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Underlying both reforms is a quiet resignation to the idea that two-tiered health care is inevitable. This sense of resignation is understandable, coming as it does on the heels of a decade-long void in federal leadership on health care. Throughout the Harper government's time in office, the Canada Health Act went substantially unenforced as private clinics popped up across the country. Even in its reduced role as a cheque-writer, the federal government took steps that undermined national unity on health care, switching the Canada Health Transfer to a strict per capita formula, which takes no account of a province's income level or health-care needs. If Canadians hope to reverse this trend, we cannot simply wage a rearguard battle for the enforcement of the Canada Health Act as it was enacted in 1984. Even if properly enforced, the act protects universal access only for medically necessary hospital and physician services. This is not the blueprint of a 21st-century public health-care system.

We desperately need universal coverage for a full array of health-care goods and services -- pharmaceuticals, mental-health services, home care and out-of-hospital diagnostics. Canada is unique among Organization for Economic Co-operation and Development countries in the paucity of what it covers on a universal basis despite falling in the top quartile of countries in levels of per capita health spending. Far from being our saviour, the Canada Health Act in its current incarnation is partly to blame -- not because of its restrictions on queue-jumping and private payment, but because it doesn't protect important modern needs, such as access to prescription drugs.

There are limits on what a public health system can provide, of course -- particularly as many provinces now spend nearly half of their budgets on health care. But fairness requires these limits be drawn on a reasoned basis, targeting public coverage at the most effective treatments. Under the current system, surgical removal of a bunion falls under universal coverage, while self-administered but life-saving insulin shots for diabetics do not. A modernized Canada Health Act would hold the provinces accountable for reasonable rationing decisions across the full spectrum of medically necessary care.

Instead of modernizing medicare, Saskatchewan and Quebec are looking to further privatize it. Experience to date suggests allowing two-tiered care will not alleviate wait times in the public system. Alberta has reversed course on its experiment with private-pay MRIs after the province's wait times surged to some of the longest in the country.

The current wisdom is long wait times are better addressed by reducing unnecessary tests. A 2013 study of two hospitals (one in Alberta, one in Ontario) found more than half of lower-back MRIs ordered were unnecessary. Skirmishes over privatization have to be fought, but they should not distract us from the bigger challenge of creating a modern and publicly accountable health system -- one that provides people the care they need, while avoiding unnecessary care.

Achieving that will make National Medicare Week a true cause for celebration. Bryan Thomas is a research associate and Colleen M. Flood is a professor at the University of Ottawa's Centre for Health Law, Policy and Ethics. Flood is also an adviser with EvidenceNetwork.ca.

But 11 years after the government promised new regional health agencies would trim waste and deliver better care, the opposite has happened too often, and how patients fare depends upon where they live.

Last year alone, Ontario’s Health Ministry funnelled $25 billion through the networks to hospitals, nursing homes and community agencies. But while the networks oversee more than half the health-care budget, the ministry does little to hold them to account, even when the care they oversee becomes worse.

The ministry instead monitors hospitals, tracking wait times and how often patients quickly return to the ER or a ward — and the verdict isn’t pretty. On most measures, performance has stagnated or worsened.

But those near the front lines are less confident — only one in five health service providers say the LHINs are on track.

The government promised LHINs would chip away inequity in access to health care but the opposite has occurred, Lysek found. In 2012, patients in the worst-performing region waited five times as long for semi-urgent cataract surgery as those in the best performing region. That gap has grown to 31-fold.

KEY FINDINGS Key findings In the auditor general’s report: Many LHINS didn’t establish quantifiable targets or performance measures. The performance gap among LHINs is increasing. Health Ministry takes little action to hold networks accountable. The networks don’t consistently monitor the quality of health services. Some networks don’t track patient complaints at all. Too little has been done to cut wasteful spending by providers who duplicate office work and fail to work together to lower costs of purchases.

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.

Silas was one of a number of speakers who called on the government of Premier Kathleen Wynne to increase spending on health care in the province. North Bay, they said, is particularly hard hit because it is a P3 (public-private partnership) hospital - and because it brought three hospitals - two general and one psychiatric - under one roof. "It is time to raise the alarm," said Natalie Mehra, executive director of the Ontario Health Coalition.

"This is devastating to the community, so let's raise the alarm." Mehra said people should not make the mistake of "believing that these hospital services are being replaced in so-called community care. You do not replace medical and surgical beds in community care. It's just not community care. It is acute hospital care services that are being cut. "You do not replace emergency room nurses. You do not replace cleaners in community care. Let's not buy into the nonsense that is just window dressing to cuts, cuts and more cuts to local services that are needed by the community." Michael Taylor, one of the organizers of the rally, said the cuts in North Bay are "the worst and deepest". .. that affect departments throughout the whole hospital.

Jamie Nyman was part of a large contingent from Sudbury to travel to North Bay Monday. "This is a very important issue," he said. "The government is cutting services and patient care is declining." Sudbury, he pointed out, has also seen many cuts.

"It's leaving us with too much workload," he said. "We are seeing a lot of workload issues because of cuts." Debbie McCrank from Kirkland Lake, the local co-ordinator for the Ontario Nurses Association, said the cuts are "going to impact all the North." She is responsible for the area from Kirkland Lake to North Bay, including Mattawa and West Nipissing.

The North Bay Regional Health Centre, she said, is "a major treatment centre," but the province's cuts are putting that designation at risk, and putting extra pressure on all hospitals in the North. "It's just having a huge impact," McCrank said of the health funding cuts.

"It comes down to cheaper care versus quality care," she said. "The province is driven by the budget, not by the concern for quality health care." Another supporter was Mike Labelle, a locked-out employee at Ontario Northland. "I'm here to support all the nurses and everyone on down," he said. "Health care has really deteriorated here, and it's time the government wakes up."

Labelle said the mass of protesters "is the heart of the hospital." About 100 Ontario Northland employees, he said, turned up for the rally. Canadian Union of Public Employees president Mark Hancock said the province's health care cuts amount to an attack on the local hospital and the community.

The funding freeze means hundreds of staffand beds across Northern Ontario," he said, pointing to placards waved by hospital workers from Timmins, New Liskeard and Sudbury pointing out the effects of cuts at those facilities. Hancock said health care needs a 5.8 per cent annual increase just to meet rising costs, but the freeze means hospitals are getting zero per cent. In real terms, he said, that works out to a 20 per cent cut over the life of the spending freeze.

Also speaking was North Bay Mayor Al McDonald, who said the situation at the hospital is a major concern in the city. In addition to proper health care for all members of the community, he said, the jobs being cut at the hospital are good-paying jobs, and "if you want to build the city, you need your hospital to provide the same level of care as they have in southern Ontario." Nearby, Stan Zima was waving a large Canadian flag on a 10-foot flagpole.

"It's obvious the cuts in Northern Ontario have become excessive, and especially in North Bay," he said. "We are taking big hits in this. Hospital cuts hurt everybody. "Wynne has got to get the message. Northern Ontario is suffering more than any other area." Nipissing MPP Vic Fedeli, speaking at Queen's Park, called on the provincial government to address the funding crisis at the North Bay Regional Health Centre.

Health-care professionals and patients alike in my riding are concerned that the quality of care we're getting in Nipissing is in jeopardy. And it's creating turmoil in the community," Fedeli said, asking the government to restore "proper ongoing funding" to the facility.

Pj Wilson, The Nugget / Natalie Mehra, executive director of the Ontario Health Coalition, addresses a crowd of close to 1,000 people at Lee Park, Monday. Supporters from across the province were in North Bay to pressure the Kathleen Wynne government into providing more funding for hospitals across the province. • Pj Wilson, The Nugget / Close to 1,000 people called for the provincial government to increase funding to Northern Ontario hospitals and, in particular North Bay Regional Health Centre, at a rally at Lee Park, Monday. Busloads of supporters came from as far as Toronto, Hamilton and Stratford to support North Bay.

And that's exactly what is happening now with the pending demise of 14 huge Ontario agencies that oversee the delivery of home care to hundreds of thousands of patients each year and employ tens of thousands of workers. The bosses involved are the chief executive officers of the 14 Community Care Access Centres (CCACs) in Ontario. These government agencies, which have been embroiled in controversy for several years, are responsible for co-ordinating access to home and community care services, such as nursing, physiotherapy and personal support workers.

Even more revealing was the fact that while the CCAC bosses were getting massive pay raises, many of the therapists, personal support workers and nurses who actually provide care to patients were earning less than $25,000 a year and hadn't seen a pay raise in years. Other managers in the CCAC system also earn huge salaries. One vice-president of strategy, communications and engagement earned $193,000 in 2014. In the Toronto Central CCAC, there were 45 employees earning more than $100,000 in 2014. In the Ontario Association of CCACs (OACCAC), there were 37 employees earning more than $100,000 with the executive director earning close to $300,000.

Politicians and bureaucrats at Queen's Park, however, regularly dismissed the complaints and did little to fix the broken system. Indeed, under former health minister Deb Matthews, the CCAC bosses were never really challenged to improve their operations. Some were openly hostile, arrogant and aggressive, operating with a sense of entitlement that saw them run their agencies as they saw fit. But as happened to Oda, the heady days for the CCAC executives came to a sudden halt when their skyrocketing salaries and stunning pay raises were revealed. In some cases, CCAC bosses were paid raises topping $65,000 a year, with salaries over $300,000. Others saw their pay jump by more than 50 per cent over three years.

Worse was the fact that the CCAC executives were also ordering their staff, most of whom cared deeply about and worked hard to deliver good care, to trim patient services such as the number of visits to patients by front-line health workers in order to meet their budgets. Suddenly, politicians at Queen's Park took notice.

n early 2014 an all-party legislative committee asked auditor general Bonnie Lysyk to conduct a wide inquiry into CCAC operations. Lysyk's report, released in September, described in detail a bloated CCAC system that costs too much money, does nothing very well and where barely 62 cents of every dollar goes to actual direct patient care. For Hoskins, that was the final straw. Now he is about to unleash the biggest change in health-care delivery in Ontario in a generation. Through it all, the CCAC executives were often their own worst enemies.

Instead of explaining why they deserved huge salaries, they became aggressive, hiring expensive lobbyists and public relations experts to promote their agencies, denouncing journalists and critics who raised legitimate concerns about the system, and misleading their own staffers on how their operations were faring or what the future might hold for them. When news first surfaced that Hoskins was planning to dismantle the CCACs, the executives denied any real moves were coming and that their futures were in jeopardy. Some CCAC bosses went so far as to tell their staff that the Star's articles about the pending demise of the CCACs were "inaccurate."

In recent days, though, the CCACs have gone silent as they come to grips with the realization that their jobs and agencies are likely doomed. Hoskins is not waiting to start the transformation, but his initial timetable for dismantling the CCACs has proven to be problematic. Hoskins originally wanted the LHINs to start assuming some CCAC roles, such as responsibility for front-line staff, as early as three months from now. But sources say these timelines keep being blown up because the LHINs are not yet ready to take on increased duties.

Still, Hoskins is planning to press ahead. He will get more ammunition on Dec. 2 for the home-care transformation when Lysyk releases the second part of her inquiry into CCACs. For patients waiting for needed treatment and who have tangled with the CCAC bureaucracy and bosses in the past, the changes can't come soon enough. Bob Hepburn's column appears Sunday. bhepburn@thestar.ca

The government's abject failure to effect reform, despite this investment, stands starkly exposed in a new report by Auditor General Bonnie Lysyk. Fundamental restructuring is needed. Until "overarching issues are addressed, Ontarians will continue to receive inequitable home-care services," Lysyk concluded. Problems are rooted in Ontario's 14 Community Care Access Centres (CCACs). Each co-ordinates home-care services in a particular part of the province, but their successes vary.

At three CCACs given a special audit, 65 per cent of initial assessments for home care were not done within the required time. Another 32 per cent of reassessments for people with complex needs were also behind, with the auditor noting "it took over a year to assess some clients." Not only does service differ across the province, it can change within a CCAC depending on the season. It's better to need help early, than near the end of the budget year, because CCACs running short of money simply slow down. The auditor found one agency had nine times more people stuck on a waiting list, at the end of the fiscal year, than at the beginning. That's outrageous. A core issue is that the government doesn't fund CCACs equally. The agency serving North Simcoe Muskoka, for example, received $4,027 per client for home care last year while the Central West CCAC got less than $2,880.

The province responded to Lysyk's findings by pledging to do better, with Health Minister Eric Hoskins expected to announce a major restructuring of home care that could eliminate CCACs or at least substantially revise their mission. But the Liberal government vowed to correct its home-care failure the last time around. Five years ago Deb Matthews, then the health minister, promised to "fix it." That's why people have every right to be outraged today. It's now up to Hoskins to deliver meaningful reform. Thousands of sick and vulnerable people are depending on it. If this government fails, yet again, it should expect - and deserves - a harsh judgment from a disillusioned and disappointed public.

The bad news is that after years of inattention and chronic underfunding, significant issues still need to be addressed. We need a broad public discussion about our expectations and priorities to ensure we get future continuing care right: These are community decisions that ought not to be left entirely to our health bureaucrats, able though they are. As we enter this discussion, we should focus on the real issues and not waste time on red herrings. For example, recent research by the Health Quality Council of Alberta (HQCA) has confirmed that quality of care is not affected by whether the provider is private, non-profit, faithbased or public, or whether the staffare unionized. There is plenty of evidence that all types of providers are responsible, committed and caring. On the other hand, the report identified five concerns of families and residents: the need for more staff; timely help and supervision for basic needs; cleaner and bettermaintained facilities; access to related services; and quality, varied and nutritious food.

This is a telling list because these concerns are primarily driven by funding and continuing care is falling behind. Current rates of funding are actually below what was received in 2011, after inflation and cost increases are factored in. For the past three years, funding increases for continuing care have been zero, between zero and two per cent, and zero. At the same time, overall healthcare funding has increased at six per cent a year.

Just as schools need teachers, funding for spaces has to come with funding for care. In Alberta, continuing care is funded at 19 per cent below the national average. In comparison, acute health care in Alberta gets 33-percent more than the national average. Under these conditions, the HQCA conclusion that there has been "no significant change" in quality of continuing care is a credit to the commitment of our care providers.

It's not just the quantity of funding that needs to be addressed. Our current patchwork system of funding, program models and regulations needs to be revisited. Changes are needed - not to reduce standards, but to allow the system to be more client-and resident-centred, giving providers the flexibility to innovate and respond to the changing needs of clients and residents, and to reflect changes in the scope of practice of our health-care professionals. We need to ask ourselves whether a 30-yearold model of care is acceptable for our loved ones. The NDP government has taken some initial steps toward getting things back on track, but there is urgency to tackling these issues as quickly as possible. The number of Albertans needing home care, supportive living or long-term care is going to increase significantly. Will we be ready? Continuing care providers want to work with the government and all Albertans to build the best possible system. The Alberta Continuing Care Association looks forward to working with government as it takes its next steps to strengthen care and supports.

Tammy Leach is CEO of the Alberta Continuing Care Association.

In addition to eliminating jobs, the hospital, which needs to find $14 million in savings in order to balance its budget, is closing 30 beds between the medical and mental health sides of the facility. The cuts are in addition to 196 positions eliminated in recent years. The Canadian Union of Public Employees (CUPE), which hosted a city-wide town hall meeting via teleconference Thursday to hear from the public and provide information about the cuts, has said 158 full-time equivalent positions could impact several hundred employees at the facility.

eanwhile, Nipissing MPP Vic Fedeli, again pressed the province Wednesday on the issue, pointing to a recent city council resolution calling on the government to take action.

"North Bay city council believes the benchmarks the province has set are forcing these cuts upon the hospital, and that the province has an obligation to the health and well-being of the people served by this hospital," Fedeli said in the legislature. "As a result, council has asked the province 'to make adjustments to the financial targets and expectations of the local health centre that could lead to some maintenance of service levels and to respect the hospital's request for one-time transitional funding."

"In our view, recent proposals for a universal pharmacare plan under which governments would pay essentially all drug costs with only very limited patient charges, are not realistic," Busby and Blomqvist argue. "We believe it is time to start moving toward a model that makes important inroads into the biggest shortcomings of the expensive and flawed system we have today." They point to five critical deficiencies:

Too many low-income people can't afford to fill their prescriptions. All Canadians pay too much for essential medications. The provinces have no common formulary, meaning the list of insured drugs varies across the country. People with rare diseases who need exceptionally expensive drugs have to beg the government or the manufacturer for help.

Fortuitously, the report - written before this week's election - dovetails nicely with the approach of Canada's new Liberal government. Prime minister-designate Justin Trudeau has promised to "improve access to necessary prescription medications" and "work with the provinces and territories to buy drugs in bulk." That isn't quite pharmacare, but it is similar to what Busby and Blomqvist are recommending. Under the C.D. Howe plan, Ottawa would top up health transfers to the provinces allowing them to ensure that drug costs do not exceed 3 per cent of family income anywhere in Canada. (For a single working parent with two children earning $30,000, the ceiling would be $900. For a two-earner family with two children with an income of $115,500 - the national average - the maximum would be $3,450).

There is no mechanism to improve the quality of prescribing by physicians. The key to addressing all these problems, the authors say, is an increased role for the federal government in drug financing. Ottawa wouldn't run the program or deliver the drugs; it would provide the cash and co-ordination to bring the existing provincial programs up to an acceptable national standard.

All of the provinces currently have upper limits but they vary from 3 per cent to 12 per cent of family income. Ontario's is 4 per cent. Ottawa would become a partner in the Pan-Canadian Pharmaceutical Alliance launched by the premiers and territorial leaders in 2010 to bulk-purchase prescription drugs. This would increase its financial muscle - the federal government supplies medications to the prison population, First Nations, soldiers and veterans - when negotiating drug prices. It would also allow the federal government to play a co-ordinating role in creation of a single national drug formulary, based on transparent clinical evidence of cost-effectiveness.

Ottawa would work with the provinces to design a national strategy for rare and high-cost diseases. Similarly it would help them build incentives into their drug plans for doctors to take responsibility for the cost of the prescriptions they write. There would be no fundamental restructuring. A substantial share of drug costs would continue to be privately funded. The disruption would be minimal. Work could begin immediately. Politically the stars are as well-aligned as they are likely to be. The provincial premiers invited Ottawa to join the Pan-Canadian Pharmaceutical Alliance in June. Their health ministers agreed that Ottawa should play a role in improving access to prescription drugs and coverage for low-income Canadians. Trudeau has promised to negotiate a long-term health accord with the premiers and budgeted an additional $415 million for health care next year rising to $1 billion by 2019. And more than 90 per cent of Canadians support universal access to prescription drugs.

"Canadians need improvements to the existing arrangements," Busby and Blomqvist point out. "What we propose would go a long toward achieving the same objectives as those of the federally funded universal drug plan." The question facing Canadians who have waited decades for a national publicly funded pharmacare program is: Do they settle for watered down version or hold out for the gold standard? They could wait a very long time. Carol Goar's column appears Monday, Wednesday and Friday.

Hoskins said he wants to follow through on Winkler's recommendation to create a task force to make recommendations for improving and funding physician services. "One of the things Winkler spoke to was putting together a team from the OMA and from the ministry and other stakeholders, to really, in a serious way for quite frankly the first time, look at the issue of physician compensation and the delivery of health services by physicians," Hoskins said. "(It would address) how they can and should be best compensated, how to create a sustainable way of doing that, how to frame it within the reforms that are taking place in the health-care system. There's a lot we can do together," he added.

The OMA has so far issued no public response. The organization's board of directors is gathering on Wednesday and plans to discuss the Hoskins' meeting. In an email update sent to doctors on Monday, OMA president Dr. Mike Toth said board members plan to discuss next steps, including possible legal action. The update hints that doctors may be preparing to take some sort of job action. Toth wrote that 200 physician leaders met on Sunday and held a "brainstorming exercise designed to test and confirm innovative and impactful actions that members might undertake in various clinical settings and geographic areas across the province."

Stakeholders throughout the province's health-care system have been lobbying successive provincial governments for at least a decade, urging them to lift restrictions that force the province's roughly 35 advanced-care paramedics to work below their full scope of practice. In February, the provincial government announced it had set aside $580,000 for a new pilot project, which will help New Brunswick figure out how best to make use of these valued health-care providers.

Health Minister Victor Boudreau said two committees have been formed to complete the behind-the-scenes work that is needed to introduce them to the existing ambulance service. So far, he said, things are going well, though he's not sure when advanced-care paramedics will be ready to use their skills on the streets. "We're still trying to put a pilot project together, making sure that we're respecting all the different moving parts to this," he said. "The money is still in the budget for this year. It's just sometimes these things prove to be a little more difficult than you'd like to put together. But it's certainly still on the table."

Chris Hood, executive director of the Paramedic Association of New Brunswick and a participating member of the committee tasked with sorting out the clinical issues around such a change, said that work is progressing nicely and he expects to see advanced-care paramedics in use within the provincial ambulance service soon. "I know the meetings have been happening and, by all indications, we're getting close," he said.

"The committees are still meeting. I've missed the last two meetings, but we had a representative there. They're getting into discussions about the protocols for practitioners, what they'll be following. From what we hear, it sounds like full-steam ahead. They accelerated the meeting times and it seems like everything is on the right track ... All of the prep-work that is necessary is, I would say, probably 80 per cent done, 85 per cent done." Ambulance New Brunswick is also completing some preparatory work, said Hood.

"They're looking at curriculum - refresher programs and things like that. From the clinical side of the business, which is what we're concerned with, that stuff is almost complete," he said. "If form follows function, we should be moving forward rather quickly."

When asked if the province's advanced-care paramedics are excited they'll finally be able to put all of their training to use in this province, Hood said many are still frustrated from the long struggle to lift these restrictions on their scope of practice. "I think many ACPs are still a bit, 'I'll believe it when I see it.' But some are very excited about it. We've had a couple of people enquire about attending ACP school and I know that the requests for enrolments in ACP classes both in New Brunswick and in the state of Maine are increasing," he said.

People are starting to feel more comfortable in spending the money to upgrade their skills, to take the education they need. But with the existing practitioners, I think, it's a wait-and-see mentality." Judy Astle, president of paramedics' union CUPE Local 4848, said she's anxious to learn what the pilot project may look like and how advanced-care paramedics will be used alongside primary-care paramedics across the province.

It's going to be a positive," she said. "But we're still waiting to find out the details."

More than two dozen people stood outside Minister Geoff MacLellan's office in Glace Bay, N.S., Wednesday rallying for an end to cuts in long-term care facilities. It was one of several rallies held across the province by the Canadian Union of Public Employees (CUPE) and UNIFOR members Wednesday.

Dr. Brian Day's court challenge is underway in Vancouver. The main issue is whether Canadians should be permitted to pay privately for "medically necessary services" already covered by their provincial health plan. Is there a need for increased private health care in Canada? If so, can it be implemented without jeopardizing the public system?

Philpott admits "innovation" is required. Yet governments are constrained by blindly adhering to certain parts of the CHA, while ignoring others. As Ben Eisen of the Fraser Institute has emphasized, provinces have been forbidden to experiment with user-fees, copayments, etc. that would encourage individuals to use health services more responsibly. A "two-tier" system has always existed. Federal prisoners, Workplace Safety and Insurance Board patients, members of the military and RCMP, politicians and professional athletes usually obtain more timely care - often at private facilities. For those not near an inter-provincial border and not a member of a "special group," the main option for timely care may be to go to the United States. This provides employment to American doctors and nurses and profits to U.S. hospitals. Wouldn't it make more sense to allow all Canadians to spend their after-tax discretionary income on health in their own province? Frozen hospital budgets have caused excessive wait times for knee and hip replacements as operating rooms often don't function at full capacity. According to a 2013 survey, 15 per cent of Canadian surgeons considered themselves underemployed and 64 per cent cited poor access to ORs. About 25 per cent of nurses in Newfoundland and Labrador work only part of the year.

If orthopedic surgeons had access to additional "private" OR time, wait times could be shortened for all Canadians and new employment would be created for health-care professionals. If hospitals were permitted to operate electively on Americans and other foreign patients, this would bring in extra revenue and relieve the strain on provincial health ministries. So that MDs did not abandon the public system, they could be required to work 25 to 30 hours per week in the public system in order to receive government reimbursement for malpractice insurance. Most MDs would confine their practice to the public system. They deserve fair treatment. Philpott should amend the Canada Health Act to mandate binding arbitration when provincial negotiations fail, as they have in Ontario. Since 1984, the population has grown and aged, new diseases have been recognized, and new drugs and technologies have developed. Some 32 years ago, it was understood that Ottawa would pay half of health costs. Now it covers less than a quarter. We need to amend and modernize the Canada Health Act. Where wait times are excessive, certain diagnostic services and surgical procedures should allow for private access for all Canadians - not just a select few. This would maximally utilize expensive equipment and provide new employment for nurses, technicians and surgeons. It would provide extra revenue that would help to keep universal public health care sustainable and accessible for all Canadians. Ottawa should then enforce all sections of the Canada Health Act on all provinces and territories. Dr. Charles Shaver Ottawa

Health Minister Jane Philpott says her government is prepared to make mental health a big priority, but she will not be writing a blank cheque to the provinces and territories until she knows how it will be spent. Philpott made the comments in Ottawa a day after meeting the provincial health ministers in Toronto to discuss the future of health-care funding in Canada.

After meeting with her provincial counterparts on Monday and Tuesday in Toronto, Philpott emerged without a long-term funding plan, or health accord, for health care in Canada.

"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.