Canadian Constitution Blogging

I don't really have a strong view on whether or not state-level health care initiatives make sense, but I do think this element of David Sirota's typically measured critique of Ezra Klein could use a little more context:

Spend 5 minutes on Wikipedia, and you'll learn that Canada's much-vaunted universal health care system began as a provincial initiative. The provinces provided both the better political opportunities, and ultimately the better initial implementation platform that ended up launching the federal program.

Back when I was in Introduction to Canadian Politics class, I was taught that the reason for this is that Section 92 of the British North America Act of 1867 stipulates that "The Establishment, Maintenance, and Management of Hospitals, Asylums, Charities, and Eleemosynary Institutions in and for the Province, other than Marine Hospitals" is one of the areas in which "In each Province the Legislature may exclusively make Laws." Much of the history of health care federalism in Canada essentially amounts to steady backdoor federalization of the nominally Province-based health care system precisely because assigning primary responsibility for these matters to the Provinces doesn't really work well in the modern context.