To anyone unfamiliar with the personal dynamics, it must seem bizarre.

Of all the things the Ontario NDP demanded in return for supporting this spring's budget – more social spending, lower auto insurance rates, efforts to collect more business tax, the appointment of a new budgetary officer – only one was outright denied by the governing Liberals. And it's something that, ostensibly, Premier Kathleen Wynne should have a hard time arguing against.

Everywhere else in Canada, patients with complaints about hospitals and other medical institutions are able to turn to provincial ombuds. Nobody can seriously argue that Ontario's health-care system is always easy to navigate, that complaints always get the attention they should. So why was Ms. Wynne so rigidly opposed to giving Ontarians the same opportunity, as the NDP asked?

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The short answer is that other provinces don't have André Marin as their ombudsman. And partly for arguably petty political reasons, partly for policy ones, he appears to be the biggest obstacle to extending his office's reach.

When Mr. Marin's name came up recently at a cabinet meeting, according to a senior Liberal, the negative reaction was "visceral." That's a response also common in the public service. Those who have come under his watch complain that he's a bully all too willing to trample all over others' reputations to advance his own.

Many outside government have a more favourable view. Thanks to his doggedness, they argue, the province has better neonatal screening; provincial lottery customers stopped being ripped off by vendors; various government agencies have been forced to behave less secretly. When the Liberals sought to replace him as his previous five-year term ended in 2010, amid revelations about questionable expenses, the provincial opposition (particularly the NDP) shamed them out of it.

That Mr. Marin is the sort of public officer whom politicians like when they're out of power, and sour on once they win it, suggests to some extent that he does his job well. But beyond its bad relationship with him, there is a valid reason for the government to worry about broadening his purview.

Regardless of whether one thinks his record makes up for it, there is no denying Mr. Marin's deep affection for the spotlight. At various points, that's meant either prioritizing complaints likely to achieve a high profile or latching onto issues that already have one.

To give Mr. Marin access to hospitals would be to indulge those inclinations. They are rich with human-interest stories that make for great headlines; meanwhile, an ombudsman's office also tasked with a multitude of other responsibilities would be hard-pressed to give weight to every concern, offering incentive to focus on those that offered the most bang for the buck.

Already, the government walks a fine line between showing sensitivity to patient and community concerns, and ensuring that the public system is able to survive an aging population and other cost pressures. That means rationing in such a way that the most possible people receive the best possible care. If the system is driven too much by those human-interest stories – unhappiness over a hospital merger here, complaints about lack of funding for an expensive and unproven treatment there – it becomes much more difficult to meet the challenge.

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The question is, if not Mr. Marin, then what?

In theory, Health Minister Deb Matthews has not ruled out an expansion of the ombudsman's powers down the road, but sources concede that's highly unlikely. An alternative would be to establish a new position dedicated to advocating on behalf of patients full-time, or making hospitals' existing complaints mechanisms more independent from management. In a more macro sense, there is an obvious need to finally give some teeth to Health Quality Ontario, the troubled agency that's supposed to measure health outcomes and offer insight on how to improve them.

The New Democrats' diagnosis, that Ontario patients shouldn't have less voice than in other provinces, was correct. Having understandably rejected the prescription, the Liberals are now obliged to come up with one of their own.