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.

 To end the impasse, Britons must end the threat to their NHS's financial integrity.

They would do it (while still in the EU) by formally announcing their intention to modify their WTO schedule of specific commitments by means of the GATS Article XXI procedure. And then do it, which might take some time. Before leaving the EU. 

And announce it to other countries as well, initiating a process to divest the UK of its longstanding trade commitments to "open up" any NHS related services, which is sort of like a divorce. It could be potentially messy, because as the UK has been in the WTO for 24 years, "enjoying the benefits" of the EU commitment to eventually privatize all services that are not public utilities. (If this doesn't sound ridiculous, you're not listening closely enough. But that's what the WTO GATS started, and its a major scam.)

See the end of this paper by the late Nicholas Skala about the situation in the US. Declaring that they would like to return all related sectors, especially health insurance and health services, but also many other related services to being public services.

And complete it.

Before they undergo any dangerous transitions. That would mean that even as a part of the EU, they would need to have separate schedules.

It cannot be overstated, its so important:

The UK does sell health insurance alongside the NHS, it's "public option", and that combined with the impending Brexit transition, (see below) is WHY the NHS has been vulnerable to demands by other countries corporations for market access.

The UK does sell health insurance alongside the NHS, it's "public option", and that is WHY the NHS has been vulnerable to attack.

The UK is NOT a single payer system (because they still sell private, for profit health insurance) so it is NOT exempted from GATS rules by virtue of the governmental authority exclusion (GATS Article 1:3(b)+(c))

GATS Article 1:3 (b+c)

"For the purposes of this Agreement...

(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."

(also, another definition applies from the Annex on Financial Services, under some limited circumstances- but only if a service is part of a "statutory system of social security" - (a retirement system, like Medicare is in the US.).

So, it seems, the NHS is more of a "public option" with all the unpleasant connotations that implies to Americans.

Which is consistent with the death of a thousand cuts its being put through.

Basically, here in the US, that term implies failure, as these public option systems have failed to do their jobs, again and again, (See "State Health Reform Flatlines" article.)

Because the GATS rules are designed to bit by bit, privatize any "public option" public health care system, into a system that makes money, even as it locks in a system that hasn't worked for the US in >40 years.

Nongroup health insurance was already un-affordable to a majority of American primary wage-earners by the late 80s and early 90s.


Death by one thousand cuts, or "slow slicing" is exactly what has been happening to the UK's NHS.

Death by one thousand cuts.

Because of the GATS rules.

The issue is discussed throughout this entire site.

Being a "public option" means that the UK's NHS is subject to a plethora of onerous WTO rules on health care that change everything.

One of them is limits on subsidized care.

These limits include a requirement that it must be eliminated, replaced by a market based solution, over time.

One market based solution is healthcare for the poor and destitute is likely to become international soon. (As Jagdish Bhagwati puts it, "Import doctors, export patients")

From the point of view of the WTO and the cult of neoliberalism generally, the NHS has been too attractive to patients, who might otherwise have bought commercial products.
(See "crowd-out", a concept which is wholly a creature of the GATS era.)

A great many things that are done in healthcare in the UK violate the WTO rules, the NHS had been violating them since before the WTO was created in 1995. However it was "grandfathered" - allowed to continue doing so, as the European countries have been, as can be seen in its WTO "Consolidated Schedule of Specific Commitments" below, however, Brexit will strip it of the meagre protection of the carve-out that is part of the European Schedule of Specific Commitments. (which likely doesn't apply to the UK anyway, if it was brought before the WTO Appellate Body, because it sells private insurance), (soon to become ineffective, if its not rescued in some way, but I would suspect that will probably happen, as much of this is political theatre)

In the European Union, only "public utilities" are exempted from WTO trade rules. That is subject to the scope limitations in GATS Article I:3 the "governmental authority exclusion"

In the European Union, only "public utilities" are exempted from WTO trade rules. That is subject to the severe scope limitations in GATS Article I:3, it's "governmental authority exclusion", which should be understood to not include the NHS because the UK also sells commercial health insurance.

To cite the WTO on this issue:
“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.

(Source: WTO Secretariat. Health and social services: background note by the Secretariat S/C/W50, 18 September, 1998 (98-3558).
Please also see discussion in "How the World Trade Organisation is shaping domestic policies in health care" by David Price, Allyson M Pollock, Jean Shaoul, in The Lancet November 27, 1999 354:1889–92)

To repeat my point it seems clear to me and many other commentators that if the official British governments interpretation of Article 1:3 (c) was ever intended to include the NHS as a public service, it clearly has always been wrong.

This issue is discussed extensively in the literature.

A particularly good example is this essay from the government of Canada
GATS and Public Service Systems

(But we can see that at least John Hilary, one of Jeremy Corbyn's advisors, does see that the UK lacks this crucial protection.) I beg the UK's Labour Party, as I have begged top members of the US Democratic Party countless times, to EXPLAIN THIS DISTINCTION to the people of the UK and US.

It's important!

Above I touched on this fact, but it needs to be emphasized, that by changing their memberships, -that loss of pre-existing condition protection, is about to occur, because of Brexit. If they do this, they open themselves to this trap.

They also really should get rid of for-profit insurance as its intrinsically incompatible with public health care and the two don't mix, intentionally.

Making the NHS additionally vulnerable - if a Brexit occurs, to pressure from the powerful insurance industry lobby and the US government which is the faithful handmaiden of large industries here in the US..

This pre-existing condition coverage (which is called "grandfathering") lapse is a situation that must sound quite familiar to poor Americans, unfortunately.

 I've mentioned the first issue here many times before.

I need to point out here that there are conflicts of interest - US Internet firms want to get a cut of financial transactions of all kinds. An involvement which will likely involve all sorts of data collection, "to prevent fraud" - Just like China.

because of GATS rules, this blocks the government from solving any of these problems, in a less privacy destructive or financially predatory way.

Government involvement was frozen at its 1998 level by another GATS document, the Understanding on Commitments in Financial Services which has gotten zero attention in the US media, probably because its behind the repeal of the Affordable Care Act. 

Its like a 500 lb weight burdening our government (the US) from ever helping free the nation from enslavement by the banking and health insurance industries. It is not the rosy picture people think where we can just vote for "Medicare For ALL" and have it fixed. (Although by all means we should vote for the candidate who stands for that, despite his lack of candor here, he's doing the best that he can, I suspect.)

I bet our legislators and Senators are in a difficult position, if they disagree with policy. We have to realize though, we can talk about GATS, we are not under prohibitions, because it is not secret, its supposed to be public in theory, as its being used to steal from us it has to be. So they can say later that we knew about it but did not speak up. Idiots are we (spoken in my best Yoda voice)

Please, lets get this out there and get a hive mind going on it.

Related links:

Jeremy Corbyn makes a statement on NHS

Twitter thread by John Hilary

Reddit thread for UK leaked documents