It's a bad time for Canada's premiers to fight with Ottawa over health-care funding

For the first time in 16 years, Canada’s first ministers gathered — albeit virtually — to discuss a new health-care deal on Thursday.

As in 2004, the meeting featured a minority Liberal government facing a potentially imminent return to the polls and a provincial front united in its demand for a larger federal health transfer.

The similarities end here.

Back at the time of their negotiation with then-prime minister Paul Martin, the premiers clearly held the better cards.

They walked away with an accord that increased the federal health transfer by six per cent every year for a decade.

Stephen Harper subsequently extended that arrangement for a further two years before bringing down the rate of the annual increase to three per cent. That is where it has remained under the current Liberal government.

The scenario was quite different this week.

While Prime Minister did not rule out an eventual increase in the federal contribution to health care, he made it clear he would consider it in his own time — after the pandemic is resolved — and on his own terms, in a way that aligns with federal priorities on long-term care and pharmacare.

That left Quebec Premier François Legault — speaking as the current chair of the Council of the Federation — to fume about a missed opportunity and to hint at asking the opposition majority in the House of Commons to exact a no-strings-attached hefty federal increase in the health transfer in exchange for support for the spring budget.

But before he steps in front of a federal election parade on behalf of the provinces, Legault might want to reflect on whether he is not playing into Trudeau’s hand.

Yes, health care is back on voters’ radar as a result of the pandemic. But the notion that it is great news for the premiers seems mostly to be a product of their collective wishful thinking.

Notwithstanding Legault’s rhetoric, he and the other premiers currently hold a weaker hand than their predecessors did in 2004.

Take Legault himself. While he was huddled with the other premiers Thursday, his provincial ombudswoman was delivering a devastating assessment of the conditions that allowed COVID-19 to wreak havoc in the province’s long-term-care homes last spring.

Marie Rinfret’s report reads like an indictment of decades of neglect on the watch of three different provincial parties. Even as federal funding was increasing faster than the rate of inflation, and even as the population was steadily aging, long-term care was anything but a priority.

The situation is hardly unique to Quebec. And it does little to shore up the argument that an extra influx in federal money — to be spent at provincial discretion — will fix the failings of less-electorally attractive sections of the health-care system.

Indeed, if only to be able to keep any additional money off the wage negotiation table, some provinces would actually be just as happy to receive funds strictly dedicated to long-term care and/or pharmacare from the federal government.

There are other cracks in the provincial front.

On Thursday, three premiers from three different parties — in Nova Scotia, Saskatchewan and British Columbia — put a rather positive spin on their exchanges with Trudeau. Their read of the meeting did not match Legault’s grim tone.

In his own debrief, the latter made much of his alignment with Ontario Premier Doug Ford. To paraphrase Legault, there is no light between the respective positions of the governments of Canada’s two largest provinces.

That is true as far as it goes. But in contrast with Quebec, Ontario’s public opinion is not predisposed to oppose national standards in the name of provincial autonomy. More often than not, the opposite is the case.

Moreover, few Ontarians, even among Ford’s supporters, would list credentials as a strong Medicare champion as a major part of his political brand.

As an aside, to acquit himself, Legault as spokesperson has had to sweep under the rhetorical carpet the fact that Quebec has a long-standing asymmetrical arrangement with the federal government that dispenses the province of any obligation to be held accountable by Ottawa for how it addresses national standards.

It stipulates that the province is accountable for its management of the health transfer to Quebec voters, not to the federal government.



That disposition, initially negotiated by Martin, but kept in place by Trudeau, means that at the end of the day Legault may not even have a dog in the fight against the imposition of national standards for long-term care that he is purporting to lead.

The last federal election saw a gaggle of Conservative premiers align against Trudeau’s climate change policies. It backfired on the federal Conservatives. Like the environment, health care has not been a strong suit of the party.

History could well repeat itself if the premiers insist on taking their fight with Trudeau over a new funding deal on health care into the next federal campaign

Chantal Hébert is an Ottawa-based freelance contributing columnist covering politics for the Star. Reach her via email: or follow her on Twitter: @ChantalHbert

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