Today, the premiers are meeting in Victoria. Top of the agenda: health care.
It's a meeting that will be long on rhetoric but short on purpose. Historically, such meetings allow premiers to bemoan the lack of stable, long-term funding from Ottawa. And Victoria was meant to be a part of the complicated federal-provincial courtship culminating in a new historic deal.
Except that, late last year, the federal government committed itself to stable, long-term funding -- extending the generous increases in federal funding for a full five more years, before tying future increases to economic growth.
Even though the provinces are limited in their ability to complain, expect two things in the coming days.
First, most provinces will complain anyway.
They will suggest that -- having received under the Tories a deal basically as generous as under the Liberals -- they are being mistreated.
In December, Manitoba NDP Finance Minister Stan Struthers declared that the federal proposal was "un-Canadian." His boss will be equally harsh, as will many of his colleagues (Alberta will be the exception).
Yes, the complaints are baseless. Six per cent annual increases at a time of recession and uncertainty are generous. But, yes, we'll hear them complain anyway.
Second, various health-care "experts" will claim that the Tories are destroying Canadian health care.
Who speaks on behalf of the doomsday school of thought on medicare? The chief spokesman is Roy Romanow. As you will recall, a decade ago, the former premier of Saskatchewan was appointed commissioner by Prime Minister Jean Chrétien to consider health care.
In recent weeks, he's been much in the news with his doomsday prophesy: The federal offer is, he claims, the end of medicare as we know it. Romanow argues that, by not setting national standards and leaving medicare to the provinces, the federal government is effectively abandoning the program to the metaphorical wolves.
Doomsday prophesies rarely come true, and this one seems about as compelling as the Mayan claim that the world will end in 2012. There will be much play in the media but on January 1 of next year, the sun will rise and Canadians will still have medicare.
The reality is that the last batch of national standards didn't work out. As Prime Minister, Paul Martin signed the health accord. The money flowed, but the provinces largely didn't keep their end of the deal -- not on the Liberal watch, not under the Tories. Reductions in wait times? Many provinces aren't even collecting all the relevant data, which they promised to do, never mind hitting the benchmarks.
It would be possible, of course, for the federal government to push the provinces. They could demand better results for the money.
But there are profound limitations to such demands. Start with practicality -- as was seen in the last federal-provincial accord, it's difficult to collect data and even more difficult to see their utility. As noted by the Wait Time Alliance, a reduction in wait times in five priority areas probably has resulted it wait times increasing in other areas.
National standards? The argument put forward by some (including Romanow) is that by setting clear goals, the provinces will be forced to innovate.
But the problem with the current system isn't a lack of ambition. The Premiers (and their predecessors) have tried for years to make this system work better.
In the 1990s, of course, the argument was that the system was underfunded. But it's hard to make that argument today. Health spending in Ontario, as an example, has rocketed up by 7.6% for the last decade, as economist Don Drummond recently observed. Add in countless reforms and consultations, and the reality is this: the system continues to be marred by deep problems. Millions are without a family doctor; waiting lists plague all aspects of the system.
A federal commitment to reduce wait times for, say, MRIs will do what all such top-down directives achieve -- some modest temporary improvement. But the core problems would remain.
Indeed, if anything, it's Ottawa's rigidity that got us into this fix in the first place. The Canada Health Act forbids much experimentation with private solutions, the sort of basic reforms seen in other countries. It's that type of innovation that would help the system -- but the law forbids it.
Consider, for instance, a 2010 report by the New York-based Commonwealth Fund. Of the seven systems studied, Canadian health care ranked second in overall cost and second last in overall performance. And, no, the study is hardly a whitewashing of the American system. For the record, the U.S. health care ranked dead last.
Ottawa isn't part of the solution. It's part of the problem. But, then, so are the Premiers, who are content not to challenge the status quo, but spend, spend, spend.
Which is why Victoria will be like so many past meetings of the Premiers. Rich in rhetoric but poor in significance.