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

Okay. I'll stick a heading on the arguments to aid the organization. I apologize to anyone who makes it this far. I'm going to start with what I think are the two most important arguments. But first, my opponent says, "i think it's obvious neither of us are experts on the methodology of the studies we cite etc, as would be necessary to eally understand this issue." Respectfully, she should speak for herself. 1. Public Spending This is a sufficient winner. Health care systems have massive cross subsidies. It doesn't cost PC physicians ~$400 to see patients, but they charge the average patient this much to cover the 1-2 patients who need much more time/effort. The same trend extends across the industry. We see, for example, massive cost shifts from CMS to private insurers. I referenced this earlier--CMS pays 89% of medical cost. This forces the private insurers to pay closer to 120%. Given the cross subsidies, what we care about is aggregate funding. Hence, we do not get the effect Canada's 7.3% public expenditure on health with our 7.4% public expenditure on healthcare. This ties to the previous, implying that our 'real' public expenditure is even higher. And we get less for this. This ties to a third argument. The causes of health disparities are complex and myriad. I argued it's dishonest to compare two countries as if we can hold every other variable constant. We can't. Therefore, since we already spend more government money on healthcare than peer nations, and this money doesn't achieve anything close to peer result, it's inaccurate to state that the transfer of funds from private to public will provide solve healthcare. This is the heart of my opponent's case: that we spend 17% GDP and 'Canada' spends 10%. He's arguing if only we spent as much public money as Canada, we could get Canada's result. We already spend more public money then Canada. His syllogism fails. 2. Cost Growth This is another sufficient winner. My opponent doesn't respond to this argument, or his response "I don't see your point" is non-responsive. We can extend the analytic from R2. " That is, if my insurance is comprehensive, but pays 1/3 of cost, then the cost is going to ultimately prevent me from receiving care. Hence, the only metric we should care about is the growth of cost. Or, let's wait 20 years. If the trends continue as is, then we'll be the ones with the cheaper healthcare." Applying the analysis from (1), funding is of paramount importance. Since US costs are growing more slowly, even if our SQ isn't desirable, our 10 year outlook is. No-change beats change. As I said, this argument wins me the round. We care about healthcare industry insofar as we use it help people. The healthcare industry is primarily limited by cost constraints (inclusive of patient health indicators). Since our longterm cost outlook is better, we should prefer SQ over my opponent's change model. It's likely to grow costs more quickly. 3. Administration My opponent doesn't address my arguments. He repeats the 'lower/higher' administration figures without engaging some of the more complicated nuance. This argument matters because 'administration' appears to be the primary benefit my opponent attributes to single-payer systems. Hence, if the administration argument falls, we have no reason to prefer s-p. First, and most importantly, private insurers cannot operate separately across states. This is the single biggest reason their 'administration' is so high. If private insurers could operate nationally, their administrative expenses would plummet. Thus, we can't draw any conclusions from the status quo private insurer expense. Second, CMS doesn't have much administration, because it pays the private insurers to do so. Hence, we can't draw conclusions from CMS's administrative expense. Third, CMS pays private companies to regulate. Again, CMS shirks activities which would inflate its administration. Now, CMS should be doing these things. JCAHO is much better at regulating than CMS used to be. But CMS doesn't get to use an artificially low administration to justify its efficiency. Fourth, CMS doesn't attribute many other costs, like the cost of taxation, fraud, or fraud prevention to its administrative estimate. Fifth, Administration can be good. Kaiser has more actively managed its patients and has in exchange lowered there costs [R2]. Also in R2, CMS abandoned its somewhat similar pilot because it failed to manage costs. Sixth, US health insurers netted ~12 billion in profit. This is less than 1% of the $2.2 trillion we spend annually on healthcare. Or, if s-p is designed to save this money, it's completely insufficient. Seventh, if the primary reason to prefer S-P is reduced administrative expenditures, why would this not apply to other industries? I.e. no need to have a Chevron/Exxon/etc. payroll. Except we know that government enterprises tend to fail, and where they've succeeded more moderately, i.e. s-p's, they've free-ridden on US innovation. My opponent agrees with the last. It's possible she intended "insurance companies are not the ones doing the innovation" as a sort of response to 6. What I can say is that she's factually wrong. Insurance companies are innovating how they manage patient populations. For example, Kaiser is developing a system of patient incentives and monitors. Or, Highmark acquired a large hospital network in PA to innovate the Accountable-Care-Organization model. I specifically told my opponent in R2 that she needed to address these if she wanted administration offense. I don't see where she did so. We should extend these through and drop administration. 4. Emergency Rooms I'm not sure my opponent understood this argument. Pulling from R2, "we should look at hospitals closing their ER's as an indicator they can't afford to continue their operation". It's not an especially important argument, merely as evidence of cross-subsidies in healthcare and that health providers are experiencing a real constriction. 5. "Ounce of Prevention" My opponent argues here: "i'm saying if we had a single payer system, they would go to get cold medicine instead of ER services." While I understand my opponent is arguing hypothetically, she's incorrect in assuming that the bulk of costs come from anything similar to 'colds'. They don't. Most spending has to do with long term chronic care. Chronic heart failure, obesity, cancer, transplant, organ failure, debilitative conditions, etc. And so, she's incorrect, and we can extend from R2 again, not responded to: "Unfortunately, this has little basis. For example, we've recently developed reasonable evidence obesity doesn't raise aggregate health costs because the obese-ist tend to die before they can get cancer." "See, it's true that "prevention" does have an important effect, but it tends to be the obvious kind. Namely, exercise, eat nutritionally, take a baby aspirin after turning 45ish. Etc. These are things we don't need doctors to tell us to do." "Or, CMS recently abandoned a pilot program that attended to assist CHF patients with drug/exercise compliance. The program was not able to generate a cost effective result." "Further, I'd reference the mammogram snafu from ~2-3 years ago." So, prevention is complicated, over wrought, and CMS hasn't been able to solve. 6. RAND Health Insurance Experiment I'm running out of space here, but essentially, incentives matter critically in our usage of care. Moral hazard has a significant effect on healthcare spending in the US. 3rd party payers tend toward poor utilization of care, but this is non-unique to the s-p conundrum. Personal behavior are the primary driver of cost growth in the US, and so when addressing the growth in costs, our solutions should be oriented around aligning patient incentives. I thank everyone for their attention, request they redirect themselves to #'s 1 and 2 as the easiest voters, and urge a Con ballot.