Year after year, the polls show that health care is the No.1 issue with Canadians. Yet during the federal election campaign the word "health" barely crossed the lips of the five party leaders.
Silence, it is said, can speak volumes.
So what does the political silence on health care mean?
Above all, it means that politicians feel there is much to lose and little to gain in speaking out on health care. Medicare is a sacred cow in Canada, and whenever politicians muse aloud about changing it fundamentally they tend to be punished by the electorate.
[But] in reality, there is little debate on health because there are few real policy differences among the major political parties.
Just look at the party platforms on health, which are remarkable for their similarities rather than differences.
Conservatives: Take "additional steps" to ensure more doctors and nurses are trained; institute "creative measures" to tackle major lung, heart and neurological diseases; work toward bringing an end to discriminatory life-insurance practices.
Liberals: Increase the number of health-care professionals in Canada; forgive $10,000 per year of student debt for health-care professionals who practise in underserviced communities for five years; create a $900-million catastrophic drug plan.
New Democratic Party: Introduce a $1-billion-per-year catastrophic drug plan; increase places in medical schools by 50 per cent; establish mental-health crisis response centres; dedicate 1 per cent of Health Canada's budget to physical fitness and amateur sports.
Greens: Immediate funds to ensure there are more doctors and nurses; hold a public inquiry into rising costs and the overprescription of drugs; $500-million over five years to address inactivity and obesity; legalize marijuana and embrace harm-reduction efforts, treatment and prevention.
Bloc Québécois: No specific platform promise, other than to say health is a provincial jurisdiction.
Based on those platforms and the election results, the new federal health minister (and the leading candidate is Ontario MP Diane Finley) should soon be announcing a program related to health human resources - some significant measures to address the shortage of nurses and physicians across much of the country.
The government will also certainly continue its approach of creating national strategies to deal with major chronic health conditions.
In recent years, the federal government has supported the fashioning of a cancer strategy, a diabetes strategy and a mental-health strategy. (And one of the real oddities of the campaign was that the Tories did not brag about these accomplishments in the health field.) This approach should - and almost certainly will - be extended to dealing with the challenges posed by cardiovascular disease, Alzheimer's disease and chronic obstructive pulmonary disease.
The opposition Liberals and New Democrats, for their part, should be pushing hard for catastrophic drug insurance and pharmacare. A natural extension of medicare would be to ensure that people who need treatment with prescription drugs are not facing discrepancies in overall costs based on age, insurance coverage and location; that people are no longer financially crippled by their drug payments; and that some of the perverse regional disparities in access to drugs are corrected.
It could also be the starting point for a real debate on the future of medicare.
Despite their behaviour on the campaign trail, politicians cannot merely silently support the status quo.
The financial crisis has supplanted health care as the No. 1 priority of voters - at least temporarily. Ironically, that may force our political leaders to engage in a serious debate on health care.
Economic calamity is going to have a severe impact on government spending, and as the top budget line in every province and one of the biggest categories of federal spending health is going to be under the microscope.
In recent years, Ottawa has been nothing but a banker, doling out health dollars to the provinces without any accountability.
The health accords and the targeted funds like those to address wait times have done nothing but paper over severe structural problems and a lack of federal direction.
While it is good to know there is broad support for the publicly funded insurance program called medicare, it is worrisome that our political leaders refuse to engage in any real debate about medicare's limitations and its potential.
Until they do, the crown jewel of Canadian social policy will continue to lose its lustre.
In health care, silence rarely serves the patient well - and that is as true on a national level as on an individual basis.
