The Instigator
Abunai
Pro (for)
Winning
12 Points
The Contender
jopo
Con (against)
Losing
0 Points

Novice Tournament R1: The United States should implement a system of Single Payer health care.

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Post Voting Period
The voting period for this debate has ended.
after 2 votes the winner is...
Abunai
Voting Style: Open Point System: 7 Point
Started: 12/28/2013 Category: Politics
Updated: 3 years ago Status: Post Voting Period
Viewed: 1,392 times Debate No: 43049
Debate Rounds (4)
Comments (5)
Votes (2)

 

Abunai

Pro

Hello all! This is Round 1 of TUF's Novice Tournament, Abunai vs jopo. A special thanks to TUF for making this possible.

The Resolution is as follows:

The United States should implement a system of Universal, Single Payer health care.

I will be arguing the pro side, and the burden of proof will fall on myself to show that the net benefits of Universal, Single Payer health care outweigh the potential negative consequences.

Jopo will be arguing the con side, and must show that the net benefits of Universal, Single Payer health care do not outweigh the potential negative consequences. If con is able to successfully negate the resolve, she wins the debate.

For the purposes of this debate, the following definitions will be used:

Universal, Single Payer health care - A system in which the government, rather than private insurers, pays for all health care costs through a single insurance pool. The system is funded through an increase in payroll taxes and all citizens are guaranteed access to care. In this debate, the model will be Canada's Medicare.

should - ought to; indicative of an obligation or necessity.


The debate format will carry out as follows:

R1: Acceptance and definitions
R2: Constructives
R3: Constructives/Rebuttals
R4: Rebuttals/Closings

Thank you, and I look forward to a fun and educational debate!

jopo

Con

I accept this challenge and look forward to officially kicking off our round in this tournament. Thank you to Abunai for proposing this topic as it should be fun.

I agree with the burdens and definitions Pro offered and don't think I need to clarify with any additional. So I suppose with that, we're off!
Debate Round No. 1
Abunai

Pro

Thank you, Jopo.




Introduction


The United States is the only nation in the industrialized world that does not have some form of Universal, Single Payer health care. Currently, slightly over 48 million Americans are without health insurance, and a significant number of personal bankruptcies in the United States occur due to lack of adequate health care [1]. The United States spends 17% of its entire GDP solely on health care, by far the highest in the industrialized world. On the other hand, in Canada, a nation with a Single Payer, Medicare-for-all system, everybody has health insurance. And conversely, Canada only spends 10% of its GDP on health care [2]. A system of Universal, Single Payer health care in the United States will dramatically expand coverage, drive down costs, and ultimately improve the quality of care.




It is a fundamental role of the state to ensure the health of the general populace.


Quality health care is tantamount to the life, liberty, and happiness of citizens. Without adequate treatment options, it is impossible to maintain one’s body and enjoy one’s life. As Dr. Duncan Cross describes, “Civil rights are what we call those claims necessary to secure free and equal citizenship, secondary to basic rights. For example, we have the right to vote because society is ordered in a way that makes voting both possible and essential to our free and full participation in society. Voting is a civil right. Health care is a civil right because society is ordered in such a way as to make it both possible and essential to the free and full participation of the sick, injured and disabled in society. I can tell you: lack of health care makes it impossible for one to participate freely and fully in society.” [3].Access to health care directly dictates our quality of life and ultimately our freedom, and is a civil right entitled to all citizens.


Arguably, the primary role of government is to ensure that all citizens are able to maintain their rights. According to the Declaration of Independence, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” [4]. If 48 million Americans are uninsured, the state is not fulfilling its obligation to promote unalienable rights, such as life, liberty, and the pursuit of happiness. A system of Universal, Single Payer health care is the clearest way for the government to ensure the rights of the American people.




Single Payer will drive down health care costs.


As I mentioned above, the United States currently spends 17% of its GDP on health care costs. Between 1997 and 2009, private health insurance premiums rose at a rate of 6.5% per year, while Medicare costs rose at a rate of 4.3% per year. Simultaneously, health care costs in Canada increased by a rate of 4.1% per year [2][5]. Evidently, the private insurance market is the driver of health care inflation in the United States, and public care is the solution.


The unsustainable costs of health care coverage can be attributed to several factors. First of all, administrative costs with private HMO’s are extremely high, typically over 31% of every dollar put into the system [6]. These “administrative costs” go towards bureaucratic overhead, advertising, and other inefficient means of handling dollars. With Universal, Single Payer insurance, administrative costs are significantly lower; Canada’s overhead is less than 1.3%. The rationale behind this, is that Single Payer is not-for-profit, and thus more money actually goes towards treating patients, and less towards bureaucracy. Rising health care costs in the US can also be attributed to bloated corporate profits. From 2000-2004, profits for the top 17 U.S. health insurance companies rose 114% [7]. This problem does not exist under Single Payer. And finally, exorbitant health care costs in the US can be attributed to inadequate preventive care and costly emergency room visits for uninsured. When one has no health insurance, they are unable to have check-ups or access to preventive measures (ex: cancer screenings). Thus, these people end up in the emergency room, which is ridiculously expensive to hospitals, forcing them to raise the cost of everyone else’s care by about $400 per person [8]. Under Single Payer, everyone has insurance and access to quality preventive care, reducing the burden on hospitals and ultimately driving costs down.


Clearly, all of the major issues that plague private insurance companies and increase health care costs are non-existent under Single Payer. In total, reducing the administrative burden to 3% would save about $101.04 billion. Then, add the $12 billion in profits from big insurance companies. Switching to Information Technology and reducing inefficiencies could save about $77.8 billion annually. Also, add the financial savings from preventive care being used, which would save $3.7 billion [8]. As Nobel Prize winning economist Paul Krugman describes, “The great advantage of universal, government-provided health insurance is lower costs. Canada’s government-run insurance system has much less bureaucracy and much lower administrative costs than our largely private system. The savings from a single-payer system would probably exceed $200 billion a year, far more than the cost of covering all of those now uninsured.”




Single Payer will improve the quality of care.


The cost savings alone from a transition to Single Payer would grant Americans significantly more disposable income to spend on supplementary care. This would likely increase health outcomes for poorer Americans and those who are currently underinsured. Additionally, storage of health information would be streamlined through a single IT system, which would improve the efficacy of health motions. Computerized IT health records would also reduce errors within the system. And finally, an emphasis on preventive care and increased health care utilization for the underinsured could save up to 2 million lives per year [9]. In the World Health Organization's rankings of overall health in 191 nations, the US ranked 72nd, which was worse than almost every industrialized nation in the world [10]. However, nations with Single Payer such as Canada, ranked significantly higher. Plus, in 2007, Gordon H. Guyatt et al. conducted a meta-analysis of 38 studies addressing conditions including cancer, coronary artery disease, chronic medical illnesses and surgical procedures in the United States and Canada. He concluded, "Available studies suggest that health outcomes are superior in patients cared for in Canada versus the United States [10].” All in all, there is widespread consensus that nations with Single Payer health care, such as Canada, receive significantly better health outcomes than the US.




Conclusion

Single Payer health care is, without a doubt, the best option for the United States. The vast majority of studies and empirical analyses suggest that Single Payer would both significantly reduce costs, as well as improve health care quality and outcomes for everyone. Moreover, Single Payer would allow the state to fulfill its moral obligation to the 48 million uninsured in this country. I would love to write more, but alas I am out of space.


The resolve is affirmed.



Sources


[1]http://kff.org...

[2]http://assets.opencrs.com...

[3] http://www.kevinmd.com...

[4]http://www.archives.gov...

[5] http://healthaffairs.org...

[6]http://www.pnhp.org...

[7]http://www.amsa.org...

[8]http://www.pnhp.org...

[9]http://tinyurl.com......

[10]http://www.pnhp.org...


jopo

Con


A brief outline of my case – my first point upholds that a free market system is better than a universal one, showing that a better system exists to a single-payer system; my second point critiques the Canadian health care system, illustrating that even if a universal health care system is deemed better in general, the resolution ought to be negated because the model system for this debate is undesirable for the United States to implement.

A Free Market System is Superior
a) it better values autonomy
It is important to adopt a system that respects autonomy. Autonomy is often compromised in health care setting because illness increases individuals’ dependency on others:
“it [illness] reduces patients’ power to exercise autonomy and it also makes them vulnerable to manipulation and even to outright coercion by those who provide them with needed health services … Without a strong principle of respect for patient autonomy, patients are vulnerable to abuse or exploitation, when their weak and dependent position makes them easy targets to serve the interest (e.g. financial, academic or social influence) of others.”1 (pg. 14)
­What’s preferable about a free market system is that it gives individuals direct control of their money by eliminating third party interference:
“unlike price controls and other tools of government rationing, markets allocate resources according to consumer preferences, rather than the preferences of politicians, government bureaucrats, or special-interest lobbyist.”2 (pg. 4)
When evaluating the protection of autonomy, a free market system is preferable because it allows individuals to better align their care with their interests.

b) it encourages growth
A free market health care system promotes growth in two key areas – entrepreneurship and the number of doctors. While many entrepreneurs exist in the health care field, they are discouraged by third-party payers (insurance companies, employers, and government) which, “With respect to healthcare, they tend to be bureaucratic, wedded to tradition, and resistant to change. They are, in a word, the entrepreneur’s nemesis.”3 Under a free market system these same hindrances don’t exist, as giving individuals more control over spending is incredibly beneficial to entrepreneurship. The bureaucracies of government involvement also affect job satisfaction in the medical field. Looking at the Great American Physician Survey of 2013, 31.7% of respondents list third-party interference as the primary reason to not be a physician4 (slide 13). America is already facing a doctor shortage, with the American Medical College estimating that by 2015 there will be 62,900 fewer doctors than needed, and the idea of universal health care does not sufficiently add to this pool, even with government attempts to incentivize it5. It is clear that a free market is preferable for growth because it frees the system from the burdens caused by third-party intrusion.

Canadian System is Flawed for the U.S.
a) costs of the system are too high
The current health care system in America is very costly, with 17% of the GDP going to health care6; while this is cited as one of the number one concerns for why America ought to adopt a new system, what needs to be seen is in the increasing instability of the Canadian system. The Fraser Institute published a report in 2011 looking at Canadian health care spending concluding, “that Canada’s health system produces rates of growth in health spending that are not sustainable solely through redistributive public financing”7. This report found that Ontario and Quebec were spending 50% of their revenue on health care in 2011, and that by 2017 four more provinces would reach this high level of spending. While Canadian spending is on the rise (“Total federal, provincial and territorial government health spending has grown by 8.1 percent annually”7) current U.S. per capita spending is slowed down to a record 1.3% growth rate over the past three years, “That is the lowest rate on record for any three-year period and less than one-third the long-term historical average stretching back to 1965.”8 This decreased rate is credited to both economic recovery, and implementation of ACA. Given these current settings, it is clear that the U.S. ought not adopt a Canadian system of universal health care, because it encourages unsustainable spending growths that cannot be justified onto the U.S.

b) quality of care is low
Quality of care in Canada is seen as low due to two factors – inaccessibility and placement of people in improper care. Canadian care has become increasingly inaccessible over the past couple of decades. Whereas 20 years ago, people had to wait on average 9.3 weeks to receive treatment, another report from the Fraser Institute found that it is currently up to 18.2 weeks9. Furthermore, this rate shows that waiting time increased a total of 3 days from 2012. The report goes on to state that looking at the number of procedures Canadians are waiting for across the 10 provinces, in 2013 it was up to 928,120, an increase of 57,658 from the previous year. A Senior Healthy Policy Analyst from the Fraser Institute sums up the impact of these numbers in his statement,
“Canada is effectively reneging on its promise of universal healthcare for those citizens forced to endure these long waits … These lengthy delays have real and important effects on Canadians’ health and wellbeing, imposing pain and suffering, mental anguish, lost productivity at work and leisure, and possibly even disability and death.”9
Unfortunately inaccessibility isn’t the only negative quality to the care that’s being delivered -- often people are placed in improper care under this system. Dr. Jeffrey Turnbull, a Canadian doctor in the Ottawa Hospital, is largely dissatisfied with how the Canadian system is implemented. The main problem he sees with the system is how it doesn’t put alternative level of care patients (ALC’s) in the proper location. While they should be quickly moved to nursing homes or other long-term care facilities, they are kept in the hospital too long due to the poorly organized system. Turnbull explained,
“There are maybe 160 people in the hospital at $1,100 a day waiting for long-term care. So we’re spending maybe $180,000 a day for care that is crappy, not in their best interests. In a nursing home, it would be about $200 a day.”10 An actual evaluation of the statistics of patients in the Ottawa Hospital on one day showed that, “Thirteen percent of the beds, therefore, are occupied by people who, under ideal circumstances, should not be in the hospital.”10
Given that this is a largely inefficient system that leaves too many people waiting for proper care too long, and displaces a considerable amount of patients in improper facilities, it is clear that the Canadian system has strong costs and its implementation is not desirable system for the United States.

Sources
1 -http://books.google.com...
2 –
http://www.cato.org...

3 –
http://www.ncpa.org...
4 -
http://www.slideshare.net...
5 -
http://www.nytimes.com...
6 -
http://assets.opencrs.com...
7 –
http://dailycaller.com...
8 -
http://www.whitehouse.gov...
9 –
http://www.ctvnews.ca...
10 –
http://fullcomment.nationalpost.com...
Debate Round No. 2
Abunai

Pro

Rebuttals


Free Market system values autonomy


My opponent makes the argument that Single Payer is a system that rejects individual autonomy and uses tools of government rationing. She claims that private insurance plans are the key to liberty and self-interest. However, this argument is both untrue and self-contradictory. Ironically, with the rise of Health Maintenance Organizations (HMOs), private health insurance plans actually regulate health planning of individuals. Essentially, if you are enrolled in a private insurance plan, a general practitioner, or, “gatekeeper,” is responsible for your case management, health planning, and doctor referrals [1]. Thus, the status quo of HMOs, PPOs, and otherwise private insurance denotes managed care, and the erosion of personal liberty with regard to health decisions. Single Payer, however, offers a different path - one that truly values individual freedom and self-autonomy. Under a system of Single Payer health care, citizens are offered free choice of doctor, as opposed to the micromanagement that occurs with private plans [7]. Free choice of doctor allows for a stronger doctor-patient relationship, as there is no longer a panel of third party “gatekeepers” that is managing individual decisions. Patients will find a significant boost in personal liberty and autonomy under Single Payer.



Free market encourages growth


I agree with my opponent that entrepreneurship is incredibly important to the health care system, but unfortunately is limited by “third parties.” However, my opponent literally concedes that insurance companies are prime examples of third parties that are inhibiting growth. The argument that the free marketplace is ideal for entrepreneurship falls flat on its own logic. As I showed in the rebuttal above, the free marketplace and ensuing HMOs, gatekeeper based planning, and managed care results in drastic inhibitions on growth. According to my opponent’s source, “With respect to healthcare, third parties [including insurance companies] tend to be bureaucratic, wedded to tradition, and resistant to change. They are, in a word, the entrepreneur’s nemesis. [2]” Clearly, the solution for greater entrepreneurship is elimination of the inefficient system of private care and replacement with free choice of doctor, significantly less regulations, and ultimately far more personal liberty that comes with Single Payer.


The number of doctors in a system, according to my opponent, is also crucial for growth. She cites a statistic which says that 31.7% of physicians are discouraged by third party interference in medicine. But again, as I showed above, private HMOs are a precise example of third parties that exist under a free market system, and they inhibit growth far more than the government through their “gatekeeping” and managed care. Next, my opponent cites a statistic which claims that the United States has 62,900 doctors fewer than it needs even despite government involvement. I would like to thank my opponent, as this is a statistic that helps my case. In the United States, where third party HMOs interfere with doctors, there is a significant shortage of physicians and practitioners. And according to a study by the Commonwealth Fund, only 64% of doctors in the US are satisfied with practicing medicine [3]. But in Canada, the UK, and Norway, nations where the government ensures stronger doctor-patient relationships through Single Payer, doctor satisfaction rates are 75%, 81%, and 89%, respectively. As you can see, Single Payer is the most efficient and rational system for growth, ensuring both more entrepreneurship and increased incentive to become a doctor.



Costs of Single Payer are too high


My opponent concedes that the United States spends significantly more on health care than Canada and other nations with Single Payer. Also, my opponent cites a quote and some data from the Daily Caller. Please note that the Daily Caller is a publication that is well known for making wholly unsubstantiated claims and, often times, completely fabricating information in order to fit their conservative agenda [4]. But, regardless, I have provided real, non-partisan statistics from the independent healthaffairs.org and from the CRS report for congress which show that, since 1965, healthcare premiums for private insurance companies have gone up 6.5%, while premiums in Canada have gone up only 4.1% [5][6]. The Medicare program, which is essentially Single Payer for the elderly, has seen costs rise at a rate of only 4.3% per year. Additionally, when Canada implemented its Single Payer system, health care costs were about 8.9% of GDP in Canada, and 11.5% of GDP in the US.Today, Canada spends about 10% of GDP, compared to the US which spends 17% of its GDP [7]. While it is true that, in the last few years, US health care inflation has been lower than Canada’s, this is in large part to the slow US economy. Moreover, Canada’s government has recently been investing in an Electronic Storage System, which appears as “health care inflation” because it is a short term expense, but is really just an investment in long term efficiency [7]. Clearly, the ridiculous overhead and lack of preventive care that plagues the free market system has resulted in extremely high health care inflation compared to nations with Single Payer.



Quality of care is low


Ironically, in this section, my opponent ignores the significantly better health outcomes in Canada and the lack of preventive care which costs the US 2 million lives per year [8]. Instead, my opponent focuses this entire section on an argument about wait times. Unfortunately, this argument is completely irrelevant. According to Dr. Aaron E. Carrol, “In 1966, Canada implemented a single-payer health care system, which is also known as Medicare. Since then, as a country, Canadians have made a conscious decision to hold down costs. One of the ways they do that is by limiting supply, mostly for elective things, which can create wait times. Please understand, the wait times could be overcome. Canadians could spend more. They don’t want to. We can choose to dislike wait times in principle, but they are a byproduct of Canada’s choice to be fiscally conservative.” [9]As Dr. Carrol describes, wait times have nothing to do with overall health outcomes, as Canadians have a higher life expectancy than the US and better treatment outcomes in nearly every area [10]. Furthermore, 99.39% of Canadians say that they would chose not to come to the US for care, and instead would prefer to stay in Canada [11]. On the other hand, only 49% of Americans approve of their health care system [12].



Conclusion


None of my opponents arguments still stand. I have showed that Single Payer would increase individual autonomy through a reduction in private health management, increase entrepreneurship and doctor incentive through reduced third party interference, cut costs through preventive care and reduced inefficiency, and improve health care quality again through preventive care, IT data storage, and simply insuring more people. The resolve is affirmed.



Sources


[1]http://www.cbsnews.com...

[2]http://www.cato.org...;

[3]http://www.aarp.org...

[4]http://www.mediaite.com...

[5]http://healthaffairs.org...;

[6]http://assets.opencrs.com...

[7]http://archive.gao.gov...

[8]http://www.floridahealth.gov...

[9]http://www.aarp.org...

[10]http://www.pnhp.org...;

[11]http://www.aarp.org...

[12]http://hotair.com...

jopo

Con

I am going to start by clarifying two aspects about my case:
1 – I’m not advocating for the status quo when I push for a free market system. In his attack on my case, my opponent would attack my points on the benefits of a free market system, by showing how they are not holding true in this status quo. However, by doing this he makes the false assumption that our status quo is a free market system, which is isn’t.

“The thing to remember in America is that we have single-payer health care for the elderly and for the poor: the two costliest groups. In addition, the relatively healthy middle class has heavily-subsidized private health insurance, in which few individuals have the freedom to choose the insurance plan they receive. Neither of these facts commend the American health-care system to devotees of the free market.”11 Since the status quo isn’t a free market, my opponent’s attacks that utilize the status quo to show the errors in a free market actually fall, as proving something is wrong with the status quo doesn’t prove that something is wrong with a free market system.

2 – The main fault with the status quo is government involvement. When addressing entrepreneurship, my opponent states that I concede that insurance companies are to mostly to blame for inhibiting growth, showing how therefore we ought to move to a universal system to give them substantially less power. However, the main inhibitor is not insurance companies.

“Of the three third-party payer institutions, government is by far the worst at resisting entrepreneurship – even when the government itself is implementing radical change.”3

Therefore, we see that if we do truly value entrepreneurship, we should not go to a universal system where the government is in charge of providing everyone access to health care.

Having clarified these points I will now go on to address the major points of contention between our cases.

Effects of a True Free Market
a) autonomy
In his rebuttal, Pro stated, “Thus, the status quo of HMOs, PPOs, and otherwise private insurance denotes managed care, and the erosion of personal liberty with regard to health decisions … Under a system of Single Payer health care, citizens are offered free choice of doctor”. First of all, note that he attacked how under the status quo autonomy is not preserved, not analyzing it in the form of an actual free market. Furthermore, he assumes that a Single Payer system will maximize autonomy, but this is not the case.

But this leaves the rationing and decisions in the hands of government officials and bureaucrats, and the special interests that influence them, rather than with the consumer. Rationing leads to long delays for some types of operations, or never doing it at all.

Again we need to see that a single payer system takes power away from citizens and puts it in the hands of the government, which is seen to result in long delays – an observed problem in the Canadian system (more on that below). As my opponent hasn’t actually attacked autonomy under a free market system, and there are clear offenses to it under a Single Payers system, it is clear that autonomy is better preserved when we negate.

b) entrepreneurship
I already attacked the first portion of my opponent’s attack on this under my second point of clarification. Then on the matter of the number of doctors, my opponent again pits the status quo against Canada to illustrate how a Single Payer system better protects for the number of doctors. However, this fails to demonstrate how it compares to a free market system. Furthermore, it is natural to assume that there will be some variation in the number of employees in each field from country to country. By my opponent’s statistics Switzerland has a 79% doctor satisfaction rate and lower spending as it is advocated for as a model of a market-oriented system11 – taken by itself that indicates that doctor satisfaction is increased by turning toward a market-oriented system. What needs to be seen is that doctor satisfaction is variable and cannot simply be reduced down to a Single Payer system increases it. However, entrepreneurship in general is discouraged by government involvement because it thrives in an environment where patients have autonomy and pay directly for their care3.

Again a free market is preferred; however, to uphold that even if that falls we must negate we turn to the following.

Providing Care to All
In his constructive, my opponent claimed a government should provide care to all because, “Access to health care directly dictates our quality of life and ultimately our freedom”. Yet, this was countered when I illustrated how with long waits, “Canada is effectively reneging on its promise of universal health care…”9 in my own constructive. To rebut this he then claimed, “… wait times have nothing to do with overall health outcomes”. What needs to be seen is that Canada is not providing universal health care because it blocks access to it by increasing the wait times for services dramatically; yet, by claiming that wait times don’t affect your health, my opponent is in contradiction with his original claim that it is having access to care that dictates our quality of life. This is a logical inconsistency to his case.

Uninsured vs. Insured with Lines
My opponent opened his case with an introduction in which he stated, “Currently slightly over 48 million Americans are without health insurance … A system of Universal, Single Payer health care in the United States will dramatically expand coverage …” Here he frames going to the Canadian system as reaching out to this 48 million and offering them coverage. Yet, the crisis of the 48 million isn’t as drastic as it appears at face value. In fact, when looking at who these uninsured are what arises is that half will covered within a year, 3-6 million are believed to have falsely reported being under insured, and many who make up both the higher portion of the “Middle-Income Families” and the “Young Invincibles” are believed to have opted out of coverage. The crisis isn’t one that speaks to the need for government involvement, but is simply attributed to, “population growth, immigration, the recession and – some instances – individual choice”13. Ultimately, going to a Single Payer system won’t drastically expand coverage, as many who aren’t currently covered are either expected to become covered soon or don’t want coverage. Given that it won’t do this, we see that a Single Payer system simply reduces care as it increases waiting times. My opponent quotes Dr. Carrol to justify these waits, “they are a byproduct of Canada’s choice to be fiscally conservative” which brings us to our final point of contention.

Cost
My opponent disregarded my statistics on the rising costs of the Canadian system because they are linked from the Daily Caller. However, the actually source for these numbers is a report done by the Fraiser Institute which is an independent Canadian public policy research and education organization. The reason I linked the data to the Daily Caller is because it seemed you had to purchase it to access it; however, to validate it I found a free electronic version14. Ultimately, the Canadian system is clearly not preferred as it has unsustainable price increases. My opponent also countered that part of the reason for the American spending drop is that, “this is in large part to the slow U.S. economy”; yet, my evidence points that this is in large part due to the ACA8, more so than the economy. This further emphasizes the undesirability of the Canadian system, showing we must negate.

Sources
11 - http://www.forbes.com...
12 -
http://www.progress.org...
13 -
http://www.ncpa.org...
14 -
http://www.fraserinstitute.org...

Debate Round No. 3
Abunai

Pro

Thank you.


The United States is mostly a free market system

The majority of my opponent’s rebuttal seems to hinge around one idea - that the United States somehow does not have a free market system, and thus all of my attacks on the status quo aren’t really an attack on the free market, but instead on the United States’ version of quasi-single payer. However, this is a deeply flawed argument. First of all, only 19% of Americans receive coverage through Medicare [1]. Where does my opponent think that the other 81% receive coverage? The fact of the matter is, with some regulations and checks on the system, the United States operates under a system dominated by private insurance companies. To deny this is to deny fact. Under the Affordable Care Act, citizens can even shop through an online marketplace, viewing competing plans and choosing the plan that offers the lowest price [2]. This is a de facto free marketplace. My opponent’s claims that, “the middle class has heavily-subsidized private health insurance,” and that “we have single-payer health care for the elderly and for the poor,” while fair claims, do not invalidate the US as having a predominantly free market system.


Insurance Companies inhibit growth

As my opponent acknowledges, empirical data unequivocally shows that nations with Single Payer have higher doctor satisfaction rates than those without Single Payer. This means that nations with Single Payer have increased incentive to become a doctor, ultimately increasing the number of doctors and the quality of said doctors. My opponent’s argument about Switzerland is erroneous. Switzerland has one of the highest doctor satisfaction rates in the world and it also has one of the most pervasive forms of Single Payer in the world [3]. With regards to entrepreneurship, it has been established that private insurance companies bear responsibility for managed care and bureaucracy. Single Payer streamlines the system and makes it more efficient through global budgets and a single IT system [1].


Single Payer is ideal for autonomy

Here, my opponent's rebuttal seems to suggest that HMOs and insurance companies don’t exist under a “free marketplace.” Perhaps I misunderstood the argument, but if not, my opponent needs to elaborate on this. As I explained in my Round 3 case, private insurance companies are very much the alternative to Single Payer - and they are in charge of health planning, health management, and doctor referrals through their “gatekeepers,” which restrict individual choice. Single Payer, on the other hand, offers free choice of doctor, stronger doctor-patient relationships, and a system that is far more popular than the US system. With regards to rationing, my opponent argues that, “rationing leads to long delays for some types of operations, or never doing it at all.” Be that as it may, healthcare inevitably must be rationed under any system, as there is not unlimited care to go around. The question is, do we want private, for-profit insurance companies to ration our care, thus taking exorbitant profits and denying coverage to certain people, or do we want the government to ration our care? In the US, or any free market system for that matter, the rationing occurs through the denying of care to the poor, and the redistribution of wealth to high administrative costs, ridiculous profits, and inefficiency. In a system with Single Payer such as Canada, rationing is reduced because inefficiency is reduced, and cost savings are implemented. Health care is a moral issue. And we should make it more equitable, which Single Payer does.



The wait times argument is flawed

My opponent commits gross hyperbole with her description of wait times in Canada. The average wait time is very close to wait specialists call reasonable in Canada [4]. Yes, wait times are slightly higher than in Canada than in the US, but again, that is due to a decision made by the Canadian people to be fiscally conservative, not by a flaw in Single Payer itself. If Canadians chose to spend as much as we do on Healthcare, there waiting times would virtually be eliminated [4]. Then my opponent claims that “Canada is not providing universal health care because it blocks access to it by increasing the wait times for services dramatically.“ This is a complete misunderstanding of my argument. Just because wait times are slightly higher in Canada does not mean that people don’t have access to care. Again, Canada is not “blocking access to care;” it still has universal coverage for every citizen, plus wait times what the majority of experts call “reasonable.”

Plus, I have established that the differences in wait times have little effect on health outcomes overall. The data is very clear that, regardless of wait times, Canada has a better life expectancy than the US, a lower infant mortality rate than the US, and better health outcomes for the majority of cancers and diseases [5]. Unless my opponent can establish an empirical link between wait times and health outcomes and disprove the plethora of statistics that I have provided, thus proving that slightly longer wait times are objectively bad, then her argument fails.


The Uninsured are very much a problem

In her rebuttal, my opponent attempts to underplay the issue of uninsurance in this country, saying that “the crisis of the 48 million isn’t as drastic as it appears at face value.” I can assure you, reader, that not having health insurance is one of the most drastic possible situations one can be in. Certainly, if over half of all bankruptcies in the US are related to medical costs, and almost 2 million people die every year due to inadequate preventive care, then this is an issue that should be of great national concern. And, despite my opponent’s wishful thinking, over 30 million Americans will still be uninsured even after the Affordable Care Act [1]. Finally my opponent claims that “a Single Payer system simply reduces care as it increases waiting times.” I have already shown that Canada still has perfectly reasonable waiting times, and that the vast majority of Canadians would prefer to stay in Canada for their treatment. Also, I have already presented an array of data which show that Canada still yields very high survival rates despite its incrementally higher wait times.


Single Payer is cost effective

I did not disregard my opponent’s statistic about Canada’s health care inflation. I simply said that my statistics regarding health inflation, all three of which come from wholly non partisan sources, should be examined as well. My opponent drops the argument that, when Canada implemented its Single Payer system, health care costs were about 8.9% of GDP in Canada, and 11.5% of GDP in the US. Today, Canada spends about 10% of GDP, compared to the US which spends 17% of its GDP. Furthermore, my opponent ceases to acknowledge the significantly lower inflation of the Medicare system, the bloated administrative costs and profits of private insurance, the $200 billion in potential Single Payer savings, and the fact that Canada has recently been investing in an ICT system, which is appearing as short term health care inflation. The fact of the matter is, there is near universal consensus among economists that Single Payer would result in substantial cost savings.


Conclusion

One of the core tenets of our Nation is that we care about one another. We can extend health care to every American, saving 2 million lives a year, reducing expenses by $200 billion, cutting health care inflation in the long term, improving health outcomes, and strengthening freedom. For this, I urge a Pro ballot.

Sources

[1]http://www.pnhp.org...
[2]http://cnsnews.com...
[3]http://www.aarp.org...;
[4]http://pnhp.org...
[5]http://www.floridahealth.gov......
jopo

Con

I will spend my summary highlighting the key arguments in this debate and illustrating why you must vote con on this issue.

1 – Free Market System Stands
As I stated in my last rebuttal, my opponent cannot attack this system by pointing to flaws in the status quo, as the status quo in America is not a free market system. However, my opponent attempted to justify that it is – yet he glossed over the reasons as to why we’re not a free market system by simply stating they weren’t significant enough. He referenced a quotation from my previous rebuttal, which I have bolded for emphasis,

“The thing to remember in America is that we have single-payer health care for the elderly and for the poor: the two costliest groups. In addition, the relatively healthy middle class has heavily-subsidized private health insurance, in which few individuals have the freedom to choose the insurance plan they receive.”11

His response was, “while fair claims, do not invalidate the US as having a predominantly free market system”. In fact these claims do invalidate that – we’re taking choice away from the middle class, a major tenant of a free market system, and implementing a single-payer system (the opposite of a free market system) for the groups that cost us the most.

Pro then claimed that under the ACA – America’s version of a universal health care system – there exists an online market. However, simply put, America is not a free market system because individuals do not have proper control over their own money and their own plans. This is reflected in the rationing argument. My opponent refuted my rationing argument with, “health care inevitably must be rationed under any system”. The issue with a Single-Payer system is that the rationing of care is no longer controlled by individuals, power is taken away from them as the government rations care. Thus, my opponent has failed to adequately attack my original point on the benefits of having a free market system and my arguments as to how it benefits autonomy and entrepreneurship stand.

2 – Government is the Biggest Threat to Entrepreneurship
Originally, Pro attempted to turn my source about the threats to entrepreneurship against me, claiming it showed private insurance harmed entrepreneurship. Pro then construed this to show that a free market system harms entrepreneurship more because it involves private insurance. However, I responded to this by returning to my source, which clearly states that the government is by far the greatest threat to entrepreneurship, thus making a strong case against a Single-Payer system if we value entrepreneurship3. If government involvement is the worst for entrepreneurship, than a free market system better protects for it as it removes the government.

Along with this argument is the one of doctor satisfaction and while my opponent claims I conceded that, “empirical data unequivocally shows that nations with Single Payer have higher doctor satisfaction rates” this is far from true. The issue is that the data does not prove that doctor satisfaction is only controlled by if a country has a Single-Payer system or not, and I brought up the example of Switzerland to illustrate how doctor satisfaction is simply something that varies between countries, regardless of their system. My opponent tried to counter by saying Switzerland is an example of Single-Payer; however, it is actual one of the model free market systems11.

Given that my free market arguments still stand, I already win as I’ve shown that the U.S. shouldn’t implement a Single-Payer system as it harms autonomy and entrepreneurship. However, I will go on to address the further points of clash that give more reason to negate. Starting by re-evaluating how the Canadian system is severely flawed.

3 – Quality of Care
The issue of wait times is a very serious one to consider when evaluating the Canadian system of care. Addressing this, Pro claims that “Canada is not “blocking access to care;” it still has universal coverage for every citizen, plus wait times what the majority of experts call “reasonable.” “ First, he is mistakenly equating having universal coverage (health insurance for all) with having health care. The issue with Canada’s system is that the large amount of coverage means that people are limited in how they can access their care. Returning to my original statistics, this is reflected in how 928,120 Canadians were waiting for surgeries in 20139. My opponent claims this is what the majority of experts call “reasonable”; however, returning to the Fraiser Institute’s reflection,

“Canada is effectively reneging on its promise of universal health care for those citizens forced to endure these long waits … These lengthy delays have real and important effects on Canadians’ health and well being, imposing pain and suffering, mental anguish, lost productivity at work and leisure, and possibly even disability and death.”9

Furthermore, note that my point from my case about people being placed in inappropriate care has stood unattacked so this also flows through to show why the care under the Canadian system is undesirable.

4 – Costs
This has been one of the greatest points of clash as to the value of the Canadian system, but you must see the Pro loses it. My opponent opened his summary on this issue by stating, “I did not disregard my opponent’s statistic about Canada’s health care inflation”; yet, he does. He dismissed it due to its source originally, and after I clarified this he left it untouched. He simply returns to his statistics about current expenditure per GDP and fails to address the current trends we see in spending. What my evidence has shown is that Canada is on a highly unsustainable spending path, by 2017 six provinces are predicted to be spending at least half of their revenue on health care14. In comparison, the United States has recently slowed its spending to a monumentally low growth rate, and this has been contributed to the implementation of ACA8. These numbers directly illustrate how the Canadian system encourages rapid, unsustainable spending. The point of this was to show that even if a Universal Health Care system is preferred, the Canadian system ought not serve as a model, urging a Con ballot as Pro’s side is flawed.

Finally I will close by addressing:

5 – Obligation to Insure
Important to regard with this point, is that my opponent never addressed the logical inconsistency I highlighted in his case, where he simultaneously claims we have an obligation to provide health insurance because, “Access to health care directly dictates our quality of life and ultimately our freedom” and that wait times don’t matter because, “… wait times have nothing to do with overall health outcomes” He is claiming both that we need to have access to care to ensure a good life, and that not being able to efficiently access care doesn’t affect our lives. He cannot uphold both of these claims as they contradict each other. Furthermore on this point, my opponent continues to draw the issue of the uninsured out of proportion. He never addressed my attack as to who the uninsured actually are, yet I talked about how statistically half will become insured within a year, 3-6 million of the poor who are uninsured falsely reported so and that a majority of the middle class and “young invincibles” who are uninsured chose to be so13. These numbers are largely significant. Furthermore, looking back at wait times – forcing all of these people into a Single-Payer system causes the government to ration care which reduces everyone’s access to care. This does a great disservice to all of the citizens. Thus we can see that there is no obligation to force a Single-Payer system to “save the 48 million who are uninsured”.

Having evaluated all of these arguments, you must vote Con in this debate given the advantages of a free market system, the harms of the Canadian system and the lack of moral obligation for a Single-Payer system.

Debate Round No. 4
5 comments have been posted on this debate. Showing 1 through 5 records.
Posted by Bullish 3 years ago
Bullish
Immagine having private companies to protect life instead of cops.
Posted by TUF 3 years ago
TUF
I have a couple other tourney debates to vote on, but I'll try to get to this before the period ends.
Posted by Abunai 3 years ago
Abunai
I apologize jopo - in my round 1 argument, source number 9 led to an incorrect link. The actual source was this: http://www.floridahealth.gov...
Posted by zrg4848 3 years ago
zrg4848
This will be great I am pro for a single payer system and look forward to learning more on both arguments. However, may I first say that I am usually against burden on proof nonsense since the creator usually tries to push that upon their acceptor. But since the creator actually accepts that burden of proof belongs to the one trying to contend against the status quo I cannot complain as that is what burden of proof is meant to be applied to.
Posted by Bullish 3 years ago
Bullish
This looks like it will be better than most of the intermediate debates.
2 votes have been placed for this debate. Showing 1 through 2 records.
Vote Placed by zrg4848 3 years ago
zrg4848
AbunaijopoTied
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Total points awarded:60 
Reasons for voting decision: Both had good conduct. Pros grammar was more advanced and combing greatly improving their ability to make a more convincing argument. Pros sources were far less biased and all of pros sources were very strong.
Vote Placed by Oromagi 3 years ago
Oromagi
AbunaijopoTied
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Total points awarded:60 
Reasons for voting decision: Grammar to Pro- I had a hard time following a number of Con's sentences due poor editing. Args to Pro- Pro had the BOP and laid out a fairly traditional case. I would have liked to see some real cost/benefit analysis, but Pro wisely relied on objective projections to counter Con's anecdotal & editorial arguments. Sources to Pro- Pro relied on more objective analyses from the field of medicine, Con's sources were more editorial in nature. There's nothing wrong with backing your opinion with someone else's opinion, but medical studies and reports get the edge.