We’ve seen this play out in previous federal election campaigns. The provinces, constitutionally responsible for health services, unite to demand more federal help in this endeavour. The party in power at the federal level rejects the ask, while the opposition parties initially embrace it. But when the writ is dropped and one of the major opposition parties starts to waffle in its support the provinces fail to react. They put party loyalty ahead of the their populations’ need for adequate federal support for health care.

When we observed this in the 2015 campaign and its aftermath it was mainly an Atlantic Provinces event. The Atlantic premiers had long been calling for federal health transfers that recognized age and health status, a so-called demographic top up. The Harper Conservatives rejected these entreaties. During the election campaign the Trudeau Liberals played coy, even though the provincial request was endorsed by the Canadian Medical Association and prominent think tanks.

Instead of criticizing the Trudeau campaign for its lack of support, Liberal governments in the Maritimes remained silent, or even suggested they’d been told on the Q.T. that a federal Liberal government would deliver a demographic top up. And when the Trudeau government failed to do that, our own former Liberal Premier bent over backwards to obscure the fact, as described here.

Six years later we are seeing a similar saga play out on a national scale, involving much greater dollar amounts. The Council of the Federation, which is made up of the premiers of all of the provinces and territories, has been pushing for an immediate $28 billion increase in federal health transfers to bring Ottawa’s share of health spending to 35 percent. The O’Toole Conservatives initially supported the demand – even suggesting they’d go for 50 percent federal funding. They quickly back-pedalled from that, committing only to increase annual growth in transfers to six percent.

The Conservatives touted the six percent pledge as a $60-billion commitment over ten years. But when full details of the Conservative platform came out last week it was revealed that most of those billions – if they ever come – will arrive between 2026 and 2032. Over the next four years under the Conservative plan provinces will receive only $3.34 billion more than they would get under the current formula, with most of that modest increase coming four years from now. As for the immediate increase of $28 billion to get to 35 percent federal funding, fuggedaboutit. For 2021-22 the increase is exactly zero.

Sadly but predictably, the Council of the Federation, dominated by eight premiers of various conservative hues, has so far remained silent in the face of rejection by the federal O’Toole faction. This is despite the fact that the other major parties have weighed in with much more expensive and extensive promises. The Liberal promises add up to $25 billion over five years and cover surgical wait times, long term care and mental health. The NDP are promising to spend $68 billion over five years, covering most of the same areas as the Liberals but adding national pharmacare at $38 billion and dental care at $11 billion. The New Democrats claim the new programs will bring federal spending on health close to the 35 percent level demanded by the premiers.

The gulf between the major parties on health funding may be too vast for the provincial premiers to ignore during the final days of the election campaign. Perhaps one of the non-conservatives – New Democrat Mike Horgan in British Columbia or Liberal Andrew Furey in Newfoundland and Labrador – will get the conversation started. Or maybe it’s up to Nova Scotia’s Tim Houston. He put out a news release last Thursday – the day after the paltriness of the Conservative commitments was revealed – calling on federal party leaders “to work with provinces to make health care the number one priority.”

Items on Houston’s wish list include the 35 percent federal share, recognition of demographic factors, partnering to create long term care beds and support for universal access to mental health care. The ‘laser focus ‘on health care Houston promised during the recent provincial campaign would make it clear to him that the Conservative platform offers little help in any of those areas.

In his successful quest for power, Houston has been careful to distance himself from O’Toole and the federal party, but at this point, distancing is not enough. Houston should take a page from Danny Williams and his ‘Anybody but Conservative’ campaign of 2008. He should call on Nova Scotia voters to reject the Conservatives and decide which of the NDP or Liberal plans they believe will best respond to the health care crisis in Nova Scotia. Or perhaps he could go out on a limb, look at the substance of what’s being proposed by the two parties and ask Nova Scotians to join his crusade to fix health care by voting NDP.