There is growing awareness about the
impact of international trade and investment agreements on the health
sector. The 142-member World Trade
Organisation (WTO) oversees 28 agreements which set the rules for international
trade. The General Agreement on Trade in Services (GATS) has particularly
alarming implications for the future of health care and the delivery of basic
services.
By making specific GATS commitments,
governments limit what current or future governments can do in a particular
service sector. At present the rules only apply to services which a government
has indicated it is prepared to open up to foreign competition. A new round of
GATS talks is currently underway and governments are being pressured to extend
their commitments to as many sectors as possible. They’re also being asked to
accept ‘disciplines’ on the domestic
regulation of services, and bring services that are publicly owned and/or
‘procured’ by government agencies under the rules.
In particular the WTO Secretariat wants
them to reconsider the “depth and breadth of their commitments” on health and
social services, which it says are “trailing behind other sectors” in the rate
they are being listed under GATS. New Zealand has had over a decade and a half
of failed free market experiments with health (and other) services. In 1999, many voted for policies that would
see an end to this narrow market approach. But GATS promises even more of the
same ‘private profit before people’ formula.
GATS has 3 basic rules:
1) a government can’t treat service
suppliers from one WTO country better than those from another
2) it can’t give better treatment to its
locals than it gives to foreign suppliers in the services it has agreed will be
covered.
3) it can’t limit the access of foreign
suppliers to its market in those services by imposing limits on the total
number of facilities and providers, requirements for local content or local
hiring, local community involvement and so on.
GATS threatens to restrict a government’s
ability to ensure access to affordable, adequate basic services by prohibiting
any restrictions and internal government regulations in the area of service
delivery that might be considered “barriers to trade”. Government regulatory measures that even
indirectly or unintentionally affect the conditions of competition of
international service suppliers could be challenged at the WTO. Enforceable
dispute mechanisms could see economic sanctions used against governments judged
to be in breach of GATS.
The privatisation agenda:
To many transnational corporations (TNCs)
health care is merely a lucrative market which they want to control. Non-commercial functions of public services
designed to meet social, environmental, Treaty of Waitangi or cultural
objectives are irrelevant to them and under GATS may be seen as “barriers to
trade”.
GATS is a backdoor to more privatisation.
Public services, especially health, are a big part of government spending.
Pharmaceutical, insurance and health care companies are lobbying hard to open
them up to private, and foreign, suppliers. Through GATS they hope to expand
and lock in the opportunities being opened up by the commercialisation and
privatisation of health care in many countries.
The WTO denies that privatisation is on
its agenda and says that services purchased under government authority are
excluded from GATS. But that does not
apply to services that have any commercial element (like user charges for
health care) or that are offered in competition with private suppliers. When
governments contracts out any part of their health services (eg. Plunket or
blood testing) or private companies supply services also provided by the
government, whether for profit or voluntary (eg. private hospitals or nursing
homes existing alongside state ones), then a WTO dispute panel could say these
are no longer government services and are subject to GATS - and subject to
competition from overseas operators.
The UN Covenant on Economic Social and
Cultural Rights sees health as a basic right: - “all people have the right to
the highest attainable standard of health…as a prerequisite for the full
enjoyment of all other human rights”
Internationally, many trade unions, non-governmental organisations,
public health advocacy groups, health professionals and others see GATS as a
grave threat to health care. Public Services International (PSI) says: “The
elite will be able to access private TNC-controlled care; the rest will have to
make do with the shrinking public system”
We can already see the effects of that
two-tiered healthcare system in New Zealand, and related threats from
commercialisation and privatisation to affordable safe drinking water,
electricity supply, food safety, road and rail safety, air quality, drainage
and sanitation. Expanding GATS to health (and environmental) services will make
things even worse, and limit the policy options available to current and future
governments which want to abandon the market model.
Through GATS, US health care corporations
want:
a) more privatisation. The powerful industry lobby group, US
Coalition of Service Industries told US Congress: “public ownership of health
care has made it difficult for US private-sector health care providers to
market in foreign countries…”
b) to be able to provide health care
services across the border through means like telemedicine
c) majority foreign ownership of health
care facilities, especially in the “entire spectrum” of geriatric services
which they view as a lucrative growing market
d) “pro-competitive” regulatory reform to
address “restrictive” licensing requirements for health professionals and
“excessive” privacy and confidentiality regulations over patient records.
US negotiators, reflecting industry
positions, have made health care a special target: “The United States is of the
view that commercial opportunities exist along the entire spectrum of health
and social care facilities, including hospitals, outpatient facilities,
clinics, nursing homes, assisted living arrangements, and services provided in the
home.” The US healthcare sector wants access to “rapidly expanding health care
expenditures in many developed countries” experiencing “an increase in their
aged population”.
Allyson Pollock and David Price, in The
Lancet (Vol 356 December 9 2000) write:
“The new criteria proposed at the WTO
threaten some of the key mechanisms that allow governments to guarantee health
care for their populations by requiring governments to demonstrate that their
pursuit of social policy goals are least restrictive and least costly to
trade.”
Geof Rayner of the UK Public Health
Association says: “a market-based approach to health not only drives up the
costs of health care, but it can also lead to disinterest in the factors that
make people ill. A consumer society
promises - falsely - that medical technology can fix diseased individuals, and
that good health can be bought and sold in the marketplace rather than being
something to promote or work for”.
Health workers’ wages are also under the
GATS gun. The WTO claims that the
biggest benefit of freer trade is through opening up services jobs to foreign
workers. “The most significant benefits from trade are unlikely to arise from
the construction and operation of hospitals, etc, but their staffing with more
skilled, more efficient and/or less costly personnel than might be available on
the domestic labour market”.
New Zealand has among the most
wide-ranging GATS commitments of any WTO member. The Labour/Alliance government
says that free market forces can’t be left to rule, yet is deeply committed to
free trade and investment. It has never
conducted a cost-benefit analysis on the impact of GATS. In its free trade and investment agreement
with Singapore it made new bilateral commitments which cover dental services,
ambulance services and residential health facilities other than hospital
services. These go further than existing GATS commitments. It commits the two governments to open all
services by 2010. The agreement being
negotiated with Hong Kong is likely to do the same. A document submitted by the
New Zealand government to the WTO Council for Trade in Services in June 2001
stated: “First and foremost, New Zealand will actively encourage Members to
explore ways in which existing commitments in all services sectors, in
terms of both market access and national treatment, can be progressively
liberalised.” This implies that the government is prepared to extend its own
commitments to all servies - including all health, education and water services.
Health care is a fundamental human right -
NOT a tradeable commodity!
What you can do:
Copy this factsheet and circulate it
Ask candidates for your local District
Health Board to take up the issue of GATS and health
Write to, or visit your MP and ask them to
make a stand against GATS
Promote debate in your union about GATS,
free trade and health - encourage them to oppose GATS
Support GATT Watchdog’s postcard campaign
on GATS (Contact us at PO Box 1905, Christchurch, email notoapec@clear.net.nz,
ph: 03 3662803)
EMAIL: notoapec@clear.net.nz