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opinion

Here’s an idea: The Conservatives should run in the next election on a platform of massive health care spending. And they should sell it is a bold step toward fiscal responsibility.

That runs counter to Conservative tradition and the way Ottawa thinks about spending. But in the world where Justin Trudeau’s Liberals have just issued an election budget with $101-billion in new spending over three years, piled onto rising debt, maybe they should think about it.

The glaring omission in the Liberals’ big-spending budget is the lack of a significant effort to refinance the health care system. They offered relatively small one-time sums instead.

That is not surprising, but it should be a little shocking. We’re in the third wave of the COVID-19 pandemic that has shown us that our health care system is stretched, when health officials called for lockdowns and restrictions to prevent hospitals from being all-too-easily overwhelmed. And even before the pandemic, we knew there will be big growth in health costs from an aging population.

Yet Monday’s federal budget basically told the provinces they are on their own. On Tuesday, Mr. Trudeau said Ottawa will increase health care transfers after the pandemic. You have to wonder how many dollars will be left.

Given the politics, it was predictable. The feds are never keen to write health transfer cheques because they don’t get much political credit for all that cash. They prefer to promise new things.

Mr. Trudeau’s government has called for national standards in long-term care, and offered the provinces $1.5-billion – a sum that Don Drummond, an economics professor in the school of public policy at Queen’s University in Kingston, calls “a rounding error.” Between now and 2041, he said, the number of older seniors will double, and the costs of long-term care will rise – by more than $60-billion per year in today’s dollars.

There’s a big bill coming for the rising costs of health care, and it will have to be paid. It may be the indebted provinces that pick up the tab, but for taxpayers, it still comes on top of all that new federal spending in Mr. Trudeau’s budget.

So here’s a small-c conservative alternative: pouring federal money into health care transfers.

It would devote Ottawa’s billions to funding a high public priority – health care – which will have to be funded, anyway. And it will reduce Ottawa’s ability to pour money into new initiatives. It’s a fiscal responsibility proposal.

At this point you might be asking, isn’t it unrealistic to think the Conservatives would embrace such an idea? Doesn’t it create a bunch of problems, too? Isn’t this merely a half-baked notion, raised to make a point? The answers to those questions are yes, yes, and yes.

But hear me out.

The public isn’t in a penny-pinching mood, so Conservative Leader Erin O’Toole had better not spend the coming election campaign clucking about austerity. Instead he can promise a generational “investment” in medicare.

It would be popular with premiers, especially Quebec’s politically influential Premier, François Legault. It would mean a shift in fiscal power to the provinces, and help for provincial budgets. It would restrain Ottawa’s tendency to look for new ways to spend.

Admittedly, the idea has drawbacks. If Ottawa pours money into health care, it lets the provinces dally over reforms to services that can be more efficient. The provinces could raise taxes – and for accountability’s sake, it would be better if there was an agreement that Ottawa will lower taxes while the provinces raise them to pay for health care. But that is never going to happen.

Adopting a policy of massive health transfers would mean cancelling a lot of the election goodies in the Liberal budget, which included important things like funding for accessible childcare. And although you’d have to wonder why premiers would agree to start a new program with the feds when Ottawa invariably cheaps out on its share after a few years, accessible childcare is still good for families and the economy.

So sure, you can argue there are wiser policy plans. And Mr. O’Toole’s Conservatives weren’t likely to scoop up the idea. But it would nice to have someone talking about the problem.

Both Ottawa and the provinces really are carrying heftier debt loads, despite the assurances that low interest rates will make it all okay. And while the federal government is dreaming up big new ways to spend, and provinces’ finances are stretched, there is another big, neglected bill coming due for health care.

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