Building the Next Generation of Medicare
The Empire Club of Canada Addresses (Toronto, Canada), 10 May 2004, p. 383-393

McGuinty, The Hon. Dalton, Speaker
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A tribute to Nursing Week. Some comments on studies on health care. Moving forward from studies. How to improve medicare in Ontario. Results desired. Challenges to face. The stress of our gorwing and aging population on health care. An example of one of the challenges. The government's determination. The plan. Destroying some myths. Some facts and figures. Some success stories. Knowing what to do. Doing it. Ways in which the government has already started. Taking action on public health. Lessons learned from SARS and Walkerton. Investing in health promotion. A last story in honour of Nursing Week and Mother's Day.
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10 May 2004
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Full Text
A joint meeting of The Empire Club of Canada and The Canadian Club of Toronto
The Hon. Dalton McGuinty Premier of Ontario
Chairman: John C. Koopman
President, The Empire Club of Canada
Head Table Guests

George L. Cooke, President and CEO, The Dominion of Canada General Insurance Company, Director, Toronto Rehabilitation Institute and Past President, The Empire Club of Canada; Reverend Canon Kimberley Beard, Rector, Christ Church, Brampton and Director, The Empire Club of Canada; Michael Goldbloom, Publisher, The Toronto Star; Christine Fuller, Clinic Nurse and Co-ordinator, Rheumatology Clinic, Hospital for Sick Children; His Worship Mayor David Miller, Mayor, City of Toronto; Dr. Jeanie L. Callum, Director, Transfusion Medicine and Tissue Banks, Sunnybrook and Women's College Health Science Centre; The Hon. George Smitherman, MPP, Minister of Health and Long Term Care, Province of Ontario; John A. Campion, Partner, Fasken Martineau DuMoulin LLP and Past President, The Empire Club of Canada; Richard O'Hagan, Senior Counsellor. Campbell Strategies; Duncan McCallum, Managing Director, RBC Capital Markets; Signe Holstein, CEO, Ontario Physical Therapy Association; and Charles S. Coffey, Executive Vice-President, Government and Community Affairs, RBC Financial Group.

Introduction by John Koopman

We have all grown used to an almost adversarial relationship between the provincial and the federal governments.

Sir John A. Macdonald wanted to keep partisan politics out of the provinces and the first Ontario government, which Sir John A. helped form, was led by the essentially non-partisan Sandfield Macdonald.

Non-partisan provincial politics didn't last long. The Reform party, the ancestor of today's Liberals, saw things differently and within four years the brilliant Liberal Edward Blake was premier of the province. Blake was followed by another Liberal, Sir Oliver Nlowat, who served as premier for 24 years.

Premier Nlowat was a pugnacious, vociferous, defender of provincial rights and helped create the decentralized federation we know today. His arch-enemy was his childhood friend. and later when he did his articles, law firm boss--the Tory Sir John A. Their long-standing ties did not stop Sir John A. from once trying to punch Mr. Mowat in Parliament.

Premier Mowat personally argued Ontario's case at the Privy Council in London, England, where to Sir John A's great Tory disgust, Mowat won a ruling that provincial legislatures were sovereign not subordinate powers within defined subject matter heads in the BNA Act. He also led Ontario in the great Battle of Rat Portage when Ontario tried to establish jurisdiction over what is now mercifully called Kenora.

For most of the last 140 years Ontario has generally elected to Queen's Park whatever party was not in power in Ottawa.

When Mitch Hepburn was elected premier we had a rare decade when the Liberals held both capitals. But Hepburn treated Prime Minister Mackenzie King as his mortal foe. At a speech to the Empire Club in 1938, after the toast to the King, he felt compelled to remark that he had toasted His Majesty the King and certainly not Prime Minister King.

It does thus seem that Ontario leaders have been at odds with Ottawa since Confederation.

However your recent election, Honourable Sir. would suggest that Ontarians just might have grown weary of jurisdictional bickering and cross words.

Contemporary Ontarians are interested in seeing what fruits might ripen in the rich loam of communication, conciliation, and co-operation with Ottawa.

The civil tone that you Sir have brought to Ontario's dialogue with Ottawa can only benefit our province and the country.

Ladies and gentlemen, please join me in welcoming the Premier of Ontario, the Honourable Dalton McGuinty to the podium of the Empire Club of Canada.

Dalton McGuinty

it is always a wonderful experience to speak here at the Empire Club.

This is Nursing Week and it would be remiss of me not to pay tribute to those people who day in and day out give expression to this innate, human desire that we have to care for people in times of sickness. So on behalf of Ontarians, twelve million strong, I say to Ontario nurses, thank you. Thanks for the work that you do. Thank you for your dedication, your commitment, your perseverance, but above all, your care and your compassion.

You know, my fabulous Minister of Health, George Smitherman, reminds me of the ongoing pressures connected with acquiring the latest kinds of technology that will help us to better diagnose and treat illness. But the single most important instrument when it comes to the delivery of care, the single most important instrument in giving expression to care and compassion remains the human hand. Nurses bring those caring hands to the job, day in and day out. So once again, to Ontario nurses, thank you so much for the work you've done.

You know, looking at the newspapers recently, I was reminded that there are a few signs of spring that you can always count on in Canada: the Leafs will fall, my Senators will go home even earlier and someone will put out another study on health care.

It might be a study that undermines confidence in medicare like the one the Fraser Institute put out just last week. Or it might be one that defends our system like the one you can expect any day now in response to the Fraser study.

Studies have their place. But when it comes to health care, Ontarians have had more than enough studies. I'm not here to announce another health-care study. Nor am I here to continue the debate over medicare. That debate is over.

Ontarians make the same point every time we ask them either in a poll, or more importantly, at the polling booth. Ontarians support a universal, publicly funded system of medicare, that's based on what you need, not how much you make. We believe in medicare because something tells us that caring for our sick--just because they're sick and not because they can afford treatment--is the right thing to do. The fact that medicare gives our businesses a competitive advantage is something that is important to us. But the real reason that we like medicare so much is because deep down something tells us it is the right thing to do.

So the debate for Ontarians isn't about whether we keep medicare. It's about how we improve it so that we get results. Results like shorter waits for cancer and cardiac care, hip and knee replacements, and MR] and CT scans.

People know that we face some tremendous challenges. They know there's a shortage of family doctors and they know the cost of health care is going up, way up. In fact, for the past five years, the health-care budget in Ontario has been increasing by an average of 8 per cent a year. Over in our hospitals, it's been 10 per cent a year. Drug costs--15 per cent a year. At these rates, there will come a time when the Ministry of Health is the only ministry we can afford to have, and we still won't be able to afford the Ministry of Health.

People know too, that our growing, aging population is placing even more stress on our health-care system. Here's just one example of the challenge that this creates: sadly, the number of diagnosed cancer cases in Ontario is expected to double by 2028. What that means is, unless we make changes, you are going to have to wait twice as long for radiation treatment if you're one of those people diagnosed in 2028. So if you're in your mid-forties today, you'll be in your seventies in 2028.

When I tell people this, they don't say: "You know, I hope when I'm in my seventies you'll allow me to dip into my retirement savings and to pay for my radiation treatment, because that's really what I want to do." What people do say is: "God, I hope somebody somewhere actually does something to improve the system, so the treatment is there for me when I need it."

That's what our government is determined to do. To set us on a course to make sure that treatment is there for us, when we need it. But the Minister of Health and I can't do this on our own. It's going to take all of us working together. All of us making a contribution to the change that we need.

We've got a plan to do it. We have the resolve to do it. And we have already started to do it. We are going to build a health-care system that is second to none.

And, along the way, we're going to destroy some myths. The first one goes like this: "It's all bleak, it's all dark, it's all bad." That is nonsense.

Let's face our challenges head-on, but let's be smart enough to look at the whole picture.

Canada spends less on health as a percentage of our GDP than the U.S. And we happen to insure everyone. The U.S. has 44 million people with no health insurance. Employers in the U.S. spend about $57 per capita on health benefits. Canadian employers spend about $8 per capita.

Our system makes sense. We have tremendous success stories here in Ontario. They are a foundation we can build on.

Here's one: the Sault Ste. Marie Group Health Centre had its humble beginnings in 1963. Today, it serves half that city's population. And what a service. Patients not only have access to doctors, nurse practitioners, and registered nurses, but to 52 other professionals as well.

Services range from diabetes education to a heart recovery program to a hearing aid dispensary to acupuncture to x-rays, to rehab to a health information Web site. I don't believe there is a better one-stop primary-care service anywhere in the world. And it's no wonder Roy Romanow called it "the jewel in the crown of medicare." And it's right here in Ontario.

Here's another homegrown success story. In the 1980s, there was concern over reports that we were losing heart patients while they were waiting for surgery. The painful truth was that there was no central wait list and very few standards for rating the urgency of a case. That led to the creation of the Cardiac Care Network. The network now co-ordinates, facilitates and monitors access to advanced cardiac care and today Ontario has some of the best cardiac surgery outcomes anywhere in the world.

My point is that we have some tremendous successes. Now it's time to build on those.

The second myth that should be blown out of the water is the one that goes like this: "No one knows what to do." That is nonsense as well.

I want to read you a quote from a panel of experts who reviewed Ontario's health-care system. It goes like this: "There is a remarkable consistency and repetition in the findings and recommendations for improvements in all the information we reviewed. "Current submissions and earlier reports highlight the need to place greater emphasis on primary care, to integrate and co-ordinate services, to achieve a community focus for health and to increase the emphasis on health promotion and disease prevention. "The panel notes with concern that well-founded recommendations made by credible groups over a period of 15 years have rarely been translated into action."

Do you know when that was written? 1987. It comes from Dr. John Evans, who chaired a panel for the Peterson government. 1987. And Dr. Evans was complaining back then that nothing had been done for the previous 15 years--even though there was a strong consensus on what to do.

We know what to do. We've known for decades now. It's just high time we did it. And we will do it.

The third myth and the most dangerous of all is that it can't be done. Medicare apparently, according to some, can't be improved. This is the pessimists' view. They see that something hasn't been done yet, so they conclude it can't be done, ever. If babies were pessimists, no one would ever learn to walk. I'm not a pessimist. I'm an optimist. I know that it can be done. I know that Ontario can do it.

We've already started. We have introduced historic legislation that will ban pay-your-way-to-the-front-of-the-line health care in Ontario. It is without precedent in this country.

If passed, the Commitment to the Future of Medicare Act would set up a new framework for accountability. For the first time, hospitals will be required to work with us on accountability agreements with the funding they receive tied to the results Ontarians want. We have introduced legislation that would give the provincial auditor the power to examine not just internal operations of government like the Ministry of Health, but our funding partners as well, including hospitals. After all, as the Minister of Health has said, accountability is a two-way street.

We are moving aggressively with an agenda on health promotion and disease prevention, and we are going to be asking Ontarians to make healthy choices in return.

We'll make our schools healthier places for our children by banning the sale of junk food in elementary schools and making physical education mandatory.

Smoking is the single greatest cause of preventable illness. It kills 16,000 of us every year and costs the system $1.5 billion. And that's only in direct health-care costs. We will not continue to quietly preside over this devastation.

We are acting. We've already increased the price of tobacco. And we will introduce legislation that will make all public places in Ontario smoke-free by 2006. When it comes to smoking we will do everything we can to make it harder for Ontarians to start and easier for them to quit.

Our government is throwing its weight behind primary-care reform. I know that those of you in the know have heard that before, but there's an important difference here. We're not talking about primary-care reform and throwing our weight behind tax cuts. We're throwing our weight, money and energy behind primary-care reform.

We have begun work on the creation of 150 family health teams--teams of doctors, nurses, nurse practitioners and pharmacists working together to provide comprehensive care, when you need it. The exact make-up and services provided by these teams will vary from community to community. What they'll have in common is a mission to deliver better care close to the people they serve. Ontarians who have been looking for family doctors will be cared for by someone they know, instead of sitting in emergency rooms waiting for someone to come.

And we are going to take action on public health. In the wake of SARS and Walkerton, experts have told us what's wrong with public health: there's too little money, too little co-ordination and too little effort to control infection. Our government will launch a comprehensive public-health strategy that commits us to more. More resources, more emergency preparedness, more independence for the Chief Medical Officer of Health, and harkening back to something that John said at the outset, more collaboration with the municipal and federal levels of government.

A virus doesn't respect provincial political jurisdictions in its attack on us. So we can't allow political jurisdictions to get in the way of our attack on a virus. That's not a call for heavy handedness. It's just a call for co-operation.

I believe that Ontarians deserve to know the truth about the quality of their services. So, we've committed to establishing the new Ontario Health Quality Council to independently measure our progress and report to the public. I believe that the information provided by this new council, in terms of how well we are doing, what progress, if any, we are making, will become an important driver to change.

And we are showing leadership on the national stage, working for a new deal on health-care funding, one that will sustain medicare for the next generation. Yes, we want Ottawa to address this so-called fiscal imbalance between the federal government and the provinces. But we haven't simply bashed the feds. We haven't simply played politics. We've put ideas on the table and we've already reached new agreements on reforms like better working conditions for nurses.

I can tell you that we see an opportunity for Ontario to lead the way in delivering positive change in health care, just as Saskatchewan led the way in the '50s and '60s. After all, this is Ontario. We are Canada's strongest and most successful province. And try as my predecessors may have, there can be no hiding from our history and destiny.

Ontario has the responsibility to be a leader in matters important to all Canadians, like health care. We gladly accept this responsibility. And we will work hard to build a win-win for Ontario and Canada.

When I see the work being done by our frontline health-care workers, when I know about the tremendous strengths that are here to build upon and when I think of what Ontarians working together are capable of, I can't help but be an optimist. We can do this.

But I'm also a realist. This is going to require sacrifice because it's going to cost money. I'm talking about money to sustain the services we provide today, and money to invest in the changes we need to make for tomorrow.

You see, once we invest in home care, then we can move people out of hospital beds and shorten waiting times for surgeries. Once we invest in primary care, then more people will have 24/7 care outside the hospital and we will shorten waiting times inside the hospital in our emergency rooms. And once we invest in health promotion then you can reduce the incidence of heart disease and shorten waiting times for cardiac care.

Change will save lives, and it will save money in the long run. But it requires an investment, up front. Right now. Our budget will address this, and we are urging the federal government to ensure its next budget does as well.

Ladies and gentlemen, I ran for premier to improve public services. I believe the most important public services--our education and health care--are the measure of our commitment to each other. I believe it's time for us to renew that commitment.

We've wasted far too much time debating medicare, instead of improving it. Par too much time dithering, instead of doing. I'm asking for your help, so together we can show the resolve and make the investments needed to make positive change happen.

I want to finish by telling you a story in honour of Nursing Week and in honour of the fact that yesterday was Mother's Day.

My mother, like all mothers, is one of a kind. My mother helped raise 10 kids. She was also a nurse for 35 years. I'm sure she sometimes felt there were more beds in her home than in the wards where she worked. At one time she worked in a hospital in psychiatry on the night shift. There were some young people who were very disturbed. And one morning, when she arrived home and joined us for breakfast, she was visibly upset. She told us that a patient had hit her and she showed us the bruises. And the kids reacted as you might expect kids to react. We were very upset. We said: "Mom, this is crazy. You've got to get out of there. You've got to quit." My Mom is a remarkable person, and she said something quite remarkable. She said, "That young man needs me. And if I don't do this job, who will?"

Right now, medicare needs our help. Our friends and family and neighbours, who depend on medicare, need our help too.

Now is the time. After so many false starts, after so many studies, after so much debate, now is the time to deliver the positive change that medicare needs, that patients need, and that Ontario needs. Now is the time for our generation to build the next generation of medicare.

It won't be easy. But it is essential. And ask yourselves this: if we don't do this job, who will?

The appreciation of the meeting was expressed by Charles S. Coffey, Executive Vice-President. Government and Community Affairs, RBC Financial Group.

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Building the Next Generation of Medicare

A tribute to Nursing Week. Some comments on studies on health care. Moving forward from studies. How to improve medicare in Ontario. Results desired. Challenges to face. The stress of our gorwing and aging population on health care. An example of one of the challenges. The government's determination. The plan. Destroying some myths. Some facts and figures. Some success stories. Knowing what to do. Doing it. Ways in which the government has already started. Taking action on public health. Lessons learned from SARS and Walkerton. Investing in health promotion. A last story in honour of Nursing Week and Mother's Day.