Links

Any link's presence here is not necessarily an endorsement of it's content. Default sorting currently places healthcare capture-related links first.
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.

GATS and Public Service Systems

This is a must-read article as its by far the most concise and understandable explanation of the "governmental authority exception" an all important "two-pronged test" or definition, that defines the scope of what is allowed to be a public service and what is not, in the GATS agreement. In other words, what is subject to privatization rules, and what isn't. This definition is also borrowed or imported, in the computer programming sense, "as is" into hundreds of other trade agreements all around the globe. So this essay is extremely useful in understanding which healthcare or higher education proposals could work (and which ones would be subjected to a death of a thousand cuts, and couldn't) for example. The essay was originally written and published by the government of British Columbia province in Canada.

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.

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.

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.

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."

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.

GATS Annex on Financial Services

This document potentially endangers the US's Social Security, Medicare and other safety net programs if they are partially privatized and compete with commercial entities. It is part of the GATS and its explained well by Patricia Arnold in her essay on GATS and Financial Regulation (Public Citizen). It contains a slightly different definition of 'services supplied as an exercise of governmental authority' than GATS Article 1:3 does, which applies in certain situations. To understand it you should also read Nicholas Skala's 2009 paper in the International Journal of Health Services and the Understanding on Commitments in Financial Services. You can also find a bit more material online if you search on the phrase "Fu Lung" or "Fu Lung Group" in the context of financial services+WTO or the Uruguay Round. It seems an effort is made to make information on FTAS difficult to find for outsiders.

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.

Model clauses for the exclusion of public services from trade and investment agreements ( EPSU & Markus Krajewski)

This paper discusses how trade agreements could be modified in the EU to protect their existing public services from trade and investment agreements which are designed to tear them apart and privatize public services against the people's will, behind their backs. _______ Unfortunately the EU examples given are much less applicable to the US because we are trying to do something which we ourselves devoted a great deal of energy into preventing by creating the WTO, other economic governance organizations and making all these conditions binding on ourselves especially, which seem generally to only allow the poorest (LDC) countries to set up new public services and monopolies. Also look up "LDC Services Waiver" for a related issue involving the jobs.

Interpreting the General Agreement on Trade in Services and the WTO Instruments Relevant to the International Trade of Financial Services: The Lawyer's Perspective

25 N.C. J. Int'l L. & Com. Reg.1 (1999). by J. S. Jarreau, This is a very good essay on the GATS financial services provisions, especially their history and where they sit in the general GATS and WTO millieu. These additions to the GATS are of extreme relevance to anybody hoping to bring about any of the changes which US progressives want, which unfortunately have been locked down by the GATS, without the nation's ever having been informed. So if you are interested in those areas, "single pauer" (a tierless, national universal healthcare system, which is really the only way to gain sustainable universal healthcare within the GATS, - This requires we withdraw/modify relevant commitments via Article XXI) Also, banking, expansion of student loans, and loan forgiveness, free college, etc. Many things conflict with the new constraints GATS created.

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 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

Lori Wallach discusses 'standstill' in this short video on Democracy Now

Note: THIS ALSO APPLIES TO TODAY'S US HEALTH INSURANCE, because it is a financial service, and Please also read the glossary entry for "negative list" because the two are functionallly the same, a freeze on any new regulation. So blocking any new public services and locking in any and all privatization, etc, of existing ones. TISA will do that and its standstill dates will go back to tthe 1990s, so its ceiling will likely leave new regulations like the ACA, out. The status quo for health insurance in 1998 was very bad.

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.

Facing Facts

Both proponents and critics agree that the scope of the GATS is very broad. Its extraordinary breadth derives from the incredible diversity of services, the architecture of the agreement, and the expansive way the GATS defines key terms. The subject matter of the GATS—services—is almost unimaginably broad. Services range from birth (midwifery) to death (burial); the trivial (shoe-shining) to the critical (heart surgery); the personal (haircutting) to the social (primary education); low-tech (household help) to high-tech (satellite communications); and from our wants (retail sales of toys) to our needs (water distribution). The GATS applies to all measures affecting “trade in services,” broadly defined. It covers measures taken by all levels of government, including central, regional, and local governments. It also applies to professional associations, standards-setting bodies, and boards of hospitals, schools and universities, where these bodies exercise authority conferred upon them by any level of government. In other words, no government action, whatever its purpose - protecting the environment, safeguarding consumers, enforcing labour standards, promoting fair competition, ensuring universal service or any other end—is, in principle, beyond GATS scrutiny and potential challenge. --- As a former director general of the WTO has correctly noted, the GATS extends “into areas never before recognized as trade policy.” Not limited to cross-border trade, it extends to every possible means of providing a service internationally, including investment. While this broad application does not mean all services-related measures violate the treaty, it does mean that any regulatory or legislative initiative in any WTO-member country must now be vetted for GATS consistency or risk possible challenge. The treaty covers “any service in any sector” with only limited exceptions; no service sector is excluded a priori. This all-inclusive framework binds member governments to certain GATS rules that already apply across all sectors—even those where no specific commitments have been made. It also means that all service sectors are on the table in ongoing, continuous negotiations."

TISA - The Really Good Friends of Transnational Corporations Agreement by Ellen Gould

Highly secretive talks began in 2012 to establish a new trade agreement, the Trade in Services Agreement (TISA). The group of countries 1 negotiating TISA have given themselves an insider joke for a name, the 'Really Good Friends of Services' 2 , to signal how truly committed they are to promoting the interests of services corporations. But there is nothing funny about the sweeping, permanent restrictions on public services and regulation that could be the impact of their work.