Why can't our national healthcare system have tiers ('metal levels') and work?

Important concepts to know about! (Work in Progress!)

From

David Price, Allyson M Pollock, Jean Shaou  The Lancet, 1999

"Extension of GATS-Articles 1.3, 13, and 19

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 1:3, 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".
end quotation
(and in the US, if it fails to exempt itself by pursuing the procedure for withdrawal, Article XXI.)