The Legal Framework for Intergovernmental Health Care Governance: Making the Most of Limited Options
There is an understandable tendency in discussions of health care policy in Canada to regard Canada’s federalism as a significant barrier to good health care governance. Outside of Quebec and perhaps segments of opinion in the west, there is also a tendency to regard more assertive leadership by the federal government as the key to getting federalism out of the way of improved health care governance. The failure of successive federal governments to act on this imperative tends to be attributed to political circumstances, including the resistance of some provinces, particularly Quebec and Alberta, to national approaches, and more generally, the absence of federal political will. In this context, it will be natural for many to attribute the mixed results achieved under the 2003 First Ministers’ Accord on Health Care Renewal (appendix 1) and the 10-Year Plan to Strengthen Health Care of 2004 (appendix 2) to the weak accountability that each of these accords placed on provincial governments to show results in exchange for the increased federal funding that both agreements promised. An obvious aspect of this weak accountability is the character of both instruments as mere political agreements that were not in themselves enforceable and that were not reinforced by stronger federal legislation. In other words, the weakness of the accords would appear to fit with their inherent weakness as “soft law.