The Liberal NDP merger.
Ask any young person about politics and they’ll say don’t care! Better than that they might say, “don’t care, don’t give a shit”! This is a sad commentary on politics today.
The reason why fewer that 55% of Canadians bothered to vote in the last federal election and why more and more Canadians are voicing displeasure with the politicians is because they (the voters) feel helpless and unengaged.
I joined the Liberal Party when I was 14 years old. In the past 35 years, I have enjoyed the experience of fighting no fewer than 15 provincial and federal elections combined, 7 leadership conventions, two leadership reviews and myriad policy conferences. Suffice to say, I am a child of MY Party. The sad fact today is that it means a hill of beans.
My political mentor John Turner, for whom I worked, laments that the democratization of parliament is an issue second only to the bolstering of policies and ingratiation of Party faithful. These people own the Party, NOT the bunch of appointed flacks who serve the Leader of the Party. The recent private discussions that have been undertaken by old flacks in some secluded spots in Ottawa are a symptom of a larger problem for the Liberal Party how to re-engage Liberals or attract new ones.
Instead of a re-evaluation of this option, these wiley old timers seek to merge the oldest political brand in Canada with a left wing rump. Let’s face it the NDP will never assume power in Canada’s federal parliament, nor were they ever expected to – they were, however, a Party who’s philosophies and policies embraced that of a true perpetual opposition. Not so with the Liberals. This is a Party that bore most of the social policy reforms that have made Canada a tour de force internationally.
A discussion of a merger at this juncture should be taken for what it really is a cynical attempt to wrest power through mathematics. The Liberal Party on its own has neither the leadership nor the voter appeal at this point to become government. Perhaps a deal with the NDP to gain power now might be a possibility but ask Bob Rae if this benefitted him in Ontario in 1985.
The simple fact is this – the appointed flacks in the Leaders office, the unelected Senate members who claim to be the conscience of the Party, the advisors and consultants who skulk around Ottawa are NOT the Liberal Party. It is the hundreds of thousands of Party faithful across this great land who believe in the philosophies of Wilfrid Laurier, MacKenzie King, Louis St. Laurent, Mike Pearson, Pierre Trudeau, John Turner, Jean Chretien, Paul Martin and others. It is also the Party of great thinkers like Vincent Massey, Norman Lambert, Gordon Fogo, Gordon Dryden, Boyd Upper, Walter Gordon, James Scott, Keith Davey, Al Graham, Norm Macleod, Martin Connell, Maurice Sauvé, Paul Desrocher, Iona Campagnolo and many other great Liberal thinkers across Canada who have perfected the Liberal brand.
There is no cross road here, the silly talks about a merger should be outed for what they are a frustration at the current prospects of a Party in disarray, with little attraction from voters. If the attempt is to increase a paltry 25% voter approval for a leader no one wants – then following that logic, what does a Conservative PM do at 32% – who does he merge with???
Let¹s get smart all you Liberals say something!
The Waterloo worriers
I’m not shocked that the University of Waterloo Warrior Football team has caused a yearlong suspension over this recent steroid kerfuffle. Neither should any followers of Canadian University football.
Over the past several years, the increase in the talent and the style of play in CIAU football has increased enormously. Any casual observer of Canadian inter-scholastic football can see powerhouses emerging. Football mad fans in the province of Quebec love their teams in Laval and the Eastern Townships. Once horrible Ontario based teams (unfortunately like my alma mater U of W) are now becoming home to really good football players. New football stadiums are springing up and programs are getting better fan base here. The western teams have always had the support of their universities and fan base and we’ve seen a huge boon in Atlantic Canadian university football programs with those behemoths that play at St. Mary’s for example.
So, it’s little wonder that a scandal would eventually break – the stakes are high. Prospects for CFL drafts notwithstanding, many Canadian football players can see benefit in post graduate opportunities as a consequence of football in universities and potential professional playing opportunities in other leagues in the US and Europe post graduation.
Here’s the rub though, the football program at U of W, for example, is a costly venture for the university. The university doesn’t have the fan support or donor support that, say, McMaster University or Western or Queens have – so the prospect of the complete loss of the program at Waterloo could be a realization that may occur as a result of some idiotic players who decided on their own that enhancement by nefarious means might have worked. Wrong!
I love my football at Waterloo, I love the program and the coaches are extraordinarily dedicated to the craft. Let’s hope this year on the sidelines gives pause to players to manage their skill through legitimate means and not off the street – or that’s where they’ll stay.
The recent legislation on drug reform in Ontario.
Major media outlets have covered the legislative process quite fairly over the past few months as the government of Ontario has moved to stabilize drug prices in Canada’s biggest province. Nothing new here, the costs of public sector formularies have been increasing at anywhere between 5% to 15% annually. When I was CEO of the Ontario Pharmacists’ Association, I implored the Board at the time to work with government and insisted that we play the Pharmacist as health care provider card when tackling the issues associated with the original reform brought in by the McGuinty Liberals in 2006. The tack we took was to demonstrate the value of pharmacists and the work they do in community pharmacy, long term care pharmacy, specialty pharmacy and hospitals across the province.
The initial legislative framework (Bill 102) had taken draconian and, frankly, chaos inducing steps to transform the drug program in Ontario. The steps we took in 2006 to counter these moves proved fruitful and beneficial to pharmacy and pharmacists. In fact, the initial financial impact of Bill 102 was some $680 million dollars out of pharmacy. Our efforts at Ontario Pharmacists’ Association, at the time, was to appeal to the issue of fairness, integration in healthcare, a new reimbursement model and the use of collaborative efforts such as Information Technology to increase competition among pharmacies. Our efforts paid off and instead of the initial $680 million dollar hit, we got back in programs and other concessions some $450 million dollars. The unintended consequence of these efforts was the establishment of a two-tiered drug pricing regime that has taken hold across the country. This means that private sector plans would pay more for the exact same drug and services as provided to public sector plan members (ODB for example).
In the ensuing years after Bill 102 was passed as the Transparent Drug System for Patients Act (TDSPA), the government has moved to integrate pharmacists into their health teams with minimal uptake from the pharmacy sector. The Meds Check program which was announced coincidentally to the TDSPA was supposed to provide some $50 million dollars to pharmacists to provide extra service to patients on their drug regimens. The program was initially a success, but pharmacy more or less blew it off in many parts of the province. The Pharmacy Council, which was also announced in the TDSPA has now become a joke.
In the ensuing years since the TDSPA was made law, there have been charges laid against pharmacies, wholesalers and manufacturers for fudging required reporting to the Ontario Public Drug Program’s Executive Officer. The Canadian Association of Change Drug Stores (CACDS), which is the de-facto negotiating body for pharmacy, or the Ontario Pharmacists’ Association have barely attempted to licit potential models that could benefit patients and the customers they serve with ways to improve the drug system. This noted, quarter after quarter publicly traded pharmacy
organizations have seen average double digit profits this in an era of economic austerity.
The trouble is that patients, plan members, formulary designers and public drug plan providers remained afflicted with cost increases. In the TDSPA there is a provision that the government will review the Act every 2 years. Last summer (2009) the then Minister of Health in Ontario announced a review of the TDSPA. Stakeholders were invited to provide their views on how to better the system.
Many stakeholders took the process seriously. It was sad to see that pharmacy did not. When the government moved to enact legislation in 2010, it seemed to take pharmacy by surprise and they reacted with faux indignation. In fact, had they been more engaged , more attuned to the needs and wants of the patients and customers they purport to cherish, they world not have used them as pawns in this massive game of chess that they have lost so publicly.
The latest polls have suggested that Ontarians overwhelming (some 93%) support the government’s initiative. So enough bitching. Here’s the deal pharmacy should stop immediately their diatribes on how they will be forced to make very difficult choices “as they evaluate the level of care they provide to all patients, especially seniors and the chronically ill”. It is sad to see that THIS rhetoric would be their response rather than engaging the public in a dialogue about an increase in cognitive services fees.
The government has announced some $100 million dollars in cognitive service fees with an additional amount for Meds Check and diabetes management. In an era where medical models of treatment are becoming teams (like a Family Health Team) pharmacists can and should integrate themselves into these models. This could prompt a call for an additional, say, $300 to $400 million in cognitive services fees. Who’s leading these pharmacy organizations? They seem to have hit every stupid button and made asses of themselves throughout this whole process. The sad reality here is that instead of looking to modernize an antiquated drug distribution process and embracing the trend of integrated healthcare, these pharmacy organization seem to think that the patients and consumers and shareholders they purport to care about are treated like lemmings and will, unfortunately, continue to fight to their own bitter end.
Good read at BenefitsCanada.com
The current wave of prescription drug reform across Canada could result in a range of benefits for plan sponsors, but the process is still in its infancy and the outcome is far from clear.
According to a panel of experts, organizations that are proactive and ready to cut a deal will fare much better than those which choose to let the government set the rules for them.
A recent International Foundation of Employee Benefit Plans webinar entitled Law & Order: the case for drug reform in Canada featured Marc Kealey, president of ArcisRx and principal with Kealey & Associates, Inc, and Murray Gold, a partner Koskie Minsky LLP. They explained that as Canada tires of its dubious distinction of paying the highest prices in the world for generic drugs, provincial governments have taken—or will be taking—action to bring costs down.
Quebec, Ontario and Alberta have either proposed or tabled drug reform legislation and British Columbia and Atlantic Canada are expected to do so shortly. The benefits of such reforms—should they be passed—are enhanced affordability for plan sponsors, clinical expertise for drug plan re‐design and analytics, and an alternative distribution process to get medications to plan members with assurances of high levels of service and cost savings.
Read the rest – http://www.benefitscanada.com/benefit/health/article.jsp?content=20100514_171312_11656
Happy National Employee Benefits Day!
This day acknowledges those with benefit responsibilities including trustees, administrators, practitioners and professional advisors for their hard work and dedication to providing quality benefits.
Congratulations on the great work you have done to date and I look forward to continuing to work with you on this very important initiative in the future.
Pharmacists are Canada’s most accessible health professionals.
Pharmacists are Canada’s most accessible health professionals and play an important role in promoting, maintaining and improving the health of the communities they serve. Health promotion is now firmly on Ontario’s healthcare agenda and there is both an opportunity and a need for community pharmacists to become more involved in delivering public health services.
Every day Ontario pharmacists work as advocates for health. They support self help. They are local and accessible and provide patients with important health advice. Pharmacists promote health not just by advising on the proper use of medicine but also by counseling patients in areas such as diet, sexual health, and reducing tobacco and alcohol consumption.
Health spending is increasing at a rate far greater than other provincial government spending. As the population ages and the prevalence of chronic conditions increases the growth in new diagnoses for chronic conditions such as hypertension, diabetes, and arthritis actually exceeds Ontario’s population growth. The increase in diagnoses of chronic conditions is a key driver of health spending growth in Ontario.
As front-line health care providers, Ontario pharmacists are uniquely positioned to help the Ontario government achieve its objectives to improve health outcomes and control costs in our healthcare system. By helping patients comply with treatment regimens, by providing counseling on lifestyle changes, by helping to reduce the complications associated with chronic conditions and by ensuring symptoms are properly managed, Ontario pharmacists can make a big difference in improving the health of Ontarians.
Patient health management is a health care intervention that allows patients to be more involved in managing their own health outcomes. By engaging in patient health management both public and private health insurers can commit healthcare resources to keep people well and to manage diseases and conditions in a manner that avoids the costly complications associated with chronic conditions. Effective patient health management programs contain health costs by reducing the need for other more costly health care interventions. It also helps the elderly maintain independence and keeps our aging population as healthy as possible through prevention, early detection, and proper management of symptoms.
Physicians know what needs to be done to provide appropriate care consistent with clinical practice guidelines, but often lack the tools, the resources, or the time to do it. Pharmacy-based patient health management addresses this issue with significant health care delivery advantages. Involving patients in their own health management increases the patient’s sense of ownership and control (patient centered care). Patients are able to remain healthy, active & productive members of society for longer through greater disease control. There is increased compliance and adherence to treatment and, with improved patient health outcomes health care costs are contained.
In many jurisdictions pharmacists are recognized as key members of primary care teams. In the United Kingdom, the Department of Health recently launched a program for pharmaceutical public health by publishing Choosing Health Through Pharmacy. The U.K Minister of Health describes this as “a commitment to publish a strategy for pharmaceutical public health in 2005 which will expand the contribution that pharmacists, their staff and the premises in which they work can make to improving health and reducing health inequalities.” In North Carolina, the City of Asheville took a proactive approach to contain its rapidly rising employee health costs by instituting a pharmacy-driven patient health management program that was so successful in improving health outcomes and containing costs that it is now being replicated in major cities across the country
Community pharmacists in Ontario are ready, willing and able to increase their involvement and contribution to public health in collaboration with government, physicians and other health professionals. Pharmacist-based patient health management can achieve better health outcomes. The results are healthier patients, and more cost-effective use of precious health care resources.
Ontario pharmacists are ready for change.
Imagine your child has asthma and needs careful instruction on using an inhaler. Your aging parent needs guidance managing multiple medications. You are a diabetic seeking advice on drugs or medical devices, or a smoker ready to adopt a cessation program.
Now imagine those services available, easily and conveniently, from a familiar health care provider right in your neighbourhood – a trusted professional you already see dozens of time a year.
Ready? It’s your pharmacist.
A breakthrough new role for the pharmacist in health care delivery is one of the transformative changes to Ontario’s drug system introduced recently by the McGuinty government, targeted to take effect this fall. It’s the initiative that stands to touch the lives of more Ontarians most often – and the one with the greatest promise to improve the efficiency of health care delivery, lessen primary care costs and reduce wait times.
Pharmacists stand ready to work with the government and take on their new role. But while the province’s plan to pay pharmacists for providing direct patient care services is laudable, other changes proposed in the Transparent Drug System for Patients Act could threaten the sustainability of community pharmacy. Pharmacists are prepared to counsel patients – but if the viability of their pharmacy businesses is undercut by other measures, they could be doing so on the province’s street corners.
Keying on pharmacists as appropriate providers of front-line health care is a wise move by the government. It’s built not only on the training, skills and capacities of the profession, but on public understanding, acceptance and demand.
Just over a year ago, a Decima survey showed Ontarians overwhelming trust their pharmacists, understand the importance of consulting them with questions about prescription and over-the-counter medications, appreciate the pharmacists’ role in ensuring patients take medication properly and avoid drug interactions, and recognize that pharmacists’ expertise assists them to avoid illness or hospitalization.
Across Ontario, pharmacists continue to earn and strengthen that trust and understanding. Every day, 10,000 pharmacists have 1.6 million interactions with patients in the province’s community pharmacies, hospitals, long-term care facilities, and clinics.
The pharmacist-patient relationship is ubiquitous and powerful. The value of this crucial piece in health care delivery is at last being recognized – and strategically leveraged by the province as it asks pharmacists to do more by providing professional services that go well beyond dispensing.
When a patient consults with a pharmacist – acting on the knowledge that an issue or question about managing a chronic disease, taking multiple medications without harmful interactions, or adhering to a prescribed drug program can be handled efficiently, authoritatively and professionally by that health care provider – pressures on many other points in the health care system can be eased. A patient whose needs are met by a pharmacist is one less person in a physician’s waiting room, a crowded emergency ward or a high-demand clinic.
Equally important, the province promises to institute long-awaited new opportunities for pharmacists to be integrated into primary care models such as Family Health Teams. Working more closely and with greater connectedness with other health care providers will bring pharmacists closer to patients, streamline and localize the delivery of services, and minimize delays and duplication.
To enable pharmacists to provide these professional services, the province will provide compensation to them. It has agreed to set up a new Pharmacy Council to permit appropriate fees to be negotiated. Pharmacists will seek a fee schedule that fairly reflects the value of the services they provide, and the savings their work brings to the province’s health care costs.
In addition, the province proposes to increase the dispensing fee paid to pharmacists for filling prescriptions. An increase of $4 is suggested – a level that reflects today’s costs of distributing and dispensing drugs.
But in spite of these positive steps toward compensating pharmacists for their valuable work, other changes in the province’s new drug scheme represent potential threats to the well-being of community pharmacy. In particular, ending the payment of rebates and incentives to pharmacists by generic drug companies may not be counterbalanced by the new sources of income.
To date, the province has been vague in detailing the financial impact of all its changes on the sustainability of pharmacy enterprises. This has sparked concerns among some pharmacists that when all the new changes are taken into account, their business models will no longer be workable. For some pharmacies – especially in rural and remote communities where the pharmacist may be the only health care provider – staying in business may not be an option.
The image looms large of a pharmacist, ready to make a much-needed contribution to the transformation of health care in Ontario, ready to counsel appreciative patients, but unable to financially support the pharmacy enterprise within which these services can best be provided.
Ontario pharmacists are ready for change. They look forward to working with the government to bring it forward successfully. Addressing their concerns about the sustainability of pharmacy is the key to making it happen, for the benefit of pharmacists, patients and the health care system we all value.
Remarks from Solutions in Drug Plan Management Discussions
Here is my speech entitled “A Challenge for Innovation”, the entire document is reproduced below.
Adam Radwanski in the Globe – “Drugstores poised to become true health-care hubs”
Another interesting article by Adam Radwanski in today’s Globe and Mail.
But now Dalton McGuinty’s government is positioned to leap to the front of the pack in transforming the profession.
Not only has it empowered pharmacists to perform certain services traditionally restricted to doctors – such as giving vaccinations and prescribing some medications – but it has the chance to provide a groundbreaking incentive to take on those tasks, turning pharmacies into health-care hubs.
Before Christmas, the Ontario legislature unanimously passed Bill 179, which permits pharmacists (along with nurses and nurse practitioners) to perform services normally limited to doctors – services they have already begun to provide in other provinces, including British Columbia, Quebec, Alberta and New Brunswick.
Pharmacists have been poised to assume a leadership role in healthcare in Ontario for decades. The lure of rebates has been the single biggest reason why community pharmacists (either independent or part of a chain) have never really fully engaged in a scope of practice that would sincerely garner public trust in their role as part of the health team.
The McGuinty government has done more for the profession in the past 6 years through landmark legislation like the passage of Bill 102, which gives pharmacists the opportunity to assume a rung in the ladder of primary care through Meds Check. It also passed Bill 171 which increased the scope of practice for Pharmacist techs which has opened the door for pharmacists to assume an even greater role as Mr. Radwanski points out through the recent passage of Bill 179.
There is much more work to do. Long Term Care and Specialty Pharmacists play a vital role in the health care of patients and their issues need to be addressed. Hospital pharmacists have long been a part of primary care teams among health professionals. Moving pharmacists out of the basement of hospitals and onto floors, so to speak, has been a boon for patient care.
The opportunity exists through all the drug reform initiatives that are occurring across the country for pharmacists to rise to the occasion and fill a role that patients want for them to be a competent part of their health care team.
