The Toronto Star | By Carol Goar | November 3, 2003
Roy Romanow's health-care blueprint is about to be put to its second big test.
It still hasn't passed Test #1.
The Health Council of Canada that Romanow recommended has fallen prey to federal-provincial bickering. Nine months after agreeing to create an independent agency to monitor health spending, Ottawa and the provinces are deadlocked over its mandate, membership and powers.
Test #2 will be even more important.
This month, trade ministers from 34 countries meet in Miami to negotiate the terms of the Free Trade Agreement of the Americas (FTAA). Romanow has expressed grave concern about the impact of globalization on medicare.
He has urged the federal government to "ensure that future international trade agreements make explicit allowance for both maintaining and expanding publicly insured, financed and delivered health care."
Canadians will soon find out whether Ottawa intends to heed his advice.
The early signs are not promising.
Trade Minister Pierre Pettigrew tabled Canada's offer for the FTAA in February. His "draft text" left the health-care sector highly vulnerable to commercial pressures.
The minister proposed that the hemispheric trade pact contain the same wording on health services as the 10-year-old North American Free Trade Agreement (NAFTA).
Now, as then, Canada is asking to have "social services established or maintained for a public purpose," exempted from the terms of the agreement.
Romanow warned in his report that this phrase is too vague, too weak and too limited in scope.
It does not apply, for instance, to health-care services that have already been privatized, such as MRI scans, eye surgery and radiation treatment. This means foreign providers would be free to widen their beachhead in Canada.
It does not apply to for-profit hospitals and clinics. This means that giant American corporations such as Humana Inc. could gain a foothold in Canada's health-care system. Once established, these companies would be extremely hard to dislodge.
It does not apply to services that Romanow would like to see brought into the public health-care system, such as drug insurance and home care. This means the government would have great difficulty expanding medicare. If Ottawa or the provinces tried to move into areas already occupied by multinational companies, they could be sued for damages.
"Provinces, territories and the federal government need to make it clear to our trading partners that Canada's health-care system will continue to be designed, financed and organized in a way that reflects Canadians' values," Romanow urged. "They also should reinforce Canada's position that reform of the Canadian health-care system is not subject to claims for compensation from foreign-based companies."
If Pettigrew has read Romanow's report, there is no evidence of it in his bargaining stance.
He has not instructed Canadian negotiators to draw up a toughly worded exemption, taking the entire health-care sector off the table. Nor has he attempted to shield the government from multi-million-dollar lawsuits by foreign investors with interests in the medical field.
There is still time to strengthen Canada's stand.
Pettigrew could do it at the Miami meeting, which takes place on Nov. 20 and 21. Federal officials could do it after the session. Incoming prime minister Paul Martin could refuse to sign the FTAA, scheduled for completion on Jan. 1, 2005, unless Canada retains control over its current and future health-care system.
Anti-free-trade activists don't believe any of these things will happen.
They think Ottawa is deliberately laying the groundwork to transform Canada's health-care sector into an engine of export growth. That would require a reciprocal opening of the Canadian market.
Unions, churches and international development organizations are mobilizing to scuttle the Miami talks. They have collected more than 54,000 signatures in their "FTAA: It's hazardous to your health" campaign.
Medicare defenders are worried too.
They have watched the hope engendered by Romanow's report fade.
They have watched his least controversial proposal, a national health council, disappear in a federal-provincial dust storm.
They have watched Alberta and Ontario (until last month's election) press ahead with their drive to privatize hospitals, diagnostic services and day surgery.
They have watched federal Health Minister Anne McLellan ignore Romanow's call to modernize the Canada Health Act; overlook his proposal to cover catastrophic drug costs; and pay no attention to his plan to begin building a national home care program.
Most discouragingly, they have watched ordinary Canadians, who found their voices during Romanow's health-care inquiry, fall silent.
Another setback in Miami won't doom Romanow's health-care reform plan.
But it should set off some loud and very insistent alarm bells.
Carol Goar's column appears Monday, Wednesday and Friday.The Toronto Star:
