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Liberal leader Justin Trudea

Adrian Wyld/The Canadian Press

Liberal Leader Justin Trudeau is promising to pump $3-billion over the next four years into improved home care and an unspecified additional amount to reduce the cost of prescription drugs and expand mental health services.

Trudeau's promises are contingent on negotiating a new, long-term health funding accord with the provinces, which have exclusive jurisdiction over health care and may have different ideas about how best to spend federal transfer payments.

The Liberal leader indicated he won't impose his agenda on the provinces, but professed confidence that his priorities are shared by premiers.

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"Every single province is challenged with an aging population and a need for better home care," Trudeau said after unveiling his health care plan Wednesday at a seniors' home in Surrey, B.C.

"We are committed to renegotiating, to re-engaging on the health care accords, on the Canada health transfer, with the provinces ... and we are bringing to the table $3 billion for something that has been a priority for provinces and for Canadians, which is greater investments in home care."

Trudeau did not commit to increasing health transfers by six per cent a year, the so-called escalator built into the 2004 federal-provincial health accord which expired last year.

Stephen Harper's Conservative government did not attempt to negotiate a renewed accord; instead it unilaterally informed provinces that it would scale back the growth of health transfers. Starting in 2017, increases in health transfers are to be tied to nominal economic growth but guaranteed to be at least three per cent. That change could mean as much as $36 billion less for the provinces over 10 years.

"We need a federal government that is willing to sit down and work with the provinces, not dictate at the provinces but set clear targets and expectations," Trudeau said.

NDP Leader Tom Mulcair has similarly not committed to reinstating the six per cent escalator, even though he promised a year ago that doing so would be an NDP government's first priority once the budget was balanced.

He has instead promised to invest $5.4 billion over four years for health and seniors' care, including working with the provinces to develop a universal prescription drug plan, hire more doctors and nurses, build more clinics and expand home care.

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Mulcair has also faced questions about whether he'd make his promised funding conditional on the provinces accepting his priorities for spending it. He's been clear at least with respect to Quebec, which has always jealously guarded its jurisdictions from federal intrusions, that the province will be able to take the money with no strings attached.

"When it comes to Quebec: a right to opt out; full compensation; no conditions," Mulcair said during last week's first French-language leaders' debate.

While Mulcair's top priority is a universal drug plan, Trudeau's is home care.

More than two million Canadians currently receive care at home, and Trudeau said that number is increasing rapidly as the population ages.

On prescription drugs, Trudeau said a Liberal government would join the provinces in bulk-buying drugs to reduce costs, and would support research to reduce unnecessary over-prescribing of medications.

As part of his promise to almost double federal investment in infrastructure, Trudeau has promised to spend almost $20 billion over 10 years on "social infrastructure," including affordable seniors' housing and long-term care facilities.

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The Canadian Medical Association, which has been calling for a national seniors' strategy, said Trudeau's focus on investing in home care and long-term care is "very welcome." The CMA has also welcomed Mulcair's plan.

Rona Ambrose, the Conservative health minister who is seeking re-election, defended her government's record, saying it has "significantly increased" annual health transfers to $34 billion from $20 billion and will continue to increase them to $40 billion by the end of the decade.

"While health care transfers to the provinces are now at record levels under our leadership, on their watch (during the 1990s), the Liberals cut health care by 30 per cent to balance their budget on the backs of the provinces," she said in a written statement.

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