Fixing Canada's health care system was one topic political parties avoided during the election campaign. Party leaders vowed to defend the medicare system, which Canadians say is their most cherished social program. Whereas specific details were given to voters on spending and taxation levels, daycare proposals, debt-to-GDP ratios and accountability reforms, it was not so with health care. The parties paid lip service to reality while defending the status quo.

A Patient Wait Time Guarantee is Conservative leader Stephen Harper's promise. Canadians will receive publicly insured health services within a medically acceptable maximum time. If care is not available at home, patients will instead be treated in another jurisdiction, including the United States, and even in a private facility, if necessary.

This is progressive policy for sure, but it fails to address the bigger reasons why Canada has unacceptably long wait lines. It also does not square with the often repeated Conservative talking point that their policy is "no private parallel health care system, and if private clinics can not operate within the single-payer public system, then they should be shut down."

The others party leaders are no less confused. Liberal leader Paul Martin unveiled a plan to tackle wait times with his Canada Health Care Guarantee. If timely medical service is not available a patient will receive treatment at another publicly funded Canadian facility. The private sector has no role to play.

Voters might wonder why any of this is necessary. In September, 2004, the prime minister signed a $41-billion health care accord with the provinces. The Martin government boasted it was a "fix for a generation." Throwing an endless stream of tax dollars at a badly flawed monopoly system has not fixed it. Of course, Mr. Martin will never be stuck on a waiting list. His personal physician heads a private health care clinic in Montreal.

Jack Layton, the New Democrat leader, was heavy on the medicare rhetoric. In Edmonton, he told the Alberta government, "Back off. You are not going to destroy public health care." For the NDP the best way to save medicare is by blocking private health - this, despite Mr. Layton himself having surgery at a Toronto private hospital in the 1990s. But this debate is about patients, not Mr. Layton's irritating double standards. A more courageous politician would have delivered his message in Quebec - it is Canada's pioneering province with more private clinics than any other.

In June, 2005, the Supreme Court of Canada struck down a Quebec law banning private medicine and health insurance. In doing so, the high court put individual rights ahead of collective rights. The court held that suffering - and dying - while waiting for government-managed medical care violates the right to "life, liberty and security of the person" as spelled out by the Quebec Charter of Human Rights and Freedoms. No federal leader will address this 800-pound gorilla sitting in the waiting room.

The high court's decision in the case of Chaoulli v. Quebec - which, for now, only applies to Quebec - sets in motion the transformation necessary to provide patients with better care. This is because reform will come from the 10 provinces, which will serve as laboratories to experiment with different solutions. Most will follow the mixed systems found in Europe, where nations deliver better health services than Canada and at a lower cost. Provincial governments that fail to reduce wait times by reforming medicare will probably be dragged into court by another sick patient.

Ottawa cannot stop private clinics from opening, but it can withhold medicare dollars that are paid out to the provinces. Yet no party leader is seriously suggesting that be done. So perhaps voters - and the patients stuck waiting for health services - should be content with federal lawmakers standing aside, and doing no more harm by restricting provincial reforms.