The Instigator
RoyLatham
Pro (for)
Winning
20 Points
The Contender
Danielle
Con (against)
Losing
18 Points

Nationalizing health care in the U.S. would increase its cost

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Post Voting Period
The voting period for this debate has ended.
after 6 votes the winner is...
RoyLatham
Voting Style: Open Point System: 7 Point
Started: 3/10/2009 Category: Health
Updated: 8 years ago Status: Post Voting Period
Viewed: 2,305 times Debate No: 7325
Debate Rounds (3)
Comments (6)
Votes (6)

 

RoyLatham

Pro

Nationalizing health care" includes any universal system by which the Federal government provides and sets payment for health care. This includes systems that both employee health workers directly or regulate the delivery of health care to the extent that costs are not determined primarily by market forces. Costs may always be reduced by limiting the amount of health care that is provided, and every nationalized health system established elsewhere uses some form of rationing to minimize costs. For this debate, however, the assumption is that we are talking about the unit cost of delivered health care.

The reasons why costs will rise are:

1. Currently the fees paid by Medicare (the current government health care system for those over 65) are inadequate, so that the private insurance ends up paying a disproportionately high fraction of the overhead costs of hospitals and physicians. When the private payers are eliminated, those costs will be realized in government costs.

2. Medicare, the model, pays only five or six percent in administrative fees compared to around eleven to thirteen percent for private insurers. The reason Medicare admin costs are low is that they do not examine claims either for validity or fraud. There are provisions to report fraud, but cases of large scale fraud are referred to the Justice Department. The Justice Department costs for investigation come out of the Justice Department's budget and are not counted. Thus the costs are there, they are just not counted.

3. Bulk purchases of drugs do not lower the costs of the drugs. The costs of development and manufacturing are the same regardless of how they end up at the patient. Currently, R&D costs are borne disproportionately by private payers. If the government takes over all drug purchases, then all the development costs will be borne by the government, or, more likely, investment in new drugs will decrease because pharmaceutical companies cannot cover the R&D costs. New drugs cost about a billion dollars apiece to develop. With the likely result of fewer newer drugs, health care costs will rise substantially. Drugs are cheaper in Canada because Americans pay the R&D costs.

4. Nationalized health care destroys competition, thereby increasing costs. Some aspects of medicine, cosmetic surgery and laser eye correction, are firmly in the free market. Neither private nor government insurance pays for them. costs in those areas half dropped by half while other health care costs have risen sharply. this happened despite the desire to make profits. In fact, costs dropped because of the desire to make profits in the face of competition. That motivates an endless search for cost savings. This is being seen in the current expansion of the "mini-clinic" industry in which small clinics are being built into drug stores to provide routine care, preventive medicine, and child health care at low fixed prices. the savings are achieved through high automation of routine services, with many services provided by nurses rather than physicians. Overhead is low.

5. Bureaucratic payment systems shift the emphasis from providing care to gaming the system. For example, Medicare pays by the office visit, so matters that could be handled in one or two visits are typically stretched into many visits. this is inconvenient for the patient and increases costs overall due to the decreased efficiency.

6. The claim is often made that a national system would increase preventive care, but it does not. My private health insurer tries very hard to make sure I take my pills and get preventive care. They know full well that lowers costs in the long run. A bureaucracy, however, only "succeeds" by expanding, and success within the system depends upon gaming the system. Neither motivator promotes preventive care. Preventive care would certainly be paid for by the government, but it wouldn't be promoted. That's evident in the Medicare system.

7. A national health care system will end up paying unskilled and low-skilled workers considerably more as a mechanism for politicians to buy their votes. That's why government contracts often require that union wages be paid, and why government employees are the largest class of union workers. For example, the Postal Service pays 30% above market rates for labor while FedEx and UPS pay slightly below the average rates.

8. There are two main reason health care costs are so high in the United States. One reason is that there is an elaborate and expensive emergency health system in the U.S. that is not paralleled in other countries. This is needed because of the very high incidence of traffic accidents, drug overdose, suicides, and criminal violence. There are also many heart attacks, which relates to the other cost factor: very poor lifestyles, characterized by obesity, poor diet, and lack of exercise. These cost factors are not treated at all by a national health care system. They are without question problems, and they may well deserve national programs, but they are social problems, not medical care problems.

Costa Rica has virtually no health care system, and costs are around $350 per year per person. U.S. costs are around $8000 per person. Yet the life expectancy in Costa Rica is only about three years less than in the United States. Clearly, the main cost driver is lifestyle, and a national system does not improve that.

9. About 16-17%, about 50 million, of the U.S. population is currently uninsured. The uninsured comprise about 15 million are illegal aliens, 10 million are eligible for Medicaid but haven't applied because they are not sick, and about 5 million are people who can afford insurance but elect not to buy it (typically young self-employed people). Illegals should be given humane emergency care and then sent home to be cared for by their home countries. That leaves about 7% of the population without health insurance. They mainly receive free health care through the emergency room system, and that is not an efficient way to deliver ordinary care. They could be covered by extending Federal aid to support Medicaid in poor states. That would improve efficiency without engendering the needless high costs of a nationalized health system.

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It is fundamental that increasing demand without increasing supply increases costs. It is also fundamental that nothing increases efficiency like the profit motive. Bureaucracy only "succeeds" by growing, further increasing costs.

The resolution is affirmed.
Danielle

Con

1. Private insurance ends up paying a high fraction of the overhead costs... Those costs will be realized in government costs.

--> Unlike privatized insurance, Medicare is fickle, not contractual. Premiums can increase at any time depending on the market, and there have been instances of Medicare being revoked, suspended, etc. should the govt. be unable to pay. If healthcare were nationalized, a greater fraction of government money could be budgeted towards this endeavor. This means an increase in government costs, but also an increase in funding (taxes). Since citizens would be paying into nationalized healthcare, it's only logical to assume that they would make use of it. This is positive for two reasons:

1) Despite being poorer and sicker, people with Medicare are FAR more satisfied with their healthcare, benefits, options, treatment, etc. then those who currently receive privatized insurance. In other words, healthcare benefits (and possibly health) in this country would increase.

2) A lot of insurance companies out there are BS. For instance, 22% of privately insured people found that their plan did not pay for care that they thought was covered, compared with 9% of Medicare beneficiaries. Insurance companies tend to charge a lot of money but offer little to no gains. Perhaps the amount of taxes one would spend on nationalized healthcare would be LESS than they currently pay for insurance costs, and yet their medical experiences would be far more helpful in their time of need. It should also be noted that over 30% of those who have private insurance cannot make their payments anyway [1].

On a final note, it's important to keep in mind that nationalized healthcare would be a lot different from Medicare/aid regarding eligibility, methods of payment, etc. Also, perhaps vouchers of some kind can be offered to those who choose privatized insurance (still) over public care.

2. Medicare, the model, pays only five or six percent in administrative fees compared to around eleven to thirteen percent for private insurers...

--> This is true, but it's because our system is so fragmented. 80% of U.S. doctors practice in groups of 4 or less, and each of those offices is filling out paperwork to be reimbursed by dozens of different insurers. The insurers add another fat layer of administrative costs, as do the employers who purchase policies. In countries where all physicians work on salary for the government, and hospitals are all owned by the government, much of the paperwork is eliminated. Now, if our system were improved and organized so that physicians worked in larger medical centers, and insurance benefits were standardized, we could reap significant savings [2].

3. Bulk purchases of drugs do not lower the costs of the drugs... With the likely result of fewer newer drugs, health care costs will rise substantially.

--> When all patients are under one system, the payer wields a lot of clout. The VA gets a 40% discount on drugs because of its buying power. This "monopsony" buying power is the main reason why other countries' drug prices are lower than ours. This also explains the drug industry's staunch opposition to single-payer national health insurance [3].

4. Nationalized health care destroys competition, thereby increasing costs. Some aspects of medicine, cosmetic surgery and laser eye correction, are firmly in the free market. Neither private nor government insurance pays for them.

--> Right, so why should any insurance pay for them now? Nationalizing healthcare would have no bearing on the cost of cosmetic surgery. Moreover, in the instances where insurance actually applies, doctors would still be competing for business regardless of where the insurance or coverage is coming from.

5. Bureaucratic payment systems shift the emphasis from providing care to gaming the system... Matters that could be handled in one or two visits are typically stretched into many visits... This is inconvenient, inefficient and increases costs...

--> Doctors are already gaming the system. It is not uncommon for a doctor to perform one procedure on a patient and list it as another to the insurance company, for example. To blame public healthcare for such a thing would be horribly invalid. To combat this, however, we have several options: First, better planning. Smaller doctors offices should be hesitant to purchase expensive and unnecessary medical equipment. Instead only hospitals or larger scale medical facilities should be privy to things that are only going to act as additional expenses to physicians, without really serving a necessary or useful purpose or costing them an awful lot of money. Second, doctors have to be held accountable. We can compare the procedures and actions of certain physicians to that of their peers. Any repeat poor decision making will be noticeable and investigated. Moreover, patients may find comfort in this type of monitoring (ensuring that their doctors both know what they're doing , and are not wasting their time).

6. Preventive care would certainly be paid for by the government, but it wouldn't be promoted. That's evident in the Medicare system.

--> This is an interesting point coming from someone who promotes individual accountability and responsibility. I would argue that it's neither the insurance company nor government's job to remind you to take your pills or get preventative care. Your insurance company does this in their own best interest, and I believe that public healthcare can/would do the same. Nationalized healthcare doesn't mean a free-for-all where people can be irresponsible about their health. People on Medicare still pay premiums, and once they become informed of certain restrictions (or limits) to aid - not to mention their own individual interest to keep themselves healthy and pain free - I don't believe that this will be a huge issue. Moreover, studies show that those on Medicare as opposed to those with private insurance actually seek MORE medical attention and preventative care. This is because insurance does not often cover the costs of all necessary tests and procedures. That would indicate that Pro's point is entirely backwards.

7. A national health care system will end up paying unskilled and low-skilled workers considerably more as a mechanism... Government contracts often require that union wages be paid... Government employees are the largest class of union workers.

--> To assume that workers would be low or unskilled is entirely rooted in assumption with no factual basis. To imply that all of those who work for the government have such value is incredibly false. That said, we don't know that this will necessarily be the case. Further, this isn't a debate regarding the Pros and Cons of labor unions. Those who are Pro Union could easily make a case for that side; in this instance I think it's best to move on and stick to other aspects of the CBA as it would take too much time/space to focus on medical labor unions, IMO. If my opponent disagrees, I'll respond in the next round.

8. There are two main reason health care costs are so high in the US - An elaborate and expensive emergency health system, and heart attacks.

--> Healthcare costs are increasing because the cost of medical PROCEDURES and PRESCRIPTIONS are increasing. Costs continue to ride: up 6.2 percent in 2000, up 8.3 percent in 2003, up 7.3 percent in 2004, up 7.4 percent in 2005, up 5.9 percent in 2006... Doctors are administering more tests, prescribing more medication and offering more treatment. Sometimes Medicare has been more effective at controlling costs, and sometimes it has been the private insurers. Still, the increase in spending cannot be blamed on 'greedy bottom feeders' who utilize public healthcare. Costs are increasing for everyone because of the problematic and broken system in general; not the methods of insuring Americans.

---------

I ran out of characters for this round...
Debate Round No. 1
RoyLatham

Pro

1. I argued that private individuals and insurers are now paying a disproportionate share of medical costs, in effect subsidizing the government-paid health care. Thus current health costs borne by the government are lower than they would be if the government took over and had to bear all the costs. Con argued that's not a problem because the government can always raise taxes to pay for what it costs. Fine, but the debate is about what health care costs, not whether the government can extract taxes to pay the higher costs. He is granting costs would be higher. Also, Con grants that demand would increase. Increasing demand without increasing supply always increases unit costs. We are debating unit costs not total costs.

I argued that Medicare administrative fees are lower than private insurers because they do not examine claims and because the investigation of large fraud cases is left to the Justice Department. Con did not dispute either point. He did not deny that paying claims without examining them results in extra costs due to error and fraud. Whether or not people understand the limits of insurance coverage versus Medicare coverage is irrelevant. The item that people often think is covered but is not is birth control. Medicare recipients are too old to be concerned with birth control.

Pro claimed that nationalized health care would be different from Medicare. How so? What will it solve?

Pro claims that forcing doctors into large health centers would reduce costs. Why would a larger bureaucracy, with more layers of management, reduce costs? In any case, America has a very large rural population, so replacing local care with a large center a hundred miles away would dramatically reduce the quality of care. Reducing the care delivered by a large percentage to obtain a small percentage of administrative efficiency raises the unit costs.

The new government requirements for digital record keeping vastly increase the costs of record keeping. The government requires far more paperwork than any insurance company. The government is requiring that vast amounts of information now kept in the doc's filing cabinet, and mailed to the patient's next physician, be laboriously digitized and stored on line. The government needs all that information so a bureaucrat can ration health care, deciding what you really need. Moreover, non-uniformity of forms among insurers poses no cost problem. They all want about the same information, so the format is not a major cost item. If it could be shown that it saved a lot of money by always having the date in the same place, or whatever, that could be accomplished with a law far short of nationalizing health care.

3. Con claims that monopsony power can force low drug prices, without any regard to whether the company making the drugs can recover their costs. Refusing to pay the manufacturing and R&D costs obviously does not lower manufacturing and R&D costs. So if Con is correct, then the government will end the development of new drugs and will drive drug companies out of business. I agree that the government can do that by refusing to cover costs. However, the subject of this debate is that costs will increase if services are provided. No one doubts that if drugs are not developed or manufactured that the cost of drugs can be brought to zero. what currently happens is that drug companies can recover their R&D from American private insurers and individuals. They can then afford to sell to Canada and the VA so long as they get more than their manufacturing costs. That system disappears when the government gets total control of pricing, and the drugs will simple disappear.

Con has proposed magic by which huge investments will be made and not recovered, and drugs will be manufactured at a loss. There is no such magic.

4. We have three cases: (1) medical services totally in the free market, where costs have dropped dramatically due to competition, (2) medical services covered by insurance, where competition is limited and costs are rising, (3) medical services where there is no competition. The principle is that competition drives down costs, while eliminating competition causes costs to rise. Nationalized health care eliminates competition. The government will decide what will be done and exactly at what price. If some innovated to lower costs, all that could happen is that the government would pay less. The incentive, therefore, is to keep costs high and game the costs. Con did not address the competitive pressures of the free market. I gave the example of innovative competing low cost mini-clinics. Con argued that giant medical centers would lower costs, contrary to competitive principles.

5. Of course doctors are gaming the system. Because Medicare doesn't pay enough, they create extra office visits. That's the only way to survive under the rule of government masters. That is not an argument in favor of making the system more arbitrary and bureaucratic.

Con asserts without proof that small doctor's offices (a) buy expensive unnecessary equipment, and (b) then succeed in passing those costs along to customers. This is false. Private insurance firms contract separately for the use of expensive medical equipment like scanners, and they obtain the services from the lowest bidder. Con believes that government can buy, allocate, and schedule equipment more efficiently than the free market. Bureaucrats have no incentive to increase efficiency or to be concerned with efficiency. the interest of bureaucrats is in expanding the bureaucracy and in replacing judgment with universal rules. Universal rules are extremely inefficient.

Con claims that inefficient doctors will be discovered, investigated, and rooted out by the government. Is this why Medicare makes no examination of claims whatsoever? They do not even check for accidental mischarges. An enduring fantasy of socialist thinking is that the very next bureaucracy will be brilliantly efficient, even though it has never happened in the past. Bureaucrats are not rewarded for being efficient, they are instead punished for making waves. A bureaucrat who falsely accuses a doctor would bring bad publicity to the agency. He won't be rewarded for rooting out inefficiency. there is only downside risk, no upside reward. In private enterprise, the rewards make taking risks worthwhile.

6. I argued that private insurance, having a profit motive, urges preventive care that lowers costs. This is evident from what private insurers do now. Con says I shouldn't have made the argument, because he supposes it violates some principle that he thinks I ought to have. That does not make the argument false. Con argues that he thinks a government bureaucracy without a profit motive would care as much about preventive care. But when we examine current systems like Medicare, it's clear that they don't. Con is having another dream about the efficiency of future bureaucracies.

7. I argued that government health care will follow the pattern of other government agencies and boost the salaries of low-skilled workers. It seems that Con is saying it is unreasonable to suppose that the new massive government-controlled establishment won't be at all like every other government-controlled establishment, per the Post Office paying 30% more than FedEx. Is it realistic to suppose that the next new bureaucracy will defy the logic of all previous bureaucracies? No, it is the nature of the beast.

8. I made the point that health care costs in the US are high due to unique aspects of American society. Thus one cannot say the US system is now less efficient than other countries where costs are less. Con did not respond to the point. He said that costs are rising because of equipment and procedures. True, but that is not why they are high in the first place.

I'll respond to references when they are put in the debate rather than in comments. I have the same problem with space as Con.
Danielle

Con

1. Since most people in the U.S. obtain private insurance over Medicaid, even if costs were to increase by nationalizing health care, thus making the government have to pay more, it would actually be DECREASING the cost for those who are privately insured. In other words, whether or not nationalizing health care will cost you more or less money depends on who's insuring you now.

It's true that increasing demand without increasing supply always increases unit costs. However, because the government will most likely not be able to significantly increase costs for patients, the most realistic scenario in this case would be citizens opting out of public health care and instead choosing to retain or purchase private insurance to ensure decent service. Private insurers wouldn't be able to market their plans at ridiculously high prices, because competition from public health care would force them to keep costs down.

2, 6 & 7. Medicare absolutely does examine claims. In fact, Medicare denies more claims than commercial insurers. To say I ignored the point regarding admin fees in R1 is simply untrue. I maintain, "The insurers add another fat layer of administrative costs, as do the employers who purchase policies. In countries where all physicians work on salary for the government, and hospitals are all owned by the government, much of the paperwork is eliminated." Since Medicare denies more claims than private insurers, I don't see how this point is relevant.

In regard to birth control being the item that people most often think is covered, I offer 2 contentions: First, Pro has provided no proof that this is in fact the case... especially since I highly doubt that people on Medicare would be seeking birth control (as he pointed out). It's more about routine exams. Second, it is not valid to use Medicare as the proper basis for comparison. Medicare would surely not be the model for public health care, as Medicare generally applies only to those over age 65. This would not be the case with nationalized health care; there would be different standards.

Pro asks: Why would a larger bureaucracy, with more layers of management, reduce costs? Perhaps in the world of business this would not be so. However, management when it comes to government is different than management when it comes to business. "Because this public customer is most closely connected to the top of the organization and is often very disconnected from the bottom (management), a top-down bureaucracy is an essential tool for ensuring focus on that customer... It takes bureaucracy to make sure federal managers and employees remember that (individual interests can diverge from the interests of the public as a whole)" [1]. In other words, if in a governmental bureaucracy the law-makers are those in most direct contact with customers (the public), than it is the law makers and politicians who will make it a priority to keep costs down. Reducing a lot of fluff Middle Management may be the way to go.

The U.S. has the most bureaucratic health care system in the world. Over 31% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, etc. Because the U.S. does not have a unified system that serves everyone, our insurance system is both extremely complex and fragmented. The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO. I highly doubt that 12 - 22% of these overhead costs are all burdened to the Justice Department! Plus, it is not necessary to have a huge bureaucracy to decide who gets care and who doesn't when everyone is covered and has the same comprehensive benefits. With a universal health care system, we would be able to cut our bureaucratic burden in half and save over $300 billion annually [2].

In regard to replacing local care with large, far-away medical centers, this point is irrelevant as I have never argued for such a thing (reduced quality of care). Obviously the concept of large centers in rural areas would not apply. Though America does have a large rural population, the majority of citizens - three times the amount - reside in more urban communities. This would be effective in urban settings, and those in rural communities can still seek to diminish costs of unnecessary, expensive medical equipment, especially since its often not used at all - or at least far less - due to far less people using such facilities.

It's true that such expensive equipment is used, Pro. When hospitals compete, they often duplicate expensive equipment in order to corner more of the market for lucrative procedure-oriented care. This drives up overall costs to pay for the equipment and encourages overtreatment. They also waste money on advertising and marketing. The preferred scenario has hospitals coordinating services and cooperating to meet the needs of their communities. Competition among insurers is not effective in containing costs either. It results in competitive practices such as avoiding the sick, cherry-picking, denial of payment for expensive procedures, etc. An insurance firm that engages in these practices may reduce its own outlays, but at the expense of other payers and patients [2].

Pro adds, "The new government requirements for digital record keeping vastly increase the costs of record keeping." First, define 'vastly.' Second, the government may choose to impose these regulations on both public AND private insurers in the near future, thus making this a moot point. Sometimes additional regulations are placed in the name of safety and caution. Such preventative measures may save people's lives and more insurance money should something go medically awry.

3. We need to consider how many new drugs we get for each extra dollar we spend. If a drug company posts in 50 billion dollars in sales, how much of this goes into useful research? We also need to consider what types of drugs we get. Pharmaceutical companies have an incentive to produce the drugs they can sell. Plus, pharmaceutical companies are not the only source of drug research. The U.S. is chock full of top notch research universities. What if the government negotiates lower drug prices, then pumps billions into publicly funded research? The NIH's budget is $28 billion dollars. Meanwhile the top 10 drug manufactures are posting $80 billion in annual profits. Paying high prices for drugs probably isn't the most effective way of supporting pharmaceutical research [3].

4. Pro notes, "The principle is that competition drives down costs, while eliminating competition causes costs to rise. Nationalized health care eliminates competition." If it weren't for public health care, the cost of private insurance would be significantly higher. Having the option of government funded care is what leads to competition amongst private insurers to keep costs down. Moreover, the government can hire people to be innovative and lower costs however and whenever possible. These people would be rewarded, thus the incentive to seek new ways to improve the system.

5. Pro writes, "Because Medicare doesn't pay enough, they (doctors) create extra office visits." The type of 'peer review' I have advocated for encourages doctors to be prudent stewards, and to make sure their colleagues are as well, because any doctor doing unnecessary procedures will be taking money away from colleagues. In addition, expert guidelines by groups like the American College of Physicians, etc., can help shape professional standards [2].

8. I maintain that costs of health care are high due to rising costs of equipment and procedures. Aspects of American society are irrelevant, as our high population and various lifestyles make it difficult to compare us with other nations. Moreover, even if Pro is correct, I don't see how this applies to the argument that nationalizing health care would increase costs.

On a final note, I haven't made any arguments in the Comments section.
Debate Round No. 2
RoyLatham

Pro

1. The resolution we are debating is "Nationalizing health care in the U.S. would increase its cost." Con seems to agree, saying, "Since most people in the U.S. obtain private insurance over Medicaid, even if costs were to increase by nationalizing health care, thus making the government have to pay more, it would actually be DECREASING the cost for those who are privately insured." Con is confusing what the costs are with who pays for the costs. She concedes that costs rise, but says its no problem because the government can always raise taxes to pay whatever it costs. Con endorses the illusion that if the government pays, it really doesn't cost anything. This untrue, it costs more.

Con argues that polls show that people like to get "free" stuff from the government, in keeping with the illusion that free stuff from the government really is free. I don't doubt that is what people say.

2. I claimed that one reason that Medicare administrative costs are lower is that they do not examine claims for mistakes and fraud. Con counters that they do examine claims. I grant that Medicare has stepped up attempts to detect fraud, compared to a few years ago when they did nothing. The results have been ineffective, and is mainly harassment about conformance with the Medicare flat rate rules. Medicare fraud is rampant [1]. "More than one-fourth (26%) of physicians who restrict services to Medicare patients do so because of "hassles and/or threats from Medicare.".." [2]

3. Con maintained that a single payer system can lower drug costs by refusing to pay even enough to cover manufacturing costs, let alone investment costs for drug R&D. She supposes that drug companies will continue to develop drugs at a loss. Con points to $80 billion in drug company profits, implying that drug companies will continue to invest if profits are substantial reduced or eliminated. The drug business is both highly competitive and highly profitable. Because of competition, half of drug company profits are reinvested in new drug development [3]. Drug companies also suffer enormous risks from lawsuits that could at any time cause investors to lose all their money. Nationalizing health care does not lower the investment costs nor reduce the lawsuit risks. They will not invest without reward.

Price controls in Canada keep drug prices a mere 5% lower than the U.S., but Canadian drug companies consequently only invest half in R&D at half the rate of US companies [8].

The NIH budget of $28 billion includes only a small amount for drug development. The costly part of drug development are clinical trials, and NIH does very little of that. NIH licenses it's drug patents and gets a few tens of millions in royalties, basically nothing compared to the industry.

4. Con asserts that "If it weren't for for public health care, the cost of private insurance would be significantly higher." The government forces drug development costs and hospital overheads costs on to private insurers. Con claims that the government is free from competitive pressure, so they can pay only whatever they choose. So therefore they don't pay their fair share of drug costs, emergency rooms, and equipment. That will show up later when government takes over. "The American Hospital Association reported that its member facilities provided $21 billion in uncompensated health-care services last year." [10]

"Moreover, the government can hire people to be innovative and lower costs however and whenever possible." Private enterprise has a profit motive for hiring and rewarding people for innovation and cost savings. Imagine an entrepreneur with a brilliant new idea in coat-saving medical technology. Will he ever say to himself, "I want to cash in on this, so I think I'll join the government bureaucracy, where innovation is really rewarded."? Con supposes that the next government bureaucracy will be completely different from every government bureaucracy that has ever existed in the past. This will never happen, because bureaucracy succeeds only by getting larger and controlling more things, not by efficiency.

A gave explicit examples of competition driving down costs, with more competition driving down costs the most. Con never refuted any example, and offered no examples of government bureaucracies driving down costs.

5. Con argues, "The type of 'peer review' I have advocated for encourages doctors to be prudent stewards, and to make sure their colleagues are as well, because any doctor doing unnecessary procedures will be taking money away from colleagues." The assertion is completely false, because as Con asserted, the government does not provide a limited pool of money that must be shared. The price reimbursed for an office visit does not increase if there are fewer office visits. Gaming the system is inherent in government attempts at price controls. It is a constant feature of government health care [5,6,7]. I argued that private insurers have a profit motive to use preventive care to drive down costs. This is unrefuted.

7. I argued that government health care will follow the pattern of other government agencies and boost the salaries of low-skilled workers. I understated the case. The recent stimulus package included a provision that all funded public works projects must pay full union wages, lowering the products delivered to the taxpayers by thirty to forty percent. This is done to curry favor with unions, who favor socialist-style elitism over competition. Con claims without a plausible reason that it won't happen in government-controlled health care. He is making another "the next bureaucracy will be magically efficient" argument. The precedent is to increase labor costs by 30 to 40 percent. [4]

Pro argues for magical bureaucracy, claiming "In other words, if in a governmental bureaucracy the law-makers are those in most direct contact with customers (the public), than it is the law makers and politicians who will make it a priority to keep costs down. Reducing a lot of fluff Middle Management may be the way to go." So is this why the Post Office pays labor 30% above market, while FedEx and UPS pay slightly below market, and why as a result FedEx and UPS provide much better service? Con's theory is also not working in the Internal Revenue Service, the FAA, your local Motor Vehicle Bureau, and every other government service that one can name. The problem is that managers of private companies are held acutely responsible. If they don't perform they will ultimately be replaced, or their company will go under. Elected officials are elected mainly on generalities and on a handful of hot issues.

Congress funded a study about what happens worldwide when nations nationalized their oil production. The production costs stay about the same, but production drops by two-thirds. That's about what we can expect from nationalized medicine. The cost per unit of delivered care will increase dramatically.

Con has provided references that are mainly partisan opinions, without references to factual evidence such as government statistics, independent studies, or other data. R1 [1] establishes that people like getting free stuff from the government. True. In R1 [2] there is a CBO graph showing that Medicare reimbursement increases tend to track private insurance increases. True, but it doesn't deny they are underpaying. R1 [3] has no factual reference. I like R2 [1] although it's an argument, not a factual reference. It argues that government needs a vast bureaucracy not needed by private enterprise. That is true, and it is therefore a large unnecessary expense that will increase health care costs. R2[2,3] are blog opinions.

Government will stifle competition, bloat bureaucratic administration, encourage fraud and gaming, and raise basic labor costs.

The resolution is affirmed.
Danielle

Con

Danielle forfeited this round.
Debate Round No. 3
6 comments have been posted on this debate. Showing 1 through 6 records.
Posted by Ragnar_Rahl 8 years ago
Ragnar_Rahl
"It is not uncommon for a doctor to perform one procedure on a patient and list it as another to the insurance company, for example. To blame public healthcare for such a thing would be horribly invalid."
Technically, the present insurance system is strictly a result of "public" (government) interference in health care. It hasn't been nationalized, but it's sure been-- trouble is there's no good word here, statalized? :)
Posted by RoyLatham 8 years ago
RoyLatham
A good, spirited debate. I appreciate it.

I apologize for the he/she confusion. Your new icon works a whole lot better than the wooden block icon. My wife fairly often refers to everyone as "he." That is because she is a native speaker of Chinese, and Chinese does not have any gender-dependent pronouns. Who would guess they would be so progressive? I have no such excuse.
Posted by RoyLatham 8 years ago
RoyLatham
theLwerd, I disagree. I think the idea of a character limit is to force everything about the debate into the debate, not to have the references in the comments. However, since you are not complying, I'll probably end up going along and putting my references in the Comments as well. I guess the solution is to put conditions into the debate challenge.
Posted by Danielle 8 years ago
Danielle
I haven't made any arguments in the comment section, Pro. Instead I have simply listed any sources that I used for information and statistics. I believe that is the proper, most honest and fair thing to do, to avoid any accusations of plagiarism. It also allows my opponent to verify my sources and critique them, which makes for useful counter attacks. Most people don't include citation in their debates at all. If you have a problem with me citing sources here, I simply won't cite them in future rounds. That said, for R2:

[1] http://www.govexec.com...
[2] http://www.pnhp.org...
[3] http://meganmcardle.theatlantic.com...

Ps. Con is a "she" - not a "he"
Posted by Danielle 8 years ago
Danielle
R1 CITATION:

[1] http://www.commonwealthfund.org...
[2] http://www.healthbeatblog.com...
[3] http://www.pnhp.org...

I unfortunately ran out of characters in Round 1 (even after I cut down my argument significantly - haha!). I'll address #9 in the next round, as I actually have the argument already written out. I haven't forgotten, and I look forward to your challenging rebuttal, Pro! Hopefully I can be more concise in future rounds.
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Vote Placed by WhiteAfricanAmerican 8 years ago
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Vote Placed by RoyLatham 8 years ago
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Vote Placed by Danielle 8 years ago
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