In reviewing feedback on our article, we are reassured by the unanimity of concern about the current situation. However, there remains much oversimplification about what is meant by “public” and “private,” which undermines clearer thinking and innovation in practice. The confusion that results needs all our efforts to be removed. Canada's health system today holds much-deserved pride and praise. However, preserving and sustaining those accomplishments is in doubt, due in part to drivers of population need and change, which cannot be avoided, and in part to, in our view, somewhat misplaced rigidity and misunderstanding about the current situation and options going forward. We observe greater flexibility and innovation in other high-income countries. We urge learning from those innovations with a more open mind. May these exchanges move us a bit further along that path.

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