It's the policy file at the core of the Ontario government's fight to eliminate its nearly $15-billion deficit. And now, it's emerging as by far the biggest issue for voters.
A Nanos Research survey of 500 Ontarians, conducted May 11-13, shows health care as the top provincial concern for 34 per cent of respondents. That's roughly double the percentage received by the next biggest issue, jobs and the economy – a much bigger spread than even a month earlier.
The surging public interest is hardly surprising, given the high-profile fight between Dalton McGuinty's governing Liberals and the Ontario Medical Association over fee cuts aimed at freezing the total amount spent on doctors. But that battle is only the tip of the iceberg when it comes to the government's efforts to rein in health costs currently on their way to topping 50 per cent of all program spending.
The changes to doctors' fee schedules that have already been announced, targeted mostly at a few specialists' groups such as ophthalmologists and radiologists, should help the government meet its target of capping health spending increases at 2.1 per cent in 2012-13. But to maintain that limited growth through 2017-18, as promised, will require major structural changes that are likely to have a bigger impact on service delivery.
With everything from hospital mergers and the centralization of services to stricter standards for prescriptions and referrals likely to be on the table in the years to come, the ensuing controversy could well push health care even further into the spotlight.
For Mr. McGuinty's government, that might to some extent be welcome. The Premier has spent his nearly nine years in power trying to position himself as a defender of core services, and traditional wisdom holds that Liberals have an advantage over their opponents on the right when social issues are more top of mind than economic ones.
But the Nanos survey suggests the Liberals are increasingly vulnerable to competition from their left. Andrea Horwath's New Democrats have seen their support grow in recent months, and now sit at 28.5 per cent – not much behind Tim Hudak's Progressive Conservatives, at 33.6 per cent, and the Liberals, at 31 per cent.
Horse-race numbers between elections should always be taken with a grain of salt, and previous surveys have suggested Mr. McGuinty still has a significant leadership advantage over Mr. Hudak in particular. But with a margin of error of 4.9 percentage points, the survey shows something of a logjam.
As they try to break it, the debate about how to make health care sustainable will be – or at least should be – inescapable. In last fall's election campaign, the three parties did little to differentiate themselves from one another on the issue. But even Mr. Hudak's Tories, who previously considered health care enough of a political liability that they mimicked Liberal commitments in hope of getting it off the table, now concede that they'll need to engage more actively – including with a "white paper" before the end of this year.
The Liberals, meanwhile, will position spending restraint as a way of saving the public system from collapse, or at least the deeper cuts they claim the Tories would make. But in the run-up to the next election, it will be no small feat for any party to convince voters that there's a smooth health-care path ahead.