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Cancer patient Mike Brady was waiting for a blood test at an Ottawa hospital when a chance encounter with Dalton McGuinty gave the Ontario Liberal Leader his biggest pause of the provincial election campaign.

The 63-year-old was thinking how Mr. McGuinty had a lot of nerve making a campaign stop at the Ottawa Hospital Cancer Centre, given the government's track record in approving new cancer drugs and its limited use of PET scanners. That's when Mr. McGuinty stopped, stuck out his hand and asked Mr. Brady how he was doing.

Mr. Brady, whose colorectal cancer has spread to his liver and lung, refused to shake his hand and said, "I've got cancer and you're not helping any."

That brief, unscripted encounter last week - from a cancer patient who says he didn't mean to say a word - made fodder for the cameras.

Afterward, in a telephone interview, Mr. Brady, a retired civil servant, said, "He's doing little, that I can see, for [cancer] drugs or equipment."

Up until that point, the Liberals had been basking in the missteps of a Progressive Conservative campaign that was fighting its way out of the highly contentious faith-based schools debacle. Eight words uttered by Mr. Brady suddenly added controversy to a smooth-running Liberal campaign by putting its health record up to closer scrutiny.

There were questions about access to new cancer drugs and diagnostic PET scans. And what about that health tax, others wondered. Some were complaining about needing family doctors: Wasn't that supposed to be solved by the government, too, they asked?

"It was the average person showing, in a really visceral way, their anger and frustration," New Democratic Party MPP Andrea Horwath said in a telephone interview.

According to Raisa Deber, a professor at the University of Toronto's health policy management and evaluation department, any government could be vulnerable on health care because there are always stories of a patient's struggle with the system.

"One of the reasons it is so difficult to deal with is because health care is so many different things," she said. "How do you put it together in a way that's going to make sense? There's no simple answer on this."

Mr. McGuinty may have been looking for that simple answer when he replied "that's not true" to Mr. Brady last week before continuing his tour of the cancer centre. But ever since that unpleasant exchange, the shadow of Mr. Brady continues to dog him.

It was an unusual turn of events, given that health is an area where the Liberals must have thought they were strong. Certainly, their spending has been: In fiscal 2007-2008, health care is expected to tally $37.9-billion.

In Goderich this week, Mr. McGuinty spoke about how the health tax has guaranteed a strong medical system and how 500,000 more people have a family doctor, compared to when the Liberals were elected in 2003. In Kitchener, he reiterated his pledge to reduce waiting times in hospital emergency departments.

Health-care spending, as a share of Canada's gross domestic product, while stable, remains at its highest level in 31 years, expected to reach 10.3 per cent in 2006, according to figures from the Canadian Institute for Health Information.

With Ontario's health-care spending consuming 46 per cent of the provincial budget, there are questions about its sustainability, given the crush of aging boomers on the horizon.

There is no question the Liberal government has poured mountains of money into health care. The question, for voters, will be: How effective have government efforts been? And are taxpayers getting value for money?

"When I was in business we wouldn't talk about how much we spent, we would talk about what return you are getting for your money," Progressive Conservative Leader John Tory said. "Are there more people with a doctor? Are emergency rooms unclogged?

He said he will significantly increase health spending, tackle the doctor and nurse shortage, and reduce waiting times. Ontarians waiting for an operation, for example, should be able to get them at private clinics, as a way to whittle down the queues. Patients would use their health cards and private clinics would be reimbursed the same rate as in the public system, he said.

Similarly, the NDP wants to whittle down emergency waiting times and invest in more doctors, nurses and long-term and home care. It also wants to reduce and, in some cases, scrap the health tax; those earning $80,000 a year would get a health tax rebate of $450, while anyone earning under $48,000 would be exempt from the tax altogether.

Mr. Tory said he was so moved by the story of Mr. Brady that he telephoned him at his home on Wednesday. He described him as "one man who has a story to tell that thousands of other people could tell as well."

During his talk, Mr. Tory said he was shocked to learn that Ontario is one of the lowest-ranking jurisdictions when it comes to funding new cancer drugs.

He was basing his comments on the Cancer Advocacy Coalition of Canada report card, published earlier this year.

When that group looked at what provinces were funding 24 new and effective anti-cancer drugs in 2006, British Columbia came out on top, funding 20 of them. Manitoba was second, funding 17 drugs; Ontario and Nova Scotia were tied for last place, funding four drugs each.

"That's unacceptable for a province like Ontario, with its wealth," Mr. Tory said.

Liberal Health Minister George Smitherman said he always expected health care to be a substantial election issue.

"Obviously, there are always going to be circumstances where people are facing such challenging health situations where there's always going to be a pressure and a desire to be able to do more. That's totally understandable," Mr. Smitherman said, referring to the incident with Mr. Brady. "That's the real privilege that goes alongside the work that you do in health care."

Mr. Smitherman said there have been tangible changes to the health-care system since the Liberals took office in 2003, including cancer care. Median radiation waiting times, for example, have dropped from six weeks in the fall of 2003 to 4.1 weeks in the fall of 2006.

Cancer care has been a prickly subject, with access to new and expensive drugs being a bone of contention.

Mr. Smitherman described access to cancer drugs not funded by the provincial government as being one of the most challenging issues in health care.

"I've always tried to be very forthright in saying no provincial drug plan is ever going to be able to provide all of the drugs that Health Canada finds a way to license," he said. "It's not realistic."

Patients and oncologists, however, have not asked that every licensed drug be funded. They are mystified at how some provinces determined these drugs to be cost effective and fund them, while others do not.

More than one year after Cancer Care Ontario recommended hospitals be allowed to provide unfunded cancer drugs to paying cancer patients, the government has yet to make a decision. The proposal was a way to remedy a problem of trying to get drugs recommended by oncologists, but often not considered cost effective by the provincial government to patients, some of whom were being forced to travel to the United States for them.

One of the key drugs for which colorectal cancer patients have clamoured is Avastin, which confers a median 4.7-month increase in survival to patients with incurable colorectal cancer. The drug is funded in British Columbia and Newfoundland; Quebec just announced it would also pay for it. It typically costs $36,000 for a course of therapy.

James Gowing, board chairman of the Cancer Advocacy Coalition of Canada, said his problem with the funding of cancer drugs in Ontario is that decisions are largely based not only on cost, but on median survival time.

Using median survival time as a measure doesn't give an accurate portrayal of how the drug is performing in certain patients. That's because results from patients for whom the drug is not working are mixed in with those who may get years in additional survival time.

If a drug works well for a patient, it should be funded. If it doesn't, it should not, he said.

"I don't know of an oncologist who would continue treating a patient with a drug that doesn't work," said Dr. Gowing, a hematologist-oncologist based in Cambridge, Ont.

That's where someone like Mr. Brady, first diagnosed with colorectal cancer in 2004, then again with a recurrence in 2005, becomes annoyed. If his oncologist had the choice to choose from the cancer drugs provided in B.C., would his treatment have differed?

Fortunately, he said he made it onto a clinical trial, where three drugs are being used to beat back the disease. Overall, he says he has been happy with his care.

Though Mr. Brady won't reveal whom he is voting for, he looks back on his exchange with the Liberal Leader as a once-in-a-lifetime event.

"If he kept walking," Mr. Brady said, "nothing would have happened."