Transcript: Fourth Reading - Show 230 | Apr 08, 2001

(music plays)

The opening sequence rolls.
Music plays as clips of politicians and demonstrations appear on an animated number 4.

Steve says THIS
WEEK ON 4TH READING,
THE VIEW FROM ONTARIO.
WHERE SHOULD A NEW ROYAL
COMMISSION TAKE OUR AILING
HEALTHCARE SYSTEM?

Steve, Ruth, Richard, Mac and a guest sit around a table in the shape of a number 4.

Steve is in his mid-thirties, clean-shaven, with short curly brown hair. He's wearing a black jacket and dark blue sweater.

Steve says HI, EVERYBODY,
I'M STEVE PAIKIN,
AND WELCOME TO
4TH READING.
IT IS THE MOST BELOVED OF
ALL GOVERNMENT PROGRAMS
BUT POLL AFTER POLL SHOWS
ONTARIANS ARE VERY WORRIED
ABOUT THE STATE OF OUR
HEALTHCARE SYSTEM.
THIS WEEK THE FEDERAL
GOVERNMENT STRUCK A NEW
ROYAL COMMISSION TO LOOK AT
SOLUTIONS TO THE MEDICARE
PROBLEMS THAT HAVE
BEDEVILED GOVERNMENTS
OF ALL POLITICAL
STRIPES.
WHAT'S THE VIEW
FROM ONTARIO?
WHERE DOES OUR GOVERNMENT
THINK WE SHOULD BE HEADED?
IN A MOMENT WE'LL DISCUSS
THAT WITH OUR GUEST,
HEALTH MINISTER,
TONY CLEMENT.
FIRST LET'S CHECK THE
VITAL SIGNS OF OUR SYSTEM.

A video plays.

[monitor beeping]
A monitor screen shows a heart rate.

Steve says IF THE HEALTHCARE
SYSTEM WERE A PATIENT,
IT MIGHT BE LISTED IN
SERIOUS CONDITION.
EVERYONE SEEMS TO AGREE
IT'S TIME FOR MAJOR REFORMS,
BUT POLICYMAKERS AND
BUREAUCRATS ARE AT ODDS
OVER WHAT TO PRESCRIBE
TO IMPROVE THE SYSTEM.

A Male Politician says AND I WISH YOU THE
BEST OF FUN POSSIBLE
BUT YOU'LL HAVE A HELL
OF A LOT OF HEADACHE.

Steve says ENTER ROY ROMANOW.
THIS WEEK JEAN CHRETIEN
CHOSE THE FORMER
SASKATCHEWAN PREMIER TO
LEAD A ROYAL COMMISSION
LOOKING AT
HEALTHCARE REFORM.

Roy Romanow is in his fifties, clean-shaven with blond hair.

Giving a press conference, Roy says I DO NOT AND CANNOT AND
WILL NOT PREJUDGE THE OUTCOME
OF THE COMMISSION'S WORK
BEFORE IT EVEN STARTS.

Steve says COULD ONE OPTION
BE A BIGGER ROLE
FOR THE PRIVATE SECTOR?
ONTARIO'S PREMIER MIKE
HARRIS WANTS EVERYTHING
ON THE TABLE.

Mike Harris speaks to the press. He is in his fifties, clean-shaven with gray hair.

Mike says I DON'T BELIEVE THAT
WE SHOULD BE SETTING
CONDITIONS AND YOU
CAN'T LOOK AT THIS,
YOU CAN'T LOOK AT THIS,
YOU CAN'T LOOK AT
OTHER ALTERNATIVES.
YOU CAN'T LOOK AT
OTHER JURISDICTIONS.

Steve says WHEN ASKED WHAT THE
COMMISSION SHOULD LOOK AT,
HARRIS SAYS THE COST
MUST BE A TOP PRIORITY.

Medical staff works at a hospital.

Mike says THE PERCENTAGE OF
FUNDS THAT WE SPEND
ON HEALTHCARE GOES UP
EACH AND VERY YEAR.
CLEARLY, IF YOU
CARRY THAT ON,
AT SOME POINT IN TIME
YOU'LL SPEND 100 PERCENT
OF YOUR MONEY ON HEALTHCARE
AND YOU'LL HAVE NOTHING
FOR ANYTHING ELSE, AND
THAT IS NOT SUSTAINABLE
IN THE LONG TERM.

[monitor beeping]

Steve says SOME SAY ANY
REFORMS THAT ALLOW MORE
PRIVATE SECTOR
INVOLVEMENT IN THE SYSTEM
WILL KILL
UNIVERSAL ACCESS.

A caption appears on screen. It reads "Frances Lankin. NDP Health Critic." Frances is in her mid-forties with shoulder-length dark brown hair.

Frances says ANY TIME THAT WE ARE
FIRST OF ALL UNDERMINING
THE PRINCIPLES OF THE PUBLIC
ADMINISTRATION AND
NON-PROFIT ADMINISTRATION
IN OUR HEALTHCARE SYSTEM,
AND WE ARE DIVERTING PUBLIC
RESOURCES TO PROFIT
AS OPPOSED TO KEEPING IT
ALL DELIVERING CARE,
WE HAVE REASON TO WORRY
ABOUT WHERE WE'RE HEADED
IN THE HEALTHCARE
SYSTEM.

A patient undergoes a tomography.

Looking at a computer screen, a Male Doctor says JUST CHECKING
THESE NOW.

Steve says THE ONTARIO
GOVERNMENT'S HEALTHCARE
SPENDING WILL HIT CLOSE
TO 23 BILLION DOLLARS THIS YEAR.
THAT'S UP 7 PERCENT
FROM LAST YEAR.
ONTARIO'S HEALTH MINISTER
HAS SAID HE'S WILLING TO
LOOK AT PRIVATE SECTOR
INVOLVEMENT AS LONG AS
UNIVERSAL ACCESS
IS GUARANTEED.
AND HE'S NOT WORRIED
THAT A NEW DEMOCRAT
IS HEADING UP
THE COMMISSION.

The caption changes to "Tony Clement. Minister of Health." Tony is in his mid-forties, clean-shaven with black hair graying in the temples.

Tony says THIS IS NOT AN NDP ISSUE
OR A LIBERAL ISSUE
OR A CONSERVATIVE ISSUE.
THIS IS WHAT WILL WORK.
WHAT WILL GET US TO
WHERE WE HAVE TO GET TO,
AND IN FACT THIS IS
PROBABLY THE MOST
NON-IDEOLOGICAL
DEBATE IN THE COUNTRY.

Steve says CRITICS
ARE SKEPTICAL.

The caption changes to "Lyn McLeod. Liberal Health Critic." Lyn is in her sixties with short curly gray hair.

Lyn says WE CERTAINLY HAVE HEARD
TONY CLEMENT TALK ABOUT
CHOICE IN HEALTHCARE AND
TOO OFTEN THIS NOTION OF
CHOICE MEANS THE CHOICE FOR
PEOPLE WHO ARE WELL TO DO
TO PAY FOR MORE OF
THE HEALTHCARE TO GET
THE BEST SUPPOSEDLY WELL
THE REST OF US MAKE DO
WHAT WHATEVER'S LEFT.

Steve says BUT PROPONENTS
OF TWO-TIER HEALTHCARE
SAY LACK OF FUNDING
AND LONG WAITING LISTS
MEAN WE HAVE TO
KEEP OUR OPTIONS OPEN,
INCLUDING A MIX OF PUBLIC
AND PRIVATE
HEALTHCARE DELIVERY.

People wait in a waiting room at a clinic.

The caption changes to "Doctor Albert Schumacher. Ontario Medical Association." Albert is in his forties, clean-shaven with receding brown hair.

Albert says THIS IS SOMETHING
THAT CANADIANS
ARE UNFORTUNATELY
ALREADY USED TO.
WHAT WE NEED TO DO IS
HELP BRING CANADIANS
INTO THE DISCUSSION ABOUT
WHAT THEY WOULD LIKE
FUNDED PUBLICLY, WHAT THE
WAITING TIME SHOULD BE,
AND THEN WHAT SHOULD
BE MADE AVAILABLE
USING OTHER RESOURCES.

The clip ends.

Steve says OKAY, WITH US TODAY, THE
MAN CHARGED WITH COMING UP
WITH ANSWERS TO SOME OF
THOSE VERY IMPORTANT QUESTIONS.
HERE'S TONY CLEMENT,
ONTARIO'S MINISTER
OF HEALTH AND
THE PC MEMBER
FOR BRAMPTON
WEST-MISSISSAUGA.

Steve continues TONY, AS ALWAYS,
WELCOME BACK TO TVO.
NICE TO HAVE YOU HERE.

Tony wears glasses, a dark suit, striped blue shirt and black tie with colourful floral details.

Tony says NICE TO BE BACK.

Steve continues AND OUR QUEEN'S PARK
ANALYSTS, YOU KNOW THEM.
THERE'S RUTH GRIER, USED TO
HAVE YOUR JOB IF I RECALL,
FORMER HEALTH MINISTER.

Ruth Grier is in her sixties, with short white hair. She’s wearing a pink blazer over a white shirt and green and pink scarf.

Steve continues RICHARD MAHONEY FROM THE
LAW FIRM FRASER MILNER
CASGRAIN.

Richard Mahoney is in his forties, clean-shaven with gray hair. He’s wearing a gray suit, blue shirt and dotted lilac tie.

Steve continues AND FROM
GOVERNMENT POLICY
CONSULTANTS,
THERE'S MAC PENNEY.

Mac Penney is in his early fifties, clean-shaven with white hair. He’s wearing a black jacket, gray shirt and patterned black and white tie.

Steve continues TONY, YOU KNOW WHAT
THEY'RE CALLING YOU.
YOU KNOW THE NICKNAME.
THEY CALL YOU
TWO-TIER TONY.
YOUR CRITICS ARE CALLING
YOU TWO-TIER TONY
BECAUSE YOU'RE GOING
ALL OVER ONTARIO
MAKING SPEECHES SAYING WE
OUGHT TO HAVE MORE CHOICE
IN HEALTHCARE, WHICH TO THEM
IS A BUZZWORD FOR SAYING,
MORE PRIVATE SECTOR
INVOLVEMENT.
A) ARE THEY RIGHT?
DO YOU BELIEVE IN MORE
PRIVATE SECTOR INVOLVEMENT?
AND B) DO YOU BELIEVE
IN TWO-TIER HEALTHCARE?

Tony says WELL, ACTUALLY MOST OF MY
SPEECHES SO FAR HAVE BEEN ABOUT
HOW TO HAVE EXCELLENT
HEALTHCARE DELIVERED
TO ONTARIANS AT A PRICE
THAT IS SUSTAINABLE
IN THE LONG TERM.
I THINK THAT'S WHAT
ONTARIANS EXPECT
OUT OF A PUBLICLY FUNDED
HEALTHCARE SYSTEM.
AND REALLY THE CHOICES
THAT ARE BEFORE US ARE,
AS I SAID IN THE
CLIP THAT YOU HAD,
VERY NON-IDEOLOGICAL.
IT IS NOT, TO ME AT LEAST,
A QUESTION OF HOW DO YOU
DO SOMETHING THAT IS GOING
TO BE 100 PERCENT PUBLICLY
DELIVERED OR 100 PERCENT
PRIVATELY DELIVERED.
IT'S GOING TO BE PROBABLY
A MIX OF THE TWO
JUST AS IT HAS
ALWAYS BEEN.
SO THE QUESTION IS, WHAT
IS GOING TO WORK BETTER,
AND HOW DO WE GIVE THE
CITIZENRY IN THIS PROVINCE
A FEELING THAT THEIR
HEALTHCARE SYSTEM
IS WORKING FOR THEM?
SO IF THAT MEANS THAT THEY
FEEL EMPOWERED BY THAT,
THAT THEY HAVE CHOICES
IN THAT SYSTEM,
THAT'S WHAT I
WAS REFERRING TO.
I WASN'T REFERRING
TO A SYSTEM,
NOR DO I BELIEVE
IN A SYSTEM,
WHERE PEOPLE ARE DENIED
MEDICALLY NECESSARY SERVICES
ON THE BASIS OF MONEY.
I DON'T THINK ANYBODY IN
CANADA IS TRULY ADVOCATING
THAT OR THEY SHOULDN'T BE.

Steve says OKAY, DO YOU BELIEVE THAT
THE PRIVATE SECTOR CAN DELIVER
SOME OR MANY HEALTH
SERVICES BETTER THAN
THE PUBLIC SECTOR CAN?

Tony says ON A CASE-BY-CASE BASIS,
THERE ARE EXAMPLES OF THAT,
YES, THERE ARE.
AND I THINK MOST ONTARIANS
AND CANADIANS WOULD SAY,
LOOK, AS LONG AS I'M NOT
BEING DENIED A SERVICE
BECAUSE OF FINANCIAL
REASONS, WHO DELIVERS IT,
TELL ME HOW IT CAN
BE DELIVERED
THE BEST POSSIBLE WAY.

Steve says TELL ME A SERVICE
NOW BEING DELIVERED
BY THE PUBLIC SECTOR
THAT YOU THINK
THE PRIVATE SECTOR
COULD DELIVER BETTER?

Tony says WELL, I CAN TELL YOU
SOMETHING THAT IS BEING
DELIVERED BY THE PRIVATE
SECTOR THAT PEOPLE
ARE VERY COMFORTABLE WITH
AND THAT'S DOCTORS.

Steve says OKAY, NO, BUT WE
KNOW ABOUT THAT.

Ruth says AND NOT
ALL THAT COMFORTABLE.
[laughing]

Steve says WHAT WE'RE
INTERESTED IN,
I THINK, IS
THE CHANGE.
WHAT IS THE PUBLIC SECTOR
NOW DELIVERING WELL
OR MAYBE NOT THAT WELL THAT
YOU THINK THE PRIVATE
SECTOR CAN DELIVER BETTER?

Tony says WELL I THINK THAT'S THE
KIND OF DISCUSSION
AND RESEARCH THAT
WE'VE GOT TO GET INTO.

Steve says WELL, THIS WHY WE'RE
HAVING YOU HERE TODAY,
SO WHAT'S THE ANSWER?

[laughing]

Tony says YOU KNOW, BEWARE THE
POLITICIAN THAT SAYS HE'S
GOT ALL THE ANSWERS
WITHIN SEVEN WEEKS
OF GETTING THE JOB.
BUT NO, CAN I GENERALIZE
FROM THAT QUESTION
AND SAY THAT THERE HAS TO
BE A FORMAL LOOK AT
HOW DIFFERENT PARTS OF THE
SYSTEM ARE BEING DELIVERED
AND SOME RESEARCH PUT INTO
THAT, AND SAY, YOU KNOW,
IS THERE A BETTER
WAY OF DELIVERING IT?
MAYBE THERE'S A BETTER WAY
OF GETTING THE PRIVATE
SECTOR INVOLVED OR A
BETTER WAY OF MAKING
THE PUBLIC SECTOR
MORE ACCOUNTABLE.
BOTH OF THOSE AIMS ARE
LEGITIMATE SO LONG AS
IT GETS US BETTER
RESULTS.

Steve says LET ME ASK RUTH
ABOUT THIS.
I THINK YOU PROBABLY WOULD
AGREE WITH PREMIER HARRIS
WHEN HE SAYS - THIS MIGHT
BE THE ONLY THING
YOU AGREE WITH PREMIER
HARRIS ON - WHEN HE SAYS,
20 YEARS AGO HEALTHCARE
MADE UP, I DON'T KNOW,
A THIRD OF THE BUDGET.
TODAY IT'S 44 PERCENT OF
PROVINCIAL SPENDING
AND IT KEEPS GOING AS FAR
AS THE EYE CAN SEE,
AND WITHIN 30 YEARS,
IT'S GOING TO BE
THE WHOLE
PROVINCIAL BUDGET.
DO WE HAVE TO CHANGE THE
WAY WE DELIVER HEALTHCARE
IN ONTARIO BECAUSE
IT IS NOW ON
A NON-SUSTAINABLE
FOOTING?
THAT'S THE QUESTION
THEY'RE ASKING.

The caption changes to "Ruth Grier. Former NDP Cabinet Minister."

Ruth says WELL, WE HAVE TO CHANGE
MANY THINGS ABOUT
HOW WE DELIVER
HEALTHCARE.

The caption changes to "Ruth Grier. Former NDP Cabinet Minister."

She continues I DON'T THINK WE HAVE TO
DELIVER WHO PAYS FOR IT
BECAUSE ONE OF THE
HUGE COST ADVANTAGES
OF OUR SYSTEM OVER THE US AND
OTHER SYSTEMS HAS BEEN
THE SINGLE PAYER SYSTEM.
AND THE MORE YOU PUT
INTO PRIVATE DELIVERY,
THE MORE YOU GET INTO THE
RISK OF PEOPLE NEEDING
PRIVATE INSURANCE AND
THEN YOU'RE INTO
THE ADMINISTRATIVE
COMPLICATIONS.

Steve says DO YOU THINK THIS
GOVERNMENT'S HELL BENT
TO PRIVATIZE THE
HEALTHCARE SYSTEM?

Ruth says I THINK - I WORRY - NO,
I DON'T THINK THEY'RE
HELL BENT TO PRIVATIZE IT,
I WOULDN'T GO THAT FAR,
BUT I WORRY THAT WHEN THEY
SAY CHOICE AND WHEN THEY
TALK ABOUT ALTERNATIVES,
WHAT THEY ARE IN FACT
DOING IS ALMOST
PASSIVE PRIVATIZATION,
THINGS BECOME
DELIVERED PRIVATELY AND
I WORRY ABOUT THAT
SINGLE-PAYER SYSTEM.
BUT HAVING SAID THAT, I
DON'T THINK - AND I DIDN'T
THINK AS MINISTER -
THAT WE ARE MAKING
THE BEST USE OF THAT
MONEY THAT WE NOW SPEND.
AND ONE OF THE REAL
DIFFERENCES I HAVE WITH
THIS GOVERNMENT IS THAT
THERE HAS NOT BEEN
THE INVESTMENT IN PREVENTION
AND IN KEEPING PEOPLE HEALTHY
AND ALL THE OTHER ASPECTS
THAT MAKE FOR A HEALTHY
POPULATION THAT WE
HAVEN'T HAD.
THE SECOND THING IS THE
RELIANCE ON THE DOCTORS
TO BE THE GATEKEEPERS
BECAUSE WHILE, YOU KNOW,
WE NOW HAVE MIDWIVES,
NURSE PRACTITIONERS,
OTHER PROFESSIONALS, WE
HAVE NOT LEVELED
THE PLAYING FIELD TO ENABLE
US TO HAVE THE HEALTHCARE
DELIVERED BY THE MOST
APPROPRIATE PROFESSIONAL.
AND I THINK THAT THERE
ARE REAL ADVANTAGES,
NOT JUST IN THE SAVINGS
OF PAYING A LOWER-COST
PROFESSIONAL, BUT IN HAVING
MORE APPROPRIATE CARE
IF WE REALLY DEMOCRATIZED
THE SYSTEM A LITTLE MORE.

Steve says I'M GOING TO HAVE YOU
TWO JUST STAND BY
FOR A SECOND BECAUSE THAT
RAISES A QUESTION THAT
I WANT TO PUT TO TONY AS
LONG AS WE'RE HERE
ON THIS RIGHT NOW.
PRIMARY CARE REFORM IS A
BUZZWORD THAT THE PUBLIC
DOESN'T UNDERSTAND, BUT IT'S
ONE OF THE KEYS EVERYBODY SAYS TO IMPROVING THE HEALTHCARE
SYSTEM IN ONTARIO.
AND BY THAT WE MEAN RIGHT
NOW ANYBODY GETS SICK,
THEY GO TO THEIR DOCTOR.
CHANCES ARE IT'S A
FEE-FOR-SERVICE THING.
YOU TELL HIM OR HER
WHAT'S WRONG WITH YOU.
THEY CHARGE THE GOVERNMENT
OF ONTARIO A FEE
FOR FIXING YOU AND
THERE YOU GO.
YOU GUYS ARE TALKING ABOUT
CHANGING THE SERVICE.
YOU'VE GOT THIS NEW ONTARIO
FAMILY HEALTH NETWORK
WHEREBY PATIENTS ROSTER UP
WITH A GROUP OF DOCTORS.
WHAT I'VE HEARD CRITICISM
REGARDING THIS IS
THAT IT'S STILL GOING
TO BE FEE-FOR-SERVICE.

Tony says NO.

Steve says YOU'VE GOT SOME NEWS
TO MAKE THE DAY ABOUT THAT,
BECAUSE AS FAR AS I KNOW,
EVERYBODY'S BEEN SAYING
IT'S STILL GOING TO
BE FEE-FOR-SERVICE,
SO I DON'T KNOW HOW THIS
IS SOME GREAT REFORM.

Tony says WELL, IT'S GOING TO BE
GREATLY - THE GREAT
MAJORITY OF IT IS GOING
TO BE WHAT IS CALLED
A CAPITATION RATE WHICH IS A
REMUNERATION TO THE FAMILY
PHYSICIAN BASED
ON UTILIZATION,
BASED ON DEMOGRAPHIC
FACTORS, BASED ON
HOW SICK THE PATIENTS ARE
THAT YOU'RE HELPING,
SO THAT THERE'LL BE
REWARDS IN THE SYSTEM
FOR DEALING WITH MORE
PATIENTS OR OLDER PATIENTS
OR SICKER PATIENTS.
AND THAT'S THE
CAPITATION RATE.
WHAT WE'VE SAID THOUGH IS
THERE MIGHT BE SOME PATIENTS
WHO ABSOLUTELY REFUSE TO
SIGN UP FOR THE FAMILY
HEALTH NETWORKS AND FOR THE
CAP - FOR THE DOCTOR
BEING PAID FOR BY A
CAPITATION RATE.
SO UNDER THOSE
CIRCUMSTANCES,
A SLIVER OF THE DOCTOR'S
ROSTER CAN INCLUDE
SOME FEE-FOR-SERVICE
PATIENTS UP TO A CAP.

Steve says A BIG SLIVER OR A
LITTLE SLIVER?

Tony says I THINK IT'S RELATIVELY
A LITTLE SLIVER
AND IT CAN GET
SMALLER.

Steve says RICHARD,
COME ON IN.

The caption changes to "Richard Mahoney. Ontario Liberal Advisor."

Richard says WELL, A COUPLE OF
THINGS ON THAT.
FIRST OF ALL, I THINK THE
FAMILY HEALTH NETWORK,
THAT'S MOVED TO ROSTERING IS A
GOOD IDEA AND MOST PEOPLE
WHO SUPPORT WHO HAVE LOOKED
AT THE MEDICAL SYSTEM
HAVE BEEN CALLING FOR
THIS FOR A LONG TIME,
INCLUDING THE PROVINCIAL
LIBERAL PARTY.
BUT I THINK YOU MAY HAVE
HIT ON WHERE THE PROBLEM IS.
THE FIRST PROBLEM IS,
YOU NEED - I MEAN,
TONY EXPRESSES A LOT OF
CONFIDENCE IT'S ONLY
GOING TO BE A SLIVER
OF PHYSICIANS.
FIRST OF ALL, AS WELL AS
TONY'S EXPLAINED THE SYSTEM
OF CAPITATION, HOW MANY
CITIZENS IN ONTARIO
ARE ACTUALLY GOING TO TOTALLY
UNDERSTAND THE CHOICE
AND THE RAMIFICATIONS OF
THEIR CHOICE BETWEEN GOING
TO A ROSTERED PRIMARY
CARE REFORM SYSTEM
OR THE SYSTEM THEY
HAVE RIGHT NOW?
FIRST OF ALL, THEY'LL
PROBABLY LIKE THE SYSTEM
THEY HAVE RIGHT NOW BECAUSE
THAT'S WHAT THEY KNOW BEST.
SECONDLY, YOU'RE PROBABLY
GOING TO NEED TO PROVIDE
A DISINCENTIVE FOR THEM IF YOU
TRULY WANT THIS TO WORK
OR AN INCENTIVE FOR
THEM, THE PATIENTS,
TO CHOOSE A ROSTERED SYSTEM
WHERE A TRUE ROSTERED
SYSTEM WOULD BE A NURSE
PRACTITIONER, AS RUTH SAYS,
AND OTHER HEALTHCARE
PROFESSIONALS, DOCTORS,
MIDWIVES, ALL
PROVIDING A COMPLEMENT
OF HEALTH SERVICES
THAT WE NEED.

Steve asks SO WHAT'S THE INCENTIVE
TO SWITCH OVER?

Richard replies THE INCENTIVE COULD BE
EITHER A DISINCENTIVE
TO THE INDIVIDUAL.
IT ALSO COULD BE AN
INCENTIVE TO THE DOCTOR
OR A DISINCENTIVE
TO THE DOCTOR.
IF THE DOCTOR CAN STAY
IN FEE FOR SERVICE,
HE OR SHE MAY CHOOSE TO DO
THAT BECAUSE HE MAKES
HOWEVER MUCH HE
MAKES A YEAR NOW,
OR SHE MAKES A
YEAR RIGHT NOW,
AND HAS NO INCENTIVE TO
NECESSARILY JOIN
THIS ROSTERED SERVICE.
SO MY WORRY IS, THE END
OF THE DAY IT ALL SOUNDS
PRETTY COMPLICATED.
WHAT WE END UP WITH IS
SORT OF TWO SYSTEMS,
A FEE-FOR-SERVICE SYSTEM
WHICH SOME PEOPLE USE,
AND A ROSTERED SYSTEM, AND
WHAT'S WRONG WITH THAT?
THAT MEANS THE ROSTERED
PRIMARY CARE REFORM
WON'T ACTUALLY HAPPEN.

Tony says LET ME MAKE IT SIMPLE
FOR EVERYONE HERE.
HERE'S THE ADVANTAGE
FOR THE DOCTOR
TO GO INTO A FAMILY
HEALTH NETWORK.
THERE WILL BE A ROSTER OF
OTHER DOCTORS AND HEALTH
PROFESSIONALS THAT WILL BE
AVAILABLE TO THE PATIENTS
SO YOU CAN TAKE A SUNDAY
OFF OR AN EVENING OFF.
SO PLUS WE'RE GOING TO GIVE
A LOT OF INVESTMENT
FOR INFORMATION TECHNOLOGY
BECAUSE WE HAVE TO HAVE
A NETWORK OF COMPUTERS TO
MANAGE THE FILE SYSTEM.
SO THAT'S WHAT'S
IN IT FOR THE DOC.
WHAT'S IN IT
FOR THE PATIENT?
24-HOUR-A-DAY,
7-DAY-A-WEEK CARE.
IF YOUR DOCTOR ISN'T
AVAILABLE BECAUSE
SHE'S DECIDED TO TAKE
A SUNDAY OFF,
WHICH IS PERFECTLY
LEGITIMATE,
THERE IS A ROSTER OF OTHER
DOCTORS AND OTHER HEALTH
PROFESSIONALS THAT
YOU KNOW AND TRUST
WHO ARE AVAILABLE
FOR YOU.

Steve says WILL IT CAP THEIR INCOME,
THOUGH, THOSE DOCTORS?
WILL IT CAP
THEIR INCOME?
IF YOU TAKE THEM OFF FEE
FOR SERVICE AND YOU
PUT THEM ON A
CAPITATION SYSTEM -

Tony says WELL, FIRST OF ALL, MOST OF
THEM ARE CAPPED RIGHT NOW.
AND SECONDLY, A LOT OF THE
FAMILY PHYSICIANS THAT
I'VE TALKED TO ARE QUITE
WILLING TO HAVE THAT CAP
BECAUSE FOR THEM IT'S ALSO
QUALITY OF LIFE ISSUE.
THEY WANT TO - THEY
ACTUALLY WANT TO TAKE SOME
DAYS OFF AND KNOW
THAT THEIR PATIENTS
ARE GOING TO BE
LOOKED AFTER.

Ruth says STEVE, I KNOW MAC
WANTS TO GET IN,
BUT LET ME JUST
FOLLOW UP ON THAT,
BECAUSE I FOR 25 YEARS
HAVE HAD MY HEALTHCARE
FROM A COMMUNITY
HEALTH CENTRE.
YOU HAVE SOME
IN THE PROVINCE.
YOU'VE CAPPED THE NUMBER -
I MEAN, THEY ARE THE MODEL
THAT ARE DOING WHAT
YOU SAY YOU WANT.
THERE ARE 80 COMMUNITIES
OUT THERE WHO HAVE ASKED
FOR COMMUNITY HEALTH
CENTRES AND YOU HAVEN'T
MADE ANY NEW ONES.

Tony says WELL THAT'S BECAUSE
WE ARE ROLLING OUT
THE FAMILY HEALTH
NETWORKS.
NOW THAT WE'VE GOT THAT
FIGURED OUT A LITTLE BIT,
NOW WE CAN START BLENDING
THESE DIFFERENT TYPES
OF PRIMARY HEALTHCARE TOGETHER
IN A COHERENT SYSTEM.

Ruth says BECAUSE IT WON'T ALL
BE ONE - I MEAN,
THAT'S THE
OTHER THING.
IT WILL BE CHOICE.
PEOPLE CAN CHOOSE WHICH
KIND OF A NETWORK TO GO TO.

Steve says MAC, LET ME PUT
THIS TO YOU.
EVERY GOVERNMENT IN THE
COUNTRY RIGHT NOW IS WRESTLING
WITH THIS CANADA HEALTH ACT
AND HOW TO BE TRUE TO IT
BECAUSE IT IS SUCH AN
ICONIC PART OF THE -
YOU KNOW, OF WHAT WE
FEEL WE ARE AS CANADIANS.
AND YET AT THE SAME TIME
EVERYBODY UNDERSTANDS
THAT THE CURRENT SYSTEM
PROBABLY CAN'T SUSTAIN ITSELF.
DO YOU THINK, ARE
POLITICIANS BEING HONEST
WITH THE PEOPLE WHEN THEY
SAY THEY WANT TO BE TRUE
TO THE TENETS OF THE
CANADA HEALTH ACT ABOUT
PORTABILITY AND ACCESSIBILITY
AND UNIVERSALITY
AND ALL OF THAT, WHILE
AT THE SAME TIME SAYING,
WE GOT TO CHANGE
IT IN A BIG WAY?

The caption changes to "Mac Penney. Ontario PC Advisor."

Mac says IT REALLY COMES DOWN,
STEVE, TO HOW THEY ADDRESS
TWO CRITICAL ISSUES AND
I THINK THAT IMPACT
ON ACCESSIBLY,
UNIVERSALITY, PORTABILITY,
SUSTAINABILITY, AND THAT'S
THE SUPPLY OF MEDICAL
PROFESSIONALS IN THE
HEALTHCARE SYSTEM
IN ONTARIO AND ACROSS
THE COUNTRY GENERALLY.
AND NOT ONLY THE SUPPLY,
BUT HOW YOU DIVIDE
THE RESPONSIBILITY FOR
PROVIDING HEALTHCARE
AMONG THE DIFFERENT
PROFESSIONAL GROUPS.
AND THE SECOND THING IS,
HOW YOU - AND THAT THEN
DRIVES HOW THE COSTS OF THE
SYSTEM ARE DISTRIBUTED.
IF YOU LOOK AT THE SORT OF
TREND LINES I'M SURE
THE MINISTER SEES, IN 20 YEARS
THE COST OF PHYSICIAN
SERVICE NATIONALLY IS
GOING TO BE 36 BILLION DOLLARS.
THE COST OF HEALTHCARE
NATIONALLY WILL PROBABLY
BE AROUND 85,
86 BILLION.

Steve says SOUNDS LIKE
A LOT OF DOUGH.

Mac continues THAT'S AN IMMENSE
AMOUNT OF MONEY.
SO THE QUESTION I THINK
THE MINISTER AND HIS
COUNTERPARTS HAVE TO ASK,
IF WE SPENT 36 BILLION
ON PHYSICIAN SERVICES, WHAT
RESULTS ARE WE GETTING
FOR SENDING THAT
MONEY THAT WAY?
IS THERE A BETTER WAY OF
GETTING BETTER RESULTS
FOR THE SAME AMOUNT OF
MONEY IF WE GIVE IT
TO NURSE PRACTITIONERS
OR CAPITATION?
SO I THINK, YEAH, YOU COULD
HONOUR THE CANADA
HEALTH SYSTEM OR THE
CANADA HEALTH ACT,
BUT I THINK YOU'VE GOT
TO DEAL WITH SUPPLY
OF MEDICAL PROFESSIONALS,
DISTRIBUTION OF WORK,
AND RESPONSIBILITY
TO THE PROFESSIONALS,
AND THEN ALLOCATE THE
RESOURCES ACCORDING TO
OUTCOMES AND RESEARCH.

Richard says I DON'T DISAGREE WITH
ANYTHING MAC SAID.
I THINK THE ANSWER - IN PART,
THE QUESTION MAC ASKED
WAS GIVEN BY RUTH, WHICH WAS,
YOU PROBABLY NEED TO EVEN
THE PLAYING FIELD A LITTLE
BIT BETWEEN - I KNOW
MY DOCTOR FRIENDS WON'T
LIKE ME SAYING THIS -
BUT WE HAVE A SYSTEM IN THIS
PROVINCE THAT ABSOLUTELY
FAVOURS DOCTORS AS THE
PRIMARY DELIVERERS
OF HEALTHCARE.
IT IS IMBEDDED IN EACH OF
OUR PSYCHE'S LET ALONE
THE FEE-FOR-SERVICE
SYSTEM.
AND THERE ARE MANY PARTS
OF HEALTHCARE WHICH
ARE BETTER AND BEST AND MORE
EFFICIENTLY AND PERHAPS,
AS I SAID, BETTER
DELIVERED,
BY OTHER HEALTHCARE
PROFESSIONALS.
IT'S JUST THAT GETTING
US TO THINK THAT WAY AND
GETTING HEALTH MINISTERS
TO THINK THAT WAY
IS A BIG STEP.

Ruth says BECAUSE THE MINISTER HAS
PUT HALF THIS NEW BOARD
THAT'S LOOKING AFTER
YOUR NETWORKS, I GATHER,
THE ONTARIO MEDICAL
ASSOCIATION APPOINTS HALF
THE PEOPLE TO IT.

Tony says NO.
HALF WILL BE PHYSICIANS
BUT NOT NECESSARILY
APPOINTED BY THE O.M.A.
BUT CAN I JUST RETURN TO
THE LARGER POINT WHICH
PROBABLY HAS TO PRECEDE A
TRUE DISCUSSION AMONGST
THE PUBLIC ON WHERE WE GO IN
HEALTHCARE IN THIS NATION.
AND THE POINT IS, WE HAVE
A SUSTAINABILITY GAP.
IT'S THERE RIGHT NOW
BUT IT'S GOING TO GROW
AND GROW AND GROW.
BABY BOOMERS ARE RETIRING
IN VAST NUMBERS STARTING
EIGHT TO TEN
YEARS FROM NOW.
THAT'S WHEN YOU START TO
CONSUME LARGE AMOUNTS
OF HEALTHCARE IN YOUR
RETIREMENT YEARS.
MEDICAL TECHNOLOGY,
NEW WONDER DRUGS,
ALL OF THAT INCREASES
UTILIZATION,
PLUS OUR POPULATION'S
GROWING BECAUSE
WE'RE A SUCCESSFUL
COUNTRY.
SO ALL OF THOSE THINGS ARE
PRESSURES ON THE SYSTEM,
AND IF YOU THINK - IT
DOESN'T MATTER WHAT SIDE
OF THE DIVIDE YOU'RE ON,
WHETHER YOU THINK
HEALTHCARE IS GOOD NOW OR
HEALTHCARE IS BAD NOW,
THE POINT IS, IT'S GOING
TO GET WORSE UNLESS
WE DO A RETHINK.

Steve says BUT CAN YOU GET
RID OF FEE FOR SERVICE?

Tony says YOU CAN DO ANY
MANNER OF THINGS.

Steve says DO YOU WANT TO GET RID
OF FEE FOR SERVICE?

Tony says WHAT I WANT TO DO IS HAVE
A WORTHWHILE LEGITIMATE
DISCUSSION COAST TO COAST TO
COAST ON WHAT THE OPTIONS ARE
AND EVERYTHING
SHOULD BE ON THE TABLE.

Steve says OKAY, SO ROY ROMANOW
IS GOING TO HAVE THAT
DISCUSSION OVER THE
NEXT YEAR AND A HALF.
WHAT ARE THE KINDS OF
THINGS YOU WANT
TO FIND OUT FROM HIM?
HE'S GOING TO BE OFFERING
YOU ADVICE IN 18 MONTHS' TIME
ABOUT WHAT YOU SHOULD BE DOING
WITH THE HEALTHCARE SYSTEM.
WHAT DO YOU WANT
TO HEAR FROM HIM?

Tony says WHAT I WANT TO SEE I THINK,
AND WHAT THE PREMIER
WANTS TO SEE, IS A DISCUSSION
ON HOW TO MAKE THE SYSTEM
SUSTAINABLE IN
THE LONG RUN,
WHILE STILL HAVING A
SYSTEM THAT IS ACCESSIBLE
FOR ONTARIANS AND
CANADIANS.
AND HOW DO WE DO THAT GIVEN
ALL OF THE DEMOGRAPHIC TRENDS
THAT I MENTIONED AND
THE TECHNOLOGICAL TRENDS
I MENTIONED?

Ruth says WHAT DOES
SUSTAINABLE MEAN?
ONE OF THE JOYS OF NOT
BEING MINISTER IS ONE
HAS THE TIME TO PERHAPS GO TO
SOME LECTURES AND I WENT
TO A LECTURE BY AN ECONOMIST
AT U OF T, MARK STABILE,
RECENTLY TALKING ABOUT
THE OECD COUNTRIES.
AND THE ISSUES THAT YOU'RE
FACING AND THAT WE HAVE
ARE ALL THE SAME AND THE
LESSONS FROM LOOKING AT
ALL OF THOSE DIFFERENT
COUNTRIES IS THAT
A PUBLICLY FUNDED - REFORM
OF A PUBLICLY FUNDED SYSTEM
IS THE BEST WAY TO GO.
AND SO WHEN YOU
SAY SUSTAINABLE,
I THINK WE'RE BACK TO THE
CONVERSATION THAT STEVE
OPENED WITH, WHICH IS, HOW
MUCH IS PAID FOR PRIVATELY,
HOW MUCH IS PAID
FOR PUBLICLY?
IS THAT NOT WHAT
YOU REALLY MEAN?

Tony says THAT'S PART OF
THE QUESTION,
PART OF THE DEBATE.

Ruth says BUT THAT'S A
SHIFTING OF COST
AS OPPOSED TO A
REDUCTION.

Tony continues NO, AND THE
OTHER PART OF IT,
WHAT IS THE PROPER ROLE OF
THE FEDERAL GOVERNMENT,
BECAUSE WE HAVE BEEN
CRITICAL IN THE PAST
IN TERMS OF THE FEDERAL
GOVERNMENT'S UNDERSTANDING
OF WHAT ITS FINANCIAL
RESPONSIBILITIES ARE.
THAT'S ALL PART OF
THE DEBATE AS WELL.
AND THE OTHER PART OF
THE DEBATE PROBABLY IS,
WHAT SORT OF CHOICES IN A
WORLD OF SCARCE RESOURCES,
IN A WORLD WHERE IT IS NOT
ALL AVAILABLE, FREE, ANYTIME,
ANYWHERE, WHAT DOES
THE PUBLIC THINK
IS ITS PRIORITIES AND
CERTAINLY WE SHOULD FUND
THOSE PRIORITIES?

Richard says MY CONCERN HERE
IS THIS.
TONY HIT A LITTLE
WHILE AGO ON A KEY
RESPONSIBILITY OF HIS.
THIS GOVERNMENT'S BEEN
IN OFFICE FOR SIX YEARS.
IT'S NOW FINALLY MOVING
TOWARDS AT LEAST
A PARTIAL PRIMARY
CARE REFORM.
WHEN THIS MINISTER GOES OUT
TO TALK TO - WHETHER IT'S
THE EMPIRE CLUB IN TORONTO,
WHETHER IT'S HERE ON THIS
PROGRAM, WHETHER IT'S IN
RESPONSE TO Mr. ROMANOW'S
APPOINTMENT, HE
FAILS TO LIVE UP TO
ONE OF RESPONSIBILITIES.
HE NEEDS AS MINISTER
OF HEALTH TO LEAD THIS
PROVINCE AND LEAD THE
CITIZENS OF THIS PROVINCE
THROUGH A DEBATE ON HOW
TO REFORM HEALTHCARE.
YOU MENTIONED HOW ICONIC
OUR VIEW OF HEALTHCARE IS,
STEVE, SO HIS JOB -
YOUR JOB, TONY, IS TO GIVE
US ALL SOME CONFIDENCE
THAT AT THE END OF THE DAY WE
END UP WITH AN IMPROVED VERSION
OF WHAT WE WANT, WHICH IS A
SINGLE TIER, SINGLE PAYER,
PUBLICLY FUNDED
HEALTHCARE SYSTEM.
THAT'S WANT WE WANT.
AND HE DECLINES EVERY
TIME HE'S GIVEN
THE OPPORTUNITY TO LEAD THE
DEBATE IN THAT FASHION.
IF HE DID - IF HE DID, I
THINK YOU COULD PROBABLY
BRING A LOT OF
ONTARIANS WITH HIM.

Mac says NO, IN FAIRNESS
TO THE MINISTRY,
I MEAN, AT THE END
OF THE DEBATE,
AND I THINK ROMANOW
SAID IT HIMSELF,
YOU CAN'T HAVE
EVERYTHING FOR EVERYBODY
ALL THE TIME.

Richard says WHAT WAS HIS
RESPONSE TO ROMANOW,
WHICH IS, I HOPE -
SUSTAINABLE NEW THING, NOT
THAT I WANT A SINGLE TIER.

Mac says YOU MAY BE ABLE -
NO, NO, RICHARD,
YOU MAY BE ABLE TO HAVE AT
THE END OF THE DAY WE MAY FIND
FOR ALL THE REASONS WE
ALL KNOW AROUND THIS TABLE
THAT YOU HAVE CAN A SINGLE
TIER, SINGLE PAYER,
HEALTHCARE SYSTEM FOR A
PARTICULAR RANGE OF SERVICES,
WHICH WILL NOT BE - FOR
MEDICALLY NECESSARY SERVICES.
WHICH PEOPLE SAY THAT'S
WHAT WE WANT AND THAT'S
WHAT WE WANT OUR
GOVERNMENTS TO PROVIDE.

Steve says I'D LIKE TONY'S THINKING ON
THIS BECAUSE MICHAEL KIRBY,
THE LIBERAL SENATOR, AS YOU
KNOW GAVE AN INTERVIEW,
I THINK, TO
THE NATIONAL
POST
LAST WEEK,
WHICH WAS PRETTY
INTERESTING,
SAYING THAT HE'D BEEN
STUDYING HEALTHCARE
AS PART OF HIS
RESPONSIBILITIES IN THE SENATE
AND HE STARTED TO EXAMINE
SOME OF THE RECORDS
FROM 40 YEARS AGO WHEN
MEDICARE WAS PUT TOGETHER
IN THE FIRST PLACE, AND
HE DISCOVERED THAT
IT WAS NEVER INTENDED TO
BE A GOVERNMENT PAYS
ALL THE TAB FOR
EVERY SINGLE THING,
THAT, IN FACT, PATIENT
PAYMENTS WERE ALWAYS
SUPPOSED TO BE A
PART OF THE MIX.

Ruth says THEY WERE ONE PROPOSAL.

Steve says HOW DOES
THAT AFFECT
YOUR THINKING ON
THIS FILE?

Tony says WELL, I THINK THAT'S A
FASCINATING TRIAL BALLOON
AND I HAVE ALWAYS SAID,
RICHARD, AND I AM SURE
WE AGREE, AND RUTH AND MAC
THAT WE CANNOT HAVE A SYSTEM
THAT DENIES THE PROVISION OF
MEDICALLY NECESSARY SERVICES
ON THE BASIS OF MONEY.
NONE OF US IN CANADA OR
IN ONTARIO WANT THAT.
SO BUT THEN THE
QUESTION BECOMES,
HOW DO YOU MAKE
THAT SUSTAINABLE?

Ruth says AND WHAT DO YOU MEAN BY
MEDICALLY NECESSARY?

Tony says AND WHAT DOES
THAT MEAN?
THAT DEBATE SHOULD
NOT BE A DEBATE
AMONGST POLITICAL PROS,
SHOULD NOT BE A DEBATE
AMONGST STAKEHOLDERS
WHO ARE QUITE WILLING TO
GORE SOMEBODY ELSE'S OX
AS LONG AS THEIR SACRED
COW REMAINS INTACT.

Steve says CAN YOU SPEAK TO RICHARD?
RICHARD DOESN'T THINK
YOU'RE LEADING THAT DEBATE,
THE DEBATE ABOUT
HOW DO YOU MAKE
THIS SYSTEM SUSTAINABLE.
HE SAYS YOU'RE
NOT LEADING IT,
YOU'RE SORT OF SEEING
WHERE IT'S GOING.

Tony says WELL TO BE HONEST, THE
FIRST TIME I WAS ASKED
THIS QUESTION WAS WITHIN HALF
AN HOUR OF BEING SWORN IN.

Richard says NO DOUBT.

Tony continues SO GIVE ME A LITTLE BIT OF
TIME TO BE A BIT MORE USED
TO THE PORTFOLIO, BUT THE
DEBATE HAS TO OCCUR AND
WITHIN THE PARAMETER OF THE
ACCESSIBILITIES I DESCRIBED
AND AS THE PREMIER'S
DESCRIBED ON COUNTLESS TIMES,
WE HAVE TO HAVE THAT DEBATE
BECAUSE THERE ARE EXPECTATIONS.

Richard says TONY, I KNOW YOU.
I LIKE YOU.
I THINK YOU'RE A
SMART GUY.
YOU HAVE INDICATED IN THE
PAST SOME ADMIRATION AND
SUPPORT FOR IDEAS WHICH ARE
PROBABLY NOT CURRENTLY
IN THE MAINSTREAM OF OUR
THINKING OF PUBLIC AREA.
YOU'RE A FAN OF
MARGARET THATCHER.
YOU HAVE FLOATED YOUR
OWN TRIAL BALLOONS
ON TWO-TIER HEALTHCARE.

Tony says NO, YOU KNOW WHAT, I THINK
THAT I MUST TAKE YOU
TO TASK ON THAT.
I'VE NEVER MENTIONED
TWO-TIER HEALTHCARE
IN THE CONTEXT OF
ONTARIO.

Ruth says YOU'VE GIVEN
RISE TO THE QUESTION.

Richard says THAT'S RIGHT.

Tony says APPARENTLY THAT
IS THE CASE,
BUT THAT DOESN'T MEAN THAT
I GAVE RISE TO IT MYSELF.

Steve says WELL YOU DID GO TO ENGLAND
ALSO TO TAKE A LOOK
AT Mrs. THATCHER'S
SYSTEM.

Tony says NO.
NO, FIRST OF ALL, TONY
BLAIR IS THE PRIME MINISTER
OF BRITAIN, FIRST OF ALL.

Steve says WHO'S RUNNING
Mrs. THATCHER'S SYSTEM.

Ruth says CHANGING THE SYSTEM.

Tony says SO I WAS THERE TO
SEE WHAT TONY BLAIR,
WHO IS A SOCIALIST PRIME
MINISTER OF BRITAIN,
WHAT HIS REFORMS WERE.

Steve says YOU'D NEVER GET
Mrs. GRIER TO AGREE
THAT HE WAS A SOCIALIST
PRIME MINISTER.

Ruth says I CERTAINLY DO AGREE HE'S
A SOCIALIST, ABSOLUTELY.

Steve says YOU DO!

Tony continues AND FOCUSED IN ON
ACCOUNTABILITY TO THE PATIENT,
TO THE PERSON WHO
IS GETTING THE SERVICES.
THAT WAS THE FOCUS OF
MY DISCUSSIONS WITH THE NHS.

Ruth says IT'S WHAT I'M TALKING
ABOUT WHEN I'M SAYING,
LET PATIENTS HAVE SOME
SAY IN WHO SERVICES THEM.

Richard says WHY DID TONY
SNEAK AWAY TO ENGLAND
TO DO THAT DO
YOU THINK?

Mac says WELL APPARENTLY HE DIDN'T
DO A VERY GOOD JOB.
YOU KNOW ABOUT THE TRIP.

[laughing]

Ruth says TO RICHARD'S POINT
ABOUT THE DEBATE.

Mac says TO THE POINT ABOUT THE
DEBATE - YOU KNOW WHAT
HAPPENS HERE
DEMONSTRATES WHY THIS
IS AN EXTREMELY
SENSITIVE DEBATE.
YOU CAN'T TALK ABOUT ANY
ALTERNATIVE TO THE STATUS QUO
WITHOUT THE OPPOSITION
PARTIES PILING ON SAYING,
AH, TWO-TIER.
IT'S THE END OF THE
MOST SACRED OF CANADIAN
INSTITUTIONS AND SO IT'S
VERY DIFFICULT TO HAVE
A REASONED CONVERSATION WHICH
DOESN'T RESULT IN SORT OF -

Steve says RICHARD AND RUTH,
FORGIVE ME,
DON'T YOUR PARTIES HAVE AN
OBLIGATION TO - OF COURSE
YOUR JOB IS TO OPPOSE,
BUT DO YOU NOT HAVE TO BE
INTELLIGENT IN THE WAY
YOU OPPOSE TO GIVE
THE GOVERNMENT SOME LATITUDE
TO FIND SOME OPTIONS?

Ruth says YES, AND I WOULD SAY THAT
FOR A VERY LONG TIME,
HEALTHCARE HAS BEEN A
FAIRLY NON-PARTISAN DEBATE.
CERTAINLY IT WAS AS WE
FOLLOWED THE LIBERALS.
I THINK THE FIRST HARRIS
MINISTER MADE IT VERY MUCH,
VERY DIFFERENT, AND
MADE A LOT OF MISTAKES
IN BEING VERY
PARTISAN ABOUT IT.
I THINK ELIZABETH WITMER
HAS EDUCATED THE GOVERNMENT
ABOUT WHAT HEALTHCARE
MEANS AND I HOPE THAT
MINISTER CLEMENT IS NOW IN
A POSITION TO MAKE SOME
OF THOSE CHANGES, BUT
HE CAN ONLY MAKE THEM
IF HE'S TRUSTED TO PROTECT
THE ICONS THAT RICHARD
TALKED ABOUT, WHICH IS
CLEARLY SPELLING OUT
WHAT IS NOT NEGOTIABLE -

Richard says IT'S A VERSION OF THE NIXON
TO CHINA ARGUMENT WHICH
VIEWERS WILL REMEMBER;
NIXON WAS THE ONE PERSON
WHO CONVINCED AMERICAN
CITIZENS THAT HE WASN'T
SOFT OF COMMUNISM WHEN HE
RECOGNIZED COMMUNIST CHINA.
WILL TONY BE
ABLE TO DO THAT?
YOU ASKED ABOUT THE
PROVINCIAL LIBERAL PARTY,
DALTON MCGUINTY
SUGGESTED - HE DID,
HE ASKED WHAT OUR
WE PROPOSED -

Mac says GIVE THE GOVERNMENT
SOME LATITUDE.

Richard continues DALTON MCGUINTY 24 7
HEALTHCARE AND PRIMARY
CARE REFORM, BOTH THINGS WHICH
THE MINISTER IS NOW ACTING ON.
SO WE HAVE PARTICIPATED AND
McGUINTY HAS PARTICIPATED
IN THIS DEBATE IN A
NON-PARTISAN FASHION.

Steve says OKAY, MAC.

Mac says WELL, I THINK ALL THIS
TALK ABOUT ICONS,
I THINK THERE'S SOME
CONFUSION BETWEEN
ICONS AND SACRED COWS.
AS FAR AS I KNOW, EVEN
SACRED COWS CAN COME DOWN
WITH FOOT-AND-MOUTH AND SO
MAYBE SOME ELEMENTS
OF THE SYSTEM WHICH
ARE, YOU KNOW, ICONIC
SACRED COWS THAT NEED
A GOOD HARD LOOK.

Steve says OKAY, WE ARE DOWN TO OUR
LAST MINUTE HERE
AND I WANT TO GIVE IT TO
THE MINISTER TO TELL US,
YOU'VE GOT A HELL OF
A JOB AHEAD OF YOU,
AND YOU KNOW THAT.
AND CAN YOU TELL US THAT
AT THE END OF THE DAY
YOU BELIEVE THAT WE'RE
ALL GOING TO MAKE -
THAT YOU'RE GOING TO MAKE
THE RIGHT DECISIONS?
PEOPLE ARE NERVOUS ABOUT
WHAT DECISIONS YOU AND
YOUR COLLEAGUES ARE ABOUT
TO MAKE RIGHT NOW.
WHAT CONFIDENCE
CAN YOU GIVE US
YOU'RE GOING TO MAKE
THE RIGHT ONES?

Tony says WELL, I WOULD SAY THIS,
THAT WE ARE IN A VERY
SERIOUS PERIOD OF
DEBATE AND REVIEW
OF OUR HEALTHCARE
SYSTEM.
I DON'T WANT TO MINCE
WORDS ABOUT THAT.
IT IS A SERIOUS DEBATE AND
THE FACT THAT A FEDERAL
LIBERAL GOVERNMENT HAS COME
TO THE SAME CONCLUSION
ABOUT SUSTAINABILITY AND
HAS HIRED A FORMER
NDP PREMIER WHO WANTS TO
LET 100 FLOWERS BLOOM.
HE WANTS TO SEE EVERYTHING
ON THE TABLE LENDS CREDENCE
TO THE IDEA THAT THIS
CAN BE AN ECUMENICAL,
A NON-PARTISAN DEBATE.
WE CAN ALL GET THERE
TOGETHER WHICH WE HAVE
TO DO BECAUSE THE CURRENT
SYSTEM WILL NOT GIVE US
WHAT ONTARIANS AND
CANADIANS WANT
IN THEIR HEALTHCARE
SYSTEM FOR THE FUTURE.

Ruth says IF YOU KEEP ON DOING
WHAT YOU'VE ALWAYS DONE,
YOU'LL GET WHAT
YOU'VE ALWAYS GOT.

Steve says TONY, WE HAD YOU HERE
AS TRANSPORTATION MINISTER,
ENVIRONMENT MINISTER,
MUNICIPAL AFFAIRS MINISTER,
AND NOW HEALTH MINISTER.
WE'RE ALL WONDERING WHY
YOU CAN'T HOLD ONTO A JOB.

Richard says HE GETS AROUND.

[laughing]

Steve says TONY CLEMENT, MPP
BRAMPTON WEST-MISSISSAUGA,
TODAY'S HEALTH MINISTER IN
THE PROVINCE OF ONTARIO.
THANKS A LOT FOR
YOUR TIME TODAY.
RUTH, MAC, RICHARD, SEE
YOU AGAIN NEXT WEEK.
THAT'S 4TH READING
FOR THIS WEEK.
I'M STEVE PAIKIN AND WE'LL
SEE YOU NEXT WEEKEND.

Music plays and the end credits roll, as Steve and the rest continue the conversation.

Queen's Park Bureau Chief, Susanna Kelley.

Researcher, Peter Harris.

Editor, Ted Ambrose.

A production of TVOntario. Copyright 2001, The Ontario Educational Communications Authority.

Watch: Fourth Reading - Show 230