When the history books are written about Ontario’s medicare system in the 1990s, they will certainly note how fiscal pressures both captivated policy-makers and dramatically changed the lives of citizens. Since the Conservatives assumed power in 1995, over 1.5 billion dollars has been restructured within Ontario’s medicare system.1 But while the scope of this restructuring is dramatic, it is only part of a major re-orientation of the fiscal structure of the province. The Conservatives have embarked upon a ‘common sense revolution’ that has systematically sought to shrink the size of the state and ‘marketize’ its remaining elements. This agenda has meant drastic change in the medicare sector, numerous hospitals have either closed or merged with others, staff has been pared, District Health Councils have been pushed into compliance, and specialized programs (such as the home oxygen service for lung patients) have been cut.2 To state the case succinctly, fiscal restraint policies have not only changed the present face of Ontario politics, they have, perhaps irreparably, changed the character of Ontario’s medicare system.