Nov-Dec LD Topic PDF

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LINCOLN-DOUGLAS DEBATE RESEARCH SERIES

Vol. 23 November/December 2012 No. 2
RESOLVED: THE UNITED STATES OUGHT TO GUARANTEE UNIVERSAL HEALTH CARE FOR ITS CITIZENS.
There can be little doubt that the motivation for choosing this topic is the current controversy surrounding
Congressional passage in 2010 of the Patient Protection and Affordable Care Act, also commonly called Obamacare.
In the first of the presidential debates of 2012, President Barack Obama embraced the Obamacare label, saying
that he had actually become quite fond of the term. Mitt Romney has promised that one of his first acts as president
would be to seek the repeal of Obamacare. The key provisions of Obamacare were explained in a July 13, 2012
article in USA Today:
The Patient Protection and Affordable Care Act may have been signed into law in March 2010,
but its two major expansions of health coverage don't begin until January 2014. One is the creation of
health care exchanges -- government agencies or non-profit groups that will organize and oversee a
private market for buying health insurance. The exchanges will offer a choice of certified health plans
from which individuals and small businesses can choose. States are expected to establish
exchanges or create partnerships with the federal government. If states don't act, a federal exchange
is supposed to serve those residents. In addition, the law calls for a vast expansion of Medicaid, the
federal-state health insurance program for the poor and people with disabilities. For the first time in
most states, adults earning up to 138% of the federal poverty rate, or $31,809 for a family of four,
would be covered. As passed and signed by President Obama, the law threatened states with the
loss of all federal Medicaid funds if they did not expand their programs. The Supreme Court struck
down that provision, freeing states to sidestep the expansion without losing other funds. (p. 5A)
The Supreme Court case referred to in the USA Today article is the June 28, 2012 decision in National
Federation of Independent Business et al. v. Sebelius, Secretary of Health and Human Services et al. Twenty-one
states had joined a suit brought by the National Federation of Independent Business, asking the Supreme Court to
strike down Obamacare as an unconstitutional expansion of the federal governments authority to regulate the health
care industry. Many observers believed that the five conservative members of the Supreme Court would agree to
strike down the law. But in a remarkable turn of events, Chief Justice John Roberts sided with the four liberal
members of the Supreme Court in upholding the most important provisions of the law. Only the provision of the law
that would have cut off all federal Medicaid funding to states refusing to expand Medicaid coverage was struck down.
The controversial individual mandate the requirement that all Americans not already covered by health insurance
must enroll in a health insurance plan was upheld by the Supreme Court.
If guarantee universal health care is taken to mean health insurance coverage for all, Obamacare falls short on
two counts. First, the individual mandate provision of Obamacare does not literally require all Americans to have
health insurance coverage. Individuals actually have the choice of purchasing an approved health insurance plan or
paying a fine for opting out of coverage. This opt-out provision was explained in the September 22, 2012 edition of the
London Times: With costs so high, many expect that some of the estimated six million people who will have to pay
the full cost of their health insurance without government or employer subsidies may simply opt to pay the "tax" --
essentially a fine -- of $695 a year or 2.5 percent of their annual income, for not having insurance. Second, because
of the Supreme Courts decision, state governments can now opt-out of the Obamacare requirement to include more
low-income Americans in their Medicaid programs. The Affordable Care Act had promised to pay for 100% of the cost
of expanding Medicaid for the first three years, but after that time, states would be expected to share in the cost of
increased coverage. Most of the twenty-one states who joined in the Supreme Court case are expected to reject the
expansion of Medicaid sought by Obamacare.
Because of these two limitations on health care coverage, Obamacare cannot properly be viewed as a guarantee
of universal health care. Cato Institute scholar, Michael Tanner, anticipates that over twenty million Americans will
remain uncovered after the Act goes into effect: While the new law will increase the number of Americans with
insurance coverage, it falls significantly short of universal coverage. By 2019, roughly 21 million Americans will still be
uninsured (Bad Medicine, 2011, p. 1).
Yet since Lincoln Douglas debate focuses on values rather than specific policies, the question is not about
whether Obamacare per se. The debate instead will focus on the more general question of whether a guarantee of
universal health care is a worthy objective.
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The conflict over the moral responsibility of government to embrace universal health care is largely confined to
the United States. The American Medical Student Association in Health Care, in the 2000 book, Health Care:
Opposing Viewpoints, writes that the United States stands alone among the Western industrialized nations in not
recognizing health care as a fundamental right in its Constitution. Countries such as Canada, the United Kingdom,
and Germany have all recognized and hailed health care as a human right and have enacted laws to provide for their
citizens accordingly. In doing so, these countries have created health care systems with notably smaller per capita
spending coupled with higher satisfaction ratings than the United States.
While the United States has never recognized health care as a fundamental human right, the United States
government has assumed responsibility for promoting access to health care for its citizens. Most Americans receive
health insurance as a benefit provided by their employers. What many people may not realize is that employer funded
health insurance began when the government passed laws which allowed employers to write-off the cost of insurance
from tax liability. Thus, private health insurance provided by employers is highly subsidized by the United States
government. Government also provides insurance to people with special needs who might not be able to obtain
private insurance. For example, in 1965 the federal government enacted the most generous health care entitlement
program in United States history. The Medicare program provides a wide range of health care services to 41 million
persons no matter what their income who are over sixty-five years of age, have long-term disabilities, or are living with
end-stage renal disease. Medicare Part A, the hospital insurance program, covers inpatient hospital, skilled nursing
facility, hospice, and home health care. Medicare Part B Supplemental Insurance covers physician and outpatient
hospital care, lab tests, medical supplies, and home health care. Starting in January 2006, Medicare Part D provided
a limited outpatient drug benefit.
Enacted simultaneously with Medicare, the Medicaid program provides health care to 60 million low-income
Americans. It is a need-based program. That means that individuals must apply for and establish need before they
qualify for care. Unlike Medicare, it is a state-funded program wherein the states determine eligibility and levels of
benefits. There is a wide disparity among state programs both for establishing eligibility and levels of benefits.
Another expansion of government-provided health care in the United States came in 1997 with the Congressional
passage of the State Childrens Health Insurance Program (SCHIP). SCHIP is a block-granted medical services
program. That is, it is a program whereby the federal government provides funds to the states to enable them to begin
or expand the provision child health assistance to uninsured, low-income children. It, like Medicaid, is a need-based
program whose availability is limited by the willingness of states to match funding for the program. The federal
government also provides care directly to qualified poor people through health care clinics and to veterans through
the Veterans Administration hospitals.
As should be obvious, although the American health care system is often described as fundamentally private in
nature, almost half of health care in the Untied States is paid for directly by public insurance programs, compared to
only a little over a third funded by private health insurance. If one includes the cost of direct health care financing
programs (such as Medicare, Medicaid, SCHIP, the Veterans Administration, and public clinics and hospitals), the
cost of tax subsidies provided to finance private health insurance, and the money federal and state governments pay
to insure their own employees, the governments share of the total health care budget climbs to almost sixty percent.
Most of those who support a guarantee of universal health care, advocate a single-payer health insurance system
by which the health care expenditures of the entire population are paid for through one source the federal
government using tax revenue from individuals and employers. It would be a system very much like Medicare
except for the entire population. The government would be a financing mechanism which collects and allocates
money for health care but has little or no involvement in the actual delivery of services.
Of course, many people reject the idea that government should be the primary guarantor of health care. They
argue that the role of government should be minimal because government financing produces government controls
which limit individual responsibility and freedom. George Lundberg, professor of medicine and public health at
Harvard University, writing in the 2000 book, Severed Trust: Why American Medicine Hasnt Been Fixed, points out
that the primary reason that the Clinton Administrations efforts to reform the system failed was that it assumed that
all Americans should have the same health care. That was a complete misreading of the American psyche, and it
killed the Clinton plan the day it was made public. Americans have never had a single level of health care, and given
our cultural beliefs, there is no particular reason to suppose that they ever should have a single level of care.
Americans do not have a single level of transportation, a single level of apparel, or a single level of housing. The idea
that government should shoehorn everyone into exactly the same level of health was unacceptable from the start. In
the United States it is unthinkable that people cannot buy with their own money whatever they want.
Opponents of government as the primary provider of health care also emphasize that government health care is
inherently inferior care, which does not provide equal treatment to all!. Government policies inherently reflect the
powers of special interest groups. Which means that government-provided health care will reflect the interests of the
politically powerful over those of the politically weak. John C. Goodman and Devon Herrick, both staff members of the
National Center for Policy Analysis, report: Our survey of national health insurance in countries provides convincing
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evidence that government control of health care usually makes citizens worse off. When health is made free at the
point of consumption, rationing by waiting is inevitable. Government control of the health care system makes the
rationing problem worse as governments attempt to slow the use of services by limiting access to modern medical
technology. Under government management, both efficiency and quality of care deteriorate. They go on to conclude
that as health care is rationed, the poor are pushed to the rear of the waiting line. In general, low-income people in
almost every country see physicians less often, spend less time with them, enter the hospital less often and spend
less time there, when the use of medical services is weighted by the incidence of illness. In countries with national
health insurance the disparity in length of life between the poor and non-poor is no better and often worse than in the
United States. Those problems have been seen in the Medicare program in the United States. Inflation in costs has
resulted in a form of economic rationing. Growing deductibles, copayments and premiums and gaps in Medicare
coverage have forced the relatively wealthy elderly to buy private Medigap insurance and make other out-of-pocket
payments totaling more than $3,000 per person. Those who cannot afford to pay lose care. The stunning result was
reported by Elmer Elhauge, professor of health law policy at Harvard, in the November 13, 2005 issue of the New
Republic: The average elderly person now has to spend a higher percentage of income on health care than before
Medicare was enacted.
Despite the British claim that health care is a right that is not conditioned on ability to pay, affluent Britons
increasingly turn to private surgery rather than wait for free care. Collectively, these hospitals account for 20 percent
of all non-emergency heart surgery, 30 percent of all hip replacements and $25 billion worth of total health care
annually.
Perhaps the most damning indictment of government provided health care is that it stifles the progress in
developing life saving innovations. Arnold Kling, an economist with the Federal Reserve Board, writing in his 2006
book, Crisis of Abundance, makes the point clearly: The paradigm of what Schumpeter called creative destruction
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and economic growth is increasingly relevant in the turbulent environment of health care in the 21 century. My
reading of history is that rapid change cannot be managed centrally. Instead, what is called competition as a
discovery procedure is better suited to navigating a rapidly changing technology landscape. Easy entry and exit of
firms will ensure that good ideas succeed and resources are released from failed or outmoded processes. He goes
on to explain that to the extent we want to foster adaptability or rapid technological change, it makes sense to
maintain a large role for the private sector with government limited. For applied research and development, forces of
competition maintain the pressure on private-sector systems to adapt to new realities. Firms that persist in obsolete
processes will eventually lose money and go out of business. In contrast, government-controlled systems are much
less capable of discarding failed models.
THE CASE FOR A GUARANTEE OF UNIVERSAL HEALTH CARE

Proponents argue that a guarantee of universal health care would improve the quality of care and reduce coats.
They cite studies showing that nations with universal health care have lower infant morality rates and lower morbidity
(human suffering) rates than the U.S. Yet these same countries spend less per capita on medical care than we do.
And the citizens of these countries strongly support the government programs. No political candidates running for
office in Great Britain, for example, even challenge the validity of universal health care, despite a general trend within
that nation for less government Intervention in the economy. Surveys of the Canadian citizenry suggest strong public
approval of universal health care there.
Why does government control succeed over a free market approach? Proponents of universal health care first
note that free market policies do not work in the health care field. As you are probably well aware, the philosophy of
the free market is that competition ensures the highest quality goods and services at the lowest possible prices.
Those marketing products compete against others marketing the same or similar products. If one producer charges
inordinately high prices, another producer will charge less, thus taking customers away from the first producer. if one
producer provides an inferior product, consumers will shift to other producers, whose products are of higher quality.
This philosophy does not work in the health care field for several reasons. First, the law of supply and demand breaks
down when medical choices are made. Because medical care is so important to human well-being, patients are
unwilling to "shop around" to find the lowest priced high quality product. Most citizens are not willing to compromise
their care and their families' care in order to minimize costs. Many do not feel competent to evaluate prices and
quality. Consequently; they defer to their family doctors ; or specialists recommended by their family doctors. The issue
of price is rarely discussed. Most patients have no Idea how much care will cost until they receive the hospital bill.
This is unfortunate since often those medical facilities charging the highest prices provide inferior care.
Free market economics fails in the health insurance industry as well. Few Americans shop around for health
insurance. Most Americans with health insurance are on their employers plan. The employer certainly has the
incentive to purchase low cost insurance. But the employer is much less concerned with the level of coverage an
insurance policy provides, how high are the deductibles charged to employees needing care, and what type of
restrictions the insurance company imposes.
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This failure of the free market affects the delivery of medical care in two ways. First, it places the health care
industry among the nation's most inefficient industries. There is little incentive to minimize cost. A recent study by the
General Accounting Office (GAO) indicates that over 50 percent of all expenditures by private insurance companies
are for administrative costs, not the provision of medical care. Proponents of a single-payer, universal health care
system claim that if private insurance companies could be removed from the equation, total health care costs could
decrease dramatically.
Opponents argue that universal health care in the U. S. would fail to reduce costs and would undermine the
quality of care for all. Several of the causes of high health care costs in the United States have nothing to do with
private health insurance coverage. First, our litigious society ensures high medical costs through inflated malpractice
claims. No country in the world comes close to the U.S. in terms of the number of malpractice awards or the money
damages sought. As long as we continue to allow patents to recover astronomical sums from doctors they claim were
negligent, our health care costs (which doctors pass on to us) will remain high. Again, it is a factor other than lack of
universal coverage that explains high medical costs in the U. S. Second, high medical costs in the U.S. are the result
of superior care. We provide citizens with far more advanced (and expensive) care in the U.S. than is provided by
other countries. Moreover, medical technology which is common in the U.S. is rare in other countries. Machines that
exist in any metropolitan hospital here are almost non-existent In Canada. Patients needing heart bypass surgery in
Canada, for instance, have to travel to the U.S. or wait weeks for the surgery (often not a feasible alternative).
Needless to say, providing more and higher quality care is more costly than providing rationed, inferior care.
Finally, government provided health care will not reduce inefficiency and administrative costs. True, private health
insurance is not as efficient as other industries. But the most inefficient organizations in this country are government
bureaucracies. Government agencies, none of which have to compete against other organizations, have little or no
incentive to keep costs down. Government spending by these agencies is far more wasteful than spending by any
private firm. One need only look at the Medicare and Medicaid programs for confirmation. Merely to provide a patient
with crutches requires a doctor to fill out several different forms for several different agencies. So a government-
sponsored single-payer system would experience inefficiency at least as great, and probably greater, than that
experienced by the private health insurance industry.
Many analyses claim that the benefits of universal health are in other countries are exaggerated. Since health
care is free, the demand for medical services is tremendous. Waiting lists for primary care are long. Some people
have to wait as long as six months for needed surgery. Patients often have to wait so long for care in these countries,
that the illness passes before they have the opportunity to see a doctor. Advanced medical technology is unavailable
largely because hospitals are underfunded. Advanced medical care often must be rationed so that those most in need
receive it. Recent surveys suggest that many Canadians are not satisfied with their nation's medical care system.
So, far from being the salvation of our health care system, a guarantee of universal health care would be just
another government boondoggle. It would be less efficient than private health care delivery so costs would not
decrease significantly. And any reductions in cost would be at the expense of high quality medical care. The
differences between the U.S. and other nations mean that those nations' medical care success cannot be replicated
here. And the quality of medical care in those countries is inferior to the quality provided in the U. S.
ANALYSIS OF THE TOPIC

As you will recall from The Value Debate Handbook, every proposition of value consists of two components: the
object(s) of evaluation and the evaluative term. The object(s) of evaluation is that which is being evaluated or
critiqued in the resolution. The evaluative term is the word or phrase in the resolution that is evaluative in nature. This
resolution contains one object of evaluation: guarantee universal health care for its citizens The evaluative
term/phrase is should. Some evaluative terms specify a core value for affirmative and negative case analysis. If, for
example, the resolution had said that a just government would guarantee universal health care, then the core value
would be justice. But the November-December resolution uses only the generic evaluative term, ought. This
requires debaters to specify their own core values, such as justice, equality, democracy, progress, or the common
good.
What is meant by the verb, guarantee? Does this mean that the United States ought to actually provide the
health care spoken of in the resolution? Does it mean that the United States government ought to be the agency to
pay for all health care? Or does guarantee just mean that the United States should see that health care is provided
for all citizens? These questions are important when one considers the many health care models used in other
industrialized countries. In Great Britain, for example, physicians are government employees, making the government
literally the provider of health care. In the Canadian model, health care providers are not government employees, but
the government pays for all health care. In such a single-payer system, the government takes over the role that
health insurance companies play in the United States.
Consider the following definitions of the word, guarantee:
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AMERICAN HERITAGE DICTIONARY, 2009. Retrieved Oct. 4, 2012 from

http://www.thefreedictionary.com/guarantee. Guarantee: Something that assures a particular
outcome or condition.
COLLINS ENGLISH DICTIONARY, 2003. Retrieved Oct. 4, 2012 from
http://www.thefreedictionary.com/guarantee. Guarantee: A formal assurance, esp in writing, that a
product, service, etc., will meet certain standards or specifications.
MACMILLAN DICTIONARY, 2009. Retrieved Oct. 4, 2012 from
www.macmillandictionary.com/dictionary/british/guarantee. Guarantee: To make it certain that
something will happen or exist.
According to these definitions, guarantee does not mean that the government ought to become the provider (as
in the British system), or even the single-payer (as in the Canadian system), but rather that the United States must
see to it that universal health care is somehow accomplished. This makes the resolution remarkably different from
the NFL LD resolution debated in September-October of 2006: Resolved: A just government should provide health
care to its citizens, Notice that this previous resolution called for the government to be the provider of health care,
presumably following the British model. Our current resolution differs substantially from that previous one; not only
does it avoid the use of the word, provide, but it also avoids the use of the word, government. The November-
December 2012 resolution allows debater to focus on whether universal health care is a good idea, without
necessarily getting caught up in the question of whether the government should become the provider or the single-
payer for health care. Such systems could be the mechanism for universal health care, but so also could the
Obamacare approach that merely attempts to expand private health insurance coverage for all Americans.
AFFIRMATIVE STRATEGIES
A number of good strategies are available for affirmative debaters. The first strategy is based on the value of
human life and the premise that access to health care is essential to the preservation of life. Coverage limitations in
private health insurance and Medicaid programs cause people to avoid seeking medical treatment in a timely fashion,
leading to needless loss of life. Charlene Harrington, professor of sociology at the University of California, San
Francisco, explains why poor health care coverage leads to poor health: The lack of access to care is directly
reflected in a failure to diagnose problems and delays in needed treatments. Those without access are vulnerable to
poor health, injury, and death. Health care services in the United States are rationed to those who can pay, but those
who cannot pay are excluded altogether (Health Policy: Crisis and Reform in the U.S. Health Care Delivery System,
2008, p. 38). Tom Daschle, former U.S. Senator from South Dakota, argues that gaps in health insurance coverage
decrease the likelihood of patient survival: Many people who are uninsured or underinsured forgo cancer screenings
and other preventive care, delay treatment for their medical conditions, or skimp on drugs. When a serious illness is
permitted to progress, a patient is less likely to survive and care is more expensive (Critical: What We Can Do About
the Health Care Crisis, 2008, p. 24). Thomas Jost, professor of law at Washington & Lee University School of Law,
reports that as many as 18,000 Americans die every year because of gaps in health insurance coverage:
Not surprisingly, the uninsured suffer higher morbidity and mortality. An estimated eighteen
thousand adults die prematurely every year from lack of insurance. Even those who are insured for
part of the year receive much worse care than those continuously insured in terms of delayed care,
unmet medical needs, and unfilled prescriptions. It is also clear that the uninsured get less health
care not by choice, and not because they fail to perceive the need for care -- the uninsured
understand that they need care to the same extent as the insured do, but they are half as likely to get
it. (Health Care at Risk: A Critique of the Consumer-Driven Movement, 2007, p. 7)
Preventive care services are especially important to the maintenance of good health. Alan Weil, director of the
National Academy of State Health Policy, argues that gaps in health insurance coverage are the main reason that
Americans fail to seek preventive care: The importance of health insurance to good health has been well
established. Although it is true that emergency care is available to all Americans, other types of care -- preventive
care, services that help people manage chronic conditions, diagnostic tests, and highly specialized care -- are all hard
to obtain without health insurance (The Next Generation of Antipoverty Policies, 2007, p. 98).
Many of the arguments offered by the negative will actually end up supporting this affirmative strategy. Negative
debaters often think it is their obligation to defend the present system, arguing that Medicaid coverage is actually
improving and that Obamacare is eliminating restrictions in private health insurance, such as those dealing with pre-
existing conditions. All such arguments actually support the benefits of universal health care coverage. The resolution
does not ask for a debate on whether the present system of health care coverage in the United States is good or bad;
instead, it calls for a debate on whether universal health care is good or bad. Any negative argument that the present
health care system has good health care coverage actually supports the affirmative side of the resolution; it implies
that universal health care coverage is a good thing.
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The second affirmative strategy is based upon equal treatment, meaning equality of opportunity. Puneet Sandhu,
writing in the August 2007 issue of the California Law Review, explains why equality of opportunity requires universal
access to health care:
There is a social argument to be made for the right to health care. Equal opportunity, a concept
that justifies unequal outcomes in our society, requires equitable access to health care. Under this
line of reasoning, if every member of society has equal opportunity to achieve their life goals,
inequalities in outcomes are the acceptable result of differences in skill, talent, effort and social
capital, rather than merely moral luck. For example, Norman Daniels explains that health care is
requisite for maintaining normal functioning in society so that individuals may act within their normal
opportunity range, the "array of life plans reasonable persons in [a given society] are likely to
construct for themselves." While an individual's success, or share of the normal opportunity range,
will depend on her skills or talents, fair equality of opportunity requires that individuals with the same
skills or talents have the same opportunity. Thus, although not every fleet-footed runner will become
an Olympian, each is entitled to an equal opportunity to try, unhindered by external, morally irrelevant
restraints. When a person might have achieved Olympic status but for a preventable or curable
disease or disability (that is, morbidity that could have been ameliorated by health care), equal
opportunity is undermined. If an individual is physically ill or mentally preoccupied due to a lack of
access to health care, it will be more difficult for him to exercise effectively the privileges, and bear
the responsibilities, of citizenship. If society demands equal opportunity to justify unequal outcomes, it
can hardly do so when poor health care determines outcomes for many. When society mitigates
moral luck by providing a right to health care, the social fabric is strengthened as citizens may accept
unequal outcomes as fair rather than arbitrary. (pp. 1157-1158)
James Roche also draws the connection between health care and equality of opportunity in the Summer 2001
issue of the St. Thomas Law Review: Depriving citizens of health care is synonymous with depriving citizens of a
public education. If one views competition and the free market as the driving force behind America's greatness then
we must enact universal health care. Without universal health care coverage, we deprive ourselves of the competition
and ingenuity of 20% of our population due to illness and inaccessibility to medical services. If the American political
tradition is based upon competition, minimum welfare is needed to provide each person with a fair chance to compete
with others on the basis of talent and ability, and such minimum welfare should include health care (p. 1017).
This second affirmative strategy also includes an international comparison of health care systems. A common
negative argument against universal health care is that it leads to rationing and poor overall quality. Americans are fond
of the claim that the U.S. health care system is the envy of the world. Yet almost every international comparison of health
care systems rates the U.S. system as inferior to those that guarantee universal health care. S. Leonard Syme, professor
emeritus of community health at the University of California at Berkeley, says that the U.S. health care system is the
most expensive and least effective among all industrialized countries:
The United States ranks at the bottom of all industrialized countries in overall mortality, life
expectancy, and infant mortality. We rank below such countries as Spain, Austria, Italy, and the
United Kingdom but above such countries as Poland, Slovakia, Hungary, and Turkey. And the
medical care costs of high-ranking countries are a fraction of those in the United States. The United
States contains about 5 percent of the world's population, but the amount of money spent on medical
care is more than 50 percent of what the world spends. We in the United States spend more on
medical care per capita than any country in the world, but our results are the poorest among
industrialized nations of the world. (Health Affairs, March/April 2008, pp. 458-459)
A third affirmative strategy is based on the common good. In a properly designed social contract, government should
guarantee universal health care to its citizens. Eleanor Kinney, professor of law at the Indiana University School of Law,
explains that most industrialized countries have adopted a concept of human rights that includes the right to health care:
Nearly sixty years ago, the United Nations adopted the Universal Declaration of Human Rights
(UDHR). This charter document, adopted by the United Nations in the wake of World War II and its
incredible atrocities, is the foundational document of human rights for the world. This declaration is
extraordinary. It recognizes an international consensus of one incredible idea - that all individuals on
Earth have an array of inalienable rights for the protection and advancement of their lives by virtue of
their status as human beings. As human beings, they are entitled to these rights irrespective of their
specific status as to gender, religion, race, ethnicity, or national origin, which have justified disparate
treatment of human beings in all societies since the inception of humankind. This declaration states
the promise of human rights in its first sentence: "Whereas recognition of the inherent dignity and of
the equal and inalienable rights of all members of the human family is the foundation of freedom,
justice and peace in the world." The UDHR then charges all people and organs of society to "strive by
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teaching and education to promote respect for these rights and freedoms and by progressive
measures, national and international, to secure their universal and effective recognition and
observance." Next, the UDHR proceeds to outline specific human rights in thirty articles. These
human rights range from civil and political rights, to economic, social, and cultural rights, to economic
security, education, and health care. (Rutgers Law Review, Winter 2008, pp. 335-336)
Jill Quadagno, professor of sociology at the University of Kansas, says that the U.S. is only industrialized country that
fails to treat health care as a universal right:
The right to health care is recognized in international law and guaranteed in the constitutions of
many nations. With the sole exception of the United States, all industrialized countries -- regardless
of how they raise funds, organize care, or determine eligibility -- guarantee comprehensive coverage
of primary, secondary, and tertiary services. To the extent that care is rationed, it is done on the basis
of clinical need, not ability to pay. Universal health care has proven to be a major tool for restraining
cost increases. Planning avoids widespread duplication that underlies the high percentage of empty
beds in the United States; high rates of unnecessary procedures, tests, and drugs; and ineffective
use of some technologies. Although many nations have flirted with competition, most are wary
because the most competitive system, the United States has consistently been least successful in
controlling costs. (Health Policy: Crisis and Reform in the U.S. Health Care Delivery System, 2008, p.
419)
Affirmative debaters should insist that the negative offer some rationale for limited health care coverage (meaning
non-universal coverage). Many negative debaters will simply attempt to minimize the harm of non-universal coverage
or claim that the U.S. health care system already has nearly universal coverage. All such claims are actually
supportive of the notion that universal coverage is a worthy goal. So what is the argument for limiting coverage? The
most common such argument is cost the fear that universal coverage will cost too much. Yet affirmative debaters
can argue that the U.S. wastes a tremendous amount of resources when it supports a massive health insurance
bureaucracy designed to ration coverage. David Himmelstein, professor at Harvard Medical School, estimates that
the U.S. spends twice as much as Canada on its health system, primarily because of the bureaucracy involved in
limiting coverage:
In terms of cost: it is very clear that our privatized health care system is by far the most costly and
least efficient in the world. We spend nearly twice per person what Canada does, and a good deal of
that excess spending is on the bureaucracy needed to keep our private health insurance in place.
Just to give you one example, more people work for Blue Cross Blue Shield in my home State that
insures 2.5 million people than work for the entire Canadian national health insurance system that
insures 30 million people. (Working Families in Financial Crisis: Medical Debt and Bankruptcy, House
Judiciary Committee Hearing, July 17, 2007, p. 111)
NEGATIVE STRATEGIES
There are also a number of excellent strategies available to negative debaters on this topic. The first negative
strategy argues that guaranteeing universal health care coverage will harm the poorest Americans. The present U.S.
approach to guaranteeing health coverage focuses available government expenditures on the poor and the elderly
(Medicaid and Medicare). The free enterprise approach to health care coverage applies to the broad middle section of
the American population. This case argues that any effort to promote government involvement in medical care for the
middle class will inevitably end up hurting the poor and the elderly societys least advantaged members. Why would
guaranteed health care for all hurt the poor? The answer is health care rationing. The key reason that the U.S.
medical care system is viewed by Americans as superior to other industrialized countries is that health care is
available when it is needed. When countries, such as Canada and Great Britain, guarantee universal health care, the
result is long waiting lines and the near unavailability of certain types of care. This health care rationing hurts
everyone, but especially the poor. As demand increases for medical services, poor Americans will inevitably be the
ones who are most harmed by shortages and long lines. John Goodman and Devon Herrick, researchers at the
National Center for Policy Analysis, explain why health care rationing would especially harm poor Americans:
There is substantial evidence that when health care is rationed, the poor are pushed to the rear
of the waiting line. In general, low-income people in almost every country see physicians less often,
spend less time with them, enter the hospital less often and spend less time there, when the use of
medical services is weighted by the incidence of illness. Moreover, scholarly evidence suggests that
the wealthy and powerful do not wait as long as others. For example, one study in Ontario found:
More than 80 percent of physicians, including 90 percent of cardiac surgeons, 81 percent of internists
and 60 percent of family physicians, had been personally involved in managing a patient who had
received preferential access on the basis of factors other than medical need. When asked about
those patients most likely to receive preferential treatment, physicians reported that 93 percent had
8
personal ties to the treating physician, 85 percent were high-profile public figures and 83 percent
were politicians. Other studies have reached similar conclusions. One found that the wealthy and
powerful have significantly greater access to medical specialists than less well-connected, poor
Canadians. Another found that preferential treatment for high-profile patients resulted in more
frequent services, shorter waiting times and greater choice in specialists. (Twenty Myths About
Health Care, 2001, p. 17)
In the United States, we have made a societal decision to focus available public subsidy dollars on the least
advantaged members in our society. This first affirmative strategy argues that this approach is superior to a
guarantee of universal health care. Affirmative debaters may argue that coverage levels in government programs
are inadequate, causing some physicians to refuse to accept Medicaid and Medicare patients. Other affirmative
arguments may claim that too few poor Americans are now eligible for Medicaid. Yet neither of these arguments
support a guarantee of universal of health care coverage. Instead, these arguments call for focusing available
government resources on the neediest Americans.
The second negative strategy argues that individual choice regarding health care is superior to a government
guarantee of access. At present the United States treats health care as a matter of individual choice; the presumption
is that Americans should decide how much they wish to spend (if any) on health insurance. Those Americans who are
young and healthy may decide to forego health insurance or purchase only cheap, catastrophic care policies. They
may decide that routine health care can inexpensively provided by going to a corner health clinic on a pay-as-you-go
basis. Even the individual mandate contained in the Affordable Care Act (Obamacare) preserves this choice. Persons
still have the choice whether to enroll in a government-approved health insurance plan or pay the income tax penalty
for failure to enroll. Many experts predict that as many as 10-20 million Americans will choose to pay the tax penalty
rather than to spend the much higher sums necessary to enroll in a health insurance plan.
Federal and state governments in the United States already spend an inordinately large portion of their budgets
on health care for needy Americans through Medicaid and Medicare programs. The Affordable Care Act, by
attempting to spread health care coverage to all Americans, will further stretch government budgets. When more
money is spent on health care, less will be spent improving education, housing, the environment, and other elements
of public welfare. This is unfortunate since evidence indicates that social welfare programs have a greater impact on
health than the availability of medical care.
So what is the rationale for trying to force all middle class Americans to enroll in health insurance programs? The
supporters of the Affordable Care Act claim that those Americans uncovered by health insurance become free riders,
adding to health care costs. In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act
(EMTALA), requiring that hospitals provide essential medical services in emergency rooms, regardless of health care
coverage. The law allows hospitals to bill patients for services rendered after treatment, but in many instances, these
medical bills are never paid. Yet Michael Cannon, director of health policy studies at the Cato Institute, argues that
uncompensated care is a minor problem: Some suggest that when people without health insurance receive
treatment, the cost of their care is passed along to the rest of us. This is undeniably true. Yet, it is a manageable
problem. According to Jack Hadley and John Holahan of the left-leaning Urban Institute, uncompensated care for the
uninsured amounts to less than 3% of total healthcare spending -- a real cost, no doubt, but hardly a crisis (Los
Angeles Times, Apr. 5, 2007, www.latimes.com/news/opinion/commentary/la-oe-tanner5apr05,0,2681638.story).
Negative debaters should argue that the problem of uncompensated care offers an inadequate justification for the
dramatic expansion of government spending that would follow a guarantee of universal health care coverage. Instead,
government should continue to focus on providing health care for the poor and the elderly, leaving middle and upper
income Americans to make their own health care decisions in a free market system.
The final negative strategy is based upon the premise that a dramatic expansion of health care services in
America is a bad idea. Many experts argue against such an expansion on the grounds that medical errors,
unnecessary surgery, over-testing, adverse drug interactions, and nocosomial infections (meaning infections acquired
in hospitals) would result in more deaths than would be prevented by expanding care. Debaters defending this
position need not argue that all medical care is bad; instead, the argument is that medical care should be used only
as absolutely needed. A guarantee of universal health care would create incentives to maximize treatment, worsening
problems of over-testing, unnecessary surgery, and related problems
9
AFFIRMATIVE CASE #1: PRESERVING HUMAN LIFE

The thesis of this case is that protecting the lives of its citizens is the primary responsibility of government. This case
can be used either to defend a single payer national health insurance approach or a more limited approach in which the
United States eliminates the coverage limitations in private insurance and Medicaid. The guarantee of access to health
care is essential to the preservation of human life.
OBSERVATIONS:
I. PRESERVING HUMAN LIFE SHOULD BE REGARDED AS THE ULTIMATE VALUE.
[See the Sanctity of Life brief in The Value Debate Handbook]
Simone Roach, (Ph.D.), THE HUMAN ACT OF CARING, 1992, 23.
Human life is the precondition for all values attributed to human persons. Human life has been
referred to as "an almost absolute value in history." The need to protect human life and the more
stringent imperative of do not kill are regarded as basic, constitutive elements of the moral life of any
society. The relationships embodied in and shaped by humans rest on the inviolability of human life. The
inestimable value of human life is based on the consideration that each person has been raised to a
sublime dignity.
II. GUARANTEEING ACCESS TO HEALTH CARE PRESERVES HUMAN LIFE.
Bill Roy, (M.D., Former U.S. Representative from Kansas), THE MARYSVILLE ADVOCATE, July 11, 2012.
Retrieved Oct. 5, 2012 from www.marysvilleonline.net/articles/2012/07/18/opinion/doc4ffda252a1eb42
01808412.txt,
Why do many people want universal health care? Because its the civilized thing to do. It saves lives,
avoids disability and prevents personal and family financial disasters. Our own well-being and the well-
being of our families are probably number one on nearly everyones list. But, absent health insurance,
many people are denied care, or delay care to their physical and financial detriment. Americans die in the
tens of thousands because they dont seek care in a timely manner. Others are unnecessarily disabled.
CONTENTIONS:
I. FAILURE TO GUARANTEE UNIVERSAL HEALTH CARE NEEDLESSLY THREATENS HUMAN LIFE.
A. LACK OF UNIVERSAL COVERAGE CAUSES PEOPLE TO AVOID NECESSARY HEALTH CARE.
Arthur Garson, Jr. & Carolyn L. Engelhard, (Dean, School of Medicine, U. Virginia & Prof., Medical
Education, U. Virginia), HEALTH CARE HALF-TRUTHS: TOO MANY MYTHS, NOT ENOUGH REALITY,
2007, 117-118.
The uninsured are also three times more likely than those with health coverage to postpone needed
care for pregnancy, for injuries, or for cancer care, so it should come as no surprise that having health
insurance improves health overall and reduces mortality rates by twenty-five percent. When you consider
the benefits of having health insurance and access to needed medical care, it is clear that the uninsured
do not get enough care.
Charlene Harrington, (Prof., Sociology, U. California, San Francisco), HEALTH POLICY: CRISIS AND
th
REFORM IN THE U.S. HEALTH CARE DELIVERY SYSTEM, 5 Edition, 2008, 38.
The lack of access to care is directly reflected in a failure to diagnose problems and delays in needed
treatments. Those without access are vulnerable to poor health, injury, and death. Health care services in
the United States are rationed to those who can pay, but those who cannot pay are excluded altogether.
Tom Daschle, (Former U.S. Senator, South Dakota), CRITICAL: WHAT WE CAN DO ABOUT THE
HEALTH CARE CRISIS, 2008, 160-161.
Those who lack health insurance rarely go to the doctor, so they simply endure their chronic
conditions until the pain becomes unbearable or there is an emergency. A 2006 study found that 59
percent of uninsured adults with a chronic condition did not fill a prescription, or skipped their
medications, because they could not afford them. And more than one-third of chronically ill adults without
insurance went to the emergency room or stayed overnight in the hospital during the previous year
because of their condition -- twice the rate of adults with insurance.
10
Ann Weilbaecher, (J.D. Candidate, Loyola U. School of Law), ANNALS OF HEALTH LAW, Summer 2008,
339.
An Institute of Medicine report indicates: Uninsured people are more likely to receive too little medical
care and to receive it too late, to be sicker and to die sooner. They are reluctant to use health services,
often waiting until there is a crisis. They receive fewer preventative services, less regular care for chronic
disease, and poorer care in the hospital. Furthermore, uninsured individuals are more likely to be
hospitalized for avoidable health problems and receive fewer diagnostic and therapeutic services once
hospitalized.
B. LACK OF UNIVERSAL COVERAGE CAUSES PEOPLE TO AVOID PREVENTIVE HEALTH CARE.
Jesse Jackson, Jr. (U.S. Representative, Illinois), BUILDING A NEW WALL: THE FUNDAMENTAL RIGHT
TO HEALTHCARE, Nov., 26, 2008. Retrieved Oct. 5, 2012 from www.alternet.org/story/110998/
we_must_establish_a_constitutional_right_to_health_care.
The absence of this human right as a health care constitutional amendment has major economic
consequences as well. Preventive medicine is almost entirely missing from our current health care
system, which costs taxpayers billions.
Brooke Hollister, (Ph.D., Staff, U.S. Institute for Health and Aging), HEALTH POLICY: CRISIS AND
th
In addition to negative health effects, 44% of the uninsured had a serious problem paying medical
bills in 2002. Lack of medical insurance -- whether at a young age, in old age, or throughout the life
course -- has significant effects on health, financial stability, and retirement security, highlighting the
importance of Medicare and Social Security.
National Association of Community Health Centers, ACCESS TRANSFORMED, Aug. 2008, 1.
The U.S. health care system is in a tailspin and in need of systemic reform. Rising numbers of people
are uninsured or even underinsured, forced to delay care at the risk of imperiling their health. Health care
disparities -- the hallmark of communities shut out of preventive medicine -- continue to widen between
the haves and have-nots. And, tragically, the U.S. is rated dead last among 19 other industrialized nations
when it comes to premature deaths that could have been prevented by timely access to care.
C. LACK OF UNIVERSAL COVERAGE CAUSES NEEDLESS LOSS OF LIFE.
Ezekiel Emanuel, (Chair, Dept. of Bioethics, Clinical Center of the National Institutes of Health),
HEALTHCARE GUARANTEED, 2008, 21-22.
According to the Institute of Medicine, 18,000 Americans die prematurely each year because their
lack of insurance prevents them from getting necessary healthcare interventions in time.
2007, 117.
The truth of the matter is that the uninsured die earlier than the insured. Adults without health
insurance have death rates twenty-five percent higher than insured persons. Generally speaking, the
uninsured are at greater risk for premature death because they receive fewer preventive services and
less effective treatment for acute medical conditions such as a heart attack. They are less likely to be
admitted to a hospital, are less likely to receive treatments, and are more likely to die in the short term.
Thomas Jost, (Prof., Law, Washington & Lee U. School of Law), HEALTH CARE AT RISK: A CRITIQUE OF
THE CONSUMER-DRIVEN MOVEMENT, 2007, 7.
Not surprisingly, the uninsured suffer higher morbidity and mortality. An estimated eighteen thousand
adults die prematurely every year from lack of insurance. Even those who are insured for part of the year
receive much worse care than those continuously insured in terms of delayed care, unmet medical
needs, and unfilled prescriptions. It is also clear that the uninsured get less health care not by choice, and
not because they fail to perceive the need for care -- the uninsured understand that they need care to the
same extent as the insured do, but they are half as likely to get it.
HEALTH CARE CRISIS, 2008, 24.
Many people who are uninsured or underinsured forgo cancer screenings and other preventive care,
delay treatment for their medical conditions, or skimp on drugs. When a serious illness is permitted to
progress, a patient is less likely to survive and care is more expensive.
11
As I noted in part 1, the Institute of Medicine has estimated that a lack of health insurance leads to
18,000 unnecessary deaths each year. Many people who are uninsured or underinsured forgo preventive
care, delay treatment for their medical conditions, or skimp on drugs. When a serious illness is permitted
to progress, a patient is less likely to survive and care is more expensive, making it possible for
employers to raise their wages. It would provide relief to businesses straining under the burden of fast-
rising premiums, and it would give a much-needed boost to companies struggling to compete in the
global marketplace.
Linda Blumberg, (Research Associate, Urban Institute), EXAMINING INNOVATIVE APPROACHES TO
COVERING THE UNINSURED THROUGH EMPLOYER-PROVIDED HEALTH BENEFITS, Hrg., House
Comm. on Education & Labor, Mar. 15, 2007, 34.
The problems associated with being uninsured are now widely known. A substantial body of literature
shows that the uninsured have reduced access to medical care, and many researchers have concluded
that the uninsured often have inferior medical outcomes when an injury or illness occurs. Urban Institute
researcher Jack Hadley recently reviewed 25 years of research and found strong evidence that the
uninsured receive fewer preventive and diagnosis services, tend to be more severely ill when diagnosed,
and received less therapeutic care. Studies found that mortality rates for the uninsured were from 4 to 25
percent higher than would have been the case had the individuals been insured.
II. HEALTH INSURANCE SYSTEMS FAIL TO GUARANTEE HEALTH CARE TO ALL CITIZENS.
A. PRIVATE HEALTH INSURANCE PLANS ARE RIDDLED WITH EXCLUSIONS.
A reformed system built upon an expanded FEHBP, employers, and Medicaid and Medicare would
cover everyone. But what kind of coverage would it be? Today, many insured Americans who become ill
or are injured discover that their policies don't cover the care they need, or cover so little they are forced
to run up huge medical bills. Health insurance should truly insure Americans against costs that block
access to needed care or induce financial distress.
B. PERSONS COVERED BY MEDICAID ARE NOT GUARANTEED ACCESS TO HEALTH CARE.
Bill Bradley, (U.S. Senator, New Jersey), THE NEW AMERICAN STORY, 2007, 140.
Medicaid patients, our poorest citizens, often get third-class care. Many of them take a bus to go
across town to see a doctor, only to find that the doctor doesn't accept Medicaid patients. More than a
third of all doctors refuse to take Medicaid patients, because the reimbursement rates are too low. Under
pressure of state budget cuts, Medicaid services and eligibility have been cut drastically. In 2003, twenty-
seven states reported narrowing eligibility. That year, twenty-five states reduced benefits, seventeen
increased copayments, and thirty-seven reduced provider payments.
D. Stanley Eitzen, (Prof., Emeritus, Sociology, Colorado State U.), SOLUTIONS TO SOCIAL PROBLEMS:
LESSONS FROM STATE AND LOCAL GOVERNMENTS, 2009, 142.
There are additional problems with Medicaid. Many physicians refuse to treat Medicaid patients
because the government does not reimburse them enough for their services. This results in delayed
medical attention, typically in hospital emergency rooms, where such patients cannot be turned away.
Even when the poor do go to physicians and clinics, they are more likely than the more affluent to receive
inferior services. This results from several factors. First, the poor often are served by understaffed clinics
and public hospitals, which means that their visits often require long waits and hurried attention by
overworked health practitioners. Second, there are disproportionately fewer physicians in poor urban and
poor rural areas than in affluent urban and suburban areas, which is a consequence of physicians'
tending to cluster where their practices will be the most lucrative.
C. THE PRIVATE HEALTH INSURANCE MODEL IS RUINOUSLY EXPENSIVE, DRIVING UP HEALTH CARE
COSTS FOR ALL AMERICANS.
Gunnar Almgren, (Prof., Social Work, U. Washington), HEALTH CARE POLITICS, POLICY, AND
SERVICES: A SOCIAL JUSTICE ANALYSIS, 2007, 188.
For decades the health care reform debate has been framed by the assumption that primary deficits
in the U.S. health care system pertain to its failure to provide universal access to health care. However,
the evidence continues to mount that the U.S. health care system, despite its being the most expensive in
the world, fails to achieve the population health outcomes of nations that spend far less per capita on
health care.
12
David Himmelstein, (Prof., Harvard Medical School), WORKING FAMILIES IN FINANCIAL CRISIS:
MEDICAL DEBT AND BANKRUPTCY, Hrg., House Judiciary Comm., July 17, 2007, 111.
In terms of cost: it is very clear that our privatized health care system is by far the most costly and
least efficient in the world. We spend nearly twice per person what Canada does, and a good deal of that
excess spending is on the bureaucracy needed to keep our private health insurance in place. Just to give
you one example, more people work for Blue Cross Blue Shield in my home State that insures 2.5 million
people than work for the entire Canadian national health insurance system that insures 30 million people.
Shannon Brownlee, (Sr. Fellow, New America Foundation), OVERTREATED: WHY TOO MUCH
MEDICINE IS MAKING US SICKER AND POORER, 2007, 2.
Instead, we've decided to put up with an unfair, dysfunctional, and spectacularly expensive system. In
2006, we spent an estimated $2.1 trillion on health care. That's almost as much as the worldwide market
for petroleum, and more than the United States spends on food. We spend more per capita on health
care than the Chinese spend, per capita, on everything. Looking to the future, the Centers for Medicare
and Medicaid Services predicts annual health care costs will hit $4.1 trillion by 2016, eating up nearly 20
percent of our gross domestic product. We currently spend nearly $6,000 apiece on health care, two and
a half times the median for the rest of the industrialized world.
There is no paradox that equals the system of health care finance in the United States. According to
estimates released in 2005, the United States spends about $1.7 trillion in health care annually, or an
average of about $5,700 per year for every person residing in the United States. In relative expenditures
per capita, the United States spends 11 times the most recent World Health Organization estimates of
the global per capita average, and over two times the average of per capita expenses for Australia,
Canada, Germany, Japan, Norway and the United Kingdom.
III. UNIVERSAL HEALTH CARE IS ESSENTIAL TO GUARANTEE ACCESS TO HEALTH CARE FOR ALL
CITIZENS.
A. GUARANTEED UNIVERSAL HEALTH CARE BEST PROVIDES QUALITY CARE FOR ALL.
James Roche, (Attorney, J.D., St. Thomas School of Law), ST. THOMAS LAW REVIEW, Summer 2001,
1048.
Universal health care is not only critical for the dignity of the person but the most efficient way to
allocate resources. Nations such as Germany, Canada, France and the Netherlands all provide universal
health care coverage to all their citizens. These nations all provide quality health care to everyone, at a
much lower cost, and experience better general health than United States citizens.
Thomas Russell, (Dir., American College of Surgeons), UNIVERSAL HEALTH CARE: DEVOS MEDICAL
ETHICS COLLOQUY, 2007, 26.
I think it is a most laudable goal for the United States of America to have universal healthcare. As I
think we all know, the United States has a much more pluralistic system than what Frank has described
as the English system. Having been a practicing surgeon for thirty years, I always say that everybody gets
care in the United States, but not everybody is covered. And the care that people get who are not covered
is extremely fragmented and not coordinated in any way. I think as a society -- as the richest society in
the world -- we should be embarrassed about that problem and should do something about it. So I think
we need to expand access to quality care and I do believe it will be done because, at the end of the day,
societies are often evaluated by how they care for their downtrodden, and we are not doing the job that
we should, given the wealth that we have in the United States.
B. GUARANTEED UNIVERSAL HEALTH CARE BEST PROVIDES PREVENTIVE HEALTH CARE.
1028.
Under universal health care patients would consume more preventive care, which is relatively
inexpensive and far more efficient than emergency care, which is excessively expensive and often
unproductive. Those who are uninsured or underinsured are reluctant to obtain treatment at the first sign
of a medical problem when treatment is both most efficient and least expensive due to cost. However,
under a universal health care system, people will be much more likely to seek medical assistance at the
first sign of an abnormality.
13
AFFIRMATIVE CASE #2: EQUALITY

The thesis of this case is that access to health care is a basic human right. Just governments must provide citizens equal
protection of their rights. Private health insurance companies adopt many restrictions. These disproportionately affect the poor,
minorities, and people with disabilities and chronic illness. These people also cannot afford private health insurance or they are not
offered the opportunity to obtain private insurance. Health statistics reveal that people without adequate insurance are denied health
care or provided with inferior health care. The statistics also show that those citizens have higher sickness and death rates than
those not excluded from adequate health care. In order for citizens to be treated alike, the United States must guarantee universal
health care.
OBSERVATIONS:
I. SECURING A JUST SOCIETY IS THE PRIMARY RESPONSIBILITY OF GOVERNMENT.
[See Justice briefs in the Value Debate Handbook]
II. EQUAL TREATMENT OF CITIZENS IS THE CRITERION OF A JUST GOVERNMENT.
[See Equality brief in the Value Debate Handbook]
Mark Robert Rank, (Prof., Social Welfare, Washington U., St. Louis), ONE NATION UNDERPRIVILEGED,
2005, 144.
But the key word here is all. The Pledge of Allegiance ends not with the words "liberty and justice for
some" or "liberty and justice for most" but "liberty and justice for all." If the principles of liberty, justice,
equality, and democracy are to fulfill their true meaning, they must apply to all.
2005, 126.
As the National Conference of Catholic Bishops notes in its pastoral letter, "Economic Justice for All,"
the overarching theme in the Old Testament is that God is a God of justice and of righteousness,
particularly in terms of the downtrodden. Individuals, communities, and rulers are judged on the basis of
how well they treat these groups.
2005, 126.
Central to the biblical presentation of justice is that the justice of a community is measured by its
treatment of the powerless in society, most often described as the widow, the orphan, the poor, and the
stranger (non-Israelite) in the land. The Law, the Prophets, and the Wisdom literature of the Old
Testament all show deep concerns for the proper treatment of such people. What these groups of people
have in common is their vulnerability and lack of power. They are often alone and have no protector or
advocate. Therefore, it is God who hears their cries, and the king who as God's anointed is commanded
to have special concern for them.
CONTENTIONS:
I. ACCESS TO HEALTH CARE IS A FUNDAMENTAL RIGHT DUE ALL CITIZENS.
A. HEALTH IS A MOST FUNDAMENTAL NEED.
Norman Daniels, (Prof., Ethics, Harvard School of Public Health), JUST HEALTH: MEETING HEALTH
NEEDS FAIRLY, 2008, 143.
Personal medical services considered essential to promoting fair opportunity for all must be
accessible to all. This will generally mean universal coverage through public or private insurance for an
array of "decent" or "adequate" services in order to protect fair equality of opportunity. There should be no
obstacles financial, racial, geographical, and so on to access to the basic tier of the system.
PHYSICIANS FOR A NATIONAL HEALTH PROGRAM, 2010. Retrieved Oct. 4, 2012 from www.pnhp.org/
publications/proposal_of_the_physicians_working_group_for_singlepayer_national_health_insurance.php?p
age=all.
Cardinal Joseph Bernardin, Catholic Chicago Archdiocese: Health care is an essential safeguard of
human life and dignity and there is an obligation for society to ensure that every person be able to realize
this right.
14
Tamara Friesen, (Staff), HEALTH LAW JOURNAL, 2001, 215-216.

The International Covenant on Economic, Social and Political Rights explicitly delineates the human
right to health care in international law. Article 12 states: The State Parties to the present Covenant
recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental
health.
1016.
Why should we guarantee health care to everyone? This question has three equally compelling
answers. First, health care is not simply a service which is enjoyed but a fundamental right to which all
citizens are entitled. Second, as a civilized and enlightened democracy we have a moral obligation to
guarantee universal health care. Finally, providing universal health care is efficient, prudent, and
increases the nation's economy and production.
B. HEALTH IS ESSENTIAL TO THE REALIZATION OF ALL OTHER SOCIAL VALUES.
1017.
Depriving citizens of health care is synonymous with depriving citizens of a public education. If one
views competition and the free market as the driving force behind America's greatness then we must
enact universal health care. Without universal health care coverage, we deprive ourselves of the
competition and ingenuity of 20% of our population due to illness and inaccessibility to medical services.
If the "American political tradition is based upon competition, minimum welfare is needed to provide each
person with a fair chance to compete with others on the basis of talent and ability, and such minimum
welfare should include health care."
2005, 211.
Access to health care is important in a variety of ways. Being able to address one's health needs is
crucial in maintaining a productive life, both at work and at home.
Jerry Menikoff, (Prof., Law, U. Kansas School of Law), UNIVERSITY OF KANSAS LAW REVIEW, June
2007, 1274.
What are the moral arguments in favor of a right to access health care? They fall broadly into two
categories: those relating to how health care is similar to certain other goods, and conversely, those
relating to how health care plays a special role in peoples' lives. With regard to the first category, health
care might be considered analogous to other services that governments traditionally provide, such as
police, fire departments, and collecting trash. The reasons justifying the government's provision of those
services might similarly justify providing health care. With regard to the second category, the argument is
that having poor health significantly diminishes a person's ability to otherwise function appropriately and
take advantage of the opportunities that society provides. It would, accordingly, be unjust not to provide
that person with the health care that would restore their ability to "use their capacities."
C. ALL OTHER INDUSTRIALIZED COUNTRIES GUARANTEE UNIVERSAL HEALTH CARE TO THEIR
CITIZENS.
Howard Dean, (Former Governor of Vermont), ST. PETERSBURG TIMES (FLORIDA), Sept. 25, 2009.
Online Nexis. Oct. 3, 2012.
Every other democracy in the world has a health care system that covers everybody, and we don't.
Marsha Freeman, (Professor of Law, Barry University School of Law), JOURNAL OF PUBLIC INTEREST
LAW, Fall 2011, 148.
Politicians fail to acknowledge the horrific costs to the American family due to lack of access to health
care and/or financial ruin, commonly referred to as "medical bankruptcy." Estimates of 46 million
uninsured and 70 million underinsured should give pause to the politicians and pundits alike, few of whom
are likely in either category, as to why the United States is the only developed nation in the world that
does not offer universal health care, and why concepts like limited or no access to medical care or
medical bankruptcies should be acceptable here.
15
II. A GUARANTEE OF UNIVERSAL HEALTH CARE IS ESSENTIAL TO MEET THE GOAL OF EQUAL
TREATMENT OF CITIZENS.
A. FAILURE TO GUARANTEE UNIVERSAL HEALTH CARE HARMS THE LEAST ADVANTAGED CITIZENS.
Puneet Sandhu, (J.D., U. California, Berkeley School of Law), CALIFORNIA LAW REVIEW, Aug. 2007,
1153.
The rate of uninsurance is disproportionately high among minorities: 17% of Asian Americans, 21%
of African Americans, and 32% of Hispanics are uninsured, compared to 11.3% of Whites. The resulting
costs to society are high. Uninsured individuals lose between 65 and 130 billion dollars annually in the
form of increased morbidity and premature mortality.
Timothy Jost, (Prof., Law, Washington & Lee U.), WAKE FOREST LAW REVIEW, Summer 2006, 540-541.
Most uninsured Americans -- about eighty percent -- are either employed or in households of persons
that are employed. This is because many Americans who are unemployable -- the elderly, the disabled,
and children -- are covered by public insurance programs. Most of the uninsured who are employed,
however, are part-time or seasonal employees, work at low-wage jobs, are self-employed, or work for
very small businesses and are not offered health insurance benefits by their employers. Most uninsured
persons also have very low incomes -- one quarter are from households with incomes below the poverty
level, fifty-four percent from households with incomes below two-hundred percent of the poverty level.
With health insurance costing hundreds of dollars a month, persons working at minimum wage jobs
simply cannot afford it. The uninsured also tend disproportionately to be minorities -- especially Hispanics
-- and to be young.
B. A GUARANTEE OF UNIVERSAL HEALTH CARE IS VITAL TO REALIZE EQUALITY OF OPPORTUNITY.
Puneet Sandhu, (J.D., U. California, Berkeley School of Law), CALIFORNIA LAW REVIEW, Aug. 2007,
1157-1158.
There is a social argument to be made for the right to health care. Equal opportunity, a concept that
justifies unequal outcomes in our society, requires equitable access to health care. Under this line of
reasoning, if every member of society has equal opportunity to achieve their life goals, inequalities in
outcomes are the acceptable result of differences in skill, talent, effort and social capital, rather than
merely moral luck. For example, Norman Daniels explains that health care is requisite for maintaining
normal functioning in society so that individuals may act within their normal opportunity range, the "array
of life plans reasonable persons in [a given society] are likely to construct for themselves." While an
individual's success, or share of the normal opportunity range, will depend on her skills or talents, fair
equality of opportunity requires that individuals with the same skills or talents have the same opportunity.
Thus, although not every fleet-footed runner will become an Olympian, each is entitled to an equal
opportunity to try, unhindered by external, morally irrelevant restraints. When a person might have
achieved Olympic status but for a preventable or curable disease or disability (that is, morbidity that could
have been ameliorated by health care), equal opportunity is undermined. If an individual is physically ill or
mentally preoccupied due to a lack of access to health care, it will be more difficult for him to exercise
effectively the privileges, and bear the responsibilities, of citizenship. If society demands equal
opportunity to justify unequal outcomes, it can hardly do so when poor health care determines outcomes
for many. When society mitigates moral luck by providing a right to health care, the social fabric is
strengthened as citizens may accept unequal outcomes as fair rather than arbitrary.
III. INTERNATIONAL COMPARISONS PROVE THAT GUARANTEED UNIVERSAL HEALTH CARE IS BEST.
A. THE CANADIAN UNIVERSAL COVERAGE MODEL IS SUPERIOR.
1. The Canadian universal health care model guarantees equal treatment.
th
Lasser, Himmelstein, and Woolhandler show that Americans are less likely to have a regular doctor,
more likely to have unmet needs for health care, and more likely to not receive needed medications than
Canadians. The universal health care in Canada reduces health disparities in access to care and could
serve as a model for reform of the U.S. system.
16
2. The Canadian universal health care model provides higher quality medical care.
Karen E. Lasser, (Prof., Medicine, Harvard Medical School), HEALTH POLICY: CRISIS AND REFORM IN
th
THE U.S. HEALTH CARE DELIVERY SYSTEM, 5 Edition, 2008, 379.
Canada, with a system of universal health insurance, spends about half as much on health care per
capita as does the United States, yet Canadians live 2 to 3 years longer. Few population-based data are
available on health habits and processes of care in the 2 countries that might explain this paradox.
Blendon et al. found that both US residents and Canadians were dissatisfied with their health care
systems, that low-income US residents reported more problems obtaining care than their peers in 4 other
English-speaking countries (Australia, Canada, New Zealand, and the United Kingdom), and that quality-
of-care ratings were similar in the 5 countries. Among other studies, some, but not all, have found better
health care quality in Canada. Socioeconomic inequalities in health, commonly perceived as pervasive in
the United States, seem less stark in Canada.
3. The Canadian universal health care model does a superior job of controlling health care costs.
th
REFORM IN THE U.S. HEALTH CARE DELIVERY SYSTEM, 5 Edition, 2008, 365-366.
The Canadian health care system has long been considered by many to be a good model for the
United States. This approach has a single payer (the government) for all health care services, with health
care providers remaining largely private. Once a year, the government negotiates with private providers to
set reimbursement rates for the year. This approach has the advantage of controlling Canada's costs
while ensuring access to services for all its citizens and reducing the administrative overhead associated
with costly billing mechanisms. U.S. health care administrative costs are dramatically higher than those in
Canada, owing to the complex and costly billing systems, marketing, competition, duplication of
equipment and personnel, and other factors in the United States.
4. The Canadian universal health care model best improves the health of least advantaged groups.
Stephen J. Kunitz, (Prof., Preventive Medicine, U. Rochester), HEALTH POLICY: CRISIS AND REFORM IN
th
THE U.S. HEALTH CARE DELIVERY SYSTEM, 5 Edition, 2008, 65.
After universal health insurance was implemented in Canada, several studies were made of the
consequences for health care utilization. The results were mixed. Some showed that the inequalities
among income groups in utilization and health status have persisted, but for the most part, utilization has
increased, especially among the poor.
B. THE BRITISH UNIVERSAL HEALTH CARE MODEL IS SUPERIOR TO THE U.S. SYSTEM.
The United Kingdom, a nation with a rigid social class structure that spends over 50% less per capita
than the United States on health care, has an adult population that is in remarkably superior health at all
levels of the social class gradient. Rich, middle income, or poor, British adults in middle age have
dramatically lower prevalence rates of diabetes, hypertension, heart disease, and cancer than U.S.
citizens of the same socioeconomic status.
C. THE QUALITY OF THE GERMAN UNIVERSAL HEALTH CARE MODEL IS SUPERIOR TO THE U.S.
SYSTEM.
Phillip Longman, (Sr. Fellow, New America Foundation), BEST CARE ANYWHERE: WHY VA HEALTH
CARE IS BETTER THAN YOURS, 2007, 75.
Because of its fragmented, market-driven system, the United States now lags at least a dozen years
behind other advanced industrialized countries in its application of information technology to health care.
Germany, for example, which began wiring its health care system in 1993, had spent $1.88 billion on its
health IT system, or $21.20 per capita, by 2005, compared with 43 cents per capita ($125 million in
spending) in the United States. Today, Germans carry encrypted "smart-cards," which they can use to let
authorized health professionals retrieve their complete medical histories wherever in Germany they may
happen to fall ill.
17
C. THE QUALITY OF HEALTH CARE IN THE U.S. IS INFERIOR TO COUNTRIES GUARANTEEING

UNIVERSAL ACCESS TO CARE.
Paul Krugman, (Staff, New York Times), THE CONSCIENCE OF A LIBERAL, 2007, 217-218.
The United States spends almost twice as much on health care per person as Canada, France, and
Germany, almost two and a half times as much as Britain -- yet our life expectancy is at the bottom of the
pack.
What do we get for our money? Politicians are constantly telling us we have the best health care in
the world, but that's simply not the case. By every conceivable measure, the health of Americans lags
behind the health of citizens in other developed countries, starting with life expectancy. In 2001, U.S. life
expectancy at birth was seventy-seven years, which put us a few months ahead of Cyprus, Costa Rica,
and Chile but years behind Canada, Japan, and Western Europe. We rank twenty-eighth in the world on
infant mortality rates, behind Cuba, the Czech Republic, and the United Kingdom, countries that ought to
be beating us at soccer, not health.
S. Leonard Syme, (Prof., Emeritus, Community Health, U. California, Berkeley), HEALTH AFFAIRS,
March/April 2008, 458-459.
The United States ranks at the bottom of all industrialized countries in overall mortality, life
expectancy, and infant mortality. We rank below such countries as Spain, Austria, Italy, and the United
Kingdom but above such countries as Poland, Slovakia, Hungary, and Turkey. And the medical care
costs of high-ranking countries are a fraction of those in the United States. The United States contains
about 5 percent of the world's population, but the amount of money spent on medical care is more than
50 percent of what the world spends. We in the United States spend more on medical care per capita
than any country in the world, but our results are the poorest among industrialized nations of the world.
Marcia Nielsen, (Ph.D.), UNIVERSITY OF KANSAS LAW REVIEW, June 2007, 1363.
Americans need access to affordable health care and that many of us - nearly 47 million people in the
United States - are uninsured. This is truly a remarkable statistic because according to the World Health
Organization (WHO), the United States spends almost double per capita on health care services than any
other country but suffers worse health outcomes on a number of public health indicators.
Jesse Jackson, Jr., (U.S. Rep., Illinois), HEALTHCARE, 2007, 30.
We spend a lot more money on health care than any other nation, approximately 15 percent of our
Gross Domestic Product (GDP) or about $1.7 trillion. With much smaller economics, Canada spends
around 9 percent and other nation's significantly less -- but they cover all of their citizens. It's why,
according to the World Health Organization (WHO), we barely rank in the top 50 nations in the world
(37th) in terms of meeting the health care needs of our people. In part, it's because about 25 percent of
our health expenditures have nothing to do with providing health care. One-quarter of our private health
dollars are spent on advertising, bureaucracy and other, non-health-care-related activities -- compared to
2-3 percent for Medicare. If we spent the same amount of money (currently $1.7 trillion or 15% of our
GDP) more efficiently and effectively, and created a unique American health care system on the basis of
H.J. Res. 30, we would have the greatest health care system ever constructed for all of the American
people.
Many industrialized countries have better aggregate health outcomes than the United States, even
though the United States spends 50 percent more on health care than nearly any other country. The
better outcomes result largely from health-promoting policies: universal health care coverage, stronger
protections against poverty and unemployment, better child care, more leisure, and better enforcement of
workplace health and safety laws.
Bonnie Lefkowitz, (Journalist, M.A. in Public Administration, Harvard U.), COMMUNITY HEALTH
CENTERS: A MOVEMENT AND THE PEOPLE WHO MADE IT HAPPEN, 2007, 146.
Medical expenditures consistently exceed those of all other developed countries, and in 2004
approached $6,300 per person. But the risk of mortality in this nation is still three times as great for the
poor compared with those who are relatively well off, and infant deaths are still twice as prevalent for
black babies as for white babies. In turn, these ongoing disparities in the face of improvement in other
countries help drive our declining international position. In 1960 the U.S. had the eleventh lowest infant
mortality rate among developed nations; in 2002 its position had dropped to twenty-eighth.
18
AFFIRMATIVE CASE #3: THE COMMON GOOD

The thesis of this case is that promoting the common good is the primary criterion of a just government. Adequate health care for
all citizens is essential for achieving the common good. Healthy individuals strengthen society in virtually every way. Without access
to health care, health is severely harmed. People excluded from health care are significantly less healthy than those who have
access to health care. A guarantee of universal health care is essential to ensure the well-being of all citizens.
OBSERVATIONS:
I. SECURING A JUST SOCIETY IS THE PRIMARY RESPONSIBILITY OF GOVERNMENT.
[See Justice brief in the Value Debate Handbook]
II. PROMOTING THE COMMON GOOD IS THE PRIMARY CRITERION OF A JUST GOVERNMENT.
[See Common Good brief in the Value Debate Handbook]
2005, 145-146.
More recently, the idea of the social contract has taken prominence in our discussions of the
obligations and responsibilities that we have to each other and to the wider community. From Jean-
Jacques Rousseau's On the Social Contract, written in 1695, to Robert Putnam's more recent Bowling
Alone (2000), political philosophers have attempted to inform us as to the manner and scope of our civic
obligations.
2005, 149.
One formal dimension or membership in a community is citizenship. For example, we are citizens of
municipalities, counties, and states, as well as citizens of the country. This formal aspect of what it means
to be a member of society carries both a legal and civic status. Fundamental to the civic component of
citizenship is responsibility. The term citizenship as defined by Webster's consists of two interrelated
parts"the state of being vested with the rights, privileges, and duties of a citizen" and "the character of
an individual viewed as a member of society; behavior in terms of the duties, obligations, and functions of
a citizen" (Webster's Encyclopedic Unabridged Dictionary of the English Languages, 1996). In other
words, citizenship bestows certain rights and privileges upon its members but asks in return that
individuals reciprocate by actively engaging in various duties, obligations, and functions (in other words,
responsibilities), which in turn benefit the community or society as a whole. That is the essence of
citizenship).
CONTENTIONS:
I. PROMOTING THE COMMON GOOD DEMANDS THAT THE GOVERNMENT GUARANTEE UNIVERSAL
HEALTH CARE FOR ALL CITIZENS.
A. ADEQUATE HEALTH CARE IS A BASIC RIGHT OF ALL CITIZENS.
Failing to promote health in a population, that is, failing to promote normal functioning in it, fails to
protect the opportunity or capability of people to function as free and equal citizens. Failing to protect that
opportunity or capability when we could reasonably do otherwise, I shall argue, is a failure to provide us
with what we owe each other. It is unjust.
SERVICES: A SOCIAL JUSTICE ANALYSIS, 2007, 28-29.
The final theory of social justice considered, that formulated in a series of treatises over the most
recent 3 decades by John Rawls, in various ways argues for a positive right to health care. Embedded in
Rawls' theory are two core arguments for a positive right to health care. One draws upon the difference
principle, the idea that a necessary precondition for a "just" state of inequality is that the inequality in
question "must be of greatest benefit to the least advantaged members of society."
19
The second core argument for the general positive right to health care embedded in Rawls's theory of
justice involves the core idea or principle of fair equality of opportunity, that is, society's obligation for
providing for "the general means necessary to underwrite fair equality of opportunity and our capacity to
take advantage of our basic rights and liberties, and thus be normal and fully cooperating members of
society over a complete life."
Rawls considered a positive right to health care as an essential foundation of free and equal
citizenship. To quote Rawls directly on this key point: "... provision for medical care, as with primary
goods generally, is to meet the needs and requirements of citizens as free and equal. Such care falls
under the general means necessary to underwrite fair equality of opportunity and our capacity to take
advantage of our basic rights and liberties, and thus to be normal and fully cooperating members of
society over a complete life."
The second principle, pertaining to the inherently unjust nature of disparities in health care, is no more and
no less than an extension of Rawls' difference principle to health care. Thus, the two principles of socially
just health care are as follows: 1. There is a positive right of access to adequate essential health care, based
upon health care's role as critical determinant of fair equality of opportunity and the capacity to take
advantage of basic rights and liberties throughout the life course; 2. Disparities in either health care access
or health care quality are presumptively unjust, and defensible only where demonstrably linked to superior
benefits for the least advantaged.
Citizens Health Care Working Group, HEALTH CARE THAT WORKS FOR ALL AMERICANS, June 1,
2006, 6.
Health and health care are fundamental to the well-being and security of the American people. It
should be public policy, established in law, that all Americans have affordable health care coverage.
Assuring health care is a shared social responsibility. This includes, on the one hand, a public
responsibility for the health and security of its people, and on the other hand, the responsibility of
everyone to contribute.
Roy Porter, (Prof., Medicine, University College, London), THE GREATEST BENEFIT TO MANKIND, 1997,
632.
The twentieth-century ship of state thus took health on board, paying lip service to medical thinkers
and social scientists who taught that a healthy population required a new compact between the state,
society and medicine: unless medicine were in some measure 'nationalized', society was doomed to be
sick and dysfunctional.
2005, 141.
The manner in which poverty restricts access to opportunities can be witnessed in other areas as
well. Take the case of health. In order to effectively compete in the labor market, one must have
reasonably good health. As we saw in chapters 2 and 4, poverty has a negative impact on health status.
Adults who are poor are more likely to have higher rates of heart disease, cancer, diabetes, and virtually
every other major illness and cause of death. Children in poverty are also more likely to suffer from
various health ailments, such as lead poisoning, asthma, and injury from accidents and violence. These
illnesses and conditions are less likely to be attended to through the health care system. As a result,
health deteriorates, again leading to reduced opportunities. In the United States, the crisis over out-of-
control health costs highlighted the plight of those excluded from the mainstream. As of the 1990s, over
35 million Americans had no medical insurance: almost one in six citizens under the age of sixty-five.
Another 20 million had such inadequate insurance that a major illness would lead to bankruptcy. Indeed,
almost 17 million Americans who are gainfully employed lack health insurance 3 million more than in
1982, and each year approximately 200,000 are turned away from hospital emergency rooms for this
reason. Half a million American mothers have no form of insurance when they give birth, and 11 million
American children are not covered by any medical insurance.
20
B. THE PRIVATE HEALTH CARE INDUSTRY DOES NOT PROVIDE HEALTH CARE FOR ALL CITIZENS.
1. Many citizens do not have adequate private insurance.
2005, 210.
One of the reasons that Americans are lacking in health care coverage; particularly those in or near-
poverty, is that their place of work does not provide health coverage. As we discussed earlier, an
increasing number of low-wage and part-time jobs have been created during the past thirty years, and
many of these jobs lack health benefits. Furthermore, for those who are under age 65 but out of work,
health coverage is unlikely to be available except through the Medicaid program.
Mark Robert Rank, (Prof., Social Welfare, Washington U., St. Louis), ONE NATION UNDERPRIVILEGED, 05, 210.
In 2002, 44 million Americans, or 15.2 percent of the population, lacked health insurance throughout the year. For
those below the poverty line, nearly a third (30.4 percent) had no health coverage in spite of the Medicaid program,
while 27.9 percent of those below 1.25 of the poverty line were without health insurance (U.S. Census Bureau, 2003d).
During a thirty-six month period (1993 to 1996), 52.7 percent of those below the poverty line failed to have coverage
continuously throughout, while 55.9 percent of those between 1.00 and 1.50 of the poverty line were not covered
continuously. An estimated twenty million more Americans have inadequate health insurance to protect them from the
expense of a major illness.
The second reason why private insurance is not adequate to cover the population of an entire country
is the problem of affordability. For reasons explored below, health care is extraordinarily expensive.
Because health care is expensive, health insurance is expensive as well. The average employment-
related family health insurance policy - the form of insurance most American families have - cost $ 9,950
in 2004. A person who works forty hours a week, fifty-two weeks a year, at the minimum wage of $ 5.15
per hour, would have to spend ninety-three percent of pre-tax income to cover the cost of such a policy if
she had to buy the policy from her own funds without employer assistance. A household would have to
earn over $66,000 per year, 350% of the federal poverty level, before the cost of health insurance would
fall to a more or less affordable fifteen percent of pre-tax income. The barriers of risk and affordability,
moreover, interact perniciously. People in bad health often find it hard to hold down jobs, while lower
income people are disproportionately in worse health. It is not surprising that most uninsured Americans
are poor and many poor are uninsured.
2. Free medical care is no longer widely available.
Maggie Mahar, (Journalist & Prof., English, Yale U.), MONEY DRIVEN MEDICINE, 2006, 216.
Although basic medical services for the poor are available at community clinics across the country,
specialty care is scarce for patients without health insurance. At one time, academic medical centers took
care of a large share of the uninsured, but as reimbursements tighten, specialists at these institutions are
treating more patients with private insuranceand fewer of the uninsured. A 2003 study by researchers
at Boston Massachusetts Hospital confirmed the trend: Of 2,000 physicians surveyed nationwide, one in
four said they had problems admitting patients to teaching hospitals or were forced to limit those patients'
care.
Maggie Mahar, (Journalist & Prof., English, Yale U.), MONEY DRIVEN MEDICINE, 2006, 216.
Even in New York, a city endowed with an embarrassment of specialists, it can be extraordinarily
difficult to find one who will take a referral for an uninsured or Medicaid patient, says. Dr. Neil Calman, a
clinical professor of family medicine at Albert Einstein College of Medicine and founder of New York City's
Institute for Urban Family Health, a not-for-profit that operates 13 health centers: "A of of doctors just
don't want to have anything to do with these patients."
Maggie Mahar, (Journalist & Prof., English, Yale U.), MONEY DRIVEN MEDICINE, 2006, 200-201.
Make no mistake, the uninsured are at risk. A 2003 study published in Health Affairs paints a stark
portrait of a two-tier system. When care is measured in dollars, uninsured cancer patients under the age
of 65 receive half as much care as those who have insurance. When researchers looked past the dollar
value of the care to the services received, the results confirmed what spending patterns suggested: the
uninsured are admitted to the hospital less often, see fewer physicians in their offices, and even log fewer
emergency room visits. At the same time, the uninsured pay more than twice as much out-of-pocket for
their care. "They're paying more of their own money for the limited services that they do get," says
Kenneth Thorpe, chairman of the health policy department at Emory University and the lead author on the
cancer study, even though "the uninsured usually are treated at public hospitals and don't have access to
some of the cancer specialists that are typically available to insured patients."
21
II. UNIVERSAL HEALTH CARE GUARANTEES ADEQUATE HEALTH CARE FOR ALL CITIZENS.
A. A GOVERNMENT GUARANTEE OF UNIVERSAL HEALTH CARE GIVES COMPREHENSIVE BENEFITS
TO ALL.
Timothy Jost, (Prof., Law, Washington & Lee U.), WAKE FOREST LAW REVIEW, Summer 2006, 575.
While employment-related insurance has worked reasonably well, the best risk spreader is the
government, which can include the entire national population in one risk pool. Most developed countries
achieve broad spreading of risk either through social insurance programs, funded through wage-based
premiums (essentially payroll taxes), or through national health insurance programs financed through
general revenue funds.
David DeGrazia (Prof., Philosophy, George Washington U.), HEALTH CARE: OPPOSING VIEWPOINTS,
2000, 181.
According to the reasoning described in the previous section, Canada's health care system has
accomplished the impossible. First, Canada provides universal access to care and still controls costs
sufficiently to spend much less per capita than the U.S. does. In 1990, for example, the U.S. spent $2566
per citizen on health care while Canadathe world's second biggest spender spent only $1770 per
citizen, less than 70 percent as much. Equally surprising to many Americans, Canadians have access,
not just to some "decent minimum" of health care, but to a very comprehensive set of benefits, including
long-term and chronic care, as well as the services of psychiatrists and psychiatric hospitals.
Commentators often state that the Canadian system provides "all medically necessary" services as
determined by physicians, but the more modest claim that the health care benefits are very
comprehensive is less likely to be contested. The quality of health care in Canada is generally considered
high, and patient satisfaction is apparently higher than in the U.S. Equally impressive is the extensive
freedom enjoyed by both providers and patients. Physicians are paid predominantly under a fee-for-
service system, thereby avoiding, for example, the various kinds of restrictions imposed by American
HMOs, such as limitations on the providers to whom patients can be referred and limits on the number of
visits patients can make for, say, psychotherapy.
Sidney Watson, (Prof., St. Louis U. School of Law), JOURNAL OF LEGAL MEDICINE, Mar. 2004, 111.
A legal entitlement to health insurance is necessary because a private, individual market cannot
achieve universal access to affordable health insurance.
B. A GOVERNMENT GUARANTEE OF UNIVERSAL HEALTH CARE PROMOTES THE HEALTH AND
WELFARE OF ALL CITIZENS.
What should perhaps be most troubling to us, however, is comparative quality data. We have long
known that our mortality and morbidity statistics do not compare favorably with other developed countries.
The average male in the United States, for example, can at birth expect to live 74.5 years, while the
average British male can expect to live 76.2 years, the average German male 75.5 years, and the
average Swedish male 77.9 years. Also, our infant mortality rate of 6.8 deaths per thousand compares
unfavorably with British, Swedish, and German infant mortality rates of 5.5, 3.7, and 4.3 deaths per
thousand, respectively. But mortality and morbidity rates depend on many things - diet, education,
housing conditions, and genetic predispositions, to name a few - and are not necessarily determined by
health care. Also, we have long known that our mortality and morbidity rates are skewed by the terrible
statistics that describe the conditions of minority groups in the United States.
David DeGrazia (Prof., Philosophy, George Washington U.), HEALTH CARE: OPPOSING VIEWPOINTS,
2000, 185.
A universal health care system simply means that everyone's health care is paid for out of a common
national fund. A universal, not-for-profit, single payer national health insurance system thus replaces our
current profit-driven, multi-payer system that leaves 42 million people uninsured, and insured patients at
risk of being denied care when they are sick so corporations can profit. Every resident has a national
health care card which they can use for care at any hospital, clinic, doctor's office, or other medical facility
in the country regardless of age, income, or employment. Funding is collected through a sliding scale of
income and payroll taxes and placed in a national health care trust fund. Publicly accountable health
boards in each state administer the funds and negotiate fees and budgets with health professionals, not-
for-profit HMOs, hospitals, and drug companies (taking care to minimize incentives for both undercare
and over-care). National health insurance is absolutely necessary if we are to remedy the problems in the
health care system that have so long plagued nurses and their patients. It will save over $100 billion
annually by reducing the amount of money spent on overhead and profits (over 25% of every health care
dollar).
22
NEGATIVE CASE #1: JUSTICE

The thesis of this case is that governments assumption of the responsibility to provide health care to its citizens violates the
requirements of justice in two ways. First, such government action undermines individual responsibility which is fundamental to a just
relationship between individuals and their government. Second, such government action enriches the politically powerful at the
expense of diminishing the health care of all citizens, especially the poor.
OBSERVATIONS:
I. JUSTICE IS THE STANDARD FOR DETERMINING APPROPRIATE GOVERNMENTAL ACTIONS.
[See Justice brief in the Value Debate Handbook]
II. THE CRITERION FOR JUSTICE IS PROTECTION OF THE LEAST ADVANTAGED MEMBERS OF SOCIETY.
[See Rawls Justice brief in the Value Debate Handbook]
For Rawls, justice requires giving some priority to improving the lifetime prospects of those who are
worse off. This has two parts: (1) his rational social contractors selecting principles of justice have to think
about which principles make their lifetime prospects acceptable, regardless of their social position, and
(2) the principles they select require them to know who are worst off and how the basic structure of
society can work to make them as well off as possible. Ideally, the same basis for judging inequalities can
play a role in both kinds of decision.
CONTENTIONS:
I. A GOVERNMENT GUARANTEE OF UNIVERSAL HEALTH CARE FOR ALL CITIZENS WASTES PRECIOUS
SOCIETAL RESOURCES.
A. MOST CITIZENS HAVE THE ABILITY TO MAKE THEIR OWN DECISION ABOUT WHETHER TO BUY
HEALTH INSURANCE.
Arnold Kling, (Economist, Federal Reserve Board), CRISIS OF ABUNDANCE, 2006, 63.
The very poor and the very sick need help paying for health care. The rest of us do not. The very
poor need help paying medical bills. People with expensive, permanent illnesses, such as diabetes, also
fall in this category. Support for the poor and the permanently ill could come from private charity, but here
I will assume that it comes from government. I term as "very sick" people who run into unusually large
medical bills in a given year, but who are not permanently ill. Catastrophic health insurance is the ideal
solution for dealing with the expenses that arise when someone becomes very sick. For people who are
not poor and whose medical expenses are not unusually large, paying for medical care out of pocket is
reasonable. Shifting responsibility to others only introduces administrative costs and economic
distortions.
Carla Howell, (Dir. , Center for Small Government), HEALTH CARE, 2008, 85.
Americans who don't have health insurance are often neither poor nor do they lack access to medical
care. They simply choose not to buy insurance because they believe it's a bad use of their money.
Devon Herrick, (Sr. Analyst, National Center for Policy Analysis), CRISIS OF THE UNINSURED, Aug. 28,
2008, 2.
About 18 million 18-to-34-year olds are uninsured. Most of them are healthy and know they can pay
incidental expenses out of pocket. Using hard-earned dollars to pay for health care they don't expect to
need is a low priority for them.
23
B. GOVERNMENT SHOULD LIMIT ITS GUARANTEE OF HEALTH CARE TO THOSE CITIZENS UNABLE TO
PROVIDE FOR THEMSELVES.
William P. Gunnar, (Prof., Surgery, Loyola U. School of Medicine), ANNALS OF HEALTH LAW, Winter
2006, 173-174.
Today, delivery of charitable health care services to the uninsured and indigent is provided by a
"safety net" of health care providers. Broadly defined, the "safety net" includes community health centers,
public health department clinics, rural health clinics, free clinics, individual physician practices that
provide health care services to indigent and uninsured patients, and any for-profit or non-profit hospital
with an emergency department as defined by EMTALA. Safety net providers are dependent upon
government financing, typically a blend of Medicaid, federal and state grants, Disproportionate Share
Hospital (DSH) funding, and local taxpayer support.
II. A GUARANTEE OF UNIVERSAL HEALTH CARE HARMS THE MOST DISADVANTAGED CITIZENS.
A. AMERICAS POOREST CITIZENS CURRENTLY RECEIVE HIGH QUALITY CARE.
John Goodman, (Pres., National Center for Policy Analysis), HEALTH CARE COVERAGE AND ACCESS:
CHALLENGES AND OPPORTUNITIES, Hrg., Sen. Comm. On Health, Education, Labor & Pensions, Jan.
10, 2007, 35.
To see what this means on the local level, consider Parkland Hospital in Dallas, a primary source of
care for the indigent and those covered by Medicaid. Uninsured patients and Medicaid patients pass
through the same emergency room door; they see the same doctors; they receive the same treatments;
and if required, they are admitted to hospital rooms on the same floors.
10, 2007, 35.
At Children's Medical Center, next door to Parkland, a similar exercise takes place. Children on
Medicaid, children on SCHIP, and uninsured children all come through the same emergency room door.
Again, they all see the same doctors and receive the same treatments. Again, it is only the hospital that
seems to care whether anybody is insured and by whom.
Darrell Gaskin, (Prof., Health Economics, U. Maryland), HEALTH AFFAIRS, March/April 2008, 526.
Our findings suggest that when minority patients receive hospital care, they receive the same
standard of care that white patients receive. Within-hospital disparities in quality of care are isolated to a
relatively small number of hospitals and appear to be for certain specific conditions.
B. A GUARANTEE OF UNIVERSAL HEALTH CARE REQUIRES MEDICAL CARE RATIONING.
Timothy Jost, (prof., Law, Washington & Lee U.), JOURNAL OF LAW, MEDICINE, AND ETHICS, Fall 2004,
436.
Some countries that spend less on health care than we spend also explicitly ration access to
services. In the U.K, for example, people often have to wait to see a specialist, and then must wait again
for surgery that the specialist may deem necessary. Waits are particularly common for certain conditions
such as varicose veins, hernias, cataracts, or painful joints -- problems that have more to do with quality
of life than with the preservation of life. Repeated efforts to clear waiting lists have proven unsuccessful.
Daniel Callahan, (Dir., The Hastings Center), AMERICAN JOURNAL OF LAW & MEDICINE, 1992, 1.
This Article argues that universal health care is neither feasible nor plausible without health care
rationing. This contention is based not on some theory of just health care but on the experience of other
countries that have some form of universal health insurance already in place. Each provides a decent
level of health care. None provide all the health care that people might want, nor necessarily provide it in
the way in which they would most like to have it. Why do these countries set such limits? Because early
on they came to recognize what might be called the economic iron law of universal health care plans: to
be affordable they must be limited. If you want universal coverage, then be prepared to ration. If you are
not prepared to ration, abandon all hopes of an affordable plan of universal coverage.
Caroline Sommers, (J.D. Candidate), PEPPERDINE JOURNAL OF BUSINESS, ENTREPRENEURSHIP &
THE LAW, 2009, 454.
Universal health care results in cost controls that will likely lead to a rationed health care and imposed
government mandated care.
24
John C. Goodman & Devon Herrick, (Staff, National Center for Policy Analysis), TWENTY MYTHS ABOUT
HEALTH CARE, 2001, 95.
Our survey of national health insurance in countries around the world provides convincing evidence
that government control of health care usually makes citizens worse off. When health care is made free
at the point of consumption, rationing by waiting is inevitable. Government control of the health care
system makes the rationing problem worse as governments attempt to slow the use of services by
limiting access to modern medical technology. Under government management, both efficiency and
quality of patient care steadily deteriorate. The lesson from other countries is that America would not be
served by an expansion of government bureaucracy or by greater governmental control over the U.S.
health care system.
Michael J. Hurd, (Psychologist & Author), HEALTH CARE: OPPOSING VIEWPOINTS, 2000, 163.
As Canada's national government slashes spending on medical care in order to reduce the deficit,
local provinces are reducing medical staff. In Ontario, pregnant women are being sent to Detroit because
no obstetricians are available. Specialists of all kinds are in short supply Patients have to wait eight
weeks for an MRI, ten weeks for referral to a specialist, and four months for heart bypass surgery Does
this sound like the utopian care Canadian politicians promised their constituents? The hard truth is that
socialized medicine is destroying health care in Canada.
C. RATIONING IN GOVERNMENT HEALTH CARE PROGRAMS HARMS THE POOR CITIZENS THE MOST.
There is substantial evidence that when health care is rationed, the poor are pushed to the rear of the
waiting line. In general, low-income people in almost every country see physicians less often, spend less
time with them, enter the hospital less often and spend less time there, when the use of medical services
is weighted by the incidence of illness. Moreover, scholarly evidence suggests that the wealthy and
powerful do not wait as long as others. For example, one study in Ontario found: More than 80 percent of
physicians, including 90 percent of cardiac surgeons, 81 percent of internists and 60 percent of family
physicians, had been personally involved in managing a patient who had received preferential access on
the basis of factors other than medical need. When asked about those patients most likely to receive
preferential treatment, physicians reported that 93 percent had personal ties to the treating physician, 85
percent were high-profile public figures and 83 percent were politicians. Other studies have reached
similar conclusions. One found that the wealthy and powerful have significantly greater access to medical
specialists than less well-connected, poor Canadians. Another found that preferential treatment for high-
profile patients resulted in more frequent services, shorter waiting times and greater choice in specialists.
In recent years, Canadian newspapers have resonated with stories of wealthy and prominent patients
"jumping the queue" for quicker treatment, while ordinary citizens languish.59 For example, the president
of the Canadian Medical Association, Dr. Victor Dirnfeld, suggests that the Canadian system is in fact a
two-tiered system, and says he knows of seven prominent political figures in British Columbia and Ontario
who had received special treatment. "Instead of waiting three months for an MRI," he said, "they will have
it done in three or four days." The issue of preferential treatment was highlighted when Canada's Health
Minister, Allan Rock, underwent a successful surgery after he was diagnosed with prostate cancer in
January 2001. Since then, Rock has come under sharp criticism from other Canadians who are suffering
from prostate cancer but who are waiting much longer periods often more than a year between
diagnosis and surgery.
The problem of unequal access is so well known in Britain that the press has begun ro refer to the
NHS as a "postcode lottery." in which a person's chances for timely, high quality treatment depend on the
neighborhood (or the "postcode") in which he or she lives. "Generally speaking, the poorer you are, and
the more socially deprived your area, the worse your care and access is likely to be,"
Roy Porter, (Prof., Medicine, University College, London), THE GREATEST BENEFIT TO MANKIND, 1997,
667.
In England the Black Report, published as Inequalities in Health in 1980, showed that the affluent
continued to live longer than the poor and were far healthier: e.g., in 1971 the death rate for adult males
in social class V (unskilled workers) was nearly twice that of adult men in social class I (professional
workers).
25
NEGATIVE CASE #2: QUALITY OF LIFE

The thesis of this case is that a government guarantee of universal health care is inappropriate because it would involve having
the government make choices that individual citizens should have a right to make for themselves. It makes sense for government to
provide basic Medicaid or Medicare coverage for citizens who are in financial need. But guaranteed access to health care would
explode health care costs, resulting in decreased government attention to many other vital areas. In a well-ordered society, health
care should be weighed against other priorities. Establishing health care as a basic right eliminates this essential weighing process.
Most Americans are perfectly capable of making their own decisions about health care without the imposition of a government
mandate or guarantee.
OBSERVATIONS:
I. PROVIDING A GOOD QUALITY OF LIFE IS THE STANDARD FOR DETERMINING THE DESIRABILITY OF
GOVERNMENT ACTIONS.
[See Quality of Life brief in the Value Debate Handbook]
II. QUALITY OF LIFE IS A MORE IMPORTANT DETERMINANT OF HEALTH THAN IS ACCESS TO HEALTH
CARE.
Robert Brown, (Fellow, Canadian Institute of Actuaries), THE GLOBE AND MAIL (CANADA), Sept. 5, 2012,
A19.
There have been remarkable improvements in life expectancy over the past 100 years. The reasons
are many: sanitary drinking water, pasteurized milk, safe sewage disposal, work safety, higher standards
of living, better education, and cures or immunizations for many communicable diseases such as
smallpox and diphtheria. Readers may wonder why universal health care is not on this list. It would be on
a longer list, but research indicates that a country's health-care system is not as important as any of the
top seven reasons - in fact, it's been estimated that they are responsible for at least three-quarters of the
increases in life expectancy in developed countries over the past 100 years.
Robert Brown, (Fellow, Canadian Institute of Actuaries), THE GLOBE AND MAIL (CANADA), Sept. 5, 2012,
A19.
How much a society spends on health care has not been found to be directly related to any health
outcome tested. For example, at 17 per cent of GDP, the United States spends more (by far) on health
care than any other country. And yet, its life expectancy and infant mortality rates (two common
measures of population health) are just average compared with other developed countries.
CONTENTIONS:
I. GUARANTEEING UNIVERSAL HEALTH CARE TRADES OFF WITH MORE IMPORTANT SOCIETAL NEEDS.
A. THE UNITED STATES BUDGET IS ALREADY OVER-BALANCED TOWARD HEALTH CARE SPENDING.
David Walker, (Former Comptroller General of the United States), HEARING BEFORE THE SENATE
BUDGET COMMITTEE, Nov. 10, 2009. Retrieved Oct. 5, 2012 from www.pgpf.org/opinion/2009/11/10/
David-Walker-Testifies-Before-Senate-Budget-Committee.aspx?p=1.
The truth is that Medicare is already underfunded by over $38 trillion and growing. At the same time,
Congress is currently debating making more federal health care promises, without adequately addressing
the tens of trillions in unfunded health care promises that we already have.
B. GUARANTEEING UNIVERSAL HEALTH CARE WILL BE RUINOUSLY EXPENSIVE.
Michael Tanner, (Sr. Fellow, Cato Institute) BAD MEDICINE, 2011, 1.
While the new law will increase the number of Americans with insurance coverage, it falls significantly
short of universal coverage. By 2019, roughly 21 million Americans will still be uninsured. The legislation
will cost far more than advertised, more than $2.7 trillion over 10 years of full implementation, and will add
more than $823 billion to the national debt over the programs first 10 years.
James Capretta, (Fellow, Heritage Foundation), OBAMACARE REMAINS A BUDGETARY AND POLICY
DISASTER, Aug. 2, 2012. Retrieved Oct. 5, 2012 from www.heritage.org/research/reports/2012/08/
obamacare-remains-a-budgetary-and-policy-disaster.
With Americas debt burden heading toward 90 percent of GDP this decade and spending on
entitlements about to soar with the baby boomers retirement, America does not need another massive,
unfunded liability. Regrettably, that is exactly what the country got with Obamacare. The law has set in
motion the largest entitlement expansion in nearly 50 years, with no realistic way to pay for it.
26
Michael Cannon, (Dir., Health Policy Studies, Cato Institute), A RIGHT TO HEALTH CARE?, June 29,
2007. Retrieved Oct. 5, 2012 from http://www.cato.org/publications/commentary/right-health-care.
Suppose Congress created a legally enforceable right to health care. Even if such a measure could
win approval, the debate would not and could not end there. The first difficulty would be to define the
scope of that right. Do we have a right to preventive care? If so, health care spending (and taxes) would
explode. Researcher J. D. Kleinke notes that if everyone followed government recommendations, the
number of people taking preventive medications for hypertension, asthma, obesity, and high cholesterol
would increase anywhere from 2- to 10- fold. Should mammograms be available to women regardless of
their likelihood of developing breast cancer? What about experimental treatments? With the wide variety
of tests and treatments, someone must decide where the right to health care ends, lest the nation be
bankrupted. Whoever makes those decisions will wield enormous power over people's health. Who
should have that power? Most nations hand that power to unelected bureaucrats, who ration medical care
-- often by making even seriously ill patients wait for care.
Arnold Kling, (Analyst, Cato Institute), CRISIS OF ABUNDANCE: RETHINKING HOW WE PAY FOR
If consumers were to have unfettered access while enjoying insulation from cost, the system would
not be affordable. Affordability might be achieved through rationing, but that would mean sacrificing
unfettered access.
C. GUARANTEED HEALTH CARE MEANS LESS SPENDING ON OTHER SOCIAL NEEDS.
Lamar Alexander, (Former Governor, Tennessee), WALL STREET JOURNAL, Mar. 29, 2012. Retrieved
Oct. 5, 2012 from http://online.wsj.com/article/SB10001424052702303404704577305973982016492.html.
The National Governors Association (NGA) reports states are facing a collective $95 billion budget
shortfall this year alone. But ObamaCare's expansion of Medicaid will force an additional $118 billion in
unfunded mandates onto the states through 2023. The National Association of State Budget Officers
says Medicaid now comprises nearly one quarter of states' entire budgets. Each one of us has served as
governor in our state and knows that increased costs in one area means less money in another.
America's families know this as well since they can't just print and borrow money when their spending
goes up like the federal government does. Yet, astonishingly, more than half of ObamaCare's newly
promised health-insurance coverage was accomplished by assigning nearly 26 million more people to an
already broken Medicaid program and telling governors, "Now, you find a way to help pay for it." This will
leave states with two choices, or a combination of both: either cut funding in areas such as K-12
education, public universities and colleges, veterans affairs programs, and other much-needed services;
or raise sales, income or property taxes.
Avik Roy, (Staff), FORBES, July 19, 2012. Retrieved Oct. 5, 2012 from www.forbes.com/sites/aroy/
2012/07/19/governors-worst-nightmare-obama-proposed-shifting-costs-of-obamacares-medicaid-
expansion-to-the-states/.
As Dan Diamond notes, a recent report from the State Budget Crisis Task Force makes plain how
runaway growth in Medicaid spending is crowding out other essential programs, like education and
policing. Those high costs have backed officials into a corner, writes Dan: The task force offers a stark
assessment: Medicaid spending growth is crowding out other needs for states and imperiling their fiscal
sustainability.
II. A GOVERNMENT GUARANTEE OF UNIVERSAL HEALTH CARE ELIMINATES INDIVIDUALS RIGHTS TO
MAKE HEALTH CARE DECISIONS.
A. A GUARANTEE OF UNIVERSAL HEALTH CARE RESTRICTS INDIVIDUAL CHOICE.
Sheldon Rishman, (Vice President for Policy Affairs, Future of Freedom Foundation), HEALTH CARE:
OPPOSING VIEWPOINTS, 2000, 38.
The provision of health care as a basic uniform civil right is more intrusive than any other element of
the welfare state: health care dramatically touches all the important passages of life, from reproduction
and birth to suffering and death. The commitment to a particular package of services brings with it a
particular interpretation of the significance of reproduction, birth, health, suffering, death, and equality
(e.g., it involves specific positions regarding artificial insemination by donors, prenatal diagnosis with the
possibility of selective abortion, physician-assisted suicide, voluntary active euthanasia, and unequal
access to better basic health care). A uniform welfare right to health care involves endorsing and
establishing one among a number of competing concrete moralities of life, death, and equality. Because
of this tie to morally controversial interventions, the establishment of uniform, universal health-care
welfare rights directly or indirectly involves citizens, patients, physicians, nurses, and others in receiving
or providing health care in a health-care system which they may find morally opprobrious.
27
Sheldon Rishman, (Vice President for Policy Affairs, Future of Freedom Foundation), HEALTH CARE:
OPPOSING VIEWPOINTS, 2000, 39.
All of this is a rather roundabout way of identifying the worst aspect of the "right to medical care": the
tethering of the citizen to the state. For all the criticism that is leveled at Medicare and proposals to reform
medical care in general, too little attention has gone to that uncomfortable fact. If government controls
medical spending, it controls you, including the very length of your life. We may correlate the progress of
mankind with the extent of its independence from the state. To put it mildly, national health insurance
would be a setback. Yet that is the direction in which we move. New regulations governing the portability
of insurance policies and coverage of existing conditions all portend creeping comprehensive control. The
newest cause, uninsured children, does the same. Ludwig von Mises explained why in his Critique of
Interventionism. One regulation creates problems, which are used to justify the next intervention. For
example, if Congress says mental-health benefits have to be equal to medical benefits, the cost of
insurance will go up. That will then be the excuse to force young people who don't wish to pay those
premiums to buy insurance. Next on the agenda will be price controls on doctors and insurance
companies. When companies flee the straitjacketed market, the government will step in. This is not
conspiracy. It's logic. It all starts with an innocuous phrase, the right to medical care.
B. A GOVERNMENT GUARANTEE OF UNIVERSAL HEALTH CARE SIGNIFICANTLY REDUCES THE
QUALITY OF MEDICAL CARE.
Joseph Califano, Jr. (President of the National Center on Addiction and Substance Abuse, Columbia U.),
HEALTH CARE: OPPOSING VIEWPOINTS, 2000, 20.
America's competitive impulse generates medical innovation not only for American consumers but for
the entire world. About half the world's output of medical devices occurs in the United States, and private
research and development spending by U.S. pharmaceutical and device manufacturers dwarfs that of
other nations. And despite the fact that other countries with less market-oriented economies benefit from
U.S. medical innovations, Americans still enjoy more access to quality health care than virtually any other
nation, according to studies by the journal Health Affairs and others.
From the time the National Health Service was formed, people who wanted to pay for private
treatment could have access to it as well as to the NHS.70 And despite the British claim that health care
is a right that is not conditioned on the ability to pay, last year an estimated 100,000 patients elected to
pay for private surgery rather than wait for free care.71 These patients went to private hospitals, of
which there are about 300 in Britain. Collectively, these hospitals account for an increasingly large share
of total health care services in Britain, including 20 percent of all non-emergency heart surgery, 30
percent of all hip replacements and $25 billion worth of total health care annually. Most of the patients in
these hospitals pay for treatment through private, employer-provided insurance. Altogether, 13 percent of
the British public is covered by private health insurance over 7 million people and that 13 percent
accounts for two-thirds of all patients in private hospitals. Because private hospitals are able to provide
fast, efficient service without waiting lines, a growing segment of the British public has come to view them
as a viable alternative to the NHS.
III. AMERICANS SHOULD NOT HAVE A RIGHT TO HEALTH CARE.
A. EVEN COUNTRIES THAT TRY TO PROVIDE UNIVERSAL HEALTH CARE DO NOT ACKNOWLEDGE
THAT HEALTH CARE IS A RIGHT.
John Goodman, (President, National Center for Policy Analysis), HEALTH CARE, 2008, 64.
In fact, no country with national health insurance has established a right to health care. Citizens of
Canada, for example, have no right to any particular health care service. They have no right to an MRI
scan. They have no right to heart surgery. They do not even have the right to a place in line. The 100th
person waiting for heart surgery is not entitled to the 100th surgery. Other people can and do jump the
queue. One could even argue that Canadians have fewer rights to health services than their pets. While
Canadian pet owners can purchase an MRI scan for their cat or dog, purchasing a scan for themselves is
illegal (although more and more human patients are finding legal loopholes, as we shall see below).
28
B. ESTABLISHING A RIGHT TO HEALTH CARE UNDERMINES MEDICAL INNOVATION.

A third difficulty is the incentives created by a right to health care. Patients would demand far more
medical care because additional consumption would cost them little. Higher tax rates would discourage
work and productivity, yielding less economic growth and wealth. Pushing down the compensation of
medical professionals would discourage many -- and many of the brightest -- from entering the field of
medicine. Divorcing their compensation from the satisfaction of their patients would reduce the quality of
care. As in other nations, policymakers would discourage medical innovation because every new
discovery puts them in the uncomfortable position of either increasing taxes or saying "no" to patients.
The paradox of a right to health care is that it discourages the very activities that help deliver on that right.
C. ESTABLISHING A RIGHT TO HEALTH CARE UNDERMINES INDIVIDUAL RIGHTS.
The fundamental problem with the idea of a right to health care is that it turns the idea of individual
rights on its head. Individual rights don't infringe on the rights of others. Smith's right to free speech takes
nothing away from Jones. The only obligation Jones owes to Smith is not to interfere with Smith's
exercise of her rights. A right to health care, however, says that Smith has a right to Jones' labor. That
turns the concept of individual rights from a shield into a sword. The underlying goal of a legally
enforceable right to health care is to provide quality medical care to the greatest number possible.
Perversely, making health care a "right" would make that goal harder to attain.
Wayne Dunn, (Staff, Capitalism Magazine), HEALTHCARE, 2007, 36-37.
Health care doesn't just pop into existence. It stems from individuals' intellectual achievements and
productive abilities. It's the product of doctors and nurses spending a decade mastering their craft, of
scientists toiling years to make life-saving breakthroughs, of capitalists staking fortunes on risky new
ventures. And it's the product of businessmen transforming those dollars and breakthroughs into
medicine and equipment, which doctors then bring to bear on human suffering. Sure, we can pass a law
giving you a "right" to all that. Heck, with enough votes, we can pass a law giving your house to the
homeless (after all, they need it). But just because something's legal doesn't make it right. Slavery,
remember, was legal.
D. ESTABLISHING A FUNDAMENTAL RIGHT TO HEALTH CARE WOULD BE UNWORKABLE BECAUSE
IT COULD NEVER BE UNIVERSALLY APPLICABLE.
Finally, if health care really were a fundamental human right, Americans presumably would have no
greater a right to medical care than Indians or Haitians. If we truly believe that everyone has an equal
right to health care, we would have to tax Americans to provide medical care to nearly every nation in the
world.
E. ESTABLISHING A RIGHT TO HEALTH CARE UNFAIRLY ADVANTAGES THOSE WHO SELECT RISKY
LIFESTYLES.
Why should some pay for the risky lifestyle choices of others? There is much evidence that
individuals can remain healthy by avoiding smoking, excessive alcohol use, unsafe sex, and certain
foods, and by getting adequate exercise and rest. Unhealthy behaviors can give rise to claims on others
that more careful people would not make.
But people who make risky lifestyle choices and expect others to assist them when ill health results
have some resemblance to those who cultivate expensive tastes: Owing them assistance for their
irresponsible choices would hijack others.
29
We know that in real life people routinely trade health risks for other benefits. They do so when they
commute longer distances for a better job or take a ski vacation. Some such trades raise questions of
fairness.
Jane Orient, (M.D.), THE FREEMAN, Dec. 2006. Retrieved Oct. 5, 2012 from
http://www.thefreemanonline.org/features/your-money-and-your-life-the-price-of-universal-health-care/
Theres ample evidence that Americans dont care very much about their health. They grouse about
copayments at the doctors office or pharmacy and may leave an office in high dudgeon if expected to
pay a reasonable bill not covered by their insurance. They often refuse to buy medical insurance even if
they can afford it. Aside from a subpopulation of health fanatics, many Americans constantly defy the
grandmotherly advice that is the proven basis for effective health maintenance. They smoke, drink, take
drugs, engage in casual sex, and/or overeat. They do not exercise, eat their vegetables, or
conscientiously wash their hands. They may be willing to take lots of pills, but appear to be allergic to
anything that interferes with instant gratification or requires self-discipline.g. establishing a right to health
care would result in FRIVOLOUS treatment.
Consider someone who feels very dissatisfied with his appearance: His face is normal but hardly
handsome. He feels he might be more successful in romance or in business if his face or hair better
matched some social model of handsomeness. To avoid responsibility for his failures, he may blame the
"superficiality" of others. The solution, he believes, lies in changing not how he thinks or behaves with
prospective social or business partners but his appearance. Are we obliged to relieve his suffering by
providing him with the means to obtain cosmetic surgery? Some may feel so obliged, but most would not.
F. EVERY RIGHT IMPOSES OBLIGATIONS ON OTHERS, REQUIRING CAREFUL BALANCE WHENEVER A
NEW RIGHT IS BEING CONSIDERED.
Walter Williams, (Prof., Economics, George Mason U.), HEALTHCARE, 2007, 38.
Rights do not include involuntary takings. Contrast that vision of a right to so-called rights to medical
care, food or decent housing, independent of whether a person can pay. Those are not rights in the
sense that free speech and freedom of travel are rights. If it is said that a person has rights to medical
care, food and housing, and has no means of paying, how does he enjoy them? There's no Santa Claus
or Tooth Fairy who provides them. You say, "The Congress provides for those rights." Not quite.
Congress does not have any resources of its very own. The only way Congress can give one American
something is to first, through the use of intimidation, threats and coercion, take it from another American.
So-called rights to medical care, food and decent housing impose an obligation on some other American
who, through the tax code, must be denied his right to his earnings. In other words, when Congress gives
one American a right to something he didn't earn, it takes away the right of another American to ,
something he did earn.
Walter Williams, (Prof., Economics, George Mason U.), HEALTHCARE, 2007, 39.
If this bogus concept of rights were applied to free speech rights and freedom to travel, my free
speech rights would impose financial obligations on others to provide me with an auditorium and
microphone. My right to travel freely would require that the government take the earnings of others to
provide me with airplane tickets and hotel accommodations.
Wayne Dunn, (Staff, Capitalism Magazine), HEALTHCARE, 2007, 36.
Why is a "right" to health care wrong? Why should we just say no? Because saying yes would not
only achieve the opposite of the desired results, it would diminish real rights. Legitimate rights don't place
demands on other people. Your right to worship, for example, doesn't obligate me to take you to church
or sing you a hymn. My right to free speech doesn't force you to toss me a megaphone or buy me some
airtime. Your neighbor's right to pursue happiness doesn't require you to rent him a condo or fly him to
Maui. Real rights demand only that you respect the rights of all. That's reality.
30
NEGATIVE CASE #3: COMMON GOOD

The thesis of this case is that a government guarantee of universal health care would undermine the quality of life in America by
promoting an overuse of the medical care system. Ironically, the expansion of medical treatment will harm public health by promoting
excessive testing, overtreatment, and unnecessary surgery.
OBSERVATIONS:
I. PROMOTING THE COMMON GOOD IS THE STANDARD FOR DETERMINING WHICH POLICIES ARE BEST.
[See the Common Good brief in the Value Debate Handbook]
CONTENTIONS:
I. GUARANTEEING UNIVERSAL HEALTH CARE WILL DRAMATICALLY EXPAND USE OF MEDICAL CARE.
A. UNIVERSAL COVERAGE ENCOURAGES PROVIDERS TO INCREASE MEDICAL TREATMENTS.
SERVICES: A SOCIAL JUSTICE ANALYSIS, 2007, 111-112.
To repeat a point made earlier in the chapter, under a variety of conditions individuals are more
disposed toward seeking health care because they have health care insurance than they otherwise would
be. To compound the problem, the availability of health insurance has fueled technological innovation in
nearly every sphere of health care (e.g. drugs, diagnostic equipment) that lends its own inflationary
pressures. Finally, providers have strong incentives to provide more health care at higher prices to the
extent that insurance is available to assure them a profitable return for their services.
B. INCREASED INSURANCE COVERAGE RESULTS IN MORE CARE, BUT NO IMPROVEMENTS IN
HEALTH.
Alan Garber, (Prof., Medicine, Stanford U.), HEALTH AFFAIRS, Nov./Dec. 2007, 1546.
Perhaps the strongest and earliest such evidence came from the RAND Health Insurance
Experiment (HIE), which randomized families to health insurance plans of varying generosity. One of the
HIE's main findings was that families in the least generous plan (95 percent coinsurance) spent nearly 30
percent less on medical care, with little or no difference in health. If we were to apply this lesson to the
nearly $1.5 trillion now spent on health care in the United States, the reductions in spending would be
remarkable.
C. FREE CARE MEANS WASTEFUL CARE.
10, 2007, 45.
One of the cardinal beliefs of advocates of single-payer health insurance (and one that is shared by
many advocates of the health maintenance organization, or HMO, form of health care delivery) is that
health care should be free at the point of consumption, regardless of willingness or ability to pay. But if
health care really were free (and easily accessible), people would have at least an economic incentive to
use health care until its value at the margin approaches zero. That would imply an enormous amount of
waste.
II. A DRAMATIC EXPANSION IN THE USE OF MEDICAL CARE WILL UNDERMINE PUBLIC HEALTH.
A. MEDICAL MISTAKES RESULT IN THOUSANDS OF DEATHS.
Michael Cannon, (Dir., Health Policy Studies, Cato Institute), PERSPECTIVES ON AN INDIVIDUAL
MANDATE, Oct. 17, 2008. Retrieved Oct. 5, 2012 from www.cato.org/publications/commentary/
perspectives-individual-mandate.
Medical errors have reached epidemic proportions in America's health-care sector. The Institute of
Medicine estimates that as many as 100,000 Americans die in hospitals every year due to medical errors.
That's more than 20 times the number of Americans who have died in the five years of the Iraq war.
Medication errors occur at a rate of one for every day a patient spends in a hospital, and injure an
estimated 1.5 million Americans each year.
31
2007, xvi.
There are close to 100,000 medical errors that cause death in the U.S. each year, the same as if a
747 jet crashed each day. For example, every day two patients either have the wrong limb amputated or
the wrong kidney taken out. Most of these do not result in lawsuits; conversely, most lawsuits are not
about actual medical errors -- and most of the time, the injured patient is not compensated.
Barbara Wexler, (Journalist), THE HEALTH CARE SYSTEM, 2007, 156.
The HealthGrades hospital patient safety study looked at nearly forty million Medicare patient records
to assess the mortality and economic impact of medical errors and injuries that occurred during hospital
admissions nationwide from 2002 through 2004. The study finds that 250,246 people in the United States
died as a result of potentially preventable, in-hospital medical errors during the study period, and the
incidence of patient safety problems had increased from 1.14 million and 1.18 million in the previous
reports to 1.24 million.
David Dranove, (Prof., Health Industry Management, Northwestern U.), CODE RED: AN ECONOMIST
EXPLAINS HOW TO REVIVE THE HEALTHCARE SYSTEM WITHOUT DESTROYING IT, 2008, 148.
The 1999 Institutes of Medicine study To Err Is Human found "at least 44,000 people, and perhaps
as many as 98,000 people, die in hospitals each year as a result of medical errors." Many of these deaths
were attributed to medication errors. (To put things in perspective, there are about thirty-five million
hospital admissions in the United States every year, so 98,000 deaths represents 0.28 percent of all
admissions; too big for sure, but only part of the quality equation.)
David Shore, (Dir., Trust Initiative, Harvard School of Public Health), THE TRUST CRISIS IN HEALTH
CARE, 2007, 9-10.
A study from the Institute of Medicine -- extensively quoted and challenged -- says that medical errors
are responsible for 44,000 to 98,000 deaths per year. Dr. Leape uses the figure 180,000, and estimates
that two-thirds of total deaths are preventable. Others claim that there are at least 225,000 deaths per
year caused by medical errors and adverse effects, which would place iatrogenic events third in causes
of death, after heart disease and cancer. Barbara Starfield, in an article in the Journal of the American
Medical Association, breaks this number down to include the following: 12,000 deaths per year from
unnecessary surgery; 7,000 deaths per year from medication errors in hospitals; 20,000 deaths per year
from other errors in hospitals; 80,000 deaths per year from nosocomial infections (those originating in
hospitals); 106,000 deaths per year from non-error adverse effects of medication. Note that these
estimates are for deaths only; they do not include errors or adverse effects that lead to discomfort or
disability.
Phillip Longman, (Sr. Fellow, New America Foundation), BEST CARE ANYWHERE: WHY VA HEALTH
CARE IS BETTER THAN YOURS, 2007, 59.
All told, according to the same RAND study, Americans receive appropriate care from their doctor
only about half of the time. The results are deadly. In addition to the 98,000 killed by medical errors in
hospitals and the 90,000 deaths caused by hospital infections, another 126,000 die from their doctor's
failure to observe evidence-based protocols for just four common conditions: hypertension, heart attack,
pneumonia, and colorectal cancer.
David Brailer, (Former Dir., National Health Technology, U.S. Dept. of Health and Human Services),
WANTING IT ALL: THE CHALLENGE OF REFORMING THE U.S. HEALTH CARE SYSTEM, 2007, 268.
Over the past 10 years, the Institute of Medicine reports have put into the American consciousness
the idea that health care does not just go wrong occasionally -- it goes wrong all the time. Estimates
indicate that up to 100,000 people die each year from inpatient medical errors, and up to two million
people are injured annually from ambulatory medical errors.
B. MORE AMERICANS DIE FROM MEDICAL ERRORS THAN FROM A LACK OF INSURANCE COVERAGE.
Michael Cannon, (Dir., Health Policy Studies, Cato Institute), PERSPECTIVES ON AN INDIVIDUAL
MANDATE, Oct. 17, 2008. Retrieved Oct. 5, 2012 from www.cato.org/publications/commentary/
perspectives-individual-mandate.
If you want to improve people's health, there is zero evidence that expanding coverage, such as
through an individual mandate, would deliver greater health improvements than other strategies. We
cannot say, for example, that an individual mandate would improve people's health more than education
or community health centers. If you want to save lives, the large number of uninsured Americans
probably shouldn't be your first priority. The Institute of Medicine estimates that two to five times as many
Americans die from preventable medical errors than from a lack of health insurance.
32
C. THOUSANDS OF PATIENTS DIE FROM INFECTIONS CONTRACTED IN HOSPITALS.

Steven Jonas, (Prof., Preventive Medicine, Graduate Program in Public Health, Stony Brook U.), AN
INTRODUCTION TO THE U.S. HEALTH CARE SYSTEM, 2007, 175-176.
The figures currently cited by nearly every author writing on the topic are about 2 million patients
affected annually by nosocomial infections, resulting in about 80,000 deaths and adding at least $5 billion
to U.S. health care costs every year.
Steven Jonas, (Prof., Preventive Medicine, Graduate Program in Public Health, Stony Brook U.), AN
INTRODUCTION TO THE U.S. HEALTH CARE SYSTEM, 2007, 175.
The microorganisms that cause infection are ubiquitous in hospitals. In addition, hospitals
inadvertently assist infective microorganisms to enter and multiply freely in a human host. For example,
the abundance of couriers in hospitals makes it easier for infective microbes to reach susceptible
humans. Every staff member -- maintenance, cleaning, and food service; laboratory, imaging, and other
technician; nurse, aide, physician, and resident -- is a possible carrier. In the course of performing their
jobs, hospital staff members move from patient to patient, potentially exposing them to pathogens
acquired from prior contact with contaminated persons, surfaces, and equipment.
Regina Herzlinger, (Prof., Harvard Business School), WHO KILLED HEALTH CARE?: AMERICAS $2
TRILLION MEDICAL PROBLEM, AND THE CONSUMER-DRIVEN CURE, 2007, 67-68.
To the contrary, the hospital is an increasingly dangerous place or a sick person. "Adverse events,"
bureaucratese for mistakes that gravely injure the patient, affected nearly 400,000 cases in 2004.
Between 1998 and 2004, tens of thousands died because of hospitals' "failure to rescue" and 32,000 had
an "infection due to care."
Ezekiel Emanuel, (Chair, Dept. of Bioethics, Clinical Center of the National Institutes of Health),
HEALTHCARE GUARANTEED, 2008, 28.
Aside from having to deal with frightening medical errors, patients routinely acquire infections in
hospitals, where new breeds of tenacious bugs resistant to almost all antibiotics can proliferate.
According to the CDC, 5 percent of all patients admitted to hospitals acquire infections during their stay.
At some of the larger hospitals in the United States the figure is as high as 10 percent. The result?
Between 2 million and 3 million cases of life-threatening hospital-acquired infections and, according to the
CDC, over 26,000 deaths per year. Almost all of these would have been preventable with the correct
hand-washing and other procedures.
D. MEDICAL OVER-TESTING RESULTS IN CANCER DEATHS.
Some radiologists have begun to worry that we are already seeing the ill effects of too much imaging
in the skyrocketing rates of cancer of the thyroid, an organ that is located in the neck and is acutely
vulnerable to radiation. The number of thyroid cancer cases per thousand people in the U.S. population
has doubled since 1980, and it's now rising at a rate of 4.3 percent per year. Some of that, says Stephen
Baker, may be that doctors have gotten better at detecting thyroid cancer or are becoming more vigilant,
but he worries that at least part of the increase is a result of medical radiation.
MEDICINE IS MAKING US SICKER AND POORER, 2007, 168-169.
In a report by the prestigious National Academy of Sciences, issued in 2006, experts estimated that a
sixty-year-old who undergoes an annual whole-body CT scan over the next fifteen years has a 1 in 220
risk of dying from cancer due to radiation exposure. The risk of dying in a car accident, by way of
comparison, is nearly the same, 1 in 200. According to another estimate, out of about six hundred
thousand children a year under the age of fifteen who receive a head or abdominal CT scan, five hundred
could ultimately die in adulthood from cancer due to the radiation they received as youngsters.
Gerald Markle, (Prof., Sociology, Western Michigan U.), WHAT IF MEDICINE DISAPPEARED?, 2008, 33.
Iatrogenesis is an issue. It is a mistake to assume the safety of a procedure, especially if it is even
minimally invasive. Any and all screening that uses radiation increases the patient's risk of cancer. The
1996 Task Force admits that radiation probably contributed to "a small number" of new cases of cancer.
Such risks may be small for the individual patient, but significant for large populations. Any invasive
procedure has the potential for iatrogenesis. Colonoscopy, for example, causes perforation of the bowel a
very serious problem -- in one of every 5,000 examinations.
33
E. ADVERSE DRUG REACTIONS KILL THOUSAND OF AMERICANS.

In 1999, there were in hospitals about two million serious adverse reactions to correctly prescribed
drugs, which killed an estimated 106,000 patients, amazingly, the fifth leading cause of death in the
United States. By comparison, all accidents in 1999 killed 98,000 people. Lives are undoubtedly saved in
hospitals, but they are also needlessly lost there.
F. GREATER ACCESS TO MEDICAL CARE DOES NOT RESULT IN MORE HEALTH.
Fisher and his colleagues discovered that patients who went to hospitals that spent the most -- and
did the most -- were 2 to 6 percent more likely to die than patients who went to hospitals that spent the
least. The upshot of this finding is inescapable. More care may not only be useless (and expensive), it
may also be downright dangerous. "The most reasonable explanation for the higher mortality rate," says
Fisher, "is that the additional medicine patients are getting in the high-cost regions is leading to harm."
When doctors give unnecessary treatment, patients are exposed to all the risks -- but not the benefits --
of medicine, risks that include hospital-borne infections, the complications and side effects that can come
with any treatment, and medical errors like the ones that led to Josie King's death. Hospitals, says Fisher,
"can be dangerous places."
Norman Hadler, (Prof., Medicine and Microbiology, U. North Carolina), WORRIED SICK: A PRESCRIPTION
FOR HEALTH IN AN OVER-TREATED AMERICA, 2008, 276.
In Medical Nemesis, Illich argues that the medical enterprise is often more harmful to humanity than
helpful, often imperialistic, and given to promulgating unrealistic expectations -- that is, medicalization.
"The medical establishment has become a major threat to health," he states.
There is little evidence that complete physical exams, which are the most common reason for a
patient's visit to a primary care physician, have a demonstrable positive effect on health. Few medical
authorities would disagree.
Alan Garber, (Prof., Medicine, Stanford U.), HEALTH AFFAIRS, Nov./Dec. 2007, 1546-1547.
Numerous other studies, such as the work on regional variation in the use of medical care, have
found that greater utilization is not associated with better health outcomes.
In 2000, Wennberg's colleague Elliott Fisher launched a study that would finally persuade many of
the skeptics that the variations the Dartmouth group were seeing were real and were causing patients
harm. He showed that Medicare recipients living in high-cost regions were no healthier and no less
disabled than those living in regions where recipients got less care. Nor were they living any longer. In
fact, their chances of dying were slightly higher. More medicine not only meant higher costs; it also meant
more deaths, not fewer. Fisher later estimated that at least thirty thousand elderly Americans were being
killed each year by too much medicine. That's four times the death rate from skin cancer; twice the
number of deaths from brain cancer; two times the number of murders committed annually in the United
States. More and more medicine wasn't necessarily helping the elderly; sometimes it was killing them.
Fisher eventually showed that Medicare recipients were dying in high-cost regions largely because they
were spending far more time in the hospital than people in lower-cost regions. For all the miracles that
hospitals deliver, they are also dangerous places, where patients risk suffering a medical error, a life-
threatening infection, complications from surgery, or getting a diagnostic test that leads to unnecessary
and life-threatening treatment.
G. DOCTORS HAVE AN INCENTIVE TO OVER-TREAT PATIENTS.
But the most powerful reason doctors and hospitals overtreat is that most of them are paid for how
much care they deliver, not how well they care for their patients. They get paid more for doing more. This
simple fact has led not only to overtreatment but also to the profound disorder of the American health
care system.
34
H. MEDICAL SCREENING IS MORE HARMFUL THAN HELPFUL TO HUMAN HEALTH.

Unfortunately, screening has very little impact on mortality, though its "false-positives" (abnormal
results in a healthy patient) surely increase our level of stress -- and therefore increase the probability of
new illness. Indeed physicians understand the limited utility and value of such procedures, but, amazingly,
justify them with the notion that they increase trust between doctor and patient. Such justification, we
believe, does nothing less than threaten the legitimacy of contemporary medicine.
False positives are not only a frequent result, but also an expensive one as well. A study of managed
care followed routine screenings for prostate, lung, colorectal and ovarian cancer. Of 1087 patients, 43%
had at least one false positive. Of those, 83% received follow-up care -- which was quite expensive,
averaging $1,024 for women, and $1,171 for men. "Along with trials evaluating the health benefits of
available cancer screening modalities," the authors conclude, "investigations into potential undesirable
consequences of cancer screening are also warranted."
Gerald Markle, (Prof., Sociology, Western Michigan U.), WHAT IF MEDICINE DISAPPEARED?, 2008, 3-4.
Taken together, the four medicine-induced problems -- adverse reactions to drugs, nosocomial
deaths, medical errors, and unnecessary surgery -- account conservatively for about a quarter million
deaths per year (about one per minute in the United States), about 11% of all deaths. Unbelievably, these
medicine-induced problems would be the third leading cause of death, behind cancer but ahead of
strokes -- though neither alone or together are any of these medicine-induced deaths ever shown in
official statistics.
Carla Howell, (Dir. , Center for Small Government), HEALTH CARE, 2008, 87.
In addition, excess treatment can put your health at risk. Patients who undergo unnecessary tests,
operations, and drug regimens sometimes end up with worse medical problems than they started with.
Alan Zellicoff, (M.D. & Sr. Scientist, Sandia National Laboratory), MORE HARM THAN GOOD, 2008, 77.
The number of available "routine screening tests" has doubled every 5 years for the past 20 years.
Most have proved to be worthless or, as we shall see, something closer to worse than worthless.
I. UNNECESSARY SURGERY KILLS THOUSANDS OF AMERICANS.
Alan Zellicoff, (M.D. & Sr. Scientist, Sandia National Laboratory), MORE HARM THAN GOOD, 2008, 171.
Chiropractors, orthopedic and neurosurgeons, primary care doctors, massage therapists,
acupuncturists, and homeopathic doctors make much of their living trying to help such patients. We'll
focus on the surgeons here because there is troubling data to indicate that, despite a complete absence
of evidence to support the practice, surgeons are increasingly offering desperate patients a surgical
treatment that can cost between $10,000 and $100,000 per operation. The question is, "Does it do more
harm than good?" The short answer is yes. More than 30,000 neck fusions, disk removals, joint space
augmentations, "decompressions," and the like were done in the United States last year alone. Neck
surgery has replaced surgical procedures on the brain as the most commonly done neurosurgical
procedure. Orthopedic surgeons have been doing neck surgery with increasing frequency since
abandoning routinely operating on the lower back for almost any chronic pain syndrome in the late 1990s.
Insurance companies had stopped reimbursing doctors for the operations (and some patients started
suing) because there was no evidence that such interventions worked.
35
Index to Evidence & Evidence 6. Commonwealth Fund, HEALTH POLICY: CRISIS AND REFORM IN
THE U.S. HEALTH CARE DELIVERY SYSTEM, 5th Edition, 2008, 44.
I. The United States ought to guarantee universal health care *On multiple indicators across quality of care and access to care, there
for its citizens. is a wide gap between low-income or uninsured populations and those
A. There should be a right to health care. (1-3) with higher incomes and insurance. On average, low-income and
uninsured rates would need to improve by one-third to close the gap.
B. Absence of health insurance means less access to health care.
(4-6) 7. Colleen Grogan, (Prof., Social Services Administration, U. Chicago),
C. African-Americans disproportionately lack access to health care. HEALTHY VOICES, UNHEALTHY SILENCE, 2007, 100. *Over the past
two decades, at least 600 journal articles and eight major reviews --
(7-9)
most notably the 2002 report by the Institute of Medicine (TOM),
D. The number of uninsured Americans is significant. (10-12) Unequal Treatment: Confronting Racial and Ethnic Disparities in
E. Claims that U.S. health care is best in the world are false. (13- Healthcare -- have verified deep racial inequities in healthcare.
15) Systematically reviewing over 100 studies conducted between 1992 and
II. The United States ought not guarantee universal health care 2002, the landmark IOM report found that racial gaps persist in the
for its citizens. delivery of evidence-based interventions even when researchers take
into account such factors as insurance coverage, disease severity, and
A. Establishing a right to health care drains resources from other expression of symptoms.
areas of society. (16)
B, Many of the uninsured are people who could afford to buy their 8. Dolores Acevedo-Garcia, (Prof., Harvard U. School of Public Health),
HEALTH AFFAIRS, Mar./Apr. 2008, 321. *One of the most striking
own health insurance if they so chose. (17-18) features of U.S. racial/ethnic health disparities is their persistence over
C. It is untrue that the uninsured receive worse care. (19-20) time. Over the past several decades, there have been many policy
D. Medical errors kills. (21) initiatives to reduce poverty and improve access to societal resources,
E. More medical care does not translate into better health. (22-24) including medical care, for disadvantaged population groups. Yet despite
F. More coverage leads to over-treatment. (25-26) initiatives such as the War on Poverty, civil rights legislation, and
Medicaid/Medicare, racial disparities in health have not changed much
over the past fifty years.
Evidence
9. George Halvorson, (CEO, Kaiser Foundation Health Plan), HEALTH
1. Ani Satz, (Prof., Law, Emory U.), ALABAMA LAW REVIEW, 2008, CARE REFORM NOW!: A PRESCRIPTION FOR CHANGE, 2007, 267.
1465. *As further developed below, Rawls's theory may be applied to *Why do I mention those facts in a chapter on universal coverage?
basic health care distribution in three ways. First, Rawls's list of social Because, to no one's surprise, there is a direct correlation between
primary goods could be extended to include health care. As such, health health insurance coverage and health care -- and the rate of being
care services could be regulated under a threshold principle establishing uninsured is also nearly double for African Americans compared to white
a certain level of basic services. Second, Rawls's model could be used Americans. Minority Americans make up roughly one-third of our total
to justify basic minimum schemes for health care based on a conditional population but well over half of our uninsured population. In California,
extension of his fair equality of opportunity principle. According to one 75 percent of the uninsured are minority groups.
dominant interpretation, basic health care is considered a good that 10. Arthur Garson, Jr. & Carolyn L. Engelhard, (Dean, School of
contributes to an individual's normal opportunity range. This is the view Medicine, U. Virginia & Prof., Medical Education, U. Virginia), HEALTH
most commonly invoked to support basic minimum schemes. CARE HALF-TRUTHS: TOO MANY MYTHS, NOT ENOUGH REALITY,
2. Barbara Wexler, (Journalist), THE HEALTH CARE SYSTEM, 2007, 2007, 97-98. *Over half of the uninsured make less than $20,000 per
17. *A wide range of groups and organizations support the idea that year and minorities are much more likely to be uninsured than white
health care is a fundamental human right, not a privilege. These Americans: thirty-four percent are Hispanic, twenty-one percent are
organizations include Physicians for a National Health Program, the African American, thirteen percent are Caucasian, twenty-nine percent
American Association of Retired Persons, National Health Care for the are American Indian or native Alaskan, eighteen percent are Asian or
Homeless, Inc., and the Friends Committee on National Legislation, a South Pacific Islander, and sixteen percent report two or more races.
Quaker public interest lobby. The American Medical Association's 11. Jared Stiefel, (J.D. Candidate, Boston U. School of Law),
Patient Bill of Rights includes the "right to essential health care." AMERICAN JOURNAL OF LAW AND MEDICINE, 2007, 683. *The
3. Dennis Kucinich, (U.S. Rep., Ohio), THE HILL, July 15, 08. Retrieved problem of the uninsured in this country continues to grow. Over the past
1 Jan. 09 from www.pnhp.org. *Every child has an inherent right to five years, proportion of uninsured Americans has risen from 14.6% to
healthcare. Without access to a structured system of healthcare, 15.9% of the population. The statistics show disparities in insurance
children are burdened with social, educational, financial and personal coverage among the various races, between native-born and non native-
health disadvantages. Lack of access is directly connected to lack of born citizens, and between other groups. The Center on Budget and
insurance. Over 9 million children were uninsured in 2006 and their Policy Priorities partially links this change to the continuous decline in
ranks are growing. Sixty-nine percent of the increase in uninsured employer sponsored health insurance plans. This is a problem that
children was from families whose income was more than 200 percent of needs to be addressed and addressed quickly.
the federal poverty level, which means they were unlikely to be covered 12. Linda Blumberg, (Research Associate, Urban Institute),
by SCHIP or Medicaid. Most were from the middle class. EXAMINING INNOVATIVE APPROACHES TO COVERING THE
4. Alan Weil, (Dir., National Academy of State Health Policy), THE UNINSURED THROUGH EMPLOYER-PROVIDED HEALTH
NEXT GENERATION OF ANTIPOVERTY POLICIES, 2007, 98. *The BENEFITS, Hrg., House Comm. on Education & Labor, Mar. 15, 2007,
importance of health insurance to good health has been well 34. *But while the negative ramifications of being without health
established. Although it is true that emergency care is available to all insurance are clear, the number of uninsured continues to grow.
Americans, other types of care -- preventive care, services that help According to an analysis by John Holahan and Allison Cook, the number
people manage chronic conditions, diagnostic tests, and highly of nonelderly people without health insurance climbed by 1.3 million
specialized care -- are all hard to obtain without health insurance. people between 2004 and 2005, bringing the rate of uninsurance in that
population to almost 18 percent. The vast majority of this increase was
5. Bonnie Lefkowitz, (Journalist, M.A. in Public Administration, Harvard amongst those with low incomes and among adults. In recent years, the
U.), COMMUNITY HEALTH CENTERS: A MOVEMENT AND THE share of the population with employer-sponsored insurance has fallen,
PEOPLE WHO MADE IT HAPPEN, 2007, 141. *Although uninsured while the share of those with public insurance coverage has risen, but by
people generally are more likely to go without needed care and less smaller amounts.
likely to receive preventive services, these disadvantages are largely
overcome for health center patients who lack insurance.
36
13. Eleanor Kinney, (Prof., Law, Indiana U. School of Law), RUTGERS 21. Phillip Longman, (Sr. Fellow, New America Foundation), BEST
LAW REVIEW, Winter 2008, 371. *Further, the United States does not CARE ANYWHERE: WHY VA HEALTH CARE IS BETTER THAN
compare well to other industrialized countries when it comes to per YOURS, 2007, 59. *But there is no doubt the number of medical
capita government expenditures on health care. According to the World mistakes is very high. In 1999, the Institute of Medicine issued a
Bank indicators, the United States - with 44.9% of recurrent and capital groundbreaking study, entitled To Err Is Human, which still haunts health
spending for health care from government (central and local) budgets, care professionals. By reviewing hospital medical records, it found that
external borrowings and grants (including donations from international up to 98,000 people die of medical errors in American hospitals each
agencies and nongovernmental organizations), and social (or year.' Subsequent findings suggest that the study may have
compulsory) health insurance funds - is ranked last in the group of most substantially underestimated the magnitude of the problem. For
industrialized states. example, hospital-acquired infections alone, most of which are
preventable, account for an additional 90,000 deaths per year. In 2006,
14. Jesse Jackson, Jr., (U.S. Rep., Illinois), HEALTHCARE, 2007, 30. the IOM issued a new study that found hospital patients in the United
*In short, we have the best health care system in the world for those who States experience an average of at least one medication error, such as
have the money to pay for it. But 44 million (and growing) Americans receiving the wrong drug or wrong dosage, every day they stay in the
have no health insurance, and 49 million in the middle class are hospital.
becoming dissatisfied with the health insurance they have, because it is
growing ever more expensive even as it is providing fewer services and 22. Alan Zellicoff, (M.D. & Sr. Scientist, Sandia National Laboratory),
less care. MORE HARM THAN GOOD, 2008, 51. *In the cases where the most
money and the most care were lavished on the luckier (or at least
15. Gunnar Almgren, (Prof., Social Work, U. Washington), HEALTH
wealthier) patients, the outcomes were slightly worse than in the poorer
CARE POLITICS, POLICY, AND SERVICES: A SOCIAL JUSTICE
areas: specifically, the survival rate of the patients was actually slightly
ANALYSIS, 2007, 92. *Although the United States leads other nations in
lower in the areas where the most money was spent.
the world in the development of new health care technologies and in
total health care expenditure per capita, it does not necessarily lead the 23. Alan Zellicoff, (M.D. & Sr. Scientist, Sandia National Laboratory),
world in the diffusion of the technologies it invents (OECD, 2003). MORE HARM THAN GOOD, 2008, 75-76. *Disease screening began to
catch on in the 1980s in the primary care specialties of medicine:
16. Ani Satz, (Prof., Law, Emory U.), ALABAMA LAW REVIEW, 2008, internal medicine, family practice, general practice. Like much of the rest
1470. *Prioritizing a threshold level of health care may result in resource of health care, delivery to the patient was put into widespread use well
drain from other goods, depending on the scope of services covered. At before the hypothesis was tested. There's no question that the concept
the same time, if the range of health care services is restricted as a is logical. After all, who can argue with preventing disease? There's also
cost-containment measure, a broad enough range of services may not no question that a few of the things that physicians do to try to keep their
be offered. In addition, it is unclear how to value health care in relation to clientele out of trouble and out of the hospital do in fact work. But what's
other goods and how to account for varying patient choice from among a striking is how few of diagnostic tests make a difference and, when they
range of health care goods. do make a difference, how little difference they make.
17. Devon Herrick, (Sr. Analyst, National Center for Policy Analysis), 24. Alan Zellicoff, (M.D. & Sr. Scientist, Sandia National Laboratory),
CRISIS OF THE UNINSURED, Aug. 28, 2008, 1. *Nearly 18 million of MORE HARM THAN GOOD, 2008, 77-78. *The outcomes from referral
the uninsured lived in households with annual incomes above $50,000 to specialist vary immensely, as already reviewed in the chapter on the
and could likely afford health insurance. Dartmouth study, which basically says, "Your chances of having an
18, Devon Herrick, (Sr. Analyst, National Center for Policy Analysis), invasive diagnostic procedure or a therapeutic intervention that
CRISIS OF THE UNINSURED, Aug. 28, 2008, 1. *It is often assumed significantly improves your quality and quantity of life varies a great
that the uninsured are all low-income families. But among households deal." And remember, on average, the outcomes are inversely related to
earning less than $25,000, the number of uninsured actually fell by how much service is provided; more is not better.
about 21 percent over the past 10 years). The uninsured include diverse 25. Alan Garber, (Prof., Medicine, Stanford U.), HEALTH AFFAIRS,
groups, each uninsured for a different reason: Nov./Dec. 2007, 1545. *Diagnostic tests can lead to earlier and more
19. John Goodman, (Pres., Center for National Policy Analysis), effective treatment, but they can also lead to the diagnosis of clinically
HEALTH CARE COVERAGE AND ACCESS: CHALLENGES AND undetectable but costly "pseudo-disease," which left undetected and
OPPORTUNITIES, Hrg., Sen. Comm. On Health, Education, Labor & untreated would have no bearing on physical well-being.' Many
Pensions, Jan. 10, 2007, 83. *It turns out that what you just said is true, interventions to prevent heart disease are dramatically effective when
there are hundreds of studies that concluded that lack of insurance used by people at high risk, but the benefits are much less pronounced,
leads to worse care. Turns out, they're all bad studies. And when the and the adverse effects just as great, among people at lower risk of
RAND Corporation did this the right way, which is to ask, Among people developing heart disease.
who see doctors, who access the system, is there then any difference in 26. Alan Zellicoff, (M.D. & Sr. Scientist, Sandia National Laboratory),
care? And the answer is, "no". And why is this important? Because if we MORE HARM THAN GOOD, 2008, 224. *By some estimates, 20% of all
just enroll people in Medicaid, but the rates are so low that their only medical costs are generated by the repetition of unnecessary tests or
opportunity to get health care is at the emergency room, we don't lower the prescription of medications that have previously been unsuccessful.
costs and we don't improve quality. This figure doesn't include the inconvenience to the patient -- time,
20. Michael Cannon, (Dir., Health Policy Studies, Cato Institute), stress, delay in diagnosis and treatment and their attendant frustration --
UNIVERSAL HEALTHCARES DIRTY LITTLE SECRETS, Apr. 6, 07. and the side effects of unneeded or potentially risky procedures.
Retrieved Nov. 27, 08 from www.cato.org. *You may think it is self- 27. Gerald Markle, (Prof., Sociology, Western Michigan U.), WHAT IF
evident that the uninsured may forgo preventive care or receive a lower MEDICINE DISAPPEARED?, 2008, 32. *Cancer screening is also
quality of care. And yet, in reviewing all the academic literature on the replete with false positives. One in ten mammograms give a false
subject, Helen Levy of the University of Michigan's Economic Research positive result, which leads not only to considerable expense, but also to
Initiative on the Uninsured, and David Meltzer of the University of biopsy and psychological trauma -- and even to unnecessary surgery.
Chicago, were unable to establish a "causal relationship" between health Fecal blood exam can detect colon cancer, but also produces significant
insurance and better health. Believe it or not, there is "no evidence," false positives; recommended yearly exams from age 50 to 75 would
Levy and Meltzer wrote, that expanding insurance coverage is a cost- produce false positives in half of all patients. Various benign conditions
effective way to promote health. Similarly, a study published in the New of the prostate also produce false PSA positives, leading to considerable
England Journal of Medicine last year found that, although far too many anxiety. The best designed studies, which combine digital examination
Americans were not receiving the appropriate standard of care, "health and PSA, show that routine testing leads to needle biopsies on about
insurance status was largely unrelated to the quality of care." 18% of the screened population.

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1

LINCOLN-DOUGLAS DEBATE RESEARCH SERIES

THE CASE FOR A GUARANTEE OF UNIVERSAL HEALTH CARE

ANALYSIS OF THE TOPIC

AMERICAN HERITAGE DICTIONARY, 2009. Retrieved Oct. 4, 2012 from

AFFIRMATIVE CASE #1: PRESERVING HUMAN LIFE

AFFIRMATIVE CASE #2: EQUALITY

Tamara Friesen, (Staff), HEALTH LAW JOURNAL, 2001, 215-216.

C. THE QUALITY OF HEALTH CARE IN THE U.S. IS INFERIOR TO COUNTRIES GUARANTEEING

AFFIRMATIVE CASE #3: THE COMMON GOOD

NEGATIVE CASE #1: JUSTICE

NEGATIVE CASE #2: QUALITY OF LIFE

B. ESTABLISHING A RIGHT TO HEALTH CARE UNDERMINES MEDICAL INNOVATION.

NEGATIVE CASE #3: COMMON GOOD

C. THOUSANDS OF PATIENTS DIE FROM INFECTIONS CONTRACTED IN HOSPITALS.

E. ADVERSE DRUG REACTIONS KILL THOUSAND OF AMERICANS.

H. MEDICAL SCREENING IS MORE HARMFUL THAN HELPFUL TO HUMAN HEALTH.

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