The Canadian Health Coalition is a large lobbying organization predominantly funded by public sector unions and has been operating for over 40 years. It is influential on Ottawa politicians with an instinctive fear of clashing with organized labour, and the group is calling on Mark Carney to cut health-care transfers to Alberta.

Provision of health care is provincial jurisdiction. Ottawa uses health-care transfers as a mechanism to strongarm the provinces into maintaining the status quo in provision, however. While Alberta isn’t legislatively bound to follow the dictates of the federal government when managing health care, it can be punished as the federal government withholds transferring Alberta’s tax dollars back to it.

Ottawa has had a history of using Alberta’s health-care transfers to keep premiers in line.

The Chrétien government cut health-care transfers to Alberta in the 1990s because Ralph Klein had instituted some user fees in the system. Chretien then defanged Klein’s planned reforms to the system by threatening to withhold even larger amounts in 2000. It led to no changes happening within the Alberta system.

The UCP government in Alberta passed Bill 11, which follows European health-care models in allowing a larger mix of private/public provision of care while still binding doctors to provide a degree of care within the public system. The Canadian Health Coalition is demanding Carney cut transfers until Smith repeals the legislation.

The current health-care transfer to Alberta is around $7 billion per year, which makes up 20% of the provincial health budget. The original Canadian health-care plan called for the federal government to provide 50% of the funding for care, but over the decades, the federal government has continued to abdicate that obligation, and the cuts have gotten smaller. They still hold enough tax dollars to shake up provincial governments if and when they choose to.

Will Carney cave to pressure and begin punishing Albertans until the province complies? Liberals tend to be more inclined to work to keep unions happy than to worry about the interests of Western provinces.

Will Premier Smith stand up and defend her legislation? Or will she follow the pattern of capitulation to federal demands as she has done since signing an MOU on pipelines last year?

With the referendum approaching on October 20, perhaps it is a good time for the province to duke it out with the federal government. Alberta citizens have a chance to express their feelings on the federal relationship soon, and it involves much more than pipelines.