The rest of the world might be looking ahead to 2012 with varying degrees of apocalypse-oriented anxiety, but in Canada that day of reckoning is far more likely to arrive in 2013. This has nothing to do with Mayan prophecies, mind you, and we can only hope that John Cusack isn’t involved in it in any way, shape or form. Instead, 2013 will mark the end of a 10-year federal funding deal that saw an additional $41.3 billion poured into the bottomless pit of health care spending, which rose over that period at an average rate of 6 per cent a year.

With a conservative government likely to still be at the helm, and a world in thrall to austerity budgets and deficit cutting, a repeat of such a generous funding agreement on the part of the federal government is about as likely a proposition as the silly end-of-days prophesies associated with 2012 actually coming true. That’s going to force us to make some very difficult choices, given that the aging of the bloated Baby Boomer generation will make holding the line on increases to health care funding somewhere near the rate of inflation a mathematical impossibility. The addition of nearly ten million new senior citizens over the next decade and the commensurate increase in demands for additional health care funding, be it for reduced prescription drug costs or increased access to hip replacements, will amount to a death sentence for the health care system as we’ve come to know it.

Thus far, efforts to address this aging elephant in the room have been limited to searching for operational efficiencies. But while outsourcing various administrative and operational tasks or will save money, it won’t save anywhere near enough to make a difference. It’s like the crew of the Titanic dumping the deck furniture into the ocean in an effort to keep the ship afloat, an exercise in self-defeating futility. Instead, we need to find a way to steer the ship around the iceberg in the first place.

The CBC’s Don Newman, for example, argues that the solution lies in the private delivery of publicly administered services. “Let the bulk of the public money going into health care go toward insuring hospital care and procedures and doctors services,” he writes. “Let the massively expensive infrastructure costs of health care — the physical hospital plant, the MRIs, CAT scans and the like — be provided by non-government sources: non-profit organizations, religious groups and, yes, for-profit hospitals.”

The problem with such a solution is that it does little to address the fundamental problem, the ever-expanding demand for health care services. Instead, it focuses on re-arranging the dynamics of the supply side of the equation. Newman gets a little closer to what might be considered a solution in suggesting that premiums on drug costs and other areas of heavy demand could be reintroduced. There, at least, he’s tying the solution to the problem, which isn’t how services are delivered but the rate at which they’re consumed.

The real solution, it seems to me, lies in taking this idea and applying it throughout the health care system. At present, we see very little relationship between the money we spend on health care and the services we receive. Yes, we know that our taxes go into a giant pool of money, and that some of that money is then re-allocated to fund health care services and programs, but the linkage is a weak one. You might call it the tragedy of the health care commons; we have access to a shared resource, but aren’t encouraged to preserve or protect it in any way. We aren’t punished for wasting health care resources, and we aren’t rewarded for saving them. If we want to avoid living in a society where 50, 60, or even 70 per cent of the annual government budget goes towards funding health care rather than, say, education, or childcare, or any other number of programs, we need to restore the link between users and the system.

My idea – and it’s just that, an idea, one without any supporting documentation or research – is a system in which every Canadian citizen is given an annual health care stipend. Each year, the stipend would be deposited into a health care account, and these stipends could be carried forward indefinitely and transferred between family members. But whenever a person accesses the health care system, be it to see a doctor or get a hip replaced, they’d have to pay for it with those stipends. If the cost of the procedure exceeded the balance of their account, they’d have to pay for it out of pocket.

For governments, this would create instant cost predictability. They could immediately cap health care spending at a certain level, and seek to reduce in future years as it saw necessary. Health care providers, meanwhile, would be governed by the same principles that define the system today. The cost of a given service could be set by a board of independent experts, a combination of health care professionals and elected officials, who would be best able to balance the demands of providers against the interests of taxpayers.

For individuals, it would forever put an end to the idea that health care was an indefinite and inalienable right. Instead, it would be viewed as a public good, something to be accessed with care and consideration and not frittered away out of indifference. It would likely act as an incentive to healthier forms of living, from staying in shape and eating well to taking a more critical view of potentially unnecessary prescriptions and procedures.

It could also be used to expand the range of health care services to which people have access. That’d be a welcome change, given the fact that the fight to keep health care public and universally accessible has often meant a reduction in the kinds of services that fall under that definition. Orthodontics, optometry, dentistry, and a variety of services that have been pushed out of the public health care tent could once again become an option for people.

The single biggest objection to this idea would be, I suspect, that it doesn’t just introduce private delivery into the public system but also the very spirit of private enterprise, a kind of Trojan horse that would inevitably lead to the conflation of patients and profits. I’d suggest, though, that what it really introduces is a sense of responsibility and thrift, values that are conspicuously absent in any debate about health care in 2010. We all want more and better, but more and better costs money, and that something that governments don’t exactly have a lot of these days. Unless Canadian explorers discover an eleventh province made entirely out of barrels of crude oil, we’re going to need to learn how to live with less for a long time to come. That effort has to be reflected in our approach to funding health care.