The USA should establish a Single-Payer Health Care System

Thanks Contra. == My case == Lucky for us, single-payer health insurance has been tried in a number of other countries. Let's see if it has made these countries better off. C1) Rationing of care When you make health insurance free for everyone, people feel like they no longer have to pay for medical services. When *any* service is free, people overuse it. A well-known study by the RAND Corporation found that free health insurance increased the amount of health services used by the participants, particularly in the category of "inappropriate or unnecessary medical care"; obviously, this increased treatment did not improve health outcomes. [1] In addition, a study at Dartmouth Medical School and a study of Medicare found that "when health care is free . . . people will exhaust [all] available resources despite whether or not it has any benefit on their health." [2] What this means is that under single-payer health insurance, people *do* exhaust all available medical resources, creating long wait times for people who actually *need* medical treatment. For example, in England, citizens take an average of one ambulance trip per citizen per year, 91% of which are for non-emergency purposes. [9] Because they are free, the British are treating ambulances as taxis. As a result, wait times in single-payer systems are well documented. A study in Sweden concluded: "Long waiting lists for coronary artery bypass grafting are associated with considerable mortality." [3] More than 50% of people in Sweden have to wait longer than 3 months for surgery. [5] In England, 21% of lung cancer patients become incurable while on the wait list. [4] "The World Health Organization has recently called [England's National Health Service] a deliverer of ‘third world cancer care.'" [2] In Canada, "Only half of ER patients are treated in a timely manner by national and international standards, according to a government study." [6] That's scary given that most Emergency Room patients are in dire need of treatment. Supposedly the greatest feature of single-payer insurance is increased access for the poor and "fairness," i.e. equal access for all. However, in Japan, the rich routinely bribe their way to the top of the wait list. [9] Canada's Fraser Institute finds that wait lists in Canada are "routinely jumped by the famous and politically-connected." [7] The rich still get better access to treatment in Canada, which is why a study published in the Forum for Health Economics & Policy concluded "that the poor [in Canada] under socialized medicine seem to be less healthy . . . than their American counterparts." [6] That's pretty bad considering the number of uninsured in the United States. Apparently it's better to be uninsured in the U.S. than insured by the government in Canada. A similar study in England concluded that health outcomes for the poor had not improved since implementing a single-payer system in 1948. [9] C2) Quality of American government health care To see if single-payer would be better in the US, we can look to whether our government is good at providing medical insurance by examining Medicare and Medicaid. According to the New York Times, more and more doctors are opting out of Medicare, "The doctors' reasons: reimbursement rates are too low and paperwork too much of a hassle." [10] USA Today reports that Congress is cutting reimbursement rates for Medicare by a further 21%; currently, the AMA reports that 17% of all doctors and 31% of primary care physicians are not accepting Medicare patients, but the number will double after the 21% reimbursement cut. [11] The numbers for Medicaid are even worse. In addition, the price controls for medicine that the government has implemented in Medicare is contributing to massive drug shortages. The Heritage Foundation reports that price controls under Medicare Part B are the #1 contributor to the shortage of 178 different generic drugs. [12] If our government ran all insurance, these shortages would become more severe. C3) Cost In France, the system costs 40% of government revenue and implements a payroll tax of 20% on citizens. [13] This amounts to a cost of $1 trillion a year in the US to the government alone. In addition, France is running a $13.5 billion shortfall per year and its health care system is on the verge of bankruptcy. [14] The US cannot afford such an expensive system when we're already struggling with our budget deficit. In addition, Americans cannot afford such an expensive system during a recession. "It has been estimated that a Swedish-style single-payer health insurance system in America would cost the median-income household some $17,200 per year in health care taxes." [15] C4) Physician shortages The US is already projecting shortages in the number of nurses and other health care professionals. Single-payer reimbursement rates are low, as we saw with Medicare. In France, doctors earn a third of what they do in the US. [16] In Japan, doctors must see 40 patients per day to make a decent living. [9] For this reason, in a survey, one in five US doctors said they would quit if the US implemented single-payer insurance. [17] France has a huge problem with doctor shortages. [20] C5) Drug innovation A study by the Boston Consulting Group found that price controls under single-payer systems resulted in an average "loss of $17-22 billion annually in pharmaceutical research, resulting in the loss of 10 to 13 new drug launches" per year per country. [18] For this reason, most countries rely on the US for drug innovations. C6) Death Panels My opponent says in his conclusion that he sets up a Health Planning board to decide which treatments to cover and which life saving treatments to NOT cover. In England, a similar death panel decided to deny a life extending drug to MS patients. [19] == Rebuttal == R1) Patient choice What my opponent has described – being able to see any doctor or specialist – exists in the private insurance market now – it's called a PPO. HMO's, which are cheaper forms of health insurance, allow you to see any specialist but your primary care physician must issue you a "referral," deeming the visit medically relevant. HMO's have lower premiums precisely because they prevent patients from taking unnecessary trips to see expensive specialists. In contrast, free choice means overuse of resources, resulting in long waiting lists under single-payer systems. R2) Increased innovation My opponent provides no actual evidence that single-payer systems are more innovative, while I have a study proving that their price controls ensure they are much less innovative. In fact, due to the high medical costs of single-payer insurance, Canada spends almost NOTHING on Research & Development. [9] R3) More efficient? A study by the Heritage Foundation found that Medicare administrative costs are only lower as a percentage of total costs because Medicare spending outlays on medicine are ENORMOUS, so administrative costs look small in comparison. [21] Heritage concludes that on a *per patient* basis, Medicare administrative costs were 48.4% higher than for private insurance in 2000. [21] The NYT evidence made clear: all doctors agree that Medicare has more annoying bureaucracy and paperwork than private insurance. R4) Decrease cost? Obama's 2009 health care reform already implements many of these cost saving measures. For example, the reform requires that 80% of private insurance premiums go to medical treatment, which will make private insurers even more efficient. In addition, France's deficit proves that single-payer is not cheaper due to the overuse of free treatment. R5) Coverage of all? "As the Canadian Supreme Court said upon ruling unconstitutional a Quebec law that banned private health care, ‘access to a waiting list is not access to health care.'" [18] R6) Quality of care? See rationing. My opponent cites rankings based on life expectancy figures. A great article in Forbes questions how the number of car accidents in a country (which affects life expectancy) is relevant in measuring health care outcomes [22]. Forbes says we should measure how well the system performs at *the point of intervention,* meaning once you get sick. The US ranks #1 on "5-year survival rates for breast cancer, colon and rectal cancer, and prostate cancer." [22] R7) Bankruptcies Most medical bankruptcies are incurred after an insurance company denies coverage for expensive experimental or uncovered treatments. Rationing and death panels would lead to the same or worse outcomes. In Canada, people desperate for care come to the US for treatment and pay cash. [9] [1] http://tinyurl.com... [2] http://tinyurl.com... [3] http://tinyurl.com... [4] http://tinyurl.com... [5] http://tinyurl.com... [6] http://tinyurl.com... [7] http://tinyurl.com... [8] http://tinyurl.com... [9] http://tinyurl.com... [10] http://tinyurl.com... [11] http://tinyurl.com... [12] http://tinyurl.com... [13] http://tinyurl.com... [14] http://tinyurl.com... [15] http://tinyurl.com... [16] http://tinyurl.com... [17] http://tinyurl.com... [18] http://tinyurl.com... [19] http://tinyurl.com... [20] http://tinyurl.com... [21] http://tinyurl.com... [22] http://tinyurl.com...