'The prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services,' the Supreme Court of Canada ruled.

The high court stopped short of striking down the constitutionality of the country's vaunted health care system nationwide, but legal experts said the ruling would open the door to a wave of lawsuits challenging the health care system in other provinces.

The health care system provides Canadians with free doctors' services that are paid for by taxes. The system has generally been supported by the public and is broadly identified with the Canadian national character.

But in recent years patients have been forced to wait longer for diagnostic tests and elective surgery while the wealthy and well- connected have either sought care in the United States or used influence to jump medical lines.

Liberty, Safety and Security

The court ruled that the waiting lists had become so long that they violated patients' "liberty, safety and security" under the Quebec charter, which covers about one-quarter of Canada's population.

"The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care," the Supreme Court ruled. "In sum, the prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services."

The issue was brought to the Supreme by Jacques Chaoulli, a Montreal family physician who argued his own case, and George Zeliotis, a chemical salesman who was forced to wait a year for hip replacement while he was prohibited from paying privately for surgery.

Chaoulli and Zeliotis lost in two Quebec provincial courts before the Supreme Court decided to take their appeal.

In a news conference, Chaoulli declared a victory and predicted that the decision would eventually apply to all Canada. "How could you imagine that Quebeckers may live," he said, "and the English Canadian has to die?"

Two-Tier System

Chaoulli, who was born in France, has long called for Canada to adopt a two-tier, public-private health care system similar to those in France, Germany and Switzerland. Supporters of the current arrangement, however, have argued that a two-tier system will draw doctors from the public system, in which there is already a shortage, and lengthen waiting lists.

Chaoulli is a passionate, if idiosyncratic, advocate who was long viewed as a lonely character on the political scene. He went on a hunger strike in the streets of Montreal for his cause in 1997 after he was forced to abandon a private emergency house call service.

He also went to the University of Montreal law school to help him make his case, but flunked out after a semester. He carried on with his legal quest anyway.

Prime Minister Paul Martin responded to the decision by saying that his government is dedicating itself and making progress in lessening waiting times for medical services.

"We are not going to have a two-tier health care system in this country," Martin told reporters. "Nobody wants that. What we want to do is to strengthen the public health care system." But legal scholars and health care experts predicted a slew of lawsuits challenging provincial health care laws across the country.

Dr. Albert Schumacher, president of the Canadian Medical Association, called the ruling historic and one that could change Canada's national health care system.