An obscure line in the General Agreement on Trade in Services could prevent Canada from expanding medicare to include a national drug or home-care program, a new report on the implications of the trade pact says.
An analysis by Matthew Sanger for the Canadian Centre for Policy Alternatives says Canada's public health-insurance program is actually covered by GATS, despite Ottawa's assurances to the contrary. This means that any expansion of medicare could trigger legal challenges from foreign health-care providers under GATS.
As a result, the report says, Canada could not institute a national home-care or pharmacare program -- two ideas the Liberals have occasionally considered -- without violating antimonopoly rules contained in the 1994 trade agreement.
International Trade Minister Pierre Pettigrew and his predecessor, Sergio Marchi, have consistently denied that anything in GATS threatens health care.
While Mr. Pettigrew, who was returning from a trade mission to China, was unreachable over the weekend, he said in a recent interview that public services such as health care and education "are not, have not been and will not be on the table," in trade negotiations. Yesterday, trade officials said they could not comment until they read the report.
However, Mr. Sanger, an independent trade consultant who specializes in health and social policy, says that because of little-understood clauses in GATS, Canada would either have to open new health-insurance programs to private-sector competition, or face massive lawsuits from foreign corporations.
"Incredibly, Canadian health insurance is already fully covered under the GATS national treatment and market-access rules," the report says. It is due for release this week, but The Globe and Mail obtained an advance copy.
In negotiating GATS, Canada took the unusual step of listing health insurance as a service to which the full force of GATS market-access rules apply. Mr. Sanger found. Canada also made the commitment binding, meaning that all future government actions in the health-insurance sector are covered by the agreement.
"It kind of belies those categorical assurances we get from the Prime Minister and the International Trade Minister," he said. "Canada certainly hasn't taken the steps it could have to protect public health insurance."
While there is a clause in GATS exempting Canada's health-care system, Mr. Sanger called the exemption "weak and narrow." 6
Mark MacKinnon