Good afternoon. It's a privilege for me to be here to address this Committee on the first day of public hearings into Bill 8, "The Commitment to the Future of Medicare Act."

This is a piece of legislation which is very important to the government, and to me, and I want to make sure that we get it right.

The purpose of Bill 8, broadly stated, is to protect essential health care services and to ensure that our public health insurance system remains publicly funded and publicly-administered. This Bill will preserve the sacred principle that Ontarians should have access to medically necessary health care services based on need, not on ability to pay.

The Romanow report affirmed that health care services are a right, not a privilege. We agree wholeheartedly with Roy Romanow. And we believe the right to health care deserves to be preserved in law.

Romanow proposed that in order to modernize the foundations of medicare, a sixth principle, Accountability, should be added to the Canada Health Act. Ontario's Bill 8 would entrench accountability as a cornerstone. This Bill, and our commitment to the principle of accountability, is Ontario's contribution to strengthening medicare in Canada. I'm proud that Ontario is leading by example.

I'd like to acknowledge, in particular, Committee Chair Kevin Flynn, and Committee Vice-Chair Jim Brownell. And I'm pleased to recognize my legislative colleagues from all parties, my parliamentary assistant, Monique Smith, and my Legislative Assistant, Abid Malik and staff from the Ministry travelling with the Committee.

Thank you for the work you are undertaking. Because in many ways, the ’heavy lifting‘ of government is done here, in committee. While Question Period gives all of us a chance to launch a few fireworks, when we move to committee hearings such as this a very different dynamic takes over. I welcome this non-partisan spirit, a spirit that was evident during the Committee on General Government's hearings on Bill 31, the Health Information Protection Act.

The amendments that we agreed upon strengthened Bill 31, and amendments that we will table and others that will be offered during these hearings will strengthen this Bill too.

We acknowledge the need to improve some areas of the Bill to better achieve the intent of the legislation- to strengthen medicare in this province.

And it's clear we didn't get the tone of the Bill right in some areas. For example, the penalty provisions are too harsh. I accept that. And I want to confirm that we have listened to concerns about the penalty provisions, and will adjusting them.

We have listened to concerns that have been brought to us and we welcome hearing many different viewpoints over the next few weeks. I have already made specific commitments to amendments. Amendments will be officially tabled on March 9^th when the Committee reviews the Bill clause-by-clause.

So, I also welcome a vigorous review of Bill 8. None of us have all the answers - I certainly don't. In fact, I've lead discussions with the Ontario Hospital Association and the Ontario Medical Association on their desired changes and we've made lots of progress through honest dialogue. Ministry staff have been involved in constructive discussions with them and other parties too. The work of this committee and the input of Ontarians will help us refine and improve the legislation and to narrow the range of differences. At the end of the day, some differences will remain. Frankly, for a Bill that is based on values that shouldn't come as a surprise.

Then, there's CUPE. Bill 8 can't open collective agreements and unions have never been subject to accountability agreements. And we've agreed to make that explicit.

We also welcome input on the regulations to make sure we get them right. With the Health Information Protection Act we introduced a new concept of a 60-day consultation period on regulations. We've had a lot of support for this approach and it's an option to consider for Bill 8.

We'd like your views about whether there's an opportunity to more explicitly define aspects of the Bill in legislation rather than through regulations. When we consider the legislation and regulations we all need to remember that Bill 8 needs to adapt and respond to changes in the health care system. It must be a living document. But, it must also offer enduring protections for our values.

Let me tell you a little more about this Bill, and what it means to our government.

I've said on numerous occasions that "medicare is the best expression of Canadian values." Our medicare system -- a system which has evolved over many years — gives life to our compassion, our fairness and our generosity.

I don't think I'm overstating the case when I say that medicare helps to define who we are as Canadians.

As a Canadian, I'm proud of our medicare system. And as a Liberal, I'm committed to doing what I can to improve and protect medicare. This Bill sets out to do just that.

And let's be clear : our medicare system is in need of protection. In recent years, various forces have been chipping away at medicare, eroding its principles, narrowing its reach, watering down the protection it gives to our citizens, and lowering the quality of the care it delivers.

Our government is determined to reverse that trend and to lead a determined drive to improved system performance.

I think we all share the fundamental goal of Bill 8, to protect essential health care services in Ontario. How we achieve them is a more complex challenge.

Let me tell you a bit more about the basic principles which guided our work. These principles are expressed in the Preamble -the Bill's values statement.

• We believe that Ontarians deserve a legal and binding commitment to a universal, publicly-funded health-care system.
• Like the Romanow Commission, we believe that the health system must be consumer-centred and based on need, not ability to pay.
• We believe that the health system is the whole of its complementary parts. It was anchored on the foundation of hospitals and physician services, but to be relevant it must evolve to encompass a full continuum of care including primary health care, home care, and pharmacare.
• We believe that the future strength of Ontario's health system depends on providers, governments, citizens and communities sharing responsibility and working together.
• We believe that our health care system must produce improved outcomes and we believe that greater accountability is at the heart of these improvements.

These principles were our starting point. Let me now tell you a little more about how we will accomplish our mission.

Bill 8 contains three key components.

FIRST : The Bill establishes the Ontario Health Quality Council which will have responsibility for reporting on important health care indicators in an effort to raise the quality of our health system.

The government has a clear plan to transform health care in Ontario. Our commitment is no less than to make Ontarians the healthiest Canadians. And we are committed to ensuring all Ontarians have effective access to quality health care, in every setting. Our plan for better health care means strengthening all parts of the system, and bringing them together into one integrated system that encompasses family health care, home care, community services, hospital care, emergency services, long-term care and pharmacare.

The Council's mandate would be to measure the effectiveness of the system and to report on its performance in priority areas. Our government would work with the Council to determine the real measures that mean something to Ontarians.

The Council would report to the people of Ontario about wait times for important procedures, for example cardiac care, and hip and knee replacements. The Council would monitor and test the effectiveness of the system through broader measures like population health status and the prevalence of serious and preventable diseases, such as diabetes. It would track rates of physical activity, obesity and smoking.

Ontarians need to know about the quality of care they are receiving, it's their right.

By measuring results of Ontario's health care priorities, the Council would ensure government is accountable to the people we serve.

The Health Quality Council exists to serve the broad and diverse interests of our citizens. Its purpose is to enhance quality outcomes in our health care system. It needs to be composed of individuals with superior knowledge of the health system. And it needs strong representation from people drawn from our communities.

According to some people's vision, stakeholder groups should be appointed to the Council so that they can represent the various silos that are all too evident in our health care system. But we see it differently. We've made sure that the Council does not advance individual stakeholder agendas, but allows for the broadest perspective possible.to advance the agenda of our most important stakeholders - 12 million Ontarians who are counting on us all.

The SECOND key component of Bill 8 is that it would strengthen the prohibition of "two-tier" medicine.

It proposes amendments to the Health Care Accessibility Act and amendments to the Health Insurance Act.

These amendments have one simple and clear purpose: to strengthen the ban on two-tier medicine in Ontario by closing legislative loopholes.

Two-tier medicine can take many forms, for example queue jumping, and extra billing. One recent example of queue jumping is a clinic that allowed people who were willing to purchase an enhanced lens for cataracts to get cataract surgery immediately, while all other cataract patients had to wait a year for the same surgery. If we subscribe to the values and principles I mentioned at the beginning of my remarks, then we cannot tolerate this kind of activity.

When it comes to health care there is only one kind of Ontarian.

We want this Bill 8 to slam the door on pay-your-way-to-the-front-of-the-line health care.

How would we do this? The Bill would require mandatory reporting of unfair activities like queue jumping and extra billing. And it would offer protections to whistleblowers so that these activities can be stopped.

It would ensure the future of medicare in Ontario by enshrining in law the belief that every member of our society has an equal right to quality health care, based on need, not money.

The Bill outlaws people getting faster medically necessary treatment based on ability to pay.

There have been concerns raised regarding the relationship between the privacy provisions of Bill 8 and Bill 31, the Health Information Protection Act.

Let me be clear, Bill 8 is subject to the enhanced privacy protections in Bill 31, the Health Information and Protection Act that has received first reading and gone through the Standing Committee hearing process. Bill 8 explicitly state that the General Manager of OHIP could collect personal health information only in extraordinary circumstances in order to investigate serious violations that harm patients such as queue jumping or extra billing. And let me be clear about one other thing when it comes to privacy. We will strike down any reference to the Minister collecting health information.

The THIRD key component of Bill 8: It will entrench accountability as a central principle in Ontario's health system.

I've said on numerous occasions that we have to make our health care system more accountable. By "accountable" I mean making sure that the government and our health partners clearly agree on what outcomes we need to achieve together.

Too often health providers are working in isolation, losing opportunities to share information and to work in a complimentary way. It's time to actually transform our health care system into a "system."

Accountability means being answerable for our actions, not just our good intentions. We need clearer performance targets, greater transparency, and better lines of communication. And let me be clear: accountability isn't a burden we place on others, it's a responsibility we all accept and share - and I include this government and my ministry.

Bill 8 is a big step towards greater accountability in the system. It creates a framework that allows the minister to establish negotiated accountability agreements with publicly-funded health resource providers. The health care providers we intend to designate in the Bill are hospitals, CCACs, long-term care facilities and Independent Health Facilities.

The Bill does not apply to solo physicians or group practices or labour unions and we will offer amendments that make that abundantly clear!

Boards and CEOs hold positions of great honour and of great responsibility. They are entrusted not only with managing precious public health care dollars, but with ensuring high quality care for the people that they serve.

The ministry would establish accountability agreements with the Board of Directors. And the Board is then required to establish a similar performance agreement with the CEO. We will be introducing amendments which will clarify the process for entering into accountability agreements.

Accountability agreements would ensure targets are met in key deliverable areas such as access, quality and safety. There are provisions that would link compensation with key deliverables, and we would expect a Board to hold its CEO accountable for failure to meet deliverables.

The intent here is not to take away any of the authority of the governing executive boards, but to clarify our expectations for deliverables.

But Bill 8 also makes clear that a CEO in charge is not only responsible to the Board, but to members of the public at large.

In the end, only if all other recourse fails, and only in exceptional circumstances, the ministry can impose penalties directly on the CEO. We have worked with the OHA to achieve an acceptable middle ground.

It should also be noted that these accountability agreements and compliance directives would be made available to the public. After all, it's the public interest that we're working to protect.

Some have told us that there is an opportunity to lay out the processes for accountability agreements more explicitly in the legislation so that the language more clearly achieves the Bill's intent. This too is an important matter for the committee to consider.

Lastly, labour unions will tell you that the accountability agreements will allow for opening collective agreements. This bill does not reduce or change any of the protections that currently exist in any of our labour laws. It does not allow anyone subject to an accountability agreement to re-open collective agreements. Unilateral wage rollbacks and unpaid days off might be the record of a previous government, but Mr. Chairman, the suggestion by anyone that Bill 8 enables this is an act of partisan-inspired fiction.

The Canada Health Act was passed unanimously by Parliament in 1984. It is this spirit of common values and purpose that I hope will guide the committee during the hearing for Bill 8.

The Canada Health Act expresses our country's fundamental commitment to a universal, accessible, comprehensive, portable and publicly administered health-insurance system. I view this as one of the most important pieces of government legislation of the past quarter-century.

The Canada Health Act aims to ensure that all residents of Canada have access to necessary hospital and physician services on a prepaid basis. It provides the provinces and territories with conditions that they must satisfy to qualify for their full share of federal transfers under the Canada Health and Social Transfer.

However, the Canada Health Act does not include the principle of accountability.

Our government's proposed Commitment to the Future of Medicare Act would entrench accountability as a cornerstone principle of Ontario's health-care system.

As public servants, each one of us recognizes the importance Ontarians place on accessible quality health care. This Bill will help to ensure that health care is available to all Ontarians, in every community in the province now and for generations to come.

By identifying the principles that are important to us, and by acting firmly and decisively to protect and apply these principles, we can make real progress in providing quality health care, today and in the future.

I'm excited about the progress we're making in transforming and improving health care. And I'm committed to the principles and values enshrined in Bill 8.

I look forward to hearing from the people of Ontario on this important piece of legislation, and I look forward to hearing the ideas and recommendations of this Committee.

Thank you.