Roy Romanow said it emphatically. He studied other public health-care systems with private-sector inputs for essential services and found "no evidence" that they deliver better access or care. "The evidence has not been forthcoming," he declared.

Other countries apparently have it wrong. They include, to name a few: Austria, Australia, Belgium, Denmark, France, Germany, Holland, Italy, New Zealand, Spain, Sweden, Switzerland, the United Kingdom.

"No! Not now, not ever," Mr. Romanow said of Canadians' attitudes to anything that would endanger medicare as a "moral enterprise," a "public trust," a "defining aspect of our citizenship," a "right of citizenship" -- descriptions that come from someone who decried "overheated rhetoric" in this debate.

Then, totally predictably, Mr. Romanow said the alternative to his recommendations was to go back 50 years to the days of entirely private medicine, something nobody in Canada suggests.

After that red herring came another, the biggest one of all -- constant references to the U.S. system. He was right about the U.S. system, except that again almost nobody recommended that system to him. And with good reason.

Two weeks ago, the U.S. National Academy of Sciences summarized its overview of U.S. health care: "The health-care delivery system is incapable of meeting the present, let alone the future, needs of the American public."

About 41 million Americans are without insurance. The uninsured are not just the poor and indigent. Members of the middle class are losing their insurance. Every U.S. state is under the fiscal gun. Many will cut eligibility for publicly supported health care.

Raising it as a bogeyman alternative to the Canadian system deforms completely the alternatives, but the U.S. comparison is apparently irresistible for those who four-square defend Canadian medicare. Canadians are so conditioned to compare everything here to the United States that they know little about systems other than the American one. That conditioning plays into the hands of those who want the status quo plus in Canada, a status quo buttressed by tens of billions of dollars of additional spending and some internal administrative changes in delivery.

So, pace the Romanow and Kirby reports, Canadians will, indeed, keep the status quo; that is, they will continue to reject borrowing from the public-private models in other Western democracies.

Canadians have made the bet of their lifetimes, supported by the Romanow and Kirby reports. That bet is simple: Spend tens of billions on the existing system and the problems will be solved.

By all means, change delivery systems. Cluster doctors into family practices. Train more health-care professionals. Buy more high-technology equipment. Monitor the system better. Give everybody an electronic health card. Do all these things and more with the additional tens of billions of dollars.

We've spent $4-billion to $5-billion more on health care in each of the past two years; we're on track to spend more than that in the next two. Thereafter, if Messrs. Romanow and Kirby have their way, we will spend much, much more -- in the range of $60-billion to $70-billion over the next decade.

The best-laid plans will partly go astray. When Canada catches up in MRIs and the latest high-technology machines, other and perhaps more expensive ones will arrive. Genomics will produce medical breakthroughs that Canadians will demand. Wages will eat up a portion of the additional billions. The new spending on health will prevent governments from addressing, as Canadians will demand, various other priorities.

Perhaps Messrs. Romanow and Kirby are right. Perhaps federal-provincial squabbling will end. Perhaps tens of billions will indeed "buy change," curtailing rising costs. Perhaps better administration and information can improve patient care, reduce waiting lists, maintain quality, and guarantee universal access on a timely basis. Perhaps the economy will grow so strongly and without interruption that governments will able to spend on other priorities.

This is the bet of a lifetime in Canadian public policy. No other country in the world would take that bet; indeed, they long ago decided they never would.

Messrs. Romanow and Kirby, and a majority of Canadians, want to take the bet. It will be a decade, maybe even a generation, before the results are known. If the bet is lost, then the experience of the rest of the world, now rejected so defiantly, will force Canadians then to have the debate about real alternatives that they are unwilling to have now.
jsimpson@globeandmail.ca