Amid funding debate, a tweet causes trouble among health ministers

Over lunch on Tuesday, in the Belgravia room on the second floor of the King Edward Hotel in downtown Toronto, discussion among the country's health ministers turned to the federal minister's use of social media.

Federal and provincial governments circle each other on the subject of a new health accord

Federal, provincial and territorial health ministers pose for a photo during a meeting in Toronto on Tuesday, October 18, 2016. (Christopher Katsarov/Canadian Press)

Over lunch on Tuesday, in the Belgravia room on the second floor of the King Edward Hotel in downtown Toronto, discussion among the country's health ministers turned to the federal minister's use of social media.

At issue was a graphic, posted to Jane Philpott's Facebook page and retweeted to her Twitter account on Monday, that included the message, "Canadians expect that any new investment for health care ought to go to health care." 

That federal funding for health care should be spent on health care was one of Philpott's messages when she spoke to reporters on Monday afternoon and it was something repeated by the prime minister in the House of Commons. 

Ontario's Eric Hoskins had questioned the implication and publicly expressed his concern when he stopped to speak with reporters early Tuesday.

"Frankly," he said, pausing for a few seconds as he seemed to consider his words, "I think that that's the one element of what's come out in the last 24 hours that most disappoints me." 

He identified a "suggestion that provinces and territories don't share the same objective and aren't acting with the same good faith and fairness and insuring that every health care dollar is invested that way."

Hoskins is then said to have then raised the tweet at lunch, according to sources briefed on the discussion.

Terry Lake, health minister for British Columbia, later said the post was not in the "spirit" of the "cordial, respectful, collaborative relationship" that the provinces otherwise have with Philpott.
Ontario Health Minister Eric Hoskins, centre, speaks as Federal Health Minister Jane Philpott, left, looks on during a federal, provincial and territorial health ministers' meeting in Toronto on, October 18, 2016. (Christopher Katsarov/Canadian Press)

Asked by a reporter about her comment at the closing news conference on Tuesday, Philpott took the opportunity to apologize "if people misunderstood."

"There's certainly no intention to make accusations," she said. It wasn't about how provinces have been using the money, she explained, but about any new investments.

Still, it seems like some kind of marker.

On the scale of federal-provincial discord, this ranks somewhere below the walkout that occurred two weeks ago when the federal government abruptly announced a price on carbon in the middle of a meeting of environment ministers.

But it was a bit of drama in what seems to have been — in between the discussion of several issues of public health that have less to do with the question of federal funding for the provinces — a two-day exercise at staking out and reaffirming bargaining positions.

Talk of a new health accord dominates

According to the official agenda for the general meeting, the topic of a new health accord was scheduled to occupy 40 minutes of the ministers' time on Tuesday, but that session ran more than an hour as each provincial and territorial minister in attendance took a turn stating (or restating) their positions, though the discussion is said to have been mostly cordial.

And while the rest of the schedule included sessions on Indigenous health, opioid addiction, marijuana legalization, medically assisted death and pharmacare, the future of federal funding for health care was very nearly the only topic discussed at every media availability.

There are essentially just two questions to be answered here: How? And how much?

Gaetan Barrette, Quebec's health minister and the federal government's most loquacious counterpoint on this file, took the opportunity of Philpott's retweet to tweet back that "Canadians expect proper healthcare funding" and not what he described as a $60 billion reduction over the next ten years.

When Barrette repeated as much at the closing news conference, Philpott, standing beside him, shook her head and then raised her eyebrows and smiled. Federal funding, she counters, is scheduled to increase over the next 10 years.

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Eric Hoskins makes the case for why the provinces aren't happy with a three per cent increase from the federal government. 8:18

This is a somewhat philosophical dispute: Philpott is referring to the fact that federal transfers will increase by three per cent each year, Barrette is focusing on the fact that those transfers won't be increasing at the previous rate of six per cent.

But anyway, Philpott would rather talk about partnering with the provinces on specific initiatives beyond the existing transfer of money. 

"We want to be able to see where that money is going to go," she said. "If we're putting new money into mental health care, it would be great to be able to say this many hours of therapy were delivered with this amount of money."

Certainly such a setup would allow the federal government to justify its own efforts to itself and to the public (being able to boast about specific initiatives is surely preferable to boasting about the size of the annual escalator). 

But Hoskins, the chair of this week's meeting, argued the current rate for increases in the basic federal transfer is below what is projected to be necessary to maintain existing services.

Meanwhile, Alberta's Sarah Hoffman, who will chair the next meeting of health ministers, emerged this week with a willingness to talk about targeted funds.

But Quebec's Barrette insists the current proposal of $3 billion for targeted funds over the next four years is insufficient.

Hoffman at least raised the possibility of pursuing "bilateral discussions" with the federal government. 

But then there remains an outstanding demand from the provinces for a first-ministers' meeting of the premiers and prime minister.

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The ministers seem to be circling each other, brandishing rhetorical knives

At the end of the day, there were general suggestions of agreement about the need to provide sufficient health care to Canadians. 

But past that, ministers seem to be warily dancing around a deal, and brandishing rhetorical knives as they go.

The federal government ventures that funds for health care should go to health care. The provinces suggest the federal government should be covering 25 per cent of the total cost. And so on.

And now this will go on for awhile longer.

It is surely just as the fathers of Canadian medicare intended it to be.

In all, for the record, the ministers shared three private meals this week — a dinner on Monday night, then breakfast and lunch on Tuesday. If nothing else, they should now be well-acquainted with each other's opening positions.


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