Topp on families, health care and pensions

By Aaron Wherry - Thursday, January 26, 2012 at 12:19 PM - 0 Comments

Brian Topp has released his sixth policy paper, this one on supporting families. He’s proposing a national child nutrition program, a renewed health accord, a national pharmacare plan, a reversal of the moratorium on family reunification, a doubled Canada Pension Plan and support for LGBTTQ families.

Mr. Topp has also picked up the endorsements of his wife and two sons.

Who pays for what?

By Aaron Wherry - Monday, January 16, 2012 at 4:41 PM - 0 Comments

In an interview with the CBC—to be broadcast this evening—the Prime Minister rejects the idea of a health care innovation fund (as proposed by Brad Wall and endorsed by Dalton McGuinty).

“What I think we all want to see now from the premiers who have the primary responsibility here, is what their plan and their vision really is to innovate and to reform and to make sure the health-care system’s going to be there for all of us,” Harper said, according to an excerpt from the interview. “So I hope that we can put the funding issue aside, and they can concentrate on actually talking about health care, because that’s the discussion we’ll be having.”

The idea of a separate fund for the provinces to use for innovation in the delivery of health care got no support from the prime minister. ”I’m not looking to spend more money. I think we’ve been clear what we think is within the capacity of the federal government over a long period of time.”

Meanwhile, in an interview with CTV yesterday, Mr. McGuinty mused intriguingly of “disentanglement.”

The feds do jails and we do jails. The feds do training and we do training. The feds inspect meat and we inspect meat. Why don’t one of us, alone, take responsibility for some of those areas. I think that introduces more efficiencies, it introduces more transparency, accountability is more easily evident. I think those are the kinds of conversations that we need to have going forward in an era of fiscal restraint.

The Ontario premier arrived at this point in response to a question about the Harper government’s crime policies and the burden they will place on the provinces, so perhaps this seems tangential to the health care debate. But maybe it’s all part of the same discussion. Consider the analysis of Scott Clark and Peter DeVries that I noted this morning. Continue…

Ashton on health care

By Aaron Wherry - Thursday, January 12, 2012 at 8:56 AM - 0 Comments

Niki Ashton promises health care reform and floats the idea of a crown corporation charged with producing generic drugs.

Drugs consume the single largest portion of health care budgets, so “why not see the benefit of the drug production and drug consumption that we need in our system come back to us as Canadians?”

The real cost of making pharmaceuticals is much lower than the prices of even private generics on the market, so it would be possible to still produce much-needed drugs at a profit while offering a lower price than private companies, she said. This could both reduce health care costs and create a new revenue stream to pay for care, says Ashton. “We ought to be looking at innovative ways of making drug costs more affordable for our public health care system.”

Paying the bills

By Aaron Wherry - Tuesday, January 10, 2012 at 2:34 PM - 0 Comments

Scott Clark and Peter DeVries consider the Harper government’s health funding proposal.

The decision to tie the growth in the CHT to the growth in nominal GDP – a rate of growth that will be less than the current 6 per cent per year – clearly indicates that the federal government recognizes that it is facing a “structural deficit”  that needs to be confronted now. The Parliamentary Budget Office (PBO), international organizations and we have argued that the federal government is facing a small structural deficit now but that it will increase rapidly after 2015 due to demographic pressures on potential economic growth and health related spending.  To date, the Minister of Finance has denied the existence of a structural deficit and has publicly ignored any discussion of the demographic pressures. This is the first indication that he has seen the numbers and is worried, although it is doubtful he will admit this in public and/or release any internal research done on this subject.

The enduring stereotype of the male nurse

By Kate Lunau - Thursday, December 22, 2011 at 11:30 AM - 0 Comments

Todd Korol

One recent November day, Tyler Hume, a 20-year-old nursing student, was at work in the maternity ward of Calgary’s Foothills Medical Centre. Tending to a patient who’d just given birth, he listened to her heart and checked other vital signs, then moved on to her new baby. Being a male nurse in a maternity unit can be tricky, he says—but as one of just a handful of men in the University of Calgary’s entire faculty of nursing, Hume is used to feeling like the odd man out sometimes. “It’s unconscious things, like when [an instructor] is talking about a nursing action, and always refers to the nurse as ‘she,’ ” he says. To create a resource for men in the program, he co-founded the Nursing Guys’ Group, a club for male nursing students.

This fall, 13 per cent of the high school students admitted to the University of Calgary’s nursing program were male, an all-time high. Across the country, the number of male nurses has doubled in the past decade, according to the Canadian Nurses Association (CNA), and now sits at roughly six per cent. But, compared to other professions that suffer from a gender imbalance, nursing is still incredibly skewed. Consider the fact that about 19 per cent of Canadian police officers are female, or that upwards of 30 per cent of elementary school teachers are male. The CNA predicts we’ll be short about 60,000 nurses by 2015, but there are no national strategies to attract more men into the profession. Calgary’s Nursing Guys’ Club is one of the few supports that’s been set up specifically for male nurses, who still face what Hume calls a “societal stigma.”

Male nurses have long been viewed as “less masculine,” notes a study in the American Journal of Men’s Health in November that attempts to put this stereotype to bed. Researchers took a survey of male and female nursing students across the U.S., scoring them based on certain personality traits. It concluded that the nursing profession attracts “males who hold a high degree of masculinity.” The fact that researchers bother to study questions like this might seem surprising, but gender-driven clichés about the nursing profession go back generations: for women, it’s “Hot Lips” Houlihan, or the “sexy nurse” Halloween costume. If female nurses are over-sexualized, male nurses are just the opposite, like Ben Stiller’s goofy character in Meet the Parents. On the TV show Scrubs, one of the main characters (a female doctor) finds herself attracted to a “murse,” despite her initial aversion to his profession.

Continue…

Ottawa cuts strings from federal health cash

By macleans.ca - Wednesday, December 21, 2011 at 11:28 AM - 0 Comments

Canadian provinces can do what they please with future federal health care dollars, although Ottawa will continue to encourage them to work together to establish national benchmarks for delivery the Globe and Mail reports. Federal Health Minister Leona Aglukkaq sent a letter to her provincial counterparts on Tuesday urging them to move beyond the “divisive issue of funding.” That’s a reference to the government’s decision, announced on Monday, to tie future health transfers to inflation and GDP growth. Under the current formula, which has been extended to 2017, the provinces were guaranteed an annual six per cent increase in health transfers. Some provinces have reacted with fury to the new offer, which Ottawa says it will not negotiate. But by announcing on Tuesday that the new money comes, essentially, with few strings, Ottawa has left the provinces with little leverage to force further talks.

Globe and Mail

What the Conservatives promised

By Aaron Wherry - Tuesday, December 20, 2011 at 10:43 AM - 0 Comments

The new health transfer model apparently comes with no strings attached.

Like the six percent promise, that seems at odds with what the Conservatives promised during the campaign. This from the party’s election platform (emphasis theirs).

Canadians expect and deserve timely access to high-quality health care services. To help achieve that goal, we will work collaboratively with the provinces and territories to renew the Health Accord and to continue reducing wait times.

In our discussions we will emphasize the importance of accountability and results for Canadians – better reporting from the provinces and territories to measure progress, and guarantees covering additional medically necessary procedures.

In the spirit of open federalism, when renewing the Health Accord we will respect the fact that health care is an area of provincial jurisdiction and respect limits on the federal spending power.

Recognizing asymmetrical federalism, we will follow the precedent of a separate agreement with the Government of Quebec regarding the implementation of the renewed Health Accord.

Accountability was a favourite word of the Conservatives after the campaign too. The Health Minister invoked it as recently as a week ago.

What Jim Flaherty said

By Aaron Wherry - Tuesday, December 20, 2011 at 8:30 AM - 0 Comments

After the Liberals and Conservatives exchanged campaign promises in April, Jim Flaherty was interviewed by Kathleen Petty on CBC radio’s The House. Here is my transcript of the portion of that conversation that dealt with health care transfers and the six percent increase.

Petty. Now let’s talk about health care because Stephen Harper, this week, along with the Liberals and we know the NDP as well, have all agreed to maintain health care transfers to the provinces to six percent as the escalator year-over-year after 2014, which is when the accord expires. But it’s not found in the platform, it’s not found in the budget, except as an assumption in 2015-16 that says that it’s subject to discussion or review, so I’m not quite sure how this is all being costed out.

Flaherty. Well, it is, I can assure you that the six percent increase is built into the fiscal track. That is, we go forward when we budget and make certain assumptions. We have assumed six percent on an ongoing basis for the Canada Health Transfer and we’re committed to that.

Petty. For how many years?

Flaherty. Well, until 2014 and then thereafter. Now, we have to negotiate…

Petty. But what’s thereafter? That’s the part I’m asking.

Flaherty. Thereafter’s at least two years…

Pause. So there’s the caveat to the six percent promise, right? Well, there might’ve been the caveat, except for the fact that the interview wasn’t over and Mr. Flaherty wasn’t done explaining himself. Continue…

Six percent, until it’s not six percent

By Aaron Wherry - Monday, December 19, 2011 at 4:49 PM - 0 Comments

The Finance Minister shows his hand on health transfers.

Under Ottawa’s plan, funding for health would climb from $30-billion in 2013-14 to $38-billion per year in 2018-19. Mr. Flaherty told reporters health transfers will continue to increase at 6 per cent a year until 2016-17 before moving to a system that ties increases to the growth in nominal Gross Domestic Product, which is a measure of GDP plus inflation.

The finance department release is here.

See previously: What did the Conservatives promise on health transfers?

What did the Conservatives promise on health transfers?

By Aaron Wherry - Wednesday, December 14, 2011 at 11:27 AM - 0 Comments

The Harper government is apparently eager to cap increases to health transfers after 2016 and is apparently willing to argue that their election promise to increase transfers at 6% per year was limited to two years. The Ontario government seems to think that’s not quite what the Conservatives promised.

… Ontario government officials pointed to an interview Mr. Flaherty gave to the CBC during the campaign. “We will keep it at 6 per cent for whatever the duration of the agreement is,” Mr. Flaherty said last April, adding that the length of the new accord will be negotiated with the provinces. “It could be two years, five years, whatever.”

During the election—on Friday, April 8, to be specific—Michael Ignatieff promised to maintain the 6% increase and challenged Stephen Harper’s willingness to do likewise. The Conservatives duly responded. Continue…

Pharmacare for all

By Aaron Wherry - Thursday, December 1, 2011 at 10:54 AM - 0 Comments

Martin Singh pitches a national pharmacare program.

This policy document outlines the components of a national pharmacare program that will provide coverage for prescription medications to all Canadians irrespective of their health, social, geographic and financial circumstances. The document also details how Canadians will save $5.455 billion as a result of the implementation of the national pharmacare program. Companies that currently provide private plan coverage to their employees stand to save $560 million. Given that health care is under provincial jurisdiction, the implementation of the plan will require leadership shown on the behalf of both the federal and provincial governments in working together for the benefit of all Canadians.

Politicians have been speaking actively about a national pharmacare plan since the 1960s. After 50 years of talk, it is most certainly time for action.

Building better health care

By Aaron Wherry - Thursday, November 24, 2011 at 1:58 PM - 0 Comments

Paul Dewar calls for the inclusion of medical facilities in a national infrastructure fund.

“Mr. Harper excluded health care investments from the Economic Action Plan and ended federal support for medical equipment,” said Dewar. “It’s time for the federal government to invest in renewing our hospitals, community clinics and medical equipment.”

That will presumably be up for discussion at what seems an increasingly busy debate schedule for NDP leadership contenders. After Mr. Dewar’s called for more than the six debates scheduled by the party, at least two other forums have been announced: one in Sudbury and another in Cambridge.

‘Not to be forgotten’

By Aaron Wherry - Friday, November 18, 2011 at 11:34 AM - 0 Comments

An ad hoc committee of Conservative, New Democrat and Liberal MPs has released an extensive report on how government can better deal with palliative care, home care, long-term care, pain control, suicide prevention and elder abuse.

The palliative care philosophy is person-centered, family-focused and community-based. It moves us from disease or condition-specific care to person-centered care. It recognizes that the psycho-social and spiritual dimensions have profound impact upon health and well being, and that a variety of specific conditions may be operating on different levels in the chronically ill or dying person’s life. The philosophy of palliative care permeating medical culture is more important than the simple delivery of “services.” As family physicians and local nurses come to accept a palliative care philosophy, palliative care services can begin to develop organically in communities.

The committee makes 14 recommendations, ranging from calls for national strategies to specific tax and funding measures.

The crunch approaches

By Aaron Wherry - Tuesday, November 15, 2011 at 10:00 AM - 0 Comments

Government spending has increased and the future looks expensive.

In figures for government budgeting for the fiscal year to date, the PBO shows health care allocations up by $1.6 billion. That transfer will continue to increase at a six-per-cent clip every year for at least the next four years if the government sticks to its election promises.

Servicing charges on the public debt have also jumped $1.4 billion from the same period a year earlier because higher deficits are more than offsetting the benefits of low interest rates. Those costs, too, will continue to grow as long as the government keeps adding to its debt. And old-age security payments rose $1.1 billion from last year — partly because of a growing number of beneficiaries and partly because the benefit has been enriched.

Kevin Page questions the government’s fiscal plans going forward. Of course, the Conservatives are openly dismissive of Mr. Page at this point.

On health care, the government has apparently considered a transfer formula based on age.

Healthier, but not cheaper

By Aaron Wherry - Thursday, October 27, 2011 at 10:31 AM - 0 Comments

Chris Auld debunks the notion that encouraging healthier lifestyles will decrease public health care costs.

The evidence suggests that unhealthy lifestyles tend to increase health care use at any given age and reduce life expectancy, so more is spent per year but for fewer years. For example, statistical estimates from a well-known 1997 paper are displayed in the graph. The lower two lines show that if we compare a smoker and a non-smoker who are the same age, we should expect to find that the smoker consumes more health care. But the top two lines show that health care costs for non-smokers eventually become much higher than those for smokers simply because smokers on average die sooner than non-smokers. This study estimated that if every smoker were to spontaneously quit, demand on the health care system would first fall, as the quitters become healthier than they otherwise would be, but eventually rise by 7 per cent in the long run as smokers live longer.

Ottawa clinic may have exposed 6,000 to hepatitis, HIV

By macleans.ca - Monday, October 17, 2011 at 3:06 PM - 2 Comments

A private clinic in Ottawa may have exposed up to 7,000 patients to hepatitis B, hepatitis C and HIV. It was revealed Monday that infection prevention and cleaning protocols were “not always followed” at the clinic located at 1081 Carling Ave., Suite 606. Letters were sent to the 6,800 patients who underwent a procedure at the clinic between April 2002 and June 2011 after an inspection by the College of Physicians and Surgeons of Ontario unvcovered what Ottawa Public Health termed “lapses in infection control.” The concerns about the clinic revolve around endoscopies, which are no longer performed there.

CBC News

The Insite ruling

By Aaron Wherry - Friday, September 30, 2011 at 9:53 AM - 41 Comments

Brian Howell/Maclean's

(This post last updated at 7:46pm)

The Supreme Court’s ruling on the Insite safe injection facility—a unanimous ruling in the facility’s favour—is here.

 The Minister made a decision not to extend the exemption from the application of the federal drug laws to Insite. The effect of that decision, but for the trial judge’s interim order, would have been to prevent injection drug users from accessing the health services offered by Insite, threatening the health and indeed the lives of the potential clients.  The Minister’s decision thus engages the claimants’ s. 7 interests and constitutes a limit on their s. 7 rights.  Based on the information available to the Minister, this limit is not in accordance with the principles of fundamental justice.  It is arbitrary, undermining the very purposes of the CDSA, which include public health and safety.  It is also grossly disproportionate: the potential denial of health services and the correlative increase in the risk of death and disease to injection drug users outweigh any benefit that might be derived from maintaining an absolute prohibition on possession of illegal drugs on Insite’s premises.

Early reads from the Globe, Canadian Press, Postmedia, Star and CBC.

10:33am. Libby Davies, whose riding includes the Insite facility, applauds. Three years ago she lectured Tony Clement and called on him to abandon the government’s appeal.

10:46am. Liberal health critic Hedy Fry applauds.

10:51am. The Canadian Public Health Association applauds.

11:37am. Ms. Davies raised the court’s decision in QP just now, provoking a response from Health Minister Leona Aglukkaq. Continue…

And if you don’t get in…

By Josh Dehaas - Thursday, September 15, 2011 at 1:45 PM - 0 Comments

Joe Raedle/Getty Images

Roughly three-quarters of medical school applicants are rejected each year. Bummer. Luckily for them, wannabe doctors have better alternatives than ever. These four professional health care programs can be completed in just a few years, are in high demand, and pay well directly out of school. That means graduates can start paying off their student loans while medical residents are still driving beat-up old cars to 24-hour shifts.

Health Care Manager

The Job: Health care managers work in hospitals, medical clinics and nursing homes where they direct teams of health care providers. Their job is to make sure patients get excellent care and, simultaneously, that Canadians get good value for the nearly $200 billion they spend on health care each year.

Continue…

Stockwell Day holds up a new sign

By Aaron Wherry - Thursday, September 8, 2011 at 11:05 AM - 12 Comments

Five and a half months removed from cabinet, Stockwell Day says we must summon the courage to consider two-tier health care.

By stubbornly refusing to allow the development of a modern system that allows those who can willingly afford it to buy services, while still providing properly for the rest of us, we are dooming every provincial budget … if we continue to demonize every MLA or MP who wants to at least look at the options and possibilities then we condemn ourselves to higher costs, higher deficits, higher taxes and lower levels of care. Even the socialized systems of European nations allow for fee for service (translation: two tier) systems.

“Two-tier health care” is a rather fraught phrase that can be interpreted variously, but the idea of “fee for service” health care is seemingly what Mr. Day rejected when confronted with this issue in 2000.

The end of hospitals

By Julia Belluz - Thursday, September 1, 2011 at 12:15 PM - 70 Comments

Luca Rossato/Flickr

For the last several years, there’s been a lot of apocalyptic chatter about whether the aging population—or “gray tsunami”—will overwhelm the health system. That, coupled with the fact that there seems to be a shortage of hospital beds, has politicians offering up home-care services as an alternative to hospital and long-term care, and health-policy wonks pondering what a system without hospitals would look like.

This week, Ontario Health Minister Deb Matthews was the latest such politico to announce the Liberal plan to invest $60 million in home-care for seniors and the disabled. Though details about the program were not yet available, Matthews said it would offer services ranging from a health professional’s house visit, to phone and online consultations.

The supposed benefits? Improved access, more cost-effective care, reduced visits to hospital, and less pressure on long-term care facilities. As Matthews’ campaign office spokesperson put it, a hospital stay can cost $1,000 per patient per day while long-term care rings in at $150 per day.

But is the suggestion that home-care programs are an efficient alternative evidence-based? Continue…

If demographics is destiny, the future looks relaxing

By From the editors - Thursday, July 28, 2011 at 2:00 PM - 6 Comments

David J. Green/Alamy/Getstock

There may be a silver lining to Canada’s looming grey wave.

An aging population, we’ve been warned repeatedly, threatens to put unprecedented pressure on our health care and pension systems. This tidal wave of baby boomers will inevitably swamp existing social programs, steal funding away from education and child care and dominate all levels of politics for decades to come, say the doomsters.

Now for the good news: whatever impact demographic destiny may have on public policy, it seems set to produce a country that’s as cool and calm as a cucumber, and with plenty of time for fun. Suddenly the future is looking…relaxed.

Last week Statistics Canada released an intriguing, if under-reported, study on how Canadians spend their time. The report is part of StatsCan’s General Social Survey, an ambitious undertaking that involves 15,000 Canadians filling out daily diaries. Evidence from last year was compared with similar answers from 1998; the results suggest a dramatic decline in the amount of tension in our lives.

Continue…

The case for a national drug plan

By Ken MacQueen - Wednesday, June 8, 2011 at 10:35 AM - 42 Comments

Photographs by Simon Hayter

On June 7, Maclean’s hosts “Health Care in Canada: Time to Rebuild Medicare,” a town hall discussion at the National Gallery of Canada, in Ottawa. The public forum is held in conjunction with the Canadian Medical Association and broadcast by CPAC.

Garrett Shakespeare is 22. He lives in North Vancouver where he supports himself as a lifeguard and swimming instructor at the local recreation centre. Many nights you’ll find him working as “DJ G-Ratt,” spinning electronic music and mixes at Vancouver nightclubs. Shakespeare exists in a world of chronic pain caused by an exceptionally rare and fatal blood disease, paroxysmal nocturnal haemoglobinuria (PNH), in which his red blood cells are attacked by the body’s immune system. There are, perhaps, 80 or 90 people in Canada similarly afflicted. Without treatment, about one-third of patients die within five years of diagnosis, and half die within 10 years, says the Canadian Association of PNH Patients. Shakespeare was diagnosed 11 years ago. And he is just one example of the many ways in which Canada’s health care system is neither universal, nor equitable, as far as our drug policy is concerned.

What is the life of a guy like Garrett Shakespeare worth? Should he be allowed to live if it costs $10,000 a year? What if $50,000 is the price of his life? How about $500,000? Is Garrett Shakespeare’s life worth $500,000 a year?

Continue…

The health care debate Stephen Harper is ready to have

By Aaron Wherry - Tuesday, June 7, 2011 at 12:46 PM - 100 Comments

For those interested in a health care debate ahead of impending federal-provincial negotiations, the Harper government seems keen to start the discussion on their terms. Or rather, their term.

Prime Minister Stephen Harper, May 18.

I do think that the public wants to understand better from all governments how the amounts of money we’re putting into health care are going to lead to better outcomes, greater accountability for results.

Continue…

Tommy Douglas takes Vermont

By Aaron Wherry - Friday, May 27, 2011 at 3:53 PM - 8 Comments

Vermont’s governor signs into law a single payer health care system. Tommy Douglas references ensue.

Vermont has become an incubator for innovative public policy. Canada’s single payer healthcare system started as an experiment in one province, Saskatchewan. It was pushed through in the early 1960s by Saskatchewan’s premier, Tommy Douglas, considered by many to be the greatest Canadian. It was so successful, it was rapidly adopted by all of Canada. (Douglas is the grandfather of actor Kiefer Sutherland.) Perhaps Vermont’s healthcare law will start a similar, national transformation.

A Washington congressman similarly invoked the father of Canadian health care earlier this month.