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Paramedics transfer a person from an ambulance into a hospital in Montreal on Jan. 9, 2022. Polls regularly show health – not just COVID-19, but the health care system – are still a top issue for Canadians.Graham Hughes/The Canadian Press

A strange thing happened in the federal budget this month. Prime Minister Justin Trudeau’s government, still in charge of a country in a pandemic, devoted less money to health care, billions less, than they promised in an election campaign just seven months ago.

They say it’s coming, one day soon. Both Mr. Trudeau and Finance Minister Chrystia Freeland suggested there will be more money when the provinces negotiate a deal. The federal-provincial health care runaround continues.

You would think that delay would be politically impossible. Canadians have seen the fragility of health care networks during the COVID-19 pandemic. Some provinces, such as Quebec, imposed tight restrictions when the Omicron variant arrived to protect strained hospitals. Public-health officers still warn that could recur. Polls regularly show health – not just COVID-19, but the health care system – are still a top issue for Canadians.

And premiers keep demanding a huge inflow of federal money, $28-billion a year, no strings attached.

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Yet the federal Liberals got away with it. Apart from a letter from the premiers, there wasn’t much fuss.

It was easier for Ottawa to get away with it because the premiers make pie-in-the-sky demands that no one expects the feds to fulfill. The federal budget noted, to make a point, that Ottawa, not provinces, covered most pandemic costs.

All of this – the fragility, the delay, the premiers’ insistence that not much can be done without federal bucks – is yet more proof of the dysfunction in the federal-provincial health care dynamic.

That’s a game that’s more about who takes blame for taxes and credit for new services – not about better care. And it allows both levels of government to dodge.

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Seven months ago, when Mr. Trudeau was campaigning for re-election, he promised that “better health care for everyone” would start “immediately,” with $6-billion in the 2021-22 fiscal year to clear surgery backlogs built up during the pandemic. In March, with a week to go in the fiscal year, the feds ponied up $2-billion – $4-billion less than promised – saying it was enough for the task.

OK. But the Liberal platform also promised sums for this year: $250-million to expand access to family doctors, $574-million for virtual care, $625-million for mental health, $1.3-billion for long-term care, and more – part of a $20-billion-plus package over five years.

But Ms. Freeland’s April 7 budget didn’t include that stuff.

Why? The feds want a deal. The provinces just want Ottawa to turn over cash, but Ottawa wants to get credit for specific types of additional care.

Mr. Trudeau’s Liberals don’t just want to increase the Canada Health Transfer to provinces. They’d like to create a new, separate transfer for mental-health care and negotiate separate agreements for long-term care funding. They’d like to say they provided services.

But health care is provincial jurisdiction, and some provinces aren’t keen to see the feds set conditions in return for a few billion dollars. Quebec is adamant. Yet there are a group of premiers working on negotiating a deal, notably British Columbia’s John Horgan, the current chair of the premiers’ Council of the Federation.

It’s not that nothing good can come from such negotiations. Jane Philpott, the former health minister who is now the dean of the faculty of health sciences at Queen’s University, argues health care systems need change, not simply more money. In an interview, she said negotiations can be used to agree to principles of access to additional forms of care not covered in the Canada Health Act. Ottawa can commit significant funds if provinces provide guarantees of access to, for example, mental-health services and long-term care.

But she acknowledged that it’s hard to track what federal dollars are used for when hundreds of billions are spent each year. “The challenge is always around how do you make sure that [federal spending] changes what provinces were going to be doing anyway?” she said.

There has always been a jurisdictional debate about whether Ottawa should even try to set goals and conditions. But as Ms. Philpott pointed out, those arguments are often soothed when the feds offer more money.

But by now, Canadians should have lost patience. Blame all of the above – provinces and Ottawa.

Provinces don’t have to wait: They can be held responsible for fixing health services now, federal money or not. After all this, after making election promises, and two years into a pandemic, Ottawa should not be asking Canadians to wait till next year.

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