In Ontario, the "massification" of long-term care and home care was a conscious strategy to cut hospital costs. Almost as soon as Ontario accepted federal money to create OHIP in 1969, the business class and "Blue Tories" (eg: Frank Miller) were pressing for hospital cuts.

Miller's attempt to close hospitals in 1974-75 was rebuffed by labour-led protests. The PCs pivoted towards taking on labour costs, sparking the fateful 1981 hospital workers wildcat. After the PC dynasty was turfed in 85, a ban on extra-billing led to the 1986 doctors strike.

As these battles unfolded and the neocon goal of radical retrenchment gained ever-greater elite support, liberal and progressive policymakers were pressing for "de-institutionalization": a transition of hospital services to more humane home care services and LTC facilities.

These proposals were put into practice after the NDP was elected in 1990. Cost-cutting was a major motivation as Ontario tumbled into a long depression and Mulroney's new federal transfer cuts kicked in. The NDP would close more thsn 6000 hospital beds - more than Harris!

The ONDP govt did not opt for public LTC or follow the Manitoba NDP's public homecare system established in the 70s. Instead, it expanded homecare through grants to largely unionized non-profit agencies like VON, St. Eliz, Red Cross and others. But the NDP was turfed in 1995.

In 96, the Harris Tories opened up HC to for-profit operators and cut the NDP's minimum care standards in LTC. For-profit, non-union HC companies grew rapidly as lowest-bid contracting became law. Non-profits adopted ruthless union-busting cost-cutting measures to compete.

As homecare conditions deteriorated rapidly, big hospital cuts were made. Numerous save-our-hospital campaigns emerged. A backbench rebellion began. Unprecedented protests in rural Tory ridings forced Harris to declare none of the 66 rural and northern hospitals would close.

Ultimately, eleven hospitals and 3700 beds were closed, all in urban centres. It was a far cry from the 30+ set for closure. The $1.3 billion cut to annual hospital budgets was lowered to $800 million. Then the govt put up $100+ million for long-term care capital costs.

By the time Harris resigned and the Liberals came to power in 2003, the great shift in Ontario healthcare was complete. Hospital costs were massively contained through the extensive closure of beds, wards and entire buildings. Private for-profit LTC homes popped up everywhere.

In homecare and LTC, the Liberals maintained the status quo, rejecting minimum care standards and dispensing millions in capital funds to for-profit LTC corporations. Overcapacity hospitals became the new norm as the Liberals implemented a 4-year hospital budget freeze in 2012.

Meanwhile, Ontario's healthcare unions were and remain paralyzed by fragmentation and administrative merger votes (PSLRTA). Anti-strike laws in hospitals and LTC have been obeyed since 81. There's no united labour crusade for socialized healthcare and smashing the profiteers.

The 1990s health reforms kickstarted the agenda of permanent austerity, privatization and union-busting. The two elite parties are deeply integrated into the for-profit healthcare industry, while the ONDP reluctantly criticizes only the worst excesses of a dying public system.

This is only a sketch of the movement of care out of Ontario's hospitals and into LTC and people's homes. It is highly instructive that this process was first proposed as one of humanizing healthcare, but instead became a nightmare of profiteering, poverty, and now mass death.

Healthcare policy can never be removed from fundamental questions of ownership, profits, democracy, and workers' power. A new crusade for socialized healthcare will have to tackle all these questions openly if we are to learn from the mistakes and shortcomings of past efforts.

Gotta give @NutellaFanatik a shout out for all the discussions we've had to help make sense of this history.