This paper addresses some of the tensions for social cohesion presented by Canada's medicare system. This system, which constitutes the country's best-loved social program, is broadly governed by the five principles of the Canada Health Act. Independently and together, these principles promote social cohesion. Medicare is however also under threat from various elites, who favour elements of its privatization, and whose principal strategy is here termed privatization by stealth. The argument that privatization is disruptive of social cohesion is advanced in general terms and with specific reference to the case of Ontario's Community Care Access Centres, which broker public funds to non-profit and for-profit home care agencies across the province.