 So, good afternoon everyone. Welcome to our Health Law and Policy Seminar series. I'd like to begin by acknowledging that we are gathered today in the ancestral and amnesteeded territory that they want people and to give thanks for the opportunity to be here. My name is Joanna Erdman and I'm the Associate Director of the Health Law Institute. And this is our last seminar for the 2017-18 academic year. And this year we've been really celebrating the interdisciplinary nature of the field. So looking to the different theories and methods of health law and policy, our presenters have come from many different fields of its practice. And today it's my great pleasure to welcome a longtime friend, Professor YY Chen from the University of Ottawa's Faculty of Law. YY is a lawyer and social worker by training and so he has intersectionality right in his very self. But it also translates into his research program in quite a unique way. So the methods he uses, action research and community engagement, the legal fields he occupies, health and immigration law, and the health inequities that he studies at the intersection of migrant health, race and marginalization, and social citizenship and belonging. And indeed YY and I worked together quite closely last year on the fifth edition of the new textbook, which is Canadian Health Law and Policy. And I really want to note YY's contribution to this textbook. He wrote the chapter on social determinants of health and marginalized populations and why his contribution is so significant is because this is the first time ever that the textbook has had a chapter on social determinants of health and marginalized populations. So it's a really unique contribution and it's something quite exciting for the field. So please join me in welcoming YY to present on the challenge of migration and health care solidarity in liberal democracies. All right, good afternoon everyone. It's a real pleasure for me to be here today. Adele, actually this is the first time I've ever stepped foot Adele. So it's fantastic. I have for a long time admired the vibrant health law program here from afar. So it truly is an honor for me to be here today and I'm grateful for this opportunity to share some of my work with you. And just before I start, I want to thank Joanna and the organizers of this seminar for giving me this opportunity. All right, so the topic of my presentation today touches on the concept of health care solidarity. So I came to this topic as part of my ongoing work that tries to untangle the normative debate around health care entitlement and access for international migrants. As someone that has closely followed that debate about whether or not and to what extent we should afford migrants health care, publicly financed health care. I keep seeing this notion of membership and solidarity popping up in that discourse. Most often it has been used as an argument to limit migrants health care entitlement. So I don't know how many of you have seen or remember this. So this is a flyer that was sent out by Saskatchewan MP, Kaylee Block, a few years back when the federal government significantly scaled back the public health care coverage for refugees and refugee climates. And so the flyer was entitled, Working Hard for You. And reads in part, quote, New arrivals to Canada has received dental and vision care paid by your tax dollars? Not anymore. And so underlying this message to me anyway is a clear sense of us versus them. As the argument goes, health care is a resource reserved for us, being members of the Canadian society, and migrants are not such members, or at least not yet. And this lack of membership somehow justifies their exclusion from our health care program. At the same time, a bit less frequently, we do see membership and solidarity-based argument being advanced by those positioning themselves on the other side of the debate. So going back to this example of when the federal refugee health care program was cut in 2012, as many of you know, the policy change was met with strong opposition led by health care professionals. And they have organized protests across the country. So let's take a look at this placard spotted one of these protests. So it reads, Stop Cuts to Refugee Health Care. Canada is a country of immigrants. Now to me, this notion of Canada being a country of immigrants is a membership-based argument. A broader concept of membership than we saw being portrayed in the previous slide, but a membership-based argument nonetheless. The idea here is that if we understand the Canadian society in a certain way, then the scope of what constitutes us should probably encompass newcomers. And so these different conceptions of membership, in my view, suggest the fuzziness of the notion of membership and solidarity, at least in the health care context. And without first clarifying what exactly is meant by us when we use the word membership, solidarity, and so on, I think it is difficult to have a meaningful debate around whether migrants are or not part of the solidarity that anchors our health care system. And so that is the subject that I'd like for us to explore today. Clarifying the nature of solidarity in health care context and in turn, considering how migrants may be positioned in relation to such health care solidarity. And so with that in mind, my presentation will proceed as follows. So I will first explain the concept of solidarity and it's linked to health care. So here I'm hoping to convince you that solidarity plays an important role in our system of health care resource allocation. As such, solidarity-based arguments relating to whether migrants should or should not be included in our health care program merits our attention. Next, I will put forth several ways that health care solidarity could be conceptualized and propose to you that constitutional patriotism as opposed to nationalism or cosmopolitanism best explains health care solidarity as we understand it today in Western liberal democracies. And finally, I will conclude by considering what the implication may be for migrants if I'm right that health care solidarity in liberal democratic states such as ours is at present best conceptualized in constitutional patriotic terms. And so the main point that I'm trying to make is this, right? Even if we follow a membership and solidarity-based argument, which again has most often been used by those seeking to limit migrants health care coverage, the way that membership and solidarity is generally understood in liberal democracies today will in fact necessitate us to extend health care entitlement to more migrants than we have typically done. That is, there are some migrants that are currently part of our health care solidarity but have not been recognized as such or has not been treated as such. And this I suggest to you is unjust. So I'll just make one more comment before I dive into my presentation. So I understand that the term migrant can be understood differently by different people. So for my purpose here today, I'm using it to mean anyone that has moved from one country to another and that their stay in that receiving country is more than transitory. And so this would include immigrants, refugees, people who are in the country for a substantial period of time while holding temporary legal statuses or no status at all. So those are the people that I'm referring to when I use the word migrants. And so in other words, I'm using the word migrants as an umbrella term today, mostly just for convenience. Although I do recognize that many people have argued that refugees and migrants should perhaps be distinguished in our use of the term just because of the different nature of their migration. But again, I'm just going to use the term migrants today as a catch-all phrase. So with that in mind, let me now briefly flesh out the concept of social solidarity and it's linked to health care. So in a nutshell, social solidarity refers to a form of group identification that is capable of inspiring non-calculating cooperation among group members. So it embodies both a feeling of togetherness and an active commitment by people to working together for a common cause. According to Emil Durkheim, solidarity can be generated in multiple ways. So it can be generated when people find themselves in the company of other people that share similar traits or when people collaborate with one another in a common project. And so this notion of solidarity is often linked to the pursuit of universal health care coverage. For example, as you can see on this slide, in the Canadian government's 2016 report to the parliament regarding the Canada Health Act, it was suggested that the Canadian health care insurance system is undergirded by these values of equity and solidarity. And similarly, if we look across the Atlantic Ocean, if we look at the Charter of Fundamental Rights of the European Union, Article 35 of that Charter guarantees everyone a right to health care. And you'll find that that article was placed under Chapter 4, which is entitled Solidarity. So what exactly is the role played by solidarity in universal health care? Today, although there are notable holdouts, the prevailing view is that the achievement of universal health care coverage entails significant state-imposed reallocation of resources and responsibilities from the rich to the poor, from the healthy to the infirm, the able-bodied persons to individuals living with disabilities, and from the relatively young to the elderly. Now such state-imposed reallocation of resources requires justification. Otherwise, it appears, at least prima facie, to be in tension with personal autonomy. Now one role that solidarity plays in the context of health care is to contribute to the legitimacy of mandatory health care redistribution. It does so by promoting individuals to agree to forego their immediate advantage for the sake of meeting the needs of other people. And as communitarian theorists such as David Miller would argue, without such solidarity there's little obligation on people to help out a complete stranger, perhaps except in cases of emergency maybe, or if somehow we have caused the stranger's plight. And therefore, generally speaking, the extent of health care redistribution must coincide with that of social solidarity. Mandatory redistribution that goes beyond the reach of solidarity will require additional justification for it to be legitimate. And redistribution that comes short of the scope of solidarity unjustly excludes individuals that have made sacrifices so as to enable that distribution of resources to happen in the first place. But what are the boundaries of health care solidarity? So the answer to that question I think depends on the nature of such solidarity. That is, if we can figure out what give rise to health care solidarity, then we can start to delineate how far that solidarity goes. And so a review of literature suggests that solidarity can stem from at least three sources, right? Nationalist identification, cosmopolitan worldview, and constitutional patriotism. Now each of these accounts of solidarity understands solidarity's boundaries differently. And so the task in front of us then is to analyze which of these forms of solidarity underlies universal health care system like the one we have here in Canada. This in turn will allow us to assess who should properly be part of our health care solidarity, therefore our health resource allocation. And to what extent migrant should be included in that resource reallocation. Okay, so now let me say a few words about how I analyze the nature of health care solidarity. That is, how do I choose from among these three concepts of solidarity that I have presented to you for one that best anchors universal health care system. Now first of all, as the title of my talk today suggests, I limit my analysis to health care solidarity in Western liberal democracies. I'm cognizant of the fact that countries of a different political tradition may well conceptualize membership in different ways. Moreover, countries around the world exhibit a wide range of income levels which impact on the extent of health care that can realistically be provided publicly. Irrespective of concerns about solidarity. So the precise question that I'm wrestling with is then as follows. So how do Western liberal democracies understand the nature of health care solidarity that binds their respective citizens? Now in terms of the actual process that I take to answer that question, my point of departure is what I observe as this near consensus among Western liberal democracies, which says public health care coverage should be made available to all resident citizens who cannot afford to pay privately. Now obviously the United States is a clear outlier to this international trend, but putting the United States aside, every other Western liberal democracies now has some form of national program that aim at ensuring adequate health care coverage for all resident citizens. Now this policy agreement I think allows us to use it as a benchmark for testing the various conceptions of health care solidarity. That is a valid account of health care solidarity must have the capacity to at least properly explain that status quo. As such the nature of inquiry that I'm pursuing here is more positive than normative. So my objective is not so much to articulate a theory of health care solidarity that should exist in Western liberal democracies. Rather I'm interested in identifying the form of solidarity that best explains the current arrangement of health care redistribution in Western liberal democracies. And what this current form of health care solidarity says about the extent to which migrants can or cannot be seen as part of us. So what I will do now is to just go over each of those three accounts of solidarity that I've presented to you and assess how well they can explain this policy consensus among Western liberal democracies that says health care resource redistribution should involve at least all citizens. Now ultimately as I've already identified for you, my conclusion is that constitutional patriotism best explains the type of solidarity that is needed to support such ubiquitous inclusion of residents and citizens in our health care system today. And so the first form of solidarity that I'm going to examine is nationalist solidarity. I trust that the various theories of nationalism are going to be familiar to many of you. Central to the nationalist doctrine is this concept of a nation. And that nation supposedly consists of a group of individuals who come to identify themselves by certain common identities and believe that because of that common identity they ought to associate with one another more closely than humankind in general. And in this sense the commonality shared by co-nationals is what I would call pre-political. It is what gives rise to nation-states. So it happened before nation-state. And therefore it's relatively fixed. It's the foundation to a nation-state. Any newcomers wishing to be considered a co-national must adopt themselves to this fixed shared identity of that nation. Now of course there are different versions of nationalism and they characterize the common identity of a nation differently. So for example ethnic nationalism sees co-nationals as a homogenous group that's distinctive in terms of their cultural and linguistic backgrounds. And that group is attached to a homeland and share a common lineage much like an extended family. That's ethnic nationalism. On the other hand liberal or civic nationalism characterizes common identity of a nation in terms of some shared value. But whether it is shared ethnicity or shared values the common national identity proposed here supposedly give rise to a solidarity, a bond between co-nationals. And is generally accepted by theorists that such nationalist solidarity indeed has that sufficient strength to legitimize and facilitate sustained redistribution among individuals that come within its ambit. And in fact if we look historically that seems quite plausible. We see that national ties can motivate individuals to accept even much greater degree of self-sacrifices than agreeing to mandatory resource redistribution including going to war. So can nationalist solidarity explain the system of healthcare that exists in western liberal democracies where coverage is extended to all resident citizens? Now I'm of the view that while nationalist solidarity may have the thickness to motivate healthcare redistribution it along lacks the necessary reach to justify the inclusion of all citizens of the modern western states in such redistribution. Contemporary western liberal democracies are increasingly if not already multinational or multicultural. And this in my view poses a problem for nationalism as an explanation for our current healthcare arrangement. This is particularly the case in countries that consider themselves multinational namely consisting of more than one nation. So nationalist solidarity by itself says nothing about how solidarity can be generated across these different national groupings. And yet even in these multinational states such as Canada, Belgium and Switzerland we see healthcare extended to all citizens across that national divide. Now what about countries that are multicultural? Could nationalist solidarity underpin healthcare resource redistribution in those countries for all citizens? Well I think it depends. In my view an ethnic version of nationalism would have a hard time explaining the apparent healthcare solidarity that's across citizens from different ethno-racial backgrounds. But even if we adopt the civic version of nationalism that rests on shared values in a pluralistic society I'm having some difficulty identifying just what values could serve as that glue, that binds, that unifies that large group of people together. Now of course there are going to be some more universal values such as equality, right, liberty and so on that could be shared by co-nationals. But as we start to rely on these universal values as an anchor for solidarity I would suggest to you that that account of nationalism starts to look very much like what I would propose to you as constitutional patriotism. And in fact in my view constitutional patriotism provides a much more robust account of how such universal values could actually generate sufficient solidarity among citizens of a state. So based on those reasons I think a nationalist account of healthcare solidarity falls short. And next I'm going to turn my attention to cosmopolitan solidarity. So at the heart of cosmopolitan solidarity or at least cosmopolitan philosophy is a notion of the world as a community made up of all humankind. And what unites us all is our human nature, right, namely a set of universal concerns that typify human experiences. And that would include for example our bodily needs, our capacity to experience emotions, our ability to reason and our inclination to distinguish between what's right and what's wrong. And out of all this shared humanity it is said that we develop a sense of solidarity with one another. Now many proponents of immigrants and refugees public healthcare coverage have adopted this cosmopolitan view on solidarity. So sometimes this is framed in humanitarian terms which zero in on the hardship associated with ill health is something that all human beings can relate to. And therefore we should try as much as possible to try to help people avoid that hardship. Others have couched their cosmopolitan ethics in terms of human rights and stressed the entitlement of all human beings to timely and appropriate healthcare as essential to the protection of human dignity. Now such cosmopolitan solidarity, if it actually exists, clearly has that potential to explain universal healthcare program, let alone for citizens in western liberal democracies. Now as much as I wish that were the case, however I think it is not a stretch for me to say that whatever pen human consciousness that we currently have, it lacks the strength or thickness to qualify as a proper form of solidarity. At this moment the communal feeling in the global context is quite weak I would argue, especially when compared with more particularistic ties that individuals also form with one another on the basis such as kinship, religion, nationality and so on. And so nowhere perhaps is this more discernible than the I guess personally I would say disappointing responses taken today by countries around the world in response to the ever growing number of refugees from around the world. And solidarity among countries appeared difficult to come by. And so what this shows to me anyway is that rightly or wrongly domestic interests currently remain much more determinative than the sense of pen human camaraderie when it comes to government decision making. As such I do not believe that cosmopolitan solidarity is a viable explanation right now anyway for the level of healthcare redistribution taking place in western liberal democracies. And so finally I turn my analysis to the theory of constitutional patriotism. Now unlike its nationalist and cosmopolitan counterparts, constitutional patriotic solidarity I argue has both the reach and the intensity required to explain the liberal democratic healthcare policy consensus. This is all because constitutional patriotic solidarity mediates between nationalist and cosmopolitan solidarity. Essentially what the theory of constitutional patriotism seeks to do is to marry a shared attachment towards some high level universalistic principles with the actualization of these principles in the form of particular national institutions. So like nationalism constitutional patriotism is admittedly particularistic. That is it refers to loyalty to and camaraderie within a bounded political community right instead of all humankind. This allows constitutional patriotism to generate that kind of solidarity to maintain a level of robustness right that is not to water down. But unlike nationalism constitutional patriotic solidarity is not anchored by some shared personal traits or common values among community members. Rather that solidarity right that bond between people stems from a shared constitutionally guaranteed practice of deliberation and policy making. In which people recognize each other as free and equal participants. So to put it differently what binds constitutional patriotic I guess individual or subjects together right it's a set of procedures and the attendant institutions through which individuals can collectively generate representations of their identity. And so in my view this procedural turn is what allows constitutional patriotic solidarity to move beyond the constraint of identity politics and extend universally across all members of a polity. Now you might ask well just how does this set of abstract procedures generate loyalty and particularistic attachment. Well according to constitutional patriotic theorist solidarity comes about when the processes and institutions of deliberation unfold within a specific context. That is the form right and sometimes the outcome of democratic deliberation controversies and disagreement will be shaped by historical context institutional arrangements. And legal traditions among other things which are all specific to a country. So for example contemporary debate about and the struggle for ethnoracial equality in Europe may be more nuanced by the legacy of Holocaust. Whereas similar discussion in North America may be more underscored by the history of colonialism and slavery. Right so because of that historical context even though we're talking about perhaps a similar set of deliberation and principles it unfolds in a different way. And it is this way of constitutional patriotic deliberation right that gives it specificity right it gives its particularistic nature. And so despite the fact that it has broader scope than nationalistic identities it's still able to command the self-sacrifices of member of a particular state. And so in other words the willingness of citizens to share healthcare resources among themselves. I argue right at President Enway is primarily inspired by this recognition of one another as equal participants in a continuous process of deliberation reflection and adjustment. Which contribute to a collective constitutional culture. So having settled on constitutional patriotism as the source of healthcare solidarity in western liberal democracies I argue that any migrants that can be said to partake in society's deliberation. To also be granted entitlement to publicly funded healthcare much like their citizens counterpart. And so in making this claim I want to highlight that migrants participation right their participation in society's deliberation can take a wide range of forms beyond political participation in its strictest sense. So clearly many migrants cannot vote in elections. And if we restrict our understanding of what accounts as participating in democratic deliberation to voting alone then migrants would seem to fall outside of our healthcare solidarity. But it is important to know that migrants are not incapable of voting right. Many newcomers to Canada would be readily take part in that franchise if given an opportunity right. So it is that they are denied the right to engage in that institution. Now in the meantime the lack of right to vote has not stopped migrants from partaking in discussions and debate. And they do so right with the view to shape the policy directions of our society through personal interactions, community events, volunteering, participation in organizations such as labor unions and so on. Many migrants are actively taking part in the dialogue right that shape our policy decisions. Now if you just do a quick scan of newspaper headlines it will yield plenty of examples. Right here we see a group of refugee youth sought to tell their stories by creating an online magazine. And then here is a news article about events that's being organized in Victoria BC where refugees and indigenous communities try to learn more about each other. And then here are a couple of examples where refugees sought to give back to Canada right by donating their blood, their time and so on. And so my point here is not that migrants should be considered part of us because somehow they have contributed to our society. I mean yes it's important to recognize migrants contribution which is often lost in our migrant health care debate. But what I'm trying to make, the point I'm trying to make here is a little different. What I mean to convey here is that there are different ways that migrants seek to voice their views. And these examples of giving back to Canada are just another way that migrants express their perspective and take part in the democratic discourse. Ending so far is such participation in the deliberative process is what anchors our present day health care solidarity. I argue that a case can be made to extend health care entitlement to more migrants than we currently do in liberal democracies. So that's where I'll conclude. Thank you very much. Thank you very much. So we have lots of time for questions and conversations. It was really fun to think through this idea of access to health care terrible on a demonstration of participation in the polity. And thinking about how radical that is as a way from the bottom up to ground or who gets health care and who doesn't, that's tied to participating in democracy. But I guess I wanted to invite you to think through it even more in terms of how it might be institutionalized. Because what I worry about a little bit is that if it becomes an empirical or fact-based question about how much you're participating, even though as you ended on a very sort of inclusive or broad definition of what participation might look about, when I think about it being institutionalizing the existing structures that we have that are involved in even people's status as our people are lost, that fact-based inquiry I can see is working quite in the opposite direction. Only this level of participation will count and without that your health care access is quite limited to not entirely. So when you think about institutionalizing this kind of project, do you have worries along the lines of suggesting or what's your counter to that? No, I definitely agree with that concern. And I think generally speaking that's a concern whenever we adopt a more membership-based kind of argument. So all this discussion about health care solidarity by nature is a membership-based argument. Anytime we want to kind of decide who's member who's not, whether it's based on participation or by some other ground, they're always going to come to a point where someone is going to be left out. And so I do recognize that's potentially an issue, especially if we institutionalize that. So the point I'm trying to make here is now that this should be the only ground that anchors our decision-making in terms of who should get health care and who shouldn't. What I'm trying to do here is a more kind of a modest proposal, which is to say that there are people who are trying to use this membership-based argument to kind of exclude migrants from health care access or entitlement. And I'm trying to say, well, even if we follow that line of thought, more people should be covered under our health care than it's currently or most often being perpetrated to cover in terms of the scope. But there are going to be other normative underpinnings as to why we should provide health care to some people, other than membership-based argument, human rights being one of those, humanitarianism and so on. There could be also policy reasons that looking at economics and so on. So I do recognize that fear, but I think that's an inherent problem with membership-based argument in itself. Just a couple things. In terms of your account of constitutional patriotism, you've all described the process as sort of a context piece, but you didn't talk much about what you're referring to as universalist values, maybe a little more elaboration on that than one thing. The other, the account that you're favoring, you talk about dialogical discourse, that participation, I guess a potential participation of migrants. And I'm thinking that if you break the migrants down into the powerful and the powerless, in terms of financially and whatever, there's a huge segment of migrants that don't participate, you know, empirically in deliberate discourse, they just don't have the power to do so. What does that do to your account? And the last piece could be just, does this account that you're providing in your part of your preference, does it provide a better account than simply adding human rights and also equal moral worth of all persons? Is it framed as that or this? How does it come up? So in terms of your question about the role of universal values that's doing in the constitutional patriotism theory, essentially the idea there, what we're talking about usually in terms of liberal democratic states, we're talking about values, as I mentioned, equality, liberty and democratic participation. So those are kind of the general values that we're referring to. But what constitutional patriotism is saying is that solidarity doesn't generate, doesn't come out from those very broad principles. It's how those principles get translated through institutions in that deliberative process. And so it's that procedural turn, as I mentioned, that anchor of solidarity. But just to answer your question, so that's the values that we're looking for, really quite kind of high level values. In terms of your two other questions, let me answer your last question first, which is how do we, whether or not this account of, in terms of basing healthcare coverage on solidarity, how does that compare to accounts such as human rights and equal moral worth? I think, again, I think those two approaches are, they're simply different approaches. I don't necessarily think that they exclude one another, even though you're right. So in terms of membership-based argument, as I kind of alluded to when I was explaining to Matthew's question, there's always going to come a lot that you just have to draw with who's part of us and who's not. But I think there's always ways for us to kind of expand that line as far out as possible to include as many people as possible. But the idea is that within that boundary, there is that equal moral worth. And so part of what this membership-based argument can do is to add to the human rights argument by clarifying who's responsible for providing healthcare. So we understand that, yes, based on human dignity arguments, everyone is entitled or has the right to health and part of that is healthcare. But at least internationally, it's not very clear in terms of our international human rights norm. It doesn't really say a whole lot about who's responsible for meeting those rights. And so a lot of times what we see is in receiving society, you will have countries that say, well, sure, you have rights, but it's your country of origin that should be responsible for covering your healthcare. Why are we paying for your healthcare? And so part of the membership argument what it can do to serve that purpose is to say that, well, no, if we conceptualize these people as our members, then the duty to fulfill that right to healthcare falls upon the receiving state. So I'm hoping it does add something to the human rights discourse, but you're right. So oftentimes it falls short when compared to human rights discourse insofar as its reach. And then your second question touches on kind of the empirical evidence. So who actually participates? And actually, can migrants actually participate? As already alluded to when we're talking about in the context of voting, people are not allowed to participate in that form. And there are other ways that migrants are limited in terms of the capacity to participate. Their socioeconomic circumstances, for example, may not allow them to do a lot of this participation. That will qualify them as part of our healthcare solidarity. But I think my argument here though is a lot of those limitations, it's state imposed. And a lot of those state imposed limitations are grounded in this idea of us versus them. And so it becomes a bit of a circular. So people can't participate because we don't recognize them as us. And therefore because we don't recognize them as us, we don't give them proper opportunities and ways to support their participation. And so it kind of becomes a self-fulfilling prophecy. So ideally when we're discussing people's participation in their ground for healthcare solidarity, I would like to suggest it's not just whether or not they actually participated, but whether or not they have to, if given the opportunity, could we say these are a group of people that usually can participate in our democratic deliberation process. That's how I would frame it. So thanks very much for your talk. I'm curious. When you talk about this being sort of an economy of participation as grounded in solidarity as a sort of frame of justification for redistribution, you're sort of talking about one end of a participation spectrum where there's barriers of profusion that's going to bring the capacity to participate and how that somehow maps onto a less grounded form of entitlement of the self-solidarity model. Because of the lack of participation there is less solidarity identified with or associated with that health entitlement. But how does this model account for, for instance, the very community where you've got maybe the highest perceived form of participation through a nationalistic cosmopolitan constitutional patriotism that sort of map when those health entitlements are called into question, when they're changed to policy, whether they be undermined in certain ways, whether that complicates the participation model, because you have possibly at least a little bit identified within that nationalistic discourse the highest form of civic participation that should correlate to the highest form of health entitlement of a solidarity model. And in all of these instances it might not, because it's equally subject to policy shift, equally subject to different governments coming through, so it's sort of less of a static economy that just shows that there's a baseline, more participation equals more health entitlements. It seems to have fluctuated a little bit more than that, so I'm curious how that other side of the pen will make it. No, that's a great question. I mean, I just want to clarify one point though. I don't think that I'm trying to suggest that there is a necessary correlation between how much you participate and how much healthcare you should get. I think what I'm trying to say is that there is a baseline in terms of, I mean, it's almost kind of you have participated to a certain extent, that should entitle you to kind of the full extent of healthcare that you extend to citizens. I think that if we look among the, just within the citizen population, without looking at migrants, we don't really go into any detail in terms of trying to kind of deciphering how much people participate. We just can simply say that, well, we assume that you're citizens and there is a level of participation that generally comes with your citizenship. We don't really go into that much detail in terms of empirical analysis. I mean, that could be for good reasons. Sometimes it's difficult to measure how much people actually participate. I'm not trying to make an empirical claim here. What I'm trying to do is to say that it seems to be the case that being a part of that deliberative process, that seems to be what's important when it comes to solidarity. And once you're part of that process, that should entitle you to the same amount of healthcare. You should be treated with respect to healthcare anyway, equally to anyone that comes, that engage in that process. But of course, there's also always going to be fluctuation in terms of actual policy implementation. What I'm trying to do here is a very kind of the foray into this field, trying to figure out what's kind of the macro level, what's the theoretical account for healthcare solidarity. Healthcare solidarity is not carved in stone. Solidarity changes all the time. It's how we feel, who we think that we are together with can change. And so that speaks to another point. If we see constitutional patriotism as a model of solidarity that we want to foster, then it requires work. It requires us as a society to enhance, to maintain that solidarity by allowing ongoing deliberation among people and engaging all the citizenry as much as possible within that deliberative process. Otherwise, we can revert it back to nationalist solidarity, for example, and that will look very different when it comes to actual healthcare coverage, in my opinion. Sorry, I'm just going to... Thanks, so I think one area... I mean, I think why your research is quite exciting is because it's really at this intersection of immigration and health law, which is a rather unique intersection in the field. So I want to start with a question about, again, participation. I think it's a really interesting proposal in the sense of thinking about solidarity in terms of participation. And I'll start with a kind of thinking of a negative on it and then moving to a positive. So the negative is on that immigration-health intersection. You think that if participation becomes your mark of a threshold, well, that is highly manipulable by government, especially on immigration rules, right? And so you can think about interdiction efforts, which are quite a direct way of literally physically limiting the capacity of migrants to enter the space. And so you could think in more metaphoric ways about the same kind of use of rules to be able to limit people's participation if participation comes to be the normative grounding of solidarity. And I thought that that was kind of interesting to think about in light of more two areas of expertise, immigration rules which are precisely to control movement and space with health care law. And my second question is a kind of positive piece on participation, which I really liked. And it's participation in the sense of, and it was an understanding of solidarity that you use in the opening couple of slides, which is participation in a common project. And I think here your kind of a common project is deliberative democracy. But when Medicare was first established right in the kind of idea of a universal health system, there was a sense of health care being connected to the national project, right? Like health care was not, universal health care was not only for the good of the health of individual people or even a group of people, it was seen as a nation-building project. And so I wonder then what that does in terms of a theory of solidarity as participation. And I was thinking in light of Trudeau's, you know, recent announcements around let's say he can take the budget recently or his ideas about immigration. I mean what kind of project is he building in terms of a constitutional patriotic project there? I think he's linking a lot of a sense of rights and entitlements to a same kind of nation-building project, but maybe in constitutional terms. And I wonder therefore, because of course we've had this major political regime change from Harper to Trudeau, and what would Trudeau's project look like in light of extending or really just guaranteeing health care benefits? In light of a, if you like, constitutional project or a nation-building project in Trudeau's and national. No, I think, yeah, I definitely agree with you in terms of the last observation there. I think that the beauty about constitutional patriotism is the fact that contrary to nationalism, which I describe as more pre-political, constitutional patriotism, it's something that's ongoing, because it's focused on that procedure of deliberation. So it's post-political in a way that we can generate solidarity by just keep talking to each other and allowing difference to surface and to try to change different directions that our constitutional project will go. And so to me that is more of a, I guess, welcoming or inclusive way of thinking about solidarity when it comes to migrants. Do you think Trudeau is definitively not about a procedural? I mean he has a substantive vision of Canada and its health and well-being, that at least in rhetoric is about a more inclusive and participatory technique. To a vision is instantibly versus just a procedural. True, but I guess my take on that is at the end of the day he's still using the institutions that we have, right, to kind of to express that view, right, and to institute that view if he's a wish. And that institution allows multiple views to be expressed to compete with each other and eventually it might reach certain, it might formulate certain way, formalize certain way, but it can be changed later on. And so I mean I think the beauty about constitutional patriotism is that you don't necessarily have to agree with Trudeau for example. Like you can still say that I feel a loyalty to Canada without believing in this kind of vision that Trudeau is trying to sell because I believe in the fact that of this kind of institution, this deliberative process that at least Trudeau is trying to follow. I think that's what the constitutional patriotist theory would argue. But I think just going back to your first comment about the intersection between health and immigration. So you're right, at the end of the day what the government can always do is just to block people, right. So we don't even talk about health, let's just deal everything with the immigration sphere. If you're not here physically anyway, there's just no discussion about health period. And then so health almost serves as additional layer of that immigration control, right. So for those people who are able to kind of come in through our physical borders, then immigration, so their control in terms of immigration takes the form of access to social services, health care and so on. And so yes, I recognize that there are limits in terms of understanding solidarity on the basis of membership. I still think though it's still a better model than the nationalist understanding of solidarity. And by all means I'm trying to say I'm not trying to propose that this is the best account of solidarity that we can have. Perhaps they would want to move to a more kind of cosmopolitan solidarity. I don't think that there's theoretically speaking anyway, I don't think there's anything that's stopping us from doing that. What we need to do then is to cultivate that sense of solidarity, right, more on the international level. And perhaps one day, right, that can be the underpinning of our health care solidarity. And so I think, you know, I'm not trying to kind of say which this is the participation is the one that we should go with. I think it's the best that we, at least in my opinion, and the best account for our current model that we have. So there was one. I don't cooperate in this basic degree very well. So I'm afraid I'm more practical level than applied level because I'm working in the community. I'm on the board of the Health Facts Refugee Clinic, which is a legal clinic in Health Facts. And we maybe have got it all wrong, you know, in our advocacy messaging, in our public awareness raising, appealing to universally, universal human rights, talking to both humanitarians, and maybe we're getting it all wrong. So I'd like your advice on how to translate constitutional solidarity to an advocacy message. And when you see headlines like this, you know, there's so much baggage behind these kinds of headlines requiring refugees to be grateful for us opening our doors, right? As Canadians, we don't need to be grateful that we're even born here, but these people need to be grateful for us letting them into our borders. So I'd like to get your advice on how do you translate that to a message that's palatable to the voting public and to health policy makers? No, that's a great question. So I mean, I would say as much as possible, if we can somehow use more of a membership argument, I'm not trying to discount the human rights, I think that that line of arguments should still be part of your advocacy. Again, just going back to the point I just want to keep emphasizing, I'm not trying to say this should be the argument that one and only argument that we should use to promote health care. So I'm not saying you should by all means continue with human rights based argument, but perhaps we can also pay more attention to counterarguments that says they're not part of us to kind of challenge that discourse to say, well, who actually is part of us? And what is your matrix when it comes to assessing who's part of us and who's not? And if your matrix today is nationalism or ethnicity, for example, well, I mean, that doesn't work. Even if you look at who we count as citizens today. So just kind of challenge that logic a little bit and to say, well, perhaps our account of who us should be broader than a lot of what opponents to migrant health care or even refugees specifically has proposed. Taxi driver that I was with when I was on, I was actually on route to a health past refugee clinic fundraiser and I told him where I was going and he himself, he's Lebanese and I also like to talk to tax drivers where they're from. And he, he'd only been in Canada for 20 years, but his reaction to this event for refugee claimants was very hostile. Why are we letting in more of these people? And we can't afford to support these people and he'd probably burn in part to health care as well as other kinds of social support. So what logic is that play there? What kind of solidarity is missing for that taxi driver? I mean, I, I, I, I can't, you know, trying to kind of pretend that I know what's behind the person's thinking. But I think, you know, it's, it's quite often. I mean, it's not a one off kind of example, right? We see that quite often. And I would just say that a lot of times there, you know, solidarity is one consideration, right? But there are also our, our calculation, our thinking, right? It's not always solidarity based. In fact, oftentimes are not solidarity based. And so, you know, there are various other factors that could influence how, why this person believed the way that, that he did. Perhaps it's self interest. Perhaps it's, you know, something else. I just, I can really speak to that. But, you know, the only thing I would say is, you know, there's always, you know, part of the solidarity if want to generate that is through deliberation, right? So the more that you can engage with people with different views and just engage in this kind of dialogue, that in itself, I think it's good in building that solidarity. Great. Thank you very much. Very much. I'm sorry, we don't have time for it. But did you want to just maybe share your question with everyone, but you can follow up? So my argument is we kind of do already base our, our membership on participation. So here in Nova Scotia, for example, if your work permit is only for five months, no coverage. But if you're here for more than 12 months, sure, we'll be coverage. Same with international students to save kind of ideas. I'm wondering how you don't see that as already the way that we do things. My second question is how as individual provinces and territories, can we ever try to make changes when we don't have any control over immigration? We don't get to have those conversations with the federal government. How can we ever think about implementing change when if Nova Scotia were to step up and do that, we would be abused as a province. We have everybody entering here and moving away. So how as a province can we kind of make change? That's great. So maybe I can just follow up with you after. Thank you. So I'm going to say thank you to YY for coming and presenting with us and for really concluding, I think, our series with an excellent seminar. And I wanted to also give thanks to everyone for joining us all year long. We really appreciated your attendance and engagement. And in the spirit of appreciation, she's not here. Ms. Barbara. I would like to appreciate Barbara in her absence. My apologies, Barbara is usually here at 20 after. So Barbara Carter, you may see her sometimes and she's around. She's the administrative assistant of the Health Law Institute. And she's really just our series maestro. She orchestrates everything to perfection. And so we have a small gift for Barbara. I'm hoping that she will arrive before the end of the sentence. That's a great idea. Thanks. Take some on federalism. No, I think that's always a tough question, right? When we're dealing with what federal government does and what provinces do. I mean, my only response would be, you know, I think there needs to be, when it comes to migration health issues, right? I think there needs to be greater inter-jurisdictional discussions, right? I mean, that would be my, I realize that. It doesn't really happen. It should happen more. And it should be part of both our immigration policymaking and also part of our healthcare portfolio for the federal government to think about how that would work. Oops, sorry. No, go ahead. Okay, sure enough. I'm here for you and just wanted to say thank you so much for all of your help in making this series, I think, a success over the year. And so we very much look forward to welcoming you back next year for our 2018-19 series. So thanks again, everyone.