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The Conservatives managed to achieve a measure of restraint while still being fair and even generous up front, allowing the 6-per-cent increases to continue each year for three more years, before moving to annual hikes that will probably settle in at between 3 and 4½ per cent. People, and provinces, don’t change unless it’s necessary to change.

The 2012 federal budget confirmed Stephen Harper’s plan to cut federal health care funding, and it showed no leadership on pressing Medicare issues. Women, both as providers and recipients of health care, will suffer most from these gaps.

The budget confirms Harper’s decision, announced last November with no negotiations, to implement long-term cuts to health care funding. Starting in 2017, Canada Health Transfer increases will be tied to economic growth, with a three percent floor, down from six percent. How much is cut depends on economic growth; assuming the worst, it means a cut of $36 billion over seven years. Using the Parliamentary Budget Office's more optimistic outlook, it's a cut of $26 billion over seven years.

The federal government's cash share of provincial health spending was 50 percent at the start of Medicare; now it stands at 21 percent. Harper wants to drag the federal government back to the 10 percent level of the late 90s

The provinces are certainly not equal in their fiscal capacity. Indeed, if one looks at per capita own-source revenues, Newfoundland and Labrador, Saskatchewan and Alberta are well above the provincial average as a result of their natural resource revenues. Meanwhile, Prince Edward Island, Nova Scotia, New Brunswick and Ontario are below the average while Manitoba and British Columbia are at about the average.

The provinces are also not equal in their rates of population growth, the rates at which their population is aging, the proportion of aboriginal or immigrant population, or the incidence of various diseases.

In 2011-12, Ottawa transferred about $58 billion in cash to the provincial and territorial governments. The three main provincial cash transfer programs are the Canada Health Transfer at $27 billion, the Canada Social Transfer (for child, post-secondary education and social programs) at about $12 billion and Equalization (funds for those provinces with a weaker fiscal capacity) at almost $15 billion.

Ottawa is moving toward a pure per-capita system of calculating how much each province should receive in federal health-care funding, starting in 2014. The new system means the existing equalization component in health transfers — intended to even things out among have and have-not provinces — will disappear.

the change means Alberta will receive $1.1 billion extra each year, on average

Redford added that Alberta got the short end of the stick for years and this finally evens the playing field.

In a July 2010 editorial board meeting with the New Brunswick Telegraph-Journal, Flaherty called for a cut to the annual Canada Health Transfer from a 6% annual increase to “real GDP” growth – or 2.6%:

Health Canada provided an estimate of the federal contribution to health care, calculated on the basis of the same notional apportioning among health care, post-secondary education and social assistance as existed in the pre-CHST days under the combined effects of EPF and CAP. This estimate was used to calculate the federal share of provincial government spending on health care.

it is difficult (…) to determine exactly how much the federal government spends on health because of the flexibility under the CHST

the federal government is contributing $1 out of every $3 spent on health by public authorities in Canada

Around 25% of public health spending is financed by the federal government, with the rest paid for by provincial governments.

The briefing notes prepared earlier this year for the federal intergovernmental affairs minister predict that "pressure is expected to build" as a 10-year federal funding program for medicare nears an end and there are increased calls from the public for a "national dialogue" on the public health-care system.

the internal documents conclude that while the federal-provincial Health Accord negotiated in 2004 delivered shorter wait times for some procedures, it "failed to deliver significant reforms" in other priority areas such as primary care, home care, and access to prescription drugs.

the federal government will move in the future to an "equal per capita allocation" of the medicare funds to provinces

Every year, the federal government transfers approximately $50 billion in its major transfers–the Canada Health Transfer, the Canada Social Transfer and Equalization.

There is broad recognition that our fiscal transfer system does not serve Canadians as well as it could.

This Report Card identifies areas of strength and for improvement against commonly agreed upon and international best benchmarks.

while premiers - to varying degrees - are miffed at Ottawa's cavalier "take it or leave it" attitude, their first agreement at the Victoria meeting of the Council of the Federation was to strike a health-care innovation working group.

The agreement will pool a variety of cost-saving ideas, including scope of practice (which means nurse practitioners), human resources management (stopping the interprovincial poaching) and clinical practice guidelines (doing things for less money).

They set up another working group to keep the argument going over the new funding arrangement

On innovation, Wall said his group will look at issues ranging from labour costs to the way patients are treated.Pointing to the success of adding private clinics into Saskatchewan's publicly delivered surgical system, Wall signalled that innovation is likely to mean a different approach to how services are delivered."Even though we're using private clinics, nobody has spontaneously combusted, no one burst into flames; we've actually delivered more surgeries more quickly in the public system," he said. "I think given a choice between ideology and surgery, people in pain will pick surgery."

Federal transfers to provinces were about 20% of provincial revenues during much of the 1960s. Topping at 30% in 1979 and hardly falling below 25% of their revenues during the Trudeau and Mulroney years, the provinces enjoyed significant federal support for their spending on major programs including health care, social services, post-secondary education and infrastructure until 1997

As part of federal deficit fighting, Liberal finance minister Paul Martin shrunk provincial transfers, sharply lowering them to 15% of their revenues in 1997. After putting federal finances under control, the Liberal government then began to boost provincial transfers, which rose to 25% of provincial revenues by 2006. The Harper government continued the trend, with transfers rising back to the historical high of 30% of provincial revenues by 2009.

Meanwhile, federal transfers to the provinces and municipalities have been rapidly increasing since 2004 with the gas tax transfer and various federal infrastructure programs.

When Stephen Harper was campaigning for the first time, he proposed a Patient Wait Times Guarantee linked to federal money.

It’ll be the first time since medicare began that a federal government has handed money over carte blanche.

The anticipated drop in indexing from 6 per cent to 4 per cent or 5 per cent thereafter won’t figure in the next election, since the decline is hardly momentous.

Jim Flaherty, the federal Finance Minister, will insist that future health-funding increases be linked to growth in the economy when he meets with his provincial counterparts in Victoria, B.C., next Monday.

Provinces have become used to annual increases of 6% as a result of the 10-year health funding agreement struck with then-prime minister Paul Martin in 2004.

Private-sector forecasts for the period 2011-15 used by the Department of Finance suggest Canada’s economy will grow by 2.2% annually over the next four years. Even optimistic projections after that date indicate the rate of growth will need to halve.

unprecedented, one-sided meetings

the majority of provincial and territorial leaders said the deal amounted to a take-it-or-leave-it offer that was slapped on the table without any chance of discussion

"We were expecting to discuss how we were going to discuss federal transfers,"

The gradual levelling off in growth ofhealth transfers is probably the best possible deal the provinces and territories – and Ottawa for that matter – could hope for. At least in base political terms.

But shrewd tactics and political palatability are not the same thing as good public policy. At a time when medicare needs leadership and vision, the new accord continues the lamentable tradition of thoughtlessly shovelling money at the status quo.

Jim Flaherty’s offer was this: Continuing the 6-per-cent annual increase in the Canada Health Transfer and 3-per-cent per annum hike in the Canada Social Transfer until the 2016-17 fiscal year; after that, until at least 2024, increases in the CHT will be tied to economic growth, while the CST will continue at 3 per cent.

some worry that retaining the existing funding formula of 6-per-cent annual increases for the next five years could drain some of the energy from the reform process that is under way and even breed complacency

An enhanced role for community care is considered essential to take the pressure off hospitals, where one in six acute-care beds in Canada is occupied by an elderly patient waiting

Bob Bell, chief executive officer of the University Health Network

In 1977 both sides agreed to an incredibly complex formula, the essence of which was that federal funding for health care would increase annually at the rate of the nominal increase in the gross domestic product averaged over the previous three years.

the rate of inflation, add the rate real of economic growth – which, combined, equals nominal GDP

John Wright is CEO of the Canadian Institute for Health Information

For years, the Alberta government has been pushing the federal Tories to boost cash health transfers here. Former premier Ed Stelmach called it discriminatory that Albertans receive $240 less per person in health transfers than the rest of Canada - a disparity he said was worth about $900 million annually.

The difference going forward is that Alberta will receive actual money from Ottawa as opposed to a combination of cash and tax points.

an agreement made in 2004 by premier Ralph Klein because of the province's strong tax base.