Lisbon Treaty
Bad hor health

Joe Higgins

There is grave concern about our health service. The system is underfunded and two-tiered, with conflicts between private interests and patient care. Closure of public hospitals is matched by incentives for private for-profit operators. Most people are unhappy with this and think health should not be a commodity to be bought and sold: that everybody should have access to free healthcare when they need it.

But Europe’s elites think otherwise. Even trade unionists who support Lisbon acknowledge the neo-liberal turn in the EU’s approach to public services.

The Lisbon Treaty threatens public services, including healthcare, in several ways. The EU wants Member States to limit public spending. Alongside  this is pressure to open public services, initially to private contractors from across the EU, but later to world markets at the WTO. This process would worsen the problems of access, accountability and quality in our services and put the profit motive centre stage.

First, Lisbon would give more power to Brussels to influence public expenditure. The Treaty would include  “price stability”  in the EU's “objectives”, and add new powers “to set out economic policy guidelines” for eurozone members (Art.115). Procedures to deal with “excessive deficits” have been strengthened (Art.104). This means pressure to curb public spending, hive off parts of the public sector and expand the use of Public Private Partnerships – which have proven costly and unreliable for the Irish taxpayer.

Second, Lisbon will not protect public services from market rules. Under these rules, an EU business can demand the right to provide a service in any Member State. European Commission policy on social and other services, based on rulings from the European Court of Justice (ECJ), is that “... in practice… the vast majority of services can be considered as ‘economic activities’ within the meaning of EC Treaty rules on the internal market” (COMM 725, 2007).

The 2006 Watts ruling of the ECJ stated that Art 49 – the right to provide cross-border services – applies also to healthcare. The Commission  concluded from this: “Some Member States with systems based on integrated public funding and provision of health services had argued that the treaty provisions on the freedom to provide services did not apply to them; the Watts judgment confirmed that they do”. And while Art 152 TEC says the EU “shall fully respect the responsibilities of Member States for the organisation and delivery of health services…”  the Commission says this does not mean Art 49 would not require Member States to change their social security systems - to pay cross-border operators. (SEC 1195/4, 2006)

Former UK Health Minister Frank Dobson (Labour) underlined the significance of the Watts ruling when criticising Lisbon in the House of Commons on February 6th: “In a recent ECJ decision, now followed by the European Commission, the neo-liberals who hold powerful positions on the Court and the Commission decided to open everything to do with healthcare up to internal market forces … I am very dubious about supporting a treaty that has not done something to set aside the Watts decision.”

Commission policy is to allow competition between direct public provision and private contractors in the 'market' for services – with the state acting as regulator and providing some of the funds. But the only way to protect health and other services from the profit motive is to clearly exclude them from market rules. Lisbon does not do this. And despite what Yes advocates say, Art 16 and the Protocol on public services will not prevent another ruling like 'Watts'.

The third area of concern is international trade in services and the WTO’s General Agreement on Trade in Services (GATS). Despite various claims by the Yes side, Lisbon will remove the veto on trade in health, education and social services. Art 188c.4b says a veto would be available only in exceptional circumstances: if trade “…risks seriously disturbing the national organisation of such services or prejudicing the responsibility of the Member State to deliver them”.

Proving to the ECJ that such “risks” exist would be very difficult. Some governments, with EU approval, are already letting the private sector into these services; and the ECJ has already said that market rules apply, despite Member State 'responsibility' (Watts).

Removing this veto is a declaration of intent: to allow outside operators into the European “market” for public services, by stealth.

Frank Dobson highlights whose interests are served by trade liberalisation: “…There are very powerful forces at work behind the proposition ... Those forces are the US health corporations... [they] are roaming around Europe and Britain looking for markets.”a

In the current WTO-GATS talks the US wants to open public health systems, worldwide, to for-profit corporations. Its opening statement is clear: “The US is of the view that commercial opportunities exist along the entire spectrum of health and social care facilities, including hospitals, outpatient facilities, clinics, nursing homes, assisted living arrangements, and services provided in the home; and that existing and new commitments should reflect this reality.”

The US is not alone. Our own employers’ body IBEC let the cat out of the bag when it declared that a Yes vote “creates the potential for increased opportunities for Irish business particularly in areas subject to increasing liberalisation such as health, education, transport, energy and the environment”.

Once the EU signs a GATS agreement on public services we will be locked into a process of deregulation and privatisation. That is why the unrestricted veto on international trade in health, education and social services must be retained. Without it, reversing this government's policy of giving health contracts to fraud-mired multinationals will be much more difficult: if the veto goes, how can we make them block an agreement?  Voting for Lisbon will effectively remove this veto.

Lisbon should have been an opportunity to exclude public services once and for all from the rules of the market and international trade. Instead it promotes privatisation and gives us less control. The only rational choice is to reject it.