The Instigator
Pro (for)
8 Points
The Contender
Con (against)
3 Points

Improved Medicare for All (USA)

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Post Voting Period
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after 3 votes the winner is...
Voting Style: Open Point System: 7 Point
Started: 8/2/2012 Category: Politics
Updated: 6 years ago Status: Post Voting Period
Viewed: 3,280 times Debate No: 24968
Debate Rounds (4)
Comments (16)
Votes (3)




R1: Acceptance and Definitions
R2: Arguments
R3: Arguments/ Rebuttals
R4: Rebuttals and Closing

*No trolling, spamming, bad conduct (new arguments last round, etc.)

*To counter net contender advantage, Con shall only be allowed to respond with 7,000 characters in R4.

*Each side must present one witty quote per round regarding the debate topic (starting R2).

Improved Medicare for All:

A health care system in which one payer (the government) funds all medically necessary procedures with a single insurance pool. Financed through a combination of payroll taxes and income taxes, or other methods. Equal access to coverage and patients have free choice of doctor.

And with that, I await Con's acceptance.


Accepted and looking forward to a good debate.
Debate Round No. 1


“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” - MLK Jr.

Improved Medicare for All would help restore America to broad prosperity.

C1: Saves Money

Improved Medicare for All, also known as Single Payer (SP) would save vast sums of wealth, so they could be reinvested into the American economy for broad growth.

A federal, simple system would finance all medicall necessary medical costs (all other things can be covered by private insurance).


The US economy is $15.3 trillion dollars. [1]

The total health care spending of the US is about 17% of our whole economy, [2] so about $2.601 trillion dollars.

Empirical evidence from the OECD shows that total administrative costs in the USA is about 7%. [3] All other nations (including Canada) have rates around 2-3%.

Crunch the numbers, and say the US reduces its administrative burden to about 3%, and we save about $101.04 billion. Then, add the $12 billion in profits from big insurance companies. [4] Then, add the savings from a fully electronic system of information like I have suggested, (ICT) which would save about $77.8 billion annually. [5]

Also, then add the financial savings from preventive care being used and making citizens having access to it, which would save $3.7 billion, and about 2 million lives a year. [6] Prescription drugs take up about 10% of all American health care spending [7], double the OECD average (per capita). [5] So, save 5% of health care spending due to cuts in prescription drug costs, that alone is $127.84 billion dollars. Then, add a health care entity that evaluates the effectiveness of drugs and procedures, this would "result in a significant reduction in health care costs." says the C.B.O. directer Peter Orszag. [8] Medical professionals/ hospitals would get a global budget, with a guaranteed profit. This would give incentives to decrease real costs through price transparency so that profits are increased. [14] This would save at least $30 billion.

With 14.66% of the USA population uninsured (out of about 303 million) [11] (illegal immigrants not covered) [13], these add to everybody's health care costs (payed partially by private insurers, out of pocket, public insurance and uncompensated care). So then, to expand full comprehensive coverage to these people instead of receiving under-insurance, it would cost $41.14 billion (adjusted). [14] Undocumented immigrants would pay out of pocket, same as when US patients go to Thailand to get more affordable care.

Compile the numbers, and the net savings with Improved Medicare for All would be at least $300 billion, or somewhat over $990 a person, assuming prior premiums are switched to public tax revenues. A simple efficient system finances care. A large risk pool lowers risk. Both factors reduce costs.

*I reduced the sum to account for the transition of the health care system and to account for job retraining and placement for workers affected.

C2: Pro-Business, Pro-Growth


Businesses would have 10-12% lower labor costs. Workers compensation would be cut by up to 50%. Related labor negotiations and the bureaucracy associated would all be eliminated. [15]

With the much lower labor costs and other associated costs eliminated, it would make American businesses more competitive in the global market, strengthening our economy and trade. There would be an equal playing field. So, Medicare for All also ensures fairness and gives opportunity to compete with businesses on all levels.

Private taxation is prevalent. When 20-30% of payments go towards denying you care, and filling CEO and investor pockets, it is essentially a tax, that does not benefit the tax payer.

SP would free up worker income, which would likely be used to buy new products and services, therefore further improving the economy. It is a win-win. Stronger demand and more competitive American businesses would help the economy grow.

-----Pay raises

Health care costs are spiking. Naturally in the market, when productivity increases, wages correlate to this. Since 1970 productivity has roughly doubled. However, health care has taken the place of compensation, making real wage growth minimal. SP would thus increase wealth for businesses, allowing increases in productivity to increase wages as a result, helping the market by huge factors.

C3: Enhances Quality


All are ensured access to care, improving one's life. Global budgets hold down costs.

Simple and fair rules make health care easier.

A database ranks procedures and treatments to identify the efficacy of health motions. [5] Portability of coverage helps all of our lives.

The doctor-patient relationship is empowered, they both make the best decisions to enhance one's life.

A stable source of funding empowers doctors. This creates a greater potential of a support network to improve care.

With improved access to care, simple and fair rules, more effective treatments and less waste, free choice of doctor, and the protection of the doctor-patient relationship all contribute to increased health care quality for Americans.


Doctor-patient care. No longer will complex and intrusive HMO rules dictate what a doctor does to help his patient.

Lower malpractice premiums are common in SP countries, as the gov't takes these costs. Computerized ICT records would lead to less errors.

Simplified billing process. Time and money saved.

Improved patient care. With a continuity of care, the doctor-patient care is improved. Decisions made improve care, instead of CEO profit margins.

C4: Expands Freedom and Life

Currently in our oppressive HMO environment, 45,000 Americans die annually [16] because of one simple reason: HMO's deny care. Doctors do care. Medicare for All emboldens the doctor-patient relationship so the best medical decisions are made. Medicare for All protects the lives of all of us.

---Private Plans

You are not free if you have a serious illness and no health insurance. You could die.

You are not free if you have to sell your home to keep a family member alive.

When big insurance plans deny you care when you need it, they deny you liberty and life.

---Oppresive insurance companies deny us freedom, liberty, and life.

---Single Payer

Everyone's life depends on Medicare for All. Health is a life and death issue.

Everyone's freedom depends on Medicare for All. You are not free when you have a serious illness without treatment, which nearly all of us have sooner or later. Medicare for All enhances our freedom.

The cure for America's sick health care system is Medicare for All. Americans care for each other. It is the basis of our democracy. Patriotism requires Medicare for All.

With SP, it is just you and your doctor. You two make the best medical decisions.

---Medicare for All protects and empowers freedom, liberty, life, and opportunity for all Americans.


Medicare for all would be protect and empower all Americans. These two goals are the basis of our Democracy. By acting on our empathy for all Americans, we would also improve care, improve our lives, and expand our freedom. We would cut costs and vastly improve America's future economy. And it would produce high dividends in return.

Health care is a moral mission. Derived from our principle of empathy for others, SP is an American plan to restore America's prosperity, peace, health, and moral core.



[2] Zakaria, Fareed, prod. "Overhauling Healthcare." CNN Presents. CNN: 2012. T.V.



[5]J. Walker et al., "The Value of Health Care Information Exchange and Interoperability."











[17] "The Little Blue Book", By George Lakoff, 2012. 38-40




Let me start by introducing my case. I am in opposition to the idea that we should have a single payer health care system in the USA

This idea is not a new one. Other nations have single payer health care systems, in various forms. The model that is being proposed by my opponent is not the exact same as the model of any other nation. After all, no two nations are the exact same so it would make sense that no two health care models are the exact same. This does not mean that the experience of these nations are not relevant. They are.

However, we must be very careful in remembering that different nations have different cultures and different populations. Some nations are more different than others. This means that the experience of some nations is more relevant than others to the USA.

Having said this, I will begin my arguments.

The Current USA Health Care System

I do not deny, or even attempt to deny, that the current USA health care system has many flaws. The system, to be modest, is very, very bad. This is a view that is shared by advocates of single payer. However, our view of the cause of the problem and the solution are very different.

First, it should be noted that it is very difficult to blame the failings of the current USA health care system on the free market. Indeed, 48% of health care spending in the USA is public spending from the government [1].

In fact, the USA health care system isn't a free market at all. On top of nearly half of health care spending coming from the public sector, the USA system is dominated by what are called third party payers. What this means is that individuals pay for virtually none of their health care costs directly. In fact, to quantify this, only 12% of USA health care costs are out of pocket in 2010, which means that only 12% of health care costs are paid for directly by individuals [1].

The other 88% is picked up by either the government or insurance companies. This is important, because it means that individuals have no incentive to be sensitive to prices. In other words, they have no reason to look at cost when choosing health providers.

The kinds of reforms I advocate would greatly increase the share of health care costs that consumers would directly pay. However, the reforms I advocate are not part of this debate. Instead, I am arguing against reforms proposed by my opponent. To that end, I will simply stop by pointing out that the current USA system is far from a free market, and that most of it's problems are, in my view, the result of lack of market forces, not too many of them.

The Drivers of USA Health Inflation

In 1960, according to the OECD, USA health spending was $148 per capita and 5.1% of GDP. In 2010, the most recent year for which we have data, health spending was $8233 per capita and 17.6% of GDP [1]. So, the real question is: what is driving health inflation?

I'm sure advocates of single payer, like my opponent, would blame private health insurance and "free market" health care. However, if that were true, we would expect private health spending per capita to have risen at a faster pace than public health spending per capita. However, the opposite has happened. From 1960 to 2010, public health spending per capita grew at an annual average rate of 10% compared to 7.5% for private health spending per capita. Over a 50 year period, this is quite a large difference indeed. If public health spending had grown the same speed as private health spending over this period, we would be spending $2082 less per capita on health care in 2010. That means we would be spending $6151 per capita as opposed to the $8233 per capita that we are spending [1].

In terms of health spending as a percentage of GDP, we would be spending 13.1% of GDP on health care as opposed to the 17.6% of GDP we are spending [1]. In other words, public health spending, or government health spending, has been a much larger driver of health inflation than private health spending.

In fact, if public health spending had grown at the same speed as private health spending over the past 50 years, we would not be the outlier in terms of health spending's share of GDP that we are among nations, a point that will be expanded upon this round.

The Economics of Single Payer

Basic economic principles apply in health care just as they do in every sector. Supply and demand determine prices, incentives matter, and other basic principles are very much alive in health care.

Unfortunatley, the whole idea of single payer health care runs totally contrary to these principles. As far as prices go, a single payer system would have a central bureacracy, not supply and demand, determine prices. Of course, the central planners do not have access to the type of information needed to set prices in health care, so disaster follows.

In terms of incentives, single payer has no incentives to stop consumers from overusing health care. Of course, the central planners don't have access to an infinite supply of medical care, so choices must be made. They must either accept rising costs and the people must accept higher and higher taxes or they must ration care and have long waiting times. This is what happens in a system with price controls and central planning, especially when there is no incentive for individuals to control their own costs.

It is amazing that this kind of system is so popular. After all, if we have learned anything in the last 100 years of history or if we just paid attention to simple logic, we would see that systems that ignore incentives, impose price controls, and rely on central planning inherently fail [2].

Single Payer in Action

We do see single payer health care systems in action in various other nations. However, as I pointed out earlier, we must be careful in comparisons. Th USA is, by comparison, a very large, unhealthy, diverse, and individualistic nation. So, it would not be fair to compare us to a small, healthy, homogeneous, and collectivistic nation when looking at health care comparisons.

In my view, there are two nations with single payer that are somewhat relevant to the USA. These would be Canada and the UK. Both of these nations are somewhat large, although not anywhere near as large as the USA, somewhat unhealthy, although not as unhealthy as the USA, somewhat diverse, although not as diverse as the USA, and somewhat individualistic, although not as individualistic as the USA.

So, it must be remembered, that however single payer works in the UK and Canada, it would likely be even worse in the USA, due to factors mentioned above.

As far as costs goes, both of these systems appear to compare favorably. Canada and UK spend 11.4% and 9.6% of GDP, respectively, on health care. That compares to 17.6% of GDP in the USA [1]. However, a closer look reveals that, while they are spending less in these nations, they actually have higher cost growth in both of these nations. From 2000 to 2010, real health spending per capita grew 72% in the USA. That is compared to 76% and 87% in Canada and the UK, respectively [1]. So, health inflation has actually been even higher in these nations with single payer than in the USA.

Outside of costs, these systems also fall short. In the UK, there are 6 MRIs and 9 CT scanners per million people. In Canada, there are 9 MRIs and 15 CT scanners per million people. In the USA, by contrast, there are 32 MRIs and 41 CT scanners per million people [1]. In other words, we have much more medical technology in the USA.

I am running low on space, but I will expand further on failings of these systems and respond to my opponent in the next round.

"If you think health care is expensive now, just wait until it is free"

-PJ O Rourke

(Must look at excel document for data, many of the figures I got from this source was based on calculations I made using these figures)

Debate Round No. 2


Thanks for your starting arguments JamesMadison. As per say the rules, in this round we will both attempt to rebut our opponent's starting arguments.

R1: Improving Health Care Results

I agree, we do not have a *general* market in healthcare. We have a market composed of bloated insurance companies and some gov't programs including Medicaid, the VA, etc.

The thing is, our current system is a disaster. We both know this. What is driving up costs?

- High cost of surgery

- High spending on pharmaceutical drugs

- Bloated Profits [7]

- Administrative costs

- Heavy use of some technologies (MRIs, etc.)

- Overusage of care [1]

However, Improved Medicare for All is a brilliant system to combat all of these issues. For starters, it is very efficient. As I've said, administrative costs would fall to about 3% or similar to this, and the system would be massively streamlined. Global budgets would encourage additional efficiency, and rewards fiscal constraint, and aligns incentives between patients, providers, to maximize profits for the medical providers. [2]

My system also with global budgets and doctor-management would limit overusage of care, by discouraging overuse of care so profits are maximized for the doctors. A separate budget for high tech items like MRI's would be established to make sure each region gets the optimal technology levels so costs are restrained. [4]

Our current system is a absolute mess. Here is a picture of our current system, a plethora of insurance companies with bloated profits and bureaucracy to deny patients care which maximizes patient suffering and death while lining the pockets of the companies. Gov't tries to solve the problem marginally by providing tax breaks and subsidies. Billing is a foreign language and requires massive bureaucracy and costs:

The alternative: Improved Medicare for all with a streamlined and simple billing process. Very efficient. Overuse of care is ended. The Doctor-Patient care improves quality and efficiency:

R2: Private Insurance Has Higher Costs

My opponent's source did not provide evidence that private insurance companies are more efficint. On the contrary. Since 1969, Medicare costs have went up 400%. However, private insurance rates went up by 700%. [3] This is why partially privatising Medicare under the GOP will increase costs. Here is a nice picture showing my point of health care inflation, Medicare vs Private insurance:

The market in private insurance companies doesn't work effectively. In fact, from 2000-2004, profits for the top 17 U.S. health insurance companies rose 114%. [7] Why is this? Companies in health insurance have an incentive to price people higher in health care and focus on denying people care to maximize profits. [5] And due to the complexity of health care, most people cannot do much about this.

Health care is not a product like bread. There is a vast complexity to it. Will I choose if my plan covers a triple bypass? You really can't, that's why its insurance — to protect yourself against risk. With private plans, that have an incentive to deny you care to maximize profits, your life is at risk. That is why private health plans could be called death plans. They have an incentive to have deny you care.

R3: The Brilliant Economics of SP

My opponent refers us to Socialist, statist healthcare. He is off, by a lot.

Ironically, since private health plans do regulate health planning of individuals, he presented an argument for my side. However, SP is different.

Improved Medicare for All has:

- Free Choice of Doctor; so all patients are free to choose their health care provider without penalties.

- Global Budgets; so hospitals receive so much funding per patient, and have an incentive to reduce overusage of care. They have an incentive to be more efficient to improve profits [2], and cut costs on other areas where waste occurs.

- A strong Doctor-patient relationship. This is a huge point with SP. In this system, it is just you and your doctor who make the best decisions to improve your health, while protecting the authority of the doctor. Private plans meddle with this. Medicare for All let's you and your doctor make the medical decisions. Furthermore, when a patient does receive overusage of care, her health card will provide evidence of this, and the doctor would deny the patient care that is unnecessary, as it would cut profits for the hospital provided in the global budget.

- Smart Copays; that are progressive to a point, and adjusted by income level. This will discourage use overuse of care, while allowing preventive care to occur. It is a win-win.

All the gov't does is finance this. The process:

You arrive and show your health card.

You receive health care services.

You leave with your health card.

An efficient system protects you and your doctor.

Everyone has comprehensive access to care.

Costs are cut and efficiency is maximized.

It really is a dreamy concept.

Bill Clinton with a health security card that all Americans would have ^

---Ultimately, Single Payer provides incentives to make doctors and hospitals become more efficient and cut costs, limiting overusage of care, allow patients free choice of doctor, and cutting costs, which is economically efficient.

R3: Single Payer works

Con mentions that both Canada and the U.K. have higher health inflation. True, but misleading. They are both, as well as other industrialized nations investing in ICT technology, which will in the future reduce costs. If we do this, as I proved in R1, it would save us ultimately $77+ billion. But the initial investments require money.

A SP system would establish separate funds for financing health care technology like MRIs and CT scanners, to make sure each region gets a sufficient supply. [5] Also, overuse of technology like we have today increases costs and doesn't help that much. [1]

The G.A.U. shows that when Canada implemented its Single Payer system, health costs were about 11.5% of total GDP in the USA, and about 8.9% in Canada [6]. Today, Canada spends on its health costs about 10% of GDP, compared to the USA rate of 17%.


As this debate has shown so far, Improved Medicare for All is a great idea. We have a moral obligation to provide access to health care. Rationing care based on if one will contribute to a company's profits is immoral. The status quo incentivizes cruel death with 45,000 deaths a year.

However, Improved Medicare for All would restore America. Our businesses would become competititve again. With $1000 per average capita savings this could be reinvested in our economy for broad growth and prosperity. With equal access to care, we would become healthier. Efficiency would be promoted with global budgets instead of encouraging overuse of care with fee-per-service. A modern and efficient system would control costs and is necessary for America's future.

"In economic terms, single-payer is clearly the way to go." - Paul Krugman











Single Payer in Action

In the first round, I did make the points that the two most relevant countries with SP, Canada and the UK, have had higher health inflation over the last 10 years. I also pointed out that both of these systems are lacking in medical technology compared to the USA (MRIs and CT scanners specifically). In this round, I plan on going into more detail on the failings of both these systems.

First, a 2007 study from the NBER compared Canadian and USA HC. It found that Canadians had longer waiting times, less access to preventative treatments, worse disease survival rates, and lower satisfaction rates than Americans. For instance, only 5% of Canadian men and women, aged 40-69, had ever had a colonoscopy compared to 30% in the USA. Likewise, only 16% of men, aged 40-69, had ever gotten a PSA test in Canada compared to 54% of men in the USA. Similiar gaps exist for other types of preventative screening and testing [1].

As for waiting times, 57% of Canadians reported having to wait 4 or more weeks to see a specialist compared to 23% of people in the USA. Similiarly, 82% of Canadians had to wait more than 4 weeks to get elective surgery compared to 42% of Americans. The median wait time for a hip replacement was 12 weeks in Canada compared to 5 weeks in the USA [1].

As far as satisfaction goes, 51.3% of people in USA aged 18-64 and 63.8% aged 65 report being "very satisfied" with the health services they receive compared with only 41.5% of Canadians aged 18-64 and 55.4% for Canadians 65 [1]. Note that asking people about the heath care they receive is different from asking them about the entire health care system. Asking them about the health care system is more relevant for the debate because it is shaped by their personal experience as opposed to the media's presentation of the larger system.

As for the UK system, on top of having very high health inflation and lacking in medical technology, as I showed last round, they also have very bad cancer care. A major cancer study from Lancet Oncology found that the UK lagged behind other nations and especially the USA when it came to cancer survival rates [2].

When it came to prostate cancer, folks in the USA had a survival rate of 92% compared to only 51% in the UK. The difference was largest for prostate cancer, but all other types of cancer had large gaps. The USA had anywhere from a 15 percentage point to 20 percentage point advantage on the other types of cancer, which included breast cancer among other types of cancer (note that it is percentage points not percent) [2]. Some people counter that the reason that the USA has high cancer survival rates is because we screen more agressively so we catch cancer earlier. This is... absolutely right. I think it was assumed that it was common knowledge that early detection means people are more likely to survive.

All in all, both the Canadian and UK SP systems have higher health inflation and much worse access to health care than the USA. Now, I will respond to my opponent's R2 arguments.

SP Does Not Save Money

My opponent claims that SP will save money. This is an interesting claim. However, it is inconsistent with two things I brought up in R1. First, health cost growth has been higher in both the UK and Canada, with SP systems, than the USA over the past 10 years. And, within the USA, health cost growth has been higher in the public sector than private sector.

My opponent, for his part, has claimed that the reason Canada and the UK have had higher cost growth is that they are "investing" in technology that will save money in the long run. Unfortunatley, my opponent did not offer a source for either of these claims. The BoP is on my opponent to show that this is the reason for cost growth AND that these will in fact save costs in the future.

With regards to public health spending in the USA, my opponent has a chart showing private premiums rising at a faster rate than medicare spending per benificiary since 1969. However, this is an extremely misleading comparison. The reason for this is that, in private insurance, there has been a huge shift from out of pocket spending to prepaid private health plans. What pro is essentially doing is only showing half the equation. After all, out of pocket health spending took up 35% of health spending in 1969, when my opponent's chart started but only took up 12% in 2008 when his chart ended [3].

An apples to apples comparison would be to look at all of private health spending and compare it to all of public health spending. And, when we look at this, over the same time period of 1969 to 2009, we see that private health spending grew about 2,000% per capita compared with an even higher 3,386% for public health spending per capita [3]. Once we look at a true apples to apples comparison, we can see that the public sector has been far worse in terms of cost growth.

Okay, but how about administrative costs? Well, this is another misleading way of looking at things. In fact, administrative costs have little to do with efficiency and more to do with accounting. Government programs, by nature, tend to focus on this sort of thing because it makes them LOOK more efficient than they actually are. And, of course, we have to look at all relevant costs [4]. As shown here, Medicare's low administrative costs are more an accounting gimmick than actual efficiency, and, even despite these gimmicks, Medicare still has HIGHER administrative costs per benificiary, which is the correct measre [5].

Pro Business?

Pro claims that SP would be a big boon to business. After all, we all know how much businesspeople like it when the federal government takes over a major sector of the economy. But, in all seriousness, we have to look at this rationally. I don't think even my opponent would deny that SP would entail a tax increase. And, it seems that his entire argument on this point rests upon the view that SP reduces costs, a view that is incorrect as shown above.

The Simplicity of Big Government

If there's one thing we all know about large government programs, it is that they are always simple and efficient... before they are implemented. Once they are actually implemented, I think we all know the rest. However, it should be noted that the health care sector is not simple.

So, I have to wonder why my opponent has such faith in the ability of a few central bureacrats to set prices and wages within this major sector. As we should all know at this point, it is simply impossible for a few bureacrats to better allocate health resources than the 300 Million individuals who actually are using them.

Again, the history of central planning should have made this common knowledge. You would think that after the fall of communism in just about every country, belief in the ability of supposedly intelligent government planners to run an entire economy or large sector of an economy would not persist but, as shown by support for SP, it does.

My opponent claims that SP really isn't a centrally planned system. This is obviously not true. Under SP, the government has a monopoly on the financing of basic health services. This means that the government, with all it's power and lack of pricing mechanism, will force providers down to extremely low prices. And, with patients having an incentive to overutilize, there will be more and more pressure for the fed to pay less and less or to tax more and more... or both. In the long run, this means higher taxes and less availability of health services.


I will finish responding to Pro in R4.







Debate Round No. 3



Superior Insurance

R1: Better Health Care Quality

Neither the American College of Physicians or the Canadian Task Force on Preventive Health Care recommend mammograms for all women 40-50 (as your source implies). They have not been empirically shown to cut overall mortality rates.

Colon cancer screenings and PSA testing are not generally recommended in Canada, based on questionable benefits.

We don't know if these may save lives, — or cause more harm than good. We don't really know if the lower use is good or bad. [2]

Health care quality is better with Medicare for All — because medical professionals work their best for your health, and are not regulated by private insurance bureaucrats.

R2: Rationing

All health care systems ration, a fact. [3]

Canada doesn't take money into the equation. There are a few waiting lists for elective care, but emergency cases receive immediate attention. Also, if Canadians spent more money on health care as we do, virtually all waiting lists would likely disappear. [4] Also, the time to wait is very close to wait specialists call reasonable in Canada. [5]

The USA rations a different way. If you can't afford care, you are denied it. Thus, the tens of millions of uninsured Americans, and the 45,000 deaths annually are both the results of rationing in America. We can end all of this death, and reduce the amount of deaths from 45,000 annually to 0.

Health care is a moral issue. And we should make it more equitable, which SP does.

American Rationing (current system):

*The United Kingdom has Socialized Medicine, not Single payer healthcare. The former has gov't financing and medical delivery. Single Payer only has public financing. Thus, the U.K. is irrelevant to our debate.

A Health Affairs survey reports that 27% of Canadians and 5% of Americans waited 4 months or more for elective surgery. However, the same study shows that 25%+ Americans didn't get medical care according to cost. That's 29%+. This is non-emergency treatment. So, American rationing is more severe as we can see. [6]

Con has stated that Americans have better access to hip replacement. Ironically, nearly all hip replacement surgeries are provided by Medicare. So, Con has stated that Medicare provides good care.

R3: Higher Satisfaction with Medicare

Medicare recepients were more happy with Medicare vs those with employer sponsored coverage by 11 points. Medicare recepients also had higher quality care, better access to care, and an easier financial time with Medicare.

All these points prove that Medicare has improved quality, improved affordability, and improved access. Thus we can derive that Medicare for All expands our freedom, is fair, improves our liberty, and is essential for our lives.

Saves Money

R1: Cut Health Inflation

The G.A.U. shows that when Canada implemented its Single Payer system, health costs were about 8.9% in Canada, and in the USA 11.5% of GDP. [1] Today, Canada spends on its health costs about 10% of GDP, compared to the USA rate of 17%. Administration costs are lower, because we have not invested in ICT (electronic sharing) information system(s). From this we can deduct that Single Payer systems have reduced health care inflation, and thus lower costs over time. This correlates with my argument last round that Medicare has lower health care inflation.

Canada has temporarily higher health care inflation because they are investing in ICT technology for future savings. [8] Taiwan with SP reduced their health care inflation to 2%. [9]

R2: True Savings

Con's sources basically say that because Medicare has no taxes, they have lower costs. It does not address the fundamental point though.

--We have a massive plethora of thousands of health insurance companies. Each one has different rules, regulations, billing procedures, the costs of marketing, advertising, CEO profits, general profits, and huge bureaucracies to deny people care (rationing). This is massively inefficient. We have administrative costs of 7% because of this.

--Other nations like Taiwan have a system in which one entity finances care. Simple billing procedures, simplified, and efficient. Administrative costs cut to 2%.

Also, an apples-to-apples approach with Medicare and Medicare Advantage shows that Medicare has rates of administration of 2%. M. Adantage is 11%. [10] This proves my point, that private entities are less efficient in health insurance.


SP would cut many costs. From administrative costs and massive simplifying of financing health care, improving ICT technology, ranking procedures by efficacy, and removing insurance profits from the equation you save about $300 billion or more. And by a large insurance pool, risk is lowered and thus costs are lowered.

This is the most important point in the savings provided by Medicare for All. It has been left unrefuted fully.

Restores American Competitiveness

Con fails to refute any of this argument. The cut in workers comp. by 50%, reducing labor costs by 10-12%, and cutting excess health bureaucracy.

Taxes replace the prior premiums. All the savings I just mentioned are after taxes are included.

Utlimately, SP would go far strides in making America's businesses competitive again in the global market, worker's wages would increase more with productivity, and the savings would be used for economic growth. All of these points have stood.

Efficient Government

Con refers us to Socialized Medicine, yet again.

Single Payer would finance care based on the actual costs, plus a marginal profit. All of this would be provided a global budget. Global budgets would finance the costs of health care on a patient basis, and a guaranteed profit with it. This would encourage efficiency to increase profits and attract new patients.

Look at Medicare now. It doesn't force providers to "extremely low levels" of costs. It just finances care.


Medicare for All would have huge benefits for America.

Equal Access to Care

Rationing Cut, ethical care restored

Universal comprehensive coverage

Free Choice of Provider

Global Budgets

Pro-business legislation:
In addition to cuts in workers comp. by 50%, a 10-12% cut in labor costs, and other cutting other bureaucracy.


Wages would correlate once again with productivity - more economic growth.

Simple rules

Doctor-Patient Relationship restored

$300 billion in savings, over $1,000 a person after taxes

We care about people. This is the core of our Democracy. We should extend this empathy to protect and empower others, and expand their liberty, expand their life, and expand their freedom. We would save over 45,000 lives and end the death panels in the insurance companies that deny us care through rationing that kills .

My opponent has also dropped the moral argument.

Health is a life and death issue. Everyone's life is expanded with Medicare for All.

Freedom is enhanced by Medicare for All. You are not free if you must sell your house or go bankrupt to survive an illness.

If an insurance company denies you care, they deny you liberty.

Fairness is restored by Medicare for All. Doctor-Patient care is restored, so you two do what is best for your health.

---Medicare for All protects and empowers freedom, liberty, life, and opportunity for all Americans. And be being very simple and economically efficient, and being morally central to America's value of empathy, it is an imperative that we must achieve.

*CON will not rebut R4 here. He will use 7500 characters. No contender advantage.












Vote Pro for affordable, secure, high quality health care.




As I have agreed to not respond to Pro's R4 arguments here, I will simply finish responding to R2 and R3 and make concluding remarks.

The Cost of SP

A core argument in this debate is the cost of single payer. Pro has made cost a centerpiece of his argument in this debate.

I have pointed out in R1 and R2 that the evidence simply does not match up with the view that SP is better for cost control. Why?

Well, as I showed in R1, the two SP systems with the most relevance to the USA, the UK and Canada, have both had HIGHER not lower health inflation over the past 10 years. Perhaps even more interesting, within the USA, government health spending has risen MUCH faster than private health spending.

Now, pro can respond with as many excuses for this as he wants. But, the core fact remains. The great supposed virtue of SP is it's ability to control costs. However, when we look at all relevant examples, Canada, UK, and USA public sector, we see costs rising FASTER not slower than private costs.

In other words, the cost efficiency of SP only exists as a theory. We always hear about how cheap SP will be, but, as reality as shown, that is simply not how it has worked out.

Also, as an expansion of my previous point on administrative costs, a big reason administrative costs are so misleading when comparing the public and private sectors is that the public sector administrative costs do NOT take into account the costs of collecting taxes. For the private sector, the cost of collecting premiums are counted. Not only that, but taxes also have the additional effect of having a deadweight loss on the economy, due to the incentive effects of taxation [1].

Of course, despite this, the private sector still has lower administrative costs than Medicare when calculated correctly, as I showed last round.

The Quality of SP

I have also pointed out that SP systems are inferior in quality. In my last round, I cited a study showing that Canada had longer wait times and LOWER health care satisfaction rates than the USA, among other problems.

The UK is even worse. This is shown, in particular, through cancer survival rates. A landmark study in Lancet Oncology, that I showed in R3, found the UK severely lacking compared to the USA in cancer survival. For example, in the USA, the prostate cancer survival rate is 92% compared to 51% in the UK. For colon cancer, the survival rate is 60% in the USA compared to 44% in the UK. For breast cancer, it is 70% for the UK vs 84% in the USA [2].

Now, the reason for this is most likely more aggressive screening for cancer in the USA. I mentioned in R2 that MRIs and CT scanners are much more common in the USA than in the UK or Canada. In fact, as I showed in R2, there are less than 1/5 as many MRIs and 1/4 as many CT scanners per capita in the UK than there are in the USA. Canada is similiar to the UK.

Pro said that the superior quantity of medical technology in the USA does not bring all that much value. However, as shown by cancer survival rates, it appears that there may be some value to having this medical technology afterall.

Final Remarks

SP, we must recognize, is basically the government financing the entire HC system, or at least all basic care.

The question then comes, how exactly can a few central bureacrats have the information to finance a system that is used by over 300 Million individuals. Individuals, by the way, with different wants and needs in health care. There simply is no way that any planners could adequatley do this.

Of course, pro claims that SP will be simple and efficient. He even has a chart showing just how simple it will be. Goverment programs are always simple when they are being proposed. Politicians have charts showing how complex a free market is and compare it to the supposed simplicity of government bureacrats making all the decisions.

Communists and socialists always disparaged the market economy for it's "messiness" and "complexity". After all, they would say, wouldn't things be so much easier if we just let a few smart people make all the decisions.

But, of course, economies aren't simple, and neither is HC. HC is a large, complex sector. As mentioned earlier, there are more than 300 Million people using the USA HC system. They all have different wants and needs.

This, by nature, is complex. And, as far as large, complex sectors go, the only solution that has ever worked is simply allowing individuals to pursue their own wants on needs without government interfering with it's heavy hand. This is not, unfortunatley, the way HC works today.

And, the results are clear. Costs have been skyrocketing without a corresponding increase in quality. But, make no mistake, this is the result of too much government not too little.

My opponent, along with other SP advocates, seems to think all we have learned about economics, the problem with central planning, the failure of price controls, and the importance of incentives, don't apply in HC for some reason. But, of course, they do. Once you understand what a free market is supposed to be, you understand why HC in the USA is failing, because it is not one.

People who support HC often claim it is a "moral issue", as my opponent has. They are right. And, it is simply not moral to have a system that fails as miserably as does ours today. It is also not moral, however, to have a system with no to little medical innovation, long waiting lines, and low cancer survival rates. These things cost real lives.

SP is an economic and a moral failure everywhere it is tried. It is a dismal failure. All of the ideas behind it have been long discredited. It is the same type of government thinking that justified socialism in every form.

In the future, mankind will look back at SP and other government HC schemes as just one more notch on the long list of failed government schemes. They will be shocked that, after communism and fascism, people were still willing to put faith in their government to run their HC system.

They will look back with not only shock but also sadness. Sadness that it takes so many lives for humans to learn simple lessons. The lesson here is that people are better at running their lives than central planners.



Debate Round No. 4
16 comments have been posted on this debate. Showing 1 through 10 records.
Posted by imabench 5 years ago
In the first round, Pro's argument consisted of showing the many improvements of Single Payer should it be implemented in the US while Con focused primarily on the faults that lie within Single Payer and focused on arguing why Single Payer is bad instead rather then try to emphasize the good qualities of the current system. In fact he even mentions that the current system is pretty sh*tty. The rest of Pro's argument in the first round tries to sell that Single Payer in the US cant be compared to Single Payer in other countries which I didnt buy.

In the second round, Pro compared the complexity of the current system to the simplicity of Single Payer which was a huge boost in his arguments, and he went on to show how the system succeeds in other countries. Con responded by focusing on inflation in countries that did exist and attacked how Single Payer would affect businesses.

In the third round Pro shifted his focus to how costs under the current system negatively affects people and how Single Payer could combat these statistics, Con spends his final round again arguing the alleged benefits of Single Payer and the alleged costs of the system as well.

My judgement: Con did a hell of a job showing where Single Payer could fall short, but the argument here wasnt about whether or not SP is a good system, its about whether or not it is an improvement compared to the current system in the US, and Pro suceeded in proving that SP would be an improvement in my opinion.

Arguments go to Pro, Pro used a crapload of sources as well so sources go to Pro to.

(for the record, it took me 2 f*cking hours to read through this whole damn thing!)
Posted by YYW 6 years ago
Detailed analysis below. I think this is the last intricate RFD I will give for a while...
Posted by YYW 6 years ago
PRO begins with argument that single payer system saves money, contends that >17% US GDP is spent on health care costs, meaning that more money is spent per capita in US for non-universal HC, relative to other nations w/univ. HC who spend less. PRO argues that private HC wastes money with admin. costs, inefficiently uses Rx costs, and that the >14% US citizens not insured are burden to HC system in sum. Continues that SP HC is "pro" biz.+growth, because SP HC will reduce labor cost to companies. Additional reasons were offered, but speculative in nature. PRO continues that quality will be enhances, argues that univ. HC will recast Dr.-Patient relationship in manor more conducive to higher qual. patient care, suggests that HMO burden will be lifted from Dr.'s. CEO profit argument was unnecessary and distracting throughout. Lastly, PRO contends that SP HC expands freedom and life, stating that 45,000 people die from HMO coverage denial (stat. is too speculative because it fails to account for other factors -more prejudicial than consequential to debate.) Ends with "HC is a moral mission." This should have been a primary argument. PRO's argument was repetitive, and lacked focus. Clearer logic would have been preferable, and would have -I think- been possible if CON had have edited his debate. Nevertheless, he satisfies his BOP that the status quo is undesirable and meriting change. Successfully presents -this- as viable alternative (but with much room for improvement).
Posted by YYW 6 years ago
CON begins by laying foundation of policy history, contends that current US HC system is flawed, but proceeds to argue that problems are to deal with lack of freer markets, and that freer markets could resolve problems. First PRO contention lays foundation that HC costs are inflated, and then begins to explore various reasons why that is the case. PRO argues that public HC spending is to blame for disproportionate US GDP being spent on HC costs. Argues that "advocates of single payer... would blame private health insurance and "free market" health care. However, if that were true, we would expect private health spending per capita to have risen at a faster pace than public health spending per capita." While interesting to consider, as a judge I need to know why that is the case -a reason which CON never provides. CON eventually argues that gov. HC spending is primary driver of inflated HC spending, suggests that reducing gov. spending would cut net expenditure rate (but does not demonstrate impact of doing so/how said impact is beneficial to US HC system, etc.) CON correctly notes that more than only supply and demand are in play in HC spending, but when countering CON's comparison of US HC to other nations, only offers that US is not other countries, and is therefore not comparable. Continues that SP HC is the reason for disproportionately higher rates of inflation in Canada, as reason not to favor SP HC. (Canada is only one example, and Canada's increased rated have more to do with pop. demographic/policy shifts rather than HC system structure.) Later, CON provides that Canadians are less satisfied with HC than Americans, that Canadians wait longer for care and that SP is not pro biz/growth. CON's evidence for why SP HC doesn't satisfy is weak, but arguments were interesting, however extraneous to the evidence presented they may have been.
Posted by YYW 6 years ago
Split BOP appropriate, given that both sides are advocating national policy positions. Debate about single payer system, financed through payroll/income taxes, where all enjoy equal access to coverage and free doctor choice. PRO wins because, while his arguments lacked focus, where BOP is split, his arguments more sufficiently affirmed the resolution then CON's negated -but only barely. VERY close debate, and well argued, given ages/backgrounds of both debaters. In future, PRO will be advised to crystalize economic arguments under one heading and more thoroughly explore moral cause under another. CON will be advised to focus more on benefits of HC market deregulation OR positives of status quo, because two are difficult to argue for in tandem, without any reasonable cognitive dissonance factor.
Posted by TheBossToss 6 years ago
And how would one know if someone does not need a test? By virtue of a test for disease, one can only know if they were needed AFTER THE FACT. Such data of positives and negatives after the test does not help the man who does not get tested because of a cost-cutting governmental bureaucracy and later dies as a result of a disease that could have been treated earlier were more aggressive tesing measures taken.
Posted by TheBossToss 6 years ago
Contra, I am 15. I do a medical internship and follow around a doctor in the Urologocal Department of Hartford Hospital. I have been doing this for two months, and this week is my last.

Insurance bureaucrats do not make decisions regarding testing. That is all paid for. The only things insurance denies are things like Viagara or Cialis that are needed after radical prostatectomies. If they do deny it, you have a right to appeal, and it would be quite easy to prove those tests are necessary to protect your life.

The tests are not overused, especially PSA; there is no other way to tell if you have prostate cancer. Compare the cost of five or ten PSA tests with that of one chemotherapy or hormone therapy treatment that you would need were you to have metastatic disease (which more people would if less-aggressive testing was done), and one can see why such aggressive testing is useful.
Posted by YYW 6 years ago
Will judge tomorrow. Tired now.
Posted by 16kadams 6 years ago
Another point was in relation quality. Everyone wants good quality. We all prefer good doctors and preventative care. Again, I believe con showed in practice single payer decreases quality. Though I have to give it to pro -- he really put up a fight on that one -- mainly as his points about making it easier for doctors sat in my mind throughout the debate. Higher doctor efficiency is always beneficial. But con showed SP's many disadvantages. He showed preventative care dropped, wait lists became longer, survival rates decreased, and based on that it seems the doctor efficiency does not counters a bad government system. Therefore in the long run I think CON won this point as well. And many of pros points were merely speculative. Go in with card. Get card. leave. This assumes efficiency. Which is false CON showed many of the wait lines and increased rationing from SP.

PRO won business point (how... how did con do that?!). PRO showed in many sectors business costs of labor and such would decrease. CON claimed tax increases. Although the point was dropped by both in round four, PROs point had more analysis and data. He showed massive savings in many departments, though ignoring the collapse of the private insurance industry (con should have brought this up), and therefore wins the point based on the quality of data in this debate.

The point on SP helps life was tied. CON shows many would die from the increased rationing and wait lines, and possibly higher taxes (more poverty). But PRO showed it would benefit the currently uninsured victims of a government system. So the point is tied.


CON -- He gets the bigger of the arguments. He gets two overall.
PRO -- He gets one not really emphasized by either side. He gets one total.
Tied -- 1

CON wins.
Posted by Wallstreetatheist 6 years ago
I've been to a doctor 6 times in my entire life, the hospital twice.
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Vote Placed by imabench 5 years ago
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