year:
OMA membership proceeds to reject the deal, rumbles about strike action but nothing ensues.
MOHLTC enforces the terms of the agreement with the arbitrator. Fee adjustment clauses are added to the RAs without a hitch.
Rinse and repeat in 4 years...
February 17, 2017 | Unregistered Commenterdocinthepark
I understand the thinking behind user fees. I don't agree they are the solution.
There are a few other options worth considering:

1. Instead of user fees for ER create mezzanine care with stat diagnostics , walk-in-clinic/Urgent care centres on steroids...for which patients can pay a fee for increased convienence to the entity if they choose to access.
Similar entity is working in the U.K.

2. Create more affordable long term care access that help ER wait times, hospital crowding, and then be used for other purposes.

3. Increasing Family practice hours beyond what we have already will result in higher unnecessary costs and increased burden to providers who are already burdened beyond what Hoskins and Wynne can even possibly recognize.

4. Increased availability of telemedicine for many of the minor medical issues.

Overall, it is my understanding from a variety of studies that the minor problems that could be dealt with by a family MD are NOT what cause the ER waits.
February 17, 2017 | Unregistered CommenterMerrilee Fullerton
R

Respectfully, increasing the services as you recommend and increased access to long term care bed is a good thing. But it is not a solution. If it were not for the bottle neck of ALC beds throttling hospital utilization and restricting the back door of the ER, utilization would soar. Wait lists are the necessary socialized medicine solution to cost containment.

Any solution you propose without patient cost accountabiity is more of the same old same old dependence on government increased funding in an unsustainable spiral.

As an aside telemedicine is a partial solution best left for Antarctica. Show me that it is more then a surrogate granny sitting service before rolling this out at public expense. I think we already have WIC free wheeling access.
February 17, 2017 | Unregistered Commentereklimek
eklimek, I can't agree more.

Telemedicine is fraught with complications. If we make it "too easy" (such as OHIP covered with no patient or provider accountability), I can imagine the volumes of incoming calls and billions in cost per year if patients don't even have to leave their home. I bet the ranch the number of $1million + grossing doctors will double or triple.

A bad day in tele-family medicine, what happens to:
- a pediatric case where you diagnose a strep but miss the crackles in the chest, patient ends up in ER 1-2 days later with pneumonia and required a switch in prescription? Family is upset that a serious condition was missed even if given an antibiotic to start...
- the abnormal BP or pulse that normally prompts an ER referral or closer follow up, would this just be ignored cause it's not something we can check through the computer ?
- someone has cold symptoms and abdominal pain, maybe you toss the patient an antibiotic through the fax, but how do you exclude acute appendicitis without an abdominal exam?
- granny has tingling down her left arm. Do you fire off a req for bloodwork or send to ER? How do you assess her JVP, heart sounds, pulmonary/leg edema to exclude cardiac causes and again, vitals?
- Presumed UTI with pulse rate 140, hypotension, and elev temp lingering in the background, is actually pyelonephritis requiring IV antibiotics/hydration, patient and doc aren't aware.

There's something intangible and inherently disturbing about the fact that a doctor attempted to diagnose an acute condition through a monitor, it's indefensible and it's surprising that the agencies being started are by ER doctors. The CPSO and CMPA are going to have to adjust to the times ahead.
February 17, 2017 | Unregistered Commenterdocinthepark
With Bill 87 eventually encouraging no-touch medicine there won't be much difference between a WIC visit on the state or a private telemedicine consult for $50.

As mentioned we are already seeing the second opinions now for the unhappy campers who went to a WIC but were not examined. If this becomes the norm then I'd say shut the WICS down and just let the Millennials pay for their eConsults from home and Ontarians can deal with the resulting CPSO and CMPA collateral fallout.

eConsults are already here and like Uber I doubt they are going to disappear.

www.getmaple.ca
www.akira.md

Us old school docs will survive either in another province in traditional full-touch WICs or by working in the new state one size fits all widgets urgent care clinics.
February 17, 2017 | Unregistered CommenterCanary in a Coal Mine
Bad link

https://akira.md
February 17, 2017 | Unregistered CommenterCanary in a Coal Mine


"If it were not for the bottle neck of ALC beds throttling hospital utilization and restricting the back door of the ER, utilization would soar. Wait lists are the necessary socialized medicine solution to cost containment.

Any solution you propose without patient cost accountabiity is more of the same old same old dependence on government increased funding in an unsustainable spiral.

As an aside telemedicine is a partial solution best left for Antarctica. Show me that it is more then a surrogate granny sitting service before rolling this out at public expense."-eklimek
Perhaps I was not clear on my posts:

Virtual visits may become an option for individuals who wish to weigh convenience with risk...but not on the public dime.
ALC patients currently occupy about 20% of hospital beds. It is COST SAVINGS measure on the part of government. Yes, utilization will increase if these patients are moved to long term care but we need the beds and hospital resources to meet the demand for tertiary care that is coming. I suggest that other funding mechanisms beyond OHIP will be necessary.

I do believe that the worst of the options is User Fees. It becomes a requirement to pay for care and is hoovered up by government to waste as we have seen on ehealth scandals, ORNGE, gas plants, payments to advertise for failed pension schemes and nail polish and hair dos and bonuses for PanAm Games...

So, I don't believe user fees are the solution. Real options to accessing care beyond OHIP are needed. Keep a robust public health care system but allow for individual freedoms...user fees only make it worse.
February 17, 2017 | Unregistered CommenterMerrilee Fullerton
docinthepark

Do you think it is indefensible to be required to wait for days in the ER for care?
The minor problems that patients who could have seen their family MD for are NOT the reason for ER waits and a clogged system.
You want to see costs go up even more, require MDs to be open 7 days a week, 24 hours a day.....
February 17, 2017 | Unregistered CommenterMerrilee Fullerton
User fees are not the solution to ER wait times...they might be another cash grab/fee required by government but they will not solve the problems we are facing.

http://www.cfhi-fcass.ca/SearchResultsNews/09-10-01/73a17f86-f6ea-4d82-b59e-d2305ff99a80.aspx
February 17, 2017 | Unregistered CommenterMerrilee Fullerton
"According to critics, patients with minor problems take up limited emergency room (ER) resources and create backlogs, leaving the sickest patients at risk of facing unreasonable and unsafe waits for potentially life-saving care. If this were true, then clearing the backlog would depend on diverting non-urgent patients away from the ER and increasing the number
of primary care doctors available to these patients. In reality, though, research shows these to be simplistic strategies that fail to address the multidimensional and complex causes of ER overcrowding.
Diverting non-urgent patients undercuts safety, not costs

It's generally considered unsafe medical practice to divert non-urgent patients from the ER, since a small percentage will legitimately need to be admitted for care. A 2002 study of an urban emergency department found a 4.3% admission rate among its less- or non-urgent patients [i] and a 2004 study of another urban emergency department found a 7.6% admission rate for its non-urgent patients alone.[ii] Diverting non-urgent patients to community care (for example, to a primary care clinic) may be considered an option, but its benefits are unproven for remedying backlogs or reducing wait times for urgent patients.[iii] Turning patients away is not shown to curb costs either, since non-urgent patients are rarely admitted for care and few require diagnostic tests or consultations with specialists"
February 17, 2017 | Unregistered CommenterMerrilee Fullerton
R i respect your opinion. Let's leave at that.

Bargaining between OMA and Government in the mutual interests win-win format is prblematic at the outset. The only shared interest might be keeping the OMA in business.

The nonsense of keeping government in charge of taxing, regulating impelementing and delvering strictly prescribed care is not a shared interest with the profession.

I suggest "to continue to improve our health care system for everyone in Ontario.” Is a noble aside that does not belong on the negotiations table. I have staff and bills to pay out of my fee for services. That is what is on the table. I really don't think government shares that concern.

If government maintains its controls, then we have negotiations of unshared interests. We want to be paid and not work for free one day a month as we are now.
February 17, 2017 | Unregistered Commentereklimek
You can't fix the mess. To much entrenched power that can not get redistributed.

Fees going up on all. Taxes rise on the rich. Estates will not be transferable.

If the USA changes its corporate tax rates, there may be a big sucking noise of businesses leaving Ontario. The hydro rates are a huge issue, that can't be fixed by more "subsidies" to the most needy, at the expense of business.
February 17, 2017 | Unregistered CommenterMovingforwardOntario
"Do you think it is indefensible to be required to wait for days in the ER for care?
The minor problems that patients who could have seen their family MD for are NOT the reason for ER waits and a clogged system.
You want to see costs go up even more, require MDs to be open 7 days a week, 24 hours a day....."- Merrilee Fullerton

Dr. F, I come at this from the standpoint of staying out of court or being disciplined... I'd rather my patient present to emerg or my office than something be missed online, at least when it comes to my CPSO profile. I don't believe telemedicine cases and ones waiting on a stretcher in the ER hallway are the same scenarios.

An ER doc can also be "old school" and treat their patients with compassion, choosing to do a brief exam and get the patient on their way. I've witnessed some serious incompetence and feel as doctors we have a lot of room to up our game as a cohort. Just saying that politics aside we have an obligation to ensure care is responsible and accurate. My best teachers were fee for service ER docs who'd hand me 5 clipboards, grab a pile for themselves and proceed to clear the board when their shift started, the waiting room/triage was pretty lean in a couple of hours...no anger or judgement for a non urgent case presenting to the ER, that's a political topic better left to the newspapers or forums like this. Is Hippocrates groaning and turning over in a grave somewhere?
February 18, 2017 | Unregistered Commenterdocinthepark
"Government rhetoric about how things are great for patients in Canada, stands in stark contrast with the experiences of frontline healthcare providers.

Somebody isn’t telling you the truth.

Public healthcare is sinking, while the government tries to putty the leaks. We need a better solution."

http://www.torontosun.com/2017/02/16/universal-health-care-is-a-sinking-ship
February 18, 2017 | Unregistered CommenterCanary in a Coal Mine
DITP,
I understand your perspective. Reality is that the public does not necessarily understand what you describe. Public wants access to care. Without access is there any quality at all?
While I agree that there is no "app for appendectomy" ( credit to BC General Surgeons for that one) there are many minor issues that could be dealt with virtually.

CPSO guidelines and regulations need to be modernized and thoughtfully move away from being an arm of OHIP that requires patient attendance in every case.

I suggest that anyone providing virtual visits for minor care must have a license to practice here in Canada.
February 18, 2017 | Unregistered CommenterMerrilee Fullerton
R:

All these issues are irrelevant to central. It needs to have a budget, and a reasonable "free" care system, that the majority of the public wants. As longer as the providers, provide, the system runs. The providers enable the care provided.
February 18, 2017 | Unregistered CommenterMovingforwardOntario
mfO,
I understand your point.
Problem is what the "providers" are currently able to provide is insufficient for a growing population, growing need, and growing science and technology.
So while I understand you highlight an ideological stance, there is the little problem of reality.
In days gone by reality based decisions could be put off. We are coming up against the fiscal and demographic wall. We need to deal with reality.
Is that too much to ask?
February 18, 2017 | Unregistered CommenterMerrilee Fullerton
They can put off reality at least until the next election.

If the Liberals win again they might be able to kick the can down the road for another four years by going after the huge wealth tied up in estates.

It might be interesting for Brown to start doing some polling and focus groups on tackling the out of control housing prices in the GTA. Talk about applying the same foreign buyer's tax that Vancouver has. This is a huge issue amongst the Millennials and I hear far more chatter about those in the GTA including Liberals not being able to afford a house than I do health care.

If polls show this is something that will help Brown I'd start making a big deal about it as the problem is going to get much worse very quickly if a similar tax is not applied to GTA purchases.
February 18, 2017 | Unregistered CommenterCanary in a Coal Mine
Raise taxes and more immigration.
February 18, 2017 | Unregistered CommenterMovingforwardOntario
The governments both provincial and health have the same plan:

1. Infrastructural deficit spending as they determined needed.
2. Increase taxes and fees.
3. Immigration to boost population.

The MDs took the king's coin, are now being to brunt of budget control on the well off, when GDP isn't growing at 5%.
February 18, 2017 | Unregistered CommenterMovingforwardOntario
The direction being taken is open to debate.

What is more relevant, is this government still capable of lsurviving the next election? Can it wiggle out of this?

"Trillium Power Wind — whose project financing was about to close just before the Liberals announced their 2011 moratorium — is suing the Liberal government for $500 million in a lawsuit that alleges malfeasance in public office.

That involves an allegation by Trillium, now being investigated by the Ontario Provincial Police, that the Liberals intentionally destroyed documents relevant to the case after Trillium launched its lawsuit."

http://www.torontosun.com/2017/02/17/liberals-spend-our-money-for-nothing
February 18, 2017 | Unregistered Commentereklimek
No charges and no investigations will be done before the election. Central will be pouring money into the GTA and Ottawa areas. If the proposed changes occur in the USA show a positive outcome, the government will change. people want jobs and income, over saving the marginalized.
February 18, 2017 | Unregistered CommenterMovingforwardOntario
Mfo

The days of social concern as a priority for spending are ending. 300,000 immigrants a year, most in Ntario (read Toronto) will refocus government. Education for new arrivals and job entry will be priorities.
February 18, 2017 | Unregistered Commentereklimek
DrK:

Nothing will change. Central will continue to express its authority in determining what is best for me.
February 19, 2017 | Unregistered CommenterMovingforwardOntario
At what point do the Ontario Liberals formally recruit Bob Rae? Maybe he can take over as health minister before the next round of "negotiations"?
February 19, 2017 | Unregistered Commenterdocinthepark
Bait and switch---the government needs the OMA to sign off on its scheme---it has to breathe some life into the corpse--- long enough to hold onto the pen anyway---so it floats a few positive words ( words costing nothing) --"binding arbitration" will be uttered once then it will be swept aside by the government's negotiators which would then push on with the government's agendas.

The OMA's negotiation team should leave the table at the rejection and first switch of topic.
February 19, 2017 | Unregistered CommenterAndris
It appears the nursing organizations silence their own. No wonder they don't speak out:

http://m.torontosun.com/2017/02/18/complaining-about-granddads-care-on-facebook-could-cost-nurse-30gs
February 19, 2017 | Unregistered CommenterMerrilee Fullerton
DrK:

One thinks the struggle between the global utopians, and the social darwinists will be going on for awhile. It seems like is going to be very nasty. The OMAs dealing with central with be interesting to see, since the MD group is the first elite group, that the globalist group had pulled out, and identified as a target.
February 19, 2017 | Unregistered CommenterMovingforwardOntario
Realist ....sad for that poor nurse....however in the health care system in Ontario, there are ways of silencing MD's...decades ago hospital based doctors were prominent in the dissident movement, with ample criticisms aimed at their own hospitals and the system as a whole....now complete and utter silence ---at society meetings....silence....lips have been sealed

One suspects that in the future Bill 41 world that those who sign contracts will be sealed, with no criticism of the system allowed.

The shadow of the CPSO club concerning unprofessional / disruptive behaviour ?
February 19, 2017 | Unregistered CommenterAndris
Very interesting article in the NY Time's on how those on the margins away from the Putin's power and largesse in Moscow and St. Petersburg are not doing well. Eating less meat and fish and having to grow their own vegetables are now the way of life as is drinking cheap alcohol which recently was made with methanol resulting in the death of 76 citizens. No dialysis available for those on the margins.

Is this what we will see away from the vote rich power centres of Ottawa and Toronto in the future?


"In Siberia, residents traditionally raise a birthday toast “to Siberian health,” as if the harsh climate forges a stronger constitution. In reality, people in the Irkutsk region die at age 67 on average — 59 for men — compared with 77 in Moscow. The climate and the drinking, as well as inferior medical services, take their toll."

https://www.nytimes.com/2017/02/18/world/europe/russia-tainted-booze-putin.html?action=click&contentCollection=Opinion&module=Trending&version=Full&region=Marginalia&pgtype=article
February 19, 2017 | Unregistered CommenterCanary in a Coal Mine
OMA contract.

Just watch the budget, when it gets announced, and one can identify the 3 year plan on resources.
February 20, 2017 | Unregistered CommenterMovingforwardOntario

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