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If you want to know what our health-care system could be like, fall on your face.

My wife did recently, and had to see a plastic surgeon. She could do so under medicare, because this was an accident. But with so much other work, the physicians in this field can practise privately, and many do. My wife's choice was either to wait a long time or pay what seemed like an excessive fee to see a private physician immediately. So right here in Canada, we have a little example of the kind of privilege that pervades and corrupts the public health-care systems of other countries, notably England. Is this what we want in Canada?

Medicare has been discussed at great length in this country. But one factor has not received sufficient attention, yet may be most important for Canadians: the sense of fairness in our health-care system. Medicare is not only about the quality of our service; it is also about the nature of our democracy. That, above all, is why the system is so sacred to so many Canadians.

The English system, and the American even more, are ones of privilege. The treatment you receive depends on the money you pay. Canadians are certainly prepared to accept this for consumer goods, but not for basic human needs such as health care.

Of course, privilege is on the rise all across society. We live in a time of shareholder "value," with money deeply influencing politics and disparities consequently growing between the rich and the poor, all justified in the name of democracy. But a society of privilege is not a society of democracy.

Imagine if the governments of Saskatchewan and Canada never introduced medicare. Imagine, instead, if they tried to bring it in today. A government controlling a health system? In today's climate, it would be dismissed as laughable. Yet we have it and it is sacred. Think about that.

Medicare is simply not in phase with the times, and that is a main reason why the system takes so much heat, at least from certain quarters. It is vital to realize, however, that the fault lies not in medicare, but with the times, which are out of phase with human values. These are times of inordinate greed, of imbalance in favour of all things economic and against all things social. These are not times that respect democracy.

Medicare is a fundamental component of Canadian democracy. The system not only treats us as individuals, it defines us as a people. And it defines us well, since we may have the most equitable health-care system anywhere.

Does that make it ineffective? Not at all. Every health-care system today, public or private, is under enormous pressure, not least because of the success of medicine in developing so many expensive new procedures. That has nothing to do with who runs the system.

I have lived in the United States, England and France. And I have come to think of medicare the way Winston Churchill once described democracy: as the worst system in the world except for all the others. There's no doubt the system needs improving; it does not need emasculating. It is time to stand up for democracy alongside health care. Henry Mintzberg is Cleghorn Professor of Management Studies at McGill University and co-author of Beyond Selfishness in the Sloan Management Review (Fall, 2002).

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