If sustainability means bending the cost curve for health care, we need more than what Flaherty’s Done Deal offers.  I’m not talking more money. The $26 billion over five years could buy important reforms if it’s harnessed to that purpose; like our governments agreed to do in 2004.

Wait times for cataract, knee and hip and cardiac surgery and screening for cancers have fallen dramatically across the country. That means that in every part of Canada more citizens are getting more care more quickly.

The Accord has shown that focus and commonality of political will, with a long-term financial guarantee, can bring about positive and meaningful change.

Canada’s most valued social program needs a plan.  A plan that tackles growing disparities in health outcomes and growing gaps in access to care.  A plan that brings our best minds together, working in concert, to bend the cost curve by focusing on improving health and improving care.  It’s possible, but it requires more than the blunt tool of cost control. It requires a shared strategy and focus on improvement. 

Widely perceived as a 50-50 bargain, the federal share of provincial and territorial health care expenditures peaked at 55 per cent of what was spent on doctors and hospitals in 1977-78

Federal cash only covered 25 per cent of what the provinces and territories spent on all health care that year.

Genuine cost sharing was most generous in the 1960s, when federal transfers for health care covered 33 per cent of provincial and territorial total health care expenditures.

By 2001-2, when negotiations for the 10-year Health Accord started, federal cash contributions covered 12 per cent of all provincial and territorial spending.  It had fallen even lower during the Troubled Times of the late 1990s

It may seem generous to put an accumulated $26 billion more into provincial and territorial coffers over the next five years.

But the deal pales in comparison with the over $220 billion dedicated to tax cuts since 2006, or the 20-year, $490 billion commitment to refurbishing military hardware.

The feds could work with the provinces to set up a “buyer in chief,” trimming costs for everyone by flexing our purchasing-power muscle through a single-payer system. Taking $600 million from the escalator, matched with existing expenditures by the provinces and territories, could start a process that, over five years, could build toward a pan-Canadian formulary of the 100 most commonly prescribed drugs, negotiate a better price through bulk buying, and collectively save ourselves billions.

bring a preventive, child-focused dental care program to every child under 14 in their schools for an estimated $564 million nationwide. The feds could provide a 50-cent dollar for every province that signs up. A $300 million investment through the new funds, matched by what the provinces already spend, would save billions down the road and improve lives

Far too many people turn to our hospitals for want of options for primary health care in the community.

integration of care between our hospitals and our communities

Take $700 million from the escalator funds today and start the process of expansion

that’s what Canadians want: change that buys better health, better care and better control of costs

We used to have parliamentarians that fought for the interests of Canada as a whole and understood the vital importance of federal leadership in those places where the central nervous system of the nation was involved. Where are they all gone?

Falcon said he supports the new plan because it gives ample lead time for provincial governments to begin to take more control of their own health care systems.

Adrian Dix who accused the B.C. Liberal finance minister of selling out taxpayers."Let's be clear, when Mr. Falcon signs off into the future on shortfalls that are at least $250 million, according to him, he is arguing for long-term cuts to senior's care and health care services

Under the new system there won't be a tax-point component, just a cash transfer.

The association wants spending in those areas increased at nearly double what the provincial government plans, arguing that there are huge cost savings to be had by treating people in less expensive settings.

The OHA estimates that chronic illness costs Ontario about $12 billion a year. Even a five-per-cent reduction through better disease management would save $600 million.

4,000 people who occupy hospital beds

Shifting 10 per cent of this group to home care would save $35 million.

What the hospitals don't want is a repeat of the late 1990s, when big changes to hospitals were made too quickly.

there isn't a whole lot of efficiency left to be gained

Since 1998, the number of hospital beds has remained constant while the population has grown by 16 per cent. Hospital bed occupancy rates are quite high, and the average length of stay is the second-lowest in Canada.

Shepter's story illustrates a problem that extends far beyond a single California nursing home. ProPublica and PBS "Frontline" have identified more than three-dozen cases in which the alleged neglect, abuse or even murder of seniors eluded authorities.

For more than a year, ProPublica, in concert with other news organizations, has scrutinized the nation's coroner and medical examiner offices [1], which are responsible for probing sudden and unusual fatalities. We found that these agencies -- hampered by chronic underfunding, a shortage of trained doctors and a lack of national standards -- have sometimes helped to send innocent people to prison and allowed killers to walk free.

If a senior like Shepter dies under suspicious circumstances, there's no guarantee anyone will ever investigate.

"a hidden national scandal."

Because of gaps in government data, it's impossible to say how many suspicious cases have been written off as natural fatalities.

In one 2008 study, nearly half the doctors surveyed failed to identify the correct cause of death for an elderly patient with a brain injury caused by a fall.

Autopsies of seniors have become increasingly rare even as the population age 65 or older has grown. Between 1972 and 2007, a government analysis [2] found, the share of U.S. autopsies performed on seniors dropped from 37 percent to 17 percent.

"father was lying in a hospital bed essentially dying of thirst, unable to express himself -- so people could have a nice, quiet cup of tea."

"We're where child abuse was 30 years ago," said Dr. Kathryn Locatell, a geriatrician who specializes in diagnosing elder abuse. "I think it's ageism -- I think it boils down to that one word. We don't value old people. We don't want to think about ourselves getting old."

A study published last year in The American Journal of Forensic Medicine and Pathology found that nearly half of 371 Florida death certificates surveyed had errors in them.

Doctors without training in forensics often have trouble determining which cases should be referred to a coroner or medical examiner.

State officials in Washington and Maryland routinely check the veracity of death certificates, but most states rarely do so

there has to be a professional, independent review process

a public, 74-bed facility

As the chief medical examiner for King County, Harruff launched a program in 2008 to double-check fatalities listed as natural on county death certificates. By 2010, the program had caught 347 serious misdiagnoses.

Of the 1.8 million seniors who died in 2008, post-mortem exams were performed on just 2 percent. The rate is even lower -- less than 1 percent -- for elders who passed away in nursing homes or care facilities.

Some counties have formed elder death review teams that bring special expertise to cases of possible abuse or neglect. In Arkansas, thanks to one crusading coroner, state law requires the review of all nursing-home fatalities, including those blamed on natural causes.

Thogmartin said "95 percent" of the elder abuse allegations he comes across "are completely false," and that many of the claims originate with personal injury attorneys.

Decubitus ulcers, better known as pressure sores or bed sores, are a possible indication of abuse or neglect. If a person remains in one position for too long, pressure on the skin can cause it to break down. Left untreated, the sores will expand, causing surrounding flesh to die and spreading infection throughout the body.

Federal data show that more than 7 percent of long-term nursing-home residents have pressure ulcers.

"Very often, that is the way these folks die," he said. "It is a preventable mechanism of death that we're missing."

"Occasionally, there are elderly people who are being assaulted. But this issue of pressure ulcers is a far, far bigger issue, and really nationwide."

a new state law requiring nursing homes to report all deaths, including those believed to be natural, to the local coroner. The law, enacted in 1999, authorizes coroners to probe all nursing-home deaths, and requires them to alert law enforcement and state regulators if they think maltreatment may have contributed to a death.

"It was a horrible place,"

investigations led state regulators to shut down the facility, in part because of the home's failure to prevent and treat pressure sores

prompted Medicare inspectors to start citing nursing homes for care-related deaths and to undergo additional elder-abuse training.

Still, nursing homes inspections are not designed to identify problem deaths. The federal government relies on state death-reporting laws and local coroners and medical examiners to root out suspicious cases

They found such problems repeatedly at Riley's Oak Hill Manor North in North Little Rock.

A 2004 review of Malcolm's efforts by the U.S. Government Accountability Office concluded that the "serious, undetected care problems identified by the Pulaski County coroner are likely a national problem not limited to Arkansas."

staffing in homes is a constant challenge. Being a caregiver is a low-paying, thankless kind of job. (at one time you could make more money flipping burgers than caring for our elderly- priorities anyone??) With all the new Medicare cuts, pharmacy companies who continue to overcharge facilities for services, insurance companies who won’t be regulated, our long-term facilities are in for a world of hurt- which will affect the loved ones we care for. Medicare cuts mean staffing cuts- there are no nurse/patient ratios here- meaning you may have one nurse for up to 50 residents. Scary? You bet it is!!  Better staffing, better care, everyone wins.

Lets not just blame the caregivers. Healthcare and business do not mix. When a business is trying to make money, they will not put the needs of patients and people first. To provide actual staffing (good-competant care with proper patient to caregiver ratios) the facilities would not make money.

As Ashish Jha, an associate professor at Harvard Public School of Medicine and a practicing physician, told me, “What you see in other industries is when there’s been an uptick of technology, it has allowed everybody to move up in terms of the kinds of work they do. [In health care] it [should] allow nurses do stuff only doctors could do before.”

a morass of state laws blocks nurses and other non-MDs from performing many tasks

Each change is approved piecemeal, often over the objections of physicians’ groups.

Recently there’s been an uptick in what’s known as “retail clinics”—that is, small health clinics being located in retail stores, often in strip malls. CVS is one big brand that’s made an investment, and it has been rumored that Wal-Mart is interested in entering the market as well.

Austin Frakt, a health economist and one of Carroll’s co-bloggers, notes that such clinics tend to poach younger and more affluent patients

contribute to the fragmentation of care problem in the health system by creating another place generating records and care and prescriptions that’s unconnected to everything else

When academic papers attempt to gauge productivity, the measure is derived from things it can count: visits to the doctor, number of scans, etc. But it’s possible, Frakt says, “to imagine a situation where greater quality means fewer visits to the doctor.”

We have new technology, people with bright ideas … but the dominant players in the market have a very specific idea of how they’re being paid.”

"We're obviously willing, you know, to be a partner and do what we can do to help," Harper said.

Aglukkaq, however, insists the federal government will continue to uphold the Canada Health Act — in a way that gives each jurisdiction the flexibility it needs to deal with regional differences.She said the act would even allow some private involvement in the delivery of services, but that no provinces are actively pushing for privatization of health care.

She sidestepped questions about whether any funding would be tied to what provinces can do with the money.And she noted that clear targets in health care policy have produced solid results, such as reductions in wait-times.

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.

the complexity of relationships between these bodies and the challenges they face in identifying and preventing quality failures in hospitals

Robert Francis listed 20 areas on which he expects to come to conclusions and make recommendations.4 These areas include the interface between the regulation of governance, finance, and quality and safety standards; the use of commissioning to require and monitor safety and quality standards; and the means of embedding the patient voice throughout the system. Particular emphasis was placed on recruitment, training, and regulation of staff, including the senior managers of NHS organisations, and the exercise of the fitness to practise functions of professional regulatory bodies.