The USA should establish a Single-Payer Health Care System

Thanks Contra. == Rebuttal == 1) Overutilization My opponent misconstrues the RAND study. When co-pays are reduced, people seek more "inappropriate or unnecessary medical services." The Dartmouth study found that when health care is free, if you double the number of doctors, people will visit the doctor twice as often. My opponent cites 24 pages of some book to show "fewer would actually go to the doctor" but I doubt this claim, the claim is empirically disproven, and I cannot access said book to see what it says. Overuse is a serious problem in running up costs. A government study in France concluded that the French, because drugs are free, demand drugs at rates three times their peers in other countries, and drug outlays are responsible for the huge deficit in French health care. [1] Does preventative care save money? First of all, blood pressure medication is covered under private insurance and so are cancer screenings. Secondly, the literature disagrees with my opponent. A meta-analysis by the New England Journal of Medicine of 599 studies found that on average, the costs of prevention and treatment are the same, and "Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not." [2] The Congressional Budget Office also concluded that under universal health care, "preventative care will raise – not cut – costs" because so many healthy people will start overusing screening and prevention. [3] Smart cards Taiwan is unique in using smart cards; the US doesn't use them for Medicare or Medicaid, and the ACLU and other civil liberty groups oppose them on privacy grounds. Thus, my opponent can't prove we would start using them. And they don't save that much money. In Taiwan, the system is nearing bankruptcy, as "the government is borrowing from banks to pay what there isn't enough to pay the providers." [4] While my opponent is correct that if someone saw a specialist 20 times a month, we'd flag their file, even if everyone saw a specialist only three times a month, that is still enough overuse to bankrupt the system, yet not enough to raise a red flag. 2) USA already rations care? This isn't true. The Emergency Medical Treatment and Active Labor Act requires emergency rooms to treat the uninsured. A study in the New England Journal of Medicine found that the breast cancer survival rate for uninsured women (who used the ER) was higher than for woman using Medicaid. [5] It's better to use the ER than to have government insurance in the US. Also, Obamacare provides a private sector solution: subsidies and state insurance pools to help the poor afford health insurance. We don't need a single payer system to achieve universal coverage; we can do it through the private sector and avoid the disadvantages of single payer. My opponent argues that we currently have enough doctors and enough equipment not to have to ration care. However, those doctors and equipment exist because private insurers are willing to pay for them. When the government lowers reimbursement rates fewer doctors are willing to accept patients. Approximately 20% of all doctors and nearly half of all primary care physicians won't accept Medicare patients anymore, and that number is projected to double with the new 21% cut in reimbursement rates. In addition, 20% of doctors said they would quit under a single payer system due to lower pay. The U.S. has far more MRI's per capita than any other (single payer) country, precisely because private insurance is willing to pay for these machines. Making reimbursement rates similar to Medicare, as opposed to the higher rates offered by private insurance, *will* lead to rationing. My opponent claims if we have to ration care, we will do so in a "fair" way. When France had a shortage in beta interferon, it held a lottery to decide which hepatitis patients would live and which would die. I'd rather avoid government-caused shortages than resort to such "fairness." 3) Wait lists My opponent's wait list argument comes down to the argument that the current supply of medical treatment will remain the same even when we start paying less for it. This contradicts the basic theory of supply: that suppliers base their supply decision on the price people are willing to pay and exit the market when that price is too low. I can't locate any of my opponent's claims about Canadian wait times and satisfaction in his source. It's not true that 80% of Canadians like their health care. "According to a recent poll called The National Pulse on Health Strategy, 80 percent of Canadians want major reforms to the health care system." [6] However, according to a Gallup poll, 80 percent of all Americans are satisfied with the current level of medical care available to them. [7] Wait times in Canada are not declining and are not just for elective procedures. The average wait time for a cardiac bypass (an emergency procedure to stop heart attacks) is 65 days; average wait time for an MRI is 126 days; average wait time for breast cancer treatment is 168 days. [6] And remember, in Canada, "Only half of ER patients are treated in a timely manner by national and international standards, according to a government study." My opponent says once again that single payer countries have better results, but these rankings measure health outcomes based on life expectancy, which includes car accidents, homicide rates, and many other irrelevant factors. If you look at effectiveness at the point of intervention, the US ranks #1 in 5 year cancer survival rates. 4) Quality in the US The doctor poll my opponent cited here talks about a "national health insurance program," which could mean single payer or a private sector approach, like Obama's. My opponent says here that France doesn't have physician shortages due to low pay. He clearly didn't read my source from earlier (footnote 20). It says that a national association of doctors called CNOM, much like the AMA here, "is concerned over 'medical desert' areas." A study by CNOM found that 19 of 22 regions have seen a steep decline in the number of doctors. He claims we could have loan forgiveness for doctors, but we could do that now as well. If we cut pay by two thirds, to be consistent with physician pay in France, we will lose a ton of doctors, even if we make medical school cheaper. 5) Death Panels My opponent says his Death Panel doesn't decide to disallow care, it just decides which treatments not to cover. If the Death Panel is forced not to cover expensive treatments, I don't see how poor people are any better off under this system. They have government health care that doesn't cover anything. This is essentially what Medicaid is now, which is why uninsured breast cancer survival rates were higher than people enrolled in Medicaid. Also, remember the studies that Canada's poor have worse health outcomes than the poor in the US and health outcomes for the poor have not improved in England since they implemented their single payer system in 1948. Between rationing, wait times, and death panels denying treatment, the poor do not find themselves better off under single payer systems. 6) Drug innovation To combat my study, my opponent again cites the same 24 pages from some book. Many new drugs are based on private research, not government research, which is why countries with single payer price controls lose $22 billion annually from drug research and lose 13 new drug launches each year. What was the last time the government invented and patented a new drug? Regardless, single payer countries like Canada are so overburdened paying for overuse of medical treatments that they cannot afford R&D. I already cited a source that showed that Canada can't afford to spend any money on R&D, so their R&D budget is near zero. 7) Cost I don't know where my opponent gets his figure that we could pay for government health care with a 2% income tax increase. France needs a 20% income tax to pay for their system. I cited a projection that the average family would need to pay $14,000 per year in taxes for single payer health insurance. The economic recovery is finally showing some momentum. If you take away 7% of employer profits (through taxes), this would mean much slower job growth since employers will have much less money for job expansions. Many employers cannot afford this tax since profit margins for them are lower than 7%. My opponent doesn't bother answering the cost to the government, which would be more than the 40% of government revenue in France, since his proposed taxes don't cover the cost of the system. I also 100% win that Medicare and Medicaid suck and result in drug shortages. If the government can't run services well for a part of the population, it won't be any better at implementing these same services for everyone. I also 100% win that Medicare has higher bureaucratic costs, so we actually lose money to bureaucracy by switching to government insurance. My opponent concedes this so I turn this point against him and thus prove that you should vote Con to save money due to wasteful bureaucratic costs associated with government inefficiency. [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...