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Today, the program is partially dismantled. Half of the provinces have scaled back their seniors' drug benefits. The rest of the system looks shaky. There has been no nationwide analysis and very little public commentary, just snippets from individual provinces. Now a Montreal think-tank has pulled it all together. The Institute for Research on Public Policy has just released an informative study, "Are Income-Based Public Drug Programs Fit for an Aging Population?"

The institute commissioned three health-care specialists - two from the University of British Columbia and one from Harvard - to track the retrenchment, analyze its impact and offer advice to the provinces that haven't ratcheted back seniors' drug benefits. The authors acknowledge that financial pressures the provinces face are real. Canada's population is aging, drug expenditures are escalating and the economy is no longer robust enough to accommodate rising costs.

What they question is the wisdom of restricting access to medicine for the highest-needs segment of the population

Former B.C. premier Gordon Campbell was the first Canadian politician to curtail drug coverage for seniors. Shortly after taking power in 2001 he imposed a three-year budget freeze on his province's health ministry. The following year, he raised the co-payment on seniors' prescriptions to $25. In 2003, he implemented an income-tested plan - "Fair PharmaCare" - requiring better-off seniors to contribute up to 3 per cent of their annual income to the cost of their medications.

It penalizes Canadians over 65 with chronic conditions or serious disabilities. "In effect the deductibles under income-based programs are tantamount to imposing a specific income tax on people with the highest medical needs," the authors say. This violates the spirit of medicare. And it is financially inefficient. By unloading the cost of medications on seniors and private insurers, governments reduce their leverage in the pharmaceutical marketplace. The fewer citizens they buy for, the less bargaining power they have.

The appeal of eliminating universal drug coverage is obvious. It reduces the burden on the public purse. It makes medicare more sustainable. It targets benefits to those who really need them. What's not to like? Three things, the authors say:

It is detrimental to the health of seniors. The more financial barriers governments put in front of elderly residents, the less likely they are to fill their prescriptions. Seniors in B.C. forgo drug treatment at twice the rate of their Ontario counterparts. Although they pay the highest price, taxpayers lose, too. Providing older people with medically necessary drugs is much cheaper than paying their hospital bills when their conditions become unmanageable.

Over the next decade, four of his counterparts followed his lead, imposing restrictions on seniors' drug benefits. In 2012, former Ontario premier Dalton McGuinty went part-way. He reduced public drug coverage for seniors with incomes over $100,000. They are now required to pay the first $100 of their annual drug bill and a $6.11 co-payment (triple the standard seniors' fee of $2) for each prescription. In 2013, Alberta indicated it was considering the B.C. model. That is where things now stand.

There is a fourth drawback the authors don't mention. The premiers are pushing a full-fledged pharmacare plan out of reach, in defiance of the will of their citizens. Public opinion polls consistently show that 75 to 90 per cent of Canadians want medically necessary drugs brought into medicare. That was part of the vision forged by Saskatchewan premier Tommy Douglas and chief justice Emmett Hall, chair of the Royal Commission on Health Services half a century ago. They recommended that the cost of hospitalization be lifted from families' shoulders first; physicians' fees would be covered next; and finally prescription drugs would be publicly insured.

Today Canada is the only country in the developed world with a universal public health-care system that excludes coverage of prescription drugs. Policy-makers were inching in the right direction until the turn of the millennium. As of 2000, seniors, social assistance recipients and aboriginal people had full drug coverage.

Now the premiers are moving backward, creating an inequitable patchwork of drug coverage for seniors and lowering the likelihood of pharmacare for everyone else. The short-term savings may look appealing. The long-term costs will add up in ways Canadians haven't begun to contemplate.

Carol Goar'

Ambulance NB has a number of resources already in place to support its paramedics, flight nurses and medical dispatchers. There's a critical incident stress-management program, which is supported by the Department of Health and the College of Psychologists of New Brunswick. It offers peer-to-peer support for paramedics who've responded to difficult calls. The provincial ambulance service also has a free, confidential employee and family assistance program. It's available around the clock and offers employees one-on-one counselling to help them cope with stresses from work or home. Tracy Bell, a spokeswoman for Ambulance NB, told The Daily Gleaner in February that the organization was taking steps to expand its offerings to paramedics.

"We recognize that we need to do more to support our front-line employees and are taking the necessary steps to get there," she said. "In addition to existing resources, Ambulance NB will be introducing an expanded employee support program in the coming weeks. We are also looking seriously at what options are available in terms of facilitating direct access to a mental health professional or network of professionals for our employees. We hope to be able to be able to share news of these new initiatives with staff very soon." When the newspaper asked for an update this week, Bell said Ambulance NB is still working on this project. "Ambulance NB looks forward to being able to share news of new mental health supports with our employees soon," she said. "Our priority is to share information first with our paramedics, dispatchers and flight nurses." Judy Astle, president of paramedics union CUPE Local 4848, said she's still waiting for some more information. "They supposedly have what they're calling an enhanced employee assistance program. But we have not seen the details as a union yet," she said.

"We have a labour management meeting coming up next week. They may present it there. That's what we're hoping." Astle said enhancing the mental health resources for paramedics should help many professionals deal with the difficulties they experience in the line of duty. "Anything that's going to try to prevent high levels of stress in our job is valuable. It's hard to do. But the support is needed out there," she said. "It's a very trying job, to say the least. What affects me may not affect someone else. But what could affect them may not affect someone else. It's often a build up of things." MLA Ross Wetmore, the Progressive Conservative member who represents the Gagetown-Petitcodiac region, recently introduced a private member's bill in the New Brunswick legislature designed to eliminate the need for first responders to prove their post-traumatic stress disorder was caused while on the job. If it passes, that could eliminate the mountains of red tape that many first responders now face as they seek benefits while on leave for treatment.

Specifically, Bill 15 would amend the Workers' Compensation Act to presume post-traumatic stress disorder in first responders has been caused by "a traumatic event or a series of traumatic events to which the worker was exposed" while at work. That would apply to both current and former firefighters, paramedics, police officers and sheriffs who have been diagnosed as having PTSD by a physician or psychologist. A second part of the bill would require workers' compensation to offer, "treatment by culturally competent clinicians who are familiar with the research concerning treatment of first responders for post-traumatic stress disorder." Astle said she supports the bill, and says it could really help first responders as they struggle to get the help they need. "That was fantastic. That's a step in the right direction," she said. "People are talking about it more, are relating to it more. In our job, we're supposed to be the 'tough guy.' We have to share with our co-workers some of the things that are bothering us. Most of us do that. We talk it out." Chris Hood, executive director of the Paramedics Association of New Brunswick, said he's going to be meeting with government soon to ask for their support of this legislation, though he currently doesn't know how they feel about such a program. "We don't know whether or not government is going to support it," he said.

Hood said his organization wants to join the effort to make life easier for paramedics. So it's announced a few goals for the future. "We're working towards increased screening and education prior to entering the profession, improved training during the (early stages of your career), high-quality mental health support through a team of dedicated practitioners during your employment, and then the presumptive diagnosis legislation (introduced by Wetmore)," he said.

The federal government has made a start with the creation of the Employer Panel for Caregivers and the Family Caregiver Tax Credit. However, it must do more to make a meaningful difference in the lives of Canadians caring for family members. For example, making the caregiver tax credit refundable would help mitigate care costs such as paying out of pocket for prescriptions, groceries and personal care items or taking time off work for medical appointments. Until all levels of government come together to form a comprehensive pan-Canadian seniors strategy, piecemeal initiatives will have a limited impact.

In a way, our generation has become a victim of our own success. Progress and innovation in medicine mean Canadians are living longer. At the same time, more people are living with chronic diseases that complicate both their health status and the treatment they need. Treatment of chronic diseases consumes 67 per cent of all direct health-care costs. Chronic disease is the main reason seniors require health care. In 2011, between 74 and 90 per cent of Canada's seniors suffered from at least one chronic condition, while nearly one-quarter had two or more. These conditions jeopardize a person's ability to live independently at home.

On any given day in Canada, "alternative level of care" patients - that is, patients approved for hospital discharge who cannot access appropriate post-hospital care - occupy about 7,500 beds. Hospitals are routinely forced into a state of overcapacity called "code gridlock" in which patient flow grinds to a halt, elective surgeries are cancelled and transfers are put on hold. If you are in a car accident or have a heart attack, our health-care system can effectively mobilize world-class acute health-care services. But the system is woefully inadequate and under-resourced to properly prevent, manage or treat the long-term and chronic health problems facing most of our over 65 population.

Too often, seniors who could and should be getting better are languishing in hospitals when more efficient and effective care could be delivered in their homes or in a long-term care facility. It costs $1,000 to keep a person in a hospital bed for a day. Long-term care costs $130 a day. Home care (excluding the economic costs of caregivers looking after relatives) costs $55. That translates to approximately $2.3 billion a year that could be better spent in the health-care system with some strategic thinking and investing. This country as we know it today was, in fact, built by our seniors - by our own mothers and fathers, aunts and uncles and grandparents. Canada's health-care providers are determined and committed to prioritizing and improving their health. We expect the same of our country's leaders. As the premiers gather just blocks from Parliament Hill, we ask that a comprehensive healthy aging and seniors care strategy be at the top of their agenda.

Christopher Simpson, MD, is president of the Canadian Medical Association. Morel Caissie is president of the Canadian Association of Social Workers. Karima Velji is president of the Canadian Nurses Association.

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

Recent polling suggests the majority of people living in this province support P3s, but, as demonstrated by the SFL's petition, there is still opposition. While still relatively new here - none of the P3-funded projects are completed yet - the controversy is not unique to Saskatchewan. Ontario and British Columbia have used P3s for much longer than Saskatchewan. The debate remains polarized across the country. "It really depends on how the deals are structured," he said. "There is no such thing as sort of 'the P3 model'. In fact, there's any number of different approaches and because of that it varies in terms of impact on both the construction side of the equation and then the operation and maintenance."

Instead of an ideological battle, which has largely dominated any discussion of P3s in Saskatchewan, Siemiatycki said each project should be evaluated by itself to decide whether or not a P3 model is the best option. "It's really not a cut-and-dry issue," he said. "It really depends on the experience in the jurisdiction and what specific deals are coming down the pipe." Where P3s have a longer history, Siemitaycki said public debate over P3s is already starting to change. "I think the debate is now shifting to under what conditions should we use them, and what specific model should be used," he said. dfraser@postmedia.com twitter.com/dcfraser

Bryan Schlosser, Regina Leader-Post / The Saskatchewan Federation of Labour delivered a petition at the Legislative Building on Monday. The petition calls for an end to privatization in Saskatchewan and criticizes the government's use of public-private partnership funding models.

Last week, CUPE Saskatchewan sent a letter to Health Minister Jane Philpott requesting her to review the provincial legislation to determine if it violates the Canada Health Act and, if it does, that she instruct the Saskatchewan government to comply with the act.

Philpott was not available for an interview Monday, but emailed the Regina Leader-Post the following statement: "Our Government will work in close collaboration with our provincial and territorial partners to build constructive relationships. Our priority is to ensure all Canadians have access to health care."

CUPE Saskatchewan president Tom Graham says the union consulted with lawyer Steven Shrybman and it is his opinion that Bill 179 violates the Canada Health Act. "Health care needs to be provided on need, not the ability to pay," Graham said. "We think there are solutions that can be done within the system that don't require people to dig into their pockets to get an MRI."

CUPE sent the letter to Philpott days after the Saskatchewan Medical Association (SMA) raised concerns that the provincial government's decision to allow people to pay privately for MRIs was "a hasty policy." In a letter to physicians, SMA president Dr. Mark Brown said the organization opposed the move and told Health Minister Dustin Duncan that at the end of October. Brown said the legislation allowing people to pay privately for MRIs runs contrary to the fundamental principle of medicare.

(Bill 179) is privatizing our health-care system as far as we're concerned ... It's a slippery slope," Graham said Monday. "We already pay for health care in this province and in this country and now we're being asked to pay twice if you want it faster." Private MRIs in Alberta have not reduced wait times, he said.

"Their wait times are worse than ours and in Quebec, it's the same thing, " Graham said. "We're really quite concerned about it and we'd like the federal government to basically direct the government here to follow the Canada Health Act." In past interviews, Duncan has said people leave the province for MRIs now. The legislation is a way to level the playing field and provide some benefits for the public system.

I think they need to put the resources in where they are needed," Graham said. "It's a matter of getting MRI machines and technicians and scheduling it - it's as simple as that. I don't know why we have to get into these elaborate, complex schemes ... We should be enhancing our system, not taking it apart."

Mark Hancock CUPE national president