The Trudeau government is trying to bribe or blackmail the provincial premiers into making federal Liberal health-care priorities their own, by offering increased funding on the condition that some of the money is spent on mental health.
This tactic resurrects the notion that Canada works best as a country when Ottawa convinces or compels the provinces to meet its nation-building priorities. This is the Liberal way. Conservatives offer a very different approach. Each has its season in the sun.
To unpack that, let's go back to the 1960s, when Lester Pearson's government introduced the Medical Care Act. The Liberals were determined to create a national program that guaranteed health care for all regardless of income. Provincial premiers objected: Daniel Johnson vowed Ottawa would never be allowed to dictate health care policy to Quebec. John Robarts warned medicare would undermine Ontario's insurance industry.
When the new program came into effect in 1968, several provinces refused the federal offer to fund half the costs of universal public health care, preferring the status quo. But public pressure forced first one, then the others, to concede. By 1972, the health-care system we have today, more or less, was in place across the country.
Not long after, Ottawa began reneging on its financial commitment, forcing provincial governments to pay for health care from their own resources. They vowed never to be fooled again, and for a season, they kept that vow. Jean Chretien and Paul Martin tried, but mostly failed, to force provincial governments to target health spending on their priorities. The premiers knew how much a federal funding promise was really worth. Still, Ottawa continued to pressure the province to set and meet national benchmarks, just because.
When he became prime minister, Stephen Harper took a different approach. He believed federalism worked best when Ottawa stuck to its constitutional knitting: defence, foreign affairs, trade, customs, criminal law, fiscal and monetary policy, setting immigration targets and the like. The provinces, according to this view, know best how to deliver services to the public, not Ottawa, which is far removed from local needs and incompetent at delivering services. (Think defence procurement, indigenous affairs and paying its own workers.)
Mr. Harper's approach kept the peace, but critics warned that vital national priorities, such as fighting climate change and improving health care, were being neglected. Which is why, when Justin Trudeau became prime minister, he resurrected the requirement that increased health-care funding meet national (that is, federal) objectives.
Most provinces, after howling, caved. Alberta is in the process of caving. Quebec and Ontario continue to resist.
If history is a guide, things will go like this. Because provincial finances are so tight, Ontario and Quebec will eventually take the money, while obtaining some fig leaf that appears to respect provincial autonomy. The Liberals will celebrate and promote their new, national mental health-care strategy.
But eventually, the federal deficits will compel Bill Morneau or his successor as finance minister to impose austerity. The mental-health funds will be folded into an omnibus health-care transfer, and that transfer will be cut back. The provinces will once again find themselves stuck with an unfunded federal program. Premiers will howl.
If the howls are loud enough, they might help the Conservatives win a future federal election. The new prime minister will promise to respect provincial autonomy, and he or she will keep that promise, even as critics warn that this or that vital national priority is being neglected.
Those warnings may become so urgent that the Liberals win a federal election, based on their promise of a new national strategy for this or that.
The cycle will repeat, even though many of the players in future chapters won't realize that they are simply the latest chapter of an ancient tale that never ends.