These discourses are related and the mainstream views are used to justify and in the hands of some seek to even deny the existence of the expanding role of capitalist businesses, motivated fundamentally by profits, who want the production and distribution of healthcare to be determined by them. While economists advocating privatization argue that markets are more effective at compelling cost efficiency than the government can, critics have responded by pointing to the lack of evidence that markets are more efficient in healthcare. In particular, there are many properties of health services that make it unique compared to commodities that capitalists normally produce.
The privatization of public healthcare and other goods and services associated with basic needs such as education and utilities has been part of a general trend of neoliberal public policy. The neoliberal restructuring of healthcare has been occurring in Canada and the U.S. in addition to Britain, taking different forms.
The Patient Protection and Affordable Care Act passed in U.S. Congress in 2010 (or ‘Obamacare’) has survived two U.S. Supreme Court challenges and has to do most with affecting the financing of healthcare and increasing patient access to health services. Obamacare expands the pre-existing system, in which corporations involved in health and life insurance, medical equipment, pharmaceuticals, and so on will continue to play key roles in the delivery of healthcare.
In Canada, the refusal to renew the Health Accord of 2004 last year within the Harper government is a major neoliberal precedent with respect to the public commitment to financing healthcare. Materially, this is playing a role in creating pressure within provincial budgets that invites austerity policies and privatization through expansion of controversial public-private partnerships (“P3s”).
Because the forces seeking privatization are global, the struggle for public healthcare in Britain, Canada, the U.S., and other places has great political potential if these movements unify.
Robin Chang is in the Department of Political Science at York University, where he studies Marxian political economy and is writing his dissertation on the political economy of healthcare in Canada and the USA.