The premiers and territorial leaders concluded their two-day Council of the Federation meetings Tuesday by announcing the formation of two groups to examine health innovation and federal dollars.
Manitoba Premier Greg Selinger will head a provincial working group composed of provincial and territorial leaders to assess the financial impact of federal fiscal proposals.
Premiers Brad Wall of Saskatchewan and Robert Ghiz of Prince Edward Island will lead a second group comprised of provincial and territorial health ministers that examines innovation that improves health care across the country.
Throughout the meetings, which started Sunday, the premiers suggested that if Ottawa cannot be convinced to reopen health-transfer payment talks, perhaps Canadians — especially seniors — can force the federal government back to the table.
But Harper hasn't budged, saying in each of the last two days there's no more money for the provinces.
That didn't stop B.C. Premier Christy Clark from suggesting No doesn't mean No when Ottawa's talking, and Quebec Premier Jean Charest appeared to say the provinces have time and politics on their side.
"The federal government will probably look at their situation and if they are closer to an election campaign, they may have a different view," said Charest at a joint premiers press conference.
"We are going to take up the responsibilities that the federal government should have normally assumed."
Wall added the federal government may start feeling pressure from Canadians when they see the provinces working together to improve health care and save money.
"Our constituents are their constituents, we get that there's one taxpayer," said Wall, who added that federal MPs will be hearing from Canadians, "especially as they see progress from the provinces and territories in terms of results on health care."
Last month, Finance Minister Jim Flaherty enraged premiers from Manitoba east with what some described as a take-it-or-leave-it plan. The scheme calls for current spending levels of six per cent annually until 2017, followed by increases tied to the rate of economic growth.
Those increases are expected to be about four per cent annually, but Flaherty said they will never drop below three per cent.
The wait-and-see approach adopted by the provinces sparked criticism from former Saskatchewan premier and health expert Roy Romanow.
He described the response of the premiers as "tepid."
Romanow said in 1995 when Ottawa proposed cutting Canada Health and Social Transfer payments to the provinces, the premiers erupted in anger and were soon back in talks with the federal government.
He said it appeared the premiers were still wounded from Harper's move last month to impose a funding formula on the provinces without negotiations.
"It was a dramatic move," said Romanow, who headed a royal commission into Canadian health care. "I think the premiers were, as Premier Charest described it, sideswiped."
"They were unprepared for it and the meeting, I think, reflected that. There was a tepid response about funding."
But an Ontario health policy expert said the provinces appear to be unilaterally choosing their direction on health care, realizing they may have achieved all they can from Ottawa at the moment under trying circumstances.
Josh Hjartarson, Toronto's Mowat Centre for Policy Innovation director, said he doesn't feel there's consensus among the premiers on health care, but they are choosing to work together.
He said 95 per cent of all federal transfer funding arrangements expire in 2014, and that includes the health transfer.
"In my view, the game is nowhere near over yet," said Hjartarson. "Health care is obviously the biggest chunk of the $50 million that the federal government redistributes on an annual basis to the provinces."
Equalization funding and infrastructure and training funding agreements also expire in 2014, he said.
"You're in a situation where this is a first volley and obviously it's a big volley, but there's lots to play out yet and I think these are very interesting days," Hjartarson said.
Ontario Premier Dalton McGuinty was not at the final news conference. Officials said he had a scheduling conflict.
Wall, who came to Victoria extolling health innovation as a best practice and money-saver, said the newly-formed Health Care Innovation Working Group will focus on the provinces and territories finding and sharing new ways to meet health challenges, including the needs of seniors, patients with chronic diseases and northern populations.
The group will provide its first report in July at the next meeting of the Council of the Federation in Halifax.
Wall and Ghiz said the working group has the ability to provide the provinces with a national perspective on what's working with health care when it comes to innovation, best practices and saving costs.
He joked that he and Ghiz won't employ a good-cop-bad-cop routine, but said the two premiers are intent on getting good information from the provinces and health ministers will soon discover that "Robert Ghiz is a scary man."
"That's really what it's about, looking for innovation, looking for best practices," said Ghiz. "It really has nothing to do with the federal government. We're in a situation where we know across Canada that certain provinces are doing things differently than others."
The seniors issue dominated the Victoria meetings because the premiers say Ottawa's plan to fund health-care on a per-capita basis is more costly to provinces with high populations of elderly people because health costs rise as people age.
The working group will focus on saving dollars while providing the best and most up-to-date health services to Canadians.
"We're going to do our work," said Wall. "The federal government is not needed for this work. They don't deliver health care. The expertise is in the provinces and the territories."
Wall told reporters in Saskatchewan following the meetings he was disappointed that Ottawa hasn't backed health innovation with federal dollars.
He said federal Health Minister Leona Aglukkaq expressed support for an innovation fund, but that appears to have dried up.
"So, either they've changed their mind or this was about tactics or the gang that doesn't shoot straight. I mean...it's frustrating," said Wall. "The bottom line though: This is very disappointing."
Harper, in Saguenay, Que., remained firm Tuesday on his stand that no further health money is coming to the provinces.
"I think we have been very clear on transfers," said Harper.
"I hope the provinces will concentrate on I think what Canadians expect, not a debate about money but really an examination of what we really need to do to better deliver health care services."
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