Canadians are aging, and their health-care system – how it runs and how it is financed – is not prepared.
Last year, the first of the baby boomers turned 65. For at least the next two decades, their departure from the work force and their greater health-care needs will strain the system as nothing has before.
Today, 14 per cent of the population is over 65 years of age. That 14 per cent consumes about 44 per cent of all health-care spending. In a decade, seniors will amount to 20 per cent of the population, and they will cost the health-care system more.
People under 55 on average consume about $3,000 of health care from the public purse each year. For those 65 to 69 years of age, the sum jumps to $6,223, according to a recent report from the Canadian Institute for Health Information. For those 70 to 74, spending rises to an average of $8,721; for those 75 to 79, spending averages $12,050; and for those over 80, the average is $20,113.
True, some seniors will be fitter than previous generations of seniors. But fit or otherwise, the largest sums for health care come in the last six months of life, and we all die sometime.
Aging, per se, is a manageable cost – somewhat more than 1 per cent per year. That's why some "experts" dismiss it as a serious problem. Stale analysis. Old stuff, they sniff.
And they're right, if only the costs of aging are calculated. But what's neglected is the flip side of an aging population – a smaller share of people working to earn money that governments will tax to get the revenue for the higher costs. This is what is called by economists the "implicit liability" of future costs.
Herb Emery, a health-care economist at the University of Calgary (and two colleagues, David Still and Tom Cottrell) has crunched numbers around the costs of health care for a population with sharply higher numbers of seniors and fewer people working to support them. They call what's coming a "Ponzi scheme," because of the sizable intergenerational inequities.
Since its inception, public health care has been funded on a pay-as-you-go model. Governments have raised taxes and/or borrowed money to buy a certain amount of health care. It worked, in a creaky sort of way, while the age profile of the population had more people working for a smaller number of retirees than now. The pay-as-you-go model begins to fall apart once the population profile ages.
The bottom line is that when people leave the work force, they will have paid the bulk of their lifetime's taxes, which governments will have already spent. When they start getting older, they will earn less, but cost governments more. Since governments have already spent their tax money, they will have to find new money from those who have not yet retired.
How much more money do they need to find? Prof. Emery and colleagues think the "implicit liability" to be somewhere near $469-billion, or roughly the amount of total indebtedness of provinces and territories in 2012.
If we were to pay off this "implicit liability," with a tax set at your birth year, someone 30 years old today with 35 years left in the work force would have to pay $390 a year; for someone who is 54, retiring his or her liability would cost more than $6,600 a year for a decade. Or, if we just set a common annual tax payment for all working Canadians, we would need to collect $1,900 per year for the next 20 years over and above what we collect for services that we need today.
His conclusion: "If access to health care is to remain universal and levels of quality are to be maintained … then taxes will have to be raised dramatically to support the aging population. … Who pays for it? If things remain as they are, such obligations will be inordinately borne by future generations."
Canadians have thought about medicare as a program based on equity and fairness within a generation. The aging of the population will force us to think about the burden we are leaving to the next generation, an approach Canadians have never felt comfortable with, in health care or anything else. Better to spend today than to think about who pays tomorrow.