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Duh. You get what you pay for. Thus in fee-for-service Ontario the government just did the reverse, ordering doctors to see fewer patients or face penalties. But which is more "productive"? You can't tell. Counting patients per doctor, minutes per visit, or dollars per doctor looks like feedback. But it's not, because you're just dividing one target by another. Actual value, consumer satisfaction, has no way into the system because you can't measure it. Actually you can. As Leonard Read's 1958 classic I, Pencil noted, nobody in the world knows how to make a pencil. It may seem a humble object. But it requires wood, glue, paint, "carbon black," graphite, copper, etc., provided through a mind-bogglingly complex system in which wood is cut with chainsaws by loggers drinking coffee, shipped in trucks, painted in factories that themselves use paint and pencils and so on. Nobody knows, or could know, how each component is made. Yet billions are made for pennies apiece because of the cybernetic miracle of prices. Nobody has to know why prices are what they are, only what they are, to make rational decisions all along the chain leading to a consumer with a limited budget deciding for herself what constitutes best value for money.

"Hence, the reason for the increased fee to this class of physicians much to the chagrin of the hospital-based physicians who perform the same function or duty for less remuneration," wrote Herauf. Before a lawsuit can proceed as a class action it must first be certified by a judge. In December, Court of Queen's Bench Justice Ted Zarzeczny found the proposed suit, argued by lawyers Tony Merchant and Casey Churko, met the requirements for a class action. That means that rather than each individual suing, one person, in this case Dr. Keith Anstead, can launch the action on behalf of himself and a group - the fulltime surgical assistants. According to Zarzeczny's decision, Saskatchewan had 61 full-time surgical assistants as of the end of 2013.

But when it comes to pensions, that's not true. Ontario's big public-sector funds are the top of their class. While companies want 110 per cent of our effort, they've largely rewarded workers by abandoning the sort of pension plans that provide security and let people sleep easy in retirement. Some 76 per cent of private-sector employees don't have a pension of any kind. Of those who do have a pension, less than half have defined benefit plans. When you do the math, only about one in 10 people working in the private sector has a defined benefit plan. Such plans pay a monthly amount for life, putting the onus on companies to come up with the money. Corporate Canada doesn't like that idea and has been bailing out, moving to defined contribution (DC) plans where they can throw some money in the pot to match workers' contributions (if they're lucky) and then wash their hands. That leaves workers with all the risks and stress of investing and managing the money on retirement. These are skills most people don't have.

The public sector still believes that collective effort can give a better outcome. So, 86 per cent of workers for provincial and local governments - people such as firefighters and police, those at universities and colleges and workers in health care - are covered by pension plans, mostly the defined benefit kind. Pensions provide a broader social benefit beyond the cash in a pensioner's pocket. According to HOOPP, 7 per cent of all income in Ontario comes from defined benefit pensions, which pay out about $27 billion a year, money that supports the communities where people live. Keohane says 20 per cent of all income in Collingwood, for example, comes from pensions. He says it's a myth that taxpayers are footing the bill. In HOOPP's case, 80 cents of every dollar in the $61-billion fund come from investment returns.

There are several reasons why an individual can't hope to match the performance of a big fund with an RRSP. Big funds bring investing expertise and economies of scale to bear in a way that individuals cannot. It is precisely because they lack a "for-profit" motive that such funds can keep fees low and returns high. Think of how many fees you might pay along the way when investing - for advisers, buying and selling stocks and funds, trailer fees, management expense ratios, fees you can't see. Big funds are also "patient money," which means they can weather market ups and downs and not be forced to sell. The next "quarter" for HOOPP is 25 years, not three months.

OMERS, Ontario's largest pension plan, also reported strong results last week. OMERS manages the assets of 450,000 municipal employees and earned a 10-per-cent investment return in 2014. The fund stumbled during the financial collapse of 2008 and has been working its way out of a hole. In 2014, OMERS made more progress, increasing its funding level to 91 cents per dollar needed, up from 88 cents a year ago. There's still a long way to go to catch HOOPP, but it's going the right way. Our frayed faith and anger with our public institutions is well-deserved, and that general discontent spills over to public pension envy. But a better target would be private-sector employers who have been abandoning their workers because it's expedient, leaving them to make financial decisions in retirement they are often ill-equipped to make.

Adam Mayers writes about investing and personal finance. Reach him at amayers@thestar.ca. What is HOOPP? Healthcare of Ontario Pension Plan is the eighth-largest pension fund in Canada. It cover 295,000 people who work at hospitals, community care facilities, labs, clinics and addiction centres. Nurses are its largest membership group. Fifty of its pensioners are over 100 years old. HOOPP earned a 17.71-per-cent return in 2014, adding $9.1 billion to its assets, which now stand at $60.8 billion. Its average annual return over the past 10 years is 10.27 per cent. Source: HOOPP

“we need to triple the number of long-term care beds in our province” over the next 20 years

Susan Eng, of the senior advocacy group CARP, said all the recommendations hold promise

The 198-page report by Dr. Samir Sinha, director of geriatrics at Mount Sinai and the University Health Network Hospitals, recommended the Health Ministry explore an income-based system for home care and community support services.

report, Living Longer, Living Well

a report, Living Longer, Living Well

“I think it is time for us to have that conversation. We have moved to that on drugs for example in the last budget,” Matthews said, adding later that “nobody got too excited about it

there already is a user fee for Meals on Wheels

Fifty-five per cent of the OMA's members — which includes 42,000 physicians, residents and medical students — participated in the vote at a townhall-style meeting on Sunday either in person or by proxy, the association said in a release Monday.

Health Canada’s annual reports show that Quebec has sometimes complied with its concerns. But in its 2003-2004 report, the agency observed that the Quebec government was “not at liberty to reveal the status of the province’s investigation” into user charges imposed by a private surgical clinic. A year earlier, Health Canada expressed concern “about private surgical clinics that allow individuals to privately pay for medically insured services and thus jump the queue. … Health Canada asked Quebec to confirm that the matter had been resolved.” A long-standing complaint of Quebec by Health Canada is that it allows patients to be charged for MRIs and CT scans if they are done in private clinics. In its 2004-2005 report, Health Canada held discussions with British Columbia, Alberta and Nova Scotia about charging for medical imaging in private clinics, but Quebec refused to participate. 

Health Canada officials did not respond to requests for an interview since last Thursday. Reacting to the Quebec lawsuit last week, federal Health Minister Jane Philpott said she’s a strong supporter of the CHA, and did not rule out reducing transfer payments to provinces that flout the law.

Online balloting has opened and will continue until May 15. While Day and Larsen Soles are both repeat contenders, they are distinctly different candidates who will appeal to different segments of the association's 12,000 members.

As an orthopedic surgeon, Day should draw more votes from specialists who have long felt the organization is too loaded with primary care doctors. Indeed, the current board of five doesn't include a single specialist and such doctors have long felt that has disadvantaged them when it comes to negotiations over fees with government. Family doctors have made impressive gains in the past two contracts while specialists, such as fee-for-service anesthesiologists, have complained bitterly about their fees and work terms. If Larsen Soles wins, she would become the fourth consecutive family doctor to be president and the second consecutive rural doctor; Ruddiman, the presidentelect, is from Oliver. She said in an interview she expects doctors will naturally want to mull those questions over.

"The thing is, people who choose rural medicine are those who are attracted to challenges and change and that's who doctors would be getting if they elect me. "Day, a private medicine pioneer, is hardly a stranger to challenge and change himself. Evidence of that is his seven-year-old lawsuit against the provincial government over whether private surgery clinics can bill patients for publicly insured services normally done in hospitals, usually after waiting long periods. Day said the litigation should not be a factor in the campaign, as it was last year. The oft-deferred sixmonth trial was supposed to begin in June but it has now been delayed to the fall. Day said provincial government lawyers recently asked for another deferral because they need yet more time to prepare. Providing the trial does start in September and lasts six months, as expected, if Day won the presidency, he'd be assuming the helm about four months after the trial ends. But regardless of which side in the trial wins, appeals all the way to the Supreme Court of Canada are expected in the landmark case that could reshape the health care system.

Day said only about 60,000 B.C. residents pay out of their own pockets to use 60 or so private surgery clinics. "I'm not saying we should privatize the health care system," he said, but he believes in a hybrid system in which private centres are used far more, as Saskatchewan is doing with its large scale contracting out of cases in which patients are waiting too long for care in hospitals. "Saskatchewan, the birthplace of socialized medicine, has taken a more pragmatic, less ideological approach, and it seems to be working. They are empowering patients to get their treatment in other places (like private surgery and radiology centres)." Larsen Soles said she's interested in the innovations in Saskatchewan but worries that a burgeoning private sector will draw health professionals away from the public sector. Sun health issues reporter pfayerman@postmedia.com twitter: @MedicineMatters

Alberta Health Services said there were more than 1,650 Albertan waiting for some type of continuing care bed — including about 500 who are taking up hospital beds with no place else to go.

And user fees? Even a Senate committee that had been warm to the idea of charging patients each time they saw a doctor changed its mind when faced with the evidence.

But the real problem with two-tier medicine, as former Saskatchewan premier Roy Romanow noted on the same CTV show, is that it simply shifts costs.

Manning made much of the fact that Quebec’s government devotes proportionally less of it provincial budget to health —30 per cent of program spending as opposed to about 40 per cent in Ontario. He appeared to attribute this to the fact that Quebec, unlike Ontario, allows physicians to opt out of medicare and bill patients privately. But the real reason why the Quebec government spends less in proportional terms on health care is that it spends more in absolute terms on everything else. Provincial government program spending per capita in Quebec is $11,457. In Ontario, the figure is $9,223.

total health spending in Ontario represents 11.9 per cent of the province’s gross domestic product. In Quebec, the comparable figure is 12.4 per cent

The Germans, Dutch and French, all of whom are praised by two-tier fans, spend more of their gross domestic product on health care than we do.

Surely it’s more productive to build on what we have — a successful, publicly funded, universal health insurance system that covers doctors and hospitals. It could be improved or even expanded. But it works. That’s why Canadians keep fighting for it. Over and over and over again.

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.

even though improvements in technology have allowed these specialists to treat a greater number of patients more swiftly

According to the Canadian Institute for Health Information, total billings by Ontario doctors have risen by an average of nine per cent over the past five years

In medical specialties, such as cataract surgery and diagnostic imaging, where the volume of procedures has increased and new technologies have boosted productivity significantly, annual raises have amounted to as much as 12 per cent.

paid in the $650,000 to $700,000 range