Social Rights,Civil Rights,and Health Reform in Canada

This article challenges the conventional wisdom that health programs have been largely insulated from welfare state retrenchment. Health care entitlements have in fact been transformed and diminished, albeit in more subtle ways. Employing rhetorical discursive constructions about the nature of social rights, and capitalizing on passive policy drift, reformists have succeeded in altering the right to health care away from a set of collective obligations and toward the competing claims of individuals. As a result, public health insurance programs are abandoning universalistic principles in favor of a narrower conception of rights that is consistent with and supportive of increased privatization of health care financing. Discursive constructions aimed at persuading target audiences to change their ideas aid and abet systemic and institutional factors, making policy changes seem both necessary and inevitable. Using the case of Canada, I contend that such changes are a form of retrenchment.