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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 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 single payer health care. This is all necessary because previous Administrations quite foolishly signed away our rights to regulate dozens of services including those relevant to healthcare financing and delivery (and many others, literally most of our economy) away in the GATS when we entered the WTO. Skala also explains how additions made to GATS in 1998 further prevented and hamstrung regulators, If they attempt to expand instead of deregulate existing social services without leaving GATS or formally modifying the US's "Schedule of Specific Commitments" using Art. XXI FIRST. (See 'Recommendations' section) Otherwise, we cannot improve anything and attempts to expand the Affordable Care Act will encounter numerous GATS provisions like "standstill" and "rollback", which are meant to protect foreign investors profits, locking them in at the Feb 1998 level. If a demand is made in the WTO, compel us to make cuts to restore that previous level of regulation. The level at the end of February 1998 is carved in stone as a regulatory ceiling we are not supposed to exceed. TISA also embeds the GATS dates apparently. GATS can also impact jobs and a newer agreement also globalizes procurement of services, requiring the opening of the economy to temp worker companies if they can provide services cheaper than US firms, potentially taking control over a very wide range of once public & quasi-public government funded and subsidized activities, unless they qualify for a very few, narrow exemptions, such as the 'governmental authority exclusion' defining what can be a 'public service'. (see that keyword on the left, below) If you only read a few papers on GATS on this site, make sure this is one and also read that keyword. Also see "explainer" tagged items.

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.

The TISA Initiative: an overview of market access issues (WTO Staff Working Paper, No. ERSD-2013-11)

"Generally speaking, in a positive-list approach to scheduling commitments, market access and national treatment are granted only in the sectors expressly listed by each party in its schedule; for each sub-sector, the parties then indicate the level of commitment granted for each mode of supply. In contrast, in a negative-list approach, market access and national treatment apply fully to all covered service sectors, except to the extent that non-conforming measures (commonly referred to as “reservations”) providing otherwise have been listed in annexes. In other words, under this approach, everything is in principle liberalized unless specified otherwise in the annexes. In a positive-list approach, nothing is liberalized, unless expressly specified otherwise. Negative-list agreements also typically include a 'ratchet' mechanism, which automatically binds future liberalization for remaining existing non-conforming measures."