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Urgent-non-partisan Medicare and Social-Security traps for the unwary -proof below

NOTE: WORK IN PROGRESS, please forgive the state of this document, its still being edited and has redundant information! BUT its important, and verifiable fact. URGENT: Both US Presidential candidates have plans to make changes to our current Medicare and Social Security systems that WILL DESTROY THEM . Also commitments we made in the 1990s have put many tens of millions of our best and future jobs in jeopardy. And most deregulatory changes by either party lock in and cant be repealed. Many changes lock in. A little known trade agreement "GATS" literally dooms them unless we leave it immediately.

services of general economic interest

Services which do not qualify for any governmental authority exclusion, i.e. commercial services with a shrinking public component (the public component must shrink, and transition to market based entirely.) Note, this only applies in services with government involvement at the federal, state or local level or when the government has control or where tax money is used see definition of "all measures of general application".

Fake "Public Option" scheme trotted out every four years to hide the GATS lock-in for another four years.

What they call in Europe "services of general economic interest". Why can't it work here? Because the EU services were pre-existing to GATS, so are grandfathered in. If they made any changes, like Brexit, they would break too. Just ike the UK's have been gradually being privatized. And like us, they are not allowed to create any new ones unless they modify their GATS commitments, and if they had committed healthcare they likely have to pay a high price for doing so.

The Selling of "Clinton Lite"

It should be noted that the (WTO) GATS negotiations - part of the Uruguay Round, which "made services tradable", and *took them off the table as something domestic regulations are supposed to be able to change*, (in order to give international investors 'certainty'), had been going on for several years and were wrapped up by 1994. That's a VERY important, easy to verify, fact that most Americans (and Britons it seems as well) have trouble digesting. Also note: There is a companion article to this one, "A Cautionary Tale for David Brooks and Others: What, really, was Jim Cooper’s ‘Clinton Lite?’" URL:https://archives.cjr.org/campaign_desk/a_cautionary_tale_for_david_br.php - Also interesting is an article What's The Matter With NAFTA by Elaine Bernard Harvard School of Law. , especially the portion (also entitled "A Cautionary Tale") starting at the bottom of page 8 Also use Archive.org URL: https://web.archive.org/web/20150611163515/http://www.law.harvard.edu/programs/lwp/nafta.pdf

A Cautionary Tale for David Brooks and Others What, really, was Jim Cooper’s ‘Clinton Lite?’

It should be noted that the GATS negotiations - part of the Uruguay Round, which "made services tradable", and took them off the table as something domestic regulations are supposed to be able to change, were wrapping up at the same time this was all going on. Making it qualify as something other than a "debate" over future policy. Instead, its more of a simulacrum. This is still the case today, one should understand. Still, its all worth reading. Note: There is a companion article to this one, which can be found at (Use archive.org) https://web.archive.org/web/20080607133503/http://backissues.cjrarchives.org/year/94/2/clinton.asp

Crowd-Out Ten Years Later: Have Recent Public Insurance Expansions Crowded Out Private Health Insurance?

This concept is important in countries like the US (and UK as part of the EU) who have made GATS and similar commitments, because whatever it does, any public option is not supposed to cut into a co-existing insurance industry's core customers, if it does, the country's laws are subject to challenge by any interested party. (typically a country, like the US) under GATS rules, which are very broad and designed to create and support new rights of corporations, as protected by countries. If a country feels its insurance industry could do better if the other country was forced to "discipline" its domestic regulations to comply with WTO rules. In the case of health care and health insurance, this key gotcha would not apply in a country where there was a single payer system like Canada's - Don't confuse a system like England's (whose NHS, despite its dominant position, is only a 'public option' therefore quite vulnerable to external challenges) with Canada's (totally single payer+exempt) . See discussions elsewhere on here of "GATS Article I:3" and the "Governmental Authority Exclusion" - use the keyword/tag interface - currently in the left hand column, you may need to scroll down, to find them.

“Right now, the deck is stacked against patients,” “Healthcare reform is not going to change the ball game.”

By Lisa Girion, Los Angeles Times - (October 2010) "Yet a patient’s ability to fight insurers’ coverage decisions could be more important than ever because Congress, in promoting cost containment and price competition, may actually add to the pressure on insurers to deny requests for treatment. "By requiring insurers to cover everyone, regardless of pre-existing conditions, healthcare reform will make it more difficult for insurers to control their costs, or “bend the cost curve,” by avoiding sick people. That leaves insurers with the other big cost-containment tool: turning down requests to cover treatments. “There are going to be a lot of denials,” said insurance industry analyst Robert Laszewski, a former health insurance executive. “I am not setting insurance companies up to be villains. But we are telling them to bend the cost curve. How else are they going to bend the cost curve?” Experts said the legislation under consideration does not significantly enhance patient protections against insurers refusing to cover requests for treatment. Most people currently have no right to challenge health insurers’ treatment decisions by suing them for damages."

No Watertight Compartments: Trade Agreements, International Health Care Reform, and the Legal Politics of Public Sector Exemptions

Debates over the legal interpretation of trade treaty (WTO and NAFTA) exemption clauses for public services display a common pattern. Critics of trade agreements argue that these clauses are likely to be narrowly interpreted, providing scant protection from international trade rules to public health care. Defenders usually argue that they will be given a reasonably expansive definition and that trade obligations (at least the more onerous WTO national treatment obligations) will generally not apply to public health care services. This paper argues that although the optimism of trade agreement defenders may be well-founded when viewed from a static perspective, the protection afforded by exemption clauses shrinks with the expansion of market elements in health care. Hence, the major implication of such “carve-outs” for health policy makers will not be the liberty to engage in “business as usual”, but rather the need to assess the trade-related risks associated with market-based reform in the future. This paper analyses the WTO and NAFTA provisions limiting the application of these trade agreements to the health care sector in terms of the various risk scenarios posed by different models of health care reform.

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.

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

(The Lancet) "The previous round of WTO ministerial talks (the Uruguayan round) allowed governments to protect health and social services from GATS treatment by defining them as government services. According to GATS Article 1.3, a government service is one “which is supplied neither on a commercial basis, nor in competition with one or more service suppliers”. Article 19 of GATS is, however, intended to end this protection. “Members shall enter into successive rounds of negotiations . . . with a view to achieving a progressively higher level of liberalisation.” The WTO secretariat has argued that for services to be classified under Article 1.3 they should be provided free. Many governments initially protected health services from GATS treatment by defining them in this way. But the WTO has highlighted the inconsistencies in this approach. 12 “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 addition, Article 13 of GATS calls for the end of subsidies that distort trade and requires members to negotiate procedures to combat them. Therefore, according to the WTO, wherever there is a mixture of public and private funding, such as user charge or private insurance, or there are subsidies for non-public infrastructure, such as public-private partnerships or competitive contracting for services, the service sector should be open to foreign corporations. Health-care systems across Europe are vulnerable on all these counts."

The Potential Impact of the World Trade Organization's General Agreement on Trade in Services on Health System Reform and Regulation in the United States. (2009)

This paper is perhaps one of the best introductions to the GATS and healthcare issue for Americans on this site. In this 2009 paper, the late Nicholas Skala, explains the "GATS" agreement, and its implications for US healthcare reform and why we urgently need to apply for and pursue a specific procedure (Article XXI) to withdraw from the GATS in order to avoid built in traps for the unwary, for example, to get sustainable public health care. If you only read a few papers on GATS on this site, make sure this is one and also read the materials on GATS Article I:3 and 'governmental authority exclusion" keyword. Also see "explainer" tagged items.