The lead article interestingly suggests that there might be a third way between publicly funded health systems and profit-driven private offerings. Securing the principles of universality and equity underpinning the Canada Health Act (1985) is at stake. However, healthcare cost is growing at a pace that is not sustainable; all the while, our health systems fail to keep up with demand. No matter how useful a third way system may prove to be, can it be a complete and sustainable solution? Deeper societal questions such as universality's affordability may also need to be answered. Built-in forces driving healthcare costs up, such as profit-driven research and development of all kinds, medical science advancement and population needs keep increasing costs unsustainably higher. What should we do? This commentary builds on the lead article to help reflect on the matter. Protecting universality and equity may mean redefining them in order to tame powerful hidden forces at play.

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