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LO Health Care Aff 2.0

LO Health Care Aff 2.0

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Published by: Adam Teel on Oct 13, 2010
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11/03/2011

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Sections

  • **1AC**
  • HEALTHCARE 1AC - INH
  • HEALTHCARE 1AC - PLAN
  • HEALTHCARE 1AC - SOLVENCY
  • **INHERENCY**
  • Obama HC Fails - Cost
  • Obama HC Fails - Concessions
  • Obama HC Fails – Industry Profit
  • Obama HC Not Single Payer
  • Universal Reform Fails - Congress
  • Universal Reform Fails – Health Politics
  • **ECON – STATES**
  • 2AC AT: Stimulus Solves State Deficits
  • 2AC AT: Kills Econ
  • 2AC AT: US Not Key to Global Econ
  • Medicaid Costs High Now
  • Medicaid Drains State Budgets
  • Obama HC Drains State Budgets
  • State Deficits Now – Job Loss
  • States Deficit Now—Tradeoffs
  • State Deficits Now—Tradeoffs
  • State Deficits Now –Tradeoffs
  • More Stimulus Needed - Unemployment
  • More Stimulus Needed - Insufficient
  • More Stimulus Needed - Statistics
  • A2: ARRA Stimulus Solves Medicaid Deficits
  • Trickle Up Stimulus Needed
  • Fed Action Key
  • Federalize Medicaid Solves State Budgets
  • Single Payer Solves State Deficits
  • Kentucky – Medicaid Chopping Block
  • Louisiana – Medicaid Deficit
  • **ECON – FEDERAL DEF**
  • Consumer Confidence Low Now
  • **ECON IMPACTS**
  • Lashout ! Scenario
  • China ! Scenario (1/2)
  • China ! Scenario (2/2)
  • Terror ! Scenario
  • **COMPETITIVENESS**
  • Competitiveness K2 Heg
  • Econ K2 Heg
  • Econ Decline Killing Heg Now
  • Econ K2 Obama Agenda
  • HC Reform Key to Econ
  • Deflation Coming
  • Increases Competitiveness
  • Competitiveness K2 Growth
  • **Medicaid Reform**
  • Federalize Medicaid Good
  • Medicaid Reform Needed
  • Medicaid Bad
  • Reform Must Start With Medicaid
  • Medicare Spill Up
  • Slow Phase In Key – Medicare & Australia Prove
  • Medicare Subsume Medicaid?
  • Medicaid Expansion Key
  • **SOLVENCY**
  • Low-Income Uninsured Coverage Needed
  • Solvency – Medicare Based System Solves
  • Squo Reform Fails – Need Single-Payer
  • Squo HC Fails
  • Single Payer Solves - Waste
  • Single Payer Solves – Waste & Patchwork
  • Single Payer Solves – Bureaucracy
  • Single Payer Solves – Medical Consensus
  • Single Payer Solves – Dem Accountability
  • Single Payer Solves – Fair Wages
  • Single Payer Solves – Drug Costs
  • Single Payer Solves - Physicians
  • Single Payer Solves –Empirics
  • Uninsured Impoverished
  • Uninsured are Poor
  • A2: High Cost
  • A2: No Innovation/Wait
  • A2: Bureaucracy
  • A2: Utopian?
  • A2: Scale Up Not Possible
  • A2: National Health Program Bad
  • A2: Canada Empirically Fails
  • A2: Rationing
  • A2: MSA/HSA
  • A2: Free Market More Efficient
  • A2: O’Neill
  • A2: Employer-Based HC
  • A2: Managed Competition
  • A2: Physician Backlash
  • **Add-ons**
  • Small Business Add-on
  • Small Business Add-on Ext
  • Equal Protection
  • **2AC**
  • Plan Pop
  • Plan Unpop
  • Losers Win?
  • 2AC Healthcare Politics (1/3)
  • 2AC Healthcare Politics (2/3)
  • 2AC Healthcare Politics (3/3)
  • 2AC CTBT Politics (1/3)
  • 2AC CTBT Politics (2/3)
  • 2AC CTBT Politics (3/3)
  • 2AC Econ DA (1/3)
  • 2AC Econ DA (2/3)
  • 2AC Econ DA (3/3)
  • 2AC Military DA (1/2)
  • 2AC Military DA (2/2)
  • 2AC Immigration DA (1/4)
  • 2AC Immigration DA (2/4)
  • 2AC Immigration DA (3/4)
  • 2AC Immigration DA (4/4)
  • 2AC States CP (1/2)
  • 2AC States CP (2/2)
  • A2: Pincer CP/Medicaid Expansion CP

Single Payer 2.

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LO

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SINGLE PAYER 2.0
SINGLE PAYER 2.0...............................................................................................................................................1 **1AC**..................................................................................................................................................................6 HEALTHCARE 1AC - INH....................................................................................................................................7 HEALTHCARE 1AC – ECON ADV......................................................................................................................8 HEALTHCARE 1AC – ECON ADV......................................................................................................................9 HEALTHCARE 1AC – ECON ADV....................................................................................................................10 HEALTHCARE 1AC – ECON ADV....................................................................................................................11 HEALTHCARE 1AC – ECON ADV....................................................................................................................12 HEALTHCARE 1AC – ECON ADV....................................................................................................................13 HEALTHCARE 1AC – ECON ADV....................................................................................................................14 HEALTHCARE 1AC – ECON ADV....................................................................................................................15 HEALTHCARE 1AC – COMP ADV...................................................................................................................16 HEALTHCARE 1AC – COMP ADV...................................................................................................................17 HEALTHCARE 1AC – COMP ADV...................................................................................................................18 HEALTHCARE 1AC – COMP ADV...................................................................................................................19 HEALTHCARE 1AC – COMP ADV...................................................................................................................20 ...............................................................................................................................................................................20 HEALTHCARE 1AC - PLAN...............................................................................................................................21 HEALTHCARE 1AC - SOLVENCY....................................................................................................................22 HEALTHCARE 1AC - SOLVENCY....................................................................................................................24 HEALTHCARE 1AC - SOLVENCY....................................................................................................................25 HEALTHCARE 1AC - SOLVENCY....................................................................................................................26 HEALTHCARE 1AC - SOLVENCY....................................................................................................................27 **INHERENCY**................................................................................................................................................28 Obama HC Inev.....................................................................................................................................................29 Obama HC Inev.....................................................................................................................................................30 Obama HC Inev.....................................................................................................................................................31 ...............................................................................................................................................................................31 Obama HC Inev.....................................................................................................................................................32 Obama HC Fails - Cost.........................................................................................................................................33 Obama HC Fails - Concessions............................................................................................................................34 Obama HC Fails – Industry Profit.........................................................................................................................35 Obama HC Not Single Payer................................................................................................................................36 Universal Reform Fails - Congress........................................................................................................................37 Universal Reform Fails – Health Politics .............................................................................................................38 ...............................................................................................................................................................................38 ...............................................................................................................................................................................38 **ECON – STATES**..........................................................................................................................................39 2AC AT: Stimulus Solves State Deficits...............................................................................................................40 2AC AT: Kills Econ...............................................................................................................................................41 2AC AT: US Not Key to Global Econ...................................................................................................................42 Medicaid Costs High Now....................................................................................................................................43 ...............................................................................................................................................................................43 Medicaid Drains State Budgets.............................................................................................................................44

You’re A Jerk

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Single Payer 2.0

LO

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Obama HC Drains State Budgets...........................................................................................................................45 ...............................................................................................................................................................................45 Obama HC Drains State Budgets..........................................................................................................................46 Obama HC Drains State Budgets...........................................................................................................................47 ...............................................................................................................................................................................47 Obama HC Drains State Budgets..........................................................................................................................48 Obama HC Drains State Budgets...........................................................................................................................49 Obama HC Drains State Budgets...........................................................................................................................50 State Deficits Now – No HC..................................................................................................................................52 State Deficits Now – No HC..................................................................................................................................53 State Deficits Now – No Education.......................................................................................................................54 State Deficits Now – No Education.......................................................................................................................55 State Deficits Now – Job Loss...............................................................................................................................56 ...............................................................................................................................................................................56 ...............................................................................................................................................................................56 States Deficit Now—Tradeoffs .............................................................................................................................57 State Deficits Now—Tradeoffs .............................................................................................................................58 State Deficits Now –Tradeoffs ..............................................................................................................................59 State Deficits Tank Econ.......................................................................................................................................60 State Deficits Tank Econ.......................................................................................................................................61 State Deficits Tank Econ.......................................................................................................................................62 More Stimulus Needed - Unemployment..............................................................................................................63 More Stimulus Needed - Insufficient.....................................................................................................................64 More Stimulus Needed - Statistics.........................................................................................................................65 ...............................................................................................................................................................................65 More Stimulus Needed – States Key.....................................................................................................................66 More Stimulus Needed – States Key.....................................................................................................................67 ...............................................................................................................................................................................67 More Stimulus Needed – States Key.....................................................................................................................68 More Stimulus Needed – States Key.....................................................................................................................69 A2: ARRA Stimulus Solves Medicaid Deficits.....................................................................................................70 Trickle Up Stimulus Needed..................................................................................................................................71 Fed Action Key......................................................................................................................................................72 ...............................................................................................................................................................................72 ...............................................................................................................................................................................72 Federalize Medicaid Solves State Budgets............................................................................................................73 Medicaid Reform Solves State Budgets................................................................................................................74 Medicaid Reform Solves State Budgets................................................................................................................75 ...............................................................................................................................................................................75 Single Payer Solves State Deficits.........................................................................................................................76 Kentucky – Medicaid Chopping Block..................................................................................................................77 Louisiana – Medicaid Deficit.................................................................................................................................78 **ECON – FEDERAL DEF**..............................................................................................................................80 Consumer Confidence Low Now...........................................................................................................................81 **ECON IMPACTS**..........................................................................................................................................82 Lashout ! Scenario.................................................................................................................................................83

You’re A Jerk

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Single Payer 2.0

LO

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China ! Scenario (1/2)............................................................................................................................................84 China ! Scenario (2/2)............................................................................................................................................85 Terror ! Scenario....................................................................................................................................................86 **COMPETITIVENESS**...................................................................................................................................87 Competitiveness K2 Heg.......................................................................................................................................88 Econ K2 Heg..........................................................................................................................................................89 Econ Decline Killing Heg Now.............................................................................................................................90 Econ K2 Obama Agenda.......................................................................................................................................91 HC Reform Key to Econ........................................................................................................................................92 ...............................................................................................................................................................................93 Deflation Coming...................................................................................................................................................93 Deflation Coming .................................................................................................................................................94 ...............................................................................................................................................................................94 Increases Competitiveness.....................................................................................................................................95 Competitiveness K2 Growth..................................................................................................................................96 ...............................................................................................................................................................................96 **Medicaid Reform**...........................................................................................................................................97 Federalize Medicaid Good ....................................................................................................................................98 Medicaid Reform Needed .....................................................................................................................................99 Medicaid Reform Needed ...................................................................................................................................100 Medicaid Reform Needed....................................................................................................................................101 .............................................................................................................................................................................101 Medicaid Reform Needed....................................................................................................................................102 Medicaid Bad.......................................................................................................................................................103 Reform Must Start With Medicaid......................................................................................................................104 Medicare Spill Up ...............................................................................................................................................105 Slow Phase In Key – Medicare & Australia Prove..............................................................................................106 Medicare Subsume Medicaid?............................................................................................................................107 Medicaid Expansion Key.....................................................................................................................................108 **SOLVENCY**................................................................................................................................................109 .............................................................................................................................................................................109 .............................................................................................................................................................................109 Low-Income Uninsured Coverage Needed..........................................................................................................110 Solvency – Medicare Based System Solves........................................................................................................111 Squo Reform Fails – Need Single-Payer.............................................................................................................112 Squo HC Fails......................................................................................................................................................113 Single Payer Solves - Waste................................................................................................................................114 .............................................................................................................................................................................114 Single Payer Solves – Waste & Patchwork.........................................................................................................115 Single Payer Solves – Bureaucracy.....................................................................................................................116 Single Payer Solves – Medical Consensus..........................................................................................................117 Single Payer Solves – Dem Accountability.........................................................................................................118 Single Payer Solves – Fair Wages.......................................................................................................................119 Single Payer Solves – Drug Costs.......................................................................................................................120 Single Payer Solves - Physicians.........................................................................................................................121 Single Payer Solves –Efficient ............................................................................................................................122

You’re A Jerk

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....................................149 Losers Win?......................................165 2AC States CP (1/2)..........................143 Small Business Add-on........................................................................................................................................................................153 2AC CTBT Politics (1/3)..............................................................................142 **Add-ons**...............................................................................................163 2AC Immigration DA (3/4).......125 Uninsured are Poor ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................147 Plan Pop.................................................145 Equal Protection................................................................................................................................................................................159 2AC Military DA (1/2)...........0 LO 4 Single Payer Solves –Efficient.................................................................................................................................................................................................130 A2: Scale Up Not Possible.................................................................................148 Plan Unpop................................................................................................................................................................................................................................................................127 A2: No Innovation/Wait...................................................................................156 2AC Econ DA (1/3)............................138 A2: O’Neill.....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................162 2AC Immigration DA (2/4)......................................................................................................................................................................................................................................................................................................................................................................155 2AC CTBT Politics (3/3)...137 A2: Free Market More Efficient...........................................................................................................................................166 You’re A Jerk 4 ..........................................158 2AC Econ DA (3/3).........................................................................................................154 2AC CTBT Politics (2/3).....................................................................................................164 2AC Immigration DA (4/4)............................................................................132 A2: Canada Empirically Fails..................................................146 **2AC**....................................................................................................150 2AC Healthcare Politics (1/3)................................................Single Payer 2..134 A2: Socialized Medicine ............160 2AC Military DA (2/2)....................................................136 A2: MSA/HSA...............................................................................................................................................................................................................................................................................................................................................................................................................................161 2AC Immigration DA (1/4)....................................................................................................................................................................................................................................126 A2: High Cost.............................................................152 2AC Healthcare Politics (3/3)..................................................139 A2: Employer-Based HC..........................................................................................................................................................................................................129 A2: Utopian?..........................140 A2: Managed Competition...133 A2: Rationing.............................................................................................................................................................140 ............................................................................................................151 2AC Healthcare Politics (2/3).......................................................................................................................................................................................................................131 A2: National Health Program Bad..............................................................................................................................................................................................................................................................................................124 Uninsured Impoverished .......................................................................................................................................................................................................................................................................123 Single Payer Solves –Empirics............157 2AC Econ DA (2/3)......................................................................................................................................................141 .....141 A2: Physician Backlash...............................................................................................................................................................................................................128 A2: Bureaucracy........................................135 A2: Socialized Medicine........................................................................................................................................144 Small Business Add-on Ext...........................................................................................

..................................................................................................................................................................................171 .................................................................................................172 You’re A Jerk 5 ........................169 A2: States CP...................0 LO 5 2AC States CP (2/2)...................................................................................................................................................................................................................................................................................171 A2: Pincer CP/Medicaid Expansion CP..................................................................................168 A2: States CP ...............................................................................................170 A2: States CP ............................167 A2: States CP.......................................................................................Single Payer 2...........................................169 .................................................................................................................................................................................................................................................................................

Single Payer 2.0 LO 6 **1AC** You’re A Jerk 6 .

do it right.com/2009/07/health-reform-still-urgent-despite-no-bill-before-recess-say-senate-dems/ [Mardjuki] Although the Senate may not vote on health care until after the August recess. news correspondent.” Dodd said that there would be a bill on the President’s desk by the end of the year. Chris Dodd (D-Conn.” Dodd said that the President’s leadership on health care reform has been strong. passing reform is still an urgent priority said top Democrats on Thursday. “Those who have health insurance are a day.” Dodd said. “If it takes a couple of extra days. but also those who do already have insurance. “The current cost curve cannot be sustained by business owners or by families.” You’re A Jerk 7 . the Senate has no excuse to take its time on finding solutions for our nation’s health care problems. and stressed that health care reform must help not only Americans who are uninsured. [President Obama] is committed. Sen. a couple of extra weeks or even a couple of extra months its worth the wait. “We do not have the luxury of not dealing with this. Woodhead. a month away from losing it.) said while it’s unlikely that a bill would be up for debate on the Senate floor before September.” said Carper.” “I’m willing to wait. http://talkradionews. but we need to get it done.” Sebelius said.INH Observation One: The Inevitable Some semblance of national health care reform will pass – even if it’s not through before the recess Obama’s political clout guarantees it will pass by the end of the year. a week.) explained that the health care bill is moving slowly through committee because of the multitude of problems being addressed. spend the time. “That does not excuse our committees from doing everything we can during these weeks before the August break. and during the August break to try and meld our ideas and bills together in order so that when we return in September we will be prepared. 7/23/09. “Health Reform Still Urgent Despite No Bill Before Recess Say Senate Dems. “This is probably the hardest legislative lift that any of us will make whether we are here for four years or forty.Single Payer 2. Thomas Carper (D-Del.0 LO 7 HEALTHCARE 1AC .” Health and Human Services Secretary Kathleen Sebelius joined the Senators.” he said. “I still believe very strongly that we are going to achieve that goal. Speaking at a press conference. Sen.” Talk Radio News Service. as committed as any president I have ever seen to a single issue. Laura. He has said over and over again that he will expand whatever capital in order to achieve the goal of national health care reform in the nation” Dodd said. “We have a mandate from the American people to address this issue.

as one means of moving toward universal coverage. and the program is one of the largest drains on every state’s budget. Sack.com/2009/01/22/us/22medicaid. New York Times senior journalist. the countercyclical program now faces a grim fiscal paradox: by definition. Rendell of Pennsylvania. stayed home to deal with budget crises. Lawmakers returning to state capitals across the country are preparing to negotiate significant reductions in Medicaid spending by freezing or reducing reimbursements to hospitals and physicians. They are already anticipating large gaps in Medicaid financing after 2010. said he feared Congress was about to You’re A Jerk 8 . The cost of the program — $333 billion in 2007 — is shared by state and federal governments.html?hp Although many governors said significant change in how the nation handles health care was needed. Kevin. at least partly because half of them did not attend. regardless of political party. As in any economic downturn. The governors said in interviews and public sessions that the bills being drafted in Congress would not do enough to curb the growth in health spending. when stimulus money dries up.0 LO 8 HEALTHCARE 1AC – ECON ADV Observation 2: Advantages Advantage 1: Economy A) Instant State Stimulus Medicaid spending already drains state budgets – state legislators are doing everything they can to stay above water. benefits or payments to doctors would impose new burdens on the states unless Washington absorbs them. Medicaid was providing coverage to an average of 50 million people. “Governors Fear Medicaid Costs in Healthcare” http://www. Tim Pawlenty of Minnesota and Bobby Jindal of Louisiana — were not here. In at least one of several bills circulating in Congress. the National Governors Association projects that states will face aggregate deficits of $200 billion over the next three years. It was unclear whether the governors would draft a statement expressing their dismay. Gov.nytimes. And they pointed out that Medicaid already suffered from low payment rates to health care providers. Edward G. Gov. Each of several health care bills coursing through Congress relies on a large increase in eligibility for Medicaid. Kevin Sack and Robert Pear. Sarah Palin of Alaska. and by narrowing eligibility for the program. with Washington roughly matching the spending approved by the states.” New York Times. the state and federal insurance program for the poor. including the group’s chairman. 2009. Many. And they said they were convinced that a major expansion of Medicaid would leave them with heavy costs. Because the states and the federal government share the cost. by eliminating coverage options like dental and vision benefits. the states would eventually pick up a share of the new costs.Single Payer 2. they said their deep-seated fiscal troubles made it a terrible time to shift costs to the states . But the sentiment among those who were could not have been more consistent. and the governors fear they cannot count on provisions in other bills that they will not bear costs. With the recession draining states of tax revenues even as their Medicaid rolls are surging. 1/21/09. a Democrat. Increased state expenses inevitable – every health care bill debated forces states to pay for massive Medicaid expansion. If Medicaid is expanded.com/2009/07/20/health/policy/20health. or about one of every six in the United States. But at any one time last year. “Growing Need for Medicaid Strains States. a Democrat. http://www. demand for Medicaid coverage is highest precisely when states are least able to afford it because of shrinking tax revenues. 7-19-2009 (two-time Pulitzer Prize winner and correspondent for the New York Times). any increase in eligibility levels. Phil Bredesen of Tennessee. discouraging some doctors and hospitals from accepting beneficiaries. eating up 7 percent of the federal budget.nytimes. The federal government currently picks up about 57 percent of the tab. states will almost surely have to increase payments to doctors to encourage more of them to participate. two-time Pulitzer Prize winner.html [Mardjuki] Eligibility for the income-based program can vary widely by state. Some of the group’s most notable names — Arnold Schwarzenegger of California.

The American Recovery and Reinvestment Act recognizes this fact and includes substantial assistance for states. state budget and tax expert.chicagofed. senior economist and economic advisor @ Chicago Federal Reserve. “As a governor. states have already drawn down much of their available reserves. California projected a $21 billion deficit after failing to get voter approval for a series of budget balancing fiscal measures. Iris and Elizabeth. the available reserves in states with deficits are likely to be depleted in the near future. for which demand rises during a recession.cfm? fa=view&id=711 [Mardjuki] The current situation has been made more difficult because many states never fully recovered from the fiscal crisis of the early part of the decade. One way states can avoid making deep reductions in services during a recession is to build up rainy day funds and other reserves. health coverage. State spending fell sharply relative to the economy during the 2001 recession. Spending as a share of the economy declined in fiscal year 2008 and is projected to decline further in 2009 and again in 2010. but generally are not sufficient to avert the need for substantial budget cuts or tax increases. 6/29/09. Also.cbpp. general fund spending for fiscal year 2008 — six years into the economic recovery — remained below pre-recession levels as a share of the gross domestic product.” Chicago Federal Reserve Bank Essay Number 265.” Mr. Federal assistance can lessen the extent to which states need to take pro-cyclical actions that can further harm the economy.Single Payer 2. There are also other streams of funding in the economic recovery act flowing through states to local governments or individuals. state budget and tax senior fellow. and work force training.org/cms/index. Federal assistance crucial to stem negative pro-cyclical economic state action. Bredesen.0 LO 9 HEALTHCARE 1AC – ECON ADV bestow “the mother of all unfunded mandates. Most of this money is in the form of increased Medicaid funding and a “Fiscal Stabilization Fund. higher education. “It’s a 45-year-old system originally designed for poor women and their children. individual state economies are struggling in this recession. In 18 states.1 In January of this year.org/publications/fedletter/cflaugust2009_265.” Center on Budget and Policy Priorities. such as Medicaid. McNichol.” This money has reduced to a degree the depth of state spending cuts and moderated state tax and fee increases. In a number of states the reductions made during the downturn in education. August 2009. http://www. Bredesen was far from alone in his concern. These important public services were suffering even as states turned to budget cuts to close the new budget gaps. Federal assistance Crucial. Lav. It’s not health care reform to dump more money into Medicaid. Richard. The amount in ARRA to help states maintain current activities is about $135 billion to $140 billion — or less than half of projected state shortfalls. Mattoon. Gold award for contribution to state fiscal policy. “State Budget Troubles Worsen.2 The rationale for such financial support is that states (which are generally prohibited from running deficits) need the money to maintain key programs. Christine Gregoire of Washington.pdf [Mardjuki] Like the economy in general . State governments face significant constraints in raising additional revenues. In this recession. Recently.5 percent of annual state spending. and for all states combined it still remains below the fiscal year 2001 level.” “Medicaid is a poor vehicle for expanding coverage. Most states are required to balance their budgets regardless of the economic environment. a former health care executive. and child care remain in effect. five prominent Democratic governors suggested that the federal government should commit $1 trillion in aid to the states over the next two years. You’re A Jerk 9 .” added Mr. state reserves — general fund balances and rainy day funds — totaled 11. This article considers the role of the federal government in helping the states to manage their finances. my concern is that if we try to cost-shift to the states we’re not going to be in a position to pick up the tab. unemployment insurance. http://www. this aid might help states avoid enacting spending cuts or tax increases that could deepen or prolong the economic downturn. Reserves can be particularly important to help states adjust in the early months of a fiscal crisis. “Should the Federal Government Bail Out the States? Lessons from Past Recessions. This heightens the potential impact on public services of the shortfalls states now are projecting.” said Gov. but this will not address state budget shortfalls. State government budget woes have been much in the news . At the end of fiscal year 2006. And a second round of stimulus is needed – federal money to ease state deficits is crucial to stem further recession.

5 million Illinoisans and cost $12 billion a year in state and federal funds. “We want to make as much positive change as possible.Single Payer 2. Consensus wasn’t reached on any issues after the two-hour meeting in Chicago. http://www. RMattoon.” State Journal-Register.” Righter said. Dean. you need to be concerned about Medicaid. which is available online at http://tinyurl. Dale Righter.” Many Republicans also believe there is too much waste in the system and that some people don’t deserve state-provided health care that was made available to more children and parents under former Gov. Howard Peters. He is one of four Republican lawmakers who began meeting privately Friday with four of their Democratic counterparts in the General Assembly and a representative of Quinn to discuss ideas for Medicaid reform. Republicans in the Democrat-controlled Illinois Senate and House have all but required that long-term Medicaid reform be part of any budget discussions. Quinn’s chief health-policy adviser. Medicaid reforms could save a total of $983 million over the next two years. “Medicaid reform tied to state budget crisis.sj-r. But there is disagreement — and outright fear — about the potential ramifications for patients. said last week. According to the most optimistic estimates. reform of Illinois’ Medicaid program — or at least firm plans to make changes in the system — appears to be a key component of any resolution to the state budget crisis.0 LO 10 HEALTHCARE 1AC – ECON ADV Medicaid reform is the only way to solve the state budget crisis. The report. but the group will meet again Tuesday or Wednesday in Springfield. more than twice the rate of inflation. according to a recent report by Gov. Rod Blagojevich.” state Sen.” “People are almost desperately looking for some kind of ‘silver bullet’ that can get us out of this thing that can be painless. said Republican fervor for Medicaid reforms appears to be fueled by “the dilemma of raising taxes. Republican votes may be crucial to reduce the impact of the state’s $9 billion deficit through a potential income tax increase. Republicans say that without changes. 6/20/09. Olsen.” he said. senior reporter. senior vice president of the Naperville-based Illinois Hospital Association.com/homepage/x488806173/Medicaidreform-tied-to-state-budget-crisis [Mardjuki] Regardless of how much money would be saved this year or next. “I’m not sure there is a clear-enough concept of the consequences of these proposals. “It should be obvious to everyone that if you’re concerned about anything in the budget. and more in future years.” Medicaid spending has grown an average of almost 8 percent per year between 2003 and 2008. the rising cost of Medicaid will take up more and more state resources and “crowd out” other state services while further delaying payments to Medicaid providers.com/taxpayerboard. said Michael Gelder. You’re A Jerk 10 . says that if costs continue to grow at that rate Medicaid spending will reach $22 billion in 2019 and could represent 50 percent of the state budget. “It is the 700-pound gorilla quickly turning into the 900-pound gorilla. hospitals and doctors when it comes to changes in state health programs that cover 2. Pat Quinn’s Taxpayer Action Board.

“Democrats Grow Wary as Health Bill Advances. 7/17/09 Robert and David. He said he and Congress had made “unprecedented progress” on health care. Polis said these taxes. Mr.” On Capitol Hill. Obama tried Friday to shift the political narrative away from the grim forecasts of the Congressional Budget Office. Democrats had three reasons for concern. were pleading to slow down.com/2009/07/18/health/policy/18health. scope and cost of the legislation. the expanded role of the federal government and the need for a raft of new taxes to pay for it all. In a letter to the House speaker. the picture is more complex. Mr. It will happen this year.” And he vowed: “We are going to get this done. Mr. Herszenhorn. Even as Democratic leaders and the White House insisted that the nation was closer than ever to landmark changes in the health care system.” To help finance coverage of the uninsured. many Democrats were apprehensive. I’m absolutely convinced of that.” You’re A Jerk 11 . “Some successful family-owned businesses would be taxed at higher rates than multinational corporations. saying. the House bill would impose a surtax on high-income people and a payroll tax — as much as 8 percent of wages — on employers who do not provide health insurance to workers. combined with the scheduled increase in tax rates resulting from the expiration of Bush-era tax cuts.nytimes. Second. We will reform health care. “Now is not the time to slow down. a freshman Democrat from Colorado who voted against the bill approved Friday in the Education and Labor Committee. http://www. But instead of celebrating their success. The comments suggest that party leaders may not yet have the votes to pass the legislation. reporter. Third. Obama as he also tries to extend insurance to more than 45 million Americans who lack it.” he said. some in their ranks. And while senior Democrats vowed to press ahead to meet Mr. senior writer.” but insisted. a growing minority of Democrats have begun to express reservations about the size. Representative Jared Polis. Polis and 20 other freshman Democrats said they were “extremely concerned that the proposed method of paying for health care reform will negatively impact small businesses. a crucial goal for Mr. the backbone of the American economy. with even the American Medical Association endorsing the House bill this week. “The last few miles of any race are the hardest to run.html?pagewanted=print [Mardjuki] Three of the five Congressional committees working on legislation to reinvent the nation’s health care system delivered bills this week along the lines proposed by President Obama.0 LO 11 HEALTHCARE 1AC – ECON ADV B) Federal Deficits Obama’s healthcare proposal fails to curb entitlement spending – increased taxes needed to fund. it was clear that Democrats could not meet their goal of passing bills before the summer recess without barreling over the concerns of Republicans and ending any hope that such a major issue could be addressed in a bipartisan manner. would have a perverse effect.Single Payer 2. Nancy Pelosi.” New York Times. Obama’s deadline of having both chambers pass bills before the summer recess. they faced basic questions about whether some of their proposals might do more harm than good. He acknowledged a treacherous path ahead. Pear. nervous about the prospect of raising taxes or proceeding without any Republican support. said he worried that the new taxes “could cost jobs in a recession. nervous and defensive. The director of the Congressional Budget Office warned Thursday that the legislative proposals so far would not slow the growth of health spending. even with House committees working in marathon sessions this week.

A National Health Insurance Program is the only affordable option for universal.0 LO 12 HEALTHCARE 1AC – ECON ADV Pressure by Senate leaders and Obama to pass healthcare quickly ensures that healthcare reform will be ineffective and costly.often rules designed to avoid payment. Commissioner of Baltimore City Health. It’s just too big a bill. Such a program .” Physicians For A National Health Program.” Representative Ron Kind of Wisconsin said. 2009. Senior Lecturer @ Harvard Medical School.” The group included three senators. including two members of the Finance Committee. The House and Senate bills would require insurers to take all applicants and vastly expand coverage. which he called “unsustainable. senior writer. Democrat of Nebraska. 26 to 22. with federal subsidies for millions of people. hospitals or clinics. Physicians could continue to practice on a feefor-service basis. expanding access to health care You’re A Jerk 12 . “Proposal of the Physicians’ Working Group for single-Payer National Health Insurance. the Connecticut independent.” A budget office analysis released Friday said the House bill would “result in a net increase in the federal budget deficit of $239 billion” over 10 years. reporter. who also signed the letter. on Friday morning. “We are not doing enough to reform the health care delivery system.” The House education committee approved the bill. American Academy of Pediatrics. President of American College of Physicians. Herszenhorn. partly because of an increase in Medicare spending to avert sharp cuts in payments to doctors. During the transition to an NHI. Peter Beilenson. 13 to 10. slowing cost growth over the long run. But the director of the Congressional Budget Office. Most hospitals and clinics would remain privately owned and operated. Obama’s ambitious timetable. Douglas W. http://www. Marcia. Under the current system. with 3 Democrats voting no. “Democrats Grow Wary as Health Bill Advances.the creation of a comprehensive National Health Insurance (NHI) Program. the savings on administration and profits would fully offset the costs of expanded and improved coverage. Doctors and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules . MD.nytimes. House Democrats who voted no cited various concerns. sent a letter to Senate leaders pleading with them to allow more time.” said Senator Joseph I. of services. the Senate health committee approved a generally similar bill on a party-line vote. Quentin Young. Editor of New England Journal of Medicine.which in essence would be an expanded and improved version of Medicare .” New York Times. Christine Cassell. “I think it’s extremely doable to get this done before the end of the year. CEO Parkland Health System. 23 to 18. Obama at the White House this week and urged him not to rush the bill. to change the incentives so reimbursement will be based on the value.com/2009/07/18/health/policy/18health. Investor-owned facilities would be converted to notfor-profit status.pnhp. Pear. American Public Health Association. testified on Thursday that doing so would come at a steep cost and that the proposals would not curb the rise in health spending by the federal government. “While we are committed to providing relief for American families as quickly as possible. NHI would make it possible to set and enforce overall spending limits for the health care system. or receive salaries from group practices. http://www. receiving a budget from the NHI to cover all operating costs. Ben Nelson. The vote came eight hours after the House Ways and Means Committee approved a nearly identical bill. investor-owned insurance industry and reducing spending for marketing and other satellite services. 7/17/09 Robert and David. Ron Anderson. Three Democrats crossed party lines and voted no. Angell.would cover every American for all necessary medical care. who met with Mr. Republicans of Maine. Lieberman.Single Payer 2. a bipartisan group of six senators.php [Mardjuki] We endorse a fundamental change in America’s health care . and their former owners compensated for past investments. Snowe and Susan Collins. comprehensive coverage.org/single_payer_resources/proposal_of_the_physicians_working_group_for_singlepayer_national_health_insurance .” they wrote.html?pagewanted=print [Mardjuki] And in the latest sign of lawmakers’ chafing at Mr. But just to try to get it passed in the Senate before we leave for the August recess seems just about impossible. Elmendorf. Only a single-payer healthcare system is able to solve for perverse incentives and bureaucratic waste. On Wednesday. “The legislative process right now is going in the wrong direction. A National Health Insurance Program would save at least $150 billion annually by eliminating the high overhead and profits of the private. rather than the volume. “we believe taking additional time to achieve a bipartisan result is critical for legislation that affects 17 percent of our economy and every individual in the United States. and Olympia J. after an all-night session. Joel Alpert.

who launched the New Deal but eventually heeded calls to curtail deficit spending. A key player in the summit will be Senator Judd Gregg. the government-run healthcare program for older Americans. the White House believes that he could be one of its most important allies in the overhaul of Social Security. Obama suggested during his campaign that he might support changing the level of income at which Social Security taxes are calculated. however. Medicare. "When you are shoveling out the goodies. warning him not to repeat what they regard as the mistake of President Franklin Roosevelt. about three-quarters of US debt was purchased by foreign interests. 2-23-09 Budget analysts are worried that a continuing economic crisis will make it impossible to raise sufficient funds from foreign markets to finance the nation's debt. you have a greater probability of getting people to sign on to some fiscal diet. Boston Globe. and tax policy. is already running a deficit. former head of the Congressional Budget Office." Gregg said. That is why many analysts are urging Obama to link changes in Medicare with an overhaul of the health system.Single Payer 2. as long as most of the benefit cuts and tax increases were not slated to take effect until well after the recession is over. the New Hampshire Republican who backed out of his commitment to be Obama's commerce secretary and then voted against the stimulus bill. and the tax code. But any measure will be even more controversial than usual because so many Americans have seen their private retirement plans pummeled by the stock market collapse. Medicare. only to see a new recession batter his presidency. he said. Unless there is a major budgetary change. a reference to criticism that Obama's stimulus bill was too partisan. Another frequently mentioned option is raising the retirement age. It would squeeze out bureaucratic waste and eliminate the perverse incentives that threaten the quality of care and the ethical foundations of medicine. Robert Reischauer. Asked about his hopes for the summit. "We need an up-or-down vote on a package that will be unquestionably bipartisan and fair. In the last four years. which would translate into higher costs for US taxpayers. The system tends to respond only in the face of unavoidable crisis. said Obama should have seized the opportunity to pair the stimulus bill with the overhaul of Social Security. some economists fear an international financial crisis could escalate and turn into a worldwide depression. You’re A Jerk 13 . Obama is being urged by some analysts to start moving toward a balanced budget as soon as possible to send a signal to the world that deficit spending will abate. In an interview. Gregg said that under such a procedure. which is expected to increase quickly as baby boomers retire. But an NHI could both expand access and reduce costs. That is because Gregg is the co-sponsor of the measure that would create a bipartisan commission to put together far-reaching recommendations for an up-or-down vote by Congress. The major reason is that entitlement programs for older Americans are running short of funds. Social Security is slated to pay out more money than it receives by 2017." Some budget specialists are skeptical. the measures could be passed within a year. Despite the embarrassment caused by Gregg's about-face. In any case. Yet some analysts are offering Obama conflicting advice. and reducing costs inevitably means limiting access. He said he is worried that nothing will happen on the most difficult issues until political leaders "have a gun at our heads. federal spending will go from being about 20 percent of the nation's economy to 42 percent in 2050.0 LO 13 HEALTHCARE 1AC – ECON ADV inevitably means increasing costs. most prominently by China. "It can either be very nice public relations or move the ball down the road on what is an impending fiscal tsunami. according to the Concord Coalition." Analysts across the political spectrum agree that the current path is unsustainable. Medicare." said Reischauer. If other nations lose confidence that the United States will pay its debts. who has been invited to the summit. Federal entitlement reform is needed to signal long term fiscal solvency and prevent spiraling sell-offs of US debt. it is widely expected that debt purchasers will soon demand higher interest rates.

For one thing. It's not just the great powers whose trajectories have been affected by the crash. providing a social security net. it is that the current crisis might end China's growth miracle. even if the recessions in the West are relatively short and mild. and India's economic miracle could be nipped in the bud. All this means that China's rise looks increasingly like a gradual process.) And the financial crisis makes it certain that China's growth is likely to be much slower during some of those years.) Worse. citing inaccuracies in the methods used to calculate purchasing power parity. the financial crisis has nevertheless had significant effects. religious extremism among both Hindus and Muslims could further polarize Indian politics. further slowing growth and. That may still come to pass--the recent economic news from China has been consistently worse than most experts predicted--but. “Only Makes You Stronger. Thanks to a generation of rapid economic growth. The crisis has not--yet--led to the nightmare scenario that China-watchers fear: a recession or slowdown producing the kind of social unrest that could challenge the government.S. if at all. position in the Middle East as falling oil prices reduce Iranian influence and increase the dependence of the oil sheikdoms on U. when both Nazi and communist politicians blamed the West for Germany's economic travails. Beijing will have to devote more resources and more attention to stabilizing Chinese society. In the worst-case scenario. and complex rather than fast and sweet. If current market turmoil seriously damaged the performance and prospects of India and China. and the Shanghai stock market is down about 60 percent. The greatest danger both to U. Kissinger Senior Fellow in U." But suggestions that China could grow at. 9 – Henry A. The collapse of asset bubbles in the stock and property markets will wipe out the savings of a generation of the Chinese middle class.S.-China relations and to American power itself is probably not that China will rise too far. The violent Naxalite insurrection plaguing a significant swath of the country could get worse. the World Bank slashed its estimate of China's GDP by 40 percent. and caring for an aging population. Lesser powers like Saudi Arabia and Iran also face new constraints. will need massive help from the government to support itself in old age.S. While India's 60-year-old democratic system has resisted many shocks. Doing so will leave China fewer resources for military build-ups and foreign adventures. and China is unlikely to be an exception. a deep economic recession in a country where mass poverty and even hunger are still major concerns could undermine political order. (Think of Weimar Germany.S. A deceleration in China's long-term growth rate would postpone indefinitely the date when China could emerge as a peer competitor to the United States. however You’re A Jerk 14 . protection. unemployment is rising. 2/4/09. Support for global integration is a fairly recent development in India.S.tnr. even if the worst case is avoided. 10 percent annually for the next 30 years were already looking premature before the economic downturn. U. as nervous investors moved their money out of the country. The political consequences could include dangerous unrest--and a bitter climate of anti-foreign feeling that blames others for China's woes. Foreign Policy at the Council on Foreign Relations (Walter Russell. (In late 2007. For another. the current crisis could join the Great Depression in the list of economic events that changed history . the turmoil in the international economy will plunge China into a major economic downturn. moves to limit market access for Chinese and Indian producers could poison relations for years. however undeserved. http://www. nobody knows what will happen if the growth stops. Millions or even tens of millions of Chinese will be unemployed in a country without an effective social safety net.S. say. The present global distribution of power could be changing slowly. Every other country in the world has experienced significant financial crises while building such systems. it has shown that China's modernization is likely to be long. in turn. creating and regulating a functional and flexible financial system is difficult. building a national health care system.0 LO 14 HEALTHCARE 1AC – ECON ADV Continued economic decline culminates in WWIII Mead. foreign policy far more severely than any mistake made by George W. At the same time. The Chinese financial system will implode as loans to both state and private enterprises go bad. China has so far been able to manage the stresses and conflicts of modernization and change. too fast.html?id=571cbbb9-2887-4d81-8542-92e83915f5f8&p=2) The damage to China's position is more subtle. it has reminded China that its growth remains dependent on the health of the U. as some assumed. long-term growth. economy.Single Payer 2. The United States should stand ready to assist Chinese and Indian financial authorities on an emergency basis--and work very hard to help both countries escape or at least weather any economic downturn. In the lead-up to last summer's Beijing Olympics. talk of a Chinese bid to challenge America's global position reached fever pitch. dangerous. thanks to the one-child policy. but the United States must avoid a protectionist response to the economic slowdown. Already exports are falling. and many serious Indians remain skeptical of it. India's future is also a question. and India's attitude toward the United States and global economic integration. It may test the political will of the Obama administration.S. The crisis has strengthened the U. Bush.com/politics/story. Success in Iraq--however late. and the inexorable rise of China is one reason why so many commentators are fretting about the "post-American era. which.” The New Republic. As the crisis has forcefully reminded Americans. For billions of people in nuclear-armed countries to emerge from this crisis believing either that the United States was indifferent to their well-being or that it had profited from their distress could damage U. instability could lead to a vicious cycle. fomenting ever-greater bitterness.

As a result. Now. yet. consequently. Karachi. They are able to invest in education. populist radicals. over time. Saudi Arabia and other oil states have become more dependent on the United States for protection against Iran. Countries that can encourage--or at least allow and sustain--the change. capitalism has appeared as an unwelcome interloper. this is not the case. to some degree. Argentina has lost ground to Chile. and what other capitalist powers like France. making their workforces ever more productive. Every crisis is different. but. the companies and banks based in these societies are often less established and more vulnerable to the consequences of a financial crisis than more established firms in wealthier societies. Beijing. None of which means that we can just sit back and enjoy the recession. If financial crises have been a normal part of life during the 300-year rise of the liberal capitalist system under the Anglophone powers. If the current crisis turns into a depression. The wars of the League of Augsburg and the Spanish Succession. the crisis has weakened the power of the merchants. according to Iran's Bank Markazi. while providing their tumultuous market societies with appropriate regulatory and legal frameworks. This is what the United Kingdom and the United States have done in past centuries. the ability to exploit the advantages of rapid economic development has been a key factor in international competition. and pain that capitalism often involves. So far.S. what rough beasts might start slouching toward Moscow. to remake the world to suit their own interests and preferences. Meanwhile. industrialists. But. less reassuring messages as well. Partly as a result of these internal cultural pressures. and Japan have done to a lesser extent. open system of liberal democratic capitalism even as many former Warsaw Pact nations were making rapid transitions. And. financial crises on balance reinforce rather than undermine the world position of the leading capitalist countries. the two World Wars. and Syria against domestic needs. They produce cutting-edge technologies that translate into military and economic power. Hezbollah. the Latin world is often drawn to anti-capitalist movements and rulers on both the right and the left. up from about 17 percent in 2007. in many other countries where capitalism rubs people the wrong way. too. imposed by foreign forces and shaped to fit foreign rather than domestic interests and preferences. They typically develop liberal political institutions and cultural norms that value. The annual inflation rate rose above 29 percent last September. so has war. When crisis strikes. None of this makes the Middle East an easy target for U. or the post-cold war leaders who so signally failed to build a stable. the cold war: The list of wars is almost as long as the list of financial crises. You’re A Jerk 15 . if we can't get the world economy back on track. or at least tolerate. such half-hearted experiments not only have failed to work. Economists forecast that Iran's real GDP growth will drop markedly in the coming months as stagnating oil revenues and the continued global economic downturn force the government to rein in its expansionary fiscal policy. but there seem to be reasons why. or authoritarian traditionalists who are determined to resist liberal capitalist society for a variety of reasons. financial crises often reinforce rather than challenge the global distribution of power and wealth. many countries are only half-heartedly capitalist. or New Delhi to be born? The United States may not. upheaval. the commissars. and partly because. we may still have to fight. Russian development has fallen farther behind that of the Baltic states and Central Europe. developing countries and countries where capitalism has relatively recent and shallow roots tend to suffer greater economic and political damage when crisis strikes--as. has never really taken to capitalism and liberal society--whether during the time of the czars. and they have fewer resources to fund religious extremism as they use diminished oil revenues to support basic domestic spending and development goals. farther behind the front-runners as time goes by. Meanwhile. the collapse in oil prices has put the Iranian regime on the defensive. it does. Crisis can also strengthen the hand of religious extremists. In these countries. they have left the societies that have tried them in a progressively worse position. dislocation. grow swiftly. the Napoleonic Wars. the American Revolution. History may suggest that financial crises actually help capitalist great powers maintain their leads-but it has other. inevitably. The vast productive capacity of leading capitalist powers gives them the ability to project influence around the world and. but the Depression poisoned German public opinion and helped bring Adolf Hitler to power. dissent and that allow people of different political and religious viewpoints to collaborate on a vast social project of modernization--and to maintain political stability in the face of accelerating social and economic change. Since capitalism first emerged in early modern Europe. the social forces that support the idea of a competitive market economy within an appropriately liberal legal and political framework are relatively strong. for example. financiers. Iranian officials must balance the relative merits of support for allies like Hamas. they are quick to decide that capitalism is a failure and look for alternatives. the Seven Years War. in much of the world. decline. Europe was a pretty peaceful place in 1928. This may be happening yet again. Russia. Bad economic times can breed wars.Single Payer 2. All this has weakened Ahmadinejad at home and Iran abroad. and professionals who want to develop a liberal capitalist society integrated into the world. but thanks in part to the economic crisis. Frequently.0 LO 15 HEALTHCARE 1AC – ECON ADV limited— had already improved the Obama administration's prospects for addressing regional crises. diplomacy. the incoming administration has the chance to try some new ideas and to enter negotiations with Iran (and Syria) from a position of enhanced strength. Germany. On either side of the Atlantic. while international sanctions and other diplomatic sticks have been made more painful and Western carrots (like trade opportunities) have become more attractive.

Many other economists.cfr. however. says the amount businesses pay for employee insurance is just one element of their total healthcare costs. you have small businesses that simply cannot afford to offer coverage." as Blinder puts it. government-run system. healthcare systems are much less reliant on private sector support--and much less expensive. General Motors. For large corporations they mean the massive "legacy costs" associated with insuring retired employees. a "hidden tax" confronted in a health care proposal (PDF) laid out by California's Governor Arnold Schwarzenegger. Rideout says businesses incur a "triple tax. according to data in a report by McKinsey.1 million employees and former employees. you have small businesses that simply cannot afford to offer coverage. The Princeton economist Alan S. U.S. have shied away from making such estimates. federal employees.S. Businesses pay higher insurance premiums to make up for the fact that Medicare and Medicaid reimbursements often do not match the total costs hospitals incur treating these patients.S. the federally supported programs for primarily poor and elderly Americans. Rather. Third. Lee. job market. For small business owners they can be even more devastating. job drift comes primarily from industries where jobs are most "tradeable." -.Rep. http://www. he says." Blinder goes on to predict that somewhere between 28 million and 42 million U.org/publication/13325/ [Mardjuki] These ballooning dollar figures place a heavy burden on companies doing business in the United States and can put them at a substantial competitive disadvantage in the international marketplace. The proposal also includes a small business tax credit for those that provide coverage to their employees to help with the costs. Americans pay roughly $500 per month.S. system costs 83 percent more per capita than the Canadian system. For large multinational corporations. The authors conclude that savings from the NHI system largely offset the incremental cost of covering the previously uninsured. but also a wide and expanding array of other service-sector jobs--will be easier to shift across national boundaries in the future.S. industry. he says. by lawmakers who are against expanding government's role in health care or placing more requirements on the industry. Health benefits for unionized auto workers became a central issue derailing the 2008 congressional push to provide a financial bailout to GM and its ailing Detroit rival. staff writer. Rideout says.S. Taiwanese are assessed around $20 a month for full health coverage. covers more than 1. 3/4/09. businesses also subsidize the strain on the system wrought by the cost of treating America's uninsured. Jeffrey Rideout. “Health Care Costs and U. in a 2006 Foreign Affairs article. footing healthcare costs presents an enormous expense. Health care is one of several factors--entrenched union contracts are another--that make doing business in the United States expensive. that healthcare expenses affect every level of U. he wants to allow people and small businesses. John Sarbanes Obama does not propose to alter the employer-based system and move to a single-payer.S. where public funds collected through taxes pay for up to 70 percent of healthcare coverage. economists disagree on the number of U. Elsewhere in the world. Tori. Johnson. For example. Teslik." Sarbanes says.500 and $2. You’re A Jerk 16 . Obama's plan may be opposed.” Council on Foreign Relations. It is clear. companies do not argue against the employer-based insurance model. Not surprisingly. "In many places.S. In contrast. they contend that a wasteful public-private system is pushing costs much higher than they should be. economic expert and assistant editor @ CFR. jobs that have been lost to offshoring--the transfer of business operations across national boundaries to friendlier operating environments. Services that can be delivered electronically--information technology. – Obama’s health care proposals do nothing to slow rampant job loss. however. they pay for insurance programs through health benefits.0 LO 16 HEALTHCARE 1AC – COMP ADV Advantage 2: Competitiveness Skyrocketing health care costs deter companies from hiring in the U. which provides comprehensive universal health coverage to Taiwan's roughly 23 million citizens. and the company says it spent roughly $5. Competitiveness. implemented in 1995. where the authors argue the legacy of British colonialism has encouraged a strong state role in the healthcare system. Second." it is apparent that "under a million service-sector jobs in the United States have been lost to offshoring to date. however. An article in Health Affairs examines Taiwan's National Health Insurance (or NHI) system. It is difficult to quantify the precise effect high healthcare costs have had so far on the overall U. says that judging by data compiled from "fragmentary studies. and some have criticized Blinder's approach. healthcare expenses make it impossible for small business owners to hire candidates they would otherwise desire . "In many places. jobs are "susceptible" to offshoring in a future where technology allows the more efficient transfer of jobs. Obama's proposal would mandate coverage for children but not adults. Malaysia. again through higher insurance premiums. and Singapore. Chrysler. Blinder." First. A number of East Asian systems also enjoy high quality of care for a much lower cost. By and large. Taiwan's system is commonly singled out as a model for cost-effectiveness . the U.S. An article in Cambridge University's Journal of Social Policy looks at what it calls the "remarkable" performance of healthcare systems in Hong Kong. Instead. businesses indirectly subsidize Medicare and Medicaid.000 to the sticker price of every automobile it makes. GM says healthcare costs add between $1.Single Payer 2. Often. who currently have trouble affording health insurance. and it's difficult to parse the effects of each factor. a medical doctor and the head of the Internet Business Solutions Group at Cisco Systems' Healthcare Practice. This doesn't mean American jobs will necessarily be lost--jobs can also be brought onshore--but it does mean industry will have to adapt. to buy into a government-sponsored insurance pool similar to the one for insuring U. for instance.6 billion on healthcare expenses in 2006. Moreover. for instance.

and abandon more and more of its external interests.Single Payer 2. In such an environment.” Washington Quarterly. “Proposal of the Physicians’ Working Group for single-Payer National Health Insurance. President of American College of Physicians. Economic competitiveness is a prerequisite to heg. The Effect on Corporate America: Firms now providing generous employee health benefits would probably realize savings because their tax contribution to NHI would likely be less than current health insurance costs. Ron Anderson. Indeed. http://www. American Academy of Pediatrics. and single source payment is the key to both equal access and cost control. most of the extra funds needed to finance the expansion of care would come from eliminating insurance company overhead and profits. the United States must maintain its technological lead in the economic realm. As the United States weakened. developments such as the agricultural and industrial revolutions produced fundamental changes positively affecting the relative position of those who were able to take advantage of them and negatively affecting those who did not. Quentin Young. Spring Vol. which will shift the sources of wealth and the relative position of classes and nations.0 LO 17 HEALTHCARE 1AC – COMP ADV And a single-payer healthcare system radically decreases employers’ health care costs. [Mardjuki] The United States is unlikely to preserve its military and technological dominance if the U.php [Mardjuki] The insurance/HMO industry would have virtually no role in health care financing.org/single_payer_resources/proposal_of_the_physicians_working_group_for_singlepayer_national_health_insurance .pnhp. 1995. 18. No. Christine Cassell. become inward-looking. Commissioner of Baltimore City Health. and abolishing the billing apparatus necessary to apportion costs among the various plans. however increase costs for companies not now providing health benefits. since public insurance administration is more efficient. If the United States fails to recognize the change and adapt its institutions. To sustain and improve its economic strength. Tax-based NHI funding might. 2009. products would be enhanced. You’re A Jerk 17 . Some argue that the world may be at the beginning of another such transformation. Marcia. Since most firms competing on international markets would save money. the domestic economic and political base for global leadership would diminish and the United States would probably incrementally withdraw from the world. enhancing competitiveness. US Ambassador to the UN. Angell. Editor of New England Journal of Medicine. “Losing the Moment? The United States and the World After the Cold War.S. LexisNexis. Its success will depend on the choices it makes. Peter Beilenson. 2. Zalmay. MD. Khalilzad. the competitiveness of U. economy declines seriously. Senior Lecturer @ Harvard Medical School. its relative position will necessarily worsen. others would try to fill the Vacuum. CEO Parkland Health System. In the past.” Physicians For A National Health Program. Joel Alpert.S. American Public Health Association.

the United States. increasingly. the United States did not retract but expanded its influence eastward across Europe and into the Middle East. the United States is the dominant naval power everywhere. Even the European Union. It is easy but also dangerous to underestimate the role the United States plays in providing a measure of stability in the world even as it also disrupts stability. would disrupt trade flows in a way that is now impossible. The current order. The United States. that would not be possible without renewing the danger of world war. Central Asia. It is shaped by configurations of power. and destructiveness. the aspects of international order that they like would remain in place. however distant and one hopes unnecessary. that the United States could step in to check any dangerous development on the continent. regional conflicts involving the large powers may You’re A Jerk 18 . 1” and are equally loath to relinquish it. is not only far from perfect but also offers no guarantee against major conflict among the world’s great powers. they are remarkably slow to withdraw from it until they believe they have substantially transformed it in their own image. Central Asia.hoover. India. the Western Hemisphere. Even under the umbrella of unipolarity. honor. liberal and conservative. the Middle East. and since the end of the Cold War. of the kind used in World War i and other major conflicts.Single Payer 2. Americans have insisted on preserving regional predominance in East Asia. with different rules and norms reflecting the interests of the powerful states that would have a hand in shaping it. influence. and with Russia in Eastern Europe.org/publications/policyreview/8552512. and so is international competition for power. But that’s not the way it works. and status. and especially since the end of the Cold War. But it is doubtful that it would suit the tastes of enlightenment liberals in the United States and Europe. People who believe greater equality among nations would be preferable to the present American predominance often succumb to a basic logical fallacy. the other nations would settle disputes as great and lesser powers have done in the past: sometimes through diplomacy and accommodation but often through confrontation and wars of varying scope. beginning with the first Bush administration and continuing through the Clinton years. Hoover Institution. They profess indifference to the world and claim they just want to be left alone even as they seek daily to shape the behavior of billions of people around the globe. and though Americans are loath to acknowledge it. of international access to markets and raw materials such as oil. Nations would compete for naval dominance at least in their own regions and possibly beyond. Once having entered a region. One novel aspect of such a multipolar world is that most of these powers would possess nuclear weapons. They imagine that in a world where American power was diminished. they generally prefer their global place as “No. The jostling for status and influence among these ambitious nations and would-be nations is a second defining feature of the new post-Cold War international system. until recently. it is able to play its role as guardian of the waterways.0 LO 18 HEALTHCARE 1AC – COMP ADV US hegemony key to check multiple scenarios for nuclear war. such that other nations cannot compete with it even in their home waters. As a matter of national policy stretching back across numerous administrations. Nationalism in all its forms is back. They either happily or grudgingly allow the United States Navy to be the guarantor of international waterways and trade routes. however. That could make wars between them less likely. of course. if it ever went away. In a genuinely multipolar world. They believe the order the world enjoys today exists independently of American power. Central Asia. Would that international order be an improvement? Perhaps for Beijing and Moscow it would. and now. owes its founding to American power. it would not. The international order we know today reflects the distribution of power in the world since World War ii. A different configuration of power. too. Even when the United States engages in a war. for without it the European nations after World War ii would never have felt secure enough to reintegrate Germany. Kagan 7 Senior Associate @ the Carnegie Endowment for International Peace (End of Dreams. it is also engaged in hegemonic competitions in these regions with China in East and Central Asia. intensity. a multipolar world in which the poles were Russia. In a more genuinely multipolar world. and the Caucasus. that great geopolitical miracle. Conflict between nations would involve struggles on the oceans as well as on land. For instance. Most Europeans recoil at the thought. International order does not rest on ideas and institutions. This was its goal after the Second World War.html) Policy Review. but even today Europe’s stability depends on the guarantee. and the Caucasus. Such order as exists in the world rests not merely on the goodwill of peoples but on a foundation provided by American power. Europe. Return of History. whether for practical or idealistic reasons. is more of a traditional than a postmodern power. and Europe. American predominance prevents these rivalries from intensifying — its regional as well as its global predominance. Even as it maintains its position as the predominant global power. Were the United States to diminish its influence in the regions where it is currently the strongest power. Finally. http://www. or it could simply make them more catastrophic. Democratic and Republican. there is the United States itself. would produce its own kind of order. with Iran in the Middle East and Central Asia. Armed embargos. China.

War could erupt between China and Taiwan and draw in both the United States and Japan. The region and the states within it remain relatively weak. which could in turn draw the United States back in the American position in the Middle East and the assumption of a more passive. 18 And one could also expect the more powerful states of the region. China. or Iran. practically ensures a heavy American military presence in the region. one likely to draw the United States back in again. no one should imagine that a reduction of American power or a retraction of American influence and global involvement will provide an easier path. obviate the need to come to Israel’s aid if its security became threatened. particularly Iran. But they are more likely to erupt if the United States weakens or withdraws from its positions of regional dominance. and therefore to the need for a permanent American role in Europe. In Europe. to expand and fill the vacuum. It is further competition. Conflict between India and Pakistan remains possible. including the United States. The subtraction of American power from any region would not end conflict but would simply change the equation. It will produce a new instability. The alternative to American regional predominance in the Middle East and elsewhere is not a new regional stability. stability. The world hasn’t changed that much. A diminution of American influence would not be followed by a diminution of other external influences. history suggests that conflicts in Europe involving Russia are possible even without Soviet communism. This is especially true in East Asia. where most nations agree that a reliable American power has a stabilizing and pacific effect on the region. The alternative to American predominance in the region is not balance and peace. One could expect deeper involvement by both China and Russia. Such conflicts may be unavoidable no matter what policies the United States pursues. the departure of the United States from the scene — even if it remained the world’s most powerful nation — could be destabilizing. Difficult as it may be to extend American predominance into the future. too.0 LO 19 HEALTHCARE 1AC – COMP ADV erupt. In the Middle East. That is certainly the view of most of China’s neighbors. War could erupt between Russia and Georgia. An American withdrawal from Iraq will not return things to “normal” or to a new kind of stability in the region. could draw in other great powers. It only adds a new and more threatening dimension to the competition. That commitment. faces the dilemma that an American withdrawal could unleash an ambitious. These. which seeks gradually to supplant the United States as the dominant power in the region. if only to secure their interests. nationalist Japan. Nor would a more “evenhanded” policy toward Israel.Single Payer 2. which some see as the magic key to unlocking peace. too. It is also optimistic to imagine that a retrenchment of stand back and hope for the best while the powers in the region battle it out. The rise of Islamic fundamentalism doesn’t change this. competition for influence among powers both inside and outside the region has raged for at least two centuries. But even China. “offshore” role would lead to greater stability there. both on the seas and on the ground . In an era of burgeoning nationalism. paired with the American commitment to protect strategic oil supplies for most of the world. It is doubtful that any American administration would voluntarily take actions that could shift the balance of power in the Middle East further toward Russia. as does conflict between Iran and Israel or other Middle Eastern states. independent. forcing the United States and its European allies to decide whether to intervene or suffer the consequences of a Russian victory. It could tempt Russia to an even more overbearing and potentially forceful approach to unruly nations on its periphery. If the United States withdrew from Europe — if it adopted what some call a strategy of “offshore balancing” — this could in time increase the likelihood of conflict involving Russia and its near neighbors. and comity in the Middle East. the future is likely to be one of intensified competition among nations and nationalist movements. You’re A Jerk 19 . Although some realist theorists seem to imagine that the disappearance of the Soviet Union put an end to the possibility of confrontation between Russia and the West. The vital interest the United States has in access to oil and the role it plays in keeping access open to other nations in Europe and Asia make it unlikely that American leaders could or would under unfavorable circumstances. which neither a sudden end to the conflict between Israel and the Palestinians nor an immediate American withdrawal from Iraq would change.

rather than to remain passive. but that does not detract from the necessity of seeking security. its interests. From this power also comes respect and admiration. and to dissuade states from challenging it. International politics is a dangerous environment in which countries have no choice but to participate.” Routledge 2k7. Any involvement—from the extensive involvement of the United States to the narrow activity of Switzerland—in this dangerous realm runs the risk of a backlash. no matter how grudging it may be at times. P. Thayer 2k7 Associate Professor in Defense and Strategic Studies Missouri State University Bradley A. rather the reverse. Americans and most of the world should welcome American primacy and work to preserve it as long as possible. and military power. Thankfully. the United States is able to defeat its enemies the world over. The issue is how much participation is right. thus far the United States recognizes it is much better to be involved so that it may shape events.Single Payer 2. This argument is based on its prodigious economic. Reply to Christopher Layne. to reassure its allies. You strive to live as long as possible although you realize that it is inevitable that you will die. Like good health. having events shaped by other countries. You’re A Jerk 20 . These advantages keep the United States. and its allies secure. ideological.105 Each country knows it will never be perfectly secure. maximizing the power of the United States aids its ability to defend itself from attacks and to advance its interests. Due to this power. “American Empire: A Debate. and then adjusting to what they desire. That is simply a fact of life in international politics. and it must strive to maintain its advantages in international politics as long as possible . Knowing that American hegemony will end someday does not mean that we should welcome or facilitate its demise. In contrast to Layne's argument. The United States should labor to maintain hegemony as long as possible—just as knowing that you will die someday does not keep you from planning your future and living today.0 LO 20 HEALTHCARE 1AC – COMP ADV Even if heg will collapse some day we should maintain it now for our protection.

0 LO 21 HEALTHCARE 1AC .PLAN PLAN: THE UNITED STATES FEDERAL GOVERNMENT SHOULD IMPLEMENT A FEDERAL SINGLE-PAYER HEALTHCARE SYSTEM FOR ALL UNINSURED PERSONS IN THE UNITED STATES.Single Payer 2. You’re A Jerk 21 .

http://www. Nothing could be further from the truth. providers are insulated from competition because private insurers often restrict coverage to select physicians. Economies of scale will save the money to make this possible. bloated by advertising. In addition. http://www. A single-payer system will harness the market's strengths while addressing its limitations. 9-5-2008. Single-payer works because of the efficiency of specialization. What's worse.0 LO 22 HEALTHCARE 1AC .letters200jul20. Prajwal Ciryamv. “A Market for Compassion: Single-Payer Health Insurance”. "For 30 years I have supported a single-payer plan. Schoonmaker.when we have a single-payer model. wouldn't you wonder why it's going to take so long to get essential elements of this version of reform in place? Wouldn't you wonder why the elements that are designed to help the millions of uninsured are the ones that are going to take the longest to implement? Or. but our next best choice is to support an exchange and a public option.[2] But they worry that it lacks the spirit of the American market. concede that single-payer insurance is probably our most efficient option. the government will fund health insurance. The private health insurance market is inefficient. If I told you that in less than a year after the historic Medicare legislation was signed into law.pubmedcentral.com/node/29667). insurance policies are so complex and individuals' future needs so unpredictable that consumers cannot make the informed selections that induce competition between insurers.le. All of the major developed nations have some form of single-payer health care. Having a shiny new insurance policy will not help if the out-of-pocket costs are such that people still cannot afford to see the doctor or get the medications they need. 7/20/09 Anne.1114455. you wondered if there's a political reason why the plan won't be fully operational until 2013.story [Mardjuki] In a Q-and-A recently posted on the Web site Crooks & Liars (http://crooksandliars. where the focus should have been from the start.nih. not insurance. the 47 million uninsured Americans[3] have little impact on the market.baltimoresun. Global Sourcing Finance Chief at GE Healthcare.fcgi?artid=2580082 In a single-payer system. and millions of older Americans had been enrolled and were getting health care with hardly a hiccup. like the fact that we will have a presidential election in November of 2012. and executive compensation. Currently. Their spending per-person on health care is less than half what we spend here. is a whole lot less than "next best?" The House plan is not set to go "live" until January of 2013. from all appearances.000-plus-page bills. thousands of people losing their jobs every month and losing their coverage. Medicare. that is not a typo. duplicated bureaucracies. why are we giving up on the best solution and settling for something that. However.com/news/opinion/readersrespond/baled. House Speaker Nancy Pelosi responded to one of the questions by saying. You’re A Jerk 22 . or dropping coverage altogether. healthier than we are. that we know works well and could be expanded or duplicated with relative ease and in a much shorter period of time? Single payer harnesses the market’s strength and maximizes efficiency. creating a Rube Goldberg-ian system whose biggest benefit will be to insurance companies that have done nothing in the last several decades to improve the current system . not the best middlemen to pay for it.but a lot to assist the political careers of more than a few members of Congress who are crafting this "reform" (and making those who need accessible and affordable care the most wait the longest to get it) . “Why not singlepayer?” Baltimore Sun. Why are we writing 1. No. with more employers changing to plans that cover less and cost the individual more. the program was up and running. is health care. maybe.gov/articlerender. by most accepted measures. A single-payer system will give all consumers the power of choice and open all healthcare providers to the effects of consumer decisions. MD/PhD from Northwestern University. So.0. dividends. consumers can create competition among healthcare providers." The question that her response prompts from me is. including Democratic presidential nominee Barack Obama.Single Payer 2. This is paramount because patients need the best healthcare. with an economy in decline. and it might not be good for the fortunes of the current president or the senators and representatives up for re-election if a new health care system is not going well or is not all it was advertised to be. what will the millions of currently uninsured people do between now and 2013? And. Many Americans. but private providers will continue to deliver care. how much more dire will things be in four years? What will the insurance companies be doing between now and 2013? How will they be positioning themselves to accommodate the changes that are coming? What will we see from them in the next 3 1/2 years that will signal they have even the slightest interest in improving our access to and delivery of actual health care? What this is really all about.SOLVENCY Observation 3: Solvency Only a single-payer system mitigates costs – Medicare proves. and their people are.

Adam Smith would be proud. You’re A Jerk 23 .0 LO 23 The government will manage the paperwork and private entities will provide the care.Single Payer 2.

If we take this approach. Martin. the hospital will probably try to increase the number of Medicaid recipients they admit (or their lengths of stay in the hospital) to recoup the lost Medicare revenue. Volume 11. For just as surely as Medicaid reform proposals that ignore the nation's health care system as whole will have limited success.Single Payer 2.SOLVENCY Medicaid reform must be considered in the context of massive healthcare restructuring – Medicaid is the starting point of effective reform. we can also draw on research into the Medicare program and into other nations' public health care systems. Furthermore. make poverty the criterion for eligibility. 1987). Most of Medicaid's problems can be traced to the principles which characterize the program. at their discretion. there is a logic to starting with the reform of the Medicaid program. more physicians will see private patients and fewer will see Medicaid eligibles. Only by changing these principles and combining Medicaid reforms with major structural reforms of American health care system can Medicaid's problems be solved. “Medicaid’s Role in Moves Toward Universal Health Care. Medicaid is a welfare benefit -not a right-to be granted by the states. As the payer of the last resort.0 LO 24 HEALTHCARE 1AC . If the Medicaid inpatient rates are relatively high. Consequently. If private insurers raise physicians' fees in a state. Medicaid must compete in a health care system run by market forces. If affordable universal coverage is our goal. If Medicaid inpatient rates are relatively low. [Mardjuki] Proposals for reform are usually combined into packages. so proposals to reform the nation's health care that do not fully consider Medicaid will have a less positive impact than they otherwise might. If a change in the Medicare program's reimbursement ra tes lowers hospital profit margins. The Medical Assistance program is greatly affected by the actions of other health care programs. Medicaid already covers a large proportion of the poor and uninsurable. hospitals will probably try to decrease the number of Medicaid recipients they admit (or their lengths of stay in the hospital) and attract more privately insured patients to compensate for the lost Medicare revenue. but they do not consider Medicaid reform in the context of radical reform of the American health care system. A more radical package would divide the acute care and long-term care components of Medicaid. its reform will not threaten the private health care industry. the nation's health care system could be transformed. horizontal inequities are not surprising. You’re A Jerk 24 . such as increased or equalized coverage. major problems would remain unsolved. This is a mistake. we should include the following elements in our reforms. These reforms always have several desirable goals. As it is a government program. this will likely affect Medicaid recipients. 1992.” Policy Studies Review. In the process. block grant long-term care and change the federal funding formulas for acute-term care (Holahan and Cohen. While the proposals could lead to some improvements in Medicaid. De Alteriis. offering the lowest reimburse must be expected. 1988). director of Medical Health Administration. We have a solid body of research specifically about Medicaid to guide us. Winter 1992. One package designed to increase Medicaid eligibility and control costs would make poverty the sole criterion for eligibility and rely on managed care to contain costs (Oberg and Polich.

SOLVENCY Single-payer system for the uninsured would function as a demonstration of a scalable model for the rest of the country – creates impetus for expansion and nation-wide adoption. And that's no small gain. can be deployed to make sure no insurer is penalized for signing up sicker customers and no insurer benefits from signing up healthier customers. the combination of increased efficiencies and greater competition drive down costs. The only way that health-care reform will truly give us a more efficient. the weak version is a lot likelier than the strong version. Ezra. “A Market for Health Reform.0 LO 25 HEALTHCARE 1AC . remain uncowed. This is not an insurmountable policy problem. will come out sounding like "80 million Americans will lose what they have. It gives them a way out of a health-care system that is eating through their wages and limiting their choices. risk adjustment. pricey. and open to everyone. inefficient mess.html [Mardjuki] The central problem in health-care reform is that good policy and good politics point in opposite directions. But amid the clamor over public insurance options -. the self-employed and small businesses. Germany and every other largely private universal health-care system uses to deal with similar issues. structured for consumer convenience. Everything. accessible only to the few able to get there. They will benefit. or at least regional. It never really grows. which will lead more employers to use the exchange. But all health insurance exchanges are not created equal.which. It's open to everyone: The unemployed. Some politicians. There are. the idea behind the health insurance exchange is almost weirdly simple: It's a single market. no matter the size.and employer tax exclusions and all the other points of controversy. inefficient mess and don't trust Washington to change it. more affordable health-care system is if it begins to fundamentally change the inefficient. It would also let those of us with employer-based insurance take the money our employers are paying for our insurance and use it on the exchange instead. would be housed on the exchange -. from an actual. Good policy proceeds from the understanding that our health-care system is a fractured. 7/27/09. in which you choose between the products of competing health insurers (both public and private). It's open to only the unemployed. except health insurance. because it is the bridge between the system we have and the system we want. that is. You let the lure of lower costs and higher quality persuade Americans to migrate over of their own accord. Right now. if it exists at all. In the short term. The huge pool of users gives the exchange tremendous advantages in scale. and instead exists as a marginal policy to mop up those who aren't covered by employers. But put those imperatives together and you have a strange problem indeed: How do you reform a system that you're not allowed to change? The answer that reformers have come up with is that you don't change the current system. Compared with the crazy-quilt system we have now. You make it kinder and gentler. insurers are eager to participate. But there is a tricky political problem: If the exchanges are effective. which the Netherlands." And that scares people. you strengthen it with subsidies and regulations on insurers. simplicity and standardization (experts say that you need at least 20 million to fully achieve these benefits -. incidentally. in other words. it offers a concrete way that reform could benefit the insured. You could easily see this exchange slowly emerge as the de facto American health-care system.something health insurers have managed to avoid for far too long. the self-employed and any business. and the efficiencies of scale and competition are minimal. But you also build the beginnings of a new. With so many potential customers. pricey. translated into political-speak. There's risk adjustment to reduce the incentive for cherry-picking." That estimate. insurers aren't driven to compete. and they will bid aggressively to ensure they're included in the market and compete aggressively to make sure they're successful within it. which will in turn give it more scale and bargaining power. however. The strong version is national. as Barack Obama frequently says. Through consumer choice. Good politics. More so than any other idea in the health-care debate. better health-care system off to the side. Good politics means.com/wpdyn/content/article/2009/07/28/AR2009072802114_pf. This is what the health insurance exchange is designed to do. The benefits of reversing that bit of accidental exceptionalism are obvious to anyone who has ever stepped inside a Target: Consumers will benefit from more choice. They are afraid of a Congressional Budget Office estimate that says something like "80 million Americans will transition from employer-based health insurance to the exchange. Politicians are very interested in the optics of preserving current insurance arrangements. from direct competition between insurance providers hungry for their business.” Washington Post. The largest of these is adverse selection: If you open it to large employers. This idea wouldn't take away what anyone has. unaffordable system we have now. One is that there are tricky policy problems in a strong exchange. is crude. you get to keep it. You let it demonstrate its efficiencies and improvements. ways to address that problem: In particular . And there are signs that it. And not through government fiat. Over time. then workers and employers alike might well decide to use them.Single Payer 2. The weak version is state-based. With such a limited pool of applicants. the health insurance exchange is hardly being discussed. http://www. Oregon Democrat Ron Wyden has proposed something he calls the Free Choice Act: It would open the exchanges to all Americans and all businesses. and thus the longterm promise of reform. there's a weak and strong version of the exchange. then costs will shoot up. however. which scares politicians. It is how we buy everything from books to socks to soup. more effective. working market -.washingtonpost. ineffective. might be in danger. Risk adjustment. But it would allow those of us who don't like what we have to change it. that wants to buy in. economic and domestic policy expert. This is not a new idea. It is arguably the single most important element of health-care reform. You’re A Jerk 25 . proceeds from the insight that a lot of people rely on this fractured. and from the sort of purchasing power that only a large base of customers can provide. Just as there's a weak and strong version of the public plan. from regulations meant to protect them from deceptive products. Sort of an outlet shopping model for health-care. from efficiencies of scale. but the only large employers who join are those with aging and ill workforces. for a couple of reasons.easy in a national exchange but harder in a regional or state-based one). however. Klein. that if you like what you have.

professor of health policy at the Mailman School of Public Health. most states deliver benefits through managed care. our political institutions are designed to make it hard to enact comprehensive legislation. states can increase coverage while shifting much of the cost to the federal treasury. Since the Reagan administration. Private insurers support such initiatives because they leave intact the core of the current system and because many states use commercial health plans to serve Medicaid beneficiaries.. Institutional providers (hospitals and nursing homes) are supportive. Columbia University. I believe that this is the only universal coverage plan with a decent chance of succeeding politically. at the high end.0 LO 26 HEALTHCARE 1AC . Bush hoped to increase funding. Employer mandates face treacherous politics: big business doesn’t want government telling it what sort of coverage to provide. New Jersey.SOLVENCY Expanding Medicaid builds support for universal care – it’s the only way to neutralize political objections Michael Sparer. Medicaid.D.2 The 2007 battle over Medicaid’s sister program. and reimbursement. whereas others act as the plan themselves. children). 2009 (Michael Sparer. Americans with incomes below 350% of the federal poverty level (around $62.” January 22. but if eligibility were standardized and minimum benefits defined.S. illustrates this broad acceptability. This history points us to an obvious path toward national health insurance: combine a Medicaid expansion and buy-in with an individual mandate. since our system of checks and balances provides opponents with numerous opportunities to block legislation. Previous efforts to enact universal coverage have failed in part because opposition from interest groups such as the business community and the insurance industry is far more influential than is organized support for uninsured low-wage workers. the debate generally ignores what I see as the most plausible path toward universal coverage: first. Even President George W. softening the impact of the continuing decline in the number of Americans with employer-sponsored coverage. program enrollment has more than doubled (surpassing 59 million). the federal–state program designed to provide health insurance for the poor. benefits. The bone of contention was the income ceiling for eligibility.000 for a family of three). however. Reform opponents also take advantage of the anti– big-government ethos that pervades our political culture. and outreach and education is a good thing. The policy debate includes references to new government programs (perhaps a federal program for the uninsured to buy into) and vague formulas for cost containment (usually involving overly optimistic assessments of savings to be generated by using health information technology). history for aiding the uninsured. though by less than Congress had proposed. expanding Medicaid to cover the largest portion of the uninsured. covers children from families with incomes up to 350% of the federal poverty level. the very factors that defeated President Bill Clinton’s proposal for universal coverage have actually encouraged expansions of Medicaid. since they rely on Medicaid dollars. Ironically. Ph. Relying on Medicaid is also good policy. requiring everyone to carry health insurance and allowing people whose incomes are too high for automatic coverage to buy into Medicaid. given both the cultural opposition to anything that could be labeled a single-payer program and the fierce opposition of the private insurance industry. the State Children’s Health Insurance Program (SCHIP). but some rely on commercial insurers and some on nonprofit health plans. Moreover. variation in other areas could result in learning and innovation.nejm. which minimizes complaints about a monolithic national program. Finally. Even less likely to fly are Medicare-expansion proposals.org/?p=300) The 2008 presidential election has rekindled long-simmering hopes for comprehensive health care reform. Path to National Health Insurance. Similarly. has been quietly becoming the most successful program in U. Medicaid’s intergovernmental structure encourages expansion: since the program is financed primarily with federal dollars. states are already experimenting with Medicaid buy-in programs. And Medicaid offers such flexibility within an overarching federal structure.4 Letting the laboratory of federalism work is a better idea than using Medicare or the congressional health plan as the basis for a reformed system — and a much You’re A Jerk 26 . and second.D. 2009. Medicaid encourages state-based experimentation in responding to local health care needs. Medicaid provides decent health insurance to more than 59 million Americans (including more than 25% of U. “Medicaid and the U.. and one state (New Jersey) has even enacted an initiative combining a Medicaid buy-in with an individual mandate for parents to cover children. Most Americans would find it fair to require those who can afford insurance to buy it.S. Medicaid is also administered in very different ways by different states. Perhaps most important. But the same interest groups that would oppose these alternatives would probably support the Medicaid strategy. J. The congressional proposal to increase SCHIP funding emerged from a bipartisan process and was supported by both Senator Edward Kennedy (D-MA) and Senator Orrin Hatch (R-UT).1 Meanwhile. http://healthcarereform. For example.3 Some people complain about interstate variation in eligibility. Business leaders support Medicaid expansions because they relieve the pressure on employers to cover low-wage employees. especially when they can pay into an affordable public insurance plan rather than being forced to buy private policies. interstate diversity in cost-containment strategies.Single Payer 2. Surprisingly. That’s about as high as moderate Republicans (and the business community) might plausibly be willing to go. programs for the chronically ill. and small business argues persuasively that many “mom and pop” shops simply cannot afford the bill.S.

You’re A Jerk 27 . Finally. I see the Medicaid model as providing the most likely path to solving the crisis of the uninsured. there is the question of paying the bill. a buy-in program. Proposals for national health insurance have a long history of failure in this country. Ultimately. Medicaid agencies could also rely more heavily on nurse practitioners and physician assistants. HEALTHCARE 1AC . Dynasaur” program in Vermont). and the businesses or individual consumers who buy in. there are no easy solutions. however. Here. however. the road to any type of national health insurance is littered with obstacles. the laboratory of federalism could help. especially in the midst of an economic crisis. Federal budget officials will also be skeptical. starting with a more modest Medicaid expansion. Although Medicaid participation is high in some states. and an individual mandate covering only children. though Congress could tie increased federal funding to innovative case management for chronic diseases (or other performance measures).5 Medicaid agencies (or the managed-care plans they rely on) will need to pay higher rates. citing low reimbursement rates and long administrative delays. One solution is to give the program a new name and thus a new identity as a middle-class entitlement. and the “Medicaid for More” model certainly faces barriers. States will complain about having to pay their share. since there are states that effectively partner with officebased physicians and have lessons to share. too. but any effort to simply bypass the physician community will fail. it is more typical for office-based physicians to refuse to treat Medicaid patients.0 LO 27 better idea than creating a brand-new administrative infrastructure. And if the recession and other priorities discourage President Obama from seeking universal coverage in one fell swoop. is that intergovernmental financing programs are the most plausible fiscal route to health insurance expansions. especially for a society disinclined to limit the diffusion of new health care technology or to regulate the prices and salaries paid by the private health care sector. and at least in this scenario the cost would be divided among the federal treasury. but any national health insurance system is going to cost money.Single Payer 2. However. More difficult would be convincing physicians to support a Medicaid expansion and participate in the program. States tried this strategy with some success when implementing SCHIP (hence the “Dr. though increases that are substantial enough to attract physician participation would undermine cost-containment efforts. One lesson of the recent Medicaid expansions.SOLVENCY Many middle-class workers would be reluctant to buy into a “welfare medicine” program. Here again. But expanding Medicaid in combination with an individual mandate offers a good policy solution that might have enough political appeal to succeed. the states. the model could be phased in. First is the stigma attached to the name.

Single Payer 2.0 LO 28 **INHERENCY** You’re A Jerk 28 .

It fails. Chait. Outcome 4: In many ways. If health care reform fails. for what I should think are obvious reasons. they can always say well. I can't see them doing it. from a purely short-sighted and self-interested perspective. 3. If fails. they went too far to the left. Undoubtedly. given something as large and complex as healthcare. But. and they vote for it. Having voted against the bill will provide little cover for moderate Democrats. because it's a big party victory. Will those problems. and they vote against it.Single Payer 2. don't look at me. Outcome 1: Not a bad outcome. I disagree. and they vote for it. hey. And that's the main difference between now and 1994 -. If fails. and they vote for it.. senior editor. as the 1994 elections show. http://blogs. There are four possible outcomes on healthcare. 2. You’re A Jerk 29 . They've stuck their necks out for nothing and practically begged to be accused of "being out of touch" with the voters of their conservative state. And that's why I think we'll end up with a health care bill. Specifically. So let's look at each of these vis-a-vis healthcare the way a centrist legislator might look at them. But there are lots of unknowns. Few unknowns.. then Obama is toast. and they vote against it. 3.com/tnr/blogs/the_plank/archive/2009/07/21/why-health-care-reform-will-pass. That's also why they're trying to get bipartisan support. but they're usually pretty good at discerning their own political self-interest. which could give them cover. It passes. “Why Health Care Reform Will Pass. Democrats will have to decide whether or not to support a filibuster of health care reform that would destroy their president and dig their own grave. which makes it all the more important that people like me stay in Washington.” The New Republic Journal. Members of Congress may not be geniuses. It fails. the solon thinks. there are going to be problems and disappointments with the new system. Outcome 3: The worst possible outcome. I'd order the outcomes like so.0 LO 29 Obama HC Inev Some type of healthcare reform is inevitable – Democrats must support it to save Democratic face and preserve their own careers even if they’re opposed to it. or any piece of legislation: 1. which is why I supported the provision that would have. I tried to tell my more liberal colleagues that this would happen. and they vote for it. at the end of the day. It passes.aspx [JM] Michael Tomasky analyzes the political logic of red state Democrats: Look at it this way. 4. the best outcome of all.health care can't be filibustered without Democratic cooperation. But the distance between the status quo anda perfect bill is so vast that we could have something that's both a massive. or possibly even the spare votes to allow them to vote against it. when problems arise with the reforms. because now. from best to worst: 1. A perfect bill? No. 7/21/09. It passes. That's what I think we'll get. It passes. so they can't be held responsible for the toes that get stepped on. historical improvement and a crushing disappointment. and they vote against it.tnr. Now. be hung around my neck when I seek reelection? Outcome 2: Preferable to 1. Jonathan. and they vote against it. they're going to have to decide whether to pass the bill or not. and the Democratic brand along with it. they can say. 2. That's why the best possible scenario for Democrats is to have the bill pass with them voting against it. it's true that you can't pass an effective health care reform without stepping on some toes. 4. And to the extent that their president and their party are damaged. Fear of the unknown is all-consuming for legislators who think they might be vulnerable to defeat someday.

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Healthcare reform inevitable. VOA News 7/14/09
“Obama: Health Care Improvements Inevitable.” http://www.voanews.com/english/2009-07-14-voa2.cfm [Mardjuki] U.S. President Barack Obama says improvements in the American health care system are inevitable. Mr. Obama made his comments in the White House Rose Garden Monday as he nominated an African-American woman, Regina Benjamin, to become the U.S. Surgeon General. The president said "naysayers and cynics" should not bet against the passage of health insurance legislation. He also said inaction on the issue is not an option. Mr. Obama has vowed to sign a health care bill into law this year. Democrats in the House of Representatives say they are nearly ready to unveil their health care reform plan.

Health care will pass – AMA backing. Nasaw, Washington correspondent. 7/16/09.
Daniel. “Powerful doctors groups backs Obama’s healthcare reform plan.” UK Guardian. http://www.guardian.co.uk/world/2009/jul/16/obama-health-plan-ama-support [Mardjuki] American Medical Association, which vigorously opposed Bill and Hillary Clinton's 1990s reform effort, today pledged to work with congressional leaders to ensure legislation is soon passed. The group endorsed the strongest legislation currently on the table, proposed this week by top Democrats in the House of Representatives. The group long opposed government intervention in the healthcare system for fear that its physician members would see their lucrative pay decline. With no universal public programme akin to the National Health Service, Americans rely on a patchwork of employee-provided healthcare, government programmes for the poor, elderly and veterans, and costly private health insurance coverage. Americans spend one out of every six dollars on healthcare - roughly twice as much per capita as other industrialised nations - but lag behind in life expectancy, infant mortality and other health indicators. The medical association's surprise turnaround may be an indication they see reform as inevitable and hope to influence the legislation at the margins. In its letter to Charles Rangel, a powerful New York Democrat, the group said it hoped for "constructive dialogue" during revision of the legislation. "We pledge to work with the House committees and leadership to build support for passage of health reform legislation to expand access to high quality, affordable health care for all Americans," the group wrote in a letter signed by executive vice president Michael Maves.

Healthcare inevitable – Obama pulling out all stops. Murray, White House correspondent. 7/13/09.
Mark. “Obama: Don’t Bet Against Health Reform.” MSNBC. http://firstread.msnbc.msn.com/archive/2009/07/13/1994860.aspx [Mardjuki] But the president also used the announcement as a kind pep talk on health-care reform, as congressional watchers and the press have begun to doubt whether Congress can meet his goal to pass reform bills before it goes on its August recess. "We are going to get this done," Obama said. "Inaction is not a option." He added, "Don't bet against us. We are going to make this happen." And mentioning a sports/exercise metaphor he's used before, Obama said that Washington's muscles for enacting change have atrophied. So: "We are whipping folks back into shape."

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Obama will ram healthcare through Congress – highest odds now. Trende, staff reporter. 7/24/09.
Sean. “Why Obama Isn’t Governing From the Center.” Real Clear Politics. http://www.realclearpolitics.com/articles/2009/07/24/why_obama_isnt_governing_from_the_center_97591.html [Mardjuki] In other words, Obama realizes that the odds are not likely going to improve for the implementation of an aggressively liberal agenda. Right now, he is in the midst of a liberal moment, where he has governing majorities in each House. He wants to get a health care bill through that is the closest to his philosophy, and he knows that future Congresses are unlikely to have similarly hearty Democratic majorities. So he’s “going for it,” knowing that if he can ram a bill through – and with a 80-seat majority in the House I think he ultimately will be able to – it will probably never be repealed, even if Republicans surge back in 2010. If he doesn’t do it now, he will likely be relegated to pursuing an incrementalist strategy, similar to what the Democrats have been pursuing since 1994. If you accept that Obama truly is a solid liberal at heart, not a centrist, and that he’s ultimately at least as concerned about getting this agenda through as he is getting re-elected, then his present approach makes sense.

Health care industry and moderate Republicans negotiating – recognize healthcare inevitable. Pershing, staff reporter. 7/10/09.
Ben. “Is health-care reform inevitable?” Washington Post. http://voices.washingtonpost.com/political-browser/2009/07/is_healthcare_reform_inevitab.html [Mardjuki] Is health-care reform inevitable? That question has come to the fore in recent days, as President Obama and Democratic leaders on Capitol Hill attempt to navigate a maze full of opposition and entrenched interests to arrive at a reform package. Politics is all about leverage, and for now, the pro-reform forces have it. That's why so many potential opponents of the White House's efforts -- drug companies, hospitals, moderate Republicans -- have been willing to sit down and negotiate on the issue. If health-care reform is inevitable, they'd rather make some sacrifices and have a seat at the table then be caught outside the room when the deal is made.

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Crisis coming – allowing Congress to control creation of healthcare legislation dooms reform to failure. Goldman, staff director of Subcommitee on Health and Scientific Research, director @ National Institute of Health, Senior Executive Service. 7/28/09.
Leroy. “A Plan to Rescue Health Care Reform.” Asheville Citizen Times. http://www.citizen-times.com/apps/pbcs.dll/article? AID=/20090728/OPINION07/90723059&template=printart [Mardjuki] The Medicare Trustees have recently reported that its Trust Fund will be exhausted by 2017. Medicaid, as currently configured, is a burden that the several states cannot adequately sustain going forward. The solvency of Social Security will face the same fate in twenty years. And next year the front edge of the 77 million Baby Boomers will be expecting these programs to support their retirement. Those in the know understand that health care costs now amount to $2,500,000,000 000—16% of GDP. They know that these costs are utterly out of control. They know that, unless they are brought under control, they imperil not only the health care system, but also the entire national economy. America faces another 911. But unlike the attack that occurred at the Twin Towers, we know that this one is coming. Allowing it to happen in the face of certain knowledge about its inevitability and the devastation it will cause is unpardonable. But, while the “experts” know what is coming, the American public does not. The President is the only person who can make this case to the nation. He needs to do so immediately. That effort on his part will not only inform the nation. It will create the political will on the part of Congress to enact Health Care Reform and to avert a calamity that will otherwise make the current financial and credit crisis seem tame by comparison. The Administration’s game plan thus far is deeply, fatally flawed. Having turned over the principal responsibility of writing the legislation to the Congress, it has allowed the destructive and polarizing forces that rule on Capitol Hill to take control of the process and doom it.

Senate/House rivalry and lobby influence guarantees that reform will be ineffective. Goldman, staff director of Subcommitee on Health and Scientific Research, director @ National Institute of Health, Senior Executive Service. 7/28/09.
Leroy. “A Plan to Rescue Health Care Reform.” Asheville Citizen Times. http://www.citizen-times.com/apps/pbcs.dll/article? AID=/20090728/OPINION07/90723059&template=printart [Mardjuki] The hard fact of the matter is that the nation faces this crisis because for decades the Congress and previous administrations have been unwilling to forthrightly prescribe the medicine needed to fix this mess. They have been unwilling because doing so involves pain and sacrifice by their constituents. As they have delayed and taken the easy road, the price of the fix has grown to the point that it has paralyzed effective action. If that isn’t a prescription for disaster, what is? So simply expecting the Hill to write the bill the nation needs is foolish and certain to fail. Why? For reasons that are obvious. First of all there is the inherent and overly destructive rivalry between the House and the Senate. Second, the process is largely in the hands of staffers who by instinct base their action on their number one objective—protect the boss. Give me a break. These bosses don’t need protecting. 97% of them win reelection automatically. In addition, they turn for ideas and for affirmation of their ideas to the lobbyists who bankroll their boss’ reelection campaigns. These lobbyists, all of them, do not have the nation’s interest as their agenda. They exist to protect the interests of their clients. These are the folks who have proven that they are not capable of fixing this mess.

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The comments suggest that party leaders may not yet have the votes to pass the legislation. the backbone of the American economy.Cost Democrats defecting – healthcare proposals on the table don’t cut costs and exacerbate job loss. would have a perverse effect.html?pagewanted=print [Mardjuki] Three of the five Congressional committees working on legislation to reinvent the nation’s health care system delivered bills this week along the lines proposed by President Obama. combined with the scheduled increase in tax rates resulting from the expiration of Bush-era tax cuts. Mr.” but insisted.” And he vowed: “We are going to get this done. Third. Obama tried Friday to shift the political narrative away from the grim forecasts of the Congressional Budget Office. Obama as he also tries to extend insurance to more than 45 million Americans who lack it.com/2009/07/18/health/policy/18health. a freshman Democrat from Colorado who voted against the bill approved Friday in the Education and Labor Committee. But instead of celebrating their success. a growing minority of Democrats have begun to express reservations about the size. the House bill would impose a surtax on high-income people and a payroll tax — as much as 8 percent of wages — on employers who do not provide health insurance to workers. Pear. Representative Jared Polis. many Democrats were apprehensive. Polis said these taxes.0 LO 33 Obama HC Fails .” On Capitol Hill. It will happen this year. And while senior Democrats vowed to press ahead to meet Mr. “Democrats Grow Wary as Health Bill Advances. He said he and Congress had made “unprecedented progress” on health care. nervous about the prospect of raising taxes or proceeding without any Republican support. “The last few miles of any race are the hardest to run. Herszenhorn. they faced basic questions about whether some of their proposals might do more harm than good.” he said. Mr.Single Payer 2. “Now is not the time to slow down. He acknowledged a treacherous path ahead. We will reform health care.” To help finance coverage of the uninsured. In a letter to the House speaker. nervous and defensive. the expanded role of the federal government and the need for a raft of new taxes to pay for it all. scope and cost of the legislation. the picture is more complex. http://www. were pleading to slow down. Nancy Pelosi. I’m absolutely convinced of that. senior writer. Second. Mr. Democrats had three reasons for concern. a crucial goal for Mr. Even as Democratic leaders and the White House insisted that the nation was closer than ever to landmark changes in the health care system. some in their ranks. 7/17/09 Robert and David.nytimes. even with House committees working in marathon sessions this week. The director of the Congressional Budget Office warned Thursday that the legislative proposals so far would not slow the growth of health spending. said he worried that the new taxes “could cost jobs in a recession. with even the American Medical Association endorsing the House bill this week.” You’re A Jerk 33 .” New York Times. saying. Obama’s deadline of having both chambers pass bills before the summer recess. Polis and 20 other freshman Democrats said they were “extremely concerned that the proposed method of paying for health care reform will negatively impact small businesses. reporter. “Some successful family-owned businesses would be taxed at higher rates than multinational corporations. it was clear that Democrats could not meet their goal of passing bills before the summer recess without barreling over the concerns of Republicans and ending any hope that such a major issue could be addressed in a bipartisan manner.

“While we are committed to providing relief for American families as quickly as possible. On Wednesday.” The House education committee approved the bill. to change the incentives so reimbursement will be based on the value. 23 to 18. after an all-night session. with 3 Democrats voting no.com/2009/07/18/health/policy/18health. Lieberman. But the director of the Congressional Budget Office. But just to try to get it passed in the Senate before we leave for the August recess seems just about impossible. You’re A Jerk 34 . Three Democrats crossed party lines and voted no.” Representative Ron Kind of Wisconsin said. and Olympia J.nytimes. on Friday morning.” they wrote. senior writer. including two members of the Finance Committee.Single Payer 2. sent a letter to Senate leaders pleading with them to allow more time. the Connecticut independent. “Democrats Grow Wary as Health Bill Advances. rather than the volume. the Senate health committee approved a generally similar bill on a party-line vote. http://www. Snowe and Susan Collins.Concessions Obama’s healthcare rushed – ineffective and too many concessions. a bipartisan group of six senators. “The legislative process right now is going in the wrong direction. reporter. Obama’s ambitious timetable. “I think it’s extremely doable to get this done before the end of the year. of services. House Democrats who voted no cited various concerns. Democrat of Nebraska. “we believe taking additional time to achieve a bipartisan result is critical for legislation that affects 17 percent of our economy and every individual in the United States.html?pagewanted=print [Mardjuki] And in the latest sign of lawmakers’ chafing at Mr. It’s just too big a bill. The House and Senate bills would require insurers to take all applicants and vastly expand coverage. Ben Nelson. 13 to 10. Obama at the White House this week and urged him not to rush the bill. which he called “unsustainable. Herszenhorn.” The group included three senators.” A budget office analysis released Friday said the House bill would “result in a net increase in the federal budget deficit of $239 billion” over 10 years.0 LO 34 Obama HC Fails . 7/17/09 Robert and David. “We are not doing enough to reform the health care delivery system. partly because of an increase in Medicare spending to avert sharp cuts in payments to doctors. Pear.” said Senator Joseph I. with federal subsidies for millions of people. testified on Thursday that doing so would come at a steep cost and that the proposals would not curb the rise in health spending by the federal government. Elmendorf. who met with Mr. Douglas W. 26 to 22. Republicans of Maine. who also signed the letter. The vote came eight hours after the House Ways and Means Committee approved a nearly identical bill.” New York Times.

And so any potential that the door would be open to arrive at a "throw the bums out" solution to health care reform by honestly considering single payer would never have been allowed to gain traction at all as Obama embarked on this process. And the possibility of the consumers acting upon that realization has the executives in these industries losing sleep. Baucus' was instead inclined toward a solution wherein we would eventually subsidize consumers as necessary until we achieved universal health insurance coverage. undoubtedly certain that they could double. “The case for keeping “single payer health care” off the table. After all. Joshua. yes it would. George Polk Award winner.to proceed with Obama's "health insurance reform." These health insurance industry providers calculated that they could improve their take from the health care system if they smartly played the reform game.” Talking Points Memo.talkingpointsmemo. potentially highly profitable . You’re A Jerk 35 . Senator Max Baucus of Montana.php?ref=reccafe [Mardjuki] And herein lies the reason that a "single payer" health care solution had to remain off the table if we were to proceed with any kind of health care reform in this country. the prime thing the consumer realizes intuitively is that the majority of waste and the inefficiencies under which our health care system suffers is related to the parasitical tagalong that is the insurance/health care/Big Pharma industries. July 15. much of what the consumer has already determined intuitively would be fleshed out in facts and figures.Single Payer 2. unless you were one of the insurance companies or Big Pharma or the health care industry that has bled our health care system dry. if such a proposed solution were to be given serious discussion. seemed to carry their water quite well for so long as he was able. chief reporter. successfully eliminating single payer as an option to be considered allowed the monied interests to reason it was safe .0 LO 35 Obama HC Fails – Industry Profit Big Pharma strangehold – health care industry stands to profit from current reform Marshall. right? Well. Stating strong opposition to any public option.com/talk/blogs/jpieterick/2009/07/the-case-for-keeping-singe-pay. On the other hand. It is an unfortunate political reality that it is these parasites who own so much of Congress in these days of pay-to-play politics.nay. 2009. Alas. Executives at the major insurance providers were nearly besides themselves in planning the next Congressional fundraisers. nay quadruple their budget for campaign contributions at a mere fraction of the profit to be made from the 42 million new customers they stood to realize out of this proposed "reform" package. triple. Chair of the Finance Committee and one of the biggest benefactors of health care industry campaign contributions. http://tpmcafe. And that would be a good thing. A full litany of efficiencies to be gained and resources to be reallocated from private industry profits and logistical support to the actual provision of health care would be enumerated. showing the way in which we could achieve universal health care without actually spending more money than is already dedicated to health insurance and health care.

No matter. is really the bad. discouraging more employers from coming into the marketplace. "This is not a trick. Obama’s healthcare bill excludes single payer which weakens the bill Glen Ford. as is the case most of the time. "Obama's reflexive instinct is to lash out to his left when frustrated.stand down and let Obama do his thing. Obama is in shifting stages of embrace with Healthcare Inc. you know. Obama demands that the Left . by assuring them his administration means their bank accounts no harm ." Sebelius told Steve Inskeep. You’re A Jerk 36 .S. for the 180 million Americans that have it. He cares only that some kind of bill emerges to which he can claim bragging rights. This is not single-payer. Obama has no principled program or irreducible objectives. since overwhelming majorities of the public support single-payer or a Medicare-for-all program. 6-16-2009.a courtship that has been Obama's preoccupation ever since his swearing in. whatever that is.npr. to demand progressives stand down and await his marching orders . Ideally." The ads have been embarrassing to rightist Democrats who are Obama's true political soulmates and a bridge to Republicans he seeks to woo. that dismantling private health coverage As lawmakers on Capitol Hill hammer out legislation to overhaul the nation's health care system this year. “Single-Payer Health Care Not In the Plans” http://www. "We shouldn't be focusing resources on each other. reporter for the Black Agenda Report." The president was attempting to shut down paid media messages seeking to pressure corporatist Democrats to support some sort of public healthcare option "" an option that Obama claims to favor. Rahm Emanuel.org/templates/story/story. http://www. Kay Hagan to endorse the idea of a public health care plan.org/znet/viewArticle/22033 President Obama has escalated his campaign to suppress single-payer healthcare advocates.S. the American people must lose. is a bad direction to go.php?storyId=105442888 Health and Human Services Secretary Kathleen Sebelius says that a single-payer option is not on the table. Health Care for America and Democracy for America. which Obama opposes. Obama's own direction is unclear. as I do. Obama would prefer to negotiate the broad outlines of legislation directly with the corporate healthcare profiteers. We ought to be focused on winning this debate.Single Payer 2. But those skyrocketing health care costs — and the increasing burden they put on the U. She added: "That's not what anyone is talking about — mostly because the president feels strongly. gross domestic product. In a pre-Fourth of July teleconference with Democratic congressional leaders.0 LO 36 Obama HC Not Single Payer Single-payer healthcare not in Obama’s bill NPR. Obama lectured. Debate is permitted only to the Right of his own fuzzy position.even when. His reflexive instinct is to lash out to his left when frustrated." The objects of his ire are advertisements or fundraisers produced by MoveOn. 7-17-2009. MoveOn's advertising plans successfully pressured North Carolina Sen.such as it is .zmag. In the real world. hinting darkly that there will be repercussions if unions and activists persist in harassing his fellow center-right Democrats. at best. economy — are exactly why the president says a health care overhaul must be a national priority. although in terms so vague his own chief of staff. while the Left is shushed and hectored. For Obama to "win" his debate." Remaking the nation's health care system is a massive task: The industry constitutes 18 percent of the U. The president's admonition that progressives focus "on winning this debate" rather than "focusing resources on each other" makes sense only to those operating under the delusion that Obama is in a real fight with corporate healthcare profiteers. Obama's modus operandi is by now well known. “Obama’s Single Payer Beat Down”. framed the issue as "negotiable.

and ability to pursue policies that diverge from those sponsored by the executive. "The political institutions of American government deliberately fragment power.tees and subcommittees that govern various legislative areas. Robert and Roger. it does not mean there is a majority for any one plan. [Mardjuki] The internal organization of Congress further complicates the road to reform. of course. prof of law @ American University. The Next Agenda: Blueprint for a New Progressive Movement. reform will not necessarily follow. The Next Agenda: Blueprint for a New Progressive Movement. and threatening to powerful interest groups as national health insurance. administrative capacity. Members of Congress who head committees and subcommittees have their own platforms from which to introduce health care reform bills that differ from the president's or their own parties'.S political system creates a number of barriers to the passage of any legislation.0 LO 37 Universal Reform Fails . However. Their first political allegiance is not to their party or president but to their congressional district. substantial overlap exists across committees` iurisdictions. Failure to get a bill through these committees dooms it to defeat. ideologically divisive. Congress is organized into a series of commit.duce policy majorities. Moreover. Members of Congress run their own campaigns. Hickey. Unlike a parliamentary system such as that in Great Britain.Congress True national healthcare will fail even with supermajority – American political system structurally flawed. Borosage. Compared to parties elsewhere in the world.fore that step is daunting. divided govemment has become a regular feature of American politics.S.‘° The fragmented structure of Congress and the relative weakness of American political parties combine to create a roadblock to reform. Consequently. even if the president’s own party enjoys majority status in both houses of Congress. measured in terms of its independence.S. The assumption that attaining a position on the policy agenda and having public majorities as well as presidential support behind reform will guarantee a political victory has misled reformers time and again. does not ensure presidential victory on any given issue—a lesson Clinton learned the hard way. 2001.tee in the Senate——have acted in the past as gatekeepers for health insurance legislation. lf those conditions were sufficient to enact national health insurance. raise their own funds. Borosage. 'I'he U. vice president @ Economic Policy Institute. 2001. Hickey. system provides no assurance that the president will represent the same party as the congressional majority. Pg 100-101. in 1970 to 1974 and in l993 to 1994. prof of law @ American University. Universal reform impossible even with supermajority – fragmented Congress structure. [Mardjuki] Even if health care recaptures a central spot on the national agenda after the 2000 elections. presidential sponsorship of major legislation. The U. the U. Robert and Roger. Perhaps the most important lesson of American politics for health reform is that partisan majorities do not necessarily pro. legislature. Pg 100-101. even if there are congressional maiorities in favor of the legislation (as was the case with Medicare legislation in the early l960s). making it difficult or impossible to achieve the necessary level of consensus on a single piece of legislation. The inability of congressional majorities to coalesce behind one plan doomed national health legislation during its last two appearances on the national agenda. two key committees—Ways and Means in the House. clear both the House and Senate to reach the president`s desk. any debate over health reform produces numerous bills sponsored by congressional policymakers seeking to be entrepreneurs. But the labyrinth that must be navigated be. and run independently from—and sometimes in opposition to—their party's platfom. a single bill is often considered by a multitude of committees. You’re A Jerk 37 . Even if there is a congressional majority in favor of national health insurance. Legislation must. American political parties are weak.Single Payer 2. As a consequence. even with a Congress controlled the president': own party. is the most powerful lawmaking body in the world. let alone a reform as controversial. such a law would have been passed five decades ago. Indeed. ln addition. that is no guarantee that the president and Congress will enact any reform legislation. vice president @ Economic Policy Institute. and the Finance Commit. The lesson is a sobering one for reformers.

Single Payer 2. 2001. The Next Agenda: Blueprint for a New Progressive Movement. [Mardjuki] A second critical barrier to the adoption of national health insurance is the structure of health politics in the United States. This includes a large proportion of American hospitals and physicians. and are likely to block any reform that threatens to erode their position. Robert and Roger.2' They are generally well organized. pharmaceutical companies.0 LO 38 Universal Reform Fails – Health Politics Too many interest groups – true universal healthcare reform impossible. as well as almost all American health insurers. and suppliers of medical equipment and technology. well handed. Fundamental reform poses a tremendous threat to institutions that are invested in maintaining the medical status quo. vice president @ Economic Policy Institute. You’re A Jerk 38 . Borosage. prof of law @ American University. and willing and able to take advantage of fragmented political institutions and of the media. Hickey. Pg 101. These groups—what political scientists call “concentrated interests"—have much at stake both financially and organizationally.

Single Payer 2.0 LO 39 **ECON – STATES** You’re A Jerk 39 .

causing a 24 percent drop in their revenues nationwide." says West Virginia Gov. staff writer. in the next several years of more than $200 billion. 3.Single Payer 2. so (the federal stimulus) was particularly welcome to shore it up over the next couple of years. a Democrat. Meanwhile." You’re A Jerk 40 . Stimulus was a temporary fix – massive restructuring necessary to avoid increased Medicaid deficits. “Governors bemoan steep slide in state revenues. Jim Douglas. the states are facing a wholesale fiscal crisis. http://www. even with the federal stimulus.0 LO 40 2AC AT: Stimulus Solves State Deficits 1.. 2.” National Public Radio. the NGA says. Demand for Medicaid is ballooning as the recession continues – and Obama’s health care reform transfers unfunded federal mandates to the states – that’s Sack and Pear. economies so we are ready to get along without these federal resources in a couple of years. Pennsylvania Gov. 7/22/09.scpr. Stimulus money only covers half of projected 2009 state budgets – insufficient to stem increased state taxes or program cuts – that’s Lav. Vermont Gov. who appeared at the summit via video link because he was preoccupied with the Keystone State's budget woes. As a result.. a quarter of our population is on Medicaid ." Douglas said. Wertheimer. a Republican. "We're projecting shortfalls collectively ." The urgency of the problem was underscored by the absence of even the NGA's chairman.. "In Vermont.org/news/2009/07/20/governorsbemoan-steep-slide-state-revenues/ [Mardjuki] The recession has hammered the states. Edward Rendell. who said that figure is "even with the assistance that we receive. says that while the cash infusion from Congress has helped. states face a difficult task in figuring out how to close their yawning budget gaps after the stimulus cash runs out in 2011.. a Democrat. Joe Manchin. Linda. the organization's incoming chairman. A large chunk of the shortfall comes from the biggest drop in tax revenue on record. "But we have to restructure our state governments (and) .

S. Maybe it's time to turn the entire program over to the feds so it's not constantly a procyclical drain on the economy and be done with it. Drum. but it wouldn’t be congress or the executive branch doing the wasting.Single Payer 2. 2.motherjones. what form should it take? Matt Yglesias comments: In an ideal world at this point what I’d like to see is more aid to state and local governments. Well. so it’d be someone else’s problem. one quick way to do this might be to stop dinking around with alterations to the Medicaid funding formula (as the first stimulus bill did) and simply turn Medicaid into a purely federal program funded entirely with federal dollars.com/kevin-drum/2009/07/let-feds-fund-medicaid [JM] If we need more stimulus. “Let the Feds Fund Medicaid?” Mother Jones. rather than being a hodgepodge of 50 different plans. but that's probably OK. Plan is an instant stimulus that immediately eases state deficits – only a direct injection of federal money into state budgets can prevent procyclical exacerbation of the economic downturn – that’s Mattoon and Lav. Some of the money would be wasted or used in bad ways. Federalizing Medicaid would be the ideal second round of stimulus – instantaneous benefits.S. 5. which would be $10 billion less in demand-destroying budget cuts we'd have to make. we'd save a little over $10 billion. Job loss – Obama’s ineffective healthcare ensures 28 million U. Eventually this might lead to Medicaid becoming more standardized throughout the country. http://www. That kind of thing would work quickly. 7/11/09. State Medicaid costs are poised to independently devastate state budgets – federal intervention is the only way to stem looming deficits – that’s Olsen. This would instantly save states something on the order of $100 billion or so. 4. Yglesias. jobs will be lost to offshoring – a single-payer system restores U. senior writer. I'm not sure Medicaid has really been a great poster child for states as laboratories of democracy anyway. and would allow structural shifts in the private sector to proceed apace.0 LO 41 2AC AT: Kills Econ 1. Probably this should just be done in a very crude way — some flat per capita disbursement that could be implemented very rapidly at the federal level and kick specific decisions to someone else. senior editor of The Atlantic Monthly. You’re A Jerk 41 . would be highly stimulative. competitiveness – that’s Angell. Kevin. 3. Impact inevitable without reform – Obama’s healthcare bill fails to curb entitlement spending – there’s only a chance that we prevent massive tax increases – that’s Pear. Here in California.

“The risks ahead for the World Economy” Lexis) Five major risks threaten the world economy.0 LO 42 2AC AT: US Not Key to Global Econ 1. and thus more protectionism and dollar vulnerability. Deep economic recession damages perception of global economic integration and derails Indian political order. let alone all five. RADICALLY REVERSE GLOBAL MARKETS Fred Bergsten Institute for International Economics 9-9-04 (The Economist. 2. and an outbreak of trade protectionism. leading to widespread unemployment and foreign resentment – that’s Mead. and a soaring American budget deficit would all generate much higher inflation and interest rates. You’re A Jerk 42 . a budget profile that is out of control. Three center on the United States: renewed sharp increases in the current account deficit leading to a crash of the dollar. US vital to world economy – deficit. A sharp dollar decline would increase the likelihood of further oil price rises. The fifth is that oil prices could rise to $60 to $70 per barrel even without a major political or terrorist disruption. If two or three. were to occur in combination then they would radically reverse the global outlook. A further oil shock. opening the door for religious radicalism – that’s Mead. Realization of any one of the five risks could substantially reduce world growth. and much higher with one Most of these risks reinforce each other. China’s volatile economy is completely dependent on ours – the Chinese financial system will implode as debt and loan structures collapse. A fourth relates to China. which faces a possible hard landing from its recent overheating. and dollar crash would devastate global markets. protectionism.Single Payer 2. 3. Larger budget deficits will produce larger American trade deficits. a dollar collapse.

Kevin.4 percent for the 12 months ending in November). the waiting area in the office of the county’s Department of Family and Children Services was so packed with applicants that the fire marshal insisted that another room be opened for overflow. In Florida.” New York Times. which had budgeted last year for increases of 1. Medicaid populations grew by 5 percent to 10 percent in the last 12 months and. “There’s just been a steady increase in the numbers. 2009. The New York Times found that in some cases the surge in enrollment had overwhelmed social services agencies. after declining by 3 percent a year earlier. an Atlanta suburb that is home to a growing immigrant population. state officials now project it will be eight times higher. New York Times senior journalist. nursing home residents.000 new Medicaid enrollees per month. which is experiencing some of the fastest Medicaid growth in the country (10. much of the growth in Medicaid has been among children from low-income families. One day last fall. with 40 states responding. State Medicaid officials also say that because enrollment often lags behind job losses by several months. You’re A Jerk 43 . In a number of states. who constitute about half of all recipients. Sack. In a nationwide survey. McMillan. and in some instances parents of covered children and childless adults. according to state officials.com/2009/01/22/us/22medicaid. as the recession tightens its grip on the economy and Americans lose their employer-sponsored health coverage along with their jobs.0 LO 43 Medicaid Costs High Now States swamped by Medicaid expenses because of a prolonged recession and surge in unemployment. Utah officials expect their state’s Medicaid enrollment to grow by 13 percent this year. the current caseload is the highest since the program’s creation in 1965.” said Glenda G.nytimes. Here in Gwinnett County. “And there’s no one population. The program also provides coverage for those with disabilities. Kentucky.” But Georgia was hardly alone in seeing substantial jumps in enrollment. Medicaid enrollment ballooned by 26 percent from July 2007 to July 2008. the growth in 2008 may represent only the leading edge of heightened demand. There’s just an array of need out there. http://www.html [Mardjuki] Medicaid rolls are surging. in many. 1/21/09. has averaged more than triple that since June.Single Payer 2. officials there said. In Colorado. the underemployed. which had forecast enrollment growth of about 1 percent for this fiscal year. We’re seeing the newly unemployed. “Growing Need for Medicaid Strains States. two-time Pulitzer Prize winner. In most states. pregnant women. and it has followed the economy. and prompted state fiscal analysts to shred estimates that were often only six months old. by unprecedented rates in some states. the growth rate was at least double what it had been in the previous year. the regional director over the Gwinnett County office.

and by narrowing eligibility for the program. Sack. and the program is one of the largest drains on every state’s budget. The federal government currently picks up about 57 percent of the tab. the countercyclical program now faces a grim fiscal paradox: by definition.0 LO 44 Medicaid Drains State Budgets Medicaid spending drains state budgets – state legislators attempting to reduce Medicaid spending. New York Times senior journalist.Single Payer 2. Medicaid was providing coverage to an average of 50 million people. Kevin. “Growing Need for Medicaid Strains States. The cost of the program — $333 billion in 2007 — is shared by state and federal governments. 2009. two-time Pulitzer Prize winner. by eliminating coverage options like dental and vision benefits. eating up 7 percent of the federal budget. But at any one time last year. As in any economic downturn. with Washington roughly matching the spending approved by the states. http://www.” New York Times. Lawmakers returning to state capitals across the country are preparing to negotiate significant reductions in Medicaid spending by freezing or reducing reimbursements to hospitals and physicians. You’re A Jerk 44 .com/2009/01/22/us/22medicaid.html [Mardjuki] Eligibility for the income-based program can vary widely by state. 1/21/09. demand for Medicaid coverage is highest precisely when states are least able to afford it because of shrinking tax revenues. or about one of every six in the United States.nytimes.

According to the Center for Budget and Policy Priorities. Miss. “Medicaid and the States: Health-Care Reform’s Next Hurdle. told the New York Times that he regarded the proposed expansion of Medicaid as "the mother of all unfunded mandates" and warned. At a luncheon with Health and Human Services Secretary Kathleen Sebelius — who until April had been governor of Kansas — her former colleagues vented their anger at the idea of being handed the bill for yet another Washington initiative." says Pennsylvania's Ed Rendell. "These could essentially be unfunded mandates. You’re A Jerk 45 .com/time/politics/article/0. few people were paying attention to one of the most farreaching proposals being considered as part of overhauling the health-care system: a dramatic expansion and redefinition of the Medicaid program.html [JM] Until the nation's governors staged a public revolt last weekend. Tumulty. was unable to attend the Biloxi meeting because he had to stay in Pennsylvania and struggle with the legislature to find a way to plug a $3. are so wary of the idea. Phil Bredesen. whose budgets are already straining under the program's growing costs.Single Payer 2. Redefining who is eligible for Medicaid would be one of the major means by which lawmakers hope to achieve universal health coverage — which is one of the reasons that governors." (See the top 10 health-care-reform players. Nor. which is being hit from every side by growing doubts. even as public need for state safety-net services is growing. Karen. at least 48 states are facing shortfalls totaling $166 billion — 24% of their total budgets.) The proposal could hardly come at a worse time for governors.” Time Magazine. national political correspondent. it seems.time." The issue came to a boil as the National Governors Association (NGA) met in Biloxi.00. 7/21/09.1911856. a Democrat.8599.0 LO 45 Obama HC Drains State Budgets Health care reform quietly increases state Medicaid financial commitments – devastates state budgets. and would be enormously destructive to state budgets. could the governors' rebellion have come at a worse time for President Obama's health-care-reform effort. Tennessee's Democratic governor.2 billion fiscal hole. http://www. "It depends on what's being proposed. The recession has drained state coffers of tax receipts. Rendell. the outgoing chairman of the NGA. "Medicaid is a poor vehicle for expanding coverage.

Tim Pawlenty of Minnesota and Bobby Jindal of Louisiana — were not here. discouraging some doctors and hospitals from accepting beneficiaries. Kevin and Robert. In at least one of several bills circulating in Congress. particularly the $1 trillion figures being batted around. Kevin and Robert. said he feared Congress was about to bestow “the mother of all unfunded mandates.” The governors’ backlash creates yet another health care headache for the Obama administration. “As a governor. the New Mexico Democrat who served in the Clinton cabinet and ran for president against Mr. And they said they were convinced that a major expansion of Medicaid would leave them with heavy costs. also a Democrat. You’re A Jerk 46 . Ms. Gov. http://www. senior journalist. If Medicaid is expanded.” Although many governors said significant change in how the nation handles health care was needed. and the federal Medicaid chief. Democrats as well as Republicans. Meanwhile.html [Mardjuki] It was unclear whether the governors would draft a statement expressing their dismay.com/2009/07/20/health/policy/20health. Sarah Palin of Alaska. Obama also plans to address questions about his health plan at a news conference on Wednesday evening. a Democrat. voiced deep concern Sunday about the shape of the health care plan emerging from Congress. But the sentiment among those who were could not have been more consistent. “We can’t have the Congress impose requirements that we are forced to absorb beyond our capacity to do so. Both Ms. Sack.” Mr. Kathleen Sebelius. Christine Gregoire of Washington. Many. Pear. two-time Pulitzer Prize winner. Bredesen.nytimes.” New York Times. Sebelius emerged from her hour-long meeting with the governors saying that “there’s a recognition that states don’t have cash right now” and that “it’s difficult to send states the bill if they don’t have the money. The role of the states in a restructured health care system dominated the summer meeting of the National Governors Association here this weekend — with bipartisan animosity voiced against the plan during a closed-door luncheon on Saturday and in a private meeting on Sunday with the health and human services secretary. stayed home to deal with budget crises. any increase in eligibility levels. Because the states and the federal government share the cost. when stimulus money dries up.” New York Times. “It’s a 45-year-old system originally designed for poor women and their children.html [Mardjuki] The nation’s governors. fearing that Washington was about to hand them expensive new Medicaid obligations without money to pay for them. “Governors Fear Medicaid Costs in Health Plan. Some of the group’s most notable names — Arnold Schwarzenegger of California. as one means of moving toward universal coverage. benefits or payments to doctors would impose new burdens on the states unless Washington absorbs them. two-time Pulitzer Prize winner. a former health care executive.” said Gov. the state and federal insurance program for the poor. Sebelius. And they pointed out that Medicaid already suffered from low payment rates to health care providers. New York Times senior journalist.” “Medicaid is a poor vehicle for expanding coverage. The governors said in interviews and public sessions that the bills being drafted in Congress would not do enough to curb the growth in health spending. at least partly because half of them did not attend. 7/19/09. made appearances at the meeting on Sunday. regardless of political party.nytimes. a Democrat. Each of several health care bills coursing through Congress relies on a large increase in eligibility for Medicaid. Mr. “I think the governors would all agree that what we don’t want from the federal government is unfunded mandates. a Republican. states will almost surely have to increase payments to doctors to encourage more of them to participate. Phil Bredesen of Tennessee. Gov. Bill Richardson. With the recession draining states of tax revenues even as their Medicaid rolls are surging. Edward G. Jim Douglas of Vermont. who was Kansas’ governor before she joined the cabinet in April. 7/19/09.0 LO 46 Obama HC Drains State Budgets Medicaid already underwater – Obama’s health care proposals will only drain state budgets further. Rendell of Pennsylvania. the National Governors Association projects that states will face aggregate deficits of $200 billion over the next three years . including the group’s chairman. Cindy Mann. Bredesen was far from alone in his concern. They are already anticipating large gaps in Medicaid financing after 2010.com/2009/07/20/health/policy/20health. the states would eventually pick up a share of the new costs. Sack.” said Gov. New York Times senior journalist. Pear. my concern is that if we try to cost-shift to the states we’re not going to be in a position to pick up the tab.Single Payer 2.” added Mr. and the governors fear they cannot count on provisions in other bills that they will not bear costs.” said Gov. other administration officials spent the day pushing President Obama’s proposal on television talk shows. It’s not health care reform to dump more money into Medicaid. “I’m personally very concerned about the cost issue. which has tried to recruit state leaders to pressure members of Congress to wrap up their fitful negotiations. Governors consensus – Obama’s healthcare program will exacerbate state funding shortages. Obama. they said their deep-seated fiscal troubles made it a terrible time to shift costs to the states. the group’s incoming chairman. “Governors Fear Medicaid Costs in Health Plan. http://www. senior journalist.

First. “There’s a concern about whether they have fully figured out a revenue stream that would cover the costs. On average. trumpeting their opposition in a conference call last week with Senator Max Baucus. could slightly reduce state spending on Medicaid and the Children’s Health Insurance Program over the next 10 years. Gallup showed Mr. The polls are crumbling because of a flood of bad news about Mr.nytimes. deputy chief of staff. New York Times senior journalist. the federal government would pick up the extra costs for perhaps five years. Obama’s personal approval was 55%. In the House bill. New Mexico and Washington joined GOP colleagues at the National Governors Association summer meeting to blast the administration for plans to shift millions of families into Medicaid.” New York Times. Karl.wsj.” Only risk that healthcare bill will damage Obama’s cred further – will balloon state deficits. One of the proposals being considered by the Finance Committee would encourage states to issue bonds to cover the costs of expanding Medicaid. Peter R. the Montana Democrat who leads the committee. Governors in both parties revolted.0 LO 47 Obama HC Drains State Budgets Increased costs inevitable – various healthcare bills being debated all increase state medical spending. chairman of the Republican Governors Association. if they did not have insurance from other sources. On Tuesday. and that if they don’t have all the dollars accounted for it will fall on the states.300 for a family of four. and that would benefit states by relieving pressure on their budgets. Sack. Those who strongly disapprove now outnumber those who strongly approve of his handling of the economy (35% to 29%).html [Mardjuki] Asked about the concerns. Medicaid eligibility would be based solely on income. Kevin and Robert. Medicaid would also cover newborns. he said.” Wall Street Journal. the federal government pays 57 percent. Rove. “One governor said it would be like taking out a mortgage to pay the grocery bill. The Congressional Budget Office projects that 11 million more people would receive coverage through Medicaid under the House bill. “ObamaCare in Trouble. of Colorado. “Governors Fear Medicaid Costs in Health Plan. Many governors expressed frustration that the prolonged negotiations in Washington had made it difficult to gauge the potential impact on their budgets. including the House bill.” said Gov.com/article/SB10001424052970203517304574304161389163586. Obama’s promise that you can keep your plan is being left on the cutting Another batch of bad news came this week as Democratic governors from Colorado. some versions of the legislation. senior journalist. In a draft of the bill in the Senate Finance Committee. Mr. a Democrat. 7/19/09. In addition. Medicaid would be expanded to cover all nonelderly people with incomes at or below 133 percent of the poverty level.” said Gov.4 million people—nearly half of those with private coverage—will lose private insurance as employers drop their plans. Bush had at this point in his first term. Obama’s overriding goals was to reduce the rate of growth of health costs. he said. without regard to factors that have historically been used to decide who qualifies.com/2009/07/20/health/policy/20health. for up to 60 days after birth. 83. and that it would increase federal Medicaid spending by $438 billion over 10 years. of deficits (38% to 19%). One batch of such news came from a July 17 study by the Lewin Group that was commissioned by the Heritage Foundation. Orszag. director of the White House Office of Management and Budget. Medicaid thus accounts for about 40 percent of the cost and 30 percent of those who gain coverage. Pear. made two points. Obama’s health-care proposals. The federal government would pay all the costs for those who were newly eligible. one of Mr. http://www. Under the health care proposals before Congress. http://online. Tennessee. Haley Barbour of Mississippi. “There is strong bipartisan opposition to the idea of the states’ issuing bonds to pay for operational expenses. Obama is also slipping on the economy. It projects that if the House bill becomes law. down from more than 60% a few weeks ago and lower than the 56% George W. two-time Pulitzer Prize winner.html?mod=googlenews_wsj [Mardjuki] Mr.Single Payer 2. That could stick states with $440 billion in new costs over the next decade. or $29. You’re A Jerk 47 . Bill Ritter Jr. but states would eventually have to pay their normal share. 7/22/09. ex-presidential senior advisor. and of unemployment (31% to 26%).

senior writer. who will take over the NGA chairmanship on Monday. States were promised relief after 2019. would have called on the states to issue 30-year bonds and pay the cost of the Medicaid expansion from the proceeds.com/wpdyn/content/article/2009/07/18/AR2009071801786_pf. . in their current state. Employers provide health insurance as a benefit. You’re A Jerk 48 . I also dislike the idea of being unable to change jobs for fear of losing one’s health insurance coverage. "We have to restructure our state governments .0 LO 48 Obama HC Drains State Budgets Obama’s healthcare exacerbates states’ Medicare and Medicaid deficits. This would have been augmented by some share of promised Medicaid drug rebates. law and politics consultant. so we are ready to get along without these resources in a couple of years. according to an estimate by an NGA official. “An Examination of the President’s Health Care Plan. governors revolted against a plan under consideration in the Senate Finance Committee.” Washington Post. One proposal has called for the federal government to pick up permanently the cost for those newly eligible for the program. But as congressional committees wrestle with projections that show health care turning into a budget buster. they are looking for ways to strip away costs. In fact it solidifies it. according to an analysis prepared by the Center on Budget and Policy Priorities and shared by Rendell's office. How might states pay for their share? Maybe not at all. Moore. not institutionalize it. I also expect the federal government to place increased mandates on states.” Manchester Examiner. “At Governors’ Meeting. and get at least a $5.washingtonpost. especially if the economy is not growing at a substantial pace. which is funded by the federal government and the states. Governors have already been warned that 100 percent federal financing is now very unlikely. 7/21/09. As they do that. Another proposal floated earlier was for the federal government to pay the entire bill for five years.html [Mardjuki] But even with the stimulus money.Single Payer 2.000 tax credit to do so. The whole concept began during WWII when employers. The health-care bills moving through Congress include a significant expansion in Medicaid. Locking citizens into a system of third party payer. employee provided insurance drowning under crushing state converge mandates is a major reason for rising medical costs. It does nothing to address the current employer based system of health insurance. states face collective deficits of more than $200 billion in the next few years. at least for the first few years. Budget Problems Are Inescapable.examiner. senatorial aide. Balz. they themselves are in serious need of reform. Dan. http://www. One congressional source described the measure as "subject to gimmick charge. Last week. That proposal. could not offer increased salaries as an incentive to recruit talent. solidifies private sector insurance. http://www. My final point relates to some important things the plan does not do. Asking the states to issue bonds for the Medicaid expansion would have taken $180 billion off the budget. to handle this type of expansion." Rendell said it was "absolutely" an attempt by the Finance Committee to make the package look less costly during the years included in the CBO scoring window. Instead many began offering to take that money and purchase their employees health insurance which until that time was generally purchased privately. hamstrung by wartime wage controls. Governors are already talking about the moves they may have to make once the stimulus money disappears after 2011. Jim Douglas (R). 7/19/09. . Whatever one thinks about the efficacy and sustainability of these two programs. A good bill would address this. The proposal smelled of an effort to offload some costs of the health-care package during the years that would be included under the Congressional Budget Office's period for "scoring" the budgetary implications of the plan. even as federal funding is eventually reduced." said Vermont Gov. More troubling proposals have been under discussion. Congressional gimmicks – hidden state costs in congressional committees’ HC proposals. governors may have another looming fiscal burden. Christian. An NGA official estimated that the cost of that expansion could be around $60 billion a year. They are in no position. or fails to keep pace with expanding federal requirements.com/x-14783-Lawand-Politics-Examiner~y2009m7d21-An-examination-of-the-presidents-health-care-plan-part-2-of-2 [Mardjuki] The plan seeks to expand on Medicare and Medicaid. On the face this will be a serious financial burden to states already facing bankruptcy." A state official called it "creative financing.

Nor. Jr.” New Mexico Governor Bill Richardson. staff writer for The New American magazine. another Democrat. said that “Medicaid is a poor vehicle for expanding coverage.” And Colorado Governor Bill Ritter. said. National Political Correspondent for Time Magazine.” Bredesen. 7-22-2009. Douglas’ assessment was backed up even by Democratic governors. http://www. Tennessee's Democratic governor.html The issue came to a boil as the National Governors Association (NGA) met in Biloxi.8599.00. “I’m personally very concerned about the cost issue. the association’s incoming chairman.” Describing it as “a 45-year-old system originally designed for poor women and their children. The recession has drained state coffers of tax receipts.Single Payer 2. could the governors' rebellion have come at a worse time for President Obama's health-care-reform effort." And even the Mayo Clinic — often cited by Obama as the model of what an efficient. “Medicaid and the States: Health-Care Reform’s Next Hurdle”. the federal Medicaid chief. worried that Congress was about to bestow “the mother of all unfunded mandates. the outgoing chairman of the NGA. Miss. more affordable health care for patients. was unable to attend the Biloxi meeting because he had to stay in Pennsylvania and struggle with the legislature to find a way to plug a $3. Tennessee Governor Phil Bredesen. “We can’t have the Congress impose requirements that we are forced to absorb beyond our capacity to do so.com/time/politics/article/0. particularly the $1 trillion figures being batted around. it seems. Senators of both parties are trying to put the brakes on the President's drive to have bills passed by the House and Senate by the August recess. At a luncheon with Health and Human Services Secretary Kathleen Sebelius — who until April had been governor of Kansas — her former colleagues vented their anger at the idea of being handed the bill for yet another Washington initiative . including a meeting with Health and Human Services Secretary Kathleen Sebelius and Cindy Mann." Governors wary of unfunded federal healthcare mandates. According to the Center for Budget and Policy Priorities. Steven J.0 LO 49 Obama HC Drains State Budgets Obama’s healthcare too costly for states Karen Tumulty. it will do the opposite. high-quality health-care system should look like — is cautioning on its blog that legislation under consideration in the House "misses the opportunity to help create higher quality . Phil Bredesen. Abortion Stymie Health Reform” http://www. head of the Congressional Budget Office. Rendell. Both Democratic and Republican governors voiced animosity toward any reform that would overload states at a time when they are already struggling financially. "Medicaid is a poor vehicle for expanding coverage.2 billion fiscal hole. even as public need for state safety-net services is growing.” said Vermont Governor Jim Douglas (R). Douglas Elmendorf.1911856.thenewamerican.time.” You’re A Jerk 49 .php/usnews/health-care/1492 The National Governors Association met on July 18 and 19.” he declared. told the New York Times that he regarded the proposed expansion of Medicaid as "the mother of all unfunded mandates" and warned.com/index.) The proposal could hardly come at a worse time for governors. 7-21-2009. a Democrat. a former executive in healthcare.” Democratic Governor Christine Gregoire of Washington is concerned that “if we try to cost- shift to the states we’re not going to be in a position to pick up the tab. which is being hit from every side by growing doubts. Republicans are calling it a dangerous "experiment. In fact. and that if they don’t have all the dollars accounted for it will fall on the states. “it’s not health care reform to dump more money into Medicaid. has testified that the legislation thus far has too little cost containment. (D) summed things up: “There’s a concern about whether they have fully figured out a revenue stream that would cover the costs. DuBord. at least 48 states are facing shortfalls totaling $166 billion — 24% of their total budgets. “I think the governors would all agree that what we don’t want from the federal government is unfunded mandates." (See the top 10 health-care-reform players. “Governors.

nytimes.” Mr.” said Gov. Governors in both parties revolted. Gov. Gov. “As a governor. Edward G. when stimulus money dries up. for up to 60 days after birth.” said Gov. the Montana Democrat who leads the committee. Many. without regard to factors that have historically been used to decide who qualifies. any increase in eligibility levels. Christine Gregoire of Washington. The Congressional Budget Office projects that 11 million more people would receive coverage through Medicaid under the House bill. In the House bill.300 for a family of four. Sarah Palin of Alaska. the National Governors Association projects that states will face aggregate deficits of $200 billion over the next three years. Each of several health care bills coursing through Congress relies on a large increase in eligibility for Medicaid. but states would eventually have to pay their normal share. including the group’s chairman. “Governors Fear Medicaid Costs in Healthcare” http://www. a former health care executive. Medicaid would also cover newborns.html?hp Although many governors said significant change in how the nation handles health care was needed. Rendell of Pennsylvania. It was unclear whether the governors would draft a statement expressing their dismay. or $29. And they pointed out that Medicaid already suffered from low payment rates to health care providers. One of the proposals being considered by the Finance Committee would encourage states to issue bonds to cover the costs of expanding Medicaid. the states would eventually pick up a share of the new costs.com/2009/07/20/health/policy/20health. Tim Pawlenty of Minnesota and Bobby Jindal of Louisiana — were not here. And they said they were convinced that a major expansion of Medicaid would leave them with heavy costs.html?hp Many governors expressed frustration that the prolonged negotiations in Washington had made it difficult to gauge the potential impact on their budgets. the federal government would pick up the extra costs for perhaps five years. my concern is that if we try to cost-shift to the states we’re not going to be in a position to pick up the tab.0 LO 50 Obama HC Drains State Budgets Governors fear states will pay for Obama’s healthcare. a Democrat. and that it would increase federal Medicaid spending by $438 billion over 10 years. and that if they don’t have all the dollars accounted for it will fall on the states. states will almost surely have to increase payments to doctors to encourage more of them to participate. at least partly because half of them did not attend. In at least one of several bills circulating in Congress. It’s not health care reform to dump more money into Medicaid. if they did not have insurance from other sources. they said their deepseated fiscal troubles made it a terrible time to shift costs to the states. The federal government would pay all the costs for those who were newly eligible. Phil Bredesen of Tennessee.” added Mr. “There is strong bipartisan opposition to the idea of the states’ issuing bonds to pay for operational expenses. 7-19-2009 (two-time Pulitzer Prize winner and correspondent for the New York Times). Medicaid thus accounts for about 40 percent of the cost and 30 percent of those who gain coverage. “One governor said it would be like taking out a mortgage to pay the grocery bill. “Governors Fear Medicaid Costs in Healthcare” http://www. regardless of political party. the federal government pays 57 percent. discouraging some doctors and hospitals from accepting beneficiaries. But the sentiment among those who were could not have been more consistent. Under the health care proposals before Congress. With the recession draining states of tax revenues even as their Medicaid rolls are surging. In a draft of the bill in the Senate Finance Committee. chairman of the Republican Governors Association. stayed home to deal with budget crises. Haley Barbour of Mississippi. “It’s a 45-year-old system originally designed for poor women and their children.nytimes. Medicaid eligibility would be based solely on income. a Democrat. Medicaid would be expanded to cover all nonelderly people with incomes at or below 133 percent of the poverty level. also a Democrat House bill encourages states to issue bonds to fund Medicaid. If Medicaid is expanded. On average. 7-19-2009 (two-time Pulitzer Prize winner and correspondent for the New York Times). “There’s a concern about whether they have fully figured out a revenue stream that would cover the costs.” “Medicaid is a poor vehicle for expanding coverage. Some of the group’s most notable names — Arnold Schwarzenegger of California. Bill Ritter Jr. a Democrat. The governors said in interviews and public sessions that the bills being drafted in Congress would not do enough to curb the growth in health spending. as one means of moving toward universal coverage. trumpeting their opposition in a conference call last week with Senator Max Baucus. of Colorado.Single Payer 2. said he feared Congress was about to bestow “the mother of all unfunded mandates. They are already anticipating large gaps in Medicaid financing after 2010.” You’re A Jerk 50 . Kevin Sack and Robert Pear. benefits or payments to doctors would impose new burdens on the states unless Washington absorbs them. Because the states and the federal government share the cost. Kevin Sack and Robert Pear.com/2009/07/20/health/policy/20health. Bredesen. the state and federal insurance program for the poor. and the governors fear they cannot count on provisions in other bills that they will not bear costs.” said Gov. Bredesen was far from alone in his concern.

0 LO 51 You’re A Jerk 51 .Single Payer 2.

Minnesota is cancelling a health insurance program for 29.500 low-income adults. Arizona has eliminated temporary health insurance for people with disabilities who are coping with serious medical problems. Service cuts with particular ramifications for vulnerable populations have occurred in the following areas: Public health programs: At least 21 states have implemented cuts that will restrict low-income children’s or families’ eligibility for health insurance or reduce their access to health care services. as the recession brought sharply weakened revenues. The cuts have intensified as the economy has worsened. and California and Utah are reducing services covered by their Medicaid programs.cfm? fa=view&id=1214. [Mardjuki] States began cutting their budgets last spring. home care. Phil. Director of BPP State Fiscal Project.0 LO 52 State Deficits Now – No HC State deficits now – healthcare is the first to go.Single Payer 2. and Rhode Island is requiring low-income elderly people to pay more for adult daycare. You’re A Jerk 52 . For example. Nevada is making it harder for beneficiaries to qualify for nursing home care.” Center on Budget and Policy Priorities. Johnson. 6/29/09.cbpp. rehabilitative. http://www. At least 39 states to date have reduced services since the recession began. Nicholas. or other services needed by low-income people who are elderly or have disabilities. Phil. or significantly increasing the cost of these services.org/cms/index. Rhode Island eliminated health coverage for 1. Senior Fellow. Programs for the elderly and disabled: At least 22 states plus the District of Columbia are cutting medical.000 low-income parents. For example. Florida has frozen reimbursements to nursing homes and relaxed staffing standards. “An Update on State Budget Cuts. eliminated temporary health insurance for people with serious medical problems.

Michigan. such as meals and homemaker services. Alabama has ended homemaker services for approximately 1. for people who are elderly or disabled. geriatric mental health services. the state has eliminated early intervention services that support young children with special needs for 850 infants and toddlers at risk of developmental delay. the District of Columbia. Vermont has reduced some home-based services. New Mexico will cut cash assistance payments for low-income disabled residents by a third beginning in July. affecting 2. Pennsylvania. This may affect access to prescription drugs for mentally ill or disabled individuals who rely on several medications to manage their conditions. This is estimated to affect more than 1.100 disabled individuals each month who cannot work and are not eligible for Temporary Assistance to Needy Families. Nicholas. Arizona has eliminated temporary health insurance for people with disabilities who are coping with serious medical problems. Phil. elder service centers. Tennessee has reduced community-based services for people with intellectual disabilities and cut nursing services for some adults with serious disabilities. low-income elderly people must pay higher rates for subsidized adult day care. Johnson. in the expectation that the freeze will result in staffing cuts. or other services needed by lowincome people who are elderly or have disabilities or significantly increased the amounts that such people must pay for services. including home care. [Mardjuki] At least 22 states and the District of Columbia have cut medical. These services often allow people to stay in their own homes and avoid nursing home care. Maryland. Other states that have capped or reduced funding for programs that serve people who have disabilities or are elderly includeCalifornia. “An Update on State Budget Cuts. prescription drug assistance. In addition. Louisiana will impose a limit on the number of Medicaid prescriptions it will pay for. You’re A Jerk 53 . Maine. Georgia has reduced such programs for the elderly as Alzheimer services.Single Payer 2. Phil. Such services help people stay in their own homes and possibly delay or avoid more expensive nursing home care. and elder support. nursing homes and other providers will not receive scheduled cost-of-living adjustments in their reimbursements and staffing standards will be relaxed for one year. Director of BPP State Fiscal Project.” Center on Budget and Policy Priorities.000.org/cms/index. The state provides these payments to an average of 2. South Carolina. Ohio plans to close two mental health facilities. http://www. Minnesota has capped enrollment at current levels for a program that provides expanded health services and care coordination for people with disabilities. 6/29/09. in February 2009 the state eliminated independent living supports for 450 elderly residents and respite-care funding for 130 caregivers. The state also eliminated general assistance.0 LO 53 State Deficits Now – No HC State healthcare being eliminated now – laundry list.cfm? fa=view&id=1214. rehabilitative. Kansas. Senior Fellow. The state also reduced pass-through grants for various aging programs and funding for local mental health providers. In Florida.100 disabled individuals. and prescription drug assistance. Utah. the governor has ordered cuts in programs for elders. The state also has cut Medicaid reimbursements to hospitals and community-based services for the elderly. or substance abuse.100 older adults.cbpp. It also established a waiting list for vocational rehabilitation services.200 people with incomes below $20. home care. and Washington. a program designed to provide time-limited cash assistance to adults with physical or mental disabilities. Virginia has decreased reimbursements for special hospitals serving people with needs relating to mental health. Furthermore. such as housekeeping and shopping. In Rhode Island. In Massachusetts. mental retardation.

000 hours of needed services. State education grants to school districts have also been cut in Alabama. services for disabled students. Massachusetts enacted cuts to Head Start. teacher training. “An Update on State Budget Cuts. The state also cut K-12 funding. California is reducing basic K-12 education aid to local school districts. Washington. cutting per pupil expenditures by $400 in a pilot program.org/cms/index. and early intervention services to help special-needs children develop appropriately and be ready for school. Nicholas. and making across-the-board cuts. Idaho. Mississippi. South Carolina cut per-pupil funding by $95 this past year.0 LO 54 State Deficits Now – No Education State K-12 education cut now – laundry list. Connecticut. http://www. Utah. Senior Fellow. Maryland cut funding for a school breakfast pilot program. and is reducing funding for some grants and programs aimed at helping high-needs students. Rhode Island has frozen state aid for K-12 education at last year’s levels in nominal terms and reduced the number of children who can be served by Head Start and similar services by more than 550. including delaying an all-day kindergarten expansion. Arizona enacted mid-year cuts of $96 per pupil in core K-12 funding. Johnson. It also is cutting a variety of other programs. Delaware. Florida cut aid to local school districts by at least $140 per pupil. eliminating funds for gifted and talented programs and a magnet program for students who are deaf or hard of hearing.cbpp. You’re A Jerk 54 . Phil. including spending for mentoring.cfm? fa=view&id=1214.Single Payer 2. Additionally. professional development for principals and educators. and Virginia. universal pre-kindergarten programs. Oregon. gifted and talented summer centers. Kentucky. and math and science initiatives. Georgia made a $112 million cut to the equalization component of the state’s education aid formula established to help close the gap in funding between wealthier and poorer school districts. young children with developmental delays will lose more than 15. In Nevada. Maine. Director of BPP State Fiscal Project. [Mardjuki] At least 24 states have implemented cuts to K-12 education. 6/29/09.” Center on Budget and Policy Priorities. reimbursements for special education residential schools. Phil. such as adult literacy instruction. and programs for gifted and talented students. Iowa. health clinics. Hawaii. the governor has ordered various cuts to K-12 education. Ohio. Kansas.

Johnson. Massachusetts. Mississippi. New Jersey. Pennsylvania. The University of California system is reducing California resident freshman enrollment by 2. North Carolina. Louisiana. http://www. Iowa.org/cms/index. Budget cuts reduced state funding for the University of Washington by 26 percent for the coming biennium. by 6. Maine. Kansas. At the State University of New York. New Mexico. The budget authorizes the university to increase tuition up to 14 percent to compensate for this funding loss. resulting in 49 staff and nine faculty layoffs. Colorado.cfm? fa=view&id=1214. Each of these institutions went one step further by increasing tuition further mid-year.3 percent respectively.300 students for next year. Utah. and Virginia. Hawaii.5 percent in response to funding cuts. Maryland.Single Payer 2. consolidating several schools and almost two dozen academic departments. Idaho. “An Update on State Budget Cuts. the California State University system is cutting enrollment by 10.” Center on Budget and Policy Priorities. Florida has cut university budgets and community college funding. As a direct result of state budget cuts.0 LO 55 State Deficits Now – No Education State higher education budgets cut now – laundry list.7 percent. the University of Rhode Island.000 students. You’re A Jerk 55 . Nicholas. Arizona State University has addressed its loss of state funds by eliminating over 550 staff positions and 200 faculty associate positions. Tuition at all 11 Florida public universities will rise by 15 percent next year. Phil. Senior Fellow. South Carolina. Phil. Kentucky. Oklahoma. Rhode Island College. The University of Florida has announced it will eliminate 150 positions for the coming year. Vermont. Director of BPP State Fiscal Project. Connecticut. Nevada . 6/29/09. and limiting enrollment in its nursing school. imposing employee furloughs ranging from 10 to 15 days. and 4. 8. resident undergraduate tuition increased by 14 percent (over $600 per year) between the fall and spring semester of this past academic year. Minnesota. Tennessee. California. Florida State University plans to lay off up to 200 faculty and staff members. Other states cutting higher education operating funding include Alabama. [Mardjuki] At least 32 states have implemented cuts to public colleges and universities and/or made large increases in college tuition to make up for insufficient state funding. Georgia.cbpp. and the Community College of Rhode Island all increased tuition for this past academic year.2 percent. Tuition in Arizona this year rose 9. When Rhode Island cut higher education funding.

Georgia. In early January the state replaced the freeze with a cap on the number of budgeted positions at each state agency. Arizona. Illinois. Iowa.Idaho.5 percent of the state workforce.000 state positions by encouraging early retirement. Connecticut. Rhode Island plans to reduce the state workforce by 2. Kansas. Michigan. laid off 567 state workers. Some 1. Mississippi.000 state positions. Florida. health care. A number of states are imposing furloughs and/or pay cuts for some state employees. Florida. child support. Colorado. Massachusetts. and leaving vacancies unfilled. Louisiana. or making other cuts affecting their state workforce. These include Arizona.500 employees accepted buy-outs for early retirement. gave early retirement to 25 employees. through a combination of early retirements. In the Department of Jobs and Family Services — which oversees disability services. New Mexico.600 under the cap. child welfare. and laying off staff. the Department of Public Advocacy (which defends clients in the criminal justice system) instituted a strict hiring freeze. Georgia.Minnesota. Vermont. Nevada. Iowa. Johnson.Delaware.000 between March 2007 and December 2008. the District of Columbia. South Dakota. and delayed a 2 percent salary increase scheduled for November 2008.” Center on Budget and Policy Priorities. Massachusetts.0 LO 56 State Deficits Now – Job Loss State employees being fired now – laundry list. http://www. Phil. Additional states — such as Arizona. New York. Hiring freezes have also been ordered in Alabama. South Carolina. Maryland. As noted above. the Ohio state workforce declined by 3. In Washington. New Mexico. 6/29/09. about 4. Hawaii. New Hampshire. Florida. andSouth Carolina. the state’s workforce is expected to fall by another 2. Michigan. New Jersey has eliminated 2. a number of state colleges and universities in states such as Alabama. imposing mandatory furloughs (time off without pay). Wisconsin.Single Payer 2. layoffs. Michigan. Arizona. and furloughed remaining employees. Phil.cbpp. North Carolina. Cutting staff — whether on a permanent or temporary basis — also may contribute to increased unemployment. Pennsylvania. The Ohio governor has announced plans to eliminate as many as 2. about 5 percent of the state workforce. You’re A Jerk 56 . The Tennessee governor has announced elimination of over 2. California. Maine. plus the District of Columbia — have laid off or announced plans to lay off state employees. “An Update on State Budget Cuts.California. North Carolina. New Jersey. and New Jersey are responding to budget cuts by cutting faculty and staff positions. Director of BPP State Fiscal Project. [Mardjuki] At least 40 states plus the District of Columbia are eliminating or not filling various state jobs.000 or more.400. Nicholas. and Wyoming. Ohio. and other services — fully 14 percent of positions will be eliminated or left unfilled. The state is encouraging early retirement but has announced that it will lay off workers if needed. Senior Fellow. To deal with budget cuts in Kentucky. Virginia’s governor has eliminated 800 currently unfilled positions. and Utah. Maine. Overall. child care. Such steps can make it more difficult for residents to obtain state services. leaving vacancies unfilled.700 positions. a hiring freeze imposed by the governor in August caused the state’s workforce to decline by more than 1. Kentucky.cfm? fa=view&id=1214.org/cms/index. Kentucky.Hawaii.

000 to $400. according to Neff. we were short-sided in the 2010 budget. "We have heard that our state department (Ohio Department of Alcohol and Drug Addiction Services) has been given a 30 percent budget cut. "This is going to mean drastic cuts. She is expecting anywhere from $300. http://www. “The criminal system will probably grow. "These cuts will definitely be a problem for these clients. "They rely on the state funding for services. mentoring services throughout the county and youth services. "We felt like we were unfairly targeted in 2009. He said the board would do its best to maintain its core client services but the cuts would surely impact residential treatment. Georgas explained. noting the department already took a $975. 7-21-2009. schizophrenia and other mental health issues by contracting out with 18 different agencies as well as psychiatric hospitals to provide service to county residents. Services will be slashed and the lines for those in need of assistance will likely be longer.txt Social service agencies in Lorain County are feeling the rippling effects of Ohio's newly passed budget. staff writer." which will likely work its way down to the county level. The Board of Mental Health treats clients suffering from depression. families and communities will all bare the burden of the cuts. "We got killed in the budget. the government could save $11 in keeping citizens out of the court system and prisons. said her department is also preparing to get hit with a financial crunch.com/articles/2009/07/21/news/mj1361976. The way Neff has it figured is for every $1 spent on mental health. "It's going to impact people who don't have Medicaid. he said. according to directors of two of the county's service boards. with preference being given to those with Medicaid. Neff said the board is expecting between $1 million and $2 million less from the state. Both Neff and Georgas agreed the impact on the criminal justice system will furthering the ripple effect. You’re A Jerk 57 ." Neff said. “State Budget Cuts to Affect Social Services”. but roughly 75 percent of the board's clients are not on Medicaid." But now. "Families are going to suffer because people who need treatment need to get treatment as soon as they can. "I know the state's issue is with Medicaid.0 LO 57 States Deficit Now—Tradeoffs Medicaid tradeoffs with social services in state budgets –Ohio proves. executive director of the Alcohol and Drug Addiction Services Board of Lorain County. Georgas said.000 in cuts. Children's services." Georgas said. Neff said he foresees the same issue arising — people without Medicaid getting bumped to the back of the line.Single Payer 2." he said. Jordan Cravens. Georgas said other clients will likely have to wait longer for services. The Alcohol and Drug Addiction Services Board seeks to minimize substance abuse and work toward prevention by contracting out with agencies who can provide treatment. Elaine Georgas." Georgas said." Georgas said.000 budget hit in 2009." and again.morningjournal. While the figures are yet to be ironed out. she said." said Charles Neff." Georgas said. executive director of the Lorain County Board of Mental Health. Georgas said.

which have already suffered their own losses of tax revenues.nytimes. 7-15-2009. bureau chief. who control the Legislature and who had worked to prevent what they called a gutting of the state’s social services. but many of the financially weaker localities may face the prospect of defaulting on their bonds. state officials said. “California Approaches a Deal on Budget Cuts”. as they would put the state in violation of federal standards.A. officials said. like fingerprinting and background checks.0 LO 58 State Deficits Now—Tradeoffs California budget cuts reduce other social services Jennifer Steinhauer. Those who work as caregivers in the state’s $4. and appeared on the brink of victory in achieving many — if not all — of the reforms he sought for some programs. its enrollment will probably be limited. The deal also required the use of accounting devices used by all states in a time of crisis.5 billion. Further Medicaid cuts seem unlikely. New York Times L. meaning that some children will be on a waiting list for health care. leaving them even less able to continue to offer programs like music and physical education. a Republican. for example. Medicaid recipients will probably be moved into a managed-care program.7 billion home health care program. Cities can try to borrow the amount they are losing. will probably lose far more as a result of the deal when the state begins dipping into tax streams on which they depend. on top of large reductions earlier. While the state’s health care program for poor uninsured children will not end. Mr. Public colleges and universities across the state have prepared for millions of dollars in cutbacks by furloughing employees. including gasoline taxes. which provides financial assistance to families with children ages 18 and under.html?hp Democrats. Statewide furloughs of three days a month for government employees are likely to continue through the rest of the fiscal year. Some school districts have already promised raises to teachers.com/2009/07/16/us/16calif. held fast to his promise to reject all tax increases. appeared to be prevailing in some measure by agreeing to cuts to other programs and localities. and the agreement in progress calls for the state to repay them over three years. The state’s education budget of nearly $52 billion seemed destined for another large hit. like putting off programs or payments until the next fiscal year so the budget gap does not seem as large. You’re A Jerk 58 . http://www. as the governor once threatened. will most likely face more stringent screening processes intended to curb fraud. of about $1. Schwarzenegger. Benefits will also be trimmed in another program the governor eyed for elimination — CalWorks.Single Payer 2. Local governments.

Single Payer 2. The plan. remains.7 billion in accounting maneuvers like shifting a payday into the next fiscal year. All told. the speaker of the California Assembly. as the Democraticcontrolled Legislature hopes. and the state plans to borrow roughly $2 billion in property taxes from localities. state officials have come up with a compromise that few who receive government services will celebrate. $3. New York Times L. both took large cuts. the program was instead given an overall cut of $500 million . While the state’s health insurance program for children.8 billion in spending cuts. One of the biggest sticking points was over the $11 billion already cut from public schools.0 LO 59 State Deficits Now –Tradeoffs California budget crisis hurting social services and schools Jennifer Steinhauer. Arnold Schwarzenegger’s proposal to eliminate health care programs for children and the state’s generous welfare program. Local governments will lose millions of dollars that are used to build housing. But that budget depended on a nod from voters on several ballot measures. which Mr. said in a telephone interview from Sacramento. The budget deal calls for roughly $650 million more in cuts. finally sealed the deal with the governor Monday night on a plan to close a $26 billion budget gap. While the governor wanted certain welfare benefits to be reduced from a fiveyear period to two years. With the deficit continuing to grow. localities will basically serve as unwilling lending agents to the state. In-home services for the elderly and infirm were reduced by several million dollars.’s to vendors and taxpayers in lieu of payment. along with the creation of a $1 billion reserve fund. universities and local governments. which would have to be repaid within three years. Healthy Families. It will raid their coffers and repay them over time as the state’s fiscal situation improves.o.nytimes. $12. which is certain to be viewed with trepidation among legislatures across the country also facing huge budget gaps. lawmakers signed off on a budget deal with $14. achieved his goal of having caregivers and the recipients fingerprinted in the future with the goal of preventing fraud. Lawmakers believe that cities and counties could in turn borrow against that borrowing.6 billion in cuts. a Republican.com/2009/07/21/us/21calif. their state broke and its credit rating shot. You’re A Jerk 59 .u. among other purposes. meaning thousands of children will probably be on a waiting list for the program unless a private foundation makes up the balance. bureau chief. which runs through the 2010 fiscal year. While the Legislature pushed back on Gov. localities bankrupt or nearly so would be exempt.1 billion in borrowing. http://www. distributes pain through nearly every aspect of government services.” Karen Bass.A. 7-20-2009. With Billions Cut”.4 billion in new borrowing. the deal contains $15. All failed. Schwarzenegger. “California Reaches Budget Deal. Under the new budget. After weeks of often-cantankerous negotiations. it was cut by $144 million. about $2.9 billion in new revenues and about $2. and Mr. So did public education.html?_r=1 California lawmakers. Last February. “I would characterize this budget as shared pain and shared sacrifice.5 billion in tax increases and $5. the state was forced to issue millions of dollars in i. Schwarzenegger had claimed he would not brook.

unlike the feds. state governors aren’t stupid (not all of them. anyway). to be cutting public services and public investment right now. lower-level governments can’t borrow their way through the crisis. our workers haven’t lost their skills. are refusing to buy anything except federal debt. Think about it: is America — not state governments. from a national point of view. It makes no sense to add to the problem by cutting public spending. too. Investors. Paul. Why can’t we keep doing good things? It’s true that the economy is currently shrinking. the true cost of government programs. 7/22/09. which will force young offenders out of group homes and into prison. public investment competes with the private sector for scarce resources — for skilled construction workers. And shredding the social safety net at a moment when many more Americans need help isn’t just cruel. but the nation as a whole — less able to afford help to troubled teens. is much lower now than in more prosperous times. medical care for families. especially public investment. Our capacity hasn’t been diminished. running temporary deficits would be difficult. http://www. But let’s step back for a moment and contemplate just how crazy it is. In fact. are subject to balanced-budget rules.nytimes. But even as Washington tries to rescue the economy.com/2008/12/29/opinion/29krugman. But even if they weren’t. The Obama administration will put deficit concerns on hold while it fights the economic crisis. or repairs to decaying roads and bridges than it was one or two years ago? Of course not.html? _r=1&ref=opinion&pagewanted=print [Mardjuki] No modern American president would repeat the fiscal mistake of 1932. is that state and local government revenues are plunging along with the economy — and unlike the federal government. to the decision by a committee that manages California state spending to halt all construction outlays for six months. But right now many of the workers employed on infrastructure projects would otherwise be unemployed. often at the expense both of their most vulnerable constituents and of the nation’s economic future. So why are we doing this to ourselves? The answer. for capital. But that’s the result of a slump in private spending.” New York Times. in which the federal government tried to balance its budget in the face of a severe recession. driven by fear. and those states that can borrow at all are being forced to pay punitive interest rates. Now. “Fifty Herbert Hoovers. prof of economics and international affairs @ Princeton. They’re cutting back because they have to — because they’re caught in a fiscal trap. You’re A Jerk 60 . It adds to the sense of insecurity that is one important factor driving the economy down. These state-level cutbacks range from small acts of cruelty to giant acts of panic — from cuts in South Carolina’s juvenile justice program.Single Payer 2. Partly that’s because these governments. the nation will be reeling from the actions of 50 Herbert Hoovers — state governors who are slashing spending in a time of recession.0 LO 60 State Deficits Tank Econ Federal economic action ineffective without rectifying state deficit problems. of course. and the money borrowed to pay for these projects would otherwise sit idle. our technological know-how is intact. Krugman. When the economy is booming.

the first day of the new fiscal year in most states. including health care (21 states). In coming months. Johnson.org/cms/index. and other areas. Federal recovery act dollars and funds raised from tax increases are greatly reducing the extent.cbpp. and elsewhere — and school districts will absorb cuts in state aid. Illinois. 6/29/09. will make the recession worse because families and businesses have less to spend in their local economies. sales taxes. Reimburse-ment rates for some health care providers and human services agencies will decline July 1 in Minnesota.Single Payer 2. “An Update on State Budget Cuts. but only to a point. higher education (32 states). 2009. Phil.cfm? fa=view&id=1214. dental and vision services for many Medicaid recipients in California and Michigan will be eliminated. Phil. or soon after. And these figures do not include the proposed cuts that many states still are discussing. States are making these cuts because the recession has caused declining revenues from income taxes. At the same time. These cuts. including Arizona. Washington. and economic impact of these cuts. some 18 states had not enacted budgets for the upcoming fiscal year. New Jersey. Massachusetts. Hundreds of thousands of people with disabilities in those states and in New Mexico will experience cuts in aid. As of June 25. more than three-fourths of states are making spending cuts that hurt families and reduce necessary services. risen as the number of families facing economic difficulties increases. Many cuts — including those hurting vulnerable families — will take effect July 1. [Mardjuki] With tax revenue declining as a result of the recession and budget reserves largely drained. Senior Fellow. severity. in fact. the need for these services has not declined and has. K-12 education (24 states). For example. and other revenue sources used to pay for these services. and Wyoming. Many of those states. You’re A Jerk 61 . The cuts enacted in at least 39 states are occurring in all major areas of state services.0 LO 61 State Deficits Tank Econ State deficits have a domino effect – have widespread negative economic impacts. Director of BPP State Fiscal Project. public university tuition will rise at double-digit percentage rates in Florida. Nicholas. and North Carolina. Utah. are almost certain to enact further cuts. http://www. Washington. in turn. services to the elderly and disabled (22 states).” Center on Budget and Policy Priorities.

To date at least 39 states have addressed their shortfalls by reducing services to their residents. All of these steps remove demand from the economy.” Center on Budget and Policy Priorities. including some of their most vulnerable families and individuals. [Mardjuki] Cuts to state services not only harm vulnerable residents but also worsen the recession by reducing overall economic activity. States are using these funds to help balance their budgets while minimizing harmful cuts in public services. For instance. Many more states will need to consider tax increases or other revenue measures. but also reduce the purchasing power of workers’ families. 6/29/09. Although the recovery package is mitigating states’ fiscal problems. Combined budget gaps for the next two years are estimated to total more than $350 billion. Phil. states are continuing to cut services like education and health care as they enact 2010 budgets. But tax increases can be better for state economies than budget cuts because some of the tax increases result in reduced saving rather than reduced consumption. reduce payments to businesses and nonprofits that provide services. 7/23/09.org/cms/index. Director of BPP State Fiscal Project. and cut benefit payments to individuals.cbpp. Cuts to state services not only harm vulnerable residents but also worsen the recession by reducing overall economic activity. • At least 48 states addressed or are facing shortfalls in their budgets for the new fiscal year totaling $163 billion or 24 percent of state budgets. CBPP. by reducing the amount of money people have to spend.cfm? fa=view&id=1214. Center on Budget and Policy Priorities. Senior Fellow. tax increases remove demand from the economy. The American Recovery and Reinvestment Act includes roughly $140 billion in fiscal relief for state governments. States are using fiscal relief to balance their budgets. Most states are enacting or considering tax increases. enough to close 30 to 40 percent of state shortfalls. as a way to minimize harmful budget cuts. This includes $24 billion in shortfalls that have opened in 12 states in just the few weeks since they passed their 2010 budgets. States are taking actions to mitigate the extent of these cuts. or use of federal stimulus dollars. withdrawals from reserves. or similar actions.. “New Fiscal Year Brings Continued Trouble for States Due to Economic Downturn. freezing new hires.cbpp. shortfalls are likely to equal $160 to $180 billion. Nicholas.cfm?fa=view&id=1283 [Mardjuki] The weak economy continues to cause great fiscal distress among states as they begin a new fiscal year (July 1 marked the start of 2010 for most states). Phil. “An Update on State Budget Cuts. As the full extent of 2011 deficits become known. At least 24 states in 2009 are addressing their budget shortfalls in part by increasing taxes. they lay off employees. http://www. tax increases remove demand from the economy. by laying off workers. Forty-eight states faced or are facing budget shortfalls. But tax increases can be less detrimental to state economies than budget cuts because some of the tax increases affect upperincome households so are likely to result in reduced saving rather than reduced consumption. Like budget cuts.” Policy Points.0 LO 62 State Deficits Tank Econ State deficits prolong recession – hinder increased economic activity. When states cut spending. at least 41 states have reduced overall wages paid to state workers.org/cms/index. cancel contracts with vendors. All of those states had already taken major steps to balance their budgets and the new gaps will require further action during the year to restore balance. and several more are considering them. http://www. by reducing the amount of money people have to spend. These shortfalls come on top of $111 billion in 2009 gaps that states closed through a combination of spending cuts. Some thirty states have enacted tax increases this year in response to budget shortfalls caused by the recession. Combined budget gaps for the remainder of this fiscal year and state fiscal years 2010 and 2011 are estimated to total over $350 billion. Johnson. Like budget cuts. revenue increases. requiring them to take unpaid leave (furloughs). as well as such steps as tapping state rainy day funds. Such measures not only can reduce the level or quality of service available to state residents. Cuts to state programs reduce overall economic activity. Initial estimates of these shortfalls total almost $51 billion. which in turn affects local businesses. You’re A Jerk 62 .Single Payer 2. • At least 33 states have prepared estimates for the 2011 fiscal year.

http://voices.html?wprss=44 [Mardjuki] Undercutting Obama's effort also is growing public discontent about his handling of the overall economy. It now stands at 9. Still. 7/22/09. Many economists agree that the employment picture would be much worse had the stimulus plan not been enacted. With the nation just beginning to emerge from the most severe economic downturn since the Great Depression. The worsening unemployment picture is expected to slow future economic growth and push projected government budget deficits even higher. staff writer. unemployment is continuing to rise.Unemployment Stimulus wasn’t enough – skyrocketing unemployment. You’re A Jerk 63 .” Washington Post. creating new obstacles for the proposed sweeping health care overhaul. Michael. hurting the credibility of its economic forecasts.Single Payer 2.0 LO 63 More Stimulus Needed .washingtonpost. the administration missed badly when it projected that unemployment would not rise above 8 percent with the measure in place.com/44/2009/07/22/a_news_conference_to_push_hard. “Obama: Health Care Reform Is Essential to Rebuilding Economy.5 percent and is projected to surge even higher in the coming months. Fletcher. despite the $787 billion economic stimulus plan that Obama managed to squeeze through Congress in the early weeks of his administration.

Nor has there been the promised “multiplier” on every stimulus dollar spent.wsj. all to the inevitable long-term damage of the U.html [Mardjuki] It is becoming painfully apparent that the Obama administration's stimulus package has failed to halt the deepening recession. economy slipped into recession in December 2007. and even larger inflation-adjusted stock market decline of the late 1970s and early ’80s—a new policy path was charted consisting of low tax rates. Michael. “What Stimulus?” Pittsburgh Tribune. arguably. estimated at some $10 trillion. The last time we had a comparable economic crisis—the double-digit inflation. With its privileged access to national statistics and confidential core data.S. by consumers. 7/22/09. personal consumption outlays have risen only $1 billion. the administration and the Fed should have predicted the downturn. less than 10% of the funds have been disbursed and what has been been saved. some from the increased transfer payments in the stimulus bill. even larger. after more than a year of contraction.25 percent.pittsburghlive. The Fed was both late and slow in lowering its key interest rate from its August 2007 level of 5. Both the stimulus packages of President Bush and President Obama could be attacked for being too little too late. What should the government do? As expensive and undesirable as it was to bail out the very "casino" banks which had precipitated a financial meltdown.” Wall Street Journal. the Bush administration. it was targeted at tax rebates and. But many Americans fear things are getting out of control. As early as the summer of 2006. but a lot less than advertised. global interest.com/x/pittsburghtrib/opinion/s_635198. the first $750 billion package was woefully inadequate. financial analyst and former British Parliament member. therefore. Boskin. quickly disseminated. more coherent policy path back to a strong market economy—not to a European style social-welfare state. slower spending growth. tragically wasted opportunity. a majority of politicians probably would agree that it was in the national and. professor of econ @ Stanford. John. it also was far too small. “Obama Needs a Move to the Middle.com/article/SB10001424052970203946904574302332578189864. Moving so far in the exact opposite direction invites eventual disaster for American workers and firms. senior fellow @ Hoover Institution. You’re A Jerk 64 .S. 20% interest rates. Likewise.) While President Obama's stimulus package was organized early in his administration. chairman of Council of Economic advisors. maintaining that the economy was healthy. was more than a year late with its stimulus package. when measured against the aggregate erosion of household wealth. Pressure is building from the left for a second stimulus program. free trade and less intrusive regulation. There is now growing pressure for a second. The specter of massive future tax hikes and inflation is worsening the outlook. stimulus. economy.Single Payer 2. The current stimulus is not the first but actually the second package. Those policies pulled us out of stagflation and led to a quarter-century of growth.html?mod=googlenews_wsj#printMode [Mardjuki] While strong recoveries sometimes follow deep recessions. not spent. the U. Half a year and two million lost jobs since the stimulus bill was passed. (To be fair. sound money. In addition. near 11% unemployment. Infrastructure spending in the pipeline will likely deliver more than this. We need a better. Score the stimulus a very expensive.Insufficient January stimulus has failed – limited impact – second round needed. Out of the $320 billion increase in personal disposable income. historically recoveries following financial crises have been slow and painful.0 LO 64 More Stimulus Needed . 7/26/09. That’s far short of President Barack Obama’s promised “immediate” help. First round of stimulus insufficient. permanent government lifelines and stagflation. http://online. some private observers predicted the economic recession of 2008. Browne. It is accepted that. http://www.

html [Mardjuki] Several events of the past week should be a wake-up call to the Obama administration. nearly every state is raising taxes or fees.S. their only choice is to cut program spending or raise taxes. And 39 states have cut program outlays on the needy. just hiked its sales taxes by 25 percent. with one of the most liberal governors. when tax receipts fall. And I would add that stimulus funds are getting out too slowly. Consider: The green-shoots school was expecting that the rising rate of unemployment would continue to slow.5 percent.” Huffington Post.5 million more workers. But instead the number spiked back up. as it did in May.com/robert-kuttner/3reasons-we-need-an-econ_b_225962. Robert.Single Payer 2. And as long as layoffs continue. The 9.5 percent official figure -. President Obama's economic stimulus simply wasn't designed for a recession this deep. Until strong economic growth returns. unlike the Federal government.the worst since 1983 -. Hidden unemployment is also setting records . and OECD economists project that U. So in a deep recession. We now have fewer jobs than in May 2000 when the recovery began.people with part time work who want full time work. At least 48 states face red ink. Both are of course perverse in a recession. Compounding the problem is inadequate government policy on three crucial fronts: The states. But most states are just plain hurting. “Three Reasons We Need an Economic Wake Up Call. companies will not resume hiring. The unemployment rate rose to 9. 7/5/09. unemployment will still be in double digits as late as 2011. This is the only recession since the Great Depression in which the job loss wiped out all the job growth of the previous recovery.000 jobs were lost. Deval Patrick. The number of longterm unemployed is at record levels. as well as people whose hours have been involuntarily cut. that means fewer customers and the downward spiral continues. since they only further undercut consumer purchasing power. Stronger stuff is needed. founder of The America Report. As our friends at the Economic Policy Institute report.conceals even worse news.0 LO 65 More Stimulus Needed . Bottom line: the medicine isn't working. or laying off workers and reducing programs. Federal aid under the stimulus covers just 30 to 40 percent of the state shortfall. Kuttner. A total of 467. as in the dance to the death between California Governor Arnold Schwarzenegger and Democrats in the legislature. http://www. senior fellow @ Demo Think Thank. are not permitted to run current budget deficits.huffingtonpost. As EPI observes. Some of the state budget crisis is self-inflicted. which is expected to total $350 billion by 2011. though the economy now has 12. You’re A Jerk 65 . Massachusetts.Statistics First round of stimulus insufficient – recent unemployment and state deficit statistics prove. according to the Center on Budget and Policy Priorities. A total of 24 other states have enacted tax increases and another 12 all have tax hikes on their agendas. The New York Times reports that several states are cutting out summer school. And there is less than one job opening for every five people seeking jobs. As the new fiscal year begins. compounded by a two-thirds supermajority requirement for any kind of tax reform.

Most effective stimulus is federal funding to balance state budgets.chicagofed. it was easy for a state to substitute federal money for own-source revenues. it would not stimulate growth in the state government sector.org/publications/fedletter/cflaugust2009_265. and the speed of getting money into the economy is often a goal of this aid. the federal government hopes to support specific types of state programs. If. How the federal government finances the aid package must also be considered. While this would improve the states’ balance sheets. August 2009. In this case. Also. five prominent Democratic governors suggested that the federal government should commit $1 trillion in aid to the states over the next two years.Single Payer 2. individual state economies are struggling in this recession. “Should the Federal Government Bail Out the States? Lessons from Past Recessions. such as Medicaid or education. The least optimal funding strategy would be for the federal government to reduce its expenditures or raise taxes to fund aid to the states and then for the states to use the money to retire debt. “Should the Federal Government Bail Out the States? Lessons from Past Recessions. for which demand rises during a recession. Unrestricted aid can also be spent faster. Richard. the federal government needs to borrow the funds and the states need to use the money to either expand spending or avoid tax increases . such as Medicaid. As such. California projected a $21 billion deficit after failing to get voter approval for a series of budget balancing fiscal measures. Further. It would also be feasible for the federal government to borrow the funds but have the states use the money to retire debt. For an aid package to be truly stimulative. Mattoon.” Chicago Federal Reserve Bank Essay Number 265. Most states are required to balance their budgets regardless of the economic environment. This article considers the role of the federal government in helping the states to manage their finances. Recently. this aid might help states avoid enacting spending cuts or tax increases that could deepen or prolong the economic downturn. senior economist and economic advisor @ Chicago Federal Reserve. the government sector would actually contract. If the goal is to stabilize spending across the state government sector.pdf [Mardjuki] Like the economy in general. Whether federal money should be unrestricted or targeted depends largely on the purpose behind the federal relief funds. August 2009. the federal government can provide the money on a matching funds basis that requires the state to maintain its contribution to the specific program and not allow it to simply withdraw state funding and replace it with federal dollars. unemployment insurance. senior economist and economic advisor @ Chicago Federal Reserve. and work force training. State government budget woes have been much in the news. State governments face significant constraints in raising additional revenues. unrestricted aid from the federal government that can be used as a state sees fi t is appropriate. Mattoon.org/publications/fedletter/cflaugust2009_265.2 The rationale for such financial support is that states (which are generally prohibited from running deficits) need the money to maintain key programs. http://www.pdf [Mardjuki] Most of the federal government’s aid to counteract the effects of the 1973–75 and 2001 recessions had very few restrictions.chicagofed. Richard. however. http://www.0 LO 66 More Stimulus Needed – States Key Federal aid to states needed to avoid prolonged recession. categorical aid increases the accountability for the spending.1 In January of this year. You’re A Jerk 66 .” Chicago Federal Reserve Bank Essay Number 265.

with $250 billion going to state and local governments by specifi c category. But the real problem isn’t the fecklessness of local politicians. is procyclical: it’s amplifying the effects of the downturn.com/talk/financial/2009/07/27/090727ta_talk_surowiecki “Fifty Ways to Kill Recovery” It’s easy enough. That aid. You’re A Jerk 67 . Nearly every state government is required to balance its budget. government expands. “Asessing the State and Local Sector – Where Will the Money Come From? A Conference Summary. then. though. In one scenario. outlined the structure of the American Recovery and Reinvestment Act of 2009 (ARRA). Think about the $787- billion federal stimulus package. some of the biggest players in the economy—state and local governments together account for about thirteen per cent of G.0 LO 67 More Stimulus Needed – States Key Stimulus aid unsustainable – increased assistance for state recovery needed. Yet there’s no sign that those budget gaps are getting smaller. to mock state governments nowadays.P. In the midst of this downturn. especially for Medicaid and education. http://www.6 billion in 2011.s to pay its bills and New York’s statehouse becoming the site of palace coups and senatorial sit-ins. Current estimates from the Congressional Budget Office show that the bulk of the stimulus money will be spent in the first three federal fiscal years (FYs) of the program—$47. So fiscal policy at the national level is countercyclical: as the economy shrinks. of course. The act provides $787 billion in total aid. States need more money for budgets even after the stimulus James Surowiecki. state cutbacks have not been as severe as they might have been. 7-26-2009. Boyd argued that it may take more than five years for these revenues to fully recover. state governments are effectively taking it out. $96. It’s a push-me. It’s the ordinary way in which state governments go about their business. as the federal money runs out.O. director of the Governor’s Office of Management and Budget. So states have to raise taxes or cut spending. what with California issuing I.D. http://www. states as a group would still face potential budget gaps of greater than $100 billion (6%) when the stimulus money is exhausted. thanks to the stimulus plan . and tax revenues fall precipitously—in New York. sales plummet. Even as the federal government is pouring money into the economy.4 billion in 2009. the opposite is happening. jobs vanish.5 billion in FY2009 and continue falling in FY2010. Receipt of the ARRA money will certainly help. By design. while significant budget cuts have become routine and are likely to get only deeper in the year ahead. and.newyorker. Ostro noted that with no policy changes Illinois is facing an $11. while the stimulus money is certainly welcomed. but it is not sufficient to preclude a combination of spending cuts and tax increases to close the budget gap.—will be doing precisely the wrong thing. $130 billion will provide immediate fiscal relief. An Illinois perspective was provided by Ginger Ostro.org/publications/fedletter/cfljuly2009_264b. instead of mitigating them.Single Payer 2. Under differing scenarios based on the behavior of state tax revenues in previous recessions. according to a recent study by the Center on Budget and Policy Priorities.pdf [Mardjuki] Donald Boyd. state tax increases and spending cutbacks are only going to become more common. senior economist and economic advisor at Chicago Fed. pull-you approach to fighting the recession. the longer term picture for state (and local) governments looks challenging. Revenues are expected to fall $2.6 billion deficit in FY2010. investment declines. and $50. When times are bad. At the state level. Now. Money for the states translates directly into jobs not lost and services not cut—which is why you can make a good case that more of the stimulus should have gone to state aid.chicagofed. It’s built on the idea that during serious economic downturns the government can use spending increases and tax cuts to counteract the effects of consumers who are cutting back on spending and businesses that are cutting back on investment. and that’s precisely what they’re doing: states from New Jersey to Oregon have raised taxes in the past year. state revenues in April and May were down thirty-six per cent from a year earlier. staff writer for The New Yorker. or both. has covered thirty to forty per cent of the states’ budget shortfalls. July 2009. According to Boyd. Richard. which includes roughly $140 billion in aid to local governments. Rockefeller Institute of Government.U. Mattoon.” Chicago Federal Reserve Essay 264b.9 billion in 2010. The states’ fiscal policy. for instance.

But the real problem isn’t the fecklessness of local politicians. falling house prices. It’s easy enough. whose budget woes are intensifying.html [Mardjuki] Planning now for another round of stimulus is prudent.s to pay its bills and New York’s statehouse becoming the site of palace coups and senatorial sit-ins. state tax increases and spending cutbacks are only going to become more common. So fiscal policy at the national level is countercyclical: as the economy shrinks. But here are fifty culprits you might not have thought of: the states. “Fifty Ways To Kill Recovery. state governments are effectively taking it out. In the midst of this downturn.0 LO 68 More Stimulus Needed – States Key More stimulus needed – aid to states and easing health care deficit key. has become a serious impediment to reversing the downturn. Even as the federal government is pouring money into the economy.— will be doing precisely the wrong thing. 7/27/09. When times are bad. So states have to raise taxes or cut spending.com/talk/financial/2009/07/27/090727ta_talk_surowiecki [JM] If you came up with a list of obstacles to economic recovery in this country. 7/11/09. investment declines. chief economist @ Moody’s Investor Services and Risk Analysis. it would include all the usual suspects—our still weak banking system. Now.D. Mark. and. Federalism. That aid. Think about the $787-billion federal stimulus package. some of the biggest players in the economy—state and local governments together account for about thirteen per cent of G. the opposite is happening. jobs vanish. http://www.newyorker. Policymakers could smooth the way for all this if they were able to demonstrate this summer they are serious about addressing the nation's darkening long-term fiscal outlook by credibly paying for health-care reform. given that the economy remains in an extraordinarily severe downturn and the risks are decidedly to the downside. “Do We Need Another Stimulus?” Washington Post. then it probably should include more aid to hard-pressed state governments. of course. Yet there’s no sign that those budget gaps are getting smaller. as the federal money runs out. though. is procyclical: it’s amplifying the effects of the downturn.com/wpdyn/content/article/2009/07/11/AR2009071100292. thanks to the stimulus plan. instead of mitigating them. The states’ fiscal policy. state revenues in April and May were down thirty-six per cent from a year earlier. has covered thirty to forty per cent of the states’ budget shortfalls. for instance.washingtonpost. It’s the ordinary way in which state governments go about their business. what with California issuing I. while significant budget cuts have become routine and are likely to get only deeper in the year ahead.Single Payer 2. James. Money for the states translates directly into jobs not lost and services not cut—which is why you can make a good case that more of the stimulus should have gone to state aid. At the state level. It’s built on the idea that during serious economic downturns the government can use spending increases and tax cuts to counteract the effects of consumers who are cutting back on spending and businesses that are cutting back on investment. http://www. then. an expansion of the housing tax credit to stem the ongoing slide in house prices.U. a delay in legislated increases in marginal personal tax rates in 2011.” New Yorker. often described as one of the great strengths of the American system. which includes roughly $140 billion in aid to local governments. and tax revenues fall precipitously—in New York.P. If additional stimulus is needed. pull-you approach to fighting the recession. or both. to mock state governments nowadays. staff writer. and that’s precisely what they’re doing: states from New Jersey to Oregon have raised taxes in the past year. though. It’s a push-me. States’ procyclical fiscal policy hampering recovery efforts – federal government should go directly to state aid. overindebted consumers. and perhaps even a payroll tax holiday. state cutbacks have not been as severe as they might have been. more aid to stressed households hammered by what will be double-digit unemployment. Zandi. according to a recent study by the Center on Budget and Policy Priorities. Suroweicki.O. cautious companies. You’re A Jerk 68 . sales plummet. Nearly every state government is required to balance its budget. government expands.

state reserves — general fund balances and rainy day funds — totaled 11. These important public services were suffering even as states turned to budget cuts to close the new budget gaps. “State Budget Troubles Worsen. There are also other streams of funding in the economic recovery act flowing through states to local governments or individuals. In this recession. states have already drawn down much of their available reserves. 6/29/09.0 LO 69 More Stimulus Needed – States Key Federal assistance crucial to stem negative pro-cyclical economic state action. and child care remain in effect. In a number of states the reductions made during the downturn in education. Reserves can be particularly important to help states adjust in the early months of a fiscal crisis. The amount in ARRA to help states maintain current activities is about $135 billion to $140 billion — or less than half of projected state shortfalls. the available reserves in states with deficits are likely to be depleted in the near future.” This money has reduced to a degree the depth of state spending cuts and moderated state tax and fee increases. and for all states combined it still remains below the fiscal year 2001 level. state budget and tax senior fellow.org/cms/index.cfm? fa=view&id=711 [Mardjuki] The current situation has been made more difficult because many states never fully recovered from the fiscal crisis of the early part of the decade. Lav. higher education. general fund spending for fiscal year 2008 — six years into the economic recovery — remained below pre-recession levels as a share of the gross domestic product. In 18 states. One way states can avoid making deep reductions in services during a recession is to build up rainy day funds and other reserves. but generally are not sufficient to avert the need for substantial budget cuts or tax increases. state budget and tax expert. At the end of fiscal year 2006. http://www. McNichol. Iris and Elizabeth. State spending fell sharply relative to the economy during the 2001 recession. but this will not address state budget shortfalls.cbpp. The American Recovery and Reinvestment Act recognizes this fact and includes substantial assistance for states. Gold award for contribution to state fiscal policy. Most of this money is in the form of increased Medicaid funding and a “Fiscal Stabilization Fund. Federal assistance Crucial. You’re A Jerk 69 . Federal assistance can lessen the extent to which states need to take pro-cyclical actions that can further harm the economy.” Center on Budget and Policy Priorities.5 percent of annual state spending. This heightens the potential impact on public services of the shortfalls states now are projecting. health coverage.Single Payer 2. Spending as a share of the economy declined in fiscal year 2008 and is projected to decline further in 2009 and again in 2010.

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A2: ARRA Stimulus Solves Medicaid Deficits
Governor consensus – unfunded federal mandates tank state economies that are surviving on stimulus cash infusions. Trygstad, staff writer. 7/21/09
Kyle. “Governors Warn Congress on Health Care Efforts.” Real Clear Politics. http://www.realclearpolitics.com/politics_nation/2009/07/governors_warn_congress_on_hea.html [Mardjuki] The nation's governors have sent a letter to Congress urging them not to impose "unfunded federal mandates and reforms that simply shift costs to states" as they consider health care reform. A House proposal would provide permanent funding for Medicaid expansions, which the governors support. Writing on behalf of the National Governors Association, chairman Jim Douglas (R) of Vermont says: Any unfunded expansions would be particularly troubling given that states face budget shortfalls of over $200 billion over the next three years. This gap persists even after the Recovery Act's temporary increases in the federal share of Medicaid, which was essential for avoiding dramatic cuts to critical state services and was greatly appreciated by governors. Governors welcome the opportunity to share and expand upon the innovative reforms we have instituted in our states to expand coverage, reduce cost and improve the quality of health care. These reforms should inform congressional efforts and must be preserved and encouraged as part of any national reform. We appreciate your willingness to work with us to pursue financing options that are sustainable at both the federal and state levels. Obama relied on the support of governors, particularly Republicans like Douglas and Florida's Charlie Crist, to sell his stimulus plan. Health and Human Services Secretary Kathleen Sebelius, the former Kansas governor, was dispatched to this weekend's NGA conference to hear the state executives' concerns.

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Trickle Up Stimulus Needed
The economy will not recover without a trickle up policy- unemployment, tax appeals, forclosures Randall Wray, 7-7– Senior Scholar and professor of economics and director of the Center for Full Employment and Price Stability
at the University of Missouri Economic Perspectives from Kansas City, “The Carnage Continues: Time to Ramp Up the Stimulus” July 7, 2009, http://neweconomicperspectives.blogspot.com/2009/07/carnage-continues-time-to-ramp-up.html) Some like to see green shoots everywhere, but that is becoming an increasingly audacious hope. Here are four related stories from the July 5th edition of the New York Times: Tax Bill Appeals Take Rising Toll on Governments By Jack Healy Homeowners across the country are challenging their property tax bills in droves as the value of their homes drop, threatening local governments with another big drain on their budgets…. The tax appeals and reassessments present a new budget nightmare for governments. In a survey conducted by the National Association of Counties, 76 percent of large counties said that falling property tax revenue was significantly affecting their budgets…. Officials in some states say their property tax revenue is falling for the first time since World War II. Safety Net Is Fraying for the Very Poor By Erik Eckholm Government "safety net" programs like Social Security and food stamps have pulled growing numbers of Americans out of poverty since the mid-1990s. But even before the current recession, these programs were providing less help to the most desperately poor, mainly nonworking families with children… The recession is expected to raise poverty rates, economists agree, although the impact is being softened by the federal stimulus package adopted this year…. "It's a good thing we have the stimulus package," Mr. {Arloc} Sherman said. "But what happens to the most vulnerable families in two years, when most of the provisions expire?" Employment Report Sours the Market By Jeff Sommer A grim report on unemployment on Thursday let the air out of the stock market…. In a monthly report, the Labor Department said that 467,000 jobs were lost in June. In surveys, most economists expected 100,000 fewer jobs lost. The unemployment rate edged up to 9.5 percent from 9.4 percent the previous month, to its highest level in 26 years, and virtually all analysts expect joblessness to mount in the coming months. So Many Foreclosures, So Little Logic By Gretchen Morgenson LAST week, the stock market tumbled on news that housing foreclosures and delinquencies rose again in the first quarter . The Office of the Comptroller of the Currency said that among the 34 million loans it tracks, foreclosures in progress rose 22 percent, to 844,389. That figure was 73 percent higher than in the same period last year.... But the most fascinating, and frightening, figures in the data detail how much money is lost when foreclosed homes are sold. In June, the data show almost 32,000 liquidation sales; the average loss on those was 64.7 percent of the original loan balance. What do these reports have in common? They provide powerful evidence that the federal government is not doing enough to help the "real" economy. As Sam Gompers famously responded when asked what workers wanted--"More!"—our nation's state and local governments, households, workers, and poor need more help, now. We have tried the Reagan/Paulson/Rubin/Geithner "trickle down" approach of targeting relief to Wall Street, but the only thing trickling down is misery. The only way to stop the downward spiral is to substitute trickle-up policy—and even if nothing tricklesup, at least we will have helped those most in need.

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Fed Action Key
Interstate issues dealt with more effectively at the federal level. Suroweicki, staff writer. 7/27/09.
James. “Fifty Ways To Kill Recovery.” New Yorker. http://www.newyorker.com/talk/financial/2009/07/27/090727ta_talk_surowiecki [JM] Even more important, federalism is getting in the way of the creation of a “smart” American power grid. This would involve turning the current hodgepodge of regional and state grids into a genuinely national grid, which would detect and respond to problems as they happen, giving users more information about and control over their electricity use, and so on. It could also dramatically reduce our dependence on oil. Wind power could eventually produce as much as twenty per cent of the energy that America consumes. The problem is that the places where most of that wind power can be generated tend to be a long way from the places where most of that power would be consumed. A new grid would enable us to get the power to where it’s needed. But since nobody likes power lines running through his property, building the grid would require overriding or placating the states—and the prospects of that aren’t great. The tension between state and national interests isn’t new: it dates back to clashes in the early Republic over programs for “internal improvements.” Of course, the federal government is far bigger than it once was, and yet in the past two decades we’ve delegated more authority, not less, to the states. The logic of this was clear: people who are closer to a problem often know better how to deal with it. But matters of a truly interstate nature, like the power grid, can’t be dealt with on a state-by-state basis. And fiscal policy is undermined if the federal government is doing one thing and the states are doing another. It’s a global economy. It would be helpful to have a genuinely national government.

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Ezra. One way to do that would be to simply federalize Medicaid funding. which would be a huge step forward: One encouraging element of the health care reform bill released today by three House committees is that it would finance expanded eligibility for Medicaid entirely with federal money. If some new Medicaid beneficiaries have their benefits entirely paid for by the feds.0 LO 73 Federalize Medicaid Solves State Budgets Federalization of Medicaid solves dysfunctional state bureaucracies and relieve waterlogged state budgets. a lot of people have been arguing for a third stimulus focused on state budgets and services. and the inability of 50 state governments to each do mischief to the programs have demonstrably led to far superior results for national social insurance. Since its inception in 1965. Medicaid’s financing has been shared jointly between the feds and state governments. The House bill would not require state contributions to pay for expanding Medicaid eligibility to 133 percent of the federal poverty level because. Economies of scale. But a potential long-term payoff to this reform would be to open the door to federalizing the program entirely down the road. writes in with a very good point on the House health-care bill: It opens the door to eventually federalizing the Medicaid program. perhaps ultimately folding it into the proposed public health plan. uniform national rules. That arrangement has much to do with Medicaid’s huge shortcomings: wide state-to-state variations in eligibility rules and benefit levels. Klein. 7/14/09. chronic under-funding.com/ezra-klein/2009/07/a_win_for_medicaid. economic and domestic policy expert. It would be good long-term policy.washingtonpost.html Greg Anrig.could be similarly shifted entirely to federal funding in later reforms. That would create opportunities for the federal government to exert greater control over the largely dysfunctional program. Because the program primarily covers adults and individuals with low incomes. Federally run insurance programs like Social Security and Medicare are vastly more efficient and effective than federal-state counterparts like Medicaid and unemployment insurance. it has never benefited from broad political support.Single Payer 2. good short-term politics. editor. and limited medical options for beneficiaries.such as those eligible for both Medicare and Medicaid -. and a huge relief for state budgets. it’s conceivable that other categories -. “A Win For Medicaid. [JM] http://voices. On a related note. vice president of policy at the Century Foundation. In the process.” Washington Post. the fragmentation that contributes so much to the flaws in our health care system would begin to wither away. the committees correctly note. state budgets are already overwhelmed due to the recession. You’re A Jerk 73 . along with nursing home residents. step by step.

5 million Illinoisans and cost $12 billion a year in state and federal funds.sj-r. He is one of four Republican lawmakers who began meeting privately Friday with four of their Democratic counterparts in the General Assembly and a representative of Quinn to discuss ideas for Medicaid reform. According to the most optimistic estimates. Medicaid reforms could save a total of $983 million over the next two years. said last week. You’re A Jerk 74 . hospitals and doctors when it comes to changes in state health programs that cover 2. Dale Righter. the rising cost of Medicaid will take up more and more state resources and “crowd out” other state services while further delaying payments to Medicaid providers. Republican votes may be crucial to reduce the impact of the state’s $9 billion deficit through a potential income tax increase.com/homepage/x488806173/Medicaidreform-tied-to-state-budget-crisis [JM] Regardless of how much money would be saved this year or next.” Righter said. which is available online at http://tinyurl. Republicans in the Democrat-controlled Illinois Senate and House have all but required that long-term Medicaid reform be part of any budget discussions. “It should be obvious to everyone that if you’re concerned about anything in the budget. “We want to make as much positive change as possible. reform of Illinois’ Medicaid program — or at least firm plans to make changes in the system — appears to be a key component of any resolution to the state budget crisis. Dean. more than twice the rate of inflation. But there is disagreement — and outright fear — about the potential ramifications for patients. said Michael Gelder. “Medicaid reform tied to state budget crisis. 6/20/09.” State Journal-Register. you need to be concerned about Medicaid.” state Sen. Quinn’s chief health-policy adviser. Republicans say that without changes.Single Payer 2.0 LO 74 Medicaid Reform Solves State Budgets Only massive Medicaid reform solves the state budget crisis Olsen. The report.” Medicaid spending has grown an average of almost 8 percent per year between 2003 and 2008. says that if costs continue to grow at that rate Medicaid spending will reach $22 billion in 2019 and could represent 50 percent of the state budget. Consensus wasn’t reached on any issues after the two-hour meeting in Chicago. Pat Quinn’s Taxpayer Action Board. senior reporter. “I’m not sure there is a clear-enough concept of the consequences of these proposals. http://www. senior vice president of the Naperville-based Illinois Hospital Association. and more in future years.” Many Republicans also believe there is too much waste in the system and that some people don’t deserve state-provided health care that was made available to more children and parents under former Gov. but the group will meet again Tuesday or Wednesday in Springfield. said Republican fervor for Medicaid reforms appears to be fueled by “the dilemma of raising taxes.com/taxpayerboard. RMattoon. Howard Peters. Rod Blagojevich. “It is the 700-pound gorilla quickly turning into the 900-pound gorilla.” he said.” “People are almost desperately looking for some kind of ‘silver bullet’ that can get us out of this thing that can be painless. according to a recent report by Gov.

adjusted for the CPI and expressed in year-2007 dollars. Charting a sustainable future for Medicaid is essential for virtually every aspect of health reform. malpractice reform. and for the fiscal survival of state governments. Medicaid has evolved into a huge and diverse program that finances almost half of American nursing home and long-term care. we must recognize that the budget challenge is more than a nasty episode brought on by the current downturn. It shows inflation-adjusted medical expenditures by state and local governments between 1960 and 2007. past and projected increases in state expenditures are modest. Rising Medicaid expenditures undermine states’ ability to address other pressing needs. economic and domestic policy expert. The cuts seem most dramatic in California. Figure 1 shows why state policymakers are panicking.” Washington Post. http://voices. underpaying providers. You’re A Jerk 75 . What can be done? First. barely exceeding 1% of GDP. Rhetoric about soaring Medicaid costs is actually misplaced. dozens of states are cutting or constraining services at precisely the moment when these services are most needed to meet human needs and to stabilize local economies. The spreadsheets can be accessed here. Yet painful measures are being taken in many other states.Single Payer 2.washingtonpost. I should be more careful here. the existing framework no longer works.com/ezraklein/2009/06/guest_graph_the_future_of_medi. It’s impossible to keep up. 6/19/09. As a percentage of GDP. arguing that it's time we recognized the centrality of Medicaid and made it a federal program rather than a state partnership. Slapped together 45 years ago as a relatively small program that mainly financed healthcare to welfare recipients and their children. They are dwarfed by corresponding changes in Medicare. comparative effectiveness research. “Guest Graph: The Future of Medicaid. delaying payment. is right on the money. states have cut financial corners for decades. Ezra. the tax treatment of employer-provided health plans. He's one of the smartest social policy thinkers I know. failing to operate these programs with the skill and humanity that patients deserve.html [JM] Harold Pollack is an associate professor of public health at the University of Chicago. Amid this health policy tumult. bears large responsibilities for the care of disabled adults and children. My inbox this morning includes a white paper comparing different versions of the public health insurance plan. The worst is yet to come. and this piece he sent in. senior editor. (These data are drawn from National Health Expenditure data. and is the major vehicle to cover millions of poor and near-poor Americans who would otherwise be uninsured.) As state and local medical expenditures cross the $300 billion mark. Saddled with balanced-budget requirements and constrained tax bases. and more. our essential but flawed state-federal partnership that finances medical care and related services for almost 50 million people. Klein. one basic issue receives less attention than it deserves: The precarious condition of Medicaid. In truth. Actuaries predict that state Medicaid expenditures will roughly double by 2017.0 LO 75 Medicaid Reform Solves State Budgets Medicaid reform needed to stabilize state budgets and local economies – current system unsustainable. States’ Medicaid problems have been building for decades. links to competing webcasts on value-based insurance design.

to place nonbinding. to be launched tomorrow. writer for the Boston Globe. The candidate backed an effort led by a grass-roots organization called Neighbor to Neighbor.Single Payer 2. He said the savings would help provide coverage to the state's estimated 600. “Roosevelt blasted for ties to Bulger.000 people who lack health insurance. single-payer questions on the ballot in seven state senate districts and one state representative district across the state." Bachrach said during a news conference outside the State House. CAMPAIGN 94 ROUNDUP” lexisnexis[LO//AS] Democratic gubernatorial candidate George Bachrach. You’re A Jerk 76 . a supporter of a single-payer health system.0 LO 76 Single Payer Solves State Deficits Plan would save billions in single states alone Aucoin 94 Don Aucoin. "There is a yearning in this state for single payer. yesterday endorsed a bid to pass ballot questions in favor of such a health plan. Bachrach said his state-run single-payer health plan would contain health care costs and yield savings of $ 4 billion currently being allocated to "wasteful administrative costs" and insurance company profits. Bachrach's plan was endorsed by the Massachusetts chapter of Physicians for a National Health Program.

Some of that $45 million included an income-tax credit for active-duty military personnel and an increase in the budgets for public defenders and prosecutors. an insurance program for the poor and the disabled. Steve Shannon. But in a special legislative session in June.” Lexington Herald-Leader. Lassiter said. which had additional money from the federal stimulus program." Lassiter said. the state picks up about 30 percent of the tab and the federal government pays 70 percent. Lassiter said. Over the past 18 months. The additional spending means that the cuts to agencies are likely to be deeper than 2. Those plans are due this week. is paid with federal and state dollars. which began July 1. the federal government retroactively increased its share of Medicaid dollars this year to nearly 80 percent of the cost. stimulus money will sunset by 2010. Yet the number of people eligible for Medicaid will probably remain the same while the state's portion of the bill will increase. Lassiter said. there could have been additional cuts in programs. "Then what are we going to do?" he said.kentucky. The agency proposals will be reviewed and discussed with Beshear. Musgrave. For the fiscal year that just ended. But it probably will be several weeks before agencies are told how much to cut. the state budget director. with a few exceptions.6 percent cut to most state agencies. However. the state was $55. Legislators also approved a tax credit of as much as $25 million for people who buy newly built homes. Lassiter said. It is fully funded for the coming fiscal year. 7/21/09 Beth. The state had to balance its books from the last fiscal year before it could determine how how much to cut from this year's budget. "This is the fifth budget reduction in 19 months. Moving money from Medicaid to the General Fund will not affect the Medicaid program. Beshear has said.0 LO 77 Kentucky – Medicaid Chopping Block Kentucky on the brink – Medicaid funding already on the chopping block. http://www.7 million short in General Fund dollars and nearly $37 million short in Road Fund money — which pays for transportation projects. the General Assembly approved a budget-reduction plan that included $45 million in spending that was not in Beshear's original proposal.html [Mardjuki] The state was in the black for the fiscal year that ended June 30. You’re A Jerk 77 . If the state had to use money set aside for this year's budget. “State plugs budget hole with Medicaid money.Single Payer 2. To balance the General Fund shortfall — which funds the bulk of state government — Kentucky used unspent General Fund money that was allocated to its Medicaid program. Gov. director of the Kentucky Association of Regional Mental Health. In general. said the increase in the federal share of the Medicaid program is supposed to sunset in December 2010. Medicaid.6 percent. which represents community mental health centers." Lassiter said of saving measures at the Transportation Cabinet. Shannon said.Mental Retardation Programs. But some people in the social-services sector questioned whether it was wise to borrow money from a program that is likely to need those dollars in the future. "We're not cutting any projects. but only because it received a loan from the Medicaid program. "Where do we find money to plug that shortfall?" The shortfall in the state's Road Fund was plugged using savings from restructuring debt and other cost-cutting measures such as restricting travel and cutting other expenses at the Transportation Cabinet. Steve Beshear had originally proposed plugging a potential $1 billion shortfall for this fiscal year with $741 million in federal stimulus dollars and a 2. said Mary Lassiter. state agencies have cut more than $600 million as the state repeatedly adjusted its budget to account for falling revenues. staff writer. Lassiter said Monday that the state has asked all agencies to show how a 3 percent and a 4 percent cut would effect the delivery of services. That means the state had additional state money in that program that could be used to cover the shortfall. Now state officials are trying to determine how much money state agencies will have to cut from this year's budget. The exceptions included the state Medicaid programs and the main funding formula for K-12 education.com/news/state/story/868712.

which serves the poor and uninsured. and should not be victimized again by their own government. Because of the formula used in the calculation of Medicaid support from the federal government. Louisiana will face the largest decrease of federal Medicaid funding in the nation . Aid to Louisiana on this front will add to the deficit. there is the problem of “Katrina fatigue. but the federal stimulus aid to the state also goes away — a double-whammy. Predicted billion-dollar Medicaid deficit will devastate Louisiana economy.html If this year’s state budget crisis was fun. according to the Bureau of Economic Analysis. This coming October. “Insurance. Louisiana's impending dramatic decrease in federal funding is due to what the governor says is a faulty calculation of sources of income in the state. “This formula will put severe pressure on health-care funding. We hope that the Obama administration and Congress listen.a dramatic.S. That figure goes far beyond wages and salaries . [Mardjuki] http://www. including insurance and Road Home payments after the 2005 storms. The problem? Louisiana’s income was artificially inflated by insurance payments and federal aid in the wake of the hurricanes of 2005.0 LO 78 Louisiana – Medicaid Deficit Louisiana set to run into a $1 billion Medicaid shortfall – drop in federal funding and miscalculated budget.” Jindal’s top health aide. Mary Landrieu. ABC News. Louisiana might face significant new budget cuts in the 2011 fiscal year that begins next July 1. higher-education funding and other key Louisiana priorities. Bobby Jindal says post-storm damage payments from insurance settlements and Louisiana's Road Home program following Hurricanes Katrina and Rita are contributing to a $1 billion Medicaid shortfall for his state. That rate is determined by a formula based on total personal income in the state.” Jindal said. Bobby Jindal and U. with the full impact starting January 2011. but it is an argument that is going to be heard. Within the next year.2theadvocate. If the reimbursement rate is adjusted for that bogus “income. recently met on the problem.. is temporarily enhanced by the federal stimulus.” http://www. And then. From 2005 to 2007. not only does Medicaid reimbursement take another dive.claimsjournal. members of Congress might be reluctant to make even this one change because the nonpolitical formula should be preserved against future raids. We hope Landrieu and the state’s delegation in Congress can plot a way through this thicket. Louisiana's Medicaid funding.” Louisiana faces a shortfall in the hundreds of millions of dollars per year. D-La. Alan Levine. Louisiana's per-capita income is reported to have increased by 42 percent . Jindal says Louisiana's reimbursement rate will drop from as high as 73 percent to 60 percent . the federal reimbursement for Medicaid — the principal medical program for the poor — is in the range of 70 percent of the cost of the care.com/news/southcentral/2009/07/22/102426. Medicaid. because of the hugely exceptional circumstances of the 2005 hurricanes. Because Louisiana is a relatively poor state. The state will start seeing this loss of funding this October. “Our Views: Medicaid rate hits Louisiana. the governor's office said. Federal Payouts Create Medicaid Problem in Louisiana.including all payments from all sources. 7/22/09. the state government is going hat-in-hand to the U.htm?print=1 [Mardjuki] Associated Press. Jindall's office says he is trying to work out a solution with federal officials over the looming crisis. has been to Washington to press the state’s case for relief. “The people of Louisiana have been devastated by four major storms in just over three years and they’re fighting to get back on their feet. Overall. Sen. as calculated by the independent Bureau of Economic Analysis. calculates payment schedules to the states based on per-capita income. Finally. wait until next year.S.com/opinion/51360777. it will decrease to 67 percent. Louisiana Governor’s Office. according to the governor's office. You’re A Jerk 78 .forcing cuts to either public health or higher education. 7/22/09.Single Payer 2. Further. and then will decrease to 63 percent in October 2010. sudden increase which will drop the state's federal Medicaid funding. but the state’s case for assistance is clouded by political concerns. Louisiana. government for more than $700 million in Medicaid funds. Gov.” with the state’s woes after the hurricanes receding in national consciousness.” WBRZ News 2. The drop from 72 to 63 percent will cost the state an estimated $700 million per year. which would normally be 72 percent. there are ballooning federal budget deficits — for which Jindal is trying to score political points by criticizing President Barack Obama. We don’t agree with the latter position. in 2011.a decrease almost twice that of the state with the next largest decrease. North Dakota. Louisiana Gov.

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8 in May.000 again. You’re A Jerk 81 . if one cannot qualify for a mortgage or auto loan one does not spend what savings they have for a downpayment. The retrenchment in consumer sentiment can only be traced to further deterioration in the real economy. incomes are not in a position to pick up the slack for access to credit. 2009 (“Falling Consumer Confidence Foreshadows Worsening Jobs Outlook” outlook/ http://www. income. Those anticipating more jobs in the months ahead decreased to 17. Fine. Based on an increase in the value of the stock markets and the constant press coverage for green-shoots and an improving economic picture. The news coverage in May and June has been positive. The credit markets remain broken. Only meaningful intervention from Washington will fix the credit markets within the next few years. The economy is made up of spending based on access to cash.escapethenewgreatdepression. They may seek to demean the data for the unemployment rate and call it once again a lagging indicator. or credit. Access to cash can come from savings. but weekly unemployment claims are not a lagging indicator.3 percent from 25.3 from a reading of 54.Single Payer 2. The weekly claims number released this week will be part of the July unemployment report. while those anticipating fewer jobs increased to 27. Prometheus Wealth Management. The rational response to a deteriorating economy even for those with access to credit is to save more. The Conference Board stated “the job outlook was also more pessimistic.0 LO 81 Consumer Confidence Low Now Consumer confidence is tanking the economy Michael A. then the unemployment rate reported for June could approach 10%. That leaves savings. The survey is a measure of attitudes and feelings. As long as credit remains extremely tight the economy has to rely on savings and income.” If this survey is accurate. Plus.3 percent. The drop is especially significant since people receiving a paycheck had fewer payroll related taxes withheld from their checks. When the economy improves employers first slow down their rate of layoffs. the decline in confidence in June has come as a cold slapped in the face to those looking for an imminent rebound in the economy.com/2009/06/30/falling-consumer-confidence-foreshadows-worsening-jobs- The Consumer Confidence Index fell in June to a reading of 49. This week they could get well get a wakeup call when the unemployment data is released. He earned a Master's Degree in Business Administration from Baylor on June 30. The weekly number has to begin to improve before the unemployment rate can improve. Access to credit remains as tight as ever for both consumers and businesses. Kamperman runs his own investment advisory firm. Then employers have their existing workforce work longer hours. If that number is above 600. The credit markets and the economy will not heal on their own in the near term. The green-shoot crowd expected confidence to continue rising. then we will know the July unemployment report will also be weak.4 percent from 19. Washington has gone on a wait and watch approach to the economy. What I found ominous in the report was the consumer outlook for employment.6 percent. But with unemployment rising and unemployment benefits starting to run out for those that lost their jobs last summer and fall. Finally employers hire and the unemployment rate begins to go down.

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Lashout ! Scenario
A) Growth is critical to preventing ineffective forms of intervention that risk nuclear holocaust and wars.
Foster, Ph.D professor @ University of Oregon, 09 (John Bellamy Foster, Ph.D professor @ University of Oregon, March 2009, “A Failed System: The World Crisis of Capitalist Globalization and its Impact,” Monthly Review; 60.10; Wilson Social Sciences Abstracts) As the foregoing indicates, the world is currently facing the threat of a new world deflation-depression, worse than anything seen since the 1930s. The ecological problem has reached a level that the entire planet as we know it is now threatened. Neoliberal capitalism appears to be at an end, along with what some have called "neoliberalism 'with Chinese characteristics.'''54 Declining U.S. hegemony, coupled with current U.S. attempts militarily to restore its global hegemony through the so called War on Terror, threaten wider wars and nuclear holocausts. The one common denominator accounting for all of these crises is the current phase of global monopoly~financed capital. The fault lines are most obvious in terms of the peril to the planet. As Evo Morales, president of Bolivia, has recently stated: "Under capitalism we are not human beings but consumers. Under capitalism mother earth does not exist, instead there are raw materials." In reality, "the earth is much more important than [the] stock exchanges of Wall Street and the world. [yet,] while the United States and the European Union allocate 4,100 billion dollars to save the bankers from a financial crisis that they themselves have caused, programs on climate change get 313 times less, that is to say, only 13 billion dollars.

B) Absent growth, the U.S. will intervene in desperation, triggering lashout and nuclear holocaust.
Burrows, Director of the Analysis and Production Staff in the National Intelligence Council, 09 (Mathew J. Burrows, Director of the Analysis and Production Staff in the National Intelligence Council, 2009, “Revisiting the Future: Geopolitical Effects of the Financial Crisis,” The Washington Quarterly) Types of conflict that the world continues to experience, such as over resources, could reemerge, particularly if protectionism grows and there is a resort to neo-mercantilist practices. Perceptions of renewed energy scarcity will drive countries to take actions to assure their future access to energy supplies. In the worst case, this could result in interstate conflicts if government leaders deem assured access to energy resources, for example, to be essential for maintaining domestic stability and the survival of their regime. Even actions short of war, however, will have important geopolitical implications. Maritime security concerns are providing a rationale for naval buildups and modernization efforts, such as China’s and India’s development of blue water naval capabilities. If the fiscal stimulus focus for these countries indeed turns inward, one of the most obvious funding targets may be military. Buildup of regional naval capabilities could lead to increased tensions, rivalries, and counterbalancing moves, but it also will create opportunities for multinational cooperation in protecting critical sea lanes. With water also becoming scarcer in Asia and the Middle East, cooperation to manage changing water resources is likely to be increasingly difficult both within and between states in a more dog-eat-dog world.

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China ! Scenario (1/2)
A. China will capitalize on the immediate recession and establish itself as the global financial hub.
AFP, Agence France Presse, 08 (AFP, Agence France Presse, November 5, 2008, “'Go East': China Inc. recruiting in gloomy London, New York,” http://afp.google.com/article/ALeqM5gQZZNGoiTxqAkAjWJEnWJwAISZsg) SHANGHAI (AFP) — Spotting an opening in the global fight for talent, China's ambitious financial institutions are planning recruiting trips to London and Wall Street on the wounded financial titans' home turf. Sovereign fund China Investment Corporation has begun a global search, multi-billion dollar Chinese-French fund Fortune SGAM plans interviews on Wall Street and Shanghai's government is headed to London and New York next month with job offers in hand. "There are layoffs on Wall Street since the crisis but China's financial industry is still in its infancy and is hungry for talent," Pei Changjiang, chief executive of the Fortune SGAM Fund, told AFP. It is estimated that the economic turmoil could lead to 165,000 job losses in New York over the next two years, while British think tank Oxford Economics predicts 194,000 job cuts in London over the same period. But from Shanghai the message to the brightest finance minds is unmistakable: China is hiring. Han Zheng, mayor of the China's rapidly growing economic hub, has previously said by 2010 -- when Shanghai hosts the World Expo -- the city will have an infrastructure worthy of an international financial centre. By 2020, he said, it will be one. Since the financial crisis, city officials are saying that could now come even sooner The crisis has presented a rare lesson and opportunity and generally it will help accelerate the establishment of Shanghai as a global financial hub," said the city's deputy mayor in charge of economic affairs, Tu Guangshao. "The US is a fatty and needs to take diet pills but in contrast China is still skinny... It needs to build a strong body," the former vice-chairman of China's securities watchdog wrote in an opinion piece in the official China Business newspaper. More than 600 financial institutions had offices in Shanghai at the beginning of the year but finance jobs account for only 2.4 percent of the 9.1 million-strong workforce, compared to 11 percent in London and 12.7 percent in New York. "More foreign financial institutions will be willing to operate in China, where financial service is in short supply, as their business at home contracts," said Fang Xinghai, director of the city's Financial Services Office.

B. That results in a Sino-American war over Taiwan.
Mearsheimer, professor of Political Science at the University of Chicago, 04 (John Mearsheimer, professor of Political Science at the University of Chicago, September 17, 2004, “Why China’s Rise Will Not Be Peaceful,” http://mearsheimer.uchicago.edu/pdfs/A0034b.pdf) The question at hand is simple and profound: can China rise peacefully? My answer is no. If China continues its impressive economic growth over the next few decades, the United States and China are likely to engage in an intense security competition with considerable potential for war. Most of China’s neighbors, to include India, Japan, Singapore, South Korea, Russia, and Vietnam, will join with the United States to contain China’s power. <<< CONTINUES – 20 PARAGRAPHS LATER – BREAK IN TEXT >>> China is likely to try to dominate Asia the way the United States dominates the Western Hemisphere. Specifically, China will seek to maximize the power gap between itself and its neighbors, especially Japan and Russia. China will want to make sure that it is so powerful that no state in Asia has the wherewithal to threaten it. It is unlikely that China will pursue military superiority so that it can go on a rampage and conquer other Asian countries, although that is always possible. Instead, it is more likely that it will want to dictate the boundaries of acceptable behavior to neighboring countries, much the way the United States makes it clear to other states in the Americas that it is the boss. Gaining regional hegemony, I might add, is probably the only way that China will get Taiwan back. An increasingly powerful China is also likely to try to push the United States out of Asia, much the way the United States pushed the European great powers out of the Western Hemisphere. We should expect China to come up with its own version of the Monroe Doctrine, as Japan did in the 1930s. These policy goals make good strategic sense for China. Beijing should want a militarily weak Japan and Russia as its neighbors, just as the United States prefers a militarily weak Canada and Mexico on its borders. What state in its right mind would want other powerful states located in its region? All Chinese surely remember what happened in the last century when Japan was powerful and China was weak. In the anarchic world of international politcs, it is better to be Godzilla than Bambi. Furthermore, why would a powerful China accept U.S. military forces operating in its backyard? American policymakers, after all, go ballistic when other great powers send military forces into the Western Hemisphere. Those foreign forces are invariably seen as a potential threat to American security. The same logic should apply to China. Why would China feel safe with (continues…no text removed)

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of course. He said military leaders considered the use of nuclear weapons mandatory if the country risked dismemberment as a result of foreign intervention. as well as smaller powers like Singapore. each armed with its own nuclear arsenal.truce or a broadened war. “Regional Fallout: No one gains in war over Taiwan. commander of the US Eighth Army which fought against the Chinese in the Korean War. If China were to retaliate. hostilities between India and Pakistan. there is little hope of winning a war against China 50 years later. a personal account of the military and political aspects of the conflict and its implications on future US foreign policy. allowing China to control that large island. told a gathering at the Woodrow Wilson International Centre for Scholars in Washington that although the government still abided by that principle. are worried about China’s ascendancy and are looking for ways to contain it. Germany. and Vietnam. much the way Britain. would not China’s security be better served by pushing the American military out of Asia? Why should we expect China to act any differently than the United States did? Are they more principled than we are? More ethical? Less nationalistic? Less concerned about their survival? They are none of these things. In the end. which could have led to the use of nuclear weapons. There would be no victors in such a war. which is sure to infuriate China and fuel the security competition between Beijing and Washington. While the prospect of a nuclear Armaggedon over Taiwan might seem inconceivable. which is why China is likely to imitate the United States and attempt to become a regional hegemon. Will a full-scale Sino-US war lead to a nuclear war? According to General Matthew Ridgeway. as well as Japan. there were strong pressures from the military to drop it. In fact. As it demonstrated in the twentieth century. If the US had to resort to nuclear weaponry to defeat China long before the latter acquired a similar capability. Therefore. this means South Korea. then a full-scale war becomes unavoidable.0 LO 85 China ! Scenario (2/2) (Continues…no text removed) U. and Russia. In essence. they will join an American-led balancing coalition to check China’s rise. Indeed. president of the military-funded Institute for Strategic Studies. Singapore.” Lexis) THE high-intensity scenario postulates a cross-strait war escalating into a full-scale war between the US and China. Extinction. THE AMERICAN RESPONSE It is clear from the historical record how American policymakers will react if China attempts to dominate Asia. Gen Ridgeway said that US was confronted with two choices in Korea -. Gen Ridgeway said that should that come to pass. the United States can be expected to go to great lengths to contain China and ultimately weaken it to the point where it is no longer capable of ruling the roost in Asia. for China puts sovereignty above everything else.Single Payer 2.S. and even China. and they too will do whatever they can to prevent it from achieving regional hegemony. Finally. the United States is likely to behave towards China much the way it behaved towards the Soviet Union during the Cold War. A Chinese military officer disclosed recently that Beijing was considering a review of its "non first use" principle regarding nuclear weapons. And the conflagration may not end there as opportunistic powers elsewhere may try to overturn the existing world order. given Taiwan’s strategic importance for controlling the sea lanes in East Asia. Taiwan is likely to be an important player in the antiChina balancing coalition. Beijing has already told the US and Japan privately that it considers any country providing bases and logistics support to any US forces attacking China as belligerent parties open to its retaliation. short of using nuclear weapons. The US estimates that China possesses about 20 nuclear warheads that can destroy major American cities. Japan. it is hard to imagine the United States . we would see the destruction of civilisation. In south Asia. China’s neighbors are certain to fear its rise as well. joined forces with the United States to contain the Soviet Union during the Cold War. If Washington were to conclude that splitting China would better serve its national interests. it cannot be ruled out entirely. there is already substantial evidence that countries like India. C. the US had at the time thought of using nuclear weapons against China to save the US from military defeat. Conflict on such a scale would embroil other countries far and near and -. Beijing also seems prepared to go for the nuclear option. could enter a new and dangerous phase.raise the possibility of a nuclear war. it is determined to remain the world’s only regional hegemon. You’re A Jerk 85 . Major-General Pan Zhangqiang. Italy. Straits Times 2k (Straits Times. South Korea. Japan.horror of horrors -. Japan. forces deployed on its doorstep? Following the logic of the Monroe Doctrine. France. In his book The Korean War. The balance of power in the Middle East may be similarly upset by the likes of Iraq. the Philippines and. east Asia will be set on fire. In the region. With the US distracted. June 25. 2000. Russia may seek to redefine Europe's political landscape. The United States does not tolerate peer competitors. to a lesser extent.

massively increasing the number of casualties and potentially triggering a full-scale nuclear conflict.C.Single Payer 2. and training procedures necessary to conduct sophisticated attacks—and newly emergent collections of the angry and disenfranchised that become selfradicalized. office.0 LO 86 Terror ! Scenario A. You’re A Jerk 86 . there would be immense political pressure in the United States to discover the perpetrators and retaliate with nuclear weapons. Director of the Analysis and Production Staff in the National Intelligence Council. 1427. Dunn & Crutcher's Washington. Dunn & Crutcher's Washington. Extinction. Lexis) The potential consequences of the unchecked spread of nuclear knowledge and material to terrorist groups that seek to cause mass destruction in the United States are truly horrifying. Terrorist groups in 2025 will likely be a combination of descendants of long established groups— Inheriting organizational structures. 09 (Mathew J. J.C. associate in Gibson. Burrows. 49 Moreover. Terrorism’s appeal will decline if economic growth continues in the Middle East and youth unemployment is reduced.” The Washington Quarterly) In surveying those risks. Director of the Analysis and Production Staff in the National Intelligence Council. associate in Gibson. Rev. the diffusion of technologies and scientific knowledge will place some of the world’s most dangerous capabilities within their reach.D. however. 2009.. D. 50 In addition to the threat posed by terrorists. Speice. Economic growth is critical to preventing WMD terrorism. particularly in the absence of economic outlets that would become narrower in an economic downturn. J. 51 This proliferation will increase the risk of nuclear attacks against the United States [*1440] or its allies by hostile states. For those terrorist groups that remain active in 2025. A terrorist attack with a nuclear weapon would be devastating in terms of immediate human and economic losses . office. D. February 2006.. Burrows. the report stressed the likelihood that terrorism and nonproliferation will remain priorities even as resource issues move up on the international agenda. 47 Wm and Mary L. leakage of nuclear knowledge and material from Russia will reduce the barriers that states with nuclear ambitions face and may trigger widespread proliferation of nuclear weapons. “Revisiting the Future: Geopolitical Effects of the Financial Crisis. command and control processes. B.D. 06 (Patrick Speice. 52 as well as increase the likelihood that regional conflicts will draw in the United States and escalate to the use of nuclear weapons.

Single Payer 2.0 LO 87 **COMPETITIVENESS** You’re A Jerk 87 .

Singapore. other countries merely followed the U. You’re A Jerk 88 . globalization cuts both ways: it is both a potent catalyst of U. the personal computer. and the most serious challenge is coming from Asia.S.S. Foreign Affairs. scientific innovation and technological entrepreneurship have ensured the country's economic prosperity and military power.org/20041101facomment83601/adam-segal/is-america-losing-its-edge. supplying.Single Payer 2. the United States must get better at fostering technological entrepreneurship at home. The United States will never be able to prevent rivals from developing new technologies. South Korea. Today.html] The United States' global primacy depends in large part on its ability to develop new technologies and industries faster than anyone else. and advanced materials used in semiconductors. to keep its privileged position in the world. For the last five decades. as the United States is learning. and Taiwan is rising. and managing database and other types of software for clients around the world.S. it can remain dominant only by continuing to innovate faster than everyone else. and preferential policies for science and technology (S&T) personnel. advantage in the manufacture of computer chips and telecommunications software.foreignaffairs. U. however. South Korea has rapidly eaten away at the U. biotechnology. Through competitive tax policies. the globalization of research and development is exerting considerable pressures on the American system. aerospace. It was Americans who invented and commercialized the semiconductor. The percentage of patents issued to and science journal articles published by scientists in China. developing. And even China has made impressive gains in advanced technologies such as lasers. and the Internet. Although the United States' technical dominance remains solid. Indian companies are quickly becoming the second-largest producers of application services in the world. http://www. increased investment in research and development (R&D).0 LO 88 Competitiveness K2 Heg Competitiveness is key to US hegemony and economy Segal 04 – Senior Fellow in China Studies at the Council on Foreign Relations [Adam.S. But this won't be easy. and many other types of manufacturing. Indeed. lead. “Is America Losing Its Edge?” November / December 2004. technological innovation and a significant threat to it. Asian governments are improving the quality of their science and ensuring the exploitation of future innovations. this technological edge-so long taken for granted-may be slipping.

which now holds only 260 prisoners. a lot of things in life are complicated. too.Turkey. But there is one pattern that comes very close to being a law of history: in the long run. U.0 LO 89 Econ K2 Heg A strong economy is key to military strength and sustainable hegemony.the gift that keeps on giving to the United States' enemies. reviving it is as important to the nation's long-term security as is keeping U.Single Payer 2.S. two areas of weakness must be repaired: the domestic economy and the United States' reputation in the world. military strength unchallengeable. including the five neighboring countries at the center of the arc of crisis that directly threatens the United States' national security -. Richard Holbrooke. Although the economy is usually treated as a domestic issue. closing it is complicated. imperial China. Afghanistan. “The Next President: Mastering a Daunting Agenda” To restore the United States to its proper world leadership role. Rome. Presidential directives making clear that the U.not because it is nice to be popular but because respect is a precondition for legitimate leadership and enduring influence.S. A NEW FACTOR History is not immutable. the rise and fall of great nations is driven primarily by their economic strength. is not just desirable but imperative. Because the Bush administration limited itself to punishing only those at the very bottom of the chain of command at Abu Ghraib. to repair the economy in the long term. You’re A Jerk 89 . Cuba. Portugal.all had their day. Venice. the Netherlands. A few early actions that lie wholly within his authority can make an immediate impact. Ambassador to the United Nations from 1999 to 2001. The president should address both issues as early as possible in order to strengthen his hand as he tackles pressing strategic issues. government does not tolerate or condone torture are necessary in order to separate the new administration from that costly legacy. a new national policy on energy and climate change will be essential. And restoring respect for American values and leadership is essential -. The most compelling such actions would be issuing a clear official ban on torture and closing the detention facility at Guantánamo Bay. the United Kingdom -. and Pakistan. This will require more than a cyclical upturn. the damage to the United States' image has been immense and continuing -. Well. no matter how difficult. As for Guantánamo. Iran. Guantánamo must not become the next president's albatross. as Bush administration apologists (and many lawyers) say.S. closing it. Iraq. and their international decline followed inexorably from their economic decline. France. Foreign Affairs September/October 08. Current Chair of Asia Society.

People whose grandparents survived the Great Leap Forward and whose parents endured the Cultural Revolution can surely cope with a decline in the growth rate from 11 to 6 per cent. and the biggest. By 1907. China is imbued with a remarkable sense of patriotism that is not just a product of Communist Party propaganda. the Chinese are understandably alarmed by this tsunami of red ink. Of course. China has not been wholly unscathed by the astonishing collapse of exports that struck Asian economies in late 2008 and early 2009. a Wall Street crash could send a shockwave across the entire British Empire. JP Morgan Chase. Last week's financial market action . In April. To be sure. According to Bank Credit Analyst research.84 trillion deficit.has an almost imperial character to it. a harbinger of a new era of American power. 9 (Niall.3 per cent a year between now and 2013. no amount of stimulus can swiftly reduce the debt burden weighing down America's over-leveraged consumers. after all.while China's is forecast to grow by more than 6 per cent. Net imports of iron ore leapt by a third. you'll soon find Martin Jacques's darkly visionary When China Rules the World. Yet I do not believe (as some Sino-pessimists do) that the regime in Beijing faces a serious threat of social unrest. the US economy will contract by 2. If that calculation is correct. Three years ago. But house prices are still falling at close to 20 per cent year on year. is rated fifth. a crisis in the market for subprime mortgages could signal the waning of US hegemony and the advent of a Chinese century. The rate of foreclosures per month is still rising.which saw both bonds and the dollar drop sharply . Indeed. The economy will do better in the current quarter than in the last one. “The Trillion Dollar Question. You don't need a Nobel prize in economics to know that $100 billion won't finance much of a $1. the People's Daily acknowledged the "global importance and influence'' of Chimerica. China's holdings of US Treasuries rose $23. Ferguson. they are to history what earthquakes are to geology. Like other rising powers in past centuries. After two wretched centuries. compared with $418 billion last year. China's stimulus is worth less in dollar terms . In short. The spouse with the money generally wins the argument. fixed investment surged by nearly 34 per cent. In 2006. who predicted just a few years ago that China's gross domestic product could equal that of the United States by 2027. People are proud of their country's economic miracle over the past 30 years.Single Payer 2. Today the top three are all Chinese. It's a measure of China's new economic influence that commodity traders attribute much of the recent upward pressure on oil. but also as an investor . It was the disastrous Mississippi Bubble of 1718-19 that fatally weakened ancien régime France. when the balance of power tilts decisively away from an established power and towards a rising challenger? It is possible.$585 billion . they believe China is on the way back. alongside Fareed Zakaria's prophetic The Post-American World.0 LO 90 Econ Decline Killing Heg Now Economic decline is killing US hegemony now. it may be time to start believing the projections made by Jim O'Neill and his colleagues at Goldman Sachs. And what debts! The US federal government's deficit this year will be $1. in much the same way. financial crises in the United States had only marginal effects on the City of London. and imports of oil by just under 14 per cent. The US stimulus package . measured by market capitalisation. Not since the Second World War has the gap between income and spending been so huge.roughly half of total expenditure and nearly 13 per cent of GDP. According to the International Monetary Fund.worth $787 billion . the Congressional Budget Office anticipates that total debt will nearly double in the decade ahead. but warned of an impending "period of chillness''. It was inflation that undermined the foundations of Habsburg power and opened the way for the Dutch Republic. China is still piling up those dollar-denominated bonds.but Beijing is clearly getting more bangs for its bucks.7 billion. Moreover. Something similar may be happening as a consequence of the American financial crisis that began nearly two years ago. For most of the nineteenth century. With the lion's share (around 70 per cent) of their $2 trillion of international reserves held in the form of US bonds. while Britain survived the contemporaneous South Sea Bubble with its fiscal system intact. Just consider the impact of this crisis on the United States and China. In March alone. lexis) In February. however. today it has three. Could this be one of those great turning points in history.8 per cent this year . China can play a much more assertive role in its relations with the United States.has had rather a muted impact. Especially when the argument is about the other spouse's debts. There. Financial crises often accelerate the gradual shifting of the geopolitical tectonic plates. But Deutsche Bank recently predicted that Chinese reserves will rise by only $100 billion this year. You’re A Jerk 90 . Just visit the nearest bookshop if you don't believe me. the United States had seven of the top 20 banks. including the top two. 6/2/09. for household debt to return to a more sustainable level. the Obama administration will have to junk its predictions of 3 per cent growth next year and 4 per cent the year after that. Moreover.not just as a buyer. China did not have a single bank among the world's top 20. real consumer spending would need to grow at no more than 1.84 trillion . copper and other raw material prices to Chinese purchases. China's growing presence in commodity markets in sub-Saharan Africa and South America .will have caused palpitations in Beijing. Many more Chinese than American workers have lost their jobs since this crisis began. Even before its economy becomes the world's biggest. And a crisis in commercial real estate could blow a new hole in the balance sheets of US banks. The flapping of a butterfly's wings may trigger a hurricane in the Home Counties.” The Daily Telegraph.

like many independent economists . you’ve undermined the basis for the rest of your policies. You’re A Jerk 91 . White House officials rebuff such suggestions.” CBS News/Politico. 4 percent growth in 2011.0 LO 91 Econ K2 Obama Agenda Econ key to Obama’s agenda – must follow through on high expectations and promises. Alternately. it is now just shy of 10 percent. if Obama clings to current optimistic forecasts for long-term growth.” he added. even if that delays an economic recovery. a bare majority . The administration is already under intense pressure over its economic calculations on the most politically sensitive statistic: employment.2 percent growth in 2013.2 percent growth next year. a miscalculation that would mean budget deficits will be much higher than the administration is now acknowledging. But a series of POLITICO interviews in recent days with independent economists of varied political stripes found widespread disdain for Obama’s first round of assumptions.cbsnews. the poll found. too.Single Payer 2. chairwoman of the White House’s Council of Economic Advisers.precisely the sort of charge he once leveled against the Bush administration. http://www.shtml [Mardjuki] President Barack Obama’s economic forecasts for long-term growth are too optimistic. 7/14/09. The White House will be forced to confront the disconnect between its original. down from 56 percent in February. She said the White House will be updating its official forecasts. It creates the basis for the revenues you need for health care and climate change. 4. under ordinary circumstances. is the kind of earnest-but-dull document that causes many Washington eyes to glaze over.” said Robert Shapiro. The new numbers will come as part of a semiannual review that. Deficit figures do not pack the same emotional punch as unemployment lines do.6 percent growth in 2012 and 4. where even the administration’s current debt projections already are prompting deep concerns on political and substantive grounds. and that’s understandable because a quick recovery makes the rest of the agenda possible. the new forecasts . Higher deficit figures also would arrive at a critical moment in the health care debate. saying the midyear correction is precisely intended to keep their economic program reality based. This time. managing editor. a former Clinton economic adviser. said in a POLITICO interview that the administration . he risks accusations that he is basing his fiscal plans on fictitious assumptions . “They used a rosy forecast.51 percent .could send a jolt through Capitol Hill. many economists warn. 58 percent said the president and Congress should focus on keeping deficits down. “Experts: Obama Too Optimistic on Economy.of respondents approved of Obama’s handling of the economy. however. upbeat predictions and the mainstream consensus about how the economy is likely to perform in a new budget forecast to be unveiled next month. “But it’s also dangerous and risky because if the forecast doesn’t come true. And the general public is paying attention. Christina Romer. In addition.did not fully anticipate the severity and pace of this recession. But they matter greatly to policymakers and the financial markets as a measure of whether the country can afford Obama’s big agenda.com/stories/2009/07/14/politics/politico/main5157452.” Obama’s current forecasts envision 3. as lawmakers are already struggling to find a way to pay for the president’s nearly $1 trillion reform package. Jeanne.if they are anything like what many outside economists expect . In a June NBC/Wall Street Journal poll. The administration once vowed to use stimulus policies to keep the jobless rate below 8 percent. Cummings. with some experts invoking such phrases as “rosy” and “fantasy.

pnhp. You’re A Jerk 92 .66 clerical workers per doctor. obviating the need for administratively complex per-patient billing. The average US hospital spends one-quarter of its budget on billing and administration.php) [LO//JW] In contrast to CDH. “Our Health Care System at a Crossroads: Single Payer or Market Reform?” www. No nation with NHI spends even half as much administering care nor tolerates the bureaucratic intrusions in clinical care that have become routine in the United States. 11/07. Indeed.org/news/2008/may/our_health_care_syst. is about half the US level. are paid a global annual budget to cover all costs. American physicians spend nearly 8 hours per week on paperwork and employ 1. nearly twice the average in Canada. much as a fire department is funded in the United States. Canadian hospitals. Proponents of NHI. nonprofit institutions. administrative overhead in Canada’s health system. fee-for-service–based practice. which are mostly private. MD. most of whom are in private practice. which resembles that of the United States in its emphasis on private. and Steffie Woolhandler. neither piecemeal tinkering nor wholesale computerization can achieve significant bureaucratic savings. dept Medicine Harvard. MD. Fee schedules are negotiated annually between provincial medical associations and governments. enough to fully cover the uninsured and to upgrade coverage for those now underinsured. Physicians for a National Health Program of Chicago. MD + MPH. Unfortunately. Himmelstein.Single Payer 2. a properly structured NHI program could expand coverage without increasing costs by reducing the huge health administrative apparatus that now consumes 31% of total health spending.0 LO 92 HC Reform Key to Econ National Health Insurance would cut annual costs by $300 billion. far more than in Canada. And HMOs inflict mountains of paperwork on doctors and hospitals. Health care’s enormous bureaucratic burden is a peculiarly American phenomenon. disinterested civil servants and . Canada’s NHI has 1% overhead and even US Medicare takes less than 4%. bill by checking a box on a simple insurance form. All patients have the same coverage. 15% of current health spending Himmelstein. The Department of Medicine at Cambridge Health Alliance/Harvard Medical School. The key to administrative simplicity in Canada and other nations is single-source payment. ‘07 (David U. and even skeptics all agree on this point. Our biggest HMOs keep 20%—even 25%—of premiums for their overhead and profit. Reducing our bureaucratic apparatus to Canadian levels would save about 15% of current health spending. Canadian physicians. and Woolhandler. $300 billion annually.

000 last year. S&P 500 stock index's rebound by nearly 40 percent since it sagged to a 12-year closing low of 676 points on March 9 is not sustainable. While gold may have already topped at above $1. crude oil hit a record peak above $147 per barrel and was just above $57 per barrel around noon on Thursday. "I think we are going to have bouts of deflation separated by recoveries. U.com/2009/06/23/news/economy/inflation_deflation_debate/index. " I think the next leg down will be at least as severe if not more severe than what we just experienced." Prechter said. believing the precious metal made a major peak when it rose above $1. who forecast the 1987 stock market crash. or a drop in prices. the government's key inflation measure. predicted this week that U. with huge government debt issuance being the main catalyst. Treasury bonds are also locked in long term bear markets. and Mnyandu 5/14 John Parry. I don't see how businesses can raise prices in this environment. banking system and company earnings sustain more damage from a financial crisis that's akin to the Great Depression. "It's not the start of a new bull market. senior writer for CNN Money. equities may plunge to half their lows hit in March as a deflationary depression bites. leading to job loss and decreased production Isidore.Single Payer 2. Unemployment continues to rise. And while lower prices might sound like a positive to consumers with budgets stretched to the breaking point.000 an ounce in March 2008. SEVEN MORE YEARS? Riskier assets such as commodities. The Consumer Price Index. Businesses unable to make a profit in an environment of declining prices will likely cut production and lay off more workers. "It's a very rare event." he told Reuters in a wide ranging interview. are likely to have short lived intense rallies. it's going to lead to a depression. and Ellis Mnyandu . In July." he said. coupled with rising unemployment and low factory utilization. senior writer for CNNMoney. "Our models are (showing) right now that it is a much bigger bear market than most people realize. That could cause a deflationary spiral.0 LO 93 Deflation Coming Deflation is a pertinent threat in the short-term and could lead to a deflationary spiral. “The inflation vs. he said.Longtime technical analyst Robert Prechter. Georgia. "the difficulties will probably last through about 2016. he said. "I think the predominant risk in the next 6 to 12 months is deflation.cnn.com. The U. "There will be plenty of rallies along the way. Prechter continues to advocate safer cash proxies such as Treasury bills. We're not at the bottom yet." said Mark Zandi. Hathaim Haddadin." Prechter also painted a bleak picture for commodities like silver and is largely unenthusiastic about gold. The Great Depression and Japan's so-called Lost Decade of economic stagnation are both well-documented examples of the damage that deflation can cause.S.S.S. You’re A Jerk 93 ." which warned of the dangers of a U. 7/23 Chris Isidore.htm?postversion=2009062313 But others argue the economy is still so weak that deflation." he added. and stocks which are currently anticipating that the severe global economic downturn may be bottoming. There's vacant real estate across all property types. hit a five-decade low of 2. corporate bonds. reporters for Reuters “Stocks still face deflationary collapse: Prechter” http://www." Oil may rally further from current levels just below $60 per barrel but the upside will be capped at about $80 per barrel as the commodity is locked in a long-term bear market. which moves inversely to its price. something along the lines of 1929-1932.S. is the more serious threat. posted its largest 12-month drop since 1950 in May." said Prechter. Prechter said in an interview with Reuters. 10-year Treasury note yield.com/article/wtUSInvestingNews/idUSTRE54D4IL20090514?pageNumber=2&virtualBrandChannel=0 NEW YORK (Reuters) ." he said.S. but within an inexorable long-term decline that may last another seven years." Experts believe that deflation and depression will come soon Parry. Treasury bond prices are likely to fall in a long term bear market. This year-over-year decline in prices. As in his 2002 book "Conquer the Crash.S. Haddadin. Oil and U. "There's excess capacity everywhere.reuters. " Deflation is coming. So you want to stay on the side of safety. deflation debate” http://money. chief economist at Moody's Economy. could be signs that prices are likely to keep falling. he said. economists are in general agreement that deflation is far more destructive to the economy than inflation. The benchmark U. As banks continue to accumulate losses and corporate earnings fall. chief executive at research company Elliott Wave International in Gainesville.04 percent in mid-December. while corporate bond prices will plunge precipitously by next year as broad economy. debt bubble and deflationary depression.

in the worst case scenario. a viral attack on the economy.for their income. Earnings may shrink. Deflation throws that process into reverse. Home prices. And several economists say they are far more worried about the threat of deflation now than they have been in the past. people buy now. but ultimately their salaries are paid from the taxes levied on earnings and. deflation in Britain has become a real possibility. Anyone in the private sector relies on prices of some sort .Japan was plagued by deflation in the Nineties and it caused havoc with its economy. It is called deflation and there have been new warnings about it from the Bank of England.Lower prices are probably at the bottom of the list of most Americans' current economic worries. It is little use a greengrocer rejoicing over a shrinking fuel bill if the prices he can charge for his produce are also dwindling. As people hold off. “The growing threat of deflation” http://money. senior writer for CNN Money.be it the cost of a cup of tea for a cafe owner or fees for an architect . That is why the Bank of England's job is to hold inflation not at zero but at two per cent a year.thisismoney. When inflation is high. A widespread drop in prices is known as deflation. the adult equivalent of being given the run of a sweet shop. Moderate inflation is useful.that is. Put simply. It makes no sense to buy now what will be cheaper next week or next month. That results in growing job losses. This inevitably bears down on economic activity. So we're all in the same boat. senior writer for CNNMoney. you become better off. Without lifting a finger. your pound goes further.Single Payer 2. worsening the squeeze. but borrowings remain stubbornly of the same size.html?in_article_id=468029&in_page_id=2 For anyone living on a budget . The biggest problem with deflation is that when businesses need to continually cut prices to spur sales. deflation causes chaos on a number of fronts. But for a growing number of economists. Public-sector workers are better protected for a while. and could. and they should know . 08 Chris Isidore. Every month. It eats into earnings. Falling wages and constant debts mean that deflation is destructive to the economy Atkinson 09 Dan Atkinson.cnn. stock prices and even people's salaries often head lower as well. writer for ThisisMoney “Deflation: Who wins when prices fall?” http://www. thus. The Federal Reserve may also be more concerned about deflation as well. And typically. More specifically.co. Yet the feeling persists that falling prices must be beneficial. almost everyone . it's not just the price of consumer goods that fall. then your income will be sucked into the downward spiral. Deflation destroys incomes but not debts.0 LO 94 Deflation Coming Economists agree that deflation is a major possibility and could culminate in a depression Isidore.com/2008/12/17/news/economy/deflation/?postversion=2008121810 NEW YORK (CNNMoney. a moderate level helps oil the wheels of the economy. But ingrained deflation is bad for the same underlying reason that high inflation is bad: it destroys money values and confidence in the price system.com) -. This becomes a self fulfilling prophecy. prices. where does your pay come from if not from prices? Unless you are very lucky and your line of work somehow escapes the crumbling of prices. assuming that prices will be even higher next week. prices fall further. In Japan they call it 'price destruction'. You’re A Jerk 94 .the prospect of falling prices must sound like heaven.uk/news/article. they eventually respond by cutting production. With the world sliding into recession. Deflation is a general fall in the overall level of prices. While high levels of inflation are a menace. even cause a depression. it's their biggest fear. Warnings? Why would any kind of killjoy warn against this latter-day consumer paradise? The short answer is deflation is a disaster in the making.

they make sure it is funded adequately.000 Americans who die prematurely because they have no health care at all. though under the current proposal they would pay an additional 3. to defend it vociferously. In spite of this decentralized approach. Since the wealthy as well as the middle income people have no alternative. We'd have a Cadillac system for the same 16% of GDP we are spending today. increasing business competitiveness and stopping outsourcing Lohman No Date Given Jack Loman.boulder. Estimates show that Canadians produce American cars for $700 less than Americans do because of the difference in the costs of providing health care to employees. It is called single payer because there is only one "payer". This together with cost controls insures that everyone including the poor. and we'd make so businesses more competitive with their foreign competitors and keep more jobs in the United States. Each province has its own system and its own unique way of funding it. Canadian doctors make about one third less that American doctors and yet their satisfaction level is high because they have more time to practice medicine because paper work is minimized. untreated health problems. Canadians are healthier and live longer than Americans.Single Payer 2.html[LO//AS] The Canadian system is a publicly funded insurance program where costs are controlled and both hospitals and doctors are private. receives the same high quality care. Further savings occur because there is no longer a need for a health insurance component of automobile or home insurance. “Canada's Single Payer Health Care System It's Worth a Look” http://bcn. The benefits to competitiveness are obvious. More importantly. there are agreements among all provinces that provide for treatment of any Canadian citizen regardless of where the need occurs. which often is picked up by the new employer. And it would be portable. deductibles. You’re A Jerk 95 . to which Canadians can turn for basic health care. there is no alternative program. retired business owner and member of the Business Coalition for Single Payer Healthcare “Why should businesses support single-payer healthcare?” http://www.us/health/healthwatch/canada. The bankruptcy attorneys might not like it because over 50% of bankruptcies are due to health care costs. In the U. such as private health insurance. employees changing jobs would no longer suffer delays and costs for COBRA. Single payer healthcare decreases the cost of employees. Canada has a much higher percentage of general practitioners and fewer specialists. mental health. Any Canadian can go to any doctor or hospital in the country. but they'll survive.co. doctor groups buy high technology equipment and then compete for selling these services. Wakeforest Law School Graduate and Lawyer. and the costs for prescription drugs.net/why_should_businesses. but this would be offset by the elimination of co-pays. Workers would also be taxed an additional 3.0 LO 95 Increases Competitiveness Single Payer healthcare benefits spillover. There is less loss of productive labor due to absence and sickness and health care is much more practical and less expensive for companies to provide to employees. But this would be more than offset by the 10-15% of wages they'd no longer have to pay for health benefits.3%. competition has led to great redundancies in expensive equipment such as for CAT scans. vision and dental. Since there is a "single payer".3% healthcare tax on payroll. Preventive care to an entire population minimizes expensive care associated with undetected. long-term care. There is very little litigation because there is no need for awards to cover future health care costs.businesscoalition. even conservatives. who use the same system.htm Businesses would no longer provide health care. they are already covered.S. The economic advantages of the Canadian system are multi-faceted. it is easier to set up and adhere to budgetary limits. increasing competitiveness and decreasing the cost to make goods Robinson No Date Given Bruce Robinson. Effective planning eliminates duplication of facilities and expensive technology. The great success of their system causes almost all Canadian politicians. so will the 18. And we'd improve the economy as families would have more money to spend on products and services..

of Commerce. lexis] My testimony this morning will address the initiatives of the Technology Administration. p. Prepared Testimony before the House Appropriations Committee. according to leading economists. I Technological Leadership is Vital to U. technology is playing an ever increasing role at home and around the world--in securing improvements in our standard of living. accounting for as much as 50 percent of the Nation's long-term growth. Technology is the single most important driver of economic growth. NIST Director Ray Kammer will discuss the Institute's budget request. [Federal News Service. Under Secretary for Technology. as we approach the new millennium. Dept. focusing primarily on the Office of the Under Secretary and the Office of Technology Policy (US/OTP).0 LO 96 Competitiveness K2 Growth Competitiveness is key to economic growth. our quality of life. Now.Single Payer 2. the economic security of our country. Economic Growth.S. You’re A Jerk 96 .S. 3-11-1998. and the competitiveness of American companies. U. Jobs & Competitiveness Technology is the engine of economic growth. Gary Bachula.

Single Payer 2.0 LO 97 **Medicaid Reform** You’re A Jerk 97 .

But something to keep an eye on during the health reform debate is that while Medicaid expansion is good. http://yglesias. And in macroeconomic terms. You’re A Jerk 98 . the large state role in Medicaid is extremely ill-advised. and reduces severity of recessions. state Medicaid responsibilities tend to work as “automatic destabilizers. Yglesias. “Medicaid and Health Reform.php [JM] Kevin Sack and Robert Pear reporting for the New York Times raise a non-crazy worry about the health reform legislation before the congress. So that’s obviously off the table for now. Better to have the federal government pick up the bulk of the tab for expansions.thinkprogress. 7/20/09. And certainly when you become very concerned with slightly arbitrary metrics like CBO scores across a 10-year window rather than with overall fiscal responsibility. associate editor @ Atlantic Monthly and TPM Media. You’d also almost certainly get better health care coverage for poor people in most of the country.org/archives/2009/07/medicaid-and-healthreform. In general in the United States you get better “quality of government” at the federal than at the state level. acts as a macroeconomic stabilizer. To the best of my knowledge.” increasing burdens on state government just when the states can’t afford to spend money. In an ideal world.0 LO 98 Federalize Medicaid Good Federalization of Medicaid increases quality of care. My go-to guy on Medicaid issues says the House bill handles this concern fairly well. but that the Senate legislation is less clear. But even though switching the financial responsibility from the state to the federal level wouldn’t involve any net change in the tax burden or the size of the public sector. it would “look like” a big increase in taxes and spending. mandated increases in state-level Medicaid expenditures are pretty questionable policy. gubernatorial concerns that Medicaid expansion will wreak devastation on state budgets. it creates incentives to craft legislation that shunts costs onto the states thus “hiding” them from the prying eyes of the scorekeepers. you’d see a much larger federal role in Medicaid and this would reduce the severity of recessions and in general reduce the need for contentious debates about stimulus bills.Single Payer 2.” Think Progress. Matt.

but they will not be enough. It’s all too plausible to devise scenarios in which state Medicaid programs end up bearing large unanticipated costs. “Guest Graph: The Future of Medicaid” http://voices.washingtonpost. we must recognize that the budget challenge is more than a nasty episode brought on by the current downturn. failing to operate these programs with the skill and humanity that patients deserve. The impact of competing proposals for state finances has received less attention than it should.com/ezra-klein/2009/06/guest_graph_the_future_of_medi. 7-19-2009. health reform can also help by providing new forms of public or private coverage for low-income Americans who might otherwise require Medicaid. Yet painful measures are being taken in many other states. One way or another. 7-19-2009.0 LO 99 Medicaid Reform Needed Medicaid costs is the cause of state budget crisis’s Ezra Klein. Saddled with balanced-budget requirements and constrained tax bases. too. that medical improvements gradually raise average lifespan of Alzheimer’s patients in long-term care. the existing framework no longer works. Suppose. The recent stimulus package suggests another useful path. The worst is yet to come. associate editor at The American Prospect. Yet another challenge of health reform. underpaying providers. not only for poor people. the federal government must carry an increasing share of the Medicaid burden . bipartisan mismanagement of public employee health and retiree benefits. What can be done? First. They face legal and institutional constraints on deficit financing and new taxes. 2010. States’ Medicaid problems have been building for decades. In truth. states have cut financial corners for decades. As my colleague Colleen Grogan suggests. Or suppose that the firms which offer private long-term care policies run into trouble. The program has outgrown the financial and administrative capacity of state governments. “Guest Graph: The Future of Medicaid” http://voices. You’re A Jerk 99 . They bear the consequences of their severe. for example.Single Payer 2. Until December 31. delaying payment. in return for greater federal oversight over matters such as quality assurance and reimbursement.com/ezra-klein/2009/06/guest_graph_the_future_of_medi. Properly designed. These subsidies should be enlarged and made permanent.washingtonpost. Actuaries predict that state Medicaid expenditures will roughly double by 2017. Rising Medicaid expenditures undermine states’ ability to address other pressing needs.html Looking at these figures. dozens of states are cutting or constraining services at precisely the moment when these services are most needed to meet human needs and to stabilize local economies. but for millions of others. Federalized Medicaid solve long-term budget for states Ezra Klein. the federal government agreed to pay a higher matching rate to states that agreed to maintain Medicaid eligibility and benefits at roughly pre-recession levels. These fixes will help. we should recognize and embrace the fact that Medicaid has become a central pillar of the American welfare state. associate editor at The American Prospect. States also bear readily-overlooked systemic risks. you might reasonably ask: Why are states complaining? The answer is: They lack the fiscal capacity to bear the load. The cuts seem most dramatic in California.html As state and local medical expenditures cross the $300 billion mark.

so it’d be someone else’s problem. would be highly stimulative. Maybe it's time to turn the entire program over to the feds so it's not constantly a procyclical drain on the economy and be done with it. and would allow structural shifts in the private sector to proceed apace.thinkprogress. staff writer for Mother Jones. Eventually this might lead to Medicaid becoming more standardized throughout the country. we'd save a little over $10 billion. gubernatorial concerns that Medicaid expansion will wreak devastation on state budgets. That kind of thing would work quickly. My go-to guy on Medicaid issues says the House bill handles this concern fairly well. Better to have the federal government pick up the bulk of the tab for expansions. You’d also almost certainly get better health care coverage for poor people in most of the country.com/kevindrum/2009/07/let-feds-fund-medicaid If we need more stimulus. Probably this should just be done in a very crude way — some flat per capita disbursement that could be implemented very rapidly at the federal level and kick specific decisions to someone else. 7-20-2009. This would instantly save states something on the order of $100 billion or so. http://yglesias.” increasing burdens on state government just when the states can’t afford to spend money. Well. “Medicaid and Health Reform”. 7-11-2009. So that’s obviously off the table for now.php Kevin Sack and Robert Pear reporting for the New York Times raise a non-crazy worry about the health reform legislation before the congress.org/archives/2009/07/medicaid-and-health-reform. which would be $10 billion less in demanddestroying budget cuts we'd have to make. http://www. Federal only Medicaid more effective than state and lessens state’s burdens Matthew Yglesias. Here in California. the large state role in Medicaid is extremely ill-advised . mandated increases in state-level Medicaid expenditures are pretty questionable policy. In an ideal world.0 LO 100 Medicaid Reform Needed Medicaid should be funded solely by the federal government Kevin Drum. what form should it take? Matt Yglesias comments: In an ideal world at this point what I’d like to see is more aid to state and local governments. To the best of my knowledge. but that the Senate legislation is less clear. but it wouldn’t be congress or the executive branch doing the wasting. You’re A Jerk 100 .motherjones. associate editor of The Atlantic Monthly. it creates incentives to craft legislation that shunts costs onto the states thus “hiding” them from the prying eyes of the scorekeepers. But even though switching the financial responsibility from the state to the federal level wouldn’t involve any net change in the tax burden or the size of the public sector. “Let the States Fund Medicaid?”. But something to keep an eye on during the health reform debate is that while Medicaid expansion is good. state Medicaid responsibilities tend to work as “automatic destabilizers. And in macroeconomic terms. rather than being a hodgepodge of 50 different plans. but that's probably OK. Some of the money would be wasted or used in bad ways. one quick way to do this might be to stop dinking around with alterations to the Medicaid funding formula (as the first stimulus bill did) and simply turn Medicaid into a purely federal program funded entirely with federal dollars. In general in the United States you get better “quality of government” at the federal than at the state level. you’d see a much larger federal role in Medicaid and this would reduce the severity of recessions and in general reduce the need for contentious debates about stimulus bills. And certainly when you become very concerned with slightly arbitrary metrics like CBO scores across a 10-year window rather than with overall fiscal responsibility.Single Payer 2. it would “look like” a big increase in taxes and spending. I'm not sure Medicaid has really been a great poster child for states as laboratories of democracy anyway.

Remedial measures that have already been tested are examined.Single Payer 2. This paper considers the problems faced by the Medicaid program in the context of the problems faced by the American health care system. Despite the program's costs.The current program for providing the poor with health care coverage is part of the problem. bureaucratic interference and the low status of the recipients (Holahan. There are geographic and demographic inequities in service provision. Despite these expenditures. Medicaid expensive and ineffective – limited access to proper care. even in the most generous states. total costs for 1992 are projected to reach $129 billion (Burner et al. According to the latest estimates." They provide shorter visits and fewer physical examinations than mainstream medical practices (Mitchell and Cromwell. Held. Ernst and Hay. total annual federal and state costs were $1. Medicaid eligibles have difficulty accessing care. what they can obtain is often of poor quality. costs are expected to rise still further in the U. 1984). Waldo and McKusick. reported delays in payment. Winter 1992. De Alteriis.Olin and Letsch. You’re A Jerk 101 .” Policy Studies Review.S. When the program was initiated in 1966. Since its inception in 1966. Der. between 30 and 40 million Americans do not have health coverage (Levit. total health care expenditures will rise from about 12 percent of GNP in 1990 to about 18 percent of GNP by the year 2000 (Burner. Kletke and Ncckerrnan.” Policy Studies Review. Access to physicians is also limited by the fact that many mainstream providers are reluctant to treat Medicaid recipients for a whole host of nonmonetary reasons: excessive paperwork. 1987. Low fees have led to low physician participation rates (Perloff. Those physicians who do treat large Medicaid caseloads tend to be older. 1992). 1992). the quality of care they receive is often poor. 1978). Associate at MHA. 1992. While other OECD nations have successfully curbed health care inflation. Most importantly. [Mardjuki] Medicaid is very costly. Even if Medicaid recipients are seen by private providers. Medicaid does not cover all poor individuals. De Alteriis. more likely to have graduated from foreign medical schools and have fewer hospital accreditations (Yett. Preliminary data for 1991 suggest that total costs rose by more than 30 percent to $98 billion. as well as a number of other possibilities and permutations.5 billion. 1985). Some of these physicians attract scarcely any private patients. 1981). “Medicaid’s Role in Moves Toward Universal Health Care. Volume 11. Others recognize the economic advantages of very large Medicaid practices. “Medicaid’s Role in Moves Toward Universal Health Care. [Mardjuki] It is widely recognized that the United States spends far more on health care than any other nation but nevertheless fails to provide health coverage for many millions of its citizens. Cromwell and Mitchell. Associate at MHA. 1983). Martin. are usually far lower than those allowed by private insurers and the Medicare program (Cromwell and Burstein. Finally. we contend that the existing research tells us what should be done. Holahan and Carlson. 1975). One study even found that a large proportion of private physicians refused to treat Medicaid recipients because of their ideological opposition to government involvement in health care provision (Sloan.0 LO 101 Medicaid Reform Needed Medicaid reform sorely needed – failure to achieve its goals. The Medical Assistance program (Medicaid) provides health services for around 20 million poor Americans. Many recipients have difficulty accessing care. it has been much criticized and its costs have soared.. 1980). Winter 1992. Martin. These large Medicaid practices are also known as "Medicaid mills. One reason is that Medicaid fees for private physicians. by 1990 total costs had reached $75 billion. which can compensate for the low fees by generating enormous volumes of claims (Cromwell and Mitchell. 1992. Volume 11. We argue that Medicaid can only be successfully restructured as part of a major reform of the entire American health care system. what we need now is the political will to act. 1992).

1988). While AFDC recipients' per capita costs actually fell. You’re A Jerk 102 . All Medicaid programs must cover individuals receiving Supplementary Security Income (SS!) and Aid to Families with Dependent Children (AFDC>. The result of all this is. Winter 1992. Martin. Andrews and Gornick. 1989).0 LO 102 Medicaid Reform Needed Patchwork state Medicaid programs must be rectified to correct inequal treatment of the impoverished. 551 recipients' total costs soared from $3 billion to $17 billion (Howell. De Alteriis. California and Wisconsin.” Policy Studies Review.4 million in 1975 to 3. The infants of women without adequate prenatal care are twice as likely to need intensive care as the infants of women who do receive adequate prenatal care (Munninger. in the words of the United States General Accounting Office. In 1981. Medicaid's funding levels for prenatal services until recently were very inadequate. 551 recipients were responsible for 73 percent of Medicaid costs. “Medicaid’s Role in Moves Toward Universal Health Care. some provided almost all the 32 services permitted by federal legislation while others provided little more than the minimum six mandated by federal legislation (Cromwell.Single Payer 2.3 million in 1987). There were also considerable differences in the number of services provided by the states. over 80 percent of the poor received Medicaid coverage in Hawaii. Michigan. 1987). whose numbers have risen steeply in recent years (from 2. Volume 11.. and the quality assurance mechanisms are poor (Alan Guttmacher Institute. Hurdle and Schurman. not all necessary services are covered by state programs. In 1987.S. 1987). Another group that suffers greatly are individuals with developmental disabilities. "pervasive horizontal inequity-similar people in similar circumstances but in different states . Associate at MHA. the total number of Medicaid eligibles has risen only moderately (by 6 percent). Idaho and South Dakota. Private providers are unwilling to treat pregnant beneficiaries. [Mardjuki] There are major inequities in the way the states confer benefits and eligibility. treated unequally in terms of both Medicaid eligibility and generosity of benefits" (U. 1988). General Accounting Office. Butler and Howard. Over the same period. Many are inappropriately institutionalized and denied access to appropriate care in their home communities (Smull. Hughes.3 percent of Medicaid costs. Infants born to Medicaid recipients have been very poorly served (Rosenbaum. while AFDC children under the ages of 21 were responsible for only 12. The largest expenditures are for disabled 551 recipients. 1988).. 1985). Some recipients fare exceptionally badly. while under 25 percent of the poor received Medicaid coverage in Wyoming. 1992.

The bad publicity from a succession of scandals across the nation has damaged the Medicaid program." and podiatrists who colluded with shoe stores to prescribe ordinary sneakers as "prescription footwear" (c. Many of the providers who do see Medicaid recipients appear to have target incomes (e.0 LO 103 Medicaid Bad Public perception of Medicaid destroyed by years of fraud and criminal activity. in which they have an interest (U. You’re A Jerk 103 . Evans. 1977). created by skillful con artists. de Alteri is. 1992. Associate at MHA. 1986). 1974) which they achieve-despite the low fees-through a variety of questionable practices. [Mardjuki] Medicaid is tainted by extensive fraud and abuse. Volume 11. such as pharmacies. refer recipients to networks of specialists even though specialist care is not required and direct recipients to particular ancillary providers. Martin. bilked Medicaid for millions of dollars of utterly nonexistent services (Cryta. De Alteriis. In the worst scenarios. Congress.Single Payer 2. For example. 1988). Finally. Major scandals inNew York state have involved pharmacists that supplied controlled substances to eligibles for "kickbacks. criminal activity plagues the program. Rice and Labelle (1989) found that states' efforts to reduce Medicaid physician fees merely led to an increase in these sorts of practices by the physicians who remained in the program (but see Feldman and Sloan. 1988).” Policy Studies Review..g.g. "phantom" providers. some physicians perform tests or prescribe drugs that are not required.S. increasing the stigma which deters both providers and eligibles. Winter 1992.. “Medicaid’s Role in Moves Toward Universal Health Care.

but they do not consider Medicaid reform in the context of radical reform of the American health care system. Furthermore. if it accepted that basic health care is a right. For just as surely as Medicaid reform proposals that ignore the nation's health care system as whole will have limited success. As the payer of the last resort. the hospital will probably try to increase the number of Medicaid recipients they admit (or their lengths of stay in the hospital) to recoup the lost Medicare revenue.” Policy Studies Review. If a change in the Medicare program's reimbursement ra tes lowers hospital profit margins. If we take this approach. there is a logic to starting with the reform of the Medicaid program. director of Medical Health Administration. One package designed to increase Medicaid eligibility and control costs would make poverty the sole criterion for eligibility and rely on managed care to contain costs (Oberg and Polich. then widespread change is required. However. [Mardjuki] Proposals for reform are usually combined into packages. offering the lowest reimburse must be expected. Martin. On the other hand. If affordable universal coverage is our goal. and take that route toward achieving our objectives. If Medicaid inpatient rates are relatively low. De Alteriis. then the poor will always have limited access and an inferior quality of care. You’re A Jerk 104 . health care reform should focus on values and priorities. Most of Medicaid's problems can be traced to the principles which characterize the program. then the federal government would be obliged to guarantee it. If the Medicaid inpatient rates are relatively high. most notably Medicaid. A more radical package would divide the acute care and long-term care components of Medicaid. more physicians will see private patients and fewer will see Medicaid eligibles. If health care is considered a benefit. 1992. Consequently. These reforms always have several desirable goals. While the proposals could lead to some improvements in Medicaid.Single Payer 2.0 LO 104 Reform Must Start With Medicaid Medicaid reform must be considered in the context of massive healthcare restructuring – Medicaid is the starting point of effective reform. We have a solid body of research specifically about Medicaid to guide us. [Mardjuki] Ultimately. This is a mistake. Volume 11. then reform of the American health care system might not benefit current Medicaid recipients and might not reach all of those now uninsured. director of Medical Health Administration. If health care is a basic right. this will likely affect Medicaid recipients. As it is a government program. its reform will not threaten the private health care industry. Least politically contentious way of restructuring healthcare is by reforming Medicaid.” Policy Studies Review. Bearing all that in mind. If health care is to be distributed by market principles. we should include the following elements in our reforms. block grant long-term care and change the federal funding formulas for acute-term care (Holahan and Cohen. Most privately insured Americans are content with their own health plan. make poverty the criterion for eligibility. 1988). Martin. Government intervention is looked upon far less favorably in the United States than in Europe and Canada. Volume 11. Medicaid already covers a large proportion of the poor and uninsurable. we should start by reforming existing government programs. The Medical Assistance program is greatly affected by the actions of other health care programs. De Alteriis. akin to life. we also need to recognize the political realities of the day. In the process. so proposals to reform the nation's health care that do not fully consider Medicaid will have a less positive impact than they otherwise might. If private insurers raise physicians' fees in a state. Only by changing these principles and combining Medicaid reforms with major structural reforms of American health care system can Medicaid's problems be solved. We need to stress the moral and legal imperatives rather than the need to control costs if we are to implement policies that would involve a high degree of redistribution. liberty and the pursuit of happiness. horizontal inequities are not surprising. the nation's health care system could be transformed. hospitals will probably try to decrease the number of Medicaid recipients they admit (or their lengths of stay in the hospital) and attract more privately insured patients to compensate for the lost Medicare revenue. even if they are discontent with the system as a whole. “Medicaid’s Role in Moves Toward Universal Health Care. Expanding health care coverage sometimes seemed to be a secondary concern. 1992. “Medicaid’s Role in Moves Toward Universal Health Care. major problems would remain unsolved. The health care industry is extremely powerful. Winter 1992. at their discretion. such as increased or equalized coverage. Medicaid is a welfare benefit -not a right-to be granted by the states. 1987). which would be nice to extend to every citizen but which we cannot afford to do. Medicaid must compete in a health care system run by market forces. we can also draw on research into the Medicare program and into other nations' public health care systems. The rhetoric in the 1992 presidential campaign focused primarily on cost containment so that middle Americans could be ensured adequate coverage and the budget deficit could be reduced. Winter 1992.

http://www. if the factual claims about politically relevant factors are questionable. Medicare was designed as a basic model for eventual spillover Theodore R. of course. Medicare's cost effectiveness arises from the fact that it does not need to expend funds on marketing and sales-functions that are obligatory for the success of competitive. However. n115 The original hope was that Medicare would grow into universal health insurance. It has been argued that. is one of the major conclusions of the program's history we have sketched: the key objective of expansion has not been achieved. the disabled. the public is largely uninformed.and should . the government protects the rights of all beneficiaries to essential health care. the "implications" drawn are equally suspect.hopkinsmedicine.com/us/lnacademic/results/docview/docview. Professor of Public Policy and Management at Yale and Professor of Political Science at Yale. That. n116 Moreover. has not been accomplished and for a variety of reasons . the reformers anticipated that Medicare would largely remove financial fearfulness from the lives of older Americans facing sickness. “Is Medicare Cost Effective?”. some argue that the competitive model for health insurance has not been successful.bring Medicare more in line with the structure of health care financing and delivery that is evolving to serve the non-Medicare population. that same work undercuts the easy connection between knowledge of the program (especially the extent to which objectives are understood to have been satisfied) and the support for the program. n113 To the extent Medicare is broadly popular. my take-home lesson is that there are examples in the success of Medicare we can apply to other sectors of our population. Other than that. 13th President of Johns Hopkins. the healthy can and will change health plans for savings of only a few dollars a month. private-sector health plans. Moreover. This was all sobering news to a market-driven entrepreneur such as yours truly.lexisnexis. In a marketdriven economy. Such behaviors lead to asymmetric risk pools and cost inequities.html 6-13-2003.org/about/Crossroads/06_13_03. n114 Nor can it be the case that the public is satisfied because the major objectives of Medicare's designers' have all been achieved. 2K. n112 While the work of Larry Jacobs and other public opinion scholars establishes that Medicare is broadly approved. n118 Since the claims are factually false. Its universal coverage nature creates the ability to redistribute benefits to those who are neediest.do? docLinkInd=true&risb=21_T7030952640&format=GNBFI&sort=BOOLEAN&startDocNo=1&resultsUrlKey=29_T7030952644&cis b=22_T7030952643&treeMax=true&treeWidth=0&csi=7405&docNo=3 The claim that Medicare's "popularity" is not only "overwhelming" but "well deserved because the program has achieved all its designers' major objectives" n111 is [*240] clearly contestable.Single Payer 2." n119 You’re A Jerk 105 . While not necessarily denying that certain reforms might be needed. 2. that support mostly reflects relatively superficial understanding of Medicare's role in helping America's elderly with large medical expenses. Moreover. William R. n117 That. Marmor and Gary J. not coverage only for the elderly. Consider one claim where the grounds for objection are quite obvious: the assertion that "congressional reforms will . so are the causal connections. It pools risk in order to share the burdens of health care among the healthy and the sick. Moon argues somewhat convincingly that Medicare has been a success. she stresses the importance of preserving three essential tenets of the program: 1.0 LO 105 Medicare Spill Up A Medicare structure can be modeled on a larger scale Dr. Through Medicare. Fiction and Folly”. Brody. McKissick. in part. http://www. given the perverse incentives that frequently drive behavior in health care. while the sick must remain in their existing plan in order to retain their physicians. None of them are "straightforward" in the sense that reasonable analysts could not find grounds for questioning their normative plausibility or predictive accuracy. “Medicare's Future: Fact. The authors cite no evidence to support their claims about the breadth and depth of the public's views. as Marilyn Moon and others have amply demonstrated. 3. injury and other medical burdens. and those suffering from renal failure.

''the US would save between US$ 891 billion and $ US3 trillion.'' And. Pg 116-117. Along the way. with its individualistic focus and shifting coalitions. Robert and Roger.'' Botsman says. allaying US fears about a bloated and intrusive bureaucracy. this will require patience. she notes. Hospital care is free. You’re A Jerk 106 . From the time the idea was first conceived. Health care costs in the US account for 14 percent of GDP. diversity. ''The doctors managed to change the Constitution so they couldn't get conscripted into a national health service. time to build and maintain a coalition. in the US they were $ 95. says Lesley Russell. starting in 1972. Low-income earners and pensioners hold a health card that entitles them to additional services. The debate over Medicare is instructive. as well as through general revenue. Medicare’s political sponsors accepted incremental steps that they believed would not detract from their ultimate goal. health services fellow at Australian National University in Canberra. In the short run this may be a painful route. not with the actual delivery of services. ''My message for the US is that you can have a single-payer system with choice. American politics. Botsman says the cost comparisons alone are dramatic: Administrative costs in Australia in 1987 were US$ 19 per capita. Sharpe & Dohme. as are most physician visits. it took fifteen years of political struggle before federal health insurance for the elderly was adopted. Hickey. manager of public affairs for the drug company Merck. Costs are set by the government. it would be foolish to focus on short-term strategies to the point of abandoning long-term aims.'' Dr. Australia's reform process took years. Costs have been consistently held to 8 percent of GDP. a liberal think tank here. and are expected to rise to 19 percent within five years. prof of law @ American University. and the commitment to absorb defeat. vice president @ Economic Policy Institute.'' says John Deeble. ''We had very tough political obstacles to get around.'' says Peter Botsman. and faced the same difficult issues of reform.Single Payer 2.0 LO 106 Slow Phase In Key – Medicare & Australia Prove Medicare creation proves – selection of single model and slow phase-in is only viable option. it might want to take a look down under. ''And you can have a private hospital system and a private health insurance system coexisting alongside a dominant single payer. 2001. Yet one clear option for reformers is to reject these pressures by agreeing on a single programmatic model and legislative goal. Borosage. Safety nets ensure that out-of-pocket spending is capped.'' Australia's 12-year-old universal health insurance system is funded by a flat 1. executive director of The Evatt Foundation. and to begin a long-term political campaign to secure eventual enactment. Staff writer of The Christian Science Monitor “Australians Offer US Tips on Health Care” lexis-nexis [LO//AS] AS the United States Congress wades deeper into the difficult debate over reforming the nation's health care. [Mardjuki] A related lesson is that although it may be necessary to respond to short-term political and economic constraints. As with Medicare. That raises some conflict with doctors and with private hospitals. who helped design the 1973 and 1984 programs. but they never abandoned the campaign for Medicare. tends to prompt short-term visions and encourage impatience.100) for singles. It had a system similar to the present American system. Phasing in means the plan saves hundreds of billions of dollars Foster 94 Catherine Foster.'' he says. over the long haul it may prove the most rewarding. Botsman.5 percent levy on gross income over A$ 10. The Next Agenda: Blueprint for a New Progressive Movement. Australia went through a similar experience in the 1970s. he says. but it does not limit what doctors can charge. the Australian health insurance system is only concerned with the monitoring of costs and ensuring that payments are made promptly. ''It's kept costs under pretty tight control. travels frequently to Washington to clarify misconceptions about the Australian system. and cost containment that satisfies all consumers' needs about health care. Medicare customers can choose their own physicians on a daily basis. who has written a national health-insurance strategy for the US. They closed down one state's [New South Wales] hospital system for seven months and refused to work. a conservative government scrapped the program and another liberal leadership started over with a new one.000 (US$ 7. pharmaceuticals are subsidized. ''If you phased in the Australian system over eight years.

Volume 11. You’re A Jerk 107 . Private individuals and employers could buy into the program at any time. If the uninsured were added to this program. To set a good example. state and local government be covered by the public plan. Martin. It should improve the average public health care recipient's access to quality care and help control overall costs. De Alteriis. the federal government should administer the public health plan. 1992. Federal control would also help ensure that the new program fully utilized the advantages of its large market share. This would create a very large program that could use its market share to control costs and ensure access. Winter 1992. The volume of business that could be granted to approved or preferred providers would increase the program's ability to negotiate with the health care industry. “Medicaid’s Role in Moves Toward Universal Health Care.0 LO 107 Medicare Subsume Medicaid? Successful healthcare reform requires Medicare to subsume Medicaid to slash costs through economics of scale.” Policy Studies Review. [Mardjuki] The starting point for our plan would be the merger of Medicaid and Medicare.Single Payer 2. To ensure that horizontal inequities are removed. director of Medical Health Administration. the proportion of the total health care market covered by the new program would rise still further. we might insist that all public servants (and their families) in federal.

Kaiser Family Foundation. Health reform will not address all the gaps in the health care system that Medicaid now helps to fill such as providing long-term care and helping to sustain the health care safety-net and covering many of the supportive services that the chronically ill and disabled need. • Medicaid has a well developed administrative structure in every state that has enabled it to be a cornerstone in federal and state efforts to expand coverage. Kaiser Family Foundation. Barbara Lyons MPA. This strong foundation will help to assure the success of larger health reform efforts. • Provide adequate Medicaid financing by having the federal government assume the costs of expanding Medicaid coverage or by shifting some current Medicaid costs to the federal government. and Rudowitz ’09 (Diane Rowland. Kaiser Commission on Medicaid and the Uninsured. • Ensure that current and new enrollees receive Medicaid’s benefit and cost-sharing protections. DC. Henry J. PhD. You’re A Jerk 108 . control costs and improve quality with shared responsibilities across employees. Medicaid also helps support community health centers and other safety-net providers in medically underserved areas. Medicaid is a low-cost program with lower per capita spending than private insurance. Accounting for the health needs of its beneficiaries.620 for a family of three in 2009). Rowland. and many have significant health needs. expanding coverage to the uninsured as well as addressing health care cost and quality issues have emerged as the dominant drivers for system reform. Kaiser Commission on Medicaid and the Uninsured. How can Medicaid be a stronger platform for health reform? • Expand Medicaid’s reach to more low income individuals by basing eligibility on income alone with federal minimum standards and making additional progress to increase participation rates. Leading health reform proposals rely on a combination of public and private approaches to expand coverage. Washington. Executive Vice President. “Medicaid As A Platform For a Broader Health Reform: Supporting High-Need and Low-Income Populations”) As debate on national health reform moves forward. government. • Most Medicaid enrollees receive care through private managed care plans that are designed to promote access to care. Why build on Medicaid? Medicaid already serves 60 million Americans and provides a base of affordable and comprehensive coverage that is well suited for low-income and high-need populations. Vice President. Medicaid plays an important role for some disadvantaged populations and the program has broad public support. consumers and insurance markets. employers. Washington. Extensive research shows that coverage is key to securing access to needed health care services. Medicaid offers a strong foundation on which broader health reforms can be built by providing coverage for the high-need and low-income populations and providing a vehicle to reach more low-income uninsured with affordable coverage. DC Co Chair. and provide stable financing by establishing a countercyclical financing mechanism during economic downturns.0 LO 108 Medicaid Expansion Key Building upon Medicaid would be a great way to expand healthcare. Washington. enhance quality and control costs. and Robin Rudowitz Principal Policy Analyst. Lyons. DC. develop strategies to expand the primary care workforce to provide better access to primary and preventive care. The costs of private health care and Medicare premiums are lessened by having Medicaid insure these highneed populations and provide key services not covered by private plans or Medicare. and promote better access by addressing payment rates to help boost provider participation. What problems do low-income individuals face in today’s health care system? • Two-thirds of the 45 million uninsured are low-income individuals (below 200% of the poverty level or $36. • Medicaid enrollees fare as well as the privately insured populations on important measures of access to primary care even though they are sicker and more disabled. Deputy Director. • Many low-income individuals do not have access to employer coverage and cannot afford or access private coverage through the individual market. As we move forward. and establish system-wide quality standards along with the implementation of health information technology to promote an efficient health care system based on positive outcomes. Executive Director. the Kaiser Commission on Medicaid and the Uninsured. • Bolster Medicaid with broader efforts to contain costs across the health system (public and private) to help ensure long term sustainability. thus covering Medicaid enrollees in private coverage would be more costly.Single Payer 2. Kaiser Commission on Medicaid and the Uninsured. 5-09. ScD.

Single Payer 2.0 LO 109 **SOLVENCY** You’re A Jerk 109 .

national political correspondent. which averages over 40%. 7/21/09. (Watch a video on uninsured Americans. it is difficult in some areas to find health-care providers who are willing to accept Medicaid patients. Drive Health-Care Debate.400 for an individual and $29. Not Coverage.200 for a family of four — account for about half the uninsured in this country. But a draft proposal by the Senate Finance Committee would have the feds paying the additional cost for only five years. the disabled and those in need of nursing-home care. upon which additional expansion efforts could build.com/time/politics/article/0. more affordable health care for patients. head of the Congressional Budget Office. http://www. the cost of the program — the supply of providers will not come close to meeting the demand for medical services. (Read "Cost." And even the Mayo Clinic — often cited by Obama as the model of what an efficient. accounting for about a third of the estimated 40 million uninsured Americans who would gain health insurance under the proposal." says the nonpartisan Kaiser Family Foundation. Governors warn that unless they increase the amount that Medicaid reimburses doctors and hospitals — and. In fact. Senators of both parties are trying to put the brakes on the President's drive to have bills passed by the House and Senate by the August recess.html [JM] Douglas Elmendorf.time. Republicans are calling it a dangerous "experiment. Tumulty. all non-elderly people earning at or below 133% of poverty — about $14.0 LO 110 Low-Income Uninsured Coverage Needed Low-income families form a disproportionate amount of the uninsured – successful health care reform provide them with coverage. The Congressional Budget Office predicts that the House proposal would add 11 million to the Medicaid rolls.") What Congress is now considering is whether to make income alone the determinant of Medicaid coverage.00. Already. Under the current rules. But there are real questions as to whether the program could handle the strain of that many new clients. after which the states would have to pick up their typical share of existing Medicaid costs. or $33. “Medicaid and the States: Health-Care Reform’s Next Hurdle. Under the health-reform bill now being considered by the House. with it. has testified that the legislation thus far has too little cost containment.) The argument in favor of expanding Medicaid is largely one of efficiency. the poor elderly. their parents. Low-income adults — those who earn under 200% of poverty. high-quality health-care system should look like — is cautioning on its blog that legislation under consideration in the House "misses the opportunity to help create higher quality.8599.300 for a family of four — would be eligible. financing and administrative structure.Single Payer 2." Medicaid has become the latest sticking-point issue in health reform because of the daunting challenge of how to cover those most likely to find themselves without health coverage. many of them are not eligible for Medicaid. it will do the opposite.1911856." You’re A Jerk 110 . which was established alongside Social Security in 1965 to cover low-income children. The existing program "is designed to meet the needs of low-income individuals and those with complex health needs and has an existing delivery.” Time Magazine. "Medicaid coverage for low-income adults could help establish a strong floor of coverage for the low-income population. The House bill would have the Federal Government pick up the entire cost for those newly covered under Medicaid — $438 billion over 10 years. Karen.

On the negative side. and well child care. The existing single-payer Medicare system could be expanded to include everyone. Changing Medicaid from a combined state-federal program to a federal program like Medicare would provide uniform eligibility and benefits across all states. copayments and deductibles would be reduced for low-income persons. Rather than including everyone. this approach would not include the millions of uninsured who are noneligible for either Medicaid or Medicare. thus eliminating Medicaid. is highly popular with constituents. Everyone would have a medical identification card (like a Medicare card). mandated Medicaid expansion could also be very costly for the states. or persons of all ages with disabilities. [Mardjuki] A new single-payer system could be designed for the entire population. Everyone living in families at or below 100% or 150% of the federal poverty level could automatically be included. Volume 4. Private insurance systems could insure for services not covered by this single public plan. Children are relatively inexpensive to insure. Expand Medicare and replace Medicaid. Medicare. has fairly effective cost control mechanisms. and expand access to vulnerable populations. Because states pay up to one half the Medicaid expenditures. Pgs.” Journal of Community Health Nursing. 1993. benefits and eligibility vary greatly and contribute to high administrative costs. Public universal coverage for children also would reduce employers' costs for family coverage and help expand employer-based insurance. Anna. On the negative side. It also has the negative potential of increasing federal budget deficits. low-income uninsured persons might not be able to afford to buy into the Medicaid program. such as all children under 18. existing governmental health insurance programs could be modified and expanded to provide insurance coverage for specific population groups. such as home-care waivers and expanded coverage for low-income pregnant women and children. “Health Care Reform: Clarifying the Concepts. Expansion of existing public programs might be more politically acceptable than establishing completely new programs (Harrington. RN and MSN @ Ball State University. special groups that now lack health insurance could be added to Medicare. Miller. Expand Medicare to special populations.Single Payer 2. Low-income persons could be added to the existing federal-state Medicaid program. increase administrative efficiency. This incremental approach would build on recent Medicaid expansions.0 LO 111 Solvency – Medicare Based System Solves A healthcare system structured off of Medicare solves – relieves state budgets. which would decrease costly overutilization of emergency rooms by guaranteeing access to primary care. This approach would relieve states of escalating Medicaid costs and allow states to focus on funding long-term care. perinatal. and there would be no charge for most preventive services. especially states with historically narrow Medicaid eligibility and low serviceprovision levels. Medicaid expenditures have escalated more rapidly than other health care sectors. another incremental approach is to expand the present single-payer Medicare program to include low-income and uninsured persons. and public perception is one of a second-class system. by contrast. Alternatively. extends coverage. Rather than continuing two publicly funded health insurance programs. Adding low-income persons could provide work incentives for welfare recipients because becoming employed would no longer mean losing Medicaid benefits. Politically. 1990). single adults. Federalize Medicaid. and reports low administrative costs. some states that provide more generous benefits might have difficulty reducing benefit levels and/or restricting eligibility. and their improved health brings societal benefits over many years. A Medicaid expansion could include mandatory enrollment in managed care through health maintenance organizations (HMOs) or Preferred Provider Organizations (PPOs). 1991). 199-211. You’re A Jerk 111 . and cuts costs. Expand Medicare to everyone. Adding children to Medicare would provide coverage for the 43010 of all children who now are uninsured (Friedman. and low-income persons above the poverty line could buy into the program on an income-related sliding scale. adding preventive. Expand Medicaid.

story [Mardjuki] In a Q-and-A recently posted on the Web site Crooks & Liars (http://crooksandliars. If I told you that in less than a year after the historic Medicare legislation was signed into law. but our next best choice is to support an exchange and a public option. wouldn't you wonder why it's going to take so long to get essential elements of this version of reform in place? Wouldn't you wonder why the elements that are designed to help the millions of uninsured are the ones that are going to take the longest to implement? Or.Single Payer 2.when we have a single-payer model.com/node/29667). like the fact that we will have a presidential election in November of 2012. with more employers changing to plans that cover less and cost the individual more. Medicare. Their spending per-person on health care is less than half what we spend here. So. Schoonmaker. healthier than we are.0 LO 112 Squo Reform Fails – Need Single-Payer Only a single-payer system mitigates costs – Medicare proves. and millions of older Americans had been enrolled and were getting health care with hardly a hiccup. that we know works well and could be expanded or duplicated with relative ease and in a much shorter period of time? You’re A Jerk 112 .1114455. is health care. Why are we writing 1. where the focus should have been from the start.but a lot to assist the political careers of more than a few members of Congress who are crafting this "reform" (and making those who need accessible and affordable care the most wait the longest to get it) .000-plus-page bills.baltimoresun. 7/20/09 Anne. Global Sourcing Finance Chief at GE Healthcare." The question that her response prompts from me is. that is not a typo. All of the major developed nations have some form of single-payer health care. how much more dire will things be in four years? What will the insurance companies be doing between now and 2013? How will they be positioning themselves to accommodate the changes that are coming? What will we see from them in the next 3 1/2 years that will signal they have even the slightest interest in improving our access to and delivery of actual health care? What this is really all about. House Speaker Nancy Pelosi responded to one of the questions by saying. Having a shiny new insurance policy will not help if the out-of-pocket costs are such that people still cannot afford to see the doctor or get the medications they need.com/news/opinion/readersrespond/baled. creating a Rube Goldberg-ian system whose biggest benefit will be to insurance companies that have done nothing in the last several decades to improve the current system . “Why not singlepayer?” Baltimore Sun. thousands of people losing their jobs every month and losing their coverage.letters200jul20. with an economy in decline. not insurance. maybe. or dropping coverage altogether. is a whole lot less than "next best?" The House plan is not set to go "live" until January of 2013. No. you wondered if there's a political reason why the plan won't be fully operational until 2013.le. and it might not be good for the fortunes of the current president or the senators and representatives up for re-election if a new health care system is not going well or is not all it was advertised to be. why are we giving up on the best solution and settling for something that. by most accepted measures. from all appearances.0. and their people are. what will the millions of currently uninsured people do between now and 2013? And. the program was up and running. "For 30 years I have supported a single-payer plan. http://www.

Discussion of health reform was muted in the 1990s after the defeat of President Clinton’s Byzantine scheme for universal coverage. ‘07 (David U.000 unnecessary deaths annually according to the Institute of Medicine [1].0 LO 113 Squo HC Fails The Current Health Care System Sucks Himmelstein.Single Payer 2. low-wage employers like Wal-Mart gain competitive advantage by purchasing goods made overseas (where health benefit costs are low) and offering only the skimpiest of health coverage to their US workers. MD + MPH + Physicians for a National Health Program of Chicago. Market pressures threaten medicine’s best traditions.org/news/2008/may/our_health_care_syst. Meanwhile. Health care costs will reach $7498 per capita this year. 11/07.php) [LO//JW] Almost all agree that our health care system is dysfunctional. Forty-five million Americans have no health insurance. 50% higher than in any other nation. the accelerating collapse of employment-based coverage under the pressure of globalization is reopening debate. The Department of Medicine at Cambridge Health Alliance/Harvard Medical School. But now. and police) as well as sharply escalating costs for public programs such as Medicaid and Medicare. teachers. and Woolhandler. MD. and continue to grow rapidly .pnhp. Tens of millions more have inadequate coverage. “Our Health Care System at a Crossroads: Single Payer or Market Reform?” www. resulting in more than 18. MD + MPH. which add $1500 to the price of a GM car versus $419 for a German Mercedes and $97 for a Japanese Toyota [2]. Himmelstein. dept Medicine Harvard. and Steffie Woolhandler. Opinion on solutions is more divided. firemen. You’re A Jerk 113 . And bureaucracy overwhelms both doctors and patients. Governments face a double whammy: ever-expanding benefit costs for their employees (eg. Firms like General Motors (GM) and Ford are crippled by the growing burden of health costs.

Duplication of services is understood to be extensive and extremely wasteful.eliminates duplicative bureaucracy. Without even getting into the specific details of how these other programs work. the American health care consumer is able to determine intuitively that there are a number of ways in which a single payer plan can introduce efficiencies that result in real savings over present costs. generally as one whole system of paperwork and policies.0 LO 114 Single Payer Solves . Multiples of $197k? Well.6 billion during 2005. chief reporter. American health care consumers have looked around at other industrialized nations and see single payer systems that are serving all their constituents at less cost per person than our present system..Single Payer 2. accumulated total compensation of $1.com/talk/blogs/jpieterick/2009/07/the-case-for-keeping-singe-pay.php?ref=reccafe [Mardjuki] Having first identified health care reform as a critical issue confronting the U.to oversee a singular bureaucracy in charge of providing universal health care to all. 2009. almost without regard for how large that family might be. that Bill McGuire. etc. These same consumers understand that it will take one CEO . probably at the level of a Cabinet Secretary . It was recently reported. as is the number of people needed to simply keep up with the myriad of different bookkeeping and other paper trails that are created. Eliminating all such highly paid executives could be expected to result in enormous savings without compromising so much as the availability of a single visit to a Doctor. yes. George Polk Award winner. To begin with.Waste Single-payer reform more efficient . “The case for keeping “single payer health care” off the table. for example. July 15. former CEO of UnitedHealth Group. each making multiples of this salary. per provider. http://tpmcafe.a government Administrator. This CEO will be expected to earn in the neighborhood of $197. Joshua..talkingpointsmemo.S. there is an intuitive sense that a single administration overseeing a universal plan is surely far more efficient than a multitude of private corporations establishing their own bureaucracies to manage their own little corner of the comprehensive system that is required.” Talking Points Memo. the consumer reasons that simply removing this one executive from the equation for one year provides enough financial resources to provide lifetime health care coverage for themselves and their extended family. You’re A Jerk 114 . Quickly doing the math. Marshall.000 (Highest rate now paid to any Cabinet Secretary) and will replace an untold number of private executives.

Costs would be controlled through negotiated fees. sales and marketing departments as well as huge profits and exorbitant executive pay.” http://www. billing. A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. PNHP 2009. prescription drug and medical supply costs. Single-payer financing is the only way to recapture this wasted money. Patients would regain free choice of doctor and hospital.pnhp. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead. global budgeting and bulk purchasing. reproductive health care. hospital. all Americans would be covered for all medically necessary services.org/facts/single_payer_resources. Combined. more than $350 billion per year. Under a single-payer system. preventive. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. long-term care.php The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. mental health. The potential savings on paperwork. Physicians For A National Health Program.0 LO 115 Single Payer Solves – Waste & Patchwork Single Payer solves – eliminates patchwork systems of administrative waste. Health facilities and expensive equipment purchases would be managed by regional health planning boards. and doctors would regain autonomy over patient care. Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. this needless administration consumes one-third (31 percent) of Americans’ health dollars. including: doctor. You’re A Jerk 115 .Single Payer 2. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. [Mardjuki] “Single Payer Resources. are enough to provide comprehensive coverage to everyone without paying any more than we already do. vision. dental. Hospitals would receive a global budget for operating expenses. underwriting.

Thanks to the paperwork and complexity of private insurance.000 a year per family. including prescription drugs. Under the leading single-payer proposal. or the European Community. By combining huge administrative savings with caps on national health spending. the U.) and 92 other House Democrats. while individuals would pay 2. Single-payer would also allow consumers to choose a doctor without paying higher premiums or extra charges for this fundamental privilege. physicians would have more freedom to order necessary medical services without the constant second-guessing and micromanagement of managed care. the savings would amount to about $ 1.1%. since under single-payer the states would negotiate fee schedules with physicians. some 24% of the nation's health-care spending now goes to administration.Single Payer 2. and long-term nursing-home care. chairman of the American College of Surgeons. sponsored by Representative Jim McDermott (D-Wash. By 2003. This year. 82 lexis-nexis [LO//AS] LESS OVERHEAD. the U. Yet the CBO estimates that the single-payer system would trim overhead by up to $ 100 billion a year -.S.S.S. ranks below many of these nations in life expectancy and infant mortality. the government would pick up the entire tab for covered procedures. business. McDermott would increase the federal cigarette tax to $ 2 a pack from 24 and impose a new 50% excise tax on handguns and ammunition. resident full coverage starting in 1997. effectively capping their income. That group's stand shocks many observers. "Single-payer provides the best assurances that patients would be able to seek care from any doctor of their choice. Ultimately. It would grant every legal U. 75% of Americans would pay less than they do now for coverage. A few frills -. McDermott estimates. Critics challenge some of McDermott's projections.enough to provide coverage for 40 million uninsured Americans.S. No other plan is as generous.0 LO 116 Single Payer Solves – Bureaucracy Less overhead costs and decreased bureaucratic costs of $100 billion a year mean that the plan makes single-payer cheaper and more effective Symonds 94 William C. the predominant concern should be controlling runaway spending on health care. while many of the alternatives would continue to leave millions uninsured. But single-payer will do the most to eliminate much of the bureaucracy that has become the plague of American medicine. You’re A Jerk 116 . CANADA” Business Week SOCIAL ISSUES. David Murray. The difference is that under single-payer. Even so. mental-health treatment." says Dr. Symonds director of the Forgotten Half Project education program at Harvard “WHITHER A HEALTH-CARE SOLUTION? OH. But most managed-care plans also limit doctors' income. But taxes would probably have to be even higher.000 per employee would face an 8.such as private hospital rooms -. As in Canada. compared with only 11% in Canada. the single-payer approach has the potential in the long run to cut spending more than any other plan. Pg. the government would become responsible for virtually all medical bills. will devote 14% of gross national product to health care: at least 40% more than Canada. Number 3363. For consumers. In addition. Businesses with more than 75 workers and wages averaging more than $ 24.4% payroll tax.would not be covered. this freedom is increasingly being constrained. single-payer offers equally compelling advantages. McDermott would finance all this with stiff federal tax increases. Smaller businesses would pay 4%. Japan. Thanks to the proliferation of managed-care plans. which would be offset by a steep decline in insurance premiums. For U.

Most hospitals and clinics would remain privately owned and operated.” Physicians For A National Health Program. President of American College of Physicians. American Academy of Pediatrics. CEO Parkland Health System.which in essence would be an expanded and improved version of Medicare . American Public Health Association. Joel Alpert. Editor of New England Journal of Medicine. and their former owners compensated for past investments. Under the current system. http://www. or receive salaries from group practices. Such a program .the creation of a comprehensive National Health Insurance (NHI) Program.0 LO 117 Single Payer Solves – Medical Consensus Medical community consensus – only single payer system solves.would cover every American for all necessary medical care. Quentin Young. Senior Lecturer @ Harvard Medical School. receiving a budget from the NHI to cover all operating costs.pnhp.Single Payer 2. expanding access to health care inevitably means increasing costs. and reducing costs inevitably means limiting access. Angell. Commissioner of Baltimore City Health. Physicians could continue to practice on a feefor-service basis. You’re A Jerk 117 . Ron Anderson. Investor-owned facilities would be converted to notfor-profit status. A National Health Insurance Program would save at least $150 billion annually by eliminating the high overhead and profits of the private. “Proposal of the Physicians’ Working Group for single-Payer National Health Insurance. hospitals or clinics. Doctors and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules . MD.often rules designed to avoid payment. comprehensive coverage. the savings on administration and profits would fully offset the costs of expanded and improved coverage. During the transition to an NHI. slowing cost growth over the long run. NHI would make it possible to set and enforce overall spending limits for the health care system. Peter Beilenson.php [Mardjuki] We endorse a fundamental change in America’s health care . It would squeeze out bureaucratic waste and eliminate the perverse incentives that threaten the quality of care and the ethical foundations of medicine. A National Health Insurance Program is the only affordable option for universal. 2009. Christine Cassell.org/single_payer_resources/proposal_of_the_physicians_working_group_for_singlepayer_national_health_insurance . But an NHI could both expand access and reduce costs. investor-owned insurance industry and reducing spending for marketing and other satellite services. Marcia.

is that it inadequately describes what most people who call for a single·payer plan re.Single Payer 2. however. Pg 114.“ The appeal of such an approach is obvi. [Mardjuki] The final option we want to discuss is what are conventionally referred to as “single·payer" plans—the model of choice for many reformers since the early 1980s. 2001. for whom.lic health insurance program is Canada’s Medicare.S.ous. You’re A Jerk 118 .ally want. setting budgets for hospitals. the governing legislation prescribes broad physician and hospital coverage (“comprehensive care"). Robert and Roger. and it places far fewer constraints on professional autonomy and patient choice than is the case within the current U. no deductibles or co. prof of law @ American University.nual national income than is consumed by medical care in the United States. The necessary consequence of Canada’s methods of financing and cost-control-paying for medical care from each provincial budget. There. vice president @ Economic Policy Institute. on what. Universal health insurance has been for most Canadians the coun. lt has brought a decent level of medical care to the country’s citizens and consumes 40 percent less of the an. accessible terms (that is. and portability (that is.mented and hence less accountable decisionmaking process in the United States. ln fact.insurance payments). The Next Agenda: Blueprint for a New Progressive Movement.0 LO 118 Single Payer Solves – Dem Accountability Canada proves – single payer system ensures democratic accountability. system. Medicare itself is a single-payer plan in the sense that the insurance funds that pay for Medicare’s benefits are in a single program. and limiting what doctors and drug firms can charge—is ongoing controversy. public administration (for accountability). There is also a democratic accountability that is truly astonishing when compared to the enormously frag. Canada°s Medicare system is more cost·efficient and more easily un-derstood than other altematives. comprehensive pub. The dominant model of a single-payer.try`s postwar public triumph. Borosage. There is continuous discussion about how much to spend. and under what nnles of fairness of access or financing. A necessary corollary is constant media attention to Canada’s "sing]e-payer" program. The trouble with the term. Hickey. featuring constant claims Canada's doctors and other medical occupations that "crises' are imminent or in full bloom. coverage that protects Canadians whether they are in their home province or not).

1. Physician payment would cover only the work of physicians and their support staff. “Proposal of the Physicians’ Working Group for single-Payer National Health Insurance. physician. The fee-for-service option would greatly reduce physicians’ office overhead by simplifying billing. migrant clinics. MD. Similar measures might be needed in the U. Global budgets for institutional providers would eliminate billing. while providing a predictable and stable financial support. 3. There might also be a concomitant cap on spending for the regulatory apparatus .pnhp. CEO Parkland Health System.Salaries within capitated groups: HMOs. expenditures for program administration and reimbursement bureaucracy might be restricted to three percent of total costs. Regulation of payment for capital and profits would be similar to that for hospitals. group practices. 2. American Academy of Pediatrics. 2009.S. and other institutions could elect to be paid capitation premiums to cover all outpatient. Peter Beilenson. health centers. Only institutions that actually deliver care could receive NHI payments. American Public Health Association.php [Mardjuki] The NHI would include three payment options for physicians and other practitioners: fee-for-service. for cosmetic surgery). and several European nations have developed successful mechanisms for reconciling the inflationary potential of fee-for-service practice with cost containment. and home care agencies could elect to be paid a global budget for the delivery of care as well as for education and prevention programs. These include: limiting the supply of physicians. President of American College of Physicians. Quentin Young. salaried positions in institutions receiving global budgets. Physicians employed in such institutions would be salaried. Investor-owned HMOs and group practices would be converted to not-for-profit status. excluding most current HMOs and some practice management firms that contract for services but don’t own or operate any clinical facilities. Senior Lecturer @ Harvard Medical School. binding fee schedule. or via computer.” Physicians For A National Health Program.eg. Christine Cassell. HMOs would pay physicians a salary. Physicians accepting payment from the NHI could bill patients directly only for uncovered services (e.Single Payer 2. and medical home care. and financial incentives based on the utilization or expense of care would be prohibited. The capitation premium would not cover inpatient services (except physician care) which would be included in hospital global budgets. Angell. Marcia. and even capping individual physicians’ reimbursement. setting overall limits on regional spending for physicians’ services (thus relying on the profession to “police” itself). and salaried positions within group practices or HMOs receiving capitation payments. Such funding could also stimulate the development of community prevention (eg. These regulatory options are not difficult (and have not required extensive bureaucracy) when all payment comes from a single source. Ron Anderson. You’re A Jerk 119 . http://www. Canada.0 LO 119 Single Payer Solves – Fair Wages Single payer structure allows for fair practitioner compensation. and would exclude reimbursement for costly office-based capital expenditures for such items as MRI scanners.Fee-for-service: The NHI and representatives of the fee-forservice practitioners (perhaps state medical societies) would negotiate a simplified. Editor of New England Journal of Medicine. The proposed pluralistic approach to delivery would avoid unnecessary disruption of current practice arrangements. school-based smoking prevention programs) whose costs are difficult to attribute (and bill) to individual patients. All three proposed options would uncouple capital purchases and institutional profits from physician payment and other operating costs. Selective enrollment policies would be prohibited and patients would be permitted to disenroll with appropriate notice. Incentives for capitated providers to skimp on care would be minimized since unused operating funds could not be diverted to profits or capital investments. monitoring for extreme practice patterns. Joel Alpert. Commissioner of Baltimore City Health. Continuity of care would no longer be disrupted as patients’ insurance coverage changes due to retirement or job change. and would receive extra payment for any bill not paid within 30 days. The negotiation process and regulations regarding capital payment and profits would be similar to those for inpatient hospital services. Physicians would submit bills to the NHI on a simple form.org/single_payer_resources/proposal_of_the_physicians_working_group_for_singlepayer_national_health_insurance .Salaries within institutions receiving global budgets: Institutions such as hospitals. a feature essential for minimizing entrepreneurial incentives.g. containing costs and facilitating health planning. group practices.

php [Mardjuki] NHI would pay for all medically necessary prescription drugs and medical supplies. upgrade monitoring of drug safety. http://www. Joel Alpert. Ron Anderson. An expert panel would establish and regularly update the formulary. Quentin Young. Peter Beilenson. Suppliers would bill the NHI directly (for the negotiated wholesale price plus a reasonable dispensing fee) for any item in the formulary that is prescribed by a licensed practitioner. NHI could simultaneously address two pressing needs: (1) providing all Americans with full coverage for necessary drugs and supplies. with exceptions available in case of medical necessity. Commissioner of Baltimore City Health. and (2) containing drug costs. Angell.g. and in other nations (e. curtail pharmaceutical marketing. The NHI would negotiate drug and equipment prices with manufacturers. the NHI could exert substantial pressure on pharmaceutical companies to lower prices. President of American College of Physicians. CEO Parkland Health System. Australia) have resulted in substantial savings.org/single_payer_resources/proposal_of_the_physicians_working_group_for_singlepayer_national_health_insurance . “Proposal of the Physicians’ Working Group for single-Payer National Health Insurance. As a monopsony purchaser. Marcia.Single Payer 2. minimize medication errors. American Public Health Association.0 LO 120 Single Payer Solves – Drug Costs Single payer system lowers drug costs – pressure on big pharma. MD. Where therapeutically equivalent drugs are available.pnhp. American Academy of Pediatrics.S. 2009. Editor of New England Journal of Medicine. based on their costs (excluding marketing or lobbying).” Physicians For A National Health Program. assure that the fruits of publicly funded drug research are not appropriated for private profit. Christine Cassell. Additional reforms are urgently needed to: improve prescribing practices. the formulary would specify use of the lowest cost medication. You’re A Jerk 120 . and ameliorate financial pressures that skew drug development. based on a national formulary. Senior Lecturer @ Harvard Medical School. Similar programs in the U.

Commissioner of Baltimore City Health. “Proposal of the Physicians’ Working Group for single-Payer National Health Insurance. Billing would involve imprinting the patient’s NHI card onto a slip. Christine Cassell.pnhp. every patient would be fully insured. pressure to skimp on care would be minimized. Senior Lecturer @ Harvard Medical School. Treatment would no longer be constrained by the patient’s insurance status. but physicians could increase their incomes only by working harder.the problems as well as the possibilities . The entrepreneurial aspects of medicine . This simplification of billing would save each practitioner thousands of dollars annually in office expense. The burdens of paperwork associated with billing would be lightened. Angell. nor by bureaucratic dictum.php [Mardjuki] Physicians would have a free choice of practice settings. Nurses and other personnel would enjoy a more humane and efficient clinical milieu. 2009. Salaried practitioners would be insulated from the financial consequences of clinical decisions.” Physicians For A National Health Program. Physicians could concentrate on medicine. Editor of New England Journal of Medicine. Since savings on patient care could no longer be used for institutional expansion or profits.Single Payer 2.would be limited. Ron Anderson. American Academy of Pediatrics. MD.0 LO 121 Single Payer Solves . Fee-for-service practitioners would be paid promptly. American Public Health Association. Bureaucratic interference in clinical decision making would sharply diminish. Quentin Young. You’re A Jerk 121 .org/single_payer_resources/proposal_of_the_physicians_working_group_for_singlepayer_national_health_insurance . http://www.Physicians No discentive for physicians – decreased bureaucratic hoops and paperwork. checking a box indicating the complexity of the encounter. Marcia. and sending the slip (or electronic equivalent) to the physician payment board. Joel Alpert. Costs would be contained by controlling overall spending and limiting entrepreneurial incentives. obviating the need for the kind of detailed administrative oversight characteristic of current practice. President of American College of Physicians. Peter Beilenson. CEO Parkland Health System.

Single-payer works because of the efficiency of specialization . duplicated bureaucracies. You’re A Jerk 122 . along with many other health care reform supporters. not the best middlemen to pay for it.pubmedcentral.N. Campus Progress. insurance policies are so complex and individuals' future needs so unpredictable that consumers cannot make the informed selections that induce competition between insurers. dividends. 7-19-2009. The private health insurance market is inefficient. introduced by Senator Conrad (D.) Baucus [Chairman of the Senate Finance Committee] has been talking out of both sides of his mouth on the public plan for some time. but are instead releasing watered-down bills. why not single-payer health care? Yes. However. http://www. http://fundingourfuture. (Kaiser Health News has profiled one existing co-op in Seattle. bloated by advertising. concede that single-payer insurance is probably our most efficient option. Many Americans.[2] But they worry that it lacks the spirit of the American market.nih. Adam Smith would be proud. and all we can say is “well it’s better than nothing. This is paramount because patients need the best healthcare. Co-ops are a weak alternative to the public plan and have been tried before. A single-payer system will harness the market's strengths while addressing its limitations. the government will fund health insurance. and seemed to quickly latch onto the co-op idea as means to having it both ways. “A ‘Better than Nothing’ Future”. Economies of scale will save the money to make this possible. Currently. In its place is the co-op proposal. the 47 million uninsured Americans[3] have little impact on the market. We can’t afford weak alternatives.Dakota).gov/articlerender.Single Payer 2. has been advocating for the public health insurance option that will provide quality. A single-payer system will give all consumers the power of choice and open all healthcare providers to the effects of consumer decisions. MD/PhD from Northwestern University.0 LO 122 Single Payer Solves –Efficient Single payer most efficient option for federal plan Prajwal Ciryamv. including Democratic presidential nominee Barack Obama. after the Great Depression.” This is unacceptable. is a scheme for health care “co-ops” that would pool individuals and businesses together into consumer co-operatives to purchase health insurance and services.fcgi?artid=2580082 In a single-payer system. “A Market for Compassion: Single-Payer Health Insurance”. Mother Jones does a good job of summing up the ugly compromise: What is in the Finance Committee’s draft. Nothing could be further from the truth. 9-5-2008.org/tag/single-payer-health-care/ Nothing is what some of these proposals seem to offer. What's worse. providers are insulated from competition because private insurers often restrict coverage to select physicians. and failed.campusprogress. affordable health care for all. Our futures deserve better. drenched in industry money and influence. The government will manage the paperwork and private entities will provide the care. The most significant omission in the leaked health care reform legislation from the Senate Finance Committee is the absence of the public option . In addition. For example. and slated for further discussion. and executive compensation. However. Congress should be writing the strongest proposals possible. Healthcare bill alternative plans weak compared to single payer Campus Progress. but private providers will continue to deliver care. if single-payer health care were on the table it would be the more progressive plan to fight for. part of the Center for American Progress for college students. consumers can create competition among healthcare providers.

Waiting lines exist when government invests too little in the medical professionals and equipment that make up our health care infrastructure. Waiting lines do not exist in countries that adequately fund national health care. implementing a single-payer system with non-profit delivery would save approximately $300 billion dollars per year and contain long.term costs. As long as health care is a priority for our nation. Labor. The facts show otherwise. Congressional Testimony. In fact. woman. US rep. It is true that Canada and the United Kingdom have had waits for elective procedures. Employment. Lexis Nexis) [LO//JW] Opponents of single-payer argue that scarcity of care and long waiting lines will inevitably occur in universal singlepayer systems. 2009.5 trillion we already spend each year. we can afford to provide true universal health care with the $2. but that is because they spend 60% and 33% less than we do on health care.0 LO 123 Single Payer Solves –Efficient Despite concerns. single-payer health care assures coverage and timely access to care Conyers.Single Payer 2. June 10. and Pensions. according Dr. You’re A Jerk 123 . US Representative on the Subcommittee on Health. If we deliberately hold down costs with a cohesive and efficient public-private partnership. Steffie Woolhandler of Harvard Medical School. Another argument utilized by those skeptical of single-payer reform is that we cannot afford a single-payer system where we insure every man.. and child in the United States. this problem will never materialize. Jr. 6-10-09 (John Conyers.

As a result.sanctioned monopoly for an industry that has left thousands of state residents without health insurance due to escalating premiums. Taiwan had a private health insurance market remarkably similar to our own. their system boasts a 70 percent approval rating from doctors and patients. co-pays. grow the ranks of the underinsured. Only a single payer health care system for all solves. Employment. The best example of such a legislative failure is the Massachusetts Health Reform Act. the reform cost taxpayers $1. Instead of pursuing a reform strategy that has been successful in developed nations around the world namely. I would respectfully submit that single-payer offers a far better model for reform than the incremental. has minimal financial barriers to care. The Massachusetts reform effort has failed to contain costs and provide universal coverage because it is built around our broken for-profit private insurance system. Labor.3 billion dollars. Governor Deval Patrick has been forced to cut money from safety-net providers such as public hospitals and community clinics. Not surprisingly. 6-10-09 (John Conyers. We have heard this argument before. US rep.. without the cost-containment measures that are integral parts of any public insurance plan. 2009. Employment. Over the course of the next six years. functions without a profit motive. June 10. Yet. 6-10-09 (John Conyers. You’re A Jerk 124 . Congressional Testimony. Labor. while only spending 2 percent on administrative costs. has low administrative costs. US Representative on the Subcommittee on Health. improving access to health insurance that emphasizes prevention.. Congressional Testimony. Lexis Nexis) [LO//JW] naysayers will also argue that dismantling our employer-based health care system is politically and economically untenable. 2009. and Pensions. Today. health care spending has exploded in Massachusetts. US rep. This argument was initially raised when Medicare was debated in The the Congress in the 1960s. Massachusetts proves Conyers. and maximizes value for patients . Taiwan proves Conyers. If the goal of reform is to limit costs and improve access to care. and deductibles. Additionally. Lexis Nexis) [LO//JW] I would like to caution the committee about the dangers of enacting partial reforms that leave some individuals uninsured. June 10. the country seamlessly transitioned to a single-payer national health insurance system. Jr. In fiscal year 2009. enacted by that state's legislature in 2006. private insurance giveaway pursued in Massachusetts. and Pensions. Medicare was enacted in 1965 and fully implemented in 1966. US Representative on the Subcommittee on Health. Until 1995.Single Payer 2. Jr. and do little to contain the out of control growth of health expenditures.lawmakers in Massachusetts instead created a government. the experience of the nation of Taiwan shows that such a transition is feasible.0 LO 124 Single Payer Solves –Empirics A shift to single-payer from privatized health care is possible.

S. even at the very lowest income levels. not because they don’t need it.gov/health/reports/05/uninsuredcps/index. given that low-income individuals are less likely to: * be working. Medicaid eligibility is based on a combination of income and population “category.amsa.8 million uninsured are more likely to be poor and low income than higher income. Data from employers shows that average single coverage premiums for employer sponsored insurance represent 2.(4) That the uninsured comprise non-trivial percentages of middle and upper income individuals is surprising. You’re A Jerk 125 . Department of Health and Human Services 05 U. say they forgo coverage because they cannot afford it. with one-in-ten (11%) uninsured above 500% FPL. Those with incomes above 300% of poverty should generally find employer insurance affordable. pregnant women. Uninsured people are more likely to have low incomes U.S. and the elderly. parents of dependent children. The income levels at which these groups qualify differs from state to state.0% of income at 300% FPL. Figure 2 shows that over half of the uninsured are below 200% of poverty. regardless of how young they are.Single Payer 2.” The population groups that qualify for Medicaid are generally children.com/gview?a=v&q=cache %3AUSbyK8FNL18J%3Awww. the disabled.htm#income The 45. then parents of dependent children last (though this varies by state). and if they do work they are less likely to be working full time. and average family coverage premiums represent 4. followed by the disabled and elderly.0 LO 125 Uninsured Impoverished Most people are uninsured because of low income Kaiser Communication on Medicaid and the Uninsured No Date Given Kaiser Communication on Medicaid and the Uninsured “Myths about the Uninsured” http://docs. with coverage of children and pregnant women being available at higher income levels. Figure 2 shows 27% of the uninsured have incomes above 300% of poverty. Only 7% of the uninsured report the main reason they lack insurance is because they don’t think they need it.google. Not all low-income individuals are eligible for Medicaid. While the income distribution of the uninsured is skewed toward those with lower incomes. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation “Overview of the Uninsured in the United States: An analysis of the 2005 Current Population Survey” http://aspe.org%2Fuhc %2FMythsAboutUninsured.(3) That the uninsured are concentrated among lower-income individuals is not surprising. with 25% below the poverty line and 28% between 100% and 199% of poverty.7% of income for a family of four at 300% FPL (with a higher percentage for smaller families). The majority of the uninsured (52%) say the main reason they don’t have health insurance is because it is too expensive and the next most common reason they give is not being eligible for their job’s health benefits (11%). and group to group. * receive an offer of insurance.pdf+uninsured+americans+income&hl=en&gl=us&pli=1 The majority of uninsured. Childless adults who are not disabled or elderly rarely qualify for Medicaid . and * be able to afford an offer of coverage.hhs.

Uninsured children are at greater risk of experiencing health problems such as obesity. "These people are going to develop diseases at a higher rate and the health care system is going to feel the brunt of it. Experts Say” http://www." Woolf said. will be substantial. associate producer with the CNN Medical Unit. By making the public more aware of the direction the economy is taking. the economic consequence to everybody. Research consistently highlights the negative link between reduced income and worsening health -. heart disease and asthma that continue to affect them later in adulthood. he said.cnn. "If we amplify the scale by the results of poverty left to run loose. “Poverty and Poor Health are Intertwined.as salaries drop. The prevailing thought is that the problem needs to be addressed. and Lack of Health Care Are Intertwined CNN ‘06 (Sabriya Rice. the CDC said.html) [LO//JW] As financially strapped families struggle to cover basic needs such as food." Woolf said. health insurance often takes a back seat on the list of priorities. CNN. You’re A Jerk 126 . Poverty's impact is felt most by the nation's children. A National Health Survey conducted by the U.0 LO 126 Uninsured are Poor Poverty. to all Americans and all taxpayers. and quickly. Woolf said.S.com/2006/HEALTH/08/29/poverty. researchers say they hope policies can be put into place that will keep Americans from living under such difficult conditions in the wealthiest country in the world. individuals tend to be more stressed. shelter and the increasing cost of energy.Single Payer 2. Centers for Disease Control and Prevention found more than 40 million people of all ages went without insurance at some point in 2005.com. and generally lead less-healthy lifestyles. Children under the age of 5 are more likely to live in extreme poverty.health/index. 9/4/06. Poor Health. The prevalence of these illnesses does not bode well for future generations. More than half remained uninsured specifically because they simply couldn't afford it.

Furthermore. You’re A Jerk 127 . Senior Lecturer @ Harvard Medical School. taxes at all levels of government.org/facts/statement_of_dr_marcia_angell_introducing_the_us_national_health_insurance_act. we will have to ration care.0 LO 127 A2: High Cost Single payer more cost effective Angell. It makes more sense to pay just once. cost-shifting and unnecessary duplication. A single-payer system would be far more efficient. MD. profits. and if we try it. http://www. We should remember that we now pay for health care in multiple ways — through our paychecks.pnhp.php [Mardjuki] Myth #1 is that we can’t afford a national health care system. “Statement of Dr. Marcia. My answer is that we can’t afford not to have a national health care system. and out-of-pocket. Editor of New England Journal of Medicine.” Physicians For A National Health Program. Marcia Angell introducing the US National Health Insurance Act. since it would eliminate excess administrative costs. 2009. the prices of goods and services.Single Payer 2. it would permit the establishment of an overall budget and the fair and rational distribution of resources.

For us. K. This misconception is based on the fact that there are indeed waits for elective procedures in some countries with national health systems. and in general.org/facts/statement_of_dr_marcia_angell_introducing_the_us_national_health_insurance_act. it’s not the money. You’re A Jerk 128 .) If they were to put the same amount of money as we do into their systems. medical care would be threadbare and less available. and Canada. we would have long waiting lists for operations and procedures. Editor of New England Journal of Medicine.pnhp. K. it’s the system.php [Mardjuki] According to Myth #2. the problem is not the system. Marcia. 2009.0 LO 128 A2: No Innovation/Wait Single payer system efficient and innovative Angell. there would be no waits and all their citizens would have immediate access to all the care they need. Marcia Angell introducing the US National Health Insurance Act. it’s the money. such as the U. Senior Lecturer @ Harvard Medical School. (The U. http://www.” Physicians For A National Health Program. innovative technologies would be scarce under a single-payer system. But that’s because they spend far less on health care than we do. For them.Single Payer 2. spends about a third of what we do per person. MD. “Statement of Dr.

but privately delivered. Marcia. MD. which is publicly funded.0 LO 129 A2: Bureaucracy Single payer comparatively streamlined bureaucracy compared to private industry. Senior Lecturer @ Harvard Medical School. Editor of New England Journal of Medicine.” Physicians For A National Health Program. nothing could be more onerous both to patients and providers than the multiple.php [Mardjuki] Myth #3 is that a single-payer system amounts to socialized medicine. although a national program would be publicly funded.Single Payer 2. bureaucratic regulations.pnhp. “Statement of Dr. providers would not work for the government. Angell. Marcia Angell introducing the US National Health Insurance Act. That’s currently the case with Medicare. You’re A Jerk 129 .org/facts/statement_of_dr_marcia_angell_introducing_the_us_national_health_insurance_act. 2009. Indeed. But in fact. which would subject doctors and other providers to onerous. many doctors who once opposed a single-payer system are now coming to see it as a far preferable option. As for onerous regulations. intrusive regulations imposed on them by the private insurance industry. http://www.

not 280 million individuals competing with one another. for example. and without considering the alternatives.org/facts/statement_of_dr_marcia_angell_introducing_the_us_national_health_insurance_act. Yes. Editor of New England Journal of Medicine. the NIH.Single Payer 2. and social privilege. Some people say that a single-payer system is a good idea. I want to mention one final and very important reason for enacting a national health program. http://www. Marcia.php [Mardjuki] Myth #4 says that the government can’t do anything right. we have an opportunity today to reassert that we are indeed a single nation. there would be powerful special interests opposing it and I don’t underestimate them. material possessions. without thinking of all the ways in which government functions very well indeed. Senior Lecturer @ Harvard Medical School. Others are education. the medical profession and the public would be enthusiastic about a single-payer system if the facts were known and the myths dispelled. and the support of the medical profession and public. In my opinion. but politically unrealistic. I believe there is nothing unrealistic about a National Health Insurance Program. such as Representative Conyers is providing. all of which we already acknowledge are public responsibilities. That is a self-fulfilling prophecy.0 LO 130 A2: Utopian? Single payer viable – necessary but needs support. We live in a country that tolerates enormous disparities in income. the National Park Service. helps ensure that we remain a cohesive and optimistic country. not to the public. We should remember that the government is elected by the public and we are responsible for it. Marcia Angell introducing the US National Health Insurance Act. Some Americans like to say that. clean water and air. MD. In seeking to ensure adequate health care for all our citizens. 2009. \ You’re A Jerk 130 . Angell. But those disparities should not extend to denying some of our citizens certain essential services because of their income or social status. or the IRS privatized. Providing these essential services to all Americans. “Statement of Dr.” Physicians For A National Health Program.pnhp. regardless of who they are. we are one community. That may be an inevitable consequence of a free market economy. It says that when it comes to vital needs. One of those services is health care. but with courageous leadership. equal justice. and protection from crime. We need to acknowledge the same thing for health care. An investor-owned insurance company reports to its owners. I would not want to see.

Editor of New England Journal of Medicine. “Single-Payer FAQ. Quentin Young. There is no reason whatsoever that would make it hard to scale up. Christine Cassell. Senior Lecturer @ Harvard Medical School.org/facts/singlepayer_faq. http://www.Single Payer 2. American Public Health Association.0 LO 131 A2: Scale Up Not Possible National modeling off Medicare feasible – Canada proves. health care is administered at the provincial level. but it wouldn’t work when scaled up to meet the needs of a large country like the US A: Medicare is a national program that works reasonably well. President of American College of Physicians. Joel Alpert. Peter Beilenson. MD. In Canada. or the Veterans Administration.” Physicians For A National Health Program. American Academy of Pediatrics. Marcia. that program seems a sound indication that scale should not be problematic. Indeed. which includes the city of Toronto as well as rural areas. Ron Anderson. CEO Parkland Health System. Commissioner of Baltimore City Health.pnhp.scaling it up 7 or 8 fold should not prove difficult. Canada. You’re A Jerk 131 . Medicare was initiated (and administered for tens of millions of enrollees) before computers became available . The Ontario Health Insurance Program. 2009. is a good example. Since much of the program we envision would be regionalized. Angell.php#socialized [Mardjuki] Q: Universal healthcare is okay for a small country or organization like Switzerland. with regions similar in size to Ontario.

1991). Volume 4. Single-payer systems are not to be confused with a national health program. [Mardjuki] In a single-payer system. such as Canada's provincial system (U. Revenue sources could include individual and corporate income taxes. General Accounting Office [GAO]. Miller. RN and MSN @ Ball State University. The single government payer could be the state. as exists in Great Britain. You’re A Jerk 132 . Increased consumer taxes would be balanced by consumer savings from lower deductibles. Medicare and Medicaid funds. where health care providers are salaried government employees working in government-owned and operated facilities. Single-payer systems would incorporate various cost containment mechanisms and insurance reforms.S. 1989). excise or consumption taxes.Single Payer 2. insurance premiums. which are then paid to providers by a single governmental entity. not national health program. or the federal government. value-added taxes (VAT).0 LO 132 A2: National Health Program Bad Single-payer system streamlined and efficient. Pgs. and supplemental insurance costs. Most single-payer systems allow private insurance coverage for additional benefits not included in the public program. as in Japan (Sokolovsky & Kline. co-payments. and make health insurance portable between jobs. “Health Care Reform: Clarifying the Concepts. with consumer choice of provider. eliminate exclusions for preexisting medical conditions. payroll taxes.” Journal of Community Health Nursing. "sin taxes" on alcohol and tobacco. and employer and employee premiums. surtaxes on upper income individuals. a health care trust fund similar to Social Security or Medicare would receive designated tax revenues. Anna. 1993. 199-211. Service delivery would remain in the private sector.

2002. MD & MPH. Conservative Spending.S.” Counterpoint.0 LO 133 A2: Canada Empirically Fails US single payer solves – even with financial failure Canadian health higher than US.S. http://www. health care spending was once comparable. during the 1990s. A system structured like Canada's but with double the funding could provide high-quality care without the waits or shortages that Canadians have experienced. do not bill for individual patients. m ost of whom are in private practice. December. “Liberal Benefits. for both cardiovascular disease and cancer. Stephanie. which are mostly private. Woolhander. For instance. bill by checking a box on a simple insurance form. hightechnology care have resulted..pnhp. Physicians.Single Payer 2. Even though shortages of expensive. Himmelstein. nonprofit institutions. Canadian hospitals. Canada's health outcomes remain better than ours: their life expectancy is two years longer and most quality comparisons indicate that Canadians enjoy care equivalent to that received by insured Americans. They are paid a global annual budget to cover all costs. MD. especially among younger individuals with potentially curable malignancies.S. Canadian death rates are lower than those in the U. Unfortunately. or patients with cancer and others who need expensive or long-term care need never fear exceeding their benefits. much as a fire department is funded in the U. Fee schedules are negotiated annually between provincial medical associations and governments but all patients have the same coverages. Canada’s health care funding was starved by governments responsive to pressure from the healthy and wealthy who did not want to subsidize care for the sick and poor. David. Canada and numerous other nations use this solution and it works.source payment. but today Canada spends barely half what we do per capita. Canadian and U. You’re A Jerk 133 .pdf [Mardjuki] The key to achieving significant health care savings is single.org/PDF_files/LiberalBenefitsConservativeSpending.

where he worked on legislation to provide low-cost insurance to low-income and unemployed people. "If you have a hernia operation. You’re A Jerk 134 . particularly unjustified. is particularly powerful. and there is some grumbling in the House that Mr. Women have a baby. The single-payer movement is often faulted for its political naivete. "That's rationing done by insurance companies.0 LO 134 A2: Rationing Status quo already faces rationing. writer for the New York Times “Competing Plan Is Stuck Offstage In Debate Over Better Health Care” lexisnexis[LO//AS] Mr. Cooper." Mr. Before coming to Congress in 1988.Single Payer 2. you don't get to stay in the hospital overnight. McDermott has the physician's full measure of disdain for insurance companies. it's happening all the time. McDermott could be more aggressive and more strategic in pressing his case. McDermott says he has heard all the objections to a single-payer system: fear of government. less artful in political positioning than Mr. in fact. in terms of rationing. they get sent home the same day they have the baby. and.from a private practice to the Seattle/King County Jail to the Foreign Service in Zaire." Mr. The rationing issue. He is. This. fear of rationing. He was a psychiatrist for two decades in a variety of settings -. where he worked with American personnel in sub-Saharan Africa. in fact. They hand you a bottle of pills and send you home after your surgery. "People don't look at what's going on in this system right now. he served 15 years in the Washington State Legislature. he asserts. he says. He was appointed to the Ways and Means Subcommittee on Health in 1992. McDermott says. plan wouldn’t affect it Toner 94 Robert Toner. gives much of the power to his arguments: He straddles the divide between those who write health policy and those who live it. right now in this country. fear of vast new taxes.

Symonds director of the Forgotten Half Project education program at Harvard “WHITHER A HEALTH-CARE SOLUTION? OH.S. or Canadian-style. Little wonder. Admittedly. nonstarter. http://fundingourfuture.0 LO 135 A2: Socialized Medicine Single payer is not socialized medicine Campus Progress. Both these principles are seriously compromised by more "conservative" proposals that would force most Americans into managed-care plans. Pg. economy to the federal government seems about as politically palatable as eliminating the tax breaks for homemortgage interest. of the care .campusprogress. the American College of Surgeons recently backed fundamental aspects of a single-payer plan.Single Payer 2. It would decimate the health-insurance industry in one swift stroke. the single-payer. I liked the Daily Kos explanation of the major differences between the two terms that are getting. part of the Center for American Progress for college students. For this reason. You’re A Jerk 135 . conveniently for those opposing it. And the insurance industry strongly opposes the plan because it would mean the end of their glory days. singlepayer is radical. No other plan would do more to preserve the two traditional bedrocks of American medicine: the freedom to choose your own doctor and the autonomy of physicians to order care as they see fit. it's time to give the single-payer plan a hard second look. It’s a system in which one institution purchases all. But the payer does not own the doctors or the hospitals or the nurses or the MRI scanners. tossed into the same boat too frequently: Socialized medicine is a system in which the government owns the means of providing medicine. But let’s get one thing straight. 82 lexis-nexis [LO//AS] For months.org/tag/single-payer-health-care/ So why isn’t single-payer health care on the table? Well to start. most. single-payer health care is NOT socialized medicine. But now that the flaws of President Clinton's and other reform plans have become painfully evident and the debate has veered toward gridlock. “A ‘Better than Nothing’ Future”. 7-19-2009. But this radicalism would serve some profoundly conservative purposes. CANADA” Business Week SOCIAL ISSUES. or in reality. Freedom to choose doctors and physician autonomy make single-payer health care uniquely non-socialist Symonds 94 William C. At first blush. Medicare is an example of a mostly single-payer system. Single-payer health care is not socialized medicine. Number 3363. the idea solution to health-care reform has been dismissed as a of turning over one-seventh of the U. And the Congressional Budget Office estimates that it would require a breathtaking $ 556 billion increase in federal spending by 1998. Conservatives are painting this option as “socialized medicine” or “government take-over”. as is France.

many observers expect it to be adopted by one or more states. But if Congress approves a bill that allows states to opt for single-payer.about waiting 45 minutes to fill up their gas tanks. home health care by 50%.5% in Canada. Meyer. The fear is that the states would then have to ration care by imposing waiting lines and limiting spending on new technology. Few believe there's any chance Congress will approve a single-payer plan this year." Rather. an American who has worked as CEO of both Toronto Hospital and Duke University Medical Center. based upon how much you or your insurer can afford to pay." says Jack A.if not furious -. Canadians do face waiting lines for some nonemergency procedures and have far less high-tech equipment. system. By 2003. "Americans get quite antsy -. Such laboratories would soon demonstrate that single-payer is not "socialized medicine. or as much as 8. To control spending. Symonds director of the Forgotten Half Project education program at Harvard “WHITHER A HEALTH-CARE SOLUTION? OH. and triple demand for drug-abuse treatment. would minimize constraints by continuing to allocate about 14% of GNP to health care. Even so. 82 lexis-nexis [LO//AS] LIBERAL PROVISIONS. health-care spending would be cut by $ 114 billion. de facto rationing already exists.S.Single Payer 2. Canada and many other nations have already proven such budgets work. thus sharply slowing the medical arms race that has burdened the U. Pg.." argues Vickery Stoughton. Symonds 94 William C. McDermott's plan. Opponents foresee a nightmare." But Canada's 30 years of experience with single-payer suggests care would not be compromised anywhere near as much as opponents predict.6% below what it would be without any changes. Proponents contend that this would force better planning. president of New Directions for Policy. single-payer would establish a national health budget indexed to economic growth. Opponents have raised some legitimate concerns. 9. vs. it's by far the best way to control costs while preserving the freedom of choice and physician autonomy that made American medicine great.0 LO 136 A2: Socialized Medicine American single-payer could handle increased demand – not socialized. Many fear that single-payer would lead to runaway demand for services and then rationing. But at what cost? The CBO predicts that single-payer's liberal provisions would jack up demand for physician services by 30%. sometimes called Canada Deluxe.S. and the average citizen. with underutilized facilities. to $ 175 billion. Number 3363. In the U. the CBO estimates. You’re A Jerk 136 . and give the government unbridled power to make life-and-death decisions. "They're not going to wait weeks or months for surgery. "the Canadian system has served society. a Washington-based think tank. better than the U.S. as Clinton's plan would. CANADA” Business Week SOCIAL ISSUES.

000 more out-of-pocket than her male counterpart. 2009. HSAs/MSAs discriminate against women. Joel Alpert. Ron Anderson. http://www. Once the account is depleted and a deductible is met. Peter Beilenson. MSA/HSA plans discourage preventive care. Senior Lecturer @ Harvard Medical School. By placing everyone in the same pool. American Academy of Pediatrics. hence they would tend to select plans with more comprehensive coverage. which generally would be paid out-of-pocket. American Public Health Association. and do nothing to restrain spending for catastrophic care. MD. President of American College of Physicians. Moreover.org/facts/singlepayer_faq. keeping health insurance costs affordable for everyone.pnhp. $1. but little to families with average incomes. Christine Cassell. CEO Parkland Health System. You’re A Jerk 137 . higher-cost individuals would be concentrated in the more comprehensive plans. Currently. Since only healthy individuals would be attracted to the MSAs/HSAs.000 more than men’s annually. which accounts for most health costs. and thus serve as a covert tax cut for the wealthy. Marcia. medical expenses are covered by a catastrophic plan. Finally. the cost of high-risk individuals is diluted by the larger sector of relatively healthy individuals. on average. Quentin Young. Commissioner of Baltimore City Health. Hence. “Why not MSAs/HSAs?” Physicians For A National Health Program. on the MSA/HAS plan. whose care costs. the average woman pays $1. Editor of New England Journal of Medicine.0 LO 137 A2: MSA/HSA Medical saving accounts don’t solve – decreases overall affordability and discourages preventative care.Single Payer 2. usually a managed care plan. HSAs offer substantial tax savings to people in highincome brackets. Individuals with significant health care needs would rapidly deplete their accounts and then be exposed to large out-of-pocket expenses.php#socialized [Mardjuki] Medical savings accounts (MSAs) and similar options such as health savings accounts (HSAs) are individual accounts from which medical expenses are paid. driving up premiums and threatening affordability. Angell.

uninformed consumers. Pgs. however. medical technology. Quentin Young.pnhp. providers have incentives to create demands for the services they provide using self-determined fees. They also waste money on advertising and marketing. There are two main areas where competition exists in health care: among the providers and among the payers. In a market economy. An insurance firm that engages in these practices may reduce its own outlays. http://www. In addition. MD. When. Rogers. CEO Parkland Health System. denial of payment for expensive procedures. feefor-service physicians tend to provide more hospital-intensive. “Health Care Reform: Clarifying the Concepts. “Won’t Competition Be Impeded By a Universal Health Care System?” Physicians For A National Health Program. however. Within a fee-for-service reimbursement system. Editor of New England Journal of Medicine. Anna. cherry-picking. 1992). and are the major cause of rising costs. and worry can cloud decision making. Peter Beilenson. 2009. pain. American Public Health Association. Volume 4. it results in competitive practices such as avoiding the sick. Rather. increased availability of hospital beds. What is overlooked is that past competitive activities in health care under a free market system have been wasteful and expensive. consumers might not have enough information to make informed choices for themselves and for other family members. President of American College of Physicians. Senior Lecturer @ Harvard Medical School. In the health care system. demand is generated by supply. & Newhouse. Compared to HMO physicians. RN and MSN @ Ball State University. increased demand usually generates greater supply (more products). Competition among insurers (the payers) is not effective in containing costs either. for example. Marcia. As in our current system. and even an expanded market system would leave an estimated 4. 1993. In addition. American Academy of Pediatrics. There are inherent difficulties in relying on market competition to provide universal access and control costs. Goldberg. You’re A Jerk 138 . Christine Cassell. Joel Alpert. [Mardjuki] Arguments Against Market Competition: The present market-oriented system has left millions uninsured.Single Payer 2. providers sometimes use "creative billing" to sidestep existing cost control mechanisms. hospitals compete they often duplicate expensive equipment in order to corner more of the market for lucrative procedure-oriented care. It is unknown whether voluntary participation would achieve significantly increased insurance coverage or whether tax credits and vouchers would provide a sufficient incentive to purchase adequate health insurance.” Journal of Community Health Nursing.php#socialized [Mardjuki] Advocates of the “free market” approach to health care claim that competition will streamline the costs of health care and make it more efficient. This drives up overall medical costs to pay for the equipment and encourages overtreatment. or outpatient services results in increased use of those services. but at the expense of other payers and patients. Free market-based healthcare invariably fails – emotional decisionmaking. and therefore more expensive medical care (Manning. The preferred scenario has hospitals coordinating services and cooperating to meet the needs of their communities.0 LO 138 A2: Free Market More Efficient Free market approach increases costs – duplicative equipment and competitive treatments. etc. Leibowitz. 1984).9 million persons uninsured (White House. and demand generated by supply. Market competition relies on an informed consumer. For example. Commissioner of Baltimore City Health.org/facts/singlepayer_faq. 199-211. Miller. health care choices often are made during crises when fear. benefits would vary with the insurance carrier or the employer's choice of insurance plan. Ron Anderson. Angell.

2009. Survey of Health (JCUSH). and Canadian government statistical agencies. CEO Parkland Health System. a population-based survey conducted jointly by the U.pnhp. American Academy of Pediatrics.php#socialized [Mardjuki] The O’Neills collected no new data. Marcia.org/facts/singlepayer_faq. Christine Cassell. Commissioner of Baltimore City Health. Peter Beilenson. While they extensively cite the few pieces of published data that supports their grim view of Canada’s health system. Angell. Joel Alpert. Their analysis rests on idiosyncratic.S. they ignore a large body of research and statistics that conflicts with their portrayal. Editor of New England Journal of Medicine. American Public Health Association. http://www. President of American College of Physicians.S. You’re A Jerk 139 .Single Payer 2. “Recent Attacks on Single Payer Health Reform: Ideology Masquerading as Scholarship” Physicians For A National Health Program.0 LO 139 A2: O’Neill Free market approach increases costs – duplicative equipment and competitive treatments. Ron Anderson. Quentin Young. highly selective and overtly biased reinterpretations of previously published data — mostly from the Joint Canada/U. MD. Senior Lecturer @ Harvard Medical School.

” Journal of Community Health Nursing. In 1990.S. You’re A Jerk 140 . they simply pass added costs on to consumers through higher prices. Volume 4. health care costs (Polzer. small business (fewer than 100 employees) provided 51% of all jobs (Edwards et al. RN and MSN @ Ball State University.0 LO 140 A2: Employer-Based HC Employer-based insurance fails – doesn’t cut costs. Small businesses might be unable to afford the added expense of providing health care insurance. 1992).Single Payer 2. American business already underwrites approximately 30% of U. A play or pay approach also does not inherently improve quality or efficiency of services or reduce administrative costs. [Mardjuki] : Opponents of the play or pay approach point out that employers do not really pay for employee benefits. “Health Care Reform: Clarifying the Concepts. with a lower quality and less adequate public plan. Miller. 199-211. 1993. 1990).. Pgs. Some fear that employer-mandated insurance establishes a two-tier system. Anna.

This would require Medicaid and Medicare waivers.) Opponents of managed competition also point out the difficulty in using outcomes to evaluate physicians. thus making competition impossible in those areas (Clancy.” Journal of Community Health Nursing. In addition. 1991). they have no authority over self-insured companies.Single Payer 2. controlling costs.0 LO 141 A2: Managed Competition Managed competition fails – lack of quality control and structure not nationally viable. Large-scale use is untried. For example. Many large businesses selfinsure and assume their own health care costs rather than buying health insurance (Dobson. 1992). are more important and more difficult to obtain. inner city areas may have difficulty attracting competing health plans. Although these self-insured businesses often contract with an insurance company to manage their insurance claims processes. Therefore. You’re A Jerk 141 . Volume 4. (Note that selfinsured is not to be confused with individual insurance for those not part of group plans. question whether managed competition would provide sufficient incentives for quality medical care. which may be possible. Without an ERISA waiver. Before mandating managed care across the country. and past experience does not indicate that HMOs are necessarily more cost-effective than other models (Polzer. Moran. 1990). Some question the feasibility of mandating nationwide managed competition. some suggest that states first be given freedom to try various methods of providing universal coverage. more than one half of all Americans live in areas with a population density too low for more than one HIPC to operate. and suggest it may be a slippery slope to a government-based system (Griffin. 1986). “Health Care Reform: Clarifying the Concepts. Himmelstein. Miller. & Woolhandler. 1992). Unless states receive an ERISA waiver. and improving quality. RN and MSN @ Ball State University. 199-211. To date. however. The federal ERISA law exempts self-insured businesses from state insurance mandates (Rublee. only Hawaii has received such a waiver because the Hawaii plan was in place before ERISA was enacted (National Health Policy Forum. Inherent difficulties include lack of accurate and understandable quality outcome data from health care providers. and the problems involved in educating consumers to make cost-efficient choices. Pgs. & Young. and they do not have to provide statemandated insurance benefits or participate in state high-risk pools (National Health Policy Forum. 1992). technically they do not sell insurance and thus are exempt from state regulations. 1990). 1993. self-insured companies can choose to provide fewer benefits or require higher co-payments. Employee Retirement Income Security Act (ERISA) waivers. Anna. ever more companies will try to escape government mandates by becoming self-insured. [Mardjuki] Managed competition continues the present employer-paid insurance with its inherent difficulties. minimal knowledge about consumer health care decision-making processes.

Knox. A similar thing happened some months back to the American Medical Association. writer for the Boston Globe. 2001. we began to take a little different approach. The Next Agenda: Blueprint for a New Progressive Movement. Historically. “Surgeons' uproar shows reform rift” Lexis-Nexis [LO//AS] When the Board of Regents was first discussing this about eight to 10 months ago. The AMA previously favored an "employer mandate" that would force employers to help pay for their workers' coverage. consumer groups and physicians’ associations have subdued their traditional enmity and are working together to pass both state and federal laws regulating HMOs and other managed care plans. Physicians may be increasingly persuaded that they will fare better under a public system that would reinstate their clinical autonomy than under the corporate control of private health plans. AMA leaders scrambled to fashion a compromise that put the group on record as neither favoring nor opposing such a policy." said Dr. The transformation of the medical system through various managed care practices has created deep discontent among physicians with current arrangements. they may prove a key catalyst to its enactment. Murray said the College of Surgeons's policy making board has not backed down from its consensus in favor of a Medicare-style. In the future. physicians have been a strong obstacle to large-scale reform. "Then as we learned more of what was going on.0 LO 142 A2: Physician Backlash Growing physician discontent with current regime – can be catalyst for large-scale reform. executive director of the American Academy of Family Physicians. when anyone says anything moderate about it." Murray and leaders of other physician groups say the College of Surgeons did not anticipate the reaction they got from members. That alliance could reasonably be taken a step further. Pg 118-119. got input from all over the country. But to placate conservative physicians opposed to the Clinton plan with its employer mandate. Single Payer has gained backing. "We felt as a board that the single-payer system would probably provide the best assurances that patients would be able to seek care from any doctor of their choice. including physician associations Knox 3/20 Richard A. [Mardjuki] The events of the past decade have provided new opportunities to expand the coalition for health reform. and learned how the Clinton plan would partially be financed by cutting back on Medicaid and Medicare. Hickey." You’re A Jerk 142 . prof of law @ American University. Despite all the damage control and spin. it suddenly sounds like a radical statement. Borosage. Robert and Roger. Already. single-payer approach to health reform. vice president @ Economic Policy Institute. I think almost to a person our reaction was: 'Single-payer system? You've gotta be kidding!' " Murray said in an interview.Single Payer 2. Robert Graham. "Because physician groups have historically been so opposed to single-payer. Given doctors’ unhappiness with their growing lack of clinical authority and with the corporatization of American insurance that incorporates large segments of the medical community.

0 LO 143 **Add-ons** You’re A Jerk 143 .Single Payer 2.

000 a year would whack small businesses who pay the individual income tax. say it could still be in a recession or in a weakened condition well into 2011. But Mr. and anyone who flips on a light switch is going to pay higher taxes under this plan. House Minority Leader John A. less economic growth. and produce as much as 60 percent of all jobs. Boehner of Ohio called the budget plan a "job killer.000 a year would whack small businesses who pay the individual income tax.S. but many economists.washingtontimes." Mr.not more. saying that this was not the time to raise taxes on higher income people because it would further weaken the economy. Bush's two top tax rates expire at the end of 2010 .and his budget calls for letting President George W.0 LO 144 Small Business Add-on Health care taxes would destroy small businesses – key to the economy. as the recession deepened last year. The White House expects the economy to be in a recovery at that time. everyone with a 401(k). less economic growth. and fewer jobs . Obama ran for president saying he will raise taxes on wealthy Americans by boosting the present 35 percent top income tax rate to the nearly 40 percent rate under President Clinton in the 1990s. chief lobbyist at the U. too. and a nationally syndicated columnist He won the 1995 Warren Brookes Award for Excellence in Journalism “LAMBRO: Obama's budget to raise small-business taxes” February 27.S. resulting in less government revenue.which will cost an estimated $1 trillion over 10 years ." saying that "small businesses. charities. including members of the Federal Reserve Board. <insert econ impact> You’re A Jerk 144 .Single Payer 2. This plan would punish them with higher taxes. Chamber of Commerce.com/news/2009/feb/27/obamasbudget-to-raise-small-business-taxes/)[LO//AS] Business advocates charged that multiple tax increases on Americans earning more than $250." said Bruce Josten. resulting in less government revenue. This plan would punish them with higher taxes. Obama needs increased revenue to launch his national health care plan . he changed his mind. retirees. and fewer jobs . and produce as much as 60 percent of all jobs. Then. chief lobbyist at the U. Lambro 2/27 Donald Lambro is the chief political correspondent of The Washington Times. too. the author of five books on the government and the economy. On Capitol Hill.not more. 2009 (http://www. Small businesses and the entrepreneurs who lead them have been the primary drivers of job growth over the past decade. Small businesses and the entrepreneurs who lead them have been the primary drivers of job growth over the past decade. family farms. "You don't build a house by blowing up its foundations." said Bruce Josten. middle-class families. "You don't build a house by blowing up its foundations. Business advocates charged that multiple tax increases on Americans earning more than $250.

But one thing I know for sure: British food is terrible. In 2008 it paid $375. Marks is the author of four best-selling small business books. If we opt for Kennedy's proposal. The National Coalition on Health Care (NCHC) estimates that. Not a bad thing. let me explain. Written in Business Week “National Health Care: How Small Business Will Fare” http://www.Single Payer 2. For one. Rogers (D-FL). If we go with the President's 8% plan. And a national health insurance system would be a good thing for small business owners. editors for Yes! Magazine.086 million. which sells customer relationship. longer wait times for treatment. and per capita costs are expected to keep rising. and a strong urge to have tea and biscuits at 4 o'clock. national health care spending will double over the next 10 years. The NCHC is not some fringe advocacy group—its co-chairs are Congressmen Robert D. The shocking facts about health care in the United States are well known. Now before my fellow conservatives handcuff me to a TV and force me to watch 20 hours of The Franken & Davis Show. Insurance premiums increased 73 percent between 2000 and 2005. author of best-selling small business books. it would save $337.0 LO 145 Small Business Add-on Ext Businesses are suffering from privatized HC Pibel and Gelder 06 Doug Pibel and Sarah Van Gelder. and it counts General Electric and Verizon among its members. National Health Insurance helps small businesses Marks. There's little argument that the system is broken. But take a look at these numbers from a client of mine—a 50-person manufacturer in Pennsylvania. publicly funded system is off the table. an award-winning publication “ Health Care: It's What Ails Us” http://www. Yes. as a business owner. without reform. But Americans in increasing numbers know what their leaders seem not to—that the United States is the only industrialized nation where such stories as Joel's and Kiki's can happen. Employers who want to offer employee health care benefits can't compete with low-road employers who offer none.000 net health insurance on a payroll totaling $2. What's not well known is that the dialogue about fixing the health care system is just as broken. 7/21 owner of the Marks Group. Ray (R-IA) and Paul G.org/issues/health-care-for-all/1498[LO//AS] Businesses are suffering too. (This included the owners.yesmagazine. a universal. That works out to 18% of its payroll cost. the company would save about $208.businessweek. those critics are probably right—socialized medicine will probably lead to higher individual taxes.htm [LO//AS] Will national health care benefit us as a country? I'm not really sure.com/smallbiz/content/jul2009/sb20090721_906996.) And this is for a pretty basic Blue Cross plan.500 per year! You’re A Jerk 145 . Way cheaper.000. lower-quality health care. Among politicians and pundits. service. Nor can they compete with companies located in countries that offer national health insurance . and financial management tools to small and midsize businesses. a national insurance plan would be cheaper for me.

those housed and those homeless. Department of Radiation Oncology at Allegheny General Hospital. or age. society differentiates in access to health care between the rural and the urban. 9/21/06. the uninsurable.” Speech to PA’s House of Representatives. “Establishing a Right to Health Care. I maintain that by implication of these sweeping but generally accepted statements this nation grants a fundamental and irrefutable right to health and to health care.democrats. or the profit needs of third parties much less the generally regarded criteria of race. and psychological health or the opportunity to be as fully as possible restored to such a state. current or prior infirmity.Single Payer 2.is unachievable. to create castes of medical untouchables. One need ask whether there are conditions under which in the daily life of a Pennsylvania resident these rights are compromised or denied. the underinsured. This creates the medically ethically untenable situation where. Chief for Pittsburg Health System.org/page/community/group/AdvocatesforSinglePayerHealthCare) [LO//JW] The Declaration of Independence speaks to unalienable rights including life. physical ability. Even those who are as Pennsylvania fully insured as this system allows are distinguished according to their private insurer and the quality of their insurance. possessing. between ethnic and racial groups. Only a system that guarantees equal access for all and a single standard of care based on scientific evidence will pass the test of equal protection for all Pennsylvania residents and I would submit to you that only through a single-payer universal health care system can that be achieved. and protecting property and reputation. In order to meet the constitutional test of equal protection. If an individual's quality of life is compromised for want of health care. liberty. those who can access the system only after a minimal problem has progressed through neglect and want of access to crisis proportions. http://www. ethnicity. ‘06 (Dr. which include enjoying and defending life and liberty. the uninsured. Barry Tepperman. site of residence. The Declaration of Rights of the Pennsylvania Constitution speaks of universal inherent and indefeasible rights. of acquiring. property and reputation are meaningless. in the same physicians' practice treating comparable patients different insurers will demand different standards of care a distinction based on the insurers' need for profit and not on any scientific evidence or medical logic. Chief of Radiation Therapy for the Pittsburg Health System. I respond that in the absence of optimal physical. life and liberty are devalued. You’re A Jerk 146 . and the pursuit of happiness. The current canon of medical ethics reasons acceptable behavior from four basic principles one of which is justice . graduated from the University of Toronto with an MBA in Health Administration.simple fairness and equity in the use and application of resources. happiness for him and for those who care for him . current employment or future prospects. these rights cannot be achieved. and of pursuing their own happiness. such care needs to be of equal quality and equally accessible to all residents of the state. in a fashion which does not discriminate according to factors such as financial resources or potential. Our current system denies care to many and violates that ethical precept in the care of countless more. according to what they will pay for and what employers have contracted for. emotional. religion.0 LO 146 Equal Protection Universal Health Care Solves Equal Protection Rights Tepperman.

0 LO 147 **2AC** You’re A Jerk 147 .Single Payer 2.

" Particularly in the absence of actual coverage of single-payer. But given the high level of popular support the policy enjoys. Expand Medicare to everyone. Private insurance systems could insure for services not covered by this single public plan. [Mardjuki] A new single-payer system could be designed for the entire population. opinion polling (e. adding preventive. and healthcare systems such as Britain's. Obama has not expressed support for singlepayer. both the idea and its advocates were marginalized in yesterday's healthcare forum. such rhetoric confuses rather than informs. 1990).Single Payer 2. Miller. 2009.. and there would be no charge for most preventive services. copayments and deductibles would be reduced for low-income persons. a la England--he will get resistance in the same way that Hillary Clinton got resistance when she tried to do tried to do this in the '90s. Expansion of Medicare system popular – less contentious than new healthcare reform.R. 2/26/09) that "if in time. 676. and well child care. ABC News/Washington Post. Pgs. Volume 4. Americans start to think what President Obama is proposing is some kind of government-run health system--a la Canada. existing governmental health insurance programs could be modified and expanded to provide insurance coverage for specific population groups.0 LO 148 Plan Pop Plan popular – public and Congress. You’re A Jerk 148 . Anna. that's all the more reason media should include it in the public debate about the future of healthcare. stating (CNN Newsroom. 199-211. 1993.fair. RN and MSN @ Ball State University. The existing single-payer Medicare system could be expanded to include everyone. Expansion of existing public programs might be more politically acceptable than establishing completely new programs (Harrington. perinatal. in which healthcare (and not just healthcare insurance) is administered by the government. “FAIR Study: Media Blackout on Single-Payer Healthcare. “Health Care Reform: Clarifying the Concepts.g. Though more than 60 lawmakers have co-sponsored H. the single-payer bill in Congress. FAIR March 6.” http://www. Fairness and Accuracy in Reporting. The views of CNN's senior medical correspondent notwithstanding. Everyone would have a medical identification card (like a Medicare card).” Journal of Community Health Nursing. blurring the differences between the Canadian model of government-administered national health insurance coupled with private healthcare delivery that single-payer proponents advocate.org/index. 10/9-19/03) suggests that the public would actually favor single-payer.php? page=3733 [Mardjuki] CNN senior medical correspondent Elizabeth Cohen has herself adopted this terminology in discussing healthcare reform. Alternatively.

`° Forty groups sponsored this campaign. including such traditional opponents of government health insurance as the Chamber of Commerce.lic legislation. Pg 115. Perhaps that is why Canada's model has held such appeal for American reformers during the past quarter century. lt is no sur. this model has awakened the intense opposition of groups whose incomes would be harmed by such a reform. prof of law @ American University. 2001. the United States has the most intrusive regulation of medical care practice of any OECD nation. and the managed care trade association have treated the Canadian model as the problem rather than the solution. and the pharmaceutical trade association. Hickey. the AMA. however. the trade association of the drug industry. The Next Agenda: Blueprint for a New Progressive Movement.0 LO 149 Plan Unpop Single payer healthcare controversial – plethora of interest groups. ln spring 2000 a newly formed group disingenuously describing itself as "Citizens for a Better Medicare" launched a multimedia campaign "urging American seniors to reject the Canadian model of health insurance and coverage of prescription drugs. Robert and Roger. In short. the National Association of Manufacturers. but the intensity of opposition to it by financially interested and ideologically opposed par.ties. Borosage. vice president @ Economic Policy Institute.Single Payer 2. although the bulk of that intrusiveness arises from private regulation rather than pub. [Mardjuki] Indeed. the problem with the Canadian model is not an absence of substantive merit.prise that the HIAA. At the same time." You’re A Jerk 149 .

As our overview of the politics of national health insurance makes clear. 2001. [Mardjuki] If You Lose. even the administration abandoned its plan. The lesson for reformers is this: If legislation cannot pass. In that respect. prof of law @ American University. In 1948. it is equally critical to influence the terms on which one loses. You’re A Jerk 150 . Borosage. As important as it is to shape the terms of victory. The administration had no end-game strategy when legislative support for health refom failed to materialize. Robert and Roger.Single Payer 2. Reformers must confront the reality that political setbacks and legislative defeats are not only possible but probable. Hickey. yet Truman used that defeat as an element in his presidential campaign against the infamous “do-nothing" Congress. after the Clinton health plan politically irnploded in I994. there still may be political benefit to extract if responsibility for blocking expanded health insurance coverage can be clearly pinned on the opposition. Lose the Right Way. In contrast. even unsuccessful legislative efforts may keep health reform on the agenda and in some circumstances may help expand support for it. therefore the blame for the failure of health reform lay as much on President Clinton as it did on his congressional opponents. vice president @ Economic Policy Institute.0 LO 150 Losers Win? Placing blame on opposition expands support for failed healthcare reform. the obstacles to enactment of substantial reform are formidable. The Next Agenda: Blueprint for a New Progressive Movement. Pg 116. President Truman’s national health insurance plan went down to defeat.

A new single-payer system could be designed for the entire population. Indeed. Everyone would have a medical identification card (like a Medicare card). [Mardjuki] 3. and hoped for the same success on health care. and there is lingering fallout from the president's remarks last week about the arrest of a friend. Expansion of existing public programs might be more politically acceptable than establishing completely new programs (Harrington. which begins at the end of the week. 2. Pgs. 1993. and well child care." Republican Senator Jim De Mint recently proclaimed.com/story. His poll numbers have slipped. Obama had wanted the bill passed before the August recess. Alternatively. including House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid. The report from the Congressional Budget Office suggested a government plan could co-exist with private insurers without driving them out of business.0 LO 151 2AC Healthcare Politics (1/3) 1. and are resisting admonishments from those top Democrats not to jeopardize Obama's most cherished and ambitious legislative effort. Expansion of Medicare system popular – less contentious than new healthcare reform. indeed. existing governmental health insurance programs could be modified and expanded to provide insurance coverage for specific population groups.” Journal of Community Health Nursing. Anna. and there would be no charge for most preventive services. adding preventive. The dog days of summer are not being kind to President Barack Obama. The Blue Dogs are apparently fearful that Republicans will have the upper hand in the 2010 mid-term elections. The existing single-payer Medicare system could be expanded to include everyone. A month ago. RN and MSN @ Ball State University. Obama’s decreasing popularity. On Monday. taking a hit as Americans worry not just about health-care reform. 199-211. The Blue Dogs take issue with crucial elements of their party's health-care reform bill. it will be his Waterloo. You’re A Jerk 151 . 7/27/09 Jillian.” Brandon Sun. They want to feel more comfortable with it. Private insurance systems could insure for services not covered by this single public plan. staff reporter. Won’t pass – slowed momentum.brandonsun. the Obama administration was delighted it had managed to push through a major climate-change bill in the House of Representatives. and Congressional opposition. The president's poll numbers are. said over the weekend. But 52 fiscally conservative Democrats . Volume 4. Expand Medicare to everyone. Austin. Democratic leaders pointed to a new congressional report to refute Republican claims that their health-care reform plan would amount to a government takeover of the health insurance industry. "If we're able to stop Obama on this. and have grown bolder in openly defying Obama and his powerful allies. the White House was hopeful it could get much of its agenda through Congress in 2009.Single Payer 2. his health-care overhaul isn't likely to be ready this week despite his fondest hopes. but deficit spending and rising unemployment. so that Americans would have a new health-care system by October.known as Blue Dogs . but it seemed unlikely with the Blue Dogs still standing firm. health-care headaches. It will break him. Miller. 1990). It's all made for a tense atmosphere in Washington that has Republicans gleeful at the idea of using health-care reform to cause permanent damage to Obama. No spillover – politicians evaluate bills on a case by case basis – make them read evidence this affects other bills." Jim Cooper. Pelosi has pledged to bring unruly Democrats to heel and pass the bill in the days to come.php?story_id=150210 [Mardjuki] controversy. copayments and deductibles would be reduced for low-income persons.have emerged as a major thorn in the side of the Obama administration and party leaders. "I think the American people want to take a closer look at this legislation . Cooper said a vote in the House on the bill likely wouldn't be held until after Labour Day. a Blue Dog from Tennessee. “Health Care Reform: Clarifying the Concepts. “Obama’s first White House summer one of http://www. Democrats also headed into a lengthy meeting on Monday afternoon to review the bill section by section in an attempt to better understand the concerns of the Blue Dogs while they hold up the bill. perinatal.

In a letter to senators released this week. Over the past couple of weeks. This solves back any infinite regression claims. His healthcare plans have stalled on Capitol Hill. is an important tool to discipline insurance companies. bailing out the financial industry. The warning signs are enough to worry Democratic strategists that Obama may be sinking into a trough that will sap his influence just when he needs it most.6 trillion. Finally.Single Payer 2. taking over much of the U. and Obama delivered.html President Obama is heading into stormy waters." 6. It’s reciprocal – negative can counterplan out of advantages to test their germaneness to the plan. not healthcare – healthcare doesn’t send the financial signal of solvency international investors are looking for You’re A Jerk 152 . "The public [government] plan. That’s Woodhead 9. according to Democratic pollster Geoff Garin. In addition. economy U.0 LO 152 2AC Healthcare Politics (2/3) 4. America's Health insurance Plans and the Blue Cross Blue Shield Association wrote. No link – do the plan and pass universal healthcare. reversing his momentum. voters wanted action from their president in tough times. Bush. b. "Regardless of how it is initially structured. a government plan would use its built-in advantages to take over the health insurance market. and proposing huge changes in healthcare. I think. “Strategists worry Obama’s popularity is dropping” http://www.usnews." But Obama told a news conference Tuesday. and confidence in his handling of the economy is ebbing.com/articles/news/obama/2009/07/01/strategists-worry-obamas-popularity-is-dropping. energy policy. Uniqueness overwhelms the link – some semblance of health care is guaranteed by Obama’s political clout – it’s too big to fail. and other areas of national life. Intrinsicness allows the aff to test the relevance of the link. In fact. Another setback came when two powerful insurers' associations announced their opposition to an Obama-backed government health plan that would be in competition with private. he has moved the federal government into a more activist role than it has had under any other president in years. This was because the supremely articulate. The DA isn’t intrinsic – a. Until now. Federal policymakers could control both impacts – they can pass the plan and healthcare reform 5. Obama’s political capital is down. Obama is very appealing as an individual. It’s fair – we’ll only make one intrinsicness argument per debate. Impact inevitable – Boston Globe 9 is in context of Social Security reform. But the ground may be shifting. employer-sponsored plans. the estimate for another plan was even larger—$1. Iran election. auto industry. who remains unpopular. 7/1/2009.S. which will in turn cause delays in considering the massive bills this summer and could jeopardize passage in the fall. b.S. This sent legislators scurrying to reduce the price tags. 7. which initially boosted his ratings. Obama has endured a surge of bad news. charismatic Obama presented such a contrast to George W. he is being faulted for a shaky response to the post-election violence in Iran. President Obama has enjoyed a honeymoon with the country and the media (although not with opposition Republicans). injecting vast sums of money into the economy. his job-approval ratings are dropping.healthcare. The Congressional Budget Office estimated that one of the major Democratic healthcare proposals being circulated in the Senate would cost an astounding $1 trillion. News.

by and large. Obama still has four years for those policy decisions to yield results. but the country does not. either increasing the deficit or raising taxes 8 percent – that’s Pear 9. At no other point in his presidency will Obama have four years to mitigate the impact of his tough choices. but not as the overriding priority. Can’t solve the economy – Obama’s healthcare proposals cause entitlement spending to skyrocket. to the benefit of those eponymous ordinary Americans—and those not so ordinary. To some Americans. Obama should consider that promise now fulfilled and the symbolic gain made. Some Americans may have surmounted preconceptions of race in voting for Obama.Single Payer 2. Obama should begin stepping on some toes. and move on—as he said he has done. Americans regard the symbolic salve on racial wounds as a welcomed development. Winners win . It would only be natural for the first black president to harbor a sense of responsibility to avoid alienating parts of the country.a Fight Is Critical For Obama to Assert Strength Ximena Ortiz.aspx?id=21156] But an appreciation for those headlines of history could unduly influence the president.org/Article. Obama’s rise to power has fulfilled a nation’s egalitarian promise and remedied racial injustice. most Americans judged the presidential contender based on his positions and their read on the current condition of the country. Indeed. <CASE OUTWEIGHS> You’re A Jerk 153 . 10. Given the fluctuations of the polls leading up to Obama’s victory in November. Obama seems to be taking pains to prevent divisiveness at a time when he should be taking clear policy directions and expending political capital. And given the state of the country he inherited. he faces nothing but tough choices. 9. rather than on preoccupations with his race. the public is probably prepared to countenance some far-reaching and consistent policy making. @ National Interest. but he has to steer that ocean liner in the right direction—and be persistent. but rather as the president. seem to perceive Obama as a black president. http://www.0 LO 153 2AC Healthcare Politics (3/3) 8. And given the state of the country and its foreign endeavors. 3/26/’9 [Barack the Timid.

nuclear deterrent on the technologically risky SSP — poses an unacceptable security risk. meaning it would be unstrategic You’re A Jerk 154 .S. 3. Treaties require a two-thirds majority in the Senate. even the most modest of which Congress has repeatedly declined to fund. "[a]t a certain point. The right to test is essential to credible deterrence Barbara Conry.realclearpolitics. RealClearPolitics. who is now Mr. which won't be easy.S. Of course. But the Obama administration also hopes that by addressing developing country concerns about disarmament.com/articles/2009/04/nuclear_arms_in_the_developing. Senate to forgo forever a test program that could in the future be of critical importance for our defense and the defense of our allies . These steps toward nuclear disarmament are worthwhile in their own right. mostly out of concerns about verification -. The Senate has a responsibility to ensure that no future Saddam Hussein or Slobodan Milosevic has any reason to doubt the effectiveness of the American nuclear arsenal. the Obama administration must now follow through on its pledges. http://www.it simply is not verifiable.or stimulate it? 4. no reason that’s key to prolif 3. Votes aren’t there from the GOP Grotto. Senator and Fellow. Which countries does it have in mind? Iran? North Korea? Syria? Countries alarmed by the nuclear ambitions of their enemies? Allies who may one day lose confidence in our nuclear umbrella? There are good reasons why the test-ban treaty has not been ratified. Obama announced that the U. ’09 (Andrew. the perception of a potential adversary is critical.Single Payer 2. Staff Writer. especially in light of our testing moratorium.go.html. he laid out an ambitious arms control agenda with Russia for achieving substantial nuclear reductions. even if the SSP functions as it is supposed to. it will become impossible to keep extending the life of our arsenal. 2. Mr.html) Thus. Countries like Iran and North Korea would not sign CTBT a. “Nuclear Arms in the developing world. American Enterprise Institute. associate policy analyst at Cato.” April 8. Robert Gates. The administration believes. “Danger or Deterrent?” 1999. He announced support for Senate ratification of the CTBT and a verifiable FMCT. CTBT won’t be ratified – it’s not verifiable Kyl and Perle.S. http://abcnews. tighter global export controls.0 LO 154 2AC CTBT Politics (1/3) 1. it is not clear that future adversaries will be convinced that the American nuclear arsenal is. indeed. accessed 8/14/02 Relinquishing the right to conduct tests — thereby gambling the U. Arizona. Obama's own secretary of defense. and a new framework for civilian nuclear energy development that precludes development of national uranium enrichment facilities. CTBT only stops testing.wsj. Moreover. Earlier in the week. that ratification of the test-ban treaty will discourage other countries from developing nuclear weapons. Arms control negotiations with the Russians will be challenging enough." Suppose future problems in our nuclear arsenal emerge that cannot be solved without testing? Would our predicament discourage nuclear proliferation -. without evidence. It also failed because of an understandable reluctance on the part of the U. would "immediately and aggressively" pursue ratification of the comprehensive ban on the testing of nuclear weapons . militarily effective. warned in a speech last October that in the absence of a nuclear modernization program. When it comes to deterrence. 6/30/09 (Jon and Richard.html) Obama's speech on Sunday should begin the process of clearing the air.” http://online. The Wall Street Journal. The attempt to do so in 1999 failed in the Senate. They want to build nuclear weapons.com/sections/world/TakingSides/takingsides1. “Our Decaying Nuclear Deterrent.com/article/SB124623202363966157. which means that the majority Democrats will still need to attract the support of more than a half-dozen Republicans for CTBT and FMCT ratification. in his Prague speech. these countries will be much more inclined to support an ambitious nonproliferation agenda that includes a more intrusive International Atomic Energy Agency Inspections regime. There is no evidence indicating that political capitol would spillover onto CTBT 5. but the Obama administration must also successfully negotiate with Capitol Hill.

it contains the same arguments Waltz makes today in interviews.'' Especially in a unipolar world. even to so-called ''states of concern'' like Iran and North Korea. ''And that makes for internal stability.com/news/globe/ideas/articles/2005/03/20/give_nukes_a_chance/?page=3 KENNETH N.'' Waltz writes. although heads of state.'' was published last August-dismisses Waltz's larger linkage between proliferation and security as ''perverse. intelligence officials. But plenty among them see at least some merit in the picture he paints. The US signing it would not incentivize them to sign it if they dislike the US 6. And North Korea in the past has sold nuclear technology to Libya and Pakistan. As a result. But it's also an argument over the motives that drive some countries to pursue nuclear weapons and others to want to keep the nuclear genie to themselves. doesn't like the phrase ''nuclear proliferation. In part. not signing CTBT would not uniquely increase it c. and that makes for cautious behavior. adjunct professor of political science at Columbia University. ''If states can score only small gains because large ones risk retaliation. You have a positive effect. Even Graham Allison. the State. After all. the spread of nuclear weapons has taken on what might appear to be a wildfire-like quality. argues Waltz.'' When fighting does break out. even counting North Korea.'' In particular. This is partly because nascent nuclear nations don't have the best command and control systems for their weapons. that he's for. writer for The Boston Globe.'' remains one of the most influential 20th-century works on international relations. Updated and republished two years ago to take into account the nuclearization of India and Pakistan. Put simply. and War. ''The gradual spread of nuclear weapons is more to be welcomed than feared. he adds. As the Nuclear Nonproliferation Treaty. ''There's something known in the literature as a crystal ball effect. the time period just after a country goes nuclear-in the case of North Korea. In recent weeks. Nuclear proliferation creates an increase in international stability – even anti-prolif experts agree that nuclear weapons are deterrents. and you can certainly see that in the India-Pakistan relationship'' since both countries acquired their nuclear arsenals. More troubling is that historically. the widely noted ''Nuclear Terrorism: The Ultimate Preventable Catastrophe. while Iran sponsors Hezbollah and Hamas.'' Waltz told me. But we've had nuclear military capabilities extant in the world for 50 years and now. since they contribute far more to a country's security than any geographical buffer could. a school that sees world politics as an unending. Waltz is as against the proliferation of nuclear weapons as the next sane human being. ''Man. Sagan in the form of an extended debate. ''It refers to things that spread like wildfire. in words Waltz wrote 10 years ago and has been reiterating ever since. the present moment-is the most dangerous. a dean and professor at Harvard's Kennedy School of Government and one of the country's most visible nonproliferation crusaders. but nonetheless interesting. He is perhaps the leading living theorist of the foreign policy realists. amoral contest between states driven by the will to power. North Korea has just declared itself a nuclear power. Waltz spells out his theory most thoroughly in the 1995 book ''The Spread of Nuclear Weapons.boston. In such a context. so it brings it home. ''With a nuclear war. Yet Allison-whose latest book. however. Nuclear weapons.'' co-written with the Stanford political scientist Scott D. Still. there's an increasing sense that it is failing. nuclear states grow cautious. including the leader and his family. ''they have little incentive to fight. he argues. . ''The only thing a country can do with nuclear weapons is use them for a deterrent. a war between nuclear powers cannot be decisively won without the risk of total destruction. say. comes up for review this May. Since the risk of escalation in any conflict is so high. we only have nine nuclear countries. .''' Allison says. probably most of the people living in the capital are going to be killed. ''most countries don't need them. concedes some of Waltz's argument. His 1959 book. Few among Waltz's colleagues share his unwavering confidence in the pacifying power of nuclear weapons. Waltz's argument may seem a Panglossian rationalization of the inevitable.'' ''The term proliferation' is a great misnomer.'' he said in a recent interview. a Soviet invasion of Western Europe. that makes for peace. then. As he sees it. nuclear weapons prevent wars. even blunt the urge for territorial expansion. Each could kick off a regional arms race.'' But the eventual acquisition of nuclear weapons by those few countries that see fit to pursue them. the backbone of nonproliferation efforts for the past 35 years. WALTZ. Iran is in negotiations with the United States and Europe over what is widely suspected to be a secret weapons program of its own.'' Strictly speaking. in You’re A Jerk 155 . He is not a member of an apocalyptic death cult. Bennett 05 Drake Bennett. . can’t fall into terrorist hands. legislators. it is likely to be a localized proxy conflict like the Korean War instead of. Allison argues. the disagreement between Waltz and his critics is over the meaning and value of nuclear deterrence in a post-Cold War world.Single Payer 2. and opinion columnists are nearly united in their deep concern over the world's nuclearization. and would only decrease the chance of great power wars. The international community already holds disdain for them. the possession of nuclear deterrents by smaller nations can check the disruptive ambitions of a reckless superpower. the scholars who spend their time thinking about the issue are in fact deeply divided over the consequences of the spread of nuclear weapons.0 LO 155 2AC CTBT Politics (2/3) b.'' Waltz is not a crank. “Give nukes a chance Can the spread of nuclear weapons make us safer?” http://www.

Goldfischer charges. USSR/China. Mearsheimer argues. ''Any country that gave [nuclear weapons] to terrorists who would use them against the US. ''is utterly convinced that there's a rational core in every brain similar to his own. Russia's inability in the years since the Cold War to keep track of all its nuclear materials-shows that even a country's strong interest in maintaining control of its nuclear weapons is no guarantee that some won't fall into the wrong hands. no matter how ''rogue. for example. ''Iran is highly unlikely to give nuclear weapons to terrorists. no warrants b. doesn’t actually indicate a chance of extinction 8. raising the threat of nuclear terrorism. that are twice as high as those in Russian Roulette.0 LO 156 2AC CTBT Politics (3/3) every so-called nuclear ''conflict dyad''-US/USSR.'' Waltz asks. . the primary threat is the United States. Kennedy himself put the chance of nuclear war during the Cuban Missile Crisis at one in three-odds. ''would disappear from the face of the earth. and there's a reasonably good chance that they would get Iran incinerated'' if the weapon was traced back to the regime in Tehran. Allison points out. nations acquire nuclear weapons not to menace their neighbors but to protect themselves.'' And that doesn't begin to account for the possibility of an accidental launch or an attack by an Al Qaeda operative whose effective statelessness and hunger for martyrdom make him undeterrable. raise a question that tends to get lost in much of the news coverage of proliferation: Do nuclear states like the United States oppose proliferation simply out of concern for their citizens' safety.) Waltz. is to subscribe to a sort of ''nuclear theology. No link – Fiat is a magic wand that eliminates the political process 9. which will act somehow at the critical moment. The problem of ''loose nukes''-in particular. or is there something more strategic at work? In Waltz's formulation. Even today's long-established nuclear powers. Nevertheless. .'' are unlikely to give their weapons to terrorists. in large part because they would be putting weapons into the hands of people who they ultimately did not control. Whatever its sympathies. says David Goldfischer of Denver University's Graduate School of International affairs.'' . ''wouldn't you be deadly determined to get nuclear weapons. ''If you were making decisions for North Korea or Iran. And to the governments of North Korea and Iran. John F.'' (Goldfischer is himself a proponent of what he calls Mutual Defense Emphasis-a proposed treaty regime in which nuclear arsenals would be sharply reduced and mutually acceptable missile defenses installed by opposing nuclear powers. Allison notes. thinkers like Waltz and Mearsheimer. describes himself as closer to Waltz than to Allison on the issue. old c. a political scientist at the University of Chicago and another preeminent realist thinker. given American capability and American policy?'' 7.Single Payer 2. that nuclear states.'' Mearsheimer adds. John J. may owe their continued survival as much to luck as logic. and that no one will be able to reach a leadership position in any society who will make the potentially suicidal decision to launch when a massive retaliation is a certainty. To share Waltz's faith in the pacifying effects of proliferation. Disad is an intrinsic policy option – permutation solves You’re A Jerk 156 . India/Pakistan-the first of the two to go nuclear came close to launching a preemptive attack to profit from its nuclear advantage. with their dogged focus on the calculus of national advantage and interest. Mearsheimer. And the precarious hold on power of the government in a nuclear nation like Pakistan only adds to the volatile mix. Mearsheimer agrees with Waltz. Utgoff is terrible a.

For those who us who believe that bringing spending in line with revenue does matter. Those outside the United States also appear to have lost faith in the U. despite all of his assuring words. Ashland. 7/21/2009 (http://www. In the ethical-behavior category. which believed deficits really didn’t matter.000 investment professionals participated in the research by taking the survey either online or via telephone interview in February and March.S. not deficit reduction. The federal government now borrows a whopping 46 cents of every $1 it spends. The Financial Market Integrity Index is designed to gauge chartered financial analysts’ perceptions of the state of ethics and integrity in different markets around the world.txt] The Daily Independent. mostly from his own Democrats trying to protect their pet projects. To be fair. Investor confidence low – comprehensive study proves Jeff Benjamin. New White House forecasts show a deficit of $1. However. Based on their perception of market ethics and integrity alone. We control the internal link to the impact – only federal action to stem states’ negative procyclical actions ends the recession – that’s Mattoon and Lav. Investment News. . The new president recently told his Cabinet: “We can no longer afford to spend as if deficits do not matter. the perception of hedge fund managers was lowest overall. You’re A Jerk 157 . President Obama plans on passing the problem of the deficit to the next president. And his proposal immediately ran into a storm of opposition on Capitol Hill.is a necessary but temporary evil to jump-start the country out of recession. When it comes to reducing the federal deficit. http://bgdailynews.. The White House contends big spending . the next administration.S.4 trillion in federal spending. . If so.. the deficits will not dip below $500 billion a year for the next decade.dll/article? AID=/20090721/REG/907219990) Hedge fund managers and corporate boards received low marks with regard to ethical behavior in a recent survey of financial-industry professionals.S. We can no longer afford to leave the hard choices for the next budget. it represents 0. but his proposals sure don’t indicate that.-based respondents were likely to recommend investing in U. Maybe so.09 [President’s policies don’t match his words.. Maybe deficits really do matter to Obama. market systems..0 LO 157 2AC Econ DA (1/3) 1. Obama’s actions tell a different story. and $1. 2.the Wall Street bailout. far short of matching his words. investor protections to ensure an orderly functioning of the equity markets.investmentnews. the stimulus package . even assuming a fully recovered economy.8 trillion this year. In short.S. 4. Deficits growing now – no fix coming THE DAILY INDEPENDENT 5 – 25 . The CFA Institute yesterday released the Financial Market Integrity Index illustrating “soured sentiment and shaken faith” among financial professionals regarding the ability of current U. More than 2. Obama’s words were most welcome. according to the finding. President Barack Obama’s actions fall far. markets. Some form of healthcare reform is inevitable by the end of the year – Obama is banking his entire agenda on successful passage and is expending all the political clout he has to push it through –– that’s Woodhead. respondents generally consider corporate boards and corporate executives to be most responsible for the current financial crisis.Single Payer 2. President Obama recently sent to Congress a proposal to either eliminate or reduce spending for 121 programs for a savings of $17 billion. If that sounds like a lot.com/articles/2009/05/25/opinion/our_opinion/opinion2.” Those words come after eight years of irresponsible spending during the administration of President George W.com/apps/pbcs. Failure to rectify ballooning state Medicaid deficits makes economic decline inevitable. almost four times the previous record set by President Bush. or the next generation. expect President Obama to boast in future years about cutting the deficit. Bush. but there’s nothing in his budgets or his economic policy speeches to indicate a serious assault on the deficit once the current crisis passes. only 49% (versus 68% a year ago) of U.3 trillion next. that would be a tactic lifted from his predecessor. 3.5 percent of next year’s projected $3. with pension fund managers earning the top-rated spot. Nevertheless. According to the report that accompanied the survey findings. The White House forecasts show that. What additional revenues there are in his budget are earmarked to offset the cost of his health-care reforms.

Then. $300 billion annually. Canada’s NHI has 1% overhead and even US Medicare takes less than 4%. The White House expects the economy to be in a recovery at that time. and Woolhandler. “Our Health Care System at a Crossroads: Single Payer or Market Reform?” www. Turn – plan slashes healthcare costs by $300 billion Himmelstein. which are mostly private. dept Medicine Harvard. far more than in Canada. most of whom are in private practice.S." Mr. he changed his mind. too. retirees.and his budget calls for letting President George W. Canadian physicians. Indeed. 11/07. MD. Small businesses and the entrepreneurs who lead them have been the primary drivers of job growth over the past decade.66 clerical workers per doctor. say it could still be in a recession or in a weakened condition well into 2011. the author of five books on the government and the economy. This plan would punish them with higher taxes. "You don't build a house by blowing up its foundations.com/news/2009/feb/27/obamasbudget-to-raise-small-business-taxes/)[LO//AS] Business advocates charged that multiple tax increases on Americans earning more than $250. Unfortunately.which will cost an estimated $1 trillion over 10 years . enough to fully cover the uninsured and to upgrade coverage for those now underinsured. a properly structured NHI program could expand coverage without increasing costs by reducing the huge health administrative apparatus that now consumes 31% of total health spending." said Bruce Josten. including members of the Federal Reserve Board. Obama ran for president saying he will raise taxes on wealthy Americans by boosting the present 35 percent top income tax rate to the nearly 40 percent rate under President Clinton in the 1990s. and Steffie Woolhandler. saying that this was not the time to raise taxes on higher income people because it would further weaken the economy.pnhp. Boehner of Ohio called the budget plan a "job killer. Lambro 2/27 Donald Lambro is the chief political correspondent of The Washington Times. Physicians for a National Health Program of Chicago. Fee schedules are You’re A Jerk 158 . less economic growth. resulting in less government revenue. Our biggest HMOs keep 20%—even 25%—of premiums for their overhead and profit. too.000 a year would whack small businesses who pay the individual income tax. The Department of Medicine at Cambridge Health Alliance/Harvard Medical School. less economic growth.not more. and a nationally syndicated columnist He won the 1995 Warren Brookes Award for Excellence in Journalism “LAMBRO: Obama's budget to raise small-business taxes” February 27. This plan would punish them with higher taxes. Obama needs increased revenue to launch his national health care plan . but many economists. Himmelstein. The average US hospital spends one-quarter of its budget on billing and administration. charities.not more. On Capitol Hill. chief lobbyist at the U. fee-for-service– based practice. middle-class families.S. bill by checking a box on a simple insurance form. And HMOs inflict mountains of paperwork on doctors and hospitals. nonprofit institutions. and even skeptics all agree on this point. "You don't build a house by blowing up its foundations. ‘07 (David U. Turn . 2009 (http://www. House Minority Leader John A.health care taxes would destroy small businesses – key to the economy. Reducing our bureaucratic apparatus to Canadian levels would save about 15% of current health spending. Health care’s enormous bureaucratic burden is a peculiarly American phenomenon. Chamber of Commerce. nearly twice the average in Canada.000 a year would whack small businesses who pay the individual income tax. neither piecemeal tinkering nor wholesale computerization can achieve significant bureaucratic savings." saying that "small businesses. MD. and anyone who flips on a light switch is going to pay higher taxes under this plan. which resembles that of the United States in its emphasis on private. Business advocates charged that multiple tax increases on Americans earning more than $250. family farms. is about half the US level. disinterested civil servants and .org/news/2008/may/our_health_care_syst. Small businesses and the entrepreneurs who lead them have been the primary drivers of job growth over the past decade.0 LO 158 2AC Econ DA (2/3) 5. much as a fire department is funded in the United States. obviating the need for administratively complex per-patient billing. Bush's two top tax rates expire at the end of 2010. MD + MPH. American physicians spend nearly 8 hours per week on paperwork and employ 1. But Mr. everyone with a 401(k). and fewer jobs . are paid a global annual budget to cover all costs.php) [LO//JW] In contrast to CDH. and fewer jobs . and produce as much as 60 percent of all jobs. No nation with NHI spends even half as much administering care nor tolerates the bureaucratic intrusions in clinical care that have become routine in the United States. resulting in less government revenue. The key to administrative simplicity in Canada and other nations is single-source payment. 6. administrative overhead in Canada’s health system.washingtontimes. Proponents of NHI. chief lobbyist at the U." said Bruce Josten. as the recession deepened last year. Canadian hospitals.Single Payer 2. and produce as much as 60 percent of all jobs.

But even as Washington tries to rescue the economy. Think about it: is America — not state governments. our technological know-how is intact.html? _r=1&ref=opinion&pagewanted=print [Mardjuki] No modern American president would repeat the fiscal mistake of 1932. often at the expense both of their most vulnerable constituents and of the nation’s economic future. You’re A Jerk 159 .” New York Times. Why can’t we keep doing good things? It’s true that the economy is currently shrinking. to be cutting public services and public investment right now. public investment competes with the private sector for scarce resources — for skilled construction workers. but the nation as a whole — less able to afford help to troubled teens. prof of economics and international affairs @ Princeton. state governors aren’t stupid (not all of them. Investors. which will force young offenders out of group homes and into prison.Single Payer 2. to the decision by a committee that manages California state spending to halt all construction outlays for six months. for capital. running temporary deficits would be difficult. These state-level cutbacks range from small acts of cruelty to giant acts of panic — from cuts in South Carolina’s juvenile justice program. the true cost of government programs. In fact. or repairs to decaying roads and bridges than it was one or two years ago? Of course not. Our capacity hasn’t been diminished. But let’s step back for a moment and contemplate just how crazy it is. But even if they weren’t. lower-level governments can’t borrow their way through the crisis.com/2008/12/29/opinion/29krugman. in which the federal government tried to balance its budget in the face of a severe recession. They’re cutting back because they have to — because they’re caught in a fiscal trap. driven by fear. But right now many of the workers employed on infrastructure projects would otherwise be unemployed. Paul. and the money borrowed to pay for these projects would otherwise sit idle. medical care for families. and those states that can borrow at all are being forced to pay punitive interest rates.0 LO 159 negotiated annually between provincial medical associations and governments. So why are we doing this to ourselves? The answer. When the economy is booming.nytimes. is much lower now than in more prosperous times. And shredding the social safety net at a moment when many more Americans need help isn’t just cruel.federal economic action ineffective without rectifying state deficit problems. especially public investment. unlike the feds. Now. But that’s the result of a slump in private spending. our workers haven’t lost their skills. The Obama administration will put deficit concerns on hold while it fights the economic crisis. is that state and local government revenues are plunging along with the economy — and unlike the federal government. are refusing to buy anything except federal debt. too. “Fifty Herbert Hoovers. the nation will be reeling from the actions of 50 Herbert Hoovers — state governors who are slashing spending in a time of recession. are subject to balanced-budget rules. 2AC Econ DA (3/3) Plan solves impact . All patients have the same coverage. 7/22/09. of course. Krugman. anyway). 7. It makes no sense to add to the problem by cutting public spending. Partly that’s because these governments. from a national point of view. It adds to the sense of insecurity that is one important factor driving the economy down. http://www.

The armed services have met or exceeded their recruitment goals in the past few months. June 4. about 15 percent of the money is for transportation. Earlier this spring. a trade group for state governments. more than construction. Budget Cuts mean recruiting will decrease Watertown Daily Times ’09 (Watertown Daily Times 5-12-09 http://www. including airports. The recession has made the armed services a more appealing alternative to job seekers at a time that the Pentagon is also increasing manpower levels to meet security needs. but it also calls for caution to avoid falling behind on future manpower needs. Arnold Schwarzenegger appeared before the cameras at a job site along a freeway east of San Francisco.7 billion budget for recruiting and retention by almost $800 million. food stamps and other social services. That comes as good news for the Pentagon and nation. highways and rail projects. that's not the case. 3.msnbc. eliminating the use of a military 2. so much so that they can again be more selective in choosing their recruits. By comparison. is hitting pay dirt in the huge federal effort to turn the economy around. Economic decline means that the US withdraws. getting back on the job to rebuild the nation's infrastructure. education.com/article/20090512/OPINION01/305129958) The Defense Department has benefited from the recession which has boosted enlistments and helped meet the nation's manpower needs. the Army has been issuing waivers to those with criminal records or health problems who would have been unacceptable before. He estimates states will get three times more money for education than for transportation. Technological dominance means that each one of our soldiers can do more damage than one of the enemy’s.com/id/31110642// Remember the "shovel-ready" projects lined up for all that stimulus money? It turns out social spending.if every single state’s economy collapsed. and that raises questions about how much help the Recovery Act backed by President Barack Obama will be to the economy in the long run. the Pentagon plans to cut its $7. Government programs benefit Two-thirds of recovery money that flows directly to states will go toward health care." said Chris Whatley. In order to meets its goals. California Gov. a service of the National Governors Association and the National Conference of State Legislatures. Stimulus spent over 300 billion dollars on expanding social services AP Associated Press." The reality of how the vast majority of the stimulus money will be spent is quite different. relief for state budgets and direct payments to the unemployed and others hurt by the recession. then other countries would perceive that the US is no longer a threat c. so we need less soldiers b. That is no longer necessary. the Washington director of the Council of State Governments. As a result. Impoverished already have healthcare from Medicaid so they wouldn’t join the military – their link ev assumes welfare-style programs which the plan doesn’t do 4. part of the administration's desire to provide immediate fiscal You’re A Jerk 160 . 2009. Economic power is perceived more than military readiness . in fact.Single Payer 2. two-thirds of the stimulus program will go toward tax cuts. for example. unemployment benefits.watertowndailytimes. Case internals outweigh the disad’s a. He declared that the stimulus-financed project would provide paychecks for 235 construction workers who otherwise would have to "stand in the unemployment line.msn. "We all talked about 'shovel-ready' since September and assumed it was a whole lot of paving and building when. according to Federal Funds Information for States. Most of the roughly $300 billion coming directly to the states is being funneled through existing government programs for health care.0 LO 160 2AC Military DA (1/2) 1. http://www. Overall. The public face of the stimulus package has been the worker in a hard hat.

Increase in U. Academic Dean and Robert and Renee Belfer Prof of International Affairs at Harvard’s Kennedy School of Government). leaving its opposition isolated and ineffective. 05 (Stephen M. the chairman of the Joint Chiefs of Staff. supremacy. The Washington Post. troop’s results in imperialism. The U. legitimacy is also a favorite way to erode Washington's international clout. the United States' opponents are currently seeking to convince others that Washington is selfish. Walt. McChrystal has undertaken a 60-day review designed to address all the issues in the war. and that its dominance harms them. 7/23/09 (The Michigan Daily. the new overall commander in Afghanistan. July/1/09 (Bob Woodward. 6. Democrats who crafted the package say they directed most of it to existing government programs such as Medicaid and education to prevent state economies from slipping even more. Jones delivered the same message to Gen.S. Ebsco) Attacking U. Academic Dean and at Harvard’s Kennedy School of Government. but it encourages other people to resent and resist U. U. Troops unnecessary.S.html?sid=ST2009063002822) The day before in Kabul. Michael Mullen.’s imperialism has dramatically damaged the way the rest of the world looks at our nation.washingtonpost.S. and it continually damages the nation’s economy.com/content/2009-07-20/ed-mcphee-attackeconomy) With U. July 1.S. When people around the world believe that U. said keeping teachers and police officers employed should help prevent the recession from getting worse. hypocritical. Obama’s health care reform bill will pass before the end of the year – impact is inevitable – that’s Woodhead 9. troops stationed in more than 150 countries according to statistics for the Department of Defense on the Census Bureau's 2009 statistical abstract. This assault on U. You’re A Jerk 161 . Vol. Only a country with imperial intentions would spread their troops that widely.hurts soft power The Michigan Daily. Jones has told Secretary of Defense Robert M. Accordingly. Ed Mcphee. Soft power is key to hegemony. Issue 5. keeping teachers and others employed while strengthening the social safety net. Washington Post staff writer. troops for Afghanistan 7. Examples range from the expansion of the USSR to Alexander the Great’s Macedonian conquest.S.S. July 23. McChrystal.different approach key Woodward. 84. a Southern California economist. 2009. While billions of dollars eventually will flow to infrastructure projects.S. Gates and Adm. Soft Power Turn a. 2AC Military DA (2/2) John Husing.com/wp dyn/content/article/2009/06/30/AR2009063002811. legitimacy does not directly challenge U.S. power. One goal was to help fill state budget gaps. armed forces sometimes seem like the United Nation’s police force. primacy advances broader global interests.0 LO 161 relief. immoral. http://www. that they should focus on implementing the current strategy. But he said the stimulus package would have improved communities' ability to grow over the long haul if it had dedicated more money to public works. the United States has much to gain from the perception that its power is legitimate. Stanley A. Much smaller pieces of the pie will be allocated for weatherization. Foreign Affairs. 5. and unsuited for world leadership. completing the review and getting more Afghan forces involved in the fight before requesting additional U. http://www. b. Washington Post Staff Writer. Sep/Oct 2005. The wide spread of troops reeks of imperialism.Single Payer 2. As the world's dominant power. 2009. Walt. affordable housing and other projects designed to create jobs. In addition.S. Washington finds it easier to rally international support for its policies.S.michigandaily.

dallasnews.nber. this technological edge-so long taken for granted-may be slipping. a study for the NATIONAL BUREAU OF ECONOMIC RESEARCH http://www. and bills being assembled in House and Senate committees are aiming to reach that goal through a mix of incentives and mandates. the personal computer. South Korea.Single Payer 2. “HOW MUCH DOES IMMIGRATION BOOST INNOVATION?”. immigrants are less likely to have patented recently than observably similar native scientists and engineers. and Taiwan is rising. Through competitive tax policies. For the last five decades. Max Baucus.html The United States' global primacy depends in large part on its ability to develop new technologies and industries faster than anyone else. South Korea has rapidly eaten away at the U. aerospace. 2. implying immigrants are not innately more able than natives. "We're not going to cover undocumented aliens. supplying.S. assuming the immigrants would have been less innovative or less able to commercialize their innovation elsewhere or that U. scientific innovation and technological entrepreneurship have ensured the country's economic prosperity and military power. said at a meeting with reporters. minimum wage just rose. 08 Jennifer Hunt.com/sharedcontent/dws/dn/latestnews/stories/0522DNBUShealthcare. U. writer for the Dallas Morning News “Senator says health insurance plan won't cover illegal immigrants” http://www.S. Indian companies are quickly becoming the second-largest producers of application services in the world. Professor of Economics at McGill University.html Health care reforms aiming for universal coverage won't provide insurance for illegal immigrants and may not address the cost to state and local governments for providing medical care to this large group of the uninsured. biotechnology. and managing database and other types of software for clients around the world. "That's too politically explosive. developing. writer for the Dallas Morning News. other countries merely followed the U. undocumented workers. Despite this. It was Americans who invented and commercialized the semiconductor. D-Mont. Normal means is that the plan doesn’t affect illegal immigrants – mitigates the link Landers. the fact that immigrants increase patenting per capita without reducing native patenting shows that their presence in the United States provides a previously undocumented benefit to natives.25377b8.0 LO 162 2AC Immigration DA (1/4) 1. advantage in the manufacture of computer chips and telecommunications software.org/papers/w14312. Today." Sen. increased investment in research and development (R&D). Innovation turn a. and advanced materials used in semiconductors. and many other types of manufacturing. as the United States is You’re A Jerk 162 . and the Internet. Asian governments are improving the quality of their science and ensuring the exploitation of future innovations.foreignaffairs. Immigration key to innovation Hunt et al. The difference is fully explained by the greater share of immigrants with science and engineering education. meaning businesses want cheaper labor 3. And even China has made impressive gains in advanced technologies such as lasers. 5/22 Jim Landers. Singapore. the globalization of research and development is exerting considerable pressures on the American system. lead.S.S.pdf page 24 We find that a college graduate immigrant contributes at least twice as much to patenting as his or her native counterpart. natives benefit more from innovation and commercialization in the United States than abroad." Universal health insurance is a key aim of health reform proposals backed by President Barack Obama and key Democrats in Congress. the chairman of the Senate Finance Committee said Thursday. Although the United States' technical dominance remains solid. and preferential policies for science and technology (S&T) personnel. b. And technological competitiveness is key to hegemony Segal 04 Writer for Foreign Affairs "Is America Losing its Edge?" http://www.org/20041101facomment83601/adam-segal/is-america-losing-its-edge.. The percentage of patents issued to and science journal articles published by scientists in China. Cheaper labor is wanted during bad economic times b. Indeed. however. Recession means businesses are more likely to hire illegal immigrant a. and the most serious challenge is coming from Asia. Indeed.

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globalization cuts both ways: it is both a potent catalyst of U.S. technological innovation and a significant threat to it. The United States will never be able to prevent rivals from developing new technologies; it can remain dominant only by continuing to innovate faster than everyone else. But this won't be easy; to keep its
privileged position in the world, the United States must get better at fostering technological entrepreneurship at home.

4. Immigration will increase
(Carl Haub, senior demographer at the Population Reference Bureau, 02 08, “U.S. Population Could Reach 438 Million by 2050, and Immigration Is Key,” http://www.prb.org/Articles/2008/pewprojections.aspx <http://www.prb.org/Articles/2008/pewprojections.aspx> ) It is no surprise that immigrants and their descendants will play a large role in future U.S. population growth, as they do now and have for much of the country's history. But the projections detailed in the new report, authored by demographer Jeffrey S. Passel and writer D'Vera Cohn, differ from previous projections from the U.S. Census Bureau by assuming that the rate of immigration will hold steady—sending the net number of immigrants from 1.4 million per year in 2005 to 2.1 million per year by 2050 as the population total rises. This assumed increase in immigrants is, as the Pew report puts it, "in line with, but somewhat slower than, the growth trend of the last several decades."The Pew projections also offer a unique analysis of immigrants' role by taking into account the different birth rates of first-, second-, and third-generation immigrants. The authors estimate that immigrants arriving after 2005, and their children and grandchildren, will account for 82 percent of the population growth between 2005 and 2050.

5. Highest immigration rate in history of America now Scott, staff writer, 2009
(Jenny, 2-10-09, “Immigration High” http://www.nytimes.com/2002/02/10/weekinreview/february-3-9-national-immigrationhigh.html?scp=4&sq=immigration%20high&st=cse) [Charlie Stephens]

The number of foreign-born residents and children of immigrants in the U.S. has climbed to its highest level in history, the Census Bureau announced. More than a quarter are from Mexico; that is the largest share
held by any country since 1890, when Germany accounted for 30 percent. On average, they are more urban, less educated and less affluent than other Americans, but as likely to be in the labor force. They make up 20 percent of the population -- less than the 1910 peak of 35 percent.

6. Immigration is good for the economy – they contribute at least $10 billion each year Melissa Marietta 06. [“Undocumented immigrants should receive social services”] http://findarticles.com/p/articles/mi_m0IMR/is_1-2_81/ai_n16599310/pg_4/?tag=content;col1 The National Research Council has found that "immigration benefits the U.S. economy overall, and has little negative effect on the income and job opportunities of most native-born Americans." (17) It asserts that "immigrants add as much as $ 10 billion to the economy each year and they will pay more in taxes than they use in government services over their lifetimes." (18) Jeffery Passel, the author of several studies on immigration, adds "that all immigrants arriving after 1970 pay a total of $70 billion in taxes to all levels of government, thereby generating $25-$30 billion more than they use in public services." (19) 7. Recession doesn’t matter - Mexico was also hit, meaning there is a minimal risk that they are comparatively better off than us

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8. Mexican Stability turn a. Immigration is key to Mexican stability Weintraub 07
Sidney Weintraub, holder of the William E. Simon Chair in Political Economy and professor emeritus at the Lyndon B. Johnson School of Public Affairs of the University of Texas at Austin, “The Immigration Debate and U.S.-Mexican Relations” http://docs.google.com/gview?a=v&q=cache%3ASQ6z89XAYQUJ%3Acsis.org%2Ffiles%2Fmedia %2Fcsis%2Fpubs%2F070625_weintraub_commentary.pdf+immigration+us-mexican+relations&hl=en&gl=us&pli=1 This polarized depiction has been changing slowly, especially since NAFTA came into effect in 1994. NAFTA itself was a significant departure in trade policy in that Mexico until then tried to limit trade and investment relations with the United States only to embrace the salience of the United States as a market and as a source of foreign investment. In the years before NAFTA, Mexico had a conscious policy of not having any policy toward U.S. immigration practices, but then lobbied hard for regularization of undocumented Mexican immigrants and a large temporary worker program – Mexico sought what former foreign minister Jorge Castañeda called “the whole enchilada.”

Mexican President Felipe Calderón publicly criticized the U.S. intention to build fences along the border during a joint press conference with President Bush when the latter was on an official visit in Yucatán. If the United
States is effective in cutting off undocumented immigration from Mexico, and if there is not a substantial temporary worker program to offset Mexico’s safety valve, this may introduce a severe problem in Mexico to create enough good jobs at home to reduce the emigration push force. Destabilization in Mexico, which could ensue, is mainly a Mexican problem, but one that will have repercussions next door in the United States. The United States would then have to devise policies to deal with Mexican instability.

b. Mexican stability key to US security and prosperity Roberts and Walser 2/12
James Roberts, Research Fellow For Economic Freedom and Growth at the Center for International Trade and Economics (CITE), and Ray Walser Senior Policy Analyst for Latin America at the Douglas and Sarah Allison Center for Foreign Policy Studies “Growing Instability in Mexico Threatens U.S. Economy and Border Security” http://www.heritage.org/research/latinamerica/wm2290.cfm

Mexico's ongoing political stability and economic health are critical to the prosperity and national security of the United States. The Obama Administration must make confronting the many challenges facing our southern neighbor both a foreign and a domestic policy priority. In order to realize this vital American interest,
the current Administration should do the following:

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9. Healthcare is not a magnet for immigration King, writer for Center for American Progress, 07
(Meredith L. King, Writer for Center for American Progress; a program dedicated to improving American lives through thoughts and actions 6/7/07 http://www.americanprogress.org/issues/2007/06/pdf/immigrant_health_report.pdf

Job opportunities across the country are the “magnet” that draws immigrants to the country; not federal incentives such as health care coverage and services. Immigrants are most likely to be employed in indus-tries that do not offer health insurance coverage, such as agriculture, construction, food processing, restau- rants, and hotel services.31 Immigrants are nearly four times more likely to work in the agricultural industry and two times more likely to work in the construction industry.32 Uninsured rates in these industries are over 30 percent for all workers compared to 19 percent for workers across all industries.33 Work opportunities through guest-worker programs also drive immigration. Yet the guest-worker pro-grams for temporary, unskilled labor (the H-2A pro- gram for agriculture workers and the H-2B program for non-agriculture workers) provide limited, if any, health care benefits to the documented
immigrants in the programs.34 Immigrants in the H-2A program do have limited legal protections, including employer compensation benefits for medical costs and payment for lost time due to temporary or permanent work injury. But ag-ricultural employers in this program are not required to provide health insurance or other needed servic-es.35 And existing protections are rarely enforced. Immigrants in the H-2B programs do not even have those limited benefits. Their employers are obligated to offer full-time work and pay the prevailing wage rate, but there is no regulation requiring any of the benefits afforded H-2A workers.36 And while it may seem that H-2A workers have limited access to the health care system on paper, in practice they often find that they do not. These laborers often toil in two of the most dangerous industries, agriculture and forestry. Fatality rates in these two industries are nearly 10 times the national average.37 Yet both H-2A and H-2B workers often do not have health insurance to cover appropriate care. Even worse, if an injury or illness is severe, immigrant workers in these two programs lose their jobs and therefore their legal status to stay in the United States.38 Immigrant day workers experience a similar fate. A 2003–2004 national survey of predominantly undocumented day workers found a high level of occupational injuries. One-fifth of the day laborers had suffered a work-related injury, but less than half received medical care for their injuries.39 Purchasing health insurance through the private market is an unlikely option for mmigrants as well. The unskilled work of many immigrants is often low-wage;40 day workers were unlikely to have annual earnings that exceeded $15,000 and full-time immi- grant workers average $23,000 in annual income in 2003.41 Yet the average annual premiums cost paid by a worker for individual employer coverage was $508 and for family coverage was $2412 that same year.42

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form debate—and one that lacks the familiarity of. for example. • Sales taxes are the largest source of state tax revenue. the federalist strategy is not problem-free. According to the Rockefeller Institute of Government.6 percent in the first quarter of 2009 compared with last year. states' rights. http://www. Robert and Roger. • Employers are reducing jobs and cutting back on employer-provided health coverage. They can have their CP if they have solvency evidence for the states uniformly doing every single plank of the CP – CP’s grounded in the literature are the only ones we can predict and research. it recognizes the variation in state health care systems and reform preferences. Kills decisionmaker education – no cost benefit analysis is involved because senators don’t consider the possibility of other actors enacting their policy – it’s not real world. 50 State fiat bad – a. 6.” Policy Points.payer insurance. [Mardjuki] The federalist option thus solves the puzzle of how to translate a majority favoring health reform into legislation when that majority cannot agree on the precise shape of reform.cfm?fa=view&id=1283 [Mardjuki] The state revenue situation is rapidly worsening. As a result. b. BPP. The first and largest barrier it has to surrnount is that it represents a new alternative in the American health re. “New Fiscal Year Brings Continued Trouble for States Due to Economic Downturn. The Rockefeller Institute of Government reports state tax collections fell 12. shifting the focus of debate from the details of a particular plan to the fundamental question of whether legislators support universal coverage. Not researchable. it is politically difficult to build legislative and public constituencies around ideas that have no prior history of support from legislators or consumer groups active in health care policy. 4.org/cms/index. Hickey. vice president @ Economic Policy Institute. single. 2. We can’t research specific solvency answers to a mechanism that isn’t predictable. state revenues must grow.and moderate income families and is jointly funded by Washington and the states. Entire econ advantage is a complete solvency takeout to this counterplan – state legislatures are already struggling to pay for current Medicaid programs – counterplan plunges states further into the red and exacerbates the recession – that’s Sack and Mattoon. The Next Agenda: Blueprint for a New Progressive Movement. But overall revenues last year were essentially flat and have weakened dramatically this year. However. Substantively. and they are declining due to the fall in both personal consumption and business purchases. income tax collections during the first four months of this year fell by 26 percent compared to the same period last year. 5. it taps into the rhetoric of devolution. c. Counterplan doesn’t end states’ procyclic economic action – only a federal system solves – that’s Lav and McNichol. 2001. prof of law @ American University.Single Payer 2. States can’t solve – increased taxes exacerbate the recession. The fifty states have never uniformly passed a single policy. lt also puts opponents of reform on the defensive. As both Clinton and Bradley learned. 3. 7/23/09. Continued job losses will depress revenues further.cbpp. more families are turning to programs like Medicaid. • To keep pace with the cost of services. Pg 112. Politically. You’re A Jerk 166 . and choice. Perm do both – perm accesses double coverage of dual single-payer healthcare systems. States face other problems from the weakening economy. Center on Budget and Policy Priorities.0 LO 166 2AC States CP (1/2) 1. Income taxes and other taxes are also falling as wages and investment income decline. which provides health coverage to low. Federalist healthcare politically controversial – lacks single-payer’s prior history of support Borosage.

8. [Mardjuki] The objection most likely to be raised is that the state-by-state variation permitted by a federalist health system would be inequitable. The Next Agenda: Blueprint for a New Progressive Movement. Such a system would be unfair. prof of law @ American University. 2001. in critics’ view. In addition. even though the federalist plan mandates a state plan for cost control. vice president @ Economic Policy Institute. Hickey. Some legislatures might replicate congressional failure to enact reform. Pg 112. States fail – inequitable. because citizens’ access to medical care services would be a function the health system chosen by the state in which they reside. Robert and Roger. Borosage. inefficient.Single Payer 2. or some states might resist the imposition of a federal mandate for health reform that they do not welcome for ideological or financial reasons. in the absence of a national budget for health care the state’s control over medical care spending could be even less certain than under the single-payer model.0 LO 167 2AC States CP (2/2) 7. Another objection might be that the federalist strategy would circumvent natural gridlock only to allow reform to fall victim to political deadlock at the state level. and vulnerable to state politics deadlock. <INSERT STATE SPECIFIC ECON DA/STATE POLITICS DA> You’re A Jerk 167 .

September 18.5 billion by states You’re A Jerk 168 . the variations in Medic-aid spending are quite extensive.2 As a result. state spending is determined by federal matching rates that vary inversely with state per capita income and with states’ willingness to spend from their own resources.5 billion for health services in 2006. The evidence shows that although federal matching rates are inversely related to income with the intent of encouraging states to spend more—that is. the federal and state spending on Medicaid services is much higher in high-income states than in low-income states. Pgs 667-669. Volume 26 No. http://healthaff. a great deal of federal money supports these programs. states are left with very different shares of the population without employer-sponsored insurance. “State Variation in Medicaid Spending: Hard to Justify. people with low incomes are a higher share of the population in some states than others. John. more than half of the cost of Medicaid and the State Children’s Health Insurance Program (SCHIP) is borne by the federal government. coverage and spending variation. The incentives in Medicaid to have low-income states spend more by having federal payments offset lower state per capita incomes have simply not been successful. the spending variations have consequences that are felt at the national level. higher-income states tend to spend far more per capita from their own resources. 2007.highwire. States then vary greatly in the extent to which public programs cover those who remain without coverage.5 Thus. Medicaid programs spent $314. As a result. Although the nation has chosen to have a decentralized system to provide coverage to low-income Americans.3 This is in part because states have very different problems to address. states’ ability to pay—but it also depends on the general philosophy toward income transfers to lower-income populations. Moreover. uninsurance rates differ greatly among states. Between the variation in spending per enrollee and the share of low-income populations that are covered. States face very different problems in covering their low-income populations because of the variation in employer-sponsored insurance.” Health Affairs: Policy Journal of the Health Sphere. income. Some variation is inevitable and exists in Medicare and private coverage as well. We have shown elsewhere that states with lower levels of spending have lower levels of access and worse health outcomes. The latter depends a lot on per capita income—that is.org/cgi/content/full/26/6/w667 [Mardjuki] Martin and colleagues’ paper does not address another major source of variation in Medicaid spending: that states cover very different shares of their low-income populations. For example. Director of Health Policy Research Center @ The Urban Institute. Holahan. education.4 That is.Single Payer 2. and a number of other factors.6 Of this. composition. This insurance varies among states because of industry and firm size. 6.0 LO 168 A2: States CP States can’t solve – can’t cover uninsured. In the end. $179. such that even with the lower federal matching contributions. the marginal cost of additional spending is lower for lower-income states—the fact is that most states don’t take advantage of the federal offer of higher matching funds. But whether the variation that we observe in Medicaid is acceptable is another matter.0 billion was spent by the federal government and $135.

0 LO 169 A2: States CP Federal action key to increase coverage and eliminate state treatment variation. but because poor access to health care will affect health outcomes. This not only will have consequences for the states in which they reside. Ironically. Moreover. “State Variation in Medicaid Spending: Hard to Justify. Coverage of individuals and spending on health services will be subject to state officials’ willingness to pay. http://healthaff. it will have implications for the nation as well. the recent interest in state health reform is likely to make current inequities worse. September 18. political agreement on an approach to extending coverage to all will be difficult to achieve. Other states will be left with the current mix of programs. Pgs 667-669. Moreover. Director of Health Policy Research Center @ The Urban Institute. In American politics today. Holahan. regardless of where they live.” Health Affairs: Policy Journal of the Health Sphere. regardless of the generosity of federal matching payments available to them. Vermont.Single Payer 2. Pennsylvania. but they have considerable flexibility in extending coverage and structuring benefit packages. then wide state variations are problematic. Massachusetts has enacted a plan to achieve (close to) universal coverage. and Illinois have enacted or are seriously considering major proposals to extend coverage to all. regardless of where they live. There would actually be more national uniformity in the Bush administration tax proposals than exists in the current Medicaid and SCHIP structure. The large federal contribution to Medicaid and SCHIP and the fact that state matching rates vary inversely with state per capita income seems to recognize a national interest in extending coverage to low-income groups. Connecticut. 2007. But such a solution would have huge costs to the federal government. If there is a strong national interest. Other relatively progressive states including New York. You’re A Jerk 169 . But it can be argued that there is a national interest in how these programs work.org/cgi/content/full/26/6/w667 [Mardjuki] States must provide a minimum amount of coverage and benefits. The result of a stalemate will be that low-income people will continue to be treated very differently depending on where they live. John. 6. it is likely that only these more progressive states can achieve the political consensus necessary to substantially extend coverage. the recent interest in extending subsidies to low-income people through federal tax credits suggests that even those who oppose expanding government insurance programs in general accept the need to extend health insurance coverage to low-income Americans. A national solution will be needed to eliminate the extensive variations that the current system has brought. including the degree in which they cover long-term care services. Volume 26 No.highwire.

the federal government must carry an increasing share of the Medicaid burden. These fixes will help. unanticipated costs. federal expenditures have increased much faster. Yet another challenge of health reform. Ezra. The recent stimulus package suggests another useful path. we should recognize and embrace the fact that Medicaid has become a central pillar of the American welfare state. Projections of future expenditures show the same pattern. Klein.html [JM] Figure 2 is identical to Figure 1—except that it includes federal expenditures on the same graph. As my colleague Colleen Grogan suggests. These subsidies should be enlarged and made permanent. Suppose. but they will not be enough. for example. economic and domestic policy expert. bipartisan mismanagement of public employee health and retiree benefits. Until December 31. Properly designed. 6/19/09.com/ezraklein/2009/06/guest_graph_the_future_of_medi.washingtonpost. The program has outgrown the financial and administrative capacity of state governments. in both relative and absolute terms. senior editor. The impact of competing proposals for state finances has received less attention than it should. that medical improvements gradually raise average lifespan of Alzheimer’s patients in long-term care. 2010. As you can see. too. you might reasonably ask: Why are states complaining? The answer is: They lack the fiscal capacity to bear the load. “Guest Graph: The Future of Medicaid. health reform can also help by providing new forms of public or private coverage for low-income Americans who might otherwise require Medicaid. One way or another. the federal government agreed to pay a higher matching rate to states that agreed to maintain Medicaid eligibility and benefits at roughly pre-recession levels.Single Payer 2. not only for poor people. but for millions of others. stimulus insufficient. States also bear readily-overlooked systemic risks. They face legal and institutional constraints on deficit financing and new taxes. in return for greater federal oversight over matters such as quality assurance and reimbursement. Looking at these figures. Or suppose that the firms which offer private long-term care policies run into trouble. You’re A Jerk 170 . It’s all too plausible to devise scenarios in which state Medicaid programs end up bearing large unanticipated costs.” Washington Post. They bear the consequences of their severe. http://voices.0 LO 170 A2: States CP States ineffective – can’t fund.

And the states don’t have the regulatory authority. like Oregon." Similar plans failed in Oregon. the people. The big one is that states don’t have the fiscal stability to run universal health care. How we pay matters. repetitive and perpetuates disparities. and many other states. You’re A Jerk 171 . and to make sure that no one gets services who is not properly poor. As a stopgap. increasing coverage through state plans is worthwhile.Single Payer 2. city. 49 of 50 states cant deficit spend. the size to do that. save in a few cases. at the end of the day. and cost will determine our achievement of quality universal coverage. village. and one big one. where the Democratic governor. state. told his state that. The universal programs currently discussed in Congress involve multiple tax exemptions and credits to pay for insurance premiums to multiple companies at multiple levels of poverty for multiple plans. The simplest and therefore the most economical way to pay is single payer. the Department of Veterans Affairs and insurance premiums for government employees at the federal. Indeed. He was formerly an associate editor for The American Prospect political magazine “Bridging the Gaps” http://www. We should not spend resources on anything that does not contribute value. Government already pays more than $3. The plans fall for a few small reasons. These useless middlemen cost us $400 billion every year. all of us! The more critical question is how we pay. but health care reform is more than access – it’s actual reform to bring down costs. The best of them operate at an overhead of 15 percent.600 per capita for health care. It didn’t work in Hawaii. and they are in enough trouble already. It didn’t work in Washington State. you don’t really want this being a state-run solution. when they tried it. We might be able to achieve universal coverage without adding any more tax money to the system. Complexity does not contribute value and is expensive. Medicare — 65 and you’re in — operates at 3 percent. upon killing off Tenncare and leaving 300. So they dismantle the program. or. We should not pay through special programs for the poor. Medical professionals have made tremendous progress but at a cost that puts care out of reach for a third of our people. There is no big lump of federal money that will make the problem go away. town and school district levels. By their own admission. in Massachusetts. Moreover. to be the Grinch. demeaning. the money. the states have been unable to solve Klein 07 Ezra Klein. We should not pay through insurance. That means that when the state goes into recession and more people need subsidies and the revenues to give them don’t exist the state can’t borrow the money. and then moved out of the state in order to kill the model. Medicaid. Who should pay for health care? The simple answer is. and the insurers first jacked up the premiums. and their average overhead is 31 percent. but they’re not going to work. Our so-called employer-based health care pays only 20 percent of the cost.prospect. and we. We have lived with HMOs for nearly two generations and they have failed to deliver affordable care. which are. They contribute nothing of value. Phil Bredesen. This process is expensive. because it affects cost in a big way. I simply don’t trust them to fundamentally reform the system. Lifting their health care burden and throwing in workers’ compensation premiums. might assuage their resistance to a modest increase in corporate tax. empty our pockets for the last 20 percent in the form of deductibles and co-pays. more than once. they have been contemptuous of patients and the medical profession. We pay a social worker to spend 3-1/2 hours per family to enroll them in Medicaid. well. This is money wasted by complexity that will not buy a single MRI or colonoscopy. Simplicity is frugal and effective. The insurance industry is complex and expensive. which would be redundant in a single-payer program.in some states. Government already pays more than 60 percent of health care cost through Medicare. which is more than the single-payer countries pay per capita to cover their entire population. It’s happened time and time again -. and I’m here to tell you that. We’ve got all these great universal bills passing at the state level. I think. They have no moral or legal obligation. and have been a source of frustration and expense. they are not sustainable without government subsidy. they are pretty great.org/csnc/blogs/ezraklein_archive?month=10&year=2007&base_name=bridging_the_gaps I’m here. Business and industry should not pay for health care.000 people uninsured. the biggest problem in the system. It would certainly improve their competitiveness in the global economy and create a few more jobs at home. "I say to you with a clear heart that I've tried everything.0 LO 171 A2: States CP Empirically. blogger for the Washington Post. which saw an economic downturn move more people onto their subsidies exactly as the state’s revenues dropped. It didn’t work in Tennessee.

some state government have deliberately tried to keep enrollments down by limiting outreach campaigns. even with the appropriate policy reforms. But the key question is whether. imposing penalties on the laggards. Remedies for the latter problem have been proposed. these are well documented: administrative inefficiency. In addition. or alternatively. this is due to the daunting bureaucratic and administrative hurdles that must be cleared in order to enroll. limitations of access. vice president @ Economic Policy Institute.0 LO 172 A2: Pincer CP/Medicaid Expansion CP Pincer strategy can’t control costs. You’re A Jerk 172 . In the case of Medicaid. unfortunately. Hickey. Lastly. one might reasonably question the effectiveness of Medicaid and CHIP as building blocks toward universal coverage. such as raising the level of federal matching funds allocated to states. however. has its downside: The pincer strategy simplifies administrative concerns by building on existing programs. the pincer strategy. Robert and Roger. would do little to control costs. Borosage. the addition of new populations to Medicaid would improve recipients’ medical care experience or merely exacerbate existing problems. and perpetual underfunding. The Next Agenda: Blueprint for a New Progressive Movement. [Mardjuki] Each of these advantages. Enrollment in CHIP so far has been disappointing. however. and millions who are eligible for Medicaid have never applied for coverage. Pg 113-114. prof of law @ American University. 2001. To some extent.Single Payer 2.

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