Abstract Canada's universal health insurance program, fully implemented in 1971 throughout the country, is considered by many to be a model system for the delivery of health services. Legislators believed at the time of its instigation that this program, through the removal of financial barriers, would increase access to needed medical services for Canada's population. Although great strides have been observed pre and post-implementation of this program, the available evidence suggests that the program has not succeeded completely in equalizing health outcomes. Selected evidence is presented and discussed in this regard, along with reasons why programs designed to equalize outcomes by equalizing access cannot necessarily respond to problems of structured inequality.