Prime Minister Stephen Harper says he hopes provincial and territorial leaders can "put the funding issue aside" as they discuss the future of health care in Canada.
In an interview with the CBC's Peter Mansbridge that was broadcast Monday on The National, Harper indicates the provinces won't be getting any cash beyond what has already been committed.
Harper's comments on health care came as the premiers and territorial leaders met to discuss, among other things, their response to his government's new long-term funding plan for health transfers after the current accord expires in 2014.
Finance Minister Jim Flaherty abruptly announced last month that Ottawa will guarantee health-care funding increases of six per cent until the 2016-17 fiscal year. After that, the annual increase will be tied to the nominal GDP, the monetary value of all goods and services produced within the country annually, including inflation. Funding increases of at least three per cent will be guaranteed.
Flaherty made the announcement at the end of a meeting with provincial finance ministers in Victoria. There was no negotiation with the provinces on how they would be funded for health post-2014.
The lack of consultation was a common complaint from the premiers at Monday's meeting.
"With respect to the process, the premiers were unanimous that the federal government's decision to unilaterally decide funding was both unprecedented and unacceptable," British Columbia Premier Christy Clark said after the meeting.
"We want to be constructive, not confrontational with the federal government," she said. "We believe very strongly that there is an opportunity for dialogue between us and that there is still time for that dialogue to take place. The current agreement doesn't expire until 2014."
Provinces will 'always ask for more money'
The prime minister said that provinces "will always ask for more money" and that his government has increased health transfers to provinces "more than any previous government in history."
"What I think we all want to see now from the premiers, who have the primary responsibility here, is what their plan and their vision really is to innovate and to reform and to make sure the health-care system's going to be there for all of us," Harper said, according to an excerpt from the interview.
"So I hope that we can put the funding issue aside, and they can concentrate on actually talking about health care, because that's the discussion we need to have."
The idea of a separate fund for the provinces to use for innovation in the delivery of health care got no support from the prime minister.
"I'm not looking to spend more money. I think we've been clear what we think is within the capacity of the federal government over a long period of time."
Harper was asked about concerns that having no strings attached to the funding will mean no national standards.
The prime minister said the provinces are all committed to the principle of universality in the Canada Health Act, and what they are wrestling with is how to make the system more effective.
"We don't just trust them, we understand they have the responsibility, and we want to make sure that we work with them," he said. Harper said his government has made a point of not blaming the provinces for problems in health-care delivery and has instead worked with the provinces to try to improve their systems.
He also said that universal public health insurance is the basis of Canada's health-care system.
"It's critical that Canadians have access to a wide range of services, necessary services without any penalty from inability to pay. That, I think, is a fundamental principle," he said. "I have never met a provincial premier or provincial government who disagrees with that principle, so I think rather than fighting boogeymen, we should concentrate on the actual challenges that are before the system. I hope that's what the premiers will do."
Premiers call for dialogue with Ottawa
Clark said Monday there was a strong sense in the room that the premiers want to keep trying to engage in a dialogue with the federal government.
"We need to have a dialogue about this and about innovation in health care and how to make sure we're meeting changing needs in health care that includes the people who are delivering it and that includes the people who it's serving," she said.
Ontario Premier Dalton McGuinty also called on the federal government to open dialogue, saying it is "unacceptable for the prime minister to say that he is effectively going to passively preside over the evolution of health care in Canada."
"We need to be together on this, so I'm hopeful that the prime minister will give some thought, yet again, to finding some way to engage us in an active, productive dialogue with respect to the future of health care," McGuinty said Monday afternoon.
Quebec Premier Jean Charest expressed his disappointment with how the federal government is treating the provinces. The lack of negotiation is something he's never seen before, he said.
"We have always in Canada, because of our federal system of government, had a dialogue on this, an exchange of information, a dialogue and decisions were made," Charest said Monday morning. "Never have I witnessed a process by which the federal government, as they did only a few weeks ago here in Victoria, come in and said 'This is it.'
"I've never seen it. What happened is that the federal government took the provinces by surprise," he said.
Charest said Quebec is doing well with health-care delivery and he made it clear that the provinces, not Ottawa, are responsible for their systems.
"The federal government doesn't operate the health-care systems," he said. "They know nothing about the health-care systems frankly, we are the ones who operate them."
'We have time'
Charest said there is still time to talk to Harper and his government about its role in funding health.
"We have time. We're in 2012. The accord expires in 2014. There's time for us to have that dialogue and discussion," he said.
He also wants discussion on federal-provincial transfers generally, not just on health. If equalization payments or social transfers are to change in the future, the federal government should be telling the provinces, he said.
The CBC's Chris Hall, reporting from the meeting in Victoria, said that as they headed into their talks, none of the premiers ruled out more private, for-profit health care, or the possibility Canadians may not get the same level of service in each and every province.
"The underlying principle is to offer comparable levels of service even if they are different, in such a way that it respects the overall framework of the Canada Health Act," Manitoba Premier Greg Selinger said.
Saskatchewan Premier Brad Wall said having room to experiment with health-care delivery isn't a bad thing.
"If it's tied to objectives, where we say we'd like to have everyone having a surgery within three months, and we identify that, in order to do that in the public system, we need to use private clinics, then I think there'll be public support for that," he said.
There is more support for the federal government's position among the western premiers than the eastern ones.
Nova Scotia's Darrell Dexter said poorer provinces will end up providing poorer care. He also worried about the aging population's cost to health care.
"Equal funding is not necessarily equitable funding," Dexter said. "This is the problem. We have 16 per cent of our population currently over the age of 65 in our province. We're going to move from 16 per cent over the age of 65 to almost 30 per cent over the next 20 years," he said.
Charest commented on what appears to be an east-west divide in support for Ottawa's funding plans.
"On Canada generally, what I see is interesting, and I think it is also quite simple: there's two realities in Canada," he said. "There are the economies of oil, gas and potash, and others. That's the reality of Canada. Once we know that, we need I think to be able to make decisions accordingly. That's the financial situation of the country and we need to take that into account as we move ahead."