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land second healthcare can be provided through insurance where hospitals and doctors are separately owned and run from the service provider the bismarck model there is a large spectrum between systems based mainly on public insurance and usually creating public option hospitals or requiring no profit such as france belgium luxembourg slovenia the czech republic or estonia and those that allow substantial private and profit making insurance and hospital or doctor provision the netherlands and germany 395 in all cases health is universal and subsidised or free wherever people cannot afford insurance premiums the healthcare outcomes vary greatly between different systems so that while there is generally higher life expectancy with more investment healthcare tends to have worse outcomes and costs more where there is more private business or profit under the treaty on the functioning of the european union article 56 there is the right to receive services with rules codified into the patients rights directive 2011 article 4 requires that people are treated article 5 requires reimbursement of costs by the person s country of origin article 6 requires national contact points to connect healthcare providers or insurers and patient organisations but under article 8 member states may require prior authorisation for people to travel abroad for treatment where the costs are high or planning is needed 396 a european health insurance card is also available for free to receive health across the eu 397 this system was developed after r watts v bedford primary care trust where in 2003 mrs watts travelled from the uk to france paid 3900 for a hip replacement operation and claimed she should be reimbursed the uk s national health service waiting lists were 4 to 6 months at the time the court of justice s grand chamber held that health care counted as a service under tfeu article 56 and that in principle there was a right to receive those services abroad however high demand could justify waiting lists in a national health system but individual circumstances of the patient had to be assessed for non eu nationals the european court of human rights held in n v united kingdom that it was not inhuman and degrading treatment contrary to echr article 3 to deport someone to a country where there were unlikely to live longer than two years without treatment there is no duty through provision of free and unlimited health care to all aliens without a right to stay within its jurisdiction to avoid too great a burden on the contracting states 398 however if someone s death would be imminent the european court of human rights has held that a decision to remove would violate echr article 3 399 banking monetary and fiscal policy edit see also european central bank european banking authority european banking union and european investment bank v t e eu banking sources udhr 1948 art 23 icescr 1966 art 7 tfeu art 282 283 gross national income regulation eu 2019 516 arts 1 2 statute of the european central bank arts 18 19 gauweiler v deutscher bundestag 2015 c 62 14 credit institutions directive 2013 36 eu arts 8 18 35 88 96 capital requirements regulation eu no 575 2013 arts 114 134 deposit guarantee directive 2014 49 eu treaty establishing the european stability mechanism pringle v government of ireland 2012 c 370 12 see european union law banking monetary and fiscal policy is overseen by the european central bank member states and the eu commission this is vital for european society as it affects the human rights to full employment to fair wages housing and to an adequate standard of living 400 when the eurozone and common currency of the euro was established there was no political agreement to develop a full eu fiscal policy i e tax and spending so that governments would pool money and lend to countries in trouble because it was thought that wealthier member states should not have to subsidise poorer member states however there was planned to be a common central bank which would aim to have common interest rates the ecb based in frankfurt controls monetary policy that underpins the euro member states also have central banks such as the bundesbank banque de france banco de españa and these 19 eurozone member state central banks have a duty to act compatibly with ecb policy 401 the ecb has an executive board with a president vice president and four other members all appointed by the european council by qualified majority after consulting the european parliament and the governing council of the ecb 402 the governing council is made up of the ecb executive board and member state central banks using the euro they have 8 year terms and can be removed only for gross misconduct 403 the european central bank is meant to maintain price stability and full employment 404 but it has not yet used its monetary policy powers to make banks divest from the fossil fuels that cause inflation 405 to prevent escalating wage inequality or escalating housing prices the european central bank s primary objective shall be to maintain price stability without prejudice to that objective it shall support the general economic policies in the union such as balanced economic growth and price stability a highly competitive social market economy aiming at full employment and social progress and a high level of protection and improvement of the quality of the environment 406 there are three main powers to achieve these goals first the ecb can require other banks to hold reserves proportionate to their type of lending 407 second it may lend money to other banks or conduct credit operations third it may operate in the financial markets by buying and selling securities 408 for example in gauweiler v deutscher bundestag a german politician claimed that the ecb s purchase of greek government debt on secondary markets violated tfeu article 123 which prohibits directly lending money to member state governments the court of justice rejected that the ecb had engaged in economic policy i e fiscal transfers rather than monetary policy decisions which it was allowed to do 409 so far the ecb has failed to use these powers to eliminate investment in fossil fuels despite the inflation that gas oil and coal cause given their price volality in international markets beyond the central bank the credit institutions directive 2013 requires authorisation and prudence provisions in other banks in all eu member states 410 under the basel iii programme created by an international banker group banks must hold more money in reserves based on the risk profile that it holds as determined by the member state regulator more risky assets require more reserves and the capital requirements regulation 2013 codifies these standards for instance by mandating that proportionally less in reserves is needed if more government debt is held but more if mortgage backed securities are held 411 to guard against the risk of bank runs the deposit guarantee directive 2014 creates an eu wide minimum guarantee of 100 000 for bank deposits so that if anyone s bank goes insolvent the state will pay the deposit up to this amount 412 there are not yet rules requiring higher reserving and accounting practices for climate risk and of gas oil or coal reserves become worthless as europe replaces fossil fuels with renewable energy european nations by gdp ppp per capita in 2019 the eu has not yet updated its gdp measures to discount for harmful goods and services that create greenhouse gas emissions pollution or ill health 413 the budget of the european union is set in 7 year cycles and in 2022 around 170bn was spent of which nearly one third was agricultural policy including regional development 414 eu member state government expenditures are far higher as a proportion of gross domestic product but are constrained by the fiscal compact which requires no more than a 3 budget deficit compared to gdp in any given year and aiming for surpluses or balanced budgets 415 as a result of the eurozone crisis a treaty establishing the european stability mechanism created a fund to assist countries with severe fiscal problems 416 the results of the strict conditionality attached to loans or so called structural adjustment that required privatisation cuts to welfare and wages in greece spain portugal or ireland was particularly negative the eu s main metric for economic performance has been gdp which adds up market exchange values in firm accounts and government expenditures according to the gross national income regulation 2019 417 even though this fails to discount polluting and harmful economic activities such as energy and industry that damages the climate the environment and human health the eu s budget mainly comes from contributions of around 0 7 of gdp per member state as well as a share of eu value added tax and customs duties the eu does not yet have a more comprehensive system for preventing tax evasion or for fair taxation of multinational or financial corporations 418 electricity and energy edit v t e eu energy sources echr 1950 art 2 and iccpr 1966 art 6 1 cfreu 2000 art 37 tfeu art 3 3 iccpr 1966 art 1 2 icescr 1966 art 1 2 tfeu art 194 hydrocarbons directive 94 22 ec arts 2 6 lliuya v rwe ag 2015 case no 2 o 285 15 urgenda v state of netherlands 20 december 2019 19 00135 friends of the earth v royal dutch shell plc 2021 hague district court electricity directive 2019 944 arts 3 8 and 35 gas directive 2009 73 ec art 4 and 9 renewable energy directive eu 2018 2001 arts 3 7 annexes i and v preussenelektra ag v schleswag ag 2001 c 379 98 foster v british gas plc 1990 c 188 89 1991 2 ac 306 tfeu arts 63 and 345 netherlands v essent 2013 c 105 12 see european union law main articles energy policy of the eu renewable energy in the eu environmental policy of the eu climate change litigation and climate change in europe like the world the eu s greatest task is to replace fossil fuels with clean energy as fast as technology allows since protection of life 419 and improvement of the quality of the environment are fundamental rights 420 and the highest policy goals of the eu 421 in international law there is also the inherent right of all peoples to enjoy and utilize fully and freely their natural wealth and resources such as clean air 422 and the right to the benefits of scientific progress such as clean energy 423 the eu s overall target is to reduce toxic greenhouse gas emissions by 50 55 by 2030 and be carbon neutral or negative by 2050 424 and 32 renewable energy by 2030 425 though a 45 target by 2030 was proposed by the commission and backed by parliament in 2022 426 since the 2022 russian invasion of ukraine it aims to eliminate russian fossil fuel imports as fast as possible 427 however laws such as the hydrocarbons directive 1994 still enable gas and oil extraction it requires that licences are awarded based on technical and financial capability methods price and previous conduct that applicants are treated equally by objective and non discriminatory criteria and advertisements for tenders must be public 428 it has not yet required that existing licensees pay for the pollution and climate damage they have caused nor sought to end extraction of gas and oil the eu s greenhouse gas emissions are 90 from 1 energy generation from gas oil and coal 2 buildings with gas heating 3 transport using oil and 4 agriculture by 2023 clean energy was cheaper from wind solar or hydro 429 but eu law has not yet required rapid clean technology adoption a growing number of cases seek to enforce liability on gas oil and coal polluters 430 in friends of the earth v royal dutch shell plc the hague district court held that shell was bound by the tort provisions of the dutch civil code book 6 section 162 2 interpreted in light of the paris agreement 2015 article 2 1 and echr articles 2 and 8 rights to life and home 431 to immediately start cutting all of its emissions by 45 by 2030 whether generated directly by its corporate group scope 1 indirectly from its purchases scope 2 or indirectly from its value chain or the purchase and use of its products scope 3 it emphasised the serious and irreversible consequences of dangerous climate change in the netherlands pose a threat to the human rights of dutch residents 432 after this loss shell dropped royal dutch from its name and moved its headquarters to london 433 in lliuya v rwe ag mr lliuya who lives in huaraz peru has claimed that rwe ag should pay 0 47 of the costs of flood defences against a melting mountain glacier that increases the size of lake palcacocha because rwe is responsible for 0 47 of historic global greenhouse gas emissions the higher regional court of essen gave leave to appeal on whether there is causation of damage and in 2022 visited the lake 434 there has also been heightened responsibility on member state governments in urgenda v state of netherlands the dutch supreme court held the dutch government must reduce greenhouse gas emissions by 25 before 2020 following the ipcc 2007 minimum recommendations and that failure to do so would violate the right to life and home in echr articles 2 and 8 435 in the klimaschutz case the german constitutional court held that the german government must speed up its climate protection measures to protect the rights to life and the environment under the grundgesetz 1949 articles 2 and 20a 436 however the eu and member states have so far failed to codify liability to prevent pollution and climate damage by corporations that profit 437 and the eu emissions trading system has failed to adequately price carbon for the damage it causes prices traded under 98 per metric ton until the end of 2022 438 deforestation in europe has been driven by biomass being classified as renewable 439 even though burning wood for power pollutes the air and harms human health more than coal and drives climate damage 440 as clean energy from wind solar or hydro storage replaces pollution from gas oil and coal eu law has standards for generation and distribution networks first in generation the renewable energy directive 2018 still enables biomass and biofuel to count toward renewable energy statistics based on the argument that trees or plants absorb greenhouse gases when they grow 439 even though biomass burning usually in ex coal plants releases more greenhouse gases than coal biomass transport is not clean forests take decades to replenish and smoke damages human health second the eu does not yet have a feed in tariff system requiring energy grids and retailers to pay a fair price to households or businesses with solar or wind generation however in preussenelektra ag v schleswag ag the court of justice held that member states could fix any price they chose so that energy companies would have to reimburse producers for the energy they received a company now owned by e on claimed the feed in tariff was state aid under tfeu article 107 and should have to pass rules for 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