Launched 30 years ago, the publicly funded system has long been a source of pride for Canadians, providing universal access to generally high-quality care. But long-simmering problems are now boiling over simultaneously.
Budget-cutting provincial governments are closing hospitals and laying off nurses. Reports of patients dying due to delayed or slipshod treatment proliferate. Doctors say more colleagues will leave for higher-paying jobs in the United States.
In Ontario, the largest province, many doctors have been refusing to see new patients as they battle with the government over pay and autonomy. In British Columbia, doctors plan to close their offices on selected weekdays to retaliate for a cap on payments.
In Alberta, which three years ago led the way in slashing health funding, pressure from doctors and patients contributed to the government's decision last week to restore most of the cut funds.
But that decision comes too late for some, according to a coalition of Alberta doctors. They said two patients died in emergency wards while awaiting transfer to hospitals that had the proper personnel to treat them.
There was unprecedented debate over the health care system in November. Ontario call-in shows focused on the doctors' slowdown, the Canadian Broadcasting Corp. aired a three-part series on cutbacks, and the national newsmagazine Maclean's ran a 36-page cover story, "Radical Surgery."
The financing of Canada's health-care system is complex. It is a combination of federal cash transfers to the provinces plus provincial tax revenues collected under a federally dictated formula.
The provinces are catching the flak for making cuts, but the Canadian Medical Association places most of the blame on the federal government for reducing its transfer payments by several billion dollars.
Health Minister David Dingwall says money must be spent more efficiently as the percentage of elderly people rises. He advocates more home care and more funds spent on prevention, including an anti-smoking campaign.
One of the most hotly debated questions is whether Canada will have to switch to a two-tiered health system in which patients with enough money would be allowed to get private care.
Alberta's premier, Ralph Klein, tried such a system briefly this year, but backed down when the federal government threatened to withhold funds. But piecemeal privatization is spreading - many hospitals contract out some services.
Doctors warn that the current furor will swell the ranks of physicians heading to the United States, where red tape is generally less cumbersome and after-tax earnings can be two or three times higher. An estimated 2,000 Canadian-trained doctors have headed south in the past 15 years.
The exodus continues even though Canada spends more money per capita on health care than any country except the United States - roughly $54 billion annually for 30 million people.
Total health spending is about 10 percent of gross domestic product, compared to 14 percent in the United States and an average of about 8.5 percent in Western Europe.
Well-off Canadians have the option of traveling to the United States for private care. But polls indicate most Canadians oppose any major steps toward privatization and tend to put up up with delays and waiting lists.
For operations such as hip and knee replacements, waits can be six months or more. For heart surgery, delays can be too long.
A heart surgeon who monitors waiting lists for the Cardiac Care Network of Ontario estimates that 40 to 50 heart patients each year die while awaiting surgery.