Page - 449 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

449Privatization and COVID-19: A Deadly Combination for Nursing Homes services, but also from a commitment to shared responsibility, demo- cratic decision-making, and the idea that the public sector operates according to a logic of service to all. The most obvious form of privatization is the move to for-profit  delivery of all or part of a health care service. Canada has a history of private, non-profit delivery of many services, but the consider- able expansion of for-profit delivery for publicly funded services is a relatively new development. This shift has been promoted on the assumption that for-profit provision is more efficient and provides better quality, primarily as a result of competition, and can provide the necessary capital without requiring public investment. These same assumptions provide the basis for privatization through the pro- motion of for-profit  managerial  practices within the not-for-profit and public services that remain. The shift  of  payment  from  the  public  to  families  and  individuals is less obvious. Services are quietly removed from public coverage and charges raised. Care deficits that remain push Canadians to seek pri- vately paid options. As Macarov explains, privatization “is sometimes attained not by outright sales but by deliberately allowing services to run down, by erecting barriers to access, by withholding information and by making receiving benefits so difficult and demeaning that the public has little alternative but to turn to the private sector.”2 It is not only the costs that are shifted, but also the work of provid- ing care when public options are not available or at least available in forms that provide adequate care. Over the last three decades there has been a growing emphasis on what has been called responsibilization,3 a transfer of responsibility for health and care to individuals and some- times their families, often ironically under the guise of “choice.” Along with these processes comes the privatization of decision- making. For-profit corporations are allowed a considerable degree of Privatization:  Women  and  Health  Care  Reform  in  Canada (Toronto: University of Toronto Press Higher Education, Broadview Press, 2001); Hugh Armstrong, Pat Armstrong & M Patricia Connelly, “The Many Forms of Privatization” (1997) 53:1 Studies in Political Economy 3. 2. David Macarov, What  the  Market  Does  to  People:  Privatization,  Globalization  and  Poverty (Atlanta: Clarity Press, 2003) at 7. 3. See, for example, Mike Dent, “Patient Choice and Medicine in Health Care: Responsibilization, Governance and Proto-Professionalization” (2006) 8:3 Public Management Review 449, DOI: <10.1080/14719030600853360>; Gary C Gray, “The Responsibilization Strategy of Health and Safety: Neo-liberalism and the Reconfiguration of Individual Responsibility for Risk” (2009) 49:3 British Journal of Criminology 326.