Fight night – be it wrestling, boxing or mixed martial arts – always features a series of preliminary bouts leading up to the much-anticipated main event.
It's like that in politics, too.
Tuesday's meeting of federal, provincial and territorial health ministers in Toronto is decidedly part of the undercard.
In other words, it will be a spirited affair but, at the end of the day, there will not be a new Health Accord.
Rather, each of the parties will be positioning itself for the coming meetings of finance ministers and, ultimately, a deal will be hashed out at the main event, a meeting of first ministers.
That does not mean Tuesday's meeting is not important. It is. But, as federal Health Minister Jane Philpott has made clear in recent weeks, her provincial and territorial counterparts should not fixate on the Canada Health Transfer.
For the past 12 years, the federal transfer of health dollars – which this year is a tad more than $38-billion – has been increasing by six per cent per annum.
Come April, 2017, that escalator clause will be tied to the increase in the nominal Gross Domestic Product, but not fall below 3 per cent a year. (In other words, health transfers will grow at the same rate as the economy, or slightly better.)
The provinces and territories have been grumbling about the decrease in the annual increase of the transfer for almost five years now, since the previous Conservative government changed the formula (but delayed its implementation until after the election.)
The other important change made by the previous government was to make transfers strictly on a per capita basis, not make them subject to equalization (meaning the poor provinces would no longer get proportionally more money).
Dr. Philpott has said repeatedly, and increasingly forcefully, that the 3-per-cent increase is not up for discussion – at least at the health ministers' meeting. "That conversation is largely a conversation between finance ministers," she said recently on CTV's Question Period.
Interestingly, however, the minister has said nothing about the idea of a demographic top-up – providing extra funds to provinces with large seniors' populations – suggesting this could be on the table later on.
Still, the insistence on a firm 3-per-cent hike has sparked a good deal of faux outrage from provincial and territorial health ministers and premiers. Many, either naively or through self-delusion, assumed the Liberals would return to the old formula and 6-per-cent annual increases.
But they promised no such thing during the election campaign. In fact, the Liberals promised three distinct things: "More and better home care," improved access to prescription drugs, and more available mental-health services, especially for first responders and military veterans. The only monetary promise was $3-billion over four years for home care.
In other words, the government-to-be (and now ruling party) sent a clear message that it's willing to invest in targeted programs.
That's where the health ministers need to focus their energies – on finding common areas of interest where they can have an impact on delivery of care.
In Canada, the health-care debate is too often about money, and not often enough about improving the delivery and quality of health services, and that's one of the main reasons that the system remains mired in mediocrity.
What the ministers of health need to be is priority-setters and visionaries, not kids whining for a bigger allowance.
We know there will be money in the next federal budget for home care, and the Liberals almost certainly have money in their back pocket for other programs and to buy peace, though it will not be of Martinesque proportions. (The 2004 Health Accord, signed by then-prime minister Paul Martin provided $41-billion for the "fix of a generation" that never came to pass.)
The other important health-related pledge by the Liberals was that the Prime Minister would sit down with the premiers to "strengthen" medicare.
The way to do that is not with money alone, but with some concrete goals.
On Tuesday, the health ministers should concentrate on identifying common goals and priorities, and leave the financial discussions to the money (wo)men.
After all, on fight night, the main bout is all about power and finesse, but the preliminaries feature a lot more strategy and risk taking.