Here’s some of the ways a US-UK trade deal could harm our health service

“Despite Donald Trump’s desperate attempt to row back his comments, the cat is well and truly out of the bag. The NHS would be on the table in any future US-UK trade talks."

Donald Trump flip-flopped on using a trade deal to break up and fragment the NHS yesterday, first telling a press conference “everything will be on the table — the NHS, everything,” before, in the face of a massive backlash, telling Piers Morgan: “I don’t see it being on the tablethat’s not trade.”

But whatever the shameless demagogue of ‘post-truth’ politics claims now, a new briefing by the People’s Vote campaign has made clear just how exposed the UK’s health care system would be in a US-UK trade deal.

US trade negotiators and lobbyists in Washington DC, have long seen breaking the NHS as key to their conquest of Europe. 

But short of the NHS being open to full-scale privatisation, what would US negotiators demand? Here we share analysis by the People’s Vote campaign.

Medicine prices

Pharmaceutical companies insist that the NHS should pay more for its drugs (currently, prices in the UK are regulated by NICE). They spend hundreds of millions world-wide opposing any and all measures to limit drug prices and the great success of the NHS’s NICE regime is a prime target.

This is why, when Barack Obama proposed a highly limited health reform in the US, pharma lobbyists and their allies invented tales of “death panels” sitting in Britain to decide who lived or died – this is the political culture that feeds their desire to break our NHS.

The price of drugs is an important political issue in the United States. Donald Trump has blamed foreign ‘socialized’ healthcare providers like the NHS, saying that they do not pay enough for American made drugs. It is therefore very likely that in any trade negotiations, the US will attempt to force the NHS to pay higher prices for its drugs and medical devices.

A dodgy deal could lead to the NHS having to pay for ineffective and overpriced drugs. The Pharmaceutical Research and Manufacturers of America called the UK’s system for evaluating drugs a: “blunt cost containment tool” and went on to say, “narrow approaches to HTA [health technology assessments], such as rigid cost-effectiveness methodologies, should not be the principle framework for assessing value.” The message is clear: they want us to pay more even if the drugs don’t work.

The US’s official trade negotiation proposal states that negotiators will “Seek standards to ensure that government regulatory reimbursement regimes are transparent, provide procedural fairness, are non-discriminatory, and provide full market access for U.S. products” in the chapter for pharmaceuticals and medical devices.

And mega-lobbyists in the US Chamber of Commerce want to force the NHS to pay more for drugs – even if they don’t work as claimed. They want drug prices to be based on research and development costs – rather than effectiveness: “Sector-specific Regulatory Priorities [should] work to ensure pricing and reimbursement systems accurately and fairly reflect the value of R&D processes.” (US Chamber of Commerce, link) In other words, the public should bear the risk of high research costs, regardless of the effectiveness of the treatments.

Given that Donald Trump has in the past accused the NHS of ‘freeloading’ because it pays less for drugs than private hospitals in America, it should be clear that a ‘fair’ reimbursement regime in US eyes is one in which the health service pays much more for its drugs.

Last year Alex Azar, the US Health and Human Services Secretary, said: “On the foreign side, we need to, through our trade negotiations and agreements, pressure them. And so we pay less, they pay more. It shouldn’t be a one-way ratchet. We all have some skin in this game.”

US pharmaceutical lobbyists are among the most powerful and highest spending in Washington DC. They have been trying for years to break the NHS’ power to set the global price of medicines and they now see their chance.

Private healthcare firms running NHS Services

It is no secret that increasing portions of the NHS are run by private healthcare firms on behalf of the government. US healthcare firms have bid on and won contracts in the past, though on a small scale, and they would like to see more NHS services opened up to private American providers.

In the chapter titled “Government Procurement” US negotiators state that they will aim to “Increase opportunities for U.S. firms to sell U.S. products and services to the UK” and to “Ensure reciprocity in market access opportunities for U.S. goods, services, and suppliers in the UK.”

It is clear that any potential US-UK trade deal would mean opening up the NHS to potentially unscrupulous and inefficient American healthcare providers.

Paying more for medical equipment

Lobbyists at the US Advanced Medical Technology Association want President Trump to force the NHS to pay more for US-made equipment: 

“The TPA states that one of the principal negotiating objectives of the United States shall be “to achieve elimination of government measures such as price controls and reference pricing which deny full market access for United States products.” 

America First means putting the NHS last. A demand that could affect the NHS’ ability to acquire medical devices for patients at a reasonable cost.

Patient safety at risk

In the US, medical devices do not have to be tested if they are judged to be “substantially similar” to already tested devices.

But cases have already come to light where such untested devices been shown to be dangerous. It is a growing scandal: “Drugs must undergo two clinical trials before hitting the market, but fewer than half a percent of high-risk medical devices have undergone that standard. In 2015, the Food and Drug Administration received 16,000 reports of deaths associated with medical devices; one analysis estimated that only 1 percent of device-related deaths are reported to the FDA.”

The US Chamber of Commerce would like the UK to be similarly irresponsible: “[We should] promote greater cooperation between relevant U.S. and UK regulators to reduce unnecessary duplication of testing, spur innovation, and provide greater access to the best available medical devices.”

As Dr Rosena Allin-Khan, Labour MP and A&E Doctor says: “Despite Donald Trump’s desperate attempt to row back his comments, the cat is well and truly out of the bag. The NHS would be on the table in any future US-UK trade talks.

“A No Deal crash out Brexit is the biggest and best weapon the enemies of the NHS could ever hope to get their hands on.”

Josiah Mortimer is Editor of Left Foot Forward. Follow him on Twitter.

Like this article? Left Foot Forward relies on support from readers to sustain our progressive journalism. Can you become a supporter for £5 a month?

4 Responses to “Here’s some of the ways a US-UK trade deal could harm our health service”

  1. steve

    EU law entitles the private sector to tender for NHS contracts. This is why Branson’s Virgin Care was able to sue the NHS over a contractual concern – the matter was settled with an undisclosed payment to billionaire Branson’s company – by the NHS.

    And of course, we had the EU’s secret TTIP deal which, had it not been for outraged public opinion, would have gifted the corporate sector even more taxpayer £billions. Yet some argue for Remain on the grounds of protecting the NHS!

    If we want to keep the NHS the only way is to protect it ourselves. Only a fool would rely on the EU or Tory/Farage Brexiters – who have shown their readiness to prioritise the corporate sector over the public good.

  2. Patrick Newman

    Wrong, steve! The obligation to put some services out to tender was created by the Lansley 2012 Health and Social Cre Act which was followed up by Statutory Instrument 500, 2013. Nothing in EU legislation obliges us to tender health services but if we do then EU law governs the T&C’s of the tendering process.
    Outside the EU we will become Trump’s little poodle and don’t think the “The greatest alliance the world has ever known” will inhibit him in plundering the NHS.

  3. Eric Walker

    As I understand it the creeping privatisation of NHS services started under the Blair Labour government when Patricia Hewitt was Secretary of State for Health. When she left government she got a job with one of the selfsame companies for whom she opened the way into the NHS. Please correct me Patrick if I am wrong.

  4. Patrick Newman

    Eric, you are not wrong but this was not demanded by national legislation and to be fair the NHS had become so run down under Thatcher and Major that the only way to get waiting times down quickly was to buy capacity from the private sector. However, obviously Blair and associates got a taste for the private sector and used them a lot for new developments like the Surgicentre in Stevenage which had to be built and operated by Carillion but was so mismanaged that it had to be handed over to the local Trust – handed also a publicity coup to the local Tory M.P.!

Leave a Reply