Health Services: Public or tradable services? By Mariarosaria Iorio, International Political Analyst
health, trade, social justice, development, economy, tradable goods
Winners from the neo-liberal credo, mostly corporations and multinationals succeeded in propagating the idea that the market needs little or no regulation as it can regulate itself through the Invisible Hand . According to this vision of the world, global wealth would automatically cascade to the vulnerable groups, including women through the opportunities provided by the market.
The adoption and the implementation of this neo-liberal credo limited governments’ policy space both locally and globally. As a result, governments reduced dramatically their roles as guarantors of social justice as well as redistributors of economic wealth , including through public health care provision.
As a result, positive obligations of governments as duty-holders in charge of the protection and promotion of their populations’ well-being were voluntarily reduced. At the same time, domestic regulation was thought to be mostly oriented towards either protecting or opening markets. The market-based approach and the subsequent withdrawal of states from right-based domestic regulation further shrank the chances for health care for all worldwide.
The Market became the regulator of both economic and social development globally and locally. These political choices weakened the capacity of national authorities to take appropriate regulatory actions to guarantee access to health care for all. The neo-liberal paradigm contributed therefore in increasing invisible barriers for the most vulnerable groups to access health care services worldwide. Gaps in opportunities between men and women and between a wealthy minority and poor majority increased over time. As the market role in the political and social policies discourses increased, the scope of action to guarantee access to health services decreased.
By opening essential services to the private investors, national policy makers created two-speed health care systems, one for the wealthy minority and one for the poor majority.
Furthermore, lack of protection of national strategic and essential sectors resulting from structural adjustment programs and disengagement of the States from public services management have set a negative trend in providing health care for all.
A clear separation should be kept between commercial and social services sectors, including health care. The main objective of national regulatory frameworks shall be egalitarian development policies and distribution of wealth through access to health care services for all.
Economic and trade regulatory frameworks are to ensure balance of power among the different economic actors. Such frameworks shall be based on the principle of social justice.
To achieve such goals the strengthening of the State capacity to formulate and implement progressive development and social policies is a prerequisite without which commercial interests of a few will prevail over economic justice and equitable redistribution of wealth for the majority of the peoples.
The market-based approach based on the equilibrium between the offer and the demand of products and services cannot be applied to health care public services. Health care should not be a tradable service. Health should not be marketable but rather be considered as a common good of societies. In this perspective, the health care services must be provided free of charges.
A rights-based domestic regulation rather than market-based regulation is therefore fundamental to guarantee free access to health services for all. It is also a tool to effectively respond to the needs of vulnerable groups to face economic shocks.
The current global economic system is no doubt full of contradictions and inconsistencies that result from the focus on short-term rather than long term policies as well as from the wrong assumption that global wealth and economic development would automatically benefit all.
The market-based approach has proved to be in contradiction with a rights-based approach of policy-making at the national level. A right-based approach would put human development of the majority at its heart. Putting the human well-being at the centre of development is necessary to concretely work towards more egalitarian and equitable societies nationally and internationally. Access to health care for all is a prerequisite to development worldwide.