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Either British Columbians are rapidly becoming much sicker, or this increase in prevalence is a reflection of what Welch and colleagues describe as “looking harder” and “changing the rules.”

about one-third of the increasing cost of testing is related to physician adherence to guidelines

patients now often request particular tests

Earlier diagnoses and more aggressive treatments appeal to our self-definition as fighters of illness—and we all shudder at the successful lawsuit against the physician who did not screen

we use them as therapy of a sort, giving hope to the patient that we will find an explanation for the symptoms instead of admitting that we do not know and might never know the exact cause of the problem

At the highest level, there needs to be a broader evaluation of guidelines. Such evaluation needs to have representation from policy thinkers and health economists in addition to family doctors, other specialists, patients, and the public.

the opportunity costs of deciding to implement widespread laboratory testing for healthy people, compared with adopting population-based policies, such as 24-hours-a-day, 7-days-a-week access to community recreation facilities and social housing, or free access to smoking cessation supports, should be debated.

Tests and repeat tests that are deemed to be of less benefit or not worth the opportunity-cost trade-off should be delisted.

Mr. Dodge’s message is straightforward: Canadians are going to be paying significantly more for health care over the next two decades. Unless things change, he said, we should expect that total health spending will be almost a fifth of the country’s gross domestic product by 2030, up from 11% today — and up from 7% in the 1960s.

“The real disaster would be if governments stood up and said, ‘We have no money, so we’re going to freeze wages in the sector and cut services.’ You do that, and five years down the road you’re going to have all the same problems and the care being provided will be that much worse.”

In April, Mr. Dodge produced a report for the C.D. Howe Institute in which he said that steadily rising health-care costs — partly, but not exclusively, due to the aging population — would force governments to either increase fees, raises taxes or delist services.

“Unless we get it off the emotional, we’re never going to solve the damn problems.”

health care needs to be considered comprehensively, “not just hospitals and docs,” with the public system including a broad range of services such as chronic care and home care.

originally the Tory government was looking at de-insuring a number of procedures

it will remove money and jobs from health care precisely at those times when they are needed most

since its inauguration by the Liberals in 1968, medicare has been under attack from those who think the federal government has no business in health care.

By 2002, Ottawa was contributing only 18 per cent of the public cash going to medicare.

This is why Roy Romanow’s 2002 Royal Commission into health care recommended a boost in federal cash contributions. And it is why the federal-provincial health accord two years later was so important.

That accord eliminated any linkage between federal health transfers and economic growth. More important, it committed Ottawa to put more real cash into medicare.

Thanks to that accord, the federal government’s cash share of health-care funding has gone back up to about 25 per cent.

the Conservative arrangement would eventually return the country to where it was in 2002 — with Ottawa putting little into medicare and the federal government losing all ability to enforce national standards that Canadians accept as given.

Stage two has not yet been announced.

Prime Minister Stephen Harper can now tell the premiers that he’ll turn a blind eye if they try to make up this shortfall through creative solutions — even if such solutions (delisting of all but core services? user fees?) run directly counter to the letter and spirit of medicare.