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Ontario Health Minister Sylvia Jones, centre, stands with her provincial counterparts during a news conference after the second of two days of meetings, in Vancouver, on Nov. 8.DARRYL DYCK/The Canadian Press

Ottawa and the provinces are at loggerheads over health care funding. Atlantic premiers are upset at no longer being exempt from the carbon tax. Alberta and Saskatchewan intend to pass so-called sovereignty acts.

As Justin Trudeau enters his eighth year as Prime Minister, federal-provincial relations are fraught. The reasons for this are historical, but point to an urgent need for change.

In Canada, new prime ministers tend to arrive just as a federal-provincial consensus is emerging on the need for reform. In that sense, federal elections can be a lagging indicator of trends already revealed at the provincial level.

Progressive Conservative prime minister Brian Mulroney pushed for constitutional and economic changes in the mid-1980s, with most premiers onside.

A decade later, Liberal prime minister Jean Chrétien and the premiers agreed on the need to eliminate deficits. A decade after that, Conservative prime minister Stephen Harper and the premiers agreed on the need to rebalance fiscal federalism.

A decade after that, Mr. Trudeau and the Liberals arrived with the premiers and the public ready for a new era of activist government.

Anthony Sayers, a political scientist who studies federalism at the University of Calgary, speaks of a “long-wave pattern” in which newly elected federal governments embark on reforms, “and there’s a good chance they can get their colleagues at the provincial level to agree.”

These reforms often take place in the context of ideological symmetry. Daniel Béland, the director of McGill University’s Institute for the Study of Canada, notes that when Mr. Trudeau became prime minister on Nov. 4, 2015, there were Liberal or NDP governments in the four biggest provinces (Ontario, Quebec, British Columbia and Alberta).

Not surprisingly, Ottawa and the provinces agreed to enhance the Canada Pension Plan and to improve funding for mental health and home care.

“Today, it would be impossible to do that,” Prof. Béland observes. Why? Because there are conservative governments of one stripe or another in Ontario, Quebec and Alberta.

“There is an ideological, partisan aspect to this divide,” he said.

And as any federal government grows longer in the tooth, it becomes less willing and able to embark on reforms or cater to provincial demands. Cue worsening federal-provincial relations.

Other factors are in play. Julie Simmons, a political scientist who researches federalism at Guelph University, points to this government’s tendency to shift between hierarchical and collaborative approaches to negotiations.

“One is where the federal government is dictating to the provinces,” she told me. “The other one is where the federal government wants to bring provinces onside.”

For example, Ottawa and the provinces worked collaboratively on the new federal-provincial child-care program, with Ottawa and each province crafting the terms of their accord, just as they did with the earlier health care agreement.

But the Liberal government simply imposed a carbon tax on provinces that don’t meet its threshold for reducing emissions, a hierarchical approach that has created serious tensions with some provinces.

All of these forces converged in November at a federal-provincial meeting of health ministers. The provinces demanded more money without strings. Ottawa insisted on plenty of strings. There was little goodwill or trust in the room. Nothing was achieved.

Canada’s universal public health care system performs poorly compared with systems in many other developed countries. Yet “no leader, whether it’s a premier or the prime minister, is prepared to suffer the potential short-term consequences of substantial reform of the health care system, because the system is so carefully tied to our identity as Canadians,” Prof. Simmons says.

The time may have come either for a new Liberal prime minister or a different governing party to work collaboratively with the premiers in pushing forward substantial, even controversial, health care reform – one that may mix public and private care.

This federation need not live in perfect harmony. A certain level of tension between the federal and provincial governments can be beneficial. “Friction within the federation is a good thing,” says Prof. Sayers. “Conflict exposes the deep logic of each government.”

But sometimes conflicts can become so serious they require a new consensus on how to solve them. We may need a new consensus on health care. And new leadership to achieve it.

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