Intro: set up context of universal health care, define Referring to the new requirement that all Americans carry

the law represented an historic loss of liberty. health -insurance coverage, he said

(Clemmitt)

The landmark law will extend coverage to about 32 million of the nation's 45 million uninsured people(Clemmitt) For the first time in history, the law establishes access to affordable health care as a national responsibility, with the great bulk of the dollars coming from taxpayers to fund the coverage expansion, says Feder.(clemmitt) the fact that the high cost of health care is the main reason people are uninsured, says Feder.

Thirty-two of the thirty-three developed nations have universal health care coverage. Guess who the lone exception is (vernon)

The government already covers medical care for seniors, disabled people, poor families and many children. But coverage in those programs is restricted to people who meet certain qualifications, including age and income.The issue now is whether middle-class workers and their families should be offered the choice of joining a government-sponsored plan similar to what they get through their employers.(Saulny) Thesis: The United States is in desperate need of health reform but universal coverage is not the answer. History of health care reform in the United States Medicaid/Medicare Medicare and Medicaid are bankrupting our state and federal governments. These two federal insurance programs compose nearly 20 percent of the federal budget, and the percentage keeps rising. In addition, for most states Medicaid is the largest single budget item,(Zinser and Hsieh) How insurance companies work Supply and Demand Economic Implications Nation

spending on health care in the United States amounts to nearly 17 percent of the entire economy, and this is expected to rise to 20 percent by 2015(Zinser and Hsieh) By 1960, 18 percent of the population was insured under an employer group plan, and that percentage grew to almost 70 percent of the insured by 1980.16 The percentage has since declined, but even today about 60 percent of insured Americans obtain health insurance through their employer.17( Zinser and Hsieh) The employee make it difficult for employees to keep sensitive health issues from employers.(Zinser and Hsieh) Many workers with preexisting conditions or serious chronic illnessesor who have spouses or children with such conditions and illnessesstay in less than desirable jobs solely to avoid the risk of changing or losing their health insurance. Currently, one out of seven Americans says he needs to remain in his current job rather than take a new job in order to keep his health insurance benefits.19(Zinser and Hsieh) Employers and insurers dictate everything from which doctors and specialists employees will be permitted to visit under the plan, to the kinds of benefits that will and will not be provided, to the co-payments and deductibles that will be paid. Because third parties are paying for both insurance and health care, the employee-patient-customer has little choice in what kind of insurance or who provides the health care he receivesand plenty of incentive to visit a doctor anytime he has a runny nose (Zinser and Hsieh) The employer the employer is insuring a group without regard to any one individuals condition, individuals with employer-purchased policies have little or no say about the policy under which they will be insured. As the Joint Economic Committee of the U.S. Senate reports, nearly four out of ten workers with employer coverage have no choice of health plans, and less than half have a choice of more than two plans.18 (Zinser and Hsieh) creates an incentive for employers to avoid hiring workers from low-income families, hurting those who need jobs the most, said Kathryn Nix, a research assistant at the conservative Heritage Foundation. (Clemmitt) Insurance companies Although insurance companies should be free to offer such coverage, no oneincluding the governmenthas a right to force them to do so.(Zinser and Hsieh) Private Sector/Taxpayers

Forcing employers to offer health insurance will cost America jobs and revenue, and inhibit small businesses from growing, according to the small-business lobbying group National Federation of Independent Businesses. It's a bad idea any time but is particularly destructive in the current economic environment. (clemmitt) Quality of Healthcare will decrease? Burdensome/unfair to doctors Pay doctors are working harder and harder but making less and less money, resulting in a critical level of stress and burnout. According to a recent survey of doctors, 30 to 40 percent of practicing physicians would not choose to enter the medical profession if they were deciding on a career again, and an even higher percentage would not encourage their children to pursue a medical career. (Zinser and Hsieh) Medicare determines what procedures and treatments are appropriate and medically necessary. It also determines the monetary value of a diagnosis, treatment, or procedure. Both patient and doctor must abide by Medicares decision; and, despite low Medicare reimbursements, doctors cannot accept any money from a patient beyond what Medicare pays, even if the patient so desires.21 Doctors are paid so poorly by Medicare and burdened by so much paperwork that about 28 percent are turning away some or all new Medicare patients.22 Hence, newer Medicare patients often cannot find a doctor in their area who will treat them at all. Such insurance does these patients no good. Nor do they have any private insurance alternative. With the insignificant exception of Medigap policies, Medicare has eliminated the private insurance market for the elderly, and many elderly patients are left with no way to seek medical treatment except through hospital emergency rooms or charity (Zinser and Hsieh) Only about 52 percent of doctors accept new Medicaid patients, whereas 99 percent will accept new private insurance patients.23 Moreover, many doctors who do take Medicaid patients limit the number of Medicaid patients they see each week so that they can control their income loss. It is not unusual for a Medicaid patient to have no family doctor because he cannot find a nearby doctor who will treat him, a problem that is especially severe in rural areas. As a result, for years Medicaid patients have used emergency rooms as their regular source of treatment (Zinser and Hsieh) Consequently, doctors who are unwilling to lose money or who are tired of treating dishonest patients withdraw from emergency rooms. This leads to more overcrowding, longer waiting times, and, in some cases, the closing of ERs. As the remaining ERs become still more overcrowded and understaffed, the quality of emergency room services necessarily declines, harming honest patients who have genuine emergencies. EMTALA also causes cost-shifting, the practice of doctors and hospitals trying to make up for the money they are losing on Medicaid

and Medicare patients by increasing the fees of patients who have private insurance or who do not have insurance but do pay their bills. This raises the costs for responsible and conscientious patients, who indirectly subsidize the irresponsible and the unconscientious. (Zinser and Hsieh) we don't deny health care to the uninsured population; if you're uninsured and you pay a visit to an emergency room, chances are good you'll receive treatment. Taxpayers and people with insurance are paying for this medical care by subsidizing the emergency rooms -- is that fair? This situation is forcing more and more emergency rooms to close their doors. (Vernon)

moral mandates Governments have further interfered with the free market by means of health care mandates governmental decrees regarding how health care providers and patients can or must act.(Zinser and Hsieh) EMTALA-Emergency treatment and Labor Act This law requires that hospitals that accept Medicare patients diagnose and treat anyone who comes within two hundred feet of an emergency room, regardless of whether the person can pay for the treatment. The effect of this law is that anyone can walk into an emergency room at any time and receive treatmentwithout concern for payment. (Zinser and Hsieh) HIPPAIf Congress actually implements Medicare payment cuts named in the law, 15 percent of hospitals and other care facilities that rely on Medicare reimbursements would become unprofitable, meaning that they might drop Medicare patients, limiting the availability of care for millions of seniors, the Columbus [Ohio] Dispatch editorialized(clemmitt) Lose the best and brightest Increasing government involvement in health care will likely drive some doctors out of Medicare and perhaps out of practice altogether, said Robert E. Moffit,(Clemmitt) Is it even constitutional? How does this affect freedom and individual rights? Violates individual freedom The bill's so-called individual mandate, requiring everyone to purchase insurance, is unconstitutional, said Sen. Orrin Hatch, R-Utah.(Clemmitt) diminishes the federalist system upon which the U.S. was founded Anaphora: The American people must have the right (life, liberty, and property, pursuit of happiness)Allusion
The partisan debate around such a sweeping piece of legislation has encompassed traditional hot-button topics: abortion and contraception funding, state and individual rights, federal deficits, end-of-life-care and the overall economy. The high court now gets the final word."These issues are really central to whether the federal government can regulate anything it wants to, or whether there are some things that only the state governments can regulate," said Paul Clement, (Mears)

Is healthcare a right? Government-run health care systems do not and cannot work, because they improperly treat health care as a right. Health care, like food and clothing, is a need, but not a right. It is a commodity that is created by the intelligent thought, creativity, and hard work of producers, such as doctors, nurses, allied medical professionals, and hospital administrators. When the government treats health care as a right, it necessarily violates the genuine rights of the providers who produce those goods and should be free to offer them for exchange on whatever terms they see fit, not forced to serve people against their own judgment. And it necessarily violates the rights of consumers, who should be free to trade with providers by mutual consent to mutual benefit. As we have seen repeatedly, good doctors cannot and will not continue working under a system that enslaves them. A final (and often unacknowledged) consequence of government interference in medicine is that it leads to violations of individual rights in other areas of life, such as violations of the right to free speech and mandates regarding what people may and may not eat. (Zinser and Hsieh)
The legal question for the justices was whether Congress had exceeded its constitutional authority in requiring most Americans to obtain insurance or pay a penalty.(Liptak) The issue took on practical urgency after some of the questioning the day before had suggested that the laws core provision, often called the individual mandate, may be in peril. It requires most Americans to obtain insurance or pay a penalty. (Liptak Last year, the United States Court of Appeals for the 11th Circuit, in Atlanta, ruled that the mandate was unconstitutional, but it said the balance of the law survived. (Liptak)

Less responsibility for self: For example, under guaranteed issue, a health insurer accepting an employer group must accept a motorcyclist employee who has had several serious injuries from multiple accidents due to reckless riding. Likewise, another employee who is fifty pounds overweight, smokes three packs of cigarettes a day, and has high blood pressure, diabetes, and a heart condition cannot be refused. Since insurers cannot exclude anyone who already suffers from serious health problems or who chooses to risk his health with poor lifestyle choices, they must price their policies accordingly.(Zinser and Hsieh) Concession: The Supreme Court decades ago held that the business of insurance fell within Congress' regulatory authority under the Commerce Clause, wrote Simon Lazarus, public policy counsel to the National Senior Citizens Law Center(Clemmitt) Supporters argue that by making it easier for people to get non-job-based health coverage and beginning to trim costs, the law will actual improve businesses' ability to create jobs. Inability to find affordable health coverage under current law is one of the major reasons why small businesses close their doors and corporations ship jobs overseas, said Obama.(Clemmitt) the estimates of possible efficiency savings range up to 30 percent or more of medical spending, said Harvard University professor of economics David M. Cutler. Because previous analyses have underestimated the cost-saving effects of such measures, there's a good chance that costs will fall more rapidly than expected, Cutler said (Clemmitt) consequences for the entire country Rebuttal: Health care and health insurance are not the same thing there will still be 23 million uninsured people in 2019, of whom about a quarter will be illegal immigrants, she says. Furthermore, many who get insurance under the bill will end up underinsured, she added, partly because about 16 million of the newly insured will be enrolled in Medicaid, which most doctors don't accept because of its lower payments. They can go to the emergency room (ER), but they'll have trouble getting primary care for conditions like high blood pressure and the like, where early treatment could keep ER-type health emergencies from happening, she says. (Steffie Woolhandler) (clemmitt)

In such a scenario, Obama and Democrats would rely on the idea that most Americans support an overhaul of the U.S. healthcare system -- even if they do not like the law Obama signed in 2010.A Reuters/Ipsos poll this week found that although just 44 percent of Americans favor the healthcare law, an additional 21 percent favor changing the healthcare system but believe the law did not go far enough. (Zengerle) Solution: Free Market. Competition. Education A fourth option, promoted by Sen. Charles Schumer, D-N.Y., would try to address concerns about unfair competition from a public plan.Schumer's proposal would require the public plan to be financed by premiums, not tax dollars. It would have to follow the same solvency rules as private insurers, maintaining a reserve fund to cover liabilities.Doctors and hospitals would be free to participate in the plan, or opt out. And the public plan would have to operate under the same consumer protection rules as private insurers.Schumer said he believes the public plan would set a high standard for quality. Since it wouldn't have to turn a profit, it could invest in prevention and wellness.His idea is getting a close look also from a group of fiscally conservative Democrats in the House, known as the Blue Dogs. (Saulny) incentives for people to take steps on their own to reduce health spending, McClellan says. For example, private insurers are implementing wellness plans to give consumers financial incentives to take common-sense steps like stopping smoking or losing weight, which should save health -system dollars down the line, he says.(clemmitt) Nurse practitioner Kathryn Quinn administers a flu shot at a clinic in a CVS store in Wyckoff, N.J. Proponents of the health-reform law say using nurse practitioners for more tasks often performed by physicians will help keep health-care costs down. (Clemmitt) Republicans, including Romney, back programs to largely privatize Medicare, the popular government healthcare insurance program for older Americans, by providing vouchers to shop for commercial insurance. (Zengerle)

Conclusion: Syllogism:Kentucky, Maine, and Washington (Zinser and Hsieh)