Providing prescription drug coverage

First, I should apologize. This is not a thoroughly thought-out scheme but I’m having one of those nights where my mind races and I need to produce something from all that idle thought.

Let’s say, for the sake of argument, that we want the government to pay for:

1. All catastrophic drug costs (for example, beyond a certain percentage of income)
2. Most costs for low-income families and individuals
3. The costs of certain drug treatments with strong societal benefits (like HIV drugs)

Right now there is a complicated patchwork of programs in Ontario which aim to accomplish those goals, but navigating the bureaucracy can be a daunting task for a sick person who needs financial aid. When dealing with multiple programs, it is also possible there are holes in the safety net.

I propose we transform the OHIP cards into a sort of pharmaceutical credit card. A patient swipes her card at the pharmacy, the pharmacist transmits the OHIP ID and prescription cost to the Ministry of Health where a computer quickly calculates the subsidy, and that information is sent back to the pharmacy. Then the patient decides if she wants to fill the prescription, knowing the ultimate cost. If yes, the province pays the pharmacist up front and collects what it is owed by the patient later.

This way, we can reduce the paperwork and delay, get the drugs to the people who need them, and tie up the loose ends later. All that is accomplished with relatively little information: income, drug expenditures, and drug identity. The most difficult part would be rearranging the machinery of government, not operating the program.

Can anyone tell me what this park is called, and if there are any plans to improve it? Especially toward the south end it is less a trail than a rut in the grass.

It runs from Lincoln Mall straight north to the intersection of Niagara and Parnell. It is probably a former railway.

Empty Parks

Biking along Walker’s Creek this afternoon I was struck by how empty the park was. It’s a great way to quickly travel north-south without worrying about traffic, but I would expect it to be used by the neighbours as well. As a long, thin park it is near many houses.

I wonder if part of the problem is that most houses, and even streets, do not meet the park. Where private property touches the park there are often fences. Entrances from the street are infrequent. Is it a coincidence that the only children I saw were just south of Lakeshore where what appears to be public housing is partially open to the park and its play equipment?

(Or maybe it’s just that there are no splash pads along the trail. They seem to be very well patronized this time of year.)

More bike lanes for St Catharines

As reported in The Standard, Welland Avenue between Grantham and Bunting will be reduced from four lanes to two, and gain a centre turning lane and bike lanes. The same will be applied to Vine Street between Lakeshore and Carlton.

It has been my experience that biking across the city (as opposed to within one’s neighbourhood) is difficult outside some isolated corridors, like the Welland Canal Trail. We are getting closer to a complete system of bicycle lanes in the north end that will make meaningful bicycle travel safer and simpler.

But we shouldn’t let these accomplishments go to our heads. There are still stretches of road that are off-limits to cautious (prudent?) bicyclists, like the crossings of highway 406 and the QEW. Many intersections, even with bike lanes, remain terrifying (try making a left turn).

Development charges remain in the news

Niagara’s development charges are among the lowest in southern Ontario — and the amount the Region collects annually covers less than a third of the cost of new infrastructure for development, said public works commissioner Ken Brothers. The Region already faces a $300-million capital budget shortfall over the next decade.

That should make the issue simple for council, Port Colborne Mayor Vance Badawey said.

“The money has to come from somewhere…. We don’t have a money tree growing behind regional headquarters,” Badawey said.

“The money is either going to come from the taxpayer, or it’s going to come from development charges.”

The consultant’s report suggests gradually increasing the fees for commercial and residential development over five years, from about $9 million annually to almost $17 million.

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A quick two-way story

I was biking south on Queen Street when I got to the newly two-directional King Street and realized I could turn in whichever direction I felt like. It was a feeling of liberation – no more biking the long way around a block to get to my destination! Two-way traffic makes navigating downtown so much simpler.

GO finally goes to St Catharines

A GO train trundles out of St Catharines toward Toronto.

It would be an uncharacteristic omission for this blog if I did not note that today the first four weekend trains between Toronto and Niagara Falls stopped in St Catharines. Apparently more than 150 people got on the first Union-bound train this morning.

I happened (by design) to be in the neighbourhood this evening when a train roared in from the east. It was ten cars long, which seemed to me like overkill, but maybe it’s more trouble than it’s worth to rearrange the cars. There didn’t appear to be 150 people getting boarding this train, though there were probably as many as usually ride the weekday morning VIA.

There were also a number of train geeks there, and I mean no offence (as a transit nerd myself), but I did not want to pull my camera out and have all the other people there think I care about the serial number on the locomotive or whatever it is train geeks obsess over. Since I was on my bike, I made it out to where the tracks sever Ridley Street before the train pulled out and I took the above photo to prove that I’m not making this up.

I am glad that GO has finally extended service to St Catharines, even if the trains are seasonal and even then only on the weekends, and the buses don’t begin until autumn. It is a solid start (although I do have some concerns about the location of our local GO bus stop).

At this point, I am required by the rules of transit advocacy to point out that now the Region has to get its act together and create an intermunicipal transit system.

Revisiting Development Charges

By a pleasant coincidence, The Urbanophile wrote about impact fees (aka development charges) today. This follows my admission that I don’t know much about the economics of development charges, and a piece in The Standard warning against raising Niagara Region’s charges.

Impact fees are fees charged to developers, typically residential developers, to help fund the capital expansion needs of public services such as sewers, parks, or roads resulting from the new housing units that will be added. This can be thousands of dollars per house in total. Also, developers are often required to construct 100% of utilities and infrastructure in the interior of their development, donate land for schools or fire stations, or even do localized road improvements. The idea is that the construction of the house creates a municipal liability that would otherwise be unfunded without the fee.

There are a couple of problems with impact fees. The first is that they are imposed on a locality by locality basis. Competition is good, but competition can also force all but the most attractive towns to limit their collection in order to entice developers. This creates economic development in the short term, but adds to the unfunded liability balance that will ultimately do in the city. The second problem is that these fees are not nearly high enough.

An externality is a cost or benefit (often a cost) that accrues to someone not party to a transaction, I think even most free marketers would suggest that externalities are a problem. In this case, the unfunded liabilities are negative externalities of development. The developer pockets the vast bulk of all of the profits and benefits flowing from his new subdivision. The residents of the whole town, both today’s and tomorrow’s, and even state and federal taxpayers, inherit the bill to make good on these costs.

He goes on to give an example of the burden a municipality has been saddled with by ‘disposable’ development. If you didn’t skim over that quote I suggest you read his entire post.

I am not entirely opposed to subsidizing development. The market can do a poor job of providing affordable housing, for example, and brownfield sites are notoriously difficult and expensive to clean up. But as with any public investment, we have to expect reasonable returns. It is unwise to subsidize a bare-bones suburban development that is going to decline and decay in a matter of years (not to mention imposing less obvious costs to health and social capital) for the short-term gain of a few jobs and property taxes.

When development charges are too low, the supposed economic benefits of development may be outweighed by the long-term costs.

I have another disease for WHO: it’s called letters-to-the-editor fever

For your amusement, another letter from the local paper:

Is the World Health Organization paying attention? Or has WHO not noticed?

Hundreds of thousands of people have died in the last few years in the Middle East.

WHO appears complacent to the point of being virtually silent, and displays very little empathy, or urgency, in its reactions and responses to war, especially when compared to those with the flu.

Why has WHO not thought of declaring a war a pandemic? Surely war is very detrimental to health.

The people of the industrial military complex are causing massive deaths and serious injuries in many countries. These people are causing their own unique strain of death and torture diseases.

Why is WHO so concerned about 25,300 people with runny noses and coughs, and for only 139 deaths, some of which can’t be attributed to the swine flu anyway? This pales in comparison to the hundreds of thousands of human lives lost, people maimed and tortured, left homeless and without family.

How does WHO warrant so much hype and attention when thousands have died, and will continue to die, simply because of a fight for the control of oil and territory, amounting to a disease known as Godlessness, greed and corruption, for which no vaccine exists.

There is truly more than just 25,300 sick people in this world — if you get my drift.

Never mind that WHO has limited resources, expertise, and a relatively narrow remit (which includes some truly devastating things like malaria). Never mind that H1N1 hysteria ended weeks ago. Never mind that a local newspaper is probably not the most effective forum for getting the word out about these sorts of things.

Just enjoy the crazy vibes. Soak ’em up. Appreciate your own sanity.

Urban golf courses

The patrons of Fairview Golf Course are not pleased with rumblings from council that it might be sold next year.

This is a good example of the trade-offs involved in city planning. There are direct benefits to quality of life and health from golfing, and this course seems to be especially popular with the older crowd. It is also nice to have green space in the centre of the city, though perhaps not fenced off as a golf course is.

For all its benefits, a golf course is probably not the most intensive use that site can support, and it is going to cost the city upwards of $300,000 to upgrade.

Ideally, the golf course would be replaced with something that provides at minimum the same quality of life and health benefits, but also pays property taxes. I was just thinking today that this parcel of land, squeezed between Fairview Mall and a large cluster of high-rise apartments, would be an excellent site for a mixed-use development.

Mizner Park, built on the site of a failed mall in suburban Florida

Imagine an outdoor “mall” in the traditional sense lined with mixed-use buildings only a few stories high – retail and restaurants at ground level with offices and residences above. Properly integrated with the preexisting residences and neighbourhoods, it might actually reduce traffic by encouraging people to walk to their destinations. In addition, it would bring more people within walking distance of Fairview Mall, which is on the small side for a successful mall (and thus has an uncertain future).

It would be a welcome change from the strip malls, car dealerships, and big boxes in that corner of the city. If we are lucky, it might even catalyse the redevelopment and intensification of the neighbourhood. Mizner Park, above, has been called an “attachable fragment of urbanism” because it was an island of urbanism in a sea of parking lots and cul-de-sacs. The other side of that coin is that it is ready for new development to attach to it; rather than being oriented primarily towards an arterial road, new development nearby can build (so to speak) on the success of Mizner Park and itself propgate further examples of good urbanism.