You could look at another country that has the same kind of constitution as Canada—Australia. In the first place, in the Australia Constitution Act of 1901, they established the role of the federal and the state governments. They have the same distribution of powers, but they have standing structures in place that create linkages. Or you could talk about a national agenda. They have a standing committee on health, which is made up of all the federal and state ministers of health. They meet on a regular basis, not just occasionally.
Second, the deputy ministers of health, federal and state, all meet through the Australian Health Ministers' Advisory Council. They advise the ministers, but together they have been able to achieve a national consensus on the reform agenda for Australia. They have one issue that we don't have in Canada—in Australia the states cannot tax for health care, whereas in Canada the provinces can. You can imagine how hard it was for them to create a discussion in which the federal power owns all the taxing powers, while the states own all the responsibility for delivery. Despite that bigger difference than what we have in Canada, they were able to achieve structures that allowed the discussion to occur.