The other, chiefly from the left, was to note with some relief that its proposals did not seem to contravene the Canada Health Act, the 1984 federal law that sets conditions on Ottawa's transfers to the provinces for health care. The Act's principles of universality, comprehensiveness, accessibility, portability and public administration are now commonly regarded as the five pillars of medicare, as reviled on the right as they are revered on the left.

To be sure, there were some outriders on both sides. Some conservatives, such as the historian Michael Bliss, groused that the report didn't go nearly far enough, while on the far reaches of the left, such as the Council of Canadians, there were warnings not to be fooled by the report's soft language, that indeed medicare and the Canada Health Act were under assault. But in the main the responses were as described. No less a free marketeer than Michael Walker, head of the Fraser Institute, gave the report his blessing ("It is a very good, refreshing report"), while as staunch a defender of the Canada Health Act as Dr. Michael Rachlis pronounced the whole thing medicare-kosher ("It seems to be quite sensible.") On the surface, this would seem impossible. If there is one point on which right and left agree, it is the incompatibility of the sort of free-market reforms the Mazankowski report recommends with the principles of the Canada Health Act. An editorial in the National Post, even as it celebrates the "watershed" report as the "first major government document that considers root and branch reforms to medicare," ends nevertheless with a call for the Act to be scrapped, given the intolerable "constraints" it imposes on provinces' freedom to innovate.

Well now. If the Mazankowski report is so radical as all that, and if at the same time it is in perfect harmony with the Canada Health Act, doesn't that suggest the Act is not the "straitjacket" it is claimed to be? Could one of the mustier orthodoxies from which the right would free us be the notion that the Canada Health Act is all that stands in the way of innovation and reform? Is it possible that such market mechanisms as prices, competition and consumer choice could be adopted within a system that met all of the Act's criteria?

It is important to remember just what the Act does and does not do. Contrary to what you may have heard, it does not empower Ottawa to "dictate" to the provinces how they may run their health care systems. Neither does it entail federal "bullying," "blackmailing" or any of the other emotive words that are commonly thrown about. It simply defines the terms on which the federal government will spend federal money. Nothing on God's green Earth requires the provinces to take the money. If they don't like Ottawa's conditions, they are free to reject Ottawa's cash.

For that matter, it's debatable just how tightly those strings are attached. Ottawa does not transfer funds "for health care": the Canada Health and Social Transfer takes the form of a block grant, which the provinces can spend on anything they like. The Canada Health Act is an entirely separate piece of legislation. And while it empowers Ottawa to withhold a portion of federal transfers from provinces that violate the Act, if this occurs at the same time as Ottawa is increasing the size of the overall grant, it's not clear what this means.

On the other hand, if the federal contribution has diminished to such an extent as the critics make out, its fiscal leverage would seem slight. Rather, federal influence seems more in the nature of moral suasion: the Act's five conditions simply give concrete expression to principles in which the public happens to believe. As irritating as that may be to provincial absolutists, for whom any federal role in health care -- other than a financial one -- is sacrilege, it does not present any meaningful obstacle to reform.

Nothing in the Act prevents provinces from contracting out services to private providers, as the Mazankowski report recommends. Neither does it prohibit delisting of some services: The Act does not define "comprehensive," but clearly it does not include every last treatment imaginable, or else provinces would be paying for cosmetic surgery. The Act does prohibit user fees for insured services, but there are plenty of ways to impose the same cost-consciousness on those within the system without charging user fees, such as the "medical savings accounts" the report proposes or the "capitation" model of paying doctors.

Indeed, these and similar reforms are already being implemented across the country, notwithstanding the Act's supposed "straitjacket." Perhaps Mazankowski's real achievement will be to wake conservatives up to this fact.