The Instigator
Contra
Pro (for)
Losing
6 Points
The Contender
bluesteel
Con (against)
Winning
15 Points

The USA should establish a Single-Payer Health Care System

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Post Voting Period
The voting period for this debate has ended.
after 7 votes the winner is...
bluesteel
Voting Style: Open Point System: 7 Point
Started: 2/1/2012 Category: Society
Updated: 4 years ago Status: Post Voting Period
Viewed: 7,714 times Debate No: 20821
Debate Rounds (4)
Comments (9)
Votes (7)

 

Contra

Pro

Round 1 is for acceptance. Good luck.

Single Payer Health Care:

Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.

Socialized Medicine:

Socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government.

http://www.pnhp.org...

bluesteel

Con

Thanks Contra. I accept.
Debate Round No. 1
Contra

Pro

Before I start this debate, I will say that I defend the resolution, while Con defends a private health care system. I request that in the last round, Con doesn't add any new arguments. I will do my best to win this debate.

Single-Payer Health Care System in USA would:

  • Restore true competition to medical providers
  • Increase innovation
  • Be More Efficient
  • Decrease total costs
  • Coverage of all citizens
  • Improve quality of care
  • Improve national economy


C1: Restore true competition to medical providers

There are two different areas where competition exists in healthcare, 1) payers, and 2) providers.

With private insurance payers, there are a lack of choices for the consumers. The reason is to make the insurance company gain a profit. It gives too much power to the administrators instead of the actual medical experts. It is offensive to medical experts as well, as well as the people who have their loved ones die because of these choices. In a Single-Payer system, people can go to any provider of health care in the nation. It would be much more efficient. Medical decisions are left to the patient and doctor, as it should be. It is also Capitalistic, because medical professionals would be still forced to make good decisions in health treatment, or else they will lose patients. Health providers get profits still in a Single-Payer system, and doctors still are well paid. Therefore, Single-Payer would restore true healthy competition to medical providers. [1] [2]

C2: Increase Innovation

Currently under HMO/ insurance payer system, grants payed towards medical research and reduced, and with much higher costs in the private system, innovation is less than what is would be in a Single Payer system. Plus, with the commericialization of research, innovation is stifled. With little to no commercialization of research, and with much more funding, as well as more research, a Single Payer system would increase innovation in healthcare. [3]

C3: Be More Efficient

The United States 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, and instead has thousands of different insurance plans, each with its own marketing, paperwork, enrollment, premiums, and rules and regulations, our insurance system is both extremely complex and fragmented. [3]

Typical HMO's have about 15-25% of total costs directed just to administrative costs. Medicare, a form of a single-payer healthcare system for the elderly, costs about 3-6 percent in total administrative costs. [3] [5] With a larger economy of scale, costs would be even lower for administrative costs. Plus, with a single-payer system, health records are much more streamlined, and would make shuffling paperwork unnecessary since records can be recorded in a electronic way. With much more electronic, streamlined recording, much less spending on paper-shuffling and much less spending on administrative costs, and by lowering bureaucracy, a Single-Payer healthcare system would be much more efficient, modern, would be more affordable, and cover all fairly and effectively.

C4: Decrease Total Costs

With a Single-Payer system, everybody is covered with high quality insurance. Experts have said that the USA could cover all medically indicated care for all citizens without additional expenditures, because current insurance premiums, as well as administrative costs, could be shifted to care instead. [5] [6] Paul Krugman, a famous economist and Nobel Prize winner, called the Single-Payer system, "good economics", and wrote, "The great advantage of universal, government-provided health insurance is lower costs... Medicare has much lower administrative costs than private insurance." Krugman also has pointed out that the savings of single-payer would be "far more than the cost of covering all those now uninsured." [7] [5] The gov't of Colorado hired the Lewin Group Technical Assessment to analyze how well several different health-care proposals might work for the state, and the result from the group was that the "single-payer plan was the only one that would achieve universal coverage and also save money - about $1.4 billion a year. " [8] [5] The government will also not need to pay for profits, marketing, shuffling paperwork, higher adminstrative costs, etc. Plus, with more directed funding, the per capita spent on healthcare would drop, as quality improves as well. If you look at other nation's spending on healthcare per citizen, many get better care for lower costs. For example, look at France, the nation with the top ranking healthcare, the USA spends twice as much, but is 36 spots behind in healthcare. This represents that a Single-Payer system is needed. [4]

C5: Coverage of All Citizens

A single-payer healthcare system covers all citizens with quality healthcare.

C6: Improves Quality of Care

Health Insurance companies usually base decisions based on coverage, restrictions, and costs, and what will make the company prosper. This does not equal great care, and may even conflict with that. [5] A single-payer program can allolocate resources based on the two vital parties in a healthcare scenario: the patients and the providers. Plus, Single-Payer plans in the USA, such as Medicare, show that the patients have higher levels of satisfaction with coverage and access to care than people to private insurance. [5] Plus, France has the top-ranking healthcare in the world, and is a Single-Payer system, and has a comprehensive plan for all citizens. However, it only has to pay HALF of what the USA does. The USA is only in place 37, but is number 1 for spending. [9]

C7: Improves National Economy

States and other businesses would have to pay less on medical care for their workers. Right now, American workers also have to compete with foreign businesses which nation's have universal health care. For example, in 2006, health care for workers added $1,500 to the price of a medium size care, while the cost in Japan was about $500. This, as well as other reasons including a cut in HALF OF BANKRUPTCIES due to a lack of medical insurance, and lower costs by a Single-Payer system, would help the economy. [4] [5] I will discuss in a different round how a Single-Payer system would be funded for.

Conclusions:

A Single-Payer Healthcare system would have huge benefits for the USA. A Health Planning board, if included (I debate Pro for this being the primary government body of execution of healthcare) would decide on what treatments, medications and services should be covered, based on community needs and medical science, and allocate capital for major new investments based on assessments of where need is greatest. Plus, coverage would be universal for a Single-Payer healthcare system. Quality would absolutely improve for all. Medical records could be streamlined in an efficient way. The national economy would get a boost with 1/2 of bankruptcies removed, and with much lower costs, businesses would be more competitive, and have more funds available. It also modernizes the USA, helps all our citizens, and returns legitimate healthcare competition to the providers and patients, while the government facilitates better health care for all.

Sources:

[1] http://bcn.boulder.co.us...

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

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

[4] Conrad, Jessamyn. What You Should Know About Politics... But Don't. 1st ed. New York: Hachette Book Group, 2008. 104-124. Print.

[5] Sherrow, Victoria. Universal Healthcare. 1st ed. New York: Infobase Publishing, 2010. Print.

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

[7] http://www.nytimes.com...

[8] http://healthcareforallcolorado.org...

[9] http://www.photius.com...

bluesteel

Con

Thanks Contra.

== My case ==

Lucky for us, single-payer health insurance has been tried in a number of other countries. Let's see if it has made these countries better off.

C1) Rationing of care

When you make health insurance free for everyone, people feel like they no longer have to pay for medical services. When *any* service is free, people overuse it. A well-known study by the RAND Corporation found that free health insurance increased the amount of health services used by the participants, particularly in the category of "inappropriate or unnecessary medical care"; obviously, this increased treatment did not improve health outcomes. [1] In addition, a study at Dartmouth Medical School and a study of Medicare found that "when health care is free . . . people will exhaust [all] available resources despite whether or not it has any benefit on their health." [2] What this means is that under single-payer health insurance, people *do* exhaust all available medical resources, creating long wait times for people who actually *need* medical treatment.

For example, in England, citizens take an average of one ambulance trip per citizen per year, 91% of which are for non-emergency purposes. [9] Because they are free, the British are treating ambulances as taxis.

As a result, wait times in single-payer systems are well documented. A study in Sweden concluded: "Long waiting lists for coronary artery bypass grafting are associated with considerable mortality." [3] More than 50% of people in Sweden have to wait longer than 3 months for surgery. [5] In England, 21% of lung cancer patients become incurable while on the wait list. [4] "The World Health Organization has recently called [England's National Health Service] a deliverer of ‘third world cancer care.'" [2] In Canada, "Only half of ER patients are treated in a timely manner by national and international standards, according to a government study." [6] That's scary given that most Emergency Room patients are in dire need of treatment.

Supposedly the greatest feature of single-payer insurance is increased access for the poor and "fairness," i.e. equal access for all. However, in Japan, the rich routinely bribe their way to the top of the wait list. [9] Canada's Fraser Institute finds that wait lists in Canada are "routinely jumped by the famous and politically-connected." [7] The rich still get better access to treatment in Canada, which is why a study published in the Forum for Health Economics & Policy concluded "that the poor [in Canada] under socialized medicine seem to be less healthy . . . than their American counterparts." [6] That's pretty bad considering the number of uninsured in the United States. Apparently it's better to be uninsured in the U.S. than insured by the government in Canada.

A similar study in England concluded that health outcomes for the poor had not improved since implementing a single-payer system in 1948. [9]

C2) Quality of American government health care

To see if single-payer would be better in the US, we can look to whether our government is good at providing medical insurance by examining Medicare and Medicaid.

According to the New York Times, more and more doctors are opting out of Medicare, "The doctors' reasons: reimbursement rates are too low and paperwork too much of a hassle." [10] USA Today reports that Congress is cutting reimbursement rates for Medicare by a further 21%; currently, the AMA reports that 17% of all doctors and 31% of primary care physicians are not accepting Medicare patients, but the number will double after the 21% reimbursement cut. [11] The numbers for Medicaid are even worse.

In addition, the price controls for medicine that the government has implemented in Medicare is contributing to massive drug shortages. The Heritage Foundation reports that price controls under Medicare Part B are the #1 contributor to the shortage of 178 different generic drugs. [12] If our government ran all insurance, these shortages would become more severe.

C3) Cost

In France, the system costs 40% of government revenue and implements a payroll tax of 20% on citizens. [13] This amounts to a cost of $1 trillion a year in the US to the government alone. In addition, France is running a $13.5 billion shortfall per year and its health care system is on the verge of bankruptcy. [14] The US cannot afford such an expensive system when we're already struggling with our budget deficit. In addition, Americans cannot afford such an expensive system during a recession. "It has been estimated that a Swedish-style single-payer health insurance system in America would cost the median-income household some $17,200 per year in health care taxes." [15]

C4) Physician shortages

The US is already projecting shortages in the number of nurses and other health care professionals. Single-payer reimbursement rates are low, as we saw with Medicare. In France, doctors earn a third of what they do in the US. [16] In Japan, doctors must see 40 patients per day to make a decent living. [9] For this reason, in a survey, one in five US doctors said they would quit if the US implemented single-payer insurance. [17] France has a huge problem with doctor shortages. [20]

C5) Drug innovation

A study by the Boston Consulting Group found that price controls under single-payer systems resulted in an average "loss of $17-22 billion annually in pharmaceutical research, resulting in the loss of 10 to 13 new drug launches" per year per country. [18] For this reason, most countries rely on the US for drug innovations.

C6) Death Panels

My opponent says in his conclusion that he sets up a Health Planning board to decide which treatments to cover and which life saving treatments to NOT cover. In England, a similar death panel decided to deny a life extending drug to MS patients. [19]

== Rebuttal ==

R1) Patient choice

What my opponent has described – being able to see any doctor or specialist – exists in the private insurance market now – it's called a PPO. HMO's, which are cheaper forms of health insurance, allow you to see any specialist but your primary care physician must issue you a "referral," deeming the visit medically relevant. HMO's have lower premiums precisely because they prevent patients from taking unnecessary trips to see expensive specialists.

In contrast, free choice means overuse of resources, resulting in long waiting lists under single-payer systems.

R2) Increased innovation

My opponent provides no actual evidence that single-payer systems are more innovative, while I have a study proving that their price controls ensure they are much less innovative. In fact, due to the high medical costs of single-payer insurance, Canada spends almost NOTHING on Research & Development. [9]

R3) More efficient?

A study by the Heritage Foundation found that Medicare administrative costs are only lower as a percentage of total costs because Medicare spending outlays on medicine are ENORMOUS, so administrative costs look small in comparison. [21] Heritage concludes that on a *per patient* basis, Medicare administrative costs were 48.4% higher than for private insurance in 2000. [21]

The NYT evidence made clear: all doctors agree that Medicare has more annoying bureaucracy and paperwork than private insurance.

R4) Decrease cost?

Obama's 2009 health care reform already implements many of these cost saving measures. For example, the reform requires that 80% of private insurance premiums go to medical treatment, which will make private insurers even more efficient. In addition, France's deficit proves that single-payer is not cheaper due to the overuse of free treatment.

R5) Coverage of all?

"As the Canadian Supreme Court said upon ruling unconstitutional a Quebec law that banned private health care, ‘access to a waiting list is not access to health care.'" [18]

R6) Quality of care?

See rationing.

My opponent cites rankings based on life expectancy figures. A great article in Forbes questions how the number of car accidents in a country (which affects life expectancy) is relevant in measuring health care outcomes [22]. Forbes says we should measure how well the system performs at *the point of intervention,* meaning once you get sick. The US ranks #1 on "5-year survival rates for breast cancer, colon and rectal cancer, and prostate cancer." [22]

R7) Bankruptcies

Most medical bankruptcies are incurred after an insurance company denies coverage for expensive experimental or uncovered treatments. Rationing and death panels would lead to the same or worse outcomes. In Canada, people desperate for care come to the US for treatment and pay cash. [9]

[1] http://tinyurl.com...
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[17] http://tinyurl.com...
[18] http://tinyurl.com...
[19] http://tinyurl.com...
[20] http://tinyurl.com...
[21] http://tinyurl.com...
[22] http://tinyurl.com...
Debate Round No. 2
Contra

Pro

Thanks Con for your swift response.

--------------Rebuttals----------------


C1: Concerns about Overutilization


Your study showed the conclusion that when co-pays were reduced: "appropriate or needed" medical care as well as "inappropriate or unnecessary" medical care were reduced. However, in a Single-Payer system with low co-pays gives these benefits:

Preventive Medicine is Used: Preventive care is less expensive than catastrophic intervention. Often, the uninsured or underinsured end up in emergency rooms because they do not get preventive care or early interventions. For example, an expensive blood pressure pill is cheaper than having a stroke. Therefore, co-pays actually increase the cost of healthcare. [1]

Reaching Doctor: Going to the doctor takes time and effort. So, since of this factor, few would actually go to the doctor more than necessary. [1]

Smart Card: In a Single-Payer system, a Smart Card could be used such as in Taiwan that includes provider and patient profiles to identify and reduce insurance fraud, overcharges, and duplication of services and tests. The physician puts the card into a reader and the patient’s medical history and prescriptions come up on a computer screen. The insurer is billed the medical bill and it is automatically paid. Taiwan’s single-payer insurer monitors standards, usage and quality of treatment for diagnosis by requiring the providers to submit a full report every 24 hours. This improves quality of treatment and limits physicians from over prescribing medications as well as keeps patients from abusing the system. The Smart Card is a major facet in Single-Payer healthcare efficiency, it makes Single-Payer healthcare remarkably efficient. [2] [3] It streamlines the system.

-----------------Further concerns about overutilization:
With a Smart Card, patient usage is also tracked. For example, if a patient visits a doctor 20 times a month, the government can visit that patient and have a chat with that person. [3] About your ambulance example, the same would apply. Plus, a co-pay could be based on a patient's income, and when used with a Smart Card, overutilization would become rare.


C2: USA already rations care, and doesn't have to:



Healthcare in the USA is already rationed.


It is rationed, based according to wealth: those who have the money for healthcare get it, and people with more money get it faster. [1]

Plus, in Canada and other Single-Payer nations, rationing is public information, publicly accountable by the government. Wait times are published online for all to see. This public attention has led to recent falls in waits there. [4]

Since in the USA nobody is accountable for how the system works, it isn't visible on the surface like other nations. Rationing in our system is carried out covertly through financial pressure, forcing millions of individuals to forgo care or to be shunted away by caregivers from services they can’t pay for. [4] As I have said already, the USA system has enough money in it already to fund all necessary medical care for all when spent wisely, with money leftover. Plus, now it sometimes takes months to visit a doctor who accepts insurance.

Rationing would not be necessary

Also, long waiting lists and rationing in necessary treatments would not occur in the USA with a Single-Payer system because of a few reasons, including the fact that the USA already has abundant healthcare resources in place, and has enough funding. Dr. Ronald Glasser pointed out:

"An axiom of economics holds that nothing can be rationed that is itself not scarce, and, absent evidence of infinite demand and infinite cost, you can't ration healthcare when there are more than enough doctors, hospitals, and high-tech equipment distributed throughout the country to do everything and anything that needs to be done. American healthcare is an unsaturated demand market, and in such markets "rationing" is simply a code word for not spending the money to take care of the poor, uninsured, the underinsured, and the high-risk patient." [5] [6]

In the worst situation, another expert, Dr. Linda Peeno said that if we do have to ration care (she is convinced we would not need to), we have an ethical system that makes fair decisions, and ensures that the money goes back into the health system to benefit patients, not stockholders. [5]

-----------USA and Waiting Lists-------------------

I have shown that the USA has a more advanced medical infrastructure than comparable nations, and that experts have shown that the USA could handle the patients that need care and anything that needs to be done in a much better way, with no waiting lists or short ones. Plus, medical decisions are made between the doctor and patient, NOT the insurance company and doctor. In Canada in 2006, 80% of Canadians were satisfied to their access to healthcare. [5] And because of the new publicly available information, waiting times are decreasing. [4] Plus most rationed procedures in national healthcare countries are elective (nonlifesaving - such as cataract surgery). [1]

Single-Payer systems universally have better results than private healthcare systems:

http://www.photius.com...


C3:
Quality in USA system


In total, 59% of physicians have said that if the USA switched to a national healthcare system, it would be a positive change. [7] Most say they favor because their patients suffer under our fragmented private system. France doesn't have a "huge problem with physician shortages", they are just decreasing, the same as the rest of the world, because different factors such as the demands, rewards, etc.

More Physicians

A Single-Payer healthcare system will provide an opportunity to restructure the USA physician workforce, and with approaches such as loan forgiveness for graduating medical students, and increased funding for medical education this will be possible. Reimburesment reform and other reforms would help as well under a Single-Payer system. We should have at least 50 percent of our physicians in primary care fields. [4]

Health Planning Board

You misunderstood, the board wouldn't decide on what literal treatments would be approved and denied, but would decide what would be PAID FOR BY THE GOVERNMENT BASED ON LOCAL SITUATIONS.

Drug Innovation

Many new drugs are based on federally funded research
usually done at universities or at the N.I.H. Plus, drug companies in nations with Single-Payer systems such as in Europe are still very profitable and highly innovative. With a new system, it would be more affordable, and just as innovative. [1]

Decreases Costs and Funding


Administration costs, overhead, profiting, advertising, etc. increases health care costs. A non-profit Single-Payer plan would be more affordable. A 7% payroll tax on employers would be utilized. Plus, an individual 2% income tax increase would occur. The payroll tax would replace all other employer expenses for employees’ health care, which would be eliminated. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and other out-of-pocket payments, and for the vast majority of people, a 2% income tax is less than what they now pay for, particularly if a family member has a serious illness. It is also a fair and sustainable contribution. [4] So, you see enormous savings.

Bankruptcies

Rationing wouldn't be needed, so no more medical bankruptcies.

Sources:

[1] Conrad, Jessamyn. What You Should Know About Politics... But Don't. 1st ed. New York: Hachette Book Group, 2008. 104-124. Print.

[2] http://en.wikipedia.org...

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

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

[5] Sherrow, Victoria. Universal Healthcare. 1st ed. New York: Infobase Publishing, 2010. Print.

[6] Ronald J. Glasser, M.D., "The Doctor Is Not In: On the Managed Failure of Managed Health Care," Harper's, March 1998, p.35

[7] http://www.reuters.com...



bluesteel

Con

Thanks Contra.

== Rebuttal ==

1) Overutilization

My opponent misconstrues the RAND study. When co-pays are reduced, people seek more "inappropriate or unnecessary medical services." The Dartmouth study found that when health care is free, if you double the number of doctors, people will visit the doctor twice as often. My opponent cites 24 pages of some book to show "fewer would actually go to the doctor" but I doubt this claim, the claim is empirically disproven, and I cannot access said book to see what it says.

Overuse is a serious problem in running up costs. A government study in France concluded that the French, because drugs are free, demand drugs at rates three times their peers in other countries, and drug outlays are responsible for the huge deficit in French health care. [1]

Does preventative care save money?

First of all, blood pressure medication is covered under private insurance and so are cancer screenings. Secondly, the literature disagrees with my opponent. A meta-analysis by the New England Journal of Medicine of 599 studies found that on average, the costs of prevention and treatment are the same, and "Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not." [2] The Congressional Budget Office also concluded that under universal health care, "preventative care will raise – not cut – costs" because so many healthy people will start overusing screening and prevention. [3]

Smart cards

Taiwan is unique in using smart cards; the US doesn't use them for Medicare or Medicaid, and the ACLU and other civil liberty groups oppose them on privacy grounds. Thus, my opponent can't prove we would start using them. And they don't save that much money. In Taiwan, the system is nearing bankruptcy, as "the government is borrowing from banks to pay what there isn't enough to pay the providers." [4]

While my opponent is correct that if someone saw a specialist 20 times a month, we'd flag their file, even if everyone saw a specialist only three times a month, that is still enough overuse to bankrupt the system, yet not enough to raise a red flag.

2) USA already rations care?

This isn't true. The Emergency Medical Treatment and Active Labor Act requires emergency rooms to treat the uninsured. A study in the New England Journal of Medicine found that the breast cancer survival rate for uninsured women (who used the ER) was higher than for woman using Medicaid. [5] It's better to use the ER than to have government insurance in the US.

Also, Obamacare provides a private sector solution: subsidies and state insurance pools to help the poor afford health insurance. We don't need a single payer system to achieve universal coverage; we can do it through the private sector and avoid the disadvantages of single payer.

My opponent argues that we currently have enough doctors and enough equipment not to have to ration care. However, those doctors and equipment exist because private insurers are willing to pay for them. When the government lowers reimbursement rates fewer doctors are willing to accept patients. Approximately 20% of all doctors and nearly half of all primary care physicians won't accept Medicare patients anymore, and that number is projected to double with the new 21% cut in reimbursement rates. In addition, 20% of doctors said they would quit under a single payer system due to lower pay. The U.S. has far more MRI's per capita than any other (single payer) country, precisely because private insurance is willing to pay for these machines. Making reimbursement rates similar to Medicare, as opposed to the higher rates offered by private insurance, *will* lead to rationing.

My opponent claims if we have to ration care, we will do so in a "fair" way. When France had a shortage in beta interferon, it held a lottery to decide which hepatitis patients would live and which would die. I'd rather avoid government-caused shortages than resort to such "fairness."

3) Wait lists

My opponent's wait list argument comes down to the argument that the current supply of medical treatment will remain the same even when we start paying less for it. This contradicts the basic theory of supply: that suppliers base their supply decision on the price people are willing to pay and exit the market when that price is too low.

I can't locate any of my opponent's claims about Canadian wait times and satisfaction in his source. It's not true that 80% of Canadians like their health care. "According to a recent poll called The National Pulse on Health Strategy, 80 percent of Canadians want major reforms to the health care system." [6] However, according to a Gallup poll, 80 percent of all Americans are satisfied with the current level of medical care available to them. [7]

Wait times in Canada are not declining and are not just for elective procedures. The average wait time for a cardiac bypass (an emergency procedure to stop heart attacks) is 65 days; average wait time for an MRI is 126 days; average wait time for breast cancer treatment is 168 days. [6] And remember, in Canada, "Only half of ER patients are treated in a timely manner by national and international standards, according to a government study."

My opponent says once again that single payer countries have better results, but these rankings measure health outcomes based on life expectancy, which includes car accidents, homicide rates, and many other irrelevant factors. If you look at effectiveness at the point of intervention, the US ranks #1 in 5 year cancer survival rates.

4) Quality in the US

The doctor poll my opponent cited here talks about a "national health insurance program," which could mean single payer or a private sector approach, like Obama's.

My opponent says here that France doesn't have physician shortages due to low pay. He clearly didn't read my source from earlier (footnote 20). It says that a national association of doctors called CNOM, much like the AMA here, "is concerned over 'medical desert' areas." A study by CNOM found that 19 of 22 regions have seen a steep decline in the number of doctors.

He claims we could have loan forgiveness for doctors, but we could do that now as well. If we cut pay by two thirds, to be consistent with physician pay in France, we will lose a ton of doctors, even if we make medical school cheaper.

5) Death Panels

My opponent says his Death Panel doesn't decide to disallow care, it just decides which treatments not to cover. If the Death Panel is forced not to cover expensive treatments, I don't see how poor people are any better off under this system. They have government health care that doesn't cover anything. This is essentially what Medicaid is now, which is why uninsured breast cancer survival rates were higher than people enrolled in Medicaid. Also, remember the studies that Canada's poor have worse health outcomes than the poor in the US and health outcomes for the poor have not improved in England since they implemented their single payer system in 1948. Between rationing, wait times, and death panels denying treatment, the poor do not find themselves better off under single payer systems.

6) Drug innovation

To combat my study, my opponent again cites the same 24 pages from some book. Many new drugs are based on private research, not government research, which is why countries with single payer price controls lose $22 billion annually from drug research and lose 13 new drug launches each year. What was the last time the government invented and patented a new drug? Regardless, single payer countries like Canada are so overburdened paying for overuse of medical treatments that they cannot afford R&D. I already cited a source that showed that Canada can't afford to spend any money on R&D, so their R&D budget is near zero.

7) Cost

I don't know where my opponent gets his figure that we could pay for government health care with a 2% income tax increase. France needs a 20% income tax to pay for their system. I cited a projection that the average family would need to pay $14,000 per year in taxes for single payer health insurance.

The economic recovery is finally showing some momentum. If you take away 7% of employer profits (through taxes), this would mean much slower job growth since employers will have much less money for job expansions. Many employers cannot afford this tax since profit margins for them are lower than 7%.

My opponent doesn't bother answering the cost to the government, which would be more than the 40% of government revenue in France, since his proposed taxes don't cover the cost of the system.

I also 100% win that Medicare and Medicaid suck and result in drug shortages. If the government can't run services well for a part of the population, it won't be any better at implementing these same services for everyone. I also 100% win that Medicare has higher bureaucratic costs, so we actually lose money to bureaucracy by switching to government insurance. My opponent concedes this so I turn this point against him and thus prove that you should vote Con to save money due to wasteful bureaucratic costs associated with government inefficiency.

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[7] http://tinyurl.com...
Debate Round No. 3
Contra

Pro

Overutilization and Smart Cards

Your source specifically said in the first paragraph that when co-pays were high, "appropriate or needed" medical care as well as "inappropriate or unnecessary" medical care were reduced."

A Smart Card, when used such as in Taiwan, hugely improves efficiency. Their administration costs are only about 2%. More Taiwanese are satisfied with their system than Americans as well, and they don't have waiting lists, like the USA won't need to have either. [1]


--------------------
Conclusion on Overutilization and Co-Pays

Single-Payer would improve care, and also because with no insurance middle-man, the doctors and the patients deal with the problems without be denied coverage, high costs, or waiting for a referral. The evidence is no longer debatable; NATIONS WITH SINGLE-PAYER SYSTEMS HAVE BETTER CARE, COSTS, AND COVERAGE. With low co-pays that are based on income, and with a Smart Card, and because of our medical establishment, waiting lists would be minor or nonexistent. Overutilization would not be a problem because it would be swiftly dealt with.


"Private Care is better than Public"

With
Medicare, patients show higher levels of satisfaction with their coverage and access to care COMPARED TO private insurance. They were more likely to rate their insurance as "excellent" and were less likely to report negative experiences with their plan. [2]

Private health insurance has to pay for profits, and has to deny coverage to make up profits for the company.
Millions are denied coverage. Plus, in our current system, 45,000 people a year die to a lack of insurance. This is the worse than a 9/11 attack a month. [8] Just because a hospital is required to let your use the emergency room doesn't mean that you will live.



About Physicians and Technology


Plus, 59% of physicians supported a Single-Payer healthcare plan.

Single-Payer would increase the amount of physicians because of training, and because of stable wages at the same rate as now. Currently, they are declining.


Health Planning Board [3]

Full explanation on the Health Planning Board:

A health planning board would be a public body with representatives of patients and medical experts. The representatives would decide on what treatments, medications and services should be covered, based on community needs and medical science, and allocate capital for major new investments based on assessments of where need is greatest.


All medically necessary care would be funded through the single payer, including rehab, dental, etc.

Drug Innovation

Much
medical research is ALREADY publicly funded under the N.I.H. In fact, usually the drug companies produce the marketing and advertising products, not the drug itself. [4] [3]

Medical research doesn't disappear under universal health care system.
Many famous discoveries have been made in countries with national health care systems. Laparoscopic gallbladder removal was pioneered in Canada. The CT scan was invented in England. The treatment for juvenile diabetes by transplanting pancreatic cells was developed in Canada. [4]

Funding

----
Businesses

The 7% payroll tax would not be crippling. It also replaces
all other employer expenses for employees’ health care, which would be eliminated. Plus, it would be a boon for business. In R2, I gave an example of Japan and the USA with auto manufacturers. In the USA, healthcare (private) adds $1500 to the price of a car. In Japan, it is just $500. So, Single-Payer healthcare would help businesses, and the whole economy. [5]

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Adjusting to New, Modern, World-Class (not 3rd world) Healthcare

After the transition to public care, the unneeded workers could be protected while be retrained in new jobs.


Total Costs

People will seek care earlier when chronic diseases such as hypertension are more treatable. Both the uninsured and many of those with skimpy private coverage delay care because they are afraid of health care bills. This will be eliminated under such a system. All
of these new costs to cover the uninsured and improve coverage for the insured will be fully offset by administrative savings, profits, and other costs now unneeded. [3]

With appropriate investments in expensive, high-tech equipment and care, negotiating fees and budgets with doctors, hospitals, and drug companies, and setting a generous but finite budget on healthcare will be the best way to contain costs.

We have the largest economy in the world. Nations that are smaller than us in economic ways still have better healthcare systems. This PROVES that the USA can do this.


USA Healthcare "Quality" [6]

Hospital Spending is 60% higher than other relatively expensive nations. Drug and medical goods here are also much more expensive, the same as administration costs (2.5 times higher there average). We also have high rates of avoidable hospital admissions for people with asthma, lung disease, diabetes, hypertension, and other common diseases.

With life expectancy, we are 28th, right behind Chile. Total quality is at 37th, and our spending is 1#. This is a sign of massive failure.

Medicare bureaucracy

Plus Con, Paul Krugman, a famous economist and Nobel Prize winner, called the Single-Payer system, "good economics", and wrote, "The great advantage of universal, government-provided health insurance is lower costs... Medicare has much lower administrative costs than private insurance." Krugman also has pointed out that the savings of single-payer would be "far more than the cost of covering all those now uninsured." [9]

Private bureaucracy literally dwarfes the size of Single-Payer bureaucracy. [4]



Conclusions: Time to Choose

Unlike now, under a Single-Payer system, physician income would stabilize, and their number would increase. Single Payer is popular among physicians. Rationing, which already exists in the USA based on wealth, would be gone or very minor, as I said in R3. Overutilization wouldn't occur in a sleek, super efficient Smart Card system and fair co-pays. Administration costs would hugely plummet. Plus, many of my opponent's arguments are based on Socialized Medicine in the U.K., not always Single-Payer.

Here is a quote from somebody in Canada on California's Single-Payer proposal:

"I live in Canada and we don't have a bunch of people here dying while waiting for healthcare. I don't know where you get this info??? No long wait times either... If you need to see a specialist you may have a wait (if not an emergency) regular doctors appts like checkups you book ahead of time. There is always a doctor on call at local clinics or hospital for any sudden illness or emergency." [7]

Care will be dealt between the doctor and patient in a private way, and the government would provide sleek, efficient coverage and payments. It is your choice: our fragmented system on life support, or a 21st century system of Single-Payer healthcare that is state-of-the-art.

Sources:

[2] Karen Davis, et al., "Medicare vs Private Insurance: Rhetoric and Reality," Commonwealth Fund, October 1, 2002,
http://www.commonwealthfund.org...

[3] Conrad, Jessamyn. What You Should Know About Politics... But Don't. 1st ed. New York: Hachette Book Group, 2008. p. 118

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

[5] Conrad, Jessamyn. What You Should Know About Politics... But Don't. 1st ed. New York: Hachette Book Group, 2008. p. 123

[6] http://michaelmoore.com...

[7] http://www.facebook.com...

[8] http://articles.cnn.com...

[9]
http://www.nytimes.com...

***********Photos from book "Universal Healthcare: Point/Counterpoint" 2010. By Victoria Sherrow*************


bluesteel

Con

Thanks for the debate Contra.

== Smart Cards ==

Face it, these are just not going to happen in the US, for the same reason a national ID card didn't happen: the ACLU and other privacy groups completely oppose a government database that can track us. Groups have expressed concerns that a national health database could be used for employment discrimination (against sick people). Regardless, the smart cards in Taiwan didn't stop overutilization of health care given the evidence I cited that they are nearing bankruptcy and are being forced to borrow from private banks to prop up their single-payer system.

== Private is better than public ==

My opponent cites a 2002 study showing that slightly more Medicare recipients were satisfied with their health care. Firstly, it is noteworthy that the same study found much lower rates of satisfaction with Medicaid compared to private insurance. [1] Given that Medicare for all would be unaffordable, single payer in the US seems more likely to resemble Medicaid.

Secondly, this study was conducted a decade ago. It even found that there was worry among those surveyed that benefits would be cut in the future – which is precisely what has and will happen. My opponent never answers the evidence that the government cut reimbursement rates by 21% recently, leading to a projected 34% of all doctors and 62% of all primary care physicians refusing to take Medicare patients (according to the AMA). Price controls have recently caused massive shortages in 178 drugs for Medicare patients. And regardless, Medicare spending is not sustainable. "By 2020, Medicare deficits will claim one in every five federal tax dollars that are not already dedicated to Medicare and Social Security." [2] This means that Medicare alone will take up 40% of our federal budget by 2020 since 20% of the budget already goes to Medicare/Medicaid. If we gave Medicare to everyone, the system would bankrupt us pretty quickly. The only reason Medicare works now is the many (labor force participants) pay for the few (retired people). If the many pay for the many, the system wouldn't work. It's far too expensive.

Obama's health care reform ensures that people will no longer be uninsured by providing government subsidies and state insurance pools to help people afford *private* insurance. This private sector solution is preferable.

== Drug innovation ==

While Canada may have been one of the first countries to switch to laparoscopic gallbladder removal, laparoscopic surgery was first patented in 1972 in the United States and the first laparoscopic surgery equipment was made by Ven Instruments in Buffalo, New York. [3] While I don't doubt that doctors in public research institutions will find new surgical techniques, I do doubt that drug companies will continue investing billions of dollars in drug research when government price controls ensure that those investments will not pay dividends. That's why a study found that countries with single payer price controls lose $22 billion per year in research from their pharmaceutical industries resulting in 13 fewer drugs being invented each year. According to Professor Robert Barro of Harvard University, price controls in Canada mean that Canada utterly relies on the US pharmaceutical industry to invent new drugs for it. [4] If we adopt single payer as well, new drugs will be invented at a snail's pace.

== Funding ==

Auto workers in the US have amazing health insurance; that says more about the strength of their unions (and the lack of unions in Japan) than about public vs. private insurance.

My opponent never proves that a 7% tax on employers is sufficient to cover the cost of insuring everyone. Employers only pay about 7.5% now for private health insurance. [5] People in France pay 20% of their incomes for their health care system and a projection for the US found that the average family needs to pay $14,000 per year in taxes to support a single-payer system.

People would also be really angry to lose their employer-provided private insurance. In France, their health care is ranked #1 because people still receive supplementary private insurance through their employers to cover everything that the government refuses to provide.

== Preventative care ==

My opponent drops the CBO analysis that preventative care will raise – not lower – costs as many healthy people start overusing it.

== Other nations are better ==

My opponent drops the Forbes analysis that life expectancy, which includes car accidents, homicides, obesity, etc, is not a good measure of the quality of a health care system. If you measure from the point of intervention (once people get sick), the US ranks #1 on five year survival rates.

== Medicare bureaucracy ==

Paul Krugman, who writes his opinions in an op-ed for the New York Times on a range of issues on which he is not qualified to speak, is merely referencing the flawed statistics my opponent already cited. Krugman has been in hot water before for using flawed statistics in his op-ed. The Heritage Foundation found that Medicare has nearly 50% higher administrative costs than private insurance on a per person basis. Doctors agree that Medicare bureaucracy is overly burdensome, which is one of the top reasons they are dropping Medicare patients (second only to the abysmally low reimbursement rates).

In contrast, private insurance overhead will only go down now that Obama has mandated that 85% of insurance money go to medical care.

== Doctors would quit ==

My opponent has no response to the poll showing that 20% of doctors would quit under single payer due to low pay. It doesn't matter if some doctors would be happier, 20% would quit. This would lead to serious quality of care issues.

Plus, more than 20% of potential medical students would instead seek other professions. Doctors in France earn two thirds less than those in the US. Average pay obviously determines the number of students in a particular field. At best, the number of MD students doesn't decline, but the quality of students becomes atrocious.

My opponent concedes that France has severe shortages in doctors in 19 of 22 regions of their country.

== Wait lists ==

This is an easy win for me. My opponent's only response in the last round is to cite some random guy in Canada who thinks there are no wait lists. I cited studies showing: 50% of people in Sweden wait more than 3 months for surgery; 21% of cancer patients in England die while on the wait list, which is why the WHO calls England a deliverer of "third world cancer care"; only half of ER patients in Canada are treated in a timely manner, according to international medical standards; in Canada, the wait time for emergency heart surgery is 65 days and for breast cancer treatment is 168 days. In such a world, it's pretty easy for the US to be ranked #1 in 5 year survival rates for cancer.

In addition, I cite evidence from Canada and Japan showing that the rich and well-connected can jump the wait list. I cite evidence that the poor in Canada have worse health outcomes than the poor in the US. And I cite evidence that the health of the poor in England has not improved since they implemented single-payer insurance in 1948. Access to a wait list is not access to health care.

== Death Panels ==

The government often doesn't cover many treatments people need, which is why people in France all buy supplementary private insurance (in addition to paying 20% of their incomes for government insurance).

== Conclusion ==

Single payer means you would have to pay $14,000 a year for access to a government wait list. If you needed care, you would likely die waiting. Government price controls would mean that all the new cancer drugs being invented currently in the US would not be invented and that there would be shortages in generic drugs as well. We would lose a substantial number of our doctors and the best and brightest would start choosing other professions. The poor would not be any better off, empirically. The rich are stuck paying for government insurance they don't want and would need to continue buying private insurance. More health care spending would go to government bureaucracy rather than to medical treatments. In fact, 25 cents of every dollar now spent on private medical care would instead go to government bureaucracy (50% higher bureaucratic costs). Under current entitlements, the government will already consume 60 cents of every dollar produced in the US by 2050. [6] With France as our guide, adding free health care for all would mean that government spending in 2050 will be at 100% of GDP. Single payer will not only bankrupt our nation, but it will quickly topple us from atop our pedestal as the best health care system in the world in regards to 5 year survival rates. Obama's private sector solution for providing universal coverage is clearly preferable. Vote Con.

[1] http://tinyurl.com...
[2] http://tinyurl.com...
[3] http://tinyurl.com...
[4] http://tinyurl.com...
[5] http://tinyurl.com...
[6] http://www.cato.org...
Debate Round No. 4
9 comments have been posted on this debate. Showing 1 through 9 records.
Posted by hfordney 3 years ago
hfordney
Really ForTheTrouble? You PREFER when someone uses a speculative argument based on hypotheticals that cant be supported by empirical evidence over the use of empirically backed data? That just says wow to me. You realize the danger of preferring speculative, deductive arguments right? Its what kept Europe in the Middle Ages for 1000 years. Sure there are things that are unique about the American context, but we still only have the evidence that history can provide us - deductive argument and hypotheticals are not an alternative that are supported by modern natural and social science. Think about it - theories ar measured by their evidence right? So a theory is only defensible if it is supported by empirical evidence. Deduction attempts to create theory from existing theory - rather than improving theory by evidence. This breaks the theory away from the evidence that validates it, and by interweaving deductive with inductive method, could possible compromise all of our knowledge. (I know this is ironic here, Im using deductive argument).
This is what makes Con's argument so insidious. It doesnt help either that Con is spread all over the place, offering no consistent agument, just a stream of emotional soundbytes, and that half of his info comes from The Heritage Foundation, which really how can a sane person trust.
Posted by Contra 4 years ago
Contra
"Con tells me that medicare failed and that the US has more research because healthcare is an industry. If medicare fails, than an even larger governmental healthcare system will logically fail (as Con showed it to in other countries)."

Makes me wonder if they even read my arguments. Plus, look at these two emoticons, the first looks like a guy with a nose, the second looks like a bird: :vD :w

I thought of that
Posted by 16kadams 4 years ago
16kadams
RFD continued:

He showed the single payer system would raise costs and lead to high payroll taxes, a huge downside. Therefore con wins.

First part RFD = in the votes.
Posted by FourTrouble 4 years ago
FourTrouble
This was an enjoyable debate to read, particularly because I didn't really know too much about the subject. That said, I think Pro could have argued better, by directing the debate towards some more theoretical issues about the future, instead of indulging Con in discussions about historical examples. The historical successes or failures of past singe payer health care systems were, I thought, not very relevant to the question of whether the US should implement such a system, because the USA is very, very different than the rest of the world. The uniqueness of the US, economically, as well as medically (medical/pharmaceutical research and technology), was what Pro should have focused on, and I think may have helped Pro make a good enough argument to win. Pro, unfortunately, only mentions the uniqueness of the USA in passing. If I could vote, I'd probably vote Con.
Posted by Maikuru 4 years ago
Maikuru
Posting to remind myself to read this.
Posted by johnnyboy54 4 years ago
johnnyboy54
This looks promising.
Posted by 16kadams 4 years ago
16kadams
H-ll No. I will not accept though (in a few debates) but hope a non-noob accepts it.
Posted by Sisyphus67 4 years ago
Sisyphus67
Dang. I wish you were taking the con so I could argue you. I am certain someone will jump on this but if no one does I will pick it up and play devil's advocate.

I'll enjoy watching this.
7 votes have been placed for this debate. Showing 1 through 7 records.
Vote Placed by Maikuru 4 years ago
Maikuru
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Total points awarded:03 
Reasons for voting decision: Pro does well to highlight the flaws in the U.S. system but is unable to answer Con's attacks on single-payer waiting times, abuses of services by patients, and dissatisfaction among patients and doctors alike. Our own examples of such a system have failed and Pro does not adequately explain what will change in a more widespread system, especially considering how unlikely it is that a smartcard system would be implemented. Arguments to Con.
Vote Placed by thett3 4 years ago
thett3
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Reasons for voting decision: Con tells me that medicare failed and that the US has more research because healthcare is an industry. If medicare fails, than an even larger governmental healthcare system will logically fail (as Con showed it to in other countries).
Vote Placed by 16kadams 4 years ago
16kadams
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Reasons for voting decision: Both did really well, I was tempted to give contra a win, but after evaluating it more bluesteesl won by the smallest of margins. He adequately showed that a single payer system would provide worse care, and it could be easily bribed and corrupted. Also as a son of a doctor I can easily understand Cons Medicare arguments, these helped his case as well because US goverment HC is bad, logically a single payer system would be bad. He also showed that a single payer system would raise. RFD more in..
Vote Placed by Sisyphus67 4 years ago
Sisyphus67
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Reasons for voting decision: Con's closing arguments were not strongly made based on the evidence provided. Specifically, concerning the quality of care, timeliness of care, the conclusions about why people go to med school and the issue of research.
Vote Placed by Greyparrot 4 years ago
Greyparrot
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Reasons for voting decision: The only thing con had to do was cite medicare failures., proving that just because it works in other countries does not mean it can work with our corrupt government that can't pass the most basic supplemental health care plans without total incompetance.
Vote Placed by darkkermit 4 years ago
darkkermit
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Reasons for voting decision: CON showed that US healthcare is better than in other nations. Cited the failures of medicaid and medicare, how there would be a shortage of doctors and research if a single payer system would occur,and how rationing would make everyone, including the poor worse off.
Vote Placed by Volkov 4 years ago
Volkov
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Reasons for voting decision: This was pretty hard to decide on because both PRO and CON gave good points, both use good sources, and both behaved themselves. I only have the edge to PRO because of Contra's evidence, which in my mind CON didn't refute as well as he could have.