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As negotiations on a new federal-provincial health-care accord get underway in earnest, the premiers have at last provided an answer to an enduring riddle: what exactly is there to negotiate? Specifically, what do the premiers bring to the table?

We know what the federal government brings: money. Pots of it. Ottawa transfers tens of billions of dollars annually to pay for what the provinces will remind anyone within hearing is provincial jurisdiction. That’s the “accord” part, in toto: the feds agree to hand over the money, and the provinces agree to take it. Notionally there are conditions attached to it — the five conditions of the Canada Health Act — but the conditions are increasingly unenforced.

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It isn’t even “for health care,” really, though that’s a fiction that it suits all sides to maintain. The money doesn’t come with little labels attached; it all goes into the provinces’ general revenues, to be spent as they like. So even as federal transfers “for health care” have gone on rising at a fixed six per cent per annum — part of a previous “accord” under Paul Martin — provincial spending on health care in recent years has been growing at something closer to one per cent. The higher federal transfers have in fact underwritten a shift in provincial spending into other areas.