The negotiations over a new health-care accord will consume much oxygen over the coming two years. Stephen Harper's first priority, according to people who know, is not to repeat Paul Martin's mistake.
The Prime Minister will not seek a new, grand bargain on health care with the provinces and territories. Nor does he plan to cut 13 separate deals.
Instead, a third option is likely to emerge. When the federal, provincial and territorial health ministers meet in Halifax on Thursday, we'll see the outlines of that option begin to take shape.
The last time Ottawa and the provinces sought a new formula for health-care funding, back in 2004, Mr. Martin convened a first-ministers conference in Ottawa, declaring the meeting wouldn't end until there was a deal.
That meant that, politically, the Liberal prime minister needed an agreement more than the premiers, and they wrangled a sweet one out of him: increases at twice the rate of inflation for a decade.
Mr. Harper has promised to continue increasing funding at that rate until 2016, but the Conservatives are sending out strong signals that they expect to bend the funding curve down after that.
Unlike Mr. Martin, the Prime Minister has no intention of striking some grand bargain aimed at achieving federal-provincial peace in our time on health care. There will be no late-night caffeine-laced negotiations at the old train station in Ottawa, no signing ceremony, complete with one or more disgruntled premiers walking out.
Neither, however, are the Conservatives planning 13 separate bilateral deals, as some have speculated, even though there's an argument for such an approach. After all, Nunavut's population is young, Nova Scotia's is old, Alberta's is growing, Quebec's is likely entering into decline.
Nonetheless, the Conservatives envision a single accord, and Mr. Harper does want to see some kind of measuring stick used to judge progress in improving service while lowering costs.
The current thinking is to invite each province to declare what matters to them: Is this province more interested in primary care reform – that is, getting family physicians to work in teams rather than separately? Does that province want to focus instead on bringing down prescription-drug costs? Or is this territory more concerned with child and maternal health? The purpose of the Halifax meetings is to begin that consultation.
In the end, there might be a suite of options for provinces to choose from, with different reporting mechanism for each option.
This is the thinking within the federal government in the early days of these talks. Everyone understands much will change. Everyone also understands that the Department of Finance as well as – or even more than – the Department of Health will call the shots.
But at least we won't be up until three in the morning waiting to hear if Newfoundland will sign the new deal. It was never much of a way to run a country, anyway.
John Ibbitson