Transcript
Speaker: I'm Jane Williams. This is the Red Eye Podcast. You can hear our live broadcast on Saturday mornings from 10 till noon at 100.5 FM in the Lower Mainland.
Speaker: On the podcast today, Alberta's Bill 11 leaves the door open for foreign companies to move into Canada's public healthcare system and be protected by trade agreements. Andrew Longhurst explains how.
Speaker: On March 16th, public healthcare care advocates across the country took part in rallies and news conferences in response to Alberta's new two-tier healthcare law, which allows doctors to practice in both the public and the private system.
Speaker: People are calling on the federal government to enforce the Canada Health Act and stop the expansion of private for-profit services. In early February, we spoke with researcher Andrew Longhurst about the threat that Bill 11 poses to universal access to health care. He warned that Alberta's new law also opens the door to U.S. companies selling private health insurance for basic care. We wanted to explore this issue further with him, so we've contacted him again today. Andrew Longhurst is a researcher with the Canadian Centre Policy Alternatives, and he joins me today from the Sunshine Coast. Hello, Andrew. Thanks for joining us again. Jane.
Speaker: Now, you and Stuart True wrote a recent report for the CCPA that focuses on the threat from trade and investment agreements. And and I was surprised to read that Canada is signatory to over 100 trade and investment treaties. What did those agreements cover, generally speaking?
Speaker: Yeah. So Canada is party many agreements and these tend to cover goods as well as services. Intellectual property really runs across different sectors. So these trade agreements are quite extensive and you know we we tend to talk about A few of them more commonly, like the Canada-US-Mexico agreement, CUSMA, which is the new NAFTA.
Speaker: But there's also others like the General Agreement on Trade and Services with the WTO. So there's a number of them. And there's also lots of agreements that are bilateral between Canada and other countries. And I understand that they guarantee foreign private service firms sort of a broad market access and national treatment in Canada.
Speaker: Yeah, that's right. So many of the agreements include rights that firms need to be treated the same way that domestic firms are treated. And there are exceptions to that. and And those are important when we talk about healthcare and publicly funded social services. In the case of the General Agreement on Trade and Services, this excludes services that are provided in the what's called the exercise of governmental authority. And so anything that's provided on a non-commercial basis or not in competition ah with other service providers is kind of exempted or excluded. And that's really important because it helps establish that there are public services like healthcare that need to not be open to trade liberalization.
Speaker: So public healthcare is exempted because it's run by government. It isn't a business. That's right. So what's the impact of Alberta's two-tier reforms on that?
Speaker: Well, what this legislation does is it really erases the boundary between public health care and private health care or private payment for health care.
Speaker: And as we see the Alberta government introduce a legislation that will encourage health care private health insurance for doctor and hospital services that are covered under the Canada Health Act. It opens the door for private health insurers and other for-profit healthcare firms to move into this space. And that When we blur or we remove the boundary between that distinction, we start to lose what is in, for example, the General Agreement on Trade and Services or GATS, that distinction of in the exercise of governmental authority. And so the more that we lose the definition and the characteristic of public health care in this country being not up for sale or investment, we really start to lose those protections that exist under some of those existing trade agreements like GATS.
Speaker: How could foreign for-profit healthcare providers gain a foothold in the healthcare market here? Yeah, there's a number of ways. The first is that these foreign, they could be U.S. or foreign providers, for-profits, could be U.S. hospital chains, for example. They could seek entry into provincial health systems by bidding on contracts for publicly funded outsourced surgeries, diagnostics, we already have two US firms that are involved in delivering community-based lab services. And so they already have a foothold in that sector.
Speaker: So the ability for them to bid on contract, we see increasingly provinces outsourcing or using public funds to pay private for-profit firms to deliver publicly funded services. So that's one avenue. The second avenue,
Speaker: for foreign and US interests to enter the Canadian market is by offering private health insurance products for medically necessary doctor and hospital services that are already covered under the Canada Health Act.
Speaker: The door is now open wide for that with Alberta's two-tier legislation. You write that Alberta Premier Daniel Smith has already said that she sees government leasing health facilities to third-party operators.
Speaker: That's right. There was a private United Conservative Party event that was reported quite widely in the press. And she stated that she sees the future of healthcare delivery in Alberta, where the Alberta government is leasing publicly owned, ostensibly hospital facilities and other healthcare facilities to third-party operators. And through that, we can assume that these are private, for-profit providers. and you know, this could very likely be the way that US or foreign corporations expand and gain that foothold into the provincial health system. And by that pathway into Canada by way of Alberta is a way that they will have protections under international trade agreements that make it very difficult for us to regulate them. and for us to ultimately get them out of the country should the Alberta government want to do that and risks them also moving into other markets across the country.
Speaker: You mentioned a couple of US corporations already involved in the healthcare care sphere in Canada. Would we be familiar with those names? Yeah, so I think folks in BC will be very aware of LifeLabs, which is owned by a New Jersey publicly traded company called Quest. And then there's also Dynacare, which has more of a presence in other parts of the country.
Speaker: It's owned by a North Carolina company called LabCorp of America. And then there's another company that's involved in blood collection and paid plasma collection, and that's called Griffles. And it's received quite a bit of attention in in recent days following two deaths of individuals who donated on a paid basis plasma in their clinics in Manitoba.
Speaker: So, you know, we already have... US s and international firms invested and entrenched in this country, and I think it would be a big mistake to see more involvement.
Speaker: When you talk about the possibility of private health insurance products being offered for medically necessary doctor or or hospital services that are insured under the Canada Health Act, how could that happen? How could that start to happen?
Speaker: Well, what the legislation in Alberta does is it allows for a private health insurance market for those services that are right now we expect to go to the doctor's office to go to the hospital and we don't walk away with a bill for tens of thousands of dollars.
Speaker: under Alberta's Bill 11, the legislation that has created two-tier healthcare in that province, that all changes. And so what we are anticipating and and kind of the direction of travel in Alberta is that insurance companies would likely... start to target their insurance products at large employers and public sector unions, where there's the largest market to begin with. And keeping in mind that in this country, we already have a very significant health insurance market for extended health benefits. These are employer-sponsored plans. And again, the market within the public sector for public sector employers and unions is quite significant. About two-thirds or so of Canadians already have extended health care through their employer. And so adding private coverage for workers to obtain public
Speaker: faster access queue jumping insurance for elective surgeries and diagnostics for example would be i think the way that this market will be built and so it is foreseeable that those private health insurance companies would try to gain a foothold through that first and then to probably start selling individual insurance products to individuals who are not covered under a ah large public sector collective agreement and selling those private insurance products to individuals who don't have that employer-sponsored private health insurance.
Speaker: So walk me through how if we have that situation, it's easy to imagine how that could happen. How then do the trade agreements come into things? That's right. So what that means is that once they are invested and there is a market to be selling these products, they benefit from protections under the trade agreements that grant foreign investors the power to sue government for actions that may affect their private investments. And this mechanism through which this happens is called the investor state dispute settlement mechanism. And
Speaker: Thankfully, it was taken out it was included in NAFTA, but it was taken out of KUSMA, so the successor to NAFTA, because the Canadian government and provincial governments were often being sued for millions of dollars by different investors. So it was good news to see that removed out of KUSMA. But it still exists in a number of bilateral agreements. It exists still in other trade obligations that we have with other countries. So the risk there, to be clear, is if these companies, these foreign investors, these foreign you know private health insurance companies, for example, are invested in Canada,
Speaker: And then provincial or federal governments start to want to regulate them in the public interest to protect patient safety, to maybe even try to get them out of the market entirely.
Speaker: The risk is that depending on the trade agreement that they would be covered under, they could sue either provincial or the federal government because their profits are being threatened.
Speaker: And so it would really put a chilling effect on provincial and federal governments if they want to try to remove or get rid of these firms once they are invested in the country. So I think what it speaks to is the importance of stopping this from happening before it does, because once they are in the country, once they have investment interests, there are trade protections that they will be able to access And it raises a lot of concerns about whether we start to lose control over our public health care system.
Speaker: At this geopolitical moment, I can't really think of something that is more Canadian than public health care in this country and and that access is based on need and not ability to pay.
Speaker: Some people have said that this is all very speculative, but you say that the evidence demonstrates that it's not. What evidence are you looking at there? Well, we have had past threats to the Canada Health Act under that investor state dispute settlement system, where the Canada Health Act was put into question when an investor in 2009 wanted to sue the federal government because they felt that they weren't able to open private pay clinics in Vancouver and Calgary.
Speaker: The case was ultimately dropped. But what it did is it really has, i think, made it very real. The other way that we know that this is not speculative, this is no longer far-fetched, is in 2023, I published a report with the Canadian Centre for Policy Alternatives called At What Cost?
Speaker: And in it, I documented a large US healthcare investment advisory firm that was contacting a number of different stakeholders across the country, including our provincial health coalitions that are citizen advocacy organizations that do work to campaign to protect public health care in their province.
Speaker: And this US investment advisory firm was really trying to size up the nature and scope of the market for outsourcing of surgeries and diagnostic procedures. So they were probably trying to put together an investment profile to be able to pitch this to investors in the United States about the potential for profit making in provincial healthcare systems as a lot of provinces were and have been pursuing greater outsourcing or publicly funded for profit delivery of surgeries. So we know already that their interest has been piqued. And I think it raises a lot of concerns about what Alberta is doing now, which is a dramatic opening of the door to investment interests, should they look to that province to invest. So it's no longer speculative. It's not far-fetched. And I think the bigger question too here is,
Speaker: Do we want to start losing both our political and economic sovereignty to the United States by way of our healthcare system? And I think, you know, when we hear the prime minister talk about elbows up and talking about strengthening the a Canadian economy,
Speaker: Our public health care system is foundational to our sovereignty. The care economy is also represents about a fifth of jobs in our country. So to not include our public health care system in this discussion is naive at best. And I think it's a really concerning development in Alberta, but we need to protect and preserve what we have and make it better.
Speaker: Does the Kearney government appear to be concerned about the broader implications of Alberta's Bill 11? Well, as you mentioned, we had a National Day of Action across the country earlier this month, and it was to break the silence on Alberta's two-tier legislation and call on the federal government to stand up for the Canada Health Act and for public Medicare. And while we haven't heard the Prime Minister speak directly to the two-tier legislation, we did hear in Vancouver, Member of Parliament, Hedy Fry, who spoke at the event. And she was very clear and unequivocal that she believes that Alberta's legislation is contravening the Canada Health Act. It's antithetical to public health care in this country. So we are starting to hear from some within the federal liberal caucus that they want the federal government to stand up. But we really need a clear and unequivocal message from the federal health minister and the prime minister to stand up for public health care before it's too late.
Speaker: Well, thanks so much for speaking with me, Andrew. It's been my pleasure. Thank you, Jane. Andrew Longhurst is a senior researcher with the Canadian Centre for Policy Alternatives. The report that he co-wrote with fellow researcher Stuart True is titled, Do Trade Deals Put Public Healthcare Up for Sale? And you can find it at policyalternatives.ca.
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Speaker: I'm Jane Williams. Thanks for listening.
