Lost in all the hubbub over deposed cabinet minister Helena Guergis and her fast-driving husband were three stories of much greater long-term significance to Canadians and their well being.

Together, what these stories show is that the governments of Canada's three largest provinces — Quebec, Ontario and B.C. — are taking dramatic steps to try to get rising health-care costs under control.

Moving from East to West, we saw Quebec Premier Jean Charest's Liberal government put forward a plan to have all patients pay a $25 fee for each visit to a doctor.

Then came Ontario Premier Dalton McGuinty's announcement to lower the cost of generic drugs and also eliminate the "professional allowances" paid pharmacists by drug manufacturers to push certain products.

Added to these initiatives is a new funding formula for B.C. hospitals, which is promised to cut wait times and so create cost-saving efficiencies.

Each proposal was designed to address a different part of the health-care system, the costs of which are rising at an unsustainable six per cent a year.

And you have to think that the almost blitzkrieg-like coordination and weight of the big three instigators means these steps could soon be copied by the other seven and blessed by the federal government.

Generic drugs

New and better drugs are a good part of the reason why people live longer than they used to.

But these new drugs are expensive and are protected by patents that allow the developing companies the time to recoup their investment.

Ontario Premier Dalton McGuinty jokingly switches two beekers during a visit to a chemistry lab at Carleton University in March 2010. Ontario pharmacies are not amused at what they see as his sleight of hand over generic drug prices. (Canadian Press)

Once these patents expire, that's when the generic manufacturers take over, with their supposedly cheaper medications.

Ontario, however, is now saying that these generic manufacturers are going too far to encourage the sale of the drugs they have copied by, in effect, paying pharmacies to sell them.

These so-called professional allowances are then added to the cost of the drugs and so can find their way onto the provincial government's drug plan.

In moving to end these professional allowances, Ontario has, not surprisingly, provoked those who receive them to scream bloody murder.

What's more, it is not just the small, family-owned drug stores that are complaining.

The big fight is being led by the giant Shoppers Drug Mart chain, which is predicting store closings and shorter hours for their pharmacies.

Indeed, the chain has already unveiled its plan to cut back on services in London, Ont., the home of the Ontario health minister, as a warning of things to come.

Hospitals next

In B.C., the change in hospital funding means that instead of receiving block grants to finance their operations, hospitals will now be paid on the basis of each procedure they perform.

It is an approach that neither the public sector unions, whose members work in the hospitals, or the opposition NDP support.

But it has been tried in a number of European countries, most recently in Britain, where it certainly has proven to cut down on wait times. The impact on costs, however, is still open to debate.

Shorter wait times are great for patients but they also mean more patients can be seen and operated on. More operations. More costs.

The longer-term argument, however, is that, over time, as people move through the system, the number of procedures will stabilize and there will be more efficiencies.

User fee

The Quebec government's proposal to put a $25 user charge on visits to the doctor is the most controversial. It doesn't penalize the usual bogeymen of drug companies, pharmacies or public sector unions. It hits everyone in the pocketbook.

Today, it is not just the revolution in drugs that are helping people live longer. Tax-supported heath care means people have access to a greater number of medical services than ever before.

Regular checkups are now a routine practice for most people, particularly as they get older.

Those checkups can reveal developing conditions that preventative drugs or elective surgery can help correct. No longer do people just go to doctors only when they feel sick.

Putting aside for now whether the Quebec proposal runs counter to the Canada Health Act prohibition against extra-billing, putting a charge on doctor visits might well reduce their number and help control costs.

But it would also almost certainly have an impact on the lives of those who stayed away from their doctors because they didn't want to pay the extra tab.

That is not something Quebeckers or people anywhere else in Canada would welcome.

Time to step up

How each of these proposals works out will be important to all provincial governments, not just the three proposing the changes.

In fact, these experiments should be important to the federal government and any thinking politician as well.

For these three governments are trying to come to grips with the costs of health care in advance of the current medicare-funding agreement between Ottawa and the provinces running out in 2014.

That 10-year deal was struck when Ottawa and the provinces were in surplus and the good times looked set to roll on indefinitely. That, of course, is no longer the case.

But we need more than just a few provincial experiments. We need a national debate on how to finance heath care in a time of rising costs, an aging population and massive government debt. And we need it soon, before the current funding agreement expires.

What we don't need is another royal commission, like the one headed by Roy Romanow in 2002.

Politicians can hide behind a commission and then ignore its recommendations if they are controversial.

We need a national debate among politicians who claim to want to be leaders. They should step up, take responsibility, and show they can deal with a real problem that matters to everyone.

Let's face it is not just their political lives that will depend on how health care is preserved. Everyone's life depends on it.