These days, public health care seems like a high-stakes TV poker game complete with bluffers willing to gamble its future away.
For the third election in a row, health care is the top of mind issue. And, for the third election in a row, every federal party leader pledges to protect health care. But beware the bluffer.
Canadians have indicated consistently we want two things in health care: A publicly insured system that provides care and promotes health, there for people based on their need, not their ability to pay. And we don't want to waste a single penny.
Question is: Which political leader holds the winning hand and is willing to reform, strengthen, and sustain our public health-care system?
Last election, we seemed to be heading out of the woods, with the Romanow report tucked under our arm, providing a clear direction on how to protect publicly insured health care for the next generation.
Its compass setting has been ignored by at least two of the leaders trying to win your vote.
Prime Minister Paul Martin vows he stands for public health care. But when you look at his record, he has built his hand on but two cards: He has given billions more in unconditional cash to the provinces and placed a major focus on reducing wait times.
There's one problem with that strategy. Since the Prime Minister is agnostic on how provinces use the money, he can't guarantee new money is buying real change or even faster service for the whole system.
He won't even ask the provinces to show their hand, telling us clearly and consistently what they're doing with all that money.
His "fix-for-a-generation" is a house of cards.
Meanwhile, he has turned a blind eye to the slow creep of for-profit health care, one that has many people warning the age of medicare is over.
Canada now has vastly more investor-owned, shareholder-driven companies providing health care both within and outside the publicly insured system than a decade ago. More commercial health care is not a record to stump on.
Conservative Leader Stephen Harper, sensing political opportunity if he stays in the Liberal shadow, claims he'll see Martin's bet, and raise him one.
He'll guarantee even shorter wait times for a handful of surgeries and procedures.
But he won't give provinces more money and he won't give Canadians a guarantee on access. So what if you can't see a doctor or a nurse for the correct diagnosis in the first place, right?
Expect further delisting of public services in this scenario, as provinces face the squeeze-play — no more resources, but increased costs of transportation to get care in the required time frame for this most-favoured-services list.
And a bigger question remains around Harper: Could he — or would he — stand up to Alberta Conservative Premier Ralph Klein's bold attempts to build a private health-care alternative to the public system? He's holding his cards close to his vest on this one.
As for NDP Leader Jack Layton, it is frankly surprising how long it took him to belly up to the table, given that Martin's fix-for-a-generation gambit of September 2004 was ready-made for legitimate NDP criticism.
That said, Layton seems to understand that in the face of creeping privatization, a Supreme Court decision that threatens more private insurance, and premiers who delist services and convert public medicare into a slush fund for private profiteers, the stakes are getting higher.
Layton's taking a gamble. His focus on the whole system, and its cost drivers, may not be as politically sexy as wait times.
But it's essential to the long-term viability of public health care in Canada, especially given all the strains on the system.
He may be holding the winning medicare hand when it comes to both evidence and values, but Layton needs to play it with more confidence and skill. Too much is at stake.
We all know what's needed.
The time is long overdue to address looming and massive health-care labour shortages in a way that pre-empts poaching between provinces and from other nations.
A strategy to control the spiralling costs of pharmacare is key, as is better integration between acute care, home care and long-term care. And capital investments are critical to shore up and expand our health-care infrastructure.
Last, but certainly not least, the determinants of health must get more emphasis, because everyone knows an ounce of prevention is worth a pound of cure.
Not one province would disagree with these imperatives. But there is no consistent change on all these fronts, nor is change always in a direction that will secure the longevity of public health care.
The federal government needs to be a player, to help shape and facilitate what we're trying to achieve together in every part of the country.
Canadians are longing for a federal leader committed to consistency of purpose and vision — the vision captured by Roy Romanow, and Monique Begin, Pierre Trudeau, Paul Martin Sr., Lester Pearson, and Tommy Douglas before him.
The vision is sweet and simple: Make sure every Canadian has access to public health care when he or she needs it — and don't spend a dollar when 99 cents will do.
It is a vision the majority of Canadians support, time and time again.
It's way too early to fold on medicare. So, this election, beware of politicians with a poker face and an empty hand.
Armine Yalnizyan, a consulting economist and research associate with the Canadian Centre for Policy Alternatives, is sharpening her poker skills during this election.