A Quebec law that banned some private health insurance, has been overruled by the Supreme Court of Canada and is a decision which is likely to pave the way to a greater use of private health care to supplement a crumbling public system.
Free health care is one of the most frequently mentioned characteristics distinguishing Canada from the United States.
This means that residents of the province of Quebec will now be able to take out insurance to pay for medical services provided by private clinics, even if these services are also available from the state-funded health care system.
Although the state-funded Medicare system gives Canadians the right to free medical treatment, all too often there are long waiting lists for heart surgery, hip replacements, cancer scans and other procedures.
Chief Justice Beverley McLachlin and Justice John Major reported that access to a waiting list is not access to health care, and that there is unchallenged evidence that in some serious cases, patients can die as a result of waiting lists for public health care.
The ruling is expected to spawn challenges of restrictions on private care across Canada.
Jacques Chaoulli, the Quebec doctor who launched the court challenge along with a man who had waited for a hip replacement, said it was unacceptable that Quebecers may live and English Canadians have to die.
Proponents point to tens of millions of uninsured Americans, while detractors point to waiting lists of as long as two years for some procedures in Canada and note that many Canadians end up going to the United States for treatment.
Private medical facilities have already sprung up in various parts of Canada, but they are controversial, and the Liberal federal government has at times threatened to cut off funds to the provinces if they were allowed to continue.
Health care is administered by Canada's provincial governments with the help of federal funding, and the issue of private care is such a hot potato that no major party has dared to publicly call for a two-tiered health system of private and public health care.
Dr. Albert Schumacher, president of the Canadian Medical Association (CMA) , says the ruling endorses the individual patient's right to access comprehensive health services when the government can not provide them.
The CMA said the court's decision amounted to a "stinging indictment" of the failure of governments to provide timely health care to all Canadians.
Prime Minister Paul Martin said the government was already pumping extra money into health care, it has promised an additional C$41 billion over 10 years.
He does not want to have a two-tier health care system but wants instead to strengthen the public health care system.
The court decision was by a vote of 4-3.
The majority said the ban on private health insurance violated the Quebec Charter of Human Rights and Freedoms, while the minority said waiting times actually helped to ration scarce resources, given that funds were limited and demand for health care was not.
But the judges split 3-3 on the question of whether the law also violated the Canadian constitution's guarantees of life and the "security of the person".