Reaction varied widely to the Supreme Court's ruling that it is unconstitutional for the state to disallow Canadians who are suffering - and at times even dying - while they wait for "non-urgent" health care to seek treatment outside of the medicare system. This is because the decision - which applies only to Quebec - will have a profound impact on Canadian health care. Over time the government monopoly will be truncated and accessibility to private care will grow.

But what are Canadians to make of the teetering reply in our nation's capital The government is asked what will be done to save medicare. This is the wrong question since it implies Ottawa's chief concern should be to retain the single-tier health system. Yet the court struck down the law forbidding Quebec residents from purchasing private medical services and private medical insurance. Medicare's monopoly status and state restrictions on constitutional freedoms is unacceptable. Elected officials instead should be questioned on how they will ensure individual rights are respected, not eroded by the state.

A point of comparison is when lower courts ruled in favour of gay marriage. The federal government did not appeal these rulings. Rather Ottawa vowed to entrench the right to same-sex marriage in legislation, even though the Supreme Court had never explicitly ruled that such a right existed. "Saving" traditional marriage took a backseat.

Ottawa should ensure the medicare ruling is respected and not blunt the decision. A bigger health care bureaucracy cannot shorten wait times. Respecting patients' rights means removing barriers to private health care erected by government.

Far from killing medicare this path will improve it. As the Supreme Court found, "many western democracies that do not impose a monopoly on the delivery of health care have successfully delivered to their citizens medical services that are superior to and more affordable than the services that are presently available in Canada. This demonstrates that a monopoly is not necessary or even related to the provision of quality public health care." Saving medicare means permitting private service. Ottawa should loosen its grip and allow provinces the flexibility to experiment with various reform measures.

The focal point will be how provincial legislatures answer the court's ruling. Provinces have the constitutional obligation to deliver health care. The Supreme Court has handed them the tools to sidestep those who want to keep the system closed to competition and simply pump more money into government-run health care.

What do taxpayers receive for the $90-billion their governments' budget annually for health care A system that is good, but not anywhere near "the best" as is claimed. The World Health Organization (WHO) recently ranked our system 30th out of 196 surveyed countries. With health care funding rising twice as fast as the growth rate of provincial revenues, governments need to develop solutions that save money and provide quality health care.

Rather than wait for patients to petition the courts for the same rights granted Quebec residents, it is hoped that provinces will now become laboratories of social policy experimentation, whereby different mixes of private and public health care are provided. Successful reforms tested in other jurisdiction should be copied.

With the exception of Cuba and North Korea, Canada stands alone in outlawing the freedom to spend one's after-tax income on one's own health. With 29 nations ranked ahead of Canada there is no shortage of jurisdictions to emulate. Allowing a parallel, private system to co-exist along side the public system is essential to improving Canada's medicare system. Hopefully, this decision will make genuine health care reform a reality.