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it will remove money and jobs from health care precisely at those times when they are needed most

since its inauguration by the Liberals in 1968, medicare has been under attack from those who think the federal government has no business in health care.

By 2002, Ottawa was contributing only 18 per cent of the public cash going to medicare.

This is why Roy Romanow’s 2002 Royal Commission into health care recommended a boost in federal cash contributions. And it is why the federal-provincial health accord two years later was so important.

That accord eliminated any linkage between federal health transfers and economic growth. More important, it committed Ottawa to put more real cash into medicare.

Thanks to that accord, the federal government’s cash share of health-care funding has gone back up to about 25 per cent.

the Conservative arrangement would eventually return the country to where it was in 2002 — with Ottawa putting little into medicare and the federal government losing all ability to enforce national standards that Canadians accept as given.

Stage two has not yet been announced.

Prime Minister Stephen Harper can now tell the premiers that he’ll turn a blind eye if they try to make up this shortfall through creative solutions — even if such solutions (delisting of all but core services? user fees?) run directly counter to the letter and spirit of medicare.

Federal-provincial-territorial officials will continue to review the technical aspects of Equalization and TFF to ensure the proper functioning of these programs. Upon renewal, both programs will be legislated out to 2018-19.

The Government has extended temporary total transfer protection another year to assist provinces and territories in transitioning through current economic challenges.

Duncan and Bachand were joined at a post-meeting news conference by the finance ministers from Manitoba, Prince Edward Island, Newfoundland and Labrador and Nova Scotia, who all blasted the new transfer arrangement.

He said tying health transfers to the nominal rate of economic growth starting in 2017-2018 effectively removes $21 billion from health care funding across Canada.

B.C. Finance Minister Kevin Falcon said he's happy with the five-year plan.

"The process that we saw today where the federal government comes and says this is our non-negotiable position simply is not the way to build a nation," he said.

the deal offered by Mr. Harper’s government is reasonable. It is fiscally responsible, tying spending increases to inflation

It is also politically astute, for a host of reasons:

* It avoids the sordid scene we saw in 2004 when provincial premiers ganged up on prime minister Paul Martin and extorted $41-billion in additional health dollars and a spendthrift 6-per-cent escalator clause on transfers.

* It is a 10-year deal, just as the provinces demanded, allowing some certainty in budgeting.

* It respects Mr. Harper’s election promise to maintain 6-per-cent increases beyond 2014 – at least nominally. (Those who wanted 6 per cent per annum were dreaming in Technicolor.)

* It puts the onus on the provinces to justify why health-care spending should exceed inflation, something they have never been able to do.

* It places no restrictions on how the provinces spend the $40-billion a year they receive in federal health transfers (along with another $20-billion in social transfers for education and welfare programs.)

It should be an instrument for improving health-care delivery, and in that regard, Mr. Flaherty’s offer fails miserably

What the public should expect from Ottawa is that federal funds be used to exercise leadership and foster innovation

The reason Ottawa transfers money to the provinces in the first place (because health is a provincial responsibility constitutionally) is to ensure some semblance of equity coast-to-coast-to-coast. But there are areas, such as catastrophic drug coverage and homecare, where there are gross regional disparities.

This accord will force the provinces to rein in health spending, which is not a bad thing in itself. But one of the consequences will likely be greater disparities in the quality of care and breadth of coverage between the have and have-not provinces.

The great failure here is not refusing to increase transfers by 6 per cent, it is failing to attach strings to the monies.

With this deal, Mr. Harper has shown himself to be politically astute and fiscally prudent, but he has failed to show a commitment to strengthening health care, and medicare more specifically.

no process. This was Ottawa’s position

When asked why Saskatchewan, Alberta and New Brunswick were not with them, Mr. Sheridan said there was a “quick decision” by some to form a front and speak. “We’ll see how it breaks down in the next few days,” he said. “We have plenty of time. There is no rush. We have to get it right for the sake of the country.”

New Brunswick Finance Minister Blaine Higgs is more concerned about the equalization program than the Canada Health Transfer, the source said.

Higgs also dismissed a report in a national newspaper that New Brunswick didn’t speak out against the federal government on Monday because the provincial government feared "retribution." Higgs said that's not true. He said the other provincial finance ministers organized a media scrum with reporters after he'd already left for the airport.

Nominal GDP is the monetary value of all goods and services produced within the country annually, including inflation. If nominal GDP rises four per cent and inflation is two per cent, the economy's real GDP growth is two per cent.

Harper is inviting provinces, with some federal guidance, to do as they see fit in their own jurisdictions while inviting them to co-operate in establishing national benchmarks for delivering health services.

The West welcomes the certainty of the new model. It sees as a key victory the fact that Ottawa will allocate funds on a per capital basis rather than disproportionately favouring poorer provinces. The East calls the offer insufficient and an abuse of the federal-provincial process.

By offering money with no strings attached, Mr. Romanow said, richer provinces can experiment with new services – via public or private routes – that other provinces can’t afford.

The Conservatives decided on a unilateral approach several months ago, government sources said.

Officials identified three potential windows for releasing the new numbers. The first was Mr. Flaherty’s November fiscal update. But cabinet had not approved the new deal then. The second opportunity was Monday’s meeting of federal and provincial finance ministers. The Conservatives also contemplated holding off until January, when the premiers meet to discuss health care

Finance Canada documents said that the slower growth is because “governments are working to move health care funding to a balanced and sustainable path,” but a CIHI official said the institute can’t explain the one year drop, or whether it is a statistical blip.

Some provinces will be able to spend more on health care, others will bear a bigger burden of the aging population, others now have an opportunity to experiment with more private delivery.

there will now be an opportunity, as Canadian Medical Association president John Haggie puts it, “to identify how resources will be used to improve patient care across the country.”

Six per cent a year is unsustainable. The provinces’ budgets would eventually be swallowed by Medicare. All that cash was the wrong kind of “fix” – it induced reliance, not change.

since what she has to say isn’t tied to the money, there is little incentive for provincial counterparts to take her seriously

The funding in the last 10-year federal-provincial health accord was used, to some success, to reduce surgical wait times.

How will it ensure federal funding leads to more doctors and nurses, better home care and more affordable prescription drugs?"

During the recent federal election campaign, in their 66-page platform the Conservatives devoted nine paragraphs - about three-quarters of a page - to renewing the Health Accord.

It also exercises many responsibilities that affect health outcomes. Here are important examples. The federal government regulates the marketing of drugs. What could it do to contribute to cost control in that area? Are there ways the federal government could use its considerable health research dollars to support health-care reforms? As the Canadian population ages, the use of health technology will cost more. Here again, the federal government has some jurisdiction. What about health costs and health outcomes for first nations?

Process matters in federal-provincial relations. A federation is about rules and process. In this case, why does it matter? Because federal involvement in health care is necessary and can be achieved only with co-operation. Even if one rejects the use of the federal spending power to influence health-care delivery, the federal government holds many levers that affect health-care costs directly.

Co-operation in these areas might be more fruitful than in areas where the federal comparative advantage is not strong.

André Juneau, director of the Institute of Intergovernmental Relations at Queen’s University, is a former federal deputy minister

Over the next decade, we anticipate major technological advances that will improve the quality of care

with restricted funding, those who could get those benefits will be those who can pay out of pocket. The result will be two-tiered health care.

Menzies acknowledged this has resulted in "some complaints from Alberta all along, but they had signed the deal."

some net improvement in what that transfer looks like

The feds could work with the provinces to set up a “buyer in chief,” trimming costs for everyone by flexing our purchasing-power muscle through a single-payer system. Taking $600 million from the escalator, matched with existing expenditures by the provinces and territories, could start a process that, over five years, could build toward a pan-Canadian formulary of the 100 most commonly prescribed drugs, negotiate a better price through bulk buying, and collectively save ourselves billions.

bring a preventive, child-focused dental care program to every child under 14 in their schools for an estimated $564 million nationwide. The feds could provide a 50-cent dollar for every province that signs up. A $300 million investment through the new funds, matched by what the provinces already spend, would save billions down the road and improve lives

Far too many people turn to our hospitals for want of options for primary health care in the community.

integration of care between our hospitals and our communities

Take $700 million from the escalator funds today and start the process of expansion

that’s what Canadians want: change that buys better health, better care and better control of costs