Changes, once allowed, cannot be reversed except by buying a nation's freedom at what would be in healthcare, a tremendous cost, via the so-called Article XXI procedure.
For how this could work, the example of the US-Gambling WTO case between Antigua and the US is instructive; however, health insurance is such a large potential export industry for the US that the likelihood of the US insurance industry allowing any deviation from GATS orthodoxy is virtually nil. In effect the poor captive people in the US market's lives are in danger of being sacrificed on the altar of corporatism in perpetuity.)
The scope of GATS is very wide and offers little refuge for exceptions under the conditions that exist today, which are quietly being made irreversible.
GATS applies to measures (meaning virtually any law or action, or failure to take action, of any kind at any level of government or quasi-governmental authority). GATS applies to "measures of general application affecting trade in services" of all signatory World Trade Organization (WTO) Members. "[A]ffecting trade in any service" is the broadest imaginable scope, and it has few exceptions, one of the only ones being those services "supplied in the exercise of governmental authority", denoting that area of governmental activity that does not effectively relate to trade and commerce and should therefore remain the prerogative of governments (free of trade-liberalization constraints). Defining the phrase "service supplied in the exercise of governmental authority" in Article I of the GATS as only "a service which is supplied neither on a commercial basis, nor in competition with one or more service suppliers".
(That also means that no "public option" could ever have existed. that the whole construct of "public option" appears to have been a lie. Made up by who? And who repeated it knowingly?)
So, if a service is completely noncommercial- it passes this test, basically the question is if the service is completely noncommercial - rendered free of charge or at least in a manner that does not suggest commerce and competition - it is allowed to continue providing the service with governmental support. What this means is that single payer has to be just that, single payer, meaning there cannot be any competition, or private providers of services, in an entire country, (This is the real reason why the NHS in the US is being torn apart by the GATS rules as we speak) and by extension it means it must be free because otherwise what would you do when people could not pay. Logic dictates that if there is only a single payer it has to be free because there has to be only one tier in a noncommercial venture.
If this test was passed, when negotiations were ongoing in 1994 then a country's entire service sector, in this case, healthcare payment, would have been excluded from the scope of the GATS. (That appears to be how Canada escaped having their health care privatized.)
When the GATS was still new, there was much discussion about if concepts such as "on a commercial basis" and "in competition with" still left much room for interpretation. However, in recent years, a number of scholarly works by members of the WTO staff have clarified much of this ambiguity putting the situation in the US under a bright light that it is unaccustomed to. Now the definition of "service supplied in the exercise of governmental authority" is no longer ambiguous; also the efforts of a great many American politicians can be seen to be messaging so as to make it clear to future WTO tribunals that US healthcare is to be seen as the most commercial in the world, and the one least likely to ever be framed as a "service supplied in the exercise of governmental authority" - if the rules are to mean anything. (A similar dynamic also would apply to other government services such as higher education, statutory systems of Social Security, and so on, if similar bright lines are crossed. It seems an effort is being made on one hand to clearly cross them, while on the other hand to hide the meanings of such behavior. If so, the American public needs to know these rules and the costly implications of them better.
This is a UNCTAD course on WTO dispute resolution, which right at the beginning spells out these rules and gives health care as an example (http://unctad.org/en/docs/edmmisc232add31_en.pdf).
Essay on Public Services and the GATS, also on the UNCTAD web site (http://www.ictsd.org/downloads/2008/06/cassim_steuart_part3.pdf).
Interpretation of Article I, Section 3 (b) and (c) of the General Agreement on Trade in Services by Markus Krajewski, published by Center for International Environmental Law (CIEL).
Video by Ellen Gould of the Council of Canadians describing GATS to a Seattle audience - this is the best video on GATS that I know of, it described these aspects of it in detail (https://www.youtube.com/watch?v=LHIfSfb-RvM).
Health-Care Memo by Public Citizen's Global Trade Watch (https://www.citizen.org/documents/Health%20Care%20Memo.pdf).GATS- What is it? (testimony to California Legislature on GATS).
Note how its clear that public services must be delivered on a noncommercial basis to be GATS legal. Otherwise they must be non-discriminatory and "not more burdensome than necessary to ensure the quality of the service".
Additionally, GATS rules elevate international trade in importance. This could lead to a modern-day equivalent of exile for people with illnesses or intolerable variations in medical care, without any accountability for service providers.
Despite the obvious red flags, the GATS puts all choices through a test of trade restrictiveness, claiming this is deregulation. However, the effect is to create a huge new system of particularly onerous and pseudo-legalistic regulations. Therefore I personally suspect new initiatives to globalize service professions will take on a life of their own, which could spin totally out of control, driven by the desire to increase profits, in a rapidly imploding economy.
What we will see is a chain of new, dishonestly framed initiatives (don't expect the US media to tell us about the WTO drivers of these changes) that could result in new "emergency" tiers in our US healthcare system (which would then become permanent additions to the health-care landscape due to the "ratchet" clauses in GATS and its progeny - more recent "negative list" deals that are even more potentially wide in scope, as they include service sectors unless explicitly excluded (i.e., carved out). Additionally, arrangements to send patients overseas to developing countries to save money on poorer patients' care increasingly are being framed and sometimes naively viewed as a form of "New Deal" for developing nations, and therefore could rapidly gain political importance and be very hard to reverse. (The idea of using world-services trade to reduce wages in developed countries is not new; however, the idea of using economic development of the poorer countries to justify it has become particularly popular recently due to work by Christoph Lakner and Branko Milanovic - specifically the work and one graphic, and the conceptual life taken on by the so called elephant chart, and the arguments for economic integration of the developing world without it needing to actually develop (an unwise and unsupported expectation, if it depends on the developed countries sacrificing the livelihoods of their allegedly "overpaid" workers to fulfill it) within the context of a "Global New Deal", which have been advanced by many.
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