This House would introduce a system of universal healthcare

On March 23rd 2010, U.S. President Barack Obama signed into law the Patient Protection and Affordable Care Act, an act the New York Times calls “the most expansive social legislation enacted in decades”.[1]

The law’s purpose is to insure 30 million more Americans by expanding Medicaid and introducing federal subsidies aimed at lower-income citizens to aid them in buying private health insurance. It will also prohibit insurers from denying coverage based on pre-existing conditions, create a panel of experts to reduce government reimbursements under Medicare and create incentives for better, bundled services.[2]

However, not all share this vision of the bill and the idea it stands for. Including the successful vote for repealing the legislation in the House, there have been numerous legal challenges launched against it, charging it with being unconstitutional, splitting judges’ in addition to politicians’ opinions down ideological lines.[3]

Additionally, Vermont has recently adopted legislature with the aim of introducing a single-payer form of healthcare, a system where a single provider, usually the government, by 2017, provides all the financing.[4]

With the legislature and the judiciary involved with their arguments, there were 52 million uninsured Americans in 2010, 9 million new on account of unemployment[5], making the need for such a policy more necessary than ever. Yet on the other hand, the economic downturn shows no signs of abating, thus making the adoption of 930bn dollar bill a costly enterprise for the government and, therefore, for the average taxpayer.[6]

Title 
Health care would substantially reduce overall costs
Point 

With universal health care, people are able to seek preventive treatment. This means having tests and check-ups before they feel ill, so that conditions can be picked up in their early stages when they are easy to treat. For example in a recent study 70% of women with health insurance knew their cholesterol level, while only 50% of uninsured women did. In the end, people who do not get preventive health care will get treatment only when their disease is more advanced. As a result their care will cost more and the outcomes are likely to be much worse. Preventative care, made more accessible, can function the same way, reducing the costs further.[1]

In addition, a single-payer system reduces the administrative costs. A different way of charging for the care, not by individual services but by outcomes, as proposed by Obama’s bill, also changes incentives from as many tests and procedures as possible to as many patients treated and healed as possible.[2]

We thus see that not only does universal health coverage inherently decrease costs because of preventative care, much of the cost can be avoided if implemented wisely and incentivized properly.

[1] Cutler, D. M., Health System Modernization Will Reduce the Deficit, published 5/11/2009, http://www.americanprogressaction.org/issues/2009/05/health_modernization.html, accessed 9/17/2011

[2] Wirzibicki, A., With health costs rising, Vermont moves toward a single-payer system, published 4/7/2011, http://www.boston.com/bostonglobe/editorial_opinion/blogs/the_angle/2011/04/vermonts_single.html, accessed 9/17/2011

Counterpoint 

While the idea that better access to preventative medicine will quickly and drastically lower general medical care costs is an incredible notion, it sadly is just that – a notion.

As an aside, the same argument – lowered costs – could be made for simply improving the existing tactics of preventative medicine without the need to invest into universal coverage.

Returning to this proposition though, while it might be realistic to expect some reduction in costs from improved prevention, those would very unlikely ever amount to a significant amount – and certainly not an amount that would make introducing universal health coverage a feasible strategy.[1]

Universal health care will cause people to use the health care system more. If they are covered, they will go to the doctor when they do not really need to, and will become heavy users of the system. We can see in other countries that this heavier use leads to delays in treatment and constant demands for more resources. As a result care is rationed and taxes keep going up.

[1] Leonhardt, D., Free Lunch on Health? Think Again, published 8/8/2007, http://www.nytimes.com/2007/08/08/business/08leonhardt.html, accessed 9/18/2011

Title 
Current health care systems are not sustainable
Point 

American health insurance payments are very high and rising rapidly. Even employer-subsidised programs are very expensive for many Americans, because they often require co-payments or high deductibles (payment for the first part of any treatment). In any case employee health benefits are being withdrawn by many companies as a way of cutting costs. For those without insurance, a relatively minor illness or injury can be a financial disaster. It is unfair that many ordinary hard-working Americans can no longer afford decent medical treatment.

Moving to a system of universal health care would reduce the burden on human resources personnel in companies. At present they must make sure the company is obeying the very many federal laws about the provision of health insurance. With a universal system where the government was the single-payer, these regulations would not apply and the costs of American businesses would be much reduced.

Counterpoint 

A range of health programs are already available. Many employers offer health insurance and some people deliberately choose to work for such companies for these benefits, even if the pay is a little lower. Other plans can be purchased by individuals with no need to rely on an employer. This means they are free to choose the level of care which is most appropriate to their needs. For other people it can be perfectly reasonable to decide to go without health insurance. Healthy younger adults will on average save money by choosing not to pay high insurance premiums, covering any necessary treatment out of their own pockets from time to time. Why should the state take away all these people’s freedom of choice by imposing a one-size-fits-all socialist system of health care?

Human resources professionals will still be needed to deal with the very many other employment regulations put in place by the federal government. Instead of employees being able to exercise control over their health care choices and work with people in their company, patients will be forced to deal with the nameless, faceless members of the government bureaucracy.

Title 
Health care programmes currently do not offer equality of care
Point 

The United States as a whole spends 14% of GDP (total income) on health care. This includes the amount spent by the federal government, state governments, employers and private citizens. Many studies have found that a single-payer system would cut costs enough to allow everyone in the USA to have access to good health care without the nation as a whole spending more than it does at the moment. Medicare, a government-run health care program, has administrative costs of less than 2% of its total budget.

The current system of health maintenance organisations (HMOs) has destroyed the doctor-patient relationship and removed patients’ ability to choose between health care providers. Patients find that their doctors are not on their new plan and are forced to leave doctors with whom they have established a trusting relationship. Also, patients must get approval to see specialists and then are allowed to see only selected doctors. Doctors usually can’t spend enough time with patients in the HMO plans. By contrast a universal health system would give patients many more choices.

In the current system the employee and the employee’s family often depend on the employer for affordable health insurance. If the worker loses their job, the cost of new health insurance can be high and is often unaffordable. Even with current federal laws making insurance more movable, the costs to the employee are too high. With a single-payer, universal health care system, health insurance would no longer be tied to the employer and employees would not have to consider health insurance as a reason to stay with a given employer. This would also be good for the economy as a whole as it would make the labour market more flexible than it has become in recent years.

Counterpoint 

The United States government cannot afford to fund universal health care. Other universal social welfare policies such as Social Security and Medicare have run into major problems with funding. Costs are rising at the same time that the baby boomer generation are growing old and retiring. Soon tens of millions of boomers will stop contributing much tax and start demanding much more in benefits than before. In such a situation we cannot afford to burden the nation with another huge government spending program. Nations that provide universal health care coverage spend a substantial amount of their national wealth on the service.

With government control of all health care, caps will be placed on costs. As a result many doctors would not be rewarded for their long hours and important roles in our lives. The road to becoming a doctor is long and hard; without the present financial rewards many young people will not choose to study medicine. Current doctors may find that they do not want to continue their careers in a government-controlled market. The American Medical Association does not back a government-controlled, single-payer universal health care system.

The current system of offering group insurance through employers covers many Americans with good quality health insurance. The group plan concept enables insurance companies to insure people who are high risk and low risk by mixing them in the same pool. Issues over losing or leaving a job with health benefits are dealt with by federal laws which require companies to continue to offer workers cover for at least 18 months after they leave employment.

Title 
Healthcare has been recognised as a right
Point 

The two crucial dimensions of the topic of introducing universal health care are morality and the affordability.

Paragraph 1 of Article 25 of the Universal Declaration of Human Rights states the following: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”[1]

Analyzing the text, we see that medical care, in so far, as it provides adequate health and well-being is considered a human right by the international community. In addition, it also states, that this right extends also to periods of unemployment, sickness, disability, and so forth.

Despite this, why should we consider health care a human right? Because health is an essential prerequisite for a functional individual – one that is capable of free expression for instance – and a functional society – one capable of holding elections, not hampered by communicable diseases, to point to just one example.

Universal health care provided by the state to all its citizens is the only form of health care that can provide what is outlined in the Declaration.

In the US the only conditions truly universally covered are medical emergencies.[2] But life without the immediate danger of death hardly constitutes an adequate standard of health and well-being. Additionally, programs such as Medicaid and Medicare do the same, yet again, only for certain parts of the population, not really providing the necessary care for the entire society.

Further, the current system of health care actively removes health insurance from the unemployed, since most (61%) of Americans are insured through their employers – thus not respecting the provision that demands care also in the case of unemployment.[3]

But does insurance equal health care? In a word: yes. Given the incredible cost of modern and sophisticated medical care – a colonoscopy can cost more than 3000 dollars – in practice, those who are not insured are also not treated.[4]

[1] UN General Assembly, Universal Declaration of Human Rights, published 12/10/1948, http://www.amnestyusa.org/research/human-rights-basics/universal-declaration-of-human-rights, accessed 9/17/2011

[2] Barrett, M., The US Universal Health Care System-Emergency Rooms, published 3/2/2009, http://www.huffingtonpost.com/marilyn-barrett/the-us-universal-health-c_b_171010.html, accessed 9/17/2011

[3] Smith, D., U.S. healthcare law seen aiding employer coverage, published 6/21/2011, http://www.reuters.com/article/2011/06/21/usa-healthcare-employers-idUSN1E75J1WP20110621, accessed 9/17/2011

[4] Mantone, J., Even With Insurance, Hospital Stay Can Cost a Million, published 11/29/2007, http://blogs.wsj.com/health/2007/11/29/even-with-insurance-hospital-stay-can-cost-a-million/, accessed 9/17/2011

Counterpoint 

There are several reasons why health care should not be considered a universal human right.

The first issue is one of definition – how do we define the services that need to be rendered in order for them to qualify as adequate health care? Where do we draw the line? Emergency surgery, sure, but how about cosmetic surgery?

The second is that all human rights have a clear addressee, an entity that needs to protect this right. But who is targeted here? The government? What if we opt for a private yet universal health coverage – is this any less moral? Let’s forget the institutions for a second, should this moral duty of health care fall solely on the doctors perhaps?[1]

In essence, viewing health care as a right robs us of another, much more essential one – that of the right to one’s own life and one’s livelihood. If it is not considered a service to be rendered, than how could a doctor charge for it? She couldn’t! If it were a right, than each of us would own it, it would have to be inseparable from us. Yet, we don’t and we can’t.[2]

We can see that considering health care as a basic human right has profound philosophical problems, not the least of them the fact that it infringes on the rights of others.

[1] Barlow, P., Health care is not a human right, published 7/31/1999, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1126951/, accessed 9/18/2011

[2] Sade, R., The Political Fallacy that Medical Care is a Right, published 12/2/1971, http://www.aapsonline.org/brochures/sademcr.htm, accessed 9/18/2011

Title 
Universal healthcare systems are inefficient
Point 

One of the countries lauded for its universal health care is France. So what has the introduction of universal coverage brought the French? Costs and waiting lists.

France’s system of single-payer health coverage goes like this: the taxpayers fund a state insurer called Assurance Maladie, so that even patients who cannot afford treatment can get it. Now although, at face value, France spends less on healthcare and achieves better public health metrics (such as infant mortality), it has a big problem. The state insurer has been deep in debt since 1989, which has now reached 15 billion euros.[1]

Another major problem with universal health care efficiency is waiting lists. In 2006 in Britain it was reported that almost a million Britons were waiting for admission to hospitals for procedures. In Sweden the lists for heart surgery are 25 weeks long and hip replacements take a year. Very telling is a ruling by the Canadian Supreme Court, another champion of universal health care: “access to a waiting list is not access to health care”.[2]

Universal health coverage does sound nice in theory, but the dual cancers of costs and waiting lists make it a subpar option when looking for a solution to offer Americans efficient, affordable and accessible health care.

[1] Gauthier-Villars, D., France Fights Universal Care's High Cost, published 8/7/2009, http://online.wsj.com/article/SB124958049241511735.html, accessed 9/17/2011

[2] Tanner, M., Cannon, M., Universal healthcare's dirty little secrets, published 4/5/2007, http://www.latimes.com/news/opinion/commentary/la-oe-tanner5apr05,0,2681638.story, accessed 9/18/2011

Counterpoint 

It is not, in fact, universal health care itself, that’s inefficient, but specific adaptations of it. Often, even those shortcomings are so blown out of proportion that it’s very difficult to get the whole story.

Universal health care can come in many shapes and sizes, meant to fit all kinds of countries and societies. When judging them it’s often useful to turn to those societies for critiques of their coverage systems.

Despite the horror stories about the British NHS, it costs 60% less per person than the current US system. Despite the haunting depictions of decades long waiting lists, Canadians with chronic conditions are much more satisfied with the treatment received than their US counterparts.[1]

We should not let hysterical reporting to divert us from the truth – universal health care makes a lot of economic, and, more importantly, moral sense.

[1] Krugman, P., The Swiss Menace, published 8/16/2009, http://www.nytimes.com/2009/08/17/opinion/17krugman.html, accessed 9/18/2011

Title 
Universal healthcare is not affordable
Point 

No policy is created, debated or implemented in a vacuum. The backdrop of implementing universal health coverage now is, unfortunately, the greatest economic downturn of the last 80 years. Although the National Bureau of Economic Research declared the recession to be over, we are not out of the woods yet.[1] Is it really the time to be considering a costly investment?

With estimates that the cost of this investment might reach 1.5 trillion dollars in the next decade, the answer is a resounding no. Even the Center on Budget and Policy Priorities – a left leaning think tank – opined that the Congress could not come up with the necessary funding to go ahead with the health reform without introducing some very unpopular policies.[2]

Does this mean universal health care should be introduced at one time in the future? Not likely. Given that there are no realistic policies in place to substantially reduce the “riot inducing” US public debt[3] and the trend of always increasing health care costs[4] the time when introducing universal health care affordably and responsibly will seem ever further away.

[1] New York Times, Recession, published 9/20/2010, http://topics.nytimes.com/top/reference/timestopics/subjects/r/recession_and_depression/index.html, accessed 9/18/2011

[2] New York Times, Paying for Universal Health Coverage, published 6/6/2009, http://www.nytimes.com/2009/06/07/opinion/07sun1.html, accessed 9/18/2011

[3] Taylor, K., Bloomberg, on Radio, Raises Specter of Riots by Jobless, published 9/16/2011, http://www.nytimes.com/2011/09/17/nyregion/mayor-bloomberg-invokes-a-concern-of-riots-on-radio.html?_r=1&scp=1&sq=public%20debt&st=cse, accessed 9/18/2011

[4] Gawande, A., The cost conondrum, published 6/1/2009,  http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande, accessed 9/18/2011

Counterpoint 

We need to analyze this issue from a couple of different perspectives.

The first is this trillion per decade cost. Is this truly a cost to the American economy? We think not, since this money will simply flow back into the economy, back into the hands of health care providers, insurance companies, etc. – back into the hands of taxpayers. So in this sense it is very much affordable.

But is this a productive enterprise? For the millions of people that at this very moment have absolutely no insurance and therefore very limited access to health care, the answer is very clear.

In addition, the reform will more or less pay for itself, not in a year, not even a decade – but as it stands now, it’s been designed to have a net worth of zero.[1]

Lastly, just because we live in a bad economic climate doesn’t mean we can simply abandon all sense of moral obligation. There are people suffering because of the current situation. No cost can offset that.

[1] Johnson, S., Kwak, J., Can We Afford Health Care Reform? We Can't Afford Not to Do It., published 9/1/2009,  http://www.washingtonpost.com/wp-dyn/content/article/2009/09/01/AR2009090101027.html, accessed 9/18/2011

Title 
Universal healthcare stifles innovation
Point 

Profits drive innovation. That’s the long and short of it. Medical care is not exception, albeit the situation is a bit more complicated in this case.

The US’s current system has a marketplace of different private insurers capable of making individual and often different decisions on how and which procedures they’ll choose to cover. Their decisions are something that helps shape and drive new and different practices in hospitals. A simple example is one of virtual colonoscopies. Without getting into the nitty gritty, they often require follow up procedures, yet are very popular with patients. Some insurers value the first, some the other, but none have the power to force the health care providers to choose one or the other. They’re free to decide for themselves, innovate with guidelines, even new procedures. Those are then communicated back to insurers, influencing them in turn and completing the cycle.

What introducing a single-payer universal health coverage would do is introduce a single overwhelming player into this field – the government. Since we have seen how the insurer can often shape the care, what such a monopoly does is opens up the possibility of top-down mandates as to what this care should be. With talk of “comparative effectiveness research”, tasked with finding optimal cost-effective methods of treatment, the process has already begun.[1]

[1] Wall Street Journal, How Washington Rations, published 5/19/2009, http://online.wsj.com/article/SB124268737705832167.html#mod=djemEditorialPage, accessed 9/18/2011

Counterpoint 

Profits do drive innovation. But there is nothing out there that would make us believes that the profits stemming from the health care industry are going to taper off or even decrease in a universal coverage system. In short in a single-payer system, it’s just the government that’ll be picking up the tab and not the private companies. But the money will still be there.

An expert on the issue from the Brigham and Women’s Hospital opined that this lack of innovation crops up every time there is talk of a health care reform, usually from the pharmaceutical industry, and usually for reasons completely unrelated to the policy proposed.[1]

Whereas the opposition fears new research into efficiency of medical practice and procedures, we, on the other hand, feel that’s exactly what the doctor ordered – and doctors do too.[2]

[1] Klein, E., Will Health-Care Reform Save Medical Innovation?, published 8/3/2009, http://voices.washingtonpost.com/ezra-klein/2009/08/will_health-care_reform_save_m.html, accessed 9/18/2011

[2] Brown, D., ‘Comparative effectiveness research’ tackles medicine’s unanswered questions, published 8/15/2011, http://www.washingtonpost.com/national/health-science/comparative-effectiveness-research-tackles-medicines-unanswered-questions/2011/08/01/gIQA7RJSHJ_story.html, accessed 9/18/2011

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