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It’s true that fiscal policy in many of the provinces has been irresponsible, gusting to reckless. It is unforgivable that, 10 years into a recovery, six of the 10 should still be running deficits, even modest ones — as if the business cycle, and the likelihood of a recession that would plunge them all back heavily into the red, had been abolished.

Likewise, that nearly half of the average province’s tax revenues now go to fund one department, health care, is not something that simply “can’t be helped.” It reflects the failure of most of them to think seriously about health care reform, still less to implement it.

Still, even the most efficient provincial health care system would be under severe pressure in the decades to come, thanks to population aging. We have, to be blunt, never seen a society like the one we are about to become. By 2035, more than 25 per cent of the population will be over the age of 65 (in the early 1970s, it was seven per cent), with historically high numbers of them over the age of 70, 80, 90, and 100. Where not so long ago there were five people of working age for every retiree, that ratio will soon fall to just over 2 to 1.

It is unforgivable that, 10 years into a recovery, six of the 10 provinces should still be running deficits

That’s nationally: the picture in some provinces, notably in Atlantic Canada, is gloomier still, the pace of aging accelerated by the flight of young people. Escalating spending — health costs rise from $2,000 per capita at age 50 to $20,000 at age 90 — and declining numbers of workers to pay for it is a recipe for fiscal disaster. The PBO estimates that Manitoba, for example, would require some combination of permanent spending cuts and/or tax increases equal to 4.5 per cent of GDP to stabilize its debt position. That’s about half as much as the province currently spends on health care.