Canada needs a frank conversation about how to finance medical care in an era of population aging—one that will require financially secure seniors to lean in.

As the share of seniors has doubled from about 10 to 20 per cent over the past half-century, the costs of aging have risen predictably and substantially, since Canadians over age 65 use roughly four times as much medical care as those under 50. This shift is now straining the universality of our health system, adding the equivalent of millions more patients to care queues—far beyond population growth alone.

This in turn adds tens of billions of dollars annually to provincial medical budgets, shifting many provinces from surplus into persistent deficit.

These pressures were foreseeable.

Yet, apart from the Canada Pension Plan—where premiums were increased by 68 per cent in the late 1990s so boomers would pre-fund more of their retirement benefits—Canada’s broader approach to taxation remained largely age-blind. Governments did not raise sufficient revenue in advance to cover the higher costs of care concentrated later in life.

The consequences are now unavoidable.

Governments are effectively protecting boomers’ wallets by underinvesting in their children and grandchildren, and by borrowing—comforting in the short term, but risky over time. Because these costs were not pre-funded, much of the growth in public spending is now absorbed by medical care for older populations, leaving fewer resources available for the foundations of a healthy society, including housing, child care, education and poverty reduction.

Younger Canadians face the flip side. They contribute more in income taxes toward older generations’ well-being than previous cohorts did at the same age, while also navigating higher costs of living and reduced public investment in their own life stages.

Addressing this imbalance will require asking financially secure boomers to contribute more in proportion to the costs of care their generation uses.

But this does not mean introducing user fees at the point of care. Universal access to medical services—for older and younger Canadians alike—must be protected and strengthened.

Decades of evidence show that public health systems function best when everyone enters through the same door, with those who have greater means contributing more through progressive taxation. Charging fees at the bedside would undermine this principle, pushing wealthier patients toward private alternatives and leaving the public system with more complex cases and fewer resources.

Protecting universal access will therefore require a renewed revenue conversation. Since younger generations already pay 20 to 40 per cent more in income taxes toward older people’s well-being than boomers did at the same age, financially secure retirees will need to make up for lost time through contributions collected through the tax system—much as Canadians were previously asked to accept substantial CPP premium increases in the late 1990s.

Some may try to deflect by focusing only on the ultra-wealthy. While they do control a frightening share of global resources, Canada’s fiscal math makes clear that a resilient revenue base cannot start and end with the top 1 per cent.

Consider the NDP’s proposed wealth tax in the 2025 election campaign, estimated to raise $23-billion a year from fortunes above $10-million. That sounds substantial – until you recall that Ottawa’s deficit now exceeds $70-billion and population aging adds $66-billion to provincial medical spending.

This makes the work ahead politically difficult, because it requires an honest conversation about taxes amongst many of us – not just the top 1 per cent.

But if we want medical care to remain universal at the point of entry, we must fund it through progressive taxation that reflects how costs fall across generations. That is how we protect healthy aging for older Canadians while keeping faith with those who follow.