HOW MUCH OF A PRIORITY IS HEALTH CARE FOR OUR RESIDENTS?

The sheer size of the number is certainly shocking when first viewed. That is, the cost to build the new Muskoka Algonquin Healthcare (MAHC) hospital locations in Huntsville and Bracebridge, now estimated at a projected cost of $967 million. And the size of the corresponding "local share" that is required for the project to move forward now sits at $225 million. But let's take a deep breath and get some further context before we react too harshly.

The arguments over whether or not there would ultimately be two hospital locations and whether this would be a "renovation" or a new build are now behind us. The bottom line for the Almaguin Highlands is that there was a strong desire to keep the hospital in Huntsville (i.e., and not just build one large facility further south). In the initial estimate for the two new builds back in 2019, we were talking about total amounts of $561 million in build costs and an associated $129 million for the local share. For those not familiar, the local share is part of any new hospital build in the province, and amounts to 10 per cent of the capital cost, plus 100 per cent of the equipment cost of the build. In reality, local share typically amounts to 23 to 26 per cent of the overall cost. This share is raised through a combination of available hospital funds, funds raised by hospital foundations and funds raised locally by municipalities in support of the build.

Although any shovels in the ground are still at least four or five years away, the hospital must be able to commit to meeting this local share amount by the end of 2023. This means that the stakeholders must be reasonably comfortable that they can commit to their own share in the same time frame. No money changes hands yet. But the commitment needs to be understood. And to be clear, if the hospital is not comfortable that, along with their partners, they can meet this $225-million number, the project ends. There are 50 potential hospital projects waiting in the queue in Ontario, and certainly they won't all get built. MAHC would effectively

move to the end of the line, or out of the line altogether, if they can't commit to the local share. And a key point in this equation is the other side of the costs. The province is willing to cover over $700 million in costs for the project, if we find a way to raise the local share.

Debate on the reasonableness of the local share in small, rural locations continues. A comparable hospital project in Niagara has to raise roughly the same amount for their local share, yet they pull on considerably more residents (not to mention, more businesses). It's another urban formula that does not fit in a rural setting. Regardless, however, while we question the fairness of the approach, we still need to determine what is feasible. Hoping that something will change is not terribly strategic. Neither is hoping that someone will step in and save us.

The Almaguin Highlands has had limited say in how and where healthcare services are provided for decades. We have typically been at the whim of organizations in other areas, and cuts to their budgets often meant cuts to, or complete loss of, our services. This will continue to happen if we don't step up as a region. The Almaguin Highlands Health Council has proposed that, based on a number of critical assumptions and based on a formula similar to that used for policing, land ambulance and home-for-theaged funding, the region set a long-term target for both support of the MAHC build and creation of a separate budget that keeps health-care funding in the Almaguin Highlands to create services specific to the region.

The local share request has actually provided an opportunity for the region. 80 per cent of a target goes to the local share. 20 per cent stays directly in the Almaguin Highlands region. The target is $12 million across 12 municipalities in 12 years — $9.5 million toward the hospital build and $2.5 million to be "held back" and used specifically

for health-care services in the Almaguin Highlands.

Before the outrage at the number sets in, based on the formula mentioned above, this would mean that, on an annual basis, each municipality would be setting aside less money per year than they currently do for policing. Less money per year than they currently do for land ambulances. Less money per year than they currently do for the homes for the aged.

The question is — how much of a priority is health care for our residents? Further, what if the hospital does not get built and we wait for the inevitable degradation, and eventual loss, of the hospital? What does that do for growth in our region?

What does it do for employment, when health care and social services is the number 1 employer (by sector) in our area?

What does it do to the primary care providers in the Almaguin Highlands if they don't have access to a top-end hospital?

What if we never position ourselves, through funding of health care in the area, to stop the cycle of "waiting until someone else cuts our health-care services"?

No one has stated throughout this process that it would be easy. And, understandably, each municipality has its own set of challenges. No one wants to see big hikes in taxes, especially with all of the other pressures. All that is being asked is for each municipality to look and see what they can afford. Perspective is important. $12 million over 12 years to get a new hospital and, finally, create a fund for health care in the region.

This time around, our friends to the south might actually be jealous of that equation.