Over the last 15 years there have been repeated calls to reform and modernize how services are delivered within the Canadian public health care system. Yet, despite broad and continuing support among academics, unions, government and the public alike, there remain systemic barriers that limit the effectiveness and scope of new approaches for delivering public health care services.
This paper argues that health care reform cannot be achieved by relying exclusively on the traditional mechanisms of governance available within liberal democracy: that is, representative government backed up by a hierarchically organized administrative structure. To effectively reform health care (and other public services) and to mobilize sufficient support for reforms in the face of opposition from entrenched interests, the forms of governance must, themselves, be democratized. This will require greater involvement of non-elite individuals and groups in governmental decision-making, as well as new ways of working within and between the public sector and the broader community.