Public purpose, private goal

Globalized trade agreements pose threats for Canadian health care

Access to an equitable and comprehensive health care system is a defining aspect of Canadian citizenship. According to a 2002 report by the Commission of Health Care in Canada, Canadians “want and expect their governments to work together to ensure that the policies and programs that define medicare remain true” to values of “equity, fairness, and solidarity.” The public health system we enjoy today, however, exists in a globalized world. Health services and related industries, from pharmaceuticals to diagnostic testing, are like most other things, tradable commodities.

Relations of trade have come to be defined by multilateral trade agreements that liberalize the trading process through measures such as tariff reduction. One key agreement – the North American Free Trade Agreement (NAFTA) – exists explicitly to guard against the creation of policies that would hamper access to markets between the tri-nation bloc of Mexico, the United States, and Canada. Canada is also a member of the World Trade Organization (WTO) and a signatory of the General Agreement on Trade in Services (GATS), which binds countries to a set of international trade rules. Thus far, certain stipulations on NAFTA exempt “social services established or maintained for a public purpose” from the kinds of regulation other industries are subject to – and certain public sectors can be excluded from GATS’ jurisdiction. This means that at present, our markets are not open to competitiveness from private health care providers. Our current medicare system – one that guarantees a basic minimum, and relatively equal, access to healthcare – is still strong.

However, these binding trade agreements may soon threaten our 70 per cent publically funded health services sector in the future, as policy changes force Canada to comply with rules it had previously signed onto.  Already, the Trade-Related Intellectual Property Rights agreement that all WTO members must comply with has forced Canadian governments to extend patents’ rights – from 17 years to 20 – to pharmaceutical companies. This means that these corporations hold exclusive rights to drugs for longer. With generic drug companies unable to manufacture more affordable alternatives to critical medications, it will become increasingly difficult for governments to afford prescription drug support for their citizens.

Also, changes to health policies that open the marketplace to certain private health care providers – and in turn foreign investment – may subject Canada’s health sector to international trade agreements. The WTO states that, “wherever there is a mixture of public and private funding…the service sector should be open to foreign competition.” Provinces like Alberta, which has already begun privatizing portions of their health services, could be opening a Pandora’s box by “commercializing” health care.

Once one part of health care delivery has been contracted out, American companies wanting a larger slice of the multibillion-dollar Canadian healthcare industry could leverage trade agreements to further penetrate the market. When for-profit health care providers come into place, can the industry really be exempt from trade regulations by masquerading as a “social” service? And when one health delivery service is opened up to competition from private companies, how far behind is the entire system?

Our health care structure is not immune to the influences of an increasingly globalized world. To protect a system that many Canadians value (and indeed, are proud of) requires strategic alliances with other countries and vigilance in ensuring we can evolve our policies without incurring unwanted consequences. Although Canada’s economy benefits from its position as a nation heavily engaged in trade our health care sector on these same global markets threatens a foundational facet of Canadian identity.