The court granted a year's reprieve Thursday on its decision striking down a ban on private insurance.
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."