Once Canada's economic engine, Alberta is now signalling that the province may be forced to hike taxes and make painful cuts unless Ottawa agrees to help with more cash for health care.

Alberta "can't carry the country" during this recession, Premier Ed Stelmach said Thursday, as he demanded a larger slice of federal health transfers from Ottawa.

"All we're asking for is respect," said the premier, complaining Alberta is being shortchanged by more than $700 million in health transfers compared to other provinces. "To me, an Albertan that requires health services, that is sick or suffers from whatever disease, is just as sick as they are in Quebec or Ontario."

Currently, Alberta gets $542 per capita in health transfers, while every other province gets at least $745 per person, according to Alberta finance ministry figures.

Messages left at federal Finance Minister Jim Flaherty's office were not returned Thursday.

In its provincial budget released earlier this month, Alberta's Tory government stated its intention to chop $2 billion from a record $4.7-billion deficit by next year. The government is already laying the groundwork for some pretty painful measures if it doesn't get more federal money.

Tax increases on the table

"I will not rule out tax increases," Health Minister Ron Liepert told The Canadian Press in an interview this week. "I don't think you can."

'If you go look at the Canada Health Act, there is no list of services that they cover. It's all open to interpretation.'—Alberta Health Minister Ron Liepert

"As an example, if we were to implement a five-cent gas tax, that's $400 million," he said. "I'm not suggesting that's what we're doing.... We are not ruling out anything, other than the premier has said there will be no provincial sales tax."

Liepert generated outcry this month by dropping chiropractic services and sex-change operations from Alberta's medicare coverage. Several other medical services will be delisted, Liepert said, but he won't provide specific details.

"We need to take a hard look at what publicly funded health care covers and what it doesn't cover," said the minister. "If you go look at the Canada Health Act, there is no list of services that they cover. It's all open to interpretation."

Alberta has been warned in the past by the federal government to not violate the Canada Health Act by delisting treatments that would be considered "medically necessary." But Liepert said he doesn't think Prime Minister Stephen Harper's Conservative government is likely to challenge Alberta's cost-cutting measures.

"I think they're going to let us run it, as they should, because it's our jurisdiction," he said.

Optional insurance coverage can cover treatments

Liepert, who is known for his blunt talk, conceded that a public backlash over any significant changes to the health-care system is inevitable.

"Is it going to be easy? Absolutely not," he said. "But I do believe that there's a recognition by a majority of Albertans that health care can't cover everything all the time."

People will have the option of broadening their group medical insurance coverage to cover treatments that are no longer covered, said the health minister.

"It's going to open up opportunities for groups like Blue Cross to offer more comprehensive packages," said Liepert. "It's going to allow patients to choose what services they might want to insure for and which ones they might not.

"If they want to use acupuncture, they should have the right to buy insurance for that," he said. "If they want to use a chiropractor, then they should have the right to buy insurance for that."

Critics pounce on musings to trim medicare

Alberta's opposition parties and a medicare lobby group were quick to pounce on the musings about trimming medicare coverage.

Friends of Medicare spokesman David Eggen said Albertans will be very upset if the Stelmach government uses a narrow interpretation of the Canada Health Act to cut medical services. "They're going against what Albertans expect and want from their public health-care system," he said.

Liberal Opposition Leader David Swann is calling for a wide-ranging public debate on what medical treatments Albertans can expect to be protected under the 25-year-old Canada Health Act.

"It's high time that the public had an opportunity to say what they want for their health system and their tax dollars," said Swann. "Let's let the debate begin."