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Even in the most optimistic scenario set out by David Dodge, the former Bank of Canada governor, health care will gobble up an increasing share of Canada's wealth year after year, forcing unpalatable choices on the country.

Well, maybe an election isn't the time to talk about chronic health-care spending disease, as Mr. Dodge and his co-author, economist Richard Dion, describe the affliction. It doesn't seem to be, anyway, to judge by the deafening silence on health care, particularly from the Conservatives and Liberals.

The parties could be talking about how to promote innovation - but then they would have to mention the p-word (for private, stand-alone clinics, publicly paid for). They could be talking about efficiency and the use of electronic records, of home care, of reforms to primary care. Yes, health-care delivery is a provincial jurisdiction, but Ottawa pays a healthy portion of the tab, and its leadership is badly needed.

Even the most rosy prognosis is poor, say the authors in a report from the C.D. Howe Institute. Assume the new generation of senior citizens is healthier than the last one. Assume the economy grows at a healthy clip, and the public health system becomes more efficient. Even then, health care's share of gross domestic product, at 12 per cent in 2009 (or $4,900 per Canadian), would rise to 15.7 per cent by 2031.

And if everything doesn't go well, health care will eat up 19 per cent of GDP in 2031, or $10,700 for each person, after inflation. If that happens, 31 cents of every additional dollar produced by Canadians will go to health care (both public services and private ones). Either way, the provinces will be in big trouble, other services will be crowded out, taxes will rise or medicare's quality fall, or a two-tier system will take hold.

Chronic health-care spending disease afflicts the United States and Britain, too. It's driven by new technologies and an aging society. And a wealthier society wants, and is entitled, to spend some of its affluence taking care of itself. At just over 15 per cent (the optimistic case), health care as a proportion of GDP in 2031 would be roughly equivalent to that spent today by the United States.

Canada needs to do its best in so many ways even to have a merely poor prognosis for its health-care system. Talking about it would be a start.