TORONTO (AP) – George Zeliotis wanted to pay for hip replacement surgery in 1997 rather than wait nearly a year for treatment at a public hospital. But that wasn’t allowed in Canada, where the state has a monopoly on health care.

The elderly Montreal man turned to the courts seeking to shake up Canada’s Medicare system, which provides care for everyone in the country. Zeliotis argued his rights were violated when he couldn’t pay for faster service at a private clinic and had to suffer months of pain while waiting for his surgery.

He won vindication Thursday, when the Supreme Court dealt a powerful blow to the health system by striking down Quebec’s ban on private health insurance for services provided under Medicare.

Although the unanimous ruling applies only to Quebec, it is sure to bring similar cases in other Canadian provinces and give impetus to a growing movement pushing for public and private care.

In recent years, 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 and possibly hurting care for the poor. 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, including the more than 200,000 immigrants arriving each year.

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 some 45 million Americans lack health insurance.

Although unanimous in voiding Quebec’s law, the court split 4-4, with one abstention, on whether the ban on private insurance was unconstitutional or violated the federal Charter of Rights and Freedom that guarantee “life, liberty and security of the person.”

Still, the ruling is expected to have a trickle-down effect on the other Canadian provinces that forbid private health insurance.

“This is the end of Medicare as we know it,” said John Williamson of the Canadian Taxpayers Federation. “It’s going to open up litigation across the country in the other nine provinces as taxpayers there press for the same right, which is the right to seek and buy insurance to cover private health care.”

“It is indeed a historical ruling that could substantially change the very foundations of Medicare as we know it,” Dr. Albert J. Schumacher, president of the Canadian Medical Association, told reporters outside the Supreme Court in the federal capital, Ottawa.

Zeliotis’ doctor, Jacques Chaoulli, argued his patient’s rights were violated because Quebec couldn’t provide the care he needed, but didn’t offer him the option of getting it privately. Chaoulli also argued doctors should be allowed to open private hospitals if patients are willing to pay.

“There will be no question of governments coming through the back door to again restrict or limit access to the health care system,” Chaoulli said at a news conference after the ruling.

Prime Minister Paul Martin insisted private health care is not the solution to Medicare’s problems.

“We are not going to have a two-tiered health care system in this country. Nobody wants that,” he said. “What we want to do is to strengthen the public health care system. We want to make sure that it is universal and to make sure that we have timely access.”

Canada’s health minister, Ujjal Dosanjh, noted the government pledged last fall to spend about $32 billion ($41 billion Canadian) over the next decade to improve the system.

“Canadians long ago entered into a social contract to make sure that we have universal, timely access to health care across the country without any regards to status and wealth,” Dosanjh said. “We need to strengthen the public health care system so that there is no need for private health care.”

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.

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