The Romanow report on the future of health care will come down some time in November. The first ministers will hold a health-care summit in January. The federal budget will commit new funding to a reformed health-care system in February.

This should be unachievable, and it is. But a compromise between Ottawa and the provinces is under way that will satisfy all sides. The only price will be making the reforms cosmetic, rather than real, turning Roy Romanow's report into yet another federal exercise in futility.

Jean Chrétien, via this week's Throne Speech, sharply rebuffed Finance Minister John Manley's prediction that health care would not figure prominently in his first budget.

It was only last August that Mr. Manley opined: "I think the real question is whether it will be possible to fully respond to Romanow in my first budget. . . . We'll do our part, but there are other issues that may affect the budget agenda other than Romanow."

Oh no there aren't. The Throne Speech promises "a comprehensive plan for reform" of health care, including "the necessary federal long-term investments, which will be included in the next budget."

How can this be? Mr. Romanow's report will contain a gazillion recommendations on how to restore public confidence in the health-care system, while also urging the federal government to substantially increase funding.

And Mr. Romanow is right: What government would throw billions more dollars at health care without also offering a comprehensive reform of the system?

As it turns out, this government would.

The Chrétien regime once dreamed big about shaping a new national health policy. It fantasized about a national pharmacare program, about national standards in home care, about influencing primary-care reform.

Several black eyes later, Ottawa learned that the provincial governments jealously protect their control over their individual systems. Ontario, Quebec and Alberta, in particular, had no intention of letting new federal funding arrive with any serious strings attached.

This time, the provinces are looking for another $5-billion a year, increasing the federal contribution to the level it was at when Mr. Chrétien took office.

The Prime Minister will be inclined to give them much of what they ask, in exchange for two things: an increased emphasis on "wellness" programs that emphasize environmental health, physical fitness, fighting childhood obesity, that sort of thing. Ottawa will also demand that it receive greater recognition of its increased contribution.

The provinces will grumble but go along, provided more onerous demands such as dedicated funds for drugs or diagnostic equipment are kept off the table. Everyone supports wellness, and if the feds want their name on a sign, well, paint is cheap.

Or, as Ontario Health Minister Tony Clement put it in an interview: "If it takes a ticker-tape parade [to get the money], that's fine. Premier Eves and I will throw them a ticker-tape parade."

The federal government's biggest challenge will be to sell the public on the need for greatly increased health-care funding in a year of little or no budget surplus, which will mean either tax increases or cuts to other programs.

Mr. Chrétien started to brace the public yesterday for the shocks to come.

"The issue is not whether we will pay more for health as a society because we will," he told the House. "I know that Canadians will be prepared to pay that cost, but we will do so collectively as a society."

That will satisfy none of the authors of various health-care studies either delivered or on their way (including Michael Kirby in the Senate and Don Mazankowski in Alberta) who have urged fundamental reforms.

Some critics argue the only way to save public health care is to partly abandon it, by allowing user fees or even a limited parallel private system.

Mr. Romanow, while insisting that the system remain fully public, will argue for such things as primary-care reform (making doctors pool their practices, and paying them a kind of salary) and an end to interprovincial raiding of each others' doctors and nurses.

But with a February deadline, there will be no time for any meaningful debate on these issues. Romanow, Kirby and Mazankowski will simply become interesting contributions to the debate.

Which is the sad thing about all this. More money won't attack the roots of the disease afflicting health care. Every year, propping up the system eats up a larger portion of government budgets; every year, as the population ages, the situation gets worse.

But time is running out, and the Prime Minister wants peace. It will only cost him $5-billion to get it.