You're right. The administration of health care is wholly under provincial jurisdiction.
In the discussion on official languages, I think it's more about looking at how the federal government fulfills its own official languages obligations. Every year, the federal government gives the provinces between $55 billion and $60 billion for health care, through health transfers or agreements. That doesn't even include transfers for social services and such. That's a lot of money. The federal government invests nearly $60 billion in health care every year.
Right now, the entirety of that funding is not subject to official languages conditions. The way I interpret the act, some bilateral agreements are supposed to take language clauses into account, or as the act states, the necessary measures are to be taken to promote the inclusion in those agreements of such language provisions. That does not mean putting obligations on the provinces. It means doing something. As I see it, there is currently no clarity on what was done to promote the inclusion of language clauses. If that was done, if those efforts were made, they are not apparent to the French-speaking community.
That requires straight dealing on the federal government's part in terms of identifying expectations related to official languages in those rare cases in health care where levers for action exist. The bilateral agreements are one of those rare cases where the federal government can take action. It has agreements in principle accepted by the provinces. That's not the same as health transfers. All the provinces agreed to the principles, including equal access for official language minority communities.
There are no regulations currently. The act exists, but it has no effect. I am saying that the negotiating parties need to be empowered; that aspect of the negotiations has to be made very clear. What does “promote” mean? In order to promote, perhaps it's necessary to ask whether the other negotiating party has identified an expectation. Was an impact analysis shared? When there was nothing, how did the government respond to a plan that had no language lens, despite being necessary under the basic principles?