Call it a symbolic gesture, a strategy that failed, or a principled stand by one when others bowed to pressure, the result remains the same: Manitoba is now the only province without a deal on the federal health transfer.

One by one the provinces fell to a kind of financial arm-twisting only Ottawa can focus on its Confederation partners. Federal Health Minister Jane Philpott can claim there was no "divide and conquer" strategy, but like a card player with a strong hand, the other provinces gradually folded.

Premier Brian Pallister can be accused of many things, but a pushover isn't one of them. At well over two metres in height, Pallister may stand like a giraffe among Canadian premiers, but on health money he has become the country's lone wolf.

Not that he had many sharp teeth to bare at the feds. Confront Pallister with Philpott's assertion there was no "divide and conquer" strategy and you might get a sound like a snarl before an answer, but that growl is lost in the wind between Winnipeg and Ottawa.

Pallister: Ottawa must help address "the disparity of health care between Indigenous and non-Indigenous Manitobans." (CBC News ) Manitoba doesn't have the economic clout of centre-of-the-universe Ontario, or the cultural and historic heft of Quebec. Nor does the Keystone province bring the same measure of resource-rich gravitas of, say, a British Columbia or Alberta.

So Pallister used what little leverage he had on the national scene: in December he held his signature back from a federal climate change plan.

Health, Pallister told Prime Minister Justin Trudeau, must come first.

"I have an obligation, because that's the first concern of the people of my province, to raise the issue, and I will continue to raise the issue," Pallister told reporters during a First Ministers conference on climate change late last year.

Trudeau never said how much he felt the sting of the Pallister pivot.

It must have hurt Pallister when his oft-admired neighbour Premier Brad Wall succumbed.

Regardless, the bargaining sand beneath Pallister's feet continued to erode as federal promises of cash for each of the province's pet projects was dangled, then snatched. Most of the Atlantic provinces buckled first. Then the northern territories went.

It must have hurt Pallister when his oft-admired neighbour Premier Brad Wall succumbed after Ottawa promised Saskatchewan a "reprieve" for one year to prove that its private MRIs don't hurt the public health-care system.

The underpinning of Pallister's argument for more funding for Manitoba is solid and justifiable. The province needs, he says, more money to improve health outcomes for Indigenous people and to fight diabetes.

In a recent letter to the Prime Minister, Pallister asked for cash to address those concerns and to fight chronic kidney disease.

This reasoning is more than sound, it is fact. Health care delivery to First Nations, both in anecdote and statistics, is in chronic disorder. Pallister's comment that Ottawa must be a partner to repair the "long-standing inequalities between Indigenous and non-Indigenous peoples" should be taken seriously.

Missed opportunity for an ally?

Though the foundation of his stand with Ottawa is rock-solid, perhaps Pallister's strategy is flawed.

Prime Minister Trudeau campaigned vigorously in the last election on a promise to renew the nation-to-nation relationship with Canada's Indigenous peoples.

But Manitoba's premier chose to carry the torch of Indigenous inequality to Canada's capital on his own. He might have sent emissaries first.

Manitoba Keewatinowi Okimakanak, the advocacy group representing 30 Cree, Oji-Cree and Dene First Nations, and its charismatic leader, Grand Chief Sheila North Wilson, could have been a good choice. But Pallister chose to go it alone.

Grand Chief Sheila North Wilson wants a dialogue about health care on First Nations but says her requests have been ignored. (CBC News)

"There shouldn't be anything about us without us," North Wilson said Friday. "We need to work together to come up with solutions ... if they do have a plan I wish they would share it with us so we can collaborate."

That collaboration didn't happen and whether it might have helped or not, Manitoba now stands alone without a deal.

This is not to say Pallister isn't correct on his stand about health funding from the feds. A 3.5 per cent per-year increase (down from more than a decade of six per cent increases) will not satisfy the growing demand for health services from an aging population and redress Ottawa's continuing withdrawal from the health care partnership with the provinces.

But being right doesn't mean the lanky Manitoba premier won the game of musical chairs on the health transfer file.

The music stopped and Manitoba couldn't find a seat.