As negotiations on a new federal-provincial health-care accord get underway in earnest, the premiers have at last provided an answer to an enduring riddle: what exactly is there to negotiate? Specifically, what do the premiers bring to the table?
We know what the federal government brings: money. Pots of it. Ottawa transfers tens of billions of dollars annually to pay for what the provinces will remind anyone within hearing is provincial jurisdiction. That’s the “accord” part, in toto: the feds agree to hand over the money, and the provinces agree to take it. Notionally there are conditions attached to it — the five conditions of the Canada Health Act — but the conditions are increasingly unenforced.
It isn’t even “for health care,” really, though that’s a fiction that it suits all sides to maintain. The money doesn’t come with little labels attached; it all goes into the provinces’ general revenues, to be spent as they like. So even as federal transfers “for health care” have gone on rising at a fixed six per cent per annum — part of a previous “accord” under Paul Martin — provincial spending on health care in recent years has been growing at something closer to one per cent. The higher federal transfers have in fact underwritten a shift in provincial spending into other areas.
Stephen Harper, tiring of the game, declined to indulge the premiers in the pretence of negotiations or even meetings. Provinces were simply informed that, as of fiscal year 2017-18, the six per cent escalator would be reduced to the rate of growth in GDP or three per cent, whichever is greater. That was Harper’s version of an “accord.” The provinces could either take the federal offer, or take it. Understand: federal transfers would continue to rise — faster than inflation, faster than inflation plus population growth, as fast or faster than the economy. They just wouldn’t rise quite as fast as they had been rising.
That’s the ‘accord’ part, in toto: the feds agree to hand over the money, and the provinces agree to take it
The provinces were given years to prepare for this. Yet here we are, with the old “accord” months away from expiring, and the premiers are still squawking as loudly as ever. The three per cent escalator, they continue to claim, amounts to a “cut” in federal transfers. Even more disingenuously, they pretend they will be forced to cut spending on health care by it — that is, by an increase in federal transfers that remains in excess of any planned increases in provincial health budgets.
Granted, when it comes to Justin Trudeau, the premiers have a right to feel as if they have been, not to put too fine a point on it, had. When the Liberals promised, during the past election campaign, that they would “negotiate a new Health Accord with provinces and territories, including a long-term agreement on funding,” the provinces might have been excused for thinking the new accord would in some way differ from the old.
Likewise, when the Grits promised, “as an immediate commitment,” to “invest $3 billion, over the next four years, to deliver more and better home-care services,” the provinces may not have suspected that the immediate commitment was also the long-term commitment. But alas that was in fact what the Liberal offer amounted to. It’s three per cent, plus a one-time infusion of $3 billion for home care. That’s it: take it or take it, as before.
Still: when B.C. Premier Christy Clark says the provinces “can’t accept” the three per cent escalator, what can she mean? That they won’t take the money? That indeed was what Quebec’s health minister, Gaétan Barrette, appeared to suggest his province would do, should there be any conditions attached to it, as in the Liberal home-care pledge. That would certainly be principled.
So it was a historic moment last week when the premiers sent the prime minister a letter demanding a meeting on health care — you know, to “negotiate.” The letter, from Yukon Premier Darrell Pasloski, acting in his capacity as chairman of the Council of the Federation (that’s the premiers, in case you were wondering) carried an implied threat. “In the spirit of collaboration,” it began, ominously, “we believe that this meeting should be confirmed prior to the first ministers’ meeting on climate change and clean growth.” Translation: that’s a nice little pan-Canadian carbon pricing framework you got there. Pity if anything should happen to it.
At last! A bargaining chip! All these years the premiers have been offering, in exchange for $70 billion annually in federal transfers (including equalization) to do, in precise terms, “nothing of any kind.” Now at last they have something constructive to propose. Should the federal government cave in to their demands and agree to restore the rate of increase in health transfers to six per cent — a rate that absolutely everyone not actually addressed as “premier” agrees is unsustainable — they won’t wreck the federal government’s signature policy initiative and Canada’s contribution to saving the planet.
Which makes Monday’s announcement confirming that the Liberals will proceed, within two years, to impose a carbon price in any province or territory whose government refuses to do so itself so interesting. On climate change, as on health care, Liberal policy is looking more and more like that of the Conservative government that preceded it: the same targets, and the same brusque approach to dealing with the provinces.
The premiers, having made the feds an offer, have now received their reply: take it, or take it.
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