The Instigator
dairygirl4u2c
Pro (for)
Losing
0 Points
The Contender
ldcon
Con (against)
Winning
1 Points

appropriate single payer system would be a better economic system than we have now

Do you like this debate?NoYes+0
Add this debate to Google Add this debate to Delicious Add this debate to FaceBook Add this debate to Digg  
Post Voting Period
The voting period for this debate has ended.
after 1 vote the winner is...
ldcon
Voting Style: Open Point System: 7 Point
Started: 6/10/2012 Category: Politics
Updated: 4 years ago Status: Post Voting Period
Viewed: 1,121 times Debate No: 24216
Debate Rounds (3)
Comments (7)
Votes (1)

 

dairygirl4u2c

Pro

the right single payer system would be a better economic system than we have now

we spend more per capita, and get less health care results back... than any other country in the world:
http://cthealth.server101.com...
-we spend 17% of our GDP on healthcare, while single payer countries spend 10%. that 7% represents a lot of money, a trillion dollars.
-the savings come from a decrease in administrative costs: insurance companies are a middleman that serves no real purpose other than spending 30% of revenue on administrative costs and profit, costs that could be just as easily streamlined by the government down to less than 5% or so. (medicare for example requires 3% for administration). The costs are higher with so many companies, because there's so much redundancy... thousands of payroll departments instead of one, for example.
-our GDP is 14 trillion, our national debt is close to there. 1 trillion dollars a year, enough to boost our economy significantly, or eliminate our debt if we wanted (political football as to how that would be done), or at the end of the day simply keep more money our pocket.
-if the government did it right (big if, granted), it would be a self contained system (no taxes other than from those who want to join), we would not coerce people to join, and/or they could utilize 'supplemental insurance' in addition to the government's system and get more options. they wouldn't have to wait in lines then, which aren't that long to begin with. (two weeks max for most standard procedures, short for emergencies etc, and with many insurance companies worse than many single payer systems... and most citizens in single payer countries do not envy us).
-insurance companies could even still exist (they may need to retain the current regulations to cover some preexisting conditions by law, so as to prevent them from skimming off a bunch of healthy people from government plans, to ensure the pool is sufficient to cover everyone in it to a reasonable extent--the most difficult aspect of allowing insurance companies to still exist, the government's power here and the overall give and take here, is huge).
-there could be limits on the amount of care which is essentially what insurance companies already do and people understand as a necessity (eg, a 200k policy) (there would be no need for 'death panels'). the copays, premiums (or taxes), carrots and sticks, could be done so as to ensure people don't abuse the system (as they do with so many insurance plans already)

-"Why I (an economically right leaning libertarian) Prefer French Health Care" (not directly on point, but interesting and relevant, with decent commentary following)

http://pnhp.org...
full article: http://reason.com...

"For a dozen years now I've led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wife's native France. On a personal level the comparison is no contest: I'll take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now"

-------------------

I had an opponent in another debate cite this source as to whether medicare would cost more, even if administration costs would be about the same...
http://www.debate.org...

assuming this is true, though, doesn't mean a single payer system isn't most economical... it means that we should not use a program that is like medicare. We could do as Europe does and have a tightly regulated insurance industry, with government involvement.
This is from the doctors for single payer link I cited above...
"The nation should listen when a prominent libertarian extolls the virtues of social insurance. Once we accept the principle of social insurance, then we can have a more rational debate over whether we want that to be a single-payer Medicare-type program or a European-style social insurance program using using private plans that are so tightly regulated that they almost function as a single payer system."

we can regulate the system to ensure redundancy and waste and not there. Basically, to be more like other single payer countries...
At the end of the day, it's well established common knowledge that single payer countries pay around ten percent GDP, and we pay seventeen percent. That's the bottom line.
ldcon

Con

Well. I have to say I love this debate, so I'm looking forward to this.

I'm quite familiar with your arguments, and would say that they present a misleading picture of the US status quo.

For example, while it's true that we spend a lot per capita on healthcare, it isn't true that we spend less public money. That is, a slew of OECD countries (http://www.oecd.org...) spend less than we do publicly. Of course, we get less result. This goes against the idea we need more public spending to achieve more judicious spending.

Much of the US excess spending comes from private payers, but it's misleading to look at this as a complete picture because of the massive cross subsidy the public system imposes on the private system. Medicare/caid are now paying ~89% of cost (that is, before profit) leading to private payers paying more than they otherwise would. Many hospitals have tried to circumvent some of the CMS loss leaders by opting out of EMTALA by closing their ER's. 1/3 of US ER's have closed over the last 15 years. So, the statement that CMS has lower administration is misleading because this is insufficient. CMS doesn't pay cost, and providers are increasingly refusing to either accept CMS or accept it as full payment of services. Even the Mayo Clinic is no longer taking CMS as full payment of services.

You present some statistics regarding insurers as not value added. But this is misleading. First, CMS operates as a national payer. No insurer has this same ability. Much of the overhead could be reduced if only insurers could close superfluous state facilities.

Moreover, CMS doesn't count fraud as part of overhead, and fraud runs rampant through CMS, while private payers count fraud prevention as part of administration. Again, administration is misleading. Further, CMS farms out the administration of its plan to regional insurers who tend to be more familiar with local facilities as well as farming out the regulatory network to private companies like JCAHO.

But I think you're, forgive me, naive to think the government payer would operate on equal footing. It couldn't. It would either be an insurer of last resort, i.e. for the sickest, or it would muscle out the competition. Either proposition is a losing one.

You suggest that single payer systems pay less, and while it's true, it doesn't capture the complete picture. That is, the OECD average rate of cost growth has exceeded the US average rate of growth for the last 15 years.

Our healthcare system has serious problems, and I'd be happy to discuss alternative proposals with you, but the single-payer solution is a fantasy.

I'd also ask if, in your view, the single payer solution would apply equally to every industry--why not nationalize energy? Surely we can 'save money' by reducing their payroll departments as well? I suspect you see the flaw.
Debate Round No. 1
dairygirl4u2c

Pro

"Much of the US excess spending comes from private payers, but it's misleading to look at this as a complete picture because of the massive cross subsidy the public system imposes on the private system. Medicare/caid are now paying ~89% of cost (that is, before profit) leading to private payers paying more than they otherwise would. Many hospitals have tried to circumvent some of the CMS loss leaders by opting out of EMTALA by closing their ER's. 1/3 of US ER's have closed over the last 15 years."

i question how much of the total costs are from the ER. ER usage compared to things like medicare, which is for old and dying people, will pale in comparison. so even if there is abuse in the ER, it is too small to say is the reason we pay more than other countries.
and the fact that there is ER abuse is all the more reason to go to single payer. they will then get sensible health care instead of going to the ER for basic health problems. we still have more people covered more health care, with cheaper results. that's why we pay 17% and they pay 10. you might be talking about instead of 17, 16, or something. i suppose i could just look up how much ER costs are and it'd probably be an amount i can just deduct etc, but intuition seems pretty clear to me here.

the savings again are because of the adminstrative costs being cut out. 31 percent is a lot (a third of our health care being admin costs).... a third of that 17% is 11%, about where we should be if we were single payer. it makes sense just looking at it that way that most of our waste could be attributed to admin waste.... ie, if you 'check our work', the math comes out that if we cut it out, there ya go.
they say it costs a third cause of calculating the costs.... we put that over the 17% GDP, and we're where should be.

"Moreover, CMS doesn't count fraud as part of overhead, and fraud runs rampant through CMS, while private payers count fraud prevention as part of administration"

you might be talking about a percent, or a few percent, out of that 30% of every dollar being spent on administration rather than health care. i can't see fraud prevention being the bulk or significant compared to running the department, it's just part of doing business. we still have too much being spent on administrative costs.
and, where do you get that they don't count cracking down on fraud in administrative costs? that's a pretty big assumption to just make, or repeat back to me without a source. if we have a stat that says one pays more and the other less... i would only assume it's holding all constant, unless shown otherwise. it's hard for me to just take your word on it.

"But I think you're, forgive me, naive to think the government payer would operate on equal footing. It couldn't. It would either be an insurer of last resort, i.e. for the sickest, or it would muscle out the competition. Either proposition is a losing one."

it would be an isurer of first resort. everyone who knew they could say thousands on health insurance would jump on it. the plan cuts out the middle man,,,, there's savings availble for everyone.
and even if it was an insurer of last resort... at hte end of the day, that's all they have and they should be happy for it. at the end of the day they spend less and get better results, so if they have someone of last resort when we leave people dying without insurance... we're all the better for it.

"You suggest that single payer systems pay less, and while it's true, it doesn't capture the complete picture. That is, the OECD average rate of cost growth has exceeded the US average rate of growth for the last 15 years."

that doesn't mean they are worse for it in terms of efficiency. they spend 10 we spend 17. there could be other factors involved... such as the simple fact that they add sick people on, but it's adding them on from a lower starting point. we have a system that is inefficient due to administrative costs profits etc. but we're not adding on more people... we let them stay uninsured. etc yet we're still inefficient.

"I'd also ask if, in your view, the single payer solution would apply equally to every industry--why not nationalize energy? Surely we can 'save money' by reducing their payroll departments as well? I suspect you see the flaw."

energy companies can cut costs by doing things cheaper. they actually can do this. the health care industry basically pays the bills as they come in, it's not about trying to find ways to do it cheapr as it is jacking up the price to pay whatever bills come in. insurance industries can't deny care etc as easily if it means preventing procedures coming due. erengy folks cut whatever they can.

---------
even if at the end of the day single payer was lower overall is because we actually cut care or something (my speculation of what it might be if it's not administrative costs being lower, given i don't buy your 'ER is the reason it costs too much', 'fraud prevention is the reason it costs too much'), whatever the reason.... they spend ten, we spend seventeen. if you want your own insurance supplemented.... most countries that do single payer allow for it.
even if they didn't, they spend less and the pepole have more money to show for it. it gives money to the people who create the demand in an economy thats driven by demand, a demand economy.
and, we cover people instead of letting them die uninsured... even if we're cutting inefficient stuff here and there to pay for it.
i ultimately do think it's the administrative problem, though.
ldcon

Con

"i question how much of the total costs are from the ER. ER usage compared to things like medicare, which is for old and dying people, will pale in comparison. so even if there is abuse in the ER, it is too small to say is the reason we pay more than other countries."

Ah, sorry I wasn't clearer. EMTALA basically says that if a hospital accepts Federal funding, which is functionally viewed as CMS payments, and it operates an emergency room, then it must disburse emergency services regardless of the patient's capacity to pay for them. So in this case, we should look at hospitals closing their ER's as an indicator they can't afford to continue their operation. This is a point I think cross-applies to a number other arguments--while it's absolutely true that payment mechanisms have important repercussions for utilization, it's also true that money is fungible--we don't care where it comes from. Since hospitals, and especially NFP hospitals, provide significantly reduced/charity care, we care more about their aggregate funding when trying to answer care disbursement. It would be very difficult for you to segregate ER costs. The entire industry cross-finances.

You next advance what I'm taking to be a version of the 'ounce of prevention = pound of cure' argument. Unfortunately, this has little basis. For example, we've recently developed reasonable evidence obesity doesn't raise aggregate health costs because the obese-ist tend to die before they can get cancer. And cancer is f***ing expensive. See, it's true that "prevention" does have an important effect, but it tends to be the obvious kind. Namely, exercise, eat nutritionally, take a baby aspirin after turning 45ish. Etc. These are things we don't need doctors to tell us to do. Or, CMS recently abandoned a pilot program that attended to assist CHF patients with drug/exercise compliance. The program was not able to generate a cost effective result. This is an individual, not societal problem. Further, I'd reference the mammogram snafu from ~2-3 years ago.

You've repeated your 'administration' argument. I didn't see a response to mine: administration is misleading because government maintains a de facto monopoly. That is, we could reduce administration costs without nationalization.

You continue the administrative argument, asking for evidence: http://granitegrok.com..., http://reason.com...

Basically, as with many government programs, CMS doesn't count the cost of collecting taxes, doesn't count a slew of overhead/payroll, etc. Fraud's sitting at 9%. This comes down to incentive. CMS doesn't have the proper orientation to care as much about fraud prevention--it has government fiat.

I don't see a response to my pointing out that CMS doesn't operate as a technical insurer since it farms out much of the actual administration of its functions. I.e. regulatory, implementation, etc.

Moreover, your focus on administration is misleading. Administration can be a good thing. For example, Kaiser has higher administrative costs, but these come from more active management and collaboration with the patient.

"It would be an isurer of first resort. everyone who knew they could say thousands on health insurance would jump on it. the plan cuts out the middle man,,,, there's savings availble for everyone."

I call bs on this argument. You can't go from complaining CMS has lower administration costs to saying it isn't a 'middle man'. CMS is as much a middle man, and it's one that doesn't compete equally. Any attempt to paint the status quo numbers as representative of the best private insurers can do is inherently misleading for the prior reasons listed. Please respond to these.

"that doesn't mean they are worse for it in terms of efficiency. they spend 10 we spend 17...."

First, http://www.kff.org..., Exhibit 9: The US already spends more *government* money than many peer nations. For example Canada spends 7.3% GDP publicly on healthcare. The US spends 7.4%.

Second, you mistreat the cost growth argument. Cost of care is the ultimate rationer. That is, if my insurance is comprehensive, but pays 1/3 of cost, then the cost is going to ultimately prevent me from receiving care. Hence, the only metric we should care about is the growth of cost. Or, let's wait 20 years. If the trends continue as is, then we'll be the ones with the cheaper healthcare.

Third, you're comparing apples to oranges, and it's dishonest. There are a number of reasons the US spends more on healthcare. Not least of which is the free riding much of Europe/Canada does on our pharmaceutical innovation. Or, approximately a third of the annual increase in healthcare spending can be attributed to obesity--i.e. personal behavior. Re. McKinsey healthcare study. You have to get into the reasoning why a single payer would be better at lowering costs in the long run. And it's quite obvious single payers are historically less innovative. Or do we really need to rehash the Cold War? Most bio-engineering is done in the US.

"energy companies can cut costs by doing things cheaper. they actually can do this. the health care industry basically pays the bills as they come in, it's not about trying to find ways to do it cheapr as it is jacking up the price to pay whatever bills come in. insurance industries can't deny care etc as easily if it means preventing procedures coming due. erengy folks cut whatever they can."

I'm sorry, why do you think healthcare can't 'find ways to do things cheaper'? Regardless, you're completely and utterly incorrect. I doubt I need much evidence to prove this point, but I'll reference arthroscopic surgeries--dramatically reduced the cost of care for select procedures.

------

"even if at the end of the day single payer was lower overall is because we actually cut care or something (my speculation of what it might be..."

-Administrative costs: you haven't demonstrated this claim--you haven't responded to the many subpoints on why it's a dishonest comparison, etc.
-ER--you're mistreating the argument. ER is an indicator for the insufficiency of CMS, not a driver of the costs.
-they spend ten, we spend seventeen--again, a dishonest comparison. There are *many* differences
-insurance supplement: interesting you bring this up--Both Canada and Sweden have banned various forms of balance billing making supplemental insurance effectively illegal. Cheers, now where on the road to servitude

So, you've given no reason government would be better at innovating for the future. The reasons the US has more expensive care are complex and myriad but this isn't the subject of this debate. This debate is on whether single-payers would better manage the cost of that care. Sufficiently--the US already spends as much publicly (and doesn't get the *single-payer* magic) and has health costs growing slower than your single-payer paragons. These alone should be sufficient to vote Con. If we already spend more government money than many single-payers, how could you possibly think that our version of single-payer is more efficient?

The primary reason you give for single-payer is 'administration'. You'll need to respond to the ~8 arguments I have against SP's administrative sleight of hand.

There's probably a roll for government to have in healthcare, but it should keep in mind that incentives matter. Patients are not economical users of care. Per RAND Health Insurance Experiment.
Debate Round No. 2
dairygirl4u2c

Pro

just because a hospital closes its ER doesn't mean it's because they can't afford it, or even more signifincantly not the reason us to be 17% GDP on health and them 10%... it's because they don't want to pay that much money. it's still a lot to surmise that ER money abused is the reason we spend so much more than everyone else.

i'm not sure why you think "an ounce of prevention... " etc. when i said that the fact that ERs are paying too much for pople with the cold etc.. i'm saying if we had a single payer system, they would go to get cold medicine instead of ER services.

i quoted the adminsitrative cost link earlier..

"Private for profit corporation are the lease efficient deliverer of health care. They spend between 20 and 30% of premiums on administration and profits. The public sector is the most efficient. Medicare spends 3% on administration."

"Single payer universal health care costs would be lower than the current US system due to lower administrative costs. The United States spends 50 to 100% more on administration than single payer systems. By lowering these administrative costs the United States would have the ability to provide universal health care, without managed care, increase benefits and still save money"

http://cthealth.server101.com...

if fraud is 9% of administration, and we see that 32% of every dollar is spent on administration... maybe we can conclude that ten percent of that should be reduced... 28%? it doesn't change much.

"I don't see a response to my pointing out that CMS doesn't operate as a technical insurer since it farms out much of the actual administration of its functions. I.e. regulatory, implementation, etc."

i'm not the one making the assertion that what they farm out would be significant. it doesn't seem like it would, to me.

"I call bs on this argument. You can't go from complaining CMS has lower administration costs to saying it isn't a 'middle man'. CMS is as much a middle man, and it's one that doesn't compete equally. Any attempt to paint the status quo numbers as representative of the best private insurers can do is inherently misleading for the prior reasons listed."

as i said... you're the one making the assertion that what they farm out would be significant. you show how it's significant.

"First, http://www.kff.org......, Exhibit 9: The US already spends more *government* money than many peer nations. For example Canada spends 7.3% GDP publicly on healthcare. The US spends 7.4%."

canada has a national health plan. so, if they are spending 7.4 percent and are mroe like the government single payer systems, with total GDP at 10%... that means they are covering a whole lot more people with that 7.3 percent. i haven't disputed with you that the US's government money expenditures isn't bad, given they miht cover less people for the same amount as others. what would make sense from the other end for the USA? well, we spend 17% GDP, that means the other ten percent from what you quoted is from the private sector.
whatever it is that canada is doing to get covering more people for less.... that's what we should be doing. as i said.. it doesn't ahve to be medicare for us to do the plan.

as to the cost of growth argument. i don't see your point. you might not go to the doctor as much, but you're still paying premiums for it.

"Or, approximately a third of the annual increase in healthcare spending can be attributed to obesity--i.e. personal behavior. Re. McKinsey healthcare study."

im sure obesity is a problem in other countries too. it's too much to imagine we're that much fatter or unhealthier that we spend so much more than everyone else.
as to the innovation free riding.... you might have a point, depending on how this is calcuated into total costs of healthcare here. i might need to examine studies more. i'd guess they don't count that,as it'd be dumb for a researcher to do.
i think it's obvious neither of us are experts on the methodology of the studies we cite etc, as would be necessary to eally understand this issue.
as to the 'tehre just a lot of things that could be causing us to cost more' argument, i don't see any magic bullet. "single payers ration care" is significant, though.

"arthroscopic surgeries--dramatically reduced the cost of care for select procedures."

insurance companies are not the ones doing the innovation. that procedure saves people money. this is between the hospitals technology sppliers and patients. etc
with the energy sector... oil companies are like the technology supplier and hospital they aren't a middle man. if we're spending so much money on a middle man, this is not analogous at all to an energy company, or whatever.

"insurance supplement: interesting you bring this up--Both Canada and Sweden have banned various forms of balance billing making supplemental insurance effectively illegal. Cheers, now where on the road to servitude"

maybe some countries did this. they all didn't. the heart of any ban on supplemental insurance should be on bannig skimming off healthy people to make an easy buck, while allowing other pools to not have money to pool unhealthy people. we could allow people to have more insurance that sin't like that, but what do we have left? insurance that has high premiums that no one wants cause it covers evrything in the book instead of getting them to price shop etc. once we did that... we'll see what insurance really is, a racketerring scheme.
the main problems are things like employer plans that allow employees to just bask in going to the doctor etc. they dont' shop around or care much about using it cause that's what it's there for. it causes premiums to go up. it's a vicious cycle.
not all plans are like that, but a sigificant amount of them are.

"The reasons the US has more expensive care are complex and myriad but this isn't the subject of this debate. This debate is on whether single-payers would better manage the cost of that care. "

actually, it is a large part of the ddebate. if we pay so much more, tehre has to be a reason. if we pay so much more, we must be doing something wrong, at least as an ainitial supposition. if we spend 17 and they spend 10... which system is better economically the title of the debate? tehre might be a lot to talk about, but it's all what we're suppose to be talking abou.

incentives do matter per your RAND insurance experiement... but if the other countries ration care, that' how they take care of over spending. the US has a racketeerniog system that only sometimes cuts out over use, if you're a smart shopper of insurance, or hat's your thing, paying less in premiums to just get teh essentials in healthcare.
ldcon

Con

Okay. I'll stick a heading on the arguments to aid the organization. I apologize to anyone who makes it this far. I'm going to start with what I think are the two most important arguments.

But first, my opponent says, "i think it's obvious neither of us are experts on the methodology of the studies we cite etc, as would be necessary to eally understand this issue."

Respectfully, she should speak for herself.

1. Public Spending

This is a sufficient winner. Health care systems have massive cross subsidies. It doesn't cost PC physicians ~$400 to see patients, but they charge the average patient this much to cover the 1-2 patients who need much more time/effort. The same trend extends across the industry. We see, for example, massive cost shifts from CMS to private insurers. I referenced this earlier--CMS pays 89% of medical cost. This forces the private insurers to pay closer to 120%.

Given the cross subsidies, what we care about is aggregate funding. Hence, we do not get the effect Canada's 7.3% public expenditure on health with our 7.4% public expenditure on healthcare. This ties to the previous, implying that our 'real' public expenditure is even higher. And we get less for this.

This ties to a third argument. The causes of health disparities are complex and myriad. I argued it's dishonest to compare two countries as if we can hold every other variable constant. We can't.

Therefore, since we already spend more government money on healthcare than peer nations, and this money doesn't achieve anything close to peer result, it's inaccurate to state that the transfer of funds from private to public will provide solve healthcare.

This is the heart of my opponent's case: that we spend 17% GDP and 'Canada' spends 10%. He's arguing if only we spent as much public money as Canada, we could get Canada's result. We already spend more public money then Canada. His syllogism fails.

2. Cost Growth

This is another sufficient winner. My opponent doesn't respond to this argument, or his response "I don't see your point" is non-responsive. We can extend the analytic from R2.

" That is, if my insurance is comprehensive, but pays 1/3 of cost, then the cost is going to ultimately prevent me from receiving care. Hence, the only metric we should care about is the growth of cost. Or, let's wait 20 years. If the trends continue as is, then we'll be the ones with the cheaper healthcare."

Applying the analysis from (1), funding is of paramount importance. Since US costs are growing more slowly, even if our SQ isn't desirable, our 10 year outlook is. No-change beats change.

As I said, this argument wins me the round. We care about healthcare industry insofar as we use it help people. The healthcare industry is primarily limited by cost constraints (inclusive of patient health indicators). Since our longterm cost outlook is better, we should prefer SQ over my opponent's change model. It's likely to grow costs more quickly.

3. Administration

My opponent doesn't address my arguments. He repeats the 'lower/higher' administration figures without engaging some of the more complicated nuance. This argument matters because 'administration' appears to be the primary benefit my opponent attributes to single-payer systems. Hence, if the administration argument falls, we have no reason to prefer s-p.

First, and most importantly, private insurers cannot operate separately across states. This is the single biggest reason their 'administration' is so high. If private insurers could operate nationally, their administrative expenses would plummet. Thus, we can't draw any conclusions from the status quo private insurer expense.

Second, CMS doesn't have much administration, because it pays the private insurers to do so. Hence, we can't draw conclusions from CMS's administrative expense.

Third, CMS pays private companies to regulate. Again, CMS shirks activities which would inflate its administration. Now, CMS should be doing these things. JCAHO is much better at regulating than CMS used to be. But CMS doesn't get to use an artificially low administration to justify its efficiency.

Fourth, CMS doesn't attribute many other costs, like the cost of taxation, fraud, or fraud prevention to its administrative estimate.

Fifth, Administration can be good. Kaiser has more actively managed its patients and has in exchange lowered there costs [R2]. Also in R2, CMS abandoned its somewhat similar pilot because it failed to manage costs.

Sixth, US health insurers netted ~12 billion in profit. This is less than 1% of the $2.2 trillion we spend annually on healthcare. Or, if s-p is designed to save this money, it's completely insufficient.

Seventh, if the primary reason to prefer S-P is reduced administrative expenditures, why would this not apply to other industries? I.e. no need to have a Chevron/Exxon/etc. payroll. Except we know that government enterprises tend to fail, and where they've succeeded more moderately, i.e. s-p's, they've free-ridden on US innovation. My opponent agrees with the last.

It's possible she intended "insurance companies are not the ones doing the innovation" as a sort of response to 6. What I can say is that she's factually wrong. Insurance companies are innovating how they manage patient populations. For example, Kaiser is developing a system of patient incentives and monitors. Or, Highmark acquired a large hospital network in PA to innovate the Accountable-Care-Organization model.

I specifically told my opponent in R2 that she needed to address these if she wanted administration offense. I don't see where she did so. We should extend these through and drop administration.

4. Emergency Rooms

I'm not sure my opponent understood this argument. Pulling from R2, "we should look at hospitals closing their ER's as an indicator they can't afford to continue their operation". It's not an especially important argument, merely as evidence of cross-subsidies in healthcare and that health providers are experiencing a real constriction.

5. "Ounce of Prevention"

My opponent argues here: "i'm saying if we had a single payer system, they would go to get cold medicine instead of ER services."

While I understand my opponent is arguing hypothetically, she's incorrect in assuming that the bulk of costs come from anything similar to 'colds'. They don't. Most spending has to do with long term chronic care. Chronic heart failure, obesity, cancer, transplant, organ failure, debilitative conditions, etc.

And so, she's incorrect, and we can extend from R2 again, not responded to:

"Unfortunately, this has little basis. For example, we've recently developed reasonable evidence obesity doesn't raise aggregate health costs because the obese-ist tend to die before they can get cancer."

"See, it's true that "prevention" does have an important effect, but it tends to be the obvious kind. Namely, exercise, eat nutritionally, take a baby aspirin after turning 45ish. Etc. These are things we don't need doctors to tell us to do."

"Or, CMS recently abandoned a pilot program that attended to assist CHF patients with drug/exercise compliance. The program was not able to generate a cost effective result."

"Further, I'd reference the mammogram snafu from ~2-3 years ago."

So, prevention is complicated, over wrought, and CMS hasn't been able to solve.

6. RAND Health Insurance Experiment

I'm running out of space here, but essentially, incentives matter critically in our usage of care. Moral hazard has a significant effect on healthcare spending in the US. 3rd party payers tend toward poor utilization of care, but this is non-unique to the s-p conundrum. Personal behavior are the primary driver of cost growth in the US, and so when addressing the growth in costs, our solutions should be oriented around aligning patient incentives.

I thank everyone for their attention, request they redirect themselves to #'s 1 and 2 as the easiest voters, and urge a Con ballot.
Debate Round No. 3
7 comments have been posted on this debate. Showing 1 through 7 records.
Posted by dairygirl4u2c 4 years ago
dairygirl4u2c
althougth this more objective looking article says we have half the overhead that canada has.

"Costs of Health Administration in the U.S. and Canada", Woolhandler, et al., NEJM 349(8) Sept. 21, 2003

'The health care system in the U.S. has a vast number of players. There are hundreds, if not thousands, of insurance companies in the U.S.[65][151] This system has considerable administrative overhead, far greater than in nationalized, single-payer systems, such as Canada's. An oft-cited study by Harvard Medical School and the Canadian Institute for Health Information determined that some 31% of U.S. health care dollars, or more than $1,000 per person per year, went to health care administrative costs, nearly double the administrative overhead in Canada, on a percentage basis'
Posted by dairygirl4u2c 4 years ago
dairygirl4u2c
http://www.opposingviews.com...#
ration care might be a good argument as to why it costs less there as they often do it in those countries.

as to amin costs... i might be wrong as this shows medicare spends about the same per patient as private insurance
http://www.debate.org...
a conservative bias organiztion, but still noteworthy
Posted by dairygirl4u2c 4 years ago
dairygirl4u2c
switzerland and dutch supplental insurance
http://www.commonwealthfund.org...

vermont supplmental
http://www.cga.ct.gov...

just a quick look to a few places that have supplemental insurance
Posted by dairygirl4u2c 4 years ago
dairygirl4u2c
some things i will post later

"In 2003, research and development expenditures were approximately $95 billion with $40 billion coming from public sources and $55 billion coming from private sources"
from wikipedia on health care expenses.

that mean, if our GDP is 15 trillion, RD is like less than a percent of our GDP
(per others skimming off us like pharmaceuticals)

that means even if we have that expense and other countires don't,it's not much as to why we spend 17 and they spend 10
Posted by ldcon 4 years ago
ldcon
you*
Posted by ldcon 4 years ago
ldcon
No worries, glad your made it in.
Posted by dairygirl4u2c 4 years ago
dairygirl4u2c
i made some typoes. like 'we' i said instead of 'they' etc. i was typing in a hurry to meet the cut off for my response.
1 votes has been placed for this debate.
Vote Placed by AnalyticArizonan 4 years ago
AnalyticArizonan
dairygirl4u2cldconTied
Agreed with before the debate:--Vote Checkmark0 points
Agreed with after the debate:--Vote Checkmark0 points
Who had better conduct:--Vote Checkmark1 point
Had better spelling and grammar:-Vote Checkmark-1 point
Made more convincing arguments:--Vote Checkmark3 points
Used the most reliable sources:--Vote Checkmark2 points
Total points awarded:01 
Reasons for voting decision: