Broad re-examinations of the healthcare industry are the order of the day. Recent federal and provincial commissions have put forward volumes of recommendations for strategies they believe will ensure the sustainability of the industry and better equip it to achieve improved international standards of health for our citizens. Where to from here? This paper reflects on this pivotal question, drawing from recommendations put forward by selected national and provincial commissions. The discussion addresses (1) federal/provincial/national relations; (2) fiscal sustainability; (3) accountabilities and health information; (4) primary care reform; (5) extended coverage of insured services; and (6) customer expectations.