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Five years ago, an accident on a downtown Montreal street quickly turned my gray hair red with blood and sent me rushing a few hundred yards away to a newly organized medical clinic in the Central Station. The wound was quickly patched up; I was given a pill and told to return a week later.

It was my first experience with a city center drop-in clinic and it proved to be a joyful relief from the crowded and disorderly emergency rooms of the city hospitals. Since then, I have found myself in three different rural hospitals in Quebec. The experience was the same in all of them - fast, competent medical care from cheery doctors and nurses.

Friends tell similar upbeat stories weekly about walk-in clinics and rural hospitals. One story I heard this summer told of a French-speaking doctor in a hospital nearly 600 kilometers northeast of Montreal who, a few weeks after treating a friend for a serious ailment, phoned her doctor in Toronto to check on her condition.

Good news stories are rare, yet whenever two or three Canadians are gathered together, it seems you hear nothing but woes about medical wars like hospital delays, deficient doctors and mixed-up or misplaced blood samples.

In fact, no issue has been argued over so often and so vigorously since the raucous debates around the Goods and Services Tax (GST) and the Free Trade Agreement (FTA) more than a decade ago. Added to the thousands of private debates are six or more official inquiries into medicare that were launched in the last few years. They, in turn, have heard millions of words from hundreds of experts and health-related organizations. The last of them, and in some ways the most important, is the commission headed by former Saskatchewan premier Roy Romanow.

So, with the barrage of recommendations about to engulf us, is there any consensus about what is wrong with the system and how we can repair it? The answer is that there is not a consensus, but there are a few common threads. One is that the medical care system costs too much and will continue to queer our spending priorities until the flow of money into the system is brought under control.

And just to show what perverse thinking still goes on when it comes to medicare, most of the studies also call for new infusions of cash - $2 billion or $3 billion or $5 billion, who knows? - as a short-term answer. Yet anyone with a modicum of experience in the system knows it needs more than the jolt money will give. It needs a series of purgative measures.

One of them is to push primary care doctors to become more innovative and more competitive. Walk-in clinics are one small step. Another is setting up group medical practices that have many of the diagnostic tools close by, like x-ray machines and blood sampling. My doctor works on Saturday and most of the tests his patients need are performed down the hall. But group practices make sense only if they cut costs compared with single-doctor practices.

One of the keys is changing the relationship with the primary care doctors that allows them to click through patients at will and with no accountability. This laissez-faire policy is making the financial burden unbearable.

There are plenty of recommendations like this last one to repair the system, but the next step is harder. That is to find leaders with the political will to push through change. We have many examples in Canada in the last decade of political risk-takers who displayed leadership. One was the Free Trade Agreement (FTA) and another was the introduction of the Goods and Services Tax (GST), both of which were vehemently opposed at the beginning and both of which have proved to be profoundly positive measures.

More recent examples are the government's support of the American anti-terrorist campaign and the Canadian commitment of troops to fight alongside the Americans in Afghanistan.

Medicare is a defining issue for the next generation of political leaders. It is a festering issue. It is dividing the country. And most disheartening of all, it is becoming a spoiler of our federal system.

Yet it would take only one of the 11 federal or provincial leaders, or a combination of several working together, to break the mold. The question is this: are there are any mold-breakers among them?

James Ferrabee welcomes comment on this column at jferrabee@irpp.org