Category Archives: Health System

Tories set the stage for problems at eHealth

Posted on September 4, 2011 | 1 comment

According to Toronto Star columnist Martin Regg Cohn, Tory leader Tim Hudak intends to use the e-Health scandal in the provincial election much like Toronto Mayor Rob Ford used gravy at the municipal level.

What Hudak might be a little more worried about is the media taking a serious look at what the Auditor-General of Ontario actually had to say in his report on eHealth.

While it is true there were many sole-source contracts, the reality is the problems at eHealth can be directly linked back to the Smarts System for Health Agency (SSHA) started by the Tories.

In fact, of the $1 billion spent as of 2009, the year the auditor filed his report, $800 million of it was spent in the six years leading up to the scandal – including the Harris/Eves years.

Much of the Ontario General’s report focuses on the fact that the SSHA was set up without a strategic plan, leading to incredible waste. Looking at the slow progress of the SSHA in 2006, McGuinty hired Deloitte Consulting to do a comprehensive review.

“Among the problems Deloitte identified was the absence of a comprehensive government eHealth strategy, which resulted in the SSHA not being clear on its role and not being able to complete its own strategy,” writes the auditor.

The problem with consultants was one that escalated over time. Some of the consultants, the auditor reported, had been under contract for seven years –that would be prior to the arrival of the McGuinty government.

In his report, the auditor questions the reliance on consultants: “The fact that the development of an EHR (Electronic Health Record) had been on the government’s agencda as far back as the early 2000s caused us to question the heavy, and in some cases almost total, reliance on consultants.”

While the auditor had found improper sole-source contracting, and contract awards to companies that had much higher bids, the auditor made it clear there was no evidence of political influence or fraud despite Hudak’s accusations of “deliberate price-fixing and bid-rigging.”

Clearly eHealth was a mess. It started with poor foundations set by the Tories, and it took the Liberals well into their second term before the mess could be addressed.

Hudak is promising an inquiry. He may think otherwise, especially if he bothered to actually read the auditor’s report.

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Peterborough Regional Health Centre and the elephant in the room

Posted on August 31, 2011 | 4 comments

Peterborough Regional Health Centre CEO Ken Tremblay certainly tries hard to fit in with his community. The reality is he was sent in to do a job – downsize an active regional hospital in order to tame a budget deficit. That doesn’t always make you the most popular guy in town.

Ken Tremblay also writes a BLOG which is posted on the hospital’s web site. The BLOG contains entries about health care, restructuring and the importance of hand washing. It also features some folksy bits and pieces about Ken, including a picture of his dog Charlie.

Recently Ken posted about his “staycation” this summer in which he spoke about doing some odd jobs around the house, playing a little golf, and doing some recreational reading. Last year he even included pictures of himself atop an elephant as he described his vacation in Thailand.

Nobody begrudges Ken his vacation. As for the little personal anecdotes, it’s nice to know who your boss is.

However, the situation for workers back at the hospital has not exactly been rosy under Tremblay. While the CEO tells us about his splendid vacations, back at PRHC workers are being denied their summer vacations due to staff shortages.

With 250 to 300 fewer staff at PRHC, the hospital is having difficulty filling shifts and maintaining service. The performance dashboard the hospital posts on its web site is full of red and yellow boxes indicating the hospital is not meeting quality targets. Under Tremblay’s watch, for example, the PRHC went from having a better than average standardized hospital mortality ratio to a much worse one. While earlier this year Tremblay boasted to the Local Health Integration Network that the hospital was ahead of its target to reduce overtime, the reality is there is much anticipation that the overtime numbers will be more than just “creeping up” over the summer.

Further, workers tell us that the hospital is also doing more contracting out to replace the work of the people they let go, calling into question whether these layoffs will really lead to permanent savings.

Hospitals use something called the “NRC Picker” to survey staff satisfaction. While staff tell us they were surveyed over the winter/spring, the posted numbers are much older — from September 2010. We have to wonder why.

A year ago Peterborough scored 29.9 per cent on staff engagement and satisfaction. The average in Ontario for the standardized survey is 55.1 per cent. That means less than one in three staff at the hospital expressed satisfaction with their work.

How PRHC expects to improve quality and efficiency when staff morale is so poor is an open question.

Denying front line workers their vacation while writing about yours is not what we would call good leadership. That’s the elephant in the room, and we saw the pictures of who was riding it.

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Workers at Peterborough Regional Centre are picketing MPP Jeff Leal’s constituency office on September 6th at 4 pm. It’s the last chance to put pressure on the MPP to address quality issues at the hospital that have resulted from staff cuts and underfunding. On September 7 the provincial election officially begins. Please join us!

 

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Video: Support workers are not optional

Posted on August 26, 2011 | Leave a comment

This week OPSEU was at Kingston’s Hotel Dieu hospital shooting a video about support workers.

These workers provide a variety of essential roles within a hospital, but are seldom talked about. It is almost cliché for the public to call for more front line health care professionals without thinking about the skilled support that is absolutely necessary for them to do their work.

Kingston Hotel Dieu is no longer a general hospital. The Health Restructuing Commission of the late 1990s had recommended that it close. Instead Hotel Dieu redefined itself. Today it does day surgeries, offers a number of clinics, provides diagnostic imaging, and hosts an urgent care center — but no emergency department.

The lack of respect for hospital support has meant these workers too often have been the first to face layoffs in tough economic times, often with deadly consequences. One has to question whether layoffs of cleaning staff has been a contributing factor in the spread of hospital-borne infections. This has been a deadly spring for C-Difficile, particularly in the Niagara region.

One member at Hotel Dieu told us she was on her third job at the hospital having been forced to use her seniority to bump into other positions. On the other hand, a member working in medical records made a point about the fact that his longevity at the hospital was connected to the investment in training they made in him.

The support workers we met at Hotel Dieu are varied, from porters, groundskeepers and cleaners to ward clerks, printers, receivers, switchboard attendants and registered practical nurses. At times it was difficult to find a window of a few minutes to talk to them on camera.

When we asked them about their jobs, they all felt they played an important part in the delivery of health care at the hospital.

Without the proper paperwork or supplies surgeries would have to be cancelled. Without accurate information in the medical record, patients could be put at risk. Without porters to move people and material about the hospital, the facility would ground to a halt. Without cleaners the risk of hospital-borne infections would grow. These workers are not optional.

To see a sneak preview of OPSEU’s Hospital Support video, click on the window below. We hope to post the full video within the month.

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LHINs – Funding in a time of scarcity

Posted on August 24, 2011 | Leave a comment

This spring’s provincial budget set aside a three per cent base funding increase for community-based health care agencies this year. That doesn’t mean Community Care Access Centres, Canadian Mental Health Association branches or other local agencies will necessarily receive that amount.

The dilemma for the Local Health Integration Networks is whether to pass on an across–the-board increase that amounts to less than this spring’s Consumer Price Index, or whether to split that modest increase to address specific problems within the regional health care system? Do you make the situation worse for some agencies by slashing their funding increase to improve the situation for high-priority agencies faced with significant challenges? Either way, you know somebody is going to be unhappy. Worst still, does the absence of adequate funding for some agencies show up in new unforeseen challenges for next year?

The Central East LHIN passed a motion today that effectively cleaved the across-the-board funding increase in half – to 1.5 per cent – while using the remaining funds to address some serious problems within the LHIN. For those receiving only the 1.5 per cent, they will be in good company with the hospitals, most of whom will receive a similar base increase for a second year in a row.

 What is important to stress is that these are base increases, not total increases.

As we have seen with the hospitals, while the base was 1.5 per cent, many hospitals increased their bottom line by more than 4 per cent last year thanks to a variety of budget envelopes and increases in own-source revenues. For some agencies, particularly the very small ones, 1.5 per cent could turn out to be the total they do receive. James Meloche, a Senior Director with the CE LHIN, said 1.5 per cent could amount to as little as $900 for some agencies.

The 1.5 per cent the LHIN is reallocating is not a huge amount – about $5 million to support a population of 1.4 million, or about 11 per cent of Ontario’s population.  That’s about $3.50 per resident. This is on a provincial health budget of $47 billion.

While Don Drummond hammers away at unsustainable costs, there are no huge funding increases here at the health care coalface.

Clearly the region has a capacity problem, particularly when it comes to placing seniors into care following a hospital stay.

The LHIN has decided that it will address the problem by targeting the problem further upstream. By providing improved supports in the home, the LHIN hopes to avoid the arrival of seniors in the region’s already crowded emergency departments. Keeping people healthy is far more likely to be a winning strategy.

That does not necessarily mean more money for the CCAC – in fact, even with an allocation of almost half the available money, the CCAC will receive slightly less than the three per cent.

The LHIN is betting that more assisted living – including home making and falls prevention, among other services – will help keep seniors healthier in their homes and avoid hospital admissions.

The Oshawa/Whitby area will also be targeted, particularly for increased support for mental health and addictions. With a struggling economy, the communities have been hard hit by the recession, a situation that is putting pressure on health care providers.

“Clearly we have an issue at Lakeridge Health,” said Meloche. “People live in the park and they come to the emergency department for care.”

Fortunately one of the few mental health agencies in Ontario that will receive patients with concurrent addictions problems is already in the Oshawa community.  While several years ago Pinewood/Destiny Manor faced closure from a Ministry that wanted the hospital to cut unfunded mental health services, the service is now considered a major asset for the LHIN.

The LHIN is also trying to take some of the pressure off the Northeast part of its region by providing about $259,000 to establish a rural-based palliative care team.

While these are the priorities of the Central East LHIN, it does not necessarily mean that other LHINs will treat the funding in this manner.

* * *

The Central East LHIN used their “Urgent Priority Funding” to increase the volume of MRIs available in the region.  Senior Director Paul Barker pointed out that while the government was generously funding new MRI machines in the region, the actual funding for scans had gone down. The LHIN is tapping into this fund to provide $285,327 to buy 1,096 more MRI hours. Most hospitals can conduct about 1.5 scans per hour. The average wait for an MRI scan in the LHIN was 77 days as of July. One board member asked how it was Ontario hospitals could perform MRI scans for $260 an hour when they were charging $1600 for the same service in the United States. Barker pointed out that it may have something to do with the free market and profit-taking.

 As part of its planned to establish an umbrella organization to coordinate specialized geriatric services, the LHIN named the Northumberland Hills Hospital the “host agency.” A small secretariat will be set up at the hospital to work on a strategy to better deliver services to frail seniors. The immediate task will be to hire a project manager, recruit staff, establish office space and work on governance issues. The LHIN had found service providers, seniors and their families were largely unaware of what services were available in the LHIN. 2,100 seniors account for a third of all acute spending on seniors in the LHIN.  By focusing on the needs of this population, it could have a substantial impact on the overall use of acute care services in the LHIN.

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Health Care Platforms: Ontario Greens to review LHINs

Posted on August 24, 2011 | 1 comment

The Greens have the most aggressive fiscal position among the four Ontario political parties, insisting they can balance the budget by 2015 — two years earlier than that promised by the Tories and Liberals.

However, the party is also promising income tax cuts and cuts to small business taxes. They also want to freeze tuition fees at post-secondary institutions.

How they intend to carry off this feat of cutting revenues and balancing the budget early while making significant spending commitments is unclear.

The Greens say they will continue to increase health care spending, but then reiterate the nonsense claim that health care is on track to consume 80 per cent ofOntario’s budget if something isn’t done soon. What would that something look like?

The Greens, like every other party, say they will “make more efficient use of health care dollars.” While they point to new initiatives they’d like to fund – including more home care, transitional care, long term care and more family/community health clinics – there is little to indicate where the efficiencies would come from aside from the usual cuts to administration.

By omission it’s also easy to see where they wouldn’t spend health care dollars: hospitals. This is despite criticism of emergency wait times.

It is not clear what administration the Greens would like to do away with. Recent drivers towards more health care administration center around government initiatives to collect data on dozens of health indicators that purportedly assist with evidence-based decision-making. Patient and staff satisfaction surveys are also costly from an administrative point of view, but part of an increased trend towards more patient-centered care. And if the Greens want the LHINs to do a better job of consulting the public, they may need to pay for that.

The Greens are promising to deliver electronic health records by using best practices from other places. Given there are already more than six million Ontarians who presently have electronic health records, and that the current timetable is to bring all Ontarians on-line by 2015, it’s not clear whether the Greens would actually stop the present work to look for something it could buy off the shelf. While the Greens want electronic health records, they say e-Health is one place they could save money.

While the Tories want to do away entirely with the LHINs – and replace them with nothing – the Greens say they will “put communities back in charge of local health care decisions.” They say they will instead review the LHINs and see if they need to be fixed or replaced. Oddly, they say they would put strict limits on administrative and consulting budgets for the LHINs despite the fact that LHINs are essentially administrative and consulting bodies.

The Greens are committed to investing $1.6 billion over four years in Community Care Centres, Aboriginal Health Access Centres, Family Health Teams and practices that team doctors with nurses, dieticians, psychologists, counsellors, physiotherapists and others.

They would also spend $2 billion over four years to improve “affordable care for seniors.” That would include more home care, transitional care, assisted living, tax credits for family members staying at home with seniors, case managers to help seniors navigate the health care system, and more supports to long term care.

They say they will also establish a goal of providing 50 per cent of Ontarians with access to a family care team by 2016, rising to 90 per cent by 2020. The assumption is Ontarians would want to drop their local GP for team-based care. The question is, would they have a choice?

One local Green candidate may have been winging it when he told a community forum “other specialized workers, such as nurse practitioners, can help streamline care by taking on tasks now done by physicians, allowing those doctors to focus on medical care.” One has to wonder what kind of care a nurse practitioner would be delivering if it wasn’t medical care?

He may have been trying to articulate the party’s position regarding expanding the scope of practice for health professions, which would allow members of those professions to “practise to the full extent of their demonstrated competencies as verified by their respective regulatory bodies.”

For-profit nursing homes will love the Green Party promise to “reform the funding model for long-term care homes to increase flexibility and to encourage innovation and efficiencies.” At present the debate in the nursing homes is about limiting the transition of funding from the clinical envelope to the accommodations envelope. Operators are only allowed to take profit from the accommodations envelope, and therefore would like a more “flexible arrangement.” The Greens would make it much easier for the large for-profit nursing home chains to siphon money from direct clinical care into profit.”

Like the other parties, the Greens place considerable emphasis on preventative care, with a focus on the environment. They will spend $600 million over four years on various food programs and on tax credits for children and adult recreation programs.

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Posted anonymously:  You have forgotten to list the Socialist Party of Ontario http://www.socialistpartyofontario.ca

 

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“Fat raises and lavish benefits?”

Posted on August 19, 2011 | 1 comment

Do you feel you have been getting “fat raises” and “lavish benefits” from the McGuinty government?

According to the Toronto Sun, Tim Hudak’s Tories are launching a television commercial attacking public sector unionized workers, urging “taxpayers” to call a toll-free number to register their objections to Dalton McGuinty “giving away more of your money to union bosses.”

The ad suggests unions are “investing in McGuinty” because “they want hundreds of millions in fat raises and lavish benefits.”

Heavy on the “cheese” – the ad looks like a late-night low-budget infomercial – it is intended to counter union messaging on the threats Hudak poses for working people.

The hysteria suggests McGuinty “handed out a 25 per cent increase for one union,” but does not say who, when or over how many years. MPPs did give themselves a 25 per cent pay raise in 2006.

The commercial also misleads the public about current wage settlements. According to statistics Canada, the average wage increase in Ontario was  2.1 per cent (as of April 2011) – well below the province’s spring’s inflation rate of 4.0 per cent. That means most workers are in fact losing ground.

The “fat raises” and “lavish benefits” also fly in the face of the McGuinty wage freeze.

A Globe and Mail review of 2010 executive pay shows CEOs at Canada’s 100 largest companies saw their compensation jump 13 per cent last year, led higher by a 20-per-cent increase in annual cash bonuses.

Hudak is taking a page out of the playbook of his former boss Mike Harris, who whipped up public sentiment against public sector workers. The Harris government ended up repealing anti-scab legislation, froze the minimum wage, made it harder to get worker’s compensation, and challenged the ability of public sector workers to bargain collectively.

Looking at their paycheques, health care workers should be asking Tory candidates if they think their current settlements are “fat” and “lavish,” and whether such attack ads are a preview of what Hudak’s relationship with labour will be?

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CMA “national dialogue” supports expansion of Canada Health Act

Posted on August 18, 2011 | Leave a comment

The Canadian Medical Association has issued a report on its “national dialogue on health care transformation” – the results of six town halls (two in Ontario, one in Quebec, one in BC, Alberta and Nova Scotia) and its on-line consultation.

The report summarizes what the CMA heard, but makes no real recommendations.

“The message that came through most strongly from the public was the need to preserve and strengthen the current principles underpinning the Canada Health Act to ensure continued support for a universally accessible, publicly funded health care system,” the report states.

The report also made clear there was strong support for broadening the scope of the existing legislation. Various respondents spoke of the need of bringing dental care, eye care, drug coverage, long term care, home care, hospice care and care from alternate providers under the Act.

Not surprisingly, Maclean’s national editor Andrew Coyne filled the role of Chicken Little overstating the cost of health care, claiming it “is eating us alive.” Coyne claims 30 per cent efficiency can be had from reorganizing the system, but never points out where these savings would come from aside from making a pitch for more competition on pricing and decentralized funding.

When the public complained the Canada Health Act was not being enforced, Coyne invited them to vote NDP, claiming neither the Liberals or Tories would enforce the Act.

Dr. Danielle Martin of Canadian Doctors for Medicare said a public, single payer system is the best way to control health care costs, noting the cost of physician and hospital costs have been remarkably stable while drug costs have been the “Pac-Man” eating its way through provincial budgets.

The CMA concluded that Canadians suffering from unacceptable wait times, crowded hospitals and a lack of physician and other services were all signs the “once proud” system was under distress. While the majority felt underfunding was part of this scenario, others, like Coyne, believed the system was adequately funded but needed to be better organized.

Click here to download the full CMA report.

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New Video: Operation Maple health care quiz

Posted on August 18, 2011 | Leave a comment

Operation Maple asks whether the Ontario Tories kept their promise to protect health care last time they were in power? 

Operation Maple is an independent video site that takes an alternate look at key issues in the news.

Watch the video below:

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Election focuses the mind — and the pace of MOHLTC’s announcements

Posted on August 17, 2011 | 1 comment

There’s nothing like an election to focus the mind on many long-standing complaints, especially if you are the Ministry of Health and Long Term Care (MOHLTC).

While many have been soaking up the sun this summer, the Ministry has been pushing out one announcement after another, bringing hospital expansions, new MRIs and even nurse-practitioner clinics to a town near you.

This week Health Minister Deb Matthews finally appointed a supervisor to investigate community complaints around the Niagara Health System – something Matthews admits has been on her radar since day one.

Similarly, August 5th the troubled Windsor Hotel Dieu hospital received $5 million in new money to hire nurses, add more administrative after-hours support, purchase new equipment and refurbish rooms. Former CEO Ken Deane was appointed supervisor in January.

At the end of July the Ministry announced a major redevelopment and expansion of the Cambridge Memorial Hospital. That will include an expansion of their ER to accommodate an additional 10,000 patient visits per year, a redevelopment of the mental health unit, 33 new medical/surgical beds, five new intensive care beds, two new maternal beds and four additional paediatric beds.

Brockville General will also get a similar major expansion. A new wing will include 48 complex continuing care beds, 29 rehabilitation beds and 29 acute mental health beds.

Hawkesbury and District General Hospital will also get a major expansion, although tenders won’t actually happen until 2013/14. Good thing we know about it now, just before the election.

A more modest expansion will also happen at Winchester District Memorial Hospital.

This summer it was also announced Barrie’s Royal Victoria Hospital will get a new MRI, as will Oakville’s Halton Health Care Services. Vaughan was reminded that they will get a totally new hospital aligned with nearby York Central. Peterborough will get a new nurse-practitioner-led clinic. Infrastructure upgrades will happen at Ross Memorial Hospital,

Long-standing complaints about doctors being overpaid due to advances in new technology were finally taken on with an amendment to the fourth year of the Ontario Medical Association agreement. The OMA is essentially giving back $223 million a year by reducing opthamology fees (including cataract surgery), payment for endoscopy services, and through a new payment model for methadone.

When the William Osler P3 hospital opened in Brampton, there was local concern about the fate of the Peel Memorial Hospital. This week a major redevelopment was announced, creating the Peel Memorial Centre for Integrated Health and Wellness. The new centre brings many services under one roof, including urgent care, preventative care for chronic care patients, diagnostic services and community learning programs. Construction is due to begin in 2013. No figure has been given on anticipated cost.

Earlier in the summer the McGuinty government vowed to regulate private patient transfer after a damning omdubsman’s report.

If the Ministry is reading, there are a few other announcements we’d like to see. How about a staffing standard for long term care, or ending competitive bidding in home care? How about a fix for Peterborough Regional Health Centre or a moratorium on bed cuts and staff losses at the province’s psychiatric hospitals? How about bringing back public coverage for some of the health services the McGuinty government delisted, such as physiotherapy and eye examinations? So little time to October 6th, so many more issues.

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Is Hudak advocating a lower standard of living for most Ontarians?

Posted on August 15, 2011 | 1 comment

“There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning.” – Warren Buffett, Chairman and CEO of Bershire Hathaway.

How is it that Canada has seen years of consistent economic growth and yet money for public services appears to be drying up and after-inflation wages for ordinary citizens in both the public and private sectors have remained stagnant for 30 years?

The question is not “if” there is enough money, but how wealth is actually distributed.

Between 2000 and 2006 real income per capita grew in Canada by 15.5 per cent, but this was not distributed equally. In fact, most workers saw no increase at all in their inflation-adjusted income.

Over the last three decades the top 20 per cent of Canadian earners found their after-inflation salaries rise by 16 per cent to an average of $86,200. That is far from the whole story. The top one per cent of Canadians almost doubled their share of the nation’s economic output, rising from 7.7 per cent of Gross Domestic Product (GDP) to 13.8 per cent. The richest 0.01 per cent more than quintupled their share, averaging a staggering $3.8 million annually.

According to Toronto research agency “Investor Economics,” the richest 3.8 per cent of Canadian households controlled 66.6 per cent of all financial wealth (excluding real estate) by 2009, up from 60.6 per cent in 2005 – just prior to Stephen Harper taking power in Ottawa. Investor Economics predicts this group will control 70 per cent of all financial wealth by 2018.

While middle income earners remained stagnant over the last 30 years, the median income of the bottom 20 per cent fell from $19,300 in 1980 to $15,300 in 2010.

Economists measure the income inequality of nations through a formula called the “Gini Coefficient.” The scales runs from zero to one, zero representing total equality, one representing the maximum inequality. In 2004-05 Canada scored .317 on the scale, much lower than the United States at .381, but much higher than many European countries, including Denmark at .232, Sweden at .234, or Germany at .298. However, Canada’s rate of inequality was rising second fastest only to Germany.

Studies have shown that social inequality is about more than who drives at Lamborghini and who takes the bus.

There is a very real cost to society for higher levels of inequality, including increased health care costs and social unrest. Given Britain’s recent experiences, is it any wonder Stephen Harper is planning for more prisons?

Unequal societies are more likely to wrestle with issues of obesity, mental illness, and teenage births.

On the other hand, countries with lower levels of inequality experience stronger community life, higher levels of trust, less violence, better mental health, longer life expectancy, more social mobility and better education. Author Linda McQuaig recently pointed out that if you really wanted to pursue the American dream, you would be better off moving to Sweden.

In the coming election we need to look at issues through the filter of the growing economic gap.

PC Leader Tim Hudak says he cares about pocketbook issues. While he wants to make modest reductions in costs to families, he is more than willing to take a cleaver to the revenue side of the equation. Will a few dollars less in hydro bills be offset by cuts to your wages or the loss of your job?

When Tim Hudak wants to bring the compensation of public sector workers down to private sector levels, or to make the workplace less secure through his desire for competitions, these policies have a direct impact on social inequality.

Reducing public sector wages will not improve wages in the private sector – in fact, it will likely set new benchmarks towards a downward trend for all workers, public and private.

When all three parties are promising corporate tax cuts – the NDP at least limiting these cuts to companies that deliver new job creation – this will also have an effect on the widening income gap. The less corporations pay, either we cut services or pay more to compensate for lost revenue.

Should it be the role of government to reduce the standard of living for the majority of Ontarians? Perhaps this is the question we most need to ask at all-candidate forums and at the doorstep.

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Where is the money? Deloitte says US millionaire households have at least $38.6 trillion in wealth, with an estimated $6.3 trillion more hidden in offshore accounts. This wealth is held by one tenth of one per cent of the population. Deloitte predicts these households will see an 225 per cent increase in wealth to $87.1 trillion by 2020, or more than $100 trillion when offshore accounts are figured into the calculation. In an analysis by Amped Status’ David DeGraw, he points out the richest 400 people in the US have as much wealth as 154 million Americans combined – that’s half the US population.

Among leaders in income are the CEOs of US health insurance companies. DeGraw writes: “Leaders of Cigna, Humana, UnitedHealth, WellPoint and Aetna received nearly $200 million in compensation in 2009… while the companies sought rate increases as high as 39 per cent.”

The richest 400 Americans paid 30 per cent in income taxes in 1995, but now pay only 18 per cent. Americans who earned more than $1 million in 2009 didn’t pay any taxes: 1,470.

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