Healthcare federalism in an age of nation-to-nation interaction

Abstract

Primary provincial responsibility over health care leads to inconsistent health care coverage across the provinces and sub-optimal coverage in many provinces. The federal government should accordingly use its available powers to standardize health care coverage across Canada. Doing so would improve health care justice and could increase Canada's realization of its health-related international human rights obligations. Yet an increased federal role in health care may be inconsistent with recognition of sub-constitutional nations-within-nations (viz., Quebec and Indigenous nations) in Canada and the increased decision-making for such nations that recognition could entail. Canada recognizes nations within the nation of Canada (at least sub-constitutionally). Should these sub-constitutional nations constrain the federal government’s ability to take an increased role in health care regulation in Canada? This talk introduces the general problem raised by the conjunction of the need for an increased federal role and sub-constitutional nations. It then offers some tentative thoughts on how to resolve the attendant issues: while there is at least a prima facie case that ‘national’ status should have some normative weight and recognized nations-within-a-nation should have an increased role in decision-making about social goods like health care, this prima facie case need not completely undermine increased federal action in the field.

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ORCID for Michael Da Silva: orcid.org/0000-0002-7021-9847

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