This page describes the corporate attempt to
include health care in international trade agreements under the
umbrella of the World Trade Organisation (WTO). If this succeeds it
will permanently redefine health care as a corporate market
internationally. It will give multinationals free access to foreign
health care systems.
- INTERNATIONAL TRADE NEGOTIATIONS
- HEALTH CARE IS A CORPORATE TARGET
- AUSTRALIA AND THE WTO
International Expansion:- The international expansion of US health care multinationals and their plans for large profits have been frustrated by the resistance of citizens and the medical profession in target countries. Local customs are very different to those in the USA. In most countries the vulnerability of the sick and elderly has long been recognised and is still an important consideration.
Regulations:- Long established regulatory restrictions based on professional and community value systems are a constant barrier to what for profit health care corporations consider legitimate free trade. These regulations seek to protect citizens from deceptive practices and from unsavoury individuals.
The US marketplace:- Pressures in the competitive US marketplace have selected for deceptive practices and unconscionable conduct by unsavoury individuals. Such individuals and their practices dominate the US health care marketplace. Restrictions on advertising and Australia's probity requirements create insoluble problems for these groups. Economic wisdom considers these restrictions to be anticompetitive and a breach of the rights of the individual to trade freely. They have long since been removed in the USA.
Advertising:- In most countries health care advertising has been tightly restricted to protect the gullible from exploitation. Most health care corporations consider marketing to be their most important activity and the key to success. In practice corporate marketing in health care has been deceptive. It has been used to fan the anxiety of target groups in the community in order to create a market for unnecessary services.
Probity provisions:- The idea that those responsible for the care of the sick and vulnerable should be "fit and proper" persons is a traditional value of society and of the health professions. These people must be trustworthy. Most societies consider that the protection of vulnerable members should be given some precedence over the rights of individuals when deciding who should provide care. Licensing regulations protect citizens and amongst the requirements is the important requirements that applicants should be "fit and proper" people. The burden of proof is reversed in favour of the community rather than the individual. Applicants are expected to show that they are fit and proper people and that there are no grounds for assuming otherwise. Integrity is a key consideration in being fit and proper. Any person failing to disclose matters impacting on their probity would be disqualified.
Several multinationals have tripped and fallen over the Australian probity provisions. Over the last 10 years these provisions have successfully protected our health system from dominance by multinationals. They have been used to frustrate the plans of governments seeking to create an international health care marketplace in Australia.
Probity Provisions Emasculated:- During this period governments and the business community have successfully rendered probity provisions unenforceable in all states except Victoria. The Australian federal government has quietly removed probity provisions from its licensing requirements. The government is walking on thin ice. The public still strongly supports the concepts behind the probity requirements and citizens have been kept in the dark about these changes. Government credibility is at an all time low.
Australian Government Policy:- As is so clearly revealed in the speech by the chairman of the Australian National Competition Council to the World Bank in February 2000, Australian government economists and marketplace advocates have a very negative view about professionalism and professional values. They clearly share the view that such structures are anticompetitive. They are certainly aware of and support the behind the scene moves to include health care in international trade agreements. This is clear from policy statements and past conduct.
Governments have failed to address the major deficiencies in the Foreign Investment and Review Board's (FIRB) regulations. They have removed probity requirements from regulations licensing nursing home operators, the most vulnerable sector of our population. The consequences are revealed by the recent nursing home scandal. They have failed to legislate to give state regulators the power to enforce probity provisions against multinationals.
It is unlikely that all this is unrelated. It should be seen as a process of quietly preparing Australia for world trade agreements without alarming the electorate. These agreements would give US multinationals free access to our health system.
CLICK HERE -- for more information about international expansion
CLICK HERE -- for more information about the US health care marketplace
CLICK HERE -- for more information about the FIRB regulations.
CLICK HERE -- for more information about probity provisions in Australia.
CLICK HERE -- for information about the World Bank Speech
CLICK HERE -- for information about the Australian nursing home scandal
Introduction:- A series of international trade negotiating groups have been established around the world in order to negotiate and enter into regional and world wide trade agreements. The intention is to foster and facilitate world trade and there is no criticism of this. The World Trade Organisation (WTO) is the central and most powerful body for implementing these agreements. It has also set itself up as a judicial body to try those who fail to meet their obligations under trade agreements.
Were this a structure set up by the worlds community to serve the needs of all of the worlds citizens and member states there would be few problems. Unfortunately this does not seem to be what has happened and the whole process has been hijacked by groups which have very different interests.
The criticism of the WTO and its supporting groups is not the benefit of free trade but a) the areas which are defined as "products" for free trade, b) the over-representation of corporate and market interests, c) the way in which it has structured its processes, d) the language used to disguise the true intent, e) the loss of national sovereignty, f) the nature and power of its dispute resolution processes, and g) the dominance of the wealthy corporatised nations.
a) Products:- Negotiating committees are dominated by economists and representatives from the corporate market sector. Discussion is consequently largely constrained by the confines of economic rationalist thinking - all embracing theories which are applied indiscriminately.
All human activity, even the duties and commitments which we owe to one another and to the vulnerable and less fortunate in our society are seen as services which have commercial potential for self interested groups. Using some remarkable logic this is seen as beneficial and desirable. Health care, aged care, social services, the environment, even pensions are services which can be defined as products which can be traded for profit in the marketplace.
It is claimed that foreign multinationals intent on profit for distant shareholders, who have no interest in the local community should be free to tender for contracts to care for the frail and vulnerable in member countries.
Because the dictionary defines these as services then the sort of agreements which are thought to be effective for other services like tourism or financial services are automatically assumed to be applicable to all services. This is not a logical argument but is typical of that used by economists (see Graeme Samuel's speech to World Bank)
b) The over-representation of corporate thinking and corporate interests:- One of the major reasons for the massive demonstrations at the WTO in Seattle in November 1999 and at the World Bank in Washington in April 2000 is the perception that the government departments and the other representatives on the negotiating and decision making bodies are simply representing the corporate lobby. They come from the market sector and they represent market views.
Multinational corporate interests, particularly those from the USA dominate and effectively dictate decisions. Non government organisations with alternative points of view are not represented. Their views are not considered credible and their arguments are simply ignored.
Canada has already experienced major problems under NAFTA (North American Free Trade Agreements). Over 40 citizens organisations banded together to form a single group, the Council of Canadians to combat similar multinational trade agreements. Businessmen and business groups, who had previously strongly supported the NAFTA have been disturbed by its adverse consequences for Canada. They spoke out strongly about what was proposed in Seattle.
Groups across Europe and in developing countries recognised the problems and took action. In Australia there was almost no discussion of the WTO. Instead we were the passive subjects of a marketing exercise extolling the benefits.
HERE -- to go to the Council of
Canadians www site
c) The WTO processes:- As with the other politically contentious issues of our time the corporate advocates of trade globalisation threaten disaster and claim urgency in dealing with the issues. They seek to frustrate informed debate and rush their prescriptions, which they see as self evident into international law.
They use the efficiency argument to circumvent critical discussion and the expression of alternate views. To accomplish their objectives they urge the adoption of the principle of "horizontal integration" in the interests of efficiency. The concept is that if an agreement is entered into in one service area then it will automatically apply to all services in the same spectrum of activity. There will be no need to negotiate an agreement about health or aged care. An agreement negotiated in another service industry, perhaps tourism will automatically apply. Politicians ratifying trade agreements negotiated by trade officials in one area will unbeknown to them be ratifying the same agreement in multiple other areas.
d) The use of language to obscure intent:- Those local regulations and restrictions which support local customs and protect citizens are conveniently reclassified as "obstructions". Restrictions on advertising is one of those mentioned for health care. Probity provisions in federal and state licensing regulations in Australia are obvious major "obstructions" in health care.
Persuading or coercing governments into removing these obstructions is called "liberalisation". Representatives are also pressured into international trade agreements which, because they are national take legal precedence over state laws.
Corporate objectives are attained by creating the public image of a desirable liberalising process which is seeking to remove obsolete obstructions to beneficial trade. Liberalisation becomes a catchphrase bracketed with that other magic word reform. In the current social climate, by claiming reform any desirable or important social structure can be effectively removed.
e) A loss of national sovereignty:- International trade agreements take precedence over local laws, particularly those of the states. Central governments can effectively impose changes on states which they would be unable to do under our constitution. Any multinational corporation could legitimately appeal a decision made by state regulators to the courts on the basis that it conflicts with international trade agreements. This has already happened on several occasions on the other side of the Atlantic and state governments have been forced to pay large sums in compensation.
Matters of dispute relating to trade agreements are referred to the WTO's own judicial process and there is no appeal. States and even governments effectively lose the ability to decide what is in the best interests of their own citizens and to take the steps which they consider necessary to protect citizens and the environment from being misused by multinationals. Tasmanian Salmon and Canadian water are two recent examples.
f) The nature and power of the WTO dispute resolution process:- A quasi judicial process set up by the WTO addresses any breaches of the agreements, imposing fines and trading penalties. It decides whether local decisions have breached trade agreements. Critics claim that this body is stacked and reflects corporate interests. It lacks transparency and there is no appeal to any higher more independent judicial process.
As a trade organisation its prime concern will be the trading rights of the commercial entity - a multinational corporation involved in the dispute with local government or local laws. The local community will be tarred with the brush of self interest and protectionism. It is unlikely to be sympathetic when "obstructions" based on the ill defined concept of probity are used to deny multinationals access to the Australian health care market.
g) The dominance of the wealthy corporatised nations:- The countries with the money, primarily corporate money attempt to dictate policy and practices for those less fortunate. They are in a position to exert strong pressure on others. In these countries corporate interests exert a profound and disproportional influence on the political process. The USA and Australia are good examples.
These countries exert a strong influence and impose their frames of understanding. They do so in their own interests and in the interests of the multinationals in their countries. The USA has been particularly dictatorial in attempting to impose its solutions on others. Australia has strongly supported the US position with a few self interested exceptions.
We need only examine the relationship between the powerful US Coalition of Service Industries (CSI) and the US government. The coalition is a body representing US service industries. It promotes the interests of US corporations. Aetna, the giant managed care corporation is a prominent member. The submission from the CSI to the US government in regard to US goals in negotiating at the the WTO can be obtained from the CSI www site. The text of the speech given by Charlene Barchevsky to the CSI is also available on this web site. It is clear that she identifies totally with the CSI's objectives including those for health care. She is going to the WTO to bat for them.
Concluding Comment:- World Organisations and World Governing bodies should represent the people of the world and enjoy their support. It is apparent that the WTO and perhaps the world bank is representative only of narrow establishment groups in many countries. The very nature of economic expertise and establishment processes ensures that this is so. The current practice is to appoint stakeholders to government bodies. Those with alternate understandings whose primary interest is in the common good are conveniently overlooked. This gives their appointment legitimacy.
Not only is the WTO unrepresentative of the main stream of world society but it does not enjoy the support of the world community, particularly those concerned about democratic processes. It is clear that its decision making powers extend way beyond those which should be held by a body which represents only a narrow sector of the world community.
HERE -- to go to the www site of the
Coalition of Service Industries (CSI)
Multinational difficulties:- Health care organisations like Aetna are well represented in the CSI. Corporate Health care groups have not found it easy to break into foreign countries. Most countries still consider health to be a humanitarian endeavour rather than a profit generating business. Many are catholic and the pope has roundly condemned for-profit medicine. Corporate interests argue that the world is being deprived of the benefits of "health care reform".
Strategy:- Sun Tsu in his 400 BC book "The Art of War" stressed the importance of selecting a battlefield in which you have an advantage. This is the same strategy which I used in confronting Tenet/NME. Instead of taking them on in the legal battleground of the courts where they were strong I chose the professional battle field of morality, ethics and probity - medical councils and state licensing boards. Here they were weak inexperienced and vulnerable. Their rhetoric could be exposed.
The health care corporations are employing the same strategy. Their own conduct renders them defenceless in the social context of community, professionalism, integrity, and values. By selecting the battlefield of international trade agreements they are selecting an area where they are protected. The language and the paradigms of understanding are their own and their critics are at a disadvantage.
Proposing changes:- Any member of society suggesting changes has an obligation to justify the proposed changes and show that they are beneficial. As this www site shows health care corporations are unable to do this. By coming in under the umbrella of international WTO processes the need to show benefit is removed. Corporate interests need not confront criticisms of their disturbing conduct. Instead critics of health care corporatisation are placed in a position where they must show why the "obvious benefits" of liberalisation should not be applied to health care, why it should not be included in trade agreements, and why an exception should be made. They are denied the opportunity to expose corporate dysfunction before a more receptive community.
Arguing in a protected environment:- Corporations are able to promote their arguments in a forum where those opponents who have marshalled evidence are not represented and where the arguments of their critics lack credibility. Liberalisation is seen as an all embracing "good". In practical terms this means that there will be no opposition. This sort of "reform" is not only highly suspect. It is manipulative and essentially immoral. To address the public good and the welfare of citizens like this is a reflection of the lack of integrity so common in the marketplace.
Making it legitimate:- By using international trade agreements and the WTO powerful forces can be harnessed in support of the corporate mission. What could be more legitimate than to seek to remove the obsolete "obstructions" which have impeded "reform" and beneficial corporate business enterprises in health care. This is a flanking manoeuvre carried out in the relative obscurity of trade negotiations. By a single decision at the WTO all of the objections and problems experienced across the world can be effectively circumvented - a thousand local battles avoided.
Credibility and coercion:- This would all be done under the very credible umbrella of the desirable liberalisation of trade. Any country objecting would be ridiculed as being out of step with the rest of the world. It could be threatened with major sanctions by the WTO.
The CSI's motives:- The CSI
submission to the US government identifies the enormous profit
potential of the health care marketplace and the opportunities
presented for the USA in foreign countries. The CSI considers this a
legitimate motive for liberalising that market and opening it to US
multinationals. Their submission specifically refers to health care,
the environment and even pensions as areas of commercial activity
which would prove profitable. It urges the removal of obstructions to
trade in these areas. It is clear that Barchevsky took this on board.
Australia has been a strong supporter of the WTO process:- The government and the health minister have been involved in a bitter dispute with the health care professions about the introduction of managed care and competition policies.
No one was told that health care was on the WTO agenda. The government was careful not to consult with the profession. A series of low key public meetings were held around the country but these were promoted as being about free trade. Few of those organisations representing citizens would have been aware of the real plans for social services to citizens. It was not until a contact in the UK and Canada drew my attention to what was happening in October 1999 that the medical profession in Australia were informed. Professional bodies took up the matter with the Department of Trade and Foreign Affairs who confirmed that health care was on the agenda. They distanced themselves by indicating that no decision had been made in this regard.
It is unlikely that health was discussed at the turbulent WTO meeting in Seattle in November 1999 but this does not mean that it will fall off the trade agenda. Whether it was discussed at the World Bank meeting in April 2000 is not known. It is clear however that this will not be the end of the matter. The corporate lobby is still extremely strong and fashionable economic belief systems dominate all discussions. That the US, Australian and Canadian governments will continue to support the liberalisation of health care is clear from the ideas expressed in the speech to the World Bank by Australia's Graeme Samuel.
The following two press releases give additional information about the threat posed by the WTO process.
CLICK HERE -- to go to the press release of the the Australkain Doctor's Fund
CLICK HERE -- to go to the press release of the National Association of Practising Psychiatrists