Discussion of devolving powers to the regional level as being a good thing for Canadian health care is not new (Department of National Health and Welfare, 1970). At least two things, however, are new in the 1990s. First, devolution is no longer merely being discussed; it is being implemented in every province except Ontario. Second, and paradoxically, devolution is now largely seen as an instrumental means to achieve other ends, and not as an end in itself.