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Japan is far from alone. Dementia is increasing across the globe - 47 million people already live with the disease, with more than 130 million projected by 2050. But the first waves have crashed over Japan. When it comes to dementia - a group of disorders affecting memory and cognition, for which there is no known cure - age is the greatest risk factor. No country has gotten older faster than Japan, the world's first "super-aged" nation. In the early '60s, Japan was the youngest of today's G7 countries. Now, it is the oldest - a dramatic shift fuelled by plummeting birth rates and the world's highest life expectancy, according to the World Health Organization, with an average of 84 years (in Canada, it's 82).

A quarter of Japan's 128 million people are already elderly, meaning over 65. By 2060, the elderly will make up 40 per cent of the population. Many will spend their dying days addled by dementia, which already affects 4.62 million Japanese. Ten years from now, an estimated 7.3 million people in Japan will have dementia - more people than live in Hong Kong, Rio de Janeiro or the entire GTA. "The impact will be so huge," said Dr. Koji Miura, director general of the Ministry of Health, Labour and Welfare's bureau for the elderly. "The burden on younger people is very rapidly increasing. If we don't do anything, society will be in trouble." Last year, more than 10,700 people with dementia went missing in Japan. The vast majority were found - some dead - but 168 were not. Violent crimes fuelled by kaigo jigoku, the Japanese term meaning "caregiver hell," are increasingly making headlines.

In July, 83-year-old Kyuji Takahashi was accused of stabbing his wife. He allegedly told police: "My wife has dementia and I am worn out from looking after her." Right now, these stories are still the exception, but Japan's challenge is to stop a public health crisis from unspooling - while battling the world's highest debt.

There is little any government can do about changing the course of dementia. The only thing Japan can change is Japan. "We see the crisis point as 2025," said Mayumi Hayashi, a research fellow with the Institute of Gerontology at King's College London. "And to cope with that crisis point, Japan is trying to create a society where everybody contributes and people with dementia have a better experience and quality of life." Grassroots efforts play a leading role in building this new society, with volunteers spearheading efforts to increase awareness and to form networks to find wanderers - those who go missing after becoming disoriented or confused.

Over the past 15 years, Japanese policy-makers have also changed everything from the social welfare system to the very word for "dementia." Before, the commonly used term was chiho, meaning "idiocy" or "stupidity," even in medical literature. In 2004, the government made an unusual announcement: chiho would know be known as ninchisho, meaning "cognitive disorder." "After the change of the name, the knowledge and acceptance of dementia has spread widely all over this country," said Dr. Takashi Asada, a psychogeriatrician who was a member of the renaming committee.

Japan's all-hands-on-deck dementia strategy - introduced in 2012 and revised last year - involves not just the health ministry but 11 other ministries and agencies. The strategy funds research but also prioritizes early detection, training front line health workers, support for caregivers and creating "dementia-friendly" communities. But the single most important - and radical - change Japan has made to improve dementia care came in 2000, when the government introduced mandatory long-term care insurance.

A primary goal was to help seniors live more independently and reduce the burden on relatives - particularly women, who are often the caregivers. So unlike long-term care insurance in countries like Germany, which offer cash, Japan's system offers services - and consumer choice. The scheme works like this: at age 40, every Japanese resident pays a monthly insurance premium. When they turn 65 - or get sick with an aging-related disease - they become eligible for a range of services: everything from dementia daycare to lunch delivery and bathing assistance. Depending on income, users also pay a 10- or 20-per-cent service fee - a measure that discourages overuse. This system also created something crucial in the field of long-term care: a market.

"Lots and lots of services developed very rapidly," said John Creighton Campbell, a University of Michigan professor emeritus and expert on Japan's long-term care system. "Without the long-term care insurance system, they wouldn't be conceivable." Campbell believes Japan is "better than any other place in the world for dementia care." Of course, Japan's unique and complicated system won't necessarily translate in other countries and significant issues remain, particularly when it comes to financial sustainability; the number of Japanese using long-term care has more than doubled since the program began, with 5.6 million people accessing it in 2013. Japanese families also continue to demand institutionalized care for their relatives and caregiver burnout is still a growing problem. But Japan's trials and errors are instructive for other nations, marching their own paths toward the destination of super-aged. The country is already living the future that countries like Canada are bracing for.

In September, national anxiety followed Statistics Canada's announcement that, for the first time ever, Canada's elderly population had surpassed its population of children. Japan hit this same milestone - in 1997. Clearly, there is good reason to keep an eye toward the Land of the Rising Sun, the Lancet medical journal recently suggested. "How Japan addresses the challenges - and opportunities - posed by a rapidly aging society will become a model for other countries facing their own demographic time bombs."

Dementia by the numbers 61,568 Japanese centenarians today 153 Japanese centenarians in 1963 1 in 5 Elderly Japanese who will have dementia in 2025 1 million

Nurses and care workers needed by 2025 to deal with dementia 40% Percentage of Japan's population that will be over 65 in 2060 15,731 Number of over-65 Japanese abused by families or relatives, according to a 2013 survey 14.5 trillion yen

Cost of dementia on the Japanese economy in 2013 6.2 trillion yen Estimated cost of informal care for de

24.3 trillion yen Estimated cost of dementia in 2060

Elderly people work out with wooden dumbbells in Tokyo to celebrate Japan's Respect for the Aged Day in September. A quarter of Japan's 128 million people are over 65. By 2060, that figure will be 40 per cent. • Nobuko Tsuboi runs a seniors daycare, covered by Japan's long-term care insurance. • Tomofumi Yamamoto is staying fit in hopes of warding off dementia.

August 21, 2015

But Japan took a few key initiatives in 2000 that are widely admired among long-term care policy experts.

A 1994 survey said one in two family caregivers in Japan had abusively treated their frail older relatives; one in three reported feelings of “hatred.” Elders were shunted into hospitals (called “social hospitalization”) since Japan offered free hospital care to frail elderly — an expensive government policy.

Public pressure propelled reform and Japan came up with a public, mandatory long-term care insurance system in 2000.

The universal elder program is funded half by general tax revenues and half by a combination of payroll taxes and additional insurance premiums paid by everyone 40+.

The clothes retailer Uniqlo has begun experimenting with a four-day, 10-hours-per-day workweek in Japan, for instance.

“Every major developed country in the world has adopted some measure of long-term care social insurance,” says Howard Gleckman, senior fellow at the Urban Institute in Washington, D.C. “Except the U.S., and maybe Britain.” (Britain has passed, but not implemented, a public universal catastrophic long-term care policy.)

Beneath the political radar, experts at places like the Urban Institute, the Bipartisan Policy Center and the Long-Term Care Financing Collaborative have been working on some ideas. They’re drawn from the ranks of health care providers, the insurance industry, the government and elder care organizations. And they’re well aware of what has worked in Japan and other countries.

Three countries we have written about in a new paper for the Macdonald-Laurier Institute - Japan, Korea and Taiwan - are not typically where Canadians look for public policy solutions. They are far away and have very different cultures and histories. But they, like other developed countries, face similar health care challenges.

apan, Korea and Taiwan are leading users of health-care technologies. Their overall health outcomes are comparable to, if not better than, those in Canada, and they do this spending a lower percentage of their GDP on health care than we do. These countries have universal public health care - something Canadians are justifiably proud of - though Japan achieved this about a decade before Canada. These countries' plans cover physician visits and hospitalization, but also dental care and outpatient prescription drugs.

What are the lessons for Canada? First, the countries' policy-makers actively learned from abroad. Japan looked to Germany as it started modernizing nearly 150 years ago; recently Korea and Taiwan studied what worked, or not, elsewhere as they developed their systems. More importantly, politicians and bureaucrats had the fortitude to implement necessary reforms. Changes were made often in the face of protests by entrenched stakeholders, including physicians. And programs were reviewed soon after implementation, making modifications when problems arose. This is in stark contrast to Canada's embrace of the status quo.

More specifically, the systems in Japan, Korea and Taiwan suggest that copayments may be useful to help moderate demand and help fund care. They can be applied and properly designed to recognize income disparities. In Canada's case, they could increase equity if used to help extend coverage to drugs and dental care for more people. Unlike in Canada, where most hospitals are de facto public, in these countries privately-owned hospitals, many of them non-profit, compete with public hospitals, creating dynamism in the sector.

Finally, and most significantly, these proactive governments have moved to introduce Long-Term Care Insurance (LTCI) to address a very predictable problem. Very few people buy LTCI on their own, mostly because they can't predict their future needs and expect long-term care be covered by public funds. However, estimates suggest that about 70 per cent of people who reach 65 will need LTC at some time. In Japan and Korea, and likely soon in Taiwan, LTCI creates distinct insurance funds devoted to supporting appropriate care at home and in institutions.

Asia deserves the attention it is getting. As we build economic links, we should also look for the good ideas of our new partners that can make our health and long-term-care systems better. Ito Peng is Director of the Centre for Global Social Policy at the University of Toronto. James Tiessen is director of the School of Health Services Management at the Ted Rogers School of Management at Ryerson University. They are co-authors of the MLI report An Asian Flavour for Medicare (macdonaldlaurier.ca).

"Of course, there is no such thing as a perfect health system and it certainly doesn't reside in any one country," Mark Britnell, global chairman for health at the consulting giant KPMG, writes in his new book, In Search of the Perfect Health System. "But there are fantastic examples of great health and health care from around the world which can offer inspiration."

As a consultant who has worked in 60 countries - and who receives in-depth briefings on the health systems of each before meeting clients - Mr. Britnell has a unique perspective and, in the book, offers up a subjective and insightful list of the traits that are important to creating good health systems. If the world had a perfect health system, he writes, it would have the following qualities: the values and universal access of the U.K.; the primary care of Israel; the community services of Brazil; the mentalhealth system of Australia; the health promotion philosophy of the Nordic countries; the patient and community empowerment in parts of Africa; the research and development infrastructure of the United States; the innovation, flair and speed of India; the information, communications and technology of Singapore; the choice offered to patients in France; the funding model of Switzerland; and the care for the aged of Japan.

In the book, Mr. Britnell elaborates on each of these examples of excellence and, in addition, provides a great precis of the strengths and weaknesses of health systems in 25 countries. The chapter on Canada is appropriately damning, noting that this country's outmoded health system has long been ripe for revolution, but the "revolution has not happened."

Why? Because this country has a penchant for doing high-level, in-depth reviews of the health system's problems, but puts all its effort into producing recommendations and none into implementing them. Ouch. "Canada stands at a crossroads," Mr. Britnell writes, "and needs to find the political will and managerial and clinical skills to establish a progressive coalition of the willing."

The book's strength is that it does not offer up simplistic solutions. Rather, it stresses that there is no single best approach because all health systems are the products of their societies, norms and cultures. One of the best parts of the book - and quite relevant to Canada - is the analysis of funding models. "The debate about universal health care is frequently confused with the ability to pay," Mr. Britnell writes. He notes that the high co-payments in the highly praised health systems of Asia would simply not be tolerated in the West.

But ultimately what matters is finding an approach that works, not a perfect one: "This is the fundamental point. There is no such thing as free health care; it is only a matter of who pays for it. Politics is the imperfect art of deciding 'who gets what, how and when.' " The book stresses that the challenges are the same everywhere: providing high-quality care to all at an affordable price, finding the work force to deliver that care and empowering patients. To do so effectively, you need vision and you need systems. Above all, you need the political will to learn from others and put in place a system that works.

£7 an hour, receives an extra £1 an hour for a night shift and £2 an hour for weekends.

"The NHS encourages you to have these NVQs, all this training, improve your knowledge, and then they [private care companies] come along and it all comes to nothing.

Care UK expects to make a profit "of under 6%" by the end of the three-year contract

£700,000 operating profit in the six months between September last year and March this year,

In 1993 the private sector provided 5% of the state-funded services given to people in their homes, known as domiciliary care. By 2012 this had risen to 89% – largely driven by the local authorities' need for cheaper ways to deliver services and the private sector's assurance that they could provide the answer. More than £2.7bn is spent by the state on this type of care every year. Private providers have targeted wages as a way to slice out profits, de-skilling the sector in the process.

1.4 million care workers in England are unregulated by any professional body and less than 50% have completed a basic NVQ2 level qualification, with 30% apparently not even completing basic induction trainin

Today 8% of care homes are supplied by private equity-owned firms – and the number is growing. The same is true of 10% of services run for those with learning disabilities

William Laing

report on private equity in July 2012

"It makes pots of money.

Those profits – which are made before debt payments and overheads – don't appear on the bottom line of the health firms' company accounts, and because of that corporation tax isn't paid on them.

Some of that was in payments on loans issued in Guernsey, meaning tax could not be charged. Its sister company, Silver Sea, responsible for funding the construction of Care UK care homes, is domiciled in the tax haven of Luxembourg

Bridgepoint

.voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_1 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_1 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_1 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_1 .ob_clear{clear:both;} .AR_1 .ob_amelia, .AR_1 .ob_logo, .AR_1 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_1 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_1 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_1 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_1:hover .ob_amelia, .AR_1:hover .ob_logo, .AR_1:hover .ob_text_logo{background-position:center bottom;} .AR_1 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } More from the guardian Rogeting: why 'sinister buttocks' are creeping into students' essays 08 Aug 2014 Theatre's decision to ban Jewish film festival is 'thin end of wedge' 09 Aug 2014 Sir Paul Nurse: 'I looked at my birth certificate. That was not my mother's name' 09 Aug 2014 Adventures in contraception: eight women discuss their choices 10 Aug 2014 Child prison deaths 08 Aug 2014 [?] .voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_2 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_2 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_2 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_2 .ob_clear{clear:both;} .AR_2 .ob_amelia, .AR_2 .ob_logo, .AR_2 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_2 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_2 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_2 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_2:hover .ob_amelia, .AR_2:hover .ob_logo, .AR_2:hover .ob_text_logo{background-position:center bottom;} .AR_2 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } /* updated via mysql on 2014-04-08 */ .AR_2 .ob_what { display: block; } /* added via mysql on 2014-06-20 */ .OUTBRAIN:hover .ob_what a { text-decoration: underline; } .ob_box_cont.AR_2 { padding-bottom: 5px; } /* end mysql add */ /* added via mysql on 2014-07-14 */ .AR_2 .ob_org_header span { color: #999; font-family: arial; font-size: 11px; font-weight: normal; display: block; } /* end 2014-07-14 */ More from around the webPromoted content by Outbrain http://paid.outbrain.com/network/redir?p=0iZOm4XuGW6R5uuT6ZFciNevzJlIfmxs0SRwpiMrH7gWrMXoPie4vIA9PlhaEW%2BXNi57pCgl9j8yOE3HuJT75pwCLNj4n18v3EKQDEV0YFQjOBxc46mOs

the price tag — an estimated $1.2 trillion over the next 35 years

backed up by a 27-page study

The final speaker was Michael Decter

The challenge is not insurmountable, he assured the audience. Germany has done it. Several other nations — Japan, Korea, the Netherlands and Luxembourg — are following the same path. But it will require a mix of public and private funding.

What all three speakers agreed on was that it is critical to get Canadians thinking and talking about this issue. The existing elder care system is breaking under the strain — the waiting list for a spot in a nursing home is approximately 20,000 in Ontario alone — and the baby boom hasn’t even hit its heavy-need years. Home care is severely underfunded. And hospitals, the most expensive option, can’t accommodate an influx of frail, elderly patients.

Though Canadians’ public health care costs are down, we still spend a lot, $155 billion last year. And when you include private spending – all your out-of-pocket and private-insurance health costs – the total was $219 billion.

Frightening Canadians about “unsustainable” health care might be nonsense, but not pointless. If you frighten people enough they’ll even cheer a government that cuts health care. It’s been successful before.

The 5% shift was good news for private health companies. It gave Chretien room to make big corporate tax cuts. Everybody wins – except Canadians. And among us, sick, older, poor and working class Canadians were surely hit hardest.

But now at 71% publicly-paid, Canadian health care is more private than Germany (76% public), France (79% public), Japan (83%) or the UK (87%).

Remember, Trudeau’s first act in the Commons was to spend $4 billion a year on a tax cut with maximum benefit to incomes between $90,000 and $200,000.

he APEC hub, which will be hosted at the University of British Columbia in collaboration with the University of Alberta and the Mood Disorders Society of Canada (MDSC), will serve as a permanent and far-reaching working effort between Canadian mental health researchers across the country and their counterparts in the United States, China, Japan, South Korea, Australia and more than a dozen other economies of the Asia-Pacific region.

in 1979, 225 of every 100,000 Canadian deaths could have been avoided by preventing a disease or injury. By 2008, the rate had fallen to 119 per 100,000 deaths — a drop of 47 per cent

Improvements in getting people timely and effective healthcare also helped to reduce untimely deaths. The rate for this measure dropped by 56 per cent in three decades, from 149 per 100,000 Canadians in 1979 to 66 per 100,000 in 2008.

the drop in preventable deaths was largely due to fewer people dying from circulatory diseases, including heart disease

gains in cancer survival rates, which are improving all the time, and policy changes to boost public safety and reduce injury, such as seatbelt laws and other driving legislation, have been the other big factors

Canada ranked third lowest in preventable death rates, coming behind Japan and France

large differences between socioeconomic groups. Specifically, the rate of preventable deaths for people living in the least affluent neighbourhoods was double that of people living in the most affluent neighbourhoods

Sarah Gregory is a researcher in health policy at The King’s Fund.

No other country recorded such a large percentage increase, although a few other rich countries also failed to keep maternal mortality in check. In Canada, deaths rose from 6 to 11 per 100,000 births between 1990 and 2013. Many European countries and Japan have mortality rates in single figures.

China has cut its rate by two-thirds since 1990, with 32 women dying for every 100,000 live births in 2013.

Maternal mortality has worsened in a handful of poor countries — the Philippines, Suriname, Cuba, Venezuela and Tonga.

"The current health system is reaching its limit," Judit Rius, manager of Médecins Sans Frontières/Doctors Without Borders Access Campaign in the United States, told IPS. "It is failing patients with rare diseases, for example." "That's why the TPP could be a tool for promoting health and improving innovation and access, instead of fostering failed, costly systems based on monopolistic patents," she added.

The TPP free trade accord went into force between Brunei, Chile, New Zealand and Singapore in January 2006. Eight other countries are now negotiating their incorporation: Australia, Canada, Japan, Malaysia, Mexico, Peru, the United States and Vietnam.

Canada's median age is now about 40, and heading upward. It was 26 in 1971. The median age could be worse; it's 46 in Germany and higher still in Japan. The total fertility rate (TFR) is about 1.6 children per woman. Population replacement rate is two per woman. As a result, and even after accounting for immigration, the annual population growth rate for the next half-century will be the lowest in Canadian history. More seniors means fewer people in the labour force, even if a few seniors keep working into their late 60s. The ratio therefore between those in the work force and those outside of it will change dramatically over time. What used to be a 5-to-1 ratio will slip to something like 2.5 to 1.

Both the federal Department of Finance and the Parliamentary Budget Office have alerted us to what lies ahead: Economic growth will be slower, the burden of expenditures on government for seniors programs will increase and government revenues will be stretched. It's arithmetic, not politics. The arithmetic of aging is politically uncomfortable. It's especially uncomfortable for provinces, the level of government that delivers labour-intensive services such as health, education, policing and welfare. The provinces' burden will also rise because, unless a new federal government changes the decision, Ottawa's yearly transfers to provinces for health care will increase less rapidly past 2017. The result will be a hole of some billions of dollars. Aging with its higher costs and lower growth is the context by which the electoral promises of every party might usefully be judged. They are all catering to today's middle class, fighting over which cares the most about their "anxieties." And they are fixated on seniors, too, since seniors vote.

You could say that the NDP daycare promise is future-oriented, in that if fully implemented it would encourage more women to work, which in turn would ease the ratio of those adults working to those who are not. It might up the fertility rate, which would help, as it has in Quebec. You could say that the Conservatives' decision to raise the age level for receipt of the Old Age Supplement to 67 from 65 recognizes that people are living much longer than when the OAS was implemented. (Women in the next decade are expected to have a life expectancy of 87.) All parties pledge to stoke up the engines of economic growth: in the NDP's case by lowering the small-business tax rate by two points. Except the party then proposes to raise the tax for large companies by two points, an impediment to creating more large companies of the kind Canada needs in a global economy.

Pledges to increase manufacturing are not worth much, since manufacturing has been more or less in decline in North America and Europe (except Germany) for a long time, for reasons rather outside the capacity of governments to influence, except by subsidies and other forms of direct or indirect help. Promises predictably have been pouring forth from every party, without any of them yet providing some sort of overall accounting for how they will be financed. Even when (if?) this accounting is provided, the chances are excellent it will be based on falsely optimistic assumptions about economic growth and the revenues it will provide. The demographic shift now beginning will likely mock those assumptions.

In practical terms, it means the economy is creating jobs - but not good ones. It means that consumers are relying on credit cards rather than wages to buy what they need. It means that entire sectors of the economy are out of whack. In Canada, this expresses itself as a reliance on notoriously volatile commodities such as oil. When oil and other commodity prices are up, Canada does OK. When they fall, as is happening now, the reverse occurs. In his stump speech, Mulcair rightly criticizes the Harper Conservatives for failing to pay enough attention to manufacturing. He is also correct when he says that too many of the jobs created are low wage and part time. But his solution to date - give tax breaks to small business and manufacturers - is singularly inadequate. Small businesses, almost by definition, require low-wage, part-time, non-union workers. Encouraging small business may create jobs. But most will be of the precarious variety that Mulcair decries.

Tax breaks to manufacturers, meanwhile, may encourage them to expand production - but only if they have customers willing to buy. As Mulcair correctly points out, too many corporations are refusing to reinvest their profits. Logically, that means government should take up the slack - even if this leads to fiscal deficits in the short term. But Mulcair pledged Tuesday that an NDP government would not run deficits. Trudeau is less categorical. He says a Liberal government would balance the books over the long haul. But, wisely, he has not ruled out deficit spending in the short run. Trudeau's real problem is that his solution to the crisis is also insufficient.

He says his Liberals would take money from the very-well-to-do and give it to those earning between roughly $50,000 and $200,000. Trudeau refers to this as helping the middle class. Making the rich pay is not a bad idea - although the economy would get more of a boost if the poor, who spend most of what they earn, received the money instead. But how would Trudeau lessen Canada's reliance on oil? How would he protect us from the kinds of shocks that roiled the world this week? How would he promote manufacturing or high-wage, new-technology industries? So far, the Liberals haven't said.

Finally, the Conservatives. Harper's party does not fit the cartoon stereotypes. It hasn't embraced the harsh austerity favoured in Europe. Rather, the Harper government has followed a kind of austerity-light regimen. It has penalized the unemployed but left welfare and medicare alone (although the Conservatives have said they will cut health spending if re-elected). Both opposition parties criticize the Conservatives for having run deficits since 2008. But given the weakness of the economy, it was the right thing to do. Arguably, Harper's real sin on this front was to move too quickly to balance the books. Still, the prime minister has much to answer for. One example: His government used the temporary worker program to suppress wages, relenting only when the politics became impossible. But his biggest mistake was to rely on oil. When petroleum prices were high and China booming, this was sufficient to hide the economy's fatal flaws. Now it is not. Thomas Walkom's columns appear in Torstar newspapers.

While the agricultural issues may dominate debate, it is only one unresolved issue of many. Indeed, the concerns associated with the agreement go far beyond the supply of products such as milk and chickens. First, a recently leaked version of the intellectual property chapter revealed that Canada would have to make significant changes to its copyright and patent rules. The TPP requires Canada to extend the term of copyright to life of the author plus an additional 70 years. The law is currently set at life of the author plus 50 years, which meets the international standard found in the Berne Convention.

The extension in the term of copyright, which has generated fear in other TPP countries such as Japan, New Zealand and Malaysia, would mean that no new works would enter the public domain in Canada for decades. The result would be higher costs for both consumers and educational institutions, with most of the additional royalties flowing out of the country. The deal reportedly also penalizes Canada for its "notice-and-notice" system for claims of infringement on the Internet. The system has been in effect since the start of the year and has been credited with significantly reducing Canadian piracy rates. The Canadian approach differs from that found in the U.S., however, leading to additional demands that Canada establish enforcement provisions targeting Internet providers and search engines.

The patent provisions in the TPP have sparked concern from health and access-to-medicines groups around the world. With requirements that would delay entry of generic pharmaceuticals into the market, the TPP threatens to create huge additional health-care costs. In fact, the agreement would also expand the right of pharmaceutical companies to sue governments over national laws, creating the prospect of more lawsuits similar to the $500-million lawsuit launched by pharmaceutical giant Eli Lilly against the government of Canada. With the media focus on agriculture, the TPP's implications for privacy have also been largely overlooked. Provinces such as British Columbia and Nova Scotia have enacted privacy safeguards in recent years that are designed to keep Canadian data in Canada. These rules have become particularly important in the aftermath of the Edward Snowden surveillance revelations, since the transmission and hosting of personal information outside the country raises genuine privacy concerns.

Yet the TPP views such privacy protections as trade barriers and seeks to establish new limits on the ability of countries to restrict the free flow of information across national borders. New rules related to copyright, patents, privacy and investor lawsuits have serious implications for the rights of Canadians, as well as for consumer, health care and education costs. With the TPP in the final stages, Canadians deserve better than canned responses from political parties and a debate limited to the impact of the deal on the agricultural sector. Michael Geist holds the Canada Research Chair in Internet and E-commerce Law at the University of Ottawa, Faculty of Law. He can be reached at mgeist@uottawa.ca or online at michaelgeist.ca.

Patients suffering in pain on wait lists for surgery have once again been denied their Charter right to access health care outside of the government's cruel, inefficient, and unaccountable monopoly. In 2005, the Supreme Court of Canada famously declared in Chaoulli vs. Quebec that "access to a waiting list is not access to health care." But last week, the Alberta Court of Appeal refused to apply and follow the Chaoulli precedent, citing a lack of evidence in the case of Darcy Allen vs. Alberta.

until September 2010 - a date later pushed back to June 2011. No longer able to work to support himself and his family, unable to perform ordinary day-to-day tasks, and experiencing pain so severe that not even the strongest drugs were effective, he spent $77,000 of his own money on surgery in Montana. Dr. Allen's surgery immediately and significantly reduced his pain, and started his slow journey back to better health. Apart from paying out of pocket, Dr. Allen's only other option was to suffer two years of extreme pain, waiting for the Alberta government's monopoly system to provide necessary surgery.

Dr. Allen's experience with medical wait times is, unfortunately, not unique. While patients in France, Germany, Japan and dozens of other developed democracies count their medical wait times in days and weeks, the government health monopolies in Canadian provinces subject patients to wait times that are counted in months and years. The international evidence demonstrates that there is simply no need for government to impose a monopoly over health care in order to ensure that health services are available to all members of the public. In Chaoulli, the Supreme Court held that while government has every right to create health-care programs, it does not have the right to create a monopoly that prevents patients from accessing health care outside of that government monopoly.

Last week's Court of Appeal decision, as well as the trial decision under appeal, declared that Dr. Allen had not brought forward enough evidence to support his claim. Curiously, neither decision refers to the extensive evidence put before the court about Alberta's long wait lists, and how wait times hurt patients, even killing them in some cases. While refusing to consider - or even mention - this abundant evidence, the court declared that Darcy Allen should have introduced expert reports and expert witnesses to testify about the fact that wait lists exist, and the fact that wait lists inflict suffering - and sometimes death - on patients. The Alberta government has not disputed either of these two facts. They are the same facts on which the Supreme Court relied in Chaoulli.

Following the court's logic, Darcy Allen should have spent $77,000 out-of-pocket on his medically necessary surgery, and then an additional $200,000 to $400,000 to assert his Charter rights, by paying a panoply of experts to "prove" basic facts that have already been admitted by the Alberta government. So much for access to justice.

To respect Charter rights, governments have only two options: ensure that a monopoly system provides real access to health care (not just access to a waiting list), or allow Canadians the freedom to access health care outside of the government's system. A law that creates a government monopoly over health care, by banning private health insurance, complies with the Charter only if that monopoly does not inflict pain and suffering - and a real risk of death - on waiting patients.

Ignoring the evidence before them about Alberta's long and painful waiting lists, Alberta's courts have refused to deal with the violation of Darcy Allen's Charter rights. Hopefully the Supreme Court of Canada will not refuse to do so. National Post Calgary lawyer John Carpay is president of the Justice Centre for Constitutional Freedoms (Jccf.ca) and acts for Darcy Allen.

Fifteen years later, the “movement of movements” has another opportunity to strike a dramatic blow to neoliberalism — this time by stopping the Trans-Pacific Partnership (TPP). The TPP is a deal the United States is negotiating with 11 countries in the Asia-Pacific region (Australia, Brunei Darussalam, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, and Vietnam) allegedly to boost “free trade.”

access to medicines

But labor and environmental standards are just the tip of the iceberg. The GAO studies don’t even touch upon the rules found in modern “trade” pacts’ chapters on financial services, food safety, public procurement, medicine patents, investment, and so-on, all of which the TPP would expand to an estimated 40 percent of the global economy — with a built-in mechanism to cover more countries still.

Given the smaller number of negotiators at the TPP table than at the WTO — and the fact that so many seem willing to sell out their nations’ public health programs, family farms, financial stability measures, and just plain sovereignty in order to cut a deal with the United States — it’s unlikely that protests in the United States are going to appeal to their sense of morality. Thus, the anti-Fast Track strategy is not only more feasible than centralized mass protest; it’s probably more effective.

TPP supporters and opponents alike both know that, with the U.S. presidential elections gearing up in the latter half of 2015, the window of opportunity for concluding the TPP is fast closing. Neither political party in the United States wants an unpopular trade debate on its hands while it’s trying to take the White House.