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Quebec Premier François Legault was smart to fire up language and cultural issues in an election year, because he sure doesn’t want voters talking about his province’s stretched health care system. Ontario Premier Doug Ford was also keen to keep talk about health care to a minimum in the campaign that won him re-election in June.

But this week, premiers gathering for a Council of the Federation meeting will point out – quite rightly – that Prime Minister Justin Trudeau talked a lot about health care in last year’s election campaign, but he hasn’t done much about it since.

Canada’s federal and provincial politicians are spending a lot of effort on deflecting responsibility for health care, rather than taking it on. Let’s hope we won’t get fooled again.

The premiers will be out to repeat their call for a massive, $28-billion-a-year increase in federal funding for health care. The feds will say they are willing to put in more money – though nothing like the whopping figures the provinces seek – as long as provinces agree to channel it for specific purposes.

Then we will be in for more months of bickering over whether the feds can set conditions on health care. That will last months, and is unlikely to be end before the Quebec election.

All of this is a political tussle over avoiding blame and garnering credit, with zero added value for patients.

The premiers’ enormous $28-billion demand is so big it makes you wonder if the goal is making sure Ottawa can be blamed. For ordinary Canadians, fiscal federalism – whether you pay for health care via your federal or provincial taxes – doesn’t matter as much as doctors and nurses. Yet premiers keep suggesting better health care depends only on more federal money.

Mr. Trudeau, on the other hand, likes to promise during election campaigns that he will fix specific problems in the health care system even though it is not in federal control. So he is willing to transfer money to the provinces for health care – as long as the premiers say it will be used for the things he promised.

You can see why that annoys the provinces, especially premiers like Mr. Legault who are sensitive to notions of provincial autonomy.

Premiers are already complaining Ottawa doesn’t pay for a big enough share of health costs, yet when Mr. Trudeau woos voters by promising an additional $5-billion a year for a $230-billion-a-year health care system, he wants a say in where the money goes. There is a perennial fight about whether federal health funding comes with strings attached.

But in practice, the provinces could force Ottawa to accept a deal that doesn’t have strings that actually ties them down.

The provinces could take the initiative and tell the feds how they plan to spend additional money – in broad terms, without binding commitments. Because health-care budgets are so big, and increasing every year, the provinces will be spending the money, anyway. The federal Liberals’ 2022 platform promised $3.2-billion over five years for access to doctors and nurses, or $640-million per year – a drop in the bucket for health care payrolls.

The catch will be a desire to see provinces report on the how the money is spent, but as long as the reporting is for the public, and not federal bureaucrats, it can only be a good thing.

There are tougher jurisdictional sticking points. The federal government wants to channel some money into a specific transfer for mental health, separate from the Canada Health Transfer. Mr. Legault won’t want that.

But in most areas, the provinces can get around the “strings-attached” problem by outlining a few areas where they would spend some of the billions their citizens want them to spend, anyway.

They won’t get $28-billion a year from Ottawa, but if they stop talking about the sum itself and start talking about the nurses and surgeries and services it would pay for, they could really pressure Mr. Trudeau to cough up more.

In the meantime, there’s actually little palpable political pressure on Mr. Trudeau to live up to his election promises, let alone do more. And as long as both the provinces and the feds can deflect responsibility, no one gets held to account.

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