Premiers seek consensus on next health accord as ‘fix for a generation’ runs out

The final day of the premiers meeting in Whitehorse finds Canada’s provinces and territories in search of a common strategy for negotiating higher health transfers from the federal government.

The 2004 federal-provincial health accord — the one former prime minister Paul Martin called the ‘fix for a generation’ — runs out next spring.

Premiers need a new fix now. And their negotiating case will be strongest if they can agree on what that looks like.

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The former Conservative government decided in late 2011 to cut the rate of growth in federal health care transfers from six to three per cent, and gave provinces five years to get used to the idea.

No surprise: they still don’t like it. And with a new Liberal government elected last year, they’re hopeful a new health accord could result in a better deal.

But although the federal Liberal campaign promised new targeted health care spending, such as $3 billion for home care, nothing’s been delivered yet.

‘Money is money’

The discussions at this year’s Council of the Federation start from the common ground of agreeing that no province has enough health care funding to meet its needs.

But that’s the easy part. It’s defining an exact form for the additional money that’s harder to pin down.

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“Money is money at the end of the day, right?” British Columbia Premier Christy Clark told reporters when she arrived Thursday. The federal government used to fund closer to 50 per cent of health costs and is now paying for less than 20, she said.

She seemed OK with an idea advanced by Federal Health Minister Jane Philpott: identifying a specific use for additional funding from Ottawa, allowing the federal government to pursue precise policy goals.

“Targeting money is good solution,” Clark said, suggesting areas like mental health or seniors as worthy priorities everyone could get behind.

But allowing the federal government to set policy can get jurisdictional backs up. Health care is supposed to be left to provinces to manage.

There’s a giant jenga game here. #COF2016 pic.twitter.com/73DwqphayP

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@CherylKawaja

Quebec Premier Philippe Couillard said he’s pleased the federal government wants to talk about more health care funding, but he wants to engage them “strictly on funding, rather than on policy.”

“We always have to remind our federal partners that provinces have the jurisdiction,” he said. “We know what to do. We know what should be done. We need the means to do it better.

“Not that money will solve everything in health care… it’s part of the solution, but an important part of the solution.” 

Targeting too temporary

Couillard’s health and finance ministers wrote to the federal government last month to argue against targeting new spending.

“By their very nature, targeted funds are temporary and generally conditional on the achievement of new initiatives that do not necessarily correspond to the priorities of the provincial governments,” they wrote.

“History has taught us that when targeted funds run out, the provinces must solely take up responsibility for the expenses related to the new initiatives, which only further increases the financial pressures bearing upon them.”

Demanding a new health accord and national pharmacare outside the premiers meetings in Whitehorse. #COF2016 pic.twitter.com/kLN8Be0Igi

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@CherylKawaja

Manitoba Premier Brian Pallister is expressing similar concerns this week.

“It’s of paramount importance that we get a long-term partnership and a commitment from the federal government that’s real,” he said, citing issues like wait times, high ambulance costs and a shortage of personal home care beds.

“We need an indication that it’s lasting and sincere.”

25% transfer a starting point

As chair of the Council of the Federation this year, Yukon Premier Darrell Pasloski is in charge of guiding the discussions towards — hopefully — a common position to take to the federal government.

“We stated last year that the federal government should be providing 25 per cent of health care dollars, and what we have heard from the parliamentary budget officer, with the aging population that we have, is this is not sustainable from a provincial or territorial level.”

But beyond strictly cutting a larger cheque across the board, Pasloski believes the federal government’s approach has to take into account the diversity of needs across Canada.

Yukon Premier Darrell Pasloski, left, seen here with Newfoundland and Labrador Premier Dwight Ball, wants a new federal-provincial health accord that takes into account the diversity of health care needs across Canada. (Jonathan Hayward/Canadian Press)

Health care works differently in remote communities than in urban centres. Regions with aging populations can expect a higher need for certain services.

“It is the provinces and territories that understand the complexities and differences that exist within jurisdictions and the federal government has to accept that,” he said.

While provinces don’t want to be told what to do, that doesn’t mean they won’t need to explain why they require more funding.

“We need to have a policy discussion and a financing discussion at the same time, otherwise things don’t move forward,” he said.

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