The Instigator
Pro (for)
0 Points
The Contender
Con (against)
6 Points

Should the U.S. have created a single-payer health care system instead of Obamacare?

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Post Voting Period
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Voting Style: Open Point System: 7 Point
Started: 4/14/2014 Category: Health
Updated: 2 years ago Status: Post Voting Period
Viewed: 587 times Debate No: 52506
Debate Rounds (5)
Comments (1)
Votes (1)




First round is for acceptance, second is for opening statements third and fourth are for rebuttals, and fifth is for closing statements.

I will be arguing Pro (for) in this debate as I feel that the U.S. should have created a single-payer health care system instead of passing Obamacare. The opponent will have to argue that Obamacare is a better option than a single-payer health care system, however, they could also argue for an alternative system over single-payer or what was at the time the status quo instead.

I look forward to a good debate.


I shall be arguing in favor of a purely free market health care system and look forward to the debate with my opponent.
Debate Round No. 1


I thank Con for challenging me and I look forward to a good debate with him.

I will first begin by outlining the main components of the single-payer system that I am suggesting followed by the benefits of this system.

The single-payer system I am proposing would be fairly simple. Since the country in question here is the United States, this model is designed with the American health care system in mind.

The first aspect of this system is the fact that all payments made to doctors for check-ups and treatments included under government plans are made by the government instead of the patients. In other words, instead of a patient or their insurance company paying for each visit to the doctor or emergency room, the government would pay each doctor's salary based mainly on the results of their patients but also on the number of patients tended to. While this is not simply a free lunch for the patients, it is generally cheaper care and is funded through taxation that is progressive and places less of the burden on those who currently struggle to pay their medical bills.

Since it would be quite expensive to pay for everyone's unlimited visits, there would be a limit on the number of check-ups each year as well as the number of hospital visits that are deemed unnecessary by the doctor before some of the cost is payed for by the patient. In addition, the government plans would not cover procedures that are unnecessary.

All hospitals would be run by the government, and since adding almost 50 million people to our current hospital capacity would be inefficient and would result in extremely long waiting lines, the government would build a sufficient number of hospitals and clinics to treat everyone. In order to incentivize health care research and new medical technologies the government would pay doctors and scientists what is due to them for their contributions in research and development of new treatments and technologies.

Now that I have outlined the system I will be arguing for, I will point out some of the benefits of this system.

1. Coverage

Perhaps the largest benefit to a single-payer system is the fact that everyone can receive treatment. Before Obamacare, about 50 million Americans lacked health care coverage. Although some do this by choice, as they prefer to take the risk of not getting sick instead of paying for insurance, others simply could not afford health insurance, were denied this coverage due to pre-existing conditions, or were dropped from their plans after becoming sick since it would be too expensive to cover them.

Not only is it morally necessary for us to ensure that everyone can afford coverage, it is in the interest of everyone that those who choose not to pay for insurance get covered since they make everyone else pay for them getting sick or hurt and going to the emergency room. In a single-payer system, everyone has access to affordable health care and the cost is much lower, bringing me to my second argument for single-payer.

2. Cost

Currently, the United States has the most expensive health care system as well as the highest uninsured rate of any developed country. Not only does a single-payer system eliminate the uninsured entirely, it also dramatically reduces the cost of healthcare. In our current system, the money you pay for premiums changes hands several times before it goes into actual treatment, each hand adding to the total administrative costs and seeking a profit for themselves. First is the health insurance company, which spends your premium money not only on coverage, but also wages for their employees and administrative costs, with some of it also going into profits. After this, it goes to the hospital which spends it on the administration of the hospital as well as wages. This remains the same in a single-payer system, but the difference falls in operating profits, even in nonprofit hospitals. There are about 3 times as many nonprofit hospitals in the US than there are for-profit ones, but after income tax deductions are factored in, the nonprofit hospitals actually make more profit. The reason for this is that while they are prevented from having shareholders, nonprofits are not prevented from having profits as long as those profits are spent on things like executive raises and bonuses, expansions, and consolidations. These things are both unfair to the uninsured (who face extremely high costs for hospital visits) and those who have private insurance (since consolidations and expansions reduce the bargaining power of insurance companies and lead to higher premiums), as well as unnecessary since we currently have more hospital beds in the US than we can fill.

In the end, much of the money that was initially spent on premiums does not even go into health care. On the other hand, a single-payer system is not interested in profit and the money goes directly to the operation of hospitals and clinics and the treatments that it was intended to cover in the first place. By reducing the amount of money spent on profit and administration, the taxes the government would collect to pay for this program would actually be lower than what is spent on premiums in a private system. Since the government has much more control over how the money is spent, it can also negotiate pricing much more effectively and fairly than before. Finally, since it would be funded mostly by progressive income taxes, the burden of health care costs would be shifted to the well off who can afford to pick up more of the bill than in our current system.

3. Equity

The last point I would like to make is about the equity of this system. Since everyone has the same plan, everyone receives coverage, and everyone receives the same care, no system is more equal and fair than a single-payer system. Instead of a system where the rich are easily able to afford high quality insurance while the poor are left with either the bare minimum or nothing at all, you are left with one where no one is left behind and everyone has a chance at a healthy life.

I will leave off there and will allow Con to advocate for his preferred system.


I will do as my opponent has and explain the system which I shall support in this debate. That system is a truly free market health care system meaning that the government in no way regulates, subsidizes, or otherwise intervenes in this system.

I shall now outline the benefits of such a system.


A free market system would produce lower cost health care for a few reasons. First is that in a free market, providers of any good or service have an incentive to provide the best possible product for the lowest possible cost to those willing to consume it. This in and of itself does not mean that all forms of health care will be extremely cheap as supply and demand for each specialized type of health care will cause the price to vary from field to field but overall, this will help bring costs down. Second, individuals, families, businesses, and employers will be better able to allocate their various resources pertaining to health care as will the providers if they no longer have to comply with certain costly and redistributive regulations such as those that mandate free emergency room care to those who can't afford it. Such regulations create incentives to, in the case of the emergency room, choose more expensive hospital care over clinical care which is lower cost to the provider causing overall costs and thus insurance premiums to go up. In addition to the burden on the provider being eased and the elimination of the need to redistribute the cost of health care to those who have insurance or pay out of pocket, a free market in health care allows everyone to produce a plan that best meets their needs and ability to pay. Another reason that costs are currently high and would be lowered by the absence of government in the health care industry is that of excessive licensing requirements. If the compulsory government licensing requirements were eliminated, the supply of health care providers would increase and thus drop the price of health care and increase variety. It would also eliminate the government's monopoly of the reputation industry and hand that job over to consumers who would by word of mouth marketing spread the word of good and bad providers. Indeed, various other institutions would likely evolve from such an environment that did the same thing. Institutions like associations of medical professionals who certified others for the knowledge of the consumer. The incentive mechanisms of the free market are such that all those who participate in it have an incentive to be honest lest they suffer the economic shunning of former and potential customers/trading partners. In addition to increasing the supply and trustworthiness of medical professionals, eliminating the government's licensing monopoly would end the idea that there is a national health care standard and cause consumers to be more discriminating and careful when shopping for health care further decreasing costs by increasing competition to provide the best possible product for the lowest possible cost. Other areas that would benefit from an end to government in health care would be pharmaceuticals and medical devices. Without an FDA to limit the introduction of new technologies and drugs, all of these products would be available for more open and competitive testing and certification similar to that which would exist for medical professionals and this would drop costs by reducing the number of unnecessary and time consuming tests and bypassing politics and bureaucracy which is often subject to legal capture in which one company or another attempts to prevent others from competing by using the government as a tool. These last two points are better explained by the following video.


The free market also incentivises constant improvement on the part of those who provide a good or service. If a business fails to improve its services, then it risks losing its market to a business that does continue to improve and thus running at a loss. This, in addition to the profit motive causes people and businesses to continue to find better, new, and useful things that not only ensure continued existence in the marketplace but rising profits. Ultimately, this increased innovation saves lives and reduces costs.


In addition to being practically superior to any government run or influenced system, the free market system for health care, if not in general, is morally superior since it does not require the initiation of the use of force or coercion for it to function. Everything that occurs is not spurred, incentivised, or in any other way coerced by a mafia-like entity but is instead completely voluntary between all those participating in the various transactions.
Debate Round No. 2


ChuckieH forfeited this round.


First I will address any incorrect claims or misconceptions that I believe Pro has then I shall proceed to explain why the system won't work/is bad.

1. Coverage
First Pro claims that everyone will receive treatment, however this contradicts the single-payer system Pro outlined in which there were certain limits on care meaning that by definition, there will be instances where coverage will be denied, even if people have the option to pay. Next pro claims that it is morally imperative to ensure that all can afford coverage but this makes the assumption that every individual's existence is justified by the existence of the majority or collective. In other words, the individual exists only so that the majority can live off his efforts. This is basically a hidden way of justifying slavery and fooling the people feeding the system into willingly sacrificing themselves. More information about this is available at the Ayn Rand Institute. Pro also makes the argument that it is in our practical interests to give those who cannot pay coverage because under the current system we pay to subsidize their care. Unfortunately for that argument, in a single payer system, these people are still subsidized by those who can afford care as the taxes are ultimately just as redistributive as the emergency room regulations.
While administrative costs do make a contribution to the high cost of insurance, the cost of health care itself is a significant factor. The reason it is so costly is not simply because of the quality but primarily due to the regulations I mentioned in round 2. Regulations such as licensing requirements for doctors, the FDA, emergency room regulations, other regulations that create barriers to entry into and innovation in the industry, and of course taxes involved. As for administrative costs, I will concede that they are significant, however, a small fraction of these costs are the result of private industry while the majority are the result of government policies at the state and national levels. In insurance there are things like state licensing requirements and other interstate trade barriers preventing competition, and high taxes on individual markets which drive insurance companies and people into the employer based markets which are far less negotiable. Each new layer of regulations and taxes that a government applies means that insurance companies must fill out more paperwork, hire more accountants and lawyers and inevitably drives up administrative costs ( Also, Pro notices that there is profit involved in insurance, this is because those who are part of an insurance plan or pool generally want someone to take care of administration to make things more efficient and to take care of more people and thus gain the advantage of economies of scale and lowering premiums. But this administration requires significant effort and those hired for this job want something in exchange and that is the profit involved in insurance, no profit means no administrators, no administrators means s less efficiency and smaller pools and no economies of scale and thus higher premiums. Also while profit will not be in the picture in a single payer system, administration costs and wages for all the employees involved in the process will still exist. In fact administrative costs will be higher because of the layers of bureaucracy involved in government. Pro also dislikes the massive and unnecessary consolidations and expansions taken on by the plethora of non-profit hospitals and how this raises premiums and harms negotiating power. I will not content this but it is wise to remember the cause of these expansions and consolidations, that cause is government incentives to be and follow the regulations concerning non-profit hospitals which Pro actually said "profit" more from their activities than do for profit hospitals. The fact that the US has surplus hospital beds can be partially attributed to the same cause. Pro then says that taxes would be lower than premiums in a private system. This is incorrect because costs will actually increase in a single payer system as I will address later. There is also incentive to keep costs low in health care and insurance in a laissez-faire system as I explained in round 2. Also, even if the taxes on for the program were marginal, the government would just make up the difference in cost the way it always does, through debt and inflation which sells off the unborn and harms the poor respectively. Pro also claims that the government will be better at negotiating prices. This however is quite false. Logically the government, which at least allegedly represents the collective of its constituents, can, like a labor union, only collectively bargain. This means that only a one size fits all plan will be produced as the results of the bargaining will be just like the negotiation, collective. If negotiation were to be on an individual basis, each individual could decide what kind of plan was best for them and there circumstances and there would be little to no under providing or over providing under a laissez-faire system. Finally, Pro says that the cost will be primarily borne by the wealthy which is true but as I shall address later, that bill will be much larger and will thus have the consequences of harming the rich, who are often employers, and thus slowing and preventing business and economic expansion and harming the fortunes of all in the economy.
Pro is not necessarily correct in that the single payer system will produce greater equality but for the sake of this argument I shall assume Pro is. Equality here is irrelevant, what is important is individual control over individual health care choices which is best supported by laissez-faire which by definition supports individual choice over individual property.
I shall now proceed to explain why the single payer system will be ineffective and detrimental primarily by analysing the incentive involved.
The incentives in Pro's single payer system are such that costs would actually increase and not decrease even with the care limits. This is because it will be in the interest of every doctor to encourage demand for health care and further discourage entry into the industry which harms innovation, competition, and quality. This incentive is provided by the fact that doctors will be paid on the number of patients. Costs will also increase because as doctors will also be paid by results (which in and of itself is quite arbitrary) they will be inclined to make multiple, repeated, and unnecessary tests on their patients further driving up costs and slowing down the system further harming quality by increasing the likelihood of waiting lines. The system will also cause people to make repeated and unnecessary visits and the doctors would be happy to comply because of their incentives. Even with the limits on checkups, doctors would still be able to authorize hospital visits which would still be in their interests particularly if they worked at the hospital. Also, it's all fine and dandy if the government builds "sufficient" hospitals and clinics but who would man them after they were built, the barriers to entry in the medical field are already high and would only get higher as I previously explained. Furthermore Pro already said that there are surplus hospital beds presently. Also who would decide what "sufficient" was and where to build the hospitals and clinics. Ultimately this is not only easier said than done but the job would fall to bureaucrats and politicians many of whom would be subject to public choice theory and/or have little to no experience in the medical or business fields and would thus know little about how and where to place a new hospital or clinic outside of which special interest group would pay them more. Also, while Pro's claim that researchers would be "paid their due" sounds nice, it begs the question, "What are they due?" Without a profit motive and private enterprise to convey information about what forms of research are valued by patients and other customers, the amount of money could be too high or too low and would either result in excessive and wasteful spending, or a sudden lack of medical researchers. Furthermore, what gets researched will no longer be dictated by the demand of patients and other customers but by some bureaucrat in Washington who doesn't know the difference between a scalpel and a stent. This means that certain "researchers" will likely be getting paid to research dead end technologies. Finally, the whole single payer system will become a tool for control. This is because after the "Nanny State" provides something for a given period of time, people grow dependent on it and many cannot imagine a life where the government did not provide such a good or service. This dependence decreases individuality and could in the future lead to despotism. Of course this would be in the very far future but it is not unimaginable and is extremely likely. This same effect has been seen with all government programs such as the Welfare State, public education, and military and law and order.
Debate Round No. 3


ChuckieH forfeited this round.


Thus far, Pro has been silent on all of my arguments so I'm not sure what else to say besides silence is consent and that Pro's solution is really just more of the same policies that have been causing the problems. Government, in attempting (and failing) to control individual and group decisions to produce outcomes that those in government of those lobbying it think are desirable, just creates more problems that are worse than the ones it was intended to fix. Empirically, when governments nationalize health care, it leads to increased costs which are then met by price controls and thus shortages and waiting lines. Add this to the many other layers of bureaucracy that government brings with it you have quite a mess on your hands. This is why Con's policy of non-intervention and laissez-faire in health care will produce the best outcomes. Laissez-faire allows the naturally selfish humans to use that selfishness to generate wealth and do good. This selfish motivation causes innovation, efficiency, and smart business decisions.
Debate Round No. 4


ChuckieH forfeited this round.


I'd thank my opponent for the debate were it not for the fact that there was no debate after the second round. Oh well. :(
Debate Round No. 5
1 comment has been posted on this debate.
Posted by Hematite12 2 years ago
You can debate whatever you want, of course, but it's kind of a false dichotomy.
1 votes has been placed for this debate.
Vote Placed by miles-pro-libertate 2 years ago
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Total points awarded:06 
Reasons for voting decision: Applaud to Con for following through and finishing the debate. The arguments themselves were well done, even in absence of a competitor.