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Brian Day wants Canadians to follow him to the paradise of private medical insurance. In his Utopia, private insurance would kick in when the publicly funded medical system exceeded waiting-time guarantees. People who had the private insurance could then be treated in private clinics, says the new president of the Canadian Medical Association. "Yes to universal care, no to status quo," is how the CMA website sums up his inaugural speech this week in Vancouver. He doesn't wish to bury medicare; he wishes to praise it.

Or does he? Two years ago, in an interview with The Globe, he was more direct: "It is not constitutional to deny a Canadian who is suffering on a wait list the right to spend his own money on health care." This was his distorted interpretation of the Supreme Court of Canada's landmark ruling in June, 2005, on medicare in Quebec. (More on that in a moment.) In the same interview he predicted private health insurance would soon be as routine for Canadians as dental and drug insurance, and Toronto would within two years - today, roughly - be dotted with a network of private clinics.

For the record, Toronto is not so dotted, and private insurance for major health services is nowhere near routine. The Supreme Court had heard from a Quebec man, George Zeliotis, who had been obliged to endure a year's painful wait for hip surgery. The court ruled that waits in Quebec's public system were so long that the province had to lift its prohibition on private medical insurance. It did not say Canadians could therefore spend their own money on health care. That would have been the end of one-tier medicare. Quebec did pass legislation allowing private insurance for cataract surgery and knee and hip replacements, but not much has changed as a result.

It's not hard to see why. How many people paying through the nose in taxes for health care will want to pay extra to insure against its failure? (Quebec's system allows private insurance to be used only after the public system fails to meet guarantees.) And how can an insurance system that does not have a broad base of customers keep premiums manageable by spreading the risk around? Who would invest in building the private clinics that would be needed to serve the dreamed-of market for the privately insured? "Frankly, it baffles me how it would work," says health-policy analyst Steven Lewis of Saskatoon.

It baffles us, too. Medicare has far more room for publicly funded private clinics than timid political leaders generally admit, and Quebec has set up a commission to look at how private care might reduce waiting times. Let's hope that commission offers something more practical than a pie-in-the-sky insurance plan.