TTIP, a Trojan horse for quality health care accessible to all? ESO seminar TTIP – Blessing or Curse? Monday 20 June 2016 Joyce Loridan- European & International Affairs

“How is it possible that an international trade agreement messes with domestic regulation” “It’s time to democratize trade negotiations”

“We as Belgian mutuals fear that TTIP and other deep liberalisation free trade agreements such as CETA will endanger our system of social protection and solidary health insurance.”

TTIP, a Trojan horse for quality health care accessible to all TTIP, a Trojan horse for quality health care accessible to all? Overview 1. Mutuals lead the way to accessible health care 2. EU health and trade competencies 3. Update & timeline CETA& TTIP 4. Recommendations of Belgian mutuals for trade agreements 4.1 Transparent negotiations with involvement of EU citizens and civil society 4.2 Excluding health insurance and health services from trade agreements 4.3 A pharmaceutical policy that remains within the competence of the member states 4.4 Guarantees on respecting national policy on health prevention and promotion 4.5 The exclusion of any investor- state arbitration mechanism 4.6 Conclusion 5. Mutuals continue to lead the way to secure accessible health care

1. Mutuals lead the way to accessible health care Social security systems: solidarity or individualism Belgian system of social security Financing Vertical and horizontal solidarity

1. Mutuals lead the way to accessible health care Health mutuals / mutual benefit socities actors at the core of the social protection system and health care provide a direct alternative to private commercial insurers Belgian law of 6 august 1990 not for profit association in spirit of providence, mutual assistance and solidarity aims to promote the physical, mental and social well-being of its members. 3 areas of activities on behalf of the state they manage the compulsory health insurance and defend its affiliates in tariff negotiations with healthcare providers complementary insurance provide legal capacity to defend its members in court & information and services relating to health and social rights (via services and associations)

1. Mutuals lead the way to accessible health care They are not for profit associations -no stakeholders- which makes them act in a socially responsible way in benefit of their affiliates. Important actor in social economy Belgium : 5 national federations of mutualist benefit funds (NVSM), auxiliary fund, rail nearly 100% of the population –without risk selection- is insured against risks of sickness and disability financially accessible& good availability Intermutualistic cooperation on trade agreements

2. EU health and trade competencies Health : article 168 of the Lisbon Treaty “ Union action shall respect the responsibilities of the Member States for the definition of their health policy and for the organisation and delivery of health services and medical care. The responsibilities of the Member States shall include the management of health services and medical care and the allocation of the resources assigned to them.” European integration & internal market >>> stronger EU competencies in economy and budgets >>>blurred lines between economic and social competencies Liberalization Trade policy: EU competence -> critique on trade agreements / deep liberalization

3. Update & timeline CETA& TTIP CETA: Comprehensive Economic and Trade agreement 2009-2014 , 2016 EU only <> mixed agreement Provisional implimentation TTIP: Transatlantic Trade and Investment Partnership 2013- … 14th cycle TTIP leaks

4. Recommendations of Belgian mutuals for trade agreements Transparent negotiations with involvement of EU citizens and civil society Excluding health insurance and health services from trade agreements A pharmaceutical policy that remains within the competence of the member states Guarantees on respecting national policy on health prevention and promotion The exclusion of any investor- state arbitration mechanism

“If you’re not at the dinner table, you’re on the menu” 4.1 Transparent negotiations with involvement of EU citizens and civil society “If you’re not at the dinner table, you’re on the menu” 88% meetings are with lobbyists 20% of the meetings are with Big Pharma Transparency in CETA was insufficient! TTIP: reading rooms, civil society dialogue ! Involve civil society !

4.2 Exclude health insurance and health services from trade agreements Positive – negative lists (CETA) Public services Versus Cooperation state & private not for profit actors Health insurance liberalized or protected? (Social) services of general interest > not protected in CETA Commercial for profit actors System of solidarity under pressure <> health care with more commercial goals > commercial benefits and not for a greater good or improvement of the general wellbeing. Comparison Belgium- US : GDP, % covered, risk selection

4.3 A pharmaceutical policy that remains within the competence of the member states No extension of intellectual property rights (patents <> generics) Direct advertisement for prescription drugs shouldn’t be allowed. Upholding strong rules for the sale of pharmaceuticals via internet (no deregulation of consumption) We ask that results from clinical trials wouldn’t be treated as trade secrets. CETA TTIP <> “The United States continues to highlight the need for closer dialogue with the government and meaningful opportunities for stakeholder input into budget and pricing decisions.”

Standards: race to the top? Precautionary principle ? 4.4 Guarantees on respecting national policy health prevention and promotion Clause on the regulatory capacity of governments in health, safety, environmental and social protection. Standards: race to the top? Precautionary principle ? Unhealthy commodities? Climate and environment

4.5 The exclusion of any investor- state arbitration mechanism ISDS > ICS Intellectual property rights, general wellbeing ICS put to the test Philip Morris vs. Australia Eli Lily vs. Canada Achmea vs. Slovakia

4.6 Conclusion “CETA disappoints the recommendations of the EP” - Prof. F. De Ville- Analysis conformity of CETA with the EP 8 July 2015 resolution on TTIP “CETA in its current form doesn’t offer the guarantees demanded by the Belgian mutual health funds to allow a system of affordable high quality health care that is accessible for everybody.” “CETA doesn’t guarantee our current system of close collaboration between government and private players in health care (hospitals,…) aid (domestic help), social security (mutual, trade unions), social services,… Analysis Belgian Mutuals “TTIP offers no improvement in economic or social conditions for European citizens” European Social observatory

5. Mutuals continue to lead the way to secure accessible health care National level: CIN – European level: AIM Belgian CivilSociety organisations Political situation Flanders- Wallonia

5. Mutuals continue to lead the way to secure accessible health care Stopttip.be

5. Mutuals continue to lead the way to secure accessible health care The national stop TTIP& CETA day Stand up for your rights Affordable, accessible and high quality health care