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Those negotiations have not yet begun. At last week's meeting of provincial health ministers, to which federal Health Minister Jane Philpott was invited, she shooed away any mention of money, which, at this stage of the game, is the correct approach. Meanwhile, the provincial health ministers said they would work on what a national prescription-drug plan would look like and cost - the cost having squelched the idea of national pharmacare in the past. Several academics, often quoted in the press, believe that national pharmacare would save money. Almost nobody else does, which is why the idea has never got off the ground. Quebec has discovered that its public plan, more elaborate than any other, costs a lot more than anyone had anticipated. Prime Minister Justin Trudeau's instructions in Dr. Philpott's mandate letter are much more limited. Since Ottawa spends in the order of $1-billion on drugs for aboriginal people and the military, let Ottawa join the provinces in more bulk drug purchases to lower costs. She is also to "explore" the idea of a national formulary - an excellent idea since no logical reason exists for every province to have one. Again, though, this is far from national pharmacare.

What the Liberals do want is directed spending on home care. Here, the federal-provincial negotiations will be fascinating, and perhaps consequential for patients. The federal Liberals are always tempted to put strings around the health-care dollars Ottawa sends to the provinces. Ottawa doesn't deliver health care to Canadians (except the military and aboriginal people) and it's paying a smaller share of overall health-care spending than years ago.

Yet the Liberal itch to influence, if not direct, how federal transfers should be spent never dies. The trouble is that every time previous Liberal governments pulled out string to wrap around the transfers, at least some of the provinces said: Just give us the cash and stuff the strings away. We do health care; you write cheques. We set priorities; you help pay. This time, though, the provinces are aware of their burgeoning number of older citizens, an increasing share of whom need or prefer to be cared for at home rather than in institutions. Provinces need to save money, too, and care at home costs less than care in a hospital bed. Home care also keeps some patients from emergency rooms and reduces calls to paramedics.

The strategic health-care plans of almost every province underscore the importance of home care. So do provincial health-care budgets, which are giving new money to home care and little or none to hospitals. Now, along comes a federal government willing to hand over money - how much remains to be seen - in what the minister's mandate letter describes as a "long-term funding agreement" that would "support the delivery of more and better home-care services."

Beefing up home care is what Ottawa wants. It seems to be what the provinces want. But will the provinces sign an agreement that binds them to spend at least some of the federal money for this purpose only? Or will the provinces offer vague assurances that cannot be monitored? Perhaps some (hello, Quebec) will say: Give us the money to spend as we wish, health care being provincial jurisdiction. Maybe home care; maybe not. We'll decide. Home care is the correct priority in a health-care world with endless priorities and incessant demands. Can the often-disputatious Canadian governments pull together around this common objective?

The health care system was in crisis. It took nearly 15 years of incremental increases to bring the federal portion of health funding back to the level is was at before Paul Martin took his axe to it. Going through an exercise like that again would be devastating for the health services that Canadians depend on each and every day.

Adding fuel to the speculation that the Liberals are planning massive cuts to health funding is Trudeau’s September 2nd letter to the Council of the Federation that makes no firm commitments to health care or federal transfers. The only firm commitment was to improve the federal-provincial relationship. That’s pretty thin gruel considering the state of that relationship after 10 years of Stephen Harper!

All Canadians who are concerned with the future of health care in this country need to scratch below Trudeau’s soothing words and take a look at his hard numbers. When you break down their plan, 77 per cent of the value of their “new investments” are tax shifts and benefits (including others not listed under that category), 12 per cent is the catch-all of ‘infrastructure’ spending (though most Canadians don’t think of early learning and cultural facilities as ‘infrastructure’), and five per cent is EI (paid for through EI premiums).

That leaves only six per cent, or a little over two billion a year for everything else. How much of that available funding will go to public home care and long-term care? How much will go to the provinces for new hospital beds after years of cuts? On reading the Liberal plan, we have to conclude: not a penny.

Their plan also targets $6.5 billion in spending reductions from an expenditure review. Will health care be on the table for cuts, if they can’t meet that ambitious target? John McCallum said on Saturday that in the effort to balance their books before the next election, ‘everything was on the table.’ Contrast this with Tom Mulcair’s plan for health care under a federal NDP government, and the stark choice is brought in to focus. 

Mulcair has committed to reversing Harper’s $36 billion in health care transfer cuts to the provinces.  He has committed to investing $5.4 billion into new public health care programs, including a prescription drugs, a plan for 41,000 home care and 5,000 long-term care spots. Over five million more Canadians will have access to primary health care through his plan to build 200 Community Health Clinics. And there are practical policy initiatives on mental health for youth, Alzheimer’s and dementia care.

Canadians cherish their universal Medicare system as one of the things that makes Canada great. They want a federal government that will commit the necessary funding and leadership to build the public health care system of our collective futures, to meet the challenges of an aging population and increasing drug costs. The next party to lead the federal government should be judged by the real dollars and focused policy it has committed to meet Canadians’ health care needs.

On that measure, the Liberal plan is dead on arrival. Paul Moist is national president of the Canadian Union of Public Employees. Representing over 633,000 members, including over 153,000 working in the health care sector, it is Canada’s largest union.

This Senate has already sent a report back to the Commons, saying the Liberal bill should be amended to allow advance directives from those who wish assistance in dying and are still able to let their wishes be known.When the bill comes back to the Senate, independent Liberal James Cowan will push for an amendment broadening restrictions on eligibility.

The B.C. Civil Liberties Association says every provincial medical regulator has issued “detailed, comprehensive” guidelines for doctors under the high court ruling. Doctors’ conscientious objection rights are protected and, under provincial guidelines, two doctors are required to confirm the patient’s eligibility and consent.The real danger may lie in future court challenges — if assisted deaths are allowed under the Supreme Court wording that would be denied under the federal legislation, the government will have a problem.We shouldn’t be here after 16 months. Canadians deserved better. They deserve a better law.

Mr. Rankin said that Ottawa should be working with the provinces, territories and municipalities to ensure they can provide an appropriate combination of services, treatment and support for those dealing with mental illness. He pointed to the national mental-health strategy developed by the Mental Health Commission of Canada in 2012 as a roadmap for improving services.

We would obviously want to look at each of those recommendations [in the strategy], but the general thrust of those recommendations, we would implement, absolutely," Mr. Rankin said. Among other points, the strategy calls for increased access to qualified psychotherapists and counsellors and the removal of financial barriers for children, youth and their families.

Mr. Rankin also called for a revival of the Health Council of Canada and a new federal health accord to foster communication between the federal government and the provinces on health. Both expired last year. Dr. Fry said the Liberals, if elected, would work closely with the provinces to develop a more integrated approach to health-care services, including mental health.

She said the last accord, which expired in 2014, had begun to look beyond the physician and the hospital and toward health care that could be provided by multidisciplinary teams. "We want to integrate mental health, in a fulsome way, into our health-care system," Dr. Fry said. "And that would mean a lot of the things that the Mental Health Commission talked about." However, she said the Liberals would not commit to specific actions before consulting with the provinces

We have to talk to the provinces about it," she said. "That's what we can commit to doing." Dr. Fry said a partnership between the federal government and the provinces on health care is necessary but declined to specify if a Liberal government would establish another health accord or bring in a different system. The length of the next partnership could also be up for discussion, she said.

Research suggests that psychotherapy, which is provided by a licensed therapist, is an effective treatment for many people struggling with anxiety and depression, the two most common psychiatric diagnoses. Therapy by private psychologists or social workers is not currently covered by any of the provinces. A spokesman for Health Minister Rona Ambrose said the provinces and territories are responsible for health-care delivery, including psychotherapy. The Conservative government created the Mental Health Commission of Canada and recently renewed its mandate for another 10-year period, he said.

A written statement from Ms. Ambrose, provided to The Globe and Mail, said the Canada Health Act does not preclude provinces and territories from extending public coverage to other services or providers such as psychologists. "Provinces and territories may choose to extend public coverage for such services," she said. With reports from Erin Anderssen in Ottawa This is part of a series about improving research, diagnosis and treatment

The program's launch on Oct. 1 will see the fulfilment of one of the new Liberal government's major health promises from the spring election campaign.

Thus the board's justification for putting him on contract to provide advice on projects: "The former CEO has specialized knowledge and experience with partnerships solutions." Still, the Partnerships brass were not oblivious to the conflicts that might arise if Blain were retained as a consultant on a project that was also being vetted by the board.

"In order to mitigate the risks of any conflict of interest arising from this arrangement," the review reported, "the board chair was required to recuse himself from any meetings where his projects or his contract were being discussed." Instead, another member of the board was designated to serve as temporary chair. The designated lead director also oversaw the authorization of Blain's consulting contract. "While this conflict of interest issue appears to have been generally well managed," the finance report went on to say, "there could be the perception by some stakeholders that the contractor role still conflicts with the board chair's role of providing independent oversight." Any such perceptions were history by the time the report was completed in July 2014. Blain had already departed as board chair earlier in the year, replaced by Dana Hayden, a former deputy minister turned private consultant.

The internal auditors didn't let Partnerships entirely off the hook for tolerating the unorthodox arrangement in the first place. "The government should consider reinforcing the conflict of interest guidelines for board members of crown corporations and government agencies and ensure that those guidelines are appropriately followed." In other words, "not guilty, but don't let us catch you doing it again." The audit findings, including recommendations to rectify other questionable procedures at Partnerships BC, were forwarded to a steering committee of government and industry representatives, chaired by deputy finance minister Peter Milburn. The committee reported back to Finance Minister Mike de Jong on Oct. 23 with further recommendations for tightening up procedures at Partnerships.

De Jong released both reports and accepted both sets of recommendations in the course of announcing the change of direction for Partnerships BC on Dec. 16 of last year. That was the same day the Liberals chose to announce they were greenlighting construction of a hydroelectric dam at Site C on the Peace River. Just one of those amazing coincidences, but it goes some way to explaining why there was relatively little reporting of the findings regarding Partnerships BC.

There matters stood until this week, when the New Democrats, drawing on a wealth of material gathered by their research department, challenged the Liberals over Partnerships' dealings with Larry (Two Hats) Blain. The highlights package: The contract with Blain's delightfully named consulting firm, Aardvark Insights, was worth $219,000. During that same four-year span he also collected $188,836 in fees and expenses as chair of the board. All this atop the $264,000 he was paid to serve as a director of three other government-owned corporations, and the almost $4 million he was paid for his eight-year service as CEO.

"There's plenty of Blain to go around," quipped one press gallery wag as the New Democrats built their case against the Liberals during question period Wednesday. Another joke making the rounds rebranded P3s as B3s, for "Blain, Blain and Blain" Responding for the government, de Jong paid tribute to Blain's well documented contributions to the agency and cited the audit findings that "the conflict issue appears to have been generally well managed." But he also said this: "Whilst one can suggest that by recusing and taking (other) steps ... the procurement process is properly followed, the standard that we set and expect of agencies, the leadership within those agencies, goes beyond that. There must not only not be a conflict; there must be no appearance of a conflict." Which is as close as the finance minister came to admitting his sense of relief that when the audit branch blew the whistle on this arrangement, Blain had already left the building at Partnerships BC.

The policies he has unveiled - a shift in the tax burden from the middle class to the richest 1 per cent of the population; a child benefit targeted at families that need financial support; a non-partisan Senate; open, transparent government; a rebuilding of trust between Ottawa and First Nations; and a federal-provincial plan to shift to clean energy - stand up to scrutiny. But they don't add up to a plan to govern. He has said nothing substantive about health care, affordable housing, early learning, immigration, human rights or poverty reduction. He has not unveiled his urban agenda. He has not told voters how he would align their tax dollars with their priorities.

It is not that Trudeau lacks policies. One of his first actions as party leader was to assign his shadow cabinet and talented Liberal outsiders to draft policy papers setting out what a Liberal government would do in all these areas. Two years later, they are all in hand. He announced a spate of policies between May 1 and June 16 for which he won generally positive reviews. But at the end of June, he turned off the spigot. He has spent the summer - with a single exception - condemning Stephen Harper's record, repeating his pledge to cut middle-class taxes and launching the odd broadside at Mulcair.

Last week in his only campaign commitment to date, he said a Liberal government would invest $2.6 billion in aboriginal education over four years (an elaboration of his earlier promise to close the inequality gap between First Nations and non-aboriginal Canadians). Why hold back the rest of his platform? Why create the impression he has no plans to tackle poverty, fix Canada's broken employment insurance system or simplify the nation's loophole-ridden tax system? Why leave voters wondering if the Liberals know how to get Canadians working or keep medicare sustainable? Why offer no alternative to Ottawa's callous, discriminatory treatment of refugees? Why say nothing about military spending? Why withhold the blueprint for strong vibrant cities that former Toronto councillor and star recruit Adam Vaughan submitted to him months ago?

Not only does this slow-release tactic contradict Trudeau's vow of openness, it detracts from what he has accomplished. In two years he has rebuilt a shattered, demoralized party, filled its coffers and attracted impressive candidates. He has withstood a barrage of Tory attack ads. He has developed a clear focus and consistent message. Initially Trudeau's advisers said he was keeping his platform under wraps so rivals couldn't pick off his ideas. But there is little danger of that now. Harper's record indicates where he stands on most issues. Mulcair released his platform months ago.

He might be saving the rest of his platform until more voters are paying attention. But the longer Trudeau waits, the more openings he gives his adversaries to portray him as a lightweight. Even an incautious phrase - "we can grow the economy from the heart outwards" - exposes him to mockery.

A more troubling possibility is that Trudeau thinks an incomplete platform will suffice, that he can rely on his charm, energy and progressive instincts to carry him to victory. That might have worked before the NDP "orange wave" swept across the land. It is the wrong strategy now.

In practical terms, it means the economy is creating jobs - but not good ones. It means that consumers are relying on credit cards rather than wages to buy what they need. It means that entire sectors of the economy are out of whack. In Canada, this expresses itself as a reliance on notoriously volatile commodities such as oil. When oil and other commodity prices are up, Canada does OK. When they fall, as is happening now, the reverse occurs. In his stump speech, Mulcair rightly criticizes the Harper Conservatives for failing to pay enough attention to manufacturing. He is also correct when he says that too many of the jobs created are low wage and part time. But his solution to date - give tax breaks to small business and manufacturers - is singularly inadequate. Small businesses, almost by definition, require low-wage, part-time, non-union workers. Encouraging small business may create jobs. But most will be of the precarious variety that Mulcair decries.

Tax breaks to manufacturers, meanwhile, may encourage them to expand production - but only if they have customers willing to buy. As Mulcair correctly points out, too many corporations are refusing to reinvest their profits. Logically, that means government should take up the slack - even if this leads to fiscal deficits in the short term. But Mulcair pledged Tuesday that an NDP government would not run deficits. Trudeau is less categorical. He says a Liberal government would balance the books over the long haul. But, wisely, he has not ruled out deficit spending in the short run. Trudeau's real problem is that his solution to the crisis is also insufficient.

He says his Liberals would take money from the very-well-to-do and give it to those earning between roughly $50,000 and $200,000. Trudeau refers to this as helping the middle class. Making the rich pay is not a bad idea - although the economy would get more of a boost if the poor, who spend most of what they earn, received the money instead. But how would Trudeau lessen Canada's reliance on oil? How would he protect us from the kinds of shocks that roiled the world this week? How would he promote manufacturing or high-wage, new-technology industries? So far, the Liberals haven't said.

Finally, the Conservatives. Harper's party does not fit the cartoon stereotypes. It hasn't embraced the harsh austerity favoured in Europe. Rather, the Harper government has followed a kind of austerity-light regimen. It has penalized the unemployed but left welfare and medicare alone (although the Conservatives have said they will cut health spending if re-elected). Both opposition parties criticize the Conservatives for having run deficits since 2008. But given the weakness of the economy, it was the right thing to do. Arguably, Harper's real sin on this front was to move too quickly to balance the books. Still, the prime minister has much to answer for. One example: His government used the temporary worker program to suppress wages, relenting only when the politics became impossible. But his biggest mistake was to rely on oil. When petroleum prices were high and China booming, this was sufficient to hide the economy's fatal flaws. Now it is not. Thomas Walkom's columns appear in Torstar newspapers.

Across Ontario, 44 clinics have fallen short of basic standards in just three years, according to CPSO inspections. Meanwhile, the number of private clinics has skyrocketed by 31 percent since 2010 under this Liberal government. At least 20 patients in Ontario have contracted serious infections at these private health clinics.

Skyrocketing hydro rates are making Ontario less attractive to manufacturers, making it harder to replace the good jobs being lost at Bombardier or Ontario Northland, he said.

"Hydro rates started going up after Mike Harris and the Conservatives started privatizing generation, and they shot up with the Liberals' private energy deals, like the sole-source Samsung contract for wind," he said. "This will get much worse with the sale of Hydro One to private interests. We'll also lose the oversight of public accountability officers like the Auditor General." Hahn was speaking to a crowd of North Bay residents calling on Queen's Park to take action to stop the loss of good jobs and quality public services in their community.

The rally organized by the North Bay and District Labour Council, began at the Ontario Northland building, then made its way to City Hall. Speakers included Canadian Labour Congress President Hassan Yussuff, new Ontario Federation of Labour President Chris Buckley, NDP MP Charlie Angus (Timmins-James Bay), NDP MPP John Vanthof (Temiskaming-Cochrane) and Sharon Richer, vice-president of the Ontario Council of Hospital Unions

"It's Kathleen Wynne listened to Ontarians. Almost 85 percent of the public and 194 municipalities oppose the Hydro One sell-off," said Hahn. "The Liberals need to listen to the people, not to Bay Street. We need quality public services and good jobs in our communities. We need at-cost, not-for-profit electricity. We need profitable corporations to pay their fair share so working-class people don't pay any more for disastrous Liberal austerity and privatization schemes."

CUPE is Ontario's community union, with more than 250,000 members providing quality public services we all rely on, in every part of the province, every day. CUPE Ontario members are proud to work in social services, health care, municipalities, school boards, universities and airlines.

St. Albert physician Dr. Darryl LaBuick said while a bit more money for home care will help the situation, it barely scratches the surface in addressing the biggest issues facing healthcare in Canada. "We've got a huge increasing requirement for seniors care. We look at home care, we look at long-term care, we look at assisted living care, palliative care," he said. "We look at all those areas nobody has looked at closely from a political point of view to address some of the issues." The importance of home care is something stressed by Dr. Kim Fraser, a nursing professor at the University of Alberta and expert on the topic.

She said while seeing the commitment to improve home care in the province is a step in the right direction, simply throwing more money at the problem won't be enough. Instead, we've got to rethink how home care in Canada is provided. "Co-ordinated home care programs first came into effect in the late '70s and 1980s in Canada, and our approach to home care has not changed since that time," she said. "It's really kind of episodic, targeted, taskspecific care rather than a more comprehensive integrated care approach." So rather than simply having more home-care aides providing this kind of task-oriented service to patients in their home, we should look at providing a higher level of care to patients with more complex needs.

"The pillars of the platform should be reflected in the work we're doing," Hoffman said. LaBuick also identified the importance of a national drug strategy that would cover the cost of prescriptions for all Canadians. Seniors still must pay a portion of prescription drug costs, and many young adults without health benefit plans are left in a position where they must pay the full cost or simply go without; it's something he's seen in his own practice. "We see young folks that don't have a good prescription plan, or any prescription plan," he said, "And the Blue Cross plan doesn't cover everything either, so there's gaps within that system, too."

"We have got just so many more patients going into that system," she said. "I think funding will help the growing home care problem, and will help provide, perhaps, more professional nursing services from RNs and LPNs in the community." Alberta Health Minister Sarah Hoffman said she was pleased to see the commitment to home care on the federal agenda, noting it was one of the main pieces of the NDP platform with respect to the healthcare system. "Home care is certainly one of the pieces we're focusing our effort on as a government, and I look forward to working with the new federal government to make that a reality," she said. When pressed for specific details about what form home care may take, she said she couldn't talk about specifics until they're released as part of the provincial budget next week.

It's a concern echoed by Friends of Medicare director Sandra Azocar, who spoke with the Gazette prior to the election and said a national drug plan was high on her organization's agenda. She expressed concern that the Trans-Pacific Partnership, a trade deal negotiated by the previous government behind closed doors that has yet to be approved by Parliament, could make it more difficult to get cheaper generic drugs. "We see that as having a negative impact for generics to be available in the market, and people will pay significantly more for drugs," she said. "I don't think medicine should be a luxury, it should be available for all people who need it. These are huge concerns we have." Hoffman said bringing down the cost of prescription drugs is something she's heard is important to Albertans, but is also significant within her own ministry when it comes to budgeting. She said a provincial prescription drug plan is something worth considering, but it's not going to happen in the near future.

"I think it's a great long-term objective, but in the short-term I need to address the immediate pressures of drug costs," she said. "I think we can find ways to do bulk buying and find other efficiencies in a pan-Canadian strategy, and look at other partnerships in taking it further so we can maximize those savings and pass those savings on for an increased benefit to all Albertans." Health Accord Azocar identified the need to renew the Canada Health Accord as an important component of what the federal government must do to support healthcare in the country.

"We need to go back to the level of leadership in our healthcare system for it to be functional all across the country," she said. "That's not something we've seen coming from some of the parties." The Liberal platform includes a commitment to renew the waccord, and to include a long-term funding agreement. This is a crucial element, Azocar noted, because in tough economic times federal funding in health care tends to decrease to the detriment of Canadians. "People don't stop needing health care when the economy is down, in fact it's the reverse," she said. "Studies have shown people need more services when the economy is down, so it's a situation that doesn't play well for the sustainability and the long-term planning that health care needs across the country."

Hoffman said she's unsure what negotiating a new accord might look like, as she hasn't been through the process before, but said it's something she looks forward to working on with the federal government. "We were elected not too long ago and they were elected more recently, and I think Albertans deserve to have the very best public health-care system," she said. "I look forward to working with the federal government to make that a reality." Elephant in the room One element of the discussion around health care that is absent and has been for quite some time, LaBuick suggested, is the "elephant in the room" of increasing private delivery as a way to reduce the budget impact of health care. "The minute we start to talk about it, they catastrophize the whole conversation," he said. "The reality is we need to talk about it because we simply can't afford it."

He noted roughly 30 per cent of health care in Canada is already provided privately - things like dental, vision, psychology, and private insurance plans. Furthermore European countries that blend public and private have better outcomes. LaBuick suggested the way forward is to look to European models that provide universal health care with a blend of public and private delivery - many of which have better outcomes at a lower cost than the Canadian model. He's not optimistic, however, that a federal Liberal government or provincial NDP government will engage in that discussion.

We have all of these areas that are private, but nobody talks about it," he said. "Nobody talks about a strategy around how it can benefit all citizens, for the betterment of everybody."

One big problem with the proposed summit: it could lead to increased tensions if the feds try to attach strings to how the provinces should spend any new money. The provinces have reason to worry: In the 1980s and nineties, as the federal fiscal situation deteriorated, Ottawa contributed less and less to the public health-care system, while prohibiting provinces from pursuing private-sector alternatives.

In the first years of the last decade, as the fiscal situation improved, the Liberal federal government was prepared to offer more robust funding, but insisted on new national standards for health-care delivery in exchange. Provincial governments resisted that federal intrusion in their jurisdiction. The struggle culminated in that 2004 first-ministers meeting in which the premiers browbeat the new Martin government into those massive increases in spending.

If Mr. Trudeau attaches conditions to increases in federal health care transfers, expect Quebec to demand that it be allowed to opt out of any program, but still get all the money. Expect Alberta to demand the same. It's called asymmetrical federalism, and it can quickly get ugly. Another major problem is that, given other Liberal spending commitments in infrastructure, fighting global warming, postsecondary education and so much else, the finance minister, whoever he or she may be, might not be able to balance the federal budget by the end of the mandate, as Mr. Trudeau has promised.

The Liberals have also promised to work with the provinces on a pharmacare strategy, which would inevitably involve funding for subsidized prescription drugs for low-income seniors.

If increased health-care commitments - along with everything else in the Liberal platform - cause federal finances to deteriorate to the point that Ottawa is running an entrenched structural deficit, the national debt will increase. At the same time, Canada's credit rating will start to decay, interest payments on the debt will consume more of the budget, and people will start saying, "Like father, like son."

To avoid that, Mr. Trudeau will have to rein in provincial expectations. But there is a political price to be paid for convening first-ministers conferences and then failing to meet the premiers' demands. It's why Stephen Harper avoided them.