In the Presidential debate recently, when asked what he would do to improve healthcare, Donald Trump's first response, was the suggestion that we allow the sale of one health care policy in all 50 states. Unfortunately that would lead to a major disaster in health care in the US, one which would be totally irreversible since we signed the GATS agreement as part of our entry into the WTO in 1995.

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The Ability of People With Pre-Existing Conditions And their Families to Purchase Health Care In the Non-Group Market, as well as All The Other Positive Changes Since 1998 (all of Obamacare's Good Parts) As Well As Our Nation's Ability To Choose What Kind of Heallthcare We Have In Any Election, (Blocking Single Payer, and Virtually Any Other Cost Saving Measure, Unless Its More Profitable) IS IN DANGER, All New Regulations Since 1998 Could Be Reversed And Regulations of Health Insurance "Rolled Back" to 1998 Levels. (Or eliminated by requiring global changes that could have a great many unanticipated effects- such as making it so poor people with chronic illnesses had to leave the country to get affordable care, at a time when many jobs will be going away, for good.)

How?

As far as rolling back new regulations, this is how- See where it says "Standstill" - start reading there. The document below freezes regulations that don't conform at their levels on February 26, 1998. Thats simple to understand. Later than February 26,1998, potentially voidable. Pre-existing, less so. (but still subject to MANY gotchas, as we discovered in 1998 with the Glass-Steagall Act which allegedly "had to" be repealed - and cannot be redone, because of other provisions in GATS) For the best overview of the healthcare situation, read this.

In the Presidential debate recently, when asked what he would do to improve healthcare, Donald Trump's first response, was the suggestion that we allow the sale of one health care policy in all 50 states. Unfortunately that would lead to a major disaster in health care in the US, one which would be totally irreversible since we signed the GATS agreement as part of our entry into the WTO in 1995. A signing of the pending TISA agreement, whose negotiations are almost completed in Geneva, might also have the same effect.

The expensive portions of the ACA may be seen as WTO-illegal, because for example, they are new regulations on financial services, when the stanstill was supposed to limit nonconforming regulations to ones that already existed on that date. And you will see below, and dont forget it, the WTO is above all national bodies. (Obama was lying to Elizabeth Warren, because its embarassing to admit that you are not top dog any more, it seems every year some new trade agreement comes out (this year it seems we're getting five or six) But this is one we already have thats been there since 1995, but parts - for example, the specifics of what services the countries plan to trade, and how the various rules will apply to them "disciplines on domestic regulation" just are not finished yet. But many many rules exist- and are binding and have been since the 1990s. Gradually a body of new law is being created. And its not exaggerating to say that this agreement is a uniquely horrid one for people. Its arguably caused 20 years of health care dysfunction, which we have been lied to about, and also quite arguably (experts say this) indirectly caused a huge financial crisis that effected the whole world and cost American families trillions of dollars, by forcing the repeal of the "Glass-Steagall Act" a body of financial rules that protected the US taxpayer from irresponsible banking practices that GATS was claimed to require the repeal of..)

Regulations must also be eliminated if they are "more burdensome than necessary to ensure the quality of the service" (for example, poorer patients could be sent elsewhere - say Mexico or India, for care cheaper, availing themselves of the services of our trading partners, instead of forcing US insurers to cover them-thats a much more trade restrictive approach than the least burdensome one necessary to insure the quality of the service. (perhaps shipping patients overseas for care, or caring for them here with foreign doctors, who arent necessarily worse doctors, just less independent, US doctors often will discuss things with insurance challenged patients that insurers dont want to pay for, without getting the insurers permission in advance, and delisting isnt always enough of a threat to make them toe the line. This will fix that) . GATS and TISA change everything involving services, from ones where the government is involved to market based solutions. And the market when the government is involved may not discriminate in favor of a US or local provider if there is better value elsewhere.

The wage situation in countries like the US is seen as a trade barrier, if foreign firms must obey it. Therefore TISA's goal like GATS before it, is also to "harmonize" US and other developed countries regulations, food regulations, chemical and endocrine disruptor, pesticides, safety, etc. finding the lowest common denominators and nailing rules there. Once wages here are the same as they are elsewhere, the problem of illegal immigration will cease in an inward direction.

GATS Mode Four was not by any means the first of a number of treaty temporary guest workers deals. They go back thousands of years. Several are in the pipeline and they are expected to be popular with multinationals. But its highly questionable practice morally, a type of program that has often been compared to slavery. That will - its its intent, push wages down, in a "race to the bottom" See my last article- it needs some typos corrected but the idea is clear. )

The reasons this health care capture disaster would happen are detailed in four easy to download documents. I suggest that you download them so you can refer to them as we go along. Basically, the roots of the problem go back more than 20 years to the Glinton Administration and the first few years of our entry into the WTO.

click here (Nicholas Skala's 2009 paper in the International Journal of Health Services is the only one on the subject, and if you read it, by the time you are 2/3 done you'll likely be amazed at how much we have never been told. As you can see the entire debate has been misleading as to the real causes of health care gridlock, at best, If we followed Trump and the GOP's suggestions, due to GATS we would swiftly lose our health policy freedom to a trap created during the former Clinton Administration,

If petitioned, the WTO could and would roll back "nonconforming" domestic financial services regulation after 1998, which includes Obamacare, for reasons which are enumerated best in the Skala paper, which include one catch all clause, something called a standstill, which basically is a freeze.. leaving a significant portion of the country - the families who have at least one member with a chronic health condition- with no affordable way to buy even high deductible health insurance. )

BUT, SINGLE PAYER will have been stopped for good, forever, unless we subsequently buy our freedom at tremendous cost, (via the intentionally expensive GATS Article XXI manumission procedure) so I am sure they will be congratulating one another.

And not a peep in the media.
www.maine.gov/legis/opla/ctpchlthcaresub.pdf (This shows the problem a state, Maine ran into when they tried to offer health insurance to their poorer residents, they concluded that it exposed them to suits under the WTO GATS agreement, and that TISA would make the situation substantially worse)

Canada's Approach To Keeping Their Single Payer System is Keeping health care Completely Free of Money. But that has worked in part because Canada's single payer system was already pre-existing when GATS was signed in 1994. The Dates these horrible things are signed (This applies to the Pending 3Ts,and others like the newly proposed TFS too) has special significance because they give corporations rights to ownership of policy that effectively begin and often, give them a legal ownership to view as sort of a ceiling, the state of regulation at that time. Regulations subsequently, can only be reduced, never increased.

(The only way Canada has avoided a similar fate is to have instituted their single payer health system decades before the WTO agreement was signed, allowing it to be grandfathered in, and also by keeping it completely free, avoiding the pitfall of Article I:3(b) and (c)

There is a bunch of additional background info at

www.citizen.org/documents/PresidentialWTOreport.pdf (This is also quite informative and the references are invaluable)

Since one commenter asked a question about the interaction of US WTO commitments with state insurance regulators I went looking for and found some relevant info-

"Not only does GATS limit the range of policy choices available to state insurance regulators, it effectively forces the federal government to preempt any state statute or regulation that the WTO's Dispute Settlement Body ("DSB") finds to be in violation of GATS The United States' GATS insurance commitments constrain states' abilities to regulate the business of insurance. If the federal government agrees to additional insurance commitments involving international trade in services during the ongoing Doha Round, the states will become even more restricted in the regulations they can adopt"

Basically, don't worry, they wouldn't have spent 20 years negotiating a deal that had no effect. We can expect international trade in services to be increased rapidly after the election.

Creating jobs "in the US" just means what it says, jobs are physically here, which can and likely will go to the lowest bidding firms, wherever they are from.

The US promoted "Global Value Chains" approach is a core part of "Clintonism". and its "redistribution of wealth upward"

To do anything differently (to discriminate against our trading parters and their firms) would be to reneg on more than 20 years of promises to developing nations to use trade in services as a tool towards economic integration of poor nations into the gobal economy. The United States and other rich nations have been cashing in on the liberalisation from trade in services for 20 years, and now there is a lot of pressure on the developed nations to help the poorer nations out by steering services contracts their way. Sort of like the New Deal.

At the same time, the trade in services deals like GATS have made it impossible to have old style New Deals that discriminate against foreign corporations. In the spirit of Citizens United the trade deals like GATS and the new Ts attempt to adopt something like "No Corporations Left Behind".

If you are one of those people, like me, who likes to have a video playing while you do other work, here is an appropriate one to add to the body of information.

This is about standstill and rollback.

click here (Video of Lori Wallach on Democracy Now)

The situation with health insurance that we face is very similar to what can happen with TISA and rolling back of any post 1998 financial regulation.

They are very slick. It raises questions about the legitimacy of the system for them to have done this.

Basically, what will happen first if we allow one policy to be sold across state lines is that foreign health insurance and healthcare providers will enter the US market, and in other respect its quite possible that "patient mobility" will allow or perhaps mandate that certain kinds of care (particularly costly care) be performed overseas if possible..

This is why even the smallest act which would have the effect of turning it into world trade and passing jurisdiction to the WTO completely shifts authority to discipline many rules from then on. Which is intentional. Visualize Ulysses having himself tied to the mast of his ship, so that he could not change anything on his ship even as the Sirens sweetly sang their song, which would have driven a lesser man to fix something like healthcare even if that was against the WTO rules.

Similar cahallenges are facing Canada from all the US FTAs plus CETA. This is a good discussion of the issues.

The GATS was the first of a bunch of FTAs, several are in the pipeline now whose main goal is regulating governments in an irreversibe way so they cant interfere with business. Trade more than anything else is a pretext they use to bypass democracy, elections, etc.

So, selling one policy across state lines will unambiguously trigger the trap. So will signing any of the new FTAs now in the pipeline. Many other things could do that too. Visualize a mine field filled with mines on hair trigger.

At that point a rubicon of sorts will have been crossed and the ability of the United States to withdraw from the agreement (which we would need to do if we wanted to control our own healthcare policy will become several orders of magnitude more expensive. It also would directly contradict a US policy reminiscent of the Vietnam era "Domino Theory" that mandates all countries gradually privatize their services, unless they are kept completely free, and noncommercial, a policy which by all accounts is seen now as a huge mistake. But they are still pushing it. Even though its killing poor people, globally.

). The reasons this is the case is the 1995 WTO General Agreement on Trade in Services. In a worst case scenario outlined by the late single payer activist Nicholas Skala shortly before his unexpected death in 2009, he explained his hunch as to the direction of US trade policy, a hunch which turns out to have been true. Due to our own efforts, as soon as a foreign provider enters our market, our legislators and Presidents hands will be tied and we will be wedded to the for profit health care system forever, unless we buy our freedom, an exit that may become quite costly due to GATS. It will become even worse under TISA, the pending Trade in Services Agreement, almost done in Geneva. To get an idea, you can look at the recent ISDS case involving the Dutch insurance company Achmea and the Slovak Republic, which you can read at italaw.com .

www.italaw.com/cases/417

www.italaw.com/cases/2564 The factual summary in this document is informative

click here (PDF of arbitral decision)

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The recent US-Gambling WTO case involving Antigua, the United States and the supply of online gambling services is also relevant as it shows how a country can trigger these provisions of the GATS without even being aware of it. The only way to prevent that would be to withdraw our health insurance sector from WTO (and other FTAs) jurisdiction now before its too late. Otherwise we're going to be shipping our poorer people overseas for care, they wont be able to get health insurance.

(Maybe that is what they wanted? National regulation preventing international trade in skilled persons and/or sick people across borders is inconsistent with the global value chains goal elucidated at the recent G20 Summit:
click here )

All regulation will be rolled back to February 26, 1998 or January 1, 1995 (There I am unclear, here is why I think the date is in 1998. www.wto.org/english/docs_e/legal_e/54-ufins_e.htm )

What do you think? Can anybody poke any holes in my theory?

WTO-GATS looks like it will be a disaster for a second time for Americans because of this impossible situation it has prolonged for decades in health care, and what it appears will be a really horrible trick. Its parting shot could leave the country either having to pay out hundreds of billions of dollars in free money to foreign insurance corporations for dumping millions of Americans from health care coverage after having delayed any actual resolution of the problems until the WTO trap was sprung and therefter it becomes impossibly expensive.

the "expected lost profits" we would need to pay to have affordable healthcare, (To go through the WTO GATS Article XXI Procedure) after the WTO Trap is sprung will likely be reallly huge, as it would be based on expected lost profits of the entire US health insurance industry.

See also Bad Medicine and Facing the Facts

Also, look at the discussions about the WTO decision for Antigua in US-Gambling case over a tiny online gambling industry. Example

(Article changed on October 16, 2016 at 15:11)

(Article changed on October 16, 2016 at 15:46)

(Article changed on October 16, 2016 at 16:47)

Authors Bio:
Chris is a person with a questioning and inquisitive mind living in the United States, who believes another world is possible.