At last. We have the best plan ever on health care with the recent report by Dr. John Ross. And the government has accepted all his recommendations to stream patients away from overcrowded emergency rooms through ER reforms, collaborative care clinics and in other ways. But what now?

Here's the skeptical argument first, from my Deep Throat in the system, an ER doctor with many scars from the bad old days of politicized health care. Notably, as a consultant, he was involved in the Alberta reforms of a few years ago -- similar to what's being proposed here -- that now seem to be coming apart because of political bungling.

Governments are still reeling from recession-induced deficits, but now their attention is turning to another fiscal elephant marching into the room: the coming renegotiation of federal-provincial transfer payments. The Canada Health Transfer (CHT) expires in 2014, and must be extended soon. Finance Minister Jim Flaherty plans to clamp down on transfers to reduce his own deficit. But that just passes the buck to the provinces, whose fiscal position is even worse.

As this debate heats up, there's a new piece of knowledge that should be considered carefully as finance ministers arm-wrestle. Since the CHT was implemented in 2004, researchers around the world have established a whole new field of scientific knowledge regarding the social determinants of health.

One thing about our health care system in Nova Scotia: It produces good reports on what to do. It's doing it that's the problem. Now, at the end of a string of studies going back a decade and a half, the one by Dr. John Ross on emergency care nails it once and for all. If nothing happens now, we're really in trouble.

It's been a year and a half since I left off writing about the crucial, politically charged and bureaucratically overwrought subject of health care, awaiting developments with the new government. Recently, I've been looking for signs of where we're at.