Paul Wells says best to check the math when provinces jostle for health care cash


“Your French is getting better,” a reporter told Jane Philpott on Wednesday as the federal health minister wrapped up a chat with some members of the press gallery before the weekly Liberal caucus meeting.

Of course her French is getting better. She’s getting a lot of practice. In mid-October Philpott will meet her provincial colleagues to discuss the amount of money Ottawa transfers to the provinces for health care. The approach of such festivities has triggered the traditional Busting of the Gaskets among Philpott’s provincial colleagues.

The Busting of the Gaskets is a highly ritualized tribal dance on two themes. First, that the federal government is not sending the provinces enough money for health care. Second, that in return for whatever pittance they send, the federal government demands that provinces allocate part of the paltry bounty toward some designated project. Home care or pharmacare or palliative care for the elderly, or better cross-border sharing of health information, depending on the seasons.

It’s traditional for the position of Head Reveller of the Busting of the Gaskets to be filled by Quebec’s health minister, and this year’s incumbent, the fiery Gaétan Barrette, is brilliantly cast.

Barrette has already complained that the Liberals are imitating their predecessors, Stephen Harper’s Conservatives, in the amount of money they plan to devote to transfers to the provinces for health care. Of course he judges the money to be insufficient. And he is even more thoroughly vexed that Philpott wants to identify shared priorities, such as home care, even before the (surely paltry!) amount of the health transfers is known.

Earlier this week Barrette said that if money from Ottawa for health comes with conditions, he will simply refuse to accept any. This is (a) improbable; (b) not his decision to make, but that of Quebec’s finance minister or premier; (c) highly entertaining all the same.

Interrogated all week by reporters, most of them from Montreal-based news organizations, on each day’s new protest from Barrette, Philpott has had to brush up on her subject-verb agreement.

“Il n’y a pas de discussion de conditions qu’on a discutées,” she said on Wednesday. Roughly: There is no discussion of conditions that we have discussed. “We have simply said that we want to support provinces and territories,” she said (and now I’m translating for her, although it should be said her French really is quite strong). “We can add more money for” — here she forgot the word for “challenges” — “for things that are difficult for them, such as home care. And I think we’ll have a good dialogue.”

Barrette, who likes to bust a gasket even when he’s home among friends in Quebec City, does have a point about health transfers. After growing at 6 per cent a year for a decade — under an agreement Paul Martin reached with the provinces in 2005, one that Stephen Harper was careful to keep — transfers are scheduled to grow only about 3 per cent a year, starting next year. This, too, was Harper’s decision. The provinces were furious. In last year’s election Tom Mulcair and the NDP promised to return the growth rate to 6 per cent, at a cost of up to $36 billion over a decade.

Justin Trudeau’s Liberals were careful to be more vague. This week Philpott has admitted what many suspected, which is that Harper’s plan for transfers is Trudeau’s. Well, she phrased it differently. And she said the government is willing to sweeten the pot a bit for specific programs, but only if the provinces meet federal conditions — sorry, “good dialogue” — on the use of any additional funds.

When pressed for more funds and fewer conditions, Philpott protests that the basic transfer programs aren’t even her file, but those of her colleague Bill Morneau over at finance. The provincial premiers have decided there is no point negotiating for cash with a minister who cannot decide how much they get. They want a meeting with Trudeau himself, mano a many manos.

Their hand would be strengthened if health costs were exploding, as everyone assumes they still are. Unfortunately for the provinces, the Canada Institute for Health Information reports that total health spending in Canada “has fallen gradually in the past few years” as a share of GDP. “Since 2011, health spending has decreased by an average of 0.6 per cent per year,” the institute’s 2015 report on health expenditure trends says.

That relative decline in health spending happened while federal health transfers were growing at 6 per cent a year. It’s too early to prejudge the outcome of the inevitable federal-provincial horse-trading that will take up much of the autumn. But when the provinces cry salty tears, it’s always a good idea to check their math.

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