MONTREAL—By all indications, peace — in the shape of a 10-year accord — may be about to break out on the federal-provincial health front.
To listen to the first ministers, a deal that would see the federal government increase its contribution to the provinces’ health-care budgets in exchange for more transparency could be struck as early as next month.
Since the New Year, the war of words that has attended the long-standing deadlock between the two levels of governments has been swept by a modest wave of optimism.
At this point, all parties to the discussion have a stake in that optimism translating into a breakthrough. Having collectively raised public expectations of a positive outcome on what has become the number one concern of many Canadians, the first ministers are under self-generated pressure to deliver a viable compromise.
That starts with the federal Liberals. They are entering a critical political year, anywhere from four to six points behind the Conservatives in voting intentions.
A general election may not be imminent. With Alberta and Manitoba respectively headed to the polls in the spring and the fall, few expect a federal campaign in 2023. But a year in politics is quickly passed.
By this time next January, Trudeau’s third term will have extended beyond the average life of a minority government.
Failing to strike a health-care deal would undoubtedly hurt Liberal prospects for reelection, but that does not mean the striking of one will turn the tide in their favour.
This is a rare instance where a win for Trudeau stands to be one for Conservative Leader Pierre Poilievre.
To understand the politics that could attend a first ministers’ health accord, it is useful to look back to the last time a comprehensive deal was struck between Ottawa and the provinces.
Back in 2004, Prime Minister Paul Martin was also at the head of a minority government.
A royal commission on the future of Medicare headed by former Saskatchewan premier Roy Romanow had just concluded the system needed a reset and fresh infusion of stable federal funding.
Martin knew he could not go back to voters without having ticked the health-care box.
But Liberal hopes that a federal-provincial consensus on the way forward for Canada’s most cherished social program would tilt the electoral balance in his favour did not pan out.
A bit more than a year after negotiating the accord, Martin lost to Stephen Harper.
Ironically, the 2006 election was triggered by the NDP’s decision to join the other parties in a vote of non-confidence in the Liberals over the latter’s health policy.
At the time, NDP Leader Jack Layton argued he had not received enough assurances the Liberal party would fight the increased use of private health care in the provinces.
It’s too early to tell whether history will repeat itself in this Parliament. Jagmeet Singh was making noises along the same lines this week as he urged Trudeau to financially punish provinces such as Ontario for contracting out some surgeries to for-profit private clinics.
Should public pushback against Premier Doug Ford’s move gather momentum, what is now only a veiled threat could yet see the NDP pull out of its pact with the Liberals.
(Before that happens, it may be worth noting that Layton’s decision to turn his back on Martin in late 2005 resulted in the election of a government even less interested in policing private health care and in a decade-long decrease in the NDP’s influence on the federal agenda.)
While the New Democrats see health care as a sword they can yield to try to inflict damage on their Liberal rivals, the Conservatives come at the file from the opposite perspective.
In 2004, Harper promptly signalled that, should it form government, his party would abide by Martin’s 10-year accord. In so doing, the CPC leader took the no-win health issue off the table for as long as he was prime minister.
By comparison to Harper, Poilievre may have an extra incentive to ensure as little light as possible shines between his party and Trudeau’s Liberals on the matter of health-care funding.
Back in 2004, the Liberals were in power at Queen’s Park. As a result, it was Martin’s MPs who were in the line of fire whenever provincial policies irked voters.
For instance, when premier Dalton McGuinty introduced a health levy during the 2004 federal campaign, it was Martin’s candidates who ended up on the receiving end of a lot of public discontent.
But now, the roles are reversed, with Poilievre vulnerable to whatever backlash may result from the Ontario government’s decision to give the private sector a larger role in the delivery of public health care.
Trudeau is not the only federal leader who has cause to wish for the shield of a 10-year health accord in time for the next election.
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