universal healthcare

Eh. What the hell. So my opponent appears to be broadly arguing the moral and economic advantages to universal care, and so I'll group accordingly. Moral. Here, my opponent makes a few arguments: 'you shouldn't have to go broke to pay for your healthcare and no one should ever die just because they cant afford it' being fairly representative. My opponent doesn't place a line on death--i.e., we all eventually die, so the more accurate concern is extended/ameliorated life against cost. Or, Quality Adjusted Life Year (QALY). Implicit to my opponent's attitude here is that death is absolute and so we have an infinite justification to avoiding it. In other words, that we should spend without limit to achieve improvements to the QALY. But there isn't a system in the world that doesn't place limits on the care that can be received. And of course, there's no reason to think the US can do otherwise, even ignoring the obvious crowding out of other investment. Therefore, my opponent cannot argue against the concept of rationing care, but rather must argue for a specifically different ration. It will be difficult for him to resolve the tension between the inevitable rationer of care and his seeming intolerance for that outcome. Economics. Here my opponent argues various shades of 'other countries do it better'. Of course, this is completely insufficient, as it ignores environmental and population differences. For example, the US is among the most obese countries [1,2] (child 2nd, adult 4th: Nauru, Lebanon, Saudi Arabian in 1, 2, 3). Obesity already accounts for 21% of US healthcare spending [3]. And through 2020, we currently expect 31% of the growth in health costs to be directly attributable to obesity [4]. So, we should also look at these other healthcare systems. It's frequently reported the US spends the most per capita. This is true. Also true is that from 1990-2008, the US healthcare system experienced a slower rate of cost growth than Australia, Belgium, Netherlands, Spain, and the UK [5]. From 2000-2008, the US had the same cost growth as did Canada [5]. That's curious. The rate of growth in US spending (pre PPACA) has been trending down. If this is maintained, we'd actually be better situated than these peer countries. Perhaps my opponent would like to argue the distribution of care--regardless of the rate of growth in costs, other systems spend more money from the government, and so their health resources have a better distribution. Good narrative, conforms to biases: completely untrue. In 2008, the US spent more public money (as a share of GDP) than did Australia, Switzerland, Spain, Japan, Italy, Norway, UK, and Canada (we spent the same as Belgium and Netherlands) [5]. Further, the US underestimates the amount of money it spends from public programs. Public programs ritualistically underpay for services, leading to significant cost shifting to private payers. Medicare pays roughly 91% of medical costs (that's before profit), Medicaid pays 88%, and so private payers cross subsidize to the tune of 115%+ [6,7,8] And in fact, US hospitals lost money on Medicare patients overall in 2011 [9]. Clearly the single-payer is a nice buzzword for people who thinks there's an easy solution to the distribution of health resources, but it isn't so. Systems around the globe are hastening to control the growth of costs, which threaten to crowd out other useful investment. So why do we spend so much on health services? A combination of factors, highlighted by the proportion of care deemed ineffective or redundant, >30% [10]. A number of factors here as well: EMRs have driven consumption of redundant tests, etc. [11]; defensive medicine, fearful of litigation [12]; fee for service [10]; and most importantly, moral hazard incentives at the point of care (even Canada has higher out of pocket expenses than does the US, lower percentage of nearly all other developed countries [13]) [14]. We can explore better solutions later. [1] http://www.vexen.co.uk... [2] http://www.wcrf.org... [3] http://www.sciencedaily.com... [4] http://www.preventionminnesota.com... [5] http://www.kff.org... [6] http://www.forbes.com... [7] http://content.healthaffairs.org... [8] http://www.thevha.net... [9] http://www.kaiserhealthnews.org... [10] http://www.wchq.org... [11] http://content.healthaffairs.org... [12] http://www.ama-assn.org... [13] http://www.thefreemanonline.org... [14] http://www.rand.org...