Re-Mapping Policy Space: Understanding the Intersection of International Trade Law and Domestic Health Policy in Canada

Abstract

Debates about the impact of international trade agreements such as the WTO General Agreement on trade in services (GATS) and the North American Free Trade Agreement (NAFTA) on health care usually focus upon the scope of exemption clauses for public services, such as the GATS Article I:3 or the NAFTA Social Services Annexes I and II. But much of the discussion seems to suggest a simplistic division of policy space into "covered" (governed by international rules) and "exempted" (pure domestic policy space, business as usual). The assumption is that we need to wait and find out how international trade tribuanls adjudicate the issue: if exemption clauses are interpreted fairly broadly, domestic space is correspondingly large and unaffected by international trade. It is aruged that this view is simplistic and naive. Trade agreements function as a conditioning framework for health care, largely because of the direct relationship that exists between markedt elements in public services and the degree of exposure to international rules. This is expecially important in the area of health care because of the trend toward market-based health care reform. Such a policy space demonstrates both the unavoidability of globalization and the continuing importance of the nation state, and potentially exhibits some distintictively new policy dynamics.