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More and more clinics are achieving same- and next-day access. According to the The Commonwealth Fund 2015 International Health Policy Survey of Primary Care Physicians, released this morning, 53% of physicians say most of their patients can get a same- or next-day appointment if they request one. That’s up from 39% in 2009, but it still places us second-last of the 10 countries surveyed. In Switzerland, which did the best, 85% of doctors said their patients had access to same- or next-day appointments; in the U.S., 74% of doctors said they did. There’s also significant variation among provinces, with 66% of Ontario’s doctors answering yes – the best of all the provinces – and 53% of physicians in Alberta saying so.

But Saskatchewan's Health Minister Dustin Duncan seems to believe that a novel feature in their "model" will make it palatable: MRI providers will be required to provide a "public" MRI for each private MRI sold. There is great fog around this stipulation. MRI clinics in Alberta and British Columbia provide a menu of services, just like an auto repair shop. Of course, it is difficult to identify prices for Canadian MRIs because their websites, while advertising "competitive" prices, ask you to contact them. The United States is more "competitive." For example, Ohio law requires hospitals to publish their prices. The website for medcentral.org lists more than 40 items in its MRI price list.

Here is my question: If a Saskatchewan MRI provider does a foot scan for a private patient, does it then have to do a foot scan for a public patient? How will this be monitored? Also, when does the public patient get her foot scan? If a paying patient is standing in the door, does the MRI provider say, "Sorry, you have to wait till we provide the public foot scan that we owe?" How is this monitored? Does the government pay for the patient from the public list? If so, at what price?

Is this simply a revenue guarantee in disguise? Undoubtedly Bill 179 provides for wide ministerial discretion. Can we bank on the minister being discreet? This model is bizarre. If the provincial government is seeking ways to provide more MRIs without having to incur the upfront capital costs and to remove the operating costs from its budget, then just negotiate MRI fees in the physician fee schedule, as currently occurs with other imaging services.

However, it might quickly become obvious that the private modality cannot compete with cost effective public provision. Glen Beck is emeritus professor of health economics at the University of Saskatchewan.

Strong and continuing interventions by federal and provincial governments are needed. In British Columbia, the Dr. Brian Day court case, seeking more private healthcare access, could undermine our publicly funded system. In Quebec, by legislation and failure to enforce the law, practitioners have been favoured over patients and a two-tier system is forming.

Excessive wait times create these issues. Provider greed then exploits the opportunities created when governments fail to act. Such waits are like a cancer in our system. Canadians deserve better. Ralph Coombs, Calgary Ralph Coombs was CEO of the Foothills Hospital from 1973 to 1991.

The VON was trapped, and ultimately crushed, by that contradiction. It was not the first - the Canadian Red Cross Society's legendary blood transfusion service flamed out in an even more spectacular fashion with the taintedblood scandal in which 20,000 recipients contracted hepatitis C or HIV - and it will not be the last. Canadian Blood Services has taken over the former Red Cross role.

The health-care advocacy group Friends of Medicare said the neardemise of the VON is proof that "experiments in private care must be ceased." But the VON's story is much more complicated than the "public, good; private, bad" and "notfor-profit, good; for-profit, bad" narrative. For a long time, governments funded not-for-profit groups in the health and social services sectors - hospitals, home care, group homes, the Red Cross and so on - in a pretty loosey-goosey fashion. These groups did good, and they were funded relatively well.

But as budgets soared, new accountability measures were put into place. In the home-care sector, for example, competitive bidding was introduced. Stodgy old organizations such as the VON were not ready, and did not adapt. Their market share fell from more than 90 per cent to about 20 per cent. On the surface, this is a good thing. Canadians spend $219-billion a year on health care, including about $10-billion on home care, and, as consumers and taxpayers, they deserve to get value for money.

While we like to preach the gospel of value-for-money, we don't measure it well - the ultimate irony being that expensive bureaucracies have been built to ensure home-care agencies are lean and mean. The VON had many disadvantages in a competitive market.. place - first and foremost that it never provided just home care to its clients. It delivered hot meals, made friendly visits (especially to veterans), ran adult daycare programs, provided respite care to families, visited new mothers and babies, did flu shots at home and did countless other little things that never had a place in the accounting ledger. Some were covered by government payments, but many were not. The VON supplemented its funds from government contracts with charitable donations. It had more volunteers (9,000) than staff (6,000). The VON also paid its workers a decent, living wage. The work force - mostly nurses and therapists - is unionized, salaried and they have benefits, including a pension plan.

In the brave new home-care industry, piecework is the norm, meaning nurses get paid per visit, and few have benefits, pensions or stable employment. It is also in the interest of workers (and employers) to get visits done quickly, and cram as many as possible into a day. While this is a cost-effective business model, anyone with a loved one in home care knows that there is little continuity of care. The relationships that are so important to intimate acts such as health-care delivery to frail seniors living at home are virtually non-existent. When you have a strict business model, when all that matters is the much-vaunted bottom line, none of that gets counted.

The real tragedy in the VON's unravelling is not that another home-care business is biting the dust (after all, there are hundreds more out there), but that the "old-fashioned" way of delivering care - taking the time required to talk and listen to patients and treating them as people, not "units of service" for example, not just changing their dressings, but feeding them and filling the fridge - is falling by the wayside. With the VON's collapse, we have a home-care system that may be more efficient - at least in theory - but one that has less heart.

One big problem with the proposed summit: it could lead to increased tensions if the feds try to attach strings to how the provinces should spend any new money. The provinces have reason to worry: In the 1980s and nineties, as the federal fiscal situation deteriorated, Ottawa contributed less and less to the public health-care system, while prohibiting provinces from pursuing private-sector alternatives.

In the first years of the last decade, as the fiscal situation improved, the Liberal federal government was prepared to offer more robust funding, but insisted on new national standards for health-care delivery in exchange. Provincial governments resisted that federal intrusion in their jurisdiction. The struggle culminated in that 2004 first-ministers meeting in which the premiers browbeat the new Martin government into those massive increases in spending.

If Mr. Trudeau attaches conditions to increases in federal health care transfers, expect Quebec to demand that it be allowed to opt out of any program, but still get all the money. Expect Alberta to demand the same. It's called asymmetrical federalism, and it can quickly get ugly. Another major problem is that, given other Liberal spending commitments in infrastructure, fighting global warming, postsecondary education and so much else, the finance minister, whoever he or she may be, might not be able to balance the federal budget by the end of the mandate, as Mr. Trudeau has promised.

The Liberals have also promised to work with the provinces on a pharmacare strategy, which would inevitably involve funding for subsidized prescription drugs for low-income seniors.

If increased health-care commitments - along with everything else in the Liberal platform - cause federal finances to deteriorate to the point that Ottawa is running an entrenched structural deficit, the national debt will increase. At the same time, Canada's credit rating will start to decay, interest payments on the debt will consume more of the budget, and people will start saying, "Like father, like son."

To avoid that, Mr. Trudeau will have to rein in provincial expectations. But there is a political price to be paid for convening first-ministers conferences and then failing to meet the premiers' demands. It's why Stephen Harper avoided them.

“The health-care transfers should not be simply on a per-capita basis but should include a formula, a ratio, indicating that [citizens] 65 years and over should get a different weight than those under 65,” he told The Globe and Mail. The minister said there is significant support for the idea.

Saskatchewan began having a Change Day in 2014, and BC followed in 2015.

"That included Mount Sinai Hospital, the Hospital For Sick Children, Sunnybrook Hospital and McMaster University Centre," said MacDonald.

"All of which were either closed or restricted."

According to the Mount Sinai Hospital website 1,100 babies are admitted to that hospital's Newton Glassman NICU each year.

He pointed out that so far no babies have needed to be sent outside of the province.

Ontario Ministry of Health and Long Term Care officials confirmed that some NICUs are facing an unusual "surge," in critically ill babies, but emphasized the situation is temporary and that they are working with the Local Health Integration Networks and affected hospitals to take immediate action.

"This is a fluctuating situation and hospitals are working closely and in coordination to manage these pressures," said Mark Nesbitt, ministry spokesperson.

"The NICU situation continues to show improvement since last week, this is consistent with the fluctuating nature of patient flow."

Nesbitt says there is no single cause for the sudden increase in babies requiring highly specialized care.

"On Tuesday night of last week (Aug. 22) the possibilities were that the child would have to go to Ottawa or possibly out of province."

"The situation is stabilizing," said Nesbitt on Sept. 1.

"While we know there is always more work to do, investing in health care is a top priority of our government. That's why as part of the 2017 Budget, we are investing an additional $518 million in all public hospitals, a 3.1 per cent overall increase to the hospital sector, to improve patient access to care, reduce wait times, and improve the patient experience for all Ontarians at their local hospital."

He said the ministry is monitoring the situation and will increase NICU capacities as necessary.

While MacDonald said he is optimistic the right people are now listening he pointed out that on Aug. 28 there were still issues at McMaster University Centre because their transport team, which picks up the sick babies from other hospitals did not have enough nurses.

He argues that ultimately this is a government funding issue, which needs to be resolved to expand the capacity of the NICUs at these children's hospitals.

"They have pared down things so much and have gotten away with it in the past and have been able to send babies to other units within the metro area, but for this cycle this wasn't a possibility," said MacDonald.

"There is a need for government funding, not just for beds, but for nurses. Nurses are critical to the running of a NICU. They look after the patients. We of course have to make decisions about how to manage the patients, but the nurses are the ones that deal with the kids from minute to minute. They are with them all the time and if they don't have enough nurses to staff the units then the units will close or the transfer team will close down, like what happened on Monday."

MacDonald also pointed out that while the province is attributing this problem to a "surge" in critically ill babies, the NICU bed shortage has really been happening on a smaller scale for years.

"It is only getting worse with the government cutbacks."

He attributes this reaction to the reality that NICU bed shortages is not a local issue, but a national one with similar problems recently reported in the Maritimes, Alberta, Manitoba and British Columbia.