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THE WTO AN D PUBLI C HEALT H

In contrast with the USA, health is a sensitive issue for European voters. It is thus essential to maintain maximum secrecy as to the true nature of the Millennium Round negotiations to be approved at the ministerial meeting in Seattle in November, especially of the GATS revision, already scheduled to start as early as January 1st, 2000.

Some of the measures proposed seem limited in their scope, but in reality this is only true in the short term. Admittedly, governments have placed restrictions on the liberalisation of some activities, but this has meant registering them for liberalisation in the longer term. In other words, by seeking, for instance, to protect hospitals from corporate encroachment, governments by the same token have in effect issued corporations with a licence to take them over later on.

The WTO Council on Trade in Services has already developed a method to achieve this. Thus, under article 1.3.C of GATS, for a service to be considered to be under 'governmental authority' and hence exempt from 'liberalisation', it is now argued that it "should be provided entirely free". However, since hospitals and clinics charge the patient or his insurance

In Europe, people are no more willing to hand over the protection of their health to the uncaring forces of the market than they are to be force-fed with hormone-treated meat. This suggests that at Seattle the corporations and their allies will not have it all their own way, nor are they likely to meet with less opposition from Third World NGOs, and perhaps even from some official delegates.

for the treatment provided, "it seems unrealistic in such cases to argue for continued application of article 13.C." In other words, i f a treatment is free for the patient, but paid for by "subsidies or other similar forms of financial advantages" then not only must the sector be opened to competition, but the same "subsidies" should be offered to competing commercial suppliers.9

To make matters worse, there is a proposal to adopt what is referred to as the "horizontal approach", which means that i f a particular measure is agreed in one sector - say telecommunications - it is automatically applied as well to all other sectors, including health. In the case of the sub-sector of 'telemedicine' for instance - which involves patient-customers consulting distant doctors and receiving prescriptions via video-phone - it will forcibly have to be liberalised, since member countries have already signed on to the Agreement on Telecommunications.

Even i f this arsenal of provisions proves insufficient for assuring the liberalisation of health-care, other devices for doing so have been anticipated. For instance, the Agreement on Government Procurement, itself backed up by another proposed Agreement on Competition Policy, which the US and the European Union intend to table for negotiation in the Millennium Round, could perfectly well serve the same purpose.

Keepin g i t Simpl e It is essential not to be intimidated by the technicality of these issues. In reality the situation is quite simple. The world's health budgets are massive, amounting to billions and billions

What treatment does the WTO have planned for us?

of dollars. Why not then classify the health sector, not only as a service industry but also as a public procurement? One of the favourite methods used by the WTO to liberalise any sector is to reclassify it under a different category. In numerous countries, the CSI complains, "contracts are awarded by the state following closed procedures which run contrary to the interests of foreign suppliers". Clear rules are therefore essential for ensuring that all public procurement contracts, whether for road construction or, as they hope, for health too, are always awarded to the most "competent companies". But above all, redefining health-care as public procurement offers a huge advantage, that the funds spent - or rather redistributed - by governments, in this case social security contributions, can then be tapped by private companies, whether national or foreign. In France, the AXA group has already bid for the management of health insurance in at least one region. The day this company obtains official consent, a precedent will have been set. Under the obligation to treat foreign companies and local firms alike (national treatment) the same conditions will have to be granted to whatever foreign corporation makes a similar bid. What is truly depressing is that the same thing is on the way with pensions, so as also to open up this sector to commercial competition.

As for the Agreement on Competition Policy, it does not involve reclassifying activities as in the GATS, but in establishing "constraining principles" and "disciplines". As Robert Vastine, President of the CSI, explained in a recent speech in Tokyo, "the WTO members will be asked to consider making reforms to their regulatory regimes". National regulations, he tells us, should have four central attributes: "adequacy, impartiality, least intrusiveness and transparency". Needless to say, he is not demanding transparency of corporate practices, or non-intrusiveness of transnational companies over people's lives. What, in effect, he means, and what the Agreement on

The Ecologist, Vol. 29, No 6, October 1999

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