Last week's flood at the Centennial Building of the Victoria General site in Halifax has again put a spotlight on the poor condition of the hospital.

Replacing the Centennial Building will be a long, expensive, complex undertaking. Tearing down an old hospital and building a new one, while providing seamless health care, is not for the faint of heart or the light of wallet.

That's why Nova Scotia politicians from all three parties have been dithering for a decade.

Cost overruns

The last hospital built from the ground up in Nova Scotia was in Truro.

As the auditor general reported in a scathing review in 2011, the initial budget of $104 million was never going to be enough.

The final tally was $184 million, almost double the original budget, and that didn't include furnishings or the cost of knocking down the old hospital.

And the Truro hospital was a much smaller undertaking than the Centennial Building.

Right now, two new super-hospitals are being built in Montreal. The total price tag is closing in on $6 billion. The projects have been plagued by cost overruns, delays, and corruption.

From these two examples, we can guess that the final price tag for replacing the Centennial Building will very likely be north of $1 billion.

Roads and schools

The potential cost of replacing the Centennial Building is so large that it's not just a matter of re-ordering priorities for capital spending. It's a category-killer.

The entire capital budget for the current fiscal year is $490 million. Almost half of that will go to roads. A good chunk of the rest is for schools.

Roads and schools, roads and schools — year after year, that's where most of the capital spending goes. That's what Nova Scotians want, so that's what they get.

There is simply no room for a new project costing $1 billion.

That's why politicians of all stripes have shrunk in the face of a Centennial Building replacement. They have had three options:

Add $1 billion to the capital budget. Put aside all other capital spending for a few years. Do nothing and hope the building can be duct-taped together for one more year.

The first option didn't fit the political imperative to balance the budget before the next election. The second is a political and operational impossibility.

That's why the choice, for our politicians, has been easy. Year after year, no matter which party is in power, the politicians have walked through the third door: do nothing.

Or to be precise, they have ordered studies. If you're going to keep putting off something this big, you must at least look busy.

Mysterious but powerful

Will the decision be different this year, now that there has been a serious flood?

The decision about whether and when to replace the Centennial Building will be made by the treasury board, that mysterious but powerful committee of cabinet.

The treasury board is chaired by the education minister, Karen Casey, includes five other ministers, and is attended by all the highest staffers from the Premier's Office.

They know they must do something about the Centennial Building, and be seen to be doing something, and yet they are also desperately keen to show a balanced budget.

Last week's flood is likely enough to force the board to find a fourth option.

They could, for example, carve the Centennial Building replacement into ten or fifteen digestible chunks. Each year, they would fund only one or two of the chunks, and only if it keeps them in balance.

It will not be elegant. Spreading the project over a decade or two increases the risk of mistakes, cost overruns, and more floods and mechanical breakdowns. But politically, it just might work.

Nobody is going to ride to the provincial government's rescue on this one. The federal government won't, no matter who wins on Oct. 19. Neither will the other Atlantic provinces. They are equally cash-strapped, and already pay for the health-care services their residents receive in Nova Scotia.

No, the decision about what to do next rests with the treasury board. We'll get some inkling of what they've decided when the 2016-17 capital plan is released later this fall.