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In a prebudget letter to Mr. Oliver, the NDP urges the Finance Minister not to delay the budget and to instead scrap the recent tax cut that allows parents with children under 18 to split their income for tax purposes. The NDP says Ottawa should cut spending on advertising, the Senate and corporate subsidies. The letter calls for more spending on health care, child care and pensions and the creation of a credit for small businesses that make new hires.

The government says it is taking a few extra weeks to release a budget in order to get a better understanding of the current changes in the economy. The price of oil has dropped by more than half since June, a development that will mean billions less in tax revenue for Ottawa than had been previously expected.

Federal Employment Minister Jason Kenney is also pledging that Ottawa can hit its target without dipping into a $3-billion contingency fund, a comment that is at odds with recent statements from Finance Minister Joe Oliver, as well as analysis from several private-sector economists. The messaging from the government is shifting quickly in the face of growing signs that current, dramatically lower oil prices will be around for some time. The Bank of Canada will release its quarterly Monetary Policy Report on Wednesday, which is expected to expand on recent warnings that prices could go lower, or remain low, "for a significant period." In a series of interviews broadcast over the weekend, Mr. Kenney said balancing the books has important symbolic value and that "it may take some additional spending restraint" in order for the government to deliver on its promise.

The 2014 federal budget reintroduced a two-year freeze on departmental operating budgets that runs through the 2015-16 fiscal year, which is when the Conservatives are promising a return to balance. The 2014 budget said this freeze would save the government $550-million in 2014-15 and $1.1-billion in 2015-16. Mr. Kenney did not explain how extending the freeze might help the government achieve its balanced-budget promise. "They spent the surplus before they had it and now they're scrambling to figure out how to make one plus one equal three," said NDP finance critic Nathan Cullen.

Economists say it makes no practical difference whether Ottawa posts a small surplus or a small deficit, given that federal finances are sound overall in terms of debt levels and longterm spending trends. But Mr. Kenney said balancing the books remains an important goal. "It's a commitment we made to Canadians in the last election," he told CTV. "It's important that, when possible, we no longer go back and borrow money to pay for government spending."

There are also infections of influenza, CPE bacteria and respiratory conditions throughout the facility, but Mr. Donohue said they are not being declared outbreaks. He said the emergency room has a triage system ensuring those with serious illness and injury are seen first, and that patient levels have already fallen over the past 24 hours.

But Gayle Duteil, president of the B.C. Nurses' Union, said her members are calling the "chaotic" conditions inside the hospital the worst they've ever seen. "While Fraser Health is describing it as unprecedented, it's certainly not unanticipated," she said, adding that patients are waiting up to 45 minutes to be looked at. Ms. Duteil said the hospital has reopened its old emergency department, that emergency room patients are lining the halls and that there are multiple admitted patients who require hospital care sitting in chairs waiting for beds.

"Nurses are professionals and they'll continue to care for any number of patients that come through the door. But it is a very difficult time," she said. Ms. Duteil said the health authority must hire more nurses.

Many nurses at the hospital are already on overtime shifts, and the emergency department, intensive care unit and family birthing units are short-staffed. "I certainly feel for the nurses in Surrey, across Fraser Health, the whole health authority today, because this should be prevented," she said. The health authority has set up a "command centre" at the hospital, consisting of a team of staff and leadership that meet regularly to ensure that everyone is working together.

The Fraser Health Authority opened Surrey Memorial's new emergency department at a cost of $500-million in October, 2013, but the nurses' union has said it's still too small for the growing population.

NDP health critic Judy Darcy says she hopes the government will throw everything it can at Dr. Day, because if he wins, she believes, British Columbia will be opening the door to a new two-tiered health-care system for the country.

NDP Leader Cam Broten said Saskatchewan has one of the worst records for ambulance fees in the country. He said it's the only province to charge for ambulance transfers between hospitals and it's one of two provinces, along with Quebec, that doesn't have a capped rate. Carr said his wife Catherine, who was 62, was not eligible for the seniors rate of $275 a trip. "I'm fighting because it's just wrong, period," he said.

Ambulance rates vary across Canada. In New Brunswick, patients without private insurance are eligible for free services; in Ontario, patients are charged $45 for medically necessary trips within the province; in Manitoba, fees depend on the area, but in Winnipeg, basic service is capped at $512. Sara Bucsis-Gunn said she wasn't prepared for the more than $7,000 in bills she received for her daughter's trips to hospital in Saskatchewan.

Leandra, who was seven years old when she died in April 2013, required emergency ambulance trips because of seizures related to a congenital medical condition. She also needed transfers between a hospital in Regina, where her family lived, and a Saskatoon facility. Bucsis-Gunn said she felt abandoned by the health care system.

"That's why I'm so angry with our government ... all of her pain and suffering and extra stress that was put onto our family when we were already at our maximum capacity, all of that was in vain," she said. Bucsis-Gunn said her daughter went home on palliative care at birth, but survived against the odds. "And the treatment she got for surviving was horrid," she said.

As ambulance bills piled up, the family struggled to pay for necessities such as a wheelchair, she added. Bucsis-Gunn said the financial stress pushed her to forgo ambulance rides whenever possible. After a hip reconstruction surgery, she transported Leandra home on a blow-up mattress in the back of a van. "She was a trooper," Bucsis-Gunn said, crying. "She had this infectious laugh ... she just loved to be loved, that's all she cared about."

Bucsis-Gunn, 29, said she doesn't want other families to go through the same thing. "You feel so much pressure to just do the right thing for your child," she said. "But at the same time, to do the right thing financially cripples your family."

David Carr's wife Catherine had stage-four cervical cancer. and required six ambulance trips before she died.

“We understand that this is a small group of patients that are affected, but we will go the extra mile to understand what their needs are and provide that service accordingly,” said Dr. Bev Adams, psychiatry department head with Alberta Health Services.

This leaves the women using Fredericton's freestanding Clinic 554, formerly the Morgentaler Clinic (which was forced to shut down after it ran out of money last summer) out in the cold. This situation frustrates Adrian Edgar, Clinic 554's new medical director, to no end. For Dr. Edgar, the main issues are privacy and accessibility. He believes many women in New Brunswick would prefer to have the procedure in a setting more private than a hospital, due to the lingering stigma and social ostracism that surround abortions. There can be repercussion for families, relationships, even jobs. Many women travel to Maine in order to protect their privacy. "I don't know why the government isn't listening to women on this," he says over the phone from Fredericton. "People want to have the procedure in an anonymous way, they don't want to go the hospital. It's a small province. You go to the hospital and everyone knows, and everyone talks ... and it's on your medical record."

The situation in New Brunswick just highlights how unequal abortion provisions are across the country. There are 46 clinics or hospitals providing the service in Quebec, but just one in Nova Scotia (in Halifax) and none in Prince Edward Island. That is not universal access. Clinic 554 offers a full range of family health care, and also provides services to the gay and transgender communities. In keeping with Dr. Morgentaler's policy, it will not turn away women who can't afford to pay for an abortion, and Dr. Edgar knows that some patients, especially women who are in vulnerable positions to begin with, are already stretched to the limit. "I feel like it's absolutely unacceptable for people to feel that pressure," he says. "It's Canada, and this should be a publicly funded service because it's a medically necessary one. It doesn't make sense to me that we should be targeting women to pay for health care."

Dr. Edgar has been trying to meet with provincial ministers to discuss the funding situation, to no avail. If invited to a meeting, he would point out not only the unfairness of some women having to pay for a service that should be publicly insured, but also that it's actually more costeffective to provide that service outside of hospitals. And, as he points out, the province is in the midst of a cost-cutting exercise to move some services away from hospitals. Why not this one? "I'm trying hard to do the province's job for them," he says, "but I would like not to, very much."

Much of the rhetoric thrown around today in scuffles between governments and physicians might ring a bell for students of medical history. More than 50 years ago, doctors were also accused of being too stubborn to accept changes to pay structure, and a provincial government was also charged with putting fiscal concerns before patient needs. Of course, if that old saying holds any merit — “Those who cannot remember the past are condemned to repeat it” — perhaps a refresher is in order. There seems, after all, to be a little bit of history repeating itself.

The origin of conflict between provincial governments and physicians can be summed up in one word: medicare. It therefore dates back to midnight of July 1, 1962, when the Saskatchewan Medical Care Insurance Act passed into law, introducing the first universal, government-run, single-payer health system to North America. All of one minute later, most of Saskatchewan’s doctors went on strike.

tually, to be precise, the fighting between the government and doctors in Saskatchewan began a couple of years earlier, during the 1960 provincial election. Premier Tommy Douglas had made universal health care the main peg of his re-election campaign. The College of Physicians and Surgeons of Saskatchewan fiercely opposed the idea, contending that government interference in medicine would do far more harm than good.

A public battle ensued, pitting doctors against politicians. Debates were held, pamphlets were circulated, pledges were signed. Did the whole affair stay civil and free of propaganda? Well, you could say that. But only if you enjoy being wrong.

Let’s start with some of the literature circulated by opponents of medicare. One pamphlet, Political Medicine is Bad Medicine, was chockablock with scary warnings and seasoned with a liberal sprinkling of words in all-caps for emphasis. Red Tape! Skyrocketing costs! Inferior care! The premier’s plan “proposes a PERMANENT INFLEXIBLE GOVERNMENT SCHEME at a high cost” that would subject medicine “to POLITICAL considerations bearing no relation to your NEEDS.”

Then there was the infamous flyer — later used by Premier Douglas to shame his opponents, according to Saturday Night magazine — that suggested many doctors would flee the province if the medicare bill passed. “They’ll have to fill up the profession with the garbage of Europe,” read one excerpt, a quote from an anonymous doctor taken from the Toronto Telegram. “Some of the European doctors who come out here are so bad we wonder if they ever practised medicine.”

Later, some in the anti-medicare camp acknowledged that mistakes were made, passion had trumped reason, and the medical profession had suffered for engaging in political mudslinging. “Many doctors concede privately that they went too far, that the campaign lost them prestige in their communities,” reported Saturday Night magazine.

Of course, the premier was no stranger to rhetoric himself. In fact, according to some political commenters of the time, he was a master of the form. He accused the province’s physicians of using “abominable” and “despicable” tactics and pedalling “scurrilous trash.”

In the end, Douglas and his party, the Co-operative Commonwealth Federation, won the election and pushed ahead with their health system plan. The doctors and government set aside their differences and all lived happily ever after. Yeah, right.

Medicare was coming to Saskatchewan — that battle was over — but physicians still weren’t cooperating with the government. They focused their efforts on changing sections of the proposed medicare act, specifically those that granted the government almost unlimited power to control the practice of medicine.

There was no provision for negotiation. The doctors would simply have to do what the government told them to do, and be paid what the government said they would be paid,” Dr. Marc Baltzan (1929–2005), a Saskatoon nephrologist and former president of the Canadian Medical Association, wrote in a 1984 article in Canadian Family Physician entitled, “Doctor/Government Fee Negotiations in Canada.”

After the act became law, unchanged, the province’s physicians closed their offices, though they still provided emergency services in hospitals. The standoff lasted 23 days, ending only after both sides compromised and signed the Saskatoon Agreement. The deal amended the act to ensure doctors would maintain their independence and could, if they wanted, opt out of medicare and bill patients directly.

The deal was brokered by Lord Stephen Taylor, a British doctor and politician who helped implement the National Health Service in the United Kingdom. Later, reflecting on his Saskatchewan adventure, Taylor wrote that much of the animosity between the two parties arose because they did not understand each other at all. The government did not anticipate how much their plan would threaten the autonomy of a proud profession. Physicians “could not believe that the government was composed of honest and responsible people.”

Taylor, a man of both medicine and government, chose to take a dispassionate view of the conflict. “I see honest men on both sides, well motivated but mystified by the actions of their opponents.”

Decades later, debate over another act — the Canada Health Act, federal legislation adopted in 1984 — again showed just how differently government and physicians can view a change to how doctors are paid. This time, the government was putting an end to extra billing by physicians. But according to Baltzan, as mentioned in his Canada Family Physician article cited above, this was merely a “political euphemism” for banning a patient’s right to be reimbursed by the government when billed directly by a doctor.

In his lament over the passing of the “deceitful bill,” Baltzan suggested that it was important to revisit the original fight over medicare in Saskatchewan because “it shows that there is nothing new under the sun: it contains all the elements of physician–government confrontation that have been replayed again and again during the Canada Health Act debate.”

Now, more than 30 years later, it might not be a stretch to say there is still nothing new under the sun regarding negotiations between doctors and government. When things go bad, as they have in Ontario, both sides sometimes resort to a little time-tested rhetoric. Then again, though some of the messages sound familiar, other elements of physician–government showdowns have changed since 1962. For one, doctors back then didn’t have Twitter accounts.

£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

Nova Scotia Government & General Employees Union president Joan Jessome, who represents the majority of Capital Health nurses, said Glavine is attempting to hide the fallout of legislation.

Many nurses are leaving because they weren’t given a say about their representation under the new provincial health authority, not because of propaganda, said Jessome. “They’re fed up.”

An arbitrator’s decision Friday will all but certainly place all nurses with the Nova Scotia Nurses’ Union.

NDP health critic Dave Wilson said Glavine should acknowledge that some of the Liberals’ moves since coming to power are hurting health care. More focus should be placed on workplace concerns and staffing levels rather than union reorganization, he said.

Glavine said steps continue to address shortages, including adding seats at nursing schools and a proposal at Dalhousie University to condence the nursing program from four years to three.

By Bob Peterson / Rethinking Schools

long history of being staff-dominated.

And it has. In New Orleans, following Katrina, unionized teachers were fired and the entire system charterized.

But it recognizes that our future depends on redefining unionism from a narrow trade union model, focused almost exclusively on protecting union members, to a broader vision that sees the future of unionized workers tied directly to the interests of the entire working class and the communities, particularly communities of color, in which we live and work.

It requires confronting racist attitudes and past practices that have marginalized people of color both inside and outside unions.

Having decimated labor law and defunded public education, Walker proceeded to expand statewide the private school voucher program that has wreaked havoc on Milwaukee, and enacted one of the nation’s most generous income tax deductions for private school tuition.

For nearly a decade we pushed for a full-time release president, a proposal resisted by most professional staff.

“Social Justice Unionism: A Working Draft”

Social justice unionism is an organizing model that calls for a radical boost in internal union democracy and increased member participation.

business model that is so dependent on staff providing services

building union power at the school level in alliance with parents, community groups, and other social movements.

The importance of parent/community alliances was downplayed

instead of helping members organize to solve their own problems.

Our challenge in Milwaukee was to transform a staff-dominated, business/service-style teachers’ union into something quite different.

only saw the union newsletter after the staff had sent it to the printer.

Key elements of our local’s “reimagine” campaign and our subsequent work include:

Building strong ties and coalitions with parent, community, and civic organizations,

broader issues

action.

earliest victories was securing an extra $5/hour (after the first hour) for educational assistants when they “cover” a teacher’s classroom.

lobby

enlist parents

we amended the constitution

consistently promoting culturally responsive, social justice teaching.

encourage members to lead our work.

release two teachers to be organizers

appear en masse at school board meetings

to shift certain powers from the staff to the elected leadership

new teacher orientation and mentoring are available and of high quality.

The strength of the Chicago Teachers Union (CTU) 2012 strike,

rested in large part on their members’ connections to parent and community groups

Karen Lewis

Portland, Oregon, and St. Paul, Minnesota

In Milwaukee, our main coalition work has been building Schools and Communities United,

We wanted to move past reacting, being on the defensive, and appearing to be only against things.

Key to the coalition’s renewal was the development of a 32-page booklet, Fulfill the Promise: The Schools and Communities Our Children Deserve.

concerns of the broader community beyond the schoolhouse door

English and Spanish

Currently the coalition’s three committees focus on fighting school privatization, promoting community schools, and supporting progressive legislation.

schools as hubs for social and health support,

This work reminds me of the words of activist/musician Bernice Johnson Reagon, of Sweet Honey in the Rock: “If you are in a coalition and you are comfortable, that coalition is not broad enough.”

Our new professional staff is committed to a broader vision of unionism with an emphasis on organizing.

We need to become the “go-to” organizations in our communities on issues ranging from teacher development to anti-racist education to quality assessments.

nonprofit organization, the Milwaukee Center for Teaching, Learning, and Public Education

We provide professional development and services to our members

reclaim our classrooms and our profession.

We partner with the MPS administration through labor/management committees

multiple committee meetings, inservice trainings, book circles (for college credit), and individual help sessions on professional development plans or licensure issues.

we offered workshops that drew 150 teachers at a time.

More teachers were convinced to join our union, too, because our teaching and learning services are only open to members.

mandate 45 minutes of uninterrupted play in 4- and 5-year-old kindergarten classes

We also won a staggered start

convincing the school board to systematically expand bilingual education programs throughout the district.

school-based canvassing around issues and pro-education candidates, and organizing to remove ineffective principals.

With the plethora of federal and state mandates and the datatization of our culture,

It’s clear to me that what is necessary is a national movement led by activists at the local, state, and national levels within the AFT and NEA—in alliance with parents, students, and community groups—to take back our classrooms and our profession.

social justice content in our curriculum

waiting to use any perceived or real weakness in public schools as an excuse to accelerate their school privatization schemes,

On the other hand, speaking out can play into the hands of the privatizers as they seek to expand privately run charters

including participation on labor/management committees, lobbying school board members, and balancing mass mobilizations with the threat of mass mobilizations.

In the end, we recognize a key element in fighting privatization is to improve our public schools.

In Los Angeles, an activist caucus, Union Power, won leadership of the United Teachers Los Angeles, the second largest teacher local in the country.

"It's now up to the government to act and decide whether it will cover the cost of certain services and the use of medical equipment in private practice, or if it wants to revise the agreement on the accessory fees with the medical federations." Under the Quebec Health and Social Services Act, doctors who work in hospitals cannot bill patients for medically necessary services. These same physicians must abide by certain conditions in their private practice, since they have not opted out of medicare. They can only charge for "medications and anesthesia agents" in private, and they are not allowed to bill patients for the use of medical equipment. However, there is one exception to the rule: private radiology clinics in Quebec can bill patients for MRI scans - a sore point with Health Canada, which has argued that the exception violates the accessibility provisions of the Canada Health Act. In addition, Quebec did negotiate with the medical federations a list of fees that are permitted, such as the use of liquid nitrogen to remove moles ($10) or the use of a topical anesthetic for a minor eye wound (also $10). Over the years, many physicians in private practice have started billing for many more items and services, sometimes prompting investigations by the Régie de l'assurance maladie du Québec (RAMQ).

Approximately three-quarters of B.C. care aides surveyed said they are forced to rush through basic care for the elderly and disabled because of high workloads and reduced staffing. And let's not forget the workers who bear the brunt of health care cuts. Between January 21 and February 26, nearly 1,500 health care workers were laid-off at care homes and hospitals across B.C. because of contracting out or contract flips. Any former workers rehired at these facilities can expect to start at the bottom of the employment ladder. Some will lose their pension, others will receive lower probationary wages and most will have zero-earned vacation time. It's plain to see public health care is going down a bad road.

As we head towards a federal election, Canadians have an opportunity to think about how they can best vote for health care in 2015. The next government in Ottawa can take immediate steps to put our nation's signature social program back on the right track. That means your vote - and the vote of your family and friends - can make a difference in electing MPs that will fight for health care. They say voters get the government they deserve. And we certainly are due for leadership in Ottawa that puts the future of a strong public health care system front and centre in their election promises. To learn more about what can be done to save public health care, please visit saveourhealthcarebc.ca online. Bonnie Pearson, HEU Secretary-Business Manager

Late last month, the province, which is projecting a $453-million budgetary deficit, released information that contained around $1 billion in options, pledging to deliver on about half of the list of new revenue measures and spending cuts. Highlighting the package are a two percentage point hike in the HST, highway tolls in eight places across the province, an increase in class sizes in schools, performance-based funding for universities, and the potential sale of the province's parks headline the report.

The government wants the public to mull over the list with the province being prepared to move on the choices in the months ahead. In an interview, Victor Boudreau, minister responsible for the Strategic Program Review, said CUPE is quick to say what it wouldn't do but not so fast to say what they would.

This has been a very long process," the minister said. "We started this process back in January. We toured the province extensively. We had meetings with New Brunswickers. We had meetings with stakeholders. We have had a lot of meetings internally within government. Every department was asked to take a close look at their budget line by line and try to identify some opportunities." At Monday's news conference, which included leaders from several unions, Robichaud said CUPE had been to every round-table and public forum.

"Nobody came to the microphone to say you should close my hospital because I don't mind travelling an extra hour to receive health care or increase the size of that classrooms the teacher will have less time to spend with my child and, on top of that, lay off education assistants," Robichaud said. "We didn't hear any New Brunswickers come forward and say you should close my school in my community and privatize road maintenance and custodial services in the school, so my neighbours or family members would lose their jobs." Boudreau said all the suggestions presented in the Choices Report were either from the public, the stakeholders or the civil service, he said. "Now, we are at the point where we have to take some decisions," Boudreau said. "We want it to be very straightforward and put all the choices out that are being considered."

Robichaud said CUPE is considering rallies, demonstrations and meetings. CUPE said it wants to know why the minister is using the deficit figure for the second quarter of 2015-2016, which is $453 million, instead of the deficit figure for 2014-2015 which stands at $388.6 million and includes a one-time expense of $229.7 million for the reform of the New Brunswick Teachers Pension Plan. Boudreau said it's well documented that the province has a structural deficit in the hundreds of millions.

"With an austerity budget, there can be some decisions that will have a short term negative impact on the economy. That's why we're accounting for more to be able to get to the actual number which is about $450 million. There's no doubt that from one year to the next, there are always adjustments."

The NDP Opposition has gladly taken up the cause, noting that the $440 per three-month cost is outrageously high compared with $90 in Saskatoon, $70 in Prince Albert, $60 in Moose Jaw and free services in Melville and North Battleford. However, Health Ministry officials and Premier Brad Wall's office were quick to justify the cost of the Schwann Centre because of its having extra amenities like costly physician supervision. They also pointed to the alternative of private gyms and fitness centres in Regina. Schaan noted such facilities come with their own price tag - and without the same medical supervision. "I agree, personally," Schaan said. "It (the Schwann Centre) was a bit of Cadillac program." Schaan suspects the Saskatchewan Party's eagerness to suggest private fitness alternatives is part of this government's bigger philosophical belief that to save money, it's OK to dump to the private sector services government should be providing to all residents. So after not hearing anything from the provincial government since their November visit to the legislature, Schaan and others are again putting the pressure on Health Minister Dustin Duncan to address their concerns about one of the basic principles of medicare - that it should be equal, accessible and affordable to all.

Schaan is right. It is ridiculous that we don't have minimum standards and expectations for something as basic as post-heart-attack care. In fairness to Duncan and other Canadian health ministers who met last week, such minimum standards continue to confound them. There are thousands of potential opportunities for inequity, and efforts to build consensus on prescription drug purchases and costs are laudable. Moreover, notwithstanding federal transfer payments and equalization, there will be disparity based on things like the quality and services provided in larger urban hospitals. And because health-care delivery is a provincial responsibility, each province - depending on its wants and needs - might have legitimately different priorities.

Specific to Duncan and his Sask. Party government, credit is due for setting wait-time goals to ensure some level of standards can exist. Not all those goals have been met by this government (see: emergency room wait times), but having goals and standards is always better. But even if everything from prescription drugs to specialist services can legitimately vary from province to province, one might think that within each province we would see relative consistency on something as basic as the cost and care available to heart attack patients on their road to recovery. There is something very wrong with the health system when the province thinks it can shuffle responsibility for basic cardiovascular recovery to private fitness facilities.

It shouldn't be up to the private sector to provide such services. Nor should the province be dumping this on the local health region or university. And no one should have to wait until an election rolls around to see that minimum standards are enforced, as Schwann Centre clientele now must do. They deserve an answer from the health minister. So far, they haven't got one. Mandryk is the political columnist for the Regina Leader-Post.

"It has been so undertreated (in the public system) that there's no way you can bring it into the 21st century without some expenditure," Dooner says. He suggests de-insuring older treatments such as sclerotherapy - the injection of saline fluid into veins to make them shrivel away - and putting that money into surgery.

At the root of the issue is the idea that varicose veins are a strictly cosmetic problem, says Dr. David Liu, an interventional radiologist at Vancouver General Hospital who also works in a private clinic with vascular surgeon Dr. Joel Gagnon. "Venous disease is really a redheaded stepchild of diseases because we're only starting to understand it now ... and the funding structures are based on antiquated concepts," Liu says.

Varicose veins can result in more serious leg damage if left untreated. The range of options and their prices can make it overwhelming for patients to choose, Liu says. Even worse are so-called vein clinics that aren't overseen by doctors using ultrasound imaging, where patients get superficial laser treatments, missing the underlying problem. Susanne Ziltener of Vancouver has experienced both traditional vein-stripping surgery and one of the new treatments, a medical glue approved last year for use in Canada. Liu and Gagnon were the first to use it in Western Canada. The 66-year-old waited about three years for the publicly-funded surgery and then paid $4,000 to have the other leg treated privately.

Ziltener says neither was particularly painful although she was dreading the surgery, based on the experience of her mother who had the same operation. The biggest difference in her experience was having to wear a compression bandage 24 hours a day for about a week following surgery, something not required after the less-invasive treatment. The choices are vast enough that B.C.'s Ministry of Health has created an online guide to walk people through their choices. In an emailed statement, ministry of health's Laura Heinze said officials reviewed alternatives to surgery this year and decided not to fund them because they are more expensive than surgery and results are similar.

Regarding waiting lists, the government added $10 million to the health system in June to reduce the number of people waiting more than 40 weeks for surgery, including surgery on varicose veins, she said. eellis@vancouversun.com Varicose veins The common condition is viewed as a cosmetic nuisance by most, but can lead to painful leg ulcers if severe cases are left untreated. What are varicose veins?

Bulging, painful veins typically in the lower leg, occur when valves inside them stop working properly and are no longer able to push blood upward to the heart. This causes it to flow backward and pool in the veins, pushing them into tortured shapes. The extra blood also makes legs feel heavy. What causes varicose veins? Family History Aging Pregnancy Being over weight Standing or sitting too long

Who gets them? At least 15 percent of Canadian adult have varicose vein although some estimates are much higher. What are the treatments? In all cases, the aim of treatment is to remove or disable damaged veins so healthier ones will take over the task of pushing blood upward. Surgery usually called vein stripping, entails making cuts in the skin above, below and in the middle of the vein to be removed, which is then pulled out. It is done under a general or spinal anesthetic.

Sclerotherapy is the injection of a saline solution directly into the vein where it irritates the lining of the blood vessel and causes its walls to stick together. It needs no anesthetic. Minimally Invasive technique are grouped under the heading of endogenous ablation, which is the destruction of veins from the inside using a tiny probe inserted through a cut in the skin which is then guided by ultrasound imaging. It can employ laser or radio frequency to heat and essentially cauterize the vein; a fluid or foam that causes the vein to collapse; or medical glue which sticks the walls of the vein together. It may require local anesthetic around the incision.