The WTO Procedure we must pursue to get our rights to regulate (for example, to implement Medicare For All) back for a service sector (like health insurance)

Its insanity not to be bringing this up at every opportunity.

(NOTE: There is additional material on this Article XXI Procedure here- The two pages should be consolidated)

Politicians aren't saints. When they get votes for free just for discussing things, they can get away with murder literally for decades if people don't press them to actually fix the situation. The real reasons for that gridlock may not be obvious, unless you dig. Well, it turns out to have been negotiations to trade away the country's future. All that policy space couldn't literally be bait if we fixed it, right?

NOW, what they want to do is not clear unless you do some digging.

The media certainly is not going to tell us.

GATS is mostly a huge way, it claims,  of making business all around the world, more profitable, by throwing the middle class and poor both under different buses.

It both guts the safety nets, and it also sets up a huge job trading program.

The jobs it trades are the jobs in sectors like health care and IT, health insurance and teaching, education, and likely in the future, lots of others, engineering, environmental services (See also the GPA or AGP, the government procurement agreement.

(likely conflicting with green new deal) and many others things people want and NEED. Once they become internationally traded they become ENTITLEMENTS of countries, or corporations) Shutting the door to all the changes we need forever, because buying our freedom in the procedure described here, (And on the other web page, which has screenshots) will likely become too expensive!

GATS itself in health care, might outsource patients to other countries, when hospital procedures or long term care are involved, (in the US, not now, its possible this could happen in the near future, but its prevented now by a reservation) and insource doctors and nurses (and dozens of other professions, basically all the decent paying jobs in the country! It is already happening in IT but the real changes are held back by a quota so have basically not begun, leading to accusations we are dragging our feet and a legal suit, a Request for Consultations in the WTO Dispute Settlement Body. That is GATS main goal, setting up a new global modern day slavery system. (GATS Mode 4, and GATS Mode 3 labor) TISA too. The goal is pushing wages down to make businesses much more profitable all around the world, at the expense of the middle class's means of existence. Thats the real world.

We are unfortunately, living under an illusion we're being listened to and cared about that's arguably wrong.

With the caveat that much/most of the House is also being kept in the dark-

That's being maintained in order to steal away the future we all thought we had some kind of birthright to.


in the real world, the US committed health insurance and a great many other service sectors (basically, most of the decent paying jobs held by fairly high skill people in the US, and those service sectors are pawns in an international game, so are quite arguably in grave danger.)

These commitments were made in several stages beginning when we joined the WTO 24 years ago and I think, with health insurance, becoming final at the end of February 1998. 

Here is the procedure we'd need to follow to  actually get the right to change health insurance back.

We should be pushing for this because all of the promises being made by all the politicians (for example, restoring pre-existing conditions coverage for those with illnesses.) would require that. Not just a single payer system everything that politicians of both parties promise arguably violates the WTO unless it arguably makes the situation worse or more risky for Americans, for example, shipping patients overseas for care could put them in a difficult situation because they have no rights whatsoever besides the ones in the contracts between their insurer and the foreign provider.

That's forbidden now but it could change overnight as we're negotiating changes in services like taht as part of TISA, and its already implicitly agreed  to in GATS even if we have a reservation now that prevents it, its very likely inconsistent with the Benefits other countries joined the GATS to get! So it could become toast very quickly.

This isn't going to happen by magic, you know. Nor is Medicare For All as its called going to be able to happen without it. 

Trying to make changes without withdrawing the relevant sectors from GATS first could actually destroy Medicare and Social Security, which begs the question, is that what the politicians want?


original URL:

See also our subject headers on carve-outs and recommendations generally.


1.1 Text of Article XXI

Article XXI
Modification of Schedules

1. (a)  A Member (referred to in this Article as the "modifying Member") may modify or
withdraw any commitment in its Schedule, at any time after three years have elapsed from
the date on which that commitment entered into force, in accordance with the provisions
of this Article.

(b)  A modifying Member shall notify its intent to modify or withdraw a commitment
pursuant to this Article to the Council for Trade in Services no later than three months
before the intended date of implementation of the modification or withdrawal.

2. (a)  At the request of any Member the benefits of which under this Agreement may
be affected (referred to in this Article as an "affected Member") by a proposed modification
or withdrawal notified under subparagraph 1(b), the modifying Member shall enter into
negotiations with a view to reaching agreement on any necessary compensatory

In such negotiations and agreement, the Members concerned shall endeavour
to maintain a general level of mutually advantageous commitments not less favourable to
trade than that provided for in Schedules of specific commitments prior to such

(b) Compensatory adjustments shall be made on a most-favoured-nation basis.

3. (a) If agreement is not reached between the modifying Member and any affected
Member before the end of the period provided for negotiations, such affected Member may
refer the matter to arbitration. Any affected Member that wishes to enforce a right that it
may have to compensation must participate in the arbitration.

(b) If no affected Member has requested arbitration, the modifying Member shall be
free to implement the proposed modification or withdrawal.

4. (a) The modifying Member may not modify or withdraw its commitment until it has
made compensatory adjustments in conformity with the findings of the arbitration.

(b) If the modifying Member implements its proposed modification or withdrawal
and does not comply with the findings of the arbitration, any affected Member that
participated in the arbitration may modify or withdraw substantially equivalent benefits in
conformity with those findings. Notwithstanding Article II, such a modification or
withdrawal may be implemented solely with respect to the modifying Member.

5. The Council for Trade in Services shall establish procedures for rectification or
modification of Schedules. Any Member which has modified or withdrawn scheduled
commitments under this Article shall modify its Schedule according to such procedures.

1.2 Article XXI:5 Procedures for the rectification or modification of schedules
Since the conclusion of the Uruguay Round, an ad hoc certification procedure had been
applied for the purpose of introducing changes or adding new commitments to Members'
schedules, pending the adoption of a formal set of procedures under Article XXI (Modification of
Schedules). On 20 July 1999, the Council for Trade in Services adopted the Procedures for the
Implementation of Article XXI upon the recommendation of the Committee on Specific
Commitments. (fn 1 below) 
The Procedures are to be used whenever a Member intends to modify or withdraw
a scheduled commitment.

2. On 14 April 2000, upon a recommendation of the Committee on Specific Commitments,
the Council for Trade in Services adopted the Procedures for the Certification of Rectifications or
Improvements to Schedules of Specific Commitments. (fn 2 below)

These Procedures are to be used whenever
a Member intends to undertake new commitments, improve existing ones, or introduce
rectifications or changes of a purely technical nature that do not alter the scope on the substance
of the existing commitments.
Current as of: February 2019

Footnotes for above:

S/C/M/38, section D. The text of the adopted procedure can be found in S/L/80. The text of the
decision to adopt Procedures can be found in S/L/79.
S/C/M/42, para. 38-41. The text of the adopted Procedures can be found in S/L/84. The text of the
decision to adopt the Procedures can be found in S/L/83.