The 40th anniversary of the Canada Health Act (CHA) highlights Canada’s commitment to equitable healthcare but underscores its core failing: fractured accountabilities between federal and provincial governments. This misalignment perpetuates inadequate access to primary and specialist care and outdated standards of comprehensiveness, excluding critical services like outpatient pharmaceuticals and mental healthcare. To address these gaps, the CHA requires a fundamental update. We propose a solution: the federal government must require, as a condition for funding, that provinces and territories implement a transparent, evidence-based process to establish clear benchmarks for accessibility – such as wait times – and define the scope of universal publicly funded services. By ensuring the CHA is fit for purpose, it can meet the healthcare needs of Canadians for another 40 years. 

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