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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

“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."

American Health Care Horror Stories: An Incomplete Inventory

The statistics demonstrating the scope of our nation’s healthcare crisis are appalling enough. Two of three Americans report skipping needed care each year due to cost, including not filling prescriptions or putting off doctor visits. Millions are forced to borrow money to pay medical bills, leading to crushing debt. Others can’t get the care they need even by borrowing, and suffer fatal consequences: physician researchers estimate tens of thousands of Americans die each year due to inability to afford care.

Medicaid Expansion in Health Reform Not Likely to “Crowd Out” Private Insurance

"Contrary to claims by some critics, the Medicaid expansion in the new health reform law will overwhelmingly provide coverage to people who otherwise would be uninsured, rather than shift people who already have private coverage to Medicaid." --- comment: This concept of "crowd-out" was literally created by the GATS and it's concept of minimal trade restrictiveness which requires that all government-subsidized measures be the most minimal possible - as well as possibly time limited, for example, only available to either an individual for only a few years, or possibly a country - for only a short period, perhaps a decade or less, (or perhaps only if they are and remain an LDC) . In this case, Medicaid is kind of a loan, not an insurance program, as it is subject to repayment, and only available to the destitute, and near destitute with assets that will only become available at their deaths, such as a home - after their other options have been used up. This "prevents healthcare prices from falling", and "preserves the profit in selling insurance", and "the value of the insurance companies investment". These are the most important things in a for-profit healthcare system. Especially as it becomes "The one bright spot in a dismal economy"

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 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 issue for Americans on this site, as it shows the blockade that has been put in the way of urgently needed healthcare reforms, a blockade that few Americans even realize is there. In this 2009 paper, the late Nicholas Skala, explained the "GATS" agreement, 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 single payer health care. This is all necessary because previous Administrations quite foolishly signed away our rights to regulate dozens of services including those relevant to healthcare financing and delivery (and many others, literally most of our economy) away in the GATS when we entered the WTO. Skala also explains how additions made to GATS in 1998 further prevented and hamstrung regulators, If they attempt to expand instead of deregulate existing social services without leaving GATS or formally modifying the US's "Schedule of Specific Commitments" using Art. XXI FIRST. (See 'Recommendations' section) Otherwise, we cannot improve anything and attempts to expand the Affordable Care Act will encounter numerous GATS provisions like "standstill" and "rollback", which are meant to protect foreign investors profits, locking them in at the Feb 1998 level. If a demand is made in the WTO, compel us to make cuts to restore that previous level of regulation. The level at the end of February 1998 is carved in stone as a regulatory ceiling we are not supposed to exceed. TISA also embeds the GATS dates apparently. GATS can also impact jobs and a newer agreement also globalizes procurement of services, requiring the opening of the economy to temp worker companies if they can provide services cheaper than US firms, potentially taking control over a very wide range of once public & quasi-public government funded and subsidized activities, unless they qualify for a very few, narrow exemptions, such as the 'governmental authority exclusion' defining what can be a 'public service'. (see that keyword on the left, below) If you only read a few papers on GATS on this site, make sure this is one and also read that keyword. Also see "explainer" tagged items.