There is a solution to the federal-provincial standoff over health care. It is to expand the definition of medicare.

Ottawa and the provinces are haggling over money. The provinces want more cash for health care but with no strings attached. Prime Minister Justin Trudeau’s federal Liberal government wants at least some of any new money it transfers to go to home care, palliative care and mental health.

The provinces, particularly Quebec, say this amounts to unwarranted federal intrusion in their area of constitutional responsibility.

But there is a precedent for such an intrusion. It is called medicare and is embodied in a federal statute known as the Canada Health Act.

That act empowers Ottawa to transfer money to provinces to help pay for physician and hospital services. The provinces don’t have to take this money. When medicare began in 1968, only two — British Columbia and Saskatchewan — did.

But if they do take federal money, they must have public insurance schemes in place that meet five conditions.

These schemes must be comprehensive — that is, cover all medically necessary services. They must be universal — that is, cover everyone. They must be accessible — that is, charge no user fees. They must be portable — that is, apply to Canadians who need care outside their home provinces. They must be publicly administered.

Polls show Canadians overwhelmingly support these conditions.

Medicare’s key limitation, however, is that it applies only to services offered by doctors and hospitals. It does not apply to home care.

Increasingly, provincial governments are trying to save money by encouraging acute-care hospitals to discharge patients as quickly as possible. In most provinces, these patients find themselves reliant on badly underfunded home-care services.

Unlike hospital care, such services are usually neither comprehensive nor universal.

As an Alberta oil worker with incurable cancer found when he tried unsuccessfully to come home to Ontario earlier this year to die near his family, they are not even portable.

Ontario pays $3 billion on home care each year. But Queen’s Park saves more than that in foregone hospital and nursing home costs.

In that sense, home care is a revenue tool. It allows provincial governments to evade the spirit, if not the letter, of the Canada Health Act.

In Ontario, as my Star colleague Bob Hepburn has pointed out, the results are sometimes absurd. When the provincial Liberal government boosted wages for badly paid home-care workers earlier this year, some cost-conscious agencies responded by cutting services.

In the weird world of Canadian health care, it was the logical thing to do.

But there is a way to fix the home-care anomaly. Roy Romanow’s royal commission on health care pointed to it 14 years ago.

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Romanow argued it made no sense to exclude home care from medicare. He recommended home care services for the mentally ill, for patients just released from acute care hospitals and for those needing palliative care be written into the Canada Health Act immediately.

By 2020, he said, all home care services should be covered by medicare.

Interestingly, federal Health Minister Jane Philpott is also focusing on home care, mental health and palliative care.

How would she get the provinces onside? Many assume a final deal over medicare spending can be hammered out only by the first ministers meeting in a marathon bargaining session — as happened in 2004.

In that session, the premiers ran roughshod over then Prime Minister Paul Martin. Quebec demanded and received the principle of asymmetric federalism — that it could do whatever it wished with the massive health transfers Martin was offering.

Alberta then demanded and received the principle of provincial equality — which meant any province could mimic Quebec. As a result, no real conditions applied to any of the money Ottawa agreed to hand over.

This is one way of doing things.

The other is for Ottawa to ignore provincial objections. That’s what Lester Pearson’s Liberal government did in 1966 when, in concert with the New Democrats and over the strident objections of Ontario, Quebec, Alberta and the federal Conservatives, it passed Canada’s first national medicare act.

The Canada Health Act is the successor to that 1966 law. It is a federal statute that can be amended unilaterally by Parliament. In 2016, it makes sense that it be amended to include home care as a core medicare service.

Some provinces may disagree. If so, they won’t have to take any extra money that Ottawa puts on offer.

Thomas Walkom’s column appears Monday, Wednesday and Friday.

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