Should the Federal Government Play a Leading Role in Health Care?
• The Canadian health care system (or Medicare) offers comprehensive physician
and hospital care to all citizens at no direct cost.
• Medicare needs to continually change to ensure that Canadians are able to receive
effective health care, and some believe that the federal government is best
positioned to orchestrate the introduction of necessary reforms.
• There is an opposing view that suggests that it is unwise for the federal
government to assume a lead role in health care.
o Reason 1: health care is a largely a provincial responsibility the rule of
law (an important element in a constitutional democracy) would be
allegedly weakened without the provinces directing Medicare
o Reason 2: the health system would perform better without the provinces
largely in charge.
• Medicare in reality ten provincial plans (plus three territorial ones) knitted
together by a commitment to principles contains in a piece of federal legislation
called the Canada Health Act. The provinces have much more experience with
health care and much more expertise as well. It is felt that the case for a strong
federal role in health assumes a notion of leadership that requires some
consideration and arguably some reformulation.
• The Constitution Act 1867 gave the provinces jurisdiction over charities,
hospitals, and insane asylums, while the new federal government gained control
over marine hospitals and quarantine. All that the provinces were granted in 1867
was the right to keep an eye on the churches and municipalities that ran the few
small hospitals existing at the time. In addition the provinces were responsible for
licensing physicians as a consequence of their jurisdiction over “property and
civil rights”; civil rights in this context meant ones rights in property, and not the
idea of civil liberties we think of today.
• The great depression showed the necessity of proving people with some insurance
against employment. The courts ruled that this was a provincial responsibility
because of their control of most employment contracts, but the provinces simple
did not have the financial resources to implement employment insurance.
• The Constitution Act, 1940 then passed to enable the federal government to take
responsibility for this area of public policy.
• In 1951, there was an amendment to allow the federal government to create the
Canada Pension Plan and in 1964 to provide old age benefits
• The period in which Medicare was first created was an era of increasing federal
government responsibility for social welfare programs
• In order to qualify for the full value of the transfers that provinces are entitles to
under the Canada health transfer, they must abide by the five conditions of the
Canada Health Act: universali