If there is one useful thing to come out of the federal election, it is the emergence of the health-care issue.

Since the 2008 election, health care has been the proverbial elephant in the room among political issues. Publicly funded health care may be this country’s pride and joy. Politicians may constantly pay lip service to it. But no political party has wanted to talk about it, even though the federal/provincial health accord expires in 2014.

It’s easy to understand why any politician would be reluctant to talk about something that is eating up half the revenue of Ontario and Quebec and is likely to affect four more provinces in the same way by 2017.

Ontario will spend 70¢ of every revenue dollar on health care by 2022 if projections hold. British Columbia will spend 71¢ by 2017. Canada’s health-care system, as it stands now, is fiscally unsustainable — something no politician dares say.

Complicating things further is the fact that aging baby boomers are the cause of this imbalance, just as the postwar generation had forced society to spend more than two decades building schools and universities.

This is why the March 22 federal budget had said little about health care or how future generations will pay for it. The Conservatives have discussed health care on the campaign trail only after the Liberals decided to raise it by promising continued 5% increases in transfer payments.

Now, all political parties are vowing to preserve public health care — without saying how, of course.

There comes the point at which a serious issue can be ignored no longer. Canada’s chronic deficit (the first one) was ignored for two decades until Canadians woke up to a special surtax on income taxes and more than 20¢ of every tax dollar went to service debt.

Neither Canadians nor their elected representatives are ready to do the math on health care. But let’s look at some possible answers:

The 2004 health accord was supposed to be a two-part deal. The provinces could bud-get for a steady stream of increases in federal transfer payments for a decade while making their own systems more efficient. The provinces haven’t delivered.

Ottawa is going to have to risk the political fallout and remind the provinces with performance benchmarks. Health care is, after all, a provincial responsibility in the first place.

A key recommendation of the Kirby Commission was that health-care funding needs to be patient-focused. That is, funding would follow those receiving care and treatment — not the hospital. Block funding for hospitals doesn’t make sense anymore.

When public funding is attached to patients instead of institutions, people have choices and hospitals compete to attract patients. And voila, we have an incentive for institutions to reduce waiting times, improve quality and increase efficiency. Britain virtually eliminated waiting periods of more than 18 weeks this way.

Getting rid of block funding would also stimulate investment in new technologies such as electronic health records.

The politicians should stop regarding private-sector participation in the health-care system as something toxic. Thirty cents of every health-care dollar is currently coming from the private sector, regardless of what Canadian voters might think.

We should stop being phobic about asking the private sector to make a bigger contribution; it already is a key stakeholder in the health-care system. There are opportunities for strategic partnerships with the private sector. A case in point is the privately owned — but publicly funded — Shouldice Hernia Centre in Toronto.

Finally, let’s put more emphasis on prevention. Nothing promotes efficiency better than prevention of a problem in the first place. But this requires policy that encourages the private sector to assist in enhancing Canadians’ overall health. For every dollar invested in wellness by companies, there is a $3 return.

Health care is something Canadians will have to stop taking for granted and must start looking at some tough options and innovative solutions.

It’s also something that could wind up dominating the next election campaign, and possibly the one after that. IE