The theme of this week's first ministers conference on health care might well have been: Be careful what you wish for.
For years, the provinces have been complaining about Ottawa's role in administering medicare. For the measly amount that the federal government contributes to provincial health-care budgets – now about 20 per cent, and shrinking – the provincial preference has been for the feds to sign a cheque, then buzz off.
That attitude was best expressed this week by Quebec Premier Jean Charest, who, amid a diatribe on the funding formula that Ottawa presented by unilateral fiat, said the federal government doesn't operate the health-care system in Canada. "They know nothing about health care," Mr. Charest said.
Beyond that, efforts by past federal governments to extract promises in exchange for their money, while well-intentioned, have proved to be misguided. The surgery wait-time targets that Paul Martin set out in the 2004 funding agreement, for instance, did not have the desired effect.
Focusing on specific procedures led to perverse outcomes. More surgeries in select areas – knees, hips – temporarily cleared up backlogs, but the vacuum was soon filled by people who could have waited years to have an operation. The exercise did little to help reduce the overall number of people getting operations or drive efficiencies but did succeed in fattening the wallets of the country's surgeons.
Now we have a situation where the federal government is prepared to write a cheque with no strings attached and the provinces still aren't happy – mostly about the size of the cheque. And no one is more displeased than Mr. Charest himself.
This is nothing new, of course. When it comes to Quebec, it's always about the money – even though it receives a majority of the equalization payments handed out in Canada. As much as many provinces resent this fact (and have for years), you can imagine how Mr. Charest feels when he looks at a new funding arrangement that is going to give Alberta – a long-time critic of the federal largesse directed to Quebec – more than $1-billion a year. Quebec, meantime, could lose about $200-million a year.
Rather than attack each other, however, the provinces united and directed their anger toward Stephen Harper. So far, the Prime Minister seems unmoved by their whining.
Behind the scenes at the first ministers conference, Mr. Charest exerted a lot of influence, according to numerous provincial officials. This isn't a surprise. The Quebec Premier has an institutional knowledge about federal-provincial relations that could fill volumes of history books. And he can be impressive in a room.
He certainly was persuasive with a group of premiers, most of whom are much younger and less experienced than he is. Mr. Charest was most effective in decrying a funding formula he insists is a fundamental attack on the basic tenets of medicare itself. He argued, convincingly it appears, that inequities in the new plan will exacerbate inequities in health care across the country.
Inside their meeting room, most eyes were focused on Alberta Premier Alison Redford, the have-not provinces enviously eyeing the loot she's getting under the new formula. In the end, Ms. Redford lent her voice of support to a working group established by the premiers to see whether a more equitable funding arrangement can be devised. Alberta's sole demand is that the per capita element of the new model be maintained – something her province has long been arguing for.
Alberta is suggesting that the funding shortcomings of provinces such as Quebec and Ontario be addressed through the back door using the federal equalization fund. I'm not sure how that helps provinces such as Saskatchewan and B.C., which also lose under the new funding formula but don't receive equalization payments.
My guess is the provinces – even Quebec – are going to have to live with the dollars Ottawa is giving them. They may not like it, but it's increasingly clear they may not have a choice.