Never mind that Mr. Klein himself had not quite decided what that prescription was: Would the premiers agree, or would they once again dissolve in discord?

But of course such an agreement was never in prospect, nor was it necessary -- nor even desirable. Mr. Klein was perhaps too blunt in suggesting that what Alberta did was "none of their business," but it is true all the same: Each province is responsible for its own health care system. Mr. Klein does not need the other premiers' approval to proceed with whatever reforms he has in mind. And the other premiers are free to prescribe their own, quite different courses of treatment. That's not a failure of federalism, that's its genius.

Whatever leadership Alberta exercises in the national health care debate will not be achieved through the premiers agreeing around a table, but rather by setting an example, blazing a trail, which the other provinces may choose to follow or not, according to their own preferences and Alberta's results. For that matter, Alberta can undoubtedly learn from the success or failure of other provinces' experiments, as it has already learned from examples overseas.

Does that mean national standards are obsolete? Not a bit. The Prime Minister was entitled to crow a little after the conference: Far from demanding that the Canada Health Act be amended or repealed, as many critics have urged, the premiers were at pains to emphasize their fealty to the Act, and to its famous five principles. Which is a reminder, not only of the enduring political power of the Act, but of its flexibility. It is quite possible to bring in reform of medicare, even radical reform, without violating the basic principles of public health care. The Canada Health Act is not a "straitjacket." Mind you, the premiers give every sign of testing the boundaries of the permissible.

There is a danger that, rather than openly defy the Act, with all the dangers that entails, they will seek to eviscerate it from within. Hence the demand for a federal-provincial panel to referee disputes over interpretation of the Act: a remarkable demand, given that the Act is federal law, governing the expenditure of federal funds. If the panel's decisions were binding, it would effectively take control over the federal purse from the federal government.

At the same time, the provinces have some justice in complaining at Ottawa's unwillingness to spell out in greater detail what is and is not acceptable under the Act.

Rather than set forth its own interpretation of what the Act's principles mean, and take responsibility for it, the federal government has preferred to lie in the weeds, waiting for the provinces to make the first move, never revealing whether or not it intends to shoot down a particular provincial initiative until the direction of public opinion becomes clear.

But that, surely, is where Roy Romanow comes in. The Romanow commission is at this moment roaming the country, seeking expert and public input on precisely these questions. What sorts of reforms are consistent with the Act's intent? Does "public administration" exclude any role for private corporations? Can a system be "universal," yet still be responsive to individual patient needs? Can "accessibility" be preserved without bankrupting the public treasury? And what does "comprehensiveness" mean, anyway?

If the provinces demand clarity from the federal government on these and other questions, the least they can do is give it a chance to answer. Yet rather than wait until the Romanow commission reports, just 10 months from now, the provinces are away to the races. Alberta insists it cannot wait until then to begin putting into effect the recommendations of its own provincial task force, the Mazankowski commission, even as it concedes that the bulk of these reforms await further study by this or that legislative committee.

And, while they may not have agreed on much, the provinces were unanimous in demanding that Ottawa agree to those federal-provincial dispute panels, no later than April -- or risk unravelling the whole Social Union agreement.

This pompous ultimatum is not only unseemly, but untimely. Depending on its contents, the Romanow report may well provide the basis for a shared interpretation of the Act between the federal government and the provinces, obviating the need for any dispute- settlement mechanism.

In any case, the provinces can't have it both ways. If they want federal money -- and, as important, the political cover of federal legislation -- they have to concede a role for the federal government: not only as the arbiter of the Canada Health Act, but as an active participant in the debate.

What does that mean? It couldn't be clearer: Wait for Romanow.