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Another difficulty is ideological resistance to such innovations as increased private health service delivery and performance-based funding

Claude Castonguay, under whose direction Quebec’s medicare system was instituted four decades ago, has written a new book

In an open letter to the premier published this week, he says that what is needed is an overall plan

For instance, there would be no Medicare - the national achievement of which Canadians are proudest - had Ottawa not unilaterally imposed it across the country in the 1960s. Ontario was among the holdouts, until its then premier discovered that Ontarians wanted what the feds were offering. Today, the feds have that same advantage of popular support for reform.

A Canadian Medical Association (CMA) poll that mirrors the results of other polls shows Canadians are strongly supportive of major health care reforms in mental-health services (83 per cent), more affordable prescription drugs (80 per cent), palliative care (80 per cent) and home care (79 per cent), among other health services. Philpott is an ardent champion of "targeted funding," to ensure that federal money gets spent on the Grits' priorities of improved home care, palliative care and mental health treatment. By contrast, the sub-governments share the view of Quebec Premier Philippe Couillard, that "We are totally opposed to targeted funding." Give us the money, let us decide how to spend it.

Philpott's valid grievance is that the $41 billion Ottawa transferred to sub-governments during the previous 2004-2014 Health Accord, which expired two years ago, did not bring health-care reform. "We didn't buy change," as the minister puts it. This time, Ottawa wants to see results for its money. In a remarkable speech to the CMA this week, Philpott indicted the sub-governments for their routine violations of the Canada Health Act, which has undercut "a fair and just society." She condemned the system as plodding and unco-ordinated, an assessment few Canadians would disagree with.

And acceding to the subgovernment's rote demands - an increase in federal funds with no strings attached - holds exactly zero chance of forcing reform. After all, the health minister noted, there are many countries that spend less than Canada on health care, yet boast better health outcomes. Examples: Britain, Italy, Spain, Norway, Israel and Ireland, among others. The sub-governments should have seen this confrontation coming. A Harper government also frustrated with lack of health-care reform slashed the increase in federal health transfers from 6 per cent to 3 per cent in a bid to force better spending decisions on provinces and territories.

It will be a struggle for the sub-governments to marshal a convincing argument against Philpott's insistence that Ottawa must have a role in moving Canadian health care "from the middle of the pack to out in front." Here's what the traditional hands-off, no-strings-attached status quo has gotten us: The World Health Organization (WHO), an arm of the UN, ranks Canada a dismal 30th in quality of health care, trailing Colombia, Cyprus and Morocco. (France and Italy rank 1st and 2nd, respectively.) Total Canadian health-care spending has more than doubled, to $219 billion, over the past 15 years, with no comparable across-the-board improvement in quality of health of Canadians. And as a percentage of GDP, Canadian health care spending has jumped from 8.3 to 10.3 in that period.

MSF said the hospital attack deprives 70,000 people in Millis and surrounding areas of essential medical care. The hospital, supported by MSF since 2014, used to receive 250 patients a day, many of them women and children "The direct bombing of another hospital in Syria is an outrage," says Silvia Dallatomasina, medical manager of MSF operations in northwestern Syria.

She called for an immediate end to attacks on hospitals, pointing that four out of five United Nations Security Council members are participants in the war in Syria.

Hospitals, mostly in rebel-held areas, are regularly attacked. In July alone, the UN said it has recorded 44 attacks on health facilities in Syria. The Syrian government and Russia, a major ally that has been carrying out air strikes in Syria since September, deny targeting health facilities.

In recent days, a number of attacks on medical facilities were reported amid increased violence, and ultimately increased pressure on the health facilities, in northern Syria

MSF said two facilities it supports in Idlib, controlled by insurgents, have reported nine mass influxes of wounded in July, that left 466 wounded and 37 dead. In the first six months of 2016, the same facilities reported only seven mass influxes of wounded, with a total 294 wounded and 33 dead.

To download all those tasks to the provinces would risk turning many Canadians into second-class citizens.

"The big, rich provinces can do it, [but] with what consequences? The small, poor ones cannot; at any rate without massive help from that central government which [further decentralization] would enfeeble."

As my father regularly pointed out, the BNA Act (now the Constitution Act, 1867), gave the Dominion government broad powers "to make laws for the Peace, Order and Good Government of Canada," embracing all matters – foreseeable or otherwise – that were not "assigned exclusively to the legislatures of the provinces."

     Federal jurisdiction has been chipped away since then

despite those rulings, the federal government retains its powers in many fields, and shares jurisdiction with the provinces in a number of others

  To further limit or eliminate the federal spending power would severely disrupt the practical balancing mechanisms that characterize Canadian federalism. It would also go against the principles of fairness and welfare (or well-being), which are inherent in the Canadian tradition.

Section 36 of our repatriated Constitution Act, 1982, which explicitly states a shared commitment to:

"(a) promoting equal opportunities for the well-being of Canadians; (b) furthering economic development to reduce disparity in opportunities; and (c) providing essential public services of reasonable quality to all Canadians.”

radically decentralist goal

"instead of sending money to the provinces, Ottawa would cut its taxes and let them use the fiscal room that has been vacated.”

this is the position of “two of the greatest conservative statesmen of our generation, Preston Manning and Mike Harris,” as well as of the Fraser Institute

     Bernier's portrayal of Macdonald, Cartier, and the rest as avid provincialists is thoroughly debunked in Dad's popular and authoritative handbook How Canadians Govern Themselves

cite the historical record to show that our country was intended from the start to be "a real federation, a real 'union,' "une grande et puissante nation," not a league of states or of sovereign or semi-independent provinces."

"Only a real country," he said, "with a powerful national Government and Parliament, can have any hope of controlling inflation and restoring full employment. Only a real country can maintain the unemployment insurance, the family allowances and child tax credits, the Medicare, which we now enjoy. Only a real country can give the people of the poorer provinces anything like modern educational and social services."

deteriorating patchwork of policies and programs that weaken the system and aggravate disparities between provinces

Contrary to the bias of rightwing think tanks, it has been proven that such privatization erodes public services, costs more, and delivers less. Any union's goal is to achieve a first collective agreement for its new members. SN Transport employees are working toward this while facing a company that has put up roadblocks to bargaining - which is how we ended up at the Labour Board.

Martinuk says nothing about the employer's obvious attempt to stall collective bargaining but instead sees nefarious purpose in CUPE's straightforward attempt to get these workers a fair first collective agreement. BRONYWN BARTER President, CUPE 873, Ambulance Paramedics of BC

"Rotund, funny and occasionally pompous, Dr. Porter was everyone's friend and nobody's confidante, the life of the party and an agile dancer, both in political circles and around a ballroom floor. A member of Air Canada's board of directors, he travelled the world free. His former friend Prime Minister Stephen Harper had him sworn in as a member of the Privy Council so he could serve as chairman of the Security Intelligence Review Committee, or SIRC, the country's spy watchdog agency. "And he was close to Quebec Premier Philippe Couillard, a relationship that began in 2004 when the politician, a neurosurgeon by training, was provincial health minister. Like many of Dr. Porter's friendships, theirs ended with the news of the hospital's megacost overrun and a $22.5-million fraud inquiry connected to the MUHC's decision to award the construction contract to a consortium led by the Montreal-based engineering firm SNC-Lavalin Group Inc.

""In a way, Arthur was like Icarus, who came crashing down to earth when his wax wings melted because he flew too close to the sun," Jeff Todd, an Ottawabased journalist who first met Dr. Porter in the Bahamas and co-authored the memoir, said. ""He told me that if he did anything wrong, it was to go way too fast," Mr. Todd continued. "There was never a peak he didn't want to climb and if there was a huge challenge, he always thought he would simply fly over it. But he couldn't always do that." "The first indication was in November, 2011, when the National Post revealed he had signed a commercial agreement the year before with Ari BenMenashe, a Montreal-based Israeli security consultant and arms dealer, all while he was head of both the MUHC and Canada's spy watchdog. Mr. BenMenashe was to secure a $120million grant from Russia for "infrastructure development" in Sierra Leone. In return, a company called the Africa Infrastructure Group, which was controlled by Dr. Porter's family, would manage what he wrote were "bridges, dams, ferries and other infrastructure projects" built with the Russian money.

"Within days, he was gone from SIRC. Less than a month later, he resigned from the MUHC, departing on the grounds that he had accomplished what he had set out to do in 2004: bring together a private-public partnership and get a long-dreamed-of facility built. "Unbeknownst to the public at the time, under his watch, a planned project deficit of $12million had somehow escalated to $115-million. "The following year, fraud charges were laid, but by then Dr. Porter was on to other projects and living in a gated community in the Bahamas, where he had maintained a home for years. After Interpol issued a warrant for his arrest, he and his wife, Pamela Mattock Porter, were detained June, 2013, by authorities at Tocumen International Airport in Panama City. "Despite claiming he could not be arrested because he was on a diplomatic mission for Sierra Leone, he was soon confined to overcrowded quarters in a wing reserved for foreigners in filthy La Joya prison. Toting an oxygen tank, he became known there as "Doc," ministering to inmates who included drug dealers and murderers. The man who had begun his ascent to the top as a doctor beloved by his patients would end at the bottom as a doctor beloved by his patients again.

"He was smart, perhaps too smart for his own good, and affable, with an ability to zero in on the most powerful person in the room with laser-like focus. His long-time friend and former teacher Karol Sikora, who partnered with Dr. Porter in a Bahamian medical clinic and is also the medical director of their joint private health-care company, Cancer Partners UK, said he was uncannily good at getting people together everywhere he touched down, even if they had opposing views. ""People like that are rare and they are very good at running big institutions," Dr. Sikora said. ""Arthur reached the peak of his career in 2010, when he was all glowing and bigger than sliced bread. Then it all went wrong." "Although Dr. Porter claimed the money from SNC was payment for other consulting work he'd done for them, his friend opined that the truth will probably never come out now. ""I'd like to think Arthur was never part of this monkey business, but we'll never know," he said.

"Others were not so kind. Responding to news of his death, the MUHC issued a terse statement that extended condolences to his family and offered no further comment, while Mr. Harper suspended the protocol that would have seen the Peace Tower flag fly at half-mast to mark the death of a Privy Council member. "In prison, living in unsanitary surroundings and denied proper treatment in a hospital for the cancer that many doubted he had, Dr. Porter, who leaves his father, sister, wife and four daughters, was outwardly still full of bravado until near the end. ""I just have to survive and make do," he told CBC reporter Dave Seglins in a phone interview in March that revolved around his treatment at the prison and his successful complaint to the United Nations torture watchdog that his human rights were being trampled on. ""[The] water, food, bedding and the fact that one has to urinate in a bucket shared by about 50 to 100 people ... for someone who has an illness and needs treatment, it was pretty obvious, I presume, the UN clearly found in my favour." "In addition, Dr. Porter continued, his raspy voice rising, he had not had a single court hearing in 22 months.

"I've never left here to go into the city. I have no idea what the inside of a courtroom looks like, not in Panama, Canada, the Bahamas or anywhere," he cried. "I've never been to court in my life." "In the end, though, he seemed to be aware that the stain on his reputation would not be erased, not even in death. ""My entire life has been devoted to climbing, winning and succeeding," he wrote in his memoir. "But with the end drawing near, it is inevitable that I, like anyone else, wonder if what I have accomplished truly matters. I wonder how I will be remembered." "To submit an I Remember: obit@globeandmail.com Send us a memory of someone we have recently profiled on the Obituaries page. Please include I Remember in the subject field.

"In his memoir, Dr. Porter said his life was 'devoted to ... winning.' " "Arthur Porter, left, chats with Stephen Harper at Montreal General Hospital in 2006. The Prime Minister had Dr. Porter sworn in as a member of the Privy Council.

£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

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