It's Thursday evening, and the cancer radiation clinic at Toronto's Sunnybrook hospital is in high gear. The patients here are from tony Rosedale, struggling Parkdale, and every place in between. Some of them have got to know each other by now, and are chatting quietly. Cancer is a great leveler. And here on the front lines, you're reminded that health-care delivery is an intensely human affair.

Sunnybrook's evening clinic delivers everything we want from our system: first-class medicine, equal treatment for everyone, efficiency, accountability, quick access, and a big helping of compassion.

It is also a prime example of what Roy Romanow deplores most. This is a private, for-profit business. And in the eyes of many, Dr. Tom McGowan, the man who runs it, is Public Enemy No. 1.

That doesn't mean you have to write a cheque to get in here. You don't. The province pays the bills, and anyone can come. The only difference between this place and the publicly operated radiation clinic at any other hospital is that you can get in here right away.

Dr. Tom McGowan was allowed to start this business in early 2001 because cancer waiting lists had spun out of control. "This place used to be dark at night," he says, waving at the state-of-the-art radiation units. They are the same units the hospital uses during the day. "Now we see between 80 and 100 patients an evening."

Fiona St. Clair, a vibrant woman of 52, has just finished her course of radiation here. Her care, she says, was excellent. Like most Canadians, she has no fixed view on the public/private debate that has raged long and hard. "We tried to have a universal public system," she says. "But it doesn't work well any more. I don't have a problem saying we have to mix and match." As for Mr. Romanow's report, she says, "I'm disappointed. He can't afford to see these as black-and-white issues."

As Ontario's cancer waiting lists grew scandalously long in the late 1990s, the hospitals were urged to extend their hours of treatment. They tried various incentive plans but said they simply couldn't get the staff. All that equipment sat idle on evenings and weekends. Meantime, the province began shipping people off to Buffalo or Detroit, putting them up in hotel rooms for weeks at a time. It was expensive, and hard on patients and their families. A few women even opted for mastectomies instead.

Dr. McGowan had an intimate knowledge of the problem. He was the policy adviser to Cancer Care Ontario, the provincial body responsible for managing the waiting lists, and also had an MBA. A desperate province accepted his controversial proposal to set up a for-profit business during hours the hospital clinic would otherwise be closed. It is designed to serve the overflow of patients until new cancer centres are completed. His clinic receives the same per-patient fee as the public clinics, but he gets a bonus if he can deliver on his promise of efficiency.

Tom McGowan, a friendly guy of 42, is not the world's most popular man. He and his clinic are reviled by just about everyone but the patients. He has been depicted on the hospital's notice board as a devil with horns. Certain e-mails circulated among the cancer establishment have darkly hinted about quality problems. Many of the clinic's staff have been told by colleagues that they are betraying medicare by choosing to work there. "I've had the worst time," says Rashid Dar, a radiation oncologist who commutes from London one evening a week. "I've been called bad names. They feel this is a threat to them."

Fiona St. Clair had her surgery in July. When she tried to line up radiation treatment, she found that waiting lists are still long. Princess Margaret, Canada's biggest cancer hospital, wouldn't take her at all. She turned to the province's referral service, but the best it could do was get her in somewhere in late November.

Reluctantly, the referral service told her about Dr. McGowan's clinic at Sunnybrook and Women's College Health Sciences Centre. They warned her that it was private. "They didn't want to offer this," she surmises, "because they think it shows the system is a failure."

She started treatment a week later.

"I've sat here for 25 nights and talked with these women," she says passionately. "And some of them are not going to make it. And we said thank goodness this was here. And if someone makes a profit, then so be it."

But surely there's a catch? Critics say that because for-profit health care has to pay the shareholders, it's bound to cheat the patients. Cutting corners is inevitable. The staff will be lower-paid and worse-trained. There's no evidence that it works as well, and plenty that it kills people. As Mr. Romanow declares, medicare is "a moral enterprise, not a business venture."

But waiting lists kill people, too.

Dr. McGowan's clinic treats 1,000 patients a year with the same resources a public clinic uses to treat 600. How? Because he has redesigned the way the work is done. He is obsessive about making the work flow so that no one's time is wasted. This is exactly what high-achieving businesses do. But it's almost impossible to implement this approach in a public monopoly, because there is no incentive to be efficient.

"In the public sector, nobody is accountable for the waste," he says. "When you waste time, you're not treating people. That is the biggest threat to the system."

Every person I met in the unit, down to the male student nurse who works as the logistics manager, projects competence and pride in their work. They function as a close-knit team, and the usual medical hierarchy does not apply. A radiation therapist can interrupt a doctor whenever she needs him. The staff can work flexible, part-time hours, which are not offered by the hospitals, and they're paid an 80-per-cent premium. But it's pretty clear that they're here not for the money, but because this is the best place they've ever worked.

Roy Romanow thinks that Tom McGowan's clinic is immoral. It would be interesting to see him explain this to the fragile, anxious, frightened people who come here every Thursday night. They aren't thinking about principles or ideology. They're thinking about when they might be well again.