Here’s what a trade deal with Trump could mean for our NHS


07 June 2019

This week the unacceptably high price of trading with Trump was laid bare as he declared that the NHS would be ‘on the table’ for a future trade deal. He then tried to retreat following a widespread backlash telling another interviewer: ‘I don’t see it being on the table’. Regardless of Trump’s confusion on this, the dangers of a potential US trade deal still are very real.

List it or lose it

American healthcare providers can already compete to deliver services in the UK. However the threat to the NHS of a US trade deal would be through clauses that lock in existing levels of privatisation and prevent future governments from rolling back deregulation and privatisation in the NHS. This is not only dangerous for the future of our NHS as it entrenches privatisation but also undermines our democracy as future governments would be shackled by the binding provisions of a US trade deal.

To prevent this happening, the government would have to specifically exempt the NHS from a US trade deal. This ‘list it or lose it’ approach was used in the now-failed negotiations for a EU-US trade deal (known as TTIP - Transatlantic Trade and Investment Partnership). Unless a sector was explicitly excluded, it would be opened up to private companies. And back in 2016, the UK government refused to exclude the NHS from the TTIP negotiations and so in spite of government claims this week that they would never sell the NHS, their track record tells us the opposite.

The pharmaceutical lobby

But the area that corporate America is really chomping at the bit for is on drug pricing. Trump has already complained that the high drug prices that patients are facing in the US are because of ‘freeloading’ by other countries’ socialised health services. His logic makes no sense whatsoever. High drug prices are being faced the world over - driven by profit-hungry big pharma. The NHS is already having to ration and reject drugs because they are too expensive, leaving patients having to crowdfund for their own treatments. And just this week, cystic fibrosis patients have set up a buyers’ club to access cheaper copies of a life-saving drug with a £104K price tag that the NHS simply can't afford.

High prices aren’t caused by the NHS and they certainly can’t be tackled by pitting US patients against UK patients. Instead we need international solidarity and global collaboration as well as political will to tackle the drug monopolies and transform the patent incentives in the pharmaceutical industry that keep prices high.

The US negotiating objectives include demands for government regulatory reimbursement regimes’ to be ‘...nondiscriminatory and provide full market access for U.S. products’ In other words, a US trade deal could see an attack on the National Institute for Health and Care Excellence (NICE), which assesses the clinical and cost-effectiveness of new medicines for the NHS and attempts to keep prices paid for by the public under control.

A US trade deal could also threaten initiatives such as the voluntary scheme for branded medicines pricing - a voluntary agreement between the industry and the Department for Health that caps the growth in NHS spend on branded medicines. Though the scheme is insufficient to address the underlying drivers of high prices and doesn’t address patient access to expensive medicines, it helps to keep NHS spending on medicines predictable and is a recognition by industry that high prices are a problem.

Attacking these price control mechanisms is a core demand being pushed by the powerful US pharmaceutical lobby group, Pharmaceutical Research and Manufacturers of America (Phrma). They argue that such mechanisms “artificially depress the market value of US innovative medicines” and call on the US government to use trade deals to push for market entry for high priced drugs of American big pharma.

Too high a price

Trading with Trump has a high price tag - metaphorically and literally - and it’s a price too high and one we should resist. Landing a US trade deal is the ultimate political prize for a future Tory party leader to create the veneer that a no-deal Brexit was all worth it in the end. But even with an orderly Brexit, the real winners of a US trade deal would be the corporate masters that would profit from dismantling the protections over drug pricing and wedging the door wide open to entrench further privatisation in the NHS. And so the message that we need to keep repeating to the UK government and all those desperate for a Trump deal is that no trade deal is worth trading in our NHS for.

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Photo: Shealah Craighead/The White House

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