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

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

0 LO 6 **1AC** You’re A Jerk 6 .Single Payer 2.

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

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

org/cms/index. but this will not address state budget shortfalls. At the end of fiscal year 2006. 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. Federal assistance can lessen the extent to which states need to take pro-cyclical actions that can further harm the economy. health coverage. These important public services were suffering even as states turned to budget cuts to close the new budget gaps.Single Payer 2. Bredesen. It’s not health care reform to dump more money into Medicaid. In 18 states.” Center on Budget and Policy Priorities. You’re A Jerk 9 . “Should the Federal Government Bail Out the States? Lessons from Past Recessions. five prominent Democratic governors suggested that the federal government should commit $1 trillion in aid to the states over the next two years. Federal assistance Crucial. Most states are required to balance their budgets regardless of the economic environment. a former health care executive. senior economist and economic advisor @ Chicago Federal Reserve. such as Medicaid. for which demand rises during a recession. http://www. “State Budget Troubles Worsen.org/publications/fedletter/cflaugust2009_265. but generally are not sufficient to avert the need for substantial budget cuts or tax increases. this aid might help states avoid enacting spending cuts or tax increases that could deepen or prolong the economic downturn.chicagofed. Bredesen was far from alone in his concern. Spending as a share of the economy declined in fiscal year 2008 and is projected to decline further in 2009 and again in 2010. Iris and Elizabeth. One way states can avoid making deep reductions in services during a recession is to build up rainy day funds and other reserves.0 LO 9 HEALTHCARE 1AC – ECON ADV bestow “the mother of all unfunded mandates. “As a governor. McNichol. unemployment insurance. State government budget woes have been much in the news . Mattoon. state reserves — general fund balances and rainy day funds — totaled 11. In this recession.” said Gov. Also. and work force training. state budget and tax senior fellow. state budget and tax expert. 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. 6/29/09.5 percent of annual state spending.1 In January of this year. Gold award for contribution to state fiscal policy.” Mr. Lav. And a second round of stimulus is needed – federal money to ease state deficits is crucial to stem further recession. Richard. individual state economies are struggling in this recession. State spending fell sharply relative to the economy during the 2001 recession. California projected a $21 billion deficit after failing to get voter approval for a series of budget balancing fiscal measures.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. The American Recovery and Reinvestment Act recognizes this fact and includes substantial assistance for states. There are also other streams of funding in the economic recovery act flowing through states to local governments or individuals. higher education. Christine Gregoire of Washington. and child care remain in effect.” added Mr. August 2009.” Chicago Federal Reserve Bank Essay Number 265.2 The rationale for such financial support is that states (which are generally prohibited from running deficits) need the money to maintain key programs. State governments face significant constraints in raising additional revenues. This article considers the role of the federal government in helping the states to manage their finances. Federal assistance crucial to stem negative pro-cyclical economic state action.cbpp. and for all states combined it still remains below the fiscal year 2001 level.” “Medicaid is a poor vehicle for expanding coverage. 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. This heightens the potential impact on public services of the shortfalls states now are projecting. In a number of states the reductions made during the downturn in education. http://www. the available reserves in states with deficits are likely to be depleted in the near future. Most of this money is in the form of increased Medicaid funding and a “Fiscal Stabilization Fund.pdf [Mardjuki] Like the economy in general . states have already drawn down much of their available reserves. Recently. “It’s a 45-year-old system originally designed for poor women and their children. Reserves can be particularly important to help states adjust in the early months of a fiscal crisis.” This money has reduced to a degree the depth of state spending cuts and moderated state tax and fee increases.

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

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

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

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

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

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

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

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

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

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

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

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

like the fact that we will have a presidential election in November of 2012.pubmedcentral.Single Payer 2. In addition. Nothing could be further from the truth. If I told you that in less than a year after the historic Medicare legislation was signed into law. why are we giving up on the best solution and settling for something that. 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. from all appearances. where the focus should have been from the start. 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. and their people are.when we have a single-payer model. and millions of older Americans had been enrolled and were getting health care with hardly a hiccup.[2] But they worry that it lacks the spirit of the American market.0. and executive compensation. However. Economies of scale will save the money to make this possible. House Speaker Nancy Pelosi responded to one of the questions by saying. insurance policies are so complex and individuals' future needs so unpredictable that consumers cannot make the informed selections that induce competition between insurers. duplicated bureaucracies. is health care. with an economy in decline. 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.story [Mardjuki] In a Q-and-A recently posted on the Web site Crooks & Liars (http://crooksandliars.000-plus-page bills. by most accepted measures.nih. "For 30 years I have supported a single-payer plan. not the best middlemen to pay for it. So. A single-payer system will give all consumers the power of choice and open all healthcare providers to the effects of consumer decisions. concede that single-payer insurance is probably our most efficient option.le. This is paramount because patients need the best healthcare. Schoonmaker. the 47 million uninsured Americans[3] have little impact on the market. You’re A Jerk 22 .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) . thousands of people losing their jobs every month and losing their coverage.SOLVENCY Observation 3: Solvency Only a single-payer system mitigates costs – Medicare proves. bloated by advertising. MD/PhD from Northwestern University. Why are we writing 1. 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. but our next best choice is to support an exchange and a public option. with more employers changing to plans that cover less and cost the individual more. not insurance. Single-payer works because of the efficiency of specialization. Many Americans. No.baltimoresun.letters200jul20. that is not a typo. All of the major developed nations have some form of single-payer health care. “A Market for Compassion: Single-Payer Health Insurance”. the program was up and running. 7/20/09 Anne. The private health insurance market is inefficient. Medicare. dividends.com/news/opinion/readersrespond/baled. or dropping coverage altogether. 9-5-2008. is a whole lot less than "next best?" The House plan is not set to go "live" until January of 2013. but private providers will continue to deliver care. 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 2013.0 LO 22 HEALTHCARE 1AC .1114455. http://www.fcgi?artid=2580082 In a single-payer system. consumers can create competition among healthcare providers. Their spending per-person on health care is less than half what we spend here.com/node/29667). providers are insulated from competition because private insurers often restrict coverage to select physicians. 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. the government will fund health insurance. A single-payer system will harness the market's strengths while addressing its limitations. including Democratic presidential nominee Barack Obama. 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 .gov/articlerender. Global Sourcing Finance Chief at GE Healthcare. maybe. healthier than we are. “Why not singlepayer?” Baltimore Sun. http://www. What's worse. Currently." The question that her response prompts from me is. Prajwal Ciryamv.

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

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

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

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

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

0 LO 28 **INHERENCY** You’re A Jerk 28 .Single Payer 2.

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

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

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

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

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

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

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

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

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

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

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

which had budgeted last year for increases of 1. One day last fall. There’s just an array of need out there. State Medicaid officials also say that because enrollment often lags behind job losses by several months.000 new Medicaid enrollees per month. Here in Gwinnett County. and in some instances parents of covered children and childless adults.html [Mardjuki] Medicaid rolls are surging. with 40 states responding. McMillan. which is experiencing some of the fastest Medicaid growth in the country (10. and it has followed the economy. Sack. and prompted state fiscal analysts to shred estimates that were often only six months old.” said Glenda G. as the recession tightens its grip on the economy and Americans lose their employer-sponsored health coverage along with their jobs. 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. who constitute about half of all recipients. the growth rate was at least double what it had been in the previous year. the current caseload is the highest since the program’s creation in 1965. according to state officials.” But Georgia was hardly alone in seeing substantial jumps in enrollment. which had forecast enrollment growth of about 1 percent for this fiscal year. Medicaid populations grew by 5 percent to 10 percent in the last 12 months and.nytimes. officials there said. state officials now project it will be eight times higher. in many. Medicaid enrollment ballooned by 26 percent from July 2007 to July 2008. You’re A Jerk 43 . 2009. In a number of states. by unprecedented rates in some states. 1/21/09. pregnant women. Utah officials expect their state’s Medicaid enrollment to grow by 13 percent this year. nursing home residents. New York Times senior journalist. http://www. “There’s just been a steady increase in the numbers.Single Payer 2.0 LO 43 Medicaid Costs High Now States swamped by Medicaid expenses because of a prolonged recession and surge in unemployment. In a nationwide survey. Kentucky.com/2009/01/22/us/22medicaid. “And there’s no one population. after declining by 3 percent a year earlier. In most states.4 percent for the 12 months ending in November). The program also provides coverage for those with disabilities. much of the growth in Medicaid has been among children from low-income families. We’re seeing the newly unemployed. Kevin. the underemployed.” New York Times. the regional director over the Gwinnett County office. The New York Times found that in some cases the surge in enrollment had overwhelmed social services agencies. In Florida. the growth in 2008 may represent only the leading edge of heightened demand. an Atlanta suburb that is home to a growing immigrant population. “Growing Need for Medicaid Strains States. has averaged more than triple that since June. two-time Pulitzer Prize winner.

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

the outgoing chairman of the NGA. Miss. Tennessee's Democratic governor. 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. According to the Center for Budget and Policy Priorities. at least 48 states are facing shortfalls totaling $166 billion — 24% of their total budgets. even as public need for state safety-net services is growing.8599. Karen. 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.time. You’re A Jerk 45 ." says Pennsylvania's Ed Rendell.00. whose budgets are already straining under the program's growing costs.html [JM] Until the nation's governors staged a public revolt last weekend. http://www. it seems. a Democrat. The recession has drained state coffers of tax receipts. 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. 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. "These could essentially be unfunded mandates. Rendell.com/time/politics/article/0." The issue came to a boil as the National Governors Association (NGA) met in Biloxi.” Time Magazine.0 LO 45 Obama HC Drains State Budgets Health care reform quietly increases state Medicaid financial commitments – devastates state budgets. are so wary of the idea. Tumulty.) The proposal could hardly come at a worse time for governors. Nor. Phil Bredesen." (See the top 10 health-care-reform players. which is being hit from every side by growing doubts. "It depends on what's being proposed. told the New York Times that he regarded the proposed expansion of Medicaid as "the mother of all unfunded mandates" and warned. 7/21/09.1911856. "Medicaid is a poor vehicle for expanding coverage. national political correspondent. and would be enormously destructive to state budgets. could the governors' rebellion have come at a worse time for President Obama's health-care-reform effort.Single Payer 2. “Medicaid and the States: Health-Care Reform’s Next Hurdle.2 billion fiscal hole.

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

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

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

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

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

Single Payer 2.0 LO 51 You’re A Jerk 51 .

or significantly increasing the cost of these services. home care. For example. Johnson. Director of BPP State Fiscal Project. Phil. as the recession brought sharply weakened revenues. “An Update on State Budget Cuts. 6/29/09. The cuts have intensified as the economy has worsened. rehabilitative. and Rhode Island is requiring low-income elderly people to pay more for adult daycare. Minnesota is cancelling a health insurance program for 29.0 LO 52 State Deficits Now – No HC State deficits now – healthcare is the first to go. You’re A Jerk 52 . For example. eliminated temporary health insurance for people with serious medical problems. At least 39 states to date have reduced services since the recession began. Senior Fellow. Nevada is making it harder for beneficiaries to qualify for nursing home care.cbpp. Nicholas.” Center on Budget and Policy Priorities.000 low-income parents. or other services needed by low-income people who are elderly or have disabilities. 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.500 low-income adults.Single Payer 2. Phil. Rhode Island eliminated health coverage for 1. Arizona has eliminated temporary health insurance for people with disabilities who are coping with serious medical problems. and California and Utah are reducing services covered by their Medicaid programs. http://www. [Mardjuki] States began cutting their budgets last spring.cfm? fa=view&id=1214. Programs for the elderly and disabled: At least 22 states plus the District of Columbia are cutting medical.org/cms/index.

and Washington. a program designed to provide time-limited cash assistance to adults with physical or mental disabilities. Michigan. You’re A Jerk 53 . Georgia has reduced such programs for the elderly as Alzheimer services. Tennessee has reduced community-based services for people with intellectual disabilities and cut nursing services for some adults with serious disabilities. http://www.” Center on Budget and Policy Priorities. and prescription drug assistance. Vermont has reduced some home-based services. prescription drug assistance. Pennsylvania. Louisiana will impose a limit on the number of Medicaid prescriptions it will pay for. Utah. Alabama has ended homemaker services for approximately 1. Kansas. South Carolina. mental retardation. home care.100 older adults. Maine. 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. in the expectation that the freeze will result in staffing cuts. the state has eliminated early intervention services that support young children with special needs for 850 infants and toddlers at risk of developmental delay. 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. The state also reduced pass-through grants for various aging programs and funding for local mental health providers. The state also eliminated general assistance. geriatric mental health services.0 LO 53 State Deficits Now – No HC State healthcare being eliminated now – laundry list. The state provides these payments to an average of 2. the District of Columbia.000. Furthermore. Senior Fellow. Minnesota has capped enrollment at current levels for a program that provides expanded health services and care coordination for people with disabilities. Phil. Johnson. such as meals and homemaker services.org/cms/index. the governor has ordered cuts in programs for elders. including home care. Arizona has eliminated temporary health insurance for people with disabilities who are coping with serious medical problems. Such services help people stay in their own homes and possibly delay or avoid more expensive nursing home care.100 disabled individuals.Single Payer 2. In Rhode Island. In Florida. Maryland. This is estimated to affect more than 1. Director of BPP State Fiscal Project. in February 2009 the state eliminated independent living supports for 450 elderly residents and respite-care funding for 130 caregivers. Nicholas. This may affect access to prescription drugs for mentally ill or disabled individuals who rely on several medications to manage their conditions. Virginia has decreased reimbursements for special hospitals serving people with needs relating to mental health. New Mexico will cut cash assistance payments for low-income disabled residents by a third beginning in July. such as housekeeping and shopping.200 people with incomes below $20.cbpp. In addition. 6/29/09.100 disabled individuals each month who cannot work and are not eligible for Temporary Assistance to Needy Families. affecting 2. In Massachusetts. Ohio plans to close two mental health facilities. The state also has cut Medicaid reimbursements to hospitals and community-based services for the elderly. It also established a waiting list for vocational rehabilitation services. or substance abuse. Other states that have capped or reduced funding for programs that serve people who have disabilities or are elderly includeCalifornia. elder service centers. Phil. rehabilitative. and elder support.cfm? fa=view&id=1214. [Mardjuki] At least 22 states and the District of Columbia have cut medical. for people who are elderly or disabled. low-income elderly people must pay higher rates for subsidized adult day care. “An Update on State Budget Cuts. These services often allow people to stay in their own homes and avoid nursing home care.

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

” Center on Budget and Policy Priorities. At the State University of New York.000 students. the California State University system is cutting enrollment by 10. Minnesota. The University of Florida has announced it will eliminate 150 positions for the coming year. Massachusetts. Florida State University plans to lay off up to 200 faculty and staff members. Idaho. Tuition at all 11 Florida public universities will rise by 15 percent next year. Phil. Maine. Mississippi. Nicholas. and the Community College of Rhode Island all increased tuition for this past academic year. When Rhode Island cut higher education funding. and limiting enrollment in its nursing school. Tuition in Arizona this year rose 9. consolidating several schools and almost two dozen academic departments. and 4. Each of these institutions went one step further by increasing tuition further mid-year. Louisiana. Pennsylvania. As a direct result of state budget cuts. Utah.3 percent respectively. Oklahoma. Georgia. New Jersey. Nevada . Kentucky. Colorado. imposing employee furloughs ranging from 10 to 15 days. South Carolina. Other states cutting higher education operating funding include Alabama. North Carolina.2 percent. 6/29/09. Rhode Island College. Florida has cut university budgets and community college funding. and Virginia. http://www. Budget cuts reduced state funding for the University of Washington by 26 percent for the coming biennium.5 percent in response to funding cuts. The budget authorizes the university to increase tuition up to 14 percent to compensate for this funding loss. resulting in 49 staff and nine faculty layoffs.cbpp. Tennessee. Hawaii. 8.cfm? fa=view&id=1214. Connecticut. resident undergraduate tuition increased by 14 percent (over $600 per year) between the fall and spring semester of this past academic year.Single Payer 2. You’re A Jerk 55 . New Mexico.0 LO 55 State Deficits Now – No Education State higher education budgets cut now – laundry list. Kansas. California. Phil. by 6. Maryland. Arizona State University has addressed its loss of state funds by eliminating over 550 staff positions and 200 faculty associate positions. Senior Fellow. Director of BPP State Fiscal Project. Johnson. Vermont. [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. The University of California system is reducing California resident freshman enrollment by 2.7 percent.300 students for next year. Iowa. the University of Rhode Island. “An Update on State Budget Cuts.org/cms/index.

These include Arizona. the state’s workforce is expected to fall by another 2. Nicholas. and New Jersey are responding to budget cuts by cutting faculty and staff positions. child care. child support. Louisiana. New Jersey. Overall. “An Update on State Budget Cuts. Florida. New Jersey has eliminated 2. Phil. and Utah. Colorado. Kentucky. imposing mandatory furloughs (time off without pay). health care. Michigan. Kansas. Senior Fellow. Rhode Island plans to reduce the state workforce by 2. a number of state colleges and universities in states such as Alabama. In early January the state replaced the freeze with a cap on the number of budgeted positions at each state agency.400.700 positions.0 LO 56 State Deficits Now – Job Loss State employees being fired now – laundry list. Nevada. Arizona.Delaware.Single Payer 2. The state is encouraging early retirement but has announced that it will lay off workers if needed. leaving vacancies unfilled.cfm? fa=view&id=1214. and leaving vacancies unfilled. New Mexico. In the Department of Jobs and Family Services — which oversees disability services.5 percent of the state workforce. Florida. Arizona. 6/29/09. the Ohio state workforce declined by 3. Illinois. To deal with budget cuts in Kentucky.Minnesota. Some 1. and delayed a 2 percent salary increase scheduled for November 2008. The Tennessee governor has announced elimination of over 2. or making other cuts affecting their state workforce. through a combination of early retirements. In Washington. gave early retirement to 25 employees. Director of BPP State Fiscal Project. Georgia. California. Connecticut.000 between March 2007 and December 2008. Maine. Massachusetts. New Mexico. [Mardjuki] At least 40 states plus the District of Columbia are eliminating or not filling various state jobs. Hiring freezes have also been ordered in Alabama. South Carolina. Massachusetts. Georgia.500 employees accepted buy-outs for early retirement. Michigan. http://www. New Hampshire. You’re A Jerk 56 . South Dakota. plus the District of Columbia — have laid off or announced plans to lay off state employees.000 state positions.Hawaii. about 5 percent of the state workforce. Michigan. Ohio. laid off 567 state workers.000 state positions by encouraging early retirement. child welfare. Johnson. and other services — fully 14 percent of positions will be eliminated or left unfilled.org/cms/index. the Department of Public Advocacy (which defends clients in the criminal justice system) instituted a strict hiring freeze. North Carolina. andSouth Carolina. Pennsylvania. Cutting staff — whether on a permanent or temporary basis — also may contribute to increased unemployment. and furloughed remaining employees. As noted above. and Wyoming. Additional states — such as Arizona. Virginia’s governor has eliminated 800 currently unfilled positions.cbpp. Hawaii. North Carolina. layoffs. and laying off staff. A number of states are imposing furloughs and/or pay cuts for some state employees. the District of Columbia. Wisconsin. Mississippi. about 4. Maine. The Ohio governor has announced plans to eliminate as many as 2.Idaho. Florida. Iowa.600 under the cap.” Center on Budget and Policy Priorities. New York.000 or more. Kentucky. Vermont. Maryland.California. Iowa. Such steps can make it more difficult for residents to obtain state services. Phil. a hiring freeze imposed by the governor in August caused the state’s workforce to decline by more than 1.

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

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

Lawmakers believe that cities and counties could in turn borrow against that borrowing. One of the biggest sticking points was over the $11 billion already cut from public schools. Healthy Families.nytimes. the deal contains $15.0 LO 59 State Deficits Now –Tradeoffs California budget crisis hurting social services and schools Jennifer Steinhauer. The budget deal calls for roughly $650 million more in cuts. While the state’s health insurance program for children. among other purposes. both took large cuts. Schwarzenegger had claimed he would not brook.6 billion in cuts. finally sealed the deal with the governor Monday night on a plan to close a $26 billion budget gap.9 billion in new revenues and about $2.5 billion in tax increases and $5.u. After weeks of often-cantankerous negotiations. distributes pain through nearly every aspect of government services.Single Payer 2. While the governor wanted certain welfare benefits to be reduced from a fiveyear period to two years. about $2.” Karen Bass. You’re A Jerk 59 . 7-20-2009. New York Times L. remains. With Billions Cut”. and Mr. lawmakers signed off on a budget deal with $14. along with the creation of a $1 billion reserve fund. achieved his goal of having caregivers and the recipients fingerprinted in the future with the goal of preventing fraud. Under the new budget. All told. the program was instead given an overall cut of $500 million . their state broke and its credit rating shot.’s to vendors and taxpayers in lieu of payment. bureau chief.com/2009/07/21/us/21calif. Last February. localities will basically serve as unwilling lending agents to the state. the state was forced to issue millions of dollars in i. With the deficit continuing to grow. which Mr. Arnold Schwarzenegger’s proposal to eliminate health care programs for children and the state’s generous welfare program.A. While the Legislature pushed back on Gov. Local governments will lose millions of dollars that are used to build housing. In-home services for the elderly and infirm were reduced by several million dollars. meaning thousands of children will probably be on a waiting list for the program unless a private foundation makes up the balance. “California Reaches Budget Deal. localities bankrupt or nearly so would be exempt. $12. The plan. http://www.o.1 billion in borrowing. as the Democraticcontrolled Legislature hopes. which runs through the 2010 fiscal year. All failed. a Republican. which is certain to be viewed with trepidation among legislatures across the country also facing huge budget gaps. $3. universities and local governments. “I would characterize this budget as shared pain and shared sacrifice. the speaker of the California Assembly.7 billion in accounting maneuvers like shifting a payday into the next fiscal year. But that budget depended on a nod from voters on several ballot measures. state officials have come up with a compromise that few who receive government services will celebrate. it was cut by $144 million. It will raid their coffers and repay them over time as the state’s fiscal situation improves. and the state plans to borrow roughly $2 billion in property taxes from localities. which would have to be repaid within three years.4 billion in new borrowing.8 billion in spending cuts.html?_r=1 California lawmakers. So did public education. said in a telephone interview from Sacramento. Schwarzenegger.

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

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

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

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

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

huffingtonpost. that means fewer customers and the downward spiral continues. are not permitted to run current budget deficits. Kuttner.000 jobs were lost.5 million more workers. Deval Patrick. unlike the Federal government. The unemployment rate rose to 9. just hiked its sales taxes by 25 percent. companies will not resume hiring. And there is less than one job opening for every five people seeking jobs. The New York Times reports that several states are cutting out summer school. though the economy now has 12. with one of the most liberal governors. Hidden unemployment is also setting records . as well as people whose hours have been involuntarily cut. and OECD economists project that U. nearly every state is raising taxes or fees. But instead the number spiked back up. You’re A Jerk 65 . when tax receipts fall.5 percent. Bottom line: the medicine isn't working. Some of the state budget crisis is self-inflicted. since they only further undercut consumer purchasing power. But most states are just plain hurting. So in a deep recession. At least 48 states face red ink. Massachusetts. 7/5/09. We now have fewer jobs than in May 2000 when the recovery began. unemployment will still be in double digits as late as 2011. as it did in May. And 39 states have cut program outlays on the needy.Single Payer 2. The number of longterm unemployed is at record levels. A total of 24 other states have enacted tax increases and another 12 all have tax hikes on their agendas. which is expected to total $350 billion by 2011.0 LO 65 More Stimulus Needed . Compounding the problem is inadequate government policy on three crucial fronts: The states.the worst since 1983 -. according to the Center on Budget and Policy Priorities.html [Mardjuki] Several events of the past week should be a wake-up call to the Obama administration. as in the dance to the death between California Governor Arnold Schwarzenegger and Democrats in the legislature. And as long as layoffs continue. Stronger stuff is needed. founder of The America Report. The 9. And I would add that stimulus funds are getting out too slowly. Robert. senior fellow @ Demo Think Thank.5 percent official figure -.people with part time work who want full time work. “Three Reasons We Need an Economic Wake Up Call.conceals even worse news.S.” Huffington Post. This is the only recession since the Great Depression in which the job loss wiped out all the job growth of the previous recovery. As the new fiscal year begins. President Obama's economic stimulus simply wasn't designed for a recession this deep. compounded by a two-thirds supermajority requirement for any kind of tax reform. their only choice is to cut program spending or raise taxes. Consider: The green-shoots school was expecting that the rising rate of unemployment would continue to slow. A total of 467. Federal aid under the stimulus covers just 30 to 40 percent of the state shortfall. or laying off workers and reducing programs. http://www.com/robert-kuttner/3reasons-we-need-an-econ_b_225962.Statistics First round of stimulus insufficient – recent unemployment and state deficit statistics prove. Both are of course perverse in a recession. Until strong economic growth returns. As our friends at the Economic Policy Institute report. As EPI observes.

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

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

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

but generally are not sufficient to avert the need for substantial budget cuts or tax increases. Iris and Elizabeth. At the end of fiscal year 2006. Gold award for contribution to state fiscal policy. One way states can avoid making deep reductions in services during a recession is to build up rainy day funds and other reserves. Federal assistance can lessen the extent to which states need to take pro-cyclical actions that can further harm the economy. health coverage. “State Budget Troubles Worsen.org/cms/index.” Center on Budget and Policy Priorities. These important public services were suffering even as states turned to budget cuts to close the new budget gaps.5 percent of annual state spending. This heightens the potential impact on public services of the shortfalls states now are projecting. http://www. The American Recovery and Reinvestment Act recognizes this fact and includes substantial assistance for states.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.cbpp. McNichol. 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 reserves — general fund balances and rainy day funds — totaled 11.0 LO 69 More Stimulus Needed – States Key Federal assistance crucial to stem negative pro-cyclical economic state action. State spending fell sharply relative to the economy during the 2001 recession. state budget and tax expert. 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. Reserves can be particularly important to help states adjust in the early months of a fiscal crisis. Federal assistance Crucial. In a number of states the reductions made during the downturn in education. There are also other streams of funding in the economic recovery act flowing through states to local governments or individuals. but this will not address state budget shortfalls. the available reserves in states with deficits are likely to be depleted in the near future. and child care remain in effect. In this recession. 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. higher education. Most of this money is in the form of increased Medicaid funding and a “Fiscal Stabilization Fund. Lav. state budget and tax senior fellow. states have already drawn down much of their available reserves. In 18 states. 6/29/09. and for all states combined it still remains below the fiscal year 2001 level. You’re A Jerk 69 .” This money has reduced to a degree the depth of state spending cuts and moderated state tax and fee increases.Single Payer 2.

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

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

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

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

Musgrave. Over the past 18 months.com/news/state/story/868712. the state was $55. 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. which began July 1.0 LO 77 Kentucky – Medicaid Chopping Block Kentucky on the brink – Medicaid funding already on the chopping block. http://www. state agencies have cut more than $600 million as the state repeatedly adjusted its budget to account for falling revenues.6 percent cut to most state agencies. "We're not cutting any projects. For the fiscal year that just ended. with a few exceptions. the federal government retroactively increased its share of Medicaid dollars this year to nearly 80 percent of the cost. 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. The additional spending means that the cuts to agencies are likely to be deeper than 2. said the increase in the federal share of the Medicaid program is supposed to sunset in December 2010." Lassiter said. the state picks up about 30 percent of the tab and the federal government pays 70 percent.Mental Retardation Programs.” Lexington Herald-Leader. 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. director of the Kentucky Association of Regional Mental Health. You’re A Jerk 77 .Single Payer 2. said Mary Lassiter. If the state had to use money set aside for this year's budget." Lassiter said of saving measures at the Transportation Cabinet. But in a special legislative session in June. staff writer. “State plugs budget hole with Medicaid money. Lassiter said. But it probably will be several weeks before agencies are told how much to cut. Gov. Lassiter said. 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. Shannon said.kentucky.6 percent. The exceptions included the state Medicaid programs and the main funding formula for K-12 education. the state budget director. "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. Moving money from Medicaid to the General Fund will not affect the Medicaid program.html [Mardjuki] The state was in the black for the fiscal year that ended June 30. but only because it received a loan from the Medicaid program. Lassiter said.7 million short in General Fund dollars and nearly $37 million short in Road Fund money — which pays for transportation projects. Beshear has said. In general. Those plans are due this week. 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. an insurance program for the poor and the disabled. However. The agency proposals will be reviewed and discussed with Beshear. there could have been additional cuts in programs. which had additional money from the federal stimulus program. Steve Shannon. 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. Legislators also approved a tax credit of as much as $25 million for people who buy newly built homes. Medicaid. is paid with federal and state dollars. Yet the number of people eligible for Medicaid will probably remain the same while the state's portion of the bill will increase. "Then what are we going to do?" he said. It is fully funded for the coming fiscal year. 7/21/09 Beth. Now state officials are trying to determine how much money state agencies will have to cut from this year's budget. Lassiter said. which represents community mental health centers. "This is the fifth budget reduction in 19 months. That means the state had additional state money in that program that could be used to cover the shortfall. the General Assembly approved a budget-reduction plan that included $45 million in spending that was not in Beshear's original proposal. stimulus money will sunset by 2010.

members of Congress might be reluctant to make even this one change because the nonpolitical formula should be preserved against future raids. The problem? Louisiana’s income was artificially inflated by insurance payments and federal aid in the wake of the hurricanes of 2005.including all payments from all sources. Jindal says Louisiana's reimbursement rate will drop from as high as 73 percent to 60 percent . We hope that the Obama administration and Congress listen. not only does Medicaid reimbursement take another dive. Bobby Jindal and U. Louisiana Governor’s Office.S. Mary Landrieu. “This formula will put severe pressure on health-care funding. 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. calculates payment schedules to the states based on per-capita income. From 2005 to 2007. Louisiana might face significant new budget cuts in the 2011 fiscal year that begins next July 1. as calculated by the independent Bureau of Economic Analysis. D-La. it will decrease to 67 percent. the federal reimbursement for Medicaid — the principal medical program for the poor — is in the range of 70 percent of the cost of the care. 7/22/09.” WBRZ News 2. there are ballooning federal budget deficits — for which Jindal is trying to score political points by criticizing President Barack Obama. the governor's office said. there is the problem of “Katrina fatigue. The state will start seeing this loss of funding this October. And then.htm?print=1 [Mardjuki] Associated Press. including insurance and Road Home payments after the 2005 storms. Aid to Louisiana on this front will add to the deficit.S. “Insurance. according to the Bureau of Economic Analysis. Within the next year. is temporarily enhanced by the federal stimulus.claimsjournal. That rate is determined by a formula based on total personal income in the state. but it is an argument that is going to be heard. which serves the poor and uninsured. You’re A Jerk 78 . Overall. Louisiana's Medicaid funding. [Mardjuki] http://www. because of the hugely exceptional circumstances of the 2005 hurricanes.forcing cuts to either public health or higher education. which would normally be 72 percent. The drop from 72 to 63 percent will cost the state an estimated $700 million per year.a dramatic. Louisiana will face the largest decrease of federal Medicaid funding in the nation . Medicaid. Louisiana's per-capita income is reported to have increased by 42 percent . 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. ABC News.0 LO 78 Louisiana – Medicaid Deficit Louisiana set to run into a $1 billion Medicaid shortfall – drop in federal funding and miscalculated budget. has been to Washington to press the state’s case for relief. 7/22/09. This coming October. Further.html If this year’s state budget crisis was fun. Predicted billion-dollar Medicaid deficit will devastate Louisiana economy. higher-education funding and other key Louisiana priorities. We hope Landrieu and the state’s delegation in Congress can plot a way through this thicket.” Jindal’s top health aide.a decrease almost twice that of the state with the next largest decrease.2theadvocate. We don’t agree with the latter position. Jindall's office says he is trying to work out a solution with federal officials over the looming crisis.” with the state’s woes after the hurricanes receding in national consciousness. but the state’s case for assistance is clouded by political concerns. with the full impact starting January 2011. Because of the formula used in the calculation of Medicaid support from the federal government.” Louisiana faces a shortfall in the hundreds of millions of dollars per year. “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. Sen. wait until next year.. and should not be victimized again by their own government. Because Louisiana is a relatively poor state. That figure goes far beyond wages and salaries . recently met on the problem. according to the governor's office.” http://www. If the reimbursement rate is adjusted for that bogus “income.” Jindal said. Gov. in 2011. sudden increase which will drop the state's federal Medicaid funding.Single Payer 2. Louisiana.com/opinion/51360777. Alan Levine. Louisiana Gov. Federal Payouts Create Medicaid Problem in Louisiana.com/news/southcentral/2009/07/22/102426. and then will decrease to 63 percent in October 2010. but the federal stimulus aid to the state also goes away — a double-whammy. the state government is going hat-in-hand to the U. government for more than $700 million in Medicaid funds. Finally. “Our Views: Medicaid rate hits Louisiana. North Dakota.

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The credit markets remain broken. You’re A Jerk 81 . The rational response to a deteriorating economy even for those with access to credit is to save more. Prometheus Wealth Management. The survey is a measure of attitudes and feelings. Fine. The weekly claims number released this week will be part of the July unemployment report. When the economy improves employers first slow down their rate of layoffs. The green-shoot crowd expected confidence to continue rising. The credit markets and the economy will not heal on their own in the near term. if one cannot qualify for a mortgage or auto loan one does not spend what savings they have for a downpayment. The retrenchment in consumer sentiment can only be traced to further deterioration in the real economy. The weekly number has to begin to improve before the unemployment rate can improve. Access to credit remains as tight as ever for both consumers and businesses. If that number is above 600. Only meaningful intervention from Washington will fix the credit markets within the next few years. then the unemployment rate reported for June could approach 10%. Plus.4 percent from 19. 2009 (“Falling Consumer Confidence Foreshadows Worsening Jobs Outlook” outlook/ http://www. But with unemployment rising and unemployment benefits starting to run out for those that lost their jobs last summer and fall. income. That leaves savings. The news coverage in May and June has been positive.3 percent. Based on an increase in the value of the stock markets and the constant press coverage for green-shoots and an improving economic picture.6 percent.” If this survey is accurate.3 percent from 25.escapethenewgreatdepression. Finally employers hire and the unemployment rate begins to go down.8 in May. Then employers have their existing workforce work longer hours. He earned a Master's Degree in Business Administration from Baylor on June 30.3 from a reading of 54. The drop is especially significant since people receiving a paycheck had fewer payroll related taxes withheld from their checks. What I found ominous in the report was the consumer outlook for employment.com/2009/06/30/falling-consumer-confidence-foreshadows-worsening-jobs- The Consumer Confidence Index fell in June to a reading of 49.0 LO 81 Consumer Confidence Low Now Consumer confidence is tanking the economy Michael A. Washington has gone on a wait and watch approach to the economy. Access to cash can come from savings. but weekly unemployment claims are not a lagging indicator. Kamperman runs his own investment advisory firm.Single Payer 2. Those anticipating more jobs in the months ahead decreased to 17.000 again. incomes are not in a position to pick up the slack for access to credit. As long as credit remains extremely tight the economy has to rely on savings and income. while those anticipating fewer jobs increased to 27. The Conference Board stated “the job outlook was also more pessimistic. The economy is made up of spending based on access to cash. They may seek to demean the data for the unemployment rate and call it once again a lagging indicator. then we will know the July unemployment report will also be weak. or credit. 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. This week they could get well get a wakeup call when the unemployment data is released.

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

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

0 LO 87 **COMPETITIVENESS** You’re A Jerk 87 .Single Payer 2.

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

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

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

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

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

is the more serious threat. hit a five-decade low of 2. Businesses unable to make a profit in an environment of declining prices will likely cut production and lay off more workers. And while lower prices might sound like a positive to consumers with budgets stretched to the breaking point. In July.Longtime technical analyst Robert Prechter. SEVEN MORE YEARS? Riskier assets such as commodities. Oil and U." he told Reuters in a wide ranging interview.reuters. U. "the difficulties will probably last through about 2016.000 an ounce in March 2008. predicted this week that U. Prechter said in an interview with Reuters.com. debt bubble and deflationary depression. "Our models are (showing) right now that it is a much bigger bear market than most people realize. the government's key inflation measure. You’re A Jerk 93 . chief economist at Moody's Economy. As banks continue to accumulate losses and corporate earnings fall." Prechter also painted a bleak picture for commodities like silver and is largely unenthusiastic about gold. “The inflation vs. " Deflation is coming.S. leading to job loss and decreased production Isidore. Prechter continues to advocate safer cash proxies such as Treasury bills. he said.Single Payer 2. reporters for Reuters “Stocks still face deflationary collapse: Prechter” http://www. Haddadin.S." said Mark Zandi. Treasury bonds are also locked in long term bear markets. Hathaim Haddadin.0 LO 93 Deflation Coming Deflation is a pertinent threat in the short-term and could lead to a deflationary spiral. That could cause a deflationary spiral." which warned of the dangers of a U. 7/23 Chris Isidore. Unemployment continues to rise.com/article/wtUSInvestingNews/idUSTRE54D4IL20090514?pageNumber=2&virtualBrandChannel=0 NEW YORK (Reuters) .htm?postversion=2009062313 But others argue the economy is still so weak that deflation. deflation debate” http://money. The U. banking system and company earnings sustain more damage from a financial crisis that's akin to the Great Depression. who forecast the 1987 stock market crash.com/2009/06/23/news/economy/inflation_deflation_debate/index. I don't see how businesses can raise prices in this environment. The benchmark U. "It's a very rare event." said Prechter. could be signs that prices are likely to keep falling. "I think the predominant risk in the next 6 to 12 months is deflation.cnn.S." he added. or a drop in prices." Prechter said. equities may plunge to half their lows hit in March as a deflationary depression bites. The Consumer Price Index.S. As in his 2002 book "Conquer the Crash." Experts believe that deflation and depression will come soon Parry. There's vacant real estate across all property types. while corporate bond prices will plunge precipitously by next year as broad economy. 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. and stocks which are currently anticipating that the severe global economic downturn may be bottoming. economists are in general agreement that deflation is far more destructive to the economy than inflation." he said. "There will be plenty of rallies along the way. chief executive at research company Elliott Wave International in Gainesville. coupled with rising unemployment and low factory utilization.S.S. crude oil hit a record peak above $147 per barrel and was just above $57 per barrel around noon on Thursday. it's going to lead to a depression. are likely to have short lived intense rallies. We're not at the bottom yet." he said. he said. So you want to stay on the side of safety. senior writer for CNNMoney.04 percent in mid-December. 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. and Mnyandu 5/14 John Parry.000 last year. Treasury bond prices are likely to fall in a long term bear market. 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." 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. "I think we are going to have bouts of deflation separated by recoveries. This year-over-year decline in prices. "There's excess capacity everywhere. believing the precious metal made a major peak when it rose above $1. Georgia. which moves inversely to its price. corporate bonds. something along the lines of 1929-1932. but within an inexorable long-term decline that may last another seven years. with huge government debt issuance being the main catalyst. senior writer for CNN Money. 10-year Treasury note yield. he said. "It's not the start of a new bull market. and Ellis Mnyandu . While gold may have already topped at above $1.

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

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

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

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

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

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

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

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. Even if Medicaid recipients are seen by private providers. 1981). De Alteriis. we contend that the existing research tells us what should be done. Those physicians who do treat large Medicaid caseloads tend to be older. it has been much criticized and its costs have soared. This paper considers the problems faced by the Medicaid program in the context of the problems faced by the American health care system.” Policy Studies Review. Ernst and Hay. 1985). Despite the program's costs. Martin. 1992). 1980). These large Medicaid practices are also known as "Medicaid mills.S. When the program was initiated in 1966. bureaucratic interference and the low status of the recipients (Holahan. Holahan and Carlson. Others recognize the economic advantages of very large Medicaid practices. between 30 and 40 million Americans do not have health coverage (Levit. reported delays in payment. Many recipients have difficulty accessing care. Since its inception in 1966. Medicaid expensive and ineffective – limited access to proper care..Olin and Letsch. Volume 11. 1992. Der. Preliminary data for 1991 suggest that total costs rose by more than 30 percent to $98 billion. 1992. Cromwell and Mitchell. total costs for 1992 are projected to reach $129 billion (Burner et al. Kletke and Ncckerrnan. Waldo and McKusick. as well as a number of other possibilities and permutations. [Mardjuki] Medicaid is very costly. Finally. Winter 1992.0 LO 101 Medicaid Reform Needed Medicaid reform sorely needed – failure to achieve its goals. You’re A Jerk 101 . 1978). 1992). “Medicaid’s Role in Moves Toward Universal Health Care. 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. Martin. De Alteriis. total annual federal and state costs were $1. 1987. Associate at MHA.The current program for providing the poor with health care coverage is part of the problem. what they can obtain is often of poor quality. Despite these expenditures. According to the latest estimates.Single Payer 2. 1975). are usually far lower than those allowed by private insurers and the Medicare program (Cromwell and Burstein.” Policy Studies Review. Most importantly. more likely to have graduated from foreign medical schools and have fewer hospital accreditations (Yett. The Medical Assistance program (Medicaid) provides health services for around 20 million poor Americans. We argue that Medicaid can only be successfully restructured as part of a major reform of the entire American health care system. Medicaid eligibles have difficulty accessing care. Winter 1992. 1983). Some of these physicians attract scarcely any private patients. 1992). the quality of care they receive is often poor. While other OECD nations have successfully curbed health care inflation. Associate at MHA. costs are expected to rise still further in the U. Held. 1984). by 1990 total costs had reached $75 billion.5 billion." They provide shorter visits and fewer physical examinations than mainstream medical practices (Mitchell and Cromwell. even in the most generous states. [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. Medicaid does not cover all poor individuals. what we need now is the political will to act. “Medicaid’s Role in Moves Toward Universal Health Care. Low fees have led to low physician participation rates (Perloff. One reason is that Medicaid fees for private physicians. which can compensate for the low fees by generating enormous volumes of claims (Cromwell and Mitchell. Volume 11. 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. Remedial measures that have already been tested are examined. There are geographic and demographic inequities in service provision.

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.0 LO 102 Medicaid Reform Needed Patchwork state Medicaid programs must be rectified to correct inequal treatment of the impoverished.3 percent of Medicaid costs. 1985). Volume 11. Hughes.Single Payer 2.4 million in 1975 to 3. Associate at MHA. In 1987. 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. All Medicaid programs must cover individuals receiving Supplementary Security Income (SS!) and Aid to Families with Dependent Children (AFDC>. 1992. 551 recipients were responsible for 73 percent of Medicaid costs. The result of all this is. 1987). Winter 1992. “Medicaid’s Role in Moves Toward Universal Health Care. while under 25 percent of the poor received Medicaid coverage in Wyoming. in the words of the United States General Accounting Office. while AFDC children under the ages of 21 were responsible for only 12. Butler and Howard. De Alteriis. You’re A Jerk 102 .. 1988). 551 recipients' total costs soared from $3 billion to $17 billion (Howell. Andrews and Gornick. California and Wisconsin. treated unequally in terms of both Medicaid eligibility and generosity of benefits" (U. 1989). General Accounting Office. Infants born to Medicaid recipients have been very poorly served (Rosenbaum. Over the same period. Some recipients fare exceptionally badly. 1988). and the quality assurance mechanisms are poor (Alan Guttmacher Institute. Michigan. not all necessary services are covered by state programs. whose numbers have risen steeply in recent years (from 2. There were also considerable differences in the number of services provided by the states. the total number of Medicaid eligibles has risen only moderately (by 6 percent). 1987). Private providers are unwilling to treat pregnant beneficiaries. Hurdle and Schurman.. Martin. over 80 percent of the poor received Medicaid coverage in Hawaii. Many are inappropriately institutionalized and denied access to appropriate care in their home communities (Smull. While AFDC recipients' per capita costs actually fell. Idaho and South Dakota. In 1981.” Policy Studies Review. Another group that suffers greatly are individuals with developmental disabilities.S. [Mardjuki] There are major inequities in the way the states confer benefits and eligibility. The largest expenditures are for disabled 551 recipients. 1988).3 million in 1987). "pervasive horizontal inequity-similar people in similar circumstances but in different states . Medicaid's funding levels for prenatal services until recently were very inadequate.

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

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

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

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

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

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

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

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

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

not insurance. 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 .Single Payer 2. If I told you that in less than a year after the historic Medicare legislation was signed into law.when we have a single-payer model." The question that her response prompts from me is. by most accepted measures.com/node/29667). Schoonmaker. No.baltimoresun. where the focus should have been from the start. 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 . is a whole lot less than "next best?" The House plan is not set to go "live" until January of 2013. 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. 7/20/09 Anne.1114455. Why are we writing 1. 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. and millions of older Americans had been enrolled and were getting health care with hardly a hiccup. 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. is health care. Medicare. "For 30 years I have supported a single-payer plan. that is not a typo. “Why not singlepayer?” Baltimore Sun. So. with an economy in decline.letters200jul20. or dropping coverage altogether. All of the major developed nations have some form of single-payer health care. Their spending per-person on health care is less than half what we spend here. thousands of people losing their jobs every month and losing their coverage. from all appearances.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) .0 LO 112 Squo Reform Fails – Need Single-Payer Only a single-payer system mitigates costs – Medicare proves.le. Global Sourcing Finance Chief at GE Healthcare. the program was up and running. and their people are.com/news/opinion/readersrespond/baled. with more employers changing to plans that cover less and cost the individual more. why are we giving up on the best solution and settling for something that. but our next best choice is to support an exchange and a public option.story [Mardjuki] In a Q-and-A recently posted on the Web site Crooks & Liars (http://crooksandliars. 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. maybe. what will the millions of currently uninsured people do between now and 2013? And.0.000-plus-page bills. healthier than we are. like the fact that we will have a presidential election in November of 2012. you wondered if there's a political reason why the plan won't be fully operational until 2013. House Speaker Nancy Pelosi responded to one of the questions by saying. http://www.

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

S. Marshall.php?ref=reccafe [Mardjuki] Having first identified health care reform as a critical issue confronting the U. 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.a government Administrator.eliminates duplicative bureaucracy. http://tpmcafe. former CEO of UnitedHealth Group. for example. These same consumers understand that it will take one CEO . 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.talkingpointsmemo.. that Bill McGuire. George Polk Award winner. etc. Joshua. 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.. 2009. each making multiples of this salary. To begin with. 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.” Talking Points Memo. accumulated total compensation of $1.0 LO 114 Single Payer Solves .000 (Highest rate now paid to any Cabinet Secretary) and will replace an untold number of private executives. It was recently reported. Without even getting into the specific details of how these other programs work. You’re A Jerk 114 .com/talk/blogs/jpieterick/2009/07/the-case-for-keeping-singe-pay. Multiples of $197k? Well.6 billion during 2005. probably at the level of a Cabinet Secretary . July 15.to oversee a singular bureaucracy in charge of providing universal health care to all. Duplication of services is understood to be extensive and extremely wasteful. yes. Quickly doing the math.Single Payer 2. as is the number of people needed to simply keep up with the myriad of different bookkeeping and other paper trails that are created. almost without regard for how large that family might be. generally as one whole system of paperwork and policies. chief reporter.Waste Single-payer reform more efficient . “The case for keeping “single payer health care” off the table. per provider. 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. This CEO will be expected to earn in the neighborhood of $197.

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

while individuals would pay 2. It would grant every legal U.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. while many of the alternatives would continue to leave millions uninsured. the U.would not be covered. You’re A Jerk 116 . which would be offset by a steep decline in insurance premiums. Even so. Single-payer would also allow consumers to choose a doctor without paying higher premiums or extra charges for this fundamental privilege. The difference is that under single-payer. Thanks to the paperwork and complexity of private insurance. the savings would amount to about $ 1. David Murray. "Single-payer provides the best assurances that patients would be able to seek care from any doctor of their choice. compared with only 11% in Canada.) and 92 other House Democrats. McDermott would finance all this with stiff federal tax increases. That group's stand shocks many observers. Under the leading single-payer proposal. No other plan is as generous.S. As in Canada.enough to provide coverage for 40 million uninsured Americans. CANADA” Business Week SOCIAL ISSUES. Japan. 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. mental-health treatment. the predominant concern should be controlling runaway spending on health care. But single-payer will do the most to eliminate much of the bureaucracy that has become the plague of American medicine.S. the U. this freedom is increasingly being constrained. will devote 14% of gross national product to health care: at least 40% more than Canada. resident full coverage starting in 1997.such as private hospital rooms -. some 24% of the nation's health-care spending now goes to administration.000 a year per family.S. single-payer offers equally compelling advantages. McDermott estimates.1%. But most managed-care plans also limit doctors' income. Critics challenge some of McDermott's projections. since under single-payer the states would negotiate fee schedules with physicians.S. chairman of the American College of Surgeons. For U. But taxes would probably have to be even higher.Single Payer 2. the government would pick up the entire tab for covered procedures. 75% of Americans would pay less than they do now for coverage. Thanks to the proliferation of managed-care plans.000 per employee would face an 8. Smaller businesses would pay 4%. Businesses with more than 75 workers and wages averaging more than $ 24. physicians would have more freedom to order necessary medical services without the constant second-guessing and micromanagement of managed care. effectively capping their income. McDermott would increase the federal cigarette tax to $ 2 a pack from 24 and impose a new 50% excise tax on handguns and ammunition. sponsored by Representative Jim McDermott (D-Wash. the single-payer approach has the potential in the long run to cut spending more than any other plan. This year. ranks below many of these nations in life expectancy and infant mortality. Number 3363. For consumers. By 2003." says Dr. including prescription drugs. In addition.4% payroll tax. 82 lexis-nexis [LO//AS] LESS OVERHEAD. A few frills -. Pg. Yet the CBO estimates that the single-payer system would trim overhead by up to $ 100 billion a year -. business. and long-term nursing-home care. or the European Community. Ultimately. By combining huge administrative savings with caps on national health spending.

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

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

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

You’re A Jerk 120 . Marcia.pnhp. Australia) have resulted in substantial savings. Quentin Young. The NHI would negotiate drug and equipment prices with manufacturers. Joel Alpert. with exceptions available in case of medical necessity. and ameliorate financial pressures that skew drug development. MD.php [Mardjuki] NHI would pay for all medically necessary prescription drugs and medical supplies. Additional reforms are urgently needed to: improve prescribing practices.” Physicians For A National Health Program. the formulary would specify use of the lowest cost medication. Ron Anderson.Single Payer 2.0 LO 120 Single Payer Solves – Drug Costs Single payer system lowers drug costs – pressure on big pharma. As a monopsony purchaser. American Public Health Association. Peter Beilenson. Christine Cassell. CEO Parkland Health System. “Proposal of the Physicians’ Working Group for single-Payer National Health Insurance. NHI could simultaneously address two pressing needs: (1) providing all Americans with full coverage for necessary drugs and supplies. Angell. curtail pharmaceutical marketing. Similar programs in the U. based on their costs (excluding marketing or lobbying). 2009. assure that the fruits of publicly funded drug research are not appropriated for private profit. American Academy of Pediatrics. upgrade monitoring of drug safety. and (2) containing drug costs. 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.org/single_payer_resources/proposal_of_the_physicians_working_group_for_singlepayer_national_health_insurance .g. minimize medication errors. and in other nations (e. Senior Lecturer @ Harvard Medical School.S. based on a national formulary. Commissioner of Baltimore City Health. Editor of New England Journal of Medicine. the NHI could exert substantial pressure on pharmaceutical companies to lower prices. Where therapeutically equivalent drugs are available. http://www. An expert panel would establish and regularly update the formulary. President of American College of Physicians.

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

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

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

You’re A Jerk 124 . Until 1995. Jr.sanctioned monopoly for an industry that has left thousands of state residents without health insurance due to escalating premiums. and maximizes value for patients . and deductibles. Yet. their system boasts a 70 percent approval rating from doctors and patients. has minimal financial barriers to care.3 billion dollars. 6-10-09 (John Conyers. US rep. Medicare was enacted in 1965 and fully implemented in 1966. 2009. In fiscal year 2009. has low administrative costs. health care spending has exploded in Massachusetts. enacted by that state's legislature in 2006. US rep. without the cost-containment measures that are integral parts of any public insurance plan. the reform cost taxpayers $1.0 LO 124 Single Payer Solves –Empirics A shift to single-payer from privatized health care is possible. June 10. Only a single payer health care system for all solves. June 10.. I would respectfully submit that single-payer offers a far better model for reform than the incremental.lawmakers in Massachusetts instead created a government. Governor Deval Patrick has been forced to cut money from safety-net providers such as public hospitals and community clinics. We have heard this argument before. US Representative on the Subcommittee on Health. Congressional Testimony. Lexis Nexis) [LO//JW] I would like to caution the committee about the dangers of enacting partial reforms that leave some individuals uninsured. This argument was initially raised when Medicare was debated in The the Congress in the 1960s. Taiwan proves Conyers.Single Payer 2. Congressional Testimony. Labor. US Representative on the Subcommittee on Health. and do little to contain the out of control growth of health expenditures. 2009. 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. grow the ranks of the underinsured. co-pays. Today. Lexis Nexis) [LO//JW] naysayers will also argue that dismantling our employer-based health care system is politically and economically untenable. Jr. Over the course of the next six years. Taiwan had a private health insurance market remarkably similar to our own. Massachusetts proves Conyers. and Pensions. As a result. 6-10-09 (John Conyers. The best example of such a legislative failure is the Massachusetts Health Reform Act. improving access to health insurance that emphasizes prevention. while only spending 2 percent on administrative costs. the country seamlessly transitioned to a single-payer national health insurance system. private insurance giveaway pursued in Massachusetts.. Not surprisingly. If the goal of reform is to limit costs and improve access to care. Employment. Employment. Additionally. the experience of the nation of Taiwan shows that such a transition is feasible. and Pensions. Instead of pursuing a reform strategy that has been successful in developed nations around the world namely. functions without a profit motive. Labor.

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

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

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

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

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

not 280 million individuals competing with one another. We should remember that the government is elected by the public and we are responsible for it. That is a self-fulfilling prophecy. and without considering the alternatives. the National Park Service. material possessions. That may be an inevitable consequence of a free market economy. regardless of who they are. we have an opportunity today to reassert that we are indeed a single nation. Some people say that a single-payer system is a good idea. http://www. 2009.0 LO 130 A2: Utopian? Single payer viable – necessary but needs support. MD. there would be powerful special interests opposing it and I don’t underestimate them. We need to acknowledge the same thing for health care. Some Americans like to say that. and social privilege. \ You’re A Jerk 130 . I want to mention one final and very important reason for enacting a national health program. I would not want to see. Editor of New England Journal of Medicine. One of those services is health care. I believe there is nothing unrealistic about a National Health Insurance Program.org/facts/statement_of_dr_marcia_angell_introducing_the_us_national_health_insurance_act. we are one community. Marcia. We live in a country that tolerates enormous disparities in income. for example.php [Mardjuki] Myth #4 says that the government can’t do anything right. An investor-owned insurance company reports to its owners.pnhp. helps ensure that we remain a cohesive and optimistic country. Senior Lecturer @ Harvard Medical School. but with courageous leadership. 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. the NIH. or the IRS privatized. It says that when it comes to vital needs. Angell. Providing these essential services to all Americans. In seeking to ensure adequate health care for all our citizens. “Statement of Dr. but politically unrealistic. In my opinion. and protection from crime. Yes. But those disparities should not extend to denying some of our citizens certain essential services because of their income or social status.Single Payer 2. not to the public. all of which we already acknowledge are public responsibilities. Marcia Angell introducing the US National Health Insurance Act. Others are education. without thinking of all the ways in which government functions very well indeed.” Physicians For A National Health Program. equal justice. and the support of the medical profession and public. clean water and air.

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

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

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

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

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

The fear is that the states would then have to ration care by imposing waiting lines and limiting spending on new technology. "They're not going to wait weeks or months for surgery. thus sharply slowing the medical arms race that has burdened the U. and give the government unbridled power to make life-and-death decisions.S. as Clinton's plan would. a Washington-based think tank. CANADA” Business Week SOCIAL ISSUES. Such laboratories would soon demonstrate that single-payer is not "socialized medicine. To control spending." But Canada's 30 years of experience with single-payer suggests care would not be compromised anywhere near as much as opponents predict." says Jack A. the CBO estimates. single-payer would establish a national health budget indexed to economic growth. would minimize constraints by continuing to allocate about 14% of GNP to health care. and triple demand for drug-abuse treatment.about waiting 45 minutes to fill up their gas tanks. with underutilized facilities. Few believe there's any chance Congress will approve a single-payer plan this year. health-care spending would be cut by $ 114 billion. sometimes called Canada Deluxe.0 LO 136 A2: Socialized Medicine American single-payer could handle increased demand – not socialized. and the average citizen. Pg. You’re A Jerk 136 .if not furious -. Symonds director of the Forgotten Half Project education program at Harvard “WHITHER A HEALTH-CARE SOLUTION? OH. home health care by 50%.Single Payer 2. "Americans get quite antsy -. it's by far the best way to control costs while preserving the freedom of choice and physician autonomy that made American medicine great. vs. Canadians do face waiting lines for some nonemergency procedures and have far less high-tech equipment." argues Vickery Stoughton.. Even so. Opponents foresee a nightmare. Opponents have raised some legitimate concerns. system. But if Congress approves a bill that allows states to opt for single-payer. "the Canadian system has served society. de facto rationing already exists. Proponents contend that this would force better planning. Canada and many other nations have already proven such budgets work. Meyer. to $ 175 billion. In the U." Rather.S. Many fear that single-payer would lead to runaway demand for services and then rationing. based upon how much you or your insurer can afford to pay. president of New Directions for Policy. By 2003. McDermott's plan. But at what cost? The CBO predicts that single-payer's liberal provisions would jack up demand for physician services by 30%. better than the U. an American who has worked as CEO of both Toronto Hospital and Duke University Medical Center. 82 lexis-nexis [LO//AS] LIBERAL PROVISIONS.S. Number 3363. 9. Symonds 94 William C. many observers expect it to be adopted by one or more states. or as much as 8.6% below what it would be without any changes.5% in Canada.

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

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

President of American College of Physicians. Commissioner of Baltimore City Health. Survey of Health (JCUSH). You’re A Jerk 139 . Editor of New England Journal of Medicine.php#socialized [Mardjuki] The O’Neills collected no new data. CEO Parkland Health System. http://www. and Canadian government statistical agencies. Their analysis rests on idiosyncratic.S. Quentin Young. Christine Cassell. “Recent Attacks on Single Payer Health Reform: Ideology Masquerading as Scholarship” Physicians For A National Health Program. highly selective and overtly biased reinterpretations of previously published data — mostly from the Joint Canada/U. Peter Beilenson.S. MD.pnhp. Ron Anderson. Joel Alpert. American Public Health Association. they ignore a large body of research and statistics that conflicts with their portrayal.Single Payer 2. American Academy of Pediatrics. 2009.0 LO 139 A2: O’Neill Free market approach increases costs – duplicative equipment and competitive treatments. While they extensively cite the few pieces of published data that supports their grim view of Canada’s health system.org/facts/singlepayer_faq. Angell. Marcia. Senior Lecturer @ Harvard Medical School. a population-based survey conducted jointly by the U.

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

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

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

Single Payer 2.0 LO 143 **Add-ons** You’re A Jerk 143 .

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

a universal. which sells customer relationship. Nor can they compete with companies located in countries that offer national health insurance . national health care spending will double over the next 10 years.0 LO 145 Small Business Add-on Ext Businesses are suffering from privatized HC Pibel and Gelder 06 Doug Pibel and Sarah Van Gelder. (This included the owners. Way cheaper.com/smallbiz/content/jul2009/sb20090721_906996. In 2008 it paid $375. If we opt for Kennedy's proposal.htm [LO//AS] Will national health care benefit us as a country? I'm not really sure. a national insurance plan would be cheaper for me. The National Coalition on Health Care (NCHC) estimates that. The shocking facts about health care in the United States are well known. 7/21 owner of the Marks Group.businessweek. service. Employers who want to offer employee health care benefits can't compete with low-road employers who offer none. editors for Yes! Magazine. Insurance premiums increased 73 percent between 2000 and 2005. author of best-selling small business books.000 net health insurance on a payroll totaling $2. Yes. But one thing I know for sure: British food is terrible.Single Payer 2. Ray (R-IA) and Paul G. But take a look at these numbers from a client of mine—a 50-person manufacturer in Pennsylvania. and it counts General Electric and Verizon among its members. those critics are probably right—socialized medicine will probably lead to higher individual taxes. Written in Business Week “National Health Care: How Small Business Will Fare” http://www. and financial management tools to small and midsize businesses.org/issues/health-care-for-all/1498[LO//AS] Businesses are suffering too. National Health Insurance helps small businesses Marks. and per capita costs are expected to keep rising. let me explain. The NCHC is not some fringe advocacy group—its co-chairs are Congressmen Robert D. That works out to 18% of its payroll cost.) And this is for a pretty basic Blue Cross plan. and a strong urge to have tea and biscuits at 4 o'clock. And a national health insurance system would be a good thing for small business owners.086 million. lower-quality health care. the company would save about $208. What's not well known is that the dialogue about fixing the health care system is just as broken. Among politicians and pundits. longer wait times for treatment. it would save $337.000. If we go with the President's 8% plan. 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. Rogers (D-FL).500 per year! You’re A Jerk 145 . Marks is the author of four best-selling small business books. Not a bad thing. publicly funded system is off the table.yesmagazine. For one. There's little argument that the system is broken. without reform. as a business owner. Now before my fellow conservatives handcuff me to a TV and force me to watch 20 hours of The Franken & Davis Show. an award-winning publication “ Health Care: It's What Ails Us” http://www.

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

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

Single Payer 2. FAIR March 6. Everyone would have a medical identification card (like a Medicare card). The views of CNN's senior medical correspondent notwithstanding. 676. Private insurance systems could insure for services not covered by this single public plan. 2009.php? page=3733 [Mardjuki] CNN senior medical correspondent Elizabeth Cohen has herself adopted this terminology in discussing healthcare reform. Though more than 60 lawmakers have co-sponsored H." Particularly in the absence of actual coverage of single-payer. adding preventive.” Journal of Community Health Nursing. But given the high level of popular support the policy enjoys. Expand Medicare to everyone. Miller. both the idea and its advocates were marginalized in yesterday's healthcare forum. and there would be no charge for most preventive services. “FAIR Study: Media Blackout on Single-Payer Healthcare. and well child care. Alternatively.fair. Obama has not expressed support for singlepayer.org/index. 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. RN and MSN @ Ball State University. Fairness and Accuracy in Reporting. Expansion of existing public programs might be more politically acceptable than establishing completely new programs (Harrington. Pgs. 1990). Volume 4.” http://www. 10/9-19/03) suggests that the public would actually favor single-payer. blurring the differences between the Canadian model of government-administered national health insurance coupled with private healthcare delivery that single-payer proponents advocate. the single-payer bill in Congress. that's all the more reason media should include it in the public debate about the future of healthcare.R. in which healthcare (and not just healthcare insurance) is administered by the government. [Mardjuki] A new single-payer system could be designed for the entire population. Anna. The existing single-payer Medicare system could be expanded to include everyone.g. stating (CNN Newsroom. 2/26/09) that "if in time. 199-211. perinatal. such rhetoric confuses rather than informs. existing governmental health insurance programs could be modified and expanded to provide insurance coverage for specific population groups. 1993.0 LO 148 Plan Pop Plan popular – public and Congress. opinion polling (e. ABC News/Washington Post. You’re A Jerk 148 . and healthcare systems such as Britain's.. copayments and deductibles would be reduced for low-income persons. “Health Care Reform: Clarifying the Concepts. Expansion of Medicare system popular – less contentious than new healthcare reform. Americans start to think what President Obama is proposing is some kind of government-run health system--a la Canada.

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

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

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

b. which will in turn cause delays in considering the massive bills this summer and could jeopardize passage in the fall. 7. In addition. “Strategists worry Obama’s popularity is dropping” http://www. Obama is very appealing as an individual. he has moved the federal government into a more activist role than it has had under any other president in years. reversing his momentum. "Regardless of how it is initially structured. Obama’s political capital is down. "The public [government] plan. This was because the supremely articulate. The DA isn’t intrinsic – a. President Obama has enjoyed a honeymoon with the country and the media (although not with opposition Republicans). Intrinsicness allows the aff to test the relevance of the link. which initially boosted his ratings. Federal policymakers could control both impacts – they can pass the plan and healthcare reform 5. Obama has endured a surge of bad news. Iran election. The Congressional Budget Office estimated that one of the major Democratic healthcare proposals being circulated in the Senate would cost an astounding $1 trillion.com/articles/news/obama/2009/07/01/strategists-worry-obamas-popularity-is-dropping. is an important tool to discipline insurance companies. In a letter to senators released this week.html President Obama is heading into stormy waters. This sent legislators scurrying to reduce the price tags. It’s reciprocal – negative can counterplan out of advantages to test their germaneness to the plan. and confidence in his handling of the economy is ebbing. Impact inevitable – Boston Globe 9 is in context of Social Security reform. he is being faulted for a shaky response to the post-election violence in Iran. In fact. according to Democratic pollster Geoff Garin. and other areas of national life.Single Payer 2. Bush. and proposing huge changes in healthcare. taking over much of the U. That’s Woodhead 9. injecting vast sums of money into the economy. Over the past couple of weeks. bailing out the financial industry. energy policy. 7/1/2009. employer-sponsored plans. Until now.S. a government plan would use its built-in advantages to take over the health insurance market. This solves back any infinite regression claims. 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. America's Health insurance Plans and the Blue Cross Blue Shield Association wrote. who remains unpopular. his job-approval ratings are dropping. No link – do the plan and pass universal healthcare. But the ground may be shifting." 6.0 LO 152 2AC Healthcare Politics (2/3) 4. auto industry. Uniqueness overwhelms the link – some semblance of health care is guaranteed by Obama’s political clout – it’s too big to fail. not healthcare – healthcare doesn’t send the financial signal of solvency international investors are looking for You’re A Jerk 152 . economy U.usnews. His healthcare plans have stalled on Capitol Hill.healthcare. Finally. It’s fair – we’ll only make one intrinsicness argument per debate. 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. and Obama delivered. charismatic Obama presented such a contrast to George W." But Obama told a news conference Tuesday. voters wanted action from their president in tough times. News. the estimate for another plan was even larger—$1.S. b. I think.6 trillion.

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

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

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

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

Those outside the United States also appear to have lost faith in the U.the Wall Street bailout. Maybe deficits really do matter to Obama. What additional revenues there are in his budget are earmarked to offset the cost of his health-care reforms. President Obama recently sent to Congress a proposal to either eliminate or reduce spending for 121 programs for a savings of $17 billion.investmentnews. even assuming a fully recovered economy. The federal government now borrows a whopping 46 cents of every $1 it spends. 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. To be fair. Deficits growing now – no fix coming THE DAILY INDEPENDENT 5 – 25 . almost four times the previous record set by President Bush. 3. 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 so.S. investor protections to ensure an orderly functioning of the equity markets. it represents 0. For those who us who believe that bringing spending in line with revenue does matter. Obama’s actions tell a different story. More than 2. The White House forecasts show that. despite all of his assuring words. or the next generation. mostly from his own Democrats trying to protect their pet projects. the stimulus package . respondents generally consider corporate boards and corporate executives to be most responsible for the current financial crisis. You’re A Jerk 157 . Ashland.3 trillion next. Maybe so. New White House forecasts show a deficit of $1.4 trillion in federal spending.com/apps/pbcs. In the ethical-behavior category. Based on their perception of market ethics and integrity alone.S.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. According to the report that accompanied the survey findings.-based respondents were likely to recommend investing in U. The White House contends big spending . In short. with pension fund managers earning the top-rated spot.0 LO 157 2AC Econ DA (1/3) 1.txt] The Daily Independent.Single Payer 2. 4. President Barack Obama’s actions fall far. markets.is a necessary but temporary evil to jump-start the country out of recession. The new president recently told his Cabinet: “We can no longer afford to spend as if deficits do not matter. only 49% (versus 68% a year ago) of U. Failure to rectify ballooning state Medicaid deficits makes economic decline inevitable.8 trillion this year. And his proposal immediately ran into a storm of opposition on Capitol Hill. Obama’s words were most welcome. 2. Investment News. If that sounds like a lot. However. expect President Obama to boast in future years about cutting the deficit. We can no longer afford to leave the hard choices for the next budget. which believed deficits really didn’t matter. far short of matching his words. Nevertheless.. .” Those words come after eight years of irresponsible spending during the administration of President George W. not deficit reduction.com/articles/2009/05/25/opinion/our_opinion/opinion2. 7/21/2009 (http://www.S. market systems. 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. the perception of hedge fund managers was lowest overall. but his proposals sure don’t indicate that. President Obama plans on passing the problem of the deficit to the next president. the next administration.000 investment professionals participated in the research by taking the survey either online or via telephone interview in February and March.S. . Investor confidence low – comprehensive study proves Jeff Benjamin. Bush..5 percent of next year’s projected $3. that would be a tactic lifted from his predecessor..09 [President’s policies don’t match his words. When it comes to reducing the federal deficit. and $1. the deficits will not dip below $500 billion a year for the next decade. according to the finding. 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.. 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. http://bgdailynews.

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

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

eliminating the use of a military 2. so much so that they can again be more selective in choosing their recruits. 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 estimates states will get three times more money for education than for transportation. education. but it also calls for caution to avoid falling behind on future manpower needs. 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." said Chris Whatley. Technological dominance means that each one of our soldiers can do more damage than one of the enemy’s. Earlier this spring. 3. the Pentagon plans to cut its $7." The reality of how the vast majority of the stimulus money will be spent is quite different. relief for state budgets and direct payments to the unemployed and others hurt by the recession.Single Payer 2.7 billion budget for recruiting and retention by almost $800 million. That comes as good news for the Pentagon and nation. getting back on the job to rebuild the nation's infrastructure.0 LO 160 2AC Military DA (1/2) 1. about 15 percent of the money is for transportation. 2009. according to Federal Funds Information for States. June 4. Arnold Schwarzenegger appeared before the cameras at a job site along a freeway east of San Francisco.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. including airports. Most of the roughly $300 billion coming directly to the states is being funneled through existing government programs for health care. food stamps and other social services. the Washington director of the Council of State Governments. two-thirds of the stimulus program will go toward tax cuts. Overall. so we need less soldiers b. the Army has been issuing waivers to those with criminal records or health problems who would have been unacceptable before. Stimulus spent over 300 billion dollars on expanding social services AP Associated Press. 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. a trade group for state governments.if every single state’s economy collapsed. in fact. The public face of the stimulus package has been the worker in a hard hat. Economic power is perceived more than military readiness .msnbc.msn. then other countries would perceive that the US is no longer a threat c. that's not the case. The armed services have met or exceeded their recruitment goals in the past few months. http://www. As a result. highways and rail projects. Government programs benefit Two-thirds of recovery money that flows directly to states will go toward health care. California Gov. part of the administration's desire to provide immediate fiscal You’re A Jerk 160 . for example. Budget Cuts mean recruiting will decrease Watertown Daily Times ’09 (Watertown Daily Times 5-12-09 http://www. That is no longer necessary.watertowndailytimes.com/id/31110642// Remember the "shovel-ready" projects lined up for all that stimulus money? It turns out social spending. He declared that the stimulus-financed project would provide paychecks for 235 construction workers who otherwise would have to "stand in the unemployment line. more than construction. "We all talked about 'shovel-ready' since September and assumed it was a whole lot of paving and building when. Case internals outweigh the disad’s a. 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. In order to meets its goals. By comparison. Economic decline means that the US withdraws. unemployment benefits.

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

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

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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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States face other problems from the weakening economy. “New Fiscal Year Brings Continued Trouble for States Due to Economic Downturn.Single Payer 2. and choice. Continued job losses will depress revenues further. As both Clinton and Bradley learned. and they are declining due to the fall in both personal consumption and business purchases. more families are turning to programs like Medicaid. BPP.and moderate income families and is jointly funded by Washington and the states. Robert and Roger. [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. state revenues must grow. The Next Agenda: Blueprint for a New Progressive Movement. which provides health coverage to low. Politically. However. 3.payer insurance. single.” Policy Points. prof of law @ American University. The Rockefeller Institute of Government reports state tax collections fell 12. Federalist healthcare politically controversial – lacks single-payer’s prior history of support Borosage. 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. 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. As a result. for example. the federalist strategy is not problem-free. b. Income taxes and other taxes are also falling as wages and investment income decline. Counterplan doesn’t end states’ procyclic economic action – only a federal system solves – that’s Lav and McNichol. The fifty states have never uniformly passed a single policy. • Employers are reducing jobs and cutting back on employer-provided health coverage. • To keep pace with the cost of services. 2001. 50 State fiat bad – a. Not researchable. Hickey. You’re A Jerk 166 . Center on Budget and Policy Priorities. income tax collections during the first four months of this year fell by 26 percent compared to the same period last year. states' rights. 5. Pg 112. We can’t research specific solvency answers to a mechanism that isn’t predictable. States can’t solve – increased taxes exacerbate the recession. • Sales taxes are the largest source of state tax revenue. 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. 6. Perm do both – perm accesses double coverage of dual single-payer healthcare systems. http://www.form debate—and one that lacks the familiarity of. it taps into the rhetoric of devolution. Substantively. vice president @ Economic Policy Institute. lt also puts opponents of reform on the defensive.cbpp. The first and largest barrier it has to surrnount is that it represents a new alternative in the American health re. But overall revenues last year were essentially flat and have weakened dramatically this year. shifting the focus of debate from the details of a particular plan to the fundamental question of whether legislators support universal coverage.cfm?fa=view&id=1283 [Mardjuki] The state revenue situation is rapidly worsening. it recognizes the variation in state health care systems and reform preferences.0 LO 166 2AC States CP (1/2) 1. c. 2. According to the Rockefeller Institute of Government. 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. 7/23/09.org/cms/index. 4.6 percent in the first quarter of 2009 compared with last year.

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

September 18. 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. States face very different problems in covering their low-income populations because of the variation in employer-sponsored insurance. Medicaid programs spent $314. This insurance varies among states because of industry and firm size. higher-income states tend to spend far more per capita from their own resources. the variations in Medic-aid spending are quite extensive.3 This is in part because states have very different problems to address. Some variation is inevitable and exists in Medicare and private coverage as well. and a number of other factors. The latter depends a lot on per capita income—that is.5 Thus. Pgs 667-669. The evidence shows that although federal matching rates are inversely related to income with the intent of encouraging states to spend more—that is.Single Payer 2. For example. coverage and spending variation.” Health Affairs: Policy Journal of the Health Sphere. a great deal of federal money supports these programs. John.5 billion by states You’re A Jerk 168 . the spending variations have consequences that are felt at the national level.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. Moreover. Although the nation has chosen to have a decentralized system to provide coverage to low-income Americans. states are left with very different shares of the population without employer-sponsored insurance. more than half of the cost of Medicaid and the State Children’s Health Insurance Program (SCHIP) is borne by the federal government. Director of Health Policy Research Center @ The Urban Institute. the federal and state spending on Medicaid services is much higher in high-income states than in low-income states. income. education. people with low incomes are a higher share of the population in some states than others.6 Of this. States then vary greatly in the extent to which public programs cover those who remain without coverage. states’ ability to pay—but it also depends on the general philosophy toward income transfers to lower-income populations. $179. such that even with the lower federal matching contributions. uninsurance rates differ greatly among states.highwire.0 LO 168 A2: States CP States can’t solve – can’t cover uninsured.0 billion was spent by the federal government and $135. In the end. As a result.4 That is.2 As a result. http://healthaff. But whether the variation that we observe in Medicaid is acceptable is another matter. 6. 2007. composition.5 billion for health services in 2006. Volume 26 No. 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. Between the variation in spending per enrollee and the share of low-income populations that are covered. We have shown elsewhere that states with lower levels of spending have lower levels of access and worse health outcomes. Holahan. 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. “State Variation in Medicaid Spending: Hard to Justify.

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

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

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

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

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