The real chance of pre-existing conditions being affordable in Trumpcare in the US is virtually NIL! — WHY- and what you can do to fix that. (It isnt what you think.)
Our healthcare issue is actually being controlled to a large extent by bad trade policy.
Now some of you may know this, and some may not but in 1995 the United States signed a trade agreement on “services” that reaches down into every aspect of our domestic policy and give the WTO power to tell us what to do. Health insurance as some realize, is a financial service. And because of our WTO membership that has binding legal implications which could become far more limiting overnight if a foreign insurer enters the US market. (This is discussed in both the link above and this paper by a committee established by the state of Maine a number of years ago-an unusually honest and straightforward treatment of this subject, highly recommended)
Additionally, all changes in regulation in the deregulatory direction are captured, we can’t reverse them. So we should be very careful what we vote for because changes will all be more restrictive from the patients point of view, and they likely will not be reverse-able. (emember this is a system created for corporations which sees all government action as bad, espcially state owned enterprises which it frames as monopolies. Instead the “solution” it would put forward are all based on international trade. It would frame the need for affordable healthcare as an opportunity for firms in the less de4veloped (or more unequal) countries to provide either directly through medical tourism (or through subcontracting, low wage high skill workers, with cross-licensing. Thats the so called “Mode Four” that is so controversial.)
Also, the state of regulation on the date the standstill went into effect is supposed to be a ceiling for regulation. That date was either January 1, 1995, or February 26, 1998.
This is in part because the US included health insurance in its Specific Commitments to the WTO. That also means we intend to globalize it and we’re trying to get other countries to help us do that. This commitment also then excludes our fixing the mess, except by the least trade restrictive measures possible. It blocks Medicare for all and virtually everything else that can help. Committing us to ideologically extreme solutions that separate families which may involve undesirable trade offs. (But which also could work, for some better off people — especially multilingual Americans, if not forced on the country)
In particular we need to be wary because the trade literature hypes these changes, which have been planned for 20 years as a huge boon for the developing world which will put the developed countries in the unenviable position of being held responsible for the poor countries economies, and which could cost a very great many jobs. Even as we are simultaneously losing as many as 40% of our planet’s jobs to automation.
(Some in the business community, arguing for the global value chains approach, argue that if so many jobs will be lost, due to automation, they need to cut their costs by off shoring yet more, especially high paying office jobs. Thats circular logic and problematic for our society.)
Most importantly, for this specific discussion quietly, in 1997, we agreed to something called a “standstill-rollback” to freeze further regulation in financial services and every indication is that even as bizarre and unwise as that clearly seems — or really, IS, its been done and for some reason, the US appears to be sticking to its guns on it. Why I dont know. This also has MAJOR potential implications for banking, Medicare and Social Security BTW.
What that means is that the ACA was never intended to last. It has had a built in escape clause built into it. My theory which is clearly supported by the facts is that the current repeal of the ACA is not what the GOP claims it is so much as its an attempt to force a crisis, which only the strong medicine will be proposed as being able to cure. This is total bullshit.
And the real reason is extreme free market ideology. You see the system we are identified with is globally infamous and nobody with credibility is still arguing its good for any of the reasons its been promoted as being, its only still there because of inertia. In particular the end run around democracy that trade deals attempt to do is hated by almost everybody except the cabal of oligarchs who run the developed countries. The fact is, they are more loyal to one another than they are to their countries. And these deals are proof of it.
Therfore I think its clear that the ACA is being rolled back because its new and that violates the rules, and perhaps because some foreign country is demanding they do it, out of sight.
Threatening to expose all their lying if they dont. Since that is quite evil and these agreements are wholly illegitimate because they hijack policy and prevent the changes that a vast majority of Americans want, by dishonesty, I think these deals need to be brought out into the light of day and discussed. because they are a huge abuse of trust and they represent a crime against humanity because they are killing people. And because jobs are going away and the system thats being forced on us forever (thats what these deals do) has never been affordable enough to be a legitimate choice.
In fact, I have what I consider to be proof that indeed a roll back of the changes is how its framed outside of the US, and the reason is that the ACA is framed, outside of the US as “protectionism”. Its quite possible that its framed as a trade barrier. For a great many reasons.
I will put some references at the bottom in addition to this one, but neoliberal thinking is fixated on marketplkace solutions to everything. the concept of healthcare or education or water as a human right or of wages needing to be “living” or supportive of a sustainable society seems by and large alien to it. They see those things strictly as business transactions.
What could happen? Well, for one thing, We could be trapped and rendered unable to do what people wanted even if they had voted for it. They cant change our laws but they could sanction us millions or billions or perhaps even trillions of dollars until we did.. Similar (bot not exactly the same) as what happened to Slovakia . See the summary/timeline which starts on page 13.
Why would this happen? To increase profits. A major complaint of the US health insurance industry is that taking care of sick people is not profitable enough. By involving other countries, US based corporations could position themselve s as middlemen, extracting an even larger pound of flesh than they do now. Also, lowering wages, cheap labor. What would be better than an “emergency” to bring that about? All of this ignores that the insurance industry itself is what makes the US system so expensive. Delaying care also makes health care much more expensive.
Also, it must be mentioned that the government ends up taking care of sick people because the insurance companies are very good at dumping them. See http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2015.302997
They do their best to figure out ways to dump patients when they get sick. So, currently, around 64% of every US healthcare dollar is paid by the government from tax revenue. Obamacare was supposed to reduce that but it wasnt that successful. (Nor was it that successful in insuring the uninsurables, because the insurance industry made sure in various ways that people with serious diseases in many cases still could not afford it. And its likely to get much worse under the GOP.) Will shipping poor patients overseas help? No, because its being done to preserve all the bad aspects of the system, not fix them.
What about taking all that money and using it fora single payer system.
That is what would work, what research has made it clear would work, so thats what they are going to all this trouble to PREVENT.
The money we spend now would be enough to give everybody in the country top quality healthcare for free, but theres a problem, that would run smack dab into this 1995 trade agreement in at least a dozen ways. See the chart in this very very good paper. If you read one of the links in this post, read this one.
So, its clear that they have already made up their minds.
GATS is also the reason Bernie Sanders was never intended by the DNC to win and why they fought that all the way. Suppose he had won and people then expected results? he might find himself in the exact position as the president of Slovakia did, staring at a brick wall in the form of trade agreements that had already turned US healthcare and the right to profit hugely from it into a corporate right. Not a theoretical right, a binding enforceable one. And the way it has been done is really a dirty trick in every sense of the word.
The GATS is part of a scheme by which a great many things were promised to the (wealthiest corporate entities in the freuently quite corrupt) developing world in order to get THEM to agree to give up public healthcare and education and other things which powerful countries like the United States wanted to sell them.
So in that respect, its kind of a distasteful deal. But then again its what corporations often do if given the chance, try to lock in the future, no matter what happens. 9It seems quite the norm that the often authoritarian leaders of developing countries need jobs to give to their patronage networks, also, because otherwise they would have to find them at home) So it seems as if our young people by virtue of being the least well connected, are likely to lose out. In exchange for playing the grand poker game they were promised market access for their firms and the trade deals set up a system where opportunities to bid for business are mandated through so called procurement reform. In order to put jobs on the table a great many public services are being privatized, based on the following test.
“For the purposes of this Agreement…
b) ‘services’ includes any service in any sector except services supplied in the exercise of governmental authority;
c) ‘a service supplied in the exercise of governmental authority’ means any service which is supplied neither on a commercial basis, nor in competition with one or more service suppliers.”
This has been going on since the 1990s, in many countries but the big developed countries have not been participating because the wages in the developing countries are so much lower that their firms would likely get a great deal more business. But the system is set up to be unable to consider issues like that, instead its been set up to be totally morally and ethically agnostic and simply prefer low bids over high. (There may be special preferences similar to afformative action for the very poorest countries firms but they are unlikely to apply to many countries because they are no longer considered poor enough.)
This will be very disruptive if it happens here the way the trade literature wants it to. So the public has been deceived, we’ve been told again and again for example, that an infrastructure spending program will create jobs. But not told that those jobs are not unlikely to go to others unless US wages fell a very great deal. And insomuch as this has been pursued very dishonestly and deceptively its a really dirty trick in my opinion.
But nonetheless this is what I think is likely to occur. Unless we get carve outs from these agreements, Public jobs and contracts for spending, such as infrastructure, healthcare and so on, which are “put into play” will be privatized and become the subject of “procurement reform” which means put up for international competitive bidding.
In order so that professional firms from all around the world get an equal chance, licenses from member countries will be accepted in other countries for like sets of skills and degrees. Its expected this will greatly increase profitability by lowering the cost of labor a great deal. It will also facilitate the moving of a great many jobs overseas as a prelude to automating them.
It will have many other effects too, many of whch are controversial. This is why the negotiations have been hung up — have repeatedly collapsed — in a process going back more than 20 years.
Only now there is a strong feeling this is going to be resolved soon, likely in Buesnos Aires later this year. The likelihood of a deal being struck is reinforced by there being multiple new FTAs on top of this existing one, plus India is proposing a new Trade Facilitation Agreement on Services which targets globalized healthcare insurance (and Social Security) portability (which has other implications — See https://www.citizen.org/documents/GATS-financial-dereg.pdf ).
This struggle is all part of a greater struggle that has been occurring continually for 22 years, the entire lifetime of the GATS agreement.
During most of that time, this bar on new financial services regulation has existed, however it would be unlikely to be challenged in health insurance UNTIL the healthcare market became internationalized, which they expected a long time ago but has not happened because of the 50 different states having different rules, some better than others. Thereare multiple longstanding requests in to the WTO from a number of other countries which see the selling of health insurance to the US’s growing ranks of poor as potentially profitable but they see a number of trade barriers as standing in thge way. The lack of a single NAIC model law (what the Republicans describe as selling one policy across state lines) Also the inability to reject who they want, which existed until 2009, and all other rules subsequent to the 1998 standstill date are likely to vanish to the first WTO petition. So rather than have that happen which is likely to be quite embarassing and expose the entire scheme, the GOP is getting rid of the new rules first. This makes it highly unlikely that meaningful pre-existing conditions coverage will remain in place, or anything new like bans on coverage caps, etc. We will return in every way to the regulatory state that existed before Obamacare, its almost certain. And very likely that efforts will be made to make whatever happens “look natural” instead of the product of collusion between the two main parties and foreign nations against the nation’s people.
Here is the WTO Understanding on Commitments in Financial Services. Scroll down to see the standstill clause. https://www.wto.org/english/docs_e/legal_e/54-ufins.pdf
I should also mention that a great deal of the trade literature supports this theory. Its also supported by a declaration made at the G20 meeting in Shanghai that “protectionist measures” made since 2008 would be rolled back, and that the G20 nations were committed to the concept of standstill and rollback and the multilateral trading system and the “rolling back” of the protectionist measures recently added.
There is a perception that Americans who are seen as having gotten really rich off this system have to give up something, and that something is understood to be jobs. Our cries will fall on deaf ears because how could Americans not know about this, its the biggest thing to happen in intranational relations in the last two decades. And its all been done in our names.
It should be mentioned that despite the foreign image cultivated by the US of Americans as prosperous (after all we have free market capitalism which eliminated poverty, we even eliminated welfare and made those hard decisions we want other countries to make- and so on. Its all a huge con game and everybody laughs in private but its fooled a hell of a lot of people.
But frankly, its going to be a disaster because as all those jobs are offshored and automated, we’re going to have tens or maybe even hundreds of millions of very poor and increasingly angry people.
And its going to blowback on those LEAST responsible for this, like immigrants. And I am sure that is what they are planning.
How could this all be prevented? Honesty and outrage. This scheme this scam needs to come out in all its glory, now to prevent a disaster. That will mean the jobs wont get channeled away, all these services wont get privatized, corporations and foreign countries will scream and start their own competitors to US MNCs but it will be far less disruptive than if the plan were to chop off the futures of the entire US middle class.
But, we will still lose as many as 40% of our jobs, from automation. So Americans need a safety net to be able to survive. Whether or not we “liberalise” as required by WTO law..
So the scheme has to be exposed. Because if so many jobs are going away, rather than trying to shed people, we need a good solution for everybody that treats everybody the same. The rich people are needed to keep the quality level up.
Otherwise empty promises will be worth less than nothing.
Because these deals are so dishonest they are criminogenic. They really cannot be fixed except in the most unambiguous terms, or any wiggle room will be abused. because the lure of easy money in a shrinking economy is very powerful. Its an extremely corrupting influence, not unlike slavery was. Actually just like that. And that is going to create a dangerously unfair situation nomatter how you slice it. One which is completely avoidable had they not lied. We should not feel sorry for the wealthy tycoons from the poor countries. Their countries are poor in no small part because of them. However we should feel sorry for our own working people (including professionals) especially young people who would be frozen out of the job market by these schemes. For no fault of their own.
These schemes by virtue of their lack of fairness also would be likely to create social unrest and vastly increase racism and classism by pulling up the ladders to success for a large portion of our nations people. These deals make the incorrect assumption that all our problems with poverty have zap been solved, and then may proceed to worsten the problems of all of us by eliminating whats left of a safety net, (framing it as a trade barrier). The list of likely unforeseen nagative consequences is mind numbingly long. And the changes would likely bring out the worst in people. Above it all grinning would be the morally unspeakable people who dreamed this scheme up and then sold it to elites. I suspect it would destroy whatever is left of a social contract i this country and others, creating a situation that would likely lead to fascism. And honestly I think that is exactly bwhat they want and why they have been hiding it.
Imagine how horrible many young people may find their situations when even after pursuing a four or six or eight year degree, they are suddenly priced out of the job market with no route to a paying stable career.
Thats what will happen, because it will take years of additional virtually unpaid experience before somebody is hired permanently.
Is our immigtation system in danger of being hijacked for multinational corporations, and closed to refugees and families? Well, considering that the stated goal of GATS and TiSA is to shift all public services to private unless they are “supplied neither on a commercial basis, nor in competition with one or more service suppliers”
A definition which is really narrow. I think it could easily end up that way.
Its a system that will only help the children of the very wealthy, globally.
And they are setting it up to contain huge and costly screens keeping out everybody else, making overcoming those barriers very difficult.
None of this would happen if these agreements were not basically changing everything. People cannot count on anything besides themselves, and they are going to learn how the global corporate state treats others because its now treating our own people the same way. We just havent been told it yet, and we never will be.
The original agreement was already cited as the reason the Glass-Steagall Act needed to be reformed in 1998, as such its *arguably already been responsible for the 2008 financial disaster*. (*see the document below, top of page 31) A single line.
Thats all the evidence there is, anywhere.
This is an archive of http://www.esf.be/pdfs/GATS%20UR%20Commitments/US%20SoC%20Supplement%203.pdf from Wednesday 15…perma.cc
So, not a peep from the US media. Also, when Ive attempted to write about this, Ive been singularly not read, and I am not expecting to be read now. Because this is real news. And it explains whats truly relevant to peoples lives.
Social Security is very likely, almost certainly in grave danger too:
So what can we do? We need carve outs from these agreements for essential public services. We need carve outs urgently. And the big con game needs to be exposed. Each of you that reads this needs to tell others. Find out more, too, and and tell other people. NOW. because for example, with the ACA, then the GOP wont be compelled by fear of exposure to gut the regulations which extend coverage at low cost to people with money who have pre-existing conditions, because the scandal will already be known.
Its even possible that the country is being blackmailed by some other country to do this in order to get those patients sent their way.
Exposure of this 22 year long LIE may bring convictions. It will bring honesty to the national debate in a way it has not seen in decades if this entire scheme is exposed, and the scheme is so evil, it wont happen any other way.
In hundreds of conversations both in person and online with media people a number of people all have told me the same thing, they would lose their jobs or be boycotted or screwed over by big MNCs they depend on if they were the first, but after other media breaks it they can write about it. So do that, tell people about it even if you are not a media person. Only by attention to it being paid by the larger community will they feel safe. Force them to cover it. Because its real news. Its essential information.