The Age of Understanding

Tag: Alberta Health Care

  • Alberta and Ottawa: Where Does the Money Go?

    Alberta and Ottawa: Where Does the Money Go?

    The Age of Understanding

    In 2024, approximately $19 billion more in federal revenue was attributed to Alberta than Ottawa spent in the province. That is not a political slogan. It is a finding grounded in Statistics Canada’s economic accounts. But what does that figure actually mean for Albertans, and what does it tell us about fairness in Confederation?

    Beyond Equalization: Following the Money

    In my previous article, Equalization Payments: Is Alberta Getting a Fair Deal?, we examined a federal program that has generated considerable debate in Alberta.

    But equalization tells only part of the story.

    To understand Alberta’s financial relationship with Ottawa, we need to look at something much broader:

    How much federal revenue comes from Alberta, and how much federal spending is attributed to Alberta?

    That means examining income taxes, corporate taxes, consumption taxes, federal benefits, government operations, transfers, and other expenditures.

    Fortunately, Statistics Canada collects this information.

    And the findings deserve attention.

    The $19 Billion Difference

    According to Statistics Canada’s provincial and territorial economic accounts, Alberta’s net federal fiscal contribution was approximately $19 billion in 2024.

    In simple terms, federal revenues attributed to Alberta exceeded federal expenditures attributed to the province by that amount.

    A 2026 Library of Parliament study examining the years 2015 through 2024 reached another significant conclusion.

    In 2024, Alberta and British Columbia were the only provinces where federal revenues exceeded federal expenditures.

    Alberta recorded the largest net contribution.

    This was not simply an equalization calculation. It reflected a much broader accounting of federal government finances.

    For context, the approximately $19 billion difference represented roughly $3,900 per Alberta resident, although that figure is a population-based average, not an amount paid personally by every Albertan.

    A family of four did not literally send Ottawa an additional $15,600. Federal revenues come from individuals and businesses with widely varying incomes, tax obligations, and economic activities.

    Still, the aggregate figure reveals an important feature of Canada’s fiscal system.

    Federal revenues and expenditures are not distributed equally among provinces, nor are they intended to be.

    Why Does Alberta Contribute So Much?

    Higher Incomes Generate Higher Federal Taxes

    Canada uses a progressive federal income tax system. People with higher taxable incomes generally pay more federal income tax.

    Alberta’s relatively high incomes have historically contributed to above-average federal tax revenues per resident.

    Corporate Activity Matters

    Alberta’s energy, construction, engineering, transportation, and other industries generate economic activity and taxable corporate income.

    That activity contributes to federal revenues.

    It is important to recognize that not all revenue generated by a business operating in Alberta is necessarily attributable to Alberta residents, and statistical methods for allocating corporate taxes can affect provincial comparisons.

    Economic Strength Influences Federal Revenues

    The Library of Parliament noted that Alberta had Canada’s highest provincial GDP per capita in 2024.

    Its resource-based economy was an important contributing factor.

    Stronger economic activity generally means higher incomes, profits, and federal tax revenues.

    What Does Alberta Receive From Ottawa?

    Federal spending in Alberta extends well beyond transfers to the provincial government.

    It includes payments and services benefiting individuals, businesses, institutions, and communities.

    • Old Age Security and other federal benefits
    • Employment Insurance
    • Federal government operations and services
    • Health and social transfers to Alberta’s provincial government
    • Federal infrastructure and program funding
    • Other federal expenditures allocated to Alberta

    The Canada Pension Plan is accounted for separately from the federal general government in the Statistics Canada data used for the net-balance calculation.

    This distinction matters because we should not compare federal revenues and spending using inconsistent definitions.

    Alberta receives substantial federal spending. The finding is that, in 2024, federal revenues attributed to Alberta were greater than the expenditures attributed to it.

    Has Alberta Always Been a Net Contributor?

    No. And this is an important part of the story.

    During 2020, the COVID-19 pandemic produced an extraordinary increase in federal spending.

    Federal emergency benefits, business assistance, and other pandemic-related expenditures substantially changed fiscal balances across the country.

    In that year, federal spending attributed to Alberta exceeded federal revenues attributed to the province by approximately $16.9 billion.

    By 2021, Alberta had returned to a small positive net contribution, followed by larger contributions in subsequent years.

    Federal fiscal relationships change with economic conditions, government policy, and unexpected national events.

    A province that contributes more during prosperous years may receive substantially more federal support during a crisis.

    That is part of the purpose of a national fiscal system.

    It is also why a single year’s figures should never be used without historical context.

    Is This Money Being Taken Away From Alberta?

    This is where the language surrounding federal finances can become misleading.

    It is tempting to describe the $19 billion difference as money Alberta sent away and never received back.

    But federal taxation does not operate like a provincial savings account.

    Federal taxes are collected from individuals and businesses across Canada. Those revenues finance national obligations, programs, services, and transfers.

    Federal spending is also attributed geographically, even though some services provide benefits beyond the province where expenditures are recorded.

    For example, national defence, federal administration, and other Canada-wide functions can benefit Albertans without all their costs being recorded as spending within Alberta.

    Therefore, a provincial net fiscal balance is a useful measure of federal financial flows, but it is not a complete measure of every benefit residents receive from Confederation.

    Nor is it an amount Alberta’s provincial government could automatically reclaim.

    Understanding these limitations makes the comparison more credible, not less.

    What Does This Mean for Alberta’s Health Care System?

    For Albertans waiting for diagnostic imaging, surgeries, emergency care, or access to a family physician, these figures may raise another question.

    If Alberta contributes substantially to federal revenues, why are our essential services under such pressure?

    The answer requires examining both levels of government.

    Ottawa provides funding to Alberta through the Canada Health Transfer and other arrangements.

    Alberta’s provincial government is responsible for most decisions about health care spending, hospital construction, staffing, and service delivery.

    A positive net federal contribution does not automatically mean Ottawa has withheld funding that Alberta was legally entitled to receive.

    Equally, receiving federal health transfers does not remove the need to examine whether federal arrangements sufficiently account for population growth and changing service demands.

    Both federal fiscal policy and provincial budget priorities deserve public scrutiny.

    We should be asking two questions simultaneously: Is Alberta receiving appropriate federal support, and is Alberta using its available provincial resources effectively?

    Neither question should be ignored.

    What About Other Provinces?

    The Library of Parliament’s 2026 analysis found substantial variation in federal revenues and expenditures across Canada.

    In 2024, Alberta and British Columbia recorded positive net contributions.

    Other provinces received more federal expenditures than the federal revenues attributed to them.

    Atlantic Canada generally recorded particularly high federal expenditures per resident.

    These differences reflect more than equalization.

    They also reflect population age, income levels, economic structure, federal programs, employment patterns, and the geographic distribution of government operations.

    For example, a province with more seniors may receive greater federal retirement-related expenditures per resident.

    A province with lower average incomes may generate less federal income tax revenue.

    These are features of a nationwide tax-and-transfer system.

    Whether the resulting distribution appropriately balances solidarity, efficiency, and regional needs remains a matter for public policy debate.

    Why the 2029 Equalization Renewal Still Matters

    As discussed in my previous article, the current legislative authority for federal equalization payments extends through March 31, 2029.

    Parliament will need to address the program’s continuation for the period beginning April 1, 2029.

    The constitutional commitment to equalization remains separate from the detailed statutory formula.

    The upcoming legislative deadline provides an opportunity to examine that formula and the broader financial relationship between Ottawa and the provinces.

    However, changing equalization alone would not necessarily change Alberta’s net federal fiscal contribution.

    Equalization is only one component of federal spending.

    Income taxes, corporate taxes, demographic differences, federal benefits, and national government operations also influence provincial fiscal balances.

    If we want an informed discussion about Alberta’s financial position within Canada, we must look beyond equalization.

    What Should Canadians Be Asking?

    Rather than reducing this issue to which province pays and which province receives, I believe there are several questions worth examining.

    • Should federal fiscal arrangements respond more effectively to rapid population growth?
    • Are the economic risks associated with resource-dependent provinces adequately recognized?
    • Do federal transfers sufficiently reflect the pressures facing health care and infrastructure?
    • Are provincial governments transparent about how they allocate their available resources?
    • Are Canadians being given clear, accessible information about how federal revenues and expenditures are distributed?

    These questions matter regardless of where we live.

    My Closing Thoughts

    I believe in the principle that Canadians should support one another.

    A person living in New Brunswick deserves access to essential public services just as much as someone living in Alberta.

    But I also believe that transparency and accountability are necessary for public trust.

    The figures from Statistics Canada tell us something significant.

    In 2024, approximately $19 billion more in federal revenue was attributed to Alberta than federal spending attributed to the province.

    That does not, by itself, prove that Alberta is being treated unfairly.

    But it provides a factual starting point for examining how Canada’s fiscal system operates and whether its outcomes reflect the needs of Canadians across the country.

    Alberta’s economic contributions are substantial.

    Its public-service pressures are also real.

    Both deserve to be acknowledged.

    The purpose of examining these numbers should not be to divide Canadians. It should be to understand the system we share, ask better questions, and hold every level of government accountable for the decisions it makes.

    Because a healthy federation requires more than the redistribution of money.

    It requires transparency, mutual responsibility, and informed public discussion.

    Sources and Further Reading

    The Age of Understanding — Exploring complex issues with curiosity, evidence, and conscience.

  • Equalization Payments: Is Alberta Getting a Fair Deal?

    Equalization Payments: Is Alberta Getting a Fair Deal?


    The Age of Understanding

    Canada’s equalization program is intended to promote fairness between provinces. But what happens when a province that contributes substantially to federal revenues struggles to meet the needs of its own residents? And why should Albertans be paying attention to March 31, 2029?

    —

    A Question of Fairness, Not Generosity

    Albertans have long been proud of their contributions to Canada’s economy.

    Our energy industry has generated jobs, investment, government revenues, and economic opportunities extending far beyond our provincial borders. Albertans also contribute substantial amounts to federal revenues through personal income taxes, corporate taxes, and other sources.

    Yet here at home, we face serious challenges.

    Emergency departments are under pressure. Patients experience lengthy waits for diagnostic imaging and surgeries. Our growing population requires additional schools, hospitals, roads, and infrastructure.

    Against that backdrop, many Albertans are asking a reasonable question:

    How can Alberta contribute so much to the federal government while struggling to adequately fund essential services within its own borders?

    To answer that question, we need to understand Canada’s equalization program, separate fact from misconception, and examine whether the current system reflects the realities facing provinces today.

    What Exactly Is Equalization?

    Equalization is a federal program intended to ensure provincial governments have sufficient revenues to provide reasonably comparable public services at reasonably comparable levels of taxation.

    The principle is established in Section 36(2) of the Constitution Act, 1982.

    The federal government calculates each province’s capacity to raise revenue using a formula that considers several major revenue sources, including personal income taxes, business taxes, consumption taxes, property taxes, and natural resources.

    Provinces whose measured fiscal capacity falls below the national standard may qualify for equalization payments.

    Provinces whose capacity exceeds that standard generally do not.

    Alberta has not received an equalization payment since the 1964–65 fiscal year.

    However, Alberta does receive other federal transfers, including funding for health care and social programs.

    That distinction is important.

    Does Alberta Send Equalization Cheques to Quebec?

    No. Not directly.

    This is one of the most persistent misconceptions surrounding equalization.

    Alberta’s provincial government does not write a cheque to Quebec or any other province.

    Equalization is financed through the federal government’s general revenues, collected from Canadians across the country.

    Because Alberta has historically had relatively high incomes and economic output per person, its residents and businesses have contributed substantial federal tax revenues.

    Some of those federal revenues finance equalization, alongside many other federal programs and expenditures.

    In other words, Alberta helps finance the federal system, but there is no separate equalization tax imposed on Albertans.

    The real question is not whether Alberta writes a cheque. It is whether the broader federal fiscal arrangement adequately recognizes Alberta’s contributions and needs.

    Where Does the Equalization Money Go?

    For the 2026–27 fiscal year, federal equalization payments total approximately $27.2 billion.

    Quebec receives the largest total allocation, approximately $13.9 billion, followed by Manitoba, Nova Scotia, and New Brunswick.

    Alberta, British Columbia, and Saskatchewan receive no equalization payments.

    Quebec’s larger total allocation partly reflects its much larger population compared with several other recipient provinces. The total amount received should not be confused with the amount received per resident.

    And importantly, receiving equalization does not mean a province is doing something wrong.

    The program is intended to address differences in provincial revenue-raising capacity, not to reward or punish particular provincial governments.

    Nevertheless, its design and consequences deserve examination.

    Why Do Many Albertans Question the System?

    1. Alberta’s Economic Contributions Are Substantial

    Alberta has historically contributed more to federal revenues than it receives in federal spending.

    This net fiscal contribution is not limited to equalization. It reflects the broader relationship between federal taxes, spending, transfers, and economic activity.

    Federal taxation is based on individuals’ and businesses’ circumstances, not on a requirement that every province receive back exactly what its residents contribute.

    That is a fundamental feature of national taxation.

    But it does not eliminate the question of whether the distribution of federal resources appropriately addresses changing provincial needs.

    2. Alberta’s Economy Carries Significant Risks

    Alberta’s energy industry has generated tremendous wealth, but resource-dependent revenues can also be volatile.

    Oil and gas prices fluctuate. Investment rises and falls. Workers and businesses can experience substantial economic disruption.

    Equalization calculations use historical revenue-capacity data, rather than responding immediately to economic conditions.

    Consequently, Alberta can experience significant economic hardship without qualifying for equalization.

    Canada has a separate Fiscal Stabilization Program intended to help provinces facing certain major revenue declines, but it is not equivalent to equalization.

    Should federal fiscal arrangements respond more quickly when a province experiences a sudden economic downturn?

    That is a question worth examining before the next renewal.

    3. Equalization Does Not Directly Account for the Cost of Delivering Services

    Perhaps one of the most important limitations of the equalization formula is what it does not measure.

    It assesses a province’s capacity to raise revenues.

    It does not directly calculate how much that province must spend to deliver public services.

    Consider Alberta’s circumstances.

    Rapid population growth increases demand for hospitals, schools, roads, emergency services, and other infrastructure.

    These pressures do not disappear simply because a province has relatively strong revenue-generating capacity.

    Other provinces also face significant costs, including aging populations, remote communities, and difficult service-delivery conditions.

    The broader question is whether Canada’s fiscal arrangements adequately recognize these different pressures.

    Revenue-raising capacity and actual public-service needs are not the same thing.

    4. Provincial Spending Choices Are Not Part of the Equalization Formula

    Quebec frequently becomes the focus of the debate because it receives the largest total allocation.

    Some Albertans question why a province receiving equalization can maintain certain programs or policies that differ from those available in Alberta.

    However, equalization is not determined by how much a province chooses to spend on individual programs.

    Recipient provinces retain authority over their budgets and spending priorities.

    This is an important principle of provincial autonomy.

    It also raises questions about transparency and accountability.

    Can Canadians easily understand how equalization is calculated, why allocations change, and what the broader federal fiscal system means for their province?

    They should be able to.

    What About Alberta’s Health Care Crisis?

    This is where the discussion becomes particularly relevant to everyday Albertans.

    When residents face lengthy emergency department waits, delayed surgeries, difficulty accessing family physicians, or postponed diagnostic procedures, questions about government funding become more than abstract economic debates.

    They become questions about people’s health and well-being.

    Alberta’s health care system is primarily a provincial responsibility, although the federal government provides substantial funding through the Canada Health Transfer.

    Equalization is a separate program.

    Reducing equalization payments to another province would not automatically provide additional money for Alberta’s hospitals.

    That would require separate federal or provincial budget decisions.

    Similarly, Alberta’s own decisions about taxation, spending, infrastructure, and health care priorities directly influence the resources available to its health system.

    A meaningful discussion about fiscal fairness must therefore examine both federal arrangements and provincial spending decisions.

    We should be asking whether the federal government adequately recognizes Alberta’s needs while also asking whether Alberta’s government is making the investments necessary to address those needs.

    The two questions are not mutually exclusive.

    March 31, 2029: A Deadline Albertans Should Know About

    There is an important date approaching that deserves far more public attention.

    The current federal equalization legislation is scheduled for renewal before March 31, 2029.

    The existing statutory authority for the program runs through the 2028–29 fiscal year. Parliament must address the program’s legislative continuation before the next fiscal period begins on April 1, 2029.

    This is not an automatic constitutional renegotiation, nor does it mean equalization will necessarily end.

    The constitutional commitment to equalization is separate from the legislation establishing its detailed formula and payments.

    However, the renewal provides an opportunity to examine how the program operates.

    It is a chance to ask:

    – Does the formula adequately reflect economic volatility?
    – Should the cost of providing public services receive greater consideration?
    – Are rapidly growing provinces facing pressures that existing federal transfers do not adequately address?
    – Is the treatment of natural resource revenues appropriate?
    – Should there be greater transparency about provincial contributions to federal revenues and federal spending?
    – What changes, if any, would make the system more responsive without undermining comparable public services across Canada?

    These are not questions that should be left exclusively to politicians or constitutional experts.

    They affect Canadians in every province.

    And Albertans have a legitimate interest in understanding the choices being made on their behalf.

    What Would Happen if Equalization Were Reduced or Changed?

    Any reform would involve trade-offs.

    Reducing equalization could lower federal expenditures, but it could also reduce the revenues available to recipient provinces for public services.

    Changing the treatment of resource revenues might alter provincial entitlements.

    Adding service-delivery costs to the formula could benefit some provinces while changing the distribution of payments to others.

    A separate stabilization mechanism could provide more timely assistance during economic downturns without fundamentally changing equalization.

    There is no guarantee that changing equalization would increase Alberta’s federal transfers or reduce federal taxes paid by Albertans.

    That would depend on the precise reform and accompanying government decisions.

    Understanding those consequences is essential to a serious discussion.

    Equalization Was Intended to Create Fairness. Is It Keeping Pace With Canada?

    Canada has changed substantially since equalization was introduced in 1957.

    Provincial economies have evolved. Populations have shifted. Infrastructure demands have grown. Health care costs have increased.

    The economic realities facing provinces today are not identical to those of previous generations.

    A formula that was designed to address disparities in revenue-raising capacity should be periodically examined to determine whether it continues to achieve its intended purpose.

    That does not require abandoning the principle of helping Canadians access comparable public services.

    Nor does it require portraying recipient provinces as undeserving.

    It requires asking whether the system is sufficiently transparent, responsive, and suited to contemporary economic realities.

    My Closing Thoughts

    I believe Canadians should care about the well-being of people across this country, regardless of provincial boundaries.

    A child in Nova Scotia deserves access to quality health care just as much as a child in Alberta.

    A senior in Quebec deserves dignity and appropriate medical treatment just as much as a senior in Saskatchewan.

    But I also believe that fairness requires accountability, transparency, and a willingness to examine policies that may no longer adequately reflect the circumstances they were designed to address.

    Alberta’s contributions to Canada’s economy deserve recognition.

    So do the pressures facing its residents.

    The question is not whether Alberta should help support the rest of Canada. The question is whether Canada’s federal fiscal arrangements fairly balance that responsibility with Alberta’s own needs.

    With the equalization program approaching its March 31, 2029 legislative deadline, now is an appropriate time for Canadians to become informed and participate in that discussion.

    Because fairness should not be assumed simply because a program was designed with fairness in mind.

    It should be examined, explained, and continually evaluated.

    —

    Sources and Further Reading

    1. “Department of Finance Canada — Equalization Program” (https://www.canada.ca/en/department-finance/programs/federal-transfers/equalization.html)
    2. “Department of Finance Canada — Major Federal Transfers” (https://www.canada.ca/en/department-finance/programs/federal-transfers/major-federal-transfers.html)
    3. “Constitution Act, 1982 — Section 36” (https://laws-lois.justice.gc.ca/eng/const/page-12.html)
    4. “Federal-Provincial Fiscal Arrangements Act” (https://laws-lois.justice.gc.ca/eng/acts/F-8/)

    The Age of Understanding — Exploring complex issues with curiosity, evidence, and conscience.

  • A Health-Care System Is More Than Buildings — It Is a Promise

    A Health-Care System Is More Than Buildings — It Is a Promise



    There is something deeply unsettling about watching a health-care system struggle when many of the pieces needed to make it work already exist.

    Operating rooms exist.

    MRI machines exist.

    Hospitals exist.

    Highly trained professionals exist.

    And yet Albertans can still find themselves waiting months for diagnostic imaging, sitting for hours in overcrowded emergency departments, or waiting for surgeries that could profoundly improve their quality of life.

    The problem is not simply that Alberta needs to spend more money.

    The deeper question is whether we are building a health-care system in which people, infrastructure, and funding actually work together.

    Because an operating room without nurses, anesthesiologists, and support staff isn’t really an operating room.

    An MRI machine sitting unused overnight isn’t really diagnostic capacity.

    And a hospital bed without enough staff to safely care for the person lying in it isn’t really an available hospital bed.

    Health care ultimately depends on people.

    Alberta Has a Capacity Problem

    Alberta’s health-care pressures are not imaginary.

    The province continues to deal with high emergency-department demand, pressure on inpatient beds, surgical backlogs, diagnostic wait times, and shortages in parts of the health-care workforce.

    Alberta Health Services has documented instances in which operating-room capacity has been reduced because of shortages of clinical personnel.

    At Edmonton’s Royal Alexandra Hospital, for example, orthopedic day-surgery cases were reduced and operating-room time reassigned, with AHS identifying a clinical personnel shortage as the reason.

    That should make us ask an important question:

    Before we conclude that Alberta simply needs more operating rooms, do we know whether we are fully using the ones we already have?

    And if we aren’t, why aren’t we?

    If the answer is staffing, then staffing needs to become one of the largest infrastructure projects Alberta undertakes.

    People Are Infrastructure Too

    When governments talk about infrastructure, we usually think about highways, bridges, schools, hospitals, and pipelines.

    But health-care workers are infrastructure.

    A province can build the most sophisticated hospital in Canada and fill it with state-of-the-art equipment.

    Without people, it is simply a very expensive building.

    Alberta should be developing a long-term health-workforce strategy with the same seriousness we apply to major capital projects.

    How many nurses will Edmonton need in 2035?

    How many family physicians?

    How many anesthesiologists?

    How many MRI and CT technologists?

    How many respiratory therapists, physiotherapists, occupational therapists, pharmacists, paramedics, and health-care aides?

    Those numbers should not surprise us when shortages arrive.

    We can forecast them.

    Then we can train, recruit, and retain accordingly.

    That means expanding Alberta training programs where shortages are predictable.

    It means recruiting exceptional professionals from across Canada.

    It means responsible international recruitment and efficient recognition of qualified internationally educated professionals while maintaining Canadian standards.

    And perhaps most importantly, it means creating working conditions that make experienced health-care professionals want to stay.

    Recruitment without retention is simply filling a bucket with a hole in the bottom.

    And Then There Is South Edmonton

    Several years ago, Alberta was planning something Edmonton had been waiting decades to see: a new hospital in the south of the city.

    The South Edmonton Hospital was intended to become a major health campus serving a rapidly growing part of the Edmonton region.

    Planning occurred.

    Money was spent.

    Then the project was cancelled in 2024.

    Perhaps the original design became too expensive.

    Perhaps circumstances changed.

    Perhaps the original plan needs to be reconsidered.

    But cancelling a particular design does not make the underlying need disappear.

    Edmonton continues to grow.

    Our existing hospitals continue to carry enormous responsibility.

    And Alberta itself is now planning additional hospital-bed capacity in Edmonton and Calgary.

    So perhaps the question should no longer be:

    Should we resurrect the exact hospital that was originally proposed?

    Perhaps the better question is:

    What does South Edmonton need now—and what will it need twenty years from now?

    Maybe We Start Differently

    There may be an opportunity here to think differently.

    What if the South Edmonton health campus began as a comprehensive urgent-care and diagnostic facility?

    Not a glorified walk-in clinic.

    A genuine intermediate level of care between a doctor’s office and a full hospital emergency department.

    Imagine a facility capable of treating fractures, significant cuts, infections, dehydration, asthma attacks, and other urgent but non-life-threatening conditions.

    Add diagnostic imaging.

    Laboratory services.

    Casting and fracture care.

    Minor procedures.

    Rapid-access specialty clinics.

    Perhaps extended hours or even 24-hour urgent care.

    Then design the site from the beginning so that it can grow.

    Future phases could add surgical suites.

    Inpatient beds.

    Specialized services.

    Eventually, if population growth requires it, a full acute-care hospital.

    We do not necessarily have to choose between building everything immediately and building nothing at all.

    There is a third option.

    Build intelligently.

    Build in phases.

    And build for the Alberta that will exist twenty years from now.

    The Public-Private Debate Is Missing an Important Question

    Alberta is also spending substantial public money expanding surgeries through privately operated chartered surgical facilities.

    That immediately turns health care into an ideological argument.

    Public versus private.

    Left versus right.

    But there is a much more useful question:

    What gives Albertans the greatest amount of safe, timely, high-quality health care for the money we are spending?

    If an operating room in a public hospital is sitting unused because funding another surgical team would allow it to operate evenings or weekends, we should know what that would cost.

    If a chartered surgical facility can perform the same procedure safely and cost-effectively without pulling scarce nurses, physicians, or other professionals away from public hospitals, we should know that too.

    And if it costs more, we should know that.

    Those comparisons should be public.

    Cost per procedure.

    Wait-time improvement.

    Patient outcomes.

    Complication rates.

    Staffing effects.

    Actual additional capacity created.

    Not ideology. Not slogans. Evidence.

    Because public money deserves public accountability.

    Emergency Rooms Should Not Be the Front Door to Everything

    One of the strangest features of modern Canadian health care is how many different problems eventually funnel into the emergency department.

    Someone cannot find a family doctor.

    Emergency.

    Someone needs diagnostic imaging quickly.

    Emergency.

    Someone has an injury that cannot wait weeks for an appointment but isn’t life-threatening.

    Emergency.

    Someone needs mental-health assistance.

    Emergency.

    Someone requires medical attention after regular clinic hours.

    Emergency.

    Then we wonder why emergency departments are overwhelmed.

    A well-designed system should have multiple doors:

    Primary care.

    Urgent care.

    Community care.

    Diagnostic care.

    Mental-health care.

    Emergency care.

    Hospital care.

    Continuing care.

    And patients should be able to move between those levels without having to navigate a maze.

    That is why a major South Edmonton urgent-care and diagnostic centre could be much more than another building.

    It could become a pressure-release valve for an entire region.

    Health Care Is Ultimately About What We Value

    Budgets tell us what governments fund.

    But health-care systems tell us something deeper.

    They tell us what societies value.

    There will always be competing demands for public money.

    Economic development matters.

    Infrastructure matters.

    Energy matters.

    Technology matters.

    Investment matters.

    But there is something uniquely fundamental about health.

    A person can lose their job and rebuild.

    A business can fail and another can take its place.

    Infrastructure can be repaired.

    But someone waiting for a diagnosis does not get those months back.

    Someone living in severe pain while waiting for surgery does not get those days back.

    And sometimes, tragically, someone waiting for care does not get another chance.

    That is why health-care capacity cannot simply be something governments react to when emergency rooms overflow.

    It must be planned decades ahead.

    Tie the Pieces Together

    Recruit health-care professionals.

    Retain the ones we already have.

    Use our existing operating rooms and diagnostic equipment as fully as safely possible.

    Expand urgent care so emergency departments can concentrate on emergencies.

    Measure whether publicly or privately delivered procedures actually provide better value and additional capacity.

    And put the South Edmonton Hospital project back on the table—perhaps not exactly as it once existed, but as a modern, expandable health campus beginning with the services Edmonton needs most urgently.

    None of those ideas solves the problem alone.

    Together, they begin to resemble a health-care strategy.

    Because the answer isn’t simply more hospitals.

    It isn’t simply more private clinics.

    It isn’t simply more money.

    And it isn’t another restructuring.

    It is having the right people, in the right facilities, providing the right level of care, at the right time.

    That is what capacity really means.

    And perhaps that is the bigger lesson.

    A health-care system is more than buildings, budgets, and organizational charts.

    It is a promise we make to one another:

    When you are sick, when you are frightened, when you are hurting, and when you need us most, we will have built a system capable of being there.

    That is a promise worth planning for.

    — The Age of Understanding