Canada's health and social care system is paralyzed by our decentralized federalist governing structure. Public policy change, such as that suggested by Chappell and Hollander, will require a new political paradigm that recognizes the need for a multi-sectoral, co-operative approach to integrated systems of care delivery. The federal government must provide the necessary leadership, and the provinces and territories must show the political will to co-operate if Canada is to embrace the challenges of an aging population.