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Prime Minister Paul Martin, first ministers and aboriginal leaders meet at the Government Conference Centre in Ottawa on Monday, Sept. 13, 2004 to discuss health care. (CP PHOTO/Fred Chartrand)
Anatomy of an agreement
CBC News Online | September 16, 2004

Sunday, Sept. 12, 2004

The premiers arrive in Ottawa a day before the first ministers' conference on health care officially kicks off. They gather at Prime Minister Paul Martin's house – 24 Sussex Drive – for dinner and some details of what the federal government will serve up in the way of a new deal on funding health care.

The premiers emerge from dinner hungry for more details on Ottawa's proposal. It's said to be a package worth more than $12 billion over six years, which includes increased base health-care funding beyond levels the Romanow report recommended and money to reduce waiting lists.

Also in the package are said to be a clause automatically increasing health-care funding each year and changes to the equalization formula to guarantee minimum payments to poorer provinces, allowing them to budget better.

But details were scarce. The premiers could not agree on exactly what Ottawa would be proposing.

"The numbers keep changing on the fly," Manitoba's Gary Doer told reporters. "The documents keep changing on the fly. We don't run a health-care system on the fly."

Quebec Premier Jean Charest had similar misgivings.

"Well, I'm not clear either, because the numbers on the federal side keep moving and they have moved in the last 24 hours."

Dollar details aren't scheduled to be on the table until Wednesday's session. That left federal Health Minister Ujjal Dosanjh trying to fill in some gaps, without giving away too much.

"I'm not going to get into the number of billions," Dosanjh said. "Is it big, little? I don't think it's helpful to talk about numbers. I can tell, there's going to be significant money on the table."

There may be a lot of money on the table by Wednesday. But Alberta's Ralph Klein won't see it in the flesh. He's sticking by his previous schedule to leave after Day One to get back to other commitments.

Monday, Sept. 13, 2004 | Day One

Prime Minister Paul Martin shakes hands with Ontario Premier Dalton McGuinty before the start of the First Ministers Conference on Health in Ottawa on Monday, Sept. 13, 2004. (CP PHOTO/Tom Hanson)
The first ministers conference opens with a morning session on aboriginal health care and details about some of the money that Ottawa is willing to commit.

Prime Minister Paul Martin proposes adding $700 million over the next five years to the $1.7 billion the federal government spends on health care each year for aboriginal people. The new funding – if the proposal leads to a deal – would go to:
  • A $200-million health fund.
  • $400-million for disease and suicide prevention.
  • $100 million to increase the number of health professionals serving native communities.
Phil Fontaine, the head of the Assembly of First Nations, welcomed the proposal, but called for more.

"It is time to put First Nations first. We are not second-class communities or second-tier citizens," Fontaine said. "We must be an integral part of the decision-making process.''

Martin said he wants health care for aboriginals to be delivered more evenly across the country, and not be dependent on whether someone lives on- or off-reserve, or is M�tis, Inuit, or a non-status native as opposed to a member of one of the First Nations.

M�tis leader Clement Chartier painted a picture of how poor health care affects his community of "forgotten people," who, he said, often fall through the cracks between provincial and federal programs.

"I see elders accepting the pain of arthritis because they cannot afford to travel to see a doctor," he said. "I see entire families plagued by diabetes, including the loss of limbs... I see communities torn apart by suicides of their best and brightest."

The rate of diabetes among native people is four times the average for other Canadians. The suicide rate is six times higher – and native women can expect to die 14 years younger than other Canadians.

The morning session wraps up with a news conference – dominated by questions about how much money is in the total package.

"Details on financing," the prime minister has said several times, "is on the table Wednesday."

But those details wound up coming out Monday afternoon. Federal officials scrambled to make their numbers public as the premiers continued to press Martin on live television after the lunch break.

As Alberta Premier Ralph Klein spoke before the conference cameras, federal officials were holding a news briefing.

Ottawa's numbers: $12.2 billion in new health money over six years – including a $4-billion fund to reduce waiting times – with an "escalator" to make sure future federal payments keep up with growing costs in the health-care system. It's pegged at five per cent a year.

There's also an increase in equalization payments to make sure have-not provinces can offer the same level of services as richer provinces.

Martin's decision to hold the briefing while the conference went on, angered the premiers. Klein made good on his promise to leave after the first day of the conference. He scoffed at the notion that Martin's numbers would buy change in medicare. He estimated the offer works out to about $65 per Canadian a year.

With health care expected to cost provinces and territories more than $500 billion over the next six years, the first ministers argue that Ottawa, with its huge surpluses, can afford to assume a greater share of the total bill.

Ontario Premier Dalton McGuinty argued the offer doesn't even cover the so-called "Romanow gap," an amount Roy Romanow recommended in his report was needed to bring federal contributions to 25 per cent of all health-care expenditures.

"That includes our drugs costs, and our home care costs, and all of those things which we have taken on the responsibility for, because we think it's part of a comprehensive health-care system."

But Romanow disagrees. He said Ottawa's offer meets his recommendation.

"I think they've met the Romanow gap, if I can describe it that way. Maybe even exceeded it."

Monday ended somewhere Paul Martin said he didn't want to be – with federal and provincial officials arguing over numbers. Those arguments, he says, obscure more than they inform.

Tuesday, Sept. 14, 2004 | Day Two

Manitoba Premier Gary Doer (left) and Ontario Premier Dalton McGuinty (right) listen to New Brunswick Premier Bernard Lord (centre) at the First Ministers Conference on Health Care in Ottawa, Tuesday September 14, 2004.(CP PHOTO/Tom Hanson)
Monday's tension spilled into Tuesday as the premiers cancelled their breakfast meeting with the prime minister, preferring to talk amongst themselves, instead.

Rumours circulated that the premiers were preparing a counter-offer.

Saskatchewan Premier Lorne Calvert said the decision to cancel the meeting was not a snub but a desire to talk strategy for Tuesday's session on how to reduce waiting times.

Provincial officials also said the premiers wanted more time to analyse Ottawa's numbers.

But as they got back to work before the live television cameras, tempers did flare.

"We cannot fix health care for a generation without funding for a generation," Manitoba's Gary Doer insisted.

Off camera, a live microphone picked up someone muttering, "Jesus Christ!"

Moments after a coffee break, Prime Minister Martin conceded that he was the offending party – and that his aunt had called during the break to suggest that he might want to wash out his mouth with soap. Martin apologized to the premiers, explaining that he made the comment after one of his officials handed him a note – and that he was not reacting to Doer's remarks.

Prime Minister Paul Martin chats with Quebec Premier Jean Charest as Premiers Dalton McGuinty (left) of Ontario and British Columbia's Gordon Campbell chat in the background during a break in the First Ministers Conference on Health in Ottawa Tuesday Sept 14, 2004.(CP PHOTO/Tom Hanson)
Still, Martin found himself the target of the premiers' barbs. They pointed out that there wouldn't be a crisis in health care today if Martin hadn't tamed the deficit on the backs of the provinces in 1995.

"If we had not acted in 1995, we would not be here today," Martin said.

"We would not be in the position to offer the kinds of money we are offering today. In 1995, 35 cents of every dollar that we spent on health care was borrowed."

"With all due respect," New Brunswick's Bernard Lord replied, "when you put your energy and your focus and your determination to break the back of the deficit, you did it for a generation, not for five years."

After lunch, the premiers did unveil a counter-offer. It includes $5.2 billion more in 2004/05, including $3.9 billion in unallocated health funding as well as $1 billion for pharmacare, and more money for health care in Labrador and the North. As well, the premiers want the "escalator" set at six per cent instead of Ottawa's offer of five per cent.

In total, the counter-offer calls for about twice the money Martin has put on the table.

"Work is now about to begin," Ontario Premier Dalton McGuinty said at a news conference announcing the numbers. "We have their proposal. We have our proposal."

Federal Finance Minister Ralph Goodale held a news conference of his own to respond to the premiers' numbers. He called them substantially the same as ones the premiers put forth at a meeting at Niagara-on-the-Lake in 2003.

Money was not on the agenda for the Tuesday afternoon session. The first ministers went ahead with their original plan to talk about reforming health care through disease prevention, among other measures.

The counter-offer was scheduled to be on the menu at a private dinner at the prime minister's house on Tuesday night.

Wednesday, Sept. 15, 2004 | Day Three

Health Minister Ujjal Dosanjh huddles with his aids outside the site of the First Ministers Conference on Health in Ottawa on Wednesday, September 15, 2004.(CP PHOTO/Fred Chartrand)
The live, televised first ministers' meeting goes behind closed doors. Tuesday night's dinner turned into an early morning bargaining session that didn't break up until a couple of hours after midnight.

The prime minister and some of the premiers say they will stay longer if they are close to reaching a deal at the end of the day.

Both sides are said to have budged on the issue of money. The premiers say money is the main issue. Prime Minister Martin says it's not so much about how much money but where the money will go and how much control Ottawa will have over how it's spent.

Thursday, Sept. 16, 2004 | Day Four

By late Wednesday night, word slipped through the closed doors that a deal had been reached. It wasn't until after midnight that details of an agreement that could not be reached in front of live television cameras, emerged.

In total, the deal is worth $41 billion over 10 years.

"Canada's first ministers have agreed to and signed a deal for a decade that will lead to better health care for all Canadians," Prime Minister Martin told an early morning news conference.

To get the 10-year pact Martin coveted, he had to come up with much more money than he originally offered the provinces and territories – but significantly less than what they asked for in their counter-offer.

Martin upped the ante by about 50 per cent to secure a commitment from the provinces and territories to make changes that would reduce waiting times for access to key services. Martin also secured promises of greater accountability from the provinces on how the money would be spent, one of his key demands.

Among the key parts of the agreement:
  • $3.5 billion over two years in additional transfers to the provinces and territories.
  • An "escalator clause" that automatically boosts transfers by six per cent a year to keep up with rising health costs.
  • $4.5 billion over six years for a special fund to reduce waiting times for treatment.
In addition, a National Wait Times Strategy will be developed for five priority areas: cancer care, cardiac treatment, diagnostic tests such as MRIs, joint replacements and cataract surgeries. The provinces have agreed to meet nationally-set benchmarks on waiting times, which are to be set by December 2005.

B.C.'s Premier Gordon Campbell said the deal offers hope for Canadians accustomed to long waits for diagnostic services, overcrowded hospital wards and a shortage of doctors and nurses.

"It provides us with sustainable funding we can count on," Campbell told reporters. When we can count on it, our patients can count on improvements across the country."

Quebec Premier Jean Charest negotiated a separate deal that allows his province to set up its own waiting time reduction plan.

But one key player was missing from the handshakes. Alberta's Ralph Klein left Ottawa after the opening session. Back in Calgary, he called the deal a helpful gesture, but he vowed to go ahead with his own health-care reforms that are expected to include more private clinics.

"I really don't want anything," he said. "I want to be left alone so we can get on with reforming our health-care system, to make it sustainable."

Klein was represented for the rest of the talks by his health minister, Gary Mar. Mar said Klein would be signing on to the deal.

The main casualty of the deal may have been a national pharmacare program. The premiers dropped their demand for a comprehensive national program in exchange for more money from Ottawa. They agreed to set up a task force to develop a national drug strategy by 2006.


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Canadian Health Coalition � Found: Federal funding. Lost: A plan to stem privatization [pdf]

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The Romanow report [pdf]

The Senate Report on health care

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