What point are you aiming to make by bringing the paper here?

International economics governance institutions led by the US pushed these changes - basically the "competition policy" mindset required that countries adopt a whole raft of policies intended to promote business and wean countries off of subsidies and regulation of all kinds, framing "public services" as only those services "supplied neither on a commercial basis, nor in competition with one or more service suppliers".

In health insurance, this meant that any new services in any market sector were and are banned unless explicitly carved out in advance.

Otherwise, anything that is considered a non-conforming measure - anything provided at below market rate by governments had to conform to something called "standstill" which basically says "Any conditions, limitations and qualifications to the commitments noted below shall be limited to existing non-conforming measures." (newer versions of standstill clause example "In detail, the agreement should seek to bind, in general, the autonomous level of liberalisation of the parties and provide for opportunities through negotiations for improved market access"

This means that the existing level of liberalisation (privatization and deregulation0 must be a sort of high water mark and everything from that day forward must be less regulation and less government involvement, so new nonconforming measures are explicitly forbidden after the date of signing and any changes if challenged have to be rolled back.

its possible this might be interpreted fairly loosely until the challenge by some countries (not the US though) -in them its possible that in order to comply, services must be neutral in terms of their impact on commercial providers so as not to become attractive, and not reduce the value of the market to investors. the US is likely to not even go that far unless its temporary. And easily explaiable as an artifact of the general need for deception of the electorate. Everybody understands that as these issues are very sensitive in the US, especially those involving jobs and globalizatiton, which is a crucial part of this transition.


Subsidies should be structured so they do not favor the providers in any one country, including services. means tested subsidies of various kinds are strongly discouraged and increasingly only available to least developed countries as most developed countries with their high level of wealth are considered to no longer need them.


---- this is referring to mostly but not entirely the WTO General Agreement on Trade in Services--- (1995-1998)

"Most-Favored-Nation Treatment: ("MFN&quot This provision requires a member to give
service suppliers of any other (WTO) member "no less favorable treatment" than it
gives service suppliers of “any other country”

(4, Art. II).

Prohibition on all new “Monopolies”: This provision requires that if a country
grants new “monopoly rights” regarding the supply of a service covered in its
schedule, the country granting the “monopoly” must enter into negotiations to
provide compensation to any other member adversely affected by it. If an agree-
ment is not reached, the affected member may refer the matter to arbitration, and
the “monopoly” may not go into force until the compensation required by the
arbitration has been made. The term “monopoly rights” is not defined anywhere
in the agreement (4, Art. VIII).

“Disciplines” on Domestic Regulation: In sectors where no commitments
have yet been undertaken, the GATS states that a special Council for Trade in Services
shall develop “disciplines on domestic regulation” that assure that qualification requirements and procedures, technical standards, and licensing requirements for the provision of services be “not more burdensome than necessary to ensure the quality of the service.”

Regarding sectors in which commitments have been undertaken, however, it
is unclear whether such a “necessity test” is already in force (4, Art. VI).

Specific Commitments. These rules apply only to service sectors that members
have volunteered to submit to the rules by inscribing them in their schedules.
Members were also given an opportunity to reserve specific exceptions to the
rules during the negotiations of their schedules. Rules in this section fall into two
broad categories, Market Access and National Treatment.


Market Access: The rules in this section are aimed at preventing governments
from limiting the number, type, form, or size of foreign service suppliers in their
markets or intervening to affect or regulate the way the firms provide the service.
Examples of prohibited measures include (4, Art. XVI):

- Limitations on the number of service suppliers

- Limitations on the total quantity of service output

- Requiring a specific type of legal entity (e.g., nonprofit)

- Limitations on the “total value of service transactions or assets”

National Treatment: This set of rules requires that foreign service suppliers
receive, “in respect of all measures affecting the supply of services,” the same
treatment that a nation gives to its own service suppliers.

"It is easy to think of situations in which a country may want to shape policy to favor domestic industry
over foreign operations, but the GATS rules go even farther than these requirements. Under the National Treatment rules, any measure that modifies the conditions of competition in favor of a domestic supplier is a GATS violation.

In other words, even if a policy has no intent to discriminate against foreign service suppliers—indeed, it can be totally unrelated to service provision at all—if it has the effect of disadvantaging them, it is potentially a violation of the GATS
(4, Art. XVII).

Health insurance has been explicitly labeled as a financial service so its subject to very explicit rules. :


Special Rules for Health Insurance.

The United States committed health insurance
to its schedule under the Financial Services section. Two special sets of rules
apply to commitments made under this section. The first is the Annex on Financial
Services, a unique set of constraints that apply to all commitments in financial
services, no matter what nation makes them. The second is an even more expansive Understanding on Commitments in Financial Services, a set of extreme liberalization rules (this was written in 2009 when provisions in all US style trade agreements were still seen as bizarre, now these provisions are common in US style FTAs- thats why they are so scary. )

that are an optional “attachment” to commitments in financial services that the United States has chosen to take. These rules go so far in
constraining governments that only developed countries have signed on to them.


The Annex on Financial Services: Most financial services are related to banking
and investment, hence the Annex provisions pertain mostly to them. One provision
in particular is significant in assessing the impact of the GATS on health care:


• Subjection of “Public Entities” to GATS Rules: Normal GATS rules make an
exception for government services and procurement (with significant limitations). The Annex specifically states that if a nation allows domestic service suppliers to compete with “public entities,” those entities are subject to
GATS rules. This will have significant implications for Medicare, as we will see (4, Annex on Financial Services, §1(b)(iii)).


The Understanding on Commitments in Financial Services:

The most far reaching document in the GATS, the Understanding binds signatory nations to
an extreme level of financial services liberalization. The commitments undertaken
by signatories to the Understanding include:

• The “Standstill” Provision: The signatories pledge that any exceptions to
the commitments they have made are limited to existing measures. The
implications of this vaguely worded provision are not entirely clear. Some
commentators believe that the signatories bind themselves to never enact a
limitation on their commitments in the future that was not in effect when
the Understanding was inscribed in their schedule. In effect, the level of
privatization at the time of the implementation of the Understanding is
“locked in” .

I'm an American presently residing in England. My partner is a British, we've been here for the past 2 1/5 years.
I'm sure you've heard about the National Health Service (NHS) here.
The NHS works excellently - it's efficient, clean, modern and overall the Carer's & Doctors are happy pleasant people.
This includes all medicines and equipment needed. It also includes dental - but not cosmetic unless it's connected with related work. This is also how the VA works (I'm a Vietnam Vet).

But there is also a thriving private practice here. It's used mainly by people who are business owners, etc and need to schedule medical care at an exact time and can afford it. But the private industry is very aware that you always have an option of getting it free. This keeps the prices in control.
Also the private clinics are almost always located near a NHS, that's because the NHS has all the expensive equipment and Specialists available if needed or the private carer or Doctor gets in a jam and needs help. Quite a few Private Services here have tried to contract some of the work for the government but they haven't worked out well, the quality of care and service slowly deteriorates or the prices start to climb (Greed). US Companies haven't been successful in taking over here so far - but they're trying.
The wait times at the NHS aren't what the mainstream Media claim, nobody here I know has had to wait long for an appointment to see a G.P. In fact they are usually seen within a week for routine visits, urgent or emergency care of course has a high priority and there's no wait time, depending on the urgency.

I've literally traveled around the world over a period of 18 years and I can tell you that the US medical system is comparable to third world systems. We deserve better, after all we're paying through the nose for what we have now. Not good enough.
Bernie is the only one brave enough to publicly talk about it.

and education.

See http://www.nhsbill2015.org/

"Yet over the last 25 years, this founding vision has been slowly but surely eroded. The final blow was the Health and Social Care Act 2012, forcing a commercialized model on the NHS in England."

You can see why they are attacking health care and education (i.e. science)


The US's system discourages poor people from getting care. Also, we have a deal where if you are getting preventative care its free, but if you have any aches or pains or other issues and a doctor does anything THEN it counts against your deductible and suddenly a person likely has sudden, large bill and cannot afford both that and rent, rent.


This is useful for certain influential industry groups- Look at this linked paper,

Estimating Burden and Disease Costs of Exposure to Endocrine-Disrupting Chemicals in the European Union: The Journal of Clinical Endocrinology & Metabolism: Vol 100, No 4


can you see why having a system like that might be desirable to chemical industry and agribusiness, to various polluters and manufacturers of products which cause endocrine disruption?

? Note that EDCs tend to be bio- persistant- they are building up over time, so the amount of potential liability-ugh- costs to society is rising all the time.

Regrettably, as far as I know, such studies have not been done in the US due to lack of adequate data, perhaps. But "Americans are very healthy" until they suddenly die.

"excess deaths per year" "amenable to health care"? I don't know..

CROWD-OUT TEN YEARS LATER: HAVE RECENT PUBLIC INSURANCE EXPANSIONS CROWDED OUT PRIVATE HEALTH INSURANCE?

Jonathan Gruber

Kosali Simon

Working Paper 12858

http://www.nber.org/papers/w12858

Note that neither paper mentions the driving factors behind it - the trade related policies that demand that for profit private insurance and its addition of waste be preserved at all costs, even when its clearly failing to address the need for health care adequately for the vast majority of Americans and will become even worse as fewer and fewer jobs remain - automation is gradually eliminating low skill jobs. High skill jobs will vanish also, as thanks to GATS and its progeny, they will soon be subject to progressive liberalisation .

So locking the country in perpetuity into (unless it is willing to buy its freedom for a kings ransom in 'expected lost profits') private insurance model is the worst possible solution at this time and its going to become even less viable over time.