Canadians can feel it -- something's not right in our country when it comes to health care. We know our public system is fundamentally sound, but we also know that there is much work to be done to improve it and ensure it's as sustainable as we want it to be for generations to come. We see our health care providers and provincial governments struggling to improve services in the context of tight public budgets and an aging population. Almost everyone is trying to make medicare better.

But one critical player is missing from the effort -- where is our federal government when it comes to health care?

Democratically elected leaders are expected to represent the views of their constituents. And in this case it's clear: Canadians want our federal government to be part of the solution to the national challenges we face in health care. Public opinion research conducted for Health Canada released in May reinforced this message.

There is so much we could accomplish with federal leadership. We're getting a raw deal on our pharmaceuticals; the federal government could coordinate a bulk-purchasing strategy and a national public drug formulary. As First Nations, refugees, rural, and inner-city populations grapple with challenges to health equity, the federal government could be the leader in improving the health of society's most vulnerable. And as interprovincial inequities deepen in a number of areas, the federal government could ensure that all Canadians are able to expect timely access to a common basket of services, such as long-term care and home care, particularly as provinces are striving to meet the changing needs of an older population

But instead of facing these challenges, in December 2011, the federal government announced that it would shift to a per capita transfer system that ties funding increases to economic growth. It then walked away from the 2014 Health Accord negotiating table, shirking a critical responsibility to provide leadership in transforming our health care system, and abandoning a commitment to ensuring that Canadians have comparable levels and quality of health care from province to province.

Why does the change in the funding formula matter? Originally, cash transfers were distributed on a formula that ensured that all provinces could meet national standards without the burden being more onerous on some than on others. A straight per capita tax transfer was seen as unfair because provinces with fewer resources would carry a heavier burden than more wealthy provinces. The same is still true today.

But health care isn't just about dollars and cents. No one wants a health care system that consumes endless pots of money. What the government of Canada is really saying with this transfer is that it doesn't want to be involved any more. They're not interested in making sure that Albertans get the same standard of care as Nova Scotians, or that a successful new approach for wait times in Victoria is used in St. John's as well. And that is what's truly unacceptable.

There are already inequities in health care, with different levels of coverage for pharmaceuticals, long-term care, and dental care from province to province. Currently, pharmaceutical coverage for seniors varies widely across the country; we need leadership to help ensure that our seniors are treated equitably from coast to coast. Moving forward without the federal government's involvement in national standards will lead to deepening inequalities between provinces.

The 2004 Health Accord drove meaningful change for health care in our country, committing to increased federal funding, and importantly, setting benchmarks and making progress on issues like wait times. Although there's still more work to be done on wait times, we at least know how the provinces stack up against each other, and waits have improved over the lifespan of the Accord because of the coordinated goal-setting with the federal government.

In late July, our country's premiers will be meeting in Halifax at the Council of the Federation, where both health care innovations and funding will be on the agenda. Our premiers need to work together, but also to work at bringing the federal government back to the table.

The federal government's current strategy seems to be diminishing the expectations of Canadians, offloading all responsibility to the provinces, and letting the chips fall where they may. The idea that we will simply get used to health care being the sole responsibility of provinces is naïve. Canadians believe deeply in a society that takes care of each other, and one way that we express that belief is through medicare - it's the highest expression of Canadians caring for one another. That aspiration is a national one, and it deserves the attention of our national leaders.

We need leaders who will rise to the challenge of protecting and improving medicare, not shirk their responsibilities. Prime Minister Harper, you are needed back at the table for a 2014 Health Accord. Canadians have real expectations of you, not just to cut cheques -- and increasingly smaller cheques at that -- but to lead Canada on health care. Your absence will hurt the health of Canadians.