On April 4, 2007, Prime Minister Stephen Harper announced that all of the provinces and territories had agreed to establish Patient Wait Times Guarantees by 2010. But as press reports indicated, most of the governments chose only one target procedure and many were already meeting the benchmarks set in September 2004. Does this suggest another round of sterile conflict ahead or does it herald a period of sustained change and renewal? Will the next phase see electronic health records introduced and a federal–provincial–territorial effort made to control drug costs? Will the needs of Aboriginal peoples and other underserviced Canadians be met? Will attention and funding shift to prevention and health promotion as Canada prepares to battle childhood and adult obesity, heart problems, diabetes and other chronic illnesses? How will changes ahead affect the historical division of labour in the health care sector? Will teams replace solo practitioners? Will community activism and a continuum of care supersede institutional loyalty? Will Canadians cease to regard doctors and hospitals as the core of medicare and focus on the determinants of health instead? And will a majority of Canadians maintain their commitment to universal access based on need? The answers to these questions will shape the future of medicare in the twenty-first century.