Canadians have long prized their public healthcare system as a reflection of national values, and have looked askance at the inequities of private medical care in the United States.
But now that the Canadian Supreme Court has ruled private health insurers should be allowed to compete with the public system, the future of Canadian healthcare is a question mark.
In the short term, the decision may light a fire under provincial governments to improve chronic problems, especially long wait times for surgeries, tests, and treatments. Some experts believe the ruling could eventually spawn a parallel, private healthcare system here.
"For our government, it's a very strong indictment of the way they've handled the system," says Dr. Albert Schumacher, president of the Canadian Medical Association. "I hope it will move us forward in the debate. 'Private' has always been used by politicians as a very evil word, associated with America and for-profit. But it's not necessarily so."
It all started with a disgruntled doctor, Dr. Jacques Chaoulli, and his patient, George Zeliotis, a retired salesman from Quebec who waited nearly a year for a hip replacement.
In a split decision, the Supreme Court in June found that waiting lists for medical treatments were unacceptably long, causing some patients to suffer or die. The judges struck down a Quebec law banning private health insurance for procedures covered by Medicare. Patients like Mr. Zeliotis should be allowed to go outside the public system and pay for timely medical treatments through private insurance, the court said.
"There are tens of thousands of Mr. Zeliotis out there languishing on waiting lists," Dr. Schumacher says. His patients, for example, go to nearby Detroit and pay out-of-pocket to get CAT scans in six days instead of waiting six months in Canada.
By the end of this year, the federal government has promised to establish benchmarks for "medically acceptable wait times" for treatment of cancer, heart disease, and other ailments. The government is already spending billions to try to reduce waiting lists.
Technically, the court ruling applies only to Quebec, and the court on Thursday granted the government's request to delay its decision for a year. But Chaoulli v. Quebec will eventually ripple through the entire country.
"No minister of health can say, 'We're going to deny you a right that exists in the province of Quebec,' " Monahan says. "As a matter of political reality, it's applicable in all provinces."
The man who sparked this revolution was often dismissed as a gadfly during the years he spent fighting the system. Dr.
Chaoulli once went on a hunger strike to protest fines levied on him for charging fees. Chaoulli represented himself in court, and his rough yet impassioned arguments struck home with the court.
"I am so happy," Chaoulli says. "Sooner or later, the medical monopoly will be stopped."
He predicts the emergence of a private healthcare system existing alongside the public one, as in Australia or New Zealand. Meanwhile, he is busy lecturing conservative US groups about the dangers of socialized medicine.
"Libertarians and conservatives do regard him as a hero," says Michael Cannon, director of health policy studies at the Cato Institute in Washington, a libertarian think tank. "He's going to be a very influential figure moving forward in Canada, in the US, and abroad."
Cannon hopes Chaoulli's victory dampens the ardor for Canadian-style healthcare in the US.
For many Canadians, private healthcare wears the scarlet A - for America.
"There is no political support for American-style healthcare," says Michael McBane, coordinator of the Canadian Health Coalition, a healthcare advocacy group. He says he hopes provinces will toughen laws to prevent private insurers from entering the market.
Allowing people to buy private health insurance violates fundamental rights, McBane says, because not everyone will be able to afford it.
"You can't discriminate based on the size of your wallet on something as important as healthcare," McBane says. "I would say this is an aberration and the democratic process will correct it."
The public appears ambivalent about the ruling. A new poll conducted for the Canadian Medical Association finds that 52 percent of Canadians view the decision "favorably," and even more said it will reduce wait times. But when asked if the ruling would weaken the public system, 54 percent agreed, saying it was "a bad thing."
Allyson Lange, a federal government employee, says she would support a parallel, private health system but doesn't expect dramatic changes.
"There would be too much opposition," Ms. Lange says. "We see a lot of what goes on in the US - people go broke because they have a health issue."