It's been more than a week since this country's highest court handed down a judgment that, by all accounts, will necessitate a major rethinking of Canada's most important social institution. So naturally, with the ball now in their court, federal leaders have spent that time scrupulously avoiding it.

While a handful of provincial premiers and senators have done their best to keep the court's June 9 decision to strike down Quebec's private health insurance ban in the spotlight and carry the issue forward, those in a position to offer national leadership are talking about anything but. There's no shortage of hot topics in Ottawa - the Gomery inquiry, Devils Lake, same-sex marriage and how Stephen Harper will spend his summer holidays, to name a few - but that small matter of whether we're on the verge of abandoning the single-payer health care system does not appear to be one of them.

All that the leaders of our two biggest parties had to say on the matter was apparently said last week - and it wasn't much.

In typical fashion, Paul Martin responded by pretending the ruling didn't happen, reiterating that "we're not going to have a two-tier health system in this country." Why? Because "nobody wants that." How was the Prime Minister going to prevent it? Who knows.

Having long been championed by the right as the only party gutsy enough to introduce more flexibility into medicare, the Conservatives should have been champing at the bit to lay out a bold new plan to bring down waiting times and save the public system. Suffice it to say it didn't quite work out that way: Instead, with deputy leader Peter MacKay standing in for Mr. Harper, the best the Tories could do was effectively blame the Liberals for not pumping enough cash into the status quo.

At the very least, our national leaders might have been expected to help Canadians interpret what the ruling really means, and what choices lie ahead of us. But they haven't even bothered to do that. And so Parliament heads toward its summer recess with no forward medicare movement; only the sense that, with each passing day, we're moving closer to the doomsday scenario hinted at by the Supreme Court - the one in which the single-payer system is no longer sustainable.

The irony is that, if it plays out that way, the people we have to thank may well be the same ones who have most staunchly defended the current system.

Preserving the same system for Canadians of every social, economic and regional background is a noble and worthy goal; indeed, it's essential to preserving the sense of social responsibility on which this country has been built. But that aim has been clouded by politicians and interest groups who, to either score points against their rivals or maintain a status quo they benefit from, have lumped together universal care with the manner in which it is delivered.

There are reasonable arguments against the private delivery of public services - mostly that there's no guarantee it would prove either cheaper or more efficient. But rarely are those arguments made. Instead, anyone trying to suggest public-private partnerships or other forms of restructuring is shouted down amid charges that they oppose universality or support "two-tier" care.

It's often a totally bogus charge, because the two have nothing to do with each other. Universality is a question of principle; delivery is one of practicality. But because the Liberals, among others, have found it expedient to pretend it's all the same thing, it's become political suicide to propose serious structural reforms to save the public system - something alluded to in these pages yesterday by senators Michael Kirby and Wilbert Keon, who cautioned that "continued scaremongering about ownership structure will make it impossible to successfully restructure the delivery system."

To their credit, some provinces are moving forward with major structural reforms (Ontario, for instance, is in the midst of a major shift toward regional management and "family health teams.") But such initiatives took far too long to manifest themselves, and without any sort of national strategy they're likely to amount to too little, too late.

Mr. Martin, Mr. Harper and other federal leaders surely know this. They also know that fee-for-service clinics are popping up in Quebec and (to a lesser extent) elsewhere - effectively proving the Supreme Court's point that if the public system isn't reformed to ensure timely care, patients will go outside it. But it still hasn't been enough to convince them to move beyond the familiar rhetoric.

Last week's ruling represents an opportunity as much as a threat - a chance for a long overdue dialogue that puts all the delivery options on the table in order to ensure universality for the long-haul. So far, none of the key players on the federal stage have taken the bait. Hopefully, they'll come to their senses over the summer.