While Canadians barbecue and swim this summer, Roy Romanow will be sweating indoors.

The federal health-care commissioner has absorbed the oral and written evidence. He even produced a rather anodyne initial report, but now he has to produce something substantive by fall.

Mr. Romanow, an inveterate talker, has already hinted broadly what he thinks about what he's heard. One commissioned report that he heartily welcomed came from the Canadian Policy Research Networks, so we can presume it told him much of what he wanted to hear.

CPRN conducted 12 daylong focus groups across Canada not just to test Canadians' attitudes to health care but to encourage participants to consider solutions, or what the focus group organizers called "difficult tradeoffs and choices."

The result: Canadians like the health-care status quo but don't believe it's sustainable. That's just what Mr. Romanow has often said.

The focus group participants then reasoned that, if the system isn't sustainable, what next? The broad answer: Keep public medicine, but change how it is delivered and provide much greater transparency and accountability for how the money is spent. Nothing there Mr. Romanow can't abide.

If these changes within the existing system aren't sufficient to produce enough economies to pay for health care's burgeoning costs, the focus group participants then say, Canadians should pay more taxes for health care.

Can Mr. Romanow buy that? Quite probably since, in his many interviews, he has said more money isn't the whole answer but it might be part of it.

No wonder, then, that Mr. Romanow welcomed the CPRN report. Its general findings roughly coincide with his own notions -- and with his ideas of what Canadians will accept in the future. After all, Mr. Romanow is a former NDP premier of Saskatchewan and friend of Jean Chrétien. He obviously wants to produce a blueprint that is politically saleable.

The focus group participants and Mr. Romanow also find common ground in viewing the solutions to health care within what he might call the "rational planners" model.

That model insists that better planning and execution can produce greater efficiencies, improve health-care delivery and forestall any more radical changes to how health care should be financed.

The focus groups, for instance, suggested a national ombudsman and an auditor-general for health, classic examples of external checks on any system. They don't want the essence of the system changed -- only a minority of the participants favoured private payments for health -- but want it better monitored.

For years, health-care managers have been struggling to implement some of the rational planners' solutions -- everything from improved technology to clustering doctors, nurses and pharmacists in primary-care units -- but the focus group participants seem unimpressed. They believe that much more can and should be done; if it is, then the system can be made financially sustainable.

There's a fair bit of wishful thinking in the rational planners' world. Not that their ideas are wrong; indeed, many are urgently needed. It's just that some of these ideas will cost more money, so the net savings will be minimal.

Of course, money could be diverted to health care from other government services. But the focus group participants didn't favour this option. They want better health care and the same levels of spending on everything else -- a square that cannot be circled.

The CPRN groups didn't explore one of the conundrums of the health-care world: extending public health care to areas now only spottily covered, such as drug coverage, long-term care, acute care and home care.

They were just looking at tradeoffs within what is now covered publicly. Throw in extended coverage and the tradeoffs become more acute.

Canadians who love their system are usually unaware how limited it is, although surely Mr. Romanow understands the limitations. Compared to most other sensible systems (the American system thereby being excluded), medicare covers a narrow range of services. After hospitals and doctors, coverage becomes hit-and-miss.

If Canadians broaden public coverage, as they should, then paying for the new costs can only occur in three ways. They can cut other government programs, which they don't want to do. They can allow private money into the system, which most oppose. Or they can get ready to pay more taxes.

They can encourage, as the CPRN focus groups did, more efficiencies and greater accountability -- the rational planners' solutions. But those solutions won't cover the burgeoning costs of the existing system, let alone a broader one.