Canada's health ministers are putting up a united front as they gather in Halifax, hoping to stick together amid high-stakes talks but set to only scrape the surface of a lengthy battle over how Canada funds and delivers health care.
Provincial and territorial ministers begin a two-day summit Thursday and will be joined by Federal Health Minister Leona Aglukkaq that evening. Altogether, they'll formally spend all of one hour discussing the need for a new deal to replace the Canada Health Transfer, which funnels billions into provincial coffers each year and expires in 2014.
The new accord is instead expected to dominate informal discussion as provinces aim to avoid bitter divides that have popped up in earlier health talks. None is making grandiose demands or picking fights. However, their solidarity movement comes at a time when they all have disparate wish lists.
"The jockeying for positioning is also going on," Saskatchewan Health Minister Don McMorris said. "It's formal conversations with ministers in the room, and then the side conversations that we all have to learn from each other."
Ontario and Manitoba want another 10-year deal, while others aren't so sure. British Columbia and the Northwest Territories want a formula that encourages and rewards healthy lifestyles. Saskatchewan has cut its surgery waiting lists by turning to private, for-profit clinics to provide services covered by medicare and wants the federal government to reward performance. Alberta wants a federal focus on primary care, continuing care and mental health, which Health Minister Fred Horne calls the "orphan of Canadian medicare." Quebec will push to maintain or increase total transfers, but believes further privatization should be off the table.
The four Atlantic provinces, Yukon and Nunavut are treading carefully, hesitant to speak out so early or bringing new ministers up to speed.
Previous negotiations, including those for the current accord, exposed fractures between certain provinces and the federal government. This group of provincial and territorial health ministers – six of whom are in the first year of their portfolio – say they'll need to avoid a repeat performance. "I hope we can get beyond the notion, especially in the initial stages, of the provinces-versus-Ottawa," B.C. Health Minister Mike de Jong said.
The provinces and territories will receive $58-billion through major transfer programs this fiscal year, accounting for about 19 per cent of their revenues. Just under half of the funding is for the Canada Health Transfer.
As such, some leaders – including Alberta's new premier, Alison Redford – believe all transfers should be considered in one discussion as premiers prepare to pick up health-accord talks during meetings in Victoria in January. "We wouldn't want funding at one table to be sawn off at another," Manitoba Health Minister Theresa Oswald said.
During the two-day Halifax meeting, ministers will share successful strategies while discussing mental health, sodium levels, healthy living and aboriginal health services, among other topics. Manitoba, Ontario, Nova Scotia and Prince Edward Island also hope to emphasize the need for a national strategy to cope with the health-care demands of an aging population.
When the national medicare program began in 1965, the federal government paid half of what the provinces and territories spent on health care. Today, it covers less than one-quarter of the tab, even with annual 6-per-cent increases from Ottawa viewed by many as unsustainable.
"It's creating some interesting conversations," said Doug Currie, health minister for Prince Edward Island. "[It's a]pretty important conversation as the federal government is getting it's financial house in order."
Some provinces said it's too soon to talk about the length or cash attached to a deal, though some want another long-term pact. "I can't imagine why anyone would not want the kind of certainty that comes with a 10-year accord," Ontario Health Minister Deb Matthews said.
In the meantime, provinces want a new regime that encourages innovation, rewards performance and meets a growing need for care in an aging country. On Thursday, however briefly, they'll begin chipping away at what that will look like.
"The 2014 accord can't be about propping up the status quo," said New Brunswick's Madeleine Dubé said in a recent Montreal speech. "It's not just about dollars."
With reports from André Picard in Montreal and Justine Hunter in Victoria