Early efforts by Western democracies torestrict freedom of contract were rationalized onthe ground that such restrictions were necessaryto prevent the suffering of ordinary citizens.People who oppose the freedom to opt out ofstate‐run health insurance schemes turn thatrationale on its head: they oppose freedom ofcontract even when it is necessary to prevent thesuffering of ordinary citizens. A recent ruling bythe Canadian Supreme Court has helped torestore that freedom and the right of patients tomake their own medical decisions.
On June 9, 2005, to the surprise of manyobservers, the Canadian Supreme Court struckdown two Quebec laws that gave the state‐runMedicare system a virtual monopoly. The courtruled that Quebec’s ban on private health insurancefor services already covered under theMedicare program violated Canadian patients’rights to life, liberty, and security of person.
The ruling in Chaoulli v. Quebec has expandedthe right of Canadians to obtain private medicalcare and opened the door to a parallel, privatehealth care system. Canada’s Supreme Court hasthus validated freedom of contract as an importantcomponent of patients’ rights. The rulingalso provides a basis for challenging other governmentactivities in health care and could havea significant impact on the U.S. Medicare program,compulsory health care programs in othernations, and certain forms of health care regulation.