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At first blush, the Supreme Court of Canada ruling striking down a Quebec ban on private health insurance appears radical.

Bold, yes, but radical, no. The court has once again picked its spot carefully, using up political capital it had been banking with a steady stream of judgments that showed elaborate deference to Parliament.

This week's ruling does not question the primacy of public health care or the ideals that underlie Canada's universal health-care system. Nor does it leave loopholes that will allow a wholesale onslaught to undermine political decisions on how to spend health dollars.

What it has done is give politicians a sharp kick in the shins, permitting private health-care options that have already popped up in many parts of the country and saying they should not be available only to the well-heeled.

The court majority roots its ruling in populist concerns for the middle class of Quebec, who do not share the option available to the wealthy simply to pay the full medical fee of a doctor who opts out of public health care.

The court says that any shortcomings in universal health care are the result of empty government promises to remedy waiting lists and end the horror of stretchers lined up in the hallways of hospital emergency departments.

Thanks to a deft manoeuvre by Madam Justice Marie Deschamps -- who makes it abundantly clear that private health insurance prohibitions violate the Canadian Charter of Rights and Freedoms, but did not explicitly rule that way -- other provinces can easily read the writing on the Supreme Court wall.

"The fate of legislation in six other provinces that discourage or prohibit private insurance will depend on evidence as to the state of their health-care delivery," notes constitutional lawyer Mahmud Jamal.

"If they deliver a reasonable standard of health care within a reasonable time, they have nothing to fear."

This ruling strongly resembles the 1988 Morgentaler decision, where the court used the Charter guarantee of life, liberty and security of the person, Section 7, to strike down therapeutic abortion procedures that forced women to endure potentially health-threatening delays.

Like the Morgentaler ruling, this one opens the door to claims for specific medical procedures under Section 7 -- but little more than a crack.

"Not every difficulty rises to the level of adverse impact on security of the person under Section 7," Chief Justice Beverley McLachlin and Mr. Justice Jack Major say guardedly. "The impact, whether psychological or physical, must be serious."

And then, in a general statement of great importance, they again leave no doubt that the floodgates will not open to any claim involving an unobtainable or restricted medical service.

"The Charter does not confer a freestanding constitutional right to health care," they say. "However, where the government puts in place a scheme to provide health care, that scheme must comply with the Charter."

Constitutional lawyer David Stratas says that the ruling "does not necessarily throw open the government coffers and require government to create a perfect health-care system, or even a system at all.

"The bold thing, perhaps, is that the majority delved deeply, without much deference, into an issue that many consider the third rail of Canadian politics -- touch it and you are dead," he said. "The problem here -- dying while on waiting lists or waiting while in searing pain -- is about as poignant a problem that can exist. If a right to security of the person means anything, surely it protects against that."

University of Ottawa law professor Errol Mendes said that an important element of the ruling runs counter to previous Section 7 decisions that limited the section's reach to the justice system, not social-policy issues.

"Now the majority [of the court]seems to say that it is not limited to where the justice system is engaged," he said. "This potentially greatly enlarges the scope of Section 7, especially in the area of social policies and economic rights."

This week's ruling belongs to a rare category where using the Charter actively pleases those who ordinarily bash "activist" judges. (Challenges to gun control legislation and third-party advertising are other examples.) For this reason, it is hard to predict what the recent addition of Madam Justice Rosalie Abella and Madam Justice Louise Charron to the court may make in future medical-service decisions.

"There is little doubt that Justice Deschamp would also find this legislation unconstitutional under the Canadian Charter," Mr. Jamal added. "But given the close split, the key question has to be how recent appointees Justice Abella and Justice Charron may tilt the balance."