US Healthcare Hijack links

US healthcare has been held hostage and its NOT for the reasons you likely think. Please read!

 It is because we've set up a system that traps it and makes it intentionally dysfunctional, and additionally, acts which seem logical and even innocuous (expanding Medicare without leaving GATS first) seem almost certain to me under the current conditions, which almost nobody realize exist, seem highly likely to trigger trigger booby traps within the WTO. that it seems to me, would make it lose its ability to be subsidized. We are also on the verge of possibly losing tens of millions of good jobs to outsourcing - This is meant to become a sort of supporting to prop up the rich in many of the world's most unequal and despotic nations. We need a national hive mind which the corporations and their social networks are preventing, This could become a huge disaster, where the middle class is destroyed because the very wealthy want a third world model rather than a first world one one. A race to the bottom instead of a race to the top.

Please read the first portion of the Annex on Financial Services, and then read Pat Arnold's paper and the GATS and Public Service Systems essay, parsing the definitions of "service supplied in the exercise of governmental authority" and "services" (The first, and only it, means exempt from GATS and so, able to get subsidies in a sustainable manner, in other words, a public service. very few remain.) and "Services" (Servicees means under the GATS rules - so subsidies are very limited, only allowed for those who could never get anything else, thats almost everything, and very greatly limited by the GATS) Currently the old traditional Medicare seems  exempt from these rules, that kind of Medicare may end or be greatly limited. Also, the ACA's ability to be better than for profit insurance may be ending due to the Understanding on Commitments in Financial Services,  standstill, and a likely ten year limit on the length of "emergency measures" I dont know but the changes made in the ACA were totally inconsistent with the GATS rules the US helped write, far too generous. See Skala. The following are what I consider to be essential links on this issue but they dont include any of my own horrible writing. But its more time consuming to read, them all, but likely more informative, or less. Everything here is speculation but I suspect I am far more realistic than my increasingly misled countrypeople. Both parties are creating a simulacrum, to prevent a public outcry.

The recent Achmea case has received a lot of news coverage in Europe but almost none of it actually explains what the case was about. This PDF..

contains a factual summary (on page 13) which explains that the case was about the electoral victory in Slovakia of a candidate who ran on a platform of restoring single payer health care in the country, as well as limiting the profits of any health insurer, in the intirim period to 20% changes which which were immediately attacked in the first of two Investor vs. State arbitral lawsuits. Slovakia lost the first round. This case is also a good introduction to the sordid history of the IntraEUBITS.

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

Public Citizen: Health Care Memo

"...However, many of today’s international trade agreements establish binding obligations constraining federal, state and local government policy and actions in numerous service sectors, including health services. These rules are not limited to trade in services across borders, but also constrain government regulation of foreign service sector firms operating within the United States. As a result, today’s “trade” pacts are delving deeply into domestic regulatory issues that have little or nothing to do with the traditional concept of trade between nations".

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"

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.

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-

Patient Mobility Beyond Calais: Health Services Under WTO Law by Markus Krajewski

"The paper analyses the impact of WTO law on transnational patient mobility by transplanting the Watts case of the European Court of Justice into WTO law. The first part of the paper concerns the question whether medical or hospital treatment abroad concerns “trade in (health) services” in the meaning of the GATS. This part identifies the legal construction of this notion through the four modes of supply and also gives a short factual account of the scope and structure of trade in health services on a global level. The next part will ask more directly which measures fall into the scope of the GATS. In particular, it has to be determined whether the exclusion of services supplied in the exercise of governmental authority from the GATS influences the application of the agreement to health and medical services. Having determined under which circumstances the GATS applies to measures affecting the cross-border supply of health services, the subsequent part of the chapter discusses the substantive obligations of the GATS. After a short overview of the main principles of the GATS, the chapter will provide an in depth inquiry into the specific commitments in health services of the EU and other WTO Members, because only the exact analysis of the limitations and qualifications of these schedules allows us to clearly determine the impact of the GATS on the cross-border to provision of health services. In addition, the potential of the general exception clause of the GATS to justify regulations of health systems which violate GATS obligations needs to be ascertained. Lastly, the legal status of GATS in the EU legal order, in particular the contentious issue of direct effect, needs to be assessed, because only if the GATS is directly applicable would a patient who received medical treatment abroad be able to rely on the agreement to claim reimbursement of the costs of said treatment."

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.

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.

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.

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

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.

Public Citizen: "Presidential Candidates' Key Proposals on Healthcare and Climate Will Require WTO Modifications"(2008)

This essay's by Public citizen explains how the 2008 Presidential candidates proposals (just as today) all violated provisions of the GATS agreement and US 'commitments' and other trade rules and how those commitments were likely to conflict with the promises, making them impossible or very difficult to implement the longer we waited. The references are extremely useful. Highly recommended you read this if you are interested in healthcare in the US.

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.

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."

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.

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 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

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.

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."

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.

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

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

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.

Public Citizen: Medicare and Social Security - SOS: Save our Services from the WTO

Bottom Line: If the Bush administration succeeds in even partially privatizing Social Security, under the WTO GATS agreement foreign corporations could end up with treaty rights to raid our tax dollars for profit and Americans could face shredded retirement and Medicare safety nets. For now, Social Security is probably safe from the GATS because the agreement exempts services that are exclusively a government monopoly and are not also offered on a commercial basis. But if Social Security is even partially privatized — as the Bush administration is advocating — and folks begin to invest some of their federal retirement funds in the stock market, then GATS would require some things that the privatizers don’t want to talk about. The agreements would: * permit foreign and offshore firms to compete for private Social Security accounts, thus preventing the most stringent regulation of these accounts and increasing the risks to retirees; * make it harder to fix Social Security after the privatization experiment predictably fails, because GATS requires that nations first compensate all of their trading partners for lost future economic opportunity if they “take back” the service from the private sector and make it public again. * Failure to compensate would result in punitive trade sanctions, which is why some say GATS makes privatization a one-way street.

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.

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

Public Citizen: Threats to Health Care Policy

"The WTO’s GATS delves into “areas never before recognized as trade policy"... "The GATS represents a 180-degree turn from the U.S. approach to health care policy − away from regulating industries for the benefit of the consumer, and towards regulating governments for the benefit of multinational firms and industries".

Putting Health First - Canadian Centre for Policy Alternatives

Canadian Health Care Reform, Trade Treaties and Foreign Policy - this essay describes the traps in the GATS agreement for Canadian health care, and it also would totally apply to a hypothetical US healthcare plan if it had prexisted the creation of the WTO. it also discusses 'carve outs' and why they are needed by Canada to protect their Medicare (public health care) from Trade Agreements put forward by countries like the US that try to destroy, and privatize them. Note: the situation of the Canadian system is different than the UK's as Canadian Healthcare is exempt from GATS, and the UK's public option the NHS like US's optional short term public experiments like the ACA are subject to the GATS privatization agreements progressive liberalization ratchet, etc. requirements. Unfortunately.

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 …