More than a few eyebrows were raised when the Saskatchewan Party chose former NDP Finance Minister Janice MacKinnon to chair the board of Investment Saskatchewan. Though her appointment showed some wisdom--not to mention political savvy--the Sask Party would have been wiser still to put her on the health file.

In 2004, MacKinnon released a scholarly paper that should be required reading for everyone involved in Canadian health care policy. In "The Arithmetic of Health Care" (online at http://www.irpp.org/pm/archive/pmvol5no3.pdf) she says the original goal of Medicare - affordable, quality health care - can only occur through substantial change, not tinkering and spending ever more tax dollars. She writes, "One of the greatest threats to Medicare is posed by those who cling tenaciously to the status quo and claim they are defending Tommy Douglass's vision of Medicare by doing so" (p. 26).

MacKinnon says burgeoning health costs already take too much of governmental budgets, and it's about to get much worse. Demographically, the tax base can afford 'pay-as-you-go' health care costs today. The working age population is greater than the retirement age population. However, the oldest baby boomers turn 65 in 2012, while the remainder will reach that age by 2026. Since half of Canadians' lifetime health care costs occur after age 65, a tsunami of health care costs will arrive at the same time the working age population shrinks.

Our choices are clear: continue the status quo until health care consumes all of our tax dollars or find sensible ways to have people pay for part of their own care. "It is reasonable," she writes, "to expect Canadians to assume some of the responsibility for making wise health care choices and to be provided with a financial incentive to do so" (p. 25).

MacKinnon's solution Make health services a taxable benefit connected to income. The greater the taxable income, and the more health care received, the higher a person's taxes. Conversely, the lower the income, and the lesser the health care received, the lower the taxes levied. Health care could remain accessible to all through placing caps on the amount of tax that can be levied, keeping in mind medical costs and personal income.

Clear benefits emerge from this plan. Canadians would see what their personal health care actually costs the system. Moreover, they would have a financial incentive to be more prudent in their choices and lifestyle. Also, those who leave the country to get timely health care would not have to pay taxes in Canada for services they never received. Best of all, a younger generation of Canadians in a globally competitive world won't be taxed into poverty to pay for the health costs of others.

Other variations of this proposal include lifetime medical savings accounts and refundable health premiums. Each allow the user more choice in directing their health outcomes and end the myth that health care is free.

From 1998 to 2007, Saskatchewan's health care costs rose by 88%, whereas the economy only grew by 56%. Politicians and bureaucrats know this can't keep up; yet they shudder to touch the sacred cow of Medicare. For this task, MacKinnon is pure gold. Her experience as a professor of public policy, and her credentials in Douglass's party and province, could be utilized as a powerful catalyst for change.

For now, MacKinnon will help direct a crown that offers investment capital to Saskatchewan corporations that require more than $3 million in equity. At best, she will offer prudence and restraint to government interference in the economy--a terrible tradition that has crippled the province far too long. Let's hope in future years she receives a different opportunity-one that allows her to change health care instead.