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

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

Basically, because GATS is a scheme to force countries to choose (within which we in the US and in other countries have been  registered as having chosen commercial healthcare - no, we were never told)

we can basically have one or the other, fully free and 100% noncommercial (it would have to be that way to prevent our accidentally again losing the protection we had paid dearly to restore as shown by the US-Gambling case).

(to do this we would need to withdraw the various service sectors involved by means of a special procedure compensating countries for the losses of entitlements they claimed to have been promised, either in the Uruguay Round or upon completion of the GATS "single undertaking")

or fully for profit, with subsidies for the very poorest - (they must be not more burdensome than necessary to insure the quality of the service, or "minimally trade restrictive" as defined by trade restrictiveness indices. Also they must be constantly under pressure to be reduced in WTO Minesterial conferences every two years. Generally the pressure is to globalize services in lieu of subsidies. This means the loss of millions of jobs in every area where subsidies are given. Subsidies generally must be continually reduced and regulations dismantled - so called "progressive liberalization" ). So a promise to expand the ACA seems inherently impossible because the ten year old ACA was itself a violation of WTO laws the US had a heavy had in writing. So likely their ten year lifespan is now over and if the US was one of the poorest countries presumably we would then presumably seek a waiver for the parts we desired to preserve for another ten years. But it could likely only shrink under the WTO system, perhaps unless there was another disaster like the one in 2008.

Under the GATS ideology the market is perfect. 

GATS is basically financializing everything, especially essentials to human life.

It turns selling them, for example, healthcare and health insurance, water, Rx drugs, everything, AND maximalizing profits, on them, into a corporate right that governments owe other governments (GATS) and/or corporations (US style FTAS) .

People have no standing except as elements of markets -the profits to cannot be devalued by governments.

If people cannot afford a service in one country, the next step is globalizing the service, so as not to devalue it in its most profitable form.

The US fancies itself as the place to go for rich people seeking the best healthcare. It is more than happy to trade away its less profitable business to poorer countries

Partially subsidized services are not meant to stay that way, they must be phased out in favor of services liberalization. A temporary period of transition to totally for profit using globalization to allow the poorest to access the international services - thats the way they plan to fix things..

Yes, that would destroy unions as well as a lot of jobs. the general equilibrium model they use frames those job losses as "efficiency gains" i.e. profits.

There is only one way out and its made intentionally very difficult.

Transitions in the other direction, from for profit to totally nonprofit are made potentially very costly, and eventually, after other countries firms and workforces have entered the market, it likely becomes almost impossible. - it is made very very costly, depending on how many foreign providers have entered the market. (Foreign firms, not their employees, that's a different story, and a very controversial complicated one.

All this is explained in a number of places in this site.

Such as

governmental authority exclusion and many other pages in the Glossary

subsidies

But the best quick explanations are in these documents by Patricia Arnold,

Nicholas Skala and for the UK, this paper

David Price, Allyson M Pollock, Jean Shaou  The Lancet, 1999  Is very good. Let me draw your attention to this portion of it.

"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.
“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
(Meaning that partially subsidized healthcare systems all across europe, or fully subsidized "public Options" like the UK's NHS are too because they also sell insurance there, generally to rich people, that makes the UK's NHS vulnerable to GATS rules requiring one way privatization. The only way to settle the situation is a fully single payer, free system that has no competition and no tiers. Everybody in, nobody out. And this needs to occur soon, or the ever stricter rules will make it impossible by bringing in foreign firms and eventually, its likely also exporting patients, using their metal levels to determine who goes and who stays and what doctors and what medicolegal standards of care apply to them, after first knocking all medicolegal standards of care down to a global lowest common denominator.)