If we want an honest, open debate about our health care system, ideas about what is and isn't "Canadian" should be left at the door.

Public finance of health care is considered emblematic of Canadian values. Our public health system is what makes us Canadian. Any attempt to increase the private sector's role in delivering health care is un-Canadian.

This is the argument advanced by many public health care advocates. The trouble with this brand of health care nationalism is not only that it misrepresents how Canada's system works. It also prevents Canadians from having an honest, open debate over what kind of health care system we want at a time when the need for such a debate has never been more urgent.

Health insurance and health care delivery in Canada have only rarely relied entirely on public provision, and the line between public and private systems has rarely been a clear one.

Historically, public insurance for health care was intended to provide coverage for citizens below an income ceiling. Those who could afford private coverage were left to what the market would bear. The public health and hospital insurance system Canada adopted in the 1960s was meant only to cover “medically necessary services” defined as those services provided in hospitals or by physicians.

Prior to 1984, “extra-billing” by physicians meant that there was effectively a role for private sources of payment for publicly provided services. However, since the federal government matched provincial expenditures on hospitals, but not expenditures financed by payments from patients, most provinces had moved away from health insurance premiums by the 1980s.

Even in today's comprehensive universal health care system, we leave dental services, drugs, and many other non-physician provided services to the private market. We have seen in many provinces arrangements whereby service providers like physical therapists treat some patients whose payment comes from the public health insurance system and other patients who pay privately. At least one-third of health care spending in Canada is from private sources and one-fifth of Canadians have private insurance coverage for ancillary health services.

Tying health care to nationalism not only promotes an inaccurate view of our health care system, it redirects debate away from a question Canadians need to address – what services should be included in the public system, and what could be left to the private market?

This is a question governments have largely avoided. When federal and provincial governments sought to cut their ballooning deficits in the late 1980s and early 1990s, they targeted health care. But instead of engaging in a dialogue with Canadians to find what services we would be comfortable leaving to the private sector to help bring deficits under control, they tried to deliver the same services while also keeping costs under control.

Governments of the time identified the number of physicians in Canada as a “cost driver” for the public health care system. Consequently, policies were implemented by the late 1980s and early 1990s to slow the growth of physician manpower and services. Now, Canada must deal with growing demand for health services with a supply of physicians effectively at 1987 levels. Not surprisingly, this has resulted in often long waiting lists and more Canadians without a family doctor.

Both sides of the debate agree that more resources are needed to improve the public health care system in Canada. Where they differ is on the ideal source of these additional resources.

The Romanow Commission proposed that more money from the federal government for the public systems was enough to solve the problem and recommended against a greater role for private service provision. Alberta’s Mazankowski Report, on the other hand, recommended a much greater role for private sources of health care funding.

With Ottawa and the provinces once again looking to cut deficits, we cannot afford to wait and see what impact a new round of cost controls might have on Canadians. We need to objectively evaluate what proposed health care reforms can and cannot do for the health system and take nationalism out of the debate.

This calls to mind the 1985 Macdonald Commission that recommended free trade with the United States. Twenty-five years ago, free trade, like health care, was a highly polarizing issue. Those who supported it said free trade was necessary for maintaining Canada’s high standard of living. Its opponents saw the elimination of tariff protection as the end of Canada.

Today, just over twenty years after Canada signed a free trade agreement with the United States, we are just as Canadian as ever. There is no reason why taking an objective look at our health care system, just as we did with our trade relationship with the United States, will change that.

This op-ed draws from a series of research papers by The School of Public Policy at the University of Calgary.