Ottawa still has sway with the provinces on health policy, despite issuing a new funding formula without conditions, Health Minister Leona Aglukkaq says.
But federal-provincial talks on the future of health care won't be the tense, high-stakes game of chicken of the past, Ms. Aglukkaq said in her first public comments since Finance Minister Jim Flaherty handed provinces the federal health funding scheme for the coming decade.
Instead, the discussions will be more about performance measurement, accountability and sharing of best practices rather than money, she told reporters.
"In 2004, when we discussed the accord, I was there. And those conversations, [it]was strictly about dollars. It did not have the pieces around what outcomes do we want to accomplish as ministers," said Ms. Aglukkaq, a former Nunavut finance and health minister.
"Health ministries across Canada can now have reassurance that there's predictable funding in health care to allow us to have a meaningful conversation on what outcomes we want to accomplish around health, around prevention, around obesity."
Ms. Aglukkaq said she will be travelling across Canada in January to meet with her provincial counterparts and lay the groundwork for talks about how health care standards should be improved, after the current accord expires in 2014.
Key to her approach, she said, will be differentiating these talks from those of a decade ago, when provinces clashed with then-prime minister Paul Martin. The provinces squeezed the federal government for long-term cash in return for promises to improve certain parts of the health care system.
She said this time, with the federal funding already in place and non-negotiable, discussions can be less confrontational, and lead to a better health care system.
Critics and some provinces have accused Ottawa of abdicating its responsibility to maintain a high national standard for health care, and Ms. Aglukkaq's comments on Thursday did nothing to change those views.
"She's dreaming if she thinks it's a better atmosphere," said NDP health critic Libby Davies. "I think they've botched the whole file."
In the past, Ottawa was able to exchange its cash for commitments to uphold a high quality of national health care, she said.
"There's always that tension, and it's a healthy tension."
Now, the federal government has no bargaining power to ensure quality of health care or adherence to the Canada Health Act after the current health accord expires in 2014, she said.
Plus, the federal Conservatives are making no attempt to ensure provincial commitments in the last health accord are kept, she added.
"It's like the federal government is walking away from this," Ms. Davies said in an interview.
Ms. Aglukkaq, however, insists the federal government will continue to uphold the Canada Health Act – in a way that gives each jurisdiction the flexibility it needs to deal with regional differences.
She said the act would even allow some private involvement in the delivery of services, but that no provinces are actively pushing for privatization of health care.
Asked repeatedly what bargaining power Ottawa has now that the money is already on the table until 2024, Ms. Aglukkaq noted that the federal government also funds several targeted health-care initiatives that have proven to be effective.
She sidestepped questions about whether any funding would be tied to what provinces can do with the money.
And she noted that clear targets in health care policy have produced solid results, such as reductions in waiting times.
But it's not clear how the federal government will go about influencing provincial targets and goals now that it has committed to non-conditional funding, countered Ms. Davies.
Earlier this month, Mr. Flaherty took his provincial counterparts by surprise by handing them a take-it-or-leave-it plan to finance health care from 2014 to 2024.
The plan sees the federal government committing to a 6 per cent annual increase in funding for each of the first three years. After that, annual increases will be a minimum of 3 per cent – or more, if the economy is strong.
While some western provinces responded with appreciation for the certainty in funding, other provinces balked at the low increases in the latter years of the accord, and the lack of any discussion about how to fund the rising costs associated with home care, long-term care, chronic care and drugs.
Health care is eating up an increasingly large part of many provinces' budgets, even as they struggle to contain deficits. Federal transfers cover about 21 per cent of their health expenditures.
Ms. Aglukkaq made the comments to reporters after announcing that long-proposed child car seat safety regulations would finally come into force on Jan. 1.
Parents are allowed to keep their old seats, but all new seats will face heavier testing, increase the maximum weight limit, and allow some harnesses to be used on school buses by children with special needs.