I am grateful for the opportunity presented by Marc Baltzan's comments to reiterate the key message of my paper1 on Alberta's Bill 11: the critical point is the future legal implication, not the current economics of health care provision in Alberta.
It is likely correct to argue than no wise offshore entrepreneur would view investment in Alberta surgical facilities as a windfall situation. One can, of course, envisage ways in which the commercially adroit might generate an attractive return through the use of obligatory amenity upgrades and administrative fees or simply by hiring less-qualified, nonunionized staff. But for the time being, only investors with a very long-term horizon are likely to consider such action.
Of far greater relevance than immediate investment returns is the role Bill 11 may play as the thin edge of the globalization wedge into Canadian health care. In that respect there are 3 key points. First, once a specific sector is opened to for-profit firms, under the General Agreement on Trade in Services (GATS) that decision cannot be reversed without potentially insurmountable reparations to the private sector. Second, when a sector of service provision is opened to domestic investment, it is automatically opened to all signatories to the GATS. Third, when a sector is so opened, it becomes subject to the decisions of international trade tribunals and less amenable to the policy direction of elected governments. Economists may view all of this as competitive efficiency, but others will rue the constraints imposed on domestic decision-making.2
Given the above line of argument in my paper, I am puzzled by Elizabeth Hall-Findlay's suggestion that the article was “another thinly disguised attempt to discredit private surgical facilities.” In fact, the paper begins with the thesis that the “two-tier debate has deflected attention from the more arcane and yet immediate concern that Bill 11 will allow international trade tribunals to intrude into our domestic health policy.”1 My paper does not discuss the merits of for-profit facilities.
In the near term, Bill 11 is likely to be relatively innocuous. But it has left open what was previously a closed door. When the timing is correct, I have no doubt that international for-profit firms will be willing to accommodate short-term losses in anticipation of achieving a lucrative foothold in the Canadian health care system through the application of the GATS provisions.