After almost nine months in hiding, the issue of the capital (read: financing) needs for local hospitals has resurfaced. And the debate will begin to play itself out next week at city hall when the Academy of Hospital Executives (the CEOs of all local hospitals) appears before the Corporate Services and Economic Development committee to make their pitch for some $120 million of help from city taxpayers over the next decade.

This issue first surfaced around this time last year while Bob Chiarelli and Claudette Cain were slugging it out for the mayor's job. Both candidates dismissed the idea of a city taxpayer contribution to local hospital construction projects. And to be fair to Mayor Bob (even though I won't be making his Christmas card list), he has remained consistent in this position citing health care as a provincial responsibility, first and foremost.

As for other council candidates (now councillors) - on the few occasions when this issue was raised - most of them made a bee-line for the exit doors or refused to take a position. But they won't be able to run next week when the health CEOs come to lay out their plan.

As I wrote in this space last February, our eight health sciences institutions (the Ottawa Hospital, CHEO, Queensway-Carleton, the Heart Institute, the Royal Ottawa, the Montfort, St. Vincent and the Regional Cancer Centre) have embarked on a collective $600 million capital improvement and modernization campaign.

Indeed, many of the projects on the list are merely to bring our facilities up to 21st century standards. No one can really argue with St. Vincent's desire to modernize its elevators or install air conditioning throughout the facility: especially after just coming through a summer with 25 days where the thermometer topped 30 C.

Likewise, the Ottawa Regional Cancer Centre's wish to consolidate its Ottawa-area work into one facility, treat patients with better equipment and house some of the country's best researchers are laudable and supportable goals. (Note: As a member of the ORCC foundation board, I admit I do have a bias toward the cancer centre). Also on the list are facility construction projects at CHEO and over at the Ottawa Hospital, ambitious plans include new surgical suites at the General campus and a host of specialty clinics on the Riverside campus.

Just under 70% of this $600 million tab will be covered by the province. The hospitals themselves plan to raise another $112 million through capital campaigns, planned giving, corporate donations and the like. But they still lack $120 million, hence, their pitch for help from the tax base.

Historically speaking, local community participation in hospital funding goes way back and some 22 communities across the province are pitching into hospital capital campaigns in their respective jurisdictions.

However, the pitch for $120 million over 10 years would result in a 1.5% property tax increase for the average 150K home, or an extra $30 on your annual tax bill. The Academy call this a levy, but let's get real, a tax is a tax.

A staff report has already recommended that council turn down the hospitals' request. And councillors and local health officials are also quick to point out that the city already spends some $92 million a year in the field of public health. The Mayor and his staff have also noted that hospital infrastructure needs are in direct competition with other infrastructure priorities including roads, sewers, libraries, community centres, recreation facilities and convention space.

Ottawa in this sense is not unique. The Canadian Council for Public Private partnerships has aptly noted that governments can not meet all the infrastructure demands to bring facilities up to par, let alone improve them.

So what should council do? On the one hand, some argue that saying "yes" to the hospitals would be a courageous and solid community expression of political and financial support for these valued institutions. On the other hand, critics caution that a new "hospital tax" on the property tax bill could set a dangerous precedent for other projects and social service needs not traditionally funded through property taxes. Moreover, asking Ottawa's 800,000 residents to help pay for facilities and services that are used by over 1.2 million people in Eastern Ontario creates a classic economic "free rider" problem.

From my not so humble perch, council truly does not have a mandate to deal with this issue. They neither were given nor sought direction on this file eleven months ago. And whatever decision council makes has the real potential to split this community and either hurt health care (if it says no) or damage a variety of other community infrastructure initiatives (if it says yes).

As I've argued before, but should make the point again, since it seems only myself and perhaps Alex Munter (and when was the last time I agreed with Alex?) are making this point: this issue is perfectly suited to be decided using the province's municipal referendum legislation passed in June 2000.

The legislation provides for the establishment of YES and NO committees with the appropriate regulations to govern conduct and fundraising activities. City council, in concert with the province, could set a date early next year for the referendum question to be posed.

A referendum is not the cleanest way to engage citizens (a survey is much more expedient) but it is the most comprehensive, egalitarian and fair manner in which to address this complex issue. The Academy of health executives is asking us to take ownership of our hospitals with our tax dollars. But we should first take ownership of this debate through a referendum