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How the United States Exports Managed Care To Third World Countries.

As their expansion slows in the United States, managed care organizations will continue to enter new markets abroad. Investors view the opening of managed care in Latin America as a lucrative business opportunity. As public-sector services and social security funds are cut …

ICU beds already near capacity with non-coronavirus patients at L.A. County hospitals

ICU beds at Los Angeles County hospitals are already at or near capacity, prompting worries of shortages ahead of expected coronavirus surge By MATT STILES, IRIS LEE MARCH 20, 20204:27 PM Intensive care beds at Los Angeles County’s emergency-room hospitals are already at or near capacity, even as those facilities have doubled the number available for COVID-19 patients in recent days, according to newly released data obtained by The Times. Fewer than 200 ICU beds were available Wednesday, with most ICU beds occupied by non-coronavirus patients, according to the data which covers the roughly 70 public and private hospitals in Los Angeles County that receive emergency patients. The figures, which haven’t been disclosed previously, offer the first real-time glimpse of capacity levels at hospitals from Long Beach to the Antelope Valley and raise fresh worries that the hospital system, which is already strained by shortages, could soon run short of beds. “I am very concerned. We have a limited number of ICU beds available in L.A. County,” said Supervisor Janice Hahn, who urged residents to heed social-distancing orders to reduce infection rates and strain on medical resources. “I would like to begin exploring every possible solution to increase the capacity of our hospital system, including building pop-up hospital sites.” The anticipated surge of coronavirus patients is setting off a scramble to increase capacity of all types of beds, some of which could be converted to ICU units, according to county health officials. To accomplish that, hospitals are halting elective services to open up more space, and are considering other plans to expand capacity, including converting existing space or erecting tents. That effort shows in the figures, with the number of beds overall nearly doubling in the last several days — from 624 on March 13 to 1,182 as of Wednesday. That change includes an increase of ICU beds, which have more equipment and a higher staff-to-patient ratio, from 85 to 191, according to the figures. Christina Ghaly, a physician who directs the county’s vast system of providers, clinics, and hospitals known as the Department of Health Services, said hospitals can add ICU beds by converting existing space. That entails equipping beds with special equipment and adding personnel and, in some cases, getting approval from state regulators. Rooms could also be opened in non-emergency room hospitals, which aren’t included in the current figures. “The hospitals across the entire county are working very hard to free up capacity, and also to create capacity,” said Ghaly. County officials stressed that the figures represent the current staffing needs by hospitals, which have a greater “surge” capacity as more patients get sick. She said they are also asking state officials to fast-track additional capacity. But despite the progress, as many as 90% percent of licensed ICU beds are already occupied with patients who have suffered other medical emergencies, such as heart attacks, car accidents and other cases, according Ghaly said.

2019-nCoV: Infectious virus can be isolated from nose, throat swabs of patients with mild symptoms

"Laboratory testing by Charité - Universitätsmedizin Berlin, the Bundeswehr Institute of Microbiology and Munich Clinic Schwabing has revealed that infectious virus can be isolated from nose and throat swabs even where these have been obtained from patients with mild symptoms. The research groups have therefore come to the conclusion that even persons with mild symptoms are capable of transmitting the virus."

WTO Secretariat. Health and social services: background note by the Secretariat S/C/W/50, 18 September, 1998 (98-3558)

“The hospital sector in many counties . . . is made up of government-owned and privately-owned entities which BOTH operate on a commercial basis, charging the patient or his insurance for the treatment provided. Supplementary subsidies may be granted for social, regional, and similar policy purposes. It seems unrealistic in such cases to argue for continued application of Article I:3, and/or maintain that no competitive relationship exists between the two groups of suppliers of services.” In other words healthcare "public options" like the UK's NHS must be subject to WTO globalization rules such as GATS' rules on services liberalization and competition.

The UK's health is threatened by the push to privatize it's National Health Service. Here is what must be done to preserve it.

The reason why the UK's NHS is vulnerable is the fact that they signed onto the WTO GATS agreement, and also SELL commercial health insurance in the UK, which opens up a Pandora's box of problems. These commitments will end when the UK leaves the EU. That change will trigger demands for compensation for any perceived loss in "future expected earnings". Additionally, re-joining the WTO may trigger similar demands from other WTO Members. This should be obvious to anybody who is familiar with the GATS and WTO negotiations. So its quite strange that there has been nothing about it in the media.

British firm may have created a successful lock in of US healthcare policy, read story to understand how scary this kind of corporate lock-in is.

It was a mystifying story. In 2014, a Midwestern TV station - in response to a viewer tip, reported on a mysterious warehouse of contractors of a controversial British firm who were allegedly "being paid to do nothing". Even though its existing workforce were literally going crazy from not having enough work to do, the company hired more people. Here we are also going to discuss the concept of "moral hazard" and governments, a discussion that has nothing to do with any particular company.

Trade in Healthcare and Health Insurance Services: The GATS as a Supporting Actor (Rudolf Adlung / WTO)

Staff Working Paper ERSD-2009-15, December 2009, World Trade Organization, Economic Research and Statistics Division Note: Unlike the European countries, the US has made extensive GATS commitments in this area which can be found in the US's Specific Commitments Supplement 3. At the same time, the US does not have a safety net in this area despite having made commitments that limit what we can do greatly. This is an inappropriate and dysfunctional combination.

Public services and the GATS, WTO Staff Working Paper, No. ERSD-2005-03, World Trade Organization (WTO), Geneva

Adlung, Rolf (2005) Adlung is a WTO employee. The EU's social safety net is under attack. Partly due to neoliberal construction via FTAs of a new corporate "right of establishment" that nullifies rights to healthcare and education that have never been created in laws as we would hope. Also WTO rules allegedly against "discrimination" ironically are a tool that's being used to dismantle policies and laws against discrimination in countries like the US.

Trade Liberalization & Women’s Reproductive Health

Women often are charged with the responsibility of caring for their families’ health, education and nutrition, and they often supplement, or earn the entirety of, the family’s income, and provide household labor to maintain upkeep of their homes. The liberalization of international trade increasingly affects women’s health by creating new opportunities to improve reproductive health as well as new obstacles to advance reproductive/sexual health and rights objectives in policies, programs and services. New employment opportunities may open up for women, for example, which may enable them to achieve higher income levels and greater access to health services and technology. However, trade liberalization also may lead to higher costs of health services and supplies, lower quality of services, shortages of critical medical personnel because of increased migration or a concentration of health services that may restrict access for lower-income or remote populations

When Worlds Collide: Implications of International Trade and Investment Agreements for Non-Profit Social Services

Although Canada has vowed that its domestic social policies will not be compromised by its international trade obligations, it has also been a leading exponent of increasing trade liberalization in the services sector. Unless great caution is taken in the current WTO and FTAA negotiations, this ambivalence could expose many of our social programs to trade-driven privatization and commercialization. Authors Andrew Jackson and Matt Sanger describe in detail the policy implications of these trade treaty talks. They demonstrate the need to strengthen and improve the protections now afforded our social services, many of which--from child care to elder care--are delivered by not-for-profit social service agencies funded by governments, rather than directly by governments. When these services are exposed to trade and investment treaties, the few limited protections provided to direct public sector programs may not apply. Only clear and forceful treaty terms can minimize the risk of trade challenges that could disrupt and undermine these important services The worlds of trade policy and social policy are very different. When they collide, as they inevitably will in the negotiations to expand the WTO’s General Agreement on Trade in Services (GATS), it will take great diligence on the part of Canada’s negotiators to ensure that our not-for-profit social programs and services survive the collision.

Reckless Abandon Canada, the GATS and the Future of Health Care

This study shows that, contrary to repeated assurances from federal government officials, the government has, in fact, recklessly exposed health care to the GATS commercial rules. Matthew Sanger made the discovery that health insurance has already been included in the list of Canadian services which are subjected to the full force of the GATS rules.

Insurance developments that could lead us into COSTLY FTA-lock-in

Which would block any further changes in health insurance, because we have accepted the faulty premise that foreign corporations deserve more than the American people who have been dying at the rate of 50-150 people a day because of their GATS scam. Work in progress

Federalism in an Era of International Free Trade THE GENERAL AGREEMENT ON TRADE IN SERVICES AND THE REGULATION OF INSURANCE IN THE UNITED STATES

(A student paper that is mostly about states rights and their potential conflict with GATS. However its quite useful because the author seems to have collected references from many other essays and papers in one place, and formatted them for legal citation. Won an ABA award.) by Ethan Marks in Tort Trial & Insurance Practice Law Journal Vol. 50, No. 1 (FALL 2014), pp. 129-154 Published by: American Bar Association "This paper placed first in the 2014 law student writing competition of the Tort Trial & Insurance Practice Section" (RIP Nicholas Skala)

The General Agreement On Trade In Services: Implications For Health Policymakers (Health Affairs)

The General Agreement on Trade in Services (GATS), created under the auspices of the World Trade Organization, aims to regulate measures affecting international trade in services—including health services such as health insurance, hospital services, telemedicine, and acquisition of medical treatment abroad. The agreement has been the subject of great controversy, for it may affect the freedom with which countries can change the shape of their domestic health care systems. We explain the rationale behind the agreement and discuss its scope. We also address the major controversies surrounding the GATS and their implications for the U.S. health care system

The General Agreement On Trade In Services: Implications For Health Policymakers (Health Affairs)

The General Agreement on Trade in Services (GATS), created under the auspices of the World Trade Organization, aims to regulate measures affecting international trade in services—including health services such as health insurance, hospital services, telemedicine, and acquisition of medical treatment abroad. The agreement has been the subject of great controversy, for it may affect the freedom with which countries can change the shape of their domestic health care systems. We explain the rationale behind the agreement and discuss its scope. We also address the major controversies surrounding the GATS and their implications for the U.S. health care system

The Scope of GATS and of Its Obligations by Bregt Natens, Jan Wouters

Bregt Natens, Jan Wouters - KU Leuven - Leuven Centre for Global Governance Studies Date Written: August 1, 2013 Abstract The GATS preamble already highlights the inevitable conflict between on the one hand achieving progressively higher levels of liberalization of trade in services in order to expand trade in services and promote growth, and on the other hand the right to introduce new regulation to meet national policy objectives. Hence, it was clear from the outset that the balance between trade liberalisation and domestic regulatory autonomy would be key in interpreting the constructively ambiguous GATS. The outcome of this exercise depends on three factors: the interpretation of (i) GATS’ overarching objectives, (ii) of the general scope of GATS and of the obligations arising from it (and the exceptions to them) and (iii) of the inherent individual flexibility of GATS. Whilst also touching on the first, this contribution mainly focuses on the second factor by addressing the scope of GATS, of its unconditional obligations, of obligations applying to sectors for which specific commitments have been scheduled and of obligations in GATS Annexes. Additionally, it provides an overview of the structure of GATS obligations. The third factor is mainly addressed throughout textboxes which provide an illustrative insight into how the European Union has used the inherent GATS flexibility to shape its obligations. Keywords: WTO, World Trade Organization, GATS, General Agreement on Trade in Services, services, scope, obligations, governmental authority exception

GATS Backgrounder from Public Citizen (2005)

“Governments are free in principle to pursue any national policy objectives provided the relevant measures are compatible with the GATS.” –WTO, Oct. 1999 “GATS provides guarantees over a much wider field of regulation and law than the GATT; the right of establishment and the obligation to treat foreign services suppliers fairly and objectively in all relevant areas of domestic regulation extend the reach of the Agreement into areas never before recognized as trade policy.” Good intro to/overview of GATS-

Maine CTPC Health Care Subcommittee Draft Report on GATS barriers to state health care reforms

US states thought they could just implement a statewide single payer system, many seem to still think that. But they were wrong. This report to the state of Maine shows what they found out! This report was prepared for the state of Maine by trade experts from Georgetown University. It shows some of the hidden traps faced by states that attempt to make it possible for the working poor to afford health care. The Health Care Subcommittee of the Maine Citizens Trade Policy Commission asked the Forum on Democracy & Trade to look at Maine’s health insurance programs in relation to U.S. commitments under international trade agreements, and specifically to identify potential conflicts or issues regarding Maine’s Dirigo Health Program with provisions of the WTO General Agreement on Trade in Services (GATS). Here we focus specifically on Dirigo and GATS in order to enable the Maine CTPC to: Understand potential trade conflicts serious enough to bring to the attention of U.S. trade negotiators and the Congress Raise questions about the meaning of vague GATS provisions on coverage and trade rules that could improve the quality of state-federal consultation on trade policy Identify potential safeguards for Dirigo and similar state-level health programs.

WTO - legal texts - Understanding on Commitments in Financial Services

"As of 2009, the 33 countries whose current schedules reference the Understanding include: Australia, Austria, Bulgaria, Canada, Czech Republic, Finland, Hungary, Iceland, Japan, Liechtenstein, New Zealand, Norway, Slovak Republic, Sweden, Switzerland, and the United States, as well as the European Communities members as of 1994 (Belgium, Denmark, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain and the United Kingdom.) The only developing nations that utilized the Understanding were Aruba, Netherland Antilles, Nigeria, Sri Lanka (for banking not insurance), and Turkey. Additionally, eight countries (Cyprus, Estonia, Latvia, Lithuania, Malta, Poland, Romania, and Slovenia) were in the process of revising their commitments to match the EC schedule" (from the commentary by Jane Kelsey on TISA Financial Services text) -- This document regulates government regulation of financial services like banking and insurance, including health insurance, greatly limiting what we can do. In particular it is thought to freeze new financial services regulations after its signing date, unless they were enumerated then. In the case of the US that date is February 26, 1998. If challenged in a WTO dispute proceeding a country that has violated a "standstill" may have to roll back its regulatory state to the level of regulation in effect on that date. A related concept, "ratchet" is also said to apply in WTO law - it denotes a one way capture of all deregulation in a committed sector making it a violation to re-regulate. See the definitions of "standstill", "rollback" and "ratchet" in trade parlance.

Interpretation of Article I, Section 3 (b) and (c) of GATS - PublicServicesScope

This article by Markus Krajewski discusses GATS' important "governmental authority exception" which defines the scope of GATS jurisdiction. (and what can be seen as a "public service" under GATS, the definition is very narrow- everything else is subject to all sorts of rules which privatize them and bar government subsidization except if its 'minimally trade restrictive') - by Markus Krajewski

State Health Reform Flatlines

US states and the Federal government have tried the same things over and over again, and have repeatedly failed to make for-profit health insurance - especially nongroup insurance, affordable as more and more Americans fell theough the cracks. This paper details the history up to the mid 2000s. It shows how despite knowledge in high places that the strategies being used don't work, they continue to be recycled. (This is because the GATS and recent, even more ideologically extreme rules give them no choices that would work, and the ideology is a higher priority than people's lives.) Meanwhile 50-120 Americans die each day due to preventable factors amenable to improved healthcare or improved access to healthcare.

Ellen Gould discusses GATS on Talking Stick TV.

Video - Ellen Gould is a trade expert whose insight here is quite accurate. See what she tells us here about domestic regulations, technical standrds, licensing, medical standards, everything. Lots of info on what they want to do with healthcare. The WTO could sanction us if we wanted our doctors to meet higher standards than those in the developing countries. (around 25:00) The WTO also wants us to allow for profit offshoring of poor patients. Which would be subject to the same problems as the for profit system does now, except likely worse, with less accountability.

GATS and Financial Services Deregulation by Patricia Arnold

Medicare, Social Security and other governmentally subsidized financial services are put in grave danger by the GATS - This paper by a noted professor in accounting who has written a great deal of highly readable material on the WTO and its interaction with financial regulation is a short and concise intro to many of the major issues, particularly the threats GATS poses to Social Security and Medicare if those areas are allowed to compete with commercial banks or insurers. Caution is needed because millions could see huge changes in their only retirement benefits just as they were needed the most if Social Security and/or Medicare lose their protection from GATS rules, which is likely if current proposals are implemented,- see the Annex on Financial Services.

GATS and Public Service Systems

This is a must-read article as its by far the most concise and understandable explanation of the "governmental authority exception" an all important "two-pronged test" or definition, that defines the scope of what is allowed to be a public service and what is not, in the GATS agreement. In other words, what is subject to privatization rules, and what isn't. This definition is also borrowed or imported, in the computer programming sense, "as is" into hundreds of other trade agreements all around the globe. So this essay is extremely useful in understanding which healthcare or higher education proposals could work (and which ones would be subjected to a death of a thousand cuts, and couldn't) for example. The essay was originally written and published by the government of British Columbia province in Canada.

How the World Trade Organisation is shaping domestic policies in health care

David Price, Allyson M Pollock, Jean Shaoul, THE LANCET - Vol 354 - November 27,1999, pp. 1889-1891 "Multinational and transnational corporations, including the pharmaceutical, insurance, and service sectors, are lining up to capture the chunks of gross domestic product that governments currently spend on public services such as education and health. The long tradition of European welfare states based on solidarity through community risk-pooling and publicly accountable services is being dismantled. The US and European Union governments are aggressively backing this project in the interests of their business corporations. But the assault on our hospitals and schools and public-service infrastructure depends ultimately on a promise from one government to another to expand private markets. Such promises can be kept only if domestic opposition to privatisation is held in check. We need to constantly reassert the principles and values on which European health-care systems are based and resist the WTO agenda"

Trading Health Care Away? GATS, Public Services and Privatisation

"But talks have since begun to change one of the 28 agreements overseen by the WTO -- the General Agreement on Trade in Services or GATS. The US, EU, Japan and Canada are trying to revise GATS so that it could be used to overturn almost any legislation governing services from national to local level. And non-government organisations (NGOs) and trade unions are demanding that services in the public interest be clearly exempt from GATS. It details how public services may not in fact be excluded from GATS and explores the implications for public health care."