I'm privileged today to have the opportunity to share my time with the members from Nipissing, Don Valley West and Etobicoke North, and Ralph Goodale.

I'm honoured to rise in the House today to be the leadoff speaker on behalf of our government for the second reading of Bill 8, the Commitment to the Future of Medicare Act. This bill reflects the values of a new government, a new government that's prepared to do its part to build on one of our nation's great successes. I have said on many points and occasions that medicare is the best expression of Canadian values. It is the intention of this government to renew and transform medicare to make it sustainable for future generations.

I do very much want to acknowledge and personally thank my legislative colleagues on the standing committee on justice and social policy, those from all parties in the House, but I particularly would like to recognize the Chair, Kevin Flynn; the committee Vice-Chair, Jim Brownell; and my parliamentary assistant, the member from North Bay.

No one has spoken as passionately and as persuasively on the future of medicare as Roy Romanow. His extraordinary report provides the playbook for transforming public health care. Mr Romanow laid out the challenge for all of us, and he laid it out this way: "Canada's journey to nationhood has been a gradual, evolutionary process, a triumph of compassion, collaboration and accommodation, and the result of many steps, both simple and bold.... That next step is to build on this proud legacy and transform medicare into a system that is more responsive, comprehensive and accountable to all Canadians."

That is what the future is, and that is what Bill 8, the Commitment to the Future of Medicare Act, is all about.

A review of Bill 8 and a read of the preamble is to see a core statement of our values, the values of medicare. It speaks to health care that is consumer-centred, it reflects a system that is accountable to the people who own it -- each and every Ontarian. It calls for a system focused on outcomes and committed to quality. Bill 8 confirms the undeniable need for co-operation in health care between providers and government, individuals and communities, and it underscores the responsibility that we all have to build a strong, sustainable public health care system.

I want to talk today about our game plan for transforming medicare in the province of Ontario, and I want to talk about Bill 8, a key part of our transformation strategy.

The government that has been elected in Ontario, the McGuinty government, has brought a greater determination to the goal of transformation in our health care system. Some people say, in response to our plans, that it has been heard before. That is because it is an echo of the vision of Roy Romanow, but it is one that brings with it the determination of a new government in Ontario.

The stakes on this task are high and the cost of failure great; in fact, immeasurable. But we are confident that a better future of medicare lays within our grasp. It is within the leadership of the province of Ontario to demonstrate to the country that the future of medicare is indeed strong, that we can transform our medicare system to one that is of higher quality, that is patient-centred and delivers on principles of sustainability.

Our goal, to make it simple, is to say that we want to make Ontarians the healthiest Canadians. When we are successful at doing that, we will have contributed greatly to ensuring that the medicare system that we pass on to future generations is a sustainable medicare system.

The challenges are great. Those that we confront are great, because against many measures, the health of our population is not in the greatest shape. Historically, I have not been in the greatest shape either, so I try to stand as a role model and encourage Ontarians to take one extra step, to eliminate one extra cigarette, to lose a little weight, climb a few stairs and make that individual personal contribution that all of us must make if we are to restore our belief that medicare is the way to go, if we are to enhance the quality of the system that we have.

The challenges are great as well because we have an aging and growing population; demand caused by access to new technology; and we have some culture in our health care system, like running annual deficits in budgets of our hospitals.

There are forces chipping away at medicare. In fact, some of them are the head of new political parties in the House of Commons. Those people want to erode its principles. They want to narrow its reach, water down its protections and lower the quality of care that it delivers, all in the name of offering some alternative parallel system for those who have money.

It's time to leave behind the status quo, where we spend billions upon billions of dollars on health care but have no reliable means of measuring the outcomes gained from these precious dollars. We're all in this together, and together we owe it to the Ontario public to show them how good it can be when we all work together.

This is, to some great extent, about change versus the status quo. There are people -- I see them and I hear them in our midst -- who resist the change that is in Bill 8 because it's not the way we've always done it. But on October 2 of last year, the people of Ontario said to the people of this party and to Dalton McGuinty, who is now our Premier, that change is absolutely required.

Let me be blunt about this : At $28 billion and growing, the public health care system is crowding out other government priorities like education and the environment. We know that we can't continue to do this. But to have a situation where we're crowding out other government priorities yet not delivering to the expectation level of Ontarians, even though we're spending 46% of program dollars, is I think a message that we must transform the medicare system in our province, transform it to sustainability, where sustainability is measured not only on our basis to be able to pay the bills, but measured on the quality of the care that we can provide.

I'm talking about the sustainability from the vantage point of the average Ontarian. Their question is: Will medicare be there for me when I need it? We have created a bill that enables us to take on these challenges head-on and restore the very best of health care, to answer, "Yes," to that question. Medicare in Dalton McGuinty's Ontario has a very, very bright future.

Review after review, study after study, have only served to reinforce the notion that universal, single-payer, publicly funded health care continues to be the right way forward for Ontario and for Canada. But they also concluded that, within that framework, major reform is required. Major reform we will bring, because this is a government of action, action on the most cherished public program of Canadians. Roy Romanow clearly concluded that we need to renovate our concept of medicare to adapt to today's realities.

The Commitment to the Future of Medicare Act represents an important signal to Ontarians -- that the significant changes to come rest on a strong foundation of familiar values. While others of us might suggest that the only way forward is to abandon these principles and to throw up our hands and surrender, we will prove that health care reform can and must be consistent with these values. That is why Bill 8 builds on the principle of accountability. Romanow reaffirmed that health care is there for, and answerable to, its owners -- 12 million Ontarians -- and that we all share a responsibility to protect it.

For those of us who have the honour of serving in health care, and the particular honour of serving Ontarians, of representing them, we are the province that must, to our nation, show the way forward for medicare. The reforms that we're undertaking here to transform our medicare system, to make it more patient-focused and more accountable, to deliver a higher-quality result -- Ontario must lead the way, because Ontario has always led the way.

I had the opportunity on February 24 to outline for the people of the province of Ontario our government's transformation plan for health care. We faced the challenge, and we have the plan of making our health care system into one unified whole system driven by quality and centred on the consumer. I have taken to saying in the days since I was appointed minister that the more I look for a system, the less of a system I see. The fact of the matter is that, on a whole range of points, dollars have been sent from the government at Queen's Park to different and diverse pieces of our health care system, but they have not bought a system with those dollars because the strategic responsibility of the government of Ontario was not there. As a result, we have a fragmentation across electronic health records, as one example. We have created a mentality, a culture, in the health care system in our province that is silo after silo. I engage all of you, all members of this house and Ontarians, to be involved in the very necessary exercise of toppling those silos so that the patient, the consumer, can make their way in a more seamless fashion across our health care system.

At the heart of our transformation plan is a recognition that our hospitals have been asked to do more than they are best built to do. Our government's challenge and our government's priority will be to ask our hospitals to hold stable while we give them predictable funding -- albeit at lower rates of growth than they've seen over the last five years when their budgets went up by 10% -- so we can make those precious and desperately necessary investments in those complementary, community-based services, like providing a doctor in the neighbourhoods where people need them; like making sure that community and mental health and addiction services that have not seen a penny of increase in their base budget since before Bob Rae's hair turned white, that they once again understand that we recognize, that the Dalton McGuinty government recognizes, their importance and the role that they play, the contribution that they make; that we make the necessary investments so that home care can provide, not only to keep our people independent and keep them in their homes as long as possible, but to support them in those very critical days following acute care stays.

This is the challenge that we face, but we will make those investments in those community-based services. Because of the work of my colleague from North Bay, and because of the commitment of this government, we will transform the long-term-care system in this province in a fashion that restores confidence that those 67,500 beds, each of them providing such a vital lifeline for an Ontarian -- that we restore the sense of quality in those; that our most vulnerable citizens who are residing in long-term-care facilities will know that this government sees the critical importance of a properly functioning system of long-term care, one that gives us confidence. This is what we'll deliver upon.

First, we will bring that sustainability and renewed accountability to hospitals, because they are the anchor of our health care system. For our part, we acknowledge that for all of the talk that has come from previous governments about delivering sustainable and predictable funding to hospitals, it is not being delivered upon. We will not only do that, but we will tie that funding to results that matter to Ontarians: reduced wait times, better-quality care and human resources strategies that recognize that hospitals are bricks and mortar and that technology, while it matters, is not nearly as important to the health care delivery that comes from people. At the end of the day, health care is about people delivering services to people, and that's reflected in the fact that 80 cents on the dollar is spent on people, but our strategies around human resources have so far not properly reflected the incredible role that human beings are playing in making our medicare system so important to Canadians.

We ask hospitals to work with us and to work with each other, to connect with other parts of the system, like I mentioned earlier -- home care, long-term care, family health care -- and to take full advantage, to take greater advantage than we have so far, of the tremendous economies of scale to improve the way they manage their resources. On this point, I pause to say that those people who are threatened by the idea that hospitals that band together to buy bandages cheaper are somehow a threat to public health care are people whom I think are stuck in the status quo, and those people need to change. Because I'm not interested any longer in being part of a government that talks about a health care system but doesn't have a system that means that we can take advantage of the spending power of $11 billion worth of hospitals.

Later on, I'll give you an example of how we can get a better bang for our buck, about some of the advantages that can flow from standardization. These are the benefits of a system; this is the medicare advantage. Yet for all of our huge spending power, we have failed time and time again to take advantage of those opportunities. But this government will not fail, because those precious dollars that can be saved from procurement policies that bring about, that take into consideration those economies of scale, that purchasing power, those dollars saved, those precious dollars saved will be driven back into the kind of health care that Ontarians need. A dollar saved on a bandage will be a dollar dedicated to reducing a wait time for cancer, for cardiac care, for hip and knee, for cataracts, and those dollars, those precious dollars, will be used to enhance those community supports that I just spoke about.

I want to recognize that government must change its behaviour toward hospitals as well. In the past, in the absence of stable, predictable funding, it has been more difficult for our hospitals to plan effectively, and sometimes that contributed to the deficit trap. Having clear rules for how hospitals are funded is an essential part of ensuring that they are given the resources to actually deliver the results expected of them. Hospitals have been working with government through the joint policy and planning committee on a new, more predictable method of funding hospitals that enables longer-term planning and links funding to quality results. This government will be the government that moves those discussions from the committee room or from the board room table, and puts them into practical application in hospitals across this province, because it is time to get on with it.

It is time to get on with delivering to Ontarians a sense that there is a government that wants to build a health care system that is integrated and of a higher quality. But accountability and predictability of funding must go hand in hand. Bill 8's accountability agreements clarify expectations in order to secure mutual benefits for both health providers and the Ontarians they serve. The accountability agreements are about a new mature relationship with our health care providers, a relationship that for the very first time ties funding to results, rewards good performance and has real consequences for poor performance. No part of the system can stand alone any longer. No one part can determine on its own what services it will provide, what outcomes it will achieve. The needs of the consumer, of the client, of the patient, should be the only determining factor.

Let me take a moment to talk about how accountability agreements will work. The Ministry of Health and Long-Term Care, the insurer, will negotiate an accountability agreement with the boards of health care institutions to ensure that health care dollars are used to achieve quality outcomes for patients and the public. Outcomes will be patient-centred: wait times for a life-saving procedure, like cardiac care and cancer care. The agreements would reward those providers who deliver excellent quality, and there would be real consequences for people who fail to meet their commitments.

It's funny how it seems that this is such a radical concept: the idea that, in exchange for a secure allotment of resources for which you've said you will deliver services, if you fail to do what you said you would do in a contractual obligation, there will be consequences for that. Some people have said that's radical. What I think is radical is that here in the province of Ontario, across the breadth of a $28-billion system, the radical part is that this has not been done before, that we haven't tied expenditures to specific outcomes. We will, because we must.

There has been a fair bit of talk about what the former Minister of Health, the member from the Kitchener-Waterloo area, likes to refer to as my new sweeping powers. The expansion in ministerial powers in Bill 8 is an expansion of power so far below those that already exist, it's hard to understand what that member's getting at. Perhaps it's because she understands that the appointment of supervisors by her government was like a reflex action. Seven times out of nine since 1981, that government, the former minister from Waterloo and the former minister from Brampton, exercised the powers of appointing a supervisor.

Let's understand what that means. If you appoint a supervisor in an Ontario hospital today, it means that in one fell swoop you have eliminated the board and the CEO. They, in opposition to what we plan, have suggested that being able to seek accountability for performance is a radical concept. We need to move to a position where we drive the care down to the community.

I want to go back to a theme that I touched on earlier. Our hospitals have been put in an untenable position. They've been forced to pick up the pieces of the health care safety net that others weren't able to deliver effectively. They've been asked to do more than they were built to do or are best suited to do, but if we make those investments, as we fully intend to, in the complementary community pieces, we'll finally be getting to the point where we ask hospitals only to provide services that they're built to provide, because we know that hospitals are the most expensive places to deliver patient care. So we'll move on family health care, high-quality, accessible, around-the-clock, front-line care where people need care, as close to home as possible from an interdisciplinary team of health care providers. That's family health teams, and we're going to move on those.

Home care : We have real recognition that we need to do more on home care. As a result, in part measure, of the health accord of last year, we have some resources to do that, and we will. We're working on long-term-care facilities and on consumer-based mental health and addiction services, as I mentioned earlier.

Let me talk for a moment about integration. I talked a little bit before about silos. Other people talk about them as well as the predominant culture of our health care system, that if you only need to see a family practitioner and you have an established relationship, chances are your level of support, your confidence level for the health care system is very high, but at the very moment you need to move from there to see a specialist, chances are that you butt up against the silo, another piece of the health care system. We need to topple the silos and make it easier for the patient to make the seamless transition along a continuum of care. We need to tear down those walls that stand between the patients and the care they need.

Information technology is an essential enabler, because it allows health care providers to speak in the same language and share information. It will revolutionize our ability to measure system performance. Bill 8, therefore, will foster integration.

One of the measures of quality for which providers and governments will be judged is how effectively we collaborate, how well we mobilize our collective resources for the common cause of quality, consumer-centred patient care. I've seen many examples of innovation and integration as I've travelled the province, and I want to speak briefly just about two of them. On a gorgeous but crisp Friday afternoon on the northern reaches of Lake Superior, I went to visit the community of Terrace Bay. In Terrace Bay I heard about the Lake Nipigon regional health forum, an ad hoc network of five hospitals formed out of necessity 15 years ago, where hospitals have found, in the ability to work together, the capacity to offer much greater, expansive programs to the people of their very small community. They recognize that services, the cost of which could not be borne on one budget alone, could be borne by five hospitals working together. They innovate and share resources. They share physiotherapists and occupational therapists, as well as human resource management and administrative resources.

In the town of Windsor, from where my seatmate hails, two hospitals, which had a long history of working against one another, have in the last three years made extraordinary strides to work better together to integrate the care they provide and to share resources where it's practical, to save costs so those dollars can be driven into the provision of clinical services.

Last week I had the opportunity to meet with Jack Kitts, the CEO of the Ottawa Hospital, Ontario's largest hospital. Six different facilities have come together in a very challenging amalgamation. They got the orthopaedic surgeons together. At that point, they were using eight different devices for hips and knees. They narrowed the list to two. The result is that those enhanced volumes saved $1.8 million in the purchase of artificial joints. That $1.8 million bought 200 more surgeries for the Ottawa community.

Accountability matters because, as Roy Romanow says, it's a principle that was missing, and because the precious resources we have must be well spent. Shared accountability of government and providers to the Ontarians we serve is the message associated with accountability. It's very much a two-way street, and it's a two-way street because we must focus on continuous improvement. I am tired of the idea too many people develop that all of sudden the expectation is that people will wake up one morning and say, as if by magic, "Health care is better." The challenge for all of us is to demonstrate to Ontarians that health care is in a state of continuous improvement. We cannot measure the state of health care, because at the moment we do not have a measuring stick, we do not have the tools. But in Bill 8 we have the tool: the Ontario Health Quality Council. It will report to Ontarians on an annual basis about the state of health care and about the state of their health.

Ontarians have never before had way of knowing how our health care system was performing. Ontarians are smart people and deserve to know the facts. They have a right to know what is happening with wait lists and about the state of our health care and about the state of our individual health. The Ontario Health Quality Council gives people this opportunity.

The council will provide Ontarians with meaningful information so they can measure our government's performance and hold us to account. The Ontario Health Quality Council exists to serve the broad and diverse interests of Ontarians by measuring across a broad array of indicators how our health care system is performing. We will, for once, finally have an annual, at-a-glimpse opportunity to measure how we're doing to mark the continuous improvement that we're involved in.

It will have strong representation brought by people from our communities, 12 of them, people of independence. I am, on this point, saddened that the former minister, the member from Waterloo, without even seeing names associated with this body, has already decided that those 12 individual Ontarians will not be capable of producing a report that is independent, balanced and provides Ontarians with the information they know. I believe that cynicism has no place if we are to be properly dedicated to the task at hand, because the task at hand is one where no failure is allowed, because the task at hand is our involvement with the most cherished program of Canadians.

Healthier Ontarians : Each of us has a role to play in this debate. I had the opportunity two weeks ago to speak to a grade 6 and 7 class in Markham. I said to those kids, "Start a revolution. Take back your health." I went in there and said that it was my 40th anniversary speech, having just celebrated my 40th birthday -- which I have been getting quite a lot of mileage out of. I talked to those kids and said that I looked at some numbers from when I was their age and compared them to the numbers now: five times the rate of childhood obesity.

I talked to those kids about personal responsibility. I said, "Society so far is not getting the job done for you." But we need all Ontarians to be more involved in the recognition that one of the greatest pressures that we have on our health care today is the pressure that is brought by the decisions that we made yesterday. So all of us have the opportunity today to begin to reinforce and develop better habits, and I take the motto of continuous improvement upon myself as well. I encourage people to take a look for those opportunities inside your daily habits to make things just a little bit better.

Not everybody can quit smoking, but everybody can quit smoking some of what they smoke. Not everybody can get their weight under control, but most people can make a difference about it. Not everybody will become an athlete overnight, because not everybody has a former Canadian Olympian as their parliamentary assistant. But everyone can look for the opportunity to walk up one more set of stairs or to walk one extra block, because we must work together to tackle the high-cost, high-burden and preventable health issues: smoking and childhood obesity caused by inactivity and unhealthy eating habits.

I am so proud that our government is going to work on this with the kind of zeal that Ontarians have been waiting for, because we have a responsibility, an obligation, an opportunity, and we will live up to the challenge that the health and safety of our kids have for us to do. We will show that leadership. I am so pleased to have the opportunity to work with someone like Gerard Kennedy and my colleague Marie Bountrogianni as we seek in this province to create a healthier environment for our kids. Why? Not just because of course we wish that everyone would have the best health possible, but because 29% of $28 billion -- 29% of $28 billion -- goes toward treating diabetes, cancer, cardiac care and other preventable diseases.

It's time for all of us to come together and take back our health. Each and every one of us can take real action to make Ontarians healthier. We want to fuel an excitement and a sense of personal mission about health. A healthy revolution is what is required in our province.

I'm proud of Bill 8, I'm proud of the McGuinty government and I'm proud to acknowledge that our government takes a different way of operating. That's what we bring to leadership in Ontario. I took responsibility when I brought the bill to committee. I took responsibility because the first draft didn't set the tone right, and in response, yesterday the former Premier was derisive because the bill had amendments. I say to the relics in that party: wouldn't it have been nice in their day if they had had the courage to take any bill to a legislative committee for the meaningful input of Ontarians and the meaningful debate among other parliamentarians.

We have worked hard to make sure that the tone matches the bill's purpose to inject new spirit and new life into medicare in Ontario.

Let me just tell you something of the key amendments approved by the standing committee on justice and social policy. The bill now clearly states that all health care decisions must be made in the public interest, something of great concern, especially to our friends at the Montfort hospital. We've made it explicit in the bill that trade unions, individual doctors and groups of doctors are not subject to accountability agreements. I witnessed through this debate the most curious of campaigns by CUPE, not satisfied with the fact that the bill, as originally written, didn't do anything about opening up contracts or forcing accountability agreements upon them.

In a meeting months and months ago, I said to Sid Ryan, "Listen, I'm happy to offer an amendment that will make it explicit on this point, just to satisfy you." For three or four months, Sid Ryan pretended that no such commitment had been made and revved and riled up the workers of CUPE all across this province in the most artificial campaign against the bill that I have ever seen, creating the illusion of threat where no threat existed. That has been the involvement of that organization on this bill.

This bill clearly defines the four providers that must enter into accountability agreements: hospitals, long-term-care facilities, community care access centres and independent health facilities. The bill states that accountability agreements will be negotiated between boards and the minister, that they're a shared contract. I'm also proud to say that the amended legislation clearly explains the steps available to health providers if we cannot reach an agreement together.

In contrast to the hammer used by the last government under the Public Hospitals Act of sending in supervisors to take over hospital boards and fire CEOs, Bill 8 takes a measured and fair approach to remedies designed to change behaviours. We ensured that bill 8 is consistent with Bill 31, the Health Information Protection Act, for the collection, use and disclosure of personal health information. I'm pleased to say to all members and to all Ontarians that our door continues to be open. We'll work, we'll listen to the debate and to the dialogue and look for opportunities consistent with our values to enhance the quality of that bill.

In the same spirit of openness, we've committed to 60 days of consultations with the public about regulations. I again want to thank Kevin Flynn and the rest of the committee for the great work they did. I want to repeat that we all have a responsibility not just to sustain medicare but to drive new life into it. I believe that we have that responsibility to Ontarians, and I am certainly encouraged by the work that Roy Romanow did that guides us in our transformation of medicare. We must pull together and move in the same direction. We in Ontario must show the way for the rest of the country, and in order to do so we must finally create a health care system in this province because Ontarians want results. They want progress and real, positive change in health care. They want a health care system that's public, universal and accessible, and they want a health care system that is accountable.

Just over four decades ago, courageous men and women created Canada's most cherished and defining social program. The torch has been passed on to us. All of us in this Legislature have a crucial responsibility to sustain and protect medicare. Ontario is leading the way in the transformation of health care in Canada. I challenge and encourage all of you to join with us as we reach out, take up that charge and demonstrate that medicare is not something about yesterday, it is not simply about today, but has a bright, long future for tomorrow in Ontario and in Canada. Thank you very much.