because of healthcare, on balance obama as president was a good thing
because of healthcare, on balance obama as president was a good thing
whether you like obamacare or not, which i tend to dislike, had mccain or a republican been president we probably wouldn't have accompished healthcare reform. it took the phenomenon that was barak obama when he was first elected, with all the democratic congressment that went with him, to get that change. he's also changed the conversation to anyone who dare question to repeal his healthcare..... to, what are you going to replace it with? yes republicans do tend to say repeal and replace, but now because of obama there's a certain heighted expectation for health care- you can't take away people's healthcare, and you need to have a plan. for real, because not everything is wrong with obamacare, they could just as easily talk about reforming it, but they mostly tend to be political and say repeal and replace.
(and, for all the states that accepted medicaid expansion, their death rates have fallen accordingly)
obama care isn't perfect, but it's changed the conversation, and is a step in the right direction.
Following suit with Pro, I will briefly cover my position in round 1.
Note that I will use the term "health care" to mean health care and/or health insurance, and the term "Obamacare" to mean any federal government health policy changes implemented under President Obama.
Pro's uses the word "good" in the resolution, which I will take to mean an on-balance improvement in the lives of American citizens.
Rather than take the position that some alternative government plan, or perhaps the status quo, would have been better than Obamacare, I will be taking the more radical position that there is a direct correlation between government involvement and a reduced quality of life related to health care. If this is the case, the resolution will be negated, since Obamacare increased federal involvement in health care.
I will accomplish this by refuting Pro's claims and covering the following:
1) a theoretical basis for free market health care
Since Pro mentioned medicaid expansion, I don't want to be accused of dropped arguments, so for now, I will just briefly state that I will be challenging any study that shows Obamacare results in a statistically significant decrease in death rates.
i wish con would have started into his arguments more that the free market would properly take care of healthcare, so that we can delve into it all sooner than later. cause you can count me as prime skeptical. free markets leads to people not having health care, and thus they get sick or die. it's pretty simple really.
if con wants to argue the free market is cheapest, i might not disagree. but it comes at hte cost of thousands of lives and isn't really a health plan.
as to the medicaid expansion saving lives. harvard studies show that more than two thousand florida citizens will die if that state doesn't take medicaid expansion. and i'm sure that i could find more stats on a national scale, which i think might actually be in that study.
in general, the lack of healthcare at least before obamacare was enacted was well established to be over forty thousand a year. again based on harvard studies and lots of other studes.
to be sure, there are plans that are similar to other industrialized nations use for healthcare that is cheaper than obamacare. they range from single payer to private insurance that is tightly regualted. and a firmly established number is that they spend ten percent of their GDP on healthcare and we spend seventeen percent. that represents a big number, a trillion dollars. bottomline. if they can do it, we can do it. insurance for everyone, while cheaper.
but again this is all getting beside the point. the point is that obama made the issue of healthcare front and center. if a republcan says he wants to repeal it, he has to say with what. or not one takes him seriously. it might be expensive, but at least people have health care in the mean time too until we find a better solution.
My free market discussion not a counter plan, but rather a framework to show that government involvement in health care cannot improve our lives.
Pro states this is simple: no government health care plan = no insurance = people die. I will show otherwise.
The Harvard Study & uninsured decreased mortality
Regarding Pro's source to the Harvard study, it's a news article that mentions they study, which is likely this:
One statement from that study is:
"Recent studies suggest that Medicaid expansion will result in health and financial gains." (1)
The recent study referred to was the "Oregon Experiment" from the New England Journal of Medicine, whose full conclusion was:
"This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain." (2)
Clearly health affairs cherry picked that line from the Oregon study. Note the Oregon study shows no link to mortality.
The Harvard study has undergone quite a bit of scrutiny. From ncpa.org:
"In independent empirical papers, Richard Kronick and David Card and his colleagues find little evidence that health insurance coverage significantly reduces mortality. Former Director of the Congressional Budget Office June O"Neill and her husband Dave also conclude that lack of insurance has little or no impact on mortality." (3)
There are many studies that can be reviewed on this subject (4), which shows how many of these studies build on each other. In this case, mainly Franks et al. (1993), which claims that lack of insurance increases death rates by 25%. However, as ncpa.org says:
"Appendix D of the 2002 Institute of Medicine cites only two studies on the topic of deaths from lack of health insurance, Franks et al. (1993) and Sorlie et al. (1994). It adopts the Franks estimate of 1.25 deaths among those without health insurance for every death among those with health insurance without explanation. The problem with this is that Franks" sample assumed that baseline insurance status remained the same for 19 years, an unrealistic assumption, and it excluded everyone covered by government programs. The 95% confidence interval for the 1.25 hazard ratio was 1.00 to 1.55" (4)
The Harvard group (Wilper 2009) also attempted to estimate this "hazard ratio", about which ncpa.org states:
"almost 30 percent of the Wilper sample was excluded due to missing data. Insurance status was self-reported, and the paper notes that 7 to 11 percent of the uninsured may be incorrectly classified. The study has no information about the duration of insurance coverage, it did not correct for income, and it excluded all people who had "public insurance," including those on Medicaid, in the military, on Medicare, or in the VA system." (4)
Why do these studies always exclude those covered by public insurance? Is it because they know it will lead to improved outcomes for those insured thus increasing the "hazard ratio". If so, it's quite ironic that these studies are being used as a basis for increasing public insurance.
The obamacarefacts.com "study"
The "2012 familiesUSA study" that is linked to from this site has no primary sources, but the 25% hazard claim is likely from Franks et al. (1993).
Without a connection between government sponsored health insurance and health care outcomes, Pro's resolution goes unfulfilled.
"if they can do it, we can do it"
I would respond to this if it contained any concrete facts.
Free market health care, a theoretical basis
Economists agree that voluntary exchange increases the welfare of both parties. The free market is simply an aggregate of voluntary exchanges. Supply balances demand and results in market prices, with resources automatically allocated to their most urgent need. The role of government in this process is in enforcing the rule of law. Health insurance and health care is just another good provided in the market. I challenge my opponent to counter this, as current issues with health care can be explained by government intervention.
Negative effects of government on health care
In economics, a Pareto improvement occurs when at least one individual becomes better off without anyone becoming worse off. Any change that does not meet this condition is said to be Pareto inferior. Obamacare is a Pareto inferior policy - it may help some, but at the expense of many.
Federal tax subsidies starting in 1943 encouraged employers to offer health insurance as a benefit. These subsidies made these plans the norm for many, with the result that much of a consumers cost becomes hidden. The money simply flows out of consumers paychecks to insurance companies then to doctors. If the "cost" to a consumer for something like an MRI is a 50$ copay, but the "cost" to the provider is 500$, then it's obvious this becomes an over-used resource. This is not a free market system and the result is that providers ask for higher and higher payments from insurers. Much of the focus with Obamacare has been to increase the use of 3rd party payers (insurers), reduce out of pocket expenses and provide payment for more services. It's clear that this will raise prices even further.
Note also that, prior to government involvement in health care, doctors often provided health care to the poor for reduced fees. Also, government involvement in health care has crowded out charity.
Free market health care, examples
Dr. Keith Smith, Oklahoma
The surgery center of Oklahoma is a free market surgery center disconnected from government bureaucracy. Their prices, listed online, are vastly lower than hospital prices:
Dr. Josh Umbehr, Kansas
This is a family medical center based on a small monthly fee between 10$ and 100$ per month:
My opponent seems to agree that the free market is capable of reducing health care costs. As I've shown, these savings would be enormous. It appears that Obamacare is primarily a form of wealth redistribution. There are more efficient ways to help the poor than through health care. For example the Earned Income Tax Credit specifically targets the issue of providing the poor with extra income and is generally favored by economists. Scott Sumner, speaking in this case about the war on poverty, states:
"However, much greater progress would have occurred if more emphasis had been put on programs like the Earned Income Tax Credit" (7)
Significantly reducing health care costs while providing an income supplement that does not reduce incentives to work or have the negative employment issues associated with a minimum wage is clearly a winning combination.
it is simple. all con's wordy bluster is a way to deny common sense. without health insurance or coverage you die, or at least regulations. if you have no money and have a heart attack, it's only the law that says they ahve to operate. otherwise what's in it for them? if you have diabetes even the ER, which is a regulation of care, doesn't maintain a regiment of care... yyou need extended care. if you spend more than you do on insurance for things lijke medication or healthcare in genearl, you are getting what you otherwise couldn't.
"Economists agree that voluntary exchange increases the welfare of both parties. The free market is simply an aggregate of voluntary exchanges. Supply balances demand and results in market prices, with resources automatically allocated to their most urgent need."
if you have no money, opr little money, you can't enter into exchanges.
"Obamacare is a Pareto inferior policy - it may help some, but at the expense of many."
this almost goes against con's resolution, that gov3ernment involvement does nothing. it deos do something, even he admits it, some good. it mgiht do bad, but it does some good. and all my resolut8ion in this debate was was obamacare set a heightened expectation to anyone who dare repeal or reform his laws, to ensuring something in fact exists to help people.
" Also, government involvement in health care has crowded out charity."
if the free market is so good, why is there need for charity? because the free market isn't so good. and, it's not charity's place to give a basic need like healthcare. things like food or healthcare should be part of the social contract.
"There are more efficient ways to help the poor than through health care. For example the Earned Income Tax Credit "
con rails against government involvement, then proposes a government involvement alternative. the EITC gives back mroe than they pay, it is welfare. and, per my resolution, if you were to do away with obamacare, you'd have a heighted expectation that the credit would be enough to afford healthcare, insruance, or whatever. that means it's good we had obamacare to ensure we have a baseline expectation to any alternatives.
Pro initially states that Obamacare (in this case medicaid expansion) will save thousands of lives in Florida alone, but when challenged, dropped that. Instead, Pro's support of Obamacare relies on an increase in diabetes detection. It's not surprising that testing and detection has gone up, but Pro provides no proof that this has improved lives in Oregon, or whether Oregon is applicable to the rest of the country. The following text is from the Oregon study:
"Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher."
Obamacare and government intervention in health care in general results in:
- vastly higher prices, resulting in health care now at 17% of GDP
- the destruction of the market exchange between consumers and health care providers
- the crowding out of health care charity
- increases in taxation, adding to the growing federal debt
For all of that, I'd hope that we'd end up with at least one example of a documented health improvement.
Pro claims this is all common sense, but unfortunately economic topics often defy common sense. After all, if economics was simply common sense, why is there a long history of discovery on this subject? Marx's labor theory of value must have been common sense at the time, but then it was abandoned. Using common sense, minimum wage helps the poor, but it takes economists to show that it hurts the poor by outlawing labor below the minimum wage. Tariffs are nice sounding talking points for politicians but in reality, because of the concept of comparative advantage, we know tariffs hurt us all in the long run. Conservatives complain that immigration hurts us by taking jobs, but economists have shown this to be false.
As Pro has admitted, emergency rooms, by law, must provide service regardless of insurance coverage. This law has been in place since 1986 when Obama was just 25 years old, so clearly Obamacare had nothing to do with this. The fact that "it's only the law" that hospitals must care for the uninsured is irrelevant to this debate, since it was not part of Obamacare. Additionally, as I've already stated, health care professionals have historically taken care of the poor, It is only through government taking over this role and crowding that out that this has been reduced.
Pro appears to want to win this debate by eluding to some who have been helped by Obamacare. However, that isn't the burden of proof in this debate. Pro must show that, on balance, the lives of us all has been improved. This means the positives must outweigh the negatives. Failing that, now it appears Pro wants to lower the bar for the BOP even more by stating that "all my resolut8ion in this debate was was obamacare set a heightened expectation".
In the last round, I brought the argument that voluntary exchanges increase welfare for both parties, and a free market is simply an aggregation of these exchanges. From this we can conclude any interference with voluntary exchanges reduces welfare. Thus our starting point must be that government interference in health care reduces welfare overall. Pro's only rebuttal to this is that some people have no, or little money. But this is not necessarily an issue with the free market. For the sake of argument, imagine we have a free market with little government intervention. Also imagine there are one million people who are very poor. Even imagine they cannot work and are flat broke. This does not stop the power of the free market. Voluntary exchanges still occur and are Pareto superior. Just because some do no participate does not mean this does not hold. Additionally, the picture Pro paints doesn't exist in the Untied States anyway due to all manner of welfare programs other than Obamacare.
"if the free market is so good, why is there need for charity?"
I never claimed the free market could cure all disease, eliminate birth defects, stop drug addiction, etc. There will always be a need for charity. Why would Pro claim it's not the place for charity to provide health care? Would it not be better if a doctor voluntarily provided service to someone down on their luck? Does Pro really think it's better to forcibly tax some, channel that money through an inefficient bureaucracy, knowingly inflate prices and then distribute one-third of whats left over to the needy?
"healthcare should be part of the social contract."
My only response is why? Given all the negatives and lack of outcomes, there is nothing left to support this.
"con rails against government involvement, then proposes a government involvement alternative. the EITC gives back mroe than they pay, it is welfare. and, per my resolution, if you were to do away with obamacare, you'd have a heighted expectation that the credit would be enough to afford healthcare, insruance, or whatever. that means it's good we had obamacare to ensure we have a baseline expectation to any alternatives."
Again, Pro's burden regards Obamacare and it's improvement of our lives. My argument is that government involvement in health care is bad, not that all welfare is bad. Ultimately, it is true, I prefer charity. But this debate isn't about charity vs EITC, it's about Obamacare. As far as the rest of this statement, I'm not sure what it means. Is Pro conceding that Obamacare was so bad we might need to get rid of it, but that's good because at least we experimented and found this out? If so, this is highly speculative and I don't think it makes sense to say that something was bad was really good because at least we know not to try that again.
In summary, Pro has not been able to counter my free exchange/Pareto superior argument and for that reason alone, the resolution is unfulfilled. Obamacare will continue to increase prices, thus making it even harder for the poor to afford it. Obamacare will also continue to deteriorate charitable giving which provides help to the poor that is superior to government bureaucracies.