Don Mazankowski's report is a breath of fresh air. For many years, the only health care debate has been about how much taxpayers' money should be spent. But now Albertans have a report with specific suggestions on improving the health care system itself, rather than just throwing more money at it.

The Alberta government should implement many of Mazankowski's recommendations to make our health care system more accountable, provide patients with more choice, establish performance goals, evaluate outcomes, and explore alternate ways of financing.

Health care was one quarter of Alberta's budget in the 1980s, is about one third today, and could take up half the provincial budget as early as 2008. It is during old age that a person incurs the majority of the total health care costs incurred over an entire lifetime. An aging population therefore makes the current system financially unsustainable.

In his report, Mazankowski weighs several options for financing health care. For example, user fees might reduce demand for medical services somewhat, but charging them at the point of service would contravene the Canada Health Act. Making health services a taxable benefit would cause financial hardship to some, and would make Alberta's income tax system more complex. A sales tax dedicated to health care would be rejected by most Albertans. Finally, he recommends against privately funded and privately delivered health services, arguing that Albertans should not be denied access to health services because they are unable to pay.

Mazankowski concludes that the best options are medical savings accounts, variable health care premiums, a national strategy to manage and contain increasing drug costs, and allowing regional health authorities to raise additional revenues to pay for the services they provide.

Mazankowski also recommends increasing health care premiums, which now provide the Alberta government with $670 million per year, about 11% of health care costs. The federal government pays 16%. The remaining 73% of Alberta's health care budget comes from provincial taxes: personal income tax, corporate income tax, fuel tax, property tax, alcohol and tobacco taxes, and oil and gas royalties.

No matter how you look at it, health care premiums are a tax. Raising health care premiums to cover 20% of health care costs, as Mazankowski recommends, is a tax increase, pure and simple.

Designating specific taxes for specific purposes, like fuel tax for road construction, promotes accountability and transparency. Using premiums to fund health care, in and of itself, is good. But health care premiums should not be increased unless there is an equivalent reduction to personal income tax.

The Premier's Advisory Council on Health was created to look at ways of improving Alberta's health care system so that it would not eat up more and more tax revenues with every passing year. Increasing taxes - in the form of higher health care premiums - is acceptable only if other taxes are cut by the same amount. The government should implement many of Mazankowski's recommendations. But health care premiums should not be increased unless there is an equivalent cut to personal income tax.