The next version of Canada’s health care accord will be written by the provinces — in red ink

When they gather for their annual summer retreat in Vancouver next week, Canada’s premiers will be hosted by British Columbia’s Christy Clark, a rookie colleague who has yet to lead her party in an election.

When they gather for their annual summer retreat in Vancouver next week, Canada’s premiers will be hosted by British Columbia’s Christy Clark, a rookie colleague who has yet to lead her party in an election.

The meeting will be attended by five government leaders — from Saskatchewan, Manitoba, Ontario, Prince Edward Island, and Newfoundland and Labrador — who are scheduled to seek re-election within the next 90 days.

In Alberta, the ruling Conservatives will be selecting a new leader on Oct. 1. This summer, the province is in the hands of a caretaker premier.

Among the premiers of the major provinces, Quebec’s Jean Charest is the most certain to be back for next year’s edition of the retreat — but only because he does not have to call an election between now and then unless he chooses to do so.

In the last federal campaign, Liberal Leader Michael Ignatieff promised to gather the premiers to discuss the future of medicare within 60 days of the election.

Had he become prime minister, his health summit would presumably be taking place this month.

Given a provincial lineup so replete with lame ducks and wannabe premiers, the meeting’s concluding communiqué would hardly have been worth the paper it was written on.

For his part, Stephen Harper is apparently in no hurry to launch a federal-provincial conversation on health care.

A cast of premiers very much in the making (or the remaking) is part of the rationale. But the arrangements negotiated by Paul Martin in 2004 also only run out in 2014 and there is talk in government circles of a more hands-off federal approach to their renegotiation.

When the time does come to discuss the way forward, there may not even be a negotiating table — or at least not in the physical sense of the horseshoe piece of furniture around which the epic federal-provincial battles that have shaped Canada have been fought in the past.

Harper has already committed to negotiating a separate agreement with Quebec, and that approach could be extended to other provinces.

That notion has many of the constituencies that make up Canada’s health lobby up in arms. Their protests are not totally disinterested.

Over the years, many key protagonists in the health debate have invested a lot of resources on the federal front.

If Harper did adopt a province-by-province approach, those groups would have to redeploy in the provincial capitals rather than to pursue what has already become a monologue in Ottawa.

Many medicare advocates fear that a more disengaged federal government will lead to the inevitable demise of the public system.

Yet, over the past two decades, a vigilant electorate has been more effective in policing the provinces than a federal government that has tended to look the other way rather than pursue possible infringement to the Canada Health Act.

Alberta and Quebec both had to beat a retreat in the face of populist backlashes against measures that seemed to fly in the face of the act, for fear of being punished at the ballot box.

Whatever the approach, the challenges of running a public health-care system are about to become even greater.

An aging population is only one piece in the puzzle.

The Conservative election promise to maintain the six per cent rate of increase in the federal health transfer for the duration of the current federal mandate will only translate into a one-year extension to the existing arrangements. And even under that regime, federal funding to most provinces could start to grow more slowly.

In one of its first budgets, the Harper government promised to bring Ontario’s share of the health transfer in line with its population as of 2014.

Topping up Ontario’s share out of the existing pie would mean that there would be less funding to go around for the other provinces.

Despite the promises of the last federal campaign, the next chapter of the medicare saga will most likely be written in red ink in the provinces.

Chantal Hébert is a syndicated national affairs writer for the Toronto Star.

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