There is a time bomb ticking in Atlantic Canada that's been building for decades and it's about to explode, with possibly devastating consequences for the region.
That's the premise of a new book from public policy expert, Richard Saillant. A Tale of Two Countries focuses on the impact of our aging population and warns that without a big boost in funding, the region's health-care system could collapse under the strain within a decade.
It's a provocative position from a man who's used to taking on controversial topics. His previous book, about New Brunswick's financial crisis, was called Over the Cliff.
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Saillant is the director of the Donald J. Savoie Institute at the University of Moncton. His latest work tackles what he calls "the great demographic imbalance." In a nutshell, we're about to pay the price for all those boomer babies.
They helped grow the population, and the economy, but that post-war generation is now retiring, and about to start costing the health-care system serious money.
Ready or not?
Saillant says we're ill prepared to cope with that huge expense. but he draws a distinction between being an alarmist, and raising an alarming message.
"It's not about blaming baby boomers," he said. "Health care is there for everyone and it should be there for generations to come."
The book is heavy on demographic statistics because Saillant needs them to make his case. And there's a depressing inevitability about those numbers that is hard to challenge, even if his conclusions are open to debate.
So why does he fear a collapse of the health-care system in as little as a decade? Because in five years' time, the baby boomers will start turning 75 — and that's the age when people become the heaviest users of health care.
Atlantic Canada has the country's highest proportion of aging boomers, so we'll see a massive and growing drain on the health system and fewer young people to help pay for it all. That's the first part of Saillant's thesis.
The tale of two countries
The second is that while baby boomers are getting older everywhere in the country, it's far less of a problem in the west because they have more young people, and that divide may lead to the rich west wondering why it should pay the rising cost of Atlantic health care.
"Demographically we have two countries emerging and unless Ottawa steps in, we have the possibility of having two countries in terms of the social safety net — and that's a problem for our federation," said Saillant.
He believes before the Atlantic provinces can ask for more cash, they will have to show they are prepared to accept some pain.
"In order to have a meaningful conversation with Ottawa the first thing we have to do is make sure that we are fit for that conversation. Have we done everything we could to put our house in order before legitimately coming to Ottawa and saying, 'you know what, we're going to need more help?'"
'It's a sacred cow'
This is where Saillant's argument becomes controversial: with his contention that Ottawa may refuse to increase transfer payments without major changes. And what he suggests, looks politically unacceptable.
He makes the point that New Brunswick has approximately the same population as Quebec City — with four times as many hospitals, but that politicians don't want to talk about reforming health care.
"It's not popular to say you're going to change health care, because it's a sacred cow," he said.
Saillant says that hospitals were never supposed to be regional economic generators, but parts of an integrated health system — and that with today's modern roads, having major hospitals in rural areas may no longer be necessary or affordable.
The future not in our hands
Saillant says the main purpose behind his book is to start a regional and national conversation, before it's too late.
"It would be great if we could talk about these things," he said, adding a final warning that there isn't much time. "The longer we wait before beginning that dialogue, the worse it will be."
Because as he points out in his book's conclusion, the future of Atlantic Canada, representing just seven per cent of Canada's population, is not in its own hands.
"The richer provinces, where the great majority of people live, will decide whether or not Canada's welfare state will tell a tale of two countries."