Rarely has the growing divide been more pronounced.
In Western Canada, where economic prospects are relatively rosy and budget deficits comparatively manageable, Finance Minister Jim Flaherty's musings about curbing growth in federal health transfers were greeted mostly with shrugs. Saskatchewan's Premier, Brad Wall, seemed almost to welcome the prospect. Alberta's Alison Redford similarly talked about the importance of moving beyond haggling over dollars. British Columbia's Health Minister, Mike de Jong, said it was "not a surprise" that the federal government wanted to talk about the "finite ability" to pay for health care. Manitoba simply declined to take the bait.
But east of Manitoba, where only resource-rich Newfoundland and Labrador has much cause to feel sanguine, the angst is palpable. And it has come to be personified by the premier of Canada's largest province.
The other eastern premiers are not exactly biting their tongues. All of them are calling for the federal government to pay 25 per cent of health costs, up from about 20 per cent.
But on Tuesday, when Ottawa fired a warning shot about ending 6-per-cent increases to health transfers after 2015-16, Ontario's Dalton McGuinty was the most eager to return fire.
Reporters were directed toward a CBC Radio interview from last spring's federal election campaign in which Mr. Flaherty appeared to commit to 6-per-cent hikes for the duration of the next federal-provincial health accord. Deb Matthews, the provincial Health Minister, was trotted out to issue warnings about the cuts that would be required if the federal spending curve were flattened. And Mr. McGuinty's chief-of-staff took to Twitter to suggest that the opposition Progressive Conservatives are in cahoots with their federal cousins to make "cuts" to health-care funding.
Mr. McGuinty's reaction was partly a reflection of Ontario's dire financial straits. The province feeling the harshest impact of global economic turmoil is somehow supposed to eliminate its $16-billion deficit by 2017 despite the continual rise of health-care spending. Even with federal transfers growing at the current rate, that looks improbable. If the increases flatten, it gets closer to impossible – at least without the draconian cuts to which Ms. Matthews was alluding.
The response was also a matter of politics. Mr. McGuinty had hoped to position himself in the fall provincial election as the only leader who could stand up to Ottawa in talks for the next health accord, but that became moot when Prime Minister Stephen Harper promised during last spring's federal campaign to maintain the 6-per-cent increases. Now, helming a minority government and needing distractions from potentially unpopular budget decisions, Mr. McGuinty is getting his chance to play Captain Ontario.
But even if there is some selfishness to his motivations, the other eastern provinces have a lot riding on his ability to rally Ontarians.
Mr. Harper's Conservatives can probably afford some ill will in Atlantic Canada or Quebec. But they cannot afford to lose the province where they paved their path to a majority government by taking 73 seats in the last election, and only recently overcame the perception that they're too western-based.
At various points in history, Ontario premiers have played a leading role in bringing Canada together. If Mr. McGuinty gets more cash out of Ottawa, none of the provinces will complain. But primarily preoccupied with his own challenges, he looks mostly like the inadvertent spokesman for the hard-hit east.