Private health care in Canada is a reality. For-profit health care in Canada is a reality. Two-tier health care in Canada is a reality.

Until a few years ago, most Canadians would have met such statements with angry denials. Public health care has, since the days of Tommy Douglas, become ingrained in the national psyche and emerged as one of the few sacred cows of the Canadian identity. But as we held to the ideal of a comprehensive, accessible and affordable health care system – contained within the public sphere – the realities on the ground were beginning to tell us something quite different.

Today, a critical mass of personal experiences, court cases and media attention has graduated the health care debate to a new level of interest and, more importantly, awareness. We are no longer able to ignore the long waiting times for surgery. We are beginning to understand what the rising costs of drugs and the availability of new medical technology will mean. We see the pressure that an aging population will soon place on the health care system.

Together, through committees and commissions, in hospitals and in legislatures, we have begun to demonstrate the leadership necessary to meet these challenges. At the same time, we are coming to accept that the private sector has for years played an important role.

There are many examples. Canadians have long been able to buy private health insurance for things not covered by medicare, such as drug prescriptions, physiotherapy or private hospital rooms. We can visit doctors who have exercised their right to opt out of the public plan. If we are in need of a particular medical test, it is becoming more and more possible to bypass the public sector and its waiting lists and pay to have the test done by a private clinic. We have increasing access to private family doctors through a form of clinic membership. In order to address backlogs, some of our public hospitals are now contracting out publically funded surgeries to private clinics.

The way we think about health care, and its future, is also undergoing an important shift. In short, we are moving beyond ideological debates that pit left-leaning Canadians against right-leaning Canadians. Health care is a universal issue not because of ideological conviction but rather because we all want to be in good health, and we all want the same for our children, our parents and our neighbours. We want to be well, to feel well, to live as fully as possible. Health care might just be the most practical of human pursuits.

As such, we as Canadians will always seek ways of improving our health. Efforts to gain access to a life-saving drug or new treatment, or travel to another province or country to have surgery today rather than in several months are the everyday stories of Canadians who want nothing more than a better life. We may prefer to seek this better life in the public system, but we know that the choice between risking our health, or the health of a loved one, on a waiting list or taking control of our health and pursuing a different solution is often really no choice at all.

In the 2005 decision Chaoulli v. Quebec, a majority of the Supreme Court of Canada ruled that, as a matter of human rights, Quebeckers may not be prohibited from taking out their own insurance to obtain in the private sector services that are in law – but not in practice – available under Quebec’s public health care plan. Lawyers for the federal government had argued that the court should not interfere with the health-care system, considered “one of Canada's finest achievements and a powerful symbol of the national identity”. The judges preferred to focus on the right to life and to personal inviolability. They acknowledged that alongside the very public debate around health care lies a very personal one, and that the necessity for action trumps any desire to preserve symbols or ideals of national identity.

The myth of a wholly public Canadian health care system has been exposed. Our ‘public’ sacred cow is not so public and may become less so in the coming years. We should neither rejoice nor shed tears. Our only obligation is to move forward in the best interests of the health of Canadians and continue to ensure that good health care for all remains a priority.