there are an assortment of past practices, (like blatant extra-billing by doctors), that ultimately brought forward federal legislation in the form of the Canada Health Act. That federal CHA law forced provinces to enact their own legislation to ensure compliance with the CHA;
The feds can't "force" the provinces to do anything. The CHA is voluntary, the provinces have to agree to it. Its just an agreement between feds and provinces of "us feds will give you health transfer money and in return you promise to abide by these rules".
O'Toole nor Trudeau can't do anything to provincial health care systems without the provinces consenting. The provinces control everything, just like the feds can't do anything on childcare without provincial consent. The feds can give more money or take away money but they can't privatize jack all. Taking away money from the provinces would be political suicide, the CPC isn't going to do that just to force 2-tier.
https://en.wikipedia.org/wiki/Canada_Health_Act"The Act deals only with how the system is financed. Because of the constitutional division of powers among levels of government in Canadian federalism, adherence to CHA conditions is voluntary (enforceable by Health Canada). However, the fiscal levers have helped to ensure a relatively consistent level of coverage across the country."
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