A debate has raged for several years in Quebec and elsewhere in Canada on ways to remedy the shortcomings of the public health care system. However, this debate has been confused by uncertainty with respect to the Quebec and Canadian legal context. The legislative framework under which the public health care system has operated for the last twenty years is indeed not only complex, but prone to various interpretations. Just what is allowed under the current laws? Which laws could a reform-minded provincial government modify in order to successfully carry out its reforms? How much room do the provinces that would like to reform the system have under current federal legislation?