Heather Whiteside

Unhealthy policy: The political economy of Canadian public-private partnership hospitals

Abstract Public–private partnerships (P3s) with the for-profit private sector are increasingly used in Canada to deliver public infrastructure and support services within the health care sector (e.g., hospitals, clinics, community health centres). This paper examines the emergence and legacy of P3s in the Canadian health care sector, classifying them as a form of neoliberal accumulation by dispossession and discussing their inability to live up to proponents’ promises. Economic and social costs are examined, and examples are drawn from operational P3 hospitals in Canada. The article also briefly examines how P3s have been affected by the recent global financial crisis, arguing that despite serious problems with the private finance component of these projects, ultimately the policy is poised to weather the storm.

Canada’s Health Care “Crisis”: Accumulation by Dispossession and the Neoliberal Fix

Heather Whitesides article, Canadas Health Care Crisis: Accumulation by Dispossession and the Neoliberal Fix, argues for the need to understand the development and transformation of the Canadian healthcare system as part of a broader analysis of capitalist accumulation strategies. Building upon the work of David Harvey, Whiteside critically interrogates how the privatization of public assets and the contracting out of essential services fits into a broader strategy to fix the current crisis of capitalist accumulation. As she points out, one of the consequences of neoliberal reforms to Canadas Medicare system is that it puts into contradiction the guiding principles of an institution developed under the auspices of the Keynesian welfare state.

Austerity for Whom

In contrast to the recent multi-billion dollar bailouts offered to leading sectors of capital, fiscal austerity is poised to make a comeback worldwide. Labour will be forced to pay for the public debt accumulated in the aftermath of the recent global financial and economic crisis. Notwithstanding change and evolution in the neoliberal model over time, this return to austerity is consistent with overall policy in the neoliberal period which can be considered an era of permanent restraint in most areas of social spending. This article examines a variety of trends that have emerged over the past thirty years of neoliberal rule: the various facets of neoliberal policy and their temporal dimensions; as well as the results of market-reliance and spending reforms: growing affluence for a minority of Canadians while the majority lose ground and inequalities are further entrenched. Asking austerity for whom directs attention at the interconnections between affluence and austerity that exist in Canada. n nContrairement aux recents plans de sauvetage impliquant des milliards de dollars offerts aux principaux secteurs de l’economie, lausterite budgetaire s’apprete a faire un retour a l’echelle planetaire. Les travailleurs n’auront d’autre choix que de rembourser la dette publique engendree a la suite de la recente crise economique et financiere mondiale. Malgre le changement et levolution dans le modele neo-liberal au fil du temps, ce retour a lausterite concorde avec la politique globale de la periode neoliberale pouvant etre consideree comme une epoque de restrictions permanentes touchant la plupart des domaines de depenses sociales. Cet article examine une serie de tendances ayant emerge au cours des trente dernieres annees du pouvoir neo-liberal: les differents aspects de la politique neoliberale et leurs dimensions temporelles, ainsi que les resultats du recours au marche financier et de la reforme du controle de la depense: forte croissance dune minorite de Canadiens alors que la majorite perd du terrain enracinant davantage les inegalites. La question « l’austerite pour qui? » dirige l’attention vers l’interconnexion entre l’affluence et l’austerite qui existent au Canada.

The Canada Infrastructure Bank: private finance as poor alternative

Abstract This paper analyzes the incipient Canada Infrastructure Bank (CIB), and argues that it offers, at best, a deceptive alternative to long-standing practices of austerity and privatization. The CIB aims to institutionalize the public–private partnership (P3) model and private finance schemes, reconfiguring public infrastructure as “commercializable” projects, and altering government decisionmaking and its orientation towards public works. Suggestions for actual, progressive alternative sources of revenue, both cheaper and more democratic than private capital, are provided.

Foreign in a domestic sense: Puerto Rico’s debt crisis and paradoxes in critical urban studies:

The 2017 Puerto Rican debt crisis is as instructive as it is sad, reflective of the familiar pressures of late modern capitalism (namely neoliberalisation, financialisation, crisis, and austerity) as well as its own unique dynamics percolating through four hundred years of colonialism and a century of legal subjugation to Washington, DC. Neither one-off explanations of fiscal crisis nor casual conflation with other cases suffice to adequately account for this, or any other, public sector debt crises. Puerto Rico is both foreign and domestic, it is neither state nor municipality but its bonds are treated as such, it reflects larger trends and is circumscribed by its own unique history, subtle economic explanations are matched by bald, large-P politics. Analytical conundrums such as these are confounding and lead to perennial, potentially circular and irresolvable, debate in the critical urban studies literature. This paper explores whether the possibility of using the philosophical notion of paradox – a situation where sound reasoning leads to incomplete, unsatisfying, or unexpected results or consequences – and Zeno’s famous paradoxes in particular, can serve as allegorical heuristics capable of provoking new theories, expectations, or assumptions in urban studies.

Public works: better, faster, cheaper infrastructure?

Abstract Are public-private partnerships (P3s) better, faster, and cheaper, as their proponents suggest? If P3s do not deliver on those promises, how might we explain their perennial appeal? Mutation and malleability have been part of the P3 story since the very beginning. This includes procurement arguments offered in favour of P3s, developments in private finance, and the leading forms of project development. Shapeshifting has, in turn, reconfigured the nature and purpose of public services and works, affecting the ease, possibility, and desirability of returning to the “public” option. Overcoming P3s requires more than addressing issues of profitmaking from public services, a common concern on the Left. It equally calls for addressing how P3s have reconfigured the “public interest” and reoriented state decisionmaking.

The state’s estate: Devaluing and revaluing ‘surplus’ public land in Canada:

Since the mid-1990s, Canadian public real property (land, buildings, and equipment) has been subject to regular scrutiny through bureaucratic procedures aimed at ridding the state’s estate of all ‘surplus’ properties. Surplus is transferred to Canada Lands Company, a state owned enterprise charged with privatizing public land. Bureaucratic devaluation thus allows for subsequent revaluation through multiple forms of state-sponsored remediation: the physical, legal, and financial manipulation of public property by Canada Lands Company. Analyzing Canada Lands Company’s history, role, budgets, and activities, this article uncovers the particular dynamics of how Canadian public land is being privatized through devaluation and revaluation by the state. Two arguments of broader significance for literatures on the political economy of the state and public land frame the discussion: (1) Canada Lands Company’s activities speak to the important managerial role played by the (Canadian) state in the land dispossession process; and (2) Canada Lands Company’s treatment of surplus public land as a financial asset is a distinguishing feature of the Canadian public property management system, setting it apart from elsewhere.

Tarnished Yet Tenacious: Examining the Track Record and Future of Public-Private Partnership Hospitals in Canada

Public—private partnerships (P3s) with the for-profit private sector first emerged in Canada in the mid-1990s and have been steadily growing in popularity ever since. More recently, proliferation since the mid-2000s has been sustained largely through infrastructure projects developed within provincial health sectors. By 2011, P3 hospitals accounted for half to three-quarters of all P3 projects in British Columbia (BC) and Ontario respectively, the Canadian provinces most enthusiastic for P3s (see Partnerships BC n.d.; Infrastructure Ontario n.d.).1 With large hospital re/development in particular, P3s are now the principal way in which these infrastructure projects and their accompanying support services are delivered. While the rise of P3s is a global phenomenon, which is in no way unique to Canada, specificity when evaluating this policy matters. By focusing on Canadian P3 hospitals, we are able to uncover how global neoliberal processes operate at the ground level (in the form of particular P3 projects) and how this unfolds within a specific sector (health care). In so doing it becomes evident that location-and sector-specific conditions shape the implementation of larger neoliberal forces.