Public healthcare comes with a bill. When governments fail to collect enough to cover it, taxpayers pay more and patients wait longer.Premier Danielle Smith should press ahead with an annual healthcare premium of at least $1,900 for temporary residents. She should also publish the accounts behind it. Albertans deserve a policy that can survive scrutiny.Smith floated the figure at a Calgary Chamber of Commerce event, pointing to the United Kingdom’s approach. The October 19 referendum will ask whether people with non-permanent immigration status should pay a reasonable fee for healthcare and education. Citizens and permanent residents would retain their existing eligibility.That is a fair question. A government has a duty to ensure the public services it promises remain available to the people funding them.The case starts with accurate numbers.The much-discussed $1 billion annual estimate includes education. The government’s estimate included roughly $600 million for schooling and $400 million for healthcare.Using Smith’s stated population of roughly 246,000 temporary residents, a $1,900 annual charge would generate $467.4 million if everyone paid. That exceeds the estimated healthcare bill before exemptions, collection costs, and other adjustments. It would still fall far short of covering the combined health and education estimate..The lower $1,400 option would produce just $344.4 million under the same assumptions — below the estimated healthcare cost alone.Smith should hold to the higher figure as a starting point, then have the actual costs independently checked. Alberta needs to account for treatment, administration, and the cost of adding capacity. A premium based on an incomplete bill could leave taxpayers carrying expenses the policy was supposed to recover.Patients have reason to demand results.The Institute for Improved Health Outcomes reports that Alberta patients who received hip replacements between January and March 2026 waited an average of 28.7 weeks for surgery. That followed a separate wait to consult a surgeon.For someone struggling to walk or keep working, those months carry a price no budget table captures.Those figures do not establish how much temporary residents contribute to delays. Staffing shortages, operating room capacity, and management also matter. Still, when demand grows faster than treatment capacity, citizens face longer queues. Governments cannot promise access to more people without arranging the staff, space, and funding to serve them.The national evidence reinforces that concern. The Canadian Institute for Health Information found that public health spending per person, adjusted for inflation, fell 1.4% in 2024 as spending failed to keep pace with inflation and population growth..Alberta NDP Leader Naheed Nenshi objects that temporary workers already pay taxes. He is right about that. Their contributions belong in any honest calculation.But paying taxes does not, by itself, settle whether a particular program covers its costs. Smith should release a full account of revenue and spending, with healthcare separated from education. Costs should reflect the people actually covered, including their ages and use of services. Broad averages cannot answer every question.Britain provides a useful example. Its immigration health surcharge is generally £1,035 a year, with a £776 rate for students, children, and certain other applicants. Temporary access to a public system can come with a specific contribution.Business leaders worry an Alberta premium could make recruitment more expensive. Of course it could. Employers should include that expense when deciding whether to recruit abroad and whether to cover the premium themselves. It might force Alberta businesses to pay citizens more for the job instead of importing foreign labour. This approach only makes sense with unemployment over 6%. We have enough workers already here who need work.Taxpayers also face rising costs. Their household budgets deserve a place in this debate alongside corporate hiring budgets.Smith should give workers and employers advance notice, allow instalments, and explain any exemptions. Emergency treatment should remain available, consistent with Alberta’s existing approach. The premium’s proceeds should support patient care, with public reporting on money collected and treatment capacity added.Collecting a fee will not automatically shorten a single waitlist. Smith must turn the revenue into care.Set the annual premium at a minimum of $1,900, publish the evidence, and review it against actual costs. Albertans have heard enough promises about protecting Medicare. They deserve to have it protected for citizens, not temporary foreign workers clogging the system up.
