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The speaker as a professional working in Ontario's health-care sector, as a decision maker, as a consumer of health-care services, and as a taxpayer. An appreciation of Ontario health-care system, and a knowledge that restructuring and reform are lagging behind other jurisdictions. A look at Ontario's system, how much has been accomplished in terms of restructuring in the past few years. How much more is needed. The challenge of delivering high-quality medical care while we change what we do and how we do it. The driving force of economics that are re-shaping all of our society. The title "Till Debt Do Us Part" because of the speaker's concern as a health-care manager and a taxpayer that debt is dividing us and preventing us from moving ahead. Debt and deficit as two fiscal forces overwhelming the abstract debates of planners and policy makers. Striking a balance between what we want and what we can afford. The cost of health care in terms of percentage of government spending. Major cuts to hospital spending. Consequences in terms of services, employment and in the number of hospitals that survive. Major changes for hospitals and the medical profession since 1989 when the speaker last addressed the Empire Club. Current issues. Bill 26, which created the Health Services Restructuring Commission. The Commission's mandate for changes. The Ontario Hospital Association opposition to many of the Bill's original provisions, and the Association's proposed changes. Tasks and activities of the Commission. Going through an age of unprecedented social transformation. The evolution of the infrastructure of the health-care system; the "medical-industrial complex." Per-capita expenditures on health in Ontario. Cost-shifting: what it does and doesn't do. The Ontario Hospital Association in the news; what has happened in the past six months, and over the past few years. Partnerships between the OHA and government. How hospitals will be funded in the future. Sources of solutions. Coming to terms with what is affordable in terms of social programmes. Medicare as a sacred institution in Canada. Changing rather than shrinking the system. Confidence in leaders pulling together down the same path.