Stockwell Day unwittingly threw the 2000 federal election with three words handwritten on a piece of paper: No Two Tier. That action, following unrelenting media questions about the then-Canadian Alliance’s hidden agenda on health care, simply caused the public to associate something socially verboten with him and his team. The party played defence until the election loss at the end of the campaign.

Stephen Harper desperately wanted to avoid that fate this year.

His solution was to embrace our state health monopoly and offer it what every politician had given it before: great huge gobs of money. Never mind reform, never mind challenging the Canada Health Act, never mind even getting out of the provinces’ way by offering no-strings-attached funding. Just promise more dough by endorsing the recent health accord, and even up the ante by appending a new catastrophic drug program to the package.

Alas, this apparently foolproof plan to endorse the status quo also went off the tracks. Alberta Premier Ralph Klein simply mentioned a date for coming health reforms and thus laid out a path of exploitable uncertainty from then until two days after the election. The Liberals, never consciously avoiding a political vacuum, went to work vilifying Mr. Harper and Premier Klein as silent partners pushing the same-old hidden agenda on health.

Enter a sense of political incorrectness and discomfort amongst the electorate, and exit Conservative chances at a minority government.

Should we blame the Conservative party leaders for this inability to explain themselves on health issues? Should we attack the Liberals for their cynical exploitation of public anxieties regarding the health care system? Or, should we all simply accept that Canada has the best darn health care system on the planet and stop trying to perfect that shining city on the hill?

No, no and, of course, no.

Political leaders cannot be expected to promote something that the general public will not accept. People cannot be led to an uncertain destination, especially one that passes down paths of misinformation and loaded language that equate the state health monopoly with patriotism, national identity, concern for your fellow man, and all other things good and proper.

The Liberals should also not be faulted. They play the political game to win and they take no prisoners. This is one of the most successful and long-lasting political institutions in the world and the party did not gain such power for so many years by pulling their punches. Elections are there to be won.

Further, on the shut-up-about-perfection option, if our public system is so great, why does no other advanced nation copy its rigid formula of centrally controlled delivery, monopoly service provision, rationed access to health providers and technology, and first-dollar (Band-Aids to bypass surgery) insurance coverage?

The sector makes up one-tenth of our economy and yet it has negligible exports, declining productivity, unsustainable cost increases and politicized care provision. The main attribute worth emulating is the promise of universal access -- but that is a gift given by at least 26 other advanced nations.

No, there is no one to blame for the surreal and disingenuous discussion of health care reforms we just witnessed in the election campaign but those in the know. People who understand market economics, anyone who can grasp the fundamentals of price incentives and demand and supply, those who have experience of other countries’ health systems, anyone who can see the simple sense in not outlawing the private sector in such an important area -- all are to blame.

In a word, the public is simply not ready for change. They have neither the facts at hand nor the clinical and economic evidence to accurately judge our health system. Why should people not be suspicious of reforms when their picture of health care is an idyllic and wholly inaccurate mix of single-tier care, delivered by publicly minded and selfless providers, under the benevolent guidance of disinterested government planners?

The only way to move forward from this fantasy garden to real-world reforms that can save lives and public expenditures is to tell the truth.

Health care is an economic activity like any other, amenable to competition between providers and insurers and dearly in need of greater financial and service accountability to patients and taxpayers. Introducing markets for health care is the only path to successful reform, the only way to actually reduce waiting lists, improve care and make needed investments.

That message can certainly come during elections, but it needs to be developed and debated now, well before the next federal campaign. Politicians can lead, but only when the public is willing to listen and to be led. It is said that Canadians get the government they deserve. Nowhere is it stated that this choice must occur in a state of ignorance and misinformation. It is time to engage in a real debate on health care reform.