Early efforts by Western democracies to restrict freedom of contract were rationalized on the ground that such restrictions were necessary to prevent the suffering of ordinary citizens. People who oppose the freedom to opt out of state-run health insurance schemes turn that rationale on its head: they oppose freedom of contract even when it is necessary to prevent the suffering of ordinary citizens. A recent ruling by the Canadian Supreme Court has helped to restore that freedom and the right of patients to make their own medical decisions.

On June 9, 2005, to the surprise of many observers, the Canadian Supreme Court struck down two Quebec laws that gave the state-run Medicare system a virtual monopoly. The court ruled that Quebec’s ban on private health insurance for services already covered under the Medicare program violated Canadian patients’ rights to life, liberty, and security of person.

The ruling in Chaoulli v. Quebec has expanded the right of Canadians to obtain private medical care and opened the door to a parallel, private health care system. Canada’s Supreme Court has thus validated freedom of contract as an important component of patients’ rights. The ruling also provides a basis for challenging other government activities in health care and could have a significant impact on the U.S. Medicare program, compulsory health care programs in other nations, and certain forms of health care regulation.