The Harper Government's heath care funding plan to the provinces announced earlier this week -- in which the Finance Minister said current levels of 6 per cent funding were unsustainable after 2016 -- should not be dismissed as another clever tactic to punt a political hot potato. It is much more consequential than that. The issue is about the very nature of the federation itself, the role of the national government, and two distinctly opposing views of the kind of country we are and want to be.

The Harper health care maneuver is an intentional attack on the idea of a strong federal government that leads in the national interest. It is a deliberate challenge to the notion that to build a common, cohesive, and unifying sense of purpose and citizenship, a strong federal government is vital.

It is an intentional and dramatic measure that will mean a passive role for Ottawa in national health care policy and the promotion and enforcement of national standards. Some find this to be a perfectly sensible approach. After all, when the Fathers of Confederation agreed to the separation of powers almost 150 years ago, jurisdiction for health care was given to the provinces. Ottawa had no role whatsoever.

Medicare has reached almost mythic dimensions. The Canadian Medical Association (CMA) has said the "cherished beliefs we have about our health care system do not hold up to serious scrutiny." At the same time, there is an overwhelming consensus that our system is in urgent need of significant reform.

CMA president Dr. Jeffrey Turnbill said:

We have seen a slow and steady decline in what we would all now agree is a deeply troubled health care system. To be clear, this pillar of Canadian society is eroding. I don't think any of us would have thought that we would be practicing in a system where five million Canadians do not have access to a family doctor, or (where) one in 10 Canadians cannot afford their medications. Where getting a knee joint replacement for severe and disabling pain within one year is considered to be an ideal target for quality care -- incidentally a target we don't achieve very often.

As a percentage of GDP, we have the second most expensive system in the world. Meanwhile, in terms of the only real metric that matters -- health outcomes -- Canada ranks far from the second in the world. We are confronted with some basic facts: a service that we have entrusted Ottawa and the provinces with is not operating as we expect it to.

Costs are rising and service levels have been deteriorating. We know that the current course, particularly given shrinking revenues and increased demand pressures, is unsustainable. We do not need another Royal Commission, another study, or another inquiry to tell us that. Medicare needs pragmatic solutions that will strengthen access, quality, service and long-term viability. Our focus must be on only one question: What do we need to do to have a system that delivers the highest quality health care in the most productive and cost effective fashion?

Must of us are not aware that Canada has fourteen health care systems, not one. Provinces want federal dollars, but do not want federal intrusions or strings attached. That's where leadership comes in. The provinces may not like it, but parliament has every right -- indeed obligation -- to set conditions in the national interest on every single dollar it authorizes. The federal government should lead and work with the provinces to construct an ambitious reform agenda. It is one that should meet the important objectives of the Canada Health Act, while providing medical professionals with the tools to provide world-class health care to citizens.

Because our leaders refuse to lead, our health care system suffers from jurisdictional paralysis, a highly fragmented vision, dysfunctional organizational and management structures, policies, and perverse incentives. We need to break the cycle of jurisdictional conflict and corral the country around some guiding values and actions that make sense.

Building a modern, efficient and responsive heath care system will require an urgent call to arms and a very different way to attack the problem. Lots of silos, barriers, and prejudices must be blown away. All of us have a very direct and personal stake. Like the other important policy issues Canada faces, health care reform is far from an insurmountable feat. But it does require some vision, toughness, political skill, and courage. Most of all, it will take leadership.

Instead, we are subjected to Mr. Harper's approach, which is inexplicably getting huge applause from the pundit class and editorial pages. They have, once again, lauded Harper's "brilliant political tactics," but have failed to carefully measure the consequences. The cost of this gambit is a cohesive federation versus a balkanized one. That is something all of us should think about and parliament should debate.

It cuts deep into the most fundamental of questions: What kind of country do we want be?

Provincial governments have acted like spoiled children for decades. It seems all we ever hear from them is the need for Ottawa to give "more," but never give anything in return to the country. They have cried wolf long enough. Canadians have tuned them out. We used to have parliamentarians that fought for the interests of Canada as a whole and understood the vital importance of federal leadership in those places where the central nervous system of the nation was involved. Where are they all gone?

Harper writes a blank cheque and tells the provinces that health care is their problem, not ours, collectively, as a nation. He signaled that his government has no interest in building a comprehensive national health policy for Canada that addresses our national health and innovation goals. He knows that only a prime minister can lead that charge. He has chosen not to.

At least Harper is consistent. Nation building is not on his agenda. And slowly, but surely, we are heading down the gradual incrementalist's path to becoming a confederation of shopping centers.

That is not the Canada I want. But we were warned.

Follow Daniel D. Veniez on Twitter: www.twitter.com/@danveniez