The Harris Legacy in Healthcare
There have been three successful sets of healthcare reforms in Ontario since the creation of Medicare in my opinion:
- Deb Matthews’ quality reporting and good management: Excellent Care for All Act, bill 102 (drug pricing) and 2011-12 OMA negotiations
- The early Dalton McGuinty Health Results Team that focused on Wait Times, LHINS and primary care reform (FHTs); and the
- Health Services Restructuring Commission (HSRC) under the leadership of Duncan Sinclair, Mark Rochon, and Peggy Leatt.
I gave several lectures on why these reforms worked at the start of Ford’s regime (2018).
When Alister Campbell assembled authors for the Harris Legacy book he recalled this and asked if I would write the healthcare chapter. I am a Liberal and he is very Conservative, but we became good friends “across the aisle” at U of T and later. I was not a supporter of the so-called “Common Sense Revolution”; I have never voted Conservative in my life. Thinking that Sinclair and team did a good job did not necessarily mean that I think that Mike Harris was a good healthcare Premier. I told Alister that and asked if he was willing to have me look fairly at the period and evaluate Harris and his healthcare record. He gave me full editorial freedom and he has stuck by that, making helpful editorial suggestions and introducing me to some smart people who were CSR’ers. Mark Rochon gave me access to a box full of primary documents and clippings.
The Health Services Restructuring Commission (HSRC) was an excellent policy initiative. Any student of government and public policy will benefit from looking carefully at it from a mechanics of government perspective A fully volunteer governance ($1 a year actually) at arm’s length from the Ministry of Health (Ministry). Superb analytical team led by David Naylor and a cast of stars. Excellent legal and communications advice. The Commission appointed leads for each region who reviewed analytical work products and then published clear and straightforward recommendations that were open for thirty days before being implemented.
To quote the Globe and Mail from July 25, 1997:
“Let’s try to set the record straight on what Ontario’s Health Services Restructuring Commission is up to. Earlier this week it ordered the closings and amalgamation that will reduce the number of hospitals in Metro Toronto to 24 for 39…. The first half of the mandate – downsizing the hospital sector, reducing the number of acute care beds, closing some institutions – is in good hands. The decisions the Commission has had to make are never easy one, nut it appears this far to have mostly made the right choices, in Toronto and elsewhere.”
The sense of fairness and touch choices runs through the newspaper many articles I have read. There is anger and hurt and fear as well. After all they closed forty hospitals. But as I detail in the book chapter this was needed. Thousands of beds had already been closed due to the shift to ambulatory care and rationalizing the infrastructure was foundational to making the Canada Health Act’s promise of universal comprehensive care accessible and affordable in Ontario. The Commission did an excellent job; I remain an unabashed fan of Sinclair and team.
Should Mike Harris be given credit? First, I note that he absolutely took blame for anything that went wrong, including Hula Hoops. More than that though, Harris and his Minsters, and the Ministry backed up the HSRC in most of its early decisions. This was tough stuff and Harris led it well and calmly. So yes, he deserves full credit. More should have been done with the Commission’s recommendations to increase spending on comprehensive team-based primary care. More home care and long-term care (LTC) was planned and only LTC was really delivered. The mental health supports in the community were not enough. But Premier Harris is not alone in not addressing these issues. All of them exist today and there have been four Premiers since Harris and two decades in which those issues needed to be addressed. Overall, I give Harris an A- grade in healthcare in the chapter. This is better than I would grade any other Premier except for Dalton McGuinty. The thing that still impresses me about Dalton is the late regime resurgence under the amazing Deb Matthews. Mr. Harris had a very impressive and productive first five years. His Premiership shaped Ontario healthcare in many important ways.
The Common Sense Revolution manifesto said little about healthcare restructuring. The Commission actually appears to have been considered and planned for by the Ministry under Bob Rae. Certainly, health policy people from all parties saw the need for restructuring. Harris inherited this policy and made it his own. There is delicious irony here! These Canadian Thatcherites were in fact some of the best central planners we have ever seen in Canada. These neo-Liberals turned into command-and-control bureaucrats. Frederick Hayek must be turning in his grave. But data-driven central planning was the right answer for the problems at that time. Why this should be the case is very interesting for our current times (when central planning is exactly not the right answer in my opinion). I spend some time trying to look at this in the chapter.
I hope that you will find the chapter a balanced review of the late 1990s in Ontario healthcare. My hope is that it can be part of a discussion about how to bring better policy and planning back into our healthcare system. We need it.
To read the full chapter click on the Article PDF button at the top of the screen.
Reproduced by permission of Sutherland House Publishers. Further reproduction, distribution or transmission is prohibited, except as otherwise permitted by law. https://sutherlandhousebooks.com/product/the-harris-legacy/.
About the Author(s)
Will Falk is a Senior Fellow at the CD Howe Institute, Rotman School of Management (U of T) and Woman’s College Institute for Health Sustainability and Virtual Care. He has been a regular contributor to Longwoods publications and events for two decades.
Falk, W., 2023, Health Care. In A. Campbell, ed., The Harris Legacy. Chapter 4, p.86-119. Sutherland House Books.
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