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The UK's health is threatened by the push to privatize it's National Health Service. Here is what must be done to preserve it.

The reason why the UK's NHS is vulnerable is the fact that they signed onto the WTO GATS agreement, and also SELL commercial health insurance in the UK, which opens up a Pandora's box of problems. These commitments will end when the UK leaves the EU. That change will trigger demands for compensation for any perceived loss in "future expected earnings". Additionally, re-joining the WTO may trigger similar demands from other WTO Members. This should be obvious to anybody who is familiar with the GATS and WTO negotiations. So its quite strange that there has been nothing about it in the media.

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.

subsidies

WORK IN PROGRESS - If you want to know about how the WTO frames subsidies in health care when those subsidies are in a "public option" situation like those in the US or UK (which is to say mixed systems) - its disturbing.

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."

governmental authority exclusion

These are articles on the all important exclusion that defines what member government activities can be called "public services" and excluded from the onerous GATS rules, if they have commitments in those areas, like the US has.

The GATS’ Article I, paragraph 3.... (and libraries)

What is Article 1:3? Article 1, Paragraph 3 of the GATS defines the scope of the agreement as follows: (b) “services” includes any service in any sector except services supplied in the exercise of governmental authority; (c) “a service supplied in the exercise of governmental authority” means any service which is supplied neither on a commercial basis, nor in competition with one or more service suppliers. What it really means...Clause (c) above constitutes the potential danger to libraries and the public sector. It appears to mean that “if a service is provided on a non-commercial basis but in competition with other suppliers or on a commercial basis but without competition, it is not a service supplied in exercise of governmental authority.” (1) (and so has to be privatized - it canot be allowed to exist as is, under GATS rules)

Interpretation of Article I, Section 3 (b) and (c) of GATS - PublicServicesScope

This is another article discussing the 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 bar government subsidization except if its 'minimally trade restrictive') - by Markus Krajewski

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

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.

The Brave New (and Smaller) World of Higher Education

A Transatlantic View European University Association EUA American Council on Education Center for Institutional and International Initiatives - arket forces, globalization, internationalization, com- petition, new providers, cost efficiency—these descriptors of the brave new world of higher education appear consistently in any discus- sion of its future. Even when used in the same national context, such terms describe different phenomena and elicit different interpretations; cross-cultural conversa- tions are even more difficult. A shared understanding of the forces that are reshaping higher education within and among nations provides an essential founda- tion for the development of sound policy and effective institutional strategies to adapt to these new realities. Such challenges were the focus of the seventh Transatlantic Dialogue, cosponsored by the American Council on Education (ACE), the Asso- ciation of Universities and Colleges of Canada (AUCC), and the European University Association (EUA) and hosted by the Université Laval in Quebec.

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.

No Watertight Compartments: Trade Agreements, International Health Care Reform, and the Legal Politics of Public Sector Exemptions

Debates over the legal interpretation of trade treaty (WTO and NAFTA) exemption clauses for public services display a common pattern. Critics of trade agreements argue that these clauses are likely to be narrowly interpreted, providing scant protection from international trade rules to public health care. Defenders usually argue that they will be given a reasonably expansive definition and that trade obligations (at least the more onerous WTO national treatment obligations) will generally not apply to public health care services. This paper argues that although the optimism of trade agreement defenders may be well-founded when viewed from a static perspective, the protection afforded by exemption clauses shrinks with the expansion of market elements in health care. Hence, the major implication of such “carve-outs” for health policy makers will not be the liberty to engage in “business as usual”, but rather the need to assess the trade-related risks associated with market-based reform in the future. This paper analyses the WTO and NAFTA provisions limiting the application of these trade agreements to the health care sector in terms of the various risk scenarios posed by different models of health care reform.

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.

The Effects of International Trade Agreements on Canadian Health Measures: Options for Canada with a View to the Upcoming Trade Negotiations (2002)

Richard Ouellet, Laval University (October 2002) -- "It will be noted that while Canada has avoided the potential effects that the international economic agreements could have on health care, it has done so by taking advantage of the structure of agreements based on quite different approaches. • If the Canadian government wishes to continue exempting our public health systems from the effects of these agreements, it will have to acknowledge that doing so by simultaneously using approaches as different as those of the GATS and the NAFTA is not without risks. What is needed is an integrated approach that reflects trade concerns while respecting the health care priorities of governments."

GATS and Government Services

"There are two major issues raised in the literature about GATS and its application to publicly funded service providers such as libraries. The first issue is the exemption of some services from all parts of the GATS agreement and the second issue pertains to the GATS articles that apply to services that are not exempt. To begin with, not all services are or will be negotiated for inclusion to the GATS. An exception was made for services which fall into the general exemption of "government authority". These services are not required to be liberalized to trade in any way nor is any part of the air transport and traffic sectors (WTO, GATS 2). The exception of "services provided to the public in the exercise of governmental authority" is contentious because its meaning has not been clearly defined in GATS. In Article I(3) of the agreement there are two tests applied to the definition of a government provided service: first, it must not be offered on a commercial basis and second, it must not be provided in competition with other service providers (Shrybman, iv). If a service offered by the government fails these tests, then the government must withdraw from providing the service or fund all other providers equally. The WTO states that this position is straightforward and covers "social security schemes and any other public service, such as health or education, that is provided at non-market conditions" (WTO, The General). However, as Hunt points out, these two tests actually make it difficult to determine what would qualify as a government service under GATS when those clauses are closely considered (32). Services such as health care and education have private for-profit suppliers, which 'in competition' with publicly funded and supplied services. Despite the assurances of the WTO, it would seem that these clauses would effectively exclude those services from the list of services offered in exercise of government authority."

Mind the GATS! (Robert Newman, The Guardian, 2000)

"Leaked WTO documents show them currently working out a list of what will be acceptable as a "legitimate" government objective for any regulation of services under GATS. That of "safeguarding the public interest" has already been rejected. If GATS goes ahead, warns economist Susan George, "then Europe can kiss goodbye its public health services". But even though that's just the start of the disaster, there has been no parliamentary debate or news coverage about GATS. (It's way too important for that.) The British government's official line is that there's nothing to worry about anyway. The DTI claims GATS won't apply to the NHS or education here because "non-commercial services" are exempt from the fiat . But GATS says that if you've got just one tiny part of a public service that's even an iddy-biddy-bit commercial then THE WHOLE THING IS UP FOR GRABS."

Like with healthcare, Brexit's influence on higher education and public colleges and universities in the UK is quite uncertain at best, because of an intentionally ambiguous WTO definition of what can be considered "public".

See the "governmental authority exclusion", "GATS Article I:3" and "Annex on Financial Services" keywords for more on this huge gotcha which also blocks proposals for free college and Medicare for All in the US (and threatens to dismantle the US's Medicare and Social Security unless they remain restricted to the retired only). How will these changes impact social mobility in the UK?