Unchartered Waters

There is a myth, perpetuated by both levels of government in Canada, that the Constitution explicitly assigns the responsibility for health care to the provinces. It does not. The Constitution does grant provinces jurisdiction over “hospitals [and] asylums” (excepting marine hospitals) and “generally all matters of a merely local or private nature.” The problem with contemporary health care, however, is that it no longer resembles what existed when the Constitution was written: much health care is delivered outside of hospitals; it is largely public; and, most importantly for the 21st century, it cannot be delivered effectively as a “merely local” service. The practice for several decades now has been to view health care as a collaborative venture between federal and provincial governments. This convention has been driven by a combination of economic necessity, political opportunism and technical utility, but it has allowed Canadian health care to...