1. 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

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

3. “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.”

4. 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

5. 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

6. 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)

7. 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

8. 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

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

10. 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

11. “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 !

12. 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

13. 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.”

14. 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

15. 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

16. 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

17. 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

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

19. 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