Based on their projections of the rising costs of healthcare over the next two decades, the authors set out four difficult choices for Canadians in the face of this “spending disease.” THE STUDY IN BRIEF THE AUTHORS This Commentary examines from a macroeconomic perspective the trajectory of total – public T I and private – healthcare spending in Canada over the next two decades. [...] As a result, nominal GDP growth decelerates age/gender structure of the population; ii) changes much less than in the base case, from about in the relative price of healthcare to GDP; 5 percent over the 2012-2016 period to 4.5 percent iii) changes in the quality and scope of medical per year in the 2020s. [...] As a result, the contribution of changes in the age-gender structure of population to growth in the healthcare spending-to-GDP ratio is reduced in the optimistic case relative to the base case over 2016-2021 but remains unchanged from the base case over 2021-2031, as Table 3 shows. [...] It is worth noting that real spending is driven by the price of healthcare consumption relative to the price of total consumption, whereas the healthcare spending-to-GDP ratio is driven by the price of healthcare consumption relative to the price of GDP (Dodge and Dion 2011). [...] At the same time, its subsequent flat profile has no effect on the the annual increase in GDP per capita in our base ratio over the projection horizon.22 Changes in the case climbs from about $1,200 in the last decade relative price of healthcare consumption boost the to about $2,200 in the 2020s and in our optimistic ratio by 0.2 percent per year from 2017 onwards.