Peter Ubel's main conclusion is that physician participation in bedside rationing is essential to controlling healthcare costs. This conclusion is out of step with the current focus of thinking and policy debate within Canada and other countries with universal public healthcare systems. In the Canadian context, collectively we need to better understand the limits and choices in defining the "medicare commons," which occurs at the intersection of the overall level of funding, the range of services provided (comprehensiveness) and the level of access that we are able to provide. This will require a deliberative process that must engage patients/the public at all levels of decision-making. Physicians must accept responsibility to use scarce resources prudently, but this is a collective responsibility and must be exercised in a transparent manner.