Posted September 7, 2018

Registry Numbers Do Not Tell Us Much About Accessibility Of Primary Care

The Nova Scotia Health Authority’s (NSHA) Need a Family Practice registry (NFP) may be a good way to connect people to a physician willing to take more patients, but it does not provide useful information about how many of them there are.

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Conservative leader Andrew Scheer had to deal with Maxime Bernier’s defection before getting back on message last week. He should have been secretly delighted.

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Cecil Clarke’s entire resume is about his experience as a politician, while Julie Chaisson has none, though she has tried.

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What were the motivations of the Liberal government in the tweet that provoked a shrill overreaction by Saudi Arabia?

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John Lohr and Tim Houston have chosen different paths in pursuing the leadership of Nova Scotia’s Progressive Conservatives.

John has been a Kings County farmer for more than 30 years and is pleased that two of his sons are taking it over to be the third generation of the family on their farm. He was first elected as an MLA in 2013.

He is strongly connected to his Baptist faith community.

His list of 17 policy ideas is easily the most extensive of the five candidates, and it is a surprise and disappointment to him that some of the other policy offerings are so meager.

He identifies doctor shortages as a priority and would raise their pay to be the highest in the Maritimes.

In total, Nova Scotia has more doctors per capita than any other province. The shortage is concentrated in family physicians. Our proportion of people without family physicians is typical of Canadian provinces.

He would fire the CEO and entire board of the Nova Scotia Health Authority and would provide governance by the Minister, operating through the Department of Health and Wellness. In the short term, that would create chaos.

It is not a good governance model, nor one that will result in more successful recruiting—the department was responsible for physician recruiting until two years ago. It is the department that has established the uncompetitive compensation formula, and still controls how much physicians will be paid and what services will be reimbursed.

John has other ideas that rest on firmer ground. He would abolish the provincial sales tax on used cars. Why should the province receive tax on the same car over and over? We don’t do that with houses.

He would remove provincial obstacles to Uber and other ride sharing services, although that would not in itself force the municipalities to allow it.

He understands that successful resource industries are crucial to economic success in rural Nova Scotia and is willing to take a stand in favour of forestry and onshore natural gas.

John wants faith-based facilities to be treated equally in support for government programs such as accessibility funding, and would insist that universities not allow “political correctness” be an obstacle to free speech.

He would continue the Liberals’ commitment to balanced budgets and has no big spending commitments other than the cost of raising doctor’s pay.

It is a rich list, not all of it sound, and some of it likely to trouble some of the party’s members, but it gives voters a clear sense of how John thinks.

The same cannot be said of the Tim Houston campaign. Tim is a father of two and has been an MLA since 2013. He has been the party’s finance critic.

There is no policy section on his website, but a smattering of ideas can be gleaned from some of his news releases.

He would increase spending on mental health and addictions. He believes that home care for many chronic illnesses can be cost effective.

He would allow young Nova Scotians to pay no provincial income tax on the first $50,000 of annual earnings until they reach age 25. This is designed to keep people at home but, like all tax-based incentives, it will have unintended side effects, such as income splitting for tax purposes.

Houston estimates that this will cost $75 million a year. That by itself should not prevent balanced budgets, to which he is committed.

Houston likes being a critic. He often fulminates about what the government has done without actually saying that he would make a different choice.

He criticizes the NSHA but would work to make it more effective rather than abolishing it. He mustered the requisite dismay over the Cape Breton hospitals announcement, but it was about process—he has not said he would undo it.

He largely endorsed the recommendations of the Glaze report on education, which the government adopted, but he declares the system to be in crisis.

He is resolutely evasive on resource development issues such as fracking and Northern Pulp.

He correctly identifies immigration as crucial to Nova Scotia’s future, although he has not said so in any of his releases. His goal of 5,000 per year is little more than we are doing now and less than the Ivany goal of 7,000.

He would like to see whether current economic development spending could be repurposed, but has no proposed reforms. Surely, in his years as finance critic, he should have been able to get some understanding and develop some ideas.

Houston rightly says that choices on his big topics—economy, education, health—require consultation with the relevant players and affected communities. But taken to a fault this results in a positioning that is devoid of substance.

Unlike John Lohr, we don’t really know how he thinks, nor whether as leader and premier he would be willing to make tough but necessary decisions.

Houston has by far the largest number of caucus supporters. Perhaps those closer to him see more than is visible at a distance.