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.
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