New NHS boss Simon Stevens ducks questions about his alleged connection to pro-TTIP treaty lobbyists pushing to open the NHS up further to profiteering US companies.
Not all of which he answered - particularly on the controversial TTIP deal that many campaigners see as threatening the NHS.
Presenter Sarah Montague read out a question: “People are concerned, not least because of trade talks that are going on which could mean that the NHS is forced to open up under TTIP to American Companies… Does Simon Stevens think he can be unbiased on TTIP given his links to a pro-TTIP lobby group when he was at UnitedHealth”?
Stevens refused to be drawn on his views or lobbying on TTIP - the controversial trade talks currently underway between the EU and the US.
“My commitment is to the National Health Service - it’s where I began my career 26 years ago…I’m optimistic”.
“Ok, but you haven’t actually answered”, commented presenter Sarah Montague.
As the Today programme closed, Times columnist Camilla Cavendish asserted that the response to such fears was, “we have to have confidence in Simon Stevens’ experience in America”.
Just what is this experience?
After a stint as Tony Blair's health advisor, Simon Stevens was ‘President of Global Affairs’ at American private healthcare giant UnitedHealth until last year.
In that role, according to Physicians for a National Health Programme, Stevens was a founder member of The Alliance for Healthcare Competitiveness - a pro-TTIP US lobby group pushing for the inclusion of health in the TTIP treaty. His role there has also been highlighted by The People's NHS.
Stevens also acted as a spokesman for the Alliance for Healthcare Competitiveness's pro-TTIP position.
In September 2011 - as health industry TTIP lobbying was already underway behind closed doors - the StarTribune reported “A coalition of U.S. health care businesses, including Minnesota-based UnitedHealth Group and Medtronic, proposes to rebuild America’s battered economy by selling the country’s ‘health ecosystem’ internationally. The Alliance for Healthcare Competitiveness (AHC) wants the U.S. government to build its foreign free-trade policy around the health care industry...”
The paper quoted Simon Stevens commenting on behalf of the AHC that:
“The worldwide need for health care in aging populations will lead to a demand for goods and services that can drive sales of American insurance, medical devices and record-keeping technology”.
The StarTribune goes on to admit that:
” …the U.S. health care system …is beset with skyrocketing costs and inefficiencies. Americans currently pay more for health care and rank lower in life expectancy and infant mortality than much of the developed world…The call to rebuild the U.S. economy by selling pieces of what is generally considered a broken health care system struck some experts as a bit awkward.”
Or, as “Physicians for a National Health Programme” put it, the aim of the AHC is to “to lobby for the export of the failing US model of healthcare abroad.”
But don’t take their word for it.
Look at what the AHC themselves said in their 2013 submission to the US Trade representative office negotiating on TTIP.
“The proposed TTIP is of great interest to our members as the European Union is the site of nearly a third of world health spending, the principal buyer of American exports of health products, and is experimenting with new approaches to health care systems… The health sector is the largest single component of the world economy.”
"In 2010, according to the World Bank, health accounted for almost $7 trillion of $63 trillion in global GDP…. The health sector will be one of the world’s main future drivers of demand and growth… This gives the United States a significant opportunity... We know that as hospitals gain rights of establishment abroad, they become natural buyers of American medical devices, natural users of American health IT systems, natural telemedicine customers of U.S.-based hospitals, and natural partners for American doctors and medical schools. Trade negotiations on behalf of the sector as a whole have the potential to unleash powerful synergies…”
The AHC say US trade negotiators must demand “full elimination of tariffs on all health goods”, from pharmaceuticals to furniture.
But that’s just for starters. “Non-tariff barriers… generally appearing as regulatory policies” are “the principal barrier…powerful obstacles”, they say.
So the AHC demands “regulations to help generate competition”, adding:
“Trade agreements are an opportunity to address these problems; further open healthcare services markets; impose disciplines on regulatory authority, including rules for technical standards and recognition of qualifications; and ensure that trade in health care services will reach its extraordinarily large potential.”
Here is the AHC at its most explicit:
“Procurement Chapters Should Cover Health Sector: Trade agreements should cover health care. Exemptions from government procurement coverage should be minimal, rather than broadly and ambiguously drawn for ‘health care’ or ‘public health.”
This is the mirror opposite of what those campaigning to protect our NHS from TTIP are saying needs to happen.
Although the actual TTIP negotiations are being kept under close wraps, the demands of groups like the AHC seem to be being heard.
But the AHC says that American corporations currently lack “effective international disciplines” to ensure that governments do not “offer advantages to State Owned Enterprises [like the NHS] at the expense of private capital, including foreign or foreign-invested competitors”.
Offering any such “advantages” - such as the ‘preferred provider’ policy Labour say they want to bring in - creates “major competitive distortions”, and should be stopped by TTIP say the AHC.
“Fundamentally, health providers and insurers should be able to establish operations abroad in the form of their choice with no artificial limits… Trade agreements like TTIP are an opportunity to create such a system.”
The AHC says regretfully that “the WTO and the procurement features of recent trade agreements have achieved relatively little in health…An open trading world for [healthcare] services would create a large new flow of revenue into the United States from foreign operations and from telemedicine.”
There is a particular focus on enabling “cross-border provision via telemedicine” and allowing health data to be shared “cross-border”.
In the name of promoting “innovation” in drugs, medical ‘apps’ and other telemedicine gadgets, AHC also says that in many countries, “U.S. Food and Drug Administration … reassurance … of dossier review and product approval, should be sufficient”, without the need for “onerous” additional requirements like the “publication of clinical evidence in peer-reviewed journals”.
It is notable that telemedicine and medical apps also feature strongly in Steven’s NHS 5 Year Forward Plan - as do US-style private ‘Accountable Care Organisations’ - though the evidence base for such approaches is currently very weak.
The AHC - which includes the main international pharmaceutical companies amongst its members - is also keen to prevent “a downward spiral in terms of prices for medicines... AHC recommends…trade agreements including TTIP…eliminate or at minimum reduce use of price limits…”.
So - what the AHC wants is less regulation of quality and price, and a ban on favouring state providers like the NHS.
As new NHS boss, Stevens is in the spotlight. He pointedly refused to set any cap on NHS privatisation in today’s Radio 4 interview. The questions about his alleged links to pro-TTIP lobby groups like the AHC - and how much we can trust him to protect the NHS - are unlikely to go away.
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