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Midway through a speech to the Canadian Club last Monday, Ontario's Health Minister previewed what will soon be a very familiar theme.

"The federal government has yet to commit to renewing the Canada Health Transfer," Deb Matthews lamented. Negotiations before that deal expires in 2014 will test whether "our generation will make the necessary investments to keep our universal system intact."

By next fall, that refrain will be heard across the country. Although the $41-billion agreement signed in 2004 did not quite prove the "fix for a generation" that then-prime minister Paul Martin promised, provinces already struggling to pay soaring health costs would be very hard-pressed to make ends meet without that cash.

The loudest noise, at least this year, will come from Ontario. There, it will be framed against an election backdrop – playing a big role in the efforts of the incumbent government to win a third term.

In the looming federal-provincial negotiations, Dalton McGuinty's Liberals see an opportunity to paint themselves as the great defenders of public health care – and to paint Progressive Conservative Leader Tim Hudak into a corner.

Historically, Ontarians have tended to avoid having the same party in power both federally and provincially. That might be mostly a coincidence. But the provincial Liberals believe that, particularly if Stephen Harper's Conservatives win a new mandate in an election this spring, it will be possible to persuade Ontarians that only Mr. McGuinty can ensure the federal deficit won't be eliminated on the back of their health care.

"The future of medicare will be at stake in the next three years," said one senior Liberal. Mr. McGuinty may soon be the last participant of the 2004 talks still in office. And he's proven before, this argument goes, that he's not afraid to tangle with Mr. Harper, while Mr. Hudak, who's comparatively inexperienced and has close ties to his federal cousins, is likelier to prove a lapdog.

"Who do you want sitting across the table from Stephen Harper?" another asks rhetorically, summarizing the case his party his will make.

Whether the stand-up-for-Ontario act gets voters excited remains to be seen. Mr. McGuinty previously scored some concessions out of Ottawa with his "fairness" campaign, which targeted the gap between what Ontarians pay to the federal government and what they get in return. But it was hardly the talk of the province. Compared to Albertans or Quebeckers or Newfoundlanders, Ontarians are famously difficult to rally around their province's alleged mistreatment.

But even if it doesn't catch populist fire, the health-accord jockeying has its political advantages. For the Liberals, any campaign day spent talking about health care – generally a vote-getter for them, and not for the Tories – has to be considered a good day. It's an opportunity, if nothing else, to tout the investments they've made in the system, and to keep the spotlight away from less helpful issues such as pocketbook pressures.

Whether that kind of focus will actually suit the province's long-term interests is a different matter.

Certainly, negotiating a new accord will be a big part of the next government's responsibilities, and Mr. McGuinty can probably make a decent case that he's the best person for it. But if he gets re-elected partly by making Mr. Harper a target during the campaign, the Prime Minister - who's not known for his thick skin - may be less than inclined to strike a conciliatory tone thereafter.

A federal-provincial blame game, coupled with dark insinuations about Mr. Hudak's intentions, is also a poor substitute for a harder and more complicated discussion about the kinds of reforms needed to preserve the public system. That discussion is rather pressing, considering that even with the current level of federal support, health costs are approaching 50 per cent of all provincial program expenditures - with an aging population threatening to accelerate that curve.

But then, it's not as though any of the parties are eager to have that conversation at election time. The Liberals would be happy enough to win the right to lead it sometime after 2011. And setting up Mr. Hudak and Mr. Harper as a twin threat is a big part of their hopes.

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