If you've read anything about Canada's health care system, you could be forgiven for thinking that a lot of health policy research is being conducted from bed, by people who would rather lie there than try anything new.

Numerous studies have been published on the Canadian health care system and most of the "reforms" recommended by their authors harken back 50 years or more. The solution to the woes of the system can be found in more government expansion (Pharmacare, home care) and more government intervention (clinical practice guidelines, capitation). Yet we're told that these are innovations. For those of us who dream of real innovations, we are warned, "But something may happen."

Perhaps the simplest way of improving the medicare system would be to allow people to spend their own money on health care. Economists assure us that a mixed health care system—with strong public and private sector delivery—is more cost-effective and efficient than an exclusively public system. If the economic argument seems unpersuasive, consider that in the limited instances when private health care is allowed (cataract surgery in Alberta, for example), patients in the public system wait less time than they had done before the private system was introduced, and yet there is no additional cost to taxpayers. But Canada's medicare supporters will have nothing to do with this talk of shorter waiting times. Instead, they reply with a list of "maybes."

Maybe we will no longer have equal access to health care if the private sector is more involved.

Overlooking the fact that we do not have equal access to quality care now—waiting lists vary by province, municipality, and income level, and queue jumping is common—this concern misses the most important point: Canadians need timely, not necessarily equal, access to medical services. In the current system, patients can wait years for hip replacements, cataract surgeries, and heart bypasses. Shouldn't the priority of a health system be to ensure that every Canadian receives timely care, rather than sacrificing people's health for the illusion of equality?

Maybe the rich won't want to pay taxes any more if they are allowed to opt out of the public health care system, thus weakening support for the public system.

Even if we falsely assume that only the rich will opt for private care, whether they want to pay taxes or not is irrelevant. Paying income taxes isn't optional in Canada. Neither is it optional in the United Kingdom, where even those people who opt out of the public health system must still pay taxes to help support it.

Maybe we shouldn't let doctors trained at public expense opt out of the public system.

Other university-trained Canadians are educated at large public expense but are not then forced to work for the government. However, even if we decide that is a problem, there are several options. For example, there could be a requirement that doctors work in both the public and private systems, or we could insist that doctors and anyone else who wishes to further their education after high school pay for it themselves.

Maybe if we allow a two-tier system, all of the good doctors will leave the public system.

Even by falsely assuming that all doctors are in medicine only to make money, there is no way that all of the best doctors could earn a living working in the private system. In other countries with parallel public-private health care systems, only 10 to 15 percent of the population has decided to opt out. So, even if we falsely assume that it is only the "rich" people who leave the system, there is no way that the many good doctors that we have in Canada could make enough of a living off this small and hypothetically healthier (because they have higher incomes) group of patients. And even if doctors somehow could eke a living out of these patients, the government is not powerless. Many countries with a public-private system require doctors to put some time into the public system.

The problem with all these maybes is that medicare is in real trouble—there’s no maybe about that. As our population ages and new technologies further drive up the cost of health care, improving the efficiency and effectiveness of our health care system is not simply worthwhile but crucial. Yes, any meaningful reform initiative will carry with it risks, but maybe it’s time to get out of bed and try something new.