Who pays for what?

In an interview with the CBC—to be broadcast this evening—the Prime Minister rejects the idea of a health care innovation fund (as proposed by Brad Wall and endorsed by Dalton McGuinty).

“What I think we all want to see now from the premiers who have the primary responsibility here, is what their plan and their vision really is to innovate and to reform and to make sure the health-care system’s going to be there for all of us,” Harper said, according to an excerpt from the interview. “So I hope that we can put the funding issue aside, and they can concentrate on actually talking about health care, because that’s the discussion we’ll be having.”

The idea of a separate fund for the provinces to use for innovation in the delivery of health care got no support from the prime minister. “I’m not looking to spend more money. I think we’ve been clear what we think is within the capacity of the federal government over a long period of time.”

Meanwhile, in an interview with CTV yesterday, Mr. McGuinty mused intriguingly of “disentanglement.”

The feds do jails and we do jails. The feds do training and we do training. The feds inspect meat and we inspect meat. Why don’t one of us, alone, take responsibility for some of those areas. I think that introduces more efficiencies, it introduces more transparency, accountability is more easily evident. I think those are the kinds of conversations that we need to have going forward in an era of fiscal restraint.

The Ontario premier arrived at this point in response to a question about the Harper government’s crime policies and the burden they will place on the provinces, so perhaps this seems tangential to the health care debate. But maybe it’s all part of the same discussion. Consider the analysis of Scott Clark and Peter DeVries that I noted this morning.

Your recent decision to tie the growth of health transfers to GDP growth after 2016-17 indicates that you now recognize that there is a structural component that needs to be confronted. This unilateral decision, without any prior discussion with the provinces and Canadians, will go along way to eliminating the structural deficit of the federal government. However, this will be achieved by simply shifting the structural deficit problem to provincial governments. Canada “Incorporated” will be no better off by this decision. Provincial governments will now have to find additional ways to deal with pressures on health spending by further cutting their program spending, raising taxes, or going into debt. As there is only one taxpayer, Canadians should be aware of this.

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