What if the Prime Minister linked a climate deal to a health deal? That could be politically explosive. But McGill economist Chris Ragan thinks it's a good idea. One reason is that Mr. Ragan thinks the federal government will end transferring more money to the provinces anyway. Although the growth in provincial health spending has actually slowed in recent years, there are forecasts that it will grow by 3 per cent of GDP - by 2040. Mr. Ragan figures Ottawa will eventually give in, and might one day pay a third, that would be about $30-billion in 2027. The feds might as well admit it now and get a climate-change deal out of it, he argues. In other words, mix talks on health and climate together. "The more things you choose to put on the table, of course it becomes more complicated, but it also becomes a lot easier," Mr. Ragan said. "Because one of the things you bring to the table is a bunch of money."

There are a few problems. One is that Mr. Trudeau's government already wants something else from the provinces, a deal on home care. Ottawa is offering $3-billion and wants provinces to agree to meet targets for home-care services. Another is that Ottawa might not be ready to concede that it's going to have to transfer more to provinces. The recent years of slower growth in provincial health-care costs is an argument that the provinces don't really need the extra money. But that doesn't mean it will stay that way: Many economists believe those costs will rise sharply again in the near future. Then there is politics. Health transfers are to help the sick. Linking it to something else is likely to be seen as crass. But in the end, health-care transfers are dollars, and no one can really identify which dollar is spent on what. Mr. Ragan suggests they could be spent both on health and a climate deal.

Mr. Ragan is also chair of the Ecofiscal Commission, an organization of economists studying climate policy, which argues pricing carbon is the most efficient way of reducing greenhouse-gas emissions, because it will cost the economy less. The Ecofiscal Commission's models indicate that as long as the revenues are pumped back into the economy in the right ways, the costs of carbon pricing will be modest. In other words, if you are going to reduce emissions, a carbon price is the least costly way. In fact, the premiers, including Mr. Wall, agreed last spring to work on carbon-pricing options. Ms. McKenna is now brandishing a federal carbon tax as a stick to demand they seal a deal. But money is the traditional carrot. Mr. Trudeau might find it too politically dangerous to link health transfers to a climate deal. But it would allow him to offer what it usually takes to make a deal: money.

The provincial government has only exercised the right to appoint a supervisor to Ontario hospitals 21 times since 1981. But CUPE, which represents more than 300 BGH front line staff, called the move "an optics exercise to distract from the significant provincial funding shortfall." The union said it relied on the latest figures from the Canadian Institute for Health Information (CIHI), to conclude the Ontario government's funding for hospitals is $1,395.73 per capita. The rest of Canada, excluding Ontario, spends $1,749.69 per capita, the union added. CUPE's own research shows that average Ontario hospital funding for a population the size of Brockville in 2005-06 would have been about $1.04 million less than average funding for the same population outside of Ontario. By 2015-16, the union adds, the funding difference would have reached $7.74 million.

That much more money every year would put an end to BGH's financial distress, added Hurley. "We're advocating for the hospital to receive an infusion of funding," he said. Leeds-Grenville MPP Steve Clark has also pointed to the provincial funding model as a "primary factor" behind BGH's fiscal woes. Staffat the Ministry of Health and Long-Term Care did not immediately respond on Friday to a question about CUPE's funding figures, but defended the appointment of a supervisor.

In an email to The Recorder and Times, spokesman David Jensen said the supervisor's appointment is based on a recommendation by the South East LHIN, which cited "ongoing concerns about the hospital's financial situation and organizational challenges." Jensen cited local media coverage "regarding the organization's financial challenges as well as other organizational issues facing BGH. "The appointment of a supervisor will help to move the hospital forward to achieve its goals and foster the development of more positive relationships," wrote Jensen. At this stage, added Jensen, the supervisor appointment is still a recommendation to be made by Health Minister Dr. Eric Hoskins.

"If appointed, a hospital supervisor would work with the hospital and government to support robust governance and management at the facility," wrote Jensen. The minister has notified BGH of his intention to recommend to the Lieutenant Governor in Council that a hospital supervisor be appointed, added Jensen. The Public Hospitals Act provides for a 14-day notice period, after which the supervisor can be appointed.

However, until now no federal government has had the nerve to take on serial offender Quebec. Quebec has been allowing its doctors and clinics to charge extra user fees since 1979. The province's current health minister, Gaetan Barrette, freely acknowledges this. In some cases, these fees were truly exorbitant. The Montreal Gazette reported last year that some colonoscopy clinics were charging patients an extra $600 for medications - on top of the publicly paid medicare fee. Many Quebecers were outraged. The provincial Liberal government's somewhat peculiar response was to pass a bill codifying the practice of extra-billing but giving itself the authority to regulate it. In March 2015, the then-Conservative government in Ottawa formally notified Quebec that it would be looking into the issue. This March, Liberal Philpott sat down with Barrette to discuss the practice. On Sept. 6, she sent her provincial counterpart a letter threatening cutbacks to Quebec's health transfer. A few days later, Barrette announced that extra billing will end as of next January.

It is hard to gauge the importance of Philpott's threat. User fees have become widely unpopular in Quebec. That alone may have been enough to drive the provincial government to disavow them. Still, it was bracing to see a federal health minister publicly standing up for the principles of medicare. It is not an everyday occurrence. It is particularly interesting that she targeted a province that is notoriously touchy about what it sees as federal interference. Perhaps she will do more. Certainly, more needs to be done. The latest annual report on the Canada Health Act filed with Parliament notes that private MRI clinics in British Columbia, Alberta, Quebec, New Brunswick and Nova Scotia are charging user fees to patients. It says some hospitals are avoiding the ban on charging for drugs by routing the sick through outpatient clinics - which do charge. It also notes that the portability requirement of medicare, which allows Canadians to receive care outside their home provinces, is routinely ignored.

Quebec routinely refuses to fully reimburse other provinces that provide health services to Quebec residents. Yet it has never been penalized by Ottawa for this. Nor have an unspecified number of other provinces that, at one time or another, did the same. Except for Prince Edward Island, the report says, no province appropriately reimburses residents who obtain medical care outside Canada. Such patients aren't necessarily entitled to the full cost of their out-of-country care. But they are entitled to be reimbursed for the amount it would have cost them to be treated in their home province. To work as a national program, Canadian medicare needs two things. First, the federal government must put up enough money to give it a real financial role in the system. The 2002 Romanow royal commission suggested that Ottawa provide at least 25 per cent of medicare funding. That figure still makes sense. Second, Ottawa has to use its financial clout to enforce those few national standards that do exist. A former Liberal health minister, Diane Marleau, tried to do this back in the 1990s. She was sandbagged by Jean Chrétien, the prime minister of the day. Let's hope Philpott has better luck.

It was bracing to see a federal health minister stand up for medicare principles, writes Thomas Walkom.

Ontario is among Canada's lowest provincial funders for hospital care. Based on the latest figures from the Canadian Institute for Health Information (CIHI), Ontario government funding for hospitals is $1,395.73 per capita. The rest of Canada, excluding Ontario, spends $1,749.69 per capita. In other words, provincial and territorial governments outside of Ontario spend $353.96 more per person on hospitals than Ontario does. That is a whopping 25.3 per cent more than Ontario. "BGH is not alone in racking up a deficit. Every hospital in Ontario is struggling because hospital funding is far too low," says Hurley. Research done by CUPE has found that average Ontario hospital funding for the population the size of Brockville in 2005/6 would have been about $1.04 million less than average funding for the same population outside of Ontario. But by 2015/16 the funding shortfall for a population the size of the City of Brockville would have exploded to $7.74 million.

"$7.74 million a year for the Brockville hospital would have them operating solidly in the black. This hospital is struggling valiantly to provide services through eight consecutive years of provincial funding cutbacks. The solution here isn't a supervisor and more cuts to care, staff and programs but to increase this hospital's funding," says Hurley.The views expressed in any and all content distributed by Newstex and its re-distributors (collectively, the "Newstex Authoritative Content") are solely those of the respective author(s) and not necessarily the views of Newstex or its re-distributors. Stories from such authors are provided "AS IS," with no warranties, and confer no rights. The material and information provided in Newstex Authoritative Content are for general information only and should not, in any respect, be relied on as professional

es," said Dr. Liz Tayler, senior technical adviser on antimicrobial resistance with WHO. There are many reasons why antibiotic resistance has struggled to gain traction as global priority, however. For one, it's a complex issue that can prove difficult to explain - a headache-inducing combination of molecular chemistry, evolutionary concepts, and bacteria with unpronounceable names. WHO has compared the problem to a "silent tsunami." Unlike

a high-profile killer like cancer, deaths caused by antibiotic resistance tend to be less obvious or visible. "It never goes on anyone's death certificate ... when someone has died of a nasty infection, the fact that it's resistant either wasn't known or hasn't been talked about," Tayler said. "And while it's a really big problem in developing countries, the labs there aren't very good and they don't have the resources to do the testing to find out (why someone died)." Antibiotic resistance is also considered a "tragedy of the commons," where the effectiveness of antibiotics has been depleted by people who prioritize their own interests over the public good. And everyone is culpable: patients who demand antibiotics unnecessarily and doctors who cave to their demands; farmers who feed their livestock antibiotics and consumers who demand cheap

meat; low-income countries that allow antibiotics to be widely sold without prescription, and wealthy nations that need to do more to help those countries improve the sanitary conditions that lead to high infection rates. All of this human activity is pouring unprecedented volumes of antibiotics into the environment - and placing evolutionary pressure on microbes to evolve new strategies for defeating them. "I think of this problem as a planetary change at a microscopic level - one that we don't even notice. We're changing microbial ecology in a very significant way," Laxminarayan said. "We need to protect antibiotics with the same seriousness as we protected the ozone layer through the Montreal protocol." Wednesday's UN meeting will likely see countries agreeing to a declaration on combating antimicrobial resistance. This step - while largely symbolic - will draw global attention to the issue, sketch out solutions, and place pressure on countries to address the problem within their own boundaries.

"It requires all of these folks to be paying attention that they are now on notice," Laxminarayan said. But the declaration won't be binding, nor will it contain specific targets. For Dr. Brad Spellberg, an antibiotic resistance expert with the University of Southern California, the UN meeting is just one step and "there's still a lot of heavy lifting that has to be done." Tackling antibiotic resistance will require work on multiple fronts, he said - everything from improving prevention efforts to reducing antibiotic use in livestock and fish farms. The world also needs to recognize that antibiotic resistance is a threat we will have to face for not just years, but centuries or millennia, he added.

Reportedly, Dr. Philpott wrote to her counterpart earlier this month, intimating Ottawa would start withholding transfer payments if extra-billing is not addressed. Now Dr. Barrette is making the typical spluttering noises about Ottawa invading provincial jurisdiction and claiming credit. In recent years, the provinces have tended to treat the federal Health Department as a cash machine; the extra-billing skirmish may end up being part of a broader negotiation over a likely reduction in federal transfers.

Let's hope Quebec's decision, and Dr. Philpott's role in it, signal a new era of robust federal defence of publicly funded medicare. With the British Columbia Supreme Court hearing arguments this week in a case that challenges some key pillars of the Canada Health Act, such robustness is needed.

Kat Lanteigne, executive director for BloodWatch.org and writer of the play Tainted based on three-years of research about the tainted blood scandal, travelled to Alberta to help spread the message about concerns about private, donor-paid plasma collection. Lanteigne said these types of clinics had started to show up in Ontario in the last few years. "This is a big-pharma push," she said. "If they can build a clinic and get a licence from Health Canada then they can open without the province's permission." She said that the private sale and collection of blood and plasma introduces risk into the system. She also dispelled another myth that plasma is being imported into the country. She said that is not the case, as about 70 per cent of the drugs produced from plasma is what is being imported. When successful in the fight to get Ontario to legislate against private, donor-paid plasma collection at the end of 2014, and because Quebec has a similar law, Lanteigne said they made the mistake of thinking that because the largest provinces in Canada had done this, the rest of the provinces would follow suit.

Instead, as part of one of her first decisions, the new federal Liberal Health Minister approved CPR opening a clinic in Saskatchewan. Lanteigne says the Saskatchewan government, led by Premier Brad Wall, then approved the private, donor-paid plasma collection business to open in Saskatoon, "in between a pawn shop and a pay-day loan company." "This collection facility is a blood broker. They are literally a middle man Ñ a source to get profits. "We're asking the provinces and territories to pass voluntary blood donation acts which adds blood and plasma to their existing human tissue acts ..." Lanteigne explained. There is a lot of information on the BloodWatch.org website about the issue, including an informative timeline. The organization also has a Heart Watch rating system. Alberta currently has three hearts and Lanteigne would like to see that increase to five. "Saskatchewan has broken our hearts," she adds.

Kim Storebo, CUPE Local 46 president who works with Canadian Blood Services (CBS), also spoke at the event. She said CUPE supports a public, voluntary-based blood system in Canada, adding CBS needs to increase the number of its own plasma collection sites. The organization has been slowly closing locations since 2012. "There is no evidence the collection of plasma from paid donors will create self-sufficiency," she said. "Under no circumstances should there be payment of blood plasma donors with cash or cash-in-kind equivalents." The union wants to see blood and plasma collection remain the sole responsibility of Canadian Blood Services and for the organization to expand its plasma collection and its work hours and ensure stable and consistent hours for its employees. As part of the wrap-up of the Alberta tour officials with FOM, BloodWatch.org and CUPE presented an online SumOfUs petition with more than 15,000 signatures to provincial health minister Sarah Hoffman asking for all provincial governments to "implement legislation that ensures no for-profit, donor-paid blood plasma collection clinics are allowed to operate in Canada." Azocar assured those at the meetings that Friends of Medicare would continue to lobby the Alberta government this fall and next spring during the Legislature sittings.