Taiwan shows single payer can work

Cheng ‘15
Cheng, Tsung-Mei. “Reflections On The 20th Anniversary Of Taiwan’s Single-Payer National Health Insurance System.” Health Affairs, March 2015,
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2014.1332.

On its twentieth anniversary, Taiwan’s

National Health Insurance (NHI) stands out as a
high-performing single-payer national health insurance system that provides
universal health coverage to Taiwan’s 23.4 million residents based on
egalitarian ethical principles. The system has encountered myriad challenges over the years, including serious
financial deficits. Taiwan’s government managed those crises through successive policy adjustments
and reforms. Taiwan’s
NHI continues to enjoy high public satisfaction and delivers
affordable modern health care to all Taiwanese without the waiting times in single-payer
systems such as those in England and Canada. It faces challenges, including balancing the system’s budget, improving the quality
of health care, and achieving greater cost-effectiveness. However, Taiwan’s
experience with the NHI shows
that a single-payer approach can work and control health care costs effectively.
There are lessons for the United States in how to expand coverage rapidly, manage incremental adjustments
to the health system, and achieve freedom of choice.

FOX and POIRIER 18 How Single-payer Stacks Up. Author(s): Ashley Fox and Roland Poirier. Source: International
Journal of Health Services, July 2018, Vol. 48, No. 3 (July 2018), pp. 568-585.Published by: Sage Publications, Inc.
Stable URL: https://www.jstor.org/stable/10.2307/48513118

Putting more objective indicators of quality aside, patient

satisfaction is considered one of the principle
performance goals of a health system along with health outcomes and risk protection.28 Overall,
23% of Americans felt that their health care system needed to be completely rebuilt, compared with
an average of 6.5% in (single payer systems) NHI and NHS systems and 4.5% in SHI systems.
Americans appear to be profoundly unhappy with their private health insurance system, whereas
those in public systems appear quite satisfied with their coverage systems.

Private health insurance is inconsistent with distributive justice

Brock and Buchanan ‘86

Brock, Dan W., and Allen Buchanan. “Ethical Issues in For-Profit Health Care - For-Profit Enterprise in Health Care.” NCBI, 1986,
https://www.ncbi.nlm.nih.gov/books/NBK217902/. Accessed 12 August 2022.

“If the goal is only to ensure that everyone is guaranteed access to some minimally adequate level of health care, why not leave its distribution to the
market and so to for-profit institutions? The difficulties with doing so are well known and need not be rehearsed in detail here. Generally, a

market system for the distribution of health care, like a market distribution of all other goods and services,
will be influenced by the initial natural endowments and wealth that people bring
to the market, rather than simply by their need for health care. The market
distribution of health care, as with other goods, will only be just if the distribution
of initial assets, including income and wealth, is just.
However, there are specific characteristics of health care, and of health care markets, which further ensure that a market distribution of health care will
fail to satisfy, the demands of any theory. of justice requiring that some minimally adequate level of access to health care be guaranteed to all.

Health care needs are highly unpredictable for any particular individual, vary greatly between different individuals (unlike
other basic needs for food or shelter), and in the context of modern health care are very expensive relative to most other goods and

services. As a result, it is difficult if not impossible for any but the very richest to

budget their health care expenditures.

The market solution to this situation, of course, is the development of a market in insurance, a device for risk-sharing that enables individuals to protect
themselves from substantial unforeseen financial losses and to secure very. expensive professional help in coping with disease or disability when it
Different insurance
occurs. However, competition in the market for health care insurance will lead to differentiation of risk pools.

packages, with different premiums, will be developed for different groups of

individuals with similar risks of sickness and disability with the result that those
individuals who have the greatest risk of ill health—that is, those who need
insurance the most—will find it prohibitively costly. Regulatory measures requiring community rating of
insurance risks and unlimited access to insurance pools can be used to counter risk-pool differentiation, although a market proponent will view these as
inefficient interferences in the operation of health care markets.
health care insurance will remain extremely
With either different risk pools or community rating, however,

expensive, and beyond the financial reach of substantial numbers of the poor in
this country. This would be true even if access to health insurance were less closely tied to employment than it is in the United States today.
Thus, even with health insurance the market will make access to even some minimally adequate level of health care depend upon ability to pay, an ability that many millions of Americans today lack (and would lack even under a system of perfectly competitive
markets for the distribution of income).
On virtually any general theory of distributive justice, and in particular any theory of justice in health care other than a rather austere libertarian view, no one in a country as wealthy as ours ought to have to go without access to at least a minimally adequate level of
health care. There is a general moral obligation of society to ensure that level of access for all, and we have argued that the obligation falls ultimately on the federal government. While general theories of rights are not well developed, nevertheless, we believe this

obligation supports the claim that there is a moral right of all Americans to that level of health care. Market distribution systems employing for-profit health care delivery systems will fail to meet this obligation, or to secure the correlative right, and so
the distribution
will distribute health care in an unjust way. To this extent, then, the rhetoric with which we began this section is correct:

of health care ought not be left to the market and ought not depend on ability to
pay.”

SP can be financed numerous streams

FOX and POIRIER 18 How Single-payer Stacks Up. Author(s): Ashley Fox and Roland Poirier. Source: International Journal of Health
Services, July 2018, Vol. 48, No. 3 (July 2018), pp. 568-585.Published by: Sage Publications, Inc.Stable URL:
https://www.jstor.org/stable/10.2307/48513118

The lack of systematic comparisons between the performance of single-payer models and other universal coverage models appears to arise at least
partially from confusion even among experts regarding what distinguishes a single-payer model from other forms of universal coverage. For instance,
Glied evaluates the cost of single-payer coverage models using the concentration of financing from a single revenue source
(i.e., payroll versus general taxes versus private insurance) as a marker of a system constituting a single-payer model.14 However, this conflates

the number of revenue streams with the number of payers, the latter of which is a better
marker of a single-payer system. Medicare, the U.S. single-payer equivalent, is financed
through a variety of sources, including payroll tax, income tax, and individual premium
payments, among other sources, and yet because the U.S. government pays all Medicare
claims via the Centers for Medicare and Medicaid Services (CMS), Medicare [it] is considered a single-payer system.

U.S. spends less on single payer

Public Citizen ‘20 “FACT CHECK: Medicare for All Would Save the U.S. Trillions; Public Option Would Leave Millions
Uninsured, Not Garner Savings.” Public Citizen,
www.citizen.org/news/fact-check-medicare-for-all-would-save-the-u-s-trillions-public-option-would-leave-millions-uninsured-not-garn
er-savings/.

Medicare for All opponents repeatedly claim that Medicare for All is “too expensive” by presenting misleading numbers without the proper context of our unsustainable health care spending. Here are the facts:
We can’t afford NOT to implement Medicare for All.

● Our health care spending is estimated to continue rising and will reachnearly $6 trillion a year by 2027 . That means according to the federal government, we will

$42.9 trillion
spend around over the next decade on health care if we maintain the status quo.

Medicare for All will cost LESS than our current system.
● study Medicare for All would save around 68,000 lives a year reducing
A recent by Yale epidemiologists found that while U.S. health care

spending by 13%, around or $450 billion a year.

● Medicare for All spending would be $37.8 trillion study approximately between 2017 and 2026, according to a by the Political Economy Research Institute (PERI) at the University of

about $5 trillion in savings reducing administrative costs

Massachusetts Amherst. That amounts to over that time. These savings would come from and allowing the government

negotiate prescription drug prices

to .

● studies Other reduce our total health care spending

by think tanks and government agencies have analyzed single-payer proposals at the state and federal levels. Most found Medicare for All would .

● Koch-funded Mercatus Center

Even a study by the found that Medicare for All would save around $2 trillion over a 10-year period.

With Medicare for All, most families would spend less on health care than they do now on premiums, copays and deductibles.

● ​Some additional taxes would be needed to pay for Medicare for All, but most Americans would spend less on health care than they do right now.

● Overall, working familie s that make around $60,000 a year would pay up to 14% less their annual health care costs.

As the debate grows on how to overhaul the health care system, Medicare for All is being pitted against a public option. It’s important to highlight the differences between the policies.

A public option would:

● Cost $175 billion more per year would cost $600
even more than the wasteful status quo, around . And because it wouldn’t have comparable savings from efficiencies and negotiating power, it

billion a year more than Medicare for All without providing as generous coverage;

● Leave millions uninsured or underinsured and subject to unnecessary out-of-pocket

costs, including copays and deductibles;
● Leave more than 100 million Americans at the whim of private for-profit insurance, so they would be under constant fear of

disruption when their employer changes plans or they lose or change jobs;

US can afford SP
Finnegan ‘20 Finnegan, Joanne. “How Can U.S. Healthcare Save More than $600B? Switch to a Single-Payer System, Study Suggests.”
Fierce Healthcare, 7 Jan. 2020,
www.fiercehealthcare.com/practices/how-can-u-s-healthcare-save-more-than-600b-switch-to-a-single-payer-system-study-says.

The study is the first of its kind that reviewed analyses of single-payer proposals and provides strong evidence that
Medicare for All would be financially affordable for the U.S., said the study’s first author Christopher Cai, a
third-year medical student at the University of California, San Francisco (UCSF), in an interview with FierceHealthcare. To study the consequences of
what would happen if the U.S. adopted a single-payer system, researchers from the University of California in San Francisco, Los Angeles and
Berkeley examined
22 economic analyses by government, business and academic
organizations of national and state-level single-payer plans, including proposals made in Massachusetts,
California, Maryland, Vermont, Minnesota, Pennsylvania, New York and Oregon. These analyses were used by policymakers to evaluate the proposals,
estimating savings the plans would create through simplified billing and lower drug costs while also taking into account increases in health spending
Nineteen of the studies showed the U.S.
that would arise as newly insured people sought healthcare, the study said.

would save money in the first year of adoption, averaging 3.5% of total healthcare
spending, and all of the studies showed healthcare savings in the long term. The greatest source of
savings comes from reduced administrative costs, with further savings from lower drug costs, the study found. The models were created by analysts
from different political perspectives, and they provided a range of cost
estimates in the first year of operation, from
7% higher to 15% lower. In the long term, savings from simplified payment administration
and reductions in drug prices and other efficiencies ranged from 3% to 27%, with the
largest savings found in plans that lowered drug costs, the study said. Actual costs and savings will depend on
features and implementation under a specific proposal. Under proposed single-payer plans, such as Medicare for All, a unified public financing system
would replace private insurance, similar to the healthcare system in Canada and many other wealthy countries. A separate study released last week in
the Annals of Internal Medicine that compared U.S. administrative healthcare costs with that of neighboring Canada indicated the U.S. would
save $600 billion in costs by switching to a single-payer system. Medicare for All has generated
discussion in the seven Democratic presidential debates held so far. Candidates Bernie Sanders, a senator from Vermont, and Elizabeth Warren, a
senator from Massachusetts, both support Medicare for All proposals, while some other candidates favor building on the Affordable Care Act. The
PLOS study could help bolster the argument for Medicare for All. “It’s always our hope that elected officials will spread accurate information. If you
watched the [Democratic presidential] debate last night, a lot of people were referencing that Medicare for All will cost more and we can’t afford it. In
light of this evidence, I think that’s simply not true,” said Cai, who disclosed as part of the study that he is an executive board member of Students for a
National Health Program, a group that supports a single-payer system.

50 states CP
Yi ‘22 Jean_Yi_. “More States Are Proposing Single-Payer Health Care. Why Aren't They Succeeding?” FiveThirtyEight, FiveThirtyEight, 9 Mar. 2022,
fivethirtyeight.com/features/more-states-are-proposing-single-payer-health-care-why-arent-they-succeeding/.

What do all these proposals have in common? They’ve all universally failed. In fact, Vermont, the only state that managed to pass single-payer health care in 2011, ended up shelving its plan three years later. It makes sense why
single-payer advocates have tried to take these fights to the states. States have traditionally been seen as the “laboratories of democracy,” and some advocates of single-payer health care have argued that liberal states could provide unique opportunities to advance

single-payer health care at the state level is next to impossible, as states are particularly
single-payer health care. But as I’ll explain, passing

limited in how they can allocate federal and private health care funds. There is, however, evidence that Americans may have an
appetite for a public option, or government-run health insurance that people can opt into at the state level. Three states (Colorado, Nevada and Washington) have already passed a public option. It’s not

finding a
single-payer health care reform, but it’s possible that we might see more states adopt their own public-option reforms. One big reason single-payer proposals haven’t caught on at the state level is because

reliable way to pay for such a program is challenging. Single-payer advocates originally envisioned a federal proposal that would cover all Americans under a more generous version of a preexisting
program — that is, Medicare, but now for all. Doing this state-by-state [it] would require each state[s] to apply for waivers to divert federal

funds used for Medicare, Medicaid and Affordable Care Act exchanges to be used for their own single-payer plans. And that’s tricky
because the Department of H Human Services has wide discretion to approve or deny states’ requests, which
ealth and

mak[ing]es any proposal highly dependent on the national political climate. This isn’t just a theoretical debate either: Trump’s administrator for
the Centers for Medicare & Medicaid Services Seema Verma said in 2018 that she would deny waivers from states to create single-payer systems, while Biden’s Health and Human Services Secretary Xavier Becerra
has expressed more favorable sentiments. Almost all single-payer proposals depend on these waivers and states don’t often have fallback plans for if this federal funding gets denied. Employer-sponsored health

Federal law largely prevents states from

insurance plans, which cover 54 percent of Americans, are another hurdle for states trying to pass single-payer health care.

regulating employer-provided health insurance, so states can’t just stop employers from
offering their own health care benefits. The exact scope of this law has been litigated for decades, but suffice it to say that it’s successfully put the kibosh on many
statewide health care reforms. Single-payer health insurance is particularly tricky as there’s no way to get everyone onto the plan without first changing how private insurance works. States have tried to address this through measures like increasing payroll taxes or

Finally,
restricting providers’ ability to accept reimbursement from private insurance plans. But the more elaborate these mechanisms get, the more complicated it becomes to implement — and the more people that could slip through the cracks

another big financial barrier is that state governments have far less leeway than the federal
government to increase budgetary spending. That means tax increases, which come with their own political challenges, are often necessary for states to secure the funding they
need. Take California’s single-payer proposal, which failed in late January. It would have required two-thirds of voters to pass a separate constitutional amendment to implement the necessary tax increases to pay for it. Concerns over tax increases also contributed to
the demise of single-payer proposals in Colorado and Vermont. It’s true that a recent analysis of New York’s single-payer health care plan found that it would lower overall health care spending by 3 percent by 2031, but it would also require additional state tax
revenue of $139 billion in 2022 — over 150 percent of the current state budget. Politicians facing the next election cycle may be leery of proposing short-term tax increases, even if the end result is long-term savings.
Additionally, tens of thousands of preventable deaths year after year results
in millions of deaths from inequitable insurance
Hahn 15 [Matthew Hahn, M.D. *Internally cites Robert Zarr, board-certified pediatrician at Unity Health Care, medical
degree from Baylor College of Medicine and completed his pediatric residency at Texas Children’s Hospital in Houston. He also has
a
master’s degree in public health, specializing in international health, from the University of Texas School of Public Health,
11-16-2015, https://www.singlepayeraction.org/2015/09/16/more-americans-have-health
coverage-but-many-cant-afford-to-use-it/]

The Census Bureau says number of uninsured has dropped to 33 million in

wake of Affordable Care Act.
But the Census Bureau is silent on problems of rising deductibles, copays, coinsurance
and narrow networks that deter people from seeking care.
“The Census Bureau’s official estimate that 33 million Americans lacked
health insurance in 2014 reflects a significant and welcome drop from the 42
million it reported as uninsured in 2013,” said Dr. Robert Zarr, president of Physicians
for a National Health Program, today. “But the number of people who remain
without coverage is stillintolerably high. And the Census Bureau report
leaves entirely unmentioned the millions of people who have health insurance but
who can’t affordto use it because of high deductibles and copays.” “Having health
insurance is better than not having coverage, as several research studies have shown,” Zarr, a Washington,
D.C.-based pediatrician, said. “For example, the 33 million people the Census Bureau says
were uninsured in 2014 means that approximately 33,000 people died needlessly
last year because they couldn’t get access to timely and appropriate care.” He
cited a landmark study in the American Journal of Public Health showing
that for every 1 million persons who are uninsured in a given year, there are
about 1,000 deaths linked chiefly to that factor“That’s an unnecessary death
every 16 minutes,” Zarr said. “That’s completely unacceptable. Moreover, the
Congressional Budget Office predicts at least 27 million people will be
uninsured every year for the next 10 years – so that’s tens of thousands of
preventable deaths, year in and year out.
“And keep in mind that even if all the states had accepted the Medicaid expansion, about 24
million people would still be uninsured under the Affordable Care Act,” he said.
“We simply can’t go on like this.”