Abstract
The COVID-19 pandemic has laid bare some profound challenges facing the preservation of Canada's single-payer, publicly administered healthcare system. At the same time, it may have presented an opportunity to take bold action on system reform. Part of that opportunity may lie in linking recent developments in intergovernmental diplomacy (termed bilateral federalism) with the growing emphasis on value-based healthcare initiatives coming out of some of the provinces. Bilateralism may be a means to steer reform efforts toward a value-based healthcare system that can articulate pan-Canadian values while accommodating provincial asymmetry in a highly decentralized federation like Canada.