1AC (Options)PLAN:

Econ AdvantageAverage Health Care Spending Will Overtake Wages By 2030Young & DeVoe 12 [Richard Allen Young MD is an American geneticist, a Member of Whitehead Institute, and a professor of biology at the Massachusetts Institute of Technology. Jennifer E. DeVoe, MD, DPhil is Chief Research Officer at OCHIN where she serves as executive director of the OCHIN practice-based research network of community health centers. “Who Will Have Health Insurance in the Future? An Updated Projection”, Annals of Family Medicine Vol 10 no. 2, March/April 2012, pgs. 156-162] BJ

If health insurance premiums and national wages continue to grow at recent rates and the US health system makes no major structural changes, the average cost of a family health insurance premium will equal 50% of the household income by the year 2021, and surpass the average household income by the year 2033. If out-of-pocket costs are added to the premium costs, the 50% threshold is crossed by 2018 and exceeds household income by 2030.As most workers do not currently pay the entire cost of their premiums, we believed it was also important to include another projection: the total cost of health care for a family. For this estimate (Figure 3), we calculated the average amount an employee pays for a family health insurance premium plus out-of-pocket family health care expenses. Because the MEPS database does not provide explicit out-of-pocket expense data for privately-insured families, MEPS premium data were combined with out-of-pocket estimates obtained from the Milliman Medical Index (out-of-pocket costs were estimated as a percentage of the total

premium).10 Without major structural changes in the US health care system, the employee contribution to a family premium plus out-of-pocket costs will comprise one-half the household income by 2031 and total income by 2042. Rising health care costs remain at the core of this unsustainable rise in insurance premiums

Wages are key to a functioning economy – low wages tank growth, productivity, investmentDuke 16 [Brendan V. Duke is the Associate Director for Economic Policy at the Center for American Progress, Duke holds a master’s degree in economics and public policy from Princeton. “To Raise Productivity, Let’s Raise Wages,” Center for American Progress, September 26, 2016 https://www.americanprogress.org/issues/economy/report/2016/09/02/142040/to-raise-productivity-lets-raise-wages/] BJ Another method for boosting productivity is offered by Northwestern University economist Robert Gordon—one of the country’s leading

productivity experts—in his recent book The Rise and Fall of American Growth. Gordon describes the period between 1929 and 1950 as “the Great Leap Forward” for productivity, which grew an astounding 3.2 percent per year—far more than any era since 1870 and double the growth rate since 1970. Gordon argues that a key reason productivity surged during this period was that rising real wages provided an incentive for firms to invest in capital, such as machinery. When labor is cheap, businesses have little incentive to invest in capital because they can always hire another worker on the cheap. But higher wages reduce the price of capital relative to labor, nudging firms to make investments and raise productivity. The 1929–1950 increase in wages was at first a result of several policies that directly raised workers’ wages, including the first federal minimum wage, the first federal overtime law, and the National Labor Relations Act, which made it easier for workers to join a union and bargain with their employers. The entry of the United States into World War II further drove investment higher, as the economy converted into what Gordon describes as a “maximum production regime.” It is striking that during this period of rapid productivity growth, wages for production workers grew even faster than productivity growth did. The current debate about whether a typical worker’s compensation has kept track with the economy’s productivity typically envisions productivity growth as the precondition for wage growth. But Gordon’s research implies that the

relationship can go both ways: Not only can productivity growth raise wages, but higher real wages also can boost productivity growth—the main reason for slow gross domestic product growth—by giving firms a

reason to purchase capital. Can higher wages raise productivity growth in 2017? Basic economic theory and common sense suggests that an increase in the price of labor—wages—achieved through higher labor standards will cause firms to invest in more capital, raising the economy’s productivity. Some have tried to use this fact to claim that raising wages ultimately will hurt workers by causing them to be replaced with machines. But automation is just another way of saying productivity growth: Robots replacing humans means more output produced using fewer human hours—the literal definition of higher productivity. We can either have a productivity problem or an automation problem, but we cannot have both at the same time. The sharp slowdown in productivity growth today heavily implies that we currently have too little automation rather than too much. At the same time, the evidence on policies that raise wages—such as the minimum wage—points to no noticeable effect on employment. Indeed, the New Deal and its rising labor standards were also a period of rapid employment growth. A more important question is whether we have enough of the other key ingredient for the productivity growth that made the 1930s possible: innovation. Technological change itself is another reason firms purchase new capital—otherwise, investment amounts to “stacking wooden ploughs on top of wooden ploughs.” Gordon makes clear that the 1930s were in fact one of the most innovative decades in history, as the economy began to harness the potential of the internal combustion engine and electrification. Firms ultimately could afford policies that raised wages because they could raise their productivity with new equipment featuring innovative technology. There exists a vigorous debate today about whether we live in a period of very ordinary or extraordinary innovation. Some—such as Gordon himself—argue that productivity growth inevitably will be slower because today’s new technology is inherently less innovative than that of the 1930s. In that case, there still exists a strong justification for raising labor standards: Slow productivity growth makes it that much more important that its fruits be shared equitably. But others—including Andrew McAfee and Erik Brynjolfsson of the Massachusetts Institute of Technology, the country’s leading growth optimists—argue that we live in a period of extraordinary technological change. Even so, recent innovations—such as 3-D printing and social media—have failed to raise productivity growth, even after accounting for the possible problems with how statistics measure it. Therefore, it may be the ability of firms to hire workers at wages that have barely grown since 2000—rather than purchasing new equipment and adopting new technology—that has prevented productivity from rising. The truth likely falls somewhere in between the pessimists and the optimists, with healthy—if not necessarily explosive—productivity growth possible. In that case, policies that raise wages may be the key to unlocking productivity growth by increasing incentives for firms to invest in capital. Such wage-raising policies include making it easier for workers to bargain collectively, raising the federal minimum wage, and modernizing overtime rules. Fortunately, the Obama administration recently has taken action on the latter and

proposed an increase in the overtime threshold to $47,000 per year. Conclusion The productivity and investment slowdown presents a direct threat to the growth of U.S. living standards. It is the main reason gross domestic product growth has slowed, and it is a challenge with which advanced economies across the world are grappling. Importantly, productivity has slowed regardless of countries’ corporate tax policies—some politicians’ favorite solution to every economic problem. Policymakers should heed the advice of the International Monetary Fund and focus on attacking the main cause of the productivity slowdown—low aggregate demand. A substantial investment in infrastructure—as the Center for American Progress recently proposed—would go a long way toward getting business investment back on track. An additional and complimentary avenue to raising productivity is policies that directly raise wages. Employers have little reason to invest in new capital and raise productivity when real wages are stagnant. When faced with higher labor costs, employers will invest and innovate—two of the keys to raising productivity. Policymakers in the 1930s and 1940s turned the Great Depression and World War II into the most rapid growth in living standards our country has ever seen. Hopefully, their counterparts today can learn from their example.

Economic Downturn risks global conflictGreen & Schrage, 2009 [Michael Green is Senior Advisor and Japan Chair at CSIS and Georgetown professor, Steven Schrage is a former Georgetown professor and was previously the Scholl Chair at CSIS, “It's not just the economy”, Asia Times, March 26 2009, http://www.atimes.com/atimes/Asian_Economy/KC26Dk01.html] BJ

However, the Great Depression taught us that a downward global economic spiral can even have jarring impacts on great powers. It is no mere coincidence that the last great global economic downturn was followed by the most destructive war in human history. In the 1930s, economic desperation helped fuel autocratic regimes and protectionism in a downward economic-security death spiral that engulfed the world in conflict. This spiral was aided by the preoccupation of the United States and

other leading nations with economic troubles at home and insufficient attention to working with other powers to maintain stability abroad. Today's challenges are different, yet 1933's London Economic Conference, which failed to stop the drift toward deeper depression and world war, should be a cautionary tale for leaders heading to next month's London Group of 20 (G-20) meeting. There is no question the US must urgently act to address banking issues and to restart its economy. But the lessons of the past suggest that we will also have to keep an eye on those fragile threads in the international system that could begin to unravel if the financial crisis is not reversed early in the Barack Obama administration and realize that economics and security are intertwined in most of the critical challenges we face.

Economic decline undermines US Heg – Makes nuclear war likelyLieberthal and O'Hanlon 12 [Kenneth Lieberthal and Michael O’Hanlon are Senior Fellows in Foreign Policy at Brookings, "The Real National Security Threat: America's Debt," Brookings Institute, July 10, 2010, https://www.brookings.edu/opinions/the-real-national-security-threat-americas-debt/ ] BJ

Lastly, American economic weakness undercuts U.S. leadership abroad. Other countries sense our weakness and wonder about our purported decline. If this perception becomes more widespread, and the case that we are in decline becomes more persuasive, countries will begin to take actions that reflect

their skepticism about America's future. Allies and friends will doubt our commitment and may pursue nuclear weapons for their own security, for example; adversaries will sense opportunity and be less restrained in throwing around their weight in their own neighborhoods. The crucial Persian Gulf and Western Pacific regions will likely become less stable. Major war will become more likely. When running for president last time, Obama eloquently articulated big foreign policy visions: healing America's breach with the Muslim world, controlling global climate change, dramatically curbing global poverty through development aid, moving toward a world free of nuclear weapons. These were, and remain, worthy if elusive goals.

However, for Obama or his successor, there is now a much more urgent big-picture issue: restoring U.S. economic strength. Nothing else is really possible if that fundamental prerequisite to effective foreign policy is not reestablished.

Private healthcare industries have inflated medical care costsFriedman 15 [Gerald, PhD, Gerald Carl Friedman is an economics professor at the University of Massachusetts at Amherst, Testimony of Professor Gerald Friedman to the Rhode Island House Finance Committee in support of H5387, May 26, 2015, pgs. 1-2 http://harddeadlines.com/sites/default/files/Friedman_Testimony_May_26_2015_to_Rhode_Island_150526_edited.pdf] BJ

Of course, we will control health care spending and we will do it in one of two ways: either we will control administrative bloat, monopoly pricing and excessive profits, or we will reduce access to health care services. So far, as a nation, we have been doing the latter, reducing access to services with higher copayments and deductibles to the point where Americans are less likely to see a physician than residents of other

affluent countries and thousands die for lack of care. This is clearly wrong. While these policies discourage people from using health care and will make us less healthy, they do not address the source of America’s out-of-control health care spending. International studies make it clear that our health care spending is not high because we use too many services; instead, our spending is out of line with other advanced economies because our health care prices are so high. The McKinsey Global Institute has found, for example, that drug prices in the United States are 60% higher than elsewhere and that we spend about $30 billion more on medical devices because of inflated prices - over 25% higher than the world average. 1 The Massachusetts Attorney General’s office has found enormous variation in hospital prices for the same procedures reflecting the bargaining power of privileged hospitals.2 Other

business-oriented researchers have similarly found that inflated prices and monopoly power, not utilization, account for high and rising health care costs in the United States.3 High and rising prices for health care in the United States are due to our reliance on a for-profit financing system that necessarily generates waste and cannot control monopolistic practices. I do not mean to name-drop, but of course, I will. My graduate-school professor, then Harvard Professor and Nobel-laureate Kenneth Arrow, showed 50 years ago that health care is not a commodity like shoes; because of risk and uncertainty, we cannot

expect health insurance markets to function like those of other commodities.4 Insurance companies do not profit by selling more; instead, they profit by screening their customers so that they sell less insurance to people who will need it.5 In his coffee business, for example, my father tried to provide quality coffee at a reasonable price because his profits grew when he sold more coffee to more people.

Similarly, Current Administrative Policies Magnify Costs Friedman 15 [Gerald, PhD, Gerald Carl Friedman is an economics professor at the University of Massachusetts at Amherst, Testimony of Professor Gerald Friedman to the Rhode Island House Finance Committee in support of H5387, May 26, 2015, pgs. 1-2 http://harddeadlines.com/sites/default/files/Friedman_Testimony_May_26_2015_to_Rhode_Island_150526_edited.pdf] BJ

Our health care cost crisis is driven by administrative waste due to the insurance industry and to monopolistic pricing. The Affordable Care Act limits administrative costs and profits to only 15% of the standard group insurance plan, a rate that is nearly ten times the administrative rate of Medicare, with nearly $200 billion dollars of extra costs. The fastest increases in cost in the American health care system over the last decades have been in drug prices and administrative activities.6 Administrative costs have risen in the United States at a rate of over 11% a year since 1971, rising from a bit over 1% of GDP to over 5% now. Compared with Canada’s single payer system, administrative cost increases account for over two-thirds of the excess increase in our health care costs. Perhaps most revealing, there is no difference between the cost increases in Canada’s Medicare single-payer system and our Medicare single-payer-system for the elderly; had all of the US health care system behaved like our Medicare system, we would be spending a third less than we spend now, about what Canada spends per person to gain longer life expectancy than we have in the United States

High health insurance costs harm US Industry Growth Sood et al., 09 [Neeraj Sood, Ph.D., is the Vice Dean for Research at the USC Price School of Public Policy. In addition, he currently serves as the Director of Research at the Leonard D. Schaeffer Center for Health Policy & Economics, “Health Care Cost Growth and the Economic Performance of U.S. Industries”, Health Services Research 44:5, pgs. 1449-1464] BJ

ESI = Employer Sponsored Insurance

The findings of our study indicate that ‘‘excess’’ growth in health care costs has adverse effects on economic outcomes in the United States, and that these effects are greater for industries where high percentages of workers have ESI [*Employer Sponsored Insurance*] . In our view, it is very unlikely that these findings are due to confounding. Our multivariate regression analyses controlled for measured and unmeasured factors other than health care cost growth that could influence economic

outcomes in different economic sectors and industries. Further, the results of our indirect test using Canadian data provided additional evidence against the possibility that residual industry-level confounding explains the study’s findings.2 We used the percentage of workers with ESI, lagged by 1 year relative to the economic data, as the measure of the degree to which industries would be affected by health care cost growth in order to minimize concerns about reverse causation. In practice, however, the percentage of workers with ESI in each industry did not change very much over the study period. For heavily unionized industries, this finding probably reflects labor contracts firms made 1460 HSR: Health Services Research 44:5, Part I (October 2009) with workers that are difficult to change. For nonunionized industries, this finding is less likely to reflect explicit contracts, but it may nonetheless capture tradition and implicit expectations held by new and established workers alike. The quantitative estimates from our simulation analyses——that is, the 120,803 jobs, US$28,022 million in gross output, and US$14,082 million in value added that would have been lost in 2005 as a result of a 10 percent increase in ‘‘excess’’ growth in health care costs——must be interpreted with caution. These estimates capture the potential magnitude of the adverse effects of rapid health care cost inflation, but in the real economy it is likely that these effects would be mitigated by economy-wide, cross-industry phenomena whereby reductions in employment or output in industries with high percentages of workers who have ESI are partially compensated by gains in other industries with low percentages of workers who have ESI. The degree to which this happens is likely to depend on the ease with which workers can move across industries. Even if this is the case, however, it implies that rapidly rising health care costs promote redistribution of workers from jobs with ESI to jobs without ESI

Slow U.S. growth destroys global stabilityHaass 13 [Richard N. Haass, President of the Council on Foreign Relations, previously served as Director of Policy Planning for the US State Department and was President George W. Bush's special envoy to Northern Ireland and Coordinator for the Future of Afghanistan, “The World Without America”, Project Syndicate, April 30, 2013, https://www.project-syndicate.org/commentary/repairing-the-roots-of-american-power-by-richard-n--haass?barrier=accessreg] BJ

Let me posit a radical idea: The most critical threat facing the United States now and for the foreseeable future is not a rising China, a reckless North Korea, a nuclear Iran, modern terrorism, or climate change. Although all of these constitute potential or actual threats, the biggest challenges facing the US are its burgeoning debt, crumbling infrastructure, second-rate primary and secondary schools, outdated immigration system, and

slow economic growth – in short, the domestic foundations of American power. Readers in other countries may be tempted to react to this judgment with a dose of schadenfreude, finding more than a little satisfaction in Amerlica’s difficulties. Such a response should not be surprising. The US and those representing it have been guilty of hubris (the US may often be the indispensable nation, but it would be better if others pointed this out), and examples of inconsistency between America’s practices and its principles understandably provoke charges of hypocrisy. When America does not adhere to the principles that it preaches to others, it breeds resentment. But, like most temptations, the urge to gloat at America’s imperfections and struggles ought to be resisted. People around

the globe should be careful what they wish for. America’s failure to deal with its internal challenges would come at a steep price. Indeed, the rest of the world’s stake in American success is nearly as large as that of the US itself. Part of the reason is economic. The US economy still accounts for about one-quarter of global output. If US growth accelerates, America’s capacity to consume other countries’ goods and services will increase, thereby boosting growth around the world. At a time when Europe is drifting and Asia is slowing, only the US (or, more broadly, North America) has the potential to drive global economic recovery. The US remains a unique source of innovation. Most of the world’s citizens communicate with mobile devices based on technology developed in Silicon Valley; likewise, the Internet was made in America. More recently, new technologies developed in the US greatly increase the ability to extract oil and natural gas from underground formations. This technology is now making its way around the globe, allowing other societies to increase their energy production and decrease both their reliance on costly imports and their carbon emissions. The US is also an invaluable source of ideas. Its world-class universities educate a significant percentage of future world leaders. More fundamentally, the US has long been a leading example of what market economies and democratic politics can accomplish. People and governments around the world are far more likely to become more open if the American model is perceived to be succeeding. Finally, the world faces many serious challenges, ranging from the need to halt the spread of weapons of mass destruction, fight climate change, and maintain a

functioning world economic order that promotes trade and investment to regulating practices in cyberspace, improving global health, and preventing armed conflicts. These problems will not simply go away or sort themselves out. While Adam Smith’s “invisible hand” may ensure the success of free markets, it is powerless in the world of geopolitics. Order requires the visible hand of leadership to formulate and realize global responses to global challenges. Don’t get me wrong: None of this is meant to suggest that the US can deal effectively with the world’s problems on its own. Unilateralism rarely works. It is not just that the US lacks the means; the very nature of contemporary global problems suggests that only collective responses stand a good chance of succeeding. But multilateralism is much easier to advocate than to design and implement. Right now there is only one candidate for this role: the US. No other country has the necessary combination

of capability and outlook. This brings me back to the argument that the US must put its house in order – economically, physically, socially, and politically – if it is to have the resources needed to promote order in the world. Everyone should hope that it does:

The alternative to a world led by the US is not a world led by China, Europe, Russia, Japan, India, or any other country, but rather a world that is not led at all. Such a world would almost certainly be characterized by chronic crisis and conflict. That would be bad not just for Americans, but for the vast majority of the planet’s inhabitants.

Health AdvantagePrivate/employer based insurance doesn’t cover everyoneLaurence Seidman, 15. 8-1-15. (Seidman, PhD: Prof of economics at University of Delaware. BA from Harvard and PhD from UCal Berkeley. Both in Economics. Very published on health insurance public policy. “The Affordable Care Act versus Medicare for All” Journal of Health Politics, Policy, and Law. [peer-reviewed, associated with Duke]. Accessed 7-19-17. JSD)

Nearly all the problems facing the ACA are the result of retaining the current system of private employer-provided and individual insurance and relying on state governments. Consider the ACA’s reliance on

employerprovided insurance. Under Medicare for All, an individual would be covered regardless of a change in employment. By contrast, under the ACA an individual who loses his or her job will usually lose insurance because buying COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage is usually too expensive for someone without a job. Under Medicare for All, employers would no longer have the burden of providing health insurance [but]; employers would pay a higher Medicare payroll tax (and possibly a new Medicare

value-added tax [VAT]) but then have no further involvement with health insurance. By contrast, under the ACA employers will have to decide whether to provide insurance and how many full-time and part-time employees to hire in light of the new ACA regulations,

exchanges, tax penalties, and tax credits. Consider the ACA’s reliance on private individual insurance. Under Medicare for All, every American would be given a Medicare card for life; there would be no regulations, online exchanges, annual enrollments, tax penalties, or tax credits relating to individual insurance. By contrast,

under the ACA individuals not covered by an employer, Medicaid, or Medicare must secure private individual insurance or pay a tax penalty. To assist these individuals in securing and changing insurance, ACA exchanges must be set up; the insurance can vary the premium according to some criteria but not others. Individuals who buy insurance are eligible for premium tax credits according to their current income, which must be documented each year. A mechanism must be put in place to enable prompt payment of the credit (rather than the usual waiting until the annual tax return is filed), so the individual can afford to pay the insurance premium. A procedure for “risk adjustment” must be established so that insurers who enroll a higherthan-average proportion of high-medical-cost patients do not

experience severe financial losses as a consequence. Consider the ACA’s reliance on state governments as well as the

federal government. Medicare for All would be a federal program. By contrast, under the ACA each state can set up its own exchange provided that it meets ACA criteria. Each state can decide whether to participate in the ACA’s expansion of Medicaid.

Lack of universal insurance leads to tens of thousands of deaths annuallyPeter Singer, 09. 7-19-09 (Singer: bioethics professor at Princeton. Laureate prof at Universtiy of Melbourne. “Why We Must Ration Health Care.” New York Times. Accessed 7-22-17. http://www.med.mcgill.ca/epidemiology/courses/EPIB654/Summer2010/Policy/nytimes%20rationing%202009_07_19.pdf JSD)

Estimates of the number of U.S. deaths caused annually by the absence of universal health insurance go as high as 20,000. One study concluded that in the age group 55 to 64 alone, more than 13,000 extra deaths a year may be attributed to the lack of insurance coverage. But the estimates vary because Americans without health insurance are more likely, for example, to smoke than Americans with health insurance, and sorting out the role that the lack of insurance plays is difficult. Richard Kronick, a professor at the School of Medicine at the University of California, San Diego, cautiously concludes from his own study that there is little evidence to suggest that extending health insurance to all Americans would have a large effect on the number of deaths

in the United States. That doesn’t mean that it wouldn’t; we simply don’t know if it would. In any case, it isn’t only uninsured Americans who can’t afford treatment. President Obama has spoken about his mother, who died from ovarian cancer in 1995. The president said that in the last weeks of her life, his mother “was spending too

much time worrying about whether her health insurance would cover her bills” — an experience, the president

went on to say, that his mother shared with millions of other Americans. It is also an experience more common in the United States than in other developed countries. A recent Commonwealth Fund study led by Cathy Schoen and Robin

Osborn surveyed [of] adults with chronic illness in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United

Kingdom and the United States. Far more Americans reported forgoing health care because of cost. More than half (54 percent) reported not filling a prescription, not visiting a doctor when sick or not getting recommended care. In comparison, in the United Kingdom the figure was 13 percent, and in the Netherlands, only 7 percent. Even among Americans with insurance, 43 percent reported that cost was a problem that had limited the treatment they received

Lack of guaranteed healthcare makes US citizens vulnerable to diseaseKahn 17 [Laura Kahn is the author of One Health and the Politics of Antimicrobial Resistance, Why access to health care is a national security issue, Bulletin of the Atomic Scientists, June 5, 2017, http://thebulletin.org/why-access-health-care-national-security-issue10819] BJ

Early last month, US House Republicans rammed through the American Health Care Act, a remarkably regressive piece of legislation that, among other flaws, would be disastrous for pandemic planning and preparedness. The bill eliminates funding for the Prevention and Public Health Fund, which was created under the 2010 Affordable Care Act to invest in vaccination programs, electronic laboratory reporting of infectious diseases, and infection-prevention programs. Vaccines are an important preventive strategy against deadly pandemics, while electronic lab reporting facilitates a rapid response to disease. In other words, these are precisely the funds that will be needed to prevent the next Ebola or Zika virus from turning into a national catastrophe. In late May, the Congressional Budget Office delivered its projections on the House bill’s costs and impacts, finding that it would leave an estimated 51 million people under the age of 65 uninsured by 2026—23 million more than the estimated 28 million who will be uninsured under the current law. A Senate version of the bill may not pass, which would end Congressional Republicans’ umpteenth attempt to undermine or reverse the Affordable Care Act. But we can be sure their fight will continue, and that has important national security implications even beyond slashing emergency-planning funds (which, by the way, Trump’s proposed federal budget also does). Cutting the Prevention and Public Health Fund, which deals directly with planning for bioterror attacks and pandemics, was only the most obvious way in which the House bill attempted to undermine American security. Over the long term, there is also a movement afoot to put basic health care out of reach of many Americans. Simply making healthcare unaffordable may seem less dramatic than slashing an emergency-preparedness budget, but doing so also

undermines national security. As the Congressional Budget Office report suggests, the American Health Care Act would make healthcare essentially unaffordable for people with pre-existing conditions, because it would allow insurance companies to dramatically increase their premiums. Ten years ago, I wrote about the security impact of the uninsured during the George W. Bush presidency. In 2005, almost 47 million people (about 16 percent of the total US population) were uninsured. Thanks to the Affordable Care Act passed under the Obama administration, that number dropped to a low of 11 percent, according to a Gallup poll taken during the first quarter of 2016. The Affordable Care Act was a big step in the right direction, but it didn’t close the gap, and the national security and public health challenges of having a large fraction of the population uninsured remain as

relevant today as they were a decade ago. Uninsured people delay seeking health care. Once they seek it, often in a busy emergency room, they are typically given less attention than people with insurance. This failure to get care becomes a danger not only for the individual but for the public at large when the problem is a deadly infectious disease. We saw this scenario play out in Dallas during the Ebola crisis of 2014 and 2015. A poor Liberian man, infected with the virus, presented himself to Texas Health Presbyterian Hospital with severe abdominal pain and a high fever. He was examined and sent home with a bottle of antibiotics. Amazingly, he did not set off an Ebola outbreak in his community, though the risk that he could have was significant and the wider public shouldn’t count on being so lucky next time. Before dying, he infected two nurses who had received inadequate training and equipment to protect themselves. During the anthrax crisis of 2001, in which spores of the deadly disease were sent through the US mail, many

people infected were federal employees with health insurance. If these postal workers hadn’t had easy access to health care, the death toll might have been higher than only five; 17 more were infected but survived thanks to timely medical attention. Anthrax spores do not spread from person to person, but it’s no stretch to imagine a different scenario: Suppose a future attack involves smallpox, a highly communicable virus, and that the initial victims are uninsured childcare workers or food handlers. The initial signs of smallpox include fever, chills, and headache. Uninsured victims would likely delay trying to get care, hoping for the symptoms to pass. By waiting they would certainly expose

others to the virus, potentially setting of a pandemic. Countries like Canada, which has universal health coverage and a well-funded public health infrastructure, are much better prepared to handle deadly epidemics. In 2003, Canada confronted Severe Acute Respiratory Syndrome (SARS), which originated in China. A physician from Guangdong province inadvertently infected a number of tourists with the SARS virus, setting off a global pandemic after everyone returned to their home countries.

Risk of an Influenza Pandemic Is High NowWalsh 17 [Bryan Walsh is a contributor to TIME. Previously, he was TIME’s International Editor, its energy and environmental correspondent and was the Tokyo bureau chief in 2006 and 2007. “The World Is Not Ready For The Next Pandemic”, TIME, May 04, 2017, http://time.com/4766624/next-global-security/] BJ

Across China, the virus that could spark the next pandemic is already circulating. It's a bird flu called H7N9, and true to its name, it mostly infects poultry. Lately, however, it's started jumping from chickens to humans more readily--bad news, because the virus is a killer. During a recent spike, 88% of people infected got pneumonia, three-quarters ended up in intensive care with severe respiratory problems, and 41% died. What H7N9 can't do--yet--is spread easily from person to person, but experts know that could change. The longer the virus spends in humans, the better the chance that it might mutate to become more contagious--and once that happens, it's only a matter of time before it hops a plane out of China and onto foreign soil, where it could spread through the air like wildfire. From Ebola in West Africa to Zika in South America to MERS in the Middle East, dangerous outbreaks are on the rise around the world. The number of new diseases per decade has increased nearly fourfold over the past 60 years, and since 1980, the number of outbreaks per year has more than tripled. Some recent outbreaks registered in the U.S. as no more than a blip in the news, while others, like Ebola, triggered an intense but temporary panic. And while a mutant bug that moves from chickens in China to humans in cities around the world may seem like something out of a Hollywood script, the danger the world faces from H7N9--and countless other pathogens with the potential to cause enormous harm--isn't science fiction. Rather, it's the highly

plausible nightmare scenario that should be keeping the President up at night. The U.S. Centers for Disease Control and Prevention (CDC) ranks H7N9 as the flu strain with the greatest potential to cause a pandemic--an infectious-disease outbreak that goes global. If a more contagious H7N9 were to be anywhere near as deadly as it is now, the death toll could be in the tens of millions.

H7N9 Is Already Mutating Quickly Schmitz 17 [Rob Schmitz is the Shanghai Correspondent for NPR. “Why Chinese Scientists Are More Worried Than Ever About Bird Flu”, NPR, April 11, 2017, http://www.npr.org/sections/goatsandsoda/2017/04/11/523271148/why-chinese-scientists-are-more-worried-than-ever-about-bird-flu] BJ

The birds that were quick to die of H7N9 were all chickens. This was a surprise, because chickens normally live with the virus in what's known as a low pathogenic state — they carry the virus but don't die from it and have a low capacity to spread it. Guan and his team discovered the H7N9 strain had mutated into a new form that kills chickens even more quickly. "Ten years ago, H7N9 was less lethal," says Guan. "Now it's become deadlier in chickens. Before it barely affected chickens. Now many are dying. Our research shows it can kill all the chickens in our lab within 24 hours. If this latest mutation isn't stopped, more will die." Guan says this is very bad news for a global poultry industry that's worth hundreds of

billions of dollars, and he says China's government is already looking into vaccinating chickens. What worries Guan more, though, is that H7N9 has proved an ability to mutate quickly. There's no evidence that the virus has become more deadly in people. But already, in the rare cases when humans catch it from birds, more than a third of them die.

Mutations risk the extinction of human lifeDarling & Schulze-Makuch 12 [David Darling is an astronomer. Dirk Schulze-Makuch is an astrophysicist at Washington State University, “9 Strange Ways the World Really Might End”, Seattle's Big Blog, March 18th 2012, http://blog.seattlepi.com/thebigblog/2012/03/18/9-strange-ways-the-world-really-might-end/?fb_xd_fragment] BJ

Our body is in constant competition with a dizzying array of viruses, bacteria, and parasites, many of which treat us simply as a source of food or a vehicle for reproduction. What’s troubling is that these microbes can mutate and evolve at fantastic speed – the more so thanks to the burgeoning human population – confronting our bodies with new dangers every year. HIV, Ebola, bird flu, and antibiotic-resistant “super bugs” are just a few of the pathogenic threats to humanity that have surfaced over the past few decades. Our soaring numbers, ubiquitous international travel, and the increasing use of chemicals and biological agents without full knowledge of their consequences, have increased the risk of unstoppable pandemics arising from mutant viruses and their ilk. Bubonic plague, the Black Death, and the Spanish Flu are vivid examples from history of how microbial agents can decimate populations. But the consequences aren’t limited to a high body count. When the death toll gets high enough, it can disrupt the very fabric of society. According to U.S. government studies, if a global pandemic affecting at least half the world’s population were to strike today, health professionals wouldn’t be able to cope with the vast numbers of sick and succumbing people. The result of so many deaths would have serious implications for the infrastructure, food supply, and security of 21st century man. While an untreatable pandemic could strike suddenly and potentially bring civilization to its knees in weeks or months, degenerative diseases might do so over longer periods. The most common degenerative disease is cancer. Every second men and every third women in the western world will be diagnosed with this disease in their lifetime. Degeneration of our environment through the release of toxins and wastes, air pollution, and intake of unhealthy foods is making this problem worse. If cancer, or some other form of degenerative disease, were to become even more commonplace and strike before reproduction, or become infectious (as seen in the transmitted facial cancer of the Tasmanian Devil, a carnivorous marsupial in Australia) the very survival of our species could be threatened.

Racial Inequality AdvantageCurrent Healthcare Policies Disproportionately Punish MinoritiesRandall 02 [Vernelia Randall is a professor at the Dayton School of Law, Randall writes extensively on and speaks internationally about race, women, and health care, INSTITUTIONAL RACISM AND RACIAL DISCRIMINATION IN THE U.S. HEALTH CARE SYSTEM, Fall 2002, http://academic.udayton.edu/health/07humanrights/racial01c.htm] BJ

Compounding the racial discrimination experienced generally is the institutional racism in health care that affects minority access to health care

and the quality of health care received. (59) Despite efforts over the past thirty *54 years to eliminate discrimination and reduce racial segregation, there has been little change in the quality of, or access to, health care for many minorities. According to the U.S. Commission on Civil Rights, "Despite the existence of civil rights legislation equal treatment and equal access are not a reality for racial/ethnic minorities and women in the current climate of the health care industry. Many barriers limit both the quality of health care and utilization for these groups, including ... discrimination."(60) Racial discrimination

in health care delivery, financing, and research continues to exist, and racial barriers to quality health care manifest themselves in a number of

ways. A. Lack of Economic Access to Health Care More than 38.4 million Americans are uninsured with no economic access to health care.(61) A disproportionate number of the uninsured are racial minorities.(62) As access to health insurance in the United States is most often tied to employment, racial stratification of the economy due to other forms of discrimination has resulted in a concentration of racial minorities in low wage jobs. These jobs are almost always without insurance benefits.(63) As a result, disproportionate numbers of the uninsured are racial minorities. Recent changes in the "safety net" have resulted in increased problems.(64) Specifically, welfare reform enacted in 1996 changed the structure of public assistance, resulting in a disparate impact on women and minorities.(65) One of the direct effects of welfare reform has been a reduction in the use of medicaid by those who qualify due to an unawareness of eligibility *55 requirements, resulting in an increased number of uninsured.(66) A second effect has been that the subsequent increased poverty among those in need of assistance has caused a worsening of health status and an increase in the need for health care services.(67) In fact, a disproportionate number of racial minorities have no insurance, are unemployed, are employed in jobs that do not provide health care insurance, are disqualified for government assistance programs, or fail to participate because of administrative barriers.(68) Gaps in health status and the absence of relevant health information are directly related to access to health care.(69)

These disparities arise early on, as black people are less likely to receive appropriate preventative careRandall 02 [Vernelia Randall is a professor at the Dayton School of Law, Randall writes extensively on and speaks internationally about race, women, and health care, INSTITUTIONAL RACISM AND RACIAL DISCRIMINATION IN THE U.S. HEALTH CARE SYSTEM, Fall 2002, http://academic.udayton.edu/health/07humanrights/racial01c.htm] BJ

Differences in health status reflect, to a large degree, inequities in preventive care and treatment. For instance, African-Americans are more likely to require health care services, but are less likely to receive them.(79) Disparity in treatment has been well documented in a number of studies, including studies done on AIDS,(80) cardiology,(81) cardiac surgery,(82) kidney disease,(83) organ transplantation,(84) internal medicine,(85) obstetrics,(86) prescription drugs,(87) treatment for

mental illness,(88) pain treatment,(89) and hospital care.(90) Certainly, difference in treatment can be based on a

number of different factors, including clinical characteristics, income, and medical or biological differences. However, race plays an independent role.(91) There are marked differences in time spent, quality of care and quantity of doctor's office visits between Whites and African-Americans.(92) Whites are *58 more likely to receive more, and more thorough, diagnostic work and better treatment and care than people of color -- even when controlling for income, education, and insurance.(93) Differences also exist in the number of doctor's office visits between Whites and African- Americans, even when controlling for income, education, and insurance.(94) Furthermore, researchers have concluded that doctors are less aggressive when treating minority patients.(95) Thus, the most favored patient is "White, male between the ages of 25 and 44."(96) In fact, at least one study indicated a combined effect of race and gender resulting in significantly different health care for African-American women. (97)

Structural Violence is a form of genocide that must be rejectedAhmed 07 [Nafeez Ahmed is Executive Director of the Institute for Policy Research and Development. “Structural Violence as a Form of Genocide: The Impact of the International Economic Order”, Revista Interdisciplinar (5), Octoboer 2007, pgs 4-5, http://www.academia.edu/1608077/Structural_Violence_as_a_Form_of_Genocide_The_Impact_of_the_International_Economic_Order] BJ

 

This form of structural violence, through the international economic order’s systematic generation of human insecurity, has led to the deaths of countless hundreds of millions of people, and the deprivation of thousands of millions of others. Most of the literature on human security, development, and genocide fails to see this phenomenon of global mass death and marginalization —a consequence of structurally-induced deprivation— as a form of genocide. In this paper, I question this failure and attempt to explore whether this form of structural violence should indeed be seen as a form of genocide. The main premises for my argument are that there are a variety of inadequacies in existing conceptualizations of genocide and structural violence. In Chapter 1, I

argue that conventional conceptualizations of genocide must be re- vised in order to account for a broader range of potential targeted groups. The categories of groups that can constitute targets of genocidal acts must be widened to include not only concepts of nationality, ethnicity, and religion, but also concepts that include other bases of collectivity and group identification/organization relevant to both the victims and perpetrators of genocide -such as cultural, ideological, class and political forms. I begin by examining the UN Convention on Genocide and predominantly ethnically focused definitions. By critiquing conceptualizations of ethnicity as problematic, in some senses subjective, and fraught with definitional ambiguity, I argue that the exclusion of other forms of group identity is arbitrary and ill-founded. Thus, I will argue that the logical underpinnings of the concept of genocide require a broader application than that espoused by the UN. In Chapter 2, I argue that the categories of method that can be employed in genocidal acts must be widened to include not merely direct, physical forms of violence, but also indirect, structural forms of violence. While there is certainly some significant recognition of this in the literature, its implications for the international economic order have been little explored. Nor has a more systematic theoretical articulation of the relationship between structural violence and genocide been conducted. This argument is premised on the idea that existing conceptualizations of structural violence must be expanded. Structural violence is of-ten viewed as a distinct form of violence to that produced directly, physically, militarily by specific agents, resulting instead from the operation of a given social system possessing a particular unequal structure and hierarchy. Due to this more abstract causal context, the role of specific agents in producing structural violence is often excluded or not properly recognized. Indeed, I will argue that no structure can be abstracted from the activity of specific agents. The

actions of human agency are reciprocally related to the operation of social systems. This inevitably means that in any critical analysis of unequal social structures, the pivotal role of agents such as states, governments, and institutions - and their policies, intentions and interests - cannot be ignored. For structures to be fully understood, the relevant agents must also be included in the analysis. Hence, a slightly revised conceptualization

of structural violence is intrinsically connected to the question of responsibility. While the causes of structural violence lead us to critically analyze social structures and systems the critique needs to be extended to include the agents responsible for erecting the very architecture underlying or constituting these structures and systems. I intend to integrate a Weberian theory of the relationship between structure and agency with the concept of structural violence. Doing so may, in some cases, suggest a

deep-seated intentionality underlying the structural violence produced by the international economic order against the South, which is relevant to assessing its genocidal import.

Single-Payer reframes healthcare as a right, reducing the profit and discrimination incentive within healthcare Caruso et al., 15 [Dominic F. Caruso, MD/MPH Candidate; David U. Himmelstein, MD; Steffie Woolhandler, MD, “Single-Payer Health Reform: A Step Toward Reducing Structural Racism in Health Care”, Harvard Public Health Review (Volume 6), July 2015, http://harvardpublichealthreview.org/single-payer-health-reform-a-step-toward-reducing-structural-racism-in-health-care/] BJ

In our view a national single-payer health insurance program offers the best possibility for equitable financing of U.S. health care. It would eliminate the motive to deny needed care or discriminate against the expensively ill for the sake of profit. A national public insurance system would provide coverage based on residence in the U.S., not employment status, income level or ability to pay, as in the current regime. A program that abolished co-payments and deductibles would level the playing field for minorities and the poor who generally lack the assets to surmount these barriers.22 A single-payer system would also offer economic benefits. A federally-run financing system would have far lower administrative costs than private insurance, as the Medicare program consistently demonstrates. A universal public model would lift a significant financial burden from businesses that currently fund health insurance for their employees. Finally, a single-payer program would largely eliminate the financial burden of illness, a

leading cause of bankruptcy and debts sent to collection.[19].23 Perhaps most importantly, a single-payer system would make a clear statement that health care is a human right. This framework recognizes health care as a universal necessity, not a commodity reserved for those lucky enough to have won the economic lottery, and most definitely not a scheme for denial and discrimination. While implementing a single-payer insurance program will not solve all of our nation’s health, racial or social inequities, it is clearly a step in that direction.

Income Inequality AdvantageRising healthcare costs are a large driver of income inequalityBlumenthal & Squirles 14 [David Blumenthal, M.D., M.P.P., is president of The Commonwealth Fund, a national philanthropy engaged in independent research on health and social policy issues. David A. Squires, M.A., is the former senior researcher to The Commonwealth Fund’s president. Do Health Care Costs Fuel Economic Inequality in the United States?, Tuesday, September 9 th, 2014, http://www.commonwealthfund.org/publications/blog/2014/sep/do-health-costs-fuel-inequality] BJ

Dr. Blumenthal is formerly the Samuel O. Thier Professor of Medicine at Harvard Medical School and Chief Health Information and Innovation Officer at Partners Healthcare System in Boston. From 2009 to 2011, he served as the National Coordinator for Health Information Technology,

The growing debate over economic inequality in the developed world, highlighted by Thomas Piketty’s Capital in the Twenty-First Century, raises an interesting question that is particularly pertinent to the United States. Have escalating health care costs contributed to the huge

economic gap between America’s rich and the rest? The evidence, it turns out, is suggestive, but not definitive. From the perspective of the more than 150 million Americans who receive health insurance through their employers, health care costs may, in fact, be widening inequality. Economists generally agree that employers for the most part treat workers’ compensation in all forms—wages and benefits—as a single expense. When health insurance premiums go up, employers may reduce take-home pay to keep overall compensation in check. Because health costs have grown so quickly over the past several decades, an increasing share of workers’ total compensation has gone toward health insurance premiums. These higher premiums partly explain why middle-class wages have stagnated, lagging productivity gains. Rising health care spending—both on premiums and out-of-pocket costs—totally erased wage gains for a typical family from 1999 to 2009. To illustrate, Exhibit 1 compares health insurance premiums relative to income for U.S.

families in the bottom 40 percent of the nation’s income distribution versus the top 5 percent. From 1988 to 2012, the average employer-sponsored insurance premium rose from $3,660 to $15,745. For families in the lower-income bracket, that represents an increase from 13 percent to 60 percent of average annual income. For those in the upper-income bracket, premium increases amounted only to a rise from 1.4 percent to 4.5 percent of income—a much smaller drain on workers’ take-home pay. Still, there are important nuances. The insurance coverage provided through employer-sponsored plans may have disproportionate value for lower-income workers. If they use more health care than their better-paid coworkers, they may gain more economic benefit from their health insurance. This could be the case for the many lower-income Americans in poor health. However, rising deductibles and copayments have reduced the value of health insurance over time, and these out-of-pocket costs weigh more heavily on low-income workers. Also, the added benefits may not be worth the disproportionate

economic burden imposed on lower-income employees. The Institute of Medicine estimates that about 30 percent of health care expenditures are wasteful. For lower-income workers, wasting 30 percent of what they pay for health care is a far greater burden than it is for higher-income employees. In other words, if the health care system were more efficient and less costly, lower-income workers might gain considerably more—as a proportion of total compensation—than higher-income workers. Other evidence

of the inequality-increasing effects of high health care costs emerges in a 2011 blog post by The Commonwealth Fund’s Sara Collins. According to a then-new Census Bureau measure, the national poverty rate increased by 3.3 percentage points, or by about 10 million people, when family incomes were adjusted for out-of-pocket medical costs (Exhibit 2). In other words, health care costs may be directly increasing the number of Americans living in poverty. This is consistent with the observation that health care–related expenses contribute to more than half of personal bankruptcies in the United States. Most of these medical debtors worked in middle-class occupations and had health insurance. The story, however, does not end here. As health care costs rise, the amount of money effectively transferred to low-income Americans through

public health care programs like Medicaid and Medicare increases as well, reducing social inequality. Two-thirds of Medicare funds and 83 percent of Medicaid funds are spent on care for the poorest 40 percent of the population.

HR 676 Reduces This Inequality Through Progressive TaxationFriedman 13 [Gerald, PhD, Gerald Carl Friedman is an economics professor at the University of Massachusetts at Amherst, Funding HR 676: The Expanded and Improved Medicare for All Act How we can afford a national single-payer health plan, July 31, 2013, p. 1 http://www.pnhp.org/sites/default/files/Funding%20HR%20676_Friedman_7.31.13_proofed.pdf] BJ

Health expenditures under the existing health care system are projected to total $3.13 trillion in 2014, plus $32 billion in spending by employers for administering employer-based health insurance plans.1 Health care financing in the U.S. is highly regressive, with low-income households and those dealing with serious illness or injury paying larger shares of their incomes towards health care than high-income and healthy households. Under HR 676, progressive federal taxes (i.e. taxes that reduce the proportion of income paid by low-income households and those faced with a serious illness for medical care) would replace current regressive, income-invariant sources of health care financing such as spending by businesses and 80% of outof-pocket spending by individuals.2 Progressive federal taxes would also replace regressive and obsolete funding sources including federal, state, and local government spending on private health insurance for government employees, and state and local government spending on Medicaid and other health programs . According to data from the Centers for Medicare and

Medicare Services (CMS), these expenditures will total $1,723 billion in 2014. See Table 1. Current spending on federal government programs to be applied to funding HR 676 amounts to $1,344 billion.3 This includes federal spending for the Medicare program, the Medicaid program, and the Children’s Health Insurance Program. Other funding sources include $47 billion in revenue from new Medicare taxes included in the Affordable Care Act of 2010, and the remaining 20% of out-of-pocket spending by individuals. Together, these funding sources amount to $1,454 billion of spending retained for funding HR 676 in 2014

Income Inequality (Tanks The Economy) and Fuels Conflicts – Several ReasonsDabla-Norris et al, 15 [Era Dabla-Norris is a Division Chief in the IMF's Fiscal Affairs Department, "Causes and Consequences of Income Inequality: A Global Perspective” International Monetary Fund, June 2015, pgs. 8-9 https://www.imf.org/external/pubs/ft/sdn/2015/sdn1513.pdf] BJ

Inequality dampens investment, and hence growth, by fueling economic, financial, and political instability. Financial crises. A growing body of evidence suggests that rising influence of the rich and stagnant incomes of the poor and middle class have a causal effect on crises, and thus directly hurt short- and long-term growth.5 In particular, studies have argued that a prolonged period of higher inequality in advanced economies was associated with the global financial crisis by intensifying leverage, overextension of credit, and a relaxation in mortgage-underwriting standards (Rajan 2010), and allowing lobbyists to push for financial deregulation (Acemoglu 2011). Global imbalances. Higher top income shares coupled with financial liberalization, which itself could be a policy response to rising income inequality, are associated with substantially larger external deficits (Kumholf and others 2012). Such large global imbalances can be challenging for macroeconomic and/or financial stability, and thus growth

(Bernanke 2011). Conflicts. Extreme inequality may damage trust and social cohesion and thus is also associated with conflicts, which discourage investment. Conflicts are particularly prevalent in the management of common resources

where, for example, inequality makes resolving disputes more difficult; see, for example, Bardhan (2005). More broadly,

inequality affects the economics of conflict, as it may intensify the grievances felt by certain groups or can reduce the opportunity costs of initiating and joining a violent conflict (Lichbach 1989). 11. Inequality can lead to policies that hurt growth. In addition to affecting growth drivers, inequality could result in poor public policy choices. For example, it can lead to a backlash against growth-enhancing economic liberalization and fuel protectionist pressures against globalization and market-oriented reforms

(Claessens and Perotti 2007). At the same time, enhanced power by the elite could result in a more limited provision of public goods that boost productivity and growth, and which disproportionately benefit the poor (Putnam 2000; Bourguignon and Dessus 2009).

SolvencyThus, the plan: the United States Federal Government should expand Medicare to all citizens of the United States.Tax mechanism is an easy shift and equalizes burdens of the systemLaurence Seidman, 13. (Seidman: Prof of economics at University of Delaware. Pretty heckin’ published on health policy “Medicare for All: An Economist’s Case” Challenge. Vol 56 no1. Accessed 7-22-17. http://www.maineallcare.org/pdf/MedicareforAll.pdf JSD)

Medicare for All would eliminate premiums and replace them with a set of taxes earmarked for Medicare for All. Rather than funding it with a single tax at a high rate, I recommend using a set of taxes, each with a moderate rate. This approach is likely to impose less efficiency loss on the economy than a single tax with a high rate because public finance economists have shown that the efficiency loss from a tax generally rises with the square of the tax rate (Seidman 2009). Moreover, a set of taxes often spreads the burden more fairly across the population than a single tax that might especially burden one group while imposing little or no burden on others. Several of the taxes I recommend are already in place in the United States, and several would be new. One tax currently in place is the Medicare payroll tax (currently 1.45 percent on the employer and 1.45 percent on the employee—a combined rate of

2.90 percent on all wage income). The tax that would be new to the United States is the VAT, which is used successfully by virtually every economically advanced country. Many U.S. economists have recommended a U.S. VAT (Hines 2007; Seidman 2004), and several analysts have recommended that a VAT be enacted and earmarked for universal health insurance

(Burman 2009; Morone 2002). It should be recognized that when taxes are levied on business firms (such as the VAT or the

payroll tax), people bear the tax burden. If businesses raise prices in response to paying taxes, consumers bear some burden. If businesses pay lower wages in response to paying taxes, workers bear some burden. If businesses pay smaller dividends or profits to investors

or owners in response to paying taxes, then investors or owners bear some burden. Everyone would bear some burden from the earmarked Medicare for All taxes levied on businesses. Seidman 92 Challenge/January–February 2013 Virtually everyone would be “paying for”—bearing some burden of— Medicare for All earmarked taxes that are levied on

business firms. There would be no free riders. Raising the payroll tax above its current 2.90 percent would be simple to administer and require no new legislation other than raising the number 2.90 to a higher value. It would

require no new tax administration. By contrast, a VAT would require new legislation and new administration. But there has been so much practical experience administering a VAT in other economically advanced countries that it would be relatively easy for the United States to get a VAT up and running. A VAT would increase the prices of most goods and services, and economic analysis shows that most of the tax burden would fall on consumers. Because of the effect on prices, a

VAT should be phased in gradually over several years. Using both the Medicare payroll tax and a VAT would prevent free riding under Medicare for All because everyone would bear some burden through either lower take-home pay or higher prices and would therefore be making some financial contribution to Medicare for All. The new Medicare for All income

Plan inevitable – triggers neg disads. Pass now to mitigate harms in the squoRichard Eskow, 7-12-17. (Eskow: huffpost contributor. Senior Fellow for Campaign for America’s Future and Host of “The Zero Hour”. “Medicare for All Is Coming, No Matter What They Say.” Huffington Post. Accessed 7-18-17 http://www.huffingtonpost.com/entry/medicare-for-all-is-coming-no-matter-what-they-say_us_5966470ae4b0deab7c646d45 JSD.)

The transition to a single-payer system will be complex, but despite what the no-can-doers say, it is achievable. None

of the obstacles that are cited are insurmountable. One-third of our health economy is already managed through government programs. Our best minds should be tackling the challenge of reforming the remaining two-thirds. We have already have built some of the infrastructure and expertise we will need. Medicare For All is not

only achievable. It’s inevitable. Health care costs are already too high for most Americans, even those with “good” insurance . The demand for a better-run public system will only grow in the years to come. It’s easy to understand why the Washington Post, with its history of hostility to social spending, would oppose Medicare For All./ But why is there such entrenched opposition

among some liberals? Some Democrats want to defend the Affordable Care Act out of loyalty, because it’s a Democratic program. Some

people have developed deep expertise in the current, flawed system. Consciously or unconsciously, they will be inclined to resist changes that render their knowledge obsolete. Other people want to be proven right about politics, and they’ve staked their reputation on claiming that single-payer is a “hard sell” because it will raise taxes. Actually, it’s an easy sell: I can save you thousands of dollars a year by replacing a terrible system with a much better one. People say Medicare For All is “politically unfeasible.” But the past ten years have taught us that it’s politically unfeasible to aim for anything less. Many single-payer advocates are also defending the ACA today for a very simple reason: people will die if it’s

repealed. But people are dying right now because we don’t have a national health care system.

Extensions

Econ

UQPrivate healthcare industries have inflated medical care costsFriedman 15 [Gerald, PhD, Gerald Carl Friedman is an economics professor at the University of Massachusetts at Amherst, Testimony of Professor Gerald Friedman to the Rhode Island House Finance Committee in support of H5387, May 26, 2015, pgs. 1-2 http://harddeadlines.com/sites/default/files/Friedman_Testimony_May_26_2015_to_Rhode_Island_150526_edited.pdf] BJ

Of course, we will control health care spending and we will do it in one of two ways: either we will control administrative bloat, monopoly pricing and excessive profits, or we will reduce access to health care services. So far, as a nation, we have been doing the latter, reducing access to services with higher copayments and deductibles to the point where Americans are less likely to see a physician than residents of other

affluent countries and thousands die for lack of care. This is clearly wrong. While these policies discourage people from using health care and will make us less healthy, they do not address the source of America’s out-of-control health care spending. International studies make it clear that our health care spending is not high because we use too many services; instead, our spending is out of line with other advanced economies because our health care prices are so high. The McKinsey Global Institute has found, for example, that drug prices in the United States are 60% higher than elsewhere and that we spend about $30 billion more on medical devices because of inflated prices - over 25% higher than the world average. 1 The Massachusetts Attorney General’s office has found enormous variation in hospital prices for the same procedures reflecting the bargaining power of privileged hospitals.2 Other business-oriented researchers have similarly found that inflated prices and monopoly power, not utilization, account for high and rising health care costs in the United States.3 High and rising prices for health care in the United States are due to our reliance on a for-profit financing system that necessarily generates waste and cannot control monopolistic practices. I do not mean to name-drop, but of course, I will. My graduate-school professor, then Harvard Professor and Nobel-laureate Kenneth Arrow, showed 50 years ago that health care is not a commodity like shoes; because of risk and uncertainty, we cannot

expect health insurance markets to function like those of other commodities.4 Insurance companies do not profit by selling more; instead, they profit by screening their customers so that they sell less insurance to people who will need it.5 In his coffee business, for example, my father tried to provide quality coffee at a reasonable price because his profits grew when he sold more coffee to more people.

Similarly, Current Administrative Policies Magnify Costs Friedman 15 [Gerald, PhD, Gerald Carl Friedman is an economics professor at the University of Massachusetts at Amherst, Testimony of Professor Gerald Friedman to the Rhode Island House Finance Committee in support of H5387, May 26, 2015, pgs. 1-2 http://harddeadlines.com/sites/default/files/Friedman_Testimony_May_26_2015_to_Rhode_Island_150526_edited.pdf] BJ

Our health care cost crisis is driven by administrative waste due to the insurance industry and to monopolistic pricing. The Affordable Care Act limits administrative costs and profits to only 15% of the standard group insurance plan, a rate that is nearly ten times the administrative rate of Medicare, with nearly $200 billion dollars of extra costs. The fastest increases in cost in the American health care system over the last decades have been in drug prices and administrative activities.6 Administrative costs have risen in the United States at a rate of over 11% a year since 1971, rising from a bit over 1% of GDP to over 5% now. Compared with Canada’s single payer system, administrative cost increases account for over two-thirds of the excess increase in our health care costs. Perhaps most revealing, there is no difference between the cost increases in Canada’s Medicare single-payer system and our Medicare

single-payer-system for the elderly; had all of the US health care system behaved like our Medicare system, we would be spending a third less than we spend now, about what Canada spends per person to gain longer life expectancy than we have in the United States

Solvency – admin costsSingle payer eliminates $350 in admin costsJiwani et al, 14 [Aliya Jiwani, health policy researcher and lead author of the journal report, which was published by the journal BMC Health Services Research: Jiwani et al. Billing and insurance related administrative costs in U.S. health care: synthesis of micro-costing evidence. BMC Health Services Research (13 Nov 2014). 14:556 DOI 10.1186/s12913-014-0556-7 http://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-014-0556-7?site=bmchealthservres.biomedcentral.com ]

BIR costs in the U.S. health care system totaled approximately $471 ($330 – $597) billion in 2012. This includes $70 ($54 – $76) billion in physician practices, $74 ($58 – $94) billion in hospitals, an estimated $94 ($47 – $141) billion in settings providing other health services and supplies, $198 ($154 – $233) billion in private insurers, and $35 ($17 – $52) billion in public insurers. Compared to simplified financing, $375 ($254 – $507) billion, or 80%, represents the added BIR costs of the current multi-payer system. Conclusions: A simplified financing system in the U.S. could result in cost savings exceeding $350 billion annually, nearly 15% of health care spending. In a well-functioning health care system, sound administration is required to ensure efficient operations and quality outcomes. In the United States however, the complex structure of health care financing has led to a large and growing administrative burden [1]. In 1993, administrative personnel accounted for 27% of the health care workforce, a 40% increase over 1968 [2]. Similarly, administrative costs as a percentage of total health care spending more than doubled between 1980 and 2010 [3]. Private insurers’ overhead costs have also increased sharply, rising 117 per- cent between 2001 to 2010 [4]. In the U.S. multi-payer system, insurers’ coverage, billing and eligibility requirements often vary greatly, requiring providers to incur added administrative effort and cost [5]. These payment-related activities can be termed “billing and insurance-related” (BIR).

Medicare eliminates administrative waste, saves $400b a year Himmelstein and Woolhandler, 15 [by Drs. David Himmelstein and Steffie Woolhandler at the Centers for Medicare and Medicaid Services (CMS), who are professors at the City University of New York School of Public Health at Hunter College and lecturers in medicine at Harvard Medical School. Their research interests include the administrative costs of U.S. health care. They co-founded Physicians for a National Health Program. The Post-Launch Problem: The Affordable Care Act’s Persistently High Administrative Costs; p. 1, 27, May 2015. http://healthaffairs.org/blog/2015/5/27/the-post-launch-problem-the-affordable-care-acts-persistently-high-administrative-costs

The authors calculated yearly estimates for private insurance overhead and government program administration costs both with, and without, the effects of the ACA. “Nearly two-thirds of this new overhead – $172.2 billion – will go for increased private insurers’ administrative costs and profits,” while the rest of the added overhead “is attributable to expanded government programs, i.e. Medicaid. But even the added dollars to administer Medicaid will flow mostly to private Medicaid HMOs, which will account for 59 percent of total Medicaid administrative costs in 2022.” By way of alternatives, they point to traditional Medicare, which runs for about 2 percent overhead. Were the 22.5 percent overhead figure associated with the ACA to drop to traditional Medicare’s level, the U.S. would save $249.3 billion by 2022. The overhead rates of universal, single-payer systems such as

Taiwan’s or Canada’s are even lower, closer to 1 percent, adding that if the U.S. were to adopt a single-payer system, the savings on bureaucracy and paperwork would amount to about $375 billion annually, enough to provide high-quality, first-dollar coverage to all Americans. “In health care, public insurance gives much more bang for each buck.”

Medicare lowers administrative costs drastically compared to private insuranceDaniel Marans, 3-9-17. (Marans: Staff Writer. Citing a infographic from America’s Health Insurance Plans – the trade group for commercial health insurance. “Insurance Companies Jut Accidentally Made the Case for Medicare for All.” Huffpost Accessed 7-19-17. http://www.huffingtonpost.com/entry/insurance-companies-medicare-for-all_us_58c1b1fae4b054a0ea690dc8 JSD)

The group apparently crafted the visual aid to defend rising premiums its member companies are charging customers. But the chart also

inadvertently helps explain why commercial health insurance is a bad deal. The graphic shows that about 80 percent of every premium dollar goes toward medical expenses ― prescription drugs, doctor visits, hospitalization and other

services. Approximately 18 percent goes to administrative costs, and some 3 percent is profit. (The total is more than 100 percent because of rounding. America’s Health Insurance Plans explains how it gathered the figures for its infographic here.)

AHIP America’s Health Insurance Plans created a graphic to show where your premium dollars go. By contrast, Medicare, the largest

U.S. public insurer, paid just 1.5 percent of its budget to administer traditional insurance plans for seniors and

workers with severe disabilities in 2015, according to official data. The rest of Medicare’s budget went to paying doctors, hospitals, drug companies and other health care providers. When you account for administrative costs of Medicare’s private plans, which cover some one-third of Medicare beneficiaries, Medicare’s overhead approaches 6.4 percent of its budget. The comparison shows that expanding Medicare to cover the entire population ― or

adopting a single-payer health insurance system ― would significantly reduce health care costs by eliminating a whole lot of expenses that aren’t related to medical care. That’s in part because Medicare does not have to advertise its services, make a profit for investors, or reward its executives with multi-million-dollar compensation packages, as private insurers do.

Medicare for All eliminates both marketing and administrative costsLaurence Seidman, 13. (Seidman: Prof of economics at University of Delaware. Pretty heckin’ published on health policy “Medicare for All: An Economist’s Case” Challenge. Vol 56 no1. Accessed 7-22-17. http://www.maineallcare.org/pdf/MedicareforAll.pdf JSD)

Marketing costs are substantial under a private health insurance system. How many ads have you seen by private

health insurance companies? These ads are costly and the cost is built into the premiums that these companies charge and that people bear. These costs disappear under Medicare for All, as do the costs of enrolling or

cancelling people in private insurance plans and negotiating contracts with providers. Medical provider administrative costs would be substantially reduced. Most doctors and hospital administrators justifiably complain about the significant staff costs they incur because their patients are covered by numerous different insurance plans that each have different payment and coverage rules. Under Medicare for All, all patients would be under one insurance plan. Administrative costs have been much lower under Canada’s single payer system than under the U.S.

multiple private insurance system (Cutler and Ly 2011; Woolhandler, Campbell, and Himmelstein 2003). The costs of processing bills submitted by doctors and hospitals to the insurer would remain. The bills would now be submitted to Medicare for

All instead of to numerous private insurance companies, but Medicare for All would do what Medicare has done for half a century: contract with private insurance companies to process bills submitted by doctors and

hospitals. There would, however, be no billing or collecting from patients, thereby achieving a substantial reduction in administrative cost.

HR 676 Would Save Billions Immediately, And Is the Best Way to Guarantee Expanded CoverageFriedman 13 [Gerald, PhD, Gerald Carl Friedman is an economics professor at the University of Massachusetts at Amherst, Funding HR 676: The Expanded and Improved Medicare for All Act How we can afford a national single-payer health plan, July 31, 2013, p. 1 http://www.pnhp.org/sites/default/files/Funding%20HR%20676_Friedman_7.31.13_proofed.pdf] BJ

The Expanded and Improved Medicare for All Act, HR 676 , introduced into the 113th Congress by Rep. John Conyers Jr. and 37 initial co-sponsors, would establish a single authority responsible for paying for medically necessary health care for all residents of the United States. Under the single-payer system created by HR 676, the U.S. could save an estimated $592 billion annually by slashing the administrative waste associated with the private insurance industry ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion). In 2014, the savings would be enough to cover all 44 million uninsured and upgrade benefits for everyone else. No other plan can achieve this magnitude of savings on health care. Specifically, the savings from a single-payer plan would be more than enough to fund $343 billion in improvements to the health system such as expanded coverage, improved benefits, enhanced reimbursement of providers serving indigent patients, and the elimination of co-payments and deductibles in 2014. The savings would also fund $51 billion in transition costs such as retraining displaced workers and phasing out investorowned, for-profit delivery systems. Health care financing in the U.S. is regressive, weighing heaviest on the poor, the working class, and the sick. With the progressive financing plan outlined for HR 676 (below), 95% of all U.S. households would save money. HR 676 (Section 211, Appendix 2) specifies a financing plan for single-payer that includes • Maintaining current federal financing for health care • Increasing personal income taxes on the top 5% of income earners • Instituting a modest tax on unearned income • Instituting a modest and progressive tax on payroll, selfemployment • Instituting a small tax on stock and bond transactions The following progressive financing plan would meet the specifications of HR 676: • Existing sources of federal revenues for health care • Tax of 0.5% on stock trades and 0.01% tax per year to maturity on transactions in bonds, swaps, and trades • 6% high-income surtax (applies to households with incomes > $225,000) • 6% tax on unearned income from capital gains, dividends, interest, profits, and rents • 6% payroll tax on top 60% of income earners (applies to incomes over $53,000, tax paid by employers) • 3% payroll tax on the bottom 40% of income earners (applies to incomes under $53,000, tax paid by employers) HR 676 would also establish a system for future cost control using proven-effective methods such as negotiated fees, global budgets, and capital planning. Over time, reduced health cost inflation over the next decade (“bending the cost curve”) would save $1.8 trillion, making comprehensive health benefits sustainable for future generations.

Solvency – cost containmentMedicare for All drives down competitive pricing and proceduresTim Worstall, 15. 9-21-15. (Worstall: Contributor. Fellow at Adam Smith Institute. “Bernie Sanders’ Medicare for All Plan Misses the Largest Cost of the Plan – Deadweight Costs.” Forbes. Accessed 7-19-17 https://www.forbes.com/sites/timworstall/2015/09/21/bernie-sanders-medicaid-for-all-plan-misses-the-largest-cost-of-the-plan-deadweight-costs/2/#6b6df6936af5 JSD.)

And if we raised the money through the tax system then that's notably more efficient in collection costs than private sector companies sending out invoices and all the rest. There is a slight problem with this logic of course: because if you accept it then this also applies

to supermarkets. Why should there be private sector companies spending advertising money trying to tempt us into their stores when having just the one National Food Service, paid for from tax revenues, would clearly be more efficient? The answer being that of course we accept that market competition has costs but also that it has benefits. Notably, competition reduces costs over time through that very process of competition. One reasonable estimate insists that Walmart saves consumers $250 billion a year simply because of its existence, being in

there and competing and driving everyone's prices down by doing so. We're also pretty certain that the same effect works in health care: or at least parts of it. Price and even quality competition don't work all that well in things like emergency surgery: that it's done right now is more important than how well it's done. But it does indeed work in the elective parts of health care, and elective is the majority of what health care is these days. As Bernie's Vermont has found out by pretty much banning competition across areas of the State: they've now got the second most expensive health care plans in the country as a result.

Single-payer system decreases prices – Government as sole negotiator controls costsLaurence Seidman, 15. 8-1-15. (Seidman, PhD: Prof of economics at University of Delaware. BA from Harvard and PhD from UCal Berkeley. Both in Economics. Very published on health insurance public policy. “The Affordable Care Act versus Medicare for All” Journal of Health Politics, Policy, and Law. [peer-reviewed, associated with Duke]. Accessed 7-19-17. JSD)

With many private insurers, no single insurer has sufficient bargaining power to significantly hold down prices. Merging private insurers into one is the wrong solution because that single private insurer would use its enormous monopoly power to charge very high premiums to employers and individuals. The best solution is for the government to become the single payer of medical providers. High price, not high quantity, is the main reason that US medical expenditure— which equals price times quantity— is so high. That is the conclusion of an empirical study of OECD countries (Anderson et al. 2003), titled “It’s the Prices, Stupid: Why the United States Is So Different from Other Countries.” The study’s authors analyze the split between price and quantity in 2000, presenting comparisons of different quantity measures including the number of doctors, nurses, hospital beds, hospital admissions, and hospital days. In most of these, the quantity per capita in the United States was at or below the OECD median. They conclude that prices, not quantities, are the drivers of cross-national differences in health spending and that a major cause of the difference in prices is the difference in the bargaining power of the payers of medical providers. They emphasize the difference between the United States and other OECD countries in the degree of bargaining power on the buyers’ side of markets for medical care, writing: Although the huge federal Medicare program and the federal-state Medicaid programs do possess some monopsonistic purchasing power, and large private insurers may enjoy some degree of monopsony power as well in some localities, the highly fragmented buy side of the U.S. health system is relatively weak by international standards. It is one factor, among others, that could explain the

relatively high prices paid for health care and for health professionals in the United States. In comparison, the government-controlled health systems of Canada, Europe, and Japan allocate considerably more market power to the buy side. (Anderson et al. 2003: 102). But will government single-payer bargaining power under Medicare for All lead to waiting lists and low quality? It depends on whether bargaining power is applied severely or moderately. The aim of the government single-payer should be to negotiate prices that are high enough to make it worthwhile for medical providers to provide high-quality medical care to all patients, but no higher. If the single-payer forces prices down too far, providers won’t find it worthwhile, and there will be waiting lists and low quality. The single-payer should let prices rise enough to eliminate waiting lists and achieve high quality, but no higher. Without government single-payer intervention and negotiation, medical prices will be much higher than needed to prevent waiting lists and achieve high quality. In countries where payer bargaining power has sometimes been applied severely (Britain and Canada), waiting lists have sometimes been generated and quality has sometimes been inadequate. But in countries where payer bargaining power has been applied moderately (France and Germany), waiting lists have generally been avoided and quality has generally been high.

Single-payer allows the government to cut drug prices through negotiationHussey and Anderson, 03. (Health Policy and Management, John Hopkins University. “A Comparison of Single- and Multi-payer Health Insurance Systems and Options for Reform.” Health Policy. Accessed 7-22-17. http://web.pdx.edu/~nwallace/GHS/SingleMultiHI.pdf JSD.)

A related tool is a drug formulary. Insurers can influence drug utilization by beneficiaries by offering reduced or no coverage for certain drugs. Formularies can be used to limit the use of drugs with unproven effectiveness compared with other treatments, or to encourage the substitution of generic equivalents to brand name products. A single-payer insurer can use its monopsony power to limit aggregate pharmaceutical costs and influence population drug utilization patterns through selective coverage of pharmaceuticals. For example, in Australia, the cost-effectiveness of new drugs is considered before the drugs are eligible for reimbursement by the National Insurance system under the Pharmaceutical Benefits Scheme

Single Payer system directly reduces costs – Taiwan provesJui-Fen Rachel Lu and William C. Hsiao, 03. 5-2003 (Lu: chair of and an associate professor in the Department of Health Care Management at Chang Gung University. Hsiao: K.T. Li Professor of Economics at Harvard. “Does Universal Health Insurance Make Health Care Unaffordable? Lessons from Taiwan” [Taiwan has an advanced economy and practices Western-style medicine. They also more recently implemented an NHI than other advanced nations, which makes this valuable. The data was collected over 7 years. Everyone can fight me over this comparison]. Health Affairs, Vol 22, No. 3. This research was funded by Taiwan’s National Health Research Institute and by Taiwan’s Bureau of National Health Insurance. Accessed 7-21-17. http://content.healthaffairs.org/content/22/3/77.long JSD)

We calculated the residual for the pre-NHI and post-NHI years. Then we compared [with] the average residual level between the two periods. Since Taiwan didn’t have any political and socioeconomic shocks that affected health

spending other than the NHI, the differences in the residual levels are likely attributable to the NHI. Exhibit 2⇓ shows the residual for 1992–2000, which represents the unexplained causes of health spending increases after the plausible causes were removed. The residual, adjusted for the increasing insured population, has been approximately 2

percent per year between 1992 and 1995, similar to the average rate during 1970–1986.20 However, the residual jumped to close to 8 percent in 1995, when the NHI was implemented. This jump is likely attributable to the insurance effect of the NHI.21 Then the residual fell measurably below the historical level, averaging close to 0.5 percent

from 1996 to 2000, as a result of actions taken by the BNHI and other unknown reasons discussed below. Single-payer NHI produces some direct savings. Before the NHI, Taiwan had a multipayer system that consisted of the three major social

insurance programs plus direct out-of-pocket payments by patients. The separate insurance programs each had different benefit packages, their own rules governing claims payments, and their own payment rates. All three contracted

separately with selected providers. These different administrations incurred additional costs while imposing additional administrative costs on providers. A universal uniform reporting procedure and claims-filing system reduces administrative costs and has economies of scale. The direct operating cost of Taiwan’s NHI program is approximately 2 percent of its total expenditure.22 Clinics and hospitals have found that their administrative costs have been reduced under the one standard benefit package and the one standard reporting and claim procedure established by the single-payer system. In contrast, studies have found that transaction costs in the United States amount to more than 20 percent of premium revenues.23

Single Payer System leads to cost containment – not cost explosionJui-Fen Rachel Lu and William C. Hsiao, 03. 5-2003 (Lu: chair of and an associate professor in the Department of Health Care Management at Chang Gung University. Hsiao: K.T. Li Professor of Economics at Harvard. “Does Universal Health Insurance Make Health Care Unaffordable? Lessons from Taiwan” [Taiwan has an advanced economy and practices Western-style medicine. They also more recently implemented an NHI than other advanced nations, which makes this valuable. The data was collected over 7 years. Everyone can fight me over this comparison]. Health Affairs, Vol 22, No. 3. This research was funded by Taiwan’s National Health Research Institute and by Taiwan’s Bureau of National Health Insurance. Accessed 7-21-17. http://content.healthaffairs.org/content/22/3/77.long JSD)

It continuously enjoys a public satisfaction rate of around 70 percent, one of the highest for Taiwanese public programs. One notable result that

should interest Americans is that Taiwan’s universal insurance single-payer system greatly reduced transaction costs and also offered the information and tools to manage health care costs. Alex Preker, a leading health economist at the World Bank, came to a similar conclusion from his research of OECD countries. He concluded that universal health care led to cost containment, not cost explosion.26 Equally important, a single-payer system can gather comprehensive information on patients and providers, which can be used to monitor and improve clinical quality and health outcomes.

NHI standardizes costs of treatments – TaiwanJui-Fen Rachel Lu and William C. Hsiao, 03. 5-2003 (Lu: chair of and an associate professor in the Department of Health Care Management at Chang Gung University. Hsiao: K.T. Li Professor of Economics at Harvard. “Does Universal Health Insurance Make Health Care Unaffordable? Lessons from Taiwan” [Taiwan has an advanced economy and practices Western-style medicine. They also more recently implemented an NHI than other advanced nations, which makes this valuable. The data was collected over 7 years. Everyone can fight me over this comparison]. Health Affairs, Vol 22, No. 3. This research was funded by Taiwan’s National Health Research Institute and by Taiwan’s Bureau of National Health Insurance. Accessed 7-21-17. http://content.healthaffairs.org/content/22/3/77.long JSD)

How else did the NHI manage spending inflation? One saving resulted from a single-payer system. Prior to the NHI, providers could shift costs and charge different payers different amounts for the same service. A single-payer system with a uniform payment schedule effectively controlled this cost shifting. Moreover, Taiwan instituted

several other payment measures to achieve savings. First, the BNHI introduced a reasonable volume standard for outpatient visit coupled with a sliding fee schedule for visits above the volume standard. This measure discouraged induced demand and reduced the number of visits per person.24 Then, a type of diagnosis-

related group (DRG) payment system was phased in for the fifty most common diseases and treatments;

this system reduced the average length-of-stay in hospitals. In recent years the BNHI reduced the high profit margin that clinics and hospitals can obtain from dispensing drugs by reducing the reimbursement rates for drugs and by using reference pricing. These measures reduced the NHI’s expenditures. At the same time, the BNHI also encourages the use of generic drugs. In addition, Taiwan also moved to set up separate global budgets for dental services, Chinese medicine, and office visits at clinics. In 2002 Taiwan created a separate global budget for hospital outpatient and inpatient services. It is too

early to assess the effects of these global budgets. On the demand side, the NHI took several measures to control the demand for selected types of health care. For example, it increased copayments for high users of drugs and rehabilitation services. In 2002 it also increased the copayment for outpatient services delivered by medical centers and regional hospitals. International spending comparisons.

Single Payer better controls aggregate spending on healthHussey and Anderson, 03. (Health Policy and Management, John Hopkins University. “A Comparison of Single- and Multi-payer Health Insurance Systems and Options for Reform.” Health Policy. Accessed 7-22-17. http://web.pdx.edu/~nwallace/GHS/SingleMultiHI.pdf JSD.)

while in other countries such as the UK there is an explicit policy to increase government spending [4]. The governments of these countries, with singlepayer health insurance systems, essentially have total control over aggregate expenditure. Aggregate expenditure for single-payer health insurance systems is typically determined through an annual budgeting process. In multi-payer systems, it is more difficult to monitor and control aggregate spending. This is because different insurers may use different utilization monitoring, payment, and information systems. This can lead to ‘‘cost shifting’’*/having one insurer pay more than another payer for a similar product.

The high degree of government control over aggregate spending in single-payer insurance systems leads to greater political determination of total health expenditure levels. In the UK, It was widely argued that it has led to under-investment in health care [5]. Others have observed that politicians may be more likely to increase health spending in election years [6]. The recent increases in the level of health spending in the UK enacted by the Labor Government demonstrate the degree of political control over health spending levels [4,7].

Health

Alt scenario – bioterrorA bioterror attack is imminent and could lead to extinctionMyhrvold 13 [Nathan Myhrvold , PhD in Theoretical and Mathematical Physics from Princeton, former Chief Strategist and Chief Technology Officer of Microsoft Corporation, July 2013, "Stratgic Terrorism: A Call to Action,” pgs. 13-14] BJ

A virus genetically engineered to infect its host quickly, to generate symptoms slowly—say, only after weeks or months—and to spread easily through the air or by casual contact would be vastly more devastating than HIV. It could silently penetrate the population to unleash its deadly effects suddenly. This type of epidemic would be almost impossible to combat because most of the infections would occur before the epidemic became obvious. A technologically sophisticated terrorist group could develop such a virus and kill a large part of humanity with it. Indeed,

terrorists may not have to develop it themselves: some scientist may do so first and publish the details. Given the rate at which biologists are making discoveries about viruses and the immune system, at some point in the near future, someone may create artificial pathogens that could drive the human race to extinction. Indeed, a detailed species-elimination plan of this nature was openly proposed in a scientific journal. The ostensible purpose of that particular research was to suggest a way to extirpate the malaria mosquito, but similar techniques could be directed toward humans.16 When I’ve talked to molecular biologists about this method, they are quick to point out that it is slow and easily detectable and could be fought with biotech remedies. If you challenge them to come up with improvements to the suggested attack plan, however, they have plenty of ideas. Modern biotechnology will soon be capable, if it is not already, of bringing about the demise of the human race— or at least of killing a sufficient number of people to end high-tech civilization and set humanity back 1,000 years or more. That terrorist groups could achieve this level of technological sophistication may seem far-fetched, but keep in mind that it takes only a handful of individuals to accomplish these tasks. Never has lethal power of this potency been accessible to so few, so easily. Even more dramatically than nuclear proliferation, modern biological science has frighteningly undermined the correlation between the lethality of a weapon and its cost, a fundamentally mechanism throughout history. Access to extremely lethal agents—lethal enough to exterminate Homo sapiens—will be available to anybody with a solid background in biology, terrorists included. The 9/11 attacks involved at least four pilots, each of whom had sufficient education to enroll in flight schools and complete several years of training. Bin Laden had a degree in civil engineering. Mohammed Atta attended a German university, where he earned a master’s degree in urban planning—not a field he likely chose for its relevance to terrorism. A future set of terrorists could just as

easily be students of molecular biology who enter their studies innocently enough but later put their skills to homicidal use. Hundreds of universities in Europe and Asia have curricula sufficient to train people in the skills necessary to make a sophisticated biological weapon, and hundreds more in the United States accept students from all over the world. Thus it seems likely that sometime in the near future a small band of terrorists, or even a single misanthropic individual, will overcome our best defenses and do something truly terrible, such as fashion a bioweapon that could kill millions or even billions of people. Indeed, the

creation of such weapons within the next 20 years seems to be a virtual certainty. The repercussions of their

use are hard to estimate. One approach is to look at how the scale of destruction they may cause compares with that of other calamities that the human race has faced.

A Single-Payer System Is Necessary To Solve For Bioterror ThreatsKahn 17 [Laura Kahn is the author of One Health and the Politics of Antimicrobial Resistance, Why access to health care is a national security issue, Bulletin of the Atomic Scientists, June 5, 2017, http://thebulletin.org/why-access-health-care-national-security-issue10819] BJ

The Canadian government’s response had its glitches—primarily in the form of poor political leadership. Mel Lastman, the mayor of Toronto and a former furniture salesman, became angry when the World Health Organization (WHO) issued a travel advisory against his city. He railed against the WHO’s decision on television, revealing his complete lack of knowledge about either the organization or public health in general. As a result of Lastman’s poor leadership, he was ultimately relegated to a secondary role as the deputy mayor took his place. Lastman’s credibility and legitimacy never recovered from the SARS outbreak. Likewise, US leaders will be judged by how they handle a bioterrorist attack or

pandemic. Unlike Canada, America’s piecemeal healthcare and public health systems are inherently less able to handle such crises. The Affordable Care Act helped fill in the gaps, but really, the only way to prepare for the eventuality of pandemics or bioterrorist attacks is with a single-payer government-run system that covers everyone. The United States might consider modeling its health care system after

the one in Israel, a country that, given longstanding threats, takes every terrorist risk very seriously. In 1994, it established universal health coverage for all citizens. The country’s Ministry of Health monitors and promotes public health, oversees the operations of the nation’s hospitals, and sets healthcare priorities. As a result, Israel’s public health, emergency response, and hospital systems are state-of-the-art, highly efficient, and coordinated—a necessity when responding to terrorist attacks.

The preamble to the US Constitution states the goals to “provide for the common defense” and “promote the general Welfare.” The US government won’t fulfill either of these duties if it fails to protect its citizens against pandemics and bioterrorism. The mandate requires a robust public health infrastructure and a universal healthcare system that covers all Americans. The Trump Administration and Congressional Republicans threaten to undermine this essential function of government, unnecessarily jeopardizing American lives.

UQACA can’t be universal – won’t solve affLaurence Seidman, 15. 8-1-15. (Seidman, PhD: Prof of economics at University of Delaware. BA from Harvard and PhD from UCal Berkeley. Both in Economics. Very published on health insurance public policy. “The Affordable Care Act versus Medicare for All” Journal of Health Politics, Policy, and Law. [peer-reviewed, associated with Duke]. Accessed 7-19-17. JSD)

Risk adjustment, however, has already been attempted in the Medicare Advantage program and the Medicare drug program, and several

studies have found that it is hard to achieve successful, equitable risk adjustment (Brown et al. 2011). Although the ACA will make a significant improvement in coverage, it will not achieve automatic universal coverage or automatic portability. Because the ACA accepts the current system [where] in which the majority of employees rely on employer-provided insurance, there will be no automatic portability for the majority given that any separation from employment will interrupt their employer-provided coverage and compel them to seek new

individual insurance unless they can afford expensive COBRA coverage or promptly obtain coverage from a new employer. The ACA will try to help individuals obtain private individual insurance through new insurance exchanges, subsidies, and regulation of

private insurers, but new coverage will not be automatic.

Uninsured delay HC treatmentsUninsured People Are More Likely To Delay Seeking HealthcareBouye et al., 09 [Karen Bouye, PhD, MPH, corresponding author Benedict I. Truman, MD, MPH, Sonja Hutchins, MD, DrPH, Roland Richard, MPH, Clive Brown, MBBS, MPH, Joyce A. Guillory, PhD, and Jamila Rashid, PhD, Pandemic Influenza Preparedness and Response Among Public-Housing Residents, Single-Parent Families, and Low-Income Populations, American Journal of Public Health, October 2009, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504369/] BJ

Pandemic influenza could cause high levels of illness, death, social disruption and economic loss. Death rates from pandemic influenza may be determined by the number of people who become infected, the virulence of the virus, the underlying characteristics and vulnerability of affected people, and the availability and effectiveness of preventive measures.28 Public-housing residents, single-parent families, and low-income populations are likely to be more susceptible to complications from pandemic influenza because of some combination of the following factors: (1) insufficient funds to stockpile medications and supplies, (2) lack of adequate insurance that delays receipt of effective health care, (3) inability to obtain high-quality health care with publicly funded health insurance, (4) unstable employment and inefficient job benefits along with weak social support networks, and (5) lack of awareness of effective personal health interventions or inability to apply them because of competing everyday survival needs.3–20 These indicators of vulnerability are in turn influenced by underlying factors such as (1) poverty,29–31 (2) inequities in health status,32,33 (3) poor access and quality of care,34–39 (4) limited supply of pandemic vaccine,17,40 (5) low immunization rates,41,42 and (6) environmental factors.30,43 These social and personal factors are confounded by system, policy, and institutional factors that cannot be readily isolated or critically examined in a short essay focused on practical advice for lay persons. Influence

of Poverty on Pandemic Influenza These populations are more susceptible to complications from pandemic influenza because of poverty. Women, especially single mothers, bear a disproportionate burden of poverty.29,30 Many low-income people are unable to meet their basic needs of adequate food, water, clothing, shelter, and health care.30 During an influenza pandemic, persons with low incomes may be reluctant to stay

home from work because of fear of losing income, fear of being unemployed, and lack of flexibility in their jobs to work from home. These population groups may not receive compensated sick leave, may be employed in service-related industries in which telecommuting is not an option, or may work in industries with increased numbers of public contacts (e.g., fast-food service). These types of conditions may cause parents to keep their children in communal (unlicensed, unorganized, or informal) child care settings where risk exposures are relatively high.2 Inequities in Health Status High prevalence of and excess morbidity from diabetes; chronic diseases of the lung, heart, and kidneys; and acute respiratory infections, including influenza, are among the manifestations of poor health status in these vulnerable populations.32 Poverty and

near poverty play an increasingly important role in determining health status.33 Access and Quality of Care The government's response to Hurricane Katrina showed gaps in the nation's ability to provide services for public-housing residents, single-parent families, and low-income populations.34 Public-housing residents are slightly more likely than other US citizens to be without health insurance or report financial barriers to medical care.35 According to the National Center for Health Statistics (NCHS), unmarried women aged 25–64 years are approximately 60% more likely than married women to lack health insurance coverage.36,37 Providing health care for the uninsured or underinsured during a pandemic may be a challenge for hospitals and physicians because more than 46 million persons living in the United States do not have health insurance38 and another 25 million are considered underinsured.39 In addition, low-income persons are more likely to obtain regular medical care in emergency rooms, health departments, and community health centers. These locations are becoming increasingly crowded. Patients waiting for care in these settings are likely to have greater exposure to influenza viruses and other pathogens.31 Limited Supply of Pandemic Vaccine In the event of a pandemic influenza outbreak, a pandemic vaccine may not be available or may be in limited supply because the antigenic details of the evolved pandemic strain of the virus may not be

known before the outbreak occurs. This factor may lead to an inability to prepare large numbers of doses of highly effective vaccine preceding an influenza pandemic outbreak.40 Vaccines will likely be administered in accordance with a prioritization scheme by which groups to be vaccinated first are already identified, including health care workers; homeland security workers, police, firefighters and other first responders; government leaders; and specific population subgroups (i.e., pregnant women, infants, and toddlers).17 Low Immunization Rates Influenza is responsible for more than 36 000 deaths per year. Some experts believe there will be a relationship between the low rates of seasonal influenza vaccination among low-income populations and the distribution and acceptance of an influenza pandemic vaccine among these groups.41 Evidence exists of effective measures that have been used to improve rates of seasonal influenza immunization among low-income groups, but there is much to be done to improve those rates.42 In 2003, the proportion of persons aged 18–64 years and aged 65 years and older who reported receiving influenza vaccinations during the preceding 12 months fell short of the 2010 Healthy People objectives of 60%

and 90%43, respectively. Characteristics associated with lower levels of vaccination coverage were race, age, and income below the federal poverty level. For persons aged 65 years and older, the vaccination rate for those below the poverty level among White, non-Hispanic, seniors was 59.5% ± 6.6, which was higher than that for Black, non-Hispanic, seniors (48.7% ± 9.7) and significantly higher than that for Hispanic seniors (38.5% ± 9.7).

SolvencyMedicare solves best – 5 decades of experienceLaurence Seidman, 15. 8-1-15. (Seidman, PhD: Prof of economics at University of Delaware. BA from Harvard and PhD from UCal Berkeley. Both in Economics. Very published on health insurance public policy. “The Affordable Care Act versus Medicare for All” Journal of Health Politics, Policy, and Law. [peer-reviewed, associated with Duke]. Accessed 7-19-17. JSD)

It is striking how many problems facing the Affordable Care Act (ACA) would disappear if the nation were instead implementing Medicare for All

— the extension of Medicare to every age-group (Morone 2002; Woolhandler et al. 2003; Seidman 2013a). Medicare has five decades of experience solving numerous practical administrative problems. Most Americans are familiar with how Medicare operates, either as covered seniors or as children of seniors who sometimes accompany their parents when

they go to the doctor or hospital. They are familiar with the free choice of doctor under Medicare. Medicare’s fee schedules for hospitals and doctors, which have been in effect for three decades, have not generated excessive waiting times, and Medicare fees have been sufficient to enable patients to obtain high-quality medical care.

Given its performance, familiarity, and popularity, it is surely sensible to ask whether Medicare should be extended to all age-groups.

ACA is complicated and riddle with holes – Medicare streamlines that processSalvatore Babones, 15. (Babones: Associate prof of sociology and social policy at University of Sudney. Associate Fellow at the Institute for Policy Studies in DC. Author of so many books. “Medicare for All” Sixteen for ’16 – A Progressive Agenda for a Better America. Accessed 7-21-17. https://ses.library.usyd.edu.au/bitstream/2123/12094/2/Medicare%20for%20all.pdf JSD)

Presidents Truman, Nixon and Clinton all believed in the necessity of universal health care and tried to pass legislation to make it a reality.

President Obama used his first-term majority to push through the Affordable Care Act of 2010 (ACA), popularly known as Obamacare. The ACA is better than nothing at all, but it is a bandaid for a sucking chest wound. It is too complicated, too expensive, riddled with perverse incentives for insurance companies and not truly universal in coverage. Worse, many states are simply not cooperating in its implementation. By contrast, Medicare is straightforward and universal. Everyone is covered, and everyone gets the same minimum coverage. Add-ons are optional. Medicare doesn't cover everything, but it is good enough for most people most of the time. It is tried and tested;

it is cost-effective; and it works. Medicare was created in 1965 to deal with a simple fact of life: the fact that we're all going to die. Death can be very expensive, and someone has to pay for it. Fortunately or

unfortunately (depending on your perspective), it can be difficult to collect from the dead. Thus Medicare. By design,

Medicare is an insurance program both for individuals and for hospitals. Individuals are insured against illness. Hospitals are insured against uncollectible bills. This insurance for hospitals is at least as important as insurance

for individuals because it reduces the incentive for hospitals to turn people away based on their ability to pay.

Cutting administrative waste pays for better coverage for all Mangan, 15 [Dan Mangan is a reporter covering health care and other issues for CNBC.com. Mangan has been a journalist for more than 20 years.] Health insurance coverage paperwork wastes $375 billion. 17 January 2015. http://www.singlepayernewyork.org/2015/01/17/health-insurance-coverage-paperwork-wastes-375-billion/ [New York's Single Payer Official Website, a statewide clearinghouse for all single payer/medicare-for-all initiatives and events throughout our very active state. In medical

billing, companies that function as intermediaries who forward claims information from healthcare providers to insurance payers are known as clearinghouses.]

The United States health-care system wastes an estimated $375 billion annually in billing and insurance-related paperwork that could be saved if the nation moved from a “multipayer” health coverage system to a “single-payer” system run by the government, a new study says. That dollar figure, tied to getting people, insurance companies and governments to pay for health-care services provided, equals almost 15 percent of total national health-care spending. “We all sort of suspected there was quite a big number, but when we came down to the actual figure it was certainly revealing,” said Aliya Jiwani, health policy researcher and lead author of the report, which was published by the journal BMC Health Services Research. Jiwani said that while “the administrative costs have been an issue” in the health-care world for years, “the fixes that have been put in place have only aggravated the issue.”

In fact, the paper notes that “administrative costs as a percentage of total health care spending more than doubled from 1980 to 2010.” The authors of the paper write that the savings from eliminating trillions of dollars in administrative waste over the years “could cover all of the uninsured” people currently in the U.S. if a single-payer system were adopted. They estimate the cost of covering all of the roughly 40 million Americans still lacking health insurance would be equal to just about half of the $375 billion in projected savings. The balance of those savings, they write, could “upgrade coverage for the tens of millions who are under-insured.” While the paper identified a very big number of wasted dollars, it remains a big question of whether that could lead to a single-payer system anytime soon.

Medicare for all eliminates patient cost-sharing – encourages seeking careLaurence Seidman, 13. (Seidman: Prof of economics at University of Delaware. Pretty heckin’ published on health policy “Medicare for All: An Economist’s Case” Challenge. Vol 56 no1. Accessed 7-22-17. http://www.maineallcare.org/pdf/MedicareforAll.pdf JSD)

The second problem, however, is harder to solve. Recent empirical literature (Baicker and Goldman 2011) has shown that patient costsharing sometimes deters patients from taking early medical action, such as seeking tests or adhering to prescribed medications, that would avoid much greater costs and hardships later. To deal with this problem, it would be necessary to enact a lengthy list of exceptions Seidman 96 Challenge/January–February 2013 to cost-sharing.

Developing such a list, keeping it up to date, and basing it on medical merit rather than lobbying strength would be extremely difficult. The simplest solution to this problem would be to eliminate patient cost-sharing. As explained below, Medicare for All would use the internationally proven method of payer bargaining power coupled with American tax resistance, not patient cost-sharing, to slow the rise in medical costs.

Single payer systems incentivize preventative careHussey and Anderson, 03. (Health Policy and Management, John Hopkins University. “A Comparison of Single- and Multi-payer Health Insurance Systems and Options for Reform.” Health Policy. Accessed 7-22-17. http://web.pdx.edu/~nwallace/GHS/SingleMultiHI.pdf JSD.)

Multi-payer systems create a financial incentive for insurers to focus on the short term. Since beneficiaries may change insurers every several years, their utilization of health care in 10 or 20 years will probably not affect the insurer currently providing

coverage. Since multi-payer insurers often do not expect to receive returns on investments in preventive health care, they may be less likely to encourage utilization of preventive services through coverage or other

mechanisms [24/ 26]. In single-payer systems, where all beneficiaries will be enrolled throughout their lifespan, greater investments in preventive care can lead to longterm savings due to a healthier population. In multi-payer systems it would only be possible to achieve the same result by having more services provided as part of government-sponsored public health or through mandates that require all insurers to provide a certain preventive benefit.

Medicare for All substantially reduces personal bankruptciesLaurence Seidman, 13. (Seidman: Prof of economics at University of Delaware. Pretty heckin’ published on health policy “Medicare for All: An Economist’s Case” Challenge. Vol 56 no1. Accessed 7-22-17. http://www.maineallcare.org/pdf/MedicareforAll.pdf JSD)

Medicare for All would end the financial hardship and bankruptcies that currently result from medical bills for the uninsured and underinsured (Himmelstein, Thorne, Warren, and Woolhandler 2009). According to a study by these

authors, illness and medical bills were linked to about 60 percent of all personal bankruptcies in the United States in 2007, and most of these medically bankrupt families were middle class and had health insurance with patient cost-sharing. Medical bankruptcies, and the fear of medical bankruptcies, would be eliminated by Medicare for All. It is crucial to recognize that actual bankruptcies are just the tip of the iceberg of financial hardship. Many people who suffer severe financial hardship due to medical bills manage to avoid actual bankruptcy. Thus, data on the number of actual bankruptcies due to medical bills greatly understates the number of people subject to financial hardship and anxiety due to medical bills, all of which would disappear under Medicare for All

Impact

Race

UQEven under the ACA, cost-sharing policies disproportionately burden minority groupsCaruso et al., 15 [Dominic F. Caruso, MD/MPH Candidate; David U. Himmelstein, MD; Steffie Woolhandler, MD, “Single-Payer Health Reform: A Step Toward Reducing Structural Racism in Health Care”, Harvard Public Health Review (Volume 6), July 2015, http://harvardpublichealthreview.org/single-payer-health-reform-a-step-toward-reducing-structural-racism-in-health-care/] BJ

The Patient Protection and Affordable Care Act (ACA) offered subsidies to expand private coverage, making insurance more affordable for many families. However, many of these new private plans carry high deductibles and co-payments. Deductibles for the ACA’s bronze and silver plans average over $5000 and $2900, respectively, for single coverage, and over $10,000 and $6,000, for family coverage.10 Deductibles have also soared in employer-sponsored plans; in 2014, more than 40% of such plans carried a deductible of more than $999, up from just 10% in 2006.11 Moreover, while Medicaid traditionally imposed virtually no cost-sharing, several conservative state governors have extracted waivers from the Centers for Medicare and Medicaid Services allowing the imposition of cost-sharing on recipients as a condition for implementing the ACA’s Medicaid expansion.1213 High cost-sharing particularly impacts minority families, whose average incomes are far lower than those of non-Hispanic whites. Yet even figures on income disparities understate minorities’ disadvantage when confronted with high out-of-pocket costs. With medical bills often reaching into the thousands for even routine care such as childbirth and appendectomy, many families must tap savings or

other assets like housing equity, and racial/ethnic disparities in assets dwarf the differences in income. 14 African American and Hispanic median household income was 58 percent and 70 percent, respectively, that of non-Hispanic whites in 2011.15 In contrast, the median net worth of black and Hispanic householders was $6,314 and $7,683, respectively, vs. $110,500 for non-Hispanic whites, a 15-fold difference.16 Hence, the average family deductibles for bronze and silver plans would bring financial ruin to most African American and Hispanic households. Even the lower cost-sharing now increasingly common under Medicaid may be prohibitive for poor families, many of whom have zero or negative net worth.

Solvency

Impact

Income

UQLower-Paid Employees See A Large Portion of Their Income Going To Rising PremiumsAuguste et al., 09 [Byron G. Auguste is the former advisor to the White House Deputy Assistant to the President for Economic Policy and Deputy Director of the National Economic Council. Auguste has D. Phil. In economics from Oxford University. Martha Laboissiere is a Senior Expert at McKinsey & Company and holds a doctorate in biochemistry. Lenny T. Mendonca Lenny Mendonca is a director emeritus (retired senior partner) from the Washington D.C. and San Francisco offices of McKinsey & Company, a global management consulting firm. He is a senior fellow at the Presidio Institute. He received his MBA and certificate in public management from the Stanford Graduate School of Business. How health care costs contribute to income disparity in the United States, April 2009, http://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/how-health-care-costs-contribute-to-income-disparity-in-the-united-states] BJ

Over the past 50 years, US workers have come to expect employers to pay for some part of employee health insurance; many consider this an

important part of overall compensation. However, recent economic trends have resulted in a growing disparity in health care coverage and affordability. A study by the McKinsey Global Institute (MGI) identified three divergent categories of workers that are emerging from trends in health care coverage and income growth. The top-income category (earning on average $210,100 annually1 ) has enjoyed rising incomes and growing employer-paid health care benefits, which have made their out-of-pocket spending on health care a relatively small and affordable portion of total spending. The higher-middle-income category (earning an average of $84,800 annually) and the lower-middle-income group (earning on average $41,500), have also seen increasing benefits and incomes—but at a much slower rate, making the uncovered portion of their health care costs ever-more expensive. In the bottom-income category (earning an average of $14,800 a year), incomes have been stagnant, and their employers are less likely to pay for their health insurance. This group is finding any health care difficult, if not impossible, to afford. As part of a study of widening income gaps between US households, we found that rising employer-paid health insurance premiums constitute a growing share of the combined income of lower-paid employees—a much larger share than for those who are higher paid. For those workers within the bottom-income group who are insured (22 percent), the ratio of employer-paid premiums to household income is 20 percent. That compares with 3.3 percent for the top-income group, in which nine out of ten workers are insured (Exhibit 1)

SolvencyApproaches must be tailored to income to be effectiveLaurence Seidman, 13. (Seidman: Prof of economics at University of Delaware. Pretty heckin’ published on health policy “Medicare for All: An Economist’s Case” Challenge. Vol 56 no1. Accessed 7-22-17. http://www.maineallcare.org/pdf/MedicareforAll.pdf JSD)

Like many economists, I have been reluctant to support the elimination of patient cost-sharing. But patient cost-sharing causes two serious

problems: (1) cost-sharing that does not vary with patient income overburdens moderate-income people when they obtain care; (2) cost-sharing deters necessary care (as well as unnecessary care). Let us consider each problem. First,

when cost-sharing is uniform for patients of all incomes (e.g., a $2,000 deductible or 20 percent of the medical bill), it is too burdensome for households with moderate income. This problem could be solved by income-relating patient cost-sharing. Patients would use a Medicare card at the doctor’s

office or hospital and at the end of the month would be billed by Medicare for a percentage of their medical cost that varies with the income reported on the previous year’s income tax return (e.g., 5 percent for a low-income household, 15 percent for middle income, 25 percent for high income) with an annual ceiling that varies with income (for example, 2 percent of income for a low-income household, 6 percent for middle income, and 10 percent for high income)

Single Payer’s progressive taxation protects lower income individualsHussey and Anderson, 03. (Health Policy and Management, John Hopkins University. “A Comparison of Single- and Multi-payer Health Insurance Systems and Options for Reform.” Health Policy. Accessed 7-22-17. http://web.pdx.edu/~nwallace/GHS/SingleMultiHI.pdf JSD.)

Through progressive financing arrangements, insurance systems can provide greater subsidization of the costs of health care for low-income individuals. Single-payer systems typically accomplish this through progressive taxation. Multipayer systems are more likely to be financed more regressively through mechanisms such as a payroll tax, as in a social insurance system after the German model, or through premiums, as in the market-

oriented system in the US. Some multi-payer insurance systems redistribute money through a variety of subsidies, such as inter-pool transfers and contribution exemptions for certain groups, such as the elderly or the unemployed. For example, in Japan, inter-pool transfers are made to the insurance pool containing the elderly population. Each insurance pool contributes an equal amount per beneficiary to the elderly insurance pool; in addition, the central and local governments contribute 30% of the revenues of the elderly insurance pool [8].

Single payer provides a sense of social solidarityHussey and Anderson, 03. (Health Policy and Management, John Hopkins University. “A Comparison of Single- and Multi-payer Health Insurance Systems and Options for Reform.” Health Policy. Accessed 7-22-17. http://web.pdx.edu/~nwallace/GHS/SingleMultiHI.pdf JSD.)

In the case of health insurance, a common concept of solidarity involves all members of a society making a fair financial contribution in return for guaranteed equal access to needed health care [34]. Solidarity is, therefore,

strongly tied to an idea of distributive justice [35]. In this case, access to health care is considered a positive freedom*/something that people have a right to, as opposed to having freedom from*/that should be distributed equally among similar individuals. This concept is supported by the UN Committee on Economic, Social and Cultural Rights [36]. However, these values are by no means shared by all societies, giving rise to a broad array of national concepts of solidarity in the area of health care. For example, the US could potentially be considered to be violating the UN’s right to health care based on the distribution of health care resources [36]. The German health care system is guided rhetorically by a notion of social solidarity: everyone is guaranteed insurance coverage, but nonetheless the well-off are allowed to opt into private insurance coverage which gives them better access to health care because providers are paid higher rates

[23]. As described above, single-payer health insurance systems tend to be financed more progressively than

multi-payer systems. Sharing the burden of health care financing in this way may increase the solidarity between richer and poorer segments of the population. A single-payer insurance system can also foster citizens’ trust in the ability of the government to protect their welfare, enhancing the population’s view of the legitimacy of the government.

Impacts

Solvency

InherencyPlan ain’t happening nowSuzy Khimm, 7-15-17. (Khimm: Freelance writer in Washington. “’Medicare for All’ Isn’t Sounding so Crazy Anymore.” NYT. Accessed 7-18-17. https://www.nytimes.com/2017/07/15/opinion/sunday/medicare-for-all-isnt-sounding-so-crazy-anymore.html JSD)

Senator Dick Durbin, the upper chamber's second-highest-ranking Democrat, told me that he'd happily sign onto a single-payer bill - and might

even bring one to the floor himself. But while liberals have spent decades pining for single payer - Ted Kennedy drew up

a bill in 1970 - there are surprisingly few detailed proposals. During the 2016 campaign, Senator Bernie Sanders released a skeletal framework for single payer that went into great detail on new taxes while skating over most everything else. In the House, Representative John Conyers's single-payer proposal has 114 co-sponsors, but it's essentially a messaging bill that signals a political position but is not expected to pass.

VATTax mechanism is an easy shift and equalizes burdens of the systemLaurence Seidman, 13. (Seidman: Prof of economics at University of Delaware. Pretty heckin’ published on health policy “Medicare for All: An Economist’s Case” Challenge. Vol 56 no1. Accessed 7-22-17. http://www.maineallcare.org/pdf/MedicareforAll.pdf JSD)

Medicare for All would eliminate premiums and replace them with a set of taxes earmarked for Medicare for All. Rather than funding it with a single tax at a high rate, I recommend using a set of taxes, each with a moderate rate. This approach is likely to impose less efficiency loss on the economy than a single tax with a high rate because public finance economists have shown that the efficiency loss from a tax generally rises with the square of the tax rate (Seidman 2009). Moreover, a set of taxes often spreads the burden more fairly across the population than a single tax that might especially burden one group while imposing little or no burden on others. Several of the taxes I recommend are already in place in the United States, and several would be new. One tax currently in place is the Medicare payroll tax (currently 1.45 percent on the employer and 1.45 percent on the employee—a combined rate of

2.90 percent on all wage income). The tax that would be new to the United States is the VAT, which is used successfully by virtually every economically advanced country. Many U.S. economists have recommended a U.S. VAT (Hines 2007; Seidman 2004), and several analysts have recommended that a VAT be enacted and earmarked for universal health insurance

(Burman 2009; Morone 2002). It should be recognized that when taxes are levied on business firms (such as the VAT or the

payroll tax), people bear the tax burden. If businesses raise prices in response to paying taxes, consumers bear some burden. If businesses pay lower wages in response to paying taxes, workers bear some burden. If businesses pay smaller dividends or profits to investors

or owners in response to paying taxes, then investors or owners bear some burden. Everyone would bear some burden from the earmarked Medicare for All taxes levied on businesses. Seidman 92 Challenge/January–February 2013 Virtually everyone would be “paying for”—bearing some burden of— Medicare for All earmarked taxes that are levied on

business firms. There would be no free riders. Raising the payroll tax above its current 2.90 percent would be simple to administer and require no new legislation other than raising the number 2.90 to a higher value. It would

require no new tax administration. By contrast, a VAT would require new legislation and new administration. But there has been so much practical experience administering a VAT in other economically advanced countries that it would be relatively easy for the United States to get a VAT up and running. A VAT would increase the prices of most goods and services, and economic analysis shows that most of the tax burden would fall on consumers. Because of the effect on prices, a

VAT should be phased in gradually over several years. Using both the Medicare payroll tax and a VAT would prevent free riding under Medicare for All because everyone would bear some burden through either lower take-home pay or higher prices and would therefore be making some financial contribution to Medicare for All. The new Medicare for All income

Taxes are better than premiums for the economy Laurence Seidman, 15. 8-1-15. (Seidman, PhD: Prof of economics at University of Delaware. BA from Harvard and PhD from UCal Berkeley. Both in Economics. Very published on health insurance public policy. “The Affordable Care Act versus Medicare for All” Journal of Health Politics, Policy, and Law. [peer-reviewed, associated with Duke]. Accessed 7-19-17. JSD)

What is the effect of replacing premiums with taxes? Taxes vary with ability to pay, while premiums do not (Seidman 2009). It would be better for the economy and fairer to use a set of earmarked taxes that have moderate rates (Seidman

2013b). The set of taxes earmarked for Medicare for All might consist of the following: the Medicare payroll tax, a VAT, and a Medicare for All income tax surcharge on the 1040 income tax return. The Medicare payroll tax is currently 1.45 percent on the employer and 1.45 percent on the employee— a combined rate of

2.90 percent on all wage income. The VAT is used successfully by virtually every economically advanced country except the United States. Many US economists have recommended a US VAT (Seidman 2004, 2013b; Hines 2007).

Several analysts have recommended that a VAT be enacted and earmarked for universal health (Morone 2002; Burman 2009). The VAT burden on low-income households would be offset by giving these households a refundable tax credit on their

1040 income tax return to compensate roughly for most of the burden they bear from the VAT (Seidman 2013b).

Today US medical costs are 18 percent of gross domestic product (GDP), while no other country exceeds 12 percent. Suppose Medicare for All aims to cut the huge 6 percentage point gap in half to 3 percent so that US medical costs are 15 percent of GDP. If Medicare for All succeeds in using its single-payer bargaining power (as explained below) to achieve its medical cost target of 15 percent of GDP, then Medicare for All taxes would need to be 15 percent of GDP. Government (federal and state) spending on Medicare, Medicaid, and other government health programs is currently about 7 percent of GDP (CBO 2012: 49, 55-57), so new earmarked taxes would need to be roughly 8 percent of GDP. To put this 8 percent of GDP number in perspective, in 2007 (before the Great Recession caused a plunge in tax revenue) US taxes (federal, state, and local) were about 30 percent of GDP. Thus taxes would rise from 30 percent of GDP to 38 percent (federal taxes would rise by 9.5 percent of GDP, while state taxes would fall by 1.5 percent of GDP due to the reduction in state Medicaid expenses), which would still leave US taxes as a percentage of GDP slightly lower than the average of the economically advanced member countries of the Organisation for Economic Cooperation and Development (OECD) (roughly 40 percent) and far below the Scandinavian countries (roughly 50 percent).

HR676Removing the Private Sector’s Stranglehold on Healthcare Saves Trillions Long-termFriedman 13 [Gerald, PhD, Gerald Carl Friedman is an economics professor at the University of Massachusetts at Amherst, Funding HR 676: The Expanded and Improved Medicare for All Act How we can afford a national single-payer health plan, July 31, 2013, p. 1 http://www.pnhp.org/sites/default/files/Funding%20HR%20676_Friedman_7.31.13_proofed.pdf] BJ

HR 676 (Section 211, Appendix 2) specifies a financing plan for single-payer that includes • Maintaining current federal financing for health care • Increasing personal income taxes on the top 5% of income earners • Instituting a modest tax on unearned income • Instituting a modest and progressive tax on payroll, selfemployment • Instituting a small tax on stock and bond transactions The following progressive financing plan would meet the specifications of HR 676: • Existing sources of federal revenues for health care • Tax of 0.5% on stock trades and 0.01% tax per year to maturity on transactions in bonds, swaps, and trades • 6% high-income surtax (applies to households with incomes > $225,000) • 6% tax on unearned income from capital gains, dividends, interest, profits, and rents • 6% payroll tax on top 60% of income earners (applies to incomes over $53,000, tax paid by employers) • 3% payroll tax on the bottom 40% of income earners (applies to incomes under $53,000, tax paid by employers) HR 676 would also establish a system for future cost control using proven-effective methods such as negotiated fees, global budgets, and capital planning. Over time, reduced health cost inflation over the next decade (“bending the cost curve”) would save $1.8 trillion, making comprehensive health benefits sustainable for future generations.

Answers

T – NHIWe meet - “Medicare-For-All” is a national health insurance plan – context provesLaurence Seidman, 13. (Seidman: Prof of economics at University of Delaware. Pretty heckin’ published on health policy “Medicare for All: An Economist’s Case” Challenge. Vol 56 no1. Accessed 7-22-17. http://www.maineallcare.org/pdf/MedicareforAll.pdf JSD)

Medicare for All would be a single-payer program that covers all Americans, and the analysis and arguments of advocates of single-payer national health insurance (e.g., Geyman 2008, 2010; Woolhandler et al.

2003b) apply to Medicare for All. A single-payer bill has been introduced many times in Congress, including in the 2011–12 session

(H.R. 676; Conyers 2011), and has always obtained a significant number of congressional sponsors. Using the name “Medicare for All” makes clear that single-payer national health insurance would be an extension of a long-running American program for all Americans, not a brand-new program or a foreign program with which Americans have no personal experience

Politics DA

FrontlineTurn: Plan gives dems needed momentum Brad Bannon, 7-11-17. (Bannon: Democratic Pollster and CEO of Bannon Communication Research. Political analyst for CLTV. “4 Reasons why Democrats Support Medicare for All.” The Hill. Accessed 7-21-17. http://thehill.com/blogs/pundits-blog/healthcare/341522-4-reasons-why-democrats-should-support-medicare-for-all JSD)

Medicare for all is good politics Democrats must push aggressively on issues where we have a big advantage. A survey conducted in June by NBC News and the Wall Street Journal indicates that the biggest advantage Democrats have over Republicans is on health care. Americans think Democrats do a better job on healthcare than Republicans by a margin of 43 percent to 26 percent. President Andrew Johnson once said Washington is 12 square miles surrounded by reality. The conventional wisdom in the swampland is that Medicare for all is a health hazard for Democrats.

But a national survey last month by the Kaiser Family Foundation found American supported the expansion of government run healthcare. So, what are Democrats afraid of anyway? A Fight for Medicare for all Demonstrates Democratic Determination Trump won because he sounded and acted like a bull in a china shop which is what angry voters wanted. In contrast, Democrats walk on eggshells and don't sound angry enough to shake things up in Washington. A push for universal health insurance is a great way for Democrats to prove that they’re not intimidated by D.C. conventional wisdom and a tough fight. Leadership means Dems need more than blind opposition to Trump. Republicans including Trump win with all sorts of push the envelope issue stands. During the campaign last year Trump and most successful GOP candidates pushed for repeal of ACA, even though few voters wanted to destroy Obamacare. A poll conducted for National Public Radio last month showed that only a quarter of the

public favored repeal while everybody else either wanted to fix Obamacare or even extend it. Taking unpopular stands on issues demonstrates leadership and boldness to Americans who are frustrated with the status quo. The good news for Dems is that Medicare for all is more than twice popular than Trumpcare.

ExtensionsNo link: Dems like the planSuzy Khimm, 7-15-17. (Khimm: Freelance writer in Washington. “’Medicare for All’ Isn’t Sounding so Crazy Anymore.” NYT. Accessed 7-18-17. https://www.nytimes.com/2017/07/15/opinion/sunday/medicare-for-all-isnt-sounding-so-crazy-anymore.html JSD)

Single payer is now poised to become the standard position for the Democratic base. More elected

Democrats are following suit as Republicans struggle to get their deeply unpopular health care bill past Congress. The prevailing assumption is that the G.O.P. effort will ultimately implode, clearing the way for a bold alternative. Senator Dick Durbin [would], the upper chamber's second-highest-ranking Democrat, told me that he'd happily sign onto a single-payer bill - and might even bring one to the floor himself. But while liberals have spent decades pining for single payer - Ted Kennedy drew up a bill in 1970 - there are surprisingly few detailed proposals.

Econ DANo link - Plan doesn’t cost that much – their article grossly overestimates the priceRichard Eskow, 7-12-17. (Eskow: huffpost contributor. Semir Fellow for Campaign for America’s Future and Host of “The Zero Hour”. “Medicare for All Is Coming, No Matter What They Say.” Huffington Post. Accessed 7-18-17 http://www.huffingtonpost.com/entry/medicare-for-all-is-coming-no-matter-what-they-say_us_5966470ae4b0deab7c646d45 JSD.)

The Washington Post Editorial Board took a harder line than Krugman, weighing in recently with an editorial entitled, “Single-payer health care

would have an astonishingly high price tag.” The “astonishing” figure is derived, not from a dispassioned analysis of all health plans, but from a single, highly controversial analysis of a single plan. The Urban Institute

reviewed Bernie Sanders’ single-payer proposal in 2016 and concluded that it would increase government spending by $32 trillion over ten years. Single-payer opponents have been citing that figure ever since. But that figure is “ridiculous,” according to Steffie Woolhandler and David Himmelstein of the City University of

New York School of Public Health and Harvard Medical School. In a detailed rebuttal, they note that the Urban Institute’s findings “project outlandish increases in the utilization of medical care, ignore vast savings under single-payer reform, and ignore the extensive and well-documented experience with single-payer systems in other nations – which all spend far less per person on health care than we do.” The Post’s editors insist that “the public piece of the American

health-care system has not proven itself to be particularly cost-efficient,” but this is misleading at best. Medicare, our country’s

only nationally-run health system, has much lower overhead costs and inflation rates than private-sector health care. You could even say they’re “astonishingly” lower: Medicare’s overhead amounts to 2 percent of total costs, versus 12-14 percent for private insurers, while annual cost increases between 2010 and 2015 were 1.4 percent for Medicare and more than double that (3.0 percent) for private insurance.

CX Sood et al from the econ flow – the plan lessens harm to industry growth. Haass 13 indicates that’s key to the economy.

Private Insurers CPPerm do both – this benefits all classes and better ensures support from all classes. This shields the link to the net benefit.Hussey and Anderson, 03. (Health Policy and Management, John Hopkins University. “A Comparison of Single- and Multi-payer Health Insurance Systems and Options for Reform.” Health Policy. Accessed 7-22-17. http://web.pdx.edu/~nwallace/GHS/SingleMultiHI.pdf JSD.)

One potential way to balance the tradeoffs between single- and multi-payer insurance systems is to increase the role of private insurance alongside a universal single-payer insurer. All citizens would have the option of buying extra benefits in the private insurance sector. In this way, private insurance coverage can accommodate consumer needs that are not met by the single-payer insurer. Those purchasing private coverage to meet these needs are likely to be higher-income individuals, creating multiple tiers in the health insurance system with an adverse impact on the equity of access to care and social solidarity.

Single Payer CP

Democrats don’t like Single Payer – see inserted chartDrew Altmann, 16. 2-25-16. (Altmann: . Originally published as a Wall Street Journal Think Tank Column. “Medicare-for-All vs. Single Payer: The Impact of Labels.” Kaiser Family Foundation. Accessed 7-18-17 http://www.kff.org/health-reform/perspective/medicare-for-all-vs-single-payer-the-impact-of-labels/ JSD.)

Perm do bothPerm do the CPDems prefer plan phrasingDrew Altmann, 16. 2-25-16. (Altmann: . Originally published as a Wall Street Journal Think Tank Column. “Medicare-for-All vs. Single Payer: The Impact of Labels.” Kaiser Family Foundation. Accessed 7-18-17 http://www.kff.org/health-reform/perspective/medicare-for-all-vs-single-payer-the-impact-of-labels/ JSD.)

Among Democrats, the term “Medicare-for-all” generates a much more enthusiastic reaction than does

“single-payer.” With this discussion still mostly at the stage of broad concepts and messaging, language matters. As the chart above shows, the latest Kaiser Family Foundation health tracking poll found that 53% of Democrats were “very positive” about Medicare-for-all, compared with 21% who felt that way about a “single-payer national health-care system.” A separate 37% are “somewhat positive ” about the term “single-payer.”

Medicare-for-all elicits the strongest positive reaction. About the same percentage were “very positive” about the term “socialized medicine” as single-payer. Medicare is a famously popular and well-known program, and associating any universal coverage plan with it makes that idea more popular.

**insert something about democrats being key to politics**

Links to politics

The CP isn’t functionally competitive. Single-payer does essentially the same thing as the plan. This harms fairness because it hijacks the entire aff and forces us to argue against ourselves. It also detriments education because the negative would rather get caught up in linguistics than discuss real harms of implementation. This is a voting issue for fairness and education.

Cost cutting CPsCP alone won’t solve – precedent doesn’t matterMegan McArdle, 6-9-17. (McArdle: Columnist for Bloomberg View. Degrees and what not from Uchicago, UPenn, etc. “Why not Try ‘Medicare for All’? Glad You Asked.” The Denver Post. Accessed 7-18-17 http://www.denverpost.com/2017/06/09/why-not-try-medicare-for-all-glad-you-asked/ JSD.)

Unfortunately, there’s also some evidence that mortality might have gone up as a result, as hospitals cut back on service quality. That may be a

tradeoff we’re willing to make for lower health care costs, but it should be explicitly discussed. And just because hospitals may have successfully cut costs in response to a previous round of reimbursement cuts doesn’t mean we can necessarily expect that to work again. Cost cutting is like dieting — the first few pounds of fat go easy, but getting to

that perfect size 10 may never happen. Those hospitals that do get there would probably have to result to draconian measures — which might result in patient lives lost. So how you feel about this proposal should probably depend on how sure you are that there are vast, easily obtained cost efficiencies to be had in hospital operations. Myself, I’d want to be a lot surer than I am before I started running a mass experiment, for our nation’s physical and fiscal health.

Perm do both

High Deductible Private insurance CPsThe CP is neither automatic nor portableLaurence Seidman, 13. (Seidman: Prof of economics at University of Delaware. Pretty heckin’ published on health policy “Medicare for All: An Economist’s Case” Challenge. Vol 56 no1. Accessed 7-22-17. http://www.maineallcare.org/pdf/MedicareforAll.pdf JSD)

Before examining whether this high-deductible insurance strategy would succeed in containing prices and costs, I want to emphasize that this strategy will not achieve automatic coverage, portability, and peace of mind. Individuals who obtain

their high-deductible insurance from their employer would still lose their insurance if they lose or leave their job. Individuals who obtain their high-deductible insurance directly from insurance companies would still be subjected to a pre-enrollment health questionnaire and would either be rejected or charged a high premium if they have a high expected medical cost.

Perm do bothCP alone can’t solve health – high risk patients likely to be left without insuranceLaurence Seidman, 13. (Seidman: Prof of economics at University of Delaware. Pretty heckin’ published on health policy “Medicare for All: An Economist’s Case” Challenge. Vol 56 no1. Accessed 7-22-17. http://www.maineallcare.org/pdf/MedicareforAll.pdf JSD)

High-deductible insurance advocates oppose having the government force private insurance companies to enroll everyone at the same premium regardless of preexisting conditions or expected medical cost. Instead,

some advocates propose that the government pay private insurance companies a subsidy to voluntarily enroll high-cost individuals at a reasonable premium. But there would be no way to make enrollment automatic.

High-cost individuals would initially be rejected and would then have to apply to demonstrate that they are likely to be high cost and entitled to a substantial subsidy. Some might still be rejected. In the meantime they might face huge medical bills. Suppose tax incentives succeed in getting most employers to offer high-

deductible insurance and most individuals to obtain such insurance. Consider two individuals, one with a high income and the other low income, who each have insurance with a $2,000 deductible and therefore must pay 100 percent of the price until they have spent $2,000 on medical care. The high-income person would be moderately deterred from obtaining medical care but would be able to afford urgent medical care, and this is exactly what the free market advocates want. But the low-income person would be strongly deterred

from obtaining medical care and may be unable to afford even urgent medical care. High-deductible insurance advocates may regret this, but they are opposed to doing anything about it. They oppose requiring private insurance companies to vary the deductible according to the individual’s income, and they oppose having the government reimburse low-income persons more than high-income persons for out-of-pocket medical costs. So their high-deductible strategy would lead the quantity of medical care to vary substantially with an individual’s ability to pay

CP won’t contain medical costs – patients aren’t negotiatorsLaurence Seidman, 13. (Seidman: Prof of economics at University of Delaware. Pretty heckin’ published on health policy “Medicare for All: An Economist’s Case” Challenge. Vol 56 no1. Accessed 7-22-17. http://www.maineallcare.org/pdf/MedicareforAll.pdf JSD)

Would the high-deductible strategy really contain medical prices and costs? In virtually all other markets, prices are posted so that consumers know in advance how much they will pay if they choose a service. High-deductible insurance advocates assume this would happen in medical care under their strategy. But would hospitals or doctors really provide prices of various services to patients in advance? Many hospital patients are literally in no position to comprehend price information. Many patients and their families are under emotional stress and time pressure and would find it extremely unpleasant to consider price information.

Many doctors would find it unpleasant to spend time discussing prices with patients. It is therefore doubtful that patients would be able to play the same role in containing prices and costs as consumers do in most other markets. Moreover, although most individuals would not exceed their high deductible, the minority of individuals who do exceed it actually account for a large share of the total medical cost incurred in a given year. These high-cost individuals would have no financial incentive to care about price once they exceed their high deductible. Although it might be possible to restrain the prices and costs incurred by these patients through government regulation, high-deductible advocates oppose such government regulation.

Premium support for private insuranceThe CP is neither automatic nor portableLaurence Seidman, 13. (Seidman: Prof of economics at University of Delaware. Pretty heckin’ published on health policy “Medicare for All: An Economist’s Case” Challenge. Vol 56 no1. Accessed 7-22-17. http://www.maineallcare.org/pdf/MedicareforAll.pdf JSD)

The premium support strategy has three serious weaknesses. It will not achieve automatic coverage and portability, ensure that all households

can afford medical care, or control medical costs. Let us consider each weakness in turn. First, the premium support strategy will not achieve automatic coverage and portability. Individuals who obtain insurance from their employer would still lose their insurance if they lose or leave their job. Individuals with high expected medical cost who lack

employmentbased coverage would still face insurance companies that want to reject them or charge them very high

premiums. To try to prevent these rejections or high premiums, government might try to prohibit private insurance companies from engaging in such actions. The ACA will try to do this. But it is doubtful that the ACA can succeed in preventing insurance companies from avoiding high-cost households or subtly

encouraging them to disenroll, given the past maneuvering of these companies as documented by a top insurance insider (Potter 2009). The ACA will also attempt to financially compensate insurance companies that enroll a disproportionate number of high-cost people, but it is doubtful that “risk-adjustment” compensation would work satisfactorily in practice (Aaron 2011; Brown, Duggan, Kuziemko, and Woolston 2011; Van der Water 2012).

Perm do bothVoucher credits won’t match rising cost of healthcare – likely will decrease in the long termLaurence Seidman, 13. (Seidman: Prof of economics at University of Delaware. Pretty heckin’ published on health policy “Medicare for All: An Economist’s Case” Challenge. Vol 56 no1. Accessed 7-22-17. http://www.maineallcare.org/pdf/MedicareforAll.pdf JSD)

Second, as medical costs and premiums rise, Congress may fail to keep the credit or voucher large enough so that all households can afford adequate insurance. It is likely that Congress will keep the credit

Medicare for All Challenge/January–February 2013 111 or voucher large enough so that high-income households with normal expected medical costs will be able to afford adequate insurance, but less likely that it will be large

enough so that low-income households with high expected medical costs can afford adequate insurance.

Private insurance will be just as bad at containing costs as they are nowLaurence Seidman, 13. (Seidman: Prof of economics at University of Delaware. Pretty heckin’ published on health policy “Medicare for All: An Economist’s Case” Challenge. Vol 56 no1. Accessed 7-22-17. http://www.maineallcare.org/pdf/MedicareforAll.pdf JSD)

Third, there is no reason to believe that private insurance companies would have any more success in holding down medical costs under a premium support plan than they do today. Currently, private insurance companies would like to hold down medical costs, but without single-payer bargaining power they have not succeeded. Premium support would have no effect on their bargaining power with providers. It is true that several countries (for example, Germany) have implemented, with some success, “all-payer” bargaining under which the government requires

all private insurers to unite to bargain as a single unit with medical providers (White 2009). Such “all-payer” bargaining has not been implemented in the United States, and though it might succeed in holding down medical costs, it

would still leave all the shortcomings of a private insurance “system” that have been emphasized throughout this article.

Medicaid CPStates administer the CP – causes massive coverage gapsSalvatore Babones, 15. (Babones: Associate prof of sociology and social policy at University of Sudney. Associate Fellow at the Institute for Policy Studies in DC. Author of so many books. “Medicare for All” Sixteen for ’16 – A Progressive Agenda for a Better America. Accessed 7-21-17. https://ses.library.usyd.edu.au/bitstream/2123/12094/2/Medicare%20for%20all.pdf JSD)

The ACA expanded Medicaid eligibility from the poor to the near-poor. By operating through the Medicaid program, the ACA effectively put control over expanding government health insurance coverage for poor Americans in the hands of the states. The ACA also allows states to set up their own insurance exchanges for the non-poor. This further reinforced the fragmentation of the US health care

system into multiple state systems. Since Medicaid is administered by the states, coverage is a kind of poverty lottery: In general, it is much better to be poor in progressive-leaning states than in conservative-leaning states. The federal government pays the majority of the costs of Medicaid, but states are not required to take the money. As a result, most conservative-controlled states are refusing to implement the Medicaid expansion funded by the ACA.(3) Worse, states tend to pay physicians much less to care for Medicaid patients than the federal government pays them for Medicare patients, making it difficult for Medicaid patients to find doctors. The Kaiser Family Foundation reports that the national average Medicaid physician payment is just two-thirds the level of Medicare physician payments.(4) The result is that

many physicians decline to treat Medicaid patients, who end up in emergency rooms instead. A much-reported study showing dramatically increased emergency room usage among people who receive Medicaid coverage proved this point.(5)

Medicaid is not a vehicle for reducing health care costs because Medicaid is so poorly designed. Medicaid is a better-than-nothing antipoverty program, not a good health care program. It is no substitute for a true national program like Medicare.

Perm do both - plan lessens burden on Medicaid programs and State budgetsLaurence Seidman, 13. (Seidman: Prof of economics at University of Delaware. Pretty heckin’ published on health policy “Medicare for All: An Economist’s Case” Challenge. Vol 56 no1. Accessed 7-22-17. http://www.maineallcare.org/pdf/MedicareforAll.pdf JSD)

Medicare for All would eliminate patient cost-sharing so there would be no need for private Medigap policies

or for Medicaid to pay medical bills. Medicaid would continue to pay for nursing homes for people with low income and low assets.

The elimination of Medicaid payment of medical bills would substantially reduce state Medicaid spending and Medicaid’s fiscal burden on state governments. Everyone would pay at least some of the taxes earmarked for Medicare for All so that there would be no free riding—everyone would make a financial contribution. Seidman 90 Challenge/January–February 2013 Medicare for All would eliminate private health insurance premiums and replace them with a set of taxes earmarked for Medicare for All.

States CP for NHICP doesn’t make sense – states don’t have the ability to do anything with medicare, the program can only be expanded by the United States Federal GovernmentStates cannot handle the economic burden of a NHI PolicyWheaton 14 [Sarah Wheaton is a White House reporter for POLITICO. Previously, she was a health care reporter for POLITICO Pro and a senior staff editor for The New York Times, “Why single payer died in Vermont”, POLITICO, December 20th 2014, http://www.politico.com/story/2014/12/single-payer-vermont-113711] BJ

Advocates of a “Medicare for all” approach were largely sidelined during the national Obamacare debate. The health law left a private insurance system in place and didn’t even include a weaker “public option” government plan to run alongside more traditional commercial

ones. So single-payer advocates looked instead to make a breakthrough in the states. Bills have been introduced from Hawaii to New York; former Medicare chief Don Berwick made it a key plank of his unsuccessful primary race for Massachusetts governor.

Vermont under Shumlin became the most visible trailblazer. Until Wednesday, when the governor admitted what critics had said all along: He couldn’t pay for it. “It is not the right time for Vermont” to pass a single-payer system, Shumlin acknowledged in a public statement ending his signature initiative. He concluded the 11.5 percent payroll assessments on businesses and sliding premiums up to 9.5 percent of individuals’ income “might hurt our economy.” Vermont’s outcome is a “small speed bump,” said New York Assembly member Richard Gottfried, who’s been pushing single-payer bills for more than 20 years. But opponents says it’s the end of

the road. “If cobalt blue Vermont couldn’t find a way to make single-payer happen, then it’s very unlikely that any other state will,” said Jack Mozloom, spokesman for the National Federation of Independent Business. “There will never be a good time for a massive tax increase on employers and consumers in Vermont, so they should abandon that silly idea now and get serious,” Mozloom added. The sense of betrayal from single-payers’ most passionate advocates after Shumlin’s announcement was palpable, particularly as he had tied his own political persona to the idea. “It is time to put the interests of patients first, ahead of political expedience,” said Andrew Coates, president of Physicians for a National Health Care Program. Single-payer is “the only reform that will cover everyone, save lives and save money. Mr. Shumlin, of all our nation’s governors, knows this well.” Vermont’s public failure is especially frustrating to single-payer advocates because, they note, the Shumlin framework, which had gotten approval of the state legislature minus that key financing element, wasn’t really a true single-payer plan. Notably, large businesses that operate in multiple

states would have been exempt. And it was unclear whether or how enrollees in federal plans like Medicare and TRICARE could be integrated into the state’s plan. Those exemptions cut into the funding base while adding administrative complexity, eliminating one of the potential cost-saving elements of single-payer: simplicity. “There are some practical problems in the idea of state-based policy,” Coates said, acknowledging the huge federal role in financing and regulating health care. There are also the political obstacles, which are “on steroids,” said Andrew McGuire, a leading activist in California, another traditional center of single-payer activism. Insurance companies, which would be essentially put out of business, are fiercely opposed, and Americans inherently distrust government-run anything — a sentiment not improved by the ACA rollout last year. McGuire, president of California OneCare, said he wasn’t surprised that Vermont backed away. “There ultimately has to be so much pressure that it’s like a volcano goes off and it happens, and that pressure has to be deep and wide in the voting public,” he

said. States’ pockets also need to be deep and wide. Oregon considered adding a public option — not the same as single-payer, but with similar challenges — to its Obamacare exchange in 2010, but ultimately decided the startup costs were too high, even if savings were forecast down the road.

Perm do both - ensures best universality50 States fiat bad lol.

Ableism KNo link -Objections to insurance methods of valuing life are incoherentPeter Singer, 09. 7-19-09 (Singer: bioethics professor at Princeton. Laureate prof at Universtiy of Melbourne. “Why We Must Ration Health Care.” New York Times. Accessed 7-22-17. http://www.med.mcgill.ca/epidemiology/courses/EPIB654/Summer2010/Policy/nytimes%20rationing%202009_07_19.pdf JSD)

Some will object that this discriminates against people with disabilities. If we return to the hypothetical assumption that a year with quadriplegia is valued at only half as much as a year without it, then a treatment that extends the lives of people without disabilities will be seen as providing twice the value of one that extends, for a similar period, the lives of quadriplegics. That clashes

with the idea that all human lives are of equal value. The problem, however, does not lie with the concept of the quality-adjusted life-year, but with the judgment that, if faced with 10 years as a quadriplegic, one would prefer a shorter lifespan without a disability. Disability advocates might argue that such judgments, made by people without disabilities, merely reflect the ignorance and prejudice of people without disabilities when they think about people with disabilities. We should, they will very reasonably say, ask quadriplegics themselves to evaluate life with quadriplegia. If we do that, and we find that quadriplegics would not give up even one year of life as a quadriplegic in order to have their disability cured, then the QALY method does not justify giving preference to procedures that extend the lives of people without disabilities over procedures that extend the lives of people with disabilities. This method

of preserving our belief that everyone has an equal right to life is, however, a double-edged sword. If life with quadriplegia is as good as life without it, there is no health benefit to be gained by curing it. That implication, no doubt, would have been vigorously rejected by someone like Christopher Reeve, who, after being paralyzed in an accident, campaigned for more research into

ways of overcoming spinal-cord injuries. Disability advocates, it seems, are forced to choose between insisting that extending their lives is just as important as extending the lives of people without disabilities, and seeking public support for research into a cure for their condition.