An Ounce of Prevention, A Pound of Cure: How Rising Medical Spending Crowds Out the Building Blocks of a Healthy Society

Quebec’s 2026 budget reveals a growing structural challenge that governments have avoided for decades: failing to prepare revenue systems for the predictable medical costs of population aging is crowding out investments in the building blocks of a healthy society — especially for younger generations.

The arithmetic is now impossible to ignore.

In 1976, when baby boomers were young, only 8 per cent of Quebecers were over age 65. Today, that figure has nearly tripled to 22 per cent. At the same time, the number of working-age Quebecers supporting each senior has collapsed from over 8 to under 3. Of the provinces with large populations, no other jurisdiction has aged as much as Quebec.

This demographic transformation matters because medical costs rise sharply with age. Data from the Canadian Institute for Health Information show that Canadians under age 50 typically use about $3,000 annually in publicly funded medical care, while costs exceed $10,000 by the early 70s and rise dramatically thereafter.  On average, Canadians over age 65 use roughly four times as much medical care as those under 50. As the population ages, costs rise accordingly — and predictably.

To capture the fiscal footprint of population aging, a recent study, “Medical Budgets in an Aging Canada,” introduced an “Equivalent-to-Under-Age-50” (E<50) framework, which distinguishes between added medical demand from simple population growth and the additional pressures created by population aging. By this measure, Quebec’s population growth since 1976 added roughly 2.7 million more residents. But population aging on top of that growth has added the equivalent medical demand of 5.5 million more patients under age 50 lining up for care in Quebec’s health system.

The fiscal implications are enormous.

If Quebec still had the same age structure it did in 1976, the province would spend roughly one-third less on medical care today — somewhere in the range of $18 billion to $23 billion annually — without changing a single spending or revenue policy. Instead of running a projected $8.6 billion deficit in 2026, Quebec would post a surplus exceeding $10 billion.

Seniors are not to blame for growing older or needing more care. Longer lives are something to celebrate.

The problem is that provincial governments had decades to prepare revenue systems for these predictable demographic pressures — and largely failed to do so.

Ottawa acted when it came to the Canada Pension Plan. In the 1990s, the federal government increased CPP by over 60 per cent so boomers would prepay more for their own retirement benefits. 

But provinces never modernized medical care financing in the same way.

The results are visible in Quebec’s 2026 budget in two ways.

First, the budget strays from the wisdom that an ounce of prevention is worth a pound of cure. Health science has long examined the relationship between government spending patterns and population wellbeing. A consistent finding in the literature is that societies improve life expectancy and reduce avoidable illness, injury and premature death when governments grow investments in social and educational supports more urgently than spending on medical care services.

The logic is straightforward. Clinics and hospitals should be understood as the last stop in a healthy society, not the first. The first stops for good health are found in neighbourhoods, schools, child cares, decent jobs and safe homes. Waiting to invest until people are already sick is like arriving with hoses once the fire is already raging; social and educational investments help prevent the sparks from spreading in the first place.

This insight is often captured through the “social-to-medical spending ratio,” which compares government investment in the building blocks of health — such as child care, education, housing, and income supports — relative to spending on clinics and hospitals. The ratio functions as a north star to guide governments to invest in “Health in All Policies,” because when governments spend more on the social foundations of health than on medical treatment alone, populations tend to fare better.

Quebec once budgeted in line with this health science. Around 1980, the province spent roughly 53 per cent more on social and educational programs than on medical care. By 2019 — before the pandemic — that relationship had reversed, with Quebec spending approximately 22 per cent less on social and educational investments than on medicine.

The 2026 budget continues this trend. Medical care spending will rise by $2.7 billion this upcoming year, from $66.0 billion in 2025 to $68.7 billion in 2026.  By contrast, combined increases for child care, grade school education, postsecondary and housing total less than $1 billion. As aging-related medical costs consume a growing share of provincial resources, Quebec risks drifting further away from the spending balance that health science associates with healthier populations and lower downstream medical pressures.

This first problem then invites a second: a budget trajectory that risks becoming anti-child, anti-parent, and anti-young worker because it grows investment far more urgently for medical care in older age than for the social and economic conditions that support younger generations earlier in life.

Of the $2.7 billion increase in medical care, approximately $1.53 billion — 56% — is tied to care for the 22 per cent of residents age 65 and older.

By contrast, spending for:

• Elementary and secondary school education rises by $559 million
• Child care rises by $170 million
• Postsecondary education rises by $414 million
• Housing falls by nearly $160 million

The pattern is unmistakable. As aging-driven medical expenditures absorb a growing share of revenue from economic growth, investments that shape health earlier in life struggle to keep pace.

The consequences are severe for younger generations. Millennials and Gen Z already face weaker earnings growth, higher housing costs, delayed family formation, and deteriorating life satisfaction compared to previous generations. Yet they are also being asked to shoulder larger tax burdens to finance aging-related expenditures that governments failed to prepare for decades ago.

None of this means governments should abandon universal access to medical care, or expand two-tier medicine.

Instead, it points to a hard question — one Quebec, like other provinces, has avoided for too long: how do we pay for the medical care we always knew boomers would need, while ensuring the costs are shared fairly across generations and aligned more closely with use of the system?

Answering this question is essential both to sustain high-quality medical care for older

Quebeckers and to preserve adequate investment in the building blocks of a healthy society for younger generations: affordable child care, quality education, safe homes, adequate incomes, and a healthy environment.

A reasonable next step is both modest and overdue — especially in Quebec, where population aging has been more dramatic than in almost every other province.

Quebec should launch a Better Late Than Never Task Force to examine how to modernize provincial revenue systems in light of population aging — bringing together fiscal experts, health leaders, and the public to answer a question deferred for decades: how do we pay, better late than never, for the additional medical care we always knew was coming as a result of population aging?

Because when governments continue to blame deficits primarily on short-term economic turbulence triggered by US tariffs and international conflicts, they miss the deeper, longer-term structural challenge we face: the predictable medical costs associated with population aging. And when we misdiagnose the problem, we delay the solutions needed to preserve universal access to care, finance that care fairly across generations, and protect investments in the policies and programs that build health and wellbeing long before people arrive at a hospital or clinic.