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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)

In this 2009 paper, the late Nicholas Skala explained the "GATS" agreement, its implications for US healthcare reform (its many conflicts with many of the things that were done in the ACA and which are proposed for Medicare For All) and why we urgently need to get carve-outs in the WTO (and the WTO's implications for Social Security and Medicare). He even gave us a sample of a carve-out-Its urgent that we do this, soon. This paper is a must-read for anybody interested in US health care reform and the obstacles to it.

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.

How the World Trade Organisation is shaping domestic policies in health care

"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."

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.

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.

PharmaMyths.net

The drug pricing policy web site of pricing expert Donald W. Light.

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"

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.