Nearly half a year ago, Dalton McGuinty told reporters he wanted to "engage Ontarians in an important conversation" about how to get the province's finances in order.
By the end of this month, we'll have a much better idea of how serious he was.
The provincial budget, to be delivered by Finance Minister Dwight Duncan in late March, will contain thousands upon thousands of words about deficit-fighting. There will be talk of living within limited means, and making hard choices.
But there will be one true test of Mr. McGuinty's commitment to avoiding a long-term structural deficit: his willingness to put health-care reform front and centre. Because as one senior Liberal put it, health care is the structural deficit.
Most people around the government know this, even if they might not use the same wording. Health costs have been rising at a rate of about 6 per cent a year, and that's mostly before baby boomers hit old age. It's acknowledged that Health is on pace to soon account for half of program spending; nobody likes to talk about how high the share might go after that.
It can't go on like this, without other services suffering. But the problem is that, outside government and health-sector circles, the issue is barely on the radar.
Less than a decade ago, health-care debate was unavoidable, dominating elections and public-opinion polls. Governments, including Ontario's, commenced pouring billions of new dollars into the system, and public attention drifted elsewhere.
To the extent that health care remains the subject of public debate, it's still mostly in the context of where more money needs to be spent. But there's not much debate about how to flatten the cost curve, which, given the pace at which it's been rising, is tantamount to cutting spending in most other departments.
Mr. McGuinty's government is on the verge of having done all it can to contain costs, short of igniting that debate. Its fight with pharmacies to reduce the cost of generic drugs, though heated, is the most winnable of the battles it could be fighting, and the least likely to cause a public backlash. But it's also a relatively small piece of the puzzle.
On the two bigger expenditure areas, the Liberals have thus far fought more skirmishes than battles. They've tinkered with the way hospitals are funded and the way doctors are paid, mostly through regional and inter-professional integration, but they haven't really overhauled either.
A prerequisite to more coherent strategies - strategies the government is prepared to stick with - is preparing patients for the ensuing upheaval.
That will mean some uncomfortable discussions about what can reasonably be expected from the system going forward. How much can the local hospital be expected to do? What relationship should there be between doctors and patients? Can certain treatments and services continue to be fully covered for everyone in perpetuity?
The next election, in October, 2011, should be largely about health reform. But beyond the more saleable prospects, such as shifting the focus toward long-term care, it probably won't be.
The opposition Conservatives won't want to propose radical change, for which they could be easily demonized. Liberals are eager to demonize the Tories anyway, which will require them to promise stability if re-elected. And the NDP will likely accuse the other two parties of starving the system.
Mr. McGuinty has an opportunity to alter that course. He can't be expected to have all the answers; nobody does. But he can at least begin awakening the public to the decisions that lie ahead, rather than leaving it until 2012 for whatever party is in power to start from scratch.
