TORONTO -- Canada's Supreme Court dealt a powerful blow to the state monopoly on health care yesterday, striking down a Quebec ban on private health insurance for services provided under the country's system of universal coverage.
Although the unanimous ruling applies only to Quebec, it is expected to spur similar cases in other Canadian provinces and accelerate a growing movement pushing for more private care.
In recent years, Canada's Medicare was plagued by long waiting lists and a lack of doctors, nurses, and state-of-the-art equipment. Some patients wait months for surgery, MRI machines are scarce, and many Canadians travel to the United States for treatment.
But government leaders defend the current system, and Medicare supporters voiced fears the ruling will bring a two-tiered system favoring those with money. Proponents of change say it will improve care by offering more choices and cut waiting times for treatment.
The Supreme Court said Quebec's prohibition violated the province's charter of rights by threatening the lives of patients, and the justices noted other countries have successfully combined private and public care.
''The evidence in this case shows that delays in the public health-care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care," Chief Justice Beverley McLachlin wrote. ''The evidence also demonstrates that the prohibition against private health insurance and its consequence of denying people vital health care result in physical and psychological suffering."
Medicare arose from a 1984 law that affirmed the federal government's commitment to provide mostly free health care for all.
Most Canadians support the system despite the high taxes needed to finance health care, seeing it as a marker of egalitarianism and independent identity that sets their country apart from the United States, where about 45 million Americans lack health insurance.
The World Health Organization ranks Canada's health system 30th in the world and the United States 37th. France, which allows private services to complement its universal system, is ranked first.