The Instigator
ConserativeDemocrat
Pro (for)
The Contender
EXOPrimal
Con (against)

Should the USA adopt a single-payer universal healthcare system?

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Voting Style: Open Point System: 7 Point
Started: 11/1/2017 Category: Politics
Updated: 8 months ago Status: Debating Period
Viewed: 489 times Debate No: 104725
Debate Rounds (5)
Comments (2)
Votes (0)

 

ConserativeDemocrat

Pro

Debate Overview:

With the rise in popularity of Vermont Senator Bernie Sanders, multiple policy ideas of his have been brought to national attention, most notably his plan for single payer, universal healthcare. Pro agrees with this policy of Sanders, and will argue for it in this debate. Con will argue against single payer, universal healthcare, and will instead argue for the individual mandate as part of the Patient Protection and Affordable Care Act, commonly known as the ACA or Obamacare, or for other forms of free market healthcare.

Definitions:

Single Payer Universal Healthcare: Health insurance provided to all legal residents of the United States of America by the government of the United States of America.

Free Market Healthcare System: A system where residents of the United States of America can buy healthcare from private insurance companies.

Individual Mandate: A government ordered mandate that requires all legal residents to buy private health insurance or pay a fee.


Rules:
1.) Cite your sources
2.) Be respectful
3.) NO TROLLING!
4.) First round is acceptance only
5.) BoP is on Pro
6.) Violation of any rules is an automatic 7 point loss

Good Luck!
EXOPrimal

Con

I accept, good luck to Pro!
Debate Round No. 1
ConserativeDemocrat

Pro

Thesis:

Single Payer Universal Healthcare (UH) is cheaper then both a free market capitalist system or an individual mandate system. Furthermore, UH improves access to healthcare, allowing for longer life expectancies and fewer premature deaths.


Contention 1: Price

The US spends more per capita on healthcare then any other country in the world [1 2013] If we average up the per capita costs of modern, first world countries such as Japan, Australia, France, Denmark, the US etc, the average is 3,404 dollars. More specifically, the average public spending is 2,598 dollars, the average out-of-pocket costs are 625 dollars, and other costs average out to 181 dollars.
The US average is much higher then the 13 other countries included in this list. Its total average is 7,813 dollars per capita. Broken down further, we spend an average of 4,197 dollars publically, 1,074 dollars privately, and our "other" category is at 3,442 dollars.

We rank last on total per capita cost, 11th on public cost, 12th on private cost, and last on other costs. Immediately, there is a strong colleration between UH and lower costs for care.

In fact, a more recent study done by the same organization as [1] has US spending up to over 9,000 dollars [2].

But why is our individual mandate/free market system so expensive?

There are 5 main reasons for it [3]

Administration [3]/[4]:

These costs make up 30% of the cost of American healthcare, and are possibly the largest factor that contributes to our bloated spending. The main reason for this is our complicated billing system. Here's a quote on it:

"American hospitals and physicians have to navigate a complex billing and insurance space that requires heavy administrative work. They must figure out how to bill a patient on case-by-case basis, with no set formula like as in a single-payer healthcare system. Each insurance bills for the same procedure differently, and administrators have to collect money from patients on a variety of mediums. As David Cutler, a health economist in the United States explains,

Duke University Hospital has 900 hospital beds and 1,300 billing clerks. The typical Canadian hospital has a handful of billing clerks. Single-payer systems have fewer administrative needs."

This is an immediate advantage of a UH system. Since public hospitals only have one entity to bill, the process is streamlined and simple, reducing the price. There is simply no way a private care system can compete with this.


Drug Costs [3]:

Unlike other single payer countries, the US bans Medicare, the healthcare aid program for seniors, from negiotating drug prices. This leads to bloated costs. UH would solve this problem, as we would obviously allow our government to negiotate drug prices.


Higher use of treatments [3]:

US doctors assign high cost treatments at a much greater frequency then European countries. This leads to higher healthcare costs as insurance has to cover these expensive treatments. Furthermore, Americans are more likely to use medical specialists then UH countries; specialists are much more expensive then general doctors and clinics, further driving up costs.


Higher Salaries [3] [5]:

There are two parts to this.


First, US doctors make much more money then their European counterparts. This obviously drives costs up, as salaries and wages need to be paid, so prices are raised to pay the salaries.
Secondly, insurance executives are paid insane amounts of money. In the 7 years since the PPACA was passed, the 113 top executives of insurance companies took home 9.3 billion dollars. I will explain this further later on, but obviously if we are to pay the executives ridiculous amounts of money, we will need to raise costs on everyone else.

Profit Margin:

This is the fundamental reason why a private/free market/capitalist system simply won't work. The point of businesses is to proved a service or product popular enough to make the business money. That works fine with optional products with lots of competition, like the car market. Just off the top of my head, there's BMW, Mercedes, Porsche, Audi, Chevrolet, GMC, Kia, Lexus, Toyota, Ram, Dodge, Ford, Volvo, Volkswagen etc. There is tons of competion, which helps lower prices, but most importantly: While cars are extremely useful, there are alternatives to owning cars, so if one doesn't own a car, especially in cities, life will go on. Healthcare/insurance isn't like that. It is a necessity for life. Having capitalist healthcare will lead to insurance providers and other medical companies raising prices to make a profit. This leads to a massive price increase for everyone, because we all need healthcare.


The government, on the other hand, doesn't exist to make a profit. It exists to provide services to the people and keep order in a country. The government has no need/motive to make a profit on health insurance, so government provided care will be significantly cheaper then private care.

Contention 2: Single Payer Universal Care Improves Access to Healthcare, Leading to Fewer Deaths and Higher Life Expectancies

There is plenty of evidence linking higher public access to healthcare/insurance and better public health. Furthermore, a clear negative coloration exists between increased private/out-of-pocket healthcare expenses and worse public health [6].


Examples:

  1. A higher reliance on OOP payments has been shown to contribute to worse health outcomes (United Nations Sustainable Development Solutions Network, 2015). For example, a 10% higher share of OOP payments was significantly associated with an average rise of 11.6 female deaths per 1000 (Moreno-serra & Smith, 2011; United Nations Sustainable Development Solutions Network, 2015).
  2. In the United States, better adult and infant health outcomes have been clearly linked to the implementation and expansion of the Medicare and Medicaid schemes (Moreno-Serra & Smith, 2015).
  3. The introduction of the universal coverage scheme in Thailand has resulted in an estimated decrease of 6.5 infant deaths per 1000 births among the poor from 2001 to 2005 (Farahani, Subramanian, & Canning, 2010; Gruber, Hendren, & Townsend, 2013; Martin, Rice, & Smith, 2008).
  4. Japan’s mortality rates for communicable diseases in children and young adults started to decline and life expectancy at birth increased in the 1950s and early 1960s, when the government scaled up population health interventions and introduced universal health coverage (Ikeda et al., 2011).
  5. Germany’s social health insurance (SHI) -- along with favourable socioeconomic factors -- has contributed to an improvement in population health outcomes. Life expectancy at birth reached 81 years old in 2013, an increase of more than 10 years since 1960.
The conclusion is obvious. Implementing a universal healthcare system will substantially increase public health in America. Furthermore, we will see a fairly large increase in life expectancy rates and substantial drops in infant mortality rates and other similar measurements because our rates for these things is already high, especially compared to other modern nations.

For infant mortality [7], out of the 225 political units recognized by the CIA World Factbook, we rank 56th, with a rate of 5.8 per 1000 births, higher then Germany's rate of 3.4, the UK's rate of 4.3, and France's rate of 3.3.

For life expectancy [8], out of the 225 political units recognized by the CIA World Factbook, we rank 42nd, with an expectancy of 79.8, lower then Germany's 80.7 years, Japan's 85 years, the UK's 80.7, and Canada's 81.9.

Almost 50,000 Americans die each year because they don't have access to basic healthcare, or a rate of 6.4 deaths per 1000 people [9].

Since we have established a clear link between UH and better public health, we can conclude that the following statistics will become better if we implement a universal healthcare plan.

Conclusion:

Pro has established a clear link between lower healthcare costs and better public health and single payer universal healthcare systems. Thus, Pro concludes that the United States of America should adopt this plan.


Sources:

[1]:
http://www.commonwealthfund.org...

[2]:
https://www.cnbc.com...

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

[4]:
https://www.singlecare.com...

[5]:
http://www.npr.org...

[6]:
https://www.oecd.org...

[7]:
https://www.cia.gov...

[8]:
https://www.cia.gov...

[9]:
https://news.harvard.edu...


EXOPrimal

Con

As the BoP lands on Pro, I will simply have to prove Pro's arguments about Single Payer Healthcare to be inefficient. I do not support Obamacare, it's a horrible plan with obvious drawbacks. I support a plan where healthcare is completely private and company mandated. Government should have no place in healthcare. As a result of this, I will concede any points that prove that ObamaCare is a failure of a program, as it is.


"First, US doctors make much more money than their European counterparts. This obviously drives costs up, as salaries and wages need to be paid, so prices are raised to pay the salaries."

The reason that Doctors are paid significantly more in the US is due to the shortage of qualified medical professionals in the field. It is estimated that the US will be short nearly 100,000 doctors by 2030(1). As the demand for doctors rises faster than the education of new doctors, the cost will go up. Pro’s connection between the higher salary of doctors to the higher cost is “obvious”, but his solution is not. It is evident that the actual solution would be to incentivize colleges to give more scholarships to medical programs, and encourage students to go into medical fields. This would increase the supply to doctors, reducing costs. Single Payer healthcare does not solve this problem, as a result in no way would the implementation of a universal healthcare system reduce the salary for US doctors.

“This is the fundamental reason why a private/free market/capitalist system simply won't work.”

Pro’s reasoning in his argument results from a basic misunderstanding of capitalist economies. If a company starts to raise prices, another company will price the product lower. The lower priced product will be bought. As a result of this, the cost of free market healthcare cannot exceed a cap. This can be seen in uninsured cosmetic procedures, prices dropped from $2,200 to $300 as a result of many insurance companies not insuring it(2). The reason that hospital prices are so high is because government healthcare and other insurance companies will pay anything, so hospitals jack up prices. This does not change in a universal healthcare system.We have never had a free market healthcare system, consent government mandates have made that impossible. What we have is a type of “crony capitalism” where the government raises prices(3). In an actual free market system, prices would drop.

“The government, on the other hand, doesn't exist to make a profit.”

Yet hospitals do exist for profit, no matter how much healthcare the government seizes, this will not stop hospitals. If the government is in charge of healthcare, hospitals can raise prices because the government is paying for the healthcare. In the UH system the patient does not feel that, as the healthcare pays it off. In a free market system hospitals will not be able to do this, as the “customers” will not agree to such high prices. This can be seen right now, in this example a hospital charged over $25,000 extra because of health care paid for by the government(4). The government doesn't exist for profit, and that is the problem. A free market insurance company does, therefore they will not pay for over expensive procedures. Existing for profit is a good thing, profit is not as simple as “price up, money up”. Competition and other factor stifle this, in a truly free market system prices do not go up infinitely.

“For infant mortality [7], out of the 225 political units recognized by the CIA World Factbook, we rank 56th, with a rate of 5.8 per 1000 births, higher than Germany's rate of 3.4, the UK's rate of 4.3, and France's rate of 3.3”

The link between our low infant mortality rates and our healthcare is weak at best. There are several reasons for our poor infant mortality rates, most has to do with culture. The primary reason for this is premature births. According to the CDC, African Americans had — and continue to have — almost double the rate of infant deaths as Caucasians, this is a culture problem. Racism or poor values in african american communities, there is a problem with the conditions pregnant mothers are in. Mothers who are African American experience high levels of emotional stress during their pregnancy are more likely to give birth preterm. If our premature birth rate was equivalent to Sweden's, our infant mortality rate would 4(5). There are no statistics to prove that Universal Healthcare would reduce premature births to the needed level. It is also illogical, as healthcare is incapable to changing a culture that creates unplanned pregnancies. Our mortality rates are a result or immaturity, not poor healthcare.

“Almost 50,000 Americans die each year because they don't have access to basic healthcare, or a rate of 6.4 deaths per 1000 people [9].”

This is a result of the failure of Obamacare. I support universal government funded catastrophic health care(6), but Bernie Sanders support that seizes control of too many aspects of healthcare. When lives are being threatened government can help, but in other cases it is not their problem. The notion that the US would be affected by Universal Healthcare at the same rate as Japan or Thailand is ridiculous. The mortality rate in the US due to the top 10 reasons of death is equivalent to Japan’s if scaled to the US population(Japan:1,415,657, US:1,421,278). The Japanese population die 50% more if compared to the US population due to their top 10 causes of death(Japan: 1,649,405, US: 958,319)(7). The life expectancy may be due to the aging population in Europe and Japan.

“This is an immediate advantage of a UH system. Since public hospitals only have one entity to bill, the process is streamlined and simple, reducing the price. There is simply no way a private care system can compete with this.”

In Canada and the UK wait time are excessively long for specialized services. 8 months in the UK, and 6 months in Canada. This is due to the inefficiency of the government, as they have to approve surgeries for the entire population. In a free market system, health care companies will only need to review cases for their clients.

“But why is our individual mandate/free market system so expensive?”

It appears that it is not only the “free market system” that is estimated to cost a good amount of money. The Committee for a Responsible Federal Budget. Estimates that the new healthcare system would cost 25 trillion in 10 years(9). 11.9 trillion dollars would be leveraged in taxes with Bernie’s plan, taxing is also a drawback. I should not have to pay for someone else's healthcare.A study by the Urban Institute also affirms this(10). Medicare also faces a 48 trillion dollar debt(11), and Sanders proposes no way to fix this.


In conclusion, proving the failure of ObamaCare does not prove Pro’s point. ObamaCare is a failure on all levels and is not a truly free-market system. From round 1: “ Pro agrees with this policy of Sanders, and will argue for it in this debate”. I would like to note that Pro fails to defend Sanders’ healthcare plan, instead focusing on universal healthcare in general. The word “Sanders” does not appear once in his argument, ironically. Pro’s argument is full of weak links and generalizations. Vote Con.

Sources
1.https://news.aamc.org...
2.http://www.investors.com...
3.http://thefederalist.com...
4.http://reason.com...
5.http://sm.stanford.edu...
6.https://www.nytimes.com...
7.http://www.worldlifeexpectancy.com...#
8.http://www.crfb.org...
9.http://www.crfb.org...
10.https://www.urban.org...
11.https://www.cato.org...
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Debate Round No. 5
2 comments have been posted on this debate. Showing 1 through 2 records.
Posted by EXOPrimal 8 months ago
EXOPrimal
Yeah that would be fine, just challenge me
Posted by ConserativeDemocrat 8 months ago
ConserativeDemocrat
I don't think I will have time to post my next round; this week has been crazy busy for me. Would you be interested in a rematch in a few days with the same first rounds?
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