by Neil Seeman

Canada's most widely read major newspapers are outperforming health blogs on reporting important clinical content. However, both newspapers and health blogs are performing poorly in this regard. Major Canadian newspapers (on average) covered just 37% of what clinical experts considered critically important medical news in 2007. By comparison, the most popular 50 health blogs, on average, covered just 23% of these stories. However, these averages obscure important findings. When isolating general interest health blogs - a minority of the top 50 health blogs, most of which cater to a particular illness, such as diabetes or autism - one finds that, in all instances, these general interest blogs fare at least as well as and usually significantly better than general interest newspapers in reporting critical medical stories. The most popular such general interest health blogs include The Wall Street Journal's health blog (http://blogs.wsj.com/health/), The Health Care Blog (www.thehealthcareblog.com/) and Kevin M.D. Medical Weblog (www.kevinmd.com/blog/).

Also revealing is the overall performance of the 50 leading health blogs, as compared with popular newspapers, on the governance criteria measured in this analysis. The vast majority ( > 90%) of these popular health blogs lack drug industry sponsorship or overt partisanship that is readily detectable by the user. By comparison, drug industry sponsorship of events (other than direct-to-consumer advertisements) is not uncommonly seen in Canadian newspapers; and all major newspapers in Canada offer overt partisan commentary on health and medical issues on the editorial page - the "official voice" of the newspaper - and these editorials are usually written by anonymous editorial writers who rarely possess any clinical credentials.

As Figure 1 illustrates, health blogs can stand to do a better job of avoiding general industry sponsorship and offering users clear confidence regarding the privacy of user-submitted content. By comparison, newspapers fall down entirely on these scores, with no major newspapers in Canada prohibiting industry sponsorship or providing prominent assurances to letter writers (online or in print) that their submitted health content will be kept private in a manner that observes the Health on the Net Foundation code of conduct (HONcode) or equivalent privacy practices. Finally, 60% of the most popular health blogs are moderated partially or fully by SMEs, usually practising clinicians. The same cannot be said of major Canadian newspapers, whose health reporters and editors seldom have any clinical or graduate-level credentials in any health-related field. In many cases, newspapers do not have dedicated health editors.

More on this topic here.

Investing in future doctors. Here is an offer to consider.

An idea whose time has come
An Investment Opportunity with Two-Fold Return. Help two Ontario farm girls complete medical school.
Two rural Ontario sisters and their family are looking for finances to complete their training as medical doctors at the Royal College of Surgeons in Ireland. Well-placed in their classes, they will graduate in 2011 and 2013. Offering an 8% return on investment, interest payments would be made until June 2011 when principal and interest payments would begin. Beyond personal guarantees, the girls offer their family business and farm, which has been in the family for 30 years, as additional security. For added security, third party management of the funds would be welcomed. Interested? Call toll-free 888.301.3477 or email: medical-investment@live.ca.

How can local, provincial and federal politicians make a constructive difference to healthcare in Canada?

How can local, provincial and federal politicians make a constructive difference to healthcare in Canada? Here are three comments from three levels of government representing Sault Ste. Marie in Ontario’s near north. To respond use this blog or send a note to the publisher@longwoods.com

From the middle of Canada: Elaine Della-Mattia comments in the Sault Star (click on the title)

. . . all area politicians agree that health care will be a major issue locally in the coming year.

(Mayor John) Rowswell called health care the No. 1 priority for council in 2009. In fact, he believes the issue will be a priority across the province.

(Sault Member of Provincial Parliament, David) Orazietti said he's predicting some relief to the doctor shortage with the first class of the Northern Ontario Medical School graduating.

"A good portion of these students were born and raised in Northern Ontario and I have huge expectations that many will remain in the North and practice here," he said.

(Sault Member of Parliament, Tony) Martin said he continues to be concerned for the Sault's aging population and their health care needs. Martin said he will encourage and work with government to support front-line workers dealing with the added demand. He said he's been personally energized by the political activity that has taken place the last month, along with many other Canadians.

What are your suggestions? How should they leverage their political position. What would be a constructive strategy for your mayors, your provincial or state representatives , your representatives in congress?

Transforming Healthcare Organizations

Healthcare Quarterly, 10(Sp) 2006: 10-19
Transforming Healthcare Organizations
Brian Golden

Abstract:
Imagine you are a member of a hospital's executive team, having just left a meeting in which you and other members discussed the possible introduction of an ambitious Computerized Physician Order Entry (CPOE) system. Around the conference table you and others questioned whether CPOE would be the most effective way to realize your hospital's commitment to patient safety. Other issues that were raised included whether clinicians would support or resist the change, whether staff would have sufficient skills, where to begin, affordability and whether to proceed incrementally or with a "big bang." While there was much disagreement with respect to each of the issues, there was near unanimity around two important decisions - CPOE would be implemented and you would be the executive responsible for the system's design and implementation. This article, based on the experiences of a multi-site hospital, and drawing on past research on organizational change, provides a Four-Stage model to help change leaders in healthcare. Although relying on Toronto's University Health Network to illustrate the change model, the model is intended to speak to change leaders implementing various types of complex changes in all healthcare organizations.

To read the complete article click here

Dear Mr. Harper: Try a Post-Partisan Approach to Public Health Policy | Neill Seeman Essay

November 4, 2008

Dear Stephen,

In 2001, we worked on a historic legal challenge to expand free speech in this country. We fought so-called election “gag laws” (enacted federally in 2000) that limit spending by third party groups – of all ideological persuasions – during political campaigns. Although our arguments failed at the Supreme Court of Canada, this was a popular cause – applauded by many legal, academic, and media commentators across the political spectrum.

Under our line of reasoning, organizations opposed to, say, seal hunting should be constitutionally entitled to advertise during elections to promote their cause. The current law, one might argue, creates a "two-tier" system, where political parties are free to advertise during an election campaign within certain limits, yet third parties are silenced.

Building up to that landmark legal challenge, you reached out to people from a variety of political camps. Yet today, some members of the media and academia unfairly characterize you as intolerant of views that differ from your own; I know this to be untrue. Given your passion for the airing of different political views – the same passion that led you to doggedly challenge Elections Canada’s limitations on third party spending during campaigns – I have a suggestion on how to show global leadership during your new mandate: Pursue a postpartisan approach to the creation of effective public health policy.

As I argue in the current special edition of HealthcarePapers focused on obesity, “post-partisanship” is unlike “bipartisanship”. Bipartisanship is horse-trading – in its best incarnation, this means crafting patchwork legislation that allows all sides to feel satisfied that some thread of their vision or ideological essence found its way into law. The process plays to ego, not good policy.

In its worst incarnation, bipartisanship is merely rhetoric on the campaign trail, and nothing more. On the other hand, “postpartisanship”, a vision of politics championed by Governor Arnold
Schwarzenegger of California and New York Mayor Michael Bloomberg, is a more sophisticated decision-making model that breathes life into novel policy ideas to yield maximum, lasting impact.

In HealthcarePapers , I apply the vision of post-partisanship – elucidated in the book Radical Middle: The Politics We Need Now by Marc Satin – to health policy. I argue that the 10 political principles of post-partisanship Satin describes are ideally suited to public health, since public health policy-making, such as anti-obesity initiatives or mental health improvement strategies, necessarily requires long-term, multi-sector solutions that are enabled by strong legislative supports. Representatives wedded to a long-term public health cause also need to sustain lasting relationships across party lines in order to buttress the original legislation with interim evaluations, re-investments and other policy supports. Herein lies one of the practical benefits of a post-partisan approach to decision-making.

As noted by Satin, the 10 post-partisan principles are as follows:
1. Relationships are as important as convictions.
2. Criticism needs to be well-balanced by self-criticism.
3. There must be an overriding commitment to dialogue and deliberation.
4. There must be an overriding commitment to diversity of opinions and perspectives.
5. Compromise is not the only endgame.
6. Be simultaneously creative and practical.
7. Demonstrate a penchant for big ideas.
8. Support a bias for action.
9. Demonstrate concern with values and principles.
10. Have a long-term vision.

I believe that these 10 principles can provide the basis for a priority setting public health policy model that will temper political self interest. Under this vision, diverse decision-makers can come together from the outset of planning and policy debate; decision-makers can feel free to disclose their competing interests; and validated analytical techniques can be used to select the most innovative, unbiased and criteria-based ideas from among all those considered.

Post-partisan decision-making, in advance of landing on any final policy proposal, allows multi-sector partners to select weighted solution criteria (a process formally referred to as multi-criteria decision-making analysis). The process enables a neutral, independent commission with assigned legislative power (comprised of members nominated by all parties) to identify the cognitive and partisan biases that may have inadvertently crept into any final, recommended policy solutions.

This process can serve innovation. As the global financial crunch tightens its noose on governments, we require innovation in the service of better value. Public health is a good place to start. Unlike other domains of health care policy (such as hospital management), both the federal and provincial governments have constitutional jurisdiction over key areas germane to public health.

Federal constitutional authority extends to “peace, order and good government” and all matters not explicitly assigned to provincial authority. The Department of Health Act provides a federal mandate to protect against the spread of disease, to provide surveillance, to guide public health research (e.g. via the Canadian Institutes for Health Research) – and to advance the physical, mental and social well-being of Canadians.

Stephen: You have the unique opportunity to make post-partisanship the new culture of Parliament. A first step might be to create a multiparty committee of independent members from across Canada charged with designing the weighted criteria by which potentially high-impact public health policies should be assessed prior to design and implementation. The criteria might include: estimated policy magnitude; the effectiveness, if known, of current interventions; the ability to effect change in the near- and long-term; and cost effectiveness.

We are in an era of zero-sum budgeting and fiscal challenge while tackling the steady, unyielding onslaught to our health care system from increasing rates of chronic disease such as diabetes, cancer, heart disease and asthma. Governments face a stark choice: innovate; or implode, borrowing against the future and creating further intergenerational inequity in order to sustain the health care system.

The good news is that you will not be the first to embrace postpartisanship. And we have seen dividends come from such an approach in the arena of public health. Consider that Gov. Schwarzenegger’s state has witnessed a dramatic percentage decline in teen pregnancy rates. This is especially impressive since it occurred during mass migration to the state of sub-populations with very high teen pregnancy rates such as those seen outside of California.

California’s ambitious plan to curb teenage pregnancy – as with the governor’s new leadership in the battle against childhood obesity through mandated school physical activity- and healthy-lunch initiatives – would never have taken place but for Mr. Schwarzenegger’s continued openness to opposing viewpoints.

Like any other political model, post-partisanship is just a suite of ideals that will only succeed if elevated to a science. In the pursuit of more innovative and cost-effective public health interventions, you possess the skills to make the approach work. This is the kind of politics Canada’s health system needs now.

Neil Seeman
Senior Resident in health system innovation
Massey College at the University of Toronto,
Adjunct Professor of Health Services Management
Ryerson University.
In 2001, legal and policy advisor to Prime Minister Stephen Harper
in Harper v. Canada (AG)
Email: neil.seeman@utoronto.ca

Blogger: Dashboard

Blogger: Dashboard

High Performing Healthcare Systems: Delivering Quality by Design. Toronto: Longwoods Publishing.

Longwoods has just launched the book "Systems" -- full title is High Performing Healthcare Systems: Delivering Quality by Design. It has its own blog, See: http://qualitybydesign.blogspot.com/ Here is part of Adalsteinn Brown's Foreword to the Book

Citation Information Brown, A. 2008. "Foreword." High Performing Healthcare Systems: Delivering Quality by Design. 9-10. Toronto: Longwoods Publishing.

Quality remains one of the great trade-offs in Canada's healthcare system. Every person working in the system agrees with the importance of quality, and many make it an explicit part of their personal and professional missions. Today, for example, when confronted by clear evidence of poor quality in their own practices and organizations, clinicians and administrators rarely question the validity of the information and they respond quickly to solve the problems identified. At the same time, however, most clinicians and administrators believe that large-scale improvement is unaffordable. Although quality continues to rise in importance, and nearly every study published identifies room for improvement, something stops us from achieving the high quality we desire. The work of G. Ross Baker - who led the Quality by Design initiative and, with Peter Norton, the landmark study on patient safety in Canada - lays out the challenge clearly. Every day in Canada's healthcare system preventable errors arise in hospitals, long-term care facilities and physicians' offices. These errors lead to extra costs, poor health and, in many cases, avoidable deaths. Yet the pursuit of safety and quality remains the something extra that many of the people working in our system can follow up on only at the end of a busy day. . . . .

Longwoods eLetter October 14, 2008

Home | About Us | Subscriptions | Contact | Healthcare JobSite | Sign up here for Longwoods FREE eLetter

“I witnessed a true force for systems understanding and change—not an economist or an accountant, but a research- and quality-oriented physician moving far beyond the traditional healthcare finance textbooks of the time” Rick Roger, Senior Editor, Healthcare Policy and former CEO, Vancouver Island Health Authority, commenting on the new book: High Performing Healthcare Systems || Delivering Quality by Design. Order here.

---

ESSAY

1. From Canadian Press: Key promises in the federal election campaign, with projected costs where applicable and available. Click here.
2. Longwoods' roving contributor and democracy revivalist Steven Lewis: caught up with the five political party leaders in their post-televised debate debrief at an undisclosed location near Toronto. For the unabridged interview click here.

---

OFF THE CUFF

PROFILE of two new books. Available Free Online.
SYSTEMS [the book] Six authors including author and editor Dr. Ross Baker announce that . . .
On October 15, 2008, Longwoods will launch the book Systems (full title: High Performing Healthcare Systems || Delivering Quality by Design) Made possible by a grant from the Ontario Ministry of Health and Long-Term Care, the project team visited seven systems around the world that met their criteria – attributes that range from equity to efficiency.

If you would like an electronic copy of the book we will send you one on October 16, 2008. Free. Please click here to order.

. . . and this just in
“Perhaps, I wondered, by looking at the nature and structure of games, I could gain valuable insights about my own life and how to live it.” From: “Unlearning.” A new book by Dr. Alejandro R. Jadad. Click on the link and learn more ... including access to free digital copies.

---

Longwoods Publishing would like to welcome Sodexo Healthcare and Price Waterhouse Coopers to the Longwoods HealthcareBoard.

They will be joining our other corporate members: 3M Healthcare, Accenture, AGFA, Baxter, Borden Ladner Gervais (BLG), Cerner, CGI, Courtyard Group, Clarity Healthcare-Consulting Cadre, Emergis, HayGroup, HP Canada, Healthtech, IBM, Johnson and Johnson Medical Products, Medtronic, McKesson Canada, Microsoft, Pharmacy.ca, Philips Healthcare, Ray & Berndtson, Roche, SAS, Strata Health.

The Longwoods HealthcareBoard members enable us to present new ideas, policies and best practices essential to healthcare management, practice, education, research and motivation. It is a measure of their support for learning. In return Longwoods creates opportunities for our corporate partners to showcase their products and systems in our journals and on our website and opportunities for corporate representatives to meet key clients and prospective clients.

For information on becoming a member contact Matthew Hart

---

PATIENT SAFETY PAPERS - CALL FOR SUBMISSIONS | DEADLINE NOVEMBER 07, 2008
Healthcare Quarterly, in collaboration with the Canadian Patient Safety Institute and other national sponsors, is pleased to announce a fourth issue of Patient Safety Papers for publication in Spring 2009. This follow up to the first three issues will again provide real-time overviews of patient safety initiatives from the field and research projects on important patient safety topics.

Guest Editor, Professor G. Ross Baker, Department of Health Policy, Management and Evaluation at the University of Toronto invites organizations and/or individuals to submit papers and case studies with a particular emphasis on contributions that highlight Canadian or comparative efforts to measure or improve patient safety. Descriptions of demonstration projects and interventions would be welcomed along with strategies for engaging patients and clients in improving safety.

Please submit abstracts or summaries of no more than 200 words to Dianne Foster Kent, Editorial Director, Longwoods Publishing, no later than Friday, November 7, 2008. Submissions will be reviewed by the editorial team and a selection of authors will be invited to prepare full manuscripts for publication.

---

FREE ISSUES

This issue of the journal Electronic Healthcare:Vol. 1 No. 1 2001 is made available at no charge courtesy of Accenture. For the editorial by Dr. Michael Guerriere, click here: The Editor's Focus: It's Leaving Here Just Fine. Other authors include: William Pascal, Tom W. Noseworthy, John A. McAllister and Dan Bader, Carla Gregor, Brian Gamble, Camille Orridge, Pat Rich, George Blake, Denis Protti and KLAS. Read the complete issue online, download and save the papers, send them to colleagues. Effective until midnight October 28, 2008.

This issue of the journal Healthcare Policy / Politiques de Santé:Vol. 1 No. 2 2006 is available at no charge courtesy of CIHR. For the editorial by Dr. Brian Hutcheson, click here: Researchers' Role in Policy Decision-Making: Purveyors of Evidence, Purveyors of Ideas? Other authors include: John N. Lavis, Huw T.O. Davies, Russell L. Gruen, Kieran Walshe, Cynthia M. Farquhar; Robert G. Evans; Trisha Greenhalgh, Jill Russell; Catherine Pope, Nicholas Mays, Jennie Popay; Rick Roger; Jonathan Lomas; John N. Lavis; Aleksandra Jokovic, Jennifer Frood, Kira Leeb; Anton Hart; Marjorie MacDonald, Sandra Regan, Heather Davidson, Rita Schreiber, Jane Crickmore, Lesley Moss, Janet Pinelli, Bernadette Pauly; Mark Crawford; Claudia Sanmartin and Nancy Ross; Kyle Whitfield, Susan Wismer; Sanober S. Motiwala, Shamali Gupta, Meredith B. Lilly, Wendy J. Ungar, Peter C. Coyte. Read the complete issue online, download and save the papers, send them to colleagues. Effective until midnight October 28, 2008.

---

BITS AND PIECES

• Send your transitions, news and innovations to news@longwoods.com. (Let your communications VP know.)
• Ever wonder what happens to all those eLetters? Stay tuned here. (This page has its own search engine)
• Ever wonder where we keep all the transitions we report? Click here.
• If you received this eLetter from a colleague, sign up for your own issue. Click here.

---

FEATURED
Learning Opportunities:

1. October 19-21, 2008: Vancouver BC. Innovation in HealthCare: Passion to Progress. Leaders from all areas of health care and related industries will attend this two-day conference focusing on leadership, systems change and sustainable outcomes. Confirmed to speak are, Hon.George Abbott, Dr. Richard Heinzl, Roger Martin, Tod Maffin, Stan Davis, Jeremy Gutsche and Rex Murphy. For more information, click here.
2. Wednesday, October 22, 2008 – Breakfast with the Chiefs. Toronto. Matt Anderson, CEO - Toronto Central LHIN. Location: Health Sciences Building, Room 610, 155 College Street, University of Toronto, Toronto. Register here.
   Sponsors: ACAHO, Accenture, Cerner, CGI, Healthtech, HP Canada, HPME, University of Toronto, IBM, McKesson Canada, Ontario Hospital Association, Philips Healthcare
   
   Breakfast with the Chiefs: registration requirements: some very fine print
   Do you work at a publicly funded organization? If so, you must hold a current personal subscription for at least one Longwoods journal. This covers attendance for the full season. This year’s speakers include: Dr. Alan Hudson, Matthew Anderson, Dr. Adalsteinn Brown, Dr. Ross Baker, Dr. Vivek Goel, Dr. Michael Guerriere, Ida Goudreau, Cliff Nordal, Murray Martin and Dr. Mary Ferguson-Pare. If you are not a subscriber click here first. If you are a subscriber register here.
   
   Registrants from private sector organizations, foundations and associations must be registered members of the Longwoods HealthcareBoard. If you are not sure of your status and want more information please contact Matthew Hart at mhart@longwoods.com.

Unlearning. A book by Dr. Alejandro R. Jadad (not reviewed)

Dr. Alejandro R. Jadad writes:
"I just published my first non-medical book, entitled "Unlearning", which I am using to explore the impact of combining online publishing, social networking and the notion of "Freeconomics".

The book can be downloaded for free or purchased at:

http://www.lulu.com/content/4132419

I hope you enjoy it. Feel free to share it with anyone you think might find this interesting.

------------------------------------

Here is an excerpt:
------------------------------------
I still remember my maternal grandfather quoting
[Benjamin] Franklin’s words:

“For Life is a kind of Chess, in which we have often points
to gain, and competitors or adversaries to contend with, and in
which there is a vast variety of good and ill events, that are, in
some degree, the effects of prudence or the want of it.”

Many years later, when I was in my late teens and already
a medical student, my grandfather’s image and Franklin’s
words came to me suddenly, while I was playing as the
captain and goalkeeper of my university in-door soccer team.
I could see the entire field from under the goalposts and was
shouting instructions to my teammates. I suddenly felt like
the King on a Chessboard, being the target of the opposing
team, unable to move from my box and hoping that my
teammates would follow my commands. I also realized that, at
the same time, in my life outside the pitch, I was a
dispensable pawn at the hospital where I was training as an
intern, with little control over my future. It was my superiors,
not me, who would decide where and when I would work, and
what role I would play in the war against diseases. I replayed
the words from Franklin’s essay and realized that I could
easily replace the word Chess for game, making his
statements even more prescient:

“Life is a kind of game, in which we have points to gain,
and competitors or adversaries to contend with, in which there
is a variety of good and ill events, that are, in some degree, the
effects of prudence or the want of it”.

At that moment, feeling like a piece on a board, I started
to suspect that not just Chess, but all games in general, are
much more than enactments of life. They may be signaling to
us, constantly, that life itself is a game.

This thought set me on a path that proved to be much
more challenging and exciting than I could have ever
anticipated.

Perhaps, I wondered, by looking at the nature and
structure of games, I could gain valuable insights about my
own life and how to live it.

Federal Election 2008: Interview with Party Leaders + commentary. Steven Lewis.

Longwoods' roving contributor and democracy revivalist Steven Lewis: caught up with the five party leaders in their post-televised debate debrief at an undisclosed location near Toronto.

Interviewer Steven Lewis: As usual, health care is front and center in this election. [Leaders look at each other quizzically, and leaf furiously through their briefing books.] Medicare is in crisis. The system hangs in the balance. What will you do as Prime Minister to strengthen this icon of Canadian identity?

Gilles Duceppe: I'm not interested in being Prime Minister, and health care is provincial jurisdiction. Next question…

Jack Layton: More doctors, more nurses, catastrophic drug coverage-

Stephane Dion: More than more doctors and way way more nurses than the NDP, and definitely more catastrophic drug coverage-

Elizabeth May: So you've finally got the Green message.

Layton and Dion: What do you mean?

May: Your platforms are all recycled. I salute you.

Stephen Harper: Let me be Prime Ministerial here. The Liberals almost killed Medicare by shoveling money at the problems with no success. We've invested wisely and got results. Especially more doctors and nurses.

Dion: But you're just continuing to do what we started in the Health Accords.

Harper: That's in the past. We've shown the kind of leadership the provinces want.

Duceppe: I agree with that. Write the cheques and get out of the way.

Harper: Exactly. But when we write the cheques with no conditions, the provinces deliver because we clearly respect the Constitution. That's the genius of the Conservative approach.

Interviewer Lewis: How many more doctors do we need. Medical school enrolment has practically doubled in the last 5 years-

Layton: What the hell?

May: I'm just new here. How could I have known that?

Harper: No way. They're nowhere to be seen. My own doctor is retiring.

Dion: Where's my briefing book?

Interviewer Lewis: It's a fact, almost double. They'll be graduating soon.

Layton (recovering quickly): Not enough. Should be quadruple.

Dion: Quintuple!

May: Gentlemen, harness yourselves. It's the wrong focus. We need to reduce smoking through education and taxes.

Harper: Let me again show the wisdom of Prime Ministership. If you raise taxes, people get anxious. Anxious people smoke. It's the only pleasure they have left once you've taken away their jobs in the oil patch. The Green Party may want young people to start smoking. We don't. In fact, we want to put young offenders in jail.

Duceppe: It's not the federal government's business. Smoking is under Section 92 of the Constitution Act.

Layton: The New Democrats have always respected Quebeckers' right to smoke without interference from Ottawa.

Harper: Our record speaks for itself. We're the ones who relieved the provinces of the intolerable burden of reporting to Canadians on how they spent the billions of new federal funding and what they accomplished. We got rid of the nanny state and overbearing federalism that threatens the very fabric of Canada. When Canadians pay their taxes to Ottawa, they want the money to go back to their own provinces with no meddling. Except they have said, very clearly, that they don't want it spent on safe injection sites.

Dion: Mr. Harper, you didn't get rid of the nanny state, you got rid of the nanny. No child care, no support for families.

Layton to May (aside): Did Dion actually get off a good one?

Dion: And also Mr. Harper, we started writing cheques with no accountability, and you stole our policy and claimed it as your own. I wish I could say I was surprised-

Duceppe: We have nothing to fear but fear itself.

Harper: That's another one of my lines Gilles. Politicians shouldn't plagiarize-

May: Is it always like this when you guys get together? I feel like drinking the hemlock.

Harper (indignant): If I were your husband, I'd take it!

Interviewer Lewis: Please, let's get back to health care. What will you do to close the technology gap?

Dion: My government will put an MRI in every hospital in Canada with more than 8 beds.

Harper: Our plan goes way beyond the Liberal broken promises. We'll put a CT scanner in every 7-11.

Layton: There you go again. Private care for the rich-

Harper: The scans would be paid for publicly.

Layton: Yes, but as a private, for-profit facility, the 7-11 will try to sell Canadians extras they don't need, like Pepsi and shrink-wrapped porn-

Duceppe: Ottawa has no place in the depanneurs of Quebec.

Layton: -so our plan is to open state-run convenience stores with CT scanners, ultrasound machines, generic drugs, sigmoidoscopies, all publicly funded.

Dion (aside): Mon dieu, that's good. Why didn't my dream team think of that that? Saboteurs….

May: Our plan is to build green roofs on every hospital. Solar panels will power the MRIs.

Interviewer Lewis: Let's turn to catastrophic drug coverage. Romanow called for it. The provinces were all for it, with leadership from Ottawa. Canadians need it. Where is it?

Dion: We're committed to it. It's in our platform.

Interviewer Lewis: But the Liberal government could have done it years ago. It could have made it a condition of the Accord and earmarked money for it.

Layton: Shame! Broken promises! Liberals, Tories, all the same, all the time.

Duceppe: Stephane, I agree with you. All the Liberal health care policies are catastrophic.

Harper: Good one Gilles.

Duceppe: You can use that in your speeches. Not that you need permission…

May: Time to move on, gentlemen. It's the environment, stupid. Clean it up, ban GMOs, put away the car, get Canadians moving, and everyone's healthier. More health, less health care.

Layton (aghast): Elizabeth, where' the leadership in that? If everyone's healthier, what will all those new doctors and nurses do? You're out to take away their livelihood. Just like I've always said, scratch a Green and there's dark Tory blue underneath. It's a neo-con job.

May: Jack, with respect, you need an exorcist. Your head spins faster than Linda Blair's.

Dion: We have the plan for the future. We're going to tax the doctors and nurses and administrators for providing excessive health care. They will charge the patients more money. We will give patients a tax cut to pay for the health care. So everyone will pay more and everyone will use less. Less for more - that's the Liberal health care solution. Just like the carbon tax.

Interviewer Lewis: Prime Minister, what do you think?

Harper: I'd like to hear more from Stephane. Keep going.

Layton (barely able to contain himself): Did you say you're going to charge people for medically necessary services?

Dion: My proposal is revenue neutral.

Duceppe: My Quebec includes the Canada Health Act. Did I really say that?

Layton: Our position is, we should never have gone in, and we should get out now.

Harper: We will be out by 2011, that's a guarantee.

May: What's this got to do with Afghanistan?

Harper: Elizabeth, we're talking about health care. I guess you're too new to understand.

Dion: Let me remind you, the Liberals were always for getting out of health care. Mr. Chretien started it, by cutting transfer payments. Mr. Martin finished the job, adding tens of billions of dollars with nothing expected in return. That's 21st century leadership.

Duceppe: I find myself agreeing with the three of you who won't be Prime Minister and the one who will. With federalists like you, who needs to separate? Did I really say that?

Interviewer Lewis: So let's wrap this up. What's your key health care message for Canadians, and how is your health care platform different?

May: We're going to strengthen publicly financed health care, write cheques, and invest in upstream health care.

Interviewer Lewis: So you'd do what every health care report has advocated for twenty years.

May: Yes. Like I said, recycling is good. Not as good as cycling, but still good.

Layton: We're going to rescue publicly financed health care from the hidden privatization agenda of the Liberals and Tories, write cheques, and make Bay Street pay for more doctors and nurses.

Interviewer Lewis: So what is that hidden agenda?

Layton: Don't be obtuse. It's hidden, so how would I know? But it's very, very bad for kitchen tables.

Duceppe: We're going to hold the government accountable for writing big cheques with no conditions, so Quebec can accept the cheques, deny the federal government has contributed anything, and participate when we feel like it in Pan-Canadian initiatives.

Interviewer Lewis: How is that different from what every other province does?

Duceppe: We are a nation, obviously.

Dion: We're going to restore Ottawa's role in national health care--

Duceppe: You mean Pan-Canadian. You can't say national.

Dion: I can so say national. National. National. National national national.

Harper: We are committed to further increases in transfers with no conditions and allow the provinces to experiment, innovate, and improve.

Interviewer Lewis: With the economy heading south, where will you get the money?

Harper: Some will come from the tar sands, and the rest from cutting the fat out of cultural spending. You can read all about it in our platform.

ALL: What platform?

Interviewer Lewis: Thanks to you all. It's a great day for democracy.