Preface

History is full of what-ifs and longings for a do-over.What if Napoleon and Hitler hadn't invaded Russia or the Lenape Indians had held onto half of Manhattan in 1626 rather than taking the extra $12?Sometimes you get a do-over: the Montreal Alouettes' Damon Duval missed the game-winning field goal on the last play of the 2009 Grey Cup against the Saskatchewan Roughriders but got a do-over because the Riders had 13 men on the field.He made that one.Rider Nation yearned for a do-over to avoid the fatal do-over.So what do we make of federalism in Canadian health care?Federalism is the result of multiple levels of government co-existing within a common jurisdiction.A federation is a coming together of parties to advance their common interests.Sometimes the union is involuntary, as in the old Soviet Union and Yugoslavia.Such federations break apart at the first opportunity.In Canada, as in the United States, the constituent parts decided that on balance, ceding some autonomy and making common cause with each other was preferable to standing alone.The resulting union is fundamentally a bargain and a tradeoff that over time requires adjustments, accommodations, and recalibrations.There are bound to be "if we knew then what we know now" debates about the wisdom of constitutional arrangements and negotiated agreements.Modern health care wasn't even a gleam in the eye of the architects of Confederation in 1864 and 1867.How much simpler matters would be had it found its way into section 91 instead of section 92 of the (then) British North America Act.Would matters truly have been simpler?Health care is never simple and free of tension.It is just as fractious in England's unitary system as it is in Canada's federalist system.There have been periods of coop-Preface xi

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