Albertans could be paying higher premiums and more user fees as the province makes changes to its health care system. But the public will first have an opportunity to offer its input.

Premier Ralph Klein says some form of change is necessary because the system as it stands now simply cannot survive without reform.

The discussion paper released today contains ideas from the Conference Board of Canada and suggests:

• charging patients more for treatment depending on their income
• an income-based deductible for medical service
• higher health care premiums, and
• cutting the annual growth in health spending in half.

The recommendations are just that -- recommendations. Alberta Minister of Health and Wellness Gary Mar says he is adamant he won't accept any of the ideas until his government consults with Albertans later this fall.

"More work needs to be done to ensure access to quality public health care in the future, but we will proceed only after Albertans have had their say," said Mar.

Roy Romanow, the former Saskatchewan premier who chaired a commission on the health system, said he thinks the whole announcement is a ploy to get more federal money.

Klein told reporters that none of the proposals will violate the Canada Health Act. He said his team had mulled over two pilot projects for private orthopedic clinics that would have violated the act as it now stands. But he says the caucus decided not to go ahead.

Federal Health Minister Pierre Pettigrew said it was good news that Alberta would respect the Canada Health Act, but didn't comment further on any specifics.

Cat amongst the pigeons

A few weeks ago, Klein announced he would be unveiling the proposals two days after the election. He also hinted the reforms may violate the Canada Health Act, which commits the federal government to a universal, publicly administered health insurance system.

Those comments infuriated Prime Minister Paul Martin, who warned voters that Klein and Conservative Leader Stephen Harper has a "hidden agenda" were secretly conspiring to unravel medicare.

Martin demanded Klein release the plan early. The Alberta premier refused, but later pulled back from his position, assuring Canadians he would only be strengthening the public health system.

Many say, though, that the damage was already done, and that Klein's scare tactics probably cost Harper the federal election. Klein dismissed the suggestion Wednesday.

"I don't think I played a significant role if you look at everything in context," he said. "I said nothing during the campaign that has not been a matter of public record for months. And those who say I had a hidden agenda on health care have been saying that for decades."

Yet one of Klein's own backbenchers cited the incident as a reason for defecting from the Tory caucus for a right-wing alternative called the Alberta Alliance Party.

'Ottawa responsible for crisis'

Klein used the proposal unveiling as an opportunity to accuse the federal Liberals of cutting the public system on one hand, while delivering empty promises on how to sustain it on the other.

"For weeks and months now, we've watched Paul Martin proclaim himself the saviour of medicare, when it was his own government's persistent failure to pay its fair share of the cost that is largely responsible for the crisis the system faces today," he said Wednesday.

"And while the federal Liberals have thumped their chests and brayed about the Canada Health Act, the provinces have borne the burden of delivering the health services and paying for them."

Klein is known for pushing the envelope when it comes to the delivery of health care. In 1994, the province experimented with allowing private clinics to charge user fees. Ottawa retaliated by fining the province $3.6 million. Klein dropped the fees.

In April 1998, the premier introduced a bill to approve private, for-profit hospitals. A less radical version of the legislation passed two years later.

In 2002, Alberta tabled a report that said people should pay more for medical care. It also said the private sector should be given a bigger role. Other reforms have included increasing provincial medicare premiums.

Alberta families pay more than $1,000 annually for health coverage, though residents don't pay any provincial sales tax. British Columbia, and now Ontario, also charge residents premiums.

Wendy Armstrong of the Consumers Association of Canada said the new measures, if passed, could force Alberta families to by supplemental health insurance.