Are we bound for yet another reform of the public health system? It would seem likely, notwithstanding the National Party's election policy.
In Opposition, the Minister of Health, Tony Ryall, had plenty of criticisms to make about the system as it had been reformed by the Clark government.
Labour abandoned the centrally administered Health Funding Authority in favour of 21 district health boards and the Ministry of Health, leaving them responsible for planning and spending, within strict budgetary constraints determined by population.
The new Government commissioned a report from a committee headed by a former secretary of the Treasury to look into the existing system and recommend any reforms.
Its report, published last week, presents Mr Ryall and his colleagues with many stern challenges.
There are more than 170 recommendations, of which the most controversial is a proposal to return to a centrally-based administration, a National Health Board, to control the funding for district boards.
A second new national agency, a sub-group to the board, would be set up to nationally control payroll, funding and purchasing roles, distribute patient subsidies to private doctors and pharmacists, and include the Ministry of Health's statistics unit.
Other key recommendations include the central board's role in determining and funding specialised services at the upper end of the scale, such as liver transplants, cardiac surgery and major burns, taking responsibility for the provision of maternity services, levels of elective surgery and the national cervical- and breast-screening programmes, provision of new facilities, information technology and workforce training.
District boards would likely find themselves required to collaborate more than they do now, and primary health organisations would find themselves being amalgamated into large units in the interests of cost efficiency, having failed to meet the expectations of them in integrated health care.
One of the admitted principal objectives of these reforms is to reduce the health "bureaucracy" and improve services to patients, and both Mr Ryall and the Prime Minister, John Key, have alluded to job losses if the report's recommendations are accepted.
They have also denied the exercise is intended to be cost-cutting, although Mr Key has stated that future increases in the health budget would not be as large as they have been.
Labour increased new health spending by $750 million every year and still people complained about the "failure" of health services; the Government has pledged to match it, but in fact it has little option but to explore alternatives to the provision of public health care on the existing model, since the costs of the service are a huge drain on the Budget and are predicted to get far greater.
The review committee itself claimed the costs are rising at a much faster rate than the country's economic output.
They are expected to double within two decades, unless greater efficiencies or methods of providing it are found.
It would be irresponsible for any government to ignore these implications.
Part charges for some non-acute services may yet return as a means of dealing with costs - already this has happened with physiotherapy treatment under accident compensation - but it is politically unpopular.
Labour's effort to encourage preventive health care was a long-overdue effort and should be continued; centralised purchasing, payroll, IT, and other accounting functions should in theory be more cost-effective; the elimination of duplication and wasteful services is to be encouraged - but determining it is a bureaucratic, not a medical, task.
The proposals for centralised decision-making in the provision of upper-level treatments implies rationing, but public health services have always been rationed: private services are available for people who want gold-plated treatments.
The minister has refrained from making useful or definite comment on the proposals, wisely waiting the public consultation process and its outcome.
He will need, however, to be decisive and some of the Government's decisions will be bound to be unpopular.
But if, as seems obvious, the funding of public health services really is unsustainable, politically unpopular decisions, even radical decisions, will need to be taken - and the public convinced of the benefits.
