Iqaluit (Feb 10/03) - All three territorial premiers walked away from the Feb. 5 federal/provincial health accord, but now a door is opening to entice them back in.

"I've had better days," said Nunavut Premier Paul Okalik in the aftermath of a health care deal that he says did little for the territories.

Nunavut spends more per person for health care than anywhere else in Canada: $6,869 versus national average of $1,904: that's 3.6 times more. The cost for the ill to travel to southern centres represents one-fifth of Nunavut's health budget: $28.5 million out of a total health budget of $146 million. An emergency medevac can cost between $12,000 and $30,000 per flight and can take up to five hours to get critically ill people the care they need. Nunavut pays $18.2 million a year to out-of-territory hospitals and doctors for health care. Nunavut has just one regional hospital, located in Iqaluit. It is 40 years old and requires immediate replacement. (Facts provided by the Government of Nunavut.)

But next day during question period, Prime Minister Jean Chretien appeared to offer another option.

"We will adjust the health requirements for the people of the North on a bilateral basis because it would not be treated the same way as the provinces on a per capita basis," Chretien said.

Politics is a strange game where "no" today can be "yes" tomorrow.

In this case, the emerging behind-the-scenes story is that the federal government didn't want to introduce exceptions to the accord that future jurisdictions might abuse.

Nunavut MP Nancy Karetak-Lindell said as much.

"Yes, we need an entirely different agreement," said Karetak-Lindell. "If you make an exception in one case, where do you draw the line in another case?"

"I know that's no comfort to the North, but we often face situations where we have to make tough decisions because of the big picture."

That "big picture" was a federal government tightly focussed on getting all the provinces into a health accord. Making room for territorial demands was not in that big picture.

"Because the territories don't have the political clout, they were being pushed aside," said Jack Layton, recently elected leader of the New Democratic Party.

It was NDP health critic Svend Robinson who popped the question that earned Chretien's response.

Offer was not enough

In the days leading to the accord signing, Okalik and fellow premiers Stephen Kakfwi (NWT) and Dennis Fentie (Yukon) received solid support from the provinces for a guaranteed 0.5 per cent slice of any new funding.

Based on the federal government agreement to provide $12 billion in new money over the next three years, Nunavut's share would have been an additional $20 million a year.

Instead, the health agreement signed by the provinces last week would provide Nunavut $10.8 million more in health care funding over the next three years -- or $3.6 million a year.

"We spend that amount in a week, so if we got the money or not it won't make a difference," said Okalik.

"We had to take a stand."

On a per capita basis, the additional money works out to an annual $138.46 for each man, woman and child in Nunavut, or 38 cents a day.

The territories say current health funding doesn't work in the North, where per capita costs are far ahead of southern experiences as territories try to serve a small population spread over a vast geography.

And yet "per capita" is the formula the federal government sticks to.

The federal government never saw the logic of the 0.5 per cent plan all week.

"There were certain points during the week where we thought we had an agreement, but each time a text was produced, we were disappointed," said Okalik.

"The prime minister was very forceful to get everyone onside, but we're not going to be pushed around.

"We know the prime minister is gone in a year, so we'll wait to talk to the next prime minister."

National aboriginal groups have called the premiers' walk out "gutsy and justified."

"The premiers were entirely justified. Northern peoples, and Inuit in particular, face the worst health standards in Canada and the prime minister knows this," said Inuit Tapiriit Kanatami president Jose Kusugak. "Still, he has the audacity to expect the Northern premiers to say 'thank you very much'."

In Inuktitut, "prime minister" is translated as "big parent."

"What kind of parent would be so inconsiderate to the less fortunate children in his family?" asked Kusugak.