Duclos says he wants to be the provinces' ally — but the health care debate is getting fractious

Health Minister Jean-Yves Duclos says the "main important objective" of a meeting next week with his provincial counterparts is to "continue building a strong relationship" between the people responsible for this country's health care system.

So whatever else can be said about the slow-moving and increasingly agitated conversation about the future of Canadian health care, at least Duclos' gentle tone is holding up.

When Duclos tried to frame federal-provincial negotiations with a speech in March, he talked about "collaboration" and working "collaboratively" and taking "collaborative" action. He finished with a flourish that repeated the word "together" three times. He pitched a three-Rs approach that begins with "respect" for jurisdiction (followed by shared "responsibility" and "results").

"If there is one thing that the last two years of the pandemic have demonstrated," he said, "it is that with good will and hard work, the federative nature of our country can yield considerable benefits."

Seven months later, the provincial governments are running radio ads accusing the federal government of failing to provide sufficient funding for Canada's struggling health care system. Last week, federal sources told the Toronto Star that the federal government was prepared to move forward with provinces that are ready to cut a deal — and freeze out the recalcitrant ones.

Manitoba Premier Heather Stefanson said that sounded like a threat. But in an interview with CBC News this week, Duclos said that suggestion made by the sources – that Ottawa is willing to leave some provinces out in the cold – is not accurate and that it would be "unfair to Canadians who expect our collaboration between health ministers to be positive, to be fruitful, to be focused on results."

"The federal role is a role of acknowledging ... the problems, convening people, bringing people together, not dividing them … supporting each other so that we do things differently this time from what perhaps in the past these efforts have led to," he said.

Maybe that's wishful thinking from a former professor and economist. Maybe Duclos is trying to clean up after federal officials who got ahead of themselves with their off-the-record comments. Maybe he's the good cop in this negotiation. 

Whatever the case, there is an obvious need to get on with the business of turning statements of concern into an actual deal. 

Results first, money later

The suggestion that the federal government might start making bilateral deals with individual provinces is at least worth considering — because there is precedent.

In 2016, the federal side — Jane Philpott as health minister, Bill Morneau as finance minister — came to the table with an offer to boost funding by $11.5 billion over ten years, with funds earmarked for home care and mental health. The premiers, who wanted a significant boost to general funding, balked.

But over the ensuing months, the federal government started making deals with specific provinces — first New Brunswick, then Nova Scotia and Newfoundland, then the territories and eventually Ontario, Quebec and Alberta. Philpott said it wasn't a matter of "divide and conquer."

However one describes the approach, it worked — at least from the federal perspective.

Duclos isn't threatening to pursue a similar strategy now. At one point in this week's interview, he described himself as an "ally" to provincial health ministers. "I'm there to help them," he said.

The federal government's desire for results focuses on five broad areas of concern: the health care workforce, access to family health services, long-term care and home care, mental health and addiction, and health data and virtual care. Duclos and the Liberals would like to discuss the desired results before they start talking about how much more money the federal government might put up.

"We want those results to be concrete and tangible," Duclos said, "And before we come to the means that will be necessary to achieve them, we first need to speak to the substance around those results."

As a federal source put it this week, "Before we put more money in, let's talk about what we want to do with it."

Another federal source suggested targeted results could be tied to dedicated funds, while a boost to the Canada Health Transfer could be tied to an agreement on greater sharing and standardization of health data across provinces. (Both sources spoke confidentially because they were not authorized to speak publicly.)

Dix says provinces waiting for a 'serious' response

Focusing on results and outcomes could have both practical and political advantages for a federal government that would like to say something was accomplished with the money it spent.

Objective observers might ask whether the targeted results are ambitious enough. And provincial governments might argue they are the ones who ultimately will be held accountable if results aren't achieved.

It's hard to imagine this coming together without some tough conversations — even if those are left to the finance ministers.

But the Liberals have something at stake here, too. If they want to stand against privatization experiments like Saskatchewan's pay-for-access MRI scheme, they need to provide a level of funding that would make such moves seem unnecessary. If they don't, their protests will ring hollow.

How much next week's meetings in Vancouver might advance this conversation is unclear. In an interview with the CBC's Power & Politics this week, British Columbia Health Minister Adrian Dix said he had the "highest regard" for Duclos but argued that the provinces have yet to hear a "serious response" from the federal government.

"Frankly, leaks from political staffers to reporters are not engagement and that's what we've seen in the last week. We need a serious approach and we take a serious approach to this issue," Dix said. 

"They've got to get with it, come to the table and work on a real answer on the Canada Health Transfer."

Dix suggested that kind of conversation needs to happen between the prime minister and the premiers.

Duclos may have been correct when he said in March that Canadians were not interested in a "sterile fiscal debate" or a "numbers war" between provinces.

"Canadians are not particularly interested in percentage points or tax points or billions of dollars if they don't feel that this is going to be useful for increasing the quality of care," he said this week.

But however the conversation takes place, Canadians might eventually become impatient to see it concluded.