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Debate: Single-payer universal health care

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*'''Life not money should be a major concern.'''The ability to afford something plays no role in whether it is just or not. If there is a conflict between life and money life should prevail because it is a right while money is a want not a need. I will offer the following example; if we wanted to save money we could stop social security payments to all long-living seniors who have already received more money than they put in the system because we can afford it. This would hardly be fair or just but it would save an awful lot of money. *'''Life not money should be a major concern.'''The ability to afford something plays no role in whether it is just or not. If there is a conflict between life and money life should prevail because it is a right while money is a want not a need. I will offer the following example; if we wanted to save money we could stop social security payments to all long-living seniors who have already received more money than they put in the system because we can afford it. This would hardly be fair or just but it would save an awful lot of money.
-*'''Universal health care is a legitimate "burden" on the tax payer. People pay for public utilities such as road and people pay for education as well. But do people who don't drive recklessly ask for money back when roads are damaged? Do people who send their children to private school ask for all their money back? We place this burden on the state because of equality of opportunity. No man should be denied the right to live his life.+*'''Universal health care is a legitimate "burden" on the tax payer.''' People pay for public utilities such as road and people pay for education as well. But do people who don't drive recklessly ask for money back when roads are damaged? Do people who send their children to private school ask for all their money back? We place this burden on the state because of equality of opportunity. No man should be denied the right to live his life.

Revision as of 14:57, 31 May 2008

Is single-payer (government-funded) free universal health care a good idea?

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Contents

Background and Context of Debate:


Motions: What are the general motions of the pro and con sides?

Yes

  • This house believes health care is a right, obligating governments to provide it universally.
  • This house believes profit companies cannot provide adequate care.
  • This house believes private companies should be excluded from the system.
  • This house argues that profit companies are less economical and efficient.
  • This house values health over wealth


No

  • This house contends that health care is not a right, making it unnecessary for governments to supply it universally.
  • This house believes that companies can better provide health care.
  • This house maintains that if a universal system is pursued, it should involve for profit companies and insurers.
  • Some on this side maintain health care is a right, but that private companies should be involved in providing it.


Human rights: Is health care a human right?

Yes

  • Health care is a basic human right or entitlement Health is fundamental to the preservation of all other individual rights. If one is sick in a hospital bed, they cannot be said to have equal opportunity or the ability to exercise free speech and religion. And, of course, one cannot pursue happiness if they are in a hospital bed. This is why health must be considered a basic human right.
  • Universal health care protects healthy citizens from many health risks. If citizens have a right to be healthy, they are due some protections from the sickly. By providing for the sickly, government is helping protect the rights of the healthy.
  • Health care is considered a right in international law. The UN Universal Declaration of Human Rights enumerates medical care as a universal right.
  • Life not money should be a major concern.The ability to afford something plays no role in whether it is just or not. If there is a conflict between life and money life should prevail because it is a right while money is a want not a need. I will offer the following example; if we wanted to save money we could stop social security payments to all long-living seniors who have already received more money than they put in the system because we can afford it. This would hardly be fair or just but it would save an awful lot of money.
  • Universal health care is a legitimate "burden" on the tax payer. People pay for public utilities such as road and people pay for education as well. But do people who don't drive recklessly ask for money back when roads are damaged? Do people who send their children to private school ask for all their money back? We place this burden on the state because of equality of opportunity. No man should be denied the right to live his life.


No

  • Free, universal health care is an illegitimate "positive" right. The main premises here is that "rights" should only protect individuals from harm from others and allow them certain freedoms, but a right to universal health care entails individuals burdening other members of society (possibly violating the liberties of innocents) for things that are perceived as needed or desirable. The extreme of this argument is the circumstance in which a careless smoker is given the "right" to burden others for their expensive health care costs.
  • The necessity of medical care does not make it a right. Food, for example, is not considered a right, and companies are allowed to sell it, as well as to withhold it from those that need it but can't afford it. This is the right of grocery stores to do, and receives no complaint from society in general.


Analogous services: Is universal health care analogous to other modern services?

Yes

  • The government funds fire-stations, why not universal health care? The government taxes citizens to fund and provide numerous services universally, including policemen and firemen. These services are comparable to physician services in many ways, particularly in the sense that they help protect the life, safety, or health of citizens. Why shouldn't health care also be provided universally through the same means - taxes?


No

  • Health problems are more about individual choices than fires and crime. While many people compare health care to police stations and fire stations, they are not the same services. Health care is largely about providing a service to the individual that compensates, often, for poor individual choices. Fire stations and police departments, on the other hand, provide services to a community and focus on protecting individuals against things they have no control over (crime and fires). The differences are very significant in regard to what the state is obligated to provide. The state is obligated to protect citizens from one-another. But, the state is not obligated to protect citizens from themselves. Universal health care is wrongheaded to the extent that it involves protecting individuals from themselves.


Needy: Is free health care important for those in dyer need?

Yes

  • Free, universal health care helps the unhealthy in times of need. When an individual is sick, they shouldn't have to think about how to pay for their treatment. In free, universal health care systems, when one is sick, they are simply told to rest and get better. This is essential for proper healing. Conversely, in a non-free-universal-health-care system, a sick person is required to figure out how to pay for their health care, rather than simply focusing on getting better. The stresses this causes hampers healing.


No

  • A right to health care is not necessary in taking care of indigent patients. Indigent patients have been taken care of by physicians with dignity and compassion in the name of genuine charity, pro bono. This model can provide adequate care to the needy. And, of course, this model can be expanded out further, if need be, to aid the needy.


Choice: Does universal health care deprive some choice? Is this OK?

Yes

  • When the wealthy must use public health care, the system improves If the wealthy are not allowed to buy better health insurance, and are forced to use public single-payer health care, they come to realize that the only way to ensure good care is to pressure for good universal health care. As a result of the wealthy pressuring for improvements, all individuals of all classes will enjoy better health care.


No


Uninsured: Do large numbers of uninsured give cause to universal health care?

Yes


No

  • Many uninsured are lazy free-loaders who don't deserve care Many uninsured are simply lazy, and believe they can get a free ride off of the system. These people do not deserve free, universal care from the system.
  • Universal health care would amount to welfare for the uninsured. The government should not create a health care system that is aimed primarily at helping the poor and uninsured. As such, it becomes merely another wealth-transfer program.


Socialized medicine: Is it wrong to call single-payer systems socialized medicine?

Yes

  • Single-payer systems involve government paying for private services Most single-payer systems in Europe, as well as ones proposed in the United States (building on Medicare), involve the government paying for the insurance of individuals. This means that individuals would still go to private hospitals and doctors. The only difference is that the government-funded insurance pays for services instead of the money coming from your own insurance company.


No

  • Universal health care is socialized medicine.
  • Universal health care leads to rationing.

Physicians: Is free, universal health care fair to physicians?

Yes

The survey suggests that opinions have changed substantially since the last survey in 2002 and as the country debates serious changes to the health care system.
Of more than 2,000 doctors surveyed, 59 percent said they support legislation to establish a national health insurance program, while 32 percent said they opposed it, researchers reported in the journal Annals of Internal Medicine."
  • Doctors in universal health care programs are paid well.
  • Universal health care is fair to doctors. A universal health care system does not mean that the private market should be abolished. Doctors can chooses to operate private practices in a two-tier system. This will attract consumers who require either more personal service, those who know or want a personal doctor, and those who want better quality of care than the public system provides.

No

  • A right to health care violates the rights of physicians One cannot have a right to other people's services. Does a physician not have the free right of association and contract with patients? Why would physicians be forced to perform free or government-set prices for their labor? Why shouldn't they be able to charge market value for their services? Did they enter into their practices with the understanding that they would not be able to charge fair market value? No. They are generally service providers like any other that expect fair, market-based compensation. Universal health care would deprive physicians of this freedom to charge market-value by imposing government pricing on their services, almost certainly at a discounted rate.
  • Single-payer health care over-loads doctors and burns them out Because more people seek care, doctors in a universal health care environment often are over-loaded. Hoping to meet their patients needs, they work over-time. Yet, by doing this, they often burn out and leave their practice early, exacerbating the problem even further.


Quality: Does free, universal health care provide superior care?

Yes

  • For-profit insurance companies often put patients at risk to cut costs - Health insurance claims are considered a "loss" for profit insurance companies. These companies are designed to maximize profits by cutting costs. How can these companies act in the best interests of their patients if their incentive structure is designed to minimize health coverage?
  • Insurance companies screen out those that need health care the most Insurance companies have a interest in maximizing profits that drives them to screen out individuals that are unhealthy, old, and "high-risk". These are the people that need health care the most, and the insurance industry has a direct interest in making it difficult or more expensive for them to obtain health insurance.
  • Universal health care systems incentivize improving patient health. Many free universal health care systems provide incentives to doctors to improve the health of their patients. This contrasts with for-profit health care systems that do not provide financial incentives to doctors to improve the health of their patients, largely because healthier patients would mean lower profits.
  • Universal health care will allow doctors to concentrate on patients In private and managed health care networks, doctors typically have to check with insurance companies before they perform a service. Such a system does not relate to the patients needs, but corresponds only to financial considerations.
  • Universal health care decreases the likelihood of health related problems. The single most destructive issue regarding health care in America is the lack of preventative care. Patients wait until their disease progresses to a dangerous level before they seek care because otherwise they can not afford medical cost. Universal health care offers them access, thus increasing the patient's incentive to seek care when the health threat is minimal, and in the long run reducing the burden to the state.

No

  • The markets are better at providing quality; same with health care. The markets and competition generally help produce higher quality goods for the least money (the highest value). The same applies to health care.
  • Quality of health care is much worse under universal health care. According to Reuters in London, one in 10 patients admitted to National Health Service hospitals in Britain is unintentionally harmed and almost a million safety incidents, more than 2,000 of which were fatal, were recorded last year, according to a report on July 6, 2006. Such figures were "terrifying enough", the report by parliament's public accounts committee said, but the reality may be worse because of what it called "substantial under-reporting" of serious incidents and deaths in the NHS

Innovation: Do single-payer systems support medical innovation?

Yes

  • Most investment in medical innovation does not come from companies Private companies make up a smaller portion of the total investment in medical innovation. This means that a single-payer health care system would not see a major reduction in funding for medical innovation. Depending on how the system is designed, it could even see an increase in such investment.
  • Profit interests corrupt investments in medical innovation Drug and medical companies are driven, in large part, by the bottom-line of profits. Their investments in new drugs and medical innovations are driven by these interests. But, what is likely to make the most money is often at odds with public and patient interests.


No

  • Single-payer health care hinders medical investment and innovation The primary cause of this is a reduction in economic incentives for innovation. In general, the only way that people will take the time, energy, and risks involved with innovation is if there are substantial returns for their investment. This notion underpins the markets and capitalism generally, but is undermined by universal health care. Universal health care, therefore, could be expected to see fewer innovations and medical advancements.


Standards: Would universal health care set a good standard of care?

Yes

No

Delays: Do universal health care systems address concerns of delays?

Yes

  • Single-payer health care reduces complexities faced by patients Insurance companies often make life as difficult as possible for patients through complicated rules and qualifications. Again, profit-interests motivate this because it makes it less likely that patients will seek a claim. This is all very stressful and time-consuming for patients. A single-payer system would simplify things.


No


Competition: Is competition a bad thing in health care?

Yes


No

  • Single-payer health care erodes competition in price and value The notion of the free markets as a source of efficiency dates back to Adam Smith. The health care industry is no exception to this rule. If it is open to the free-markets, consumers will shop for and purchase the best price and value. Pressure will be placed on insurance companies to cut costs and sell their surface at a lower price for greater value. Free universal health care would interrupt this, reduce efficiency, and increase costs.
  • Governments might attempt to control costs by gaining or enforcing monopsony power. For example, governments, such as Canada, have outlawed medical care if the service is paid for by private individual funds.


Economic efficiencies: Would universal health care be more economically efficient?

Yes

  • Universal health care systems are more economically efficient America spends a far higher percentage of GDP on health care than any other country, and has worse ratings on a variety of subjects such as quality of care, efficiency of care, access to care, safe care, equity, right care and wait times according to the commonwealth fund. New Zealand, which spends one third per capita what the US spends on health care beats the US on every marker of efficiency and care. Although not definitive, this does lend credence to the idea that universal health care is more efficient than our for profit health care system as the US was inferior to Germany, the UK, Australia, New Zealand and to a lesser degree Canada in nearly all health care quality issues. This despite the fact that the US system costs 2-3x more per capita than the systems in these other countries.
  • Single-payer health care gets rid of wasteful middlemen According to an estimate by Dr. Marcia Angell roughly 50% of healthcare dollars are spent on healthcare, the rest go to various middlemen and intermediates to providing healthcare. A streamlined, non-profit, universal system would increase the efficiency with which money spent on healthcare goes to healthcare.
  • Costs are inconsequential if health care is considered a universal right. It may very well be true that universal health care increases costs. Yet, if we presume that health care is a right, then such added costs are insignificant; they must be born to secure the right of universal health care.


No


Administrative costs: Would it reduce administrative costs or add to them?

Yes

  • Universal health care reduces administrative costs (i.e. paper work) Medical professionals are often challenged with massive amounts of paperwork in private health care systems. A universal health care system will help coordinate and reduce paperwork, allowing doctors to concentrate on treating patients. A single payer system could save $286 billion a year in overhead and paperwork. Administrative costs in the US health care system are estimated to be substantially higher than in other countries and than in the public sector in the US: one estimate put the total administrative costs at 24 percent of US health care spending.


No

  • The costs of transition to a universal health care program would be large: It would involve lost insurance industry jobs, business closures, and new patient record creation, among other things. Creating a new administrative framework and patient database would be a massive under-taking.


Price: Is the price to the individual taxpayer significantly lower?

Yes


No

Risk: Does universal health care adequately address patient risk?

Yes

No

Aging population: Can countries with aging populations contain costs of universal care?

Yes


No

World vs. US: What does a comparison between the US and world reveal?

Yes


No


Prevention: Is free universal health care important to preventive care?

Yes


No

Paying for it: Are there sound proposals for paying for added costs?

Yes

No

Vs. private: Is a mixed private-public universal health care model flawed?

Yes

  • Only the government can provide a coherent universal health care system. Such a system is important from the standpoint of providing quality care, in that only a standardized system and unified database can enable doctors to treat any patient that comes in front of them. Privatized systems often see doctors unable to access the history and files of patients that come before them. The main reasons include the cost and complexity of unifying and standardizing a system as well as the lack of a private-industry interest in seeing such a system emerge.


No

Equality: Does universal health care improve equality?

Yes

  • Universal healthcare helps foster greater equality across classes. In the United States, the poor commonly go without access to healthcare. Providing universal health care helps establish greater equality in this area.


No

Database: Would a centralized database be a good idea?

Yes


No

Access/expense: Does universal healthcare lower costs and increase patient access?

Yes

  • Total costs for individuals would be reduced by universal health care: The current US system is already funded 64% by tax money with the remaining 36% split between private and employer spending. A universal healthcare system would merely replace private/employer spending with tax revenues. Total spending would go down for individuals and employers.


No

  • All taxpayers would be burdened by universal healthcare, so there is really no overall cost savings for citizens:

Privacy: Would universal public health care be consistent with doctor-patient privacy?

Yes

No


Health tax: Can we tax people for unhealthy lifestyle to discourage them and reduce costs

Yes



No

  • This puts government in the role of arbiter of what practices are healthy and unhealthy.
  • The collection and enforcement of these taxes is not free, but will entail additional bureaucracy.
  • Some controversial practices could be taxed. e.g. medical marijuana.
  • Such taxes are likely to be regressive, especially taxes on tobacco.
  • The healthfulness of some things is dependent on context, e.g. pain killers.


Businesses: Would a universal health care system be good for businesses?

Yes


No

  • Free, universal health care would devastate the insurance industry "Should the Government Provide Free Universal Health Care for All Americans?" Balanced Politics.org - "A long, painful transition will have to take place involving lost insurance industry jobs, business closures, and new patient record creation. A universal health plan means the entire health insurance industry would be unnecessary. All companies in that area would have to go out of business, meaning all people employed in the industry would be out of work. A number of hospital record clerks that dealt with insurance would also be out of work. A number of these unemployed would be able to get jobs in the new government bureaucracy, but it would still be a long, painful transition. We'd also have to once again go through a whole new round of patient record creation and database construction, which would cost huge amounts of both time and money."
  • Universal health care risks monopsony: Universal health care systems, in an effort to control costs by gaining or enforcing monopsony power, sometimes outlaw medical care paid for by private, individual funds.



Countries: Where do countries general fall in this debate?

Yes

  • 28 industrialized nations have single payer universal health care systems. Germany has a multipayer universal health care system like President Clinton proposed for the United States. The United States is considered the only industrialized nation to not have universal health care.



No

  • The United States is the only industrialized nation that does not provide universal health care



Key players

Yes

  • Harry Truman advocated universal healthcare.
  • Paul Krugman.[2]
  • Tommy Douglas. - The father of universal health care in Canada.


No

Organizations pro and con

Yes



No


Pro/con resources

Yes


No


References:

This debate in legislation, policy, and elsewhere

See also on Debatepedia

Neutral sources

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