The universal health care system has long been sacred for Canadians of every political stripe. However, the strain placed upon the system during the COVID-19 pandemic has created an opportunity for right-wing governments to challenge this conventional wisdom, seeking to expand private sector involvement in the delivery of health services.

Ontario’s Bill 60, euphemistically titled Your Health Act, which received royal assent last month, is the latest, most aggressive effort to introduce a two-tiered model of health care in Canada.

Given the centrality of universal health care to Canadian civic identity, the Ford government could not depend upon mass popular support to enact its reforms. Instead of compromising on the content of Bill 60, however, the province instead applied an aggressive parliamentary strategy, ramming the bill through the legislature at warp speed and concentrating the authority to implement its provisions in the provincial executive, before public opposition was able to consolidate against it.

In so doing, the Ford government marginalized parliamentary scrutiny and democratic deliberation, pursuing the kinds of authoritarian strategies observed elsewhere around the world, in response to neoliberalism’s declining popular legitimacy.

What is Bill 60?

Bill 60 takes the most significant steps toward the privatization of the province’s health care services in decades, expanding the authority of the province to issue licenses to private contractors for CT scans, colonoscopies, diagnostics, and orthopedics, among other health services.

Opponents of Bill 60 have argued that the expansion of private health care will lead to a two-tiered system that results in a loss of staff and expertise in the public system. It is also likely to lead to “manipulative upselling” for routine procedures that were previously covered by OHIP.

Public opinion sampling demonstrates that, despite the Ford government’s effort to portray the expansion of market options as the lone possible solution to hospital wait times, Ontarians are by-and-large opposed to health care privatization of any kind.

An online poll conducted by Environics, for instance, found that approximately 80 percent of Ontarians believe the government should increase funding to the public health system, rather than expand private access. Similarly, a cross-country poll by Angus Reid in February 2023 revealed that almost 40 percent of Canadians are “public health care purists” who wish to see no private sector involvement whatsoever in health care.

The critical question confronting the Ford government, then, was how to enact a policy that almost no one was asking for, but that it was nevertheless committed to. Put differently, how does a government implement legislation that nakedly serves the interests of the elite, but that is broadly opposed by a majority of the population?

Circumventing the legislature

To achieve its objectives, the Ford government embraced an approach that is consistent with what I have elsewhere called “neoliberal parliamentarism,” which is a deliberate strategy to renovate legislative institutions as a means of overcoming institutional resistance to contentious neoliberal reforms. It achieved this in two principal ways.

First, it granted sweeping power to the executive to implement Bill 60’s provisions through delegated authority, including powers presently exercised only by cabinet. The legislation grants the minister complete discretion to appoint a “director,” or board of directors, who are empowered to classify and establish new private sector clinics, oversee the expansion of existing clinics, and supervise the licensing process.

The director is accountable only to the cabinet, altering the previous requirement that oversight for private clinics always be directed by an employee of the Ministry of Health. This means the director is no longer subjected to freedom of information and financial accountability disclosures required of the public service.

Additionally, by referring to the new private clinics using the deliberately vague term, “integrated community health services centres,” the bill gives the director broad discretion to license different types and classifications of health services to private sector clinics.

Although parliament can scrutinize the activities of the director through the Standing Committee on Procedure and House Affairs, it can only do so retrospectively, and has no direct ability to influence or control their actions.

Second, the Ford government manipulated the rules of the legislature to ram Bill 60 through house procedure at break-neck speed, ensuring it became law before a popular resistance was able to consolidate against it.

Introduced on the first day of the fall legislative session, Your Health Act is an omnibus bill that makes changes to 34 different provincial laws, and dozens of regulations, under the heading of a single bill. The bill was subject to just four days of committee hearings, in which only a handful of speakers were given the opportunity to appear.

Additionally, to secure the rapid passage of Bill 60 through the legislature, the government invoked closure, an extreme measure designed to be used only in the rarest of occasions to break legislative deadlock, on both second and third readings in the house. Closure was not used, in this instance, to bypass a legislative stalemate, but as a pre-emptive measure designed to limit debate.

Ultimately, Bill 60 completed the legislative process in just 73 total days, hardly sufficient time for a meaningful debate about its implications.

Conclusion

The story of Bill 60, then, is not merely about the privatization of health care. It is equally a tale of the reciprocal and necessary relationship between the elite-driven push towards a two-tiered model, and the curtailment of democratic norms.

Given the lack of meaningful popular support for privatized care, the government was forced to design an aggressive legislative strategy, rushing Bill 60 through the house, using closure, and entrenching it as law before meaningful popular resistance could ossify.

By granting czar-like authority to the executive to direct the terms of the bill’s implementation, the government also placed the administrative process beyond the reach of the civil service and the usual channels of public sector accountability.

In this way, the Ford government’s approach to the legislature is consistent with a wider process of democratic backsliding occurring elsewhere around the world, as governments have adapted to neoliberalism’s declining popularity by insulating its reforms in a more authoritarian political shell.

With senior public officials around the country musing openly about health care privatization, Ontario’s Ford government has offered a ready-made legislative blueprint for other provinces considering implementing reforms to universal health care, against the headwinds of popular resistance, to make use of.

Dr. Tom McDowell is an instructor at Toronto Metropolitan University in the Department of Politics and Public Administration. He is the author of Neoliberal Parliamentarism: The Decline of Parliament at the Ontario Legislature.