1ar

CP
Perm do both - adopt a single payer system for funding
the voucher system advocated by the neg CP. This implies
that the government would fund the voucher system.
The voucher system cant ensure health care for the least
well off, such as seniorsthats the solvency deficit
compared to the plan
Davis 12 (Kenneth Davis, 10/8/12, A Voucher-Based System for Medicare Is
Not a Solution for Health Care, CEO and President of Mount Sinai Health
System, Huffington Post,
http://www.huffingtonpost.com/kennethdavis/medicarevouchers_b_1947804.html)
Turning Medicare into a voucher-based system is not a solution for our seniors
or what ails our health care system in this country. With over 100,000 visits to Mount Sinai last year by
Medicare beneficiaries, I am acutely aware and concerned about the changes that are being proposed to
the Medicare system. The voucher model which essentially gives seniors a check and sends them off
into the private marketplace is based on the notion that competition, facilitated by a free market, will
bring down the cost of health care. Putting private insurers into the ring with traditional Medicare, it is
presumed, will change the trajectory of overall health care costs, and solve our cost crisis. Unfortunately,
the answer is not so simple. There are three major reasons why private insurance simply cannot and
should not compete with traditional Medicare. First, private insurance is fundamentally more expensive
than the Medicare program. Private plans have significant overhead costs that the Medicare system does
not, including stockholder profits, administrative costs, and marketing expenses. Medicare does not have
these additional costs. Further, while reforms are still needed, the fact remains that the single payer
Medicare system is extremely efficient. Indeed, 97 cents of every Medicare dollar goes to medical care. In
contrast, only 80 cents on every dollar goes to medical care in the individual insurance market, where
seniors would be taking their vouchers. Prior to the new health care reform law, the number was even

the voucher-based system, and perhaps most concerning,

hurts those seniors who are already hurting the most. We must
recognize that the voucher system is a fixed benefit plan. It is designed to
control the governments contribution to Medicare. If health care costs
continue to grow driven by numerous factors including the aging of the
baby boom generation Medicare costs will inevitably grow at a rate
taxpayers cannot afford. However simply setting the share that the government will pay through
lower. The second major problem with
is that it

a fixed benefit voucher is one of the least humane ways to save the system. With this approach, the fixed
voucher will simply buy less and less in the private marketplace. As a result, the wealthy will supplement
their vouchers to buy adequate insurance, while the average senior living on social security and perhaps a
modest pension will likely not have the resources to purchase todays level of coverage. Lower-income
seniors will find themselves with unaffordable copays and the inability to afford comprehensive health
care. At Mount Sinai, we will see the effect first hand. Our hospital is located between the most and least
affluent communities in New York City, and while many patients from the Upper East Side may be able to
budget for these increased costs, those visiting us from lower-income neighborhoods will not be able to
afford the care. This simply is not right. Medicare was never intended to provide two levels of care.
Medicare was created to provide reliable, affordable, comprehensive care for our grandparents and parents

Under a voucher system, that safety net may

only catch a handful of seniors it is no longer provides piece of mind that we will all have
after retirement. It was a safety net for all.

healthcare in our golden years. With so many of our seniors already trying to make ends meet on Medicare
and Social Security, we should not be dumping our debt on the most vulnerable. This leads to the final
concern with the voucher-based system. Changing the structure of an insurance benefit, as vouchers do,
does not guarantee to change the trajectory of health care costs. We can only change the cost of health
care by changing how we pay for it and what we pay for. Our health care system is shifting albeit slowly
away from a fee-for-service approach toward a more value-based system. To date, the Medicare

program is a leader on turning this tide by imposing penalties for hospital acquired infections and
readmissions; bundling payments for episodes of care; and sharing savings with providers who actually
lower costs for populations of patients who receive high-quality care, like in Accountable Care
Organizations. These innovative practices are already starting to have an effect, and in the coming years,
will be held up as examples that can be used throughout our entire heath care system to lower costs while

There is nothing inherent in a voucher system that will

encourage innovation, or change the trajectory of health care costs. At some
not sacrificing care.

point, we must ask ourselves what kind of society we want to live in. Are we really ready to ration health
care for our senior citizens, assuring that the less affluent receive less care? Are we really ready to give up
on solving our health care cost crisis through innovation and ingenuity, and instead submit to nave, blunt
instruments that provide no long-term solutions? If not, we have to reject the voucher system and find
more equitable ways to bend the Medicare cost curve. Addressing difficult issues such as obesity, dying in
America, inefficient prescription drug management, organ failure, malpractice costs, and administrative
inefficiencies are a much better way to reform the system, save money, and keep vital care available than
a dramatic shift to a voucher program fraught with uncertainties, inequities, de facto rationing and other
unintended consequences.

Case
On the innovations turn: Free market leads to worse
health care
Dr. Abdulrahman M El-Sayed 12 is a social epidemiologist and physicianin-training at Columbia University. He is also a Fellow at Demos, a nonpartisan public policy center in New York. Staff analyst at highly regarded
papers, The Fallacy of Free Market Healthcare, 04/26/12
http://www.policymic.com/debates/6445
Last weeks debate on the floor of the Supreme Court about the
constitutionality of the Affordable Care Act reignited a substantially more
lively, if not bipolar, public conversation about healthcare in our country.
Conservatives pontificated about freedom and the sanctity of the
constitution, and progressives waxed philosophical about health as a human
right and the wellbeing of the poor. Although an issue like healthcare
certainly reflects many of the broader ideological schisms in our political
debate, amiss in ideological debates like these is the technical reality
epidemiologic and economic of the unique challenge posed by healthcare.
How do we provide equitable access to high quality healthcare in a cost
effective way? Thats the $2.5 trillion dollar question right now. And no ones
sure exactly what the right answer is. But heres one thing its definitely not:
the free market. Here are five reasons why. First, theres this peculiar thing
about people if given the choice, they prefer a certain future to an
uncertain one. And theyre willing to pay for that certainty. Given the fact that
health is, by its very nature, really uncertain, people are willing to invest
money to make more certain its effects on their pocketbooks. Thats why in a
free market health system, people buy insurance. Insurance is tricky.
Insurance companies exist because some people get sick, but they make
money because some people dont. So they want the healthiest people to buy
their plans, even though the sickest people need them most. But as youd
expect, in a completely unregulated market, healthy people dont buy plans
as often as sick ones do after all, theyre less likely to get sick and so
theyre less worried about the uncertainty disease can cause. That drives the
cost of health insurance up as insurers try to pay for the costs of the sick they
cover, further pricing out the healthy whom the insurers desperately need to
keep costs down. A vicious cycle takes hold, and eventually, the whole
market unravels because there are too few healthy, less expensive people
to cover the costs of the sick, more expensive ones. Ultimately, only a few
people can afford this insurance, and the rest of us are left to deal with the
uncertainty of disease as it comes which isnt very pleasant. Second,
theres this problem of imbalanced information. When you get sick and you
go to a doctor, how do you know that the doctor really has your best interest
at heart? After all, she spent 12 years training for her job and has likely
forgotten more about medicine than youll ever know. Can you be sure shes
not running you for a loop? That becomes even more problematic when your
health and her pocketbook are at odds. In his article in the New Yorker on the

misaligned incentives of surgeons, Jerome Groopman shows how for doctors,

patients interests can often take a back seat to making a buck in a free
market healthcare system and that the result can often be poor quality
healthcare at a high cost. Third, people are really bad at understanding and
valuing the consequences of their actions especially when it comes to their
health. This tendency, called discounting means that people usually want
what maximizes their happiness today over what maximizes it tomorrow.
Thats why making decisions that promote long-term health like eating
healthy foods or exercising is so difficult: It feels way better in the shortterm to sit on your butt and have a second helping of ice cream than it does
to forgo ice cream altogether and go for a run. Whats worse, in a free market
health system, providers get paid more for providing more care. That means
that they have no incentive to help their patients prevent disease. Because
prevention is hard, and because market healthcare systems dont incentivize
it, it just doesnt get done in free market health systems. In the end, this
raises costs and contributes to more disease, which is bad for everyone.
Fourth, theres the problem that access to care in a free market health care
system is completely contingent on ones ability to pay for it. Thats a
problem when health care costs can hit several thousand dollars per year,
even among healthy people. If we believe, as a society, that it is immoral to
allow a sick person to suffer, then a free market system, which prices out
societys poorest, is complicit in that immorality. Whats worse, there are
pages upon pages of medical studies that show that the poorest are also the
sickest, independent of access to care. That means that in free market health
systems, health care is denied to the people who need it most. Fifth, and
finally: Unlike most circumstances, where markets produce meaningful
innovation, in healthcare, the government produces the most important
innovations. Consider this: The U.S. is the worlds leader in medical
innovation. And pundits and politicians alike like to attribute this to our free
market health system, as Rick Santorum suggested in a recent op/ed in USA
Today. But nothing could be further from the truth. The U.S. is the worlds
leader in medical innovation because our government pumps tens of billions
of dollars into health research each year through the National Institutes of
Health. In fact, many of the drugs, medical devices, and clinical tests that
ultimately get marketed and sold by private sector medical companies
originated in NIH-funded labs across the country. So, whats the best way to
provide equitable access to high quality healthcare in a cost effective way? At
least we know what its not. And that should be a start.

Waiting times arent too much of an issue and waiting

times are high now
Viji Sundaram 16 [Health Editor for New America Media. Before joining
NAM in 2006 Viji was a general assignment reporter with India-West, a
national weekly published in San Leandro, CA. While there, Viji won eight
journalism awards, five from the South Asian Journalism Association and three
from New California Media]. Doctors Agree With Sanders on Universal Health

Care May 12, 2016. http://www.alternet.org/election-2016/doctors-agreesanders-universal-health-care

VS: In countries that have a single-payer health care system, there seems to
be a long waiting period before a patient can see a doctor. How can we keep
that from happening in this country? AG: The problem of waiting times for
care in other nations is often exaggerated. Moreover, where there are
excessive waiting times for elective procedures, it is often due to
underinvestment. We spend much more than other countries on health care,
and have the resources to ensure that waiting times for elective procedures
are reasonable. Its also worth noting that we have waiting times in the
United States also, though they are not as visible. Indeed, if you have the
wrong insurance plan [currently], the waiting time for some providers may, so
to speak, be infinite.

Extend Schnirring 10 and Stern 6they say that single

payer is key to ensuring that everyone receives
vaccinations, while keeping single-payer cost effective for
the government. Even if a few people dont receive
vaccinations, immunization allows for herd immunity that
solves for disease. Efficient health care also can help
prepare for a quicker response to bioterror.
Extend Parson 6bioweapons are the strongest internal
link to extinction because they can be designed to be
deadly, have a long incubation period, and be transmitted
through the air.

DA
Turn: Single-payer UHC would overall save moneyturns
the link
Gerald Friedman 12 is a professor of economics at the University of
Massachusetts-Amherst. Funding a national single-Payer system dollars &
sense l March/april 2012 https://www.healthcare-now.org/wpcontent/uploads/2008/09/0312friedman.pdf
The Expanded & improved Medicare for all act (hr 676) would establish a single authority responsible for

a single-payer
system would change many aspects of american health care. While it would
raise some costs by providing access to care for those currently uninsured or
under-insured, it would save much larger sums by eliminating insurance
middlemen and radically simplifying payment to doctors and hospitals. While
providing superior health care, a single-payer system would save as much as
$570 billion now wasted on administrative overhead and monopoly profits . a
paying for health care for all americans. Providing universal coverage with

single-payer system would also make health-care financing dramatically more progressive by replacing
fixed, income-invariant health-care expenditures with progressive taxes. This series of charts and graphs
shows why we need a single-payer system and how it could be funded.

Turn: Insurance companies create more restraints on the

free market that prevent competition that would help the
economy cross apply Geyman from the AC
Econ resilient- new structural reforms prevent collapse

Behravesh, 6 (Nariman, most accurate economist tracked by USA Today

and chief global economist and executive vice president for Global Insight,
Newsweek, The Great Shock Absorber; Good macroeconomic policies and
improved microeconomic flexibility have strengthened the global economy's
'immune system.' 10-15-2006, www.newsweek.com/id/47483) // JMP
The U.S. and global economies were able to withstand three body
blows in 2005--one of the worst tsunamis on record (which struck at the very
end of 2004), one of the worst hurricanes on record and the highest
energy prices after Hurricane Katrina--without missing a beat. This
resilience was especially remarkable in the case of the United
States, which since 2000 has been able to shrug off the biggest
stock-market drop since the 1930s, a major terrorist attack,
corporate scandals and war. Does this mean that recessions are a relic of the past? No, but
recent events do suggest that the global economy's "immune
system" is now strong enough to absorb shocks that 25 years ago
would probably have triggered a downturn. In fact, over the past two decades,
recessions have not disappeared, but have become considerably milder in many parts of the world.

What explains this enhanced recession resistance? The answer: a

combination of good macroeconomic policies and improved
microeconomic flexibility. Since the mid-1980s, central banks worldwide have had great

success in taming inflation. This has meant that long-term interest rates are at levels not seen in more
than 40 years. A low-inflation and low-interest-rate environment is especially conducive to sustained,
robust growth. Moreover, central bankers have avoided some of the policy mistakes of the earlier oil
shocks (in the mid-1970s and early 1980s), during which they typically did too much too late, and

in recent years the Fed has

been particularly adept at crisis management, aggressively cutting
interest rates in response to stock-market crashes, terrorist attacks
and weakness in the economy. The benign inflationary picture has also benefited from
exacerbated the ensuing recessions. Even more important,

increasing competitive pressures, both worldwide (thanks to globalization and the rise of Asia as a
manufacturing juggernaut) and domestically (thanks to technology and deregulation). Since the late
1970s, the United States, the United Kingdom and a handful of other countries have been especially
aggressive in deregulating their financial and industrial sectors. This has greatly increased the flexibility of
their economies and reduced their vulnerability to inflationary shocks. Looking ahead, what all this means
is that a global or U.S. recession will likely be avoided in 2006, and probably in 2007 as well. Whether the
current expansion will be able to break the record set in the 1990s for longevity will depend on the ability
of central banks to keep the inflation dragon at bay and to avoid policy mistakes. The prospects look good.

Bernanke, the incoming

chairman of the Federal Reserve Board, spent much of his academic career
studying the past mistakes of the Fed and has vowed not to repeat
them. At the same time, no single shock will likely be big enough to derail
the expansion. What if oil prices rise to $80 or $90 a barrel? Most estimates suggest that growth
Inflation is likely to remain a low-level threat for some time, and Ben

would be cut by about 1 percent--not good, but no recession. What if U.S. house prices fall by 5 percent in
2006 (an extreme assumption, given that house prices haven't fallen nationally in any given year during
the past four decades)? Economic growth would slow by about 0.5 percent to 1 percent. What about

an attack on the order

of 9/11 or the Madrid or London bombings would probably have an
even smaller impact on overall GDP growth. So what would it take to trigger a
another terrorist attack? Here the scenarios can be pretty scary, but

recession in the U.S. or world economies over the next couple of years? Two or more big shocks occurring
more or less simultaneously. Global Insight recently ran a scenario showing that a world recession could
happen if the following combination of events were to take place: oil prices above $100 per barrel, inflation
and interest rates running 3 percentage points above current levels and a 10 percent drop in home prices
across many industrial nations (e.g., the United States, the United Kingdom, Spain, Australia, Sweden). The
likely timing of such a recession would be 2007. However, given the extremeness of these assumptions,
the probability of such a scenario is less than 20 percent. The good news is that the chances of a recession
occurring in the next couple of years are low. The not-so-good news is that assertions about recessions
being relegated to history's trash heap are still premature.

First, we outweigh neg impacts on time framethe

uncertainty of a bioterror attack and the speed at which
these infections spread means that we should always be
as prepared as possible. Second, we outweigh on
magnitudethe ability for these diseases to spread
rapidly means that a huge scope of people will be harmed,
and there will likely be a high mortality rate.