How a deal with Trump would put the US first... and NHS last

PUBLISHED: 15:38 05 June 2019 | UPDATED: 15:53 05 June 2019

Protesters protest against NHS privatisation. Photograph: David Whinham/PA.

Protesters protest against NHS privatisation. Photograph: David Whinham/PA.

CrowdSpark/PA Images

Donald Trump's comments about using a post-Brexit trade deal to break up and fragment the NHS has reignited fears about the health service in a UK outside of the European Union.

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Trump echoed US ambassador Woody Johnson by saying that "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 table... somebody asked me a question today and I say everything is up for negotiation, because everything is but I don't see that being... that's something that I would not consider part of trade. That's not trade."

Now the People's Vote campaign have published further research into how a post-Brexit trade deal with the US would threaten the NHS and potentially lead to poorer quality healthcare in the UK.

A spokesperson for the campaign said the reality is that US trade negotiators, and big money lobbyists in Washington DC, have long seen breaking the NHS as key to their conquest of Europe. The NHS, as a monopsony buyer in an advanced economy, with a world-leading drug assessment and pricing regime through the National Institute of Health and Care Excellence (NICE) has enormous market power which it uses to keep US pharma in check to the benefit of people well beyond Britain's shores - in fact NICE is an outstanding example of the UK's soft-power globally and as such is a prime target for the America First chauvinists and nationalists of the Trump administration.

US health providers could also see openings in direct service provision. In the coming decades health care will shift increasingly towards individualised treatments as the role of general hospitals diminishes. The financial dislocation this may bring will be an opportunity for unscrupulous providers to seize control of health assets and assert their market power against a publicly-owned NHS. A trade treaty that limited government ability to regulate the system and restrict marketisation could see the NHS decay as a universal provider as public provision is increasingly limited by owners who invest solely in the most profitable parts of the system.

Here is some more of their report which explains the risks to the NHS from a post-Brexit trade deal from the US.

The pharmaceutical companies

People's Vote campaigners say that pharmaceutical companies insist that the NHS should pay more for its drugs. 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.

Meanwhile, many private American healthcare firms want to bid for contracts to run parts of the NHS. Both demands have been taken into account by the Office of the US Trade Representative, and it is clear that a US-UK trade deal represents a profound threat to the National Health Service.

NHS Drug Procurement

The price of drugs is an important political issue in the United States, say the anti-Brexit campaigners. 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.

In a request 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.

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 - saying: "Sector-specific Regulatory Priorities: […] Work to ensure pricing and reimbursement systems accurately and fairly reflect the value of R&D processes." For them we should the risk of the 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" (link).

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US pharmaceutical lobbyists are amongst the most powerful and highest spending in Washington DC. They have been trying for years to break the NHS's 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".

The People's Vote campaign argue that it is clear that any potential US-UK trade deal would mean opening up the NHS to potentially unscrupulous and inefficient American healthcare providers.

Pay 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." The People's Vote campaign says 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.

…and risk patient safety too

In the US medical devices do not have to be tested if they are judged to be "substantially similar" to already tested devices, argues the campaigners. But cases have already come to light where such untested devices been shown to be dangerous. The US Chamber of Commerce would like the UK to be similarly irresponsible: "Sector-specific Regulatory Priorities […] 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".

Dr Rosena Allin-Khan, Labour MP, an A&E Doctor and People's Vote campaigner, said the "cat is well and truly out of the bag" on America's plans for the NHS.

She said: "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.

"By weakening Britain's economy it will make it all but essential for any British Prime Minister to sign up to a trade deal on Trump's 'America First' terms. And for those around the US President, or in the pay of the US pharma lobby, that will be a golden opportunity to destroy the NHS's drug-price regulation regime and get their hands on chunks of direct provision.

"There is no mandate for any of this from the British people. No deal has no legitimacy but we are being driven towards it by a highly radicalised group of elite politicians, who promised the exact opposite during the 2016 referendum campaign.

"The only democratic answer to this is to put the decision back into the hands of the British people. Now we know just how much is at stake and how deeply No Deal would damage our way of life and our NHS, a final say referendum on Brexit is now an absolute necessity.

"There is no mandate for no deal. There is no mandate for a Trump trade deal. There must be a People's Vote on Brexit."

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