The Instigator
dairygirl4u2c
Pro (for)
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The Contender
wgt1984
Con (against)
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single payer health care is optimal health care system

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Voting Style: Open Point System: 7 Point
Started: 6/30/2015 Category: Politics
Updated: 1 year ago Status: Post Voting Period
Viewed: 373 times Debate No: 77146
Debate Rounds (3)
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dairygirl4u2c

Pro

single payer health care is optimal health care system

i am borrowing this debate from else where. please use this link to find working links in this debate
http://www.debate.org...

The right single payer system would cover everyone, while yielding better results, and saving money.

BETTER RESULTS WHILE SAVING MONEY:
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.
-More Options:
"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"
-"Why I (an economically right leaning libertarian) Prefer French Health Care"
http://pnhp.org.........
full article: http://reason.com.........

More from the Congressional Budget Office:

""The Congressional Budget Office and related government agencies scored the cost of a single payer health care system several times since 1991. The General Accounting Office published a report in 1991 noting that "[I]f the US were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs [10 percent of health spending] would be more than enough to offset the expense of universal coverage."[40] The CBO scored the cost in 1991, noting that "the population that is currently uninsured could be covered without dramatically increasing national spending on health" and that "all US residents might be covered by health insurance for roughly the current level of spending or even somewhat less, because of savings in administrative costs and lower payment rates for services used by the privately insured.[41] A CBO report in 1993 stated that "[t]he net cost of achieving universal insurance coverage under this single payer system would be negative" in part because "consumer payments for health would fall by $1,118 per capita, but taxes would have to increase by $1,261 per capita" in order to pay for the plan.[42] A July 1993 scoring also resulted in positive outcomes, with the CBO stating that, "[a]s the program was phased in, the administrative savings from switching to a single-payer system would offset much of the increased demand for health care services. Later, the cap on the growth of the national health budget would hold the rate of growth of spending below the baseline."[43] The CBO also scored Sen. Paul Wellstone's American Health and Security Act of 1993 in December 1993, finding that "by year five (and in subsequent years) the new system would cost less than baseline."[44]""

-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)

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

some opponents cite this source as to whether medicare would cost more, even if administration costs would be about the same...
http://tinypic.com.........

heritage used 'justice' expenses to come to a higher per patient cost. those expsnes include nonmedicare related expenses. if you took that into consitiation....

"So almost all of the $7.2 billion should be taken away from the allocated indirect Medicare expenses. Being generous to Book and Zycher and taking away only $6 billion reduces the per-beneficiary expense for FY 2005 from Book"s $509 to $356. That compares to $453 for private sector insurance. So without addressing any of the other questionable expense allocations, Medicare administrative expense per beneficiary is at least 21 percent lower than that of private insurance." - See more at:
http://angrybearblog.com.........
http://www.angrybearblog.com.........

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.
wgt1984

Con

At first glance, many Americans might find the idea of single-payer health insurance appealing, given current economic conditions and high health insurance costs. However, before we accept such a drastic shift in national health policy, we should examine how single-payer health insurance could affect all individuals’ health care costs, choices, and privacy.

If history is any indication, a single-payer initiative will end up costing much more than advocates claim. That, in turn, will lead to higher taxes and/or rationing under which the government will determine which medical treatments will and will not be covered. How do we know this will happen? Because single-payer health care has already been empirically tested on seniors in the United States. Many people may not realize it, but the Medicare program is one of the largest single payers of health care in the U.S. and in the world. An examination of Medicare’s 38-year-old track record provides evidence of what happens when the government controls the financing of health services for millions of U.S. citizens. Consider the following facts.

When Medicare was debated in 1965 (the year it was signed into law), business and taxpayer groups were concerned that program expenditures might grow out of control. However, single-payer advocates assured them that all seniors could easily be covered under Medicare with only a small increase in workers’ payroll taxes. The federal government’s lead actuary in 1965 projected that the hospital program (Medicare Part A) would grow to only $9 billion by 1990. The program ended up costing more than $66 billion that year.

Just three years after Medicare was passed, a 1968 Tax Foundation study found that public spending on medical care had nearly doubled in the first few years of Medicare. In subsequent decades, Medicare payroll taxes and general taxes have continued to rise to pay for skyrocketing health care costs.

One of the major issues is that the federal government does nothing to negotiate with medical providers for lower prices for services. It dictates undervalued prices for reimbursements with a monopoly-like power as a purchaser of health care for senior citizens. The actual costs of the discounted services eventually reduces access to quality care.

Before Medicare was passed, seniors were promised that the program would not interfere with their choice of insurance. However, existing rules force most seniors to rely on Medicare to pay their hospital bills — even if they can afford to pay for private insurance. Additionally, today’s seniors and doctors must abide by more than 100,000 pages of Medicare rules and regulations dictating what types of services are covered or not under the program.

Currently, many Americans choose to pay privately for health services to maintain their medical privacy. However, a single-payer health plan would eliminate that option and all citizens would be forced to give up their ability to maintain a confidential doctor-patient relationship. Just look at what has happened with Medicare.

Under Medicare rules established in 1999, patients receiving home health care are required to divulge personal medical, sexual, and emotional information. Government contractors — mainly home health nurses — are directed to record such things as whether a senior has expressed “depressed feelings” or has used “excessive profanity.” If seniors refuse to share medical and lifestyle information, their health care workers are required to act as proxies. This means total strangers will be permitted to speak for seniors.

Medicare officials stress that the government protects patients’ privacy. However, the General Accounting Office reported to Congress several years ago that at five of 12 Medicare contractors’ sites, auditors were able to penetrate security and obtain sensitive Medicare information. At a time when citizens are concerned about high health care costs, fewer choices and loss of medical privacy, a single-payer health plan could exacerbate these concerns. Given our empirical evidence from the single-payer Medicare program, a single-payer health insurance program for Americans of all ages would most definitely lead to increased costs, reduced choices and less medical privacy for everyone. These are warning signs that no American — including the moderates pushing universal health care — can afford to ignore.

Debate Round No. 1
dairygirl4u2c

Pro

con cites lots of figures but does nothing to put them into perspective. con ignores when i did.... we spend eighteen percent on health care per GDP and other single payer countires spend ten percent. insurance spends thirty percent of income on profit and administration, while medicare spends less than five on administration.

"advocates assured them that all seniors could easily be covered under Medicare with only a small increase in workers" payroll taxes."

medicare is not a lot of a person's pay roll tax.

if people can't afford to have insurance with medicare, that is their own problem and nothing to do with medicare. they should be happy they have medicare. con says it's "existing rules" that cause some to not be able to afford it, but he doesn't say what rules or explain himself.

con has a point that the government could and should negotitate to get lower prices.

con says people would be forced to give up their doctor relationship with singe payer. but they dont have to with medicare. they dont even have to take medicare, if they dont want, and if they want additional services, they can pay extra.
wgt1984

Con

I've outlined my opponents points in bold below and address them accordingly.


con cites lots of figures but does nothing to put them into perspective.


Please let me know which figures you would need perspective on. After reviewing, all of my numbers are not only accurate, but also in context to the debate. I am happy to make it easier to understand, if possible.

con ignores when i did.... we spend eighteen percent on health care per GDP and other single payer countires spend ten percent.

A common argument advanced in support of greater government intervention in the American healthcare market is that a large and growing fraction of the gross domestic product (GDP) is spent on healthcare, while the results, such as average life expectancy, do not compare favorably to the Western nations that have adopted some form of universal healthcare. This argument is spurious for two reasons:
  1. A growing fraction of GDP spent on healthcare is not a problem per se. In the early half of the 20th century, the fraction of GDP spent on healthcare grew significantly as new treatments, medical technology and drugs became available. Growth in spending of this nature is desirable if it satisfies consumer preferences.

  2. Attributing national-health results to the healthcare system adopted by different countries confuses correlation with causation and ignores the many salient variables that are causal factors affecting aggregate statistics (such as average life expectancy). Factors that are likely to be at least as important as the healthcare system include the dietary and exercise preferences of a population.



insurance spends thirty percent of income on profit and administration, while medicare spends less than five on administration.

All being equal, the fact that a government program would not need to turn a profit suggests that it might enjoy a price advantage over for-profit insurers. If so, that price advantage would be slight. According to the Congressional Budget Office, profits account for less than 3 percent of private health insurance premiums. Furthermore, government’s lack of a profit motive may not be an advantage at all. Profits are an important market signal that increase efficiency by encouraging producers to find lower-cost ways of meeting consumers’ needs. The lack of a profit motive could lead a government program to be less efficient than private insurance, not more.

Moreover, all else is not equal. Government programs typically keep administrative expenditures low by avoiding activities like utilization or claims review. Yet avoiding those activities increases overall costs. According to the CBO, the traditional fee-for-service Medicare program does relatively little to manage benefits, which tends to reduce its administrative costs but may raise its overall spending relative to a more tightly managed approach. Similarly, the Medicare Payment Advisory Commission writes:

[The Centers for Medicare & Medicaid Services] estimates that about $9.8 billion in erroneous payments were made in the fee-for-service program in 2007, a figure more than double what CMS spent for claims processing and review activities. In Medicare Advantage, CMS estimates that erroneous payments equaled $6.8 billion in 2006, or approximately 10.6 percent of payments. The significant size of Medicare’s erroneous payments suggests that the program’s low administrative costs may come at a price.

CMS further estimates that it made $10.4 billion in improper payments in the fee-for-service Medicare program in 2008.

Medicare keeps its measured administrative-cost ratio relatively low by avoiding important administrative activities (which shrinks the numerator) and tolerating vast amounts of wasteful and fraudulent claims (which inflates the denominator).

Medicare also keeps its administrative expenditures down by conducting almost no quality-improvement activities. Journalist Shannon Brownlee and Obama adviser Ezekiel Emanuel wrote a while back:

[S]ome administrative costs are not only necessary but beneficial. Following heart-attack or cancer patients to see which interventions work best is an administrative cost, but it’s also invaluable if you want to improve care. Tracking the rate of heart attacks from drugs such as Avandia is key to ensuring safe pharmaceuticals.

According to the CBO, private insurers spend nearly 1 percent of premiums on “medical management.” The fact that Medicare keeps administrative expenditures low by avoiding such quality-improvement activities may likewise result in higher overall costs—in this case by suppressing the quality of care.

Supporters who praise Medicare’s apparently low administrative costs often fail to note that some of those costs are hidden costs that are borne by other federal agencies, and thus fail to appear in the standard under 3% estimate that my debator cites. These include “parts of salaries for legislators, staff and others working on Medicare, building costs, marketing costs, collection of premiums and taxes, accounting including auditing and fraud issues, etc.”

Also, Medicare’s administrative costs should be understood to include the deadweight loss from the taxes that fund the program. Economists estimate that it can easily cost society $1.30 to raise just $1 in tax revenue, and it may sometimes cost as much as $2.36 That “excess burden” of taxation is a very real cost of administering (i.e., collecting the taxes for) compulsory health insurance programs like Medicare, even though it appears in no government budgets.

Economists who have tallied the full administrative burden of government health insurance programs conclude that administrative costs are far higher in government programs than in private insurance. In 1992,University of Pennsylvania economist Patricia Danzon estimated that total administrative costs were more than 45 percent of claims in Canada’s Medicare system, compared to less than 8 percent of claims for private insurance in the United States. Pacific Research Institute economist Ben Zycher writes that a “realistic assumption” about the size of the deadweight burden puts “the true cost of delivering Medicare benefits [at] about 52 percent of Medicare outlays, or between four and five times the net cost of private health insurance.”

Administrative costs can appear quite low if you only count some of them. Medicare hides its higher administrative costs from enrollees and taxpayers, and public-plan supporters rely on the hidden nature of those costs when they argue in favor of a new government program.



"advocates assured them that all seniors could easily be covered under Medicare with only a small increase in workers" payroll taxes."

medicare is not a lot of a person's pay roll tax.

It's 2.9%. Saying that isn't a lot is subjective (to say the least) and has a much more significant burden on the lowest wage earners.


if people can't afford to have insurance with medicare, that is their own problem and nothing to do with medicare. they should be happy they have medicare. con says it's "existing rules" that cause some to not be able to afford it, but he doesn't say what rules or explain himself.

I'm sorry, but I am unable to say what can/should make someone "happy." That's left to the individual from my viewpoint. To be fair, the exisiting rules have been altered more in favor of the customer with the advent of Part B, so my arguement here - while still valid - is less compelling with these new rules. (Not enough characters here to go into the details of Part B.)

con has a point that the government could and should negotitate to get lower prices.

con says people would be forced to give up their doctor relationship with singe payer. but they dont have to with medicare. they dont even have to take medicare, if they dont want, and if they want additional services, they can pay extra.

But my point is that the customer shouldn't ever be forced to break their relationship with an exisiting doctor for a state-run system.
Debate Round No. 2
dairygirl4u2c

Pro

lack of perspective.

you cite the billions spent on medicare, but dont show any way that means anything. our budget is like 15 trillion. a few billion is not a lot of money. and the bottomline, is medicare pays for itself with payroll taxes, that are not that high, and gives healthcare to all elderly.

"A growing fraction of GDP spent on healthcare is not a problem per se. In the early half of the 20th century, the fraction of GDP spent on healthcare grew significantly as new treatments, medical technology and drugs became available. Growth in spending of this nature is desirable if it satisfies consumer preferences."

all countries have new technologies. why do we spend more? because of administrative costs of insurance companeis as a large reason. bottomline, is that GDP is compariong apples to apples among nations, and we spend a lot more.

"According to the Congressional Budget Office, profits account for less than 3 percent of private health insurance premiums."

do you have a source for this? you may have a compelling point, but it needs to counteract the fact they spend 30% on adminstrative costs adn profit.

"Moreover, all else is not equal. Government programs typically keep administrative expenditures low by avoiding activities like utilization or claims review. Yet avoiding those activities increases overall costs."

you showed how there are excesses by medicare, but haven't put it in perspective, to show how much private insurance saves as a percentage of what it spends in quality control. you may have a real point here but it needs more persepctive.

a bottomline, as the initial congressional budget office data i cited in the first round shows, we can cover people with less spending than already occurs with single payer. that would mean my resolution is probably true that we should switch to single payer. we might be able to go even cheaper with a tightly regualted insurnace market like obamacare with regulation, but that remains to be seen? con posits that private insurance is more efficient, so something like obamacare would be necessary to cover everyone, id assume.
out of curiosity, what healthcare situation do you con propose? no governemnt intervebntion and every man for himself? or do you have some sort of idea? and if you dont propose insuring all are covered, but had to pick a way to do so, what would it be?
wgt1984

Con

wgt1984 forfeited this round.
Debate Round No. 3
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