National Column: Health-care power play on deck

by Paul Wells

On Friday evening, something will happen that hasn’t happened in nearly 13 years. The prime minister and the provincial premiers will talk about Canada’s health-care system.

Oh, the fun they had last time! Paul Martin was the prime minister. He had run and won re-election on a promise to “fix health care for a generation.”

He would do it with a first ministers conference, televised live, at which he would “buy change” by increasing health transfers in return for provincial promises to make certain changes to their health-care systems.

The reality was messier.

Premiers threatened to walk out. Martin had to sweeten the pot. The negotiations – mercifully, not televised live – dragged on in an atmosphere of high tension. The whole thing was such a festival of stress that for at least the first few years he was prime minister, Stephen Harper probably scored positive karma points by declining to reconvene the premiers.

(That karma turned sour near the end of his time in office, when Harper turned his reluctance to meet the premiers into extended dogmatic refusal. But in those early days, the same bureaucrats who had organized Martin’s meeting with the premiers were offering Harper plenty of reasons why they’d prefer not to relive the experience.)

In the end, Harper implemented precisely half of Martin’s plan. He faithfully completed a decade-long injection of new federal cash into transfers for health, at a rhythm of 6 per cent a year.

He even extended that funding trajectory for two more years after the decade ended.

What he didn’t do was deliver on Martin’s promise to diligently monitor provincial compliance with the fine print of the 2004 health accord, believing the provinces knew best how to run their health-care systems.

While it was hardly the generational fix Martin promised, it was more durable than skeptics like me would have predicted. Martin’s health summit was the third in four years, following two similarly acrimonious meetings chaired by his predecessor, Jean ChrÈtien. The constant churn of urgent meetings was their dubious reward for having cut health transfers in the late 1990s to get chronic federal deficits under control.

The hybrid Martin-Harper solution – growing payments, no real conditions – bought extended peace.

But Harper’s two-year extension to Martin’s 10-year deal ended this year, so first ministers are back at the bargaining table. Both the manner and the substance of their talks show how far we’ve come from Paul Martin’s days.

Trudeau has not been much more eager than Harper was to talk about health care with the provinces.

Friday’s dinner comes tacked on at the end of a daylong meeting on another topic: climate change. There is no formal agenda for the dinner and nobody expects any decisions to be reached.

The provinces, as always, want more money to deal with aging populations, pharmaceutical costs and a shift from hospitals to homes as the location for a lot of health-care delivery.

What they sure don’t want is the cut in the rate of increase in cash transfers – from 6 per cent to something closer to 3 per cent – that Harper called for.

Trudeau rather likes Harper’s schedule for transfer payments. If Trudeau is to sweeten the pot, it’ll be only in return for that favourite Liberal demand: a provincial promise to sign on to pan-Canadian programs in home care, palliative care and mental health.

To varying degrees, the provinces hate the whole scheme. It’s not as though they have been sitting around, waiting for Ottawa’s permission to allocate resources to home care and mental health. As always, they view Ottawa as a back-seat driver with a suspiciously thin wallet.

They’ll take the cash, thanks, and none of the advice.

The traditional Liberal response has been: You don’t get a dime of the cash until you agree to take the advice.

And for all I know, that’ll be Trudeau’s reply, too. But he can be surprising.

He already has been surprising on the climate-change file, threatening to levy a carbon tax in provinces that don’t take their own measures, but offering to deliver every dime he collects to the governments of the provinces where he collects the tax.

A similarly surprising move would be for Trudeau to transfer tax points to the provinces for health, increasing their ability to raise the money they need without cash transfers, in return for some long-term health agreement. Earlier generations of Ottawa-knows-best Liberals wouldn’t think of it.

For Trudeau, I make no predictions. It depends on whether he views health care as a headache he can only hope to contain, or as an opportunity to innovate.

Paul Wells is a national affairs writer.

His column appears Wednesday, Friday, and Saturday.

Copyright 2016-Torstar Syndication Services

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