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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.

Insurance developments that could lead us into COSTLY FTA-lock-in

Which would block any further changes in health insurance, because we have accepted the faulty premise that foreign corporations deserve more than the American people who have been dying at the rate of 50-150 people a day because of their GATS scam. Work in progress

British firm may have created a successful lock in of US healthcare policy, read story to understand how scary this kind of corporate lock-in is.

It was a mystifying story. In 2014, a Midwestern TV station - in response to a viewer tip, reported on a mysterious warehouse of contractors of a controversial British firm who were allegedly "being paid to do nothing". Even though its existing workforce were literally going crazy from not having enough work to do, the company hired more people. Here we are also going to discuss the concept of "moral hazard" and governments, a discussion that has nothing to do with any particular company.

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.

Maine CTPC Health Care Subcommittee Draft Report on GATS barriers to state health care reforms

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 better quality health care. This report is a must read for anybody interested in the United States health insurance situation. Note that we need to withdraw our country from these service sectors to be able to fix this problem. Note also that the situation could become much worse if additional trade agreements are signed, such as the "Friends of Services" negotiations going on in Geneva in 2006, which became TISA.

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.

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, it also discusses 'carve outs' and why they are needed by Canada to protect their Medicare (public health care) from Trade Agreements that try to destroy, and privatize them. This death of a thousand cuts is caused by GATS, that is what's been done to the UK's NHS.

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.

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.

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

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.

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.

GATS Backgrounder from Public Citizen (2005)

“Governments are free in principle to pursue any national policy objectives provided the relevant measures are compatible with the GATS.” –WTO, Oct. 1999 “GATS provides guarantees over a much wider field of regulation and law than the GATT; the right of establishment and the obligation to treat foreign services suppliers fairly and objectively in all relevant areas of domestic regulation extend the reach of the Agreement into areas never before recognized as trade policy.” Good intro to/overview of GATS-

Public Citizen: Health Care Memo

"...However, many of today’s international trade agreements establish binding obligations constraining federal, state and local government policy and actions in numerous service sectors, including health services. These rules are not limited to trade in services across borders, but also constrain government regulation of foreign service sector firms operating within the United States. As a result, today’s “trade” pacts are delving deeply into domestic regulatory issues that have little or nothing to do with the traditional concept of trade between nations".

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

Public Citizen: Threats to Health Care Policy

"The WTO’s GATS delves into “areas never before recognized as trade policy"... "The GATS represents a 180-degree turn from the U.S. approach to health care policy − away from regulating industries for the benefit of the consumer, and towards regulating governments for the benefit of multinational firms and industries".

WTO - legal texts - Understanding on Commitments in Financial Services

"As of 2009, the 33 countries whose current schedules reference the Understanding include: Australia, Austria, Bulgaria, Canada, Czech Republic, Finland, Hungary, Iceland, Japan, Liechtenstein, New Zealand, Norway, Slovak Republic, Sweden, Switzerland, and the United States, as well as the European Communities members as of 1994 (Belgium, Denmark, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain and the United Kingdom.) The only developing nations that utilized the Understanding were Aruba, Netherland Antilles, Nigeria, Sri Lanka (for banking not insurance), and Turkey. Additionally, eight countries (Cyprus, Estonia, Latvia, Lithuania, Malta, Poland, Romania, and Slovenia) were in the process of revising their commitments to match the EC schedule" (from the commentary by Jane Kelsey on TISA Financial Services text) -- This document regulates government regulation of financial services like banking and insurance, including health insurance, greatly limiting what we can do. In particular it is thought to freeze new financial services regulations after its signing date, unless they were enumerated then. In the case of the US that date is February 26, 1998. If challenged in a WTO dispute proceeding a country that has violated a "standstill" may have to roll back its regulatory state to the level of regulation in effect on that date. A related concept, "ratchet" is also said to apply in WTO law - it denotes a one way capture of all deregulation in a committed sector making it a violation to re-regulate. See the definitions of "standstill", "rollback" and "ratchet" in trade parlance.

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.

Trading Health Care Away? GATS, Public Services and Privatisation

"But talks have since begun to change one of the 28 agreements overseen by the WTO -- the General Agreement on Trade in Services or GATS. The US, EU, Japan and Canada are trying to revise GATS so that it could be used to overturn almost any legislation governing services from national to local level. And non-government organisations (NGOs) and trade unions are demanding that services in the public interest be clearly exempt from GATS. It details how public services may not in fact be excluded from GATS and explores the implications for public health care."

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

David Price, Allyson M Pollock, Jean Shaoul, THE LANCET - Vol 354 - November 27,1999, pp. 1889-1891 "Multinational and transnational corporations, including the pharmaceutical, insurance, and service sectors, are lining up to capture the chunks of gross domestic product that governments currently spend on public services such as education and health. The long tradition of European welfare states based on solidarity through community risk-pooling and publicly accountable services is being dismantled. The US and European Union governments are aggressively backing this project in the interests of their business corporations. But the assault on our hospitals and schools and public-service infrastructure depends ultimately on a promise from one government to another to expand private markets. Such promises can be kept only if domestic opposition to privatisation is held in check. We need to constantly reassert the principles and values on which European health-care systems are based and resist the WTO agenda"

Patient Mobility Beyond Calais: Health Services Under WTO Law by Markus Krajewski

"The paper analyses the impact of WTO law on transnational patient mobility by transplanting the Watts case of the European Court of Justice into WTO law. The first part of the paper concerns the question whether medical or hospital treatment abroad concerns “trade in (health) services” in the meaning of the GATS. This part identifies the legal construction of this notion through the four modes of supply and also gives a short factual account of the scope and structure of trade in health services on a global level. The next part will ask more directly which measures fall into the scope of the GATS. In particular, it has to be determined whether the exclusion of services supplied in the exercise of governmental authority from the GATS influences the application of the agreement to health and medical services. Having determined under which circumstances the GATS applies to measures affecting the cross-border supply of health services, the subsequent part of the chapter discusses the substantive obligations of the GATS. After a short overview of the main principles of the GATS, the chapter will provide an in depth inquiry into the specific commitments in health services of the EU and other WTO Members, because only the exact analysis of the limitations and qualifications of these schedules allows us to clearly determine the impact of the GATS on the cross-border to provision of health services. In addition, the potential of the general exception clause of the GATS to justify regulations of health systems which violate GATS obligations needs to be ascertained. Lastly, the legal status of GATS in the EU legal order, in particular the contentious issue of direct effect, needs to be assessed, because only if the GATS is directly applicable would a patient who received medical treatment abroad be able to rely on the agreement to claim reimbursement of the costs of said treatment."

The recent Achmea case has received a lot of news coverage in Europe but almost none of it actually explains what the case was about. This PDF..

contains a factual summary (on page 13) which explains that the case was about the electoral victory in Slovakia of a candidate who ran on a platform of restoring single payer health care in the country, as well as limiting the profits of any health insurer, in the intirim period to 20% changes which which were immediately attacked in the first of two Investor vs. State arbitral lawsuits. Slovakia lost the first round. This case is also a good introduction to the sordid history of the IntraEUBITS.

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

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

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.

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.

Trade Liberalization & Women’s Reproductive Health

Women often are charged with the responsibility of caring for their families’ health, education and nutrition, and they often supplement, or earn the entirety of, the family’s income, and provide household labor to maintain upkeep of their homes. The liberalization of international trade increasingly affects women’s health by creating new opportunities to improve reproductive health as well as new obstacles to advance reproductive/sexual health and rights objectives in policies, programs and services. New employment opportunities may open up for women, for example, which may enable them to achieve higher income levels and greater access to health services and technology. However, trade liberalization also may lead to higher costs of health services and supplies, lower quality of services, shortages of critical medical personnel because of increased migration or a concentration of health services that may restrict access for lower-income or remote populations

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.

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.