Bad medicine : trade treaties, privatization and health care reform in Canada
Bad medicine : trade treaties, privatization and health care reform in
Canada / Jim Grieshaber-Otto and Scott Sinclair
Canadian Centre for Policy Alternatives
http://www.policyalternatives.ca/sites/default/files/uploads/publications/National_Office_Pubs/bad_medicine.pdf
Contents
Acknowledgements ........................................................................................7
Summary ..............................................................................................................8
Chapter 1 Introduction .............................................................................17
Chapter 2 Key trade treaty rules and health safeguards ..........21
2.1 Introduction ....................................................................21
2.2 Key provisions, scope and safeguards ...................23
2.2.1
Provisions common to both
the NAFTA and the WTO ................................25
Most-Favoured Nation (MFN) and
National Treatment (NT) rules .....................................25
Rules on public monopolies
and state enterprises ....................................................27
Rules on government procurement ............................28
Rules on intellectual property rights ...........................28
2.2.2
Provisions unique to the GATS .........................29
Quantitative restrictions ..................................................29
Restrictions on domestic regulation ...........................31
2.2.3
Provisions unique to the NAFTA .................32
Restrictions on performance
requirements ....................................................................32
Minimum standard of treatment ....................................33
Rules on expropriation and compensation ..............33
34
CANADIAN CENTRE FOR POLICY ALTERNATIVES
Chapter 3
Examining recent reports on
health care reform............................................................... 35
3.1
3.2
3.3
The Mazankowski Report (December 2001) .......35
3.1.1 Introduction: Proposing radical change ......35
3.1.2 The Mazankowski Report on funding ...........36
3.1.3 The Mazankowski Report on
organization and delivery ............................38
3.1.4 Promoting health care commercialization
and privatization ............................................41
The Kirby Report (October 2002) .............................48
3.2.1 Introduction ...........................................................48
3.2.2 Service-based funding, hospitals and
private, for-profit delivery ................................48
3.2.3 Devolving responsibilities for health
services to regional health authorities ........52
3.2.4 Establishing a “Health Care Guarantee” ......55
3.2.5 Expanding insurance to cover catastrophic
prescription drug costs ...................................63
3.2.6 Expanding public insurance to cover post-
acute home care ................................................65
3.2.7 Expanding public insurance to cover
palliative home care .....................................67
3.2.8 Conclusion ...........................................................68
The Romanow Report (November 2002) ...............70
3.3.1 Introduction ...........................................................70
3.3.2 The Romanow Report’s vision
for medicare .......................................................70BAD MEDICINE: Trade treaties, privatization and health care reform in Canada
3.4
Chapter 4
3.3.3 Sustainability of Canada’s health care
system ..................................................................70
3.3.4 Expanding public health care insurance
coverage to include home care services ...72
3.3.5 Improving timely access to services .............73
3.3.6 Perennial debate: public vs. private ............76
3.3.7 Electronic health records ...............................83
3.3.8 Prescriptions drugs ...........................................86
3.3.9 Globalization and trade treaties ...................88
The Courchene paper (October 2003) ..................90
3.4.1 Courchene’s analysis of the Romanow
report ......................................................................91
3.4.2 Courchene’s analysis of the Kirby report ...94
Hazardous mixture: Trade treaties and health
care reform proposals .........................................................97
4.1 At odds: Trade treaty principles and
Medicare principles ....................................................97
4.2 Flashpoints in the health care reports ................99
4.2.1 Public-private partnerships (P3s) ..............99
4.2.2 Reducing the scope of public insurance
coverage ..............................................................104
4.2.3 Expanding private for-profit delivery of
publicly-insured services ................................107
4.2.4 Expanding private for-profit delivery of
services that are not publicly-insured .......112
4.2.5 More private for-profit health care delivery:
Market-based devolution; health care
guarantee; care groups ..................................114
56
CANADIAN CENTRE FOR POLICY ALTERNATIVES
4.2.6
4.3
4.4
Chapter 5
Telehealth .............................................................116
Unsafe practices: current health policies that
increase trade treaty risks ......................................118
4.3.1 Provincial approaches .....................................118
4.3.2 New federal approach: P3s are ‘in’ ................119
4.3.3 Examples of privatization at the provincial
level .........................................................................125
Looming challenges of even more expansive
trade treaties ................................................................135
4.4.1 GATS negotiations ............................................135
4.4.2 FTAA and other negotiations ........................139
4.4.3 Conclusion ...........................................................142
Towards healthy health care reform .....................143
5.1
5.2
Minimizing trade risks while avoiding
‘regulatory chill’ in health care reform .................144
5.1.1 Expanding Medicare coverage ......................146
5.1.2 Public, not-for-profit delivery ........................147
Relieving pressure on health: changing the
approach to trade treaties .........................................150
5.2.1 Changes to existing treaty commitments..151
5.2.2 Overhauling Canada’s trade negotiating
strategies ..............................................................152
5.2.3 Re-balancing the right to health and the
protection of commercial interests in the
international system .......................................154
Endnotes ..........................................................................................................156
