Are the TPP and TiSA the beginning of the globalisation of health care?

“It’s hard not feel that we are being attacked at from all angles with corporations eying off developing and developed countries public health services for profit. With an Australian government seemingly hell bent on dismantling its Medicare system with outsourcing payments while introducing co-payments, it’s looking clearer now as to what the current Australian government has planned” writes Mel Mac.

I recently wrote about the TPP and now I think it’s time that we take a look at the Trade in Services Agreement (TiSA). It’s a services-only free trade agreement (FTA) that began in 2012 with exploratory discussions between Australia, US and the European Union (EU) for a year and with formal discussions beginning in early 2013. Australia, US and the EU take it in turns to chair the negotiations in Geneva. The services sector accounts for around 70% of Australia’s economic activity and accounts for around 17% of Australia’s total exports. Current countries negotiating the TiSA are Australia, Canada, Chile, Chinese Taipei, Colombia, Costa Rica, The European Union (representing its 28 Member States), Hong Kong, Iceland, Israel, Japan, Liechtenstein, Mexico, New Zealand, Norway, Pakistan, Panama, Paraguay, Peru, Republic of Korea, Switzerland, Turkey and the United States. These countries also account for around 70% of global trade in services. China and Uruguay have expressed interest but have yet to be invited, it’s also worth mentioning that the Brazil, Russia, India, China and South Africa (BRICS) bloc have not been invited.

The World Trade Organization (WTO) deals with the global rules of trade between nations and the General Agreement on Trade in Services (GATS) came into effect in April 1994, and involves all WTO members. The TiSA’s aim is to be compatible with GATS yet, set a new standard in services trade that covers all service sectors including health and public services; financial services; ICT services (including telecommunications and e-commerce); professional services; maritime transport services; air transport services; competitive delivery services; energy services; temporary entry of business persons; government procurement; and new rules on domestic regulation to ensure regulatory settings do not operate as a barrier to trade in services. The discussions are held behind closed doors as per other trade agreements, Wikileaks managed to leak draft text from the April 2014 round of discussions involving further deregulation of global financial services markets, despite the Global Financial Crisis (GFC). The draft Financial Services Annex sets rules to assist the expansion of financial multi-nationals into other nations by preventing regulatory barriers. The leaked draft also shows that the US is particularly keen on boosting cross-border data flow, allowing the uninhibited exchange of personal and financial data.

The Australian government has a web page for it’s involvement in TiSA and in the sixth April/May round that Australia also chaired, more than 140 negotiators and sector-specific government experts attended. There were advanced discussions in all areas of the negotiations, including on new and enhanced disciplines (trade rules) for financial services, domestic regulation and transparency, e-commerce and telecommunications, and maritime transport. TiSA parties also agreed to move to a negotiating text for air transport and market access negotiations also continued. The Global Services Coalition or “Team TiSA” organised a substantial industry presence in the margins of the negotiations and as the name suggests is pro the TiSA for the US. Trading in services has grown at a faster pace than trading in goods since the 1980s. The United Nations Conference on Trade And Development (UNCTAD) estimates that in 2013 global services exports reached $4.7 trillion and grew at an annual rate of 5%. Overall, the services trade has grown by 95% since 2000. World Bank research shows that the services sector has become the dominant driver of economic growth in developing countries, delivering both GDP growth and poverty reduction. In 2011, the services sector accounted for a massive 49% of GDP in low income countries and 47% in least developed countries. Team TiSA has every right to be cheering for it as it would benefit the US greatly. The US is the world’s largest single-country exporter and importer of services and they generate more than 75% of their national economic output. In 2013 the US exported over $681bn in services, resulting in a $231 billion surplus. Services exports in 2013 grew by $31.8 bn and services imports in 2013 grew by $12.9bn.

Australia chaired the ninth round early last December and this time it was attended by more than 200 negotiators and sector-specific government experts. Good progress was made in advancing the enhanced disciplines (trade rules) for e-commerce and telecommunications, domestic regulation and transparency, financial services, temporary entry of business persons, professional services, maritime and air transport services and delivery services. There was also further discussion of proposals on government procurement, environmental and energy services, and the facilitation of patient mobility. Parties reported on progress in bilateral market access discussions held since the September round and committed to advance these further in 2015. Besides the vagueness and secretiveness above and what it all means for every day Australians, one thing leaps out and that is the facilitation of patient mobility. Luckily another leak was sprung, the proposal was titled ‘A concept paper on health care services within TISA Negotiations’ and it states there is ‘huge untapped potential for the globalisation of healthcare services’ mainly because ‘health care services is (sic) funded and provided by state or welfare organisations and is of virtually no interest for foreign competitors due to lack of market-orientated scope for activity’. It was allegedly a proposal put forward by Turkey, and was discussed by TiSA members in the September round of discussions. And there are justifiable fears that they want to commodify health services globally as well as to promote “medical tourism” for patients.

Experts, such as Dr Odile Frank of Public Services International (PSI) say, ‘The proposal would raise health care costs in developing countries and lower quality in developed countries in Europe, North America, Australia and elsewhere’. Rosa Pavanelli, PSI General Secretary, also commented that ‘Health is a human right and is not for sale or for trade. The health system exists to keep our families safe and healthy, not to ensure the profits of large corporations’. The proposal could see patients being treated in other TiSA countries for reasons such as long waiting times in their home country or a lack of expertise for specific medical problems. The patients’s costs would need to be reimbursed through their own countries social security system, private insurance coverage or other healthcare arrangements.

The beneficiaries of this are the large health corporations and insurance companies, the ones actually behind the negotiations, that would benefit from an approximate $USD 6 trillion business. Public services are designed to provide vital social and economic necessities such as health care and education affordably, universally and on the basis of need. They exist because markets can’t produce these outcomes. Furthermore, public services are fundamental to ensuring fair competition for business, and they provide effective regulation to avoid environmental, social and economic disasters, such as the GFC and global warming. Even the most die-hard supporters of FTA’s admit that there are winners and losers.

New South Wales (NSW) Australia, Nurses and Midwives’ Association organiser Michael Whaites said: “Prime Minister Tony Abbott and Treasurer Joe Hockey have been saying that healthcare expenditure is unsustainable, but Trade Minister Andrew Robb is quietly engaged in negotiations that could potentially see scarce healthcare dollars going overseas”, and that “You can ask whether the government is working in a co-ordinated manner, and indeed what is their real intention on the future of Medicare?” Professor Jane Kelsey, an expert on trade in services at the University of Auckland, warns that health-service-exporting countries such as Australia could find qualified staff being diverted to health export services “that often have better pay and facilities, eroding the personnel base for public facilities and perpetuating inequalities in the health care system”. Education and training investments could also be diverted “to benefit foreign healthcare users, rather than local citizens and taxpayers”.

In August 2014 the Australian Health Department called for expressions of interest from private players interested in taking over the payments of $29bn each year in health and pharmaceutical benefits currently being managed by the Human Services. Human Services Minister Marise Payne said much of the Department of Human Services (DHS) IT infrastructure for processing the payments was old and needed to be replaced and that the private sector might have cheaper solutions. The government claims it is merely testing the market with an initial expression of Interest process, not via cost analysis or efficiencies already provided. Australia Post stuck it’s hand up from the get go and other Australian corporations that are keen are – Eftpos and Stellar (Telstra) with overseas companies being Oracle, Fuji-Xerox, SAP, Accenture and Serco.

It’s hard not feel that we are being attacked at from all angles with corporations eying off developing and developed countries public health services for profit. With an Australian government seemingly hell bent on dismantling its Medicare system with outsourcing payments while introducing co-payments, it’s looking clearer now as to what the current Australian government has planned. The rise of corporations and their lust for profits no matter what the cost is, has to stop. Governments must get out of bed with them and understand that they don’t know best and an even mix of private and government is required sometimes, but not all of the time. The people elect governments to govern and make decisions, we do not elect corporations. Take some advice from them but if you give them an inch they will take a mile as we have been seeing in recent years. Greed is worming it’s way in globally under the guise of competition and job creation. I find this very hard to believe for your average person, for the corporations yes, they keep getting richer and the equality gap wider. Low income countries delivering GDP growth and poverty reduction will be hardest hit and that’s not fair with many only just recovering from the GFC. The US has the most to benefit from this and all other FTA’s, this also needs to stop, they aren’t the biggest power anymore and even if they were why should they get all of the advantages? People over profits, after all you can’t make profits without us and there’s no need to ruin everyone globally once again for it.

This article was originally published on Political Omniscience as Corporations want to profit from global health with TiSA and the TPP.