First Ministers’ conferences in Canada tend to be exercises of political theatre and this week’s health-care summit hosted by Prime Minister Justin Trudeau was no exception. The show went smoothly aside from the awkward handshake episode between a smiling Trudeau and a clearly nonplussed Alberta Premier Danielle Smith during the photo-op stage of the affair.
The premiers had entered the summit seeking an increase in federal health transfers in the range of $28 billion per year. Trudeau’s offer fell well short with a proposed increase of $4.6 billion per year. While the gulf between what was demanded and what was offered appears massive, it is all just part of the negotiation games played between provincial and federal leaders. Canada’s premiers will now meet and discuss potential counterproposals to the federal offer.
Most of the premiers sounded tentatively optimistic about reaching a deal. Ontario Premier Doug Ford called Trudeau’s offer a starting point while P.E.I. Premier Dennis King sounded eager to accept the deal immediately saying, “This is money that is so needed in P.E.I. and we need to get to work on it as quickly as possible.”
One noteworthy aspect of the summit was what wasn’t said by the prime minister.
NDP leader Jagmeet Singh has been demanding an emergency parliamentary debate on health care since mid-January. Singh wants Trudeau to intervene in Alberta and Ontario to prevent the provinces from expanding private health-care service delivery. If Trudeau were to try to pressure the provinces on how they choose to deliver health-care services, the summit would have provided that opportunity. The prime minister could have attached conditions to the proposed health-care transfer increase limiting what provinces could invest the funds into. Instead, the only condition Trudeau offered was that provinces remain within the constraints of the Canada Health Act.
Despite Singh’s indignance and posturing over Alberta and Ontario’s expansion of privately provided health-care services, those provincial initiatives don’t clash with the Canada Health Act in any way if universal coverage is offered. If Trudeau had acceded to Singh’s demands, it surely would have led to a heated jurisdictional battle between Ottawa and the provinces as health-care delivery is exclusively within provincial authority.
The NDP can’t afford to keep looking like the weaker partner in the NDP/Liberal marriage. Core NDP supporters will start losing faith in Singh’s leadership while Trudeau’s Liberals will appear to be the only viable alternative to Pierre Poilievre’s Conservatives. Singh can only bluff for so long.
In the original Canadian Medical Care Act, the federal government was to provide 50 percent of the funding for health care to the provinces while the provinces were to be solely responsible for providing the care. Today, the federal government is providing 22 percent of the costs of health care to the provinces and often adds conditions to the transfers. The spirit of the original act and the independence of provinces within it has been seriously eroded over time but cash-strapped premiers just don’t have the time or political will to try and battle the federal government on the issue.
If anybody could be declared a winner in the recent health-care summit, it is Prime Minister Trudeau. Trudeau weakened the position of his NDP rival while appearing magnanimous in offering a modest increase in federal health-care funding to the provinces. Premiers may be discontent with the increase, but they will likely accept the deal with a minimum in negotiations and counteroffers.
