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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

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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

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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

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

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

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

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

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

unemployment insurance. Federal assistance Crucial. higher education. Christine Gregoire of Washington. Bredesen. and work force training.0 LO 9 HEALTHCARE 1AC – ECON ADV bestow “the mother of all unfunded mandates. State government budget woes have been much in the news . You’re A Jerk 9 . This article considers the role of the federal government in helping the states to manage their finances. These important public services were suffering even as states turned to budget cuts to close the new budget gaps. http://www. 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.cbpp.2 The rationale for such financial support is that states (which are generally prohibited from running deficits) need the money to maintain key programs. this aid might help states avoid enacting spending cuts or tax increases that could deepen or prolong the economic downturn. Gold award for contribution to state fiscal policy. Iris and Elizabeth. state reserves — general fund balances and rainy day funds — totaled 11. Also. “As a governor.” “Medicaid is a poor vehicle for expanding coverage. http://www.chicagofed. individual state economies are struggling in this recession. but this will not address state budget shortfalls.pdf [Mardjuki] Like the economy in general . and for all states combined it still remains below the fiscal year 2001 level. Bredesen was far from alone in his concern. 6/29/09. Federal assistance can lessen the extent to which states need to take pro-cyclical actions that can further harm the economy. There are also other streams of funding in the economic recovery act flowing through states to local governments or individuals.org/publications/fedletter/cflaugust2009_265. Reserves can be particularly important to help states adjust in the early months of a fiscal crisis.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. Richard.Single Payer 2. Recently. for which demand rises during a recession. And a second round of stimulus is needed – federal money to ease state deficits is crucial to stem further recession. In a number of states the reductions made during the downturn in education. the available reserves in states with deficits are likely to be depleted in the near future.” Center on Budget and Policy Priorities.” Mr. “Should the Federal Government Bail Out the States? Lessons from Past Recessions. Mattoon. This heightens the potential impact on public services of the shortfalls states now are projecting. The American Recovery and Reinvestment Act recognizes this fact and includes substantial assistance for states. One way states can avoid making deep reductions in services during a recession is to build up rainy day funds and other reserves. and child care remain in effect. “State Budget Troubles Worsen. Spending as a share of the economy declined in fiscal year 2008 and is projected to decline further in 2009 and again in 2010. state budget and tax senior fellow.” added Mr. state budget and tax expert. In this recession. In 18 states. health coverage.1 In January of this year.org/cms/index. 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. five prominent Democratic governors suggested that the federal government should commit $1 trillion in aid to the states over the next two years. 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. McNichol. states have already drawn down much of their available reserves. At the end of fiscal year 2006.5 percent of annual state spending. such as Medicaid. “It’s a 45-year-old system originally designed for poor women and their children. State spending fell sharply relative to the economy during the 2001 recession. but generally are not sufficient to avert the need for substantial budget cuts or tax increases. Federal assistance crucial to stem negative pro-cyclical economic state action. California projected a $21 billion deficit after failing to get voter approval for a series of budget balancing fiscal measures. Most of this money is in the form of increased Medicaid funding and a “Fiscal Stabilization Fund. a former health care executive. senior economist and economic advisor @ Chicago Federal Reserve.” said Gov. August 2009. Most states are required to balance their budgets regardless of the economic environment.” This money has reduced to a degree the depth of state spending cuts and moderated state tax and fee increases.” Chicago Federal Reserve Bank Essay Number 265. Lav. State governments face significant constraints in raising additional revenues. It’s not health care reform to dump more money into Medicaid.

” 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. more than twice the rate of inflation.” Medicaid spending has grown an average of almost 8 percent per year between 2003 and 2008. you need to be concerned about Medicaid. “We want to make as much positive change as possible. According to the most optimistic estimates. Olsen. Pat Quinn’s Taxpayer Action Board.” he said.” Righter said.com/homepage/x488806173/Medicaidreform-tied-to-state-budget-crisis [Mardjuki] Regardless of how much money would be saved this year or next.sj-r. Medicaid reforms could save a total of $983 million over the next two years. Republicans in the Democrat-controlled Illinois Senate and House have all but required that long-term Medicaid reform be part of any budget discussions. which is available online at http://tinyurl.com/taxpayerboard.” State Journal-Register. Howard Peters. Rod Blagojevich. and more in future years. Republican votes may be crucial to reduce the impact of the state’s $9 billion deficit through a potential income tax increase. said Republican fervor for Medicaid reforms appears to be fueled by “the dilemma of raising taxes.5 million Illinoisans and cost $12 billion a year in state and federal funds. “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. The report. 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. but the group will meet again Tuesday or Wednesday in Springfield. Dean. Consensus wasn’t reached on any issues after the two-hour meeting in Chicago.0 LO 10 HEALTHCARE 1AC – ECON ADV Medicaid reform is the only way to solve the state budget crisis.” 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. said Michael Gelder. according to a recent report by Gov. senior reporter. Republicans say that without changes. 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. “It should be obvious to everyone that if you’re concerned about anything in the budget. 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. “I’m not sure there is a clear-enough concept of the consequences of these proposals. You’re A Jerk 10 . “Medicaid reform tied to state budget crisis. said last week. RMattoon. http://www. Dale Righter.Single Payer 2. senior vice president of the Naperville-based Illinois Hospital Association. Quinn’s chief health-policy adviser. But there is disagreement — and outright fear — about the potential ramifications for patients. 6/20/09. 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.

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

23 to 18. a bipartisan group of six senators. “The legislative process right now is going in the wrong direction. Elmendorf. 13 to 10. investor-owned insurance industry and reducing spending for marketing and other satellite services. It’s just too big a bill.often rules designed to avoid payment. Marcia. receiving a budget from the NHI to cover all operating costs. The vote came eight hours after the House Ways and Means Committee approved a nearly identical bill. House Democrats who voted no cited various concerns. “Proposal of the Physicians’ Working Group for single-Payer National Health Insurance.com/2009/07/18/health/policy/18health. Lieberman. The House and Senate bills would require insurers to take all applicants and vastly expand coverage. But the director of the Congressional Budget Office. comprehensive coverage.nytimes. 2009. During the transition to an NHI. on Friday morning. or receive salaries from group practices.would cover every American for all necessary medical care. Investor-owned facilities would be converted to notfor-profit status.pnhp. with federal subsidies for millions of people. partly because of an increase in Medicare spending to avert sharp cuts in payments to doctors. But just to try to get it passed in the Senate before we leave for the August recess seems just about impossible. Obama at the White House this week and urged him not to rush the bill.” said Senator Joseph I. “While we are committed to providing relief for American families as quickly as possible. http://www.” New York Times. Three Democrats crossed party lines and voted no.the creation of a comprehensive National Health Insurance (NHI) Program. A National Health Insurance Program is the only affordable option for universal. Ron Anderson. 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. senior writer. with 3 Democrats voting no.which in essence would be an expanded and improved version of Medicare . Such a program . and Olympia J. Only a single-payer healthcare system is able to solve for perverse incentives and bureaucratic waste.php [Mardjuki] We endorse a fundamental change in America’s health care . who also signed the letter.” Representative Ron Kind of Wisconsin said. who met with Mr. President of American College of Physicians. Herszenhorn. A National Health Insurance Program would save at least $150 billion annually by eliminating the high overhead and profits of the private. slowing cost growth over the long run.” The House education committee approved the bill. Physicians could continue to practice on a feefor-service basis. including two members of the Finance Committee. American Academy of Pediatrics.” they wrote. CEO Parkland Health System. which he called “unsustainable. 7/17/09 Robert and David.Single Payer 2. hospitals or clinics. Senior Lecturer @ Harvard Medical School. to change the incentives so reimbursement will be based on the value.org/single_payer_resources/proposal_of_the_physicians_working_group_for_singlepayer_national_health_insurance .” Physicians For A National Health Program.” 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. Under the current system. Democrat of Nebraska. Christine Cassell. “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. http://www. Ben Nelson. Obama’s ambitious timetable. Douglas W.html?pagewanted=print [Mardjuki] And in the latest sign of lawmakers’ chafing at Mr. 26 to 22.0 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. Angell. MD. “We are not doing enough to reform the health care delivery system. Most hospitals and clinics would remain privately owned and operated. reporter. the savings on administration and profits would fully offset the costs of expanded and improved coverage. On Wednesday. of services. Snowe and Susan Collins.” The group included three senators. the Senate health committee approved a generally similar bill on a party-line vote. sent a letter to Senate leaders pleading with them to allow more time. “Democrats Grow Wary as Health Bill Advances. Quentin Young. “I think it’s extremely doable to get this done before the end of the year. 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 . Joel Alpert. expanding access to health care You’re A Jerk 12 . NHI would make it possible to set and enforce overall spending limits for the health care system. and their former owners compensated for past investments. Republicans of Maine. Peter Beilenson. Editor of New England Journal of Medicine. the Connecticut independent. Commissioner of Baltimore City Health. rather than the volume. Pear. American Public Health Association. after an all-night session.

In any case. Yet some analysts are offering Obama conflicting advice. and tax policy. Boston Globe. Robert Reischauer." Some budget specialists are skeptical. The major reason is that entitlement programs for older Americans are running short of funds. is already running a deficit. 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. That is why many analysts are urging Obama to link changes in Medicare with an overhaul of the health system. former head of the Congressional Budget Office. Obama suggested during his campaign that he might support changing the level of income at which Social Security taxes are calculated. federal spending will go from being about 20 percent of the nation's economy to 42 percent in 2050. some economists fear an international financial crisis could escalate and turn into a worldwide depression. 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. But an NHI could both expand access and reduce costs. the White House believes that he could be one of its most important allies in the overhaul of Social Security.0 LO 13 HEALTHCARE 1AC – ECON ADV inevitably means increasing costs. "When you are shoveling out the goodies. who launched the New Deal but eventually heeded calls to curtail deficit spending." said Reischauer. "It can either be very nice public relations or move the ball down the road on what is an impending fiscal tsunami. 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. you have a greater probability of getting people to sign on to some fiscal diet. most prominently by China. It would squeeze out bureaucratic waste and eliminate the perverse incentives that threaten the quality of care and the ethical foundations of medicine. as long as most of the benefit cuts and tax increases were not slated to take effect until well after the recession is over." Analysts across the political spectrum agree that the current path is unsustainable. which would translate into higher costs for US taxpayers. In an interview. Unless there is a major budgetary change. Medicare. about three-quarters of US debt was purchased by foreign interests. and reducing costs inevitably means limiting access. said Obama should have seized the opportunity to pair the stimulus bill with the overhaul of Social Security. The system tends to respond only in the face of unavoidable crisis.Single Payer 2. If other nations lose confidence that the United States will pay its debts. only to see a new recession batter his presidency. the New Hampshire Republican who backed out of his commitment to be Obama's commerce secretary and then voted against the stimulus bill. Another frequently mentioned option is raising the retirement age. the government-run healthcare program for older Americans. who has been invited to the summit. however. warning him not to repeat what they regard as the mistake of President Franklin Roosevelt. Medicare. a reference to criticism that Obama's stimulus bill was too partisan. In the last four years. 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. according to the Concord Coalition. A key player in the summit will be Senator Judd Gregg. Gregg said that under such a procedure. He said he is worried that nothing will happen on the most difficult issues until political leaders "have a gun at our heads. 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. which is expected to increase quickly as baby boomers retire. Despite the embarrassment caused by Gregg's about-face. and the tax code. "We need an up-or-down vote on a package that will be unquestionably bipartisan and fair. the measures could be passed within a year. Social Security is slated to pay out more money than it receives by 2017. he said. Medicare." Gregg said. Asked about his hopes for the summit. You’re A Jerk 13 .

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

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

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

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

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

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

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

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. You’re A Jerk 21 .Single Payer 2.

when we have a single-payer model. and millions of older Americans had been enrolled and were getting health care with hardly a hiccup. However. 9-5-2008. the government will fund health insurance.com/node/29667). Medicare. http://www. Economies of scale will save the money to make this possible. thousands of people losing their jobs every month and losing their coverage. or dropping coverage altogether. Currently. concede that single-payer insurance is probably our most efficient option. is a whole lot less than "next best?" The House plan is not set to go "live" until January of 2013. If I told you that in less than a year after the historic Medicare legislation was signed into law. maybe. What's worse. http://www. duplicated bureaucracies. insurance policies are so complex and individuals' future needs so unpredictable that consumers cannot make the informed selections that induce competition between insurers. 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. This is paramount because patients need the best healthcare. Global Sourcing Finance Chief at GE Healthcare." The question that her response prompts from me is. 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. Nothing could be further from the truth.pubmedcentral. MD/PhD from Northwestern University. “Why not singlepayer?” Baltimore Sun. Schoonmaker. bloated by advertising. from all appearances. and executive compensation.SOLVENCY Observation 3: Solvency Only a single-payer system mitigates costs – Medicare proves. Many Americans. and their people are. like the fact that we will have a presidential election in November of 2012. with an economy in decline. Why are we writing 1. but our next best choice is to support an exchange and a public option. House Speaker Nancy Pelosi responded to one of the questions by saying. healthier than we are. consumers can create competition among healthcare providers.baltimoresun.[2] But they worry that it lacks the spirit of the American market. 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 . Their spending per-person on health care is less than half what we spend here.0 LO 22 HEALTHCARE 1AC . You’re A Jerk 22 . dividends. Single-payer works because of the efficiency of specialization. A single-payer system will harness the market's strengths while addressing its limitations.1114455. providers are insulated from competition because private insurers often restrict coverage to select physicians.gov/articlerender. with more employers changing to plans that cover less and cost the individual more.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) . A single-payer system will give all consumers the power of choice and open all healthcare providers to the effects of consumer decisions. 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. not insurance.0.fcgi?artid=2580082 In a single-payer system. but private providers will continue to deliver care. In addition. 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. not the best middlemen to pay for it.com/news/opinion/readersrespond/baled. is health care. No. including Democratic presidential nominee Barack Obama. the 47 million uninsured Americans[3] have little impact on the market. Prajwal Ciryamv.le. what will the millions of currently uninsured people do between now and 2013? And.letters200jul20. why are we giving up on the best solution and settling for something that. the program was up and running.000-plus-page bills. 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.nih. "For 30 years I have supported a single-payer plan. that is not a typo. The private health insurance market is inefficient. “A Market for Compassion: Single-Payer Health Insurance”. where the focus should have been from the start. 7/20/09 Anne. by most accepted measures.Single Payer 2. 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. So. All of the major developed nations have some form of single-payer health care.

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

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

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

our political institutions are designed to make it hard to enact comprehensive legislation.0 LO 26 HEALTHCARE 1AC . 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. http://healthcarereform. Ph. history for aiding the uninsured.Single Payer 2.1 Meanwhile. Bush hoped to increase funding. Institutional providers (hospitals and nursing homes) are supportive. benefits.nejm. I believe that this is the only universal coverage plan with a decent chance of succeeding politically. which minimizes complaints about a monolithic national program. Ironically.2 The 2007 battle over Medicaid’s sister program. Even less likely to fly are Medicare-expansion proposals.SOLVENCY Expanding Medicaid builds support for universal care – it’s the only way to neutralize political objections Michael Sparer. but if eligibility were standardized and minimum benefits defined. professor of health policy at the Mailman School of Public Health. Even President George W.. and reimbursement. The bone of contention was the income ceiling for eligibility. softening the impact of the continuing decline in the number of Americans with employer-sponsored coverage. but some rely on commercial insurers and some on nonprofit health plans. Most Americans would find it fair to require those who can afford insurance to buy it. especially when they can pay into an affordable public insurance plan rather than being forced to buy private policies. and one state (New Jersey) has even enacted an initiative combining a Medicaid buy-in with an individual mandate for parents to cover children. the very factors that defeated President Bill Clinton’s proposal for universal coverage have actually encouraged expansions of Medicaid. Similarly. 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. Finally. covers children from families with incomes up to 350% of the federal poverty level. Employer mandates face treacherous politics: big business doesn’t want government telling it what sort of coverage to provide. expanding Medicaid to cover the largest portion of the uninsured. Medicaid provides decent health insurance to more than 59 million Americans (including more than 25% of U. interstate diversity in cost-containment strategies. 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). most states deliver benefits through managed care. the State Children’s Health Insurance Program (SCHIP). though by less than Congress had proposed. given both the cultural opposition to anything that could be labeled a single-payer program and the fierce opposition of the private insurance industry. J. This history points us to an obvious path toward national health insurance: combine a Medicaid expansion and buy-in with an individual mandate. That’s about as high as moderate Republicans (and the business community) might plausibly be willing to go. at the high end. 2009 (Michael Sparer. children). and outreach and education is a good thing. since our system of checks and balances provides opponents with numerous opportunities to block legislation. has been quietly becoming the most successful program in U.D. the federal–state program designed to provide health insurance for the poor. Perhaps most important. whereas others act as the plan themselves.org/?p=300) The 2008 presidential election has rekindled long-simmering hopes for comprehensive health care reform. requiring everyone to carry health insurance and allowing people whose incomes are too high for automatic coverage to buy into Medicaid.S.S. But the same interest groups that would oppose these alternatives would probably support the Medicaid strategy. New Jersey. Path to National Health Insurance.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 . Reform opponents also take advantage of the anti– big-government ethos that pervades our political culture. illustrates this broad acceptability. states are already experimenting with Medicaid buy-in programs. Medicaid.D. 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). Moreover. variation in other areas could result in learning and innovation. and small business argues persuasively that many “mom and pop” shops simply cannot afford the bill. Americans with incomes below 350% of the federal poverty level (around $62. 2009. Surprisingly. since they rely on Medicaid dollars. Business leaders support Medicaid expansions because they relieve the pressure on employers to cover low-wage employees. Medicaid’s intergovernmental structure encourages expansion: since the program is financed primarily with federal dollars. however. the debate generally ignores what I see as the most plausible path toward universal coverage: first.” January 22.3 Some people complain about interstate variation in eligibility. Relying on Medicaid is also good policy. Columbia University.S. For example. Since the Reagan administration. “Medicaid and the U. programs for the chronically ill. Medicaid encourages state-based experimentation in responding to local health care needs. program enrollment has more than doubled (surpassing 59 million).000 for a family of three). And Medicaid offers such flexibility within an overarching federal structure.. Medicaid is also administered in very different ways by different states. and second. states can increase coverage while shifting much of the cost to the federal treasury.

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

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

Jonathan. because it's a big party victory. There are four possible outcomes on healthcare. Outcome 4: In many ways. and the Democratic brand along with it. hey. Specifically. and they vote for it. and they vote against it. Undoubtedly. from best to worst: 1.. Outcome 3: The worst possible outcome. they're going to have to decide whether to pass the bill or not.aspx [JM] Michael Tomasky analyzes the political logic of red state Democrats: Look at it this way. Members of Congress may not be geniuses. 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. the best outcome of all. If health care reform fails. That's why the best possible scenario for Democrats is to have the bill pass with them voting against it. 3. 4.0 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. Chait.” The New Republic Journal. the solon thinks. but they're usually pretty good at discerning their own political self-interest. It fails. You’re A Jerk 29 . which is why I supported the provision that would have. 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. http://blogs. I'd order the outcomes like so. then Obama is toast. be hung around my neck when I seek reelection? Outcome 2: Preferable to 1. And that's the main difference between now and 1994 -. And that's why I think we'll end up with a health care bill. But the distance between the status quo anda perfect bill is so vast that we could have something that's both a massive. they can say. they can always say well. given something as large and complex as healthcare. 2. 2. 4. Having voted against the bill will provide little cover for moderate Democrats. when problems arise with the reforms. If fails. Few unknowns. If fails. That's what I think we'll get. they went too far to the left. or any piece of legislation: 1. It passes. A perfect bill? No. or possibly even the spare votes to allow them to vote against it. I can't see them doing it. Will those problems. because now. and they vote against it. Fear of the unknown is all-consuming for legislators who think they might be vulnerable to defeat someday.health care can't be filibustered without Democratic cooperation. “Why Health Care Reform Will Pass. I tried to tell my more liberal colleagues that this would happen.tnr. don't look at me. It fails. there are going to be problems and disappointments with the new system.com/tnr/blogs/the_plank/archive/2009/07/21/why-health-care-reform-will-pass. 7/21/09. So let's look at each of these vis-a-vis healthcare the way a centrist legislator might look at them. Outcome 1: Not a bad outcome.. That's also why they're trying to get bipartisan support. and they vote for it. which makes it all the more important that people like me stay in Washington. It passes. Now. and they vote against it. senior editor. and they vote for it. It passes. historical improvement and a crushing disappointment. and they vote for it. 3. at the end of the day. it's true that you can't pass an effective health care reform without stepping on some toes. But. It passes.Single Payer 2. so they can't be held responsible for the toes that get stepped on. I disagree. for what I should think are obvious reasons. from a purely short-sighted and self-interested perspective. And to the extent that their president and their party are damaged. which could give them cover. But there are lots of unknowns. as the 1994 elections show. and they vote against it.

Single Payer 2.0

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

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

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. Stating strong opposition to any public option. “The case for keeping “single payer health care” off the table. Joshua. chief reporter. Chair of the Finance Committee and one of the biggest benefactors of health care industry campaign contributions. much of what the consumer has already determined intuitively would be fleshed out in facts and figures. yes it would. George Polk Award winner. After all.talkingpointsmemo. potentially highly profitable . 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." These health insurance industry providers calculated that they could improve their take from the health care system if they smartly played the reform game. 2009. http://tpmcafe. And that would be a good thing.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. undoubtedly certain that they could double. unless you were one of the insurance companies or Big Pharma or the health care industry that has bled our health care system dry.to proceed with Obama's "health insurance reform. Baucus' was instead inclined toward a solution wherein we would eventually subsidize consumers as necessary until we achieved universal health insurance coverage.” Talking Points Memo. successfully eliminating single payer as an option to be considered allowed the monied interests to reason it was safe . seemed to carry their water quite well for so long as he was able.0 LO 35 Obama HC Fails – Industry Profit Big Pharma strangehold – health care industry stands to profit from current reform Marshall. July 15.Single Payer 2. if such a proposed solution were to be given serious discussion. 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.com/talk/blogs/jpieterick/2009/07/the-case-for-keeping-singe-pay. 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. right? Well.nay. And the possibility of the consumers acting upon that realization has the executives in these industries losing sleep. On the other hand. Executives at the major insurance providers were nearly besides themselves in planning the next Congressional fundraisers. 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. You’re A Jerk 35 . 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. triple. Senator Max Baucus of Montana. Alas.

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

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

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

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

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

jobs will be lost to offshoring – a single-payer system restores U. Eventually this might lead to Medicaid becoming more standardized throughout the country. 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. senior writer. rather than being a hodgepodge of 50 different plans. 4. This would instantly save states something on the order of $100 billion or so.motherjones. That kind of thing would work quickly. “Let the Feds Fund Medicaid?” Mother Jones. 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. 5. 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. which would be $10 billion less in demand-destroying budget cuts we'd have to make. so it’d be someone else’s problem. http://www. 3. competitiveness – that’s Angell.S. Yglesias. but it wouldn’t be congress or the executive branch doing the wasting. Kevin.0 LO 41 2AC AT: Kills Econ 1.com/kevin-drum/2009/07/let-feds-fund-medicaid [JM] If we need more stimulus. Job loss – Obama’s ineffective healthcare ensures 28 million U. 7/11/09. I'm not sure Medicaid has really been a great poster child for states as laboratories of democracy anyway. 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. Some of the money would be wasted or used in bad ways. and would allow structural shifts in the private sector to proceed apace. Well. 2. Drum. 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. Here in California. we'd save a little over $10 billion. You’re A Jerk 41 . but that's probably OK.S. would be highly stimulative.Single Payer 2. senior editor of The Atlantic Monthly. 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. Federalizing Medicaid would be the ideal second round of stimulus – instantaneous benefits. State Medicaid costs are poised to independently devastate state budgets – federal intervention is the only way to stem looming deficits – that’s Olsen.

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

and it has followed the economy. State Medicaid officials also say that because enrollment often lags behind job losses by several months. state officials now project it will be eight times higher. There’s just an array of need out there. which had budgeted last year for increases of 1.0 LO 43 Medicaid Costs High Now States swamped by Medicaid expenses because of a prolonged recession and surge in unemployment.” New York Times. the current caseload is the highest since the program’s creation in 1965. The New York Times found that in some cases the surge in enrollment had overwhelmed social services agencies. much of the growth in Medicaid has been among children from low-income families. which is experiencing some of the fastest Medicaid growth in the country (10. after declining by 3 percent a year earlier. You’re A Jerk 43 . has averaged more than triple that since June. in many. who constitute about half of all recipients. 1/21/09. with 40 states responding. In most states. officials there said.html [Mardjuki] Medicaid rolls are surging. One day last fall. 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 Colorado. In a nationwide survey.000 new Medicaid enrollees per month. In a number of states. an Atlanta suburb that is home to a growing immigrant population. http://www. nursing home residents.” But Georgia was hardly alone in seeing substantial jumps in enrollment. the underemployed.4 percent for the 12 months ending in November). “Growing Need for Medicaid Strains States. Utah officials expect their state’s Medicaid enrollment to grow by 13 percent this year. “And there’s no one population. The program also provides coverage for those with disabilities. Medicaid populations grew by 5 percent to 10 percent in the last 12 months and. Kevin. Kentucky. the growth in 2008 may represent only the leading edge of heightened demand.Single Payer 2. and in some instances parents of covered children and childless adults. the regional director over the Gwinnett County office.nytimes. according to state officials. the growth rate was at least double what it had been in the previous year. Here in Gwinnett County. which had forecast enrollment growth of about 1 percent for this fiscal year. Sack. New York Times senior journalist. 2009. McMillan. “There’s just been a steady increase in the numbers. as the recession tightens its grip on the economy and Americans lose their employer-sponsored health coverage along with their jobs. We’re seeing the newly unemployed. pregnant women. In Florida. by unprecedented rates in some states. Medicaid enrollment ballooned by 26 percent from July 2007 to July 2008.” said Glenda G. and prompted state fiscal analysts to shred estimates that were often only six months old. two-time Pulitzer Prize winner.com/2009/01/22/us/22medicaid.

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

" (See the top 10 health-care-reform players. Tumulty. Phil Bredesen.0 LO 45 Obama HC Drains State Budgets Health care reform quietly increases state Medicaid financial commitments – devastates state budgets.Single Payer 2. Nor.00. 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. Karen. You’re A Jerk 45 . it seems. http://www.2 billion fiscal hole.8599.) The proposal could hardly come at a worse time for governors. and would be enormously destructive to state budgets.” Time Magazine. "These could essentially be unfunded mandates." The issue came to a boil as the National Governors Association (NGA) met in Biloxi." says Pennsylvania's Ed Rendell. According to the Center for Budget and Policy Priorities. The recession has drained state coffers of tax receipts. 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. which is being hit from every side by growing doubts. “Medicaid and the States: Health-Care Reform’s Next Hurdle.time. Miss.com/time/politics/article/0. are so wary of the idea. at least 48 states are facing shortfalls totaling $166 billion — 24% of their total budgets. 7/21/09. even as public need for state safety-net services is growing. whose budgets are already straining under the program's growing costs. national political correspondent. 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. Rendell. "Medicaid is a poor vehicle for expanding coverage.html [JM] Until the nation's governors staged a public revolt last weekend. 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. "It depends on what's being proposed. Tennessee's Democratic governor. the outgoing chairman of the NGA.1911856. a Democrat. told the New York Times that he regarded the proposed expansion of Medicaid as "the mother of all unfunded mandates" and warned. could the governors' rebellion have come at a worse time for President Obama's health-care-reform effort.

nytimes. With the recession draining states of tax revenues even as their Medicaid rolls are surging. fearing that Washington was about to hand them expensive new Medicaid obligations without money to pay for them.” said Gov. particularly the $1 trillion figures being batted around. Jim Douglas of Vermont. 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. Kevin and Robert. But the sentiment among those who were could not have been more consistent. 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. Each of several health care bills coursing through Congress relies on a large increase in eligibility for Medicaid. Rendell of Pennsylvania. “Governors Fear Medicaid Costs in Health Plan.” New York Times. a Republican. 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.” added Mr. stayed home to deal with budget crises. Sack. Ms. 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. 7/19/09. “As a governor.” said Gov. they said their deep-seated fiscal troubles made it a terrible time to shift costs to the states. Democrats as well as Republicans. at least partly because half of them did not attend. Phil Bredesen of Tennessee.html [Mardjuki] It was unclear whether the governors would draft a statement expressing their dismay. 7/19/09. a Democrat. and the governors fear they cannot count on provisions in other bills that they will not bear costs. http://www. They are already anticipating large gaps in Medicaid financing after 2010.com/2009/07/20/health/policy/20health. “It’s a 45-year-old system originally designed for poor women and their children. Many. Edward G. a Democrat. Governors consensus – Obama’s healthcare program will exacerbate state funding shortages. as one means of moving toward universal coverage.0 LO 46 Obama HC Drains State Budgets Medicaid already underwater – Obama’s health care proposals will only drain state budgets further. the group’s incoming chairman.Single Payer 2. Sarah Palin of Alaska.” Mr. two-time Pulitzer Prize winner. regardless of political party. Because the states and the federal government share the cost. You’re A Jerk 46 . Bill Richardson. senior journalist. states will almost surely have to increase payments to doctors to encourage more of them to participate. who was Kansas’ governor before she joined the cabinet in April. Tim Pawlenty of Minnesota and Bobby Jindal of Louisiana — were not here. Gov.” Although many governors said significant change in how the nation handles health care was needed. Bredesen. Pear. Obama. And they said they were convinced that a major expansion of Medicaid would leave them with heavy costs. New York Times senior journalist. Cindy Mann.” The governors’ backlash creates yet another health care headache for the Obama administration.html [Mardjuki] The nation’s governors. the National Governors Association projects that states will face aggregate deficits of $200 billion over the next three years . Sebelius. any increase in eligibility levels. Pear. Both Ms. In at least one of several bills circulating in Congress. senior journalist. “Governors Fear Medicaid Costs in Health Plan. New York Times senior journalist. Kevin and Robert. benefits or payments to doctors would impose new burdens on the states unless Washington absorbs them. made appearances at the meeting on Sunday. And they pointed out that Medicaid already suffered from low payment rates to health care providers. Gov. other administration officials spent the day pushing President Obama’s proposal on television talk shows. the New Mexico Democrat who served in the Clinton cabinet and ran for president against Mr.” said Gov. It’s not health care reform to dump more money into Medicaid. which has tried to recruit state leaders to pressure members of Congress to wrap up their fitful negotiations. Kathleen Sebelius. a former health care executive. the states would eventually pick up a share of the new costs. http://www. voiced deep concern Sunday about the shape of the health care plan emerging from Congress. including the group’s chairman. Obama also plans to address questions about his health plan at a news conference on Wednesday evening. Meanwhile.nytimes.” New York Times.com/2009/07/20/health/policy/20health. “I’m personally very concerned about the cost issue. Mr. “We can’t have the Congress impose requirements that we are forced to absorb beyond our capacity to do so. If Medicaid is expanded. Bredesen was far from alone in his concern. Sack. Christine Gregoire of Washington. said he feared Congress was about to bestow “the mother of all unfunded mandates. discouraging some doctors and hospitals from accepting beneficiaries. “I think the governors would all agree that what we don’t want from the federal government is unfunded mandates. also a Democrat. when stimulus money dries up. and the federal Medicaid chief. the state and federal insurance program for the poor. two-time Pulitzer Prize winner.” “Medicaid is a poor vehicle for expanding coverage. Some of the group’s most notable names — Arnold Schwarzenegger of California.

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

employee provided insurance drowning under crushing state converge mandates is a major reason for rising medical costs. States were promised relief after 2019. They are in no position. hamstrung by wartime wage controls. I also expect the federal government to place increased mandates on states. You’re A Jerk 48 . My final point relates to some important things the plan does not do. . who will take over the NGA chairmanship on Monday.html [Mardjuki] But even with the stimulus money. "We have to restructure our state governments . would have called on the states to issue 30-year bonds and pay the cost of the Medicaid expansion from the proceeds. “At Governors’ Meeting. especially if the economy is not growing at a substantial pace. More troubling proposals have been under discussion. Employers provide health insurance as a benefit. law and politics consultant.Single Payer 2. 7/21/09.examiner. Governors are already talking about the moves they may have to make once the stimulus money disappears after 2011. This would have been augmented by some share of promised Medicaid drug rebates. governors revolted against a plan under consideration in the Senate Finance Committee. I also dislike the idea of being unable to change jobs for fear of losing one’s health insurance coverage. Governors have already been warned that 100 percent federal financing is now very unlikely. and get at least a $5." 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. Balz. It does nothing to address the current employer based system of health insurance.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.com/wpdyn/content/article/2009/07/18/AR2009071801786_pf. 7/19/09. according to an analysis prepared by the Center on Budget and Policy Priorities and shared by Rendell's office. states face collective deficits of more than $200 billion in the next few years. The whole concept began during WWII when employers. in their current state. “An Examination of the President’s Health Care Plan. As they do that. which is funded by the federal government and the states. Another proposal floated earlier was for the federal government to pay the entire bill for five years. In fact it solidifies it. Instead many began offering to take that money and purchase their employees health insurance which until that time was generally purchased privately. even as federal funding is eventually reduced. Moore.washingtonpost. ." A state official called it "creative financing.” Manchester Examiner. Budget Problems Are Inescapable. The health-care bills moving through Congress include a significant expansion in Medicaid. Jim Douglas (R). according to an estimate by an NGA official. so we are ready to get along without these resources in a couple of years. Locking citizens into a system of third party payer. governors may have another looming fiscal burden. Last week. Dan. solidifies private sector insurance. 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. Asking the states to issue bonds for the Medicaid expansion would have taken $180 billion off the budget. Whatever one thinks about the efficacy and sustainability of these two programs. A good bill would address this. senior writer. That proposal. An NGA official estimated that the cost of that expansion could be around $60 billion a year. http://www.” Washington Post. at least for the first few years. On the face this will be a serious financial burden to states already facing bankruptcy. or fails to keep pace with expanding federal requirements. could not offer increased salaries as an incentive to recruit talent. How might states pay for their share? Maybe not at all." said Vermont Gov. to handle this type of expansion. Congressional gimmicks – hidden state costs in congressional committees’ HC proposals. senatorial aide. they are looking for ways to strip away costs. One proposal has called for the federal government to pick up permanently the cost for those newly eligible for the program. they themselves are in serious need of reform. http://www. Christian.000 tax credit to do so.0 LO 48 Obama HC Drains State Budgets Obama’s healthcare exacerbates states’ Medicare and Medicaid deficits. But as congressional committees wrestle with projections that show health care turning into a budget buster. not institutionalize it. One congressional source described the measure as "subject to gimmick charge.

more affordable health care for patients.Single Payer 2. “it’s not health care reform to dump more money into Medicaid. which is being hit from every side by growing doubts. told the New York Times that he regarded the proposed expansion of Medicaid as "the mother of all unfunded mandates" and warned. Republicans are calling it a dangerous "experiment. 7-22-2009. at least 48 states are facing shortfalls totaling $166 billion — 24% of their total budgets.” 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. In fact. 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. "Medicaid is a poor vehicle for expanding coverage." And even the Mayo Clinic — often cited by Obama as the model of what an efficient. 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. “I think the governors would all agree that what we don’t want from the federal government is unfunded mandates. Steven J. 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 . it will do the opposite. said.html The issue came to a boil as the National Governors Association (NGA) met in Biloxi.thenewamerican.” Bredesen.com/index. http://www. including a meeting with Health and Human Services Secretary Kathleen Sebelius and Cindy Mann. Tennessee's Democratic governor. (D) summed things up: “There’s a concern about whether they have fully figured out a revenue stream that would cover the costs. a Democrat. 7-21-2009. Both Democratic and Republican governors voiced animosity toward any reform that would overload states at a time when they are already struggling financially.00. Jr. it seems. even as public need for state safety-net services is growing. staff writer for The New American magazine. “I’m personally very concerned about the cost issue." Governors wary of unfunded federal healthcare mandates.time. Abortion Stymie Health Reform” http://www. another Democrat. Nor. the association’s incoming chairman.” he declared. Tennessee Governor Phil Bredesen. and that if they don’t have all the dollars accounted for it will fall on the states. particularly the $1 trillion figures being batted around. The recession has drained state coffers of tax receipts. Miss. According to the Center for Budget and Policy Priorities. the outgoing chairman of the NGA." (See the top 10 health-care-reform players. a former executive in healthcare. said that “Medicaid is a poor vehicle for expanding coverage.php/usnews/health-care/1492 The National Governors Association met on July 18 and 19.) The proposal could hardly come at a worse time for governors. the federal Medicaid chief. Douglas’ assessment was backed up even by Democratic governors. Rendell.” New Mexico Governor Bill Richardson. National Political Correspondent for Time Magazine. could the governors' rebellion have come at a worse time for President Obama's health-care-reform effort. “Medicaid and the States: Health-Care Reform’s Next Hurdle”.2 billion fiscal hole. DuBord. has testified that the legislation thus far has too little cost containment. worried that Congress was about to bestow “the mother of all unfunded mandates. 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 .com/time/politics/article/0.” You’re A Jerk 49 . Douglas Elmendorf. Phil Bredesen.8599.” said Vermont Governor Jim Douglas (R). “We can’t have the Congress impose requirements that we are forced to absorb beyond our capacity to do so.0 LO 49 Obama HC Drains State Budgets Obama’s healthcare too costly for states Karen Tumulty. “Governors. head of the Congressional Budget Office.” And Colorado Governor Bill Ritter.1911856.” Describing it as “a 45-year-old system originally designed for poor women and their children.

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

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

Johnson. Arizona has eliminated temporary health insurance for people with disabilities who are coping with serious medical problems. http://www. Phil. You’re A Jerk 52 . and California and Utah are reducing services covered by their Medicaid programs.cbpp. as the recession brought sharply weakened revenues.Single Payer 2. “An Update on State Budget Cuts.000 low-income parents. eliminated temporary health insurance for people with serious medical problems. Nicholas. Nevada is making it harder for beneficiaries to qualify for nursing home care. 6/29/09. The cuts have intensified as the economy has worsened.org/cms/index. Senior Fellow. Phil.cfm? fa=view&id=1214.500 low-income adults. For example. [Mardjuki] States began cutting their budgets last spring.0 LO 52 State Deficits Now – No HC State deficits now – healthcare is the first to go. or significantly increasing the cost of these services. For example. home care. Programs for the elderly and disabled: At least 22 states plus the District of Columbia are cutting medical.” Center on Budget and Policy Priorities. Director of BPP State Fiscal Project. rehabilitative. or other services needed by low-income people who are elderly or have disabilities. and Rhode Island is requiring low-income elderly people to pay more for adult daycare. Rhode Island eliminated health coverage for 1. Florida has frozen reimbursements to nursing homes and relaxed staffing standards. 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. Minnesota is cancelling a health insurance program for 29. At least 39 states to date have reduced services since the recession began.

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

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

Budget cuts reduced state funding for the University of Washington by 26 percent for the coming biennium. When Rhode Island cut higher education funding. Arizona State University has addressed its loss of state funds by eliminating over 550 staff positions and 200 faculty associate positions. The University of Florida has announced it will eliminate 150 positions for the coming year. California. and the Community College of Rhode Island all increased tuition for this past academic year. [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. Maryland. and Virginia. Georgia. South Carolina.cfm? fa=view&id=1214. Florida State University plans to lay off up to 200 faculty and staff members. Nevada .000 students. You’re A Jerk 55 . Louisiana. http://www. Rhode Island College. 6/29/09. As a direct result of state budget cuts. The University of California system is reducing California resident freshman enrollment by 2.2 percent. Kentucky. Idaho. Tuition in Arizona this year rose 9. Maine.5 percent in response to funding cuts. Senior Fellow.300 students for next year. Florida has cut university budgets and community college funding. Other states cutting higher education operating funding include Alabama. Oklahoma. Director of BPP State Fiscal Project. “An Update on State Budget Cuts. Tennessee. Vermont.” Center on Budget and Policy Priorities.3 percent respectively. Nicholas. Mississippi. Iowa. New Mexico. consolidating several schools and almost two dozen academic departments. resident undergraduate tuition increased by 14 percent (over $600 per year) between the fall and spring semester of this past academic year. Tuition at all 11 Florida public universities will rise by 15 percent next year. Colorado.Single Payer 2. Kansas. At the State University of New York. by 6. and limiting enrollment in its nursing school. Each of these institutions went one step further by increasing tuition further mid-year. imposing employee furloughs ranging from 10 to 15 days. Connecticut.0 LO 55 State Deficits Now – No Education State higher education budgets cut now – laundry list. Massachusetts. North Carolina.org/cms/index. the California State University system is cutting enrollment by 10. Pennsylvania. Hawaii. 8. and 4. Minnesota. the University of Rhode Island. New Jersey.cbpp. Phil. The budget authorizes the university to increase tuition up to 14 percent to compensate for this funding loss. Utah.7 percent. Phil. Johnson. resulting in 49 staff and nine faculty layoffs.

New York. In early January the state replaced the freeze with a cap on the number of budgeted positions at each state agency. In Washington.California. As noted above. Overall. Michigan. Cutting staff — whether on a permanent or temporary basis — also may contribute to increased unemployment. Senior Fellow. the Ohio state workforce declined by 3.Idaho. Director of BPP State Fiscal Project.000 state positions. Nicholas. Johnson. North Carolina. http://www. plus the District of Columbia — have laid off or announced plans to lay off state employees.Single Payer 2.000 between March 2007 and December 2008.” Center on Budget and Policy Priorities. Kentucky. imposing mandatory furloughs (time off without pay).000 state positions by encouraging early retirement. the Department of Public Advocacy (which defends clients in the criminal justice system) instituted a strict hiring freeze.000 or more. gave early retirement to 25 employees. and furloughed remaining employees. about 4. and Wyoming. child welfare. 6/29/09. Hiring freezes have also been ordered in Alabama. The Tennessee governor has announced elimination of over 2. New Mexico. about 5 percent of the state workforce.org/cms/index. Arizona. The Ohio governor has announced plans to eliminate as many as 2. and leaving vacancies unfilled. layoffs. Kansas. and Utah. child support.0 LO 56 State Deficits Now – Job Loss State employees being fired now – laundry list. and delayed a 2 percent salary increase scheduled for November 2008. Louisiana. Florida.500 employees accepted buy-outs for early retirement.cfm? fa=view&id=1214. Maine. Some 1. Phil. Kentucky. New Jersey has eliminated 2. North Carolina. Maryland.Delaware.700 positions. A number of states are imposing furloughs and/or pay cuts for some state employees. Massachusetts. You’re A Jerk 56 . child care. Florida. Vermont. New Mexico. and other services — fully 14 percent of positions will be eliminated or left unfilled. Mississippi. a hiring freeze imposed by the governor in August caused the state’s workforce to decline by more than 1. Georgia. Florida. the District of Columbia. or making other cuts affecting their state workforce. New Hampshire.Minnesota. Wisconsin. New Jersey. Pennsylvania. Phil. health care. These include Arizona. To deal with budget cuts in Kentucky. Maine. Connecticut. In the Department of Jobs and Family Services — which oversees disability services. Rhode Island plans to reduce the state workforce by 2. Nevada.5 percent of the state workforce. Massachusetts. Additional states — such as Arizona. Iowa. a number of state colleges and universities in states such as Alabama. Illinois. and laying off staff. leaving vacancies unfilled. Georgia. laid off 567 state workers. [Mardjuki] At least 40 states plus the District of Columbia are eliminating or not filling various state jobs. Ohio. Hawaii. The state is encouraging early retirement but has announced that it will lay off workers if needed. South Dakota. the state’s workforce is expected to fall by another 2.Hawaii. Arizona. andSouth Carolina. California.cbpp. South Carolina. Colorado. Virginia’s governor has eliminated 800 currently unfilled positions. Iowa.600 under the cap.400. through a combination of early retirements. Michigan. Michigan. and New Jersey are responding to budget cuts by cutting faculty and staff positions. “An Update on State Budget Cuts. Such steps can make it more difficult for residents to obtain state services.

schizophrenia and other mental health issues by contracting out with 18 different agencies as well as psychiatric hospitals to provide service to county residents.morningjournal. He said the board would do its best to maintain its core client services but the cuts would surely impact residential treatment. Elaine Georgas. Neff said he foresees the same issue arising — people without Medicaid getting bumped to the back of the line. 7-21-2009." Georgas said. Georgas said. noting the department already took a $975.0 LO 57 States Deficit Now—Tradeoffs Medicaid tradeoffs with social services in state budgets –Ohio proves. The Board of Mental Health treats clients suffering from depression. While the figures are yet to be ironed out. The way Neff has it figured is for every $1 spent on mental health. executive director of the Lorain County Board of Mental Health. Services will be slashed and the lines for those in need of assistance will likely be longer. Children's services.Single Payer 2. with preference being given to those with Medicaid. "We felt like we were unfairly targeted in 2009. "This is going to mean drastic cuts." But now. mentoring services throughout the county and youth services.txt Social service agencies in Lorain County are feeling the rippling effects of Ohio's newly passed budget. You’re A Jerk 57 . executive director of the Alcohol and Drug Addiction Services Board of Lorain County." which will likely work its way down to the county level. "These cuts will definitely be a problem for these clients.000 in cuts. families and communities will all bare the burden of the cuts. according to directors of two of the county's service boards. Jordan Cravens. Both Neff and Georgas agreed the impact on the criminal justice system will furthering the ripple effect.com/articles/2009/07/21/news/mj1361976. we were short-sided in the 2010 budget. "They rely on the state funding for services. Neff said the board is expecting between $1 million and $2 million less from the state. Georgas said other clients will likely have to wait longer for services. "We have heard that our state department (Ohio Department of Alcohol and Drug Addiction Services) has been given a 30 percent budget cut. “State Budget Cuts to Affect Social Services”." Georgas said. She is expecting anywhere from $300. "It's going to impact people who don't have Medicaid. “The criminal system will probably grow. he said. Georgas explained. "We got killed in the budget." he said.000 to $400. according to Neff. staff writer. said her department is also preparing to get hit with a financial crunch. the government could save $11 in keeping citizens out of the court system and prisons. "I know the state's issue is with Medicaid. "Families are going to suffer because people who need treatment need to get treatment as soon as they can. http://www. 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. she said." Georgas said. but roughly 75 percent of the board's clients are not on Medicaid." and again.000 budget hit in 2009. Georgas said." Georgas said." said Charles Neff." Neff said.

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

both took large cuts. http://www. localities bankrupt or nearly so would be exempt. it was cut by $144 million. said in a telephone interview from Sacramento. “California Reaches Budget Deal. $3. the deal contains $15.” Karen Bass.5 billion in tax increases and $5. their state broke and its credit rating shot.html?_r=1 California lawmakers. state officials have come up with a compromise that few who receive government services will celebrate.8 billion in spending cuts. localities will basically serve as unwilling lending agents to the state.4 billion in new borrowing. $12. which Mr. “I would characterize this budget as shared pain and shared sacrifice. and Mr.nytimes. which is certain to be viewed with trepidation among legislatures across the country also facing huge budget gaps.6 billion in cuts. remains. the state was forced to issue millions of dollars in i. universities and local governments. 7-20-2009. which runs through the 2010 fiscal year. distributes pain through nearly every aspect of government services. Schwarzenegger had claimed he would not brook. Lawmakers believe that cities and counties could in turn borrow against that borrowing. among other purposes. about $2. along with the creation of a $1 billion reserve fund. With Billions Cut”. One of the biggest sticking points was over the $11 billion already cut from public schools. the speaker of the California Assembly. Schwarzenegger. lawmakers signed off on a budget deal with $14. which would have to be repaid within three years. All told. finally sealed the deal with the governor Monday night on a plan to close a $26 billion budget gap.A. The budget deal calls for roughly $650 million more in cuts.7 billion in accounting maneuvers like shifting a payday into the next fiscal year. Local governments will lose millions of dollars that are used to build housing. New York Times L.0 LO 59 State Deficits Now –Tradeoffs California budget crisis hurting social services and schools Jennifer Steinhauer. So did public education. achieved his goal of having caregivers and the recipients fingerprinted in the future with the goal of preventing fraud. a Republican. as the Democraticcontrolled Legislature hopes.u.9 billion in new revenues and about $2. The plan. and the state plans to borrow roughly $2 billion in property taxes from localities. You’re A Jerk 59 . Under the new budget. Healthy Families. But that budget depended on a nod from voters on several ballot measures.o. bureau chief. With the deficit continuing to grow. Last February. While the state’s health insurance program for children.Single Payer 2. It will raid their coffers and repay them over time as the state’s fiscal situation improves.’s to vendors and taxpayers in lieu of payment. meaning thousands of children will probably be on a waiting list for the program unless a private foundation makes up the balance. While the Legislature pushed back on Gov. All failed. the program was instead given an overall cut of $500 million .1 billion in borrowing. In-home services for the elderly and infirm were reduced by several million dollars.com/2009/07/21/us/21calif. Arnold Schwarzenegger’s proposal to eliminate health care programs for children and the state’s generous welfare program. While the governor wanted certain welfare benefits to be reduced from a fiveyear period to two years. After weeks of often-cantankerous negotiations.

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

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

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

Michael. Still.” Washington Post.washingtonpost. It now stands at 9. You’re A Jerk 63 . the administration missed badly when it projected that unemployment would not rise above 8 percent with the measure in place. 7/22/09.Single Payer 2. The worsening unemployment picture is expected to slow future economic growth and push projected government budget deficits even higher. staff writer.5 percent and is projected to surge even higher in the coming months. Fletcher.0 LO 63 More Stimulus Needed .com/44/2009/07/22/a_news_conference_to_push_hard.html?wprss=44 [Mardjuki] Undercutting Obama's effort also is growing public discontent about his handling of the overall economy. With the nation just beginning to emerge from the most severe economic downturn since the Great Depression. creating new obstacles for the proposed sweeping health care overhaul. “Obama: Health Care Reform Is Essential to Rebuilding Economy. hurting the credibility of its economic forecasts.Unemployment Stimulus wasn’t enough – skyrocketing unemployment. Many economists agree that the employment picture would be much worse had the stimulus plan not been enacted. http://voices. unemployment is continuing to rise. despite the $787 billion economic stimulus plan that Obama managed to squeeze through Congress in the early weeks of his administration.

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

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

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

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

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

This heightens the potential impact on public services of the shortfalls states now are projecting. In this recession. 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.org/cms/index. The American Recovery and Reinvestment Act recognizes this fact and includes substantial assistance for states. 6/29/09. “State Budget Troubles Worsen. but generally are not sufficient to avert the need for substantial budget cuts or tax increases. Lav. At the end of fiscal year 2006. higher education.0 LO 69 More Stimulus Needed – States Key Federal assistance crucial to stem negative pro-cyclical economic state action. In 18 states. Spending as a share of the economy declined in fiscal year 2008 and is projected to decline further in 2009 and again in 2010. and for all states combined it still remains below the fiscal year 2001 level. Most of this money is in the form of increased Medicaid funding and a “Fiscal Stabilization Fund. http://www. McNichol. Reserves can be particularly important to help states adjust in the early months of a fiscal crisis.5 percent of annual state spending.Single Payer 2. the available reserves in states with deficits are likely to be depleted in the near future. Federal assistance Crucial. states have already drawn down much of their available reserves.” Center on Budget and Policy Priorities. but this will not address state budget shortfalls.” This money has reduced to a degree the depth of state spending cuts and moderated state tax and fee increases. state budget and tax expert. There are also other streams of funding in the economic recovery act flowing through states to local governments or individuals. health coverage. Gold award for contribution to state fiscal policy. 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. State spending fell sharply relative to the economy during the 2001 recession. These important public services were suffering even as states turned to budget cuts to close the new budget gaps. state reserves — general fund balances and rainy day funds — totaled 11. state budget and tax senior fellow. and child care remain in effect.cbpp. One way states can avoid making deep reductions in services during a recession is to build up rainy day funds and other reserves.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. Iris and Elizabeth. In a number of states the reductions made during the downturn in education. Federal assistance can lessen the extent to which states need to take pro-cyclical actions that can further harm the economy. You’re A Jerk 69 .

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

Dean. 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. But there is disagreement — and outright fear — about the potential ramifications for patients. 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.” state Sen.” 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. 6/20/09. Republicans say that without changes.com/homepage/x488806173/Medicaidreform-tied-to-state-budget-crisis [JM] Regardless of how much money would be saved this year or next. which is available online at http://tinyurl. “It should be obvious to everyone that if you’re concerned about anything in the budget. Quinn’s chief health-policy adviser. according to a recent report by Gov. and more in future years. senior reporter.” State Journal-Register. “Medicaid reform tied to state budget crisis. Consensus wasn’t reached on any issues after the two-hour meeting in Chicago. Howard Peters.Single Payer 2. said Republican fervor for Medicaid reforms appears to be fueled by “the dilemma of raising taxes.” Medicaid spending has grown an average of almost 8 percent per year between 2003 and 2008. “I’m not sure there is a clear-enough concept of the consequences of these proposals.sj-r. “It is the 700-pound gorilla quickly turning into the 900-pound gorilla. said Michael Gelder. 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. http://www. Rod Blagojevich. Medicaid reforms could save a total of $983 million over the next two years. “We want to make as much positive change as possible.com/taxpayerboard. Republican votes may be crucial to reduce the impact of the state’s $9 billion deficit through a potential income tax increase. You’re A Jerk 74 . Republicans in the Democrat-controlled Illinois Senate and House have all but required that long-term Medicaid reform be part of any budget discussions.” Righter said. but the group will meet again Tuesday or Wednesday in Springfield.” “People are almost desperately looking for some kind of ‘silver bullet’ that can get us out of this thing that can be painless.0 LO 74 Medicaid Reform Solves State Budgets Only massive Medicaid reform solves the state budget crisis Olsen. According to the most optimistic estimates. you need to be concerned about Medicaid. Dale Righter. The report. RMattoon. Pat Quinn’s Taxpayer Action Board.5 million Illinoisans and cost $12 billion a year in state and federal funds. senior vice president of the Naperville-based Illinois Hospital Association. hospitals and doctors when it comes to changes in state health programs that cover 2. more than twice the rate of inflation. 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. said last week.” he said.

In truth.washingtonpost. Slapped together 45 years ago as a relatively small program that mainly financed healthcare to welfare recipients and their children.html [JM] Harold Pollack is an associate professor of public health at the University of Chicago. The cuts seem most dramatic in California. The spreadsheets can be accessed here. The worst is yet to come. Amid this health policy tumult. He's one of the smartest social policy thinkers I know. “Guest Graph: The Future of Medicaid. is right on the money. and more. the tax treatment of employer-provided health plans. Yet painful measures are being taken in many other states. and for the fiscal survival of state governments. Charting a sustainable future for Medicaid is essential for virtually every aspect of health reform. and is the major vehicle to cover millions of poor and near-poor Americans who would otherwise be uninsured. our essential but flawed state-federal partnership that finances medical care and related services for almost 50 million people. senior editor.Single Payer 2. You’re A Jerk 75 .com/ezraklein/2009/06/guest_graph_the_future_of_medi. Saddled with balanced-budget requirements and constrained tax bases. 6/19/09. underpaying providers. comparative effectiveness research. one basic issue receives less attention than it deserves: The precarious condition of Medicaid. links to competing webcasts on value-based insurance design. It’s impossible to keep up. Ezra. Rhetoric about soaring Medicaid costs is actually misplaced. http://voices. Klein. adjusted for the CPI and expressed in year-2007 dollars. Rising Medicaid expenditures undermine states’ ability to address other pressing needs. They are dwarfed by corresponding changes in Medicare. It shows inflation-adjusted medical expenditures by state and local governments between 1960 and 2007. we must recognize that the budget challenge is more than a nasty episode brought on by the current downturn. Figure 1 shows why state policymakers are panicking. arguing that it's time we recognized the centrality of Medicaid and made it a federal program rather than a state partnership. barely exceeding 1% of GDP. states have cut financial corners for decades. delaying payment. failing to operate these programs with the skill and humanity that patients deserve. past and projected increases in state expenditures are modest. States’ Medicaid problems have been building for decades. the existing framework no longer works. 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. My inbox this morning includes a white paper comparing different versions of the public health insurance plan. malpractice reform. What can be done? First. economic and domestic policy expert. As a percentage of GDP. and this piece he sent in.) As state and local medical expenditures cross the $300 billion mark. Medicaid has evolved into a huge and diverse program that finances almost half of American nursing home and long-term care.” Washington Post. bears large responsibilities for the care of disabled adults and children. (These data are drawn from National Health Expenditure data. I should be more careful here.0 LO 75 Medicaid Reform Solves State Budgets Medicaid reform needed to stabilize state budgets and local economies – current system unsustainable. Actuaries predict that state Medicaid expenditures will roughly double by 2017.

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

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

and should not be victimized again by their own government.Single Payer 2. Overall.com/opinion/51360777. because of the hugely exceptional circumstances of the 2005 hurricanes. which would normally be 72 percent. Jindal says Louisiana's reimbursement rate will drop from as high as 73 percent to 60 percent . 7/22/09. Louisiana. Louisiana's Medicaid funding. Louisiana will face the largest decrease of federal Medicaid funding in the nation . 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.” Jindal’s top health aide. North Dakota. the state government is going hat-in-hand to the U. You’re A Jerk 78 . Further. Predicted billion-dollar Medicaid deficit will devastate Louisiana economy. recently met on the problem. Bobby Jindal and U. government for more than $700 million in Medicaid funds. has been to Washington to press the state’s case for relief. Alan Levine. which serves the poor and uninsured.htm?print=1 [Mardjuki] Associated Press. And then. Finally. That rate is determined by a formula based on total personal income in the state. Federal Payouts Create Medicaid Problem in Louisiana. Louisiana's per-capita income is reported to have increased by 42 percent .com/news/southcentral/2009/07/22/102426. with the full impact starting January 2011. D-La. Within the next year. there is the problem of “Katrina fatigue. Because of the formula used in the calculation of Medicaid support from the federal government. there are ballooning federal budget deficits — for which Jindal is trying to score political points by criticizing President Barack Obama. Louisiana might face significant new budget cuts in the 2011 fiscal year that begins next July 1. “Insurance.claimsjournal. Medicaid.” http://www. The problem? Louisiana’s income was artificially inflated by insurance payments and federal aid in the wake of the hurricanes of 2005. The state will start seeing this loss of funding this October. We don’t agree with the latter position. wait until next year.” with the state’s woes after the hurricanes receding in national consciousness. The drop from 72 to 63 percent will cost the state an estimated $700 million per year.” Louisiana faces a shortfall in the hundreds of millions of dollars per year. Sen.. Mary Landrieu. 7/22/09. and then will decrease to 63 percent in October 2010.forcing cuts to either public health or higher education.a decrease almost twice that of the state with the next largest decrease. according to the governor's office.S. according to the Bureau of Economic Analysis.” WBRZ News 2. Jindall's office says he is trying to work out a solution with federal officials over the looming crisis. Aid to Louisiana on this front will add to the deficit. higher-education funding and other key Louisiana priorities. From 2005 to 2007.” Jindal said. This coming October. If the reimbursement rate is adjusted for that bogus “income. 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.0 LO 78 Louisiana – Medicaid Deficit Louisiana set to run into a $1 billion Medicaid shortfall – drop in federal funding and miscalculated budget. “Our Views: Medicaid rate hits Louisiana. Gov. “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. in 2011. Louisiana Governor’s Office. ABC News. Louisiana Gov. We hope that the Obama administration and Congress listen. Because Louisiana is a relatively poor state. “This formula will put severe pressure on health-care funding. That figure goes far beyond wages and salaries . but the state’s case for assistance is clouded by political concerns.S.html If this year’s state budget crisis was fun.including all payments from all sources. not only does Medicaid reimbursement take another dive. 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. but the federal stimulus aid to the state also goes away — a double-whammy. calculates payment schedules to the states based on per-capita income. it will decrease to 67 percent. [Mardjuki] http://www. but it is an argument that is going to be heard. sudden increase which will drop the state's federal Medicaid funding. is temporarily enhanced by the federal stimulus. the governor's office said. members of Congress might be reluctant to make even this one change because the nonpolitical formula should be preserved against future raids. as calculated by the independent Bureau of Economic Analysis.2theadvocate. We hope Landrieu and the state’s delegation in Congress can plot a way through this thicket.a dramatic. including insurance and Road Home payments after the 2005 storms.

0 LO 79 You’re A Jerk 79 .Single Payer 2.

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If that number is above 600. The retrenchment in consumer sentiment can only be traced to further deterioration in the real economy.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. As long as credit remains extremely tight the economy has to rely on savings and income.0 LO 81 Consumer Confidence Low Now Consumer confidence is tanking the economy Michael A.” If this survey is accurate. if one cannot qualify for a mortgage or auto loan one does not spend what savings they have for a downpayment. The rational response to a deteriorating economy even for those with access to credit is to save more.3 percent from 25. When the economy improves employers first slow down their rate of layoffs. while those anticipating fewer jobs increased to 27. The Conference Board stated “the job outlook was also more pessimistic. The survey is a measure of attitudes and feelings. The economy is made up of spending based on access to cash. Only meaningful intervention from Washington will fix the credit markets within the next few years. Those anticipating more jobs in the months ahead decreased to 17. 2009 (“Falling Consumer Confidence Foreshadows Worsening Jobs Outlook” outlook/ http://www. The news coverage in May and June has been positive. He earned a Master's Degree in Business Administration from Baylor on June 30. income. The weekly number has to begin to improve before the unemployment rate can improve. The weekly claims number released this week will be part of the July unemployment report.000 again. 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. The green-shoot crowd expected confidence to continue rising. Plus. That leaves savings.Single Payer 2. The credit markets remain broken. then we will know the July unemployment report will also be weak. The drop is especially significant since people receiving a paycheck had fewer payroll related taxes withheld from their checks. Based on an increase in the value of the stock markets and the constant press coverage for green-shoots and an improving economic picture.3 percent. or credit.3 from a reading of 54. You’re A Jerk 81 . incomes are not in a position to pick up the slack for access to credit. But with unemployment rising and unemployment benefits starting to run out for those that lost their jobs last summer and fall.escapethenewgreatdepression. The credit markets and the economy will not heal on their own in the near term. Finally employers hire and the unemployment rate begins to go down. Fine. Then employers have their existing workforce work longer hours. Prometheus Wealth Management. They may seek to demean the data for the unemployment rate and call it once again a lagging indicator. but weekly unemployment claims are not a lagging indicator. Access to cash can come from savings. Kamperman runs his own investment advisory firm.6 percent. Access to credit remains as tight as ever for both consumers and businesses.8 in May.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. then the unemployment rate reported for June could approach 10%.

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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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each armed with its own nuclear arsenal. the United States is likely to behave towards China much the way it behaved towards the Soviet Union during the Cold War. Gen Ridgeway said that should that come to pass. allowing China to control that large island. “Regional Fallout: No one gains in war over Taiwan. the Philippines and. there is little hope of winning a war against China 50 years later. Major-General Pan Zhangqiang. and they too will do whatever they can to prevent it from achieving regional hegemony. Russia may seek to redefine Europe's political landscape. 2000. And the conflagration may not end there as opportunistic powers elsewhere may try to overturn the existing world order. Japan.S. this means South Korea. which is sure to infuriate China and fuel the security competition between Beijing and Washington. Italy. it is hard to imagine the United States . THE AMERICAN RESPONSE It is clear from the historical record how American policymakers will react if China attempts to dominate Asia. If the US had to resort to nuclear weaponry to defeat China long before the latter acquired a similar capability. C. With the US distracted. The United States does not tolerate peer competitors. Taiwan is likely to be an important player in the antiChina balancing coalition. and even China. commander of the US Eighth Army which fought against the Chinese in the Korean War. Japan. In south Asia. east Asia will be set on fire. South Korea. The US estimates that China possesses about 20 nuclear warheads that can destroy major American cities. Germany. a personal account of the military and political aspects of the conflict and its implications on future US foreign policy. China’s neighbors are certain to fear its rise as well. to a lesser extent. given Taiwan’s strategic importance for controlling the sea lanes in East Asia. which is why China is likely to imitate the United States and attempt to become a regional hegemon.raise the possibility of a nuclear war. In essence. Japan. He said military leaders considered the use of nuclear weapons mandatory if the country risked dismemberment as a result of foreign intervention. France. which could have led to the use of nuclear weapons. they will join an American-led balancing coalition to check China’s rise. June 25. The balance of power in the Middle East may be similarly upset by the likes of Iraq. A Chinese military officer disclosed recently that Beijing was considering a review of its "non first use" principle regarding nuclear weapons.0 LO 85 China ! Scenario (2/2) (Continues…no text removed) U. hostilities between India and Pakistan. Gen Ridgeway said that US was confronted with two choices in Korea -. the US had at the time thought of using nuclear weapons against China to save the US from military defeat. much the way Britain. short of using nuclear weapons. If Washington were to conclude that splitting China would better serve its national interests. as well as Japan. there is already substantial evidence that countries like India. of course. As it demonstrated in the twentieth century. You’re A Jerk 85 . are worried about China’s ascendancy and are looking for ways to contain it. In his book The Korean War. and Russia. 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. it cannot be ruled out entirely. If China were to retaliate. joined forces with the United States to contain the Soviet Union during the Cold War. it is determined to remain the world’s only regional hegemon. There would be no victors in such a war. then a full-scale war becomes unavoidable. as well as smaller powers like Singapore. Therefore. Conflict on such a scale would embroil other countries far and near and -. 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. and Vietnam.horror of horrors -. we would see the destruction of civilisation. for China puts sovereignty above everything else. forces deployed on its doorstep? Following the logic of the Monroe Doctrine. could enter a new and dangerous phase. 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. Finally. 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. Straits Times 2k (Straits Times. Extinction.truce or a broadened war. While the prospect of a nuclear Armaggedon over Taiwan might seem inconceivable. Indeed. In the end. told a gathering at the Woodrow Wilson International Centre for Scholars in Washington that although the government still abided by that principle.Single Payer 2. Beijing also seems prepared to go for the nuclear option. Will a full-scale Sino-US war lead to a nuclear war? According to General Matthew Ridgeway. there were strong pressures from the military to drop it. In the region. In fact.

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

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

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

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

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

You’re A Jerk 91 .2 percent growth in 2013. White House officials rebuff such suggestions. the new forecasts . But they matter greatly to policymakers and the financial markets as a measure of whether the country can afford Obama’s big agenda. said in a POLITICO interview that the administration . saying the midyear correction is precisely intended to keep their economic program reality based.Single Payer 2. In a June NBC/Wall Street Journal poll. The administration once vowed to use stimulus policies to keep the jobless rate below 8 percent. It creates the basis for the revenues you need for health care and climate change. Higher deficit figures also would arrive at a critical moment in the health care debate. And the general public is paying attention.” Obama’s current forecasts envision 3. if Obama clings to current optimistic forecasts for long-term growth. however.cbsnews.if they are anything like what many outside economists expect . http://www. many economists warn. Alternately. a former Clinton economic adviser.” he added. Deficit figures do not pack the same emotional punch as unemployment lines do. with some experts invoking such phrases as “rosy” and “fantasy. Cummings. “They used a rosy forecast. 7/14/09. down from 56 percent in February.could send a jolt through Capitol Hill. The White House will be forced to confront the disconnect between its original. The new numbers will come as part of a semiannual review that.shtml [Mardjuki] President Barack Obama’s economic forecasts for long-term growth are too optimistic. and that’s understandable because a quick recovery makes the rest of the agenda possible. a miscalculation that would mean budget deficits will be much higher than the administration is now acknowledging. Jeanne.” CBS News/Politico. a bare majority . “Experts: Obama Too Optimistic on Economy. In addition. Christina Romer. where even the administration’s current debt projections already are prompting deep concerns on political and substantive grounds. She said the White House will be updating its official forecasts. too. “But it’s also dangerous and risky because if the forecast doesn’t come true.6 percent growth in 2012 and 4. as lawmakers are already struggling to find a way to pay for the president’s nearly $1 trillion reform package. 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. he risks accusations that he is basing his fiscal plans on fictitious assumptions .0 LO 91 Econ K2 Obama Agenda Econ key to Obama’s agenda – must follow through on high expectations and promises. you’ve undermined the basis for the rest of your policies.of respondents approved of Obama’s handling of the economy. the poll found.did not fully anticipate the severity and pace of this recession.51 percent . 4. This time. is the kind of earnest-but-dull document that causes many Washington eyes to glaze over. even if that delays an economic recovery. 58 percent said the president and Congress should focus on keeping deficits down. under ordinary circumstances.” said Robert Shapiro. The administration is already under intense pressure over its economic calculations on the most politically sensitive statistic: employment. chairwoman of the White House’s Council of Economic Advisers. managing editor.precisely the sort of charge he once leveled against the Bush administration.com/stories/2009/07/14/politics/politico/main5157452.2 percent growth next year.like many independent economists . 4 percent growth in 2011. upbeat predictions and the mainstream consensus about how the economy is likely to perform in a new budget forecast to be unveiled next month. it is now just shy of 10 percent.

is about half the US level. All patients have the same coverage.Single Payer 2.pnhp. Himmelstein. The Department of Medicine at Cambridge Health Alliance/Harvard Medical School. fee-for-service–based practice.php) [LO//JW] In contrast to CDH. MD. nonprofit institutions. MD. neither piecemeal tinkering nor wholesale computerization can achieve significant bureaucratic savings. Unfortunately. 11/07. Indeed. which resembles that of the United States in its emphasis on private. American physicians spend nearly 8 hours per week on paperwork and employ 1. nearly twice the average in Canada.org/news/2008/may/our_health_care_syst. Canadian hospitals. most of whom are in private practice. “Our Health Care System at a Crossroads: Single Payer or Market Reform?” www. And HMOs inflict mountains of paperwork on doctors and hospitals. Health care’s enormous bureaucratic burden is a peculiarly American phenomenon. Canada’s NHI has 1% overhead and even US Medicare takes less than 4%. and Woolhandler. enough to fully cover the uninsured and to upgrade coverage for those now underinsured. 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. Reducing our bureaucratic apparatus to Canadian levels would save about 15% of current health spending. $300 billion annually. administrative overhead in Canada’s health system. dept Medicine Harvard. far more than in Canada. The average US hospital spends one-quarter of its budget on billing and administration. Our biggest HMOs keep 20%—even 25%—of premiums for their overhead and profit.0 LO 92 HC Reform Key to Econ National Health Insurance would cut annual costs by $300 billion.66 clerical workers per doctor. obviating the need for administratively complex per-patient billing. ‘07 (David U. Fee schedules are negotiated annually between provincial medical associations and governments. bill by checking a box on a simple insurance form. Physicians for a National Health Program of Chicago. and even skeptics all agree on this point. Proponents of NHI. much as a fire department is funded in the United States. are paid a global annual budget to cover all costs. You’re A Jerk 92 . The key to administrative simplicity in Canada and other nations is single-source payment. disinterested civil servants and . MD + MPH. Canadian physicians. and Steffie Woolhandler. 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. 15% of current health spending Himmelstein. which are mostly private.

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

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

mental health. increasing competitiveness and decreasing the cost to make goods Robinson No Date Given Bruce Robinson.000 Americans who die prematurely because they have no health care at all. they are already covered.htm Businesses would no longer provide health care. they make sure it is funded adequately. though under the current proposal they would pay an additional 3. The great success of their system causes almost all Canadian politicians. You’re A Jerk 95 . Canada has a much higher percentage of general practitioners and fewer specialists.co. More importantly. 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. Since the wealthy as well as the middle income people have no alternative. deductibles. to defend it vociferously.. Effective planning eliminates duplication of facilities and expensive technology. “Canada's Single Payer Health Care System It's Worth a Look” http://bcn.net/why_should_businesses. even conservatives.3% healthcare tax on payroll. And we'd improve the economy as families would have more money to spend on products and services. and the costs for prescription drugs. Canadians are healthier and live longer than Americans. there is no alternative program. Single payer healthcare decreases the cost of employees. which often is picked up by the new employer. but this would be offset by the elimination of co-pays.Single Payer 2. The bankruptcy attorneys might not like it because over 50% of bankruptcies are due to health care costs. Further savings occur because there is no longer a need for a health insurance component of automobile or home insurance. but they'll survive. 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. The benefits to competitiveness are obvious. employees changing jobs would no longer suffer delays and costs for COBRA. to which Canadians can turn for basic health care. This together with cost controls insures that everyone including the poor. Preventive care to an entire population minimizes expensive care associated with undetected. there are agreements among all provinces that provide for treatment of any Canadian citizen regardless of where the need occurs.S. increasing business competitiveness and stopping outsourcing Lohman No Date Given Jack Loman.boulder. It is called single payer because there is only one "payer". Since there is a "single payer". long-term care.html[LO//AS] The Canadian system is a publicly funded insurance program where costs are controlled and both hospitals and doctors are private.0 LO 95 Increases Competitiveness Single Payer healthcare benefits spillover. There is very little litigation because there is no need for awards to cover future health care costs.3%. who use the same system. it is easier to set up and adhere to budgetary limits. Wakeforest Law School Graduate and Lawyer. receives the same high quality care. retired business owner and member of the Business Coalition for Single Payer Healthcare “Why should businesses support single-payer healthcare?” http://www. competition has led to great redundancies in expensive equipment such as for CAT scans. Any Canadian can go to any doctor or hospital in the country. vision and dental. In the U.us/health/healthwatch/canada. such as private health insurance. 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. Workers would also be taxed an additional 3. But this would be more than offset by the 10-15% of wages they'd no longer have to pay for health benefits. so will the 18.businesscoalition. In spite of this decentralized approach. We'd have a Cadillac system for the same 16% of GDP we are spending today. Each province has its own system and its own unique way of funding it. The economic advantages of the Canadian system are multi-faceted. doctor groups buy high technology equipment and then compete for selling these services. and we'd make so businesses more competitive with their foreign competitors and keep more jobs in the United States. And it would be portable.

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

0 LO 97 **Medicaid Reform** You’re A Jerk 97 .Single Payer 2.

In an ideal world. 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.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.” increasing burdens on state government just when the states can’t afford to spend money.Single Payer 2. So that’s obviously off the table for now. associate editor @ Atlantic Monthly and TPM Media. acts as a macroeconomic stabilizer. gubernatorial concerns that Medicaid expansion will wreak devastation on state budgets.org/archives/2009/07/medicaid-and-healthreform. Matt. In general in the United States you get better “quality of government” at the federal than at the state level. Yglesias. 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. Better to have the federal government pick up the bulk of the tab for expansions. “Medicaid and Health Reform. You’d also almost certainly get better health care coverage for poor people in most of the country. You’re A Jerk 98 . it creates incentives to craft legislation that shunts costs onto the states thus “hiding” them from the prying eyes of the scorekeepers. To the best of my knowledge. 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. mandated increases in state-level Medicaid expenditures are pretty questionable policy.0 LO 98 Federalize Medicaid Good Federalization of Medicaid increases quality of care. and reduces severity of recessions. My go-to guy on Medicaid issues says the House bill handles this concern fairly well. the large state role in Medicaid is extremely ill-advised. it would “look like” a big increase in taxes and spending. http://yglesias. but that the Senate legislation is less clear.” Think Progress. state Medicaid responsibilities tend to work as “automatic destabilizers. But something to keep an eye on during the health reform debate is that while Medicaid expansion is good.thinkprogress. 7/20/09. And in macroeconomic terms.

The worst is yet to come. Properly designed. Until December 31. for example. The cuts seem most dramatic in California. too. but for millions of others.0 LO 99 Medicaid Reform Needed Medicaid costs is the cause of state budget crisis’s Ezra Klein. not only for poor people. in return for greater federal oversight over matters such as quality assurance and reimbursement. health reform can also help by providing new forms of public or private coverage for low-income Americans who might otherwise require Medicaid. 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. As my colleague Colleen Grogan suggests.html As state and local medical expenditures cross the $300 billion mark. They face legal and institutional constraints on deficit financing and new taxes. What can be done? First. failing to operate these programs with the skill and humanity that patients deserve. 2010.com/ezra-klein/2009/06/guest_graph_the_future_of_medi. These fixes will help. States also bear readily-overlooked systemic risks. These subsidies should be enlarged and made permanent.html Looking at these figures. Yet another challenge of health reform. delaying payment. They bear the consequences of their severe. Saddled with balanced-budget requirements and constrained tax bases. we should recognize and embrace the fact that Medicaid has become a central pillar of the American welfare state. 7-19-2009. associate editor at The American Prospect. 7-19-2009. Rising Medicaid expenditures undermine states’ ability to address other pressing needs.washingtonpost. The recent stimulus package suggests another useful path. the federal government must carry an increasing share of the Medicaid burden . Or suppose that the firms which offer private long-term care policies run into trouble. It’s all too plausible to devise scenarios in which state Medicaid programs end up bearing large unanticipated costs. The impact of competing proposals for state finances has received less attention than it should. Suppose. Actuaries predict that state Medicaid expenditures will roughly double by 2017. associate editor at The American Prospect.com/ezra-klein/2009/06/guest_graph_the_future_of_medi. but they will not be enough.Single Payer 2. “Guest Graph: The Future of Medicaid” http://voices. States’ Medicaid problems have been building for decades. the existing framework no longer works. The program has outgrown the financial and administrative capacity of state governments. underpaying providers.washingtonpost. 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” http://voices. states have cut financial corners for decades. 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. Yet painful measures are being taken in many other states. One way or another. that medical improvements gradually raise average lifespan of Alzheimer’s patients in long-term care. You’re A Jerk 99 . Federalized Medicaid solve long-term budget for states Ezra Klein. we must recognize that the budget challenge is more than a nasty episode brought on by the current downturn. In truth. bipartisan mismanagement of public employee health and retiree benefits.

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.org/archives/2009/07/medicaid-and-health-reform. 7-11-2009. but it wouldn’t be congress or the executive branch doing the wasting. 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. Federal only Medicaid more effective than state and lessens state’s burdens Matthew Yglesias. state Medicaid responsibilities tend to work as “automatic destabilizers.0 LO 100 Medicaid Reform Needed Medicaid should be funded solely by the federal government Kevin Drum. 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. “Medicaid and Health Reform”. http://yglesias.thinkprogress. Here in California. 7-20-2009. it creates incentives to craft legislation that shunts costs onto the states thus “hiding” them from the prying eyes of the scorekeepers.Single Payer 2. would be highly stimulative. but that the Senate legislation is less clear. That kind of thing would work quickly. “Let the States Fund Medicaid?”.com/kevindrum/2009/07/let-feds-fund-medicaid If we need more stimulus. we'd save a little over $10 billion. but that's probably OK. the large state role in Medicaid is extremely ill-advised . it would “look like” a big increase in taxes and spending. http://www. And in macroeconomic terms. So that’s obviously off the table for now. 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.motherjones. which would be $10 billion less in demanddestroying budget cuts we'd have to make. To the best of my knowledge. My go-to guy on Medicaid issues says the House bill handles this concern fairly well. 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.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. In an ideal world. 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. Better to have the federal government pick up the bulk of the tab for expansions. mandated increases in state-level Medicaid expenditures are pretty questionable policy. I'm not sure Medicaid has really been a great poster child for states as laboratories of democracy anyway. so it’d be someone else’s problem. In general in the United States you get better “quality of government” at the federal than at the state level. associate editor of The Atlantic Monthly. But something to keep an eye on during the health reform debate is that while Medicaid expansion is good. You’re A Jerk 100 . gubernatorial concerns that Medicaid expansion will wreak devastation on state budgets. 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. staff writer for Mother Jones. Well. and would allow structural shifts in the private sector to proceed apace. Eventually this might lead to Medicaid becoming more standardized throughout the country.” increasing burdens on state government just when the states can’t afford to spend money. Some of the money would be wasted or used in bad ways. You’d also almost certainly get better health care coverage for poor people in most of the country. rather than being a hodgepodge of 50 different plans. This would instantly save states something on the order of $100 billion or so.

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

Over the same period.” Policy Studies Review. Associate at MHA. Martin. 1992. and the quality assurance mechanisms are poor (Alan Guttmacher Institute. While AFDC recipients' per capita costs actually fell. in the words of the United States General Accounting Office. The largest expenditures are for disabled 551 recipients. Volume 11. treated unequally in terms of both Medicaid eligibility and generosity of benefits" (U. the total number of Medicaid eligibles has risen only moderately (by 6 percent). 1988). Hurdle and Schurman. Andrews and Gornick. 1987). over 80 percent of the poor received Medicaid coverage in Hawaii. Another group that suffers greatly are individuals with developmental disabilities. "pervasive horizontal inequity-similar people in similar circumstances but in different states . 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. California and Wisconsin. The result of all this is. 1989). Some recipients fare exceptionally badly. 551 recipients were responsible for 73 percent of Medicaid costs. “Medicaid’s Role in Moves Toward Universal Health Care. Infants born to Medicaid recipients have been very poorly served (Rosenbaum. All Medicaid programs must cover individuals receiving Supplementary Security Income (SS!) and Aid to Families with Dependent Children (AFDC>. while AFDC children under the ages of 21 were responsible for only 12. 1987). De Alteriis. There were also considerable differences in the number of services provided by the states. whose numbers have risen steeply in recent years (from 2. Many are inappropriately institutionalized and denied access to appropriate care in their home communities (Smull.0 LO 102 Medicaid Reform Needed Patchwork state Medicaid programs must be rectified to correct inequal treatment of the impoverished. You’re A Jerk 102 . Winter 1992..3 million in 1987). General Accounting Office. not all necessary services are covered by state programs.S. 1988).4 million in 1975 to 3. Medicaid's funding levels for prenatal services until recently were very inadequate. 551 recipients' total costs soared from $3 billion to $17 billion (Howell. 1985).Single Payer 2. while under 25 percent of the poor received Medicaid coverage in Wyoming. Michigan. 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. Idaho and South Dakota. In 1987. Butler and Howard. Hughes. In 1981.3 percent of Medicaid costs. [Mardjuki] There are major inequities in the way the states confer benefits and eligibility. Private providers are unwilling to treat pregnant beneficiaries.. 1988).

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

Most privately insured Americans are content with their own health plan. Medicaid must compete in a health care system run by market forces. we should start by reforming existing government programs.” Policy Studies Review. Most of Medicaid's problems can be traced to the principles which characterize the program. If private insurers raise physicians' fees in a state. Expanding health care coverage sometimes seemed to be a secondary concern. health care reform should focus on values and priorities. Winter 1992. then widespread change is required.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. If a change in the Medicare program's reimbursement ra tes lowers hospital profit margins. Government intervention is looked upon far less favorably in the United States than in Europe and Canada. 1987). De Alteriis. director of Medical Health Administration. offering the lowest reimburse must be expected. horizontal inequities are not surprising. 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. 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. If health care is a basic right. such as increased or equalized coverage. make poverty the criterion for eligibility. Medicaid is a welfare benefit -not a right-to be granted by the states. Only by changing these principles and combining Medicaid reforms with major structural reforms of American health care system can Medicaid's problems be solved. [Mardjuki] Proposals for reform are usually combined into packages. However. block grant long-term care and change the federal funding formulas for acute-term care (Holahan and Cohen. 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. 1992. we also need to recognize the political realities of the day.” Policy Studies Review. its reform will not threaten the private health care industry. at their discretion. These reforms always have several desirable goals. then reform of the American health care system might not benefit current Medicaid recipients and might not reach all of those now uninsured. De Alteriis. more physicians will see private patients and fewer will see Medicaid eligibles. If health care is to be distributed by market principles. The Medical Assistance program is greatly affected by the actions of other health care programs. this will likely affect Medicaid recipients. 1992. You’re A Jerk 104 . Medicaid already covers a large proportion of the poor and uninsurable. 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. The health care industry is extremely powerful. if it accepted that basic health care is a right. Consequently. We have a solid body of research specifically about Medicaid to guide us. then the poor will always have limited access and an inferior quality of care. While the proposals could lead to some improvements in Medicaid. even if they are discontent with the system as a whole. we should include the following elements in our reforms. 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. Martin. but they do not consider Medicaid reform in the context of radical reform of the American health care system. director of Medical Health Administration. This is a mistake. Furthermore. there is a logic to starting with the reform of the Medicaid program. If affordable universal coverage is our goal. As the payer of the last resort. then the federal government would be obliged to guarantee it. If the Medicaid inpatient rates are relatively high. major problems would remain unsolved. Least politically contentious way of restructuring healthcare is by reforming Medicaid. Bearing all that in mind. As it is a government program. which would be nice to extend to every citizen but which we cannot afford to do. Volume 11. For just as surely as Medicaid reform proposals that ignore the nation's health care system as whole will have limited success. “Medicaid’s Role in Moves Toward Universal Health Care. “Medicaid’s Role in Moves Toward Universal Health Care. we can also draw on research into the Medicare program and into other nations' public health care systems. akin to life. A more radical package would divide the acute care and long-term care components of Medicaid. most notably Medicaid. If we take this approach. [Mardjuki] Ultimately. liberty and the pursuit of happiness. 1988).Single Payer 2. Martin. Volume 11. 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. On the other hand. If health care is considered a benefit. and take that route toward achieving our objectives. If Medicaid inpatient rates are relatively low. Winter 1992. In the process. the nation's health care system could be transformed.

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

not with the actual delivery of services.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. Safety nets ensure that out-of-pocket spending is capped.'' he says. The debate over Medicare is instructive. time to build and maintain a coalition. prof of law @ American University. You’re A Jerk 106 . Medicare’s political sponsors accepted incremental steps that they believed would not detract from their ultimate goal. As with Medicare. diversity. The Next Agenda: Blueprint for a New Progressive Movement.'' Botsman says.000 (US$ 7. Hospital care is free. and faced the same difficult issues of reform. she notes. Robert and Roger. Health care costs in the US account for 14 percent of GDP. vice president @ Economic Policy Institute. In the short run this may be a painful route. Costs have been consistently held to 8 percent of GDP.'' Dr. American politics. as are most physician visits.'' says Peter Botsman. ''And you can have a private hospital system and a private health insurance system coexisting alongside a dominant single payer. ''The doctors managed to change the Constitution so they couldn't get conscripted into a national health service. and to begin a long-term political campaign to secure eventual enactment. 2001. it would be foolish to focus on short-term strategies to the point of abandoning long-term aims. as well as through general revenue.'' says John Deeble. but they never abandoned the campaign for Medicare. Sharpe & Dohme.100) for singles. says Lesley Russell. ''It's kept costs under pretty tight control. Botsman says the cost comparisons alone are dramatic: Administrative costs in Australia in 1987 were US$ 19 per capita. with its individualistic focus and shifting coalitions. 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. Pg 116-117. Australia went through a similar experience in the 1970s. Australia's reform process took years. That raises some conflict with doctors and with private hospitals. Yet one clear option for reformers is to reject these pressures by agreeing on a single programmatic model and legislative goal. over the long haul it may prove the most rewarding. starting in 1972. manager of public affairs for the drug company Merck. ''If you phased in the Australian system over eight years. and cost containment that satisfies all consumers' needs about health care. who helped design the 1973 and 1984 programs.'' And. From the time the idea was first conceived. Botsman. this will require patience. Borosage. allaying US fears about a bloated and intrusive bureaucracy. Low-income earners and pensioners hold a health card that entitles them to additional services. a conservative government scrapped the program and another liberal leadership started over with a new one. They closed down one state's [New South Wales] hospital system for seven months and refused to work. Phasing in means the plan saves hundreds of billions of dollars Foster 94 Catherine Foster. Hickey. It had a system similar to the present American system. Costs are set by the government. Medicare customers can choose their own physicians on a daily basis.'' Australia's 12-year-old universal health insurance system is funded by a flat 1. tends to prompt short-term visions and encourage impatience. a liberal think tank here. in the US they were $ 95. ''We had very tough political obstacles to get around. Along the way. who has written a national health-insurance strategy for the US. executive director of The Evatt Foundation. ''the US would save between US$ 891 billion and $ US3 trillion. it might want to take a look down under. he says. and the commitment to absorb defeat. health services fellow at Australian National University in Canberra.5 percent levy on gross income over A$ 10. the Australian health insurance system is only concerned with the monitoring of costs and ensuring that payments are made promptly. and are expected to rise to 19 percent within five years. it took fifteen years of political struggle before federal health insurance for the elderly was adopted. ''My message for the US is that you can have a single-payer system with choice. but it does not limit what doctors can charge. pharmaceuticals are subsidized. travels frequently to Washington to clarify misconceptions about the Australian system.Single Payer 2. [Mardjuki] A related lesson is that although it may be necessary to respond to short-term political and economic constraints.

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

5-09. • Many low-income individuals do not have access to employer coverage and cannot afford or access private coverage through the individual market. employers. Washington. and Rudowitz ’09 (Diane Rowland. Kaiser Family Foundation. Executive Vice President. the Kaiser Commission on Medicaid and the Uninsured. Kaiser Commission on Medicaid and the Uninsured. • Most Medicaid enrollees receive care through private managed care plans that are designed to promote access to care. 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. Washington. Washington. enhance quality and control costs. Rowland. • 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. 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. Barbara Lyons MPA. Kaiser Commission on Medicaid and the Uninsured. and many have significant health needs. thus covering Medicaid enrollees in private coverage would be more costly. Leading health reform proposals rely on a combination of public and private approaches to expand coverage.620 for a family of three in 2009). DC Co Chair. Deputy Director. Accounting for the health needs of its beneficiaries. Kaiser Family Foundation. Medicaid is a low-cost program with lower per capita spending than private insurance. As we move forward. • 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. This strong foundation will help to assure the success of larger health reform efforts. Medicaid plays an important role for some disadvantaged populations and the program has broad public support. 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. Executive Director. DC. Medicaid also helps support community health centers and other safety-net providers in medically underserved areas. ScD. and provide stable financing by establishing a countercyclical financing mechanism during economic downturns. consumers and insurance markets. develop strategies to expand the primary care workforce to provide better access to primary and preventive care. Vice President. Henry J. • Ensure that current and new enrollees receive Medicaid’s benefit and cost-sharing protections. Kaiser Commission on Medicaid and the Uninsured. Lyons. • 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. DC. 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. “Medicaid As A Platform For a Broader Health Reform: Supporting High-Need and Low-Income Populations”) As debate on national health reform moves forward. 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. and Robin Rudowitz Principal Policy Analyst. and promote better access by addressing payment rates to help boost provider participation. control costs and improve quality with shared responsibilities across employees.0 LO 108 Medicaid Expansion Key Building upon Medicaid would be a great way to expand healthcare. expanding coverage to the uninsured as well as addressing health care cost and quality issues have emerged as the dominant drivers for system reform. 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. PhD.Single Payer 2. government. You’re A Jerk 108 . Extensive research shows that coverage is key to securing access to needed health care services. 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. • Bolster Medicaid with broader efforts to contain costs across the health system (public and private) to help ensure long term sustainability.

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

or $33. the cost of the program — the supply of providers will not come close to meeting the demand for medical services. (Watch a video on uninsured Americans. Drive Health-Care Debate.") What Congress is now considering is whether to make income alone the determinant of Medicaid coverage. their parents. it is difficult in some areas to find health-care providers who are willing to accept Medicaid patients. 7/21/09. 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." 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. it will do the opposite. Tumulty. http://www. with it. more affordable health care for patients.time. Republicans are calling it a dangerous "experiment.00.html [JM] Douglas Elmendorf. Karen. all non-elderly people earning at or below 133% of poverty — about $14. Already.” Time Magazine.com/time/politics/article/0.Single Payer 2." You’re A Jerk 110 . But there are real questions as to whether the program could handle the strain of that many new clients.8599. the disabled and those in need of nursing-home care. the poor elderly.200 for a family of four — account for about half the uninsured in this country. many of them are not eligible for Medicaid.300 for a family of four — would be eligible. The House bill would have the Federal Government pick up the entire cost for those newly covered under Medicaid — $438 billion over 10 years. The Congressional Budget Office predicts that the House proposal would add 11 million to the Medicaid rolls. upon which additional expansion efforts could build. The existing program "is designed to meet the needs of low-income individuals and those with complex health needs and has an existing delivery. which averages over 40%. Under the current rules. Not Coverage. Under the health-reform bill now being considered by the House. has testified that the legislation thus far has too little cost containment.) The argument in favor of expanding Medicaid is largely one of efficiency.400 for an individual and $29. national political correspondent. But a draft proposal by the Senate Finance Committee would have the feds paying the additional cost for only five years. “Medicaid and the States: Health-Care Reform’s Next Hurdle. financing and administrative structure.1911856. head of the Congressional Budget Office. 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. accounting for about a third of the estimated 40 million uninsured Americans who would gain health insurance under the proposal. (Read "Cost. Governors warn that unless they increase the amount that Medicaid reimburses doctors and hospitals — and. which was established alongside Social Security in 1965 to cover low-income children. In fact. "Medicaid coverage for low-income adults could help establish a strong floor of coverage for the low-income population. after which the states would have to pick up their typical share of existing Medicaid costs. Low-income adults — those who earn under 200% of poverty." And even the Mayo Clinic — often cited by Obama as the model of what an efficient.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." says the nonpartisan Kaiser Family Foundation.

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

that is not a typo. Their spending per-person on health care is less than half what we spend here. 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? You’re A Jerk 112 . what will the millions of currently uninsured people do between now and 2013? And. you wondered if there's a political reason why the plan won't be fully operational until 2013. All of the major developed nations have some form of single-payer health care.1114455.story [Mardjuki] In a Q-and-A recently posted on the Web site Crooks & Liars (http://crooksandliars. like the fact that we will have a presidential election in November of 2012. and their people are.Single Payer 2." The question that her response prompts from me is. "For 30 years I have supported a single-payer plan. Why are we writing 1. House Speaker Nancy Pelosi responded to one of the questions by saying.letters200jul20. http://www. not insurance.com/node/29667). but our next best choice is to support an exchange and a public option.com/news/opinion/readersrespond/baled. “Why not singlepayer?” Baltimore Sun. 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. If I told you that in less than a year after the historic Medicare legislation was signed into law. 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. 7/20/09 Anne. is health care.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) .le. the program was up and running. why are we giving up on the best solution and settling for something that. Global Sourcing Finance Chief at GE Healthcare.000-plus-page bills. with an economy in decline. 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 . thousands of people losing their jobs every month and losing their coverage. No. from all appearances. Medicare. where the focus should have been from the start. Schoonmaker. 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. is a whole lot less than "next best?" The House plan is not set to go "live" until January of 2013.when we have a single-payer model. by most accepted measures. maybe. with more employers changing to plans that cover less and cost the individual more. or dropping coverage altogether.0 LO 112 Squo Reform Fails – Need Single-Payer Only a single-payer system mitigates costs – Medicare proves. So. and millions of older Americans had been enrolled and were getting health care with hardly a hiccup.baltimoresun. 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.0.

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

July 15. probably at the level of a Cabinet Secretary .eliminates duplicative bureaucracy. Quickly doing the math. Joshua.. per provider. http://tpmcafe.” Talking Points Memo.6 billion during 2005. that Bill McGuire.talkingpointsmemo. accumulated total compensation of $1. It was recently reported. This CEO will be expected to earn in the neighborhood of $197. You’re A Jerk 114 . George Polk Award winner. Without even getting into the specific details of how these other programs work. each making multiples of this salary. 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. yes.Waste Single-payer reform more efficient . as is the number of people needed to simply keep up with the myriad of different bookkeeping and other paper trails that are created. generally as one whole system of paperwork and policies.. To begin with.Single Payer 2. former CEO of UnitedHealth Group. These same consumers understand that it will take one CEO .000 (Highest rate now paid to any Cabinet Secretary) and will replace an untold number of private executives.S. 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.0 LO 114 Single Payer Solves .to oversee a singular bureaucracy in charge of providing universal health care to all. etc. Duplication of services is understood to be extensive and extremely wasteful.a government Administrator. chief reporter. almost without regard for how large that family might be. Marshall.com/talk/blogs/jpieterick/2009/07/the-case-for-keeping-singe-pay. “The case for keeping “single payer health care” off the table.php?ref=reccafe [Mardjuki] Having first identified health care reform as a critical issue confronting the U. 2009. 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. 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. for example. 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. Multiples of $197k? Well.

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

By combining huge administrative savings with caps on national health spending. single-payer offers equally compelling advantages.S. ranks below many of these nations in life expectancy and infant mortality.Single Payer 2. Yet the CBO estimates that the single-payer system would trim overhead by up to $ 100 billion a year -.S. while many of the alternatives would continue to leave millions uninsured.such as private hospital rooms -. McDermott would increase the federal cigarette tax to $ 2 a pack from 24 and impose a new 50% excise tax on handguns and ammunition. As in Canada.enough to provide coverage for 40 million uninsured Americans. That group's stand shocks many observers.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. Pg.) and 92 other House Democrats. the government would pick up the entire tab for covered procedures. the U. But most managed-care plans also limit doctors' income. David Murray. McDermott would finance all this with stiff federal tax increases. But taxes would probably have to be even higher. the predominant concern should be controlling runaway spending on health care. Number 3363. By 2003. 82 lexis-nexis [LO//AS] LESS OVERHEAD. The difference is that under single-payer. For consumers. 75% of Americans would pay less than they do now for coverage.000 a year per family. which would be offset by a steep decline in insurance premiums.000 per employee would face an 8." says Dr. this freedom is increasingly being constrained. physicians would have more freedom to order necessary medical services without the constant second-guessing and micromanagement of managed care. the U. while individuals would pay 2. Smaller businesses would pay 4%.1%. Symonds director of the Forgotten Half Project education program at Harvard “WHITHER A HEALTH-CARE SOLUTION? OH. the government would become responsible for virtually all medical bills. Ultimately.4% payroll tax. A few frills -. and long-term nursing-home care. compared with only 11% in Canada. No other plan is as generous. business. including prescription drugs. since under single-payer the states would negotiate fee schedules with physicians.would not be covered. Under the leading single-payer proposal. "Single-payer provides the best assurances that patients would be able to seek care from any doctor of their choice. McDermott estimates. sponsored by Representative Jim McDermott (D-Wash. effectively capping their income.S. Single-payer would also allow consumers to choose a doctor without paying higher premiums or extra charges for this fundamental privilege. For U. In addition. It would grant every legal U. Businesses with more than 75 workers and wages averaging more than $ 24. resident full coverage starting in 1997. or the European Community. This year. Even so. Thanks to the paperwork and complexity of private insurance. chairman of the American College of Surgeons. the savings would amount to about $ 1. CANADA” Business Week SOCIAL ISSUES. some 24% of the nation's health-care spending now goes to administration. mental-health treatment. Thanks to the proliferation of managed-care plans.S. will devote 14% of gross national product to health care: at least 40% more than Canada. Critics challenge some of McDermott's projections. the single-payer approach has the potential in the long run to cut spending more than any other plan. Japan. 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 .

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

S. however. setting budgets for hospitals. vice president @ Economic Policy Institute.ally want.lic health insurance program is Canada’s Medicare.nual national income than is consumed by medical care in the United States. the governing legislation prescribes broad physician and hospital coverage (“comprehensive care"). for whom. prof of law @ American University. is that it inadequately describes what most people who call for a single·payer plan re. Robert and Roger. [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. comprehensive pub.try`s postwar public triumph. ln fact.insurance payments). The dominant model of a single-payer. Hickey. and limiting what doctors and drug firms can charge—is ongoing controversy.mented and hence less accountable decisionmaking process in the United States. A necessary corollary is constant media attention to Canada’s "sing]e-payer" program.Single Payer 2.ous. Canada°s Medicare system is more cost·efficient and more easily un-derstood than other altematives. There is also a democratic accountability that is truly astonishing when compared to the enormously frag.“ The appeal of such an approach is obvi. lt has brought a decent level of medical care to the country’s citizens and consumes 40 percent less of the an. Universal health insurance has been for most Canadians the coun. system. 2001. 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). The Next Agenda: Blueprint for a New Progressive Movement. no deductibles or co. and it places far fewer constraints on professional autonomy and patient choice than is the case within the current U. The trouble with the term. The necessary consequence of Canada’s methods of financing and cost-control-paying for medical care from each provincial budget. and portability (that is. Pg 114. There is continuous discussion about how much to spend. and under what nnles of fairness of access or financing. Borosage. accessible terms (that is. on what. You’re A Jerk 118 . There.0 LO 118 Single Payer Solves – Dem Accountability Canada proves – single payer system ensures democratic accountability. public administration (for accountability). 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.

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

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

pressure to skimp on care would be minimized. Billing would involve imprinting the patient’s NHI card onto a slip. You’re A Jerk 121 .php [Mardjuki] Physicians would have a free choice of practice settings. Physicians could concentrate on medicine. Costs would be contained by controlling overall spending and limiting entrepreneurial incentives.org/single_payer_resources/proposal_of_the_physicians_working_group_for_singlepayer_national_health_insurance . Marcia. Treatment would no longer be constrained by the patient’s insurance status. http://www.Single Payer 2.0 LO 121 Single Payer Solves . Editor of New England Journal of Medicine. Fee-for-service practitioners would be paid promptly. “Proposal of the Physicians’ Working Group for single-Payer National Health Insurance. Since savings on patient care could no longer be used for institutional expansion or profits. Nurses and other personnel would enjoy a more humane and efficient clinical milieu. The entrepreneurial aspects of medicine . Bureaucratic interference in clinical decision making would sharply diminish. and sending the slip (or electronic equivalent) to the physician payment board.pnhp. Ron Anderson. checking a box indicating the complexity of the encounter. 2009. but physicians could increase their incomes only by working harder. every patient would be fully insured. Quentin Young. CEO Parkland Health System. American Academy of Pediatrics. American Public Health Association.Physicians No discentive for physicians – decreased bureaucratic hoops and paperwork. Senior Lecturer @ Harvard Medical School.the problems as well as the possibilities . The burdens of paperwork associated with billing would be lightened. Salaried practitioners would be insulated from the financial consequences of clinical decisions. Joel Alpert. obviating the need for the kind of detailed administrative oversight characteristic of current practice. President of American College of Physicians. Angell. This simplification of billing would save each practitioner thousands of dollars annually in office expense. Christine Cassell. nor by bureaucratic dictum. MD. Peter Beilenson.” Physicians For A National Health Program.would be limited. Commissioner of Baltimore City Health.

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

but that is because they spend 60% and 33% less than we do on health care. according Dr. 6-10-09 (John Conyers. Congressional Testimony. As long as health care is a priority for our nation. Waiting lines do not exist in countries that adequately fund national health care. and child in the United States.0 LO 123 Single Payer Solves –Efficient Despite concerns. You’re A Jerk 123 . June 10. Employment. In fact. we can afford to provide true universal health care with the $2. implementing a single-payer system with non-profit delivery would save approximately $300 billion dollars per year and contain long. US rep. Waiting lines exist when government invests too little in the medical professionals and equipment that make up our health care infrastructure. 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 Pensions. US Representative on the Subcommittee on Health. single-payer health care assures coverage and timely access to care Conyers. 2009.. Jr. If we deliberately hold down costs with a cohesive and efficient public-private partnership.Single Payer 2. It is true that Canada and the United Kingdom have had waits for elective procedures. woman.term costs.5 trillion we already spend each year. Labor. Steffie Woolhandler of Harvard Medical School. The facts show otherwise. Lexis Nexis) [LO//JW] Opponents of single-payer argue that scarcity of care and long waiting lines will inevitably occur in universal singlepayer systems. this problem will never materialize.

functions without a profit motive. Congressional Testimony. Only a single payer health care system for all solves. US Representative on the Subcommittee on Health. June 10.0 LO 124 Single Payer Solves –Empirics A shift to single-payer from privatized health care is possible. their system boasts a 70 percent approval rating from doctors and patients. This argument was initially raised when Medicare was debated in The the Congress in the 1960s. and do little to contain the out of control growth of health expenditures. Today. and deductibles.sanctioned monopoly for an industry that has left thousands of state residents without health insurance due to escalating premiums. Jr. co-pays. Massachusetts proves Conyers. Taiwan had a private health insurance market remarkably similar to our own. has low administrative costs. Medicare was enacted in 1965 and fully implemented in 1966. grow the ranks of the underinsured. Labor. health care spending has exploded in Massachusetts. 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. Lexis Nexis) [LO//JW] naysayers will also argue that dismantling our employer-based health care system is politically and economically untenable. the reform cost taxpayers $1. Employment. Taiwan proves Conyers. private insurance giveaway pursued in Massachusetts. Jr. improving access to health insurance that emphasizes prevention. I would respectfully submit that single-payer offers a far better model for reform than the incremental. US rep. We have heard this argument before. 2009. US Representative on the Subcommittee on Health. 6-10-09 (John Conyers.Single Payer 2. Congressional Testimony. Not surprisingly. 2009. June 10. the experience of the nation of Taiwan shows that such a transition is feasible. Over the course of the next six years. 6-10-09 (John Conyers. and Pensions. Labor. If the goal of reform is to limit costs and improve access to care. As a result. the country seamlessly transitioned to a single-payer national health insurance system. has minimal financial barriers to care. enacted by that state's legislature in 2006.3 billion dollars.. and Pensions. Instead of pursuing a reform strategy that has been successful in developed nations around the world namely. Lexis Nexis) [LO//JW] I would like to caution the committee about the dangers of enacting partial reforms that leave some individuals uninsured. Employment.lawmakers in Massachusetts instead created a government. Additionally. Governor Deval Patrick has been forced to cut money from safety-net providers such as public hospitals and community clinics. In fiscal year 2009. Yet. without the cost-containment measures that are integral parts of any public insurance plan. and maximizes value for patients . while only spending 2 percent on administrative costs. The best example of such a legislative failure is the Massachusetts Health Reform Act. US rep. You’re A Jerk 124 .. Until 1995.

” The population groups that qualify for Medicaid are generally children. then parents of dependent children last (though this varies by state). say they forgo coverage because they cannot afford it. Figure 2 shows that over half of the uninsured are below 200% of poverty. and the elderly.gov/health/reports/05/uninsuredcps/index.hhs.(4) That the uninsured comprise non-trivial percentages of middle and upper income individuals is surprising. even at the very lowest income levels.(3) That the uninsured are concentrated among lower-income individuals is not surprising. Figure 2 shows 27% of the uninsured have incomes above 300% of poverty.8 million uninsured are more likely to be poor and low income than higher income.Single Payer 2.com/gview?a=v&q=cache %3AUSbyK8FNL18J%3Awww. parents of dependent children. and * be able to afford an offer of coverage. Medicaid eligibility is based on a combination of income and population “category.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. and group to group. and if they do work they are less likely to be working full time. Not all low-income individuals are eligible for Medicaid.pdf+uninsured+americans+income&hl=en&gl=us&pli=1 The majority of uninsured. * receive an offer of insurance.S. Only 7% of the uninsured report the main reason they lack insurance is because they don’t think they need it.google. Childless adults who are not disabled or elderly rarely qualify for Medicaid . Data from employers shows that average single coverage premiums for employer sponsored insurance represent 2. 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%).0% of income at 300% FPL. 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. pregnant women.org%2Fuhc %2FMythsAboutUninsured.amsa. The income levels at which these groups qualify differs from state to state. the disabled. Those with incomes above 300% of poverty should generally find employer insurance affordable. not because they don’t need it.7% of income for a family of four at 300% FPL (with a higher percentage for smaller families). with 25% below the poverty line and 28% between 100% and 199% of poverty. given that low-income individuals are less likely to: * be working. You’re A Jerk 125 . regardless of how young they are. and average family coverage premiums represent 4.htm#income The 45. Department of Health and Human Services 05 U. with coverage of children and pregnant women being available at higher income levels. Uninsured people are more likely to have low incomes U.S. with one-in-ten (11%) uninsured above 500% FPL. followed by the disabled and elderly. While the income distribution of the uninsured is skewed toward those with lower incomes.

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

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

such as the U.pnhp.) If they were to put the same amount of money as we do into their systems. For them. and Canada. spends about a third of what we do per person. it’s the money. (The U.0 LO 128 A2: No Innovation/Wait Single payer system efficient and innovative Angell. and in general. 2009. Editor of New England Journal of Medicine. innovative technologies would be scarce under a single-payer system. But that’s because they spend far less on health care than we do. “Statement of Dr. we would have long waiting lists for operations and procedures. there would be no waits and all their citizens would have immediate access to all the care they need. Marcia. MD.” Physicians For A National Health Program. it’s the system. K. Marcia Angell introducing the US National Health Insurance Act. it’s not the money. the problem is not the system. medical care would be threadbare and less available. http://www. K.Single Payer 2. For us.php [Mardjuki] According to Myth #2. You’re A Jerk 128 . Senior Lecturer @ Harvard Medical School. This misconception is based on the fact that there are indeed waits for elective procedures in some countries with national health systems.org/facts/statement_of_dr_marcia_angell_introducing_the_us_national_health_insurance_act.

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

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

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

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

0 LO 133 A2: Canada Empirically Fails US single payer solves – even with financial failure Canadian health higher than US.pnhp. for both cardiovascular disease and cancer. do not bill for individual patients. hightechnology care have resulted. or patients with cancer and others who need expensive or long-term care need never fear exceeding their benefits. Stephanie. For instance. 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.S.. bill by checking a box on a simple insurance form. Physicians. 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.Single Payer 2.org/PDF_files/LiberalBenefitsConservativeSpending. Canadian death rates are lower than those in the U.source payment. Woolhander. Conservative Spending.” Counterpoint. which are mostly private. Unfortunately. Canada and numerous other nations use this solution and it works. MD. Canadian hospitals. David. You’re A Jerk 133 . health care spending was once comparable.S.S. especially among younger individuals with potentially curable malignancies. December. They are paid a global annual budget to cover all costs. but today Canada spends barely half what we do per capita. much as a fire department is funded in the U. nonprofit institutions. Canadian and U. m ost of whom are in private practice. during the 1990s. 2002. Fee schedules are negotiated annually between provincial medical associations and governments but all patients have the same coverages. http://www. 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. Even though shortages of expensive.pdf [Mardjuki] The key to achieving significant health care savings is single. Himmelstein. MD & MPH. “Liberal Benefits.

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

For this reason. economy to the federal government seems about as politically palatable as eliminating the tax breaks for homemortgage interest. 82 lexis-nexis [LO//AS] For months. I liked the Daily Kos explanation of the major differences between the two terms that are getting. nonstarter. 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 a system in which one institution purchases all.Single Payer 2. Single-payer health care is not socialized medicine. the idea solution to health-care reform has been dismissed as a of turning over one-seventh of the U. But this radicalism would serve some profoundly conservative purposes. Little wonder. http://fundingourfuture. tossed into the same boat too frequently: Socialized medicine is a system in which the government owns the means of providing medicine. as is France. the American College of Surgeons recently backed fundamental aspects of a single-payer plan. Pg. CANADA” Business Week SOCIAL ISSUES. Symonds director of the Forgotten Half Project education program at Harvard “WHITHER A HEALTH-CARE SOLUTION? OH. “A ‘Better than Nothing’ Future”. most. it's time to give the single-payer plan a hard second look. You’re A Jerk 135 . Freedom to choose doctors and physician autonomy make single-payer health care uniquely non-socialist Symonds 94 William C. part of the Center for American Progress for college students. of the care . It would decimate the health-insurance industry in one swift stroke. But let’s get one thing straight. Medicare is an example of a mostly single-payer system. And the Congressional Budget Office estimates that it would require a breathtaking $ 556 billion increase in federal spending by 1998. But now that the flaws of President Clinton's and other reform plans have become painfully evident and the debate has veered toward gridlock. the single-payer. 7-19-2009.S. singlepayer is radical. single-payer health care is NOT socialized medicine. Both these principles are seriously compromised by more "conservative" proposals that would force most Americans into managed-care plans.0 LO 135 A2: Socialized Medicine Single payer is not socialized medicine Campus Progress. or in reality.campusprogress. or Canadian-style. And the insurance industry strongly opposes the plan because it would mean the end of their glory days.org/tag/single-payer-health-care/ So why isn’t single-payer health care on the table? Well to start. Number 3363. At first blush. Conservatives are painting this option as “socialized medicine” or “government take-over”. But the payer does not own the doctors or the hospitals or the nurses or the MRI scanners. Admittedly. conveniently for those opposing it.

Even so. Opponents have raised some legitimate concerns. Symonds 94 William C. vs..0 LO 136 A2: Socialized Medicine American single-payer could handle increased demand – not socialized. an American who has worked as CEO of both Toronto Hospital and Duke University Medical Center. McDermott's plan.about waiting 45 minutes to fill up their gas tanks. it's by far the best way to control costs while preserving the freedom of choice and physician autonomy that made American medicine great. You’re A Jerk 136 . 82 lexis-nexis [LO//AS] LIBERAL PROVISIONS. Pg. Number 3363. a Washington-based think tank. But if Congress approves a bill that allows states to opt for single-payer. single-payer would establish a national health budget indexed to economic growth.Single Payer 2. or as much as 8. "They're not going to wait weeks or months for surgery. as Clinton's plan would. thus sharply slowing the medical arms race that has burdened the U. and the average citizen. Opponents foresee a nightmare. By 2003.5% in Canada. system. sometimes called Canada Deluxe. In the U. home health care by 50%. But at what cost? The CBO predicts that single-payer's liberal provisions would jack up demand for physician services by 30%. would minimize constraints by continuing to allocate about 14% of GNP to health care. health-care spending would be cut by $ 114 billion. To control spending. Proponents contend that this would force better planning." says Jack A. Symonds director of the Forgotten Half Project education program at Harvard “WHITHER A HEALTH-CARE SOLUTION? OH." Rather. CANADA” Business Week SOCIAL ISSUES. de facto rationing already exists. and triple demand for drug-abuse treatment. Canadians do face waiting lines for some nonemergency procedures and have far less high-tech equipment. Many fear that single-payer would lead to runaway demand for services and then rationing." argues Vickery Stoughton. Few believe there's any chance Congress will approve a single-payer plan this year. the CBO estimates. "Americans get quite antsy -. "the Canadian system has served society. 9. and give the government unbridled power to make life-and-death decisions. to $ 175 billion.S. better than the U. Canada and many other nations have already proven such budgets work. Such laboratories would soon demonstrate that single-payer is not "socialized medicine. The fear is that the states would then have to ration care by imposing waiting lines and limiting spending on new technology. with underutilized facilities.S. Meyer. based upon how much you or your insurer can afford to pay. president of New Directions for Policy.S.6% below what it would be without any changes.if not furious -." But Canada's 30 years of experience with single-payer suggests care would not be compromised anywhere near as much as opponents predict. many observers expect it to be adopted by one or more states.

medical expenses are covered by a catastrophic plan. “Why not MSAs/HSAs?” Physicians For A National Health Program. Editor of New England Journal of Medicine. President of American College of Physicians. on the MSA/HAS plan.0 LO 137 A2: MSA/HSA Medical saving accounts don’t solve – decreases overall affordability and discourages preventative care. Currently. Commissioner of Baltimore City Health. Peter Beilenson. http://www. on average. the cost of high-risk individuals is diluted by the larger sector of relatively healthy individuals. MD. the average woman pays $1. whose care costs. Hence. Once the account is depleted and a deductible is met. Angell. and do nothing to restrain spending for catastrophic care. You’re A Jerk 137 . keeping health insurance costs affordable for everyone. but little to families with average incomes.000 more than men’s annually. $1. HSAs offer substantial tax savings to people in highincome brackets. driving up premiums and threatening affordability. Marcia. which accounts for most health costs. MSA/HSA plans discourage preventive care. Since only healthy individuals would be attracted to the MSAs/HSAs.pnhp. usually a managed care plan. and thus serve as a covert tax cut for the wealthy. American Academy of Pediatrics. Ron Anderson. Christine Cassell. Individuals with significant health care needs would rapidly deplete their accounts and then be exposed to large out-of-pocket expenses. Quentin Young. hence they would tend to select plans with more comprehensive coverage. higher-cost individuals would be concentrated in the more comprehensive plans. American Public Health Association. Finally.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. Senior Lecturer @ Harvard Medical School. CEO Parkland Health System. By placing everyone in the same pool. which generally would be paid out-of-pocket. 2009.000 more out-of-pocket than her male counterpart.Single Payer 2. HSAs/MSAs discriminate against women.org/facts/singlepayer_faq. Moreover. Joel Alpert.

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

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

small business (fewer than 100 employees) provided 51% of all jobs (Edwards et al. Volume 4.0 LO 140 A2: Employer-Based HC Employer-based insurance fails – doesn’t cut costs.Single Payer 2. Some fear that employer-mandated insurance establishes a two-tier system. 199-211. A play or pay approach also does not inherently improve quality or efficiency of services or reduce administrative costs. 1992). Small businesses might be unable to afford the added expense of providing health care insurance. “Health Care Reform: Clarifying the Concepts. Pgs. American business already underwrites approximately 30% of U. 1993. 1990). In 1990. they simply pass added costs on to consumers through higher prices. Miller. with a lower quality and less adequate public plan.S. You’re A Jerk 140 . [Mardjuki] : Opponents of the play or pay approach point out that employers do not really pay for employee benefits. Anna. health care costs (Polzer. RN and MSN @ Ball State University..” Journal of Community Health Nursing.

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

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

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

" saying that "small businesses. <insert econ impact> You’re A Jerk 144 .and his budget calls for letting President George W.S." Mr. resulting in less government revenue. family farms. 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. as the recession deepened last year.not more. Chamber of Commerce. Obama needs increased revenue to launch his national health care plan .S. House Minority Leader John A. Small businesses and the entrepreneurs who lead them have been the primary drivers of job growth over the past decade. "You don't build a house by blowing up its foundations.Single Payer 2. everyone with a 401(k). say it could still be in a recession or in a weakened condition well into 2011. and produce as much as 60 percent of all jobs. 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. saying that this was not the time to raise taxes on higher income people because it would further weaken the economy.washingtontimes. The White House expects the economy to be in a recovery at that time. less economic growth.which will cost an estimated $1 trillion over 10 years . On Capitol Hill. Boehner of Ohio called the budget plan a "job killer. Business advocates charged that multiple tax increases on Americans earning more than $250. middle-class families. Small businesses and the entrepreneurs who lead them have been the primary drivers of job growth over the past decade. charities." said Bruce Josten.000 a year would whack small businesses who pay the individual income tax. But Mr. less economic growth. he changed his mind. chief lobbyist at the U." said Bruce Josten. but many economists. the author of five books on the government and the economy. resulting in less government revenue. Bush's two top tax rates expire at the end of 2010 . Then. This plan would punish them with higher taxes.0 LO 144 Small Business Add-on Health care taxes would destroy small businesses – key to the economy. and produce as much as 60 percent of all jobs. chief lobbyist at the U. "You don't build a house by blowing up its foundations. too. and anyone who flips on a light switch is going to pay higher taxes under this plan.not more. including members of the Federal Reserve Board. too. retirees. 2009 (http://www. Lambro 2/27 Donald Lambro is the chief political correspondent of The Washington Times.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 $250.000 a year would whack small businesses who pay the individual income tax. This plan would punish them with higher taxes. and fewer jobs .

national health care spending will double over the next 10 years. lower-quality health care.businessweek. a universal.Single Payer 2. an award-winning publication “ Health Care: It's What Ails Us” http://www. which sells customer relationship. 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.086 million. Nor can they compete with companies located in countries that offer national health insurance . a national insurance plan would be cheaper for me. What's not well known is that the dialogue about fixing the health care system is just as broken. Way cheaper.500 per year! You’re A Jerk 145 . and financial management tools to small and midsize businesses.) And this is for a pretty basic Blue Cross plan. But take a look at these numbers from a client of mine—a 50-person manufacturer in Pennsylvania. Now before my fellow conservatives handcuff me to a TV and force me to watch 20 hours of The Franken & Davis Show. Among politicians and pundits. Marks is the author of four best-selling small business books. longer wait times for treatment.htm [LO//AS] Will national health care benefit us as a country? I'm not really sure. author of best-selling small business books. let me explain. Written in Business Week “National Health Care: How Small Business Will Fare” http://www. National Health Insurance helps small businesses Marks. If we go with the President's 8% plan. the company would save about $208. If we opt for Kennedy's proposal. Insurance premiums increased 73 percent between 2000 and 2005. Ray (R-IA) and Paul G.000 net health insurance on a payroll totaling $2.yesmagazine. The National Coalition on Health Care (NCHC) estimates that. editors for Yes! Magazine. And a national health insurance system would be a good thing for small business owners. But one thing I know for sure: British food is terrible.com/smallbiz/content/jul2009/sb20090721_906996. without reform. 7/21 owner of the Marks Group. The shocking facts about health care in the United States are well known. (This included the owners.0 LO 145 Small Business Add-on Ext Businesses are suffering from privatized HC Pibel and Gelder 06 Doug Pibel and Sarah Van Gelder.org/issues/health-care-for-all/1498[LO//AS] Businesses are suffering too. and per capita costs are expected to keep rising. Employers who want to offer employee health care benefits can't compete with low-road employers who offer none. In 2008 it paid $375. Not a bad thing. it would save $337. as a business owner. Yes. and it counts General Electric and Verizon among its members.000. those critics are probably right—socialized medicine will probably lead to higher individual taxes. The NCHC is not some fringe advocacy group—its co-chairs are Congressmen Robert D. and a strong urge to have tea and biscuits at 4 o'clock. publicly funded system is off the table. Rogers (D-FL). There's little argument that the system is broken. service. For one. That works out to 18% of its payroll cost.

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

Single Payer 2.0 LO 147 **2AC** You’re A Jerk 147 .

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

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

Single Payer 2.0 LO 150 Losers Win? Placing blame on opposition expands support for failed healthcare reform. [Mardjuki] If You Lose. The Next Agenda: Blueprint for a New Progressive Movement. Lose the Right Way. In that respect. 2001. there still may be political benefit to extract if responsibility for blocking expanded health insurance coverage can be clearly pinned on the opposition. the obstacles to enactment of substantial reform are formidable. Borosage. As our overview of the politics of national health insurance makes clear. The lesson for reformers is this: If legislation cannot pass. yet Truman used that defeat as an element in his presidential campaign against the infamous “do-nothing" Congress. 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. As important as it is to shape the terms of victory. after the Clinton health plan politically irnploded in I994. In contrast. President Truman’s national health insurance plan went down to defeat. Robert and Roger. Hickey. even the administration abandoned its plan. even unsuccessful legislative efforts may keep health reform on the agenda and in some circumstances may help expand support for it. it is equally critical to influence the terms on which one loses. Reformers must confront the reality that political setbacks and legislative defeats are not only possible but probable. The administration had no end-game strategy when legislative support for health refom failed to materialize. You’re A Jerk 150 . In 1948. Pg 116. prof of law @ American University.

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

"Regardless of how it is initially structured. energy policy. America's Health insurance Plans and the Blue Cross Blue Shield Association wrote. injecting vast sums of money into the economy. It’s reciprocal – negative can counterplan out of advantages to test their germaneness to the plan. Until now. This solves back any infinite regression claims. 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. The Congressional Budget Office estimated that one of the major Democratic healthcare proposals being circulated in the Senate would cost an astounding $1 trillion. and confidence in his handling of the economy is ebbing. It’s fair – we’ll only make one intrinsicness argument per debate. In a letter to senators released this week. charismatic Obama presented such a contrast to George W. which will in turn cause delays in considering the massive bills this summer and could jeopardize passage in the fall. and Obama delivered.S. a government plan would use its built-in advantages to take over the health insurance market. Obama is very appealing as an individual. Obama has endured a surge of bad news. That’s Woodhead 9. I think. voters wanted action from their president in tough times. In addition. Intrinsicness allows the aff to test the relevance of the link. which initially boosted his ratings. and other areas of national life. his job-approval ratings are dropping. 7/1/2009.S. Over the past couple of weeks. 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. Uniqueness overwhelms the link – some semblance of health care is guaranteed by Obama’s political clout – it’s too big to fail. taking over much of the U.usnews. b." But Obama told a news conference Tuesday. according to Democratic pollster Geoff Garin. This sent legislators scurrying to reduce the price tags. His healthcare plans have stalled on Capitol Hill. But the ground may be shifting. Impact inevitable – Boston Globe 9 is in context of Social Security reform.com/articles/news/obama/2009/07/01/strategists-worry-obamas-popularity-is-dropping. and proposing huge changes in healthcare. Iran election. auto industry.Single Payer 2.0 LO 152 2AC Healthcare Politics (2/3) 4. This was because the supremely articulate. President Obama has enjoyed a honeymoon with the country and the media (although not with opposition Republicans). Federal policymakers could control both impacts – they can pass the plan and healthcare reform 5. "The public [government] plan. News.6 trillion. the estimate for another plan was even larger—$1. The DA isn’t intrinsic – a. Bush. In fact. not healthcare – healthcare doesn’t send the financial signal of solvency international investors are looking for You’re A Jerk 152 .healthcare. he is being faulted for a shaky response to the post-election violence in Iran." 6. Obama’s political capital is down. economy U.html President Obama is heading into stormy waters. Finally. reversing his momentum. “Strategists worry Obama’s popularity is dropping” http://www. b. who remains unpopular. No link – do the plan and pass universal healthcare. is an important tool to discipline insurance companies. he has moved the federal government into a more activist role than it has had under any other president in years. employer-sponsored plans. 7.

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

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

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

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. ''wouldn't you be deadly determined to get nuclear weapons. describes himself as closer to Waltz than to Allison on the issue. USSR/China. ''Any country that gave [nuclear weapons] to terrorists who would use them against the US. No link – Fiat is a magic wand that eliminates the political process 9. Allison points out.0 LO 156 2AC CTBT Politics (3/3) every so-called nuclear ''conflict dyad''-US/USSR. nations acquire nuclear weapons not to menace their neighbors but to protect themselves. raising the threat of nuclear terrorism. with their dogged focus on the calculus of national advantage and interest.Single Payer 2. . John J. Disad is an intrinsic policy option – permutation solves You’re A Jerk 156 . Mearsheimer agrees with Waltz. and there's a reasonably good chance that they would get Iran incinerated'' if the weapon was traced back to the regime in Tehran. is to subscribe to a sort of ''nuclear theology. And to the governments of North Korea and Iran.'' 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. . no matter how ''rogue. that nuclear states.'' (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.'' .'' Mearsheimer adds. Mearsheimer argues. Whatever its sympathies. doesn’t actually indicate a chance of extinction 8. ''If you were making decisions for North Korea or Iran. Kennedy himself put the chance of nuclear war during the Cuban Missile Crisis at one in three-odds. Utgoff is terrible a. ''Iran is highly unlikely to give nuclear weapons to terrorists. Even today's long-established nuclear powers. the primary threat is the United States. Mearsheimer. in large part because they would be putting weapons into the hands of people who they ultimately did not control. 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. for example. which will act somehow at the critical moment. And the precarious hold on power of the government in a nuclear nation like Pakistan only adds to the volatile mix. ''would disappear from the face of the earth. given American capability and American policy?'' 7. says David Goldfischer of Denver University's Graduate School of International affairs. Goldfischer charges. may owe their continued survival as much to luck as logic. John F. To share Waltz's faith in the pacifying effects of proliferation.'' Waltz asks. India/Pakistan-the first of the two to go nuclear came close to launching a preemptive attack to profit from its nuclear advantage. Nevertheless. a political scientist at the University of Chicago and another preeminent realist thinker. thinkers like Waltz and Mearsheimer. ''is utterly convinced that there's a rational core in every brain similar to his own.'' are unlikely to give their weapons to terrorists. The problem of ''loose nukes''-in particular. that are twice as high as those in Russian Roulette. old c. no warrants b. Allison notes. or is there something more strategic at work? In Waltz's formulation. 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.

When it comes to reducing the federal deficit. almost four times the previous record set by President Bush.-based respondents were likely to recommend investing in U. The White House contends big spending . 7/21/2009 (http://www. In short.com/apps/pbcs. the deficits will not dip below $500 billion a year for the next decade.is a necessary but temporary evil to jump-start the country out of recession.the Wall Street bailout.” Those words come after eight years of irresponsible spending during the administration of President George W. Bush. 2.. and $1. 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... markets. despite all of his assuring words. the next administration.S.S. expect President Obama to boast in future years about cutting the deficit. What additional revenues there are in his budget are earmarked to offset the cost of his health-care reforms. However.000 investment professionals participated in the research by taking the survey either online or via telephone interview in February and March. More than 2. President Barack Obama’s actions fall far. Investment News. . investor protections to ensure an orderly functioning of the equity markets. The new president recently told his Cabinet: “We can no longer afford to spend as if deficits do not matter.com/articles/2009/05/25/opinion/our_opinion/opinion2.3 trillion next.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.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. or the next generation. even assuming a fully recovered economy. the perception of hedge fund managers was lowest overall. Maybe so. that would be a tactic lifted from his predecessor. You’re A Jerk 157 . In the ethical-behavior category.4 trillion in federal spending. New White House forecasts show a deficit of $1. market systems. Nevertheless. Investor confidence low – comprehensive study proves Jeff Benjamin. President Obama plans on passing the problem of the deficit to the next president. only 49% (versus 68% a year ago) of U. And his proposal immediately ran into a storm of opposition on Capitol Hill. The federal government now borrows a whopping 46 cents of every $1 it spends. 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. Deficits growing now – no fix coming THE DAILY INDEPENDENT 5 – 25 . If so. Ashland. but his proposals sure don’t indicate that. which believed deficits really didn’t matter.5 percent of next year’s projected $3. far short of matching his words.09 [President’s policies don’t match his words. Obama’s actions tell a different story. 3.S. 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. If that sounds like a lot. not deficit reduction. Failure to rectify ballooning state Medicaid deficits makes economic decline inevitable. To be fair. respondents generally consider corporate boards and corporate executives to be most responsible for the current financial crisis. Maybe deficits really do matter to Obama. Based on their perception of market ethics and integrity alone. http://bgdailynews. mostly from his own Democrats trying to protect their pet projects.. it represents 0.txt] The Daily Independent. . 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.S. The White House forecasts show that. We can no longer afford to leave the hard choices for the next budget. with pension fund managers earning the top-rated spot. 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. For those who us who believe that bringing spending in line with revenue does matter. 4.0 LO 157 2AC Econ DA (1/3) 1.8 trillion this year. Obama’s words were most welcome. according to the finding. Those outside the United States also appear to have lost faith in the U.investmentnews. According to the report that accompanied the survey findings. the stimulus package .

The key to administrative simplicity in Canada and other nations is single-source payment. $300 billion annually. middle-class families. nearly twice the average in Canada.S. On Capitol Hill.pnhp. obviating the need for administratively complex per-patient billing.org/news/2008/may/our_health_care_syst. everyone with a 401(k).washingtontimes. dept Medicine Harvard. Bush's two top tax rates expire at the end of 2010. and fewer jobs . But Mr. too.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. Reducing our bureaucratic apparatus to Canadian levels would save about 15% of current health spending. 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. This plan would punish them with higher taxes. and Woolhandler. MD + MPH. The Department of Medicine at Cambridge Health Alliance/Harvard Medical School. And HMOs inflict mountains of paperwork on doctors and hospitals. Boehner of Ohio called the budget plan a "job killer. "You don't build a house by blowing up its foundations. “Our Health Care System at a Crossroads: Single Payer or Market Reform?” www. less economic growth. Then.0 LO 158 2AC Econ DA (2/3) 5. Canada’s NHI has 1% overhead and even US Medicare takes less than 4%.php) [LO//JW] In contrast to CDH. bill by checking a box on a simple insurance form. MD. including members of the Federal Reserve Board. Obama needs increased revenue to launch his national health care plan . the author of five books on the government and the economy.000 a year would whack small businesses who pay the individual income tax. Turn . Canadian hospitals. family farms. "You don't build a house by blowing up its foundations." said Bruce Josten. 11/07. charities. 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.66 clerical workers per doctor.S. Our biggest HMOs keep 20%—even 25%—of premiums for their overhead and profit. resulting in less government revenue. and Steffie Woolhandler. retirees.not more. Small businesses and the entrepreneurs who lead them have been the primary drivers of job growth over the past decade. which are mostly private. saying that this was not the time to raise taxes on higher income people because it would further weaken the economy. far more than in Canada. Chamber of Commerce. enough to fully cover the uninsured and to upgrade coverage for those now underinsured. and produce as much as 60 percent of all jobs. but many economists. which resembles that of the United States in its emphasis on private. American physicians spend nearly 8 hours per week on paperwork and employ 1. and anyone who flips on a light switch is going to pay higher taxes under this plan. Lambro 2/27 Donald Lambro is the chief political correspondent of The Washington Times. This plan would punish them with higher taxes. Physicians for a National Health Program of Chicago. 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. Proponents of NHI. neither piecemeal tinkering nor wholesale computerization can achieve significant bureaucratic savings.Single Payer 2. less economic growth. House Minority Leader John A. administrative overhead in Canada’s health system. 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. Health care’s enormous bureaucratic burden is a peculiarly American phenomenon.000 a year would whack small businesses who pay the individual income tax." saying that "small businesses.health care taxes would destroy small businesses – key to the economy. The average US hospital spends one-quarter of its budget on billing and administration. Indeed. too.which will cost an estimated $1 trillion over 10 years . most of whom are in private practice." Mr. chief lobbyist at the U. is about half the US level. nonprofit institutions. he changed his mind. 2009 (http://www." said Bruce Josten. Himmelstein. and fewer jobs . fee-for-service– based practice. 6. ‘07 (David U. chief lobbyist at the U. Unfortunately. Business advocates charged that multiple tax increases on Americans earning more than $250. say it could still be in a recession or in a weakened condition well into 2011. MD.not more. Turn – plan slashes healthcare costs by $300 billion Himmelstein. disinterested civil servants and . Small businesses and the entrepreneurs who lead them have been the primary drivers of job growth over the past decade. and produce as much as 60 percent of all jobs. as the recession deepened last year. resulting in less government revenue. are paid a global annual budget to cover all costs. much as a fire department is funded in the United States. Fee schedules are You’re A Jerk 158 . and even skeptics all agree on this point.and his budget calls for letting President George W. Canadian physicians. The White House expects the economy to be in a recovery at that time.

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

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

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

Singapore.S. a study for the NATIONAL BUREAU OF ECONOMIC RESEARCH http://www. and many other types of manufacturing. Recession means businesses are more likely to hire illegal immigrant a. b. "We're not going to cover undocumented aliens.com/sharedcontent/dws/dn/latestnews/stories/0522DNBUShealthcare.S. Although the United States' technical dominance remains solid. lead." Universal health insurance is a key aim of health reform proposals backed by President Barack Obama and key Democrats in Congress. supplying. aerospace. 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. "That's too politically explosive. biotechnology. and the most serious challenge is coming from Asia. meaning businesses want cheaper labor 3. assuming the immigrants would have been less innovative or less able to commercialize their innovation elsewhere or that U.foreignaffairs. the chairman of the Senate Finance Committee said Thursday. increased investment in research and development (R&D). the globalization of research and development is exerting considerable pressures on the American system. South Korea. the personal computer. 5/22 Jim Landers.pdf page 24 We find that a college graduate immigrant contributes at least twice as much to patenting as his or her native counterpart.org/papers/w14312.. For the last five decades.nber. 08 Jennifer Hunt." Sen. writer for the Dallas Morning News “Senator says health insurance plan won't cover illegal immigrants” http://www. U. other countries merely followed the U. Indeed. as the United States is You’re A Jerk 162 . And technological competitiveness is key to hegemony Segal 04 Writer for Foreign Affairs "Is America Losing its Edge?" http://www. The percentage of patents issued to and science journal articles published by scientists in China.dallasnews. Immigration key to innovation Hunt et al. and managing database and other types of software for clients around the world. Professor of Economics at McGill University. minimum wage just rose. natives benefit more from innovation and commercialization in the United States than abroad. Indeed. It was Americans who invented and commercialized the semiconductor. advantage in the manufacture of computer chips and telecommunications software. immigrants are less likely to have patented recently than observably similar native scientists and engineers. The difference is fully explained by the greater share of immigrants with science and engineering education.S. this technological edge-so long taken for granted-may be slipping.S. implying immigrants are not innately more able than natives. and advanced materials used in semiconductors. and bills being assembled in House and Senate committees are aiming to reach that goal through a mix of incentives and mandates. Indian companies are quickly becoming the second-largest producers of application services in the world. writer for the Dallas Morning News. undocumented workers. 2. developing. and the Internet. Despite this. however. “HOW MUCH DOES IMMIGRATION BOOST INNOVATION?”. Through competitive tax policies.org/20041101facomment83601/adam-segal/is-america-losing-its-edge.25377b8.html The United States' global primacy depends in large part on its ability to develop new technologies and industries faster than anyone else.0 LO 162 2AC Immigration DA (1/4) 1.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. scientific innovation and technological entrepreneurship have ensured the country's economic prosperity and military power. and Taiwan is rising. And even China has made impressive gains in advanced technologies such as lasers. D-Mont. said at a meeting with reporters.Single Payer 2. Max Baucus. Innovation turn a. Cheaper labor is wanted during bad economic times b. and preferential policies for science and technology (S&T) personnel. South Korea has rapidly eaten away at the U. Normal means is that the plan doesn’t affect illegal immigrants – mitigates the link Landers. Today. Asian governments are improving the quality of their science and ensuring the exploitation of future innovations.

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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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• Employers are reducing jobs and cutting back on employer-provided health coverage. states' rights. 3.Single Payer 2. 7/23/09.org/cms/index. The fifty states have never uniformly passed a single policy. vice president @ Economic Policy Institute. 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. more families are turning to programs like Medicaid. BPP. and choice. Perm do both – perm accesses double coverage of dual single-payer healthcare systems. But overall revenues last year were essentially flat and have weakened dramatically this year. 6. which provides health coverage to low. http://www. 2001. c.cfm?fa=view&id=1283 [Mardjuki] The state revenue situation is rapidly worsening. We can’t research specific solvency answers to a mechanism that isn’t predictable. Not researchable. 4. it taps into the rhetoric of devolution. According to the Rockefeller Institute of Government. prof of law @ American University.cbpp.6 percent in the first quarter of 2009 compared with last year. Politically. 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.” Policy Points.form debate—and one that lacks the familiarity of. state revenues must grow. Income taxes and other taxes are also falling as wages and investment income decline. As a result. Substantively. it recognizes the variation in state health care systems and reform preferences. 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. • To keep pace with the cost of services. However. for example. You’re A Jerk 166 . lt also puts opponents of reform on the defensive. 2. Robert and Roger. The Rockefeller Institute of Government reports state tax collections fell 12. As both Clinton and Bradley learned. • Sales taxes are the largest source of state tax revenue. Hickey. States can’t solve – increased taxes exacerbate the recession. single. Federalist healthcare politically controversial – lacks single-payer’s prior history of support Borosage. b.and moderate income families and is jointly funded by Washington and the states. Continued job losses will depress revenues further.payer insurance. 5. “New Fiscal Year Brings Continued Trouble for States Due to Economic Downturn. The first and largest barrier it has to surrnount is that it represents a new alternative in the American health re. 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. shifting the focus of debate from the details of a particular plan to the fundamental question of whether legislators support universal coverage. [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. Center on Budget and Policy Priorities. The Next Agenda: Blueprint for a New Progressive Movement. Counterplan doesn’t end states’ procyclic economic action – only a federal system solves – that’s Lav and McNichol. Pg 112. 50 State fiat bad – a.0 LO 166 2AC States CP (1/2) 1. the federalist strategy is not problem-free. 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. States face other problems from the weakening economy.

because citizens’ access to medical care services would be a function the health system chosen by the state in which they reside. 8. 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. The Next Agenda: Blueprint for a New Progressive Movement. in critics’ view. Robert and Roger. In addition. States fail – inequitable. Pg 112. <INSERT STATE SPECIFIC ECON DA/STATE POLITICS DA> You’re A Jerk 167 . prof of law @ American University. Hickey.Single Payer 2.0 LO 167 2AC States CP (2/2) 7. Some legislatures might replicate congressional failure to enact reform. and vulnerable to state politics deadlock. or some states might resist the imposition of a federal mandate for health reform that they do not welcome for ideological or financial reasons. 2001. inefficient. Borosage. [Mardjuki] The objection most likely to be raised is that the state-by-state variation permitted by a federalist health system would be inequitable. 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. vice president @ Economic Policy Institute. even though the federalist plan mandates a state plan for cost control. Such a system would be unfair.

states’ ability to pay—but it also depends on the general philosophy toward income transfers to lower-income populations. 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. September 18. $179. Volume 26 No. a great deal of federal money supports these programs. As a result. Between the variation in spending per enrollee and the share of low-income populations that are covered. and a number of other factors. the variations in Medic-aid spending are quite extensive. The evidence shows that although federal matching rates are inversely related to income with the intent of encouraging states to spend more—that is. Pgs 667-669.2 As a result. But whether the variation that we observe in Medicaid is acceptable is another matter. higher-income states tend to spend far more per capita from their own resources. “State Variation in Medicaid Spending: Hard to Justify. This insurance varies among states because of industry and firm size. the federal and state spending on Medicaid services is much higher in high-income states than in low-income states. more than half of the cost of Medicaid and the State Children’s Health Insurance Program (SCHIP) is borne by the federal government. uninsurance rates differ greatly among states. John. Director of Health Policy Research Center @ The Urban Institute. 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. people with low incomes are a higher share of the population in some states than others. 2007. 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. States then vary greatly in the extent to which public programs cover those who remain without coverage.Single Payer 2. the spending variations have consequences that are felt at the national level. The latter depends a lot on per capita income—that is.highwire. We have shown elsewhere that states with lower levels of spending have lower levels of access and worse health outcomes. States face very different problems in covering their low-income populations because of the variation in employer-sponsored insurance. Some variation is inevitable and exists in Medicare and private coverage as well.0 LO 168 A2: States CP States can’t solve – can’t cover uninsured. Moreover.5 billion for health services in 2006. Holahan. http://healthaff. Although the nation has chosen to have a decentralized system to provide coverage to low-income Americans.4 That is. education.” Health Affairs: Policy Journal of the Health Sphere. Medicaid programs spent $314. composition.0 billion was spent by the federal government and $135. such that even with the lower federal matching contributions. income. In the end. states are left with very different shares of the population without employer-sponsored insurance.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. 6. For example.5 billion by states You’re A Jerk 168 .3 This is in part because states have very different problems to address. coverage and spending variation.6 Of this.5 Thus.

2007. including the degree in which they cover long-term care services.Single Payer 2.0 LO 169 A2: States CP Federal action key to increase coverage and eliminate state treatment variation. Connecticut. the recent interest in state health reform is likely to make current inequities worse. 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. Coverage of individuals and spending on health services will be subject to state officials’ willingness to pay. A national solution will be needed to eliminate the extensive variations that the current system has brought. You’re A Jerk 169 . Director of Health Policy Research Center @ The Urban Institute. But such a solution would have huge costs to the federal government.” Health Affairs: Policy Journal of the Health Sphere. In American politics today. Other relatively progressive states including New York. John. and Illinois have enacted or are seriously considering major proposals to extend coverage to all. regardless of where they live. This not only will have consequences for the states in which they reside. “State Variation in Medicaid Spending: Hard to Justify. it is likely that only these more progressive states can achieve the political consensus necessary to substantially extend coverage. Ironically. 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. September 18.highwire. regardless of the generosity of federal matching payments available to them. But it can be argued that there is a national interest in how these programs work. Pennsylvania. it will have implications for the nation as well. Volume 26 No. then wide state variations are problematic. Vermont. 6. The result of a stalemate will be that low-income people will continue to be treated very differently depending on where they live. http://healthaff. but they have considerable flexibility in extending coverage and structuring benefit packages. Other states will be left with the current mix of programs. political agreement on an approach to extending coverage to all will be difficult to achieve. but because poor access to health care will affect health outcomes. If there is a strong national interest. Holahan.org/cgi/content/full/26/6/w667 [Mardjuki] States must provide a minimum amount of coverage and benefits. Moreover. Moreover. 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. Massachusetts has enacted a plan to achieve (close to) universal coverage. Pgs 667-669.

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

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

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

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