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Harper told reporters. He also reminded the Alberta government that it has "repeatedly committed in legislation and elsewhere they will respect the Canada Health Act." The act obliges Ottawa to withhold cash payments to the provinces if their provincial health systems don't meet certain federal requirements, including ensuring universal access to insured health care and outlawing extra−billing and user charges. Klein told reporters in Edmonton yesterday that it may come to the point where Alberta will have to weigh the possibility of federal penalties against the benefits of the reforms. Still, critics called on Harper to threaten Alberta with consequences if the province goes ahead with its proposals. "We'll hold the government to account to ensure they enforce the Canada Health Act," interim Liberal leader Bill Graham told reporters. Premier Dalton McGuinty called Alberta's plan a threat to medicare and said Harper must act quickly to stop it. "The ball is clearly in the Prime Minister's court now," McGuinty said outside his government's weekly cabinet meeting. Ontario Health Minister George Smitherman said the longer Harper waits to respond to Alberta's plan, the more doubts it could create about his desire to protect medicare. Allowing doctors to work in both public and private care in Alberta will make waiting lists longer in the public system because there's already a shortage of doctors, and doctors tend to see fewer patients in the private system, Smitherman said. McGuinty said Harper told premiers over dinner Friday in Ottawa that he supports medicare as defined by the Canada Health Act, which requires that medically necessary services be made available to all citizens at public expense without regard to an individual's ability to pay. Alberta's plans go way beyond the bounds of the health act, McGuinty said, noting Harper "specifically said that he was going to encourage experimentation and innovation within the Canada Health Act." Klein, also facing a tricky political situation, with fellow Conservatives now in power in Ottawa, took aim at McGuinty, accusing the Ontario premier of overreacting to proposals that have yet to be drafted into legislation. "I'm no doctor, but I think that Mr. McGuinty's got a case of premature speculation." WITH FILES FROM ROB FERGUSON and cp



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