From jwhiteside@cupe.ca Wed Dec 1 11:39:04 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oB1Gd4bp020155 for ; Wed, 1 Dec 2010 11:39:04 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Wed, 1 Dec 2010 11:39:04 -0500 From: Jennifer Whiteside To: "healthcare@lists.cupe.ca" Date: Wed, 1 Dec 2010 11:39:04 -0500 Thread-Topic: Leaked document shows two-tier Alberta health plan Thread-Index: AcuRdkPrvGkRdlN4SPek9ul2V1lr/g== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C59638021@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C59638021E2K7CLUSTERcu_" MIME-Version: 1.0 Subject: [CUPE healthcare list] Leaked document shows two-tier Alberta health plan X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Wed, 01 Dec 2010 16:39:04 -0000 --_000_8F5713DF2D6DF14293423EF519BFB40D8C59638021E2K7CLUSTERcu_ Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Leaked document shows two-tier Alberta health plan The Province Wed Dec 1 2010 Page: A30 Section: News Dateline: EDMONTON Source: Postmedia News A leaked internal document from the Alberta government shows the Tories pla= n to privatize health care after the next provincial election, opposition p= arties are charging. The 27-page internal Alberta Health and Wellness presentation suggests the = provincial government has a two-part plan to delist health services, legali= ze new kinds of private insurance and allow doctors to provide public and p= rivate health care at the same time. Health Minister Gene Zwozdesky denied the allegations late Monday, but exil= ed Conservative MLA Dr. Raj Sherman confirmed its authenticity. "This is basically privatizing health care," said Sherman, who was Zwozdesk= y's parliamentary assistant until he was ousted from the Tory caucus last w= eek for criticizing the government's record on health care. "My understandi= ng is that Phase 2 is coming after the next election," he said. The leaked document suggests there will be two phases to health-care reform= . The first focuses on building public confidence -- enshrining a patient c= harter and creating a patient advocate. The second phase outlines nine "policy shifts" required to meet legislative= goals. For example, the presentation explains that health-care providers don't hav= e a level playing field, because doctors must opt in or out of the public s= ystem entirely while midwives and pharmacists can work in both sectors at t= he same time. Another section on private insurance options says "there is no evidence tha= t private insurance negatively impacts a public health system" and that "pr= ohibiting private insurance limits choice in accessing publicly funded heal= th services within Alberta." The document then calls for a "policy shift" to "consider private insurance= options for limited health services." "This shows clear evidence the government is entertaining notions of privat= e insurance, a two-tiered system and a move toward what we believe is going= to undermine the very foundations of the Canada Health Act," Liberal leade= r David Swann said. Edition: Final Story Type: News Length: 299 words Idnumber: 201012010038 Jennifer Whiteside Senior Officer/Agente principale Research, Job Evaluation and Health & Safety Branch/ Service de la recherche, de l'=E9valuation des emplois et de la sant=E9-s= =E9curit=E9 Canadian Union of Public Employees/SCFP 1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7 (613) 237-1590, x 248 --_000_8F5713DF2D6DF14293423EF519BFB40D8C59638021E2K7CLUSTERcu_ Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable

Leaked d= ocument shows two-tier Alberta health plan

The Province
Wed Dec 1 2010
Page: A30
Section: News
Dat= eline: EDMONTON
Source: Postmedia News

A leaked intern= al document from the Alberta government shows the Tories plan to privatize = health care after the next= provincial election, opposition parties are charging.

T= he 27-page internal Alberta Health and Wellness presentation suggests the p= rovincial government has a two-part plan to delist health services, legaliz= e new kinds of private insurance and allow doctors to provide public and pr= ivate health care at the s= ame time.

Health Minister Gene Zwozdesky denied the alle= gations late Monday, but exiled Conservative MLA Dr. Raj Sherman confirmed = its authenticity.

"This is basically privatizing health care," said Sher= man, who was Zwozdesky's parliamentary assistant until he was ousted from t= he Tory caucus last week for criticizing the government's record on health care. "My understandi= ng is that Phase 2 is coming after the next election," he said. <= /o:p>

The leaked document suggests there will be two phases to health-care reform. The first f= ocuses on building public confidence -- enshrining a patient charter and cr= eating a patient advocate.

The second phase outlines nin= e "policy shifts" required to meet legislative goals. =

For example, the presentation explains that health-care providers don't have a level playing = field, because doctors must opt in or out of the public system entirely whi= le midwives and pharmacists can work in both sectors at the same time.

Another section on private insurance options says "ther= e is no evidence that private insurance negatively impacts a public health = system" and that "prohibiting private insurance limits choice in = accessing publicly funded health services within Alberta." =

The document then calls for a "policy shift" to "con= sider private insurance options for limited health services."

"This shows clear evidence the government is entertaining n= otions of private insurance, a two-tiered system and a move toward what we = believe is going to undermine the very foundations of the Canada Health Act," Liberal leader Dav= id Swann said.

Edition: Final
Story Type: News
L= ength: 299 words
Idnumber: 201012010038

 

 

Jennifer Whiteside=

Seni= or Officer/Agente principale

Research, Job Evaluation and Health & Safe= ty Branch/

Service de la recherche, de l’=E9valuation de= s emplois et de la sant=E9-s=E9curit=E9

Canadian Union of Public Employees/= SCFP

1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7

(613) 237-1590, x 248<= /o:p>

 

= --_000_8F5713DF2D6DF14293423EF519BFB40D8C59638021E2K7CLUSTERcu_-- From jwhiteside@cupe.ca Wed Dec 1 11:46:11 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oB1GkBlQ020445 for ; Wed, 1 Dec 2010 11:46:11 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Wed, 1 Dec 2010 11:46:11 -0500 From: Jennifer Whiteside To: "healthcare@lists.cupe.ca" Date: Wed, 1 Dec 2010 11:46:10 -0500 Thread-Topic: Finding money is tricky; Advances in care, not boomers, fuelling health costs Thread-Index: AcuRd0JDeRe3XxElTTyrNLQpdO9V4A== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C59638030@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C59638030E2K7CLUSTERcu_" MIME-Version: 1.0 Subject: [CUPE healthcare list] Finding money is tricky; Advances in care, not boomers, fuelling health costs X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Wed, 01 Dec 2010 16:46:11 -0000 --_000_8F5713DF2D6DF14293423EF519BFB40D8C59638030E2K7CLUSTERcu_ Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Finding money is tricky; Advances in care, not boomers, fuelling health cos= ts Hamilton Spectator Wed Dec 1 2010 Page: A2 Section: Local / News Byline: Wade Hemsworth The Hamilton Spectator The choice is clear: Spend more on health care or settle for less. So goes the argument in an analysis published Monday in the Canadian Medical Association Journal. "Like human beings everywhere, we would like to get the benefits without th= e costs," says Gordon Guyatt, a physician and professor of clinical epidemi= ology and biostatistics at McMaster University, and one of four authors of = the paper. "Unfortunately, it doesn't work that way." With growing demand expected to push the cost of health care to 10.9 per ce= nt of the GDP by 2050, compared to 6.9 per cent in 2007, the analysis argue= s that it's time to start talking about where to find the money. Contrary to popular belief, Guyatt said, it's not the baby boom driving up = the price of health care as much as it is advancements in care itself, whic= h today is much more comprehensive and effective than ever and is expected = to continue improving. "The reason that health care costs are rising, in considerable part, is bec= ause we're able to do so much more for people's health nowadays," Guyatt sa= id. "People are actually getting benefits out of this spending." Since the public places a very high priority on health care, Guyatt said, t= he solution is to find more money. That, according to the CMAJ paper, is the tricky part. The analysis argues that since public health care is more efficient than pr= ivatized care on a dollar-for-dollar basis, then funding should come from t= he public. In the U.S., Guyatt said, health care takes up twice as much of the GDP as = it does here, half of it public, half private. "Dollar for dollar, we're getting much more high quality health care than i= s the United States," he said. "It just goes to show how incredibly ineffic= ient a mixed system such as the American system is." Though raising new money through income tax increases would be the most eff= icient and equitable way to fund new costs, the authors say political reali= ty means it is unlikely to happen. That leaves a limited range of options: reducing services, finding new effi= ciencies or raising revenue through other means, such as public health insu= rance premiums or new sin taxes - perhaps on unhealthy foods, for example. Guyatt said the authors wrote the article in the hope of stimulating discus= sion among policy-makers about the most equitable and acceptable ways of fu= nding ongoing improvements to health care. "We should be, if necessary, spending more money on publicly funded health = care," he said. "It gives people what they want and it's the most efficient= way of doing it." whemsworth@thespec.com 905-526-3254 =A9 2010 Torstar Corporation Jennifer Whiteside Senior Officer/Agente principale Research, Job Evaluation and Health & Safety Branch/ Service de la recherche, de l'=E9valuation des emplois et de la sant=E9-s= =E9curit=E9 Canadian Union of Public Employees/SCFP 1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7 (613) 237-1590, x 248 --_000_8F5713DF2D6DF14293423EF519BFB40D8C59638030E2K7CLUSTERcu_ Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable

Finding = money is tricky; Advances in care, not boomers, fuelling health costs

Ha= milton Spectator
Wed Dec 1 2010
Page: A2
Section: Local / News =
Byline: Wade Hemsworth The Hamilton Spectator

The choi= ce is clear: Spend more on health care or settle for less.

So goes the argument = in an

analysis published Monday in the Canadian Medical = Association Journal.

"Like human beings everywhere,= we would like to get the benefits without the costs," says Gordon Guy= att, a physician and professor of clinical epidemiology and biostatistics a= t McMaster University, and one of four authors of the paper. "Unfortun= ately, it doesn't work that way."

With growing dema= nd expected to push the cost of healt= h care to 10.9 per cent of the GDP by 2050, compared to 6.9 per = cent in 2007, the analysis argues that it's time to start talking about whe= re to find the money.

Contrary to popular belief, Guyatt= said, it's not the baby boom driving up the price of health care as much as it is advancements in ca= re itself, which today is much more comprehensive and effective than ever a= nd is expected to continue improving.

"The reason t= hat health care costs are = rising, in considerable part, is because we're able to do so much more for = people's health nowadays,&= quot; Guyatt said. "People are actually getting benefits out of this s= pending."

Since the public places a very high prior= ity on health care, Guyatt= said, the solution is to find more money.

<= span style=3D'font-size:9.5pt;font-family:"Arial","sans-serif"'>That, accor= ding to the CMAJ paper, is the tricky part.

<= span style=3D'font-size:9.5pt;font-family:"Arial","sans-serif"'>The analysi= s argues that since public health care is more efficient than p= rivatized care on a dollar-for-dollar basis, then funding should= come from the public.

In the U.S., Guyatt said, health care takes up twice as muc= h of the GDP as it does here, half of it public, half private. <= /span>

"Dollar for dollar, we're getting much more high quality health care than is the United S= tates," he said. "It just goes to show how incredibly inefficient= a mixed system such as the American system is."

Th= ough raising new money through income tax increases would be the most effic= ient and equitable way to fund new costs, the authors say political reality= means it is unlikely to happen.

That leaves a limited= range of options: reducing services, finding new efficiencies or raising r= evenue through other means, such as public health insurance premiums or new sin taxes - perhaps on un= healthy foods, for example.

Guyatt said the authors wrot= e the article in the hope of stimulating discussion among policy-makers abo= ut the most equitable and acceptable ways of funding ongoing improvements t= o health care. =

"We should be, if necessary, spending more money on publicly f= unded health care," h= e said. "It gives people what they want and it's the most efficient wa= y of doing it."

whemsworth@thespec.com <= /span>

905-526-3254

=A9 2010 Torstar Corporation<= /span>

 

 

Je= nnifer Whiteside

Senior Officer/Agente principale

Research, Job Evaluation = and Health & Safety Branch/

<= span lang=3DFR-CA style=3D'font-size:10.0pt'>Service de la recherche, de l&= #8217;=E9valuation des emplois et de la sant=E9-s=E9curit=E9

Canadian Union= of Public Employees/SCFP

1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7

(613) = 237-1590, x 248

 =

= --_000_8F5713DF2D6DF14293423EF519BFB40D8C59638030E2K7CLUSTERcu_-- From jwhiteside@cupe.ca Wed Dec 1 11:56:44 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oB1Guij2020874 for ; Wed, 1 Dec 2010 11:56:44 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Wed, 1 Dec 2010 11:56:44 -0500 From: Jennifer Whiteside To: "healthcare@lists.cupe.ca" Date: Wed, 1 Dec 2010 11:56:43 -0500 Thread-Topic: Canada Health Act rules ignore human nature (re: queue jumping and cash payments in Quebec) Thread-Index: AcuReLubXlgG2L3CSnWtlbCj2Ih1UA== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C59638041@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C59638041E2K7CLUSTERcu_" MIME-Version: 1.0 Subject: [CUPE healthcare list] Canada Health Act rules ignore human nature (re: queue jumping and cash payments in Quebec) X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Wed, 01 Dec 2010 16:56:44 -0000 --_000_8F5713DF2D6DF14293423EF519BFB40D8C59638041E2K7CLUSTERcu_ Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable A shockingly cynical view on the very disturbing news this week that there = is evidence of doctors in Quebec accepting cash payments to expedite surgic= al procedures for their patients: Canada Health Act rules ignore human nature Montreal Gazette Wed Dec 1 2010 Page: A22 Section: Editorial / Op-Ed Source: The Gazette The Quebec College of Physicians is shocked, shocked to learn that some doc= tors are accepting cash payments to jump patients up the surgery waiting li= st. And federal Liberal health critic Ujjal Dosanjh claimed that he "could = never in my wildest nightmare imagine this happening here." We find it deeply disturbing that a prominent politician and the whole medi= cal establishment are so ignorant of human nature, or else so hypocritical. Nobody with any common sense will have been surprised to learn, in a Gazett= e report Saturday, that some insiders say the practice is widespread. Despi= te endless pious pronouncements from so-called friends of medicare, people = do stubbornly try to spend their own money to protect their own health and = the health of their loved ones, and the Canada Health Act be damned. Not, we hasten to add, that we approve of anyone breaking the law. But a la= w that expects people to wait passively for life-saving operations is not a= law that will enjoy universal obedience. Supporters of the medicare status= quo need to tackle this problem in the light of day, not sweep it back und= er the rug. The core dilemma is simple: Medical care can be rationed only two ways: by = price, or by fiat; in the marketplace or by government decrees. Canadians a= ccept that richer people can have better homes, cars, food, and even school= s than poorer people, but balk at letting them have better health care. Acc= ordingly we give the power to allocate care to a medical bureaucracy in whi= ch priority lists are written and revised by ... well, by whom, exactly? An= d on what criteria? What is fairness, anyway? Widespread murmurings about e= nvelopes of cash suggest that old-fashioned money has undermined our high-m= inded "public" medicine. If Canadians want these decisions made without regard for money, the whole = system will have to be far more open and more regulated. Good intentions an= d solemn hypocrisy are not enough to create "fairness." Jennifer Whiteside Senior Officer/Agente principale Research, Job Evaluation and Health & Safety Branch/ Service de la recherche, de l'=E9valuation des emplois et de la sant=E9-s= =E9curit=E9 Canadian Union of Public Employees/SCFP 1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7 (613) 237-1590, x 248 --_000_8F5713DF2D6DF14293423EF519BFB40D8C59638041E2K7CLUSTERcu_ Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable

A shockingly cyn= ical view on the very disturbing news this week that there is evidence of d= octors in Quebec accepting cash payments to expedite surgical procedures fo= r their patients:

 

Canada Health Act rules ignore human nature

Montreal Gazette
Wed Dec 1 2010
Page: A= 22
Section: Editorial / Op-Ed
Source: The Gazette <= /p>

= The Quebec College of Physicians is shocked, shocked to learn that some doc= tors are accepting cash payments to jump patients up the surgery waiting li= st. And federal Liberal health critic Ujjal Dosanjh claimed that he "c= ould never in my wildest nightmare imagine this happening here." =

We find it deeply disturbing that a prominent politician and = the whole medical establishment are so ignorant of human nature, or else so= hypocritical.

Nobody with any common sense will have be= en surprised to learn, in a Gazette report Saturday, that some insiders say= the practice is widespread. Despite endless pious pronouncements from so-c= alled friends of medicare, people do stubbornly try to spend their own mone= y to protect their own health and the health of their loved ones, and the <= b>Canada Health Act be damned= .

Not, we hasten to add, that we approve of anyone break= ing the law. But a law that expects people to wait passively for life-savin= g operations is not a law that will enjoy universal obedience. Supporters o= f the medicare status quo need to tackle this problem in the light of day, = not sweep it back under the rug.

The core dilemma is simple: Medical care can be rationed only= two ways: by price, or by fiat; in the marketplace or by government decree= s. Canadians accept that richer people can have better homes, cars, food, a= nd even schools than poorer people, but balk at letting them have better he= alth care. Accordingly we give the power to allocate care to a medical bureauc= racy in which priority lists are written and revised by ... well, by whom, = exactly? And on what criteria? What is fairness, anyway? Widespread murmuri= ngs about envelopes of cash suggest that old-fashioned money has undermined= our high-minded "public" medicine.

= If Canadia= ns want these decisions made without regard for money, the whole system wil= l have to be far more open and more regulated. Good intentions and solemn h= ypocrisy are not enough to create "fairness." <= /p>

 

Jennifer Whiteside

Senior Officer/Agente principale=

Research, Job Evaluation and Health & Safety Branch/=

Serv= ice de la recherche, de l’=E9valuation des emplois et de la sant=E9-s= =E9curit=E9

Canadian Union of Public Employees/SCFP

1375 St. Laurent Blvd.,= Ottawa, ON K1G 0Z7

(613) 237-1590, x 248

 

= --_000_8F5713DF2D6DF14293423EF519BFB40D8C59638041E2K7CLUSTERcu_-- From jwhiteside@cupe.ca Thu Dec 2 11:12:09 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oB2GC9Iq004813 for ; Thu, 2 Dec 2010 11:12:09 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Thu, 2 Dec 2010 11:12:09 -0500 From: Jennifer Whiteside To: "healthcare@lists.cupe.ca" Date: Thu, 2 Dec 2010 11:12:08 -0500 Thread-Topic: Alberta Health Act & Privatization Thread-Index: AcuSO6sjjuJ/+zfRQuWidZQYwCHllg== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C59687B21@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C59687B21E2K7CLUSTERcu_" MIME-Version: 1.0 Subject: [CUPE healthcare list] Alberta Health Act & Privatization X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Thu, 02 Dec 2010 16:12:09 -0000 --_000_8F5713DF2D6DF14293423EF519BFB40D8C59687B21E2K7CLUSTERcu_ Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Alberta Premier Ed Stelmach promises public input on future health changes Canadian Press Wed Dec 1 2010 Section: Western regional general news Byline: BY DEAN BENNETT EDMONTON _ Alberta Premier Ed Stelmach, facing renewed accusations Wednesda= y of a secret agenda to privatize health care, said any changes to the syst= em won't violate universal, accessible care and will have the blessing of t= he public. ``The one thing that all members should focus on is the bill that we've deb= ated in this house that says very explicitly that Albertans will have a say= in the future direction of health-care delivery,'' Stelmach said during qu= estion period. The statement came after Opposition Alberta Liberal Leader David Swann trie= d to pin the premier down on specific changes. ``Will the premier, in writing, promise Albertans he will not allow doctors= to work in both the public and private systems at the same time? Yes or no= ?'' Swann asked. ``It's most unfortunate but we do have doctors that do opt out (of the publ= ic system) and when they opt out, they stay out,'' was Stelmach's reply. The attacks on the governing Progressive Conservative government stem from = a leaked government document made public on Monday. The document, from a PowerPoint presentation delivered in July, is titled `= `Alberta's Health Legislation: Moving Forward.'' It describes a two-phase plan. The first phase establishes public confidence by passing laws to create a h= ealth charter for patients, a new patient advocate to troubleshoot problems= , and a process to ensure the public has a say in future policy decisions. = Those three goals were reached late Tuesday night, when the Conservatives p= assed a bill which revises the Alberta Health Act. Phase 2 details planned policy shifts, which include allowing doctors to wo= rk in the public and private systems simultaneously. The plan would also consider allowing patients to buy private insurance for= a limited range of health services. There would also be a re-evaluation of which services should be fully funde= d, partially funded, or not funded. Critics say that opens the door to deli= sting a wide range of publicly-funded procedures. Raj Sherman, the former parliamentary assistant for health turfed from cauc= us over a week ago for criticizing his colleagues over problems in the heal= th system, has said the plan was to roll out the policy shifts after the ne= xt election, expected in the spring of 2012. Alberta Health Minister Gene Zwozdesky has distanced himself from the docum= ent, saying it's not a policy directive, but simply feedback from Albertans= . Opposition NDP leader Brian Mason went after him during question period on = that, noting that Sherman has fingered Zwozdesky as a key figure in the pol= icy document. ``Everyone is denying paternity of this inconvenient new arrival, but I can= tell you that the baby has a salt-and-pepper moustache, a cleft in his chi= n, and a talent for music and languages. The father is sitting right over t= here,'' Mason said pointing at Zwozdesky. ``Will you admit you are the person responsible for this secret Tory plan t= o privatize our health care system!'' Zwozdesky stood up. ``Let's be very clear: there is no secret plan, there is no secret agenda, = there is nothing on the table whatsoever to do with privatization (and) the= re's nothing to do with a two-tier system,'' he said. It's been a difficult fall session for the Tories on the health file. The head of emergency services for the Alberta Medical Association says ove= rcrowding in emergency rooms has reached a crisis situation, with patients = suffering, and occasionally dying awaiting care. Along with Sherman's ouster, Zwozdesky's department has butted heads with A= lberta Health Services, the arm of the department charged with delivering t= he services. Last week, the arms-length board that runs Alberta Health Services parted w= ays with CEO Stephen Duckett. It was a contentious issue and a third of the= 14-member board has since quit, one saying that Zwozdesky interfered in th= e board's autonomy. Zwozdesky, however, is urging everyone to move forward. On Tuesday, he unve= iled a new five-year action plan with defined benchmarks to increase beds a= nd slash surgery wait times. Paul Hinman of the opposition Wildrose Alliance told the house that Zwozdes= ky himself is now the problem. ``He's withheld information. In the last week, he's desperately turned to s= capegoating his CEO and his parliamentary assistant. The best he can do is = wave around a Christmas wish (list) with a (wait times) target that can nev= er be met,'' said Hinman. ``The (Health Services) superboard is crumbling and his reputation is crumb= ling with it. Even his bureaucracy has lost confidence. Hinman turned to Stelmach: ``How long can you stand by this minister and wh= en will your replace him?'' ``I'm going to stand with my minister and support him,'' Stelmach shot back= as colleagues pounded their desks in approval. Copyright =A9 2010 The Canadian Press Jennifer Whiteside Senior Officer/Agente principale Research, Job Evaluation and Health & Safety Branch/ Service de la recherche, de l'=E9valuation des emplois et de la sant=E9-s= =E9curit=E9 Canadian Union of Public Employees/SCFP 1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7 (613) 237-1590, x 248 --_000_8F5713DF2D6DF14293423EF519BFB40D8C59687B21E2K7CLUSTERcu_ Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable

Alberta = Premier Ed Stelmach promises public input on future health changes

Canadian Press
Wed Dec 1 2010
Section: Western regional gene= ral news
Byline: BY DEAN BENNETT

EDMONTON _ Alberta Premier Ed Stelmach, facing renewed accusations Wedne= sday of a secret agenda to privatize = health care, said any changes to the system won't violate univer= sal, accessible care and will have the blessing of the public. <= /span>

``The one thing that all members should focus on is the = bill that we've debated in this house that says very explicitly that Albert= ans will have a say in the future direction of health-care delivery,'' Stelmach said during question = period.

The statement came after Opposition = Alberta Liberal Leader David Swann tried to pin the premier down on specifi= c changes.

``Will the premier, in writing, p= romise Albertans he will not allow doctors to work in both the public and p= rivate systems at the same time? Yes or no?'' Swann asked.

``It's most unfortunate but we do have doctors that do opt o= ut (of the public system) and when they opt out, they stay out,'' was Stelm= ach's reply.

The attacks on the governing Pr= ogressive Conservative government stem from a leaked government document ma= de public on Monday.

The document, from a Po= werPoint presentation delivered in July, is titled ``Alberta's Health Legislation: Moving Forward.'' =

It describes a two-phase plan.

The first phase establishes public confidence by passing = laws to create a health ch= arter for patients, a new patient advocate to troubleshoot problems, and a = process to ensure the public has a say in future policy decisions. Those th= ree goals were reached late Tuesday night, when the Conservatives passed a = bill which revises the Alberta Health= Act.

Phase 2 details planned pol= icy shifts, which include allowing doctors to work in the public and privat= e systems simultaneously.

The plan would al= so consider allowing patients to buy private insurance for a limited range = of health services. <= /o:p>

There would also be a re-evaluation of which servi= ces should be fully funded, partially funded, or not funded. Critics say th= at opens the door to delisting a wide range of publicly-funded procedures. =

Raj Sherman, the former parliamentary assist= ant for health turfed from= caucus over a week ago for criticizing his colleagues over problems in the= health system, has said t= he plan was to roll out the policy shifts after the next election, expected= in the spring of 2012.

Alberta Health Minister Gene Zwozdesky has dis= tanced himself from the document, saying it's not a policy directive, but s= imply feedback from Albertans.

Opposition ND= P leader Brian Mason went after him during question period on that, noting = that Sherman has fingered Zwozdesky as a key figure in the policy document.=

``Everyone is denying paternity of this inc= onvenient new arrival, but I can tell you that the baby has a salt-and-pepp= er moustache, a cleft in his chin, and a talent for music and languages. Th= e father is sitting right over there,'' Mason said pointing at Zwozdesky. <= o:p>

``Will you admit you are the person responsib= le for this secret Tory plan to privatize our health care system!''

Zw= ozdesky stood up.

``Let's be very clear: the= re is no secret plan, there is no secret agenda, there is nothing on the ta= ble whatsoever to do with privatization (and) there's nothing to do with a = two-tier system,'' he said.

It's been a diff= icult fall session for the Tories on the health file.

The head of emer= gency services for the Alberta Medical Association says overcrowding in eme= rgency rooms has reached a crisis situation, with patients suffering, and o= ccasionally dying awaiting care.

Along wit= h Sherman's ouster, Zwozdesky's department has butted heads with Alberta Health Services, the arm of = the department charged with delivering the services.

=

Last week, the arms-length board that runs Alberta Health Services parted ways with CEO Ste= phen Duckett. It was a contentious issue and a third of the 14-member board= has since quit, one saying that Zwozdesky interfered in the board's autono= my.

Zwozdesky, however, is urging everyone t= o move forward. On Tuesday, he unveiled a new five-year action plan with de= fined benchmarks to increase beds and slash surgery wait times.

Paul H= inman of the opposition Wildrose Alliance told the house that Zwozdesky him= self is now the problem.

``He's withheld i= nformation. In the last week, he's desperately turned to scapegoating his C= EO and his parliamentary assistant. The best he can do is wave around a Chr= istmas wish (list) with a (wait times= ) target that can never be met,'' said Hinman.

``The (Health Services) superboard is crumbling and his reputation is crumbling with it= . Even his bureaucracy has lost confidence.

<= span style=3D'font-size:9.5pt;font-family:"Arial","sans-serif";color:black'= >Hinman turned to Stelmach: ``How long can you stand by this minister and w= hen will your replace him?''

``I'm going to = stand with my minister and support him,'' Stelmach shot back as colleagues = pounded their desks in approval.

<= span style=3D'font-size:8.0pt;font-family:"Arial","sans-serif";color:black'= >Copyright =A9 2010 The Canadian Press

 

 =

Jennifer Whitesid= e

Senior Officer/Agente principale

Research, Job Evaluation and Health &= ; Safety Branch/

Service de la recherche, de l’=E9valuat= ion des emplois et de la sant=E9-s=E9curit=E9

Canadian Union of Public Empl= oyees/SCFP

1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7

=

(613) 237-1590, x 248=

 

= --_000_8F5713DF2D6DF14293423EF519BFB40D8C59687B21E2K7CLUSTERcu_-- From jwhiteside@cupe.ca Thu Dec 2 11:14:41 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oB2GEfFO005071 for ; Thu, 2 Dec 2010 11:14:41 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Thu, 2 Dec 2010 11:14:41 -0500 From: Jennifer Whiteside To: "healthcare@lists.cupe.ca" Date: Thu, 2 Dec 2010 11:14:40 -0500 Thread-Topic: Doctors as gatekeepers; What are the ethics of physicians accepting money for jumping patients to the head of the line? Thread-Index: AcuSPAW4upgC8m+4RWeTU5CtGsqKcA== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C59687B29@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: yes X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: multipart/related; boundary="_016_8F5713DF2D6DF14293423EF519BFB40D8C59687B29E2K7CLUSTERcu_"; type="multipart/alternative" MIME-Version: 1.0 Subject: [CUPE healthcare list] Doctors as gatekeepers; What are the ethics of physicians accepting money for jumping patients to the head of the line? X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Thu, 02 Dec 2010 16:14:41 -0000 --_016_8F5713DF2D6DF14293423EF519BFB40D8C59687B29E2K7CLUSTERcu_ Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C59687B29E2K7CLUSTERcu_" --_000_8F5713DF2D6DF14293423EF519BFB40D8C59687B29E2K7CLUSTERcu_ Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable [cid:image001.gif@01CB9212.1CD1F6E0] DOCUMENT TOOLS [cid:image004.gif@01CB9212.1CD1F6E0]Printer Friendly [cid:image005.gif@01CB9212.1CD1F6E0]PDF Output [cid:image006.gif@01CB9212.1CD1F6E0]E-mail [cid:image007.gif@01CB9212.1CD1F6E0]Add To Clipboard [cid:image008.gif@01CB9212.1CD1F6E0]Save To Folder [cid:image009.gif@01CB9212.1CD1F6E0]Tone [cid:image010.gif@01CB9212.1CD1F6E0]Quotes PAGE VIEW [cid:image011.jpg@01CB9212.1CD1F6E0] [cid:image013.gif@01CB9212.1CD1F6E0] Doctors as gatekeepers; What are the ethics of physicians accepting money f= or jumping patients to the head of the line? Montreal Gazette Thu Dec 2 2010 Page: A25 Section: Editorial / Op-Ed Byline: MARGARET SOMERVILLE Column: MARGARET SOMERVILLE Source: Freelance Charlie Fidelman's article ( "Want fast care? Slip an MD some cash," (Gazet= te, Nov. 27) about Montreal physicians accepting cash payments to give pati= ents priority access to publicly-funded health care, raises the ethics of p= hysician gatekeeping. This is an important issue, but not a new one. Here's what I wrote in 2000, when my concern was largely that physicians we= re unethically denying patients access to care: "Whether you or members of your family receive certain types of health care= depends mainly on your physician. The final allocation of nearly 80 per ce= nt of all healthcare resources is made by physicians. This allocation mecha= nism is sometimes described as "de-facto gatekeeping" and physicians necess= arily have to undertake it -it is an intrinsic element of the practice of m= edicine. De-facto gatekeeping by physicians can be compared to "positive gate-keepin= g" -in undertaking this action the physician benefits personally from alloc= ating resources to patients -and "negative gate-keeping" -in which the phys= ician benefits personally from restricting patients' access to resources. S= ome commentators believe that positive and negative gatekeeping are inheren= tly unethical. Certainly, if they are allowed, great care needs to be taken= to ensure that physicians engaging in them act ethically. Unethical incentives for physicians can range from financial or other benef= its -for example, for using certain companies' products -to being a part-ow= ner of a diagnostic laboratory to which patients are referred, to health-in= surance companies paying physicians a bonus for denying patients' access to= necessary medical treatment. Giving physicians financial rewards for refusing patients access to treatme= nt matters, especially when that treatment might be life-prolonging or even= life-saving as could be true of some treatments for diseases such as cance= r. Physicians employed by some HMOs in the United States have given evidenc= e to hearings investigating the health insurance industry that they receive= d bonuses for rejecting other physicians' applications for approval of cert= ain treatments for patients. For instance, a physician whose terms of emplo= yment included such a bonus scheme gave evidence that she deeply regretted = rejecting a certain treatment for a woman who was suffering from breast can= cer. In fact, she said the case haunted her because she believed the woman = should have been given it." So what are the ethics in the opposite situation, when physicians might be = giving patients unethical access to care and the "positive gatekeeping" inc= entive -the money the physician receives -comes from the patient or the pat= ient's family? Most of us have a gut reaction -a moral intuition -that the physicians acce= pting this money are acting unethically. Indeed, does the fact that some of= the payments are made as "envelopes of cash" indicate that the physicians = receiving them have just this intuition? But is our intuition valid? The ethical problem with the situation that Fidelman describes is that the = payment is to give the payor-patient priority access to public health-care = resources that may not be accessed on that basis and to which everyone cove= red by medicare should, at least in principle, have equal access. Physicians don't own the power that they have to allocate medicare resource= s; they are entrusted with this power by the government and the community a= nd hold it on trust for them. To use it for personal financial gain is a br= each of that trust, because the power is not theirs to sell. Moreover, in a= llocating healthcare resources for payment they are breaching the condition= s on which the power must be exercised, that is, allocating, first, accordi= ng to patients' medical needs and, second, on a "first-come, first-served" = basis. It is also ethically relevant that often the patient who pays benefi= ts at the cost of other patients: Priority for one patient means unjustifia= ble loss of priority for another and that is unethical. But what about situations where the patient who pays is getting a "special = service" from the physician that the physician is not obliged to provide an= d its provision does not affect other patients, as is true, for instance, i= n relation to some payments made to Montreal obstetricians? These doctors h= ave no obligation to be personally present when their patients give birth, = but will do so, if they are paid. Or what about the patient who needs day surgery and is told by the surgeon = that the waiting time in the public system is 12 months, but he could do th= e surgery in two weeks time in the private clinic in which he also works. T= he procedure would still be covered by medicare, but there would be a subst= antial charge for "operating-room space," if she chooses the clinic. In thi= s case, patients choosing to pay to go to private clinics could augment pri= ority for patients in the public system by reducing their wait times. And, in a situation where nearly 2 million Quebecers can't find a family ph= ysician, what about physicians who will not accept new patients, unless the= y agree to use private diagnostic facilities for which they must pay, but t= heir use results in a financial payment to the physician, which using the p= ublic ones does not? In view of the shortage of physicians, is this conditi= on coercive and unethical? What are the rules on paying physicians practising in Canada? Those physicians who have completely opted out of medicare may be paid by p= atients for all the care they give them -these physicians are practising so= lely private medicine. Physicians paid under medicare may only be paid by patients for procedures = not covered by medicare. Some of these physicians "disconnect" certain aspe= cts of their interactions with patients from the medicare procedure they ar= e providing and charge the patient for the former, while being paid by medi= care for the latter: for instance, they charge new patients between $50 and= $1000 as a "registration" or "enrolment" fee, or $500 to become a member o= f an executive health clinic, and also bill medicare for the procedures it = covers. In short, some physicians have set up systems that allow them to be paid by= medicare and to receive payments from patients that (they hope) do not con= travene the Canada Health Act's prohibition of extra-billing. And some, but probably few, physicians receive large cash payments, for ins= tance as Christmas gifts, from wealthy patients in return for a promise to = be readily available to these patients at all times. One such patient told me the following story: She was hosting a Saturday-ni= ght dinner party and around 10:30 p.m. there was disagreement among the gue= sts about the facts regarding a new medical treatment. She said she telepho= ned a well-known Montreal specialist and he gave her the information needed= to settle the dispute. When I expressed surprise that she could and would = do this, she explained her annual $10,000 Christmas gift to him. And what about people who are powerful, well-known, a celebrity, a senior p= olitician or even a health-care professional, so they know others in the sy= stem, being given preferential treatment? Is this also unethical, or is the= payment of money a different kind of special access? In being critical of = the ethics of the physicians who receive "envelopes of cash" (and is this a= uniquely Quebec practice?) and the patients who pay them, we must be caref= ul not to be hypocritical. Fidelman also reports the surprise and horror of officials of the Quebec Co= llege of Physicians and Surgeons on learning about these cash payments. If,= indeed, it is correct that this was the first time this matter had been br= ought to their attention, I believe they would be among the few Montreal ph= ysicians who had never heard of this practice. One of my specialist physici= an colleagues, whom I asked to read this article, responded: "Is this suppo= sed to be 'news'!?! It's like watching a rerun of Coronation Street." But p= erhaps the College meant that, so far, there had been no formal complaint. = In considering its role in dealing with this issue, the college should keep= in mind that the ethical tone of an organization or profession is set by j= ust a few people at the top. The majority of the questions I've asked raise ethical issues, to many of w= hich I have not provided clear answers. That is because depending where we = stand and the range of considerations we take into account, those answers m= ight be different. We can prohibit all forms of payment other than medicare= to physicians working in the public system, but if that means we lose larg= e numbers of physicians, it's a pyrrhic victory. The bottom line question i= s whether the way in which our health-care system is currently funded and t= he rules that govern how we pay physicians do more good than harm, and whet= her some changes are needed to try to augment the good and reduce the harms= . Margaret Somerville is director of the Centre for Medicine, Ethics and Law = at McGill University. Illustration: * Photo: PHOTOS.COM / Doctors control access to 80 per cent of Quebec's med= ical system, opening the potential for ethical abuses. Jennifer Whiteside Senior Officer/Agente principale Research, Job Evaluation and Health & Safety Branch/ Service de la recherche, de l'=E9valuation des emplois et de la sant=E9-s= =E9curit=E9 Canadian Union of Public Employees/SCFP 1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7 (613) 237-1590, x 248 --_000_8F5713DF2D6DF14293423EF519BFB40D8C59687B29E2K7CLUSTERcu_ Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable

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Doctors as gatekeepers; What are the ethics of ph= ysicians accepting money for jumping patients to the head of the line?=

Montreal Gazette
Thu Dec 2 2010
Page: = A25
Section: Editorial / Op-Ed
Byline: MARGARET SOMERVILLE
Colu= mn: MARGARET SOMERVILLE
Source: Freelance

Charlie Fidelman's article ( &quo= t;Want fast care? Slip an MD some cash," (Gazette, Nov. 27) about Mont= real physicians accepting cash payments to give patients priority access to= publicly-funded health care, raises the ethics of physician gatekeeping. This is an important issue,= but not a new one.

Here's what I wrote in 2000, when my con= cern was largely that physicians were unethically denying patients access t= o care:

"Whether you or members of your family receive = certain types of health care depends mainly on your physician. The final allocation of nearly 80 per = cent of all healthcare res= ources is made by physicians. This allocation mechanism is sometimes descri= bed as "de-facto gatekeeping" and physicians necessarily have to = undertake it -it is an intrinsic element of the practice of medicine. =

De-facto gatekeeping by physicians can be compared to "posit= ive gate-keeping" -in undertaking this action the physician benefits p= ersonally from allocating resources to patients -and "negative gate-ke= eping" -in which the physician benefits personally from restricting pa= tients' access to resources. Some commentators believe that positive and ne= gative gatekeeping are inherently unethical. Certainly, if they are allowed= , great care needs to be taken to ensure that physicians engaging in them a= ct ethically.

Unethical incentives for physicians can range = from financial or other benefits -for example, for using certain companies'= products -to being a part-owner of a diagnostic laboratory to which patien= ts are referred, to health-insurance companies paying physicians a bonus fo= r denying patients' access to necessary medical treatment.

G= iving physicians financial rewards for refusing patients access to treatmen= t matters, especially when that treatment might be life-prolonging or even = life-saving as could be true of some treatments for diseases such as cancer= . Physicians employed by some HMOs in the United States have given evidence= to hearings investigating the health insurance industry that they received= bonuses for rejecting other physicians' applications for approval of certa= in treatments for patients. For instance, a physician whose terms of employ= ment included such a bonus scheme gave evidence that she deeply regretted r= ejecting a certain treatment for a woman who was suffering from breast canc= er. In fact, she said the case haunted her because she believed the woman s= hould have been given it."

So what are the ethics in th= e opposite situation, when physicians might be giving patients unethical ac= cess to care and the "positive gatekeeping" incentive -the money = the physician receives -comes from the patient or the patient's family?

Most of us have a gut reaction -a moral intuition -that the phy= sicians accepting this money are acting unethically. Indeed, does the fact = that some of the payments are made as "envelopes of cash" indicat= e that the physicians receiving them have just this intuition? But is our i= ntuition valid?

The ethical problem with the situation that = Fidelman describes is that the payment is to give the payor-patient priorit= y access to public health-care= resources that may not be accessed on that basis and to which everyone= covered by medicare shoul= d, at least in principle, have equal access.

Physicians don'= t own the power that they have to allocate medicare resources; they are entrusted with this power by = the government and the community and hold it on trust for them. To use it f= or personal financial gain is a breach of that trust, because the power is = not theirs to sell. Moreover, in allocating healthcare resources for payment they are breaching the c= onditions on which the power must be exercised, that is, allocating, first,= according to patients' medical needs and, second, on a "first-come, f= irst-served" basis. It is also ethically relevant that often the patie= nt who pays benefits at the cost of other patients: Priority for one patien= t means unjustifiable loss of priority for another and that is unethical. <= o:p>

But what about situations where the patient who pays is getti= ng a "special service" from the physician that the physician is n= ot obliged to provide and its provision does not affect other patients, as = is true, for instance, in relation to some payments made to Montreal obstet= ricians? These doctors have no obligation to be personally present when the= ir patients give birth, but will do so, if they are paid.

Or= what about the patient who needs day surgery and is told by the surgeon th= at the waiting time in the public system is 12 months, but he could do the = surgery in two weeks time in the private clinic in which he also works. The= procedure would still be covered by = medicare, but there would be a substantial charge for "oper= ating-room space," if she chooses the clinic. In this case, patients c= hoosing to pay to go to private clinics could augment priority for patients= in the public system by reducing their wait times.

<= p>And, in = a situation where nearly 2 million Quebecers can't find a family physician,= what about physicians who will not accept new patients, unless they agree = to use private diagnostic facilities for which they must pay, but their use= results in a financial payment to the physician, which using the public on= es does not? In view of the shortage of physicians, is this condition coerc= ive and unethical?

What are the rules on paying physicians p= ractising in Canada?

Those physicians who have completely op= ted out of medicare may be= paid by patients for all the care they give them -these physicians are pra= ctising solely private medicine.

Physicians paid under medicare may only be paid by pa= tients for procedures not covered by = medicare. Some of these physicians "disconnect" certai= n aspects of their interactions with patients from the medicare procedure they are providing and char= ge the patient for the former, while being paid by medicare for the latter: for instance, they charge= new patients between $50 and $1000 as a "registration" or "= enrolment" fee, or $500 to become a member of an executive health clin= ic, and also bill medicare= for the procedures it covers.

In short, some physicians hav= e set up systems that allow them to be paid by medicare and to receive payments from patients that (t= hey hope) do not contravene the Canad= a Health Act's prohibition of extra-billing. <= /p>

And = some, but probably few, physicians receive large cash payments, for instanc= e as Christmas gifts, from wealthy patients in return for a promise to be r= eadily available to these patients at all times.

<= span style=3D'font-size:9.5pt;font-family:"Arial","sans-serif"'>One such pa= tient told me the following story: She was hosting a Saturday-night dinner = party and around 10:30 p.m. there was disagreement among the guests about t= he facts regarding a new medical treatment. She said she telephoned a well-= known Montreal specialist and he gave her the information needed to settle = the dispute. When I expressed surprise that she could and would do this, sh= e explained her annual $10,000 Christmas gift to him.

And wh= at about people who are powerful, well-known, a celebrity, a senior politic= ian or even a health-care = professional, so they know others in the system, being given preferential t= reatment? Is this also unethical, or is the payment of money a different ki= nd of special access? In being critical of the ethics of the physicians who= receive "envelopes of cash" (and is this a uniquely Quebec pract= ice?) and the patients who pay them, we must be careful not to be hypocriti= cal.

Fidelman also reports the surprise and horror of offici= als of the Quebec College of Physicians and Surgeons on learning about thes= e cash payments. If, indeed, it is correct that this was the first time thi= s matter had been brought to their attention, I believe they would be among= the few Montreal physicians who had never heard of this practice. One of m= y specialist physician colleagues, whom I asked to read this article, respo= nded: "Is this supposed to be 'news'!?! It's like watching a rerun of = Coronation Street." But perhaps the College meant that, so far, there = had been no formal complaint. In considering its role in dealing with this = issue, the college should keep in mind that the ethical tone of an organiza= tion or profession is set by just a few people at the top.

T= he majority of the questions I've asked raise ethical issues, to many of wh= ich I have not provided clear answers. That is because depending where we s= tand and the range of considerations we take into account, those answers mi= ght be different. We can prohibit all forms of payment other than medicare to physicians working in t= he public system, but if that means we lose large numbers of physicians, it= 's a pyrrhic victory. The bottom line question is whether the way in which = our health-care system is = currently funded and the rules that govern how we pay physicians do more go= od than harm, and whether some changes are needed to try to augment the goo= d and reduce the harms.

Margaret Somerville is director of t= he Centre for Medicine, Ethics and Law at McGill University.

Illustration:
• Photo: PHOTOS.COM / Doctors control access to 80 = per cent of Quebec's medical system, opening the potential for ethical abus= es.

 <= /o:p>

 

Jennifer Whiteside

Senior Officer/Agente prin= cipale

Research, Job Evaluation and Health & Safety Branch/<= /span>

Service de la recherche, de l’=E9valuation des emplois et de la san= t=E9-s=E9curit=E9

Canadian Union of Public Employees/SCFP=

1375 St. Laurent = Blvd., Ottawa, ON K1G 0Z7

(613) 237-1590, x 248

 

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<8F5713DF2D6DF14293423EF519BFB40D8C592A4376@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-CA X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: text/plain; charset="us-ascii" MIME-Version: 1.0 Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by lists.cupe.ca id oB3Gr1ok022824 Subject: [CUPE healthcare list] New CIHI Report on Number of Doctors X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Fri, 03 Dec 2010 16:53:01 -0000 Number of Canadian MDs - and their cost - growing; 4.1% increase biggest since late 1980s, but some regions lacking Toronto Star Fri Dec 3 2010 Page: A19 Section: News Byline: Joseph Hall Toronto Star The number of doctors in Canada is growing at its fastest rate in a generation. But the amount the health-care system is paying physicians is growing even faster, a new report from the Canadian Institute for Health Information shows. The country saw a 4.1 per cent increase in the number of doctors practising between 2008 and 2009, with some 2,700 more hanging out their shingle. That was up from 1,700 new physicians the previous year and brought the total count to some 68,000, the largest number ever. "We actually haven't seen an increase like this since the late 1980s," says Geoff Ballinger, manager of physicians' information at CIHI. The doctor surge sent the ratio of physicians to population in the country up to 201 per 100,000 people, its highest recorded level. That's up from 150 per 100,000 people 30 years ago. But the cost of all those doctors is also increasing rapidly, with the total amount billed by physicians shooting up almost 10 per cent last year alone. Ballinger says much of the price tag can be attributed to the fact that we simply have more doctors to pay. But he adds increases in alternative payment methods to the traditional fee-for-service model are also playing a role. More doctors than ever are billing for such things as special stipends for specializing in chronic illnesses and "rostering" fees for physicians working in teams, Ballinger says. Currently, it is hard to track how these fees flow down to individual doctors, he says. But based on fee-for-service charges, the average family doctor grossed $235,000, while specialists averaged $320,000. The country's total bill for doctors last year was $17 billion, about 14 per cent of Canada's total health-care costs. "Physician expenditures over the last few years are growing faster than expenditures on hospitals or expenditures on drugs," Ballinger says. Ballinger says the vast majority of new physicians - 54 per cent of them women - are coming out of Canadian medical schools, although the country recorded a net gain of about 100 from the migration of foreign doctors. Of the 2,700 new doctors last year, 2,400 were churned out of Canadian medical schools. That was due largely to policies hatched by provinces across Canada last decade to compensate for 1990s cuts to medical school funding, which led to endemic physician shortages, especially in rural areas. Despite the surging numbers, that rural shortage continues to plague many areas, Ballinger says. "There is still an issue that a lot of physicians are attracted, like the rest of us, to large urban centres," he says. "Trying to find incentives to attract physicians to these communities continues to be a challenge." 68,000 Number of doctors in Canada in 2009 (the largest number ever) $17B Canada's total bill for doctors in 2009 (14% of health-care costs) $235,000 Average gross income for a family doctor in Canada in 2009 4.1 % Increase in number of doctors in Canada between 2008-09 From jwhiteside@cupe.ca Tue Dec 7 16:32:13 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oB7LWDiG009808 for ; Tue, 7 Dec 2010 16:32:13 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Tue, 7 Dec 2010 16:32:12 -0500 From: Jennifer Whiteside To: "healthcare@lists.cupe.ca" Date: Tue, 7 Dec 2010 16:32:12 -0500 Thread-Topic: Home-care system swamped by demand; Wide disparities found across Ontario as 10,000 await services Thread-Index: AQHLllY1Fk/JElagRUitn8Q6HFMUQw== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C592A438A@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-CA X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: text/plain; charset="iso-8859-1" MIME-Version: 1.0 Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by lists.cupe.ca id oB7LWDiG009808 Subject: [CUPE healthcare list] Home-care system swamped by demand; Wide disparities found across Ontario as 10,000 await services X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Tue, 07 Dec 2010 21:32:13 -0000 Home-care system swamped by demand; Wide disparities found across Ontario as 10,000 await services Toronto Star Tue Dec 7 2010 Page: A8 Section: News Byline: Moira Welsh and Theresa Boyle Toronto Star Janet Tapping is trained as a chartered accountant, but now she's giving speech therapy to her 7-year-old son because he's spent more than a year on Ontario's home-care waiting list. "I am not a professional speech therapist - I'm hoping the sounds coming out of his mouth are the right sounds," Tapping said. "My options were to pay for a regular speech therapist, which I can't afford, or stay on the waiting list." Tapping's son, Jonathan, who has been on the Central Community Care Access Centre (CCAC) list since October 2009, is one of 10,000 Ontarians waiting for home-care services, according to a report released Monday by the provincial auditor general. Jim McCarter devoted a chapter of his annual report to home care, finding the sector is unable to keep up with demand for personal support, homemaking and therapy services. The sector doesn't have the financial resources to meet demand for personal support and homemaking services, the report noted. These services are often required by seniors and people discharged from hospitals. And a shortage of professionals in occupational therapy, physiotherapy and speech-language therapy is resulting in waiting lists. Ontario's 14 community care access centres are responsible for providing home-care services to more than half a million people who might otherwise be in hospitals or long-term care facilities. Average wait times at the centres range from eight days to 262 days. McCarter found significant disparities across the province. His report noted, for example, that one CCAC had twice as much funding per capita as another. (The report did not identify the location of these CCACs.) "The Ministry of Health and Long-Term Care recognizes that enhancing home-care services saves money and improves quality of life by allowing people to remain in their homes rather than in hospitals or long-term care facilities," he said. "However, although home-care funding has increased, funding inequities we've noted in previous audits remain because the ministry is still allocating funding based largely on what it gave in the past rather than on the specific needs of the local clientele," he added. Natalie Mehra of the Ontario Health Coalition applauded the report, saying it "gives numbers to support what many people across Ontario have been saying." "Home-care services are inequitable, and many patients who need them don't receive them when they get out of the hospital ...," she said. "This is a service gap that the government ignores at its peril." Sharleen Stewart, president of Service Employees International Union, which represents most unionized home-care workers, called the auditor's findings the "tip of the iceberg in the crisis that is about to hit us." The reporters can be reached at mwelsh@thestar.ca and tboyle@thestar.ca © 2010 Torstar Corporation From jwhiteside@cupe.ca Fri Dec 10 14:36:45 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oBAJaj6Q007260 for ; Fri, 10 Dec 2010 14:36:45 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Fri, 10 Dec 2010 14:36:45 -0500 From: Jennifer Whiteside To: "healthcare@lists.cupe.ca" Date: Fri, 10 Dec 2010 14:36:44 -0500 Thread-Topic: Number of RNs and other nurses in Canada rises by 9 per cent: CIHI report Thread-Index: AQHLmKGTKViouDz4SkaqszlM8XciHA== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C592A4399@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-CA X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: text/plain; charset="iso-8859-1" MIME-Version: 1.0 Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by lists.cupe.ca id oBAJaj6Q007260 Subject: [CUPE healthcare list] Number of RNs and other nurses in Canada rises by 9 per cent: CIHI report X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Fri, 10 Dec 2010 19:36:45 -0000 Number of RNs and other nurses in Canada rises by 9 per cent: report Canadian Press Thu Dec 9 2010 Section: National general news TORONTO _ Canada's nursing workforce has grown significantly in the last five years but still falls short of the level the profession had achieved two decades ago relative to the population, says a report by the Canadian Institute for Health Information. The CIHI report shows Canada gained more than 27,000 nurses between 2005 and 2009, bringing the total of regulated nurses to about 348,500 _ a nine per cent increase. Over the same period, the country's population grew by five per cent. Three-quarters of the nursing workforce is made up of registered nurses, followed by licensed practical nurses and registered psychiatric nurses. Over the last five years, growth in the number of RNs and LPNs has exceeded population growth, while the growth rate for registered psychiatric nurses has kept pace with the increase in population in the western provinces where they are regulated and work. However, statistics show there are actually fewer registered nurses today relative to the size of the population than there were 20 years ago. In 1992, there were 824 RNs for every 100,000 Canadians, compared to 789 per 100,000 in 2009. ``In the mid-1990s, with cuts to health-care budgets across Canada, we saw reductions in the numbers of nurses and other health-care professionals working in this country, as governments implemented hiring freezes and early-retirement packages,'' Michael Hunt, CIHI's director of health workforce information services, said Thursday in a release. ``Despite reinvestments in health care over the past 10 years, the ratio of nurses to the Canadian population has still not returned to what it was in the early '90s,'' said Hunt. ``In contrast, the number of physicians relative to the size of the population is now at an all-time high. (A CIHI report last week found physician numbers rose 4.1 per cent last year.) Even so, the Canadian Nurses Association said it is pleased to see the country tackling the nursing shortage, which is expected to improve access to care while decreasing wait times. ``This is encouraging news for the nearly five million Canadians who don't have regular access to primary health-care providers,'' said CNA president Judith Shamian, noting that an increasing number of Canadians are receiving care from nurse practitioners. The report shows there are more than 266,000 registered nurses practising in Canada, six per cent more than five years ago. However, most new RN positions are in hospitals, and the association believes more resources should be dedicated to primary care, community care, and health-promotion and illness-prevention activities. ``Bringing care closer to home and placing an emphasis on prevention, early diagnosis and treatment are proven strategies that avert costly hospital stays down the road, freeing up beds and reducing emergency room bottlenecks,'' said Rachel Bard, CEO of the Canadian Nurses Association, the body that represents registered nurses. ``Similarly, CNA would also like to see a shift in investment towards long-term care, home care and chronic disease management,'' Bard said. The CIHI report also found that the number of nurse practitioners more than doubled between 2005 and 2009 to nearly 2,000, but the specialty still represents less than one per cent of the nursing workforce. ``Nurse practitioners are an emerging specialty,'' said Carol Brule, CIHI's manager of health human resources. ``They receive an education in health assessment, diagnosis and management of illness and injuries, and they have responsibilities that include ordering tests and prescribing medication; they are a small but increasingly important group.'' Copyright © 2010 The Canadian Pres From jwhiteside@cupe.ca Fri Dec 10 14:58:04 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oBAJw4KI008350 for ; Fri, 10 Dec 2010 14:58:04 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Fri, 10 Dec 2010 14:58:04 -0500 From: Jennifer Whiteside To: "healthcare@lists.cupe.ca" Date: Fri, 10 Dec 2010 14:58:04 -0500 Thread-Topic: To manage health costs, invest in social well-being Thread-Index: AQHLmKSOO0CMUox2W0GxIovns3lG2w== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C592A439C@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-CA X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: text/plain; charset="iso-8859-1" MIME-Version: 1.0 Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by lists.cupe.ca id oBAJw4KI008350 Subject: [CUPE healthcare list] To manage health costs, invest in social well-being X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Fri, 10 Dec 2010 19:58:04 -0000 To manage health costs, invest in social well-being The Globe and Mail Wed Dec 8 2010 Page: A23 Section: Comment Byline: Jim Stanford Economist with the Canadian Auto Workers union Governments are still reeling from recession-induced deficits, but now their attention is turning to another fiscal elephant marching into the room: the coming renegotiation of federal-provincial transfer payments. The Canada Health Transfer (CHT) expires in 2014, and must be extended soon. Finance Minister Jim Flaherty plans to clamp down on transfers to reduce his own deficit. But that just passes the buck to the provinces, whose fiscal position is even worse. As this debate heats up, there's a new piece of knowledge that should be considered carefully as finance ministers arm-wrestle. Since the CHT was implemented in 2004, researchers around the world have established a whole new field of scientific knowledge regarding the social determinants of health. There is now hard medical evidence that a person's economic status and social participation directly affects their physical health. And that, in turn, affects the cost of health care. This is not vague, bleeding-heart sentimentalism; it is hard scientific proof. For concrete physiological reasons, human health suffers when people are subjected to prolonged hardship, stress and disparity. The physiology of this connection involves many body systems, including the impact of stress and unhappiness on metabolism, hormone production, circulatory function and other systems. This research is well-established in medical journals, was popularized by British epidemiologist Richard Wilkinson in his best-seller The Spirit Level, and was further affirmed by the World Health Organization in a recent expert commission. What does all this mean for health-care finance? It means that addressing the underlying social problems that scientists now know cause so much ill health, can help to rein in health costs. Governments must therefore be holistic in their programming and budgeting, instead of obsessing on reducing one budget line without regard to how that may affect other expenses. Diabetes, for example, is an illness with especially strong links to poverty and inequality. Incredibly, poverty is a greater risk factor in diabetes than diet or exercise. Canadians with annual incomes under $30,000 are at least twice as likely to contract diabetes as those with incomes over $80,000. Poverty thus drives up the overall incidence of diabetes - and public-health costs in the process. Researchers estimate that one in 10 hospital admissions in Canada are due to diabetes and its complications; the Canadian Diabetes Association tallies total direct health costs at over $13-billion per year. Ironically, however, while medicare shells out billions to treat diabetes, we penny-pinch when it comes to supporting poor people so they don't get it in the first place. Ottawa denies employment insurance to most of Canada's unemployed; meanwhile, the provinces underfund social assistance (even programs with direct health impacts, like Ontario's special diet allowance). Governments then bicker over who should shoulder the burden of health costs, much of which results from the poverty and ghettoization that their own policies caused. Worse yet, many patients are poor and can't afford the substantial expenses associated with diabetes (including medication and supplies); this often lands them with expensive complications. Penny-pinching in one fiscal envelope thus contributes directly to ballooning costs in another. If we reduced the incidence of diabetes among the poorest Canadians to the same average experienced in the population as a whole, we'd cut overall incidence by about 15 per cent. More ambitiously, countries with very low poverty rates (like Sweden and Norway) suffer less than half as much diabetes as Canada. We could therefore cut diabetes costs in half (saving $7-billion per year in health costs) if we matched their social performance. Exactly the same math applies to many other socially determined diseases, such as hypertension, digestive maladies and mental health. So a holistic strategy to improve the living conditions of Canadians would not just produce a stronger and more inclusive society. It would pay off in more manageable health-care costs. That would give finance ministers, as well as social planning officials, something to smile about. © 2010 CTVglobemedia Publishing Inc. All Rights Reserved. From jwhiteside@cupe.ca Mon Dec 13 13:08:25 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oBDI8P9R026082 for ; Mon, 13 Dec 2010 13:08:25 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Mon, 13 Dec 2010 13:08:26 -0500 From: Jennifer Whiteside To: "healthcare@lists.cupe.ca" Date: Mon, 13 Dec 2010 13:08:22 -0500 Thread-Topic: US Health Care Law Ruled Unconstitutional Thread-Index: Acua8Lral9EDwix3QYK40dIvtinEuw== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C5A076185@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: X-MS-TNEF-Correlator: x-cr-hashedpuzzle: ATLn AgGf A5CQ BwQC B/7w C/j3 Dgr1 EC9b EbU+ EeL0 EuzQ FJ0q GAV3 Gg3v JRgj K+Yq; 1; aABlAGEAbAB0AGgAYwBhAHIAZQBAAGwAaQBzAHQAcwAuAGMAdQBwAGUALgBjAGEA; Sosha1_v1; 7; {D06BF27A-E467-469D-B688-AE5ACF13E657}; agB3AGgAaQB0AGUAcwBpAGQAZQBAAGMAdQBwAGUALgBjAGEA; Mon, 13 Dec 2010 18:08:22 GMT; VQBTACAASABlAGEAbAB0AGgAIABDAGEAcgBlACAATABhAHcAIABSAHUAbABlAGQAIABVAG4AYwBvAG4AcwB0AGkAdAB1AHQAaQBvAG4AYQBsAA== x-cr-puzzleid: {D06BF27A-E467-469D-B688-AE5ACF13E657} acceptlanguage: en-US Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C5A076185E2K7CLUSTERcu_" MIME-Version: 1.0 Subject: [CUPE healthcare list] US Health Care Law Ruled Unconstitutional X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Mon, 13 Dec 2010 18:08:25 -0000 --_000_8F5713DF2D6DF14293423EF519BFB40D8C5A076185E2K7CLUSTERcu_ Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Health Care Law Ruled Unconstitutional By KEVIN SACK Published: December 13, 2010 Top of Form Top of Form A federal district judge in Virginia ruled on Monday that the keystone prov= ision in the Obama health care law is unconstitutional, becoming the first = court in the country to invalidate any part of the sprawling act and ensuri= ng that appellate courts will receive contradictory opinions from below. Judge Henry E. Hudson, who was appointed to the bench by President George W= . Bush, declined the plaintiff's request to fr= eeze implementation of the law pending appeal, meaning that there should be= no immediate effect on the ongoing rollout of the law. But the ruling is l= ikely to create confusion among the public and further destabilize politica= l support for legislation that is under fierce attack from Republicans in C= ongress and in many statehouses. In a 42-page opinion issued in Richmond, Va., Judge Hudson wrote that the l= aw's central requirement that most Americans obtain health insurance exceeds th= e regulatory authority granted to Congress under the Commerce Clause of the= Constitution. The insurance mandate is central to the law's mission of cov= ering more than 30 million uninsured because insurers argue that only by re= quiring healthy people to have policies can they afford to treat those with= expensive chronic conditions. The judge wrote that his survey of case law "yielded no reported decisions = from any federal appellate courts extending the Commerce Clause or General = Welfare Clause to encompass regulation of a person's decision not to purcha= se a product, not withstanding its effect on interstate commerce or role in= a global regulatory scheme." Judge Hudson is the third district court judge to reach a determination on = the merits in one of the two dozen lawsuits filed against the health care l= aw. The others - in Detroit and Lynchburg, Va. - have upheld the law. Lawye= rs on both sides said the appellate process could last another two years be= fore the Supreme Court settles the disp= ute. The opinion by Judge Hudson, who has a long history in Republican politics = in northern Virginia, continued a partisan pattern in the health care cases= . Thus far, judges appointed by Republican presidents have ruled consistent= ly against the Obama administration while Democratic appointees have found = for it. That has reinforced the notion - fueled by the White House - that the lawsu= its are as much a political assault as a constitutional one. The Richmond c= ase was filed by Virginia's attorney general, Kenneth T. Cuccinelli II, a R= epublican, and all but one of the 20 attorneys general and governors who fi= led a similar case in Pensacola, Fla., are Republicans. Other lawsuits have= been filed by conservative law firms and interest groups. The two cases previously decided by district courts are already before the = midlevel courts of appeal, with the Detroit case in the Sixth Circuit in Ci= ncinnati and the Lynchburg case in the Fourth Circuit in Richmond. The Justice Department, which is defending the statute, is also considering= whether to appeal Judge Hudson's ruling to the Fourth Circuit, which hears= cases from Virginia and four other states. That would leave that court to = consider opposite rulings handed down over two weeks in courthouses situate= d only 116 miles apart. The Richmond ruling is the latest in a string of recent setbacks for the Ob= ama administration, following the Democrats' loss of the House in the midte= rm elections and last week's intraparty mutiny over Mr. Obama's agreement t= o extend the Bush era tax cuts. But administration officials, who have been bracing for an adverse ruling, = emphasized that Judge Hudson's opinion was just one among several. They sai= d they maintained high confidence that the law eventually would be upheld, = and expressed frustration that negative rulings were attracting more attent= ion than affirming ones. The officials stressed that the judge's decision to not enjoin the law woul= d defer any actual impact for years. They noted that the insurance requirem= ent does not even take effect until 2014, when the Supreme Court presumably= will have ruled. The administration has said that if that provision eventually falls, relate= d insurance reforms would necessarily collapse with it, most notably the ba= n on insurer exclusions of applicants with pre-existing health conditions. = But officials said other innovations, including a vast expansion of Medicai= d eligibility and the sale of= subsidized insurance policies through state-based exchanges, would withsta= nd even a Supreme Court ruling against the insurance mandate. "It's our strongly held view that those provisions survive" in judicial dec= isions invalidating the insurance requirement, one administration official = said, speaking anonymously because he was not authorized to discuss the cas= e publicly. However, even state officials who support the new law said Monday's ruling = would reinforce calls by many Republican governors and lawmakers to slow do= wn its implementation. "I think you might see some air taken out of the balloon nationwide," said = Jason A. Helgerson, the Medicaid director in Wisconsin, which is about to t= ransition from Democratic to Republican control of the executive and legisl= ative branches. Mr. Helgerson said states still ignore looming federal deadlines at their p= eril. For instance, if states do not make adequate progress toward setting = up their insurance exchanges by January 2013, the federal government can ta= ke control. Judge Hudson, who previously was best known for sentencing the N.F.L. quarterback Michael Vick to 23 months for dog fighting, had telegraphed his leanings in a series of hearings and prelim= inary opinions. But the ruling was nonetheless striking given that only nin= e months ago prominent law professors were dismissing the constitutional cl= aims as just north of frivolous. The case centers on whether Congress has authority under the Commerce Claus= e to compel citizens to purchase a commercial product - namely health insur= ance - in the name of regulating an interstate economic market. Plaintiffs = in the lawsuits argue there effectively would be no limits on federal power= , and that the government could force people to buy American cars or, as Ju= dge Hudson remarked at one hearing, "to eat asparagus." The Supreme Court's position on the Commerce Clause has evolved through fou= r signature cases over the last 68 years, with three decided since 1995. Tw= o of the opinions established broad powers to regulate even personal commer= cial decisions that may influence a broader economic scheme. But other case= s have limited regulation to "activities that have a substantial effect on = interstate commerce." A major question, therefore, has been whether the income tax penalties levi= ed against those who do not obtain health insurance are designed to regulat= e "activity" or, as Virginia's solicitor general, E. Duncan Getchell Jr., h= as argued, "inactivity" that is beyond Congress' reach. Justice Department lawyers have responded that individuals cannot opt out o= f the medical market, and that the act of not obtaining insurance is an act= ive decision to pay for health care out of pocket. They say that such decis= ions, taken in the aggregate, shift billions of dollars in uncompensated ca= re costs to governments, hospitals and the privately insured. The ruling is a political score for Mr. Cuccinelli, who filed the lawsuit o= n his own rather than join the Pensacola case. It upstages a major hearing = in Florida scheduled for Thursday before Judge Roger Vinson of Federal Dist= rict Court in Pensacola, Fla., who is expected to rule early next year. Lik= e Judge Hudson, Judge Vinson has expressed reservations about the insurance= mandate. Mr. Cuccinelli, who was elected in 2009, has said he filed on his own becau= se Virginia passed a law this year aimed at nullifying the federal insuranc= e requirement, giving the commonwealth a distinct constitutional claim. Oth= ers attribute the strategy to political ambition, suggesting that Mr. Cucci= nelli did not want to share the spotlight and knew he could exploit the acc= elerated pace of judging in Richmond's "rocket docket" to raise his profile= . Mr. Cuccinelli filed the lawsuit minutes after President Obama signed the law on March 23, and has been discussing the cas= e since on cable television shows and think tank panels. He follows each he= aring and ruling with a news conference. Even before Monday's ruling, Mr. Cuccinelli and Gov. Robert F. McDonnell of Virginia, also a Republican, were seekin= g an agreement with the Justice Department to bypass the Court of Appeals a= nd file for expedited review by the Supreme Court. That would have the effe= ct of further marginalizing the Pensacola case, and the politicians bringin= g it. The Supreme Court rarely takes such requests and the Justice Departme= nt has not publicly expressed an opinion. Jennifer Whiteside Senior Officer/Agente principale Research, Job Evaluation and Health & Safety Branch/ Service de la recherche, de l'=E9valuation des emplois et de la sant=E9-s= =E9curit=E9 Canadian Union of Public Employees/SCFP 1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7 (613) 237-1590, x 248 --_000_8F5713DF2D6DF14293423EF519BFB40D8C5A076185E2K7CLUSTERcu_ Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable

Health Care Law Ruled Unconstitutional=

By KEVIN SACK<= /o:p>

Published: December 13, 2010

<= p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;border:none;p= adding:0in'>Top of Form

Top of F= orm

A federal district judge in Virginia ruled o= n Monday that the keystone provision in the Obama health care law is uncons= titutional, becoming the first court in the country to invalidate any part = of the sprawling act and ensuring that appellate courts will receive contra= dictory opinions from below.

 =

Judge Henry E. = Hudson, who was appointed to the bench by President George W. Bush, declined the plaintiff’= s request to freeze implementation of the law pending appeal, meaning that = there should be no immediate effect on the ongoing rollout of the law. But = the ruling is likely to create confusion among the public and further desta= bilize political support for legislation that is under fierce attack from R= epublicans in Congress and in many statehouses.

In a 42-page opinion iss= ued in Richmond, Va., Judge Hudson wrote that the law’s central requi= rement that most Americans obtain health insurance exceeds the regulatory authority granted to= Congress under the Commerce Clause of the Constitution. The insurance mand= ate is central to the law’s mission of covering more than 30 million = uninsured because insurers argue that only by requiring healthy people to h= ave policies can they afford to treat those with expensive chronic conditio= ns.

The judge wrote that his survey of case law “yielded no report= ed decisions from any federal appellate courts extending the Commerce Claus= e or General Welfare Clause to encompass regulation of a person’s dec= ision not to purchase a product, not withstanding its effect on interstate = commerce or role in a global regulatory scheme.”

Judge Hudson is t= he third district court judge to reach a determination on the merits in one= of the two dozen lawsuits filed against the health care law. The others &#= 8212; in Detroit and Lynchburg, Va. — have upheld the law. Lawyers on= both sides said the appellate process could last another two years before = the Supreme Court settles the dispute.

The opinion by Judge Hudson, who has a lo= ng history in Republican politics in northern Virginia, continued a partisa= n pattern in the health care cases. Thus far, judges appointed by Republica= n presidents have ruled consistently against the Obama administration while= Democratic appointees have found for it.

That has reinforced the notion= — fueled by the White House — that the lawsuits are as much a = political assault as a constitutional one. The Richmond case was filed by V= irginia’s attorney general, Kenneth T. Cuccinelli II, a Republican, a= nd all but one of the 20 attorneys general and governors who filed a simila= r case in Pensacola, Fla., are Republicans. Other lawsuits have been filed = by conservative law firms and interest groups.

The two cases previously = decided by district courts are already before the midlevel courts of appeal= , with the Detroit case in the Sixth Circuit in Cincinnati and the Lynchbur= g case in the Fourth Circuit in Richmond.

The Justice Department, which = is defending the statute, is also considering whether to appeal Judge Hudso= n’s ruling to the Fourth Circuit, which hears cases from Virginia and= four other states. That would leave that court to consider opposite ruling= s handed down over two weeks in courthouses situated only 116 miles apart. =

The Richmond ruling is the latest in a string of recent setbacks for the= Obama administration, following the Democrats’ loss of the House in = the midterm elections and last week’s intraparty mutiny over Mr. Obam= a’s agreement to extend the Bush era tax cuts.

=

But administration = officials, who have been bracing for an adverse ruling, emphasized that Jud= ge Hudson’s opinion was just one among several. They said they mainta= ined high confidence that the law eventually would be upheld, and expressed= frustration that negative rulings were attracting more attention than affi= rming ones.

The officials stressed that the judge’s decision to no= t enjoin the law would defer any actual impact for years. They noted that t= he insurance requirement does not even take effect until 2014, when the Sup= reme Court presumably will have ruled.

The administration has said that = if that provision eventually falls, related insurance reforms would necessa= rily collapse with it, most notably the ban on insurer exclusions of applic= ants with pre-existing health conditions. But officials said other innovati= ons, including a vast expansion of “= ;It’s our strongly held view that those provisions survive” in = judicial decisions invalidating the insurance requirement, one administrati= on official said, speaking anonymously because he was not authorized to dis= cuss the case publicly.

However, even state officials= who support the new law said Monday’s ruling would reinforce calls b= y many Republican governors and lawmakers to slow down its implementation. =

“I think you might see some air taken out of the ba= lloon nationwide,” said Jason A. Helgerson, the Medicaid director in = Wisconsin, which is about to transition from Democratic to Republican contr= ol of the executive and legislative branches.

Mr. Helgers= on said states still ignore looming federal deadlines at their peril. For i= nstance, if states do not make adequate progress toward setting up their in= surance exchanges by January 2013, the federal government can take control.=

Judge Hudson, who previously was best known for s= entencing the N.F.L. quarterback Michael Vick to 23 months for dog fighting, had telegraphed his leanings in= a series of hearings and preliminary opinions. But the ruling was nonethel= ess striking given that only nine months ago prominent law professors were = dismissing the constitutional claims as just north of frivolous.

The case centers on whether = Congress has authority under the Commerce Clause to compel citizens to purc= hase a commercial product – namely health insurance – in the na= me of regulating an interstate economic market. Plaintiffs in the lawsuits = argue there effectively would be no limits on federal power, and that the g= overnment could force people to buy American cars or, as Judge Hudson remar= ked at one hearing, “to eat asparagus.”

The Supreme Court’s position on the Commerce Clause has evolved thr= ough four signature cases over the last 68 years, with three decided since = 1995. Two of the opinions established broad powers to regulate even persona= l commercial decisions that may influence a broader economic scheme. But ot= her cases have limited regulation to “activities that have a substant= ial effect on interstate commerce.”

A major questio= n, therefore, has been whether the income tax penalties levied against thos= e who do not obtain health insurance are designed to regulate “activi= ty” or, as Virginia’s solicitor general, E. Duncan Getchell Jr.= , has argued, “inactivity” that is beyond Congress’ reach= .

Justice Department lawyers have responded that individu= als cannot opt out of the medical market, and that the act of not obtaining= insurance is an active decision to pay for health care out of pocket. They= say that such decisions, taken in the aggregate, shift billions of dollars= in uncompensated care costs to governments, hospitals and the priv= ately insured.

The ruling is a political score for Mr. Cu= ccinelli, who filed the lawsuit on his own rather than join the Pensacola c= ase. It upstages a major hearing in Florida scheduled for Thursday before J= udge Roger Vinson of Federal District Court in Pensacola, Fla., who is expe= cted to rule early next year. Like Judge Hudson, Judge Vinson has expressed= reservations about the insurance mandate.

Mr. Cuccine= lli, who was elected in 2009, has said he filed on his own because Virginia= passed a law this year aimed at nullifying the federal insurance requireme= nt, giving the commonwealth a distinct constitutional claim. Others attribu= te the strategy to political ambition, suggesting that Mr. Cuccinelli did n= ot want to share the spotlight and knew he could exploit the accelerated pa= ce of judging in Richmond’s “rocket docket” to raise his = profile.

Mr. Cuccinelli filed the lawsuit minutes after <= a href=3D"http://topics.nytimes.com/top/reference/timestopics/people/o/bara= ck_obama/index.html?inline=3Dnyt-per" title=3D"More articles about Barack O= bama.">President Obama signed the = law on March 23, and has been discussing the case since on cable television= shows and think tank panels. He follows each hearing and ruling with a new= s conference.

Even before Monday’s ruling, Mr. Cucc= inelli and Gov. Robert F= . McDonnell of Virginia, also a Republican, were seeking an agre= ement with the Justice Department to bypass the Court of Appeals and file f= or expedited review by the Supreme Court. That would have the effect of fur= ther marginalizing the Pensacola case, and the politicians bringing it. The= Supreme Court rarely takes such requests and the Justice Department has no= t publicly expressed an opinion.

 

 

 

Jenn= ifer Whiteside

Senior Officer/Agente principale

Research, Job Evaluation an= d Health & Safety Branch/

Service de la recherche, de l= 217;=E9valuation des emplois et de la sant=E9-s=E9curit=E9

Canadian Union o= f Public Employees/SCFP

1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7

(613) 23= 7-1590, x 248

 

= --_000_8F5713DF2D6DF14293423EF519BFB40D8C5A076185E2K7CLUSTERcu_-- From jwhiteside@cupe.ca Tue Dec 14 10:46:39 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oBEFkdCX001186 for ; Tue, 14 Dec 2010 10:46:39 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Tue, 14 Dec 2010 10:46:39 -0500 From: Jennifer Whiteside To: "healthcare@lists.cupe.ca" Date: Tue, 14 Dec 2010 10:46:38 -0500 Thread-Topic: CMA wants to persuade Ottawa to fund drug costs and long-term acute care and looks to public input for added clout Thread-Index: Acubphhb3uUHkeNqQjm6TJm3IueCzQ== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C5A0763CB@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C5A0763CBE2K7CLUSTERcu_" MIME-Version: 1.0 Subject: [CUPE healthcare list] CMA wants to persuade Ottawa to fund drug costs and long-term acute care and looks to public input for added clout X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Tue, 14 Dec 2010 15:46:39 -0000 --_000_8F5713DF2D6DF14293423EF519BFB40D8C5A0763CBE2K7CLUSTERcu_ Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Doctors want help in setting agenda; CMA wants to persuade Ottawa to fund d= rug costs and long-term acute care and looks to public input for added clou= t The Globe and Mail Tue Dec 14 2010 Page: A8 Section: National News Byline: Gloria Galloway Dateline: OTTAWA OTTAWA -- Canada's doctors want to expand the national health-care umbrella= to include pharmacare and long-term care, and they want ordinary Canadians= to join them in pressing their case to the government. The Canadian Medical Association announced on Monday that it is beginning a= public dialogue to let decision makers know what Canadians want in their h= ealth- care system - a consultation that will take place as provinces, terr= itories and the federal government look ahead to the expiry of the Canada H= ealth Transfer Program in 2014. That program requires Ottawa to increase the amount it gives the provinces = for health services by 6 per cent each year. "We are very concerned that that transfer won't continue," Jeff Turnbull, t= he CMA president, told reporters. "It's a very significant amount of money = for provinces who are already struggling to deliver health services." But the association doesn't want to talk about financing at this juncture. = Instead, it wants to persuade politicians that other services should be pub= licly funded - specifically drug costs and long-term care for patients who = are taking up beds in acute-care hospitals. If those beds could be vacated,= emergency-room backlogs would drop, said Dr. Turnbull. The doctors know their message stands a better chance of being heard if the= consumers of health care get involved. "Once we get a consortium of individuals, other allied health professionals= , doctors, patients, community members, then we'll actually have clout, the= n we'll have our decision-makers listening," Dr. Turnbull said. To mobilize the public, the association has created a website on which Cana= dians can give their opinions about the health-care system. The doctors will also hold town-hall meetings across the country to discuss= the issues. They will commission policy papers and write to newspapers. An= d the 77,000 physicians who are CMA members all have patients, Dr. Turnbull= said. "We would hope that those doctors as well would be out there informi= ng their patients about the important aspects of the health-care system." The CMA will appoint a committee to weigh the responses it receives and hop= es to prepare an action plan by next fall. Once the vision of the health- c= are system has been shaped, then it will be time to talk about how to finan= ce it, Dr. Turnbull said. The Conservative government in Ottawa has given no indication that it is an= xious to begin a dialogue about what will happen after 2014 - or to confron= t the competing pressures of rising budgets and an aging population. When asked on Monday if the government plans to extend the health transfer = after 2014, Jenny Van Alystyne, a spokeswoman for Health Minister Leona Agl= ukkaq, refused to answer directly. "We will continue to work with provinces= , territories and health care professionals to look for ways to improve the= health care system," she said. Pamela Fralick, the president of the Canadian Healthcare Association, a gro= up that advocates for sustainable, publicly funded care, said the discussio= n about health-care needs does not need to be linked to the deadline of 201= 4. "So many things could happen at the political level that I don't think we s= hould ever be tied completely to those sorts of milestones, Ms. Fralick sai= d. Her organization agrees with the CMA that pharmacare should be part of the = Canadian system. "We are out of step with the rest of the world, or at leas= t comparable countries, on that one," she said. Finland, Belgium, Great Bri= tain, Ireland and Sweden, Germany, New Zealand, Australia and France all ha= ve national pharmacare programs. In addition, the Canadian Healthcare Association says home care and respite= care should be discussed along with long-term care, Ms. Fralick said. *** THREE QUESTIONS The Canadian Medical Association is asking Canadians for their thoughts abo= ut the health-care system of the future. The association wants the public t= o respond to three questions, which have been posted on the website healthc= aretransformation.ca. 1. The law underpinning our system - the Canada Health Act - dates back to = the 1980s. It covers only doctor and hospital care. Do you think it should = be broadened to include things like pharmacare and long-term care? 2. It's important for citizens to feel they are receiving good value for th= eir health care. What would you consider good value? 3. Patients and their families play an important part in their health care.= What do you think Canadians' responsibilities are, now and in the future, = regarding their health? =A9 2010 CTVglobemedia Publishing Inc. All Rights Reserved. Jennifer Whiteside Senior Officer/Agente principale Research, Job Evaluation and Health & Safety Branch/ Service de la recherche, de l'=E9valuation des emplois et de la sant=E9-s= =E9curit=E9 Canadian Union of Public Employees/SCFP 1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7 (613) 237-1590, x 248 --_000_8F5713DF2D6DF14293423EF519BFB40D8C5A0763CBE2K7CLUSTERcu_ Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable

Doctors = want help in setting agenda; CMA wants to persuade Ottawa to fund drug cost= s and long-term acute care and looks to public input for added clout

The Globe and Mail
Tue Dec 14 2010
Pa= ge: A8
Section: National News
Byline: Gloria Galloway
Dateline:= OTTAWA

OTTAWA -- Canada's doctors want to expand the nati= onal health-care umbrella to include pharmacare and long-term care, and they want ordinary Canadians = to join them in pressing their case to the government.

T= he Canadian Medical Association announced on Monday that it is beginning a = public dialogue to let decision makers know what Canadians want in their he= alth- care system - a consultation that will take place as provinces, terri= tories and the federal government look ahead to the expiry of the Canada He= alth Transfer Program in 2014.

That program requires Ott= awa to increase the amount it gives the provinces for health services by 6 = per cent each year.

"We are very concerned that tha= t transfer won't continue," Jeff Turnbull, the CMA president, told rep= orters. "It's a very significant amount of money for provinces who are= already struggling to deliver health services."

Bu= t the association doesn't want to talk about financing at this juncture. In= stead, it wants to persuade politicians that other services should be publi= cly funded - specifically drug costs and long-term care for patients who are taking up beds in acute-= care hospitals. If those beds could be vacated, emergency-room backlogs wou= ld drop, said Dr. Turnbull.

The doctors know their messa= ge stands a better chance of being heard if the consumers of health care ge= t involved.

"Once we get a consortium of individual= s, other allied health professionals, doctors, patients, community members,= then we'll actually have clout, then we'll have our decision-makers listen= ing," Dr. Turnbull said.

To mobilize the public, th= e association has created a website on which Canadians can give their opini= ons about the health-care system.

The doctors will also= hold town-hall meetings across the country to discuss the issues. They wil= l commission policy papers and write to newspapers. And the 77,000 physicia= ns who are CMA members all have patients, Dr. Turnbull said. "We would= hope that those doctors as well would be out there informing their patient= s about the important aspects of the health-care system." <= /span>

The CMA will appoint a committee to weigh the responses it receives = and hopes to prepare an action plan by next fall. Once the vision of the he= alth- care system has been shaped, then it will be time to talk about how t= o finance it, Dr. Turnbull said.

The Conservative gove= rnment in Ottawa has given no indication that it is anxious to begin a dial= ogue about what will happen after 2014 - or to confront the competing press= ures of rising budgets and an aging population.

When ask= ed on Monday if the government plans to extend the health transfer after 20= 14, Jenny Van Alystyne, a spokeswoman for Health Minister Leona Aglukkaq, r= efused to answer directly. "We will continue to work with provinces, t= erritories and health care professionals to look for ways to improve the he= alth care system," she said.

Pamela Fralick, the p= resident of the Canadian Healthcare Association, a group that advocates for= sustainable, publicly funded care, said the discussion about health-care n= eeds does not need to be linked to the deadline of 2014. =

"So many things could happen at the political level that I don't thin= k we should ever be tied completely to those sorts of milestones, Ms. Frali= ck said.

Her organization agrees with the CMA that pharm= acare should be part of the Canadian system. "We are out of step with = the rest of the world, or at least comparable countries, on that one,"= she said. Finland, Belgium, Great Britain, Ireland and Sweden, Germany, Ne= w Zealand, Australia and France all have national pharmacare programs.

In addition, the Canadian Healthcare Association says home care and respite care shoul= d be discussed along with long-term c= are, Ms. Fralick said.

***

THREE QUESTIONS

The Canadian Medical Association is as= king Canadians for their thoughts about the health-care system of the futur= e. The association wants the public to respond to three questions, which ha= ve been posted on the website healthcaretransformation.ca.

1. The law underpinning our system - the Canada Health Act - dates back = to the 1980s. It covers only doctor and hospital care. Do you think it shou= ld be broadened to include things like pharmacare and long-term care?

<= span style=3D'font-size:9.5pt;font-family:"Arial","sans-serif"'>2. It's imp= ortant for citizens to feel they are receiving good value for their health = care. What would you consider good value?

3. Patients an= d their families play an important part in their health care. What do you t= hink Canadians' responsibilities are, now and in the future, regarding thei= r health?

=A9 2010 CTVglobemedia Publishing Inc. All Right= s Reserved.

 

 

Jennifer Whiteside

Senior Officer/Agente principale=

Rese= arch, Job Evaluation and Health & Safety Branch/

<= p class=3DMsoNormal>Service d= e la recherche, de l’=E9valuation des emplois et de la sant=E9-s=E9cu= rit=E9

Canadian Union of Public Employees/SCFP

1375 St. Laurent Blvd., Otta= wa, ON K1G 0Z7

(613) 237-1590, x 248

 

= --_000_8F5713DF2D6DF14293423EF519BFB40D8C5A0763CBE2K7CLUSTERcu_-- From jwhiteside@cupe.ca Tue Dec 14 12:14:01 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oBEHE1VQ004528 for ; Tue, 14 Dec 2010 12:14:01 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Tue, 14 Dec 2010 12:14:01 -0500 From: Jennifer Whiteside To: "healthcare@lists.cupe.ca" Date: Tue, 14 Dec 2010 12:14:01 -0500 Thread-Topic: Mulrony/Kirby op-ed on health care Thread-Index: Acubsk1LTOvfCGZvQQ+pD7t8ufjJag== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C5A07644D@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C5A07644DE2K7CLUSTERcu_" MIME-Version: 1.0 Subject: [CUPE healthcare list] Mulrony/Kirby op-ed on health care X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Tue, 14 Dec 2010 17:14:01 -0000 --_000_8F5713DF2D6DF14293423EF519BFB40D8C5A07644DE2K7CLUSTERcu_ Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Is there a task force in the house?; Canada has the resources to update its= health system. All that's required is the will to do so The Globe and Mail Tue Dec 14 2010 Page: A23 Section: Comment Byline: Michael Kirby And Brian Mulroney Michael Kirby / Chair, Mental Health Commission of Canada and Brian Mulroney / Former prime minister, senior partner at Ogilvy Renault Canada's health-care system is not financially sustainable. We face a crisi= s if efforts are not made to avert disaster. Costs are exploding, increasing by 5 per cent to 7 per cent annually. Yet, = GDP and tax revenue - which finance health care - are growing much more slo= wly. At this rate, health care will make up 80 per cent of total program spendin= g in Ontario by 2030, leaving the rest to be funded from the remaining 20 p= er cent. That clearly isn't feasible. This trend can be seen across all pro= vinces and territories. The need for a frank discussion on our health-care future must no longer be= avoided. What are some of the ideas we could be discussing? Here are a few: We need = to deliver more services outside hospitals in specialty clinics, whether th= ese are publicly or privately operated. We must accelerate the rate of prim= ary care reform. We need to create more long-term care beds to stop tying u= p acute care beds with people who do not need them. Provinces should be encouraged to experiment and not be shackled by outdate= d principles. For instance, with an increasingly aging population, we need = incentives for families to provide home care for elderly relatives, easing = the burden on long-care institutions. Adoption of electronic communications services, including electronic health= records, needs to be drastically accelerated. Our health-care system lags = two decades behind other sectors in use of digital technology. And our licensing procedure and rules around scope of practice need to beco= me more flexible and reflect modern reality. These are important ideas that must be implemented; even then, we will not = have solved health care's financial crisis. We believe Canadians can accept the fact that either health-care services m= ust be reduced or revenues to the system must be increased. There are no ot= her ways to close the gap. Canadians will not want to reduce services. Indeed, there is a compelling a= rgument that services should be increased to at least include prescription = drugs. So the question is: How do we get new money into the health-care sys= tem? Either Canadians can pay increased income or sales taxes to the government,= which would then put the money into health care, or they could contribute = an income-based tax or levy directly to the health-care system. For example, Canada could return to the days when users co-paid the premium= for their insurance coverage, again subject to an income test. Even Tommy = Douglas argued that "there is [a psychological] value in having every indiv= idual make some individual contribution [to health-care costs]" and that "e= ven if we could finance [medicare] without a per capita tax, I personally w= ould advise against it." Whatever change is made, it must meet the two key principles of health care= that Canadians cherish: that everyone is covered, and that no one will suf= fer undue financial hardship as a result of becoming sick. Canadians treasu= re their health-care insurance, which ensures that no one will have to coug= h up cash at the point of service. Every developed Western European country has a health-care system that pres= erves these fundamental principles, yet each funds its system in a slightly= different way. Unfortunately, intelligent debate about what should be done has basically g= round to a halt by incendiary claims that any attempt to update the system = amounts to treason - a repudiation of sacred Canadian values. Critics have = been able to score cheap and easy points by accusing governments of intendi= ng to destroy universal health care should any change to the system be disc= ussed. We must move beyond this impasse and have a national adult discussion that = will allow us to arrive at a common goal: finding new ways to increase fund= ing to our system while preserving the fundamental principles Canadians che= rish. In 2014, Canada's current accord with the provinces will expire. In designi= ng a new agreement, we have an opportunity to create an improved, yet finan= cially sustainable, health-care system to serve the next generation. We nee= d to engage in serious debate now. We both have had some experience with the challenges and complexities of ne= gotiating national agreements with the provinces that affect all Canadians.= We feel that, because the politics of leading change will be virtually imp= ossible for any government (partisanship being what it is), Ottawa needs to= recruit a task force of experienced public- and private-sector people to d= evelop a plan for putting health care on a stable, long-term, financial foo= ting. Canada has the resources required to update its system for the 21st century= ; all that is required is the will of the nation to do so. =A9 2010 CTVglobemedia Publishing Inc. All Rights Reserved. Jennifer Whiteside Senior Officer/Agente principale Research, Job Evaluation and Health & Safety Branch/ Service de la recherche, de l'=E9valuation des emplois et de la sant=E9-s= =E9curit=E9 Canadian Union of Public Employees/SCFP 1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7 (613) 237-1590, x 248 --_000_8F5713DF2D6DF14293423EF519BFB40D8C5A07644DE2K7CLUSTERcu_ Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable

Is there= a task force in the house?; Canada has the resources to update its health = system. All that's required is the will to do so

<= p class=3DMsoNormal>The Globe and Mail
Tue Dec 14 2010
Page: A23
Section:= Comment
Byline: Michael Kirby And Brian Mulroney

<= p class=3DMsoNormal style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt:= auto'>Mich= ael Kirby / Chair, Mental Health Commission of Canada

an= d

Brian Mulroney / Former prime minister, senior partner= at Ogilvy Renault

Canada's health-care system is not fi= nancially sustainable. We face a crisis if efforts are not made to avert di= saster.

Costs are exploding, increasing by 5 per cent to= 7 per cent annually. Yet, GDP and tax revenue - which finance health care = - are growing much more slowly.

At this rate, health car= e will make up 80 per cent of total program spending in Ontario by 2030, le= aving the rest to be funded from the remaining 20 per cent. That clearly is= n't feasible. This trend can be seen across all provinces and territories. =

The need for a frank discussion on our health-care futur= e must no longer be avoided.

What are some of the ideas = we could be discussing? Here are a few: We need to deliver more services ou= tside hospitals in specialty clinics, whether these are publicly or private= ly operated. We must accelerate the rate of primary care reform. We need to= create more long-term care beds to stop tying up acute care beds with people who do not need them. <= o:p>

Provinces should be encouraged to experiment and not be s= hackled by outdated principles. For instance, with an increasingly aging po= pulation, we need incentives for families to provide home care for elderly relatives, easing the burd= en on long-care institutions.

Adoption of electronic com= munications services, including electronic health records, needs to be dras= tically accelerated. Our health-care system lags two decades behind other s= ectors in use of digital technology.

And our licensing p= rocedure and rules around scope of practice need to become more flexible an= d reflect modern reality.

These are important ideas tha= t must be implemented; even then, we will not have solved health care's fin= ancial crisis.

We believe Canadians can accept the fact = that either health-care services must be reduced or revenues to the system = must be increased. There are no other ways to close the gap.

Canadians will not want to reduce services. Indeed, there is a compell= ing argument that services should be increased to at least include prescrip= tion drugs. So the question is: How do we get new money into the health-car= e system?

Either Canadians can pay increased income or s= ales taxes to the government, which would then put the money into health ca= re, or they could contribute an income-based tax or levy directly to the he= alth-care system.

For example, Canada could return to th= e days when users co-paid the premium for their insurance coverage, again s= ubject to an income test. Even Tommy Douglas argued that "there is [a = psychological] value in having every individual make some individual contri= bution [to health-care costs]" and that "even if we could finance= [medicare] without a per capita tax, I personally would advise against it.= "

Whatever change is made, it must meet the two key= principles of health care that Canadians cherish: that everyone is covered= , and that no one will suffer undue financial hardship as a result of becom= ing sick. Canadians treasure their health-care insurance, which ensures tha= t no one will have to cough up cash at the point of service.

Every developed Western European country has a health-care system that= preserves these fundamental principles, yet each funds its system in a sli= ghtly different way.

Unfortunately, intelligent debate a= bout what should be done has basically ground to a halt by incendiary claim= s that any attempt to update the system amounts to treason - a repudiation = of sacred Canadian values. Critics have been able to score cheap and easy p= oints by accusing governments of intending to destroy universal health care= should any change to the system be discussed.

We must m= ove beyond this impasse and have a national adult discussion that will allo= w us to arrive at a common goal: finding new ways to increase funding to ou= r system while preserving the fundamental principles Canadians cherish.

In 2014, Canada's current accord with the provinces will ex= pire. In designing a new agreement, we have an opportunity to create an imp= roved, yet financially sustainable, health-care system to serve the next ge= neration. We need to engage in serious debate now.

We bo= th have had some experience with the challenges and complexities of negotia= ting national agreements with the provinces that affect all Canadians. We f= eel that, because the politics of leading change will be virtually impossib= le for any government (partisanship being what it is), Ottawa needs to recr= uit a task force of experienced public- and private-sector people to develo= p a plan for putting health care on a stable, long-term, financial footing.=

Canada has the resources required to update its system = for the 21st century; all that is required is the will of the nation to do = so.

=A9 2010 CTVglobemedia Publishing Inc. All Rights Rese= rved.

 

 

Jennifer Whiteside

<= span style=3D'font-size:10.0pt'>Senior Officer/Agente principale=

Research, = Job Evaluation and Health & Safety Branch/

Service de la r= echerche, de l’=E9valuation des emplois et de la sant=E9-s=E9curit=E9=

Canadian Union of Public Employees/SCFP

1375 St. Laurent Blvd., Ottawa, ON= K1G 0Z7

(613) 237-1590, x 248

 

= --_000_8F5713DF2D6DF14293423EF519BFB40D8C5A07644DE2K7CLUSTERcu_-- From hfarrow@cupe.ca Tue Dec 14 12:56:16 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oBEHuGn2006127 for ; Tue, 14 Dec 2010 12:56:16 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Tue, 14 Dec 2010 12:56:16 -0500 From: Heather Farrow To: "healthcare@lists.cupe.ca" Date: Tue, 14 Dec 2010 12:56:12 -0500 Thread-Topic: 1000 protest the cuts at Providence Health care Toronto OCHU Thread-Index: AcubuDIALtTZ2zRoQyWL/ELk7OzipQ== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C5A07647D@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: X-MS-TNEF-Correlator: x-cr-hashedpuzzle: AEQE BXdg DWBP DkY1 Dlhb EjfT HIcq HVoF IVRj I0pr JPeI JnDA J8ad Kw1B Lf8x Lqgw; 1; aABlAGEAbAB0AGgAYwBhAHIAZQBAAGwAaQBzAHQAcwAuAGMAdQBwAGUALgBjAGEA; Sosha1_v1; 7; {E56736E5-272C-4269-86B8-802978EE2F18}; aABmAGEAcgByAG8AdwBAAGMAdQBwAGUALgBjAGEA; Tue, 14 Dec 2010 17:56:12 GMT; MQAwADAAMAAgAHAAcgBvAHQAZQBzAHQAIAB0AGgAZQAgAGMAdQB0AHMAIABhAHQAIABQAHIAbwB2AGkAZABlAG4AYwBlACAASABlAGEAbAB0AGgAIABjAGEAcgBlACAAVABvAHIAbwBuAHQAbwAgAE8AQwBIAFUA x-cr-puzzleid: {E56736E5-272C-4269-86B8-802978EE2F18} acceptlanguage: en-US Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C5A07647DE2K7CLUSTERcu_" MIME-Version: 1.0 Subject: [CUPE healthcare list] 1000 protest the cuts at Providence Health care Toronto OCHU X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Tue, 14 Dec 2010 17:56:16 -0000 --_000_8F5713DF2D6DF14293423EF519BFB40D8C5A07647DE2K7CLUSTERcu_ Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: quoted-printable >From http://www.ochu.on.ca/ ******************************************* 1000 Protest the cuts at Providence Healthcare! Toronto Ministry of Health On November 26th over 1000 people rallied outside The Ministry of Health in protest against the cuts at Providence Healthcare and the Liberal Govern= ments attack on senior care ...read more > Heather Heather Farrow Health Care Research Assistant Canadian Union of Public Employees (CUPE) National Office 1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7 hfarrow@cupe.ca www.cupe.ca Fax: 613-237-5508 Tel: 613-237-1590, ext. 320 Cell from Sept. 1 to Nov. 1 2010: 613-552-0858 --_000_8F5713DF2D6DF14293423EF519BFB40D8C5A07647DE2K7CLUSTERcu_ Content-Type: text/html; charset="us-ascii" Content-Transfer-Encoding: quoted-printable

 

From <= a href=3D"http://www.ochu.on.ca/">http://www.ochu.on.ca/

=

*******************************************

 

1000 Protest the cuts at Providence Healthcare!

 

Toronto Min= istry of Health

On November 26th ove= r 1000 people rallied outside The Ministry of Health

in protest against the cuts at Providence Healthcare and th= e Liberal Governments

attack on senio= r care ...read more

<http://www.ochu.on.ca//prov= idence_healthcare.html>

 

 

=

=  

 

 

 =

Heather

 

Heather Farr= ow
Health Care Research Assistant
Canadian Union of Public Empl= oyees (CUPE)
National Office
1375 St. Laurent Blvd., Ottawa, ON K1G= 0Z7  
hfarrow@cupe.ca
www.cupe.ca
Fax: 613-237-5508
Tel:= 613-237-1590, ext. 320

Cell from Sept. 1= to Nov. 1 2010: 613-552-0858

 

 

 

 

 

 

<= o:p> 

= --_000_8F5713DF2D6DF14293423EF519BFB40D8C5A07647DE2K7CLUSTERcu_-- From hfarrow@cupe.ca Wed Dec 15 13:45:32 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oBFIjW4c019942 for ; Wed, 15 Dec 2010 13:45:32 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Wed, 15 Dec 2010 13:45:32 -0500 From: Heather Farrow To: "healthcare@members.cupe.ca" Date: Wed, 15 Dec 2010 13:44:44 -0500 Thread-Topic: Leftwords: Sudbury hospital workers protest bed closures Thread-Index: AcucgyHEIFsVeUhwSeieu1AexZlOtwABQI9g Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C5BE8BAC8@E2K7CLUSTER.cupedom.local> References: <0022150481137d2450049776d38c@google.com> In-Reply-To: <0022150481137d2450049776d38c@google.com> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: text/plain; charset="iso-8859-1" MIME-Version: 1.0 Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by lists.cupe.ca id oBFIjW4c019942 Subject: [CUPE healthcare list] FW: Leftwords: Sudbury hospital workers protest bed closures X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Wed, 15 Dec 2010 18:45:32 -0000 ________________________________ From: noreply+feedproxy@google.com [noreply+feedproxy@google.com] On Behalf Of Leftwords: Defending Public Healthcare [dallan@cupe.ca] Sent: Wednesday, December 15, 2010 1:08 PM To: Heather Farrow Subject: Leftwords: Sudbury hospital workers protest bed closures Leftwords: Sudbury hospital workers protest bed closures [http://gmodules.com/ig/images/plus_google.gif] ________________________________ Sudbury hospital workers protest bed closures Posted: 14 Dec 2010 07:36 PM PST CUPE Local 1623 members protested Monday to demand the North East LHIN consult citizens in northeastern Ontario before it closes 130 hospital beds at the Memorial site of Sudbury Regional Hospital in March. About 190 hospital jobs are at stake, but Dave Shelefontiuk, CUPE Local 1623 president, noted that he is more worried about how the elderly will be taken care of in the future. Shelefontiuk called on the North East Local Health Integration Network to live up to the word "local" in its name and hold a public forum to discuss the closure of transitional beds. When contacted about the protest by the Sudbury Star, the LHIN replied via email, re-issuing a statement the LHIN made Nov. 24. Shelefontiuk adds of the rally: "It was freezing, with the wind chill it was minus 30. But there was some workers from Memorial site there. We are now planning a public forum." dallan@cupe.ca [http://feeds.feedburner.com/~ff/Leftwords?d=qj6IDK7rITs] [http://feeds.feedburner.com/~ff/Leftwords?i=xhLj8i5xwko:cP3IeAzSa7Y:-BTjWOF_DHI] [http://feeds.feedburner.com/~ff/Leftwords?i=xhLj8i5xwko:cP3IeAzSa7Y:F7zBnMyn0Lo] [http://feeds.feedburner.com/~ff/Leftwords?i=xhLj8i5xwko:cP3IeAzSa7Y:gIN9vFwOqvQ] You are subscribed to email updates from Leftwords: Defending Public Healthcare To stop receiving these emails, you may unsubscribe now. Email delivery powered by Google Google Inc., 20 West Kinzie, Chicago IL USA 60610 From jwhiteside@cupe.ca Thu Dec 16 13:33:51 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oBGIXp8s030859 for ; Thu, 16 Dec 2010 13:33:51 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Thu, 16 Dec 2010 13:33:52 -0500 From: Jennifer Whiteside To: "healthcare@lists.cupe.ca" Date: Thu, 16 Dec 2010 13:33:49 -0500 Thread-Topic: New Health Council report on poverty and health Thread-Index: AcudT8hcX+PV120ITmWA9PFUUTNB0A== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C5BDBA319@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C5BDBA319E2K7CLUSTERcu_" MIME-Version: 1.0 Subject: [CUPE healthcare list] New Health Council report on poverty and health X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Thu, 16 Dec 2010 18:33:51 -0000 --_000_8F5713DF2D6DF14293423EF519BFB40D8C5BDBA319E2K7CLUSTERcu_ Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable http://healthcouncilcanada.ca/en/index.php?page=3Dshop.product_details&flyp= age=3Dshop.flypage&product_id=3D134&category_id=3D16&manufacturer_id=3D0&op= tion=3Dcom_virtuemart&Itemid=3D170 Health costs tied to incomes, education; Health Council report calls for ne= w approach to reducing poverty Toronto Star Thu Dec 16 2010 Page: A14 Section: News Byline: Joseph Hall Toronto Star Some 20 per cent of Canada's spiralling health-care costs can be directly a= ttributed to low income and education levels, a new report says. And reducing the innate health risks that poverty carries requires lifting = the socioeconomic status of the country's poorest people, according to a He= alth Council of Canada report. "There is a direct correlation (between) low incomes, low socioeconomic sta= tus and health," council head John Abbott says. "And when you look at the pressures on the health-care system, who is using= the system, it tends to be that very same group." The link between low incomes and chronic diseases such as Type 2 diabetes a= nd heart disease is well established, Abbott concedes. Yet the factors that= make poverty itself a health risk will remain endemic among the poor unles= s the socioeconomic gaps are closed, he says. He says health promotion programs aimed at decreasing high-calorie, process= ed-food diets and increasing exercise levels do not penetrate society's low= er reaches, where education levels tend to be lower. And even if they did, Abbott says, there isn't the financial capacity to ch= ange to a healthier lifestyle. "In the short term ... we need to be more focused in our health prevention = and health promotion strategies," Abbott says. "But for the longer term we have to address the underlying conditions in wh= ich people find themselves." Abbott says solutions must come not just from national and provincial healt= h ministries, but from all government agencies that can have a hand in pove= rty reduction. "We need all the ministries really sitting around and saying, 'Look, what c= an we do, what can we contribute or should we contribute to start to rebala= nce this in Canada?'" Abbott says. "We need the health minister at the table, we need, obviously, the educatio= n ministry at the table, but we need the housing minster at the table, the = industry minister at the table." Abbott says new government initiatives should be assessed, in part, on thei= r likely impact on health, particularly in relation to socioeconomic factor= s. =A9 2010 Torstar Corporation Jennifer Whiteside Senior Officer/Agente principale Research, Job Evaluation and Health & Safety Branch/ Service de la recherche, de l'=E9valuation des emplois et de la sant=E9-s= =E9curit=E9 Canadian Union of Public Employees/SCFP 1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7 (613) 237-1590, x 248 --_000_8F5713DF2D6DF14293423EF519BFB40D8C5BDBA319E2K7CLUSTERcu_ Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable

http://healthcouncilcanada.ca= /en/index.php?page=3Dshop.product_details&flypage=3Dshop.flypage&pr= oduct_id=3D134&category_id=3D16&manufacturer_id=3D0&option=3Dco= m_virtuemart&Itemid=3D170

 

=  

Health costs tied to = incomes, education; Health Council report calls for new approach to reducin= g poverty

Toronto Star
Thu Dec 16 2= 010
Page: A14
Section: News
Byline: Joseph Hall Toronto Star

Some 20 per cent of Canada's spiralling health-care costs ca= n be directly attributed to low income and education levels, a new report s= ays.

And reducing the innate health risks that poverty c= arries requires lifting the socioeconomic status of the country's poorest p= eople, according to a Health Council = of Canada report.

"There is a direct cor= relation (between) low incomes, low socioeconomic status and health," = council head John Abbott says.

"And when you look a= t the pressures on the health-care system, who is using the system, it tend= s to be that very same group."

The link between low= incomes and chronic diseases such as Type 2 diabetes and heart disease is = well established, Abbott concedes. Yet the factors that make poverty itself= a health risk will remain endemic among the poor unless the socioeconomic = gaps are closed, he says.

He says health promotion prog= rams aimed at decreasing high-calorie, processed-food diets and increasing = exercise levels do not penetrate society's lower reaches, where education l= evels tend to be lower.

And even if they did, Abbott say= s, there isn't the financial capacity to change to a healthier lifestyle. <= o:p>

"In the short term ... we need to be more focused in= our health prevention and health promotion strategies," Abbott says. =

"But for the longer term we have to address the und= erlying conditions in which people find themselves."

Abbott says solutions must come not just from national and provincial hea= lth ministries, but from all government agencies that can have a hand in po= verty reduction.

"We need all the ministries really= sitting around and saying, 'Look, what can we do, what can we contribute o= r should we contribute to start to rebalance this in Canada?'" Abbott = says.

"We need the health minister at the table, we= need, obviously, the education ministry at the table, but we need the hous= ing minster at the table, the industry minister at the table."

Abbott says new government initiatives should be assessed, in p= art, on their likely impact on health, particularly in relation to socioeco= nomic factors.

=A9 2010 Torstar Corporation

 

&n= bsp;

Jennife= r Whiteside

Senior Officer/Agente principale

Research, Job Evaluation and = Health & Safety Branch/

Service de la recherche, de l̵= 7;=E9valuation des emplois et de la sant=E9-s=E9curit=E9<= /p>

Canadian Union of = Public Employees/SCFP

1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7=

(613) 237-= 1590, x 248

 

=
= --_000_8F5713DF2D6DF14293423EF519BFB40D8C5BDBA319E2K7CLUSTERcu_-- From jwhiteside@cupe.ca Mon Dec 20 09:30:40 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oBKEUeGl029322 for ; Mon, 20 Dec 2010 09:30:40 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Mon, 20 Dec 2010 09:30:41 -0500 From: Jennifer Whiteside To: "healthcare@lists.cupe.ca" Date: Mon, 20 Dec 2010 09:30:40 -0500 Thread-Topic: REAL POLITICS / FINANCE MINISTERS HEAD FOR A SHOWDOWN WITH OTTAWA Thread-Index: AQHLoFJ6rKQ9IlCylEiSR95iR+62Ig== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C5BEA9CFA@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-CA X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: text/plain; charset="us-ascii" MIME-Version: 1.0 Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by lists.cupe.ca id oBKEUeGl029322 Subject: [CUPE healthcare list] REAL POLITICS / FINANCE MINISTERS HEAD FOR A SHOWDOWN WITH OTTAWA X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Mon, 20 Dec 2010 14:30:41 -0000 REAL POLITICS / FINANCE MINISTERS HEAD FOR A SHOWDOWN WITH OTTAWA The Globe and Mail Mon Dec 20 2010 Page: A4 Section: National News Byline: Karen Howlett Canada's provinces are bracing for a showdown with the Harper government when finance ministers meet in Kananaskis, Alta., on Monday. Provincial ministers will present a united front in a potentially divisive debate over a federal funding accord for health care set to expire in 2013-14. They will push federal Finance Minister Jim Flaherty not to apply the brakes to transfer payments. But on other agenda items, don't expect the provinces and territories to speak with one voice. In fact, there will be plenty of discord among the regions over such thorny topics as tackling deficits, a proposed national securities regulator and pension reform. STOP LECTURING ME Mr. Flaherty set the tone for the meeting by telling the country's provincial governments last week to speed up their plans to eliminate their deficits and balance their books by 2015. That did not go over well with Ontario Finance Minister Dwight Duncan. He is grappling with a projected deficit of $18.7-billion for fiscal 2010-11, the largest of any province, and is expecting Ontario to remain in the red until 2018. Before he starts telling others what to do, Mr. Duncan said, Mr. Flaherty should do a better job of managing his own financial affairs. He said Ottawa has continually understated the size of its deficit, now pegged at $55.6- billion. "I don't think the pot should call the kettle black when it comes to deficits," Mr. Duncan said. "The fellow with the biggest deficit shouldn't be the one lecturing me." On this point, Mr. Duncan could end up as the odd man out among his provincial peers. Other finance ministers said Mr. Flaherty has every right to set overall fiscal direction for Canada's provinces and territories. Alberta Finance Minister Ted Morton suggested that if Ontario and Quebec do not get their deficits under control, Canada could head in the same direction as the European Union, where leaders are grappling with countries threatened by a debt crisis. DIVVYING UP THE PIE Mr. Flaherty will feel the heat from provincial ministers as they urge him not to curtail federal transfers for health care. The transfers are crucial because about 20 cents of every dollar the provinces spend on health care comes from Ottawa. They are slated to receive annual increases of 6 per cent until the Canada Health Transfer program expires in fiscal 2013-14. Mr. Flaherty has hinted that he wants to tie the increase in transfers to inflation and economic growth, both of which are projected to remain in the range of 0 to 2 per cent in coming years. The provinces will fight hard against that. Mr. Morton also runs the risk of igniting tensions with other provinces because he will argue that Ottawa is short-changing Alberta. His province receives lower per capita funding for health care than other regions, he argues. Mr. Duncan said Canada's governments need to confront the challenges facing health care, which currently consumes about 40 cents of every dollar the provinces spend on programs. "The discussions are going to be difficult. They are going to be chock full of controversy," he said. "But we can't shirk the debate." BICKERING MINISTERS Mr. Flaherty will have few allies around the table when he discusses his plans to create a national securities regulator. Only Ontario enthusiastically supports replacing Canada's 13 provincial and territorial regulators with a single entity. British Columbia and Nova Scotia are on board, but their support is conditional. Three provinces - Alberta, Manitoba and Quebec - are staunchly opposed. Mr. Duncan warned last month that the plan is "falling apart." Alberta and Saskatchewan have had preliminary talks about the creation of a western regional regulator. And Nova Scotia has set out five conditions for supporting a single regulator, including compensation for lost revenue of about $10- million a year, and recognition that the province has jurisdiction to regulate securities markets. "We don't want the federal government to assert exclusive jurisdiction over securities," said Nova Scotia Finance Minister Graham Steele From jwhiteside@cupe.ca Mon Dec 20 10:59:22 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id oBKFxMIZ000815 for ; Mon, 20 Dec 2010 10:59:22 -0500 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Mon, 20 Dec 2010 10:59:22 -0500 From: Jennifer Whiteside To: "healthcare@lists.cupe.ca" Date: Mon, 20 Dec 2010 10:59:21 -0500 Thread-Topic: Canadians going under the knife unnecessarily; Millions of dollars could be saved by eliminating ineffective surgeries Thread-Index: AQHLoF7d+GkdnTszyUCUwbR2yx1KIw== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C5BEA9D02@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-CA X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: text/plain; charset="iso-8859-1" MIME-Version: 1.0 Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by lists.cupe.ca id oBKFxMIZ000815 Subject: [CUPE healthcare list] Canadians going under the knife unnecessarily; Millions of dollars could be saved by eliminating ineffective surgeries X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Mon, 20 Dec 2010 15:59:22 -0000 Canadians going under the knife unnecessarily; Millions of dollars could be saved by eliminating ineffective surgeries Toronto Star Fri Dec 17 2010 Page: A6 Section: News Byline: Megan Ogilvie Toronto Star Canada could be saving millions of dollars and putting fewer people under the knife by reducing the number of potentially unnecessary surgeries done in the country each year, a new report suggests. An annual report by the Canadian Institute for Health Information (CIHI) found the country could save up to $180 million a year if doctors consistently offered the most appropriate and most cost-effective procedures to their patients. The report found vast discrepancies in the number of caesarian sections and hysterectomies performed in Canada, suggesting some of those procedures are not needed. It also found too many procedures are still being done despite evidence that indicates they don't help, such as surgery for knee pain. The report highlights areas where efficiencies can be found in how medical treatments are delivered, said Tom Closson, president of the Ontario Hospital Association. "This report suggests great opportunities of how we could be delivering health care a lot more cheaply in this province," he said. For example, last year in Ontario the rate of first-time caesarian sections was 19.6 per cent of all deliveries. If the rate could be lowered to match Manitoba's rate of 14 per cent, the lowest in Canada, Ontario would do 7,200 fewer surgeries and save $16.2 million. According to CIHI, caesarian deliveries can cost hospitals twice as much in obstetric care than if a woman delivers her baby naturally. Also, if Ontario reduced its hysterectomy rate (in 2008-09 it was 330 per 100,000 women) to B.C.'s rate (311 per 100,000 women), the province could save $5.8 million. Wide variation in surgical rates from region to region are a sign that questions should be raised, said Kira Leeb, director of health systems analysis at CIHI. "What we do know is when we see significant or dramatic variations in rates that are two-, three- and four-fold differences, those are places where you can start asking questions about the care people are getting." Leeb said the report should prompt a conversation about the appropriateness of care in Canada. The CIHI report, Health Care in Canada 2010, found, among other things: Across Canada in 2008-09, rates of caesarian sections varied widely, with a high of 23 per cent of deliveries in Newfoundland and Labrador and a low of 14 per cent in Manitoba. Rates for hysterectomies varied threefold, with a high of 512 per 100,000 women in P.E.I. and a low of 185 per 100,000 in Nunavut. The study also found hysterectomy rates were 46 per cent higher for women living in rural areas than for women living in urban areas. On any given day in Canada, 7,550 beds in acute care hospitals are occupied by patients waiting to be transferred to a long-term care home, rehabilitation facility or other more appropriate setting. More than 3,600 Canadians had surgery for knee pain in 2008-09, even though studies have shown the procedure is little more than a temporary fix. Last year, Canada could have saved $4 million by not performing these procedures. More than 1,000 vertebroplasties - where fractured vertebra are filled with synthetic material - were performed in 2008-09 in Canada, an increase over the 600 procedures done two years earlier. Recent studies have suggested the procedure is largely ineffective. Closson said Ontario does not have the resources to waste on potentially unnecessary surgeries. Each of the examples highlighted by CIHI seems small on their own, but together could save the province - and Canada - significant health-care costs, he said. "It's been shown that if the government stops funding something, then the providers don't provide it," Closson said. "I would say for the knee and spine procedures, a good solution would be to stop funding them." © 2010 Torstar Corporation