WHEN Stephen Harper, prime minister of Canada, summed up the record of his first five months in office, he could justifiably boast that four of his five campaign "priorities" had been met. Since being sworn in on February 6th, he has introduced legislation to make bureaucrats and politicians more accountable and cut the federal sales tax from 7% to 6%. He has created a new C$100-a-month ($88) payment for child care and brought in a bill to crack down on street crime. But the glaring omission from that list is the one issue Canadians care most about: guaranteeing speedy access to public health care.
The Patient Wait Times Guarantee, under which patients would be transferred to another province or even to America for treatment if they did not receive attention within a specified time, was always an odd item for Mr Harper to put on his list. Stories of patients waiting up to two years for a hip replacement or ten months to see an orthopaedic surgeon have stirred public anxiety. But health care in Canada is a provincial responsibility, not a federal one. And although the provincial premiers happily accept federal money-including the extra C$41billion over ten years promised in 2004-they fiercely resist instructions on how to spend it.
Mr Harper's current strategy is to blame failure on the provinces. Earlier this year Tony Clement, the health minister, angrily told his provincial counterparts to "get off the pot" and produce a waiting-times guarantee. The premiers protest that they are making progress, but that a guarantee is not as simple as Ottawa makes out. They received support in a report last month by Dr Brian Postl, the federal adviser on waiting times, who was appointed by the previous Liberal government.
Long waiting times were a symptom of a much bigger problem, Dr Postl said: there could be no quick fix. Before a guarantee could be issued, a series of system-wide changes was required, ranging from the common-sensical, such as increasing the number of doctors using computer records (only 14% do so at present), to the more innovative, such as using the queuing theories used by air-traffic controllers and amusement parks. Canada might also take a look at countries like Britain, which have had some success in cutting their waiting times, he suggested.
This was not what Mr Harper wanted to hear. He now finds himself stuck in the uncomfortable position of having promised something that it is not in his power to deliver. But a landmark decision by Canada's Supreme Court last year could put fresh pressure on the provinces. The court ruled that Quebec was obliged to provide timely medical treatment or allow patients to pay personally for such services. But to get his promised guarantees, Mr Harper will have to stop sitting on the sidelines and engage the premiers directly.