Breaking the emergency department binary: Why Canada needs a continuum of care — and a more responsible narrative

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“Thank you for calling the office of Dr. [Name]. Our office hours are Monday to Friday from 9:00 a.m. to 5:00 p.m. If you are calling to book or change an appointment, please remain on the line or press 1 to speak with reception. If this is a medical emergency, please hang up and dial 911 or go immediately to your nearest emergency department.” How often have you heard this? It cuts to the chase of an important binary. Canada has slowly built a healthcare system that forces patients into a false choice. If something might be serious — a flu that will not break, a strange growth, chest discomfort that may or may not be alarming — Canadians face two options: wait for a family doctor appointment that may…
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Life course thresholds: Why do we wait for the fall?

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Four quiet caregiving action thresholds   We are very good at recognizing crisis. We recognize the stairway fall.We recognize the stove fire.We recognize the utilities cut off.We recognize the unpaid tax bill with penalties attached.We recognize the emergency room visit. But caregiving rarely begins with crisis. It begins with smaller thresholds — inflection points — that are easy to dismiss because each one, taken alone, resembles ordinary human error. The question is not whether someone makes a mistake. The question is whether they can correct it. That distinction marks the beginning of something deeper. Building on earlier life-course thresholds — when stairs become unsafe, when grip weakens, when exercise becomes impossible — there are four earlier inflection points that often precede visible decline. They are subtle. They are cumulative. And…
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Boomers, wealth, and the architecture of advantage

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Why the generational debate misses the real design question A recent Pew Research analysis in the United States found that Baby Boomers hold more wealth at comparable ages than previous older generations did. At the median, American Boomers in 2022 were substantially wealthier than the Silent Generation in 2001 or the Greatest Generation in 1983. The predictable reaction followed: Boomers won. Younger generations lost. In Canada, the pattern is similar — but the interpretation is often incomplete. Yes, Canadian Boomers hold roughly half of total household wealth. Yes, average Boomer net worth exceeds $1 million. Yes, housing equity plays a dominant role. But the generational framing — Boomers versus Millennials — obscures something more important. This is not primarily a story about age. It is a story about architecture. The…
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The ‘envelope test’ and CRA’s income tax double standard

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I have written about CRA's enforcement and entitlement double standard before but always as part of a laundry list of complaints. This time I want to showcase it on its own. Imagine a restaurant server, honest and methodical, who one day finds an envelope at home marked “2024” with $1,200 in cash inside. He is at first surprised, then remembers it. It is not marked, not documented, and not connected to any slip on any tax form — it is just there. Being a law-abiding citizen, he does the only thing the system teaches him to do: he reports it to the Canada Revenue Agency (CRA) and offers to pay tax on it. On its face, that seems like an act of civic integrity. But what his experience exposes is…
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The Olympics and the cult of maximum volume

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A modest proposal for turning down the sound or changing channels I used to live across from a man whose sole civic function appeared to be shouting at children. Whenever we were playing road hockey, building snow forts, or engaging in any activity detectable by human ears, he would emerge and declare: “Hey, you kids! Shut up!” At the time, we viewed him as the villain in a small suburban opera. Now, watching the modern Olympics, I find myself sympathizing with him. Not because children are loud. Because everything is. Curling has discovered heavy metal Let us begin with curling. A sport whose essential mechanics involve granite stones gliding across ice at contemplative speed has somehow transformed into an auditory siege. The shouting is constant. Not directional calls. Not strategy.…
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Cutting Old Age Security is not a test of courage

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In a recent column, Robyn Urback suggested that if Mark Carney were truly serious about the economy, he might consider making “politically unpopular decisions … like reining in Old Age Security.” It was a throwaway line. But it reveals something deeper about how we talk — and don’t talk — about seniors’ income policy in Canada. OAS is clawed back through the tax system First, the premise is wrong. Reining in Old Age Security (OAS) is not some taboo that no government dares touch. We already do it. Since 1989, Canada has applied a 15% recovery tax on OAS for higher-income seniors. Above a defined income threshold (about $93,000), OAS is clawed back automatically through the tax system. It is not universal in any meaningful sense at the top. It…
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From “No car, no radio” to engineered scarcity: The changing face of welfare isolation

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In 1998, Margaret Hillyard Little published No Car, No Radio, No Liquor Permit: The Moral Regulation of Single Mothers in Ontario, 1920–1997. Drawing on archival records and interviews, she documented how Ontario’s mothers’ allowance (welfare) system explicitly monitored and regulated single mothers. Eligibility was not merely financial; it was moral. Caseworkers inspected homes. Cars were forbidden. Radios were deemed luxuries. Liquor permits were denied. Telephones were suspect. Your way to hear from the world, talk to the world and get to the world were all forbidden. Relief came with isolation. The message was unambiguous: assistance must not resemble belonging. James Struthers, in The Limits of Affluence, similarly showed how Canadian social policy was shaped by an enduring caution. Aid was necessary, but it must remain less attractive than independence. Isolation…
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Life course thresholds: The inflection points of care we seldom hear about

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Modern health literature is saturated with advice. Eat better.Drink more water.Exercise daily.Maintain grip strength.Reduce alcohol.Stop smoking.Prevent falls. The genre is endless and reassuring. It assumes that decline is negotiable — that with sufficient vigilance, discipline and compliance, deterioration can be deferred indefinitely. There is truth in this. Prevention matters. Diet and exercise change outcomes. Smoking cessation works. Public health victories are real. But what we rarely discuss are the moments when prevention gives way to thresholds. There are inflection points in aging and illness that are not about optimization. They are about transition. And these transitions are precisely where caregiving begins in earnest, where homes must be altered or abandoned, where autonomy changes from assumption to negotiation. We write extensively about avoiding these moments. We write very little about recognizing…
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Beyond the needle, Part 3: When skepticism hardens and institutions overpromise

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The public argument about vaccines is rarely about vaccines alone. It is about trust. It is about who defines credible evidence. And it is about what happens when institutional confidence thins. Regulatory capture To understand the appeal of vaccine skepticism associated with figures like Robert F. Kennedy Jr., we have to begin in an uncomfortable place: with the plausibility of its starting point. The starting point is regulatory capture. Pharmaceutical companies are powerful. Regulators rely on industry-generated data. Revolving doors exist. In other sectors — opioids, finance, environmental regulation — oversight has visibly failed. In that context, suspicion toward regulatory assurances does not sound absurd. It sounds cautious. From that premise, a chain of reasoning follows: If regulators are compromised, and vaccine safety depends on regulators, then vaccine assurances deserve…
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The Beagle, Peas, Northern Dancer and Secretariat: what Darwin and Mendel’s solitary work can still teach us about theory and practice

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This essay concerns itself with schools of thought that initially did not engage each other  but eventually met both informally and formally. The formal meeting took place through modern genetic and evolutionary thinking. The earlier yet informal meeting is exemplified through the thoroughbred horse breeding of Federico Tesio.   If  Darwin and Mendel’s thinking had met earlier and fluently, we would have possibly avoided the scourge of Eugenics. The fact that they did meet before the theoretical bridge had been built between them gives us the modern thoroughbred horse through Federico Tesio – both Northern Dancer and Secretariat. It’s an interesting story in two parts. Part 1: Darwin and Mendel I have a deep interest in Darwin and Mendel. Over the last year, I traveled to South America twice –…
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