Money can't buy happiness. But it would sure go a long way in pleasing the provinces as their negotiations drag on with the federal government for a new health care accord.

Provincial health ministers wrapped up meetings this week with their federal counterpart without much to show for all the hours spent talking behind closed doors.

The provinces want more money. The federal government wants more say in how the money is spent. It is, as federal Health Minister Jane Philpott told the Commons on Thursday, the only prescription that makes sense.

"We are active participants in making sure Canadians are healthy, and that they have a health care system that works for them," she said. "We also have a responsibility to be good stewards of the public purse and to make sure that when we make investments in health, that they go to health care."

It's that last bit that rankles Quebec Health Minister Gaétan Barrette. He says all the money from the Canada Health Transfer, to the very last nickel, goes into health.

That may be true now but it wasn't always so obvious. Provinces used federal health money in the past to lower taxes and buy lawn mowers for hospitals.

Health outcomes haven't necessarily improved as the amounts being spent on health care have gone up.

Stick to plan, Romanow says

Of course, federal and provincial tensions over health care spending are as old as medicare itself. It's like a long-running soap opera. The plot never changes even if the characters do.

But if Philpott and Prime Minister Justin Trudeau are interested in a second opinion on their demand for greater accountability in health care spending, they might want to talk to a specialist — in this case, former Saskatchewan premier Roy Romanow, the author of the 2002 report that bears his name on the future of health care in Canada.

He says they should stick to their prescription that federal transfers come with conditions.

"It's going to take leadership. Strong leadership," says Romanow in an interview airing Saturday on CBC Radio's The House.

Roy Romanow in 2002, holding up copies of his landmark report on the future of Canada’s health care system. (Fred Chartrand/Canadian Press)

Romanow says former Liberal prime minister Paul Martin made a mistake in 2004 when his government agreed to hand over $41 billion to the provinces for health care. Martin called the 10-year accord a "fix for a generation."

Twelve years later and the country's desperately in need of another fix. According to the World Health Organization, Canada's medicare system ranks 30th in the world in terms of services, but 10th in terms of per capita expenditure.

"What happened was a lot of money increased the federal portion [of health spending] to 50 per cent but there were no conditions attached for fundamental reform," Romanow says. "The money was taken, it was spent, the system was unreformed — and here we go again."

The money was taken, it was spent, the system was unreformed — and here we go again. - Roy Romanow , former Sask. premier

Trudeau is taking the right approach, Romanow says.

"He's not putting a whole lot of cash on the table but enough to stimulate the proper debate for solutions," he says.

The Trudeau government promised to invest $3 billion over four years to make home care more available. It also promised more money to make prescription drugs more affordable, and mental health care more accessible.

What it didn't promise, and won't bow to now, is provincial demands to increase the annual health transfers beyond the three per cent floor put in place by the previous Conservative government. That money, as Conservative House leader Denis Lebel trumpeted Thursday, came with no strings attached, respecting the provinces' jurisdiction over health care services.

Health care is the single most expensive item in provincial and territorial budgets, amounting to 40 per cent or more of what they spend, or roughly $6,000 per person on average.

And the demands continue as populations age and more people survive with chronic illnesses.

Canadians 'asking for more services'

Quebec's Barrette says the money Philpott is offering is just not enough. And until the federal government agrees to increase the amount of the health care transfers to cover the real costs of medicare, he says there can be no discussion of what Ottawa wants.

Barrette says he understands that Philpott doesn't have the power to make the final decision. But he tells CBC News that she agrees with him and the other provincial and territorial health ministers that a three per cent increase is not enough.

Quebec Health Minister Gaetan Barrette, pictured here at the federal, provincial and territorial health ministers' meeting in Toronto on Tuesday, says the money Philpott is offering is just not enough. (Christopher Katsarov/Canadian Press)

His conclusion: Trudeau and his finance minister Bill Morneau are calling the shots.

"It's not about Minister Philpott," Barrette says. "She is caught in between us, the provinces and territories, and Morneau and Trudeau."

At the same, Barrette says the provinces must confront the demands being made of them.

"We also are facing our own population," he says. "They are electing us. They are expecting change. The are asking, year after year, for more services, and we have to answer that. Not Ottawa. Ottawa never has to answer that. Never."

Only Ottawa has the fiscal room, he says, to spend more on health care. The provinces do not.

So what's next?

Barrette insists the only way this impasse will be resolved is by the first ministers, when they sit down in December to discuss climate change. Barrette said the meeting should really be about health care.

"If it is not on the agenda, it's because adding money to provide for more and better care for Canadians is not what they want," he says.

That, of course, is not at all how the federal Liberals see their role. They want better results from the health care system. The kind of results their money can buy.