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FWIW New Brunswick did not have kindergarten at all when I lived in that province, that's why I started in SK when I moved to Ontario. All-day kindergarten needs to be chopped.

Health and Education are to the two cost-drivers in the provincial budget and they need some intelligent management. For instance the public drugs formulary should be subject to the rigorous cost-benefit and clinical efficacy trials that BC had a decade ago. Ignore the screaming drug companies, get the losers off the formulary.

Police salaries, which the Globe & Mail mentioned today, also need to be reined in. Toronto and the OPP started a silly bidding war to see who could have the highest pay rates for constables in the province. That needs to stop, it never should have started. Other municipalities have had trouble with their policing costs, mainly due to salaries.

Demographics and healthcare are (is?, since it's the combination of the two) what scares me about fiscal sustainability. And that's provincial. Ontario's best hope is that all the boomers migrate to BC to spend their declining years.

Determinant - Don Drummond gave a very interesting talk at Carleton today - one thing he was saying is that an unacceptably high (I don't remember the number) percentage of people with diabetes in Ontario don't get the three standard annuals tests - and as a result the province doesn't have great diabetes outcomes. I need to look at the background documents to the health care part of the report because it sounds as if there's some interesting stuff in there.

That would be Type II Diabetes; I am a Type I. Despite the name they are completely different diseases under the hood with very different causes on a biological level. They really should have different names. Type I's are only 10% of all diabetics though we have it for a lifetime. Type II's are generally worse cases to deal with because you have to break a lifetime of habits. Type I's are young and pliable.

The tests he is referring to are Hemoglobin A1C (average blood sugar), cholesterol and blood pressure. Certain blood pressure meds have a secondary protective function for kidneys, they are as common to see today in Diabetics as insulin.

On the hope front, there is some very interesting cure research going on at Massachusetts General Hospital for Type I Diabetes. Cure as in restoration of full endochrine function. The bonus is that the protocol uses a generic drug that has been around for decades. The testing is going into the Phase 2, make or break stage this year, it will take three years to complete. As a dose of reality, this research would not have been possible without the advances in computers, the discovery of DNA and the radical improvement in molecular biology in recent decades. Banting & Co. were really taking a shot in the dark in the 1920's and got lucky.

But if I were Minister of Health I would fall all over myself to get this cure out to Type I diabetics and get them off the expensive, heavy-hitter list. We are high health care users, there just aren't so many of us.

Certain lists of chronic diseases or very expensive like Diabetes, many Mental Health issues, Cancer ought to have dedicated "streams" with agreed treatment protocols that are judged on clinical efficacy and cost. Letting them fester in local centres with family doctors doesn't work and leads to repeat visits that cost money and don't do anything.

How much of Ontario's structural gap is due to the tax cuts passed in the mid-1990s?

Tyronen:
That's a good question - I'm not sure if anyone has worked directly on that question. The reduction in income tax rates in the 1990s and later on corporate tax rates would have had some effect but these were accompanied by the Employer Health Tax as well as the Ontario Health Premium after 2003 (really an income tax surcharge). Per capita revenues in Ontario are on an upward trend as the Figure shows but to borrow from Star Trek, they are on a parallel rather than intercept course with per capita spending.

What I find mighty interesting is the fact Ontario is supposed to now be the down and out laggard of the Canadian economy but BC and Alberta the two new leading lights of confederation appear to undergoing a 1993 level of political convulsion. Do Alberta and BC voters know something on the ground about their economic situations that the professionals don't(Perhaps the absolute depression in natural gas prices?). I have to say I love Wildrose Party leader and Premier in waiting Danielle Smith going on and on about Eastern Canadian "elites". I thought all the Eastern Canadian "elites" were broke now.

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