Toronto ? Canada’s Supreme Court dealt a powerful blow to the state monopoly on health care Thursday, striking down a Quebec ban on private health insurance for services provided under the country’s Medicare system of universal coverage.

Although the unanimous ruling applies only to Quebec, it is sure to bring similar cases in other Canadian provinces and give impetus to a growing movement pushing for public and private care.

Government leaders rushed to defend the current system, and Medicare supporters voiced fears the ruling will bring a two-tiered system favoring those with money and possibly hurting care for the poor. Proponents of change say it will improve care by offering more choices and cut waiting times for treatment.

The Supreme Court said Quebec’s prohibition violated the province’s charter of rights by threatening the lives of patients, and the justices noted other countries had successfully combined private and public care.

Medicare arose from a 1984 law that affirmed the federal government’s commitment to provide mostly free health care for all, including the more than 200,000 immigrants arriving each year.

Most polls indicate Canadians support the system despite the high taxes needed to finance health care, seeing it as a marker that sets their country apart from the United States, where some 45 million Americans lack health insurance.

But in recent years Medicare has been plagued by long waiting lists and a lack of doctors, nurses and state-of-the-art equipment.