Psychologists are familiar with the idea of cognitive dissonance, whereby a person must reconcile beliefs and behaviour that are contradictory. Because behaviour is much more difficult to change than beliefs, a person is more likely to change his beliefs than his behaviour.

Roy Romanow began his travelling medicare salvation show, 18 months and $15 million ago, with the belief that he was willing to learn from people who had analyzed the weaknesses of the Canadian health-care system as a function of its failure to adopt user-fees, private clinics, hospitals and insurance, as well as to recognize the value of an open profit motive (as opposed to a hidden one, which obviously exists in Canadian health care).

He gave it a good shot. Of his 40 commissioned papers, two were written by persons associated with, but not employed by, The Fraser Institute (the Institute does not accept money from governments). When he came to Vancouver, four Fraser Institute analysts addressed him, at his invitation. We were preceded by Brian Day, a physician-entrepreneur who operates a private clinic for orthopedic surgery in Vancouver.

Unfortunately, we only addressed him once. Supporters of government-monopoly health care shadowed him, blanketed him and smothered him. Maude Barlow of the Council of Canadians and Michael McBane of the Canadian Health Coalition followed him from town to town, repeating their message from East to West, for the benefit of the local galleries.

Mr. Romanow thought that he would hear from ordinary Canadians on his cross-country jaunt. (This is one of the strangest ironies about Canadian public health care. Its promoters pay lip-service to democracy by appealing to average Joes, not just experts, to help shape an awesomely complex beast that chews through more than $70 billion annually. On the other hand, they do not think that those same individuals are mentally or emotionally capable of making choices about how to procure health care for themselves. That’s not the kind of decision a parent with a sick child wants to make at 3 a.m., says Carolyn Bennett, MD, MP.)

Unfortunately, ordinary Canadians are generally too busy putting in a hard day’s work to take time to whip up a dog-and-pony show for Mr. Romanow. Nevertheless, he made great efforts to fill up his calendar. He even found time for a presentation from Senator Hilary Rodham Clinton, who apparently inspired her husband’s failed attempt to Canadianize the American health-care system during his presidency.

At some point, it all became too much for him. As the former premier of Saskatchewan who had governed when that province’s waiting-lists for surgery grew longer than those in any province in Canadian history, it became unbearable for him to continue to consider international evidence demanding a significant reduction in the scope of government monopoly in Canadian health care.

User-fees, private clinics and hospitals, private insurance: some or all of these are characteristic of every industrialized democracy except the Czech Republic, a country with just more than a decade of release from communist dictatorship behind it. When we look at members of the Organization for Economic Co-operation and Development (OECD), a club that encompasses the industrialized democracies (as well as some, like Mexico and Turkey, on their way to that status), we see where the failure to embrace these tools has brought us: big spending and poor performance.

In terms of health spending as a share of Gross Domestic Product (GDP) per capita, Canada ranks fourth after Germany, Switzerland and France of OECD countries that guarantee universal access to health care (that is, not the U.S.). However, Canada is a relatively young country. If we make a simple and transparent adjustment to determine what countries’ health spending as a share of GDP would be if every country had Sweden’s demography, Canada rises to tie Iceland as top spender. What do we get for all our spending?

Canada ranks 17th of 21 countries in the number of doctors per capita, 18th of 23 in the number of magnetic resonance imaging (MRI) machines per capita, 18th of 22 in the number of computerized tomography (CT) scanners, and 13th of 21 in the number of lithotripters per capita.

We rank eighth or 10th in terms of commonly-used mortality statistics. France, Sweden, Japan and Australia have comprehensive private, for-profit health care operating alongside the public system and get better health outcomes for less money than Canada does (when adjusted for age distribution of the population). Other countries that do not have decidedly superior performance indicators to Canada’s nevertheless spend less money and get good results by employing these private options. Even the World Health Organization, whose ranking of national health systems includes such Romanow-friendly notions as fairness of financial contribution, puts Canada in 30th place.

Faced with this information, which contradicted 35 years of his own political behaviour, Mr. Romanow’s belief that he could manage to incorporate this evidence into his proposals to change the behaviour of the entire Canadian health-care system fell by the wayside. As demonstrated by his ferocious outburst against any of these options, replayed so often on Thursday’s newscasts, he had become angry that we had even shared them with him. Although we heaped research papers on his desk when we spoke to him in Vancouver, none of them are cited in the report’s bibliography.

At some point in his difficult journey, Mr. Romanow decided to return to the warm and friendly womb of Canadian values, where international evidence could not force him to demand serious change in the behaviour of our health-care system. Unfortunately for him, ordinary Canadians, for whom he has convinced himself that he speaks, are moving in a different direction. Private clinics are sprouting up all over the country, and Canadians are using them.

It is too late to turn the clock back.