Minh A. Luong & Company Tutorial
September-October 2006 National Forensic League Lincoln-Douglas topic
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Resolved: A just government should provide health care to its citizens.
PlanetDebate.com / Lincoln-Douglas.com
Minh A. Luong & Company Tutorial:
September-October 2006 National Forensic League Lincoln-Douglas topic
Resolved: A just government should provide health care to its citizens.
Minh A. Luong
Author/Editor
International Security Studies
and
Department of History
Yale University
New Haven, Connecticut USA
<minh.a.luong@yale.edu>
Taubman Center for Public Policy and
American Institutions
and
Watson Institute for International Affairs
Brown University
Providence, Rhode Island
<Minh_Luong@Brown.EDU>
The potential economic value to be gained in better health outcomes from uninterrupted coverage for all Americans
is estimated to be between $65 and $130 billion each year.
– Hidden Costs, Value Lost: Uninsurance in America
Institute Of Medicine of The National Academies
The National Academies Press, 2003
What the government is saying is, “no more can you turn and put your cost of health insurance and health care on
everybody else.” You have a personal responsibility to either pay for your own health care yourself, or buy an
insurance policy, but no more just showing up at the hospital and saying, “I can't pay, make someone else pay for
me.”
– Governor Mitt Romney (R-Massachuetts)
“Must-Have Health Insurance” CBS Evening News
January 28, 2006
The overall United States health care performance was ranked 37th by the World Health Organization (WHO) in
1997, far below the average of developed nations.
– World Health Organization
"Health system performance in all Member States" 1997.
Health level according to the DALE index indicates the United States was ranked 72nd in the world by WHO; worse
than China and comparable to Iraq.
– World Health Organization
"Health system performance in all Member States" 1997.
In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to
emergency services regardless of ability to pay.
– U.S. Department of Health and Human Services
http://www.cms.hhs.gov/EMTALA/
© 2006 Minh A. Luong and Harvard Debate, Inc., All Rights Reserved
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Resolved: A just government should provide health care to its citizens.
In This Topic Briefing…
Cover page with selected quotations
1
In This Topic Briefing (aka the Table of Contents)
2
A Note from the Editor
3
Topic in Context
4
Topic Briefing
6
Definitional Concepts and Definitions
8
Strategies and Arguments
Affirmative
11
Negative
13
Sources
15
Selected Quotations on the Topic
21-40
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Resolved: A just government should provide health care to its citizens.
A Note from the Editor
The first Lincoln-Douglas debate topic of the 2006-07 season is Resolved: A just government
should provide health care to its citizens. Debaters, coaches and judges will find this
straightforward topic timely, debatable, and reasonably accessible.
This topic is rooted in one of the most fundamental questions in the field of political
philosophy – namely, what is the proper role of a “just” government? Additionally, this topic
focuses on a more tangible subject compared to more amorphous issues covered in previous
topics.
This topic briefing seeks to give you a philosophical and policy-relevant introduction to a
broad topic that has been a perennial public policy issue since the 1960s. As many industrialized
countries see their populations age and many developing countries struggle with major health
care challenges such as HIV/AIDS and other diseases, the question of who is responsible for
providing quality health care will become even more urgent. For example, The Economist
observed that providing health care for HIV-positive people in developing countries could cost
$40 billion per year by the end of the next decade.1 If developing countries cannot afford this
type of care, does that make these countries unjust?
To be sure, there is a wide variety of positions on both the affirmative and negative. This
briefing document serves as a start to your topic preparation and is not a substitute for original
research and case preparation. Our research team has concentrated on including quotations from
hard to research sources such as legal journals and specialized policy publications.
I thank my colleagues at the School of Public Health and Yale Medical School for their
comments and suggestions.
My colleagues and I thank you for being a PlanetDebate.com/Lincoln-Douglas.com
subscriber and we hope that you will continue your subscription throughout the 2006-07
Lincoln-Douglas season. We are planning more improvements to the PlanetDebate.com/LincolnDouglas.com website including instructional and coaching resources.
As always, we invite your comments and feedback, and greatly value your confidence in our
project by using our materials to help your program prepare for each National Forensic League
Lincoln-Douglas debate topic. My email address is minh.a.luong@yale.edu.
With best wishes for success throughout the coming debate season,
Minh A. Luong
Editor
1
“The War Against AIDS: Look to the Future,” The Economist, August 19, 2006, p. 11.
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Resolved: A just government should provide health care to its citizens.
TOPIC IN CONTEXT
Health care is considered an essential need – even a right – by many international human
rights advocates, ethicists, and international organizations like the United Nations.2 The value
proposition regarding the necessity of health care is nearly universally accepted, however, the
answers to the philosophical questions that follows are less clear – who should provide health
care and, in many situations, what level of care ought to be provided. In some countries, the
government is the primary provider of health care and in other countries, government
involvement is limited; health care is provided by network of private and charitable
organizations.
The public policy question that always accompanies the value and philosophical questions is:
who should pay for health care? It is easy for observers and advocacy groups to demand high
quality health care for all citizens and for family members who are caring for a seriously ill or
dying loved one, access to the very best medical professionals, technology, and therapies
becomes a top priority. In a perfect world, everyone should be able to receive the best health care
at little or no direct cost but regardless of governmental and economic system, resources are
finite and every system faces some sort of a depth versus breadth choice:
Depth: Provide a high level of care to fewer citizens knowing that some citizens will not be
covered but for those who are covered will have access to the best care and therapies.
Breadth: Provide a standard level of care to as many citizens as possible knowing that access
to cutting-edge therapies will be limited, if not unavailable, because of high cost.
Many developing and socialist countries have chosen the first approach and the wealth of the
country has a direct impact on the level of care that country can provide its citizens. But a
number of countries, primarily capitalistic countries such as the United States, have taken a
middle course, known as a hybrid approach. These countries offer a tiered system of delivering
health care. There are a wide range of private and government-subsidized health care plans
available at various cost levels ranging from under $50 per month to a few thousand dollars per
month. A system of private, non-profit, and government health care facilities deliver services and
the health care plans pay for the services provided. Under nearly all plans, the patient is expected
to pay at least a portion of the cost and that is frequently known as a deductible, the amount the
patient pays before the health plan or insurance starts paying,3 and co-pay, a fixed amount that
the patient pays for each session.4
2
Article 25 of the United Nations Universal Declaration of Human Rights: (1) Everyone has the right to a standard
of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and
medical care and necessary social services, and the right to security in the event of unemployment, sickness,
disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
3
Deductible amounts vary significantly. Health care plans that are affordable frequently have high deductible
amounts, requiring that the subscriber pay the first $1,000 to $5,000 of health care costs before the plan begins
paying. These plans are commonly known as “catastrophic medical plans” because their high deductible amounts
mean that the real benefit will come only when major illness strikes or expensive procedure is required. For people
who have limited means, this type of coverage is the only type available due to lower cost.
4
Co-pay amounts vary significantly as well. Some plans charge as little as $5.00 per doctor visit and as much as
$100 per emergency room visit. Since emergency care is among the most expensive type of health care service,
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Resolved: A just government should provide health care to its citizens.
Governments have significant incentives to provide some level of health care to its citizens if for
no other reason than economics – healthy, productive citizens generate tax revenue and sick,
unproductive citizens generate little or no tax revenue. That is why governments frequently
embark on major public health awareness campaigns aimed at preventing diseases. By creating
awareness and reducing the number affected by common or widespread diseases, countries
reduce the burden on the health care system and the overall cost of providing health care is
reduced. By keeping more workers healthy and productive, the gross domestic product (GDP) is
raised without increasing population.5
Governments avoid the dreaded “double-whammy” of ill, unproductive citizens by providing
effective health care services. The “double-whammy” effect is the swing from a worker who is
healthy and net contributor to the economy to a worker who is sick and is no longer contributing
to the economy. The sick worker also adds to the burden of the health care system incurring
additional costs.
insurance companies and health management organizations (HMOs) set high co-pays to discourage subscribers from
using the emergency room as a primary care facility.
5
Gross Domestic Product (GDP) is the primary measurement of the productivity of a country. GDP is the total
amount generated by the production of goods and delivery of services in a country in a year.
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Resolved: A just government should provide health care to its citizens.
TOPIC BRIEFING
There are two types of government-provided health care systems – socialized systems and
market-based systems.
Socialized systems:
The government plays a central role in both the delivery and financing of health care. Socialized
systems are typically operated by the government6 and tax revenue is collected to finance the
operation of the health care system. The operating principle is that health care is provided for all
(or nearly all) citizens and that the quality of health care is consistent across providers and for
patients regardless of status or class.
Access to health care is a strength of socialized systems as is the low cost since nearly all
socialized systems are financed or heavily subsidized by the government. In socialist countries
like Sweden and Denmark, all citizens have access to good quality of health care but the tax rates
are among the highest in the world at over 50%.
The disadvantage of socialized systems is that there is an emphasis on cost containment and
since any national system has to cover all citizens, access to specialized care, cutting-edge
technologies, and advanced drugs is limited, if not unavailable. Under the present system,
wealthy individuals simply travel to another country such as the United States or Canada and are
able to pay for the best care. In fact many leading health care providers cater to such clientele
which include billionaires and royalty.
Market-based systems:
The government has a limited role and it is usually limited to regulation. In a market-based
system, government licenses medical practitioners, pharmaceutical companies, and health care
institutions such as hospitals and nursing homes. Private industry and charitable organizations
form the provider network.
Payment for health care consists of a diverse system of private insurance plans, mutual heath
maintenance organizations (HMOs), and some government-funded programs for the poor and
elderly.
The advantage of market-based systems is that they provide a very high level of quality of care,
frequently including cutting-edge technologies and access to specialists and advanced drug
therapies. Because access is priced based on costs, high cost plans provide virtually limitless
access to the very best care possible.
The flip side, of course, is that market-based systems are expensive and not everyone can afford
access to health care. Since the market determines price (and access) these systems leave a
significant segment of the population without health care. Most governments, even if it
6
Some countries centralize their health care delivery system and operate it from the central or federal government.
Other countries allow regional and/or local governments to deliver the health care services.
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Resolved: A just government should provide health care to its citizens.
subscribes to an open market philosophy, have realized that there are significant social problems
from having a segment of the population without access to health care. So even in capitalist
countries like the United States, government-provided networks have been established to provide
health care to poor and elderly citizens such as Medicare and Medicaid.
To support military veterans, the U.S. established the Veterans Administration system of
hospitals which provide health care to millions of current and former military servicepersons.
It is also important to distinguish the difference between health care and emergency care. Health
care is the broader process of preventing, treating, and curing patients from disease and illness.
The health care system is complex and comprehensive.
Emergency care is a subset of the health care system and focuses on immediate but temporary
responses to urgent medical situations such as injuries or sudden illness.
It is very important to distinguish the differences between the two as many people (and even
experts!) conflate the two. The United States has the best emergency care system in the world
because of access to advanced technology and the fact that it is the most profitable type of health
care. Emergency room physicians make significantly more than general practitioners, for
example.
On the other hand, the United States has a health care system that is not as efficient and serves a
lower percentage of its population than other modern industrialized countries.
It is important to use the resource list provided in this briefing document to become acquainted
with the different systems and how governments operate and finance their health care systems.
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Resolved: A just government should provide health care to its citizens.
DEFINITIONAL CONCEPTS
When analyzing this topic, one of the first questions concerns perspective. The resolution has
no stated geographical or political focus areas – at first glance, it is a general philosophical
proposition.
Should the debaters and the judge evaluate the resolution as a neutral observer or attempt to
make the debate relevant to the judge pool by taking the perspective on an American citizen as is
common in many parts of the country. While there is sufficient room for debate with either
approach, the flavor and range of arguments will be different depending on the approach taken.
For this particular topic, definitions are of critical importance.
just government. The phrase just government means a ruling body that operates from the
principles of justice. There are many interpretations of justice; some of which are relevant and
others not. An examination of the various sub-definitions of just from Dictionary.com based on
the new Random House Unabridged Dictionary (2006) reveals no fewer than 12 different
interpretations:
just:
1. guided by truth, reason, justice, and fairness: We hope to be just in our understanding of
such difficult situations.
2. done or made according to principle; equitable; proper: a just reply.
3. based on right; rightful; lawful: a just claim.
4. in keeping with truth or fact; true; correct: a just analysis.
5. given or awarded rightly; deserved, as a sentence, punishment, or reward: a just penalty.
6. in accordance with standards or requirements; proper or right: just proportions.
7. (esp. in Biblical use) righteous.
8. actual, real, or genuine.
—Synonyms 1. upright; equitable, fair, impartial. 3. legitimate, legal. 4. accurate, exact;
honest. 5. merited, appropriate, condign, suited, apt, due.
—Antonyms 1. biased. 4. untrue. 5. unjustified.
Dictionary.com Unabridged (v 1.0.1). Based on the Random House Unabridged Dictionary,
© Random House, Inc. 2006.
Definitions #1 and #2 show the most promise. #1 implies that A fair government provides
health care to its citizens – meaning that in upholding justice and fairness, health care is a
commodity that is provided to all citizens.
The same approach can be taken for definition #2. According to a principle focuses on a
policy grounded in values and if the values include taking care of citizens, then by providing
health care, the government fulfills those principles.
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Resolved: A just government should provide health care to its citizens.
should. This term is synonymous with ought which implies a moral duty or obligation to do
something. Other interpretations include a policy prescription or a call for policy action.
should:
1. pt. of shall.
2. (used to express condition): Were he to arrive, I should be pleased.
3. must; ought (used to indicate duty, propriety, or expediency): You should not do that.
Dictionary.com Unabridged (v 1.0.1). Based on the Random House Unabridged Dictionary,
© Random House, Inc. 2006.
Definition #3 is the appropriate interpretation for this resolution. The term should creates a
duty or obligation for the government to fulfill; in this case, provide health care to its citizens.
provide. This is a critical definition to correctly define and defend. Many debates on this
topic will be decided on the definition of provide. The definition of provide will establish the
burden that the affirmative will have to overcome. For example, it will be more challenging if the
affirmative has to support the government supplying and paying for health care services. There is
a lower burden of proof and more flexibility if the affirmative merely has to show that the
government should arrange or pay for health care.
Provide:
1. to make available; furnish: to provide employees with various benefits.
2. to supply or equip: to provide the army with new fighter planes.
3. to afford or yield.
4. Law. to arrange for or stipulate beforehand, as by a provision or proviso.
5. Archaic. to prepare or procure beforehand.
6. to take measures with due foresight (usually fol. by for or against).
7. to make arrangements for supplying means of support, money, etc. (usually fol. by for):
He provided for his children in his will.
8. to supply means of support (often fol. by for): to provide for oneself.
Dictionary.com Unabridged (v 1.0.1). Based on the Random House Unabridged Dictionary,
© Random House, Inc. 2006.
If debaters want to make the government actually provide the health care services, then
definitions #1 and #2 are preferred. If debaters want to have the government merely pay or make
arrangements for health care, then the remaining definitions are more useful.
health care. The American Heritage Dictionary provides two of the most relevant definitions
to this topic. This interpretation best follows the reasonable person doctrine which is the
standard of definitions that most debate judges use.
health care:
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Resolved: A just government should provide health care to its citizens.
The prevention, treatment, and management of illness and the preservation of mental and
physical well-being through the services offered by the medical and allied health professions.
adj. also health-care
Of or relating to health care: the health care industry.
The American Heritage Dictionary of the English Language, Fourth Edition, 2000.
Published by Houghton Mifflin Company.
Its. Most debaters overlook this critical term but given the level of international aid in
combating diseases and providing health care in other countries, the term its will be important in
keeping the debate focused on the question whether the government should provide health care
to the citizens who live that that particular country. Defining its in this manner will exclude
arguments about providing health care to people in other countries.
Its: used to represent a group understood or previously mentioned.
Dictionary.com Unabridged (v 1.0.1). Based on the Random House Unabridged Dictionary,
© Random House, Inc. 2006.
citizens. This term needs care in defining. The literal term citizen means status conferred by
birthright or acceptance into a particular society or country. The term citizen is controversial as
international law frequently conflicts with national laws with regards to rights of individuals who
live in a country other than their recognized citizenship. A more casual or colloquial
interpretation of citizen refers to the people who live within the boundaries of a country
regardless of their particular legal standing. In certain parts of the country where illegal
immigration is a hot topic, the definition of citizen can sidetrack the entire debate.
citizen:
1. A person owing loyalty to and entitled by birth or naturalization to the protection of a
state or nation.
2. A resident of a city or town, especially one entitled to vote and enjoy other privileges
there.
3. A civilian.
4. A native, inhabitant, or denizen of a particular place: “We have learned to be citizens of
the world, members of the human community” (Franklin D. Roosevelt).
The American Heritage Dictionary of the English Language, Fourth Edition, 2000.
Published by Houghton Mifflin Company.
The strict interpretation of citizen is found in definitions #1 and #2. #3 is less useful and the
looser interpretation can be found in definition #4.
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Resolved: A just government should provide health care to its citizens.
AFFIRMATIVE POSITIONS
There are a wide variety of arguments for the affirmative and this essay covers a mere
sampling of them.
Government intervention is necessary to provide the poor with health care.
There is quite a bit of data that suggests that poor people are unable to access necessary
health care due to prohibitive costs. Because the poor also tend to be uninsured, they are likely
to not spend money on unnecessary preventive medicine that would help prevent costly, longterm health problems. Other data suggests that there are economic incentives for hospitals to
exclude or divert poor people from consuming medical goods.
Given the social and economic reasons for the private sector excluding the poor, some
intervention must be made to correct the biases that exclude the poor. There is also quite a bit of
empirical data that suggests that the poor have better access to health care in places that have
universal health care compared to countries that have market-based health care systems. The
resolution also has no modifier that allows the government in the affirmative world to exclude
anyone from health care. In this way, the affirmative can make a strong argument about how
affirming promotes class equality by forcing the government to give health care to all people.
Universal health care is necessary for minority groups.
Many minority groups are disadvantaged in society because of social prejudices against
these groups. Quite a bit of empirical data shows that medical care systems fail to serve many
minority groups across the globe. Some argue that the government often enacts policies that
allow some groups to have more access to health care than others to support some races,
ethnicities, and religions over others. Others argue that there are market incentives for health
care providers to ignore minorities because they often have fewer resources than their majority
counterparts.
Affirming offers a possible check by mandating that all citizens receive health care.
Since there are a myriad of reasons as to why minorities are denied health care, a categorical
policy must be enacted to prevent the government from shirking on its obligation to make sure
that all people are protected.
Government provided health care provides quality health care.
Some argue that government provided health care offers the best means to meet the
health needs of the people. Private insurance is often too expensive for many families to pay for,
which suggests that the free market fails to produce health care for all people. Private
insurance’s profit motivation also encourages wasteful expenditures on advertising and
government lobbying. Since the government would not have to worry about these expenses, it
may be less expensive to let the government assume the responsibility for health care. Empirical
data suggests that governments that have universal health care systems spend less of their GDP
on health care than countries that have more private health care systems.
Profit motivated health care is harmful.
An important distinction can be made between health care for the sake of health care and
health care for the sake of profit. Modern American health care is typically viewed as a forprofit enterprise that benefits doctors, pharmaceutical companies, or some other profit motivated
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Resolved: A just government should provide health care to its citizens.
group. This profit motivation may encourage some health providers to prescribe unnecessary or
sub-optimal health care in favor of increased profits from drug or medical companies.
The affirmative can make an argument, then, that the government lacks the same profit
motive as the doctors and pharmaceutical companies that traditionally dominate the health care
arena. Since the government is concerned mostly with the protection of the people, it will
probably be less motivated to use harmful treatments, although they might serve some economic
interest. You could also make the argument that the government has the incentive to treat the
people well to maximize its legitimacy and decrease unrest. Since the government lacks the
incentive to give bad medical care, we ought to look to the government instead of private
corporations.
A government committed to fairness should provide health care
Providing health care to all citizens removes one more barrier that separates classes, races, and
different groups and creates a fairer society by providing an essential human right to everyone
regardless of status. Similar arguments were made to support governments providing elementary
and secondary education to all citizens regardless of ability to pay or color of skin. Not providing
health care is a glaring omission by any government which purports to be just.
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Resolved: A just government should provide health care to its citizens.
NEGATIVE POSITIONS
Government provided health care decreases the quantity of health care.
Patients must be able to have access to health care in order to benefit from it. Health care
is a finite resource, as doctors have a limited amount of time, certain medications, and access to
particular medical technologies. Thus, the supply of health goods must be able to meet the
demand of medical care consumers. If there is a significant lack of health care goods, then some
people will not be treated, and there will be suffering.
Health care is already in high demand, as individuals have an incentive to be as healthy
as they can be. If this health care is available to all people, then those that seek health care will
be able to do so without cost to them. If there is no cost to those who seek health care, they will
be able to consume that care without any payment, which will only encourage them to seek more
care. Since health care is finite in quantity, increasing demand will only make health services
scarcer, which may mean that health care could be come less accessible to everyone else.
Government provided health care decreases the quality of health care.
When governments allow people to have access to all of the health care that they wish to
consume, they create high demand for doctors and other medical goods, as there is no longer any
disincentive to not use medical resources. Quality doctors are essential to providing a high level
of care. Treatment can be directly fatal through mistakes during treatment, or can be indirectly
fatal by misdiagnosing or missing a fatal illness. Because a high demand for doctors is created,
there will be an incentive to either allow less qualified doctors to enter the profession to meet the
new demand of medical care.
Even if quality standards remain high in allowing new doctors into the profession, current
doctors will be swamped by the newly stimulated demand, which will force doctors to see more
patients. This forces doctors to either spend less time with patients, which increases the
likelihood that they will miss entirely or misdiagnose a patient’s disease, or patients may be
forced to wait too long to receive necessary medical care.
Free market solutions give people all the health care that we need.
Many have argued that government intervention into the market process will often be
disastrous because it cannot possibly know the market better than the consumers that participate
in it. Moreover, interventions into the market may have unforeseen consequences, which may
produce the opposite of the intended result. Once the intervention into the market is taken,
governments may decide to intervene again to compensate for the previous intervention. This
creates a cycle of intervention, which becomes more and more costly, and more and more
damaging. Empirical data also suggests that the American system, which is arguably the most
free system, is more efficient and provides a higher quality of care than most other places in the
world.
Government provided health care violates liberty.
If the government decides to provide all people with health care, it will have to have
some way of paying for the health services that it provides. Since the government must always
pay for the services that it takes, it will have to rely on taxpayers to fund universal health
programs. It is commonly accepted that people have a right to dispose of their property as they
see fit because they have earned that property through labor. Since the right to own one’s labor
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Resolved: A just government should provide health care to its citizens.
is an extension of one’s freedom to do what one pleases, violating property is a violation of
freedom.
Affirming would have the government, then, force people to give up money to pay for the
choices of others. The only other option that would be available to the government would be to
force doctors to work for free for the state, but that would probably be considered a more direct
violation of freedom by directly controlling physicians’ life choices. Since individual rights and
liberties act as a check on what society can do to the people, those rights must be sacred to
prevent the community from trampling the individual.
CONCLUSIONS
Definitions and interpretations of the topic words are essential to success on this topic.
Interpretations should be reasonable but using examples from various countries can be a doubleedged sword – if debaters use examples, they must be applicable and relevant. Keep in mind that
each country’s health care system is different and knowledge of those differences, even minor,
can cause examples to become irrelevant and thus not useful in debates. Avoid lumping Cuban
and Swedish health care systems together even if both are considered “socialist” models.
Similarly, don’t assume that the French, German, and British health care systems are similar
merely because they are European. They are radically different both in structure, governance,
and how health care is financed.
This topic calls for some “focus group testing” prior to competition. Students who debated
this topic previously found it very helpful to read their cases or stage exhibition debates in front
of college students and adults to get feedback on the argumentation and philosophical approach
of the cases.
On behalf of the Lincoln-Douglas research team here at PlanetDebate.com, I wish you the
best of luck and good hunting!
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Resolved: A just government should provide health care to its citizens.
SELECTED RESOURCES
Must read:
Committee on the Consequences of Uninsurance, Board on Health Care Services, Institute Of
Medicine of The National Academies, Hidden Costs, Value Lost: Uninsurance in America (full
report), The National Academies Press, 2003.
URL: http://newton.nap.edu/catalog/10719.html
CBS News, “Must-Have Health Insurance,” CBS Evening News, January 28, 2006.
URL: http://www.cbsnews.com/stories/2006/01/28/eveningnews/main1249052.shtml
Websites:
Americans Rate Canadian Health Care System Better than U.S. System
http://www.harrisinteractive.com/news/newsletters_healthcare.asp
The above link takes you to a list of Harris Interactive results, as I could not get the link directly
to the report to consistently work. The relevant report is about a quarter of the way down the list,
and is well worth the search. Harris Interactive’s August 2004 poll revealed that only 34% of
Americans surveyed felt confident about the United States healthcare system. The survey of
over 2000 Americans indicated that, while Americans considered their quality of life, system of
government, present government, and economy to be better than that in Canada, they actually
thought the Canadian health care system was better.
Cameos on Universal Health Care
http://www.theharbinger.org/xix/000822/walker.html
This article by Townsend Walker, Sr., former President of the Alabama Health and Action
League, was published in The Harbinger and deals with the way the United States media reports
on health care in the United States and Canada. Walker quotes the presentation of a colleague
who follows the reporting of health conditions through a variety of important periodicals,
including Washington Monthly, The Washington Post, and The New York Times. Although
Walker’s article is primarily a compendium of quotations, it is nonetheless interesting.
The Case for Universal Health Care in the United States
http://cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.ht
m
The Connecticut Coalition for Universal Health Care runs this site, which is unabashedly tied to
the Green Party. The article by two doctors—one M.D. and one Ph.D.—gives shocking facts
challenging the notion that the United States has a good health care system. Some of the most
shocking are that the United States ranks 23rd in the world in infant mortality, 20th and 21st
respectively in women’s and men’s life expectancies, and ranks 67th (right behind Botswana) in
overall immunizations.
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Resolved: A just government should provide health care to its citizens.
Department of Health and Ageing (Australia)
http://www.health.gov.au/
The direct link http://www.health.gov.au/internet/wcms/publishing.nsf/Content/Services-3
outlines the services provided by Australia’s universal health care system. This site is useful if
you are using Australia specifically in your case or expect others to do so, but is not a great
overview of the success or failure of the system, as it is primarily created for the use of
Australians. However, the “Research and Statistics” link does include reports on various aspects
of the Australian health system.
Health Canada
http://www.hc-sc.gc.ca/english/care/
The homepage of the Canadian health care system describes the tenets behind Canada’s
universal health care system, the structure of the system, and includes, at the bottom of the main
page, links to additional resources and reports. One report addresses patient safety and
healthcare error in Canada, while another addresses the same issues in Australia, the United
Kingdom, and the United States. Other links on the left side of the main page include
“Estimates, Plans, and Performance” and “Health Spending.”
Health Care in the United States
http://en.wikipedia.org/wiki/Health_care_in_the_United_States
This wikipedia entry is a thorough and non-biased description of the United States health care
system that is interesting to read from the perspective of a participant in that system. The site
states that the United States has a less “socialist” health care system than other countries, and
gives an excellent description of “Who Provides It,” “Who Covers It,” “The Coverage Gap,” and
“Major Issues,” which includes “Prescription Drug Coverage” and “Universal Health Care.”
This website should be required for all students debating this topic, as it provides a uniquely
unbiased perspective on and thorough evaluation of United States health care.
Health Cover System in France for Foreign Scientists
http://www.fnak.fr/dn_health_cover_system_france/
One of the few French-designed websites on the French health care system written in English,
this site is not necessarily comprehensive, but does include a description of France’s universal
health system under the heading “the French System of Health Protection” on the main page.
The site asserts that “France has one of the most efficient systems of social protection in the
world.” These benefits are only available to salaried workers, however, and do not cover all
costs.
Health Policy Watch
http://www.healthpolicywatch.org/
Health Policy Watch is part of the Century Foundation, and is designed to “provide experts and
non-experts alike with a portal on these developing debates on health policy and on ideas for
achieving universal coverage.” The main page has a plan for health care by Leif Wellington
Haase, which proposes a move away from employer-based health coverage to a program that
covers the uninsured and is cost-effective. Another useful link from the main page is an article
entitled “America’s Achilles Heel: Job-Based Coverage and the Uninsured.” The site also offers
pages with “Publications,” “News and Opinion,” “Issues,” and “Related Research.”
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Resolved: A just government should provide health care to its citizens.
Laying the Groundwork for Universal Health Care Coverage
http://www.heritage.org/Research/HealthCare/test031003.cfm
The full-text of Stuart Butler’s testimony to the Special Committee on Aging, United States
Senate is well-organized and informative. Dr. Butler states that the current health care system in
the United States is characterized by “gaps and unevenness in coverage” and “multiple systems
of health care.” Dr. Stewart explores these problems, draws three lessons from his analysis, and
then proposes a move towards universal health coverage with four steps. Aside from being a
useful source, this text is an excellent example of a well-signposted, easy to follow verbal
presentation. Dr. Stewart concludes “Reaching the goal of universal coverage will be difficult.
But it will be much easier if we rationalize subsidies for health coverage, enable people to pick
the form of coverage that is best for them, and encourage state-federal experiments to explore
innovative ways of organizing health care coverage.”
National Center for Health Statistics
http://www.cdc.gov/nchs/
The CDC’s site of health statistics is very colorful and very informative. Particularly useful
under “Information Showcase” is the “Joint Canada/United States Survey of Health.” The direct
link to the study is http://www.cdc.gov/nchs/about/major/nhis/jcush_mainpage.htm. The study
of 3500 Canadians and 5200 United States citizens concludes that “Americans were more likely
than Canadians to report that they were very satisfied with health care (53 percent compared to
44 percent), but findings for uninsured Americans accounted for significant differences between
the countries in a number of categories.” The report also states that “Among low-income
respondents, 31 percent of Americans said they were in fair or poor health, compared with 23
percent of low income Canadians.”
National Coalition on Health Care
http://www.nchc.org/
This organization, based in Washington D.C. describes itself as “the nation’s largest and most
broadly representative alliance working to improve America’s health care.” The organization is
officially non-partisan. The most useful portion of the site is the “Materials” tab,
“Studies/Reports” link at the top of the page, which takes you to a number of useful reports. Of
these reports, I recommend checking out “Building a Better Health Care System” and “Charting
the Cost of Inaction.” The “Facts about Health Care” tab on the main page also includes several
useful links, particularly “Health Insurance Cost,” which states that in 2004 “The annual
premium for an employer health plan covering a family of four averaged nearly $10,000.”
Physicians for a National Health Program
http://www.pnhp.org/
PNHP states “Specifically, we believe that a single-payer system (where the government
finances health care, but keeps the delivery of health care to mostly private control) is the only
solution to solving the United States' many health care problems.” The site explains this single
payer proposal and the PNHP’s proposal for maintaining quality and long-term affordability.
Aside from these links, available in the text on the main page, the site includes a section entitled
“Get the Facts” and another called “Our Publications and Slideshow” that have useful
information.
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Resolved: A just government should provide health care to its citizens.
Solved!
http://www.washingtonmonthly.com/features/2005/0506.emanuel.html
This Washington Monthly article by Ezekiel Emanuel and Victor Fuchs asserts that universal
health care vouchers will revolutionize health care in the United States. Emanuel and Fuchs
believe that the vouchers will “make the most of what’s good about the current system and
reflect American’s basic values.” The site gives seven criteria for an effective health care
system, explain the voucher system, and address how the voucher system will be successful. The
article ends with the ten principles of the voucher system, including universality, free choice of
health care plan, freedom to purchase additional services, ending employment-based insurance,
and eliminating Medicaid.
Universal Health Care
http://www.nationmaster.com/encyclopedia/Universal-health-care
NationMaster.com describes itself as a “massive central data source and a handy way to
graphically compare nations” that compiles information from many sources, including the “CIA
World Factbook, United Nations, World Health Organization, World Bank, World Resources
Institute, UNESCO, UNICEF and OECD.” This NationMaster encyclopedia entry is a
comprehensive explanation of health care systems around the world, including an overview,
varieties of public health systems, and a description of the health care system of each country
with a universal system. The site describes the United States health care system as a parallel
public/private system, and address the role of the free market in health care and difficulties of
analysis.
Universal Health Care: A Debate on Health Care in the U.S. and Canada
http://www.democracynow.org/article.pl?sid=04/10/15/157222
This is actually the transcript of a radio broadcast on Democracy Now!, a daily radio and TV
news program. You have the option of reading the transcript, which is included in full-text (with
commercials) on the main site, or watching the broadcast. The debate involves two experts, one
on each side of the issue. It is unedited for grammar, etc., but is very interesting and insightful.
Both experts cite numerous statistics and examples, and, unlike most of the sites on this issue,
both sides of the issue are covered.
Universal Health Care Action Network: Working for Justice in Health Care
http://www.uhcan.org/
The most useful portion of this site is the “Current Issues” link on the left side of the main page.
This section of the UHCAN site includes links to multiple articles about each of the following
sub-topics: US health care system, Medicare, Medicaid, prescription drugs, money in health care
politics, medical privacy, racial disparities, and cost shifting to employees/patients. Of particular
potential use are “Health Care as a Moral Value” and “Democracy on Drugs.”
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Resolved: A just government should provide health care to its citizens.
Universal Health Care Coverage
http://www.policyalmanac.org/health/universal_health.shtml
This site is part of the “Almanac of Public Policy Issues.” Although the information on the main
page is based on old Census Bureau reports, the site also includes excellent links under “Site
Listings” and “Articles” when you scroll down the main page. There are about 40 articles from
1999-2004 addressing both negative and affirmative positions, including one entitled “Clinton
Got Quick Care, Unlike Canadian Heart Patients,” which compares American and Canadian
health care systems, hypothesizing about the kind of care former President Clinton would have
received after his recent heart attack had he lived in Canada. The article states “Since the
Clinton health plan was defeated, untold patients have been aided because America's health care
system, whatever its faults, was not subjected to the shortages and waiting lines that plague other
nations.”
Universal Health Care Initiative
http://www.amsa.org/hp/uhcinitiative.cfm
The American Medical Student Association website states that “we remain the only
industrialized nation that does not guarantee health care for all of our brothers and sisters. AMSA
believes that universal health care is long overdue.” The site includes a link to “AMSA in the
States,” which explores those states that have taken the need for better health care into their own
hands; “Educational Resources,” an invaluable source of information about Universal Health
Care; and “What’s Going on in Congress,” which addresses current legislature in Congress and
its potential.
Universal Health Care Initiatives
http://www.newrules.org/equity/universalhealth.html
The New Rules Project, based in Minnesota, supports the idea of a new localism—a drive to
community-based government. Although the credibility of the site is never provided or
established, it does have an excellent Health Care section, including this page of local health care
initiatives in Maine, Massachusetts, New Mexico, and Vermont. The site also covers the
Canadian health care system, “Community-based Health Care,” “Single-Payer Universal Health
Care Efforts,” “Health Care System Reform,” and “States’ Right to Innovate in Health Care
Act.” There are many useful links to additional information within each section.
U.S. Health Care Concerns Increase
http://abcnews.go.com/sections/living/US/healthcare031020_poll.html
This ABC News article describes the growing unhappiness expressed by Americans for the
current health care system. The article includes the results of a poll of 1000 adults conducted by
ABC News in 2003. The statistics include “Seventy-eight percent are dissatisfied with the cost
of the nation's health care system, including 54 percent "very" dissatisfied.” The site concludes
that “Americans by a 2-1 margin prefer a universal health insurance program over the current
employer-based system.”
Books:
Health Care in the United States. Marie Gottschalk. Cornell UP, 2000.
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Resolved: A just government should provide health care to its citizens.
One Nation, Uninsured: Why the U.S. Has No National Health Insurance. Jill S. Quadagno.
Oxford UP, 2005.
Politics of Public Health in the United States. Deborah McFarlane. Sharpe, 2005.
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Resolved: A just government should provide health care to its citizens.
SELECTED QUOTATIONS ON THE TOPIC
AFFIRMATIVE QUOTATIONS
The United States’ lack of health care causes death.
Vicente Navarro, professor of public policy, sociology, and policy studies at the Johns Hopkins
School of Public Health and the editor in chief of the International Journal of Health Services.,
"America's Class Structure Has Created an Unfair Health Care System." Medical Ethics. Ed.
Laura K. Egendorf. San Diego: Greenhaven Press, 2005.
Even though the United States spends more on health care (14 percent of its GNP [gross national
product]) than any other country, we still have problems that no other developed capitalist
country faces. Let me list some of them. The first and most overwhelming problem is that no less
than forty-four million of our people have no form of health benefits coverage whatsoever. The
majority of them are working people, and their children, who cannot afford to pay the health
insurance premium that would enable them to get care in time of need. Many of them work for
small companies that cannot or will not pay their part of the health insurance premium. Because
these individuals cannot pay for insurance, they do not get needed care, and many die as a
consequence. The most credible estimate of the number of people in the United States who have
died because of lack of medical care was provided by a study carried out by Professors David
Himmelstein and Steffie Woolhandler. They concluded that almost 100,000 people died in the
United States each year because of lack of needed care—three times the number of people who
died of AIDs.
A pure economic analysis of health care fails to take into account other morally relevant factors
in decision making.
Lois Shepherd, professor at Florida State University College of Law, “RETHINKING HEALTH
LAW: ARTICLE & ESSAY: ASSUMING RESPONSIBILITY”, Wake Forest Law Review,
Volume 41, 2006.
Economic analysis of the law can indeed provide us with many useful answers. We can learn
about how to create effective incentives and penalties for various activities that we want to
encourage or discourage. We can learn about the consequences of certain actions that may not be
readily apparent, recognize the true costs of decisions to allocate resources one way rather than
another, and be made to focus on information deficiencies and unlikely alliances. But if we push
economic analysis beyond its usefulness as a tool and suppose that it should define the goals of
medicine - under the view that health care is simply a business and consumer choice is the
beginning and end of the story - then we ignore the central importance of good health care to the
absence or reduction of human suffering and the opportunity to lead a good life. We might like to
think that we can revise the statement in the Introduction of this Essay, that "health care is
fundamentally about the prevention and alleviation of suffering" to read "health care is
fundamentally about the business of the prevention and alleviation of suffering," but that cannot
be. No one is in that business. The consumer model of health care cedes power to those who are
wealthy and well, to actually redefine the goals of medicine by what they purchase, changing our
collective understanding of what it is that doctors do. The health care goods purchased in these
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Resolved: A just government should provide health care to its citizens.
instances may not even promote good health. Does anyone believe that Michael Jackson's plastic
surgeons were really helping him? What about elective Cesarean sections for parents'
convenience? Breast augmentation surgeries given as high school graduation gifts? The
implantation of five or six embryos in the fertility treatments of white, economically advantaged
infertile couples (a practice that has hopefully ended)?
Giving health care only to the poor creates incentives for people to remain in poverty.
Susan Waysdorf, Associate Proffesor of Law at Columbia, “Fighting for Their Lives: Women,
Poverty, and the Historical Role of United States Law in Shaping Access to Women's Health
Care”, Kentucky Law Journal, Volume 84, 1995. Lexis.
Thus, with the emergence of these New Deal programs, the "doubleedged sword" or
dichotomous nature of the social welfare perspective was becoming clear for the first time in
United States history. On the one hand, the importance of the federal government's recognition
and provision for the nation's poor can not be overstated from a humanitarian perspective and as
a matter of public policy. On the other hand, with the linking of health care to poverty, the poor
increasingly became marginalized and stigmatized. Government's responsibility for health care
became increasingly framed as an entitlement for the poor and the disadvantaged, rather than as
an issue of public right and universal coverage for all women, for all children, or for all
Americans. Therefore, a woman with health care needs for herself and her family would now
have a government established incentive to be poor and to remain poor, in order to receive health
care entitlements.
Private medical coverage is often unaffordable.
Timothy Stoltzfus Jost, Robert L. Willett Family Professor of Law, Washington and Lee
University School of Law, “RETHINKING HEALTH LAW: ARTICLE & ESSAY: OUR
BROKEN HEALTH CARE SYSTEM AND HOW TO FIX IT: AN ESSAY ON HEALTH
LAW AND POLICY”, Wake Forest Law Review, Volume 41, 2006
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 pretax 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.
Providing universal health care corrects moral inequities.
Sharona Hoffman, assistant professor of law at Case Western Reserve University School of Law,
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Resolved: A just government should provide health care to its citizens.
“Unmanaged Care: Towards Moral Fairness in Health Care Coverage”, Indiana Law Journal,
Volume 78, 2003.
Universal health care can be a potent tool for promoting moral fairness in health coverage. It
would eliminate the large segment of the American population that is currently uninsured and
suffers from deteriorating health due to medical neglect. It would eliminate externalities
associated with the provision of medical care in emergency rooms and clinics to those who could
afford insurance but choose not to purchase it. It may also diminish incentives for some to
remain on welfare rather than work in order to receive Medicaid benefits.
Lack of government health care causes people to forgo needed care.
Vicente Navarro, professor of public policy, sociology, and policy studies at the Johns Hopkins
School of Public Health and the editor in chief of the International Journal of Health Services.,
"America's Class Structure Has Created an Unfair Health Care System." Medical Ethics. Ed.
Laura K. Egendorf. San Diego: Greenhaven Press, 2005.
An even larger problem is the underinsured, that is, people whose health benefits coverage is
inadequate. Most people find, at a crucial moment in their lives when they really need care, that
their health insurance coverage does not include the type of medical problem they have, the type
of intervention they need, or the type of tests or pharmaceuticals they require—or, that it covers
only a minute portion of what must be paid for the services. We, as Americans, are the citizens
with the least amount of health benefits coverage in the western world. Even the federal
programs, such as Medicare (which in theory should cover all care for the elderly), are very
insufficient. In every European country and in Canada, the elderly do not have to pay for the
pharmaceuticals they need. Not so in the United States, where many elderly must cut back on
necessities in order to pay for the drugs they need. In the United States, 35 percent of the elderly
cut back on their food purchases so they can afford their medications. But where the cruelty of
the system reaches its utmost is among those who are dying. Among the terminally ill, 39 percent
indicate that they have "moderate to severe problems" in paying their medical bills. No other
major capitalist country comes even close to this level of inhumanity.
The United States uniquely denies the right of universal health care.
Susan Waysdorf, Associate Proffesor of Law at Columbia, “Fighting for Their Lives: Women,
Poverty, and the Historical Role of United States Law in Shaping Access to Women's Health
Care”, Kentucky Law Journal, Volume 84, 1995. Lexis.
To this day, the United States stands virtually alone among developed or industrialized nations in
lacking universal health coverage for all people, and universal prenatal care and maternity care
for all women, regardless of their economic status. In other words, the United States fails to
assure at least a floor of health care, a minimum set of services for all pregnant women and
children. There simply are no statutory entitlements, no recognized guarantees under the United
States Constitution, and no body of case law that assures access to comprehensive, basic health
care to all women and children, regardless of their ability to pay or their social status.
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Resolved: A just government should provide health care to its citizens.
Sex influences possible access to health care.
Susan Waysdorf, Associate Proffesor of Law at Columbia, “Fighting for Their Lives: Women,
Poverty, and the Historical Role of United States Law in Shaping Access to Women's Health
Care”, Kentucky Law Journal, Volume 84, 1995. Lexis.
Perhaps in no other context of American life is the relationship between poverty, racial
discrimination, and gender discrimination more stark and historically consistent than in the area
of health care delivery and medicine. Today, women's daily relationship to securing and
maintaining health care for themselves and their children remains a major factor in keeping
women and their families locked in poverty. Yet, women are the primary consumers of health
care, both for themselves and as the primary caregivers of their children and their parents. In the
United States, access to health care, and the scope and quality of one's health care needs directly
correlate to one's power, privilege, wealth, and status. In this context, poverty has always been a
key factor in determining a person's prospects for health. For women the cycle has for the most
part remained unbroken. As a group women have been oppressed on the basis of race, gender,
sexuality, and the caregiver-homemaker-childrearer designation. Women's oppression has led to
poverty, poverty to poor health, and poor health back to poverty. In fact, the term "feminization
of poverty" aptly paints the picture that depicts the connection between women, health care, and
poverty.
Race is a factor in accessing health care.
Vicente Navarro, professor of public policy, sociology, and policy studies at the Johns Hopkins
School of Public Health and the editor in chief of the International Journal of Health Services.,
"America's Class Structure Has Created an Unfair Health Care System." Medical Ethics. Ed.
Laura K. Egendorf. San Diego: Greenhaven Press, 2005.
Indeed, the health care sector of any society is the best mirror of the power relations existing in
that country. In the United States, most people would agree that race is a category of power. In
general, whites have more power than blacks or Hispanics. And the mortality statistics reflect
this. A black man with a cardiovascular disease is 1.8 times more likely to die of it than is a
white man with the same disease.
Class influences access to health care.
Susan Waysdorf, Associate Proffesor of Law at Columbia, “Fighting for Their Lives: Women,
Poverty, and the Historical Role of United States Law in Shaping Access to Women's Health
Care”, Kentucky Law Journal, Volume 84, 1995. Lexis.
Furthermore, poverty is a dispositive factor in a person's prospects for health. Being poor usually
means living without access to adequate nutrition, housing, heat, clean water, clothing, and
sanitation, each of which has a negative impact on a person's health. Furthermore, the poor are
more likely to work in dangerous, unregulated industries which pose health risks. Workers in
marginal, high-risk workplace environments are subject to increased disease-inducing stress.
These workers also are more likely not to have health insurance and not to seek medical care
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Resolved: A just government should provide health care to its citizens.
until diseases have reached an advanced state. They are also more likely to suffer from multiple
health-compromising addictions than other segments of the population. In general then, poverty
contributes to poor health; and viewed from a demographic perspective, the lower the economic
status, the "poorer" one's health is likely to be.
Even for the insured, high costs of care discourage necessary medical treatments.
Timothy Stoltzfus Jost, Robert L. Willett Family Professor of Law, Washington and Lee
University School of Law, “RETHINKING HEALTH LAW: ARTICLE & ESSAY: OUR
BROKEN HEALTH CARE SYSTEM AND HOW TO FIX IT: AN ESSAY ON HEALTH
LAW AND POLICY”, Wake Forest Law Review, Volume 41, 2006
Private health insurance plans are increasingly transferring the cost of health care to their
insureds through high cost-sharing obligations, which are likely to discourage the provision of
some necessary health care. Surveys show that even fully insured persons often experience
serious financial difficulties because of health care expenses. Delaying health care because of its
costs, however, can result in higher costs down the road when conditions become more grave
and must be treated.
Health care systems that are based on profit will exclude the poor.
Lois Shepherd, professor at Florida State University College of Law, “RETHINKING HEALTH
LAW: ARTICLE & ESSAY: ASSUMING RESPONSIBILITY”, Wake Forest Law Review,
Volume 41, 2006.
It matters if the goals of medicine are something other than the preservation and restoration of
health or the provision of comfort when health fails. As we are continually reminded, we have
limited health care resources; there is not enough for everyone to have everything she wants or
needs. Our current health care delivery practices mean, as others have explained, that health care
is rationed - by price. Since there is not enough to go around, those lacking the resources to pay
are the ones who will go without. While we might prefer (and in fact, might even be responsible
for creating) a different health care system altogether that does not ration on the basis of ability
to pay, the current system becomes less defensible the more it blindly follows consumer dollars
to provide services that do not preserve or restore health.
Employers often fail to provide insurance.
Timothy Stoltzfus Jost, Robert L. Willett Family Professor of Law, Washington and Lee
University School of Law, “RETHINKING HEALTH LAW: ARTICLE & ESSAY: OUR
BROKEN HEALTH CARE SYSTEM AND HOW TO FIX IT: AN ESSAY ON HEALTH
LAW AND POLICY”, Wake Forest Law Review, Volume 41, 2006
Moreover, the system has never worked very well for some people. Small employers, who
cannot offer insurers large risk pools, have long had problems affording insurance. Employmentrelated insurance is often not available to part-time, temporary, and seasonal workers, even
though these workers comprise a significant share of our workforce. As we have moved over the
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Resolved: A just government should provide health care to its citizens.
past half century toward a workforce of two-worker families, moreover, it would appear that
some businesses - indeed whole industries - have tended to free-ride on other businesses that
have offered family policies to their workers.
A lack of universal health care hurts the economy.
Timothy Stoltzfus Jost, Robert L. Willett Family Professor of Law, Washington and Lee
University School of Law, “RETHINKING HEALTH LAW: ARTICLE & ESSAY: OUR
BROKEN HEALTH CARE SYSTEM AND HOW TO FIX IT: AN ESSAY ON HEALTH
LAW AND POLICY”, Wake Forest Law Review, Volume 41, 2006
All of this would not matter so much if health insurance were not so necessary conditional for
getting health care in the United States. For reasons explained below, it is possible to gain access
to emergency care in the United States without health insurance. It is much more difficult to
gain access to preventive or primary care or to care for chronic conditions. For these reasons, the
uninsured get less health care than the insured, and they get it later when it is often less effective.
Accordingly, the uninsured suffer higher morbidity and mortality rates, and, as noted above, an
estimated 18,000 adults die prematurely every year from lack of insurance. Not only do
individuals suffer, however, families and communities suffer as well. Medical costs contribute to
half of all bankruptcies, while hospitals in communities with high numbers of the uninsured offer
fewer services to vulnerable populations and have worse financial margins. Indeed, the entire
country loses because of the lost productivity of those whose diseases and disabilities are not
addressed because of a lack of health insurance.
Non-universal health systems may create incentives for worse health care.
Sharona Hoffman, assistant professor of law at Case Western Reserve University School of Law,
“Unmanaged Care: Towards Moral Fairness in Health Care Coverage”, Indiana Law Journal,
Volume 78, 2003.
The existence of a parallel private insurance system, however, could threaten the integrity of the
public insurance system. If the public system is tax-funded, and every worker must contribute a
certain percentage of her wages, the system's survival would depend upon the participation of
high earners. If wealthy Americans are allowed to opt out, the system might be forced to operate
on a shoe-string budget, based on minimal tax revenues collected from the poor and
governmental subsidies. Similarly, if people of means can choose to purchase private insurance,
they will not be personally invested in supporting the public health system. Without the political
support of individuals who make large campaign contributions, have lobbying power, and enjoy
access to the media, the public health system is unlikely to thrive. In addition, a parallel private
insurance system might induce providers to generate artificial shortages and waiting lists in the
public health system in order to encourage individuals to switch to the private system, in which
providers can charge higher prices.
Sex and race both play a role in health care access.
Susan Waysdorf, Associate Proffesor of Law at Columbia, “Fighting for Their Lives: Women,
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Resolved: A just government should provide health care to its citizens.
Poverty, and the Historical Role of United States Law in Shaping Access to Women's Health
Care”, Kentucky Law Journal, Volume 84, 1995. Lexis.
Among women, most health care advances predominately remain accessible to those who are
white and middle class, and have scarcely affected poor women's access to health care. This is a
reflection of the fact that federal public policy decisions and legislation over the last eight
decades have resulted in a form of medical apartheid for men, women, and children in this
country. This is a system which is overtly based on economic status, and covertly based on race
and gender. In other words, this is a two-tiered, health care caste system, built for the benefit
and profit of the privatized medical profession and health care industry, and resulting in
particular detriment to poor women and their children. Under this system, those who can afford
private health insurance, or those who are in the labor market and receive health insurance as a
benefit of employment, have access to a world-renowned health care system. Most other
Americans are medically disenfranchised. The unemployed, the working poor, the impoverished
- who are increasingly women and their children - people of color, the homeless, immigrants, the
institutionalized, are locked out of the top tier of health care. This apartheid system of "welfare
medicine," which bases one's access to quality health care on one's economic status, finds its
roots in the legal and policy decisions of the last seventy-five years.
Charity alone is insufficient to solve the problem of not having health care.
Lois Shepherd, professor at Florida State University College of Law, “RETHINKING HEALTH
LAW: ARTICLE & ESSAY: ASSUMING RESPONSIBILITY”, Wake Forest Law Review,
Volume 41, 2006.
Realizing that liberty rights - rights to be left alone - do not answer the problems of suffering
since what is needed is help, we might think that we can rely on altruism, volunteerism,
compassion, or benevolence - how medical ethicists refer to the concern for the well-being of
others. But clearly this has not been sufficient. Too many people are sick, disabled, or dead
because of inadequate health care in this country to think that a system of liberty rights plus
benevolence is working.
Health care must be about helping people instead of profit.
Lois Shepherd, professor at Florida State University College of Law, “RETHINKING HEALTH
LAW: ARTICLE & ESSAY: ASSUMING RESPONSIBILITY”, Wake Forest Law Review,
Volume 41, 2006.
Traditionally, health care has been thought of as the preservation and restoration of health (and
thus the avoidance of suffering) and the provision of comfort to those suffering from healthrelated causes. It should remain so. If we have a responsibility to the sufferer and the provision
of health care services can prevent and alleviate suffering, then we are responsible for continuing
to define the goals of medicine toward that suffering. But something more is lost when we
define health care as simply a business. It is not only the suffering of the individual that is
ignored, but the vulnerability caused by suffering that makes responding an ethical imperative.
Seeing health care as a business and the patient as a consumer or client fundamentally avoids
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Resolved: A just government should provide health care to its citizens.
seeing the patient as he really is: sick, sometimes desperate, sometimes dying, seeking care,
comfort, direction, and (sometimes life-saving) aid from others with the resources, special skills
and knowledge to help. The adult cancer patient cannot honestly be described as a "savvy
consumer" when it comes to health care; nor can the child with cancer or the parent of that child.
Understanding the individual seeking health care as a consumer, rather than a patient, wildly
imagines him as having more choices than he actually does and as having far more control of his
own health and his own suffering than he actually possesses.
Universal health care saves on many costs.
Sharona Hoffman, assistant professor of law at Case Western Reserve University School of Law,
“Unmanaged Care: Towards Moral Fairness in Health Care Coverage”, Indiana Law Journal,
Volume 78, 2003.
If universal coverage is publicly supported, it will require substantial federal spending, which
would have to be financed through taxes or cuts in other programs. International experience,
however, provides some encouraging indications concerning the cost of universal coverage. The
cost of administering public health systems can be relatively low because funds are collected
through taxes and paid directly to providers for services rendered. Furthermore, many of the
expenses absorbed by private insurers are avoided by a public system, including marketing costs,
underwriting costs, and commission payments for insurance policy sales.
Countries that have universal health care have fewer costs than free market systems.
Sharona Hoffman, assistant professor of law at Case Western Reserve University School of Law,
“Unmanaged Care: Towards Moral Fairness in Health Care Coverage”, Indiana Law Journal,
Volume 78, 2003.
Scholars have noted that countries with universal coverage uniformly spend a smaller percentage
of their GNPs on health care than does the U.S. In addition, the United States has far less
success in controlling health care costs than do other nations. Scholars have argued that in the
American health care system, an "excess administrative apparatus" accounts for ten percent of
spending, that compared with Canada's national health program, the U.S. system is inefficient
because of its administrative structure, and that the administrative costs of hospitals in the
United States are more than double the costs of those in Canada. In the words of one
commentator: We generally see that private insurance programs pay more for services--not less-than public programs. When we leave the nirvana of economic models and return to the real
world, the superiority of private to public systems seems much less clear cut; indeed, public
programs may come out on top.
Prioritizing market forces makes health care unsafe.
Lois Shepherd, professor at Florida State University College of Law, “RETHINKING HEALTH
LAW: ARTICLE & ESSAY: ASSUMING RESPONSIBILITY”, Wake Forest Law Review,
Volume 41, 2006.
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Resolved: A just government should provide health care to its citizens.
It is not only consumer demands for specialty care that skew health care resources away from the
prevention and alleviation of suffering. Indeed, the vested economic interests of insurers,
personal injury lawyers, hospital corporations, and others mean that patient choice is often
illusory. The drive for pharmaceutical profits, for example, can mean that drugs are pushed to
market before they are proven to be safe. The economic interests of lawyers can encourage
wasteful defensive medicine, and tilt malpractice awards towards those with greater injuries but
weaker proof of negligence and away from those whom negligence has truly injured.
There are many ways the government could implement universal health care.
Sharona Hoffman, assistant professor of law at Case Western Reserve University School of Law,
“Unmanaged Care: Towards Moral Fairness in Health Care Coverage”, Indiana Law Journal,
Volume 78, 2003.
Universal coverage can be implemented through a variety of mechanisms. First, the government
can establish a national health care system with public insurance, by which the government pays
for medical services, employs the health care providers, and owns all hospitals and medical
facilities. In the alternative, the government can provide health coverage for the public while
exercising less control over providers and delivery systems. Doctors, therefore, could work as
independent contractors for the government, as is done in Canada and Denmark, and hospitals
could be private nonprofits or religiously affiliated.
Government sponsored insurance can cover individual health needs.
Sharona Hoffman, assistant professor of law at Case Western Reserve University School of Law,
“Unmanaged Care: Towards Moral Fairness in Health Care Coverage”, Indiana Law Journal,
Volume 78, 2003.
A "mandatory private insurance" system can also be utilized. Under such a scheme, all
individuals are required to obtain health insurance, just as they are obligated to purchase auto
insurance, and the insurance industry is extensively regulated by the government. Insurers are
prohibited from denying coverage to any eligible individual; the government dictates the
premiums that insurers can charge and the benefits they must cover; and individual risk
underwriting is disallowed. Finally, the existing private insurance system could remain intact,
and Medicaid programs could be expanded to cover all those who are otherwise uninsured.
Vermont, for example, has moved close to this approach. The state enhanced its Medicaid
program for children so that only 4% of children are without health insurance, and it allows
adults in families whose incomes are less than 150% of the poverty line to purchase Medicaid
coverage for small payments. In 2002 Vermont's overall uninsured rate was just eight percent.
National health insurance is the best way to distribute risk.
Timothy Stoltzfus Jost, Robert L. Willett Family Professor of Law, Washington and Lee
University School of Law, “RETHINKING HEALTH LAW: ARTICLE & ESSAY: OUR
BROKEN HEALTH CARE SYSTEM AND HOW TO FIX IT: AN ESSAY ON HEALTH
LAW AND POLICY”, Wake Forest Law Review, Volume 41, 2006
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Resolved: A just government should provide health care to its citizens.
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. As an increasing share of national income is
being directed in most developed countries toward capital in the form of profits, dividends, or
interest, rather than toward labor in the form of wages, broad-based taxes not limited to wages
alone have begun to make more sense for spreading the cost broadly.
There are many plausible funding options for universal health care.
Sharona Hoffman, assistant professor of law at Case Western Reserve University School of Law,
“Unmanaged Care: Towards Moral Fairness in Health Care Coverage”, Indiana Law Journal,
Volume 78, 2003.
Universal health care can be funded through general taxes, as are many other federal programs.
Alternatively, coverage for members of the workforce and their dependents can be funded by
payroll taxes paid either by employees or by employers. Under this system, workers would be
required to purchase insurance, whether it be public insurance or mandatory private insurance.
Individuals who are unemployed can receive public subsidies or be placed in a separate,
Medicaid-type system. A third option was delineated in the Clinton plan, which would have
avoided a tax-based system by requiring employers to pay eighty percent of the cost of insurance
for all full-time and part-time employees. Government subsidies would have assisted the
unemployed.
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Resolved: A just government should provide health care to its citizens.
Negative Quotations
Bad health is largely due to bad personal choices, not the health care system.
Robert Sade, MD from Columbia University, “The Political Fallacy that Medical Care is a
Right”, New England Journal of Medicine, 1971.
A simple calculation from American mortality statistics quickly corrects that false concept: 67
percent of deaths in 1967 were due to diseases known to be caused or exacerbated by alcohol,
tobacco smoking or overeating, or were due to accidents. Each of those factors is either largely
or wholly correctable by individual action. Although no statistics are available, it is likely that
morbidity, with the exception of common respiratory infections, has a relation like that of
mortality to personal habits and excesses.
Racial health inequalities are not caused by the medical system.
John Goodman, founder and president of the National Center for Policy Analysis, “Five Myths
of Socialized Medicine”, Cato’s Letter, Volume 3, Number 1, Winter 2005.
http://www.cato.org/pubs/catosletter/catosletterv3n1.pdf
The first thing we need to do is separate those phenomena that have little to do with health care
from those that do. In the United States, life expectancy at birth for African American men is 68
years, while for Asian American men it’s 81 years. W e find wide differences in life expectancy
among women, too. Nobody thinks that those differences are due to the health care system.
Racial health inequalities can be accounted for by maternal health habbits.
Tom Miller, "Will More Health Insurance Improve Health Outcomes?" Cato Institute Policy
Forum, June 2002.
A limited set of maternal health habits during pregnancy, particularly smoking habits, can
explain about half of the correlation between socioeconomic status and low birth weight among
white mothers and about one-third of the correlation among black mothers. In contrast,
controlling for differential access to medical care and differences in prepregnancy maternal
health status has no impact on differentials in health outcomes by socioeconomic status
Universal health care creates incentives for wasteful allocations of resources.
John Goodman, founder and president of the National Center for Policy Analysis, “Five Myths
of Socialized Medicine”, Cato’s Letter, Volume 3, Number 1, Winter 2005.
http://www.cato.org/pubs/catosletter/catosletterv3n1.pdf
In Britain, where at any one time there are a million people waiting to get into British hospitals,
15 percent of the beds are empty, and another 15 percent are filled with chronic patients who
really don’t need the services of hospital; they’re simply using the hospital as an expensive
nursing home. So, effectively, almost one-third of the beds are closed off to acute care patients.
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Resolved: A just government should provide health care to its citizens.
State decisions about health policy are short sighted.
Michael W. Lynch, "Timing Error: Politicians Just Can't Keep Up with Health Care Markets,"
Reason magazine, July 1998.
By the time laws and regulations are shaped, the information to which they are meant to respond
has become outdated. But if government can't keep up with rapidly evolving markets that are
experimenting with new ways to deliver products, that doesn't mean policy makers should make
the work of markets more difficult. The health care debate is a striking example of what
economist and scholar Friedrich A. Hayek called the "fatal conceit": that statist ideas of rational
planning can improve on the collective knowledge of thousands, as expressed through the
marketplace. Perhaps health-obsessed lawmakers should study the Hippocratic Oath, which has
long enjoined doctors to, "First, do no harm."
Increased access to health care decreases physician availability for quality care.
John Goodman, founder and president of the National Center for Policy Analysis, “Five Myths
of Socialized Medicine”, Cato’s Letter, Volume 3, Number 1, Winter 2005.
http://www.cato.org/pubs/catosletter/catosletterv3n1.pdf
In fact, Canadian and British doctors see 50 percent more patients than American doctors do,
and, as a consequence, they have less time to spend with each patient. In Britain, the typical
general practitioner barely has time to take your temperature and write a prescription. And even
if they discover something wrong with you, they may not have the technology to solve your
problem.
Government solutions fail to address the root problem of the autonomy of doctors.
Robert Sade, MD from Columbia University, “The Political Fallacy that Medical Care is a
Right”, New England Journal of Medicine, 1971.
In the face of the raw power that lies behind government programs, nonparticipation is the only
way in which personal values can be maintained. And it is only with the attainment of the highest
of those values-integrity, honesty and self-esteem-that the physician can achieve his most
important professional value, the absolute priority of the welfare of his patients. The preceding
discussion should not be interpreted as proposing that there are no problems in the delivery of
medical care. Problems such as high cost, few doctors, low quantity of available care in
economically depressed areas may be real, but it is naive to believe that governmental solutions
through coercive legislation can be anything but shortsighted and formulated on the basis of
political expediency
Excessive controls prevent doctors from delivering quality care.
Robert Sade, MD from Columbia University, “The Political Fallacy that Medical Care is a
Right”, New England Journal of Medicine, 1971.
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Resolved: A just government should provide health care to its citizens.
Any act of force is anti-mind. It is a confession of the failure of persuasion, the failure of reason.
When politicians say that the health system must be forced into a mold of their own design, they
are admitting their inability to persuade doctors and patients to use the plan voluntarily; they are
proclaiming the supremacy of the state's logic over the judgments of the individual minds of all
concerned with health care. Statists throughout history have never learned that compulsion and
reason are contradictory, that a forced mind can not think effectively and, by extension, that a
regimented profession will eventually choke and stagnate from its own lack of freedom. a
persuasive example of this is the moribund condition of medicine as a profession in Sweden, a
country that has enjoyed socialized medicine since 1955. Werko, a Swedish physician, has
stated: "The details and the complicated working schedule have not yet been determined in all
hospitals and districts, but the general feeling of belonging to a free profession, free to decide - at
least in principle - how to organize its work has been lost. Many hospital-based physicians regard
their work now with an apathy previously unknown." One wonders how American legislators
will like having their myocardial infarctions treated by apathetic internists, their mitral valves
replaced by apathetic surgeons, their wives' tumors removed by apathetic gynecologists. They
will find it very difficult to legislate self-esteem, integrity and competence into the doctors
whose minds, and judgments they have throttled
Market solutions provide more efficient medical care.
John Goodman, founder and president of the National Center for Policy Analysis, “Five Myths
of Socialized Medicine”, Cato’s Letter, Volume 3, Number 1, Winter 2005.
http://www.cato.org/pubs/catosletter/catosletterv3n1.pdf
A study compared Kaiser in California with the NHS and concluded that, after you make all of
the appropriate adjustments, Kaiser spends about the same per capita on its enrollees as Britain
spends on its population. But the Kaiser enrollees were getting more care, more access to
specialists, and other services.
Market failure in health care is not a significant issue.
Michael W. Lynch, "Timing Error: Politicians Just Can't Keep Up with Health Care Markets,"
Reason magazine, July 1998.
In October 1993, Laura D'Andrea Tyson, who then chaired the Council of Economic Advisors,
claimed "market failures" were driving what was still thought to be America's health care
inflation. "There is a lack of price competition in the market for insurance," Tyson wrote in a
document released by the White House, "because many individuals do not have a choice of
health plans." Today's would-be reformers charge just the opposite: that individuals are deprived
of a choice because intense price competition relegates them to restrictive HMOs. These
criticisms are not only at odds with each other, they are at odds with reality, too. At the very time
Tyson was developing her inaccurate explanation for health care costs, intense price competition
was bringing health costs down. Employers simply wouldn't continue to suffer double-digit
increases in health costs, nor would their employees, who preferred such things as salary
increases to gold-plated health insurance. Similarly, as upwards of 80 percent of Americans
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Resolved: A just government should provide health care to its citizens.
find themselves in some sort of managed care, that industry is developing products to meet a
diversity of needs. Just because Americans don't purchase their own health insurance directly
doesn't mean there's "market failure." And just because employers are cost-conscious doesn't
mean they have an incentive to cut corners on their health plan. They must ultimately keep their
employees happy.
Free market health care systems save more lives than state run medical care systems.
John Goodman, founder and president of the National Center for Policy Analysis, “Five Myths
of Socialized Medicine”, Cato’s Letter, Volume 3, Number 1, Winter 2005.
http://www.cato.org/pubs/catosletter/catosletterv3n1.pdf
What, then, would we want to look at if we really wanted to compare the efficacy of health care
systems? We would look at those conditions for which we know medical services can make a
real difference. Among women who are diagnosed with breast cancer, only one fifth die in the
United States, compared to one third in France and Germany, and almost half in the United
Kingdom and New Zealand. Among men who are diagnosed with prostate cancer, fewer than
one fifth die in the United States, compared to one fourth in Canada, almost half in France, and
more than half in the United Kingdom.
Non-government solutions are key to solving health care problems.
Robert Sade, MD from Columbia University, “The Political Fallacy that Medical Care is a
Right”, New England Journal of Medicine, 1971.
The only longrange plan that can hope to provide for the day after tomorrow is a "nonsystem"that is, a system that proscribes the imposition by force (legislation) of any one group's
conception of the best forms of medical care. We must identify our problems and seek to solve
them by experimentation and trial in an atmosphere of freedom from compulsion. Our sanction
of anything less will mean the loss of our personal values, the death of our profession, and a
heavy blow to political liberty.
Private agencies have a strong incentive to give preventive care
Stephen Chapman, "Refusing to Be Scared of Managed Care," Conservative Chronicle,
November 20, 1996
Critics say that HMOs encourage undertreatment since their profits are the difference between
the insurance premiums they receive and the cost of the care they provide. Less care equals more
profits, the theory goes. But HMOs also have an incentive to attend to preventive care. Every
ailment they nip in the bud is an expense they don't have to bear later
Free experimentation by doctors can be emulated by other doctors to generate better care.
Robert Sade, MD from Columbia University, “The Political Fallacy that Medical Care is a
Right”, New England Journal of Medicine, 1971.
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Resolved: A just government should provide health care to its citizens.
Progress is made by the free interaction of free minds developing new ideas in an atmosphere
conducive to experimentation and trial. If group practice really is better than solo, we will find
out because the success of groups will result in more groups (which has, in fact, been
happening); if prepaid comprehensive care really is the best form of practice, it will succeed and
the health industry will swell with new Kaiser -Permanente plans. But let one of these or any
other form of practice become the law, and the system is in a straightjacket that will stifle
progress. Progress requires freedom of action, and that is precisely what national health
legislation aims at restricting.
Market solutions work better in medicine empirically.
John Goodman, founder and president of the National Center for Policy Analysis, “Five Myths
of Socialized Medicine”, Cato’s Letter, Volume 3, Number 1, Winter 2005.
http://www.cato.org/pubs/catosletter/catosletterv3n1.pdf
While our health care system is more market-oriented than in most industrialized nations, we
don’t really have a free market in health care in the United States. Half the spending is done by
government. Most of the rest is done by bureaucratic institutions. The cosmetic surgery market is
about the only market where patients are really spending their own money. And guess what? It
works like a real market. People get package prices. They can compare prices. And over the
decade of the 1990s, the average price of cosmetic surgery actually went down in real terms,
even as there were all kinds of technological innovations that we are told drive up costs
elsewhere.
Competition between firms over qualified labor encourages good corporate health care.
Stephen Chapman, "Refusing to Be Scared of Managed Care," Conservative Chronicle,
November 20, 1996
People who get health-insurance coverage from their employers are free to gripe, to make
demands and even to change jobs if they are unhappy with their HMOs. Employers need to keep
their workers passably content. If their HMOs are generating resentment among employees,
managers will find other HMOs that can do better. Competition forces managed-care providers
to worry about the interests of patients as well as the bottom line.
Market solutions generate more choices for employees.
Michael W. Lynch, "Timing Error: Politicians Just Can't Keep Up with Health Care Markets,"
Reason July 1998.
The American Association of Health Plans, which represents more than 1,000 managed-care
companies, reports that just under 92 percent of Americans with employment-based health
insurance have the choice of at least one plan that allows patients to use doctors who are not part
of a company's network. Mercer/Foster Higgins data also show that the trend in health care is
clearly to more open networks. From 1992 to 1997, seven in 10 Americans who left traditional
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Resolved: A just government should provide health care to its citizens.
indemnity plans went to preferred provider plans or point-of-service plans, which are less
restrictive than traditional HMOs.
Education solves more health problems than access to health care.
Tom Miller, "Will More Health Insurance Improve Health Outcomes?" Cato Institute Policy
Forum, June 2002.
If we want to close the health outcomes gap between rich and poor, and simply transferring
money directly to poor people won't do the job, why not just throw more subsidies at the health
care industry itself, so that more and better health care can be produced and then made available
to everyone at lower prices? Well, let's take a look at what Dana Goldman and Darius
Lakdawalla of RAND said in that regard. They started in their paper, Understanding Health
Disparities Against Education Groups, with the widely accepted consensus view that better
educated people are healthier, but then they dug a little deeper to find that health disparities
actually increase as the price of health inputs fall. Indeed, government subsidies for health care
research, technological progress and, ironically, even universal health insurance, may worsen
health inequality over time. What is really at work here is that the reductions in the price of
health care, or expansions in the overall demand for health inputs, disproportionately benefit the
well-educated. Technological progress also lowers the quality-adjusted price of health care.
Inequalities still exist in universal health care systems.
John Goodman, founder and president of the National Center for Policy Analysis, “Five Myths
of Socialized Medicine”, Cato’s Letter, Volume 3, Number 1, Winter 2005.
http://www.cato.org/pubs/catosletter/catosletterv3n1.pdf
A Canadian study showed vast inequalities among the health regions of British Columbia. In
some cases, there were spending differences of 10 to 1 in services provided in one area compared
to another.
Universal health care does not solve racial inequalities.
John Goodman, founder and president of the National Center for Policy Analysis, “Five Myths
of Socialized Medicine”, Cato’s Letter, Volume 3, Number 1, Winter 2005.
http://www.cato.org/pubs/catosletter/catosletterv3n1.pdf
It’s true that racial and ethnic minorities are underserved in the United States. But we are hardly
alone. In Canada, the indigenous groups are the Cree and the Inuits. In New Zealand, they are
Maoris. In Australia, the Aborigines. Those populations have more health care problems, shorter
life expectancies, higher infant mortality, more health care needs, and they get less health care.
When health care is rationed, racial and ethnic minorities do not usually do well in the rationing
scheme.
Access to health care has relatively little impact on actual health
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Resolved: A just government should provide health care to its citizens.
Tom Miller, "Will More Health Insurance Improve Health Outcomes?" Cato Institute Policy
Forum, June 2002.
Harvey Rosen and Craig Perry of Princeton, in a paper called Insurance and the Utilization of
Medical Services Among the Self-Employed, analyzed how the self-employed and wage earners
differ with respect to insurance coverage and utilization of various health care services. They
found that even though the self-employed received significantly smaller tax incentives to
purchase health insurance and they accordingly are less likely to be insured, the self-employed
are able to finance access to care from sources other than insurance. Their relative lack of health
insurance does not substantially reduce their utilization of health care services, it does not create
economic hardship, or have a negative impact either on their health or the health of their
children. Perry and Rosen suggest that access to health care may be responsible for only a
relatively small part of health, with more important determinants being genetics, environment,
and human behaviors.
Doctors must take a principled stand against invasions of their freedom
Robert Sade, MD from Columbia University, “The Political Fallacy that Medical Care is a
Right”, New England Journal of Medicine, 1971.
The means by which non producers and hangers-on throughout history have been able to
expropriate material and intellectual values from the producers has been identified only relatively
recently: the sanction of the victim. Historically, few people have lost their freedom and their
rights without some degree of complicity in the plunder. If the American medical profession
accepts the concept of health care as the right of the patient, it will have earned the KennedyGriffiths bill by default. The alternative for any health professional is to withhold his sanctions
and make clear who is being victimized. Any physician can say to those who would shackle his
judgment and control his profession: I do not recognize your right to my life and my mind, which
belong to me and me alone; I will not participate in any legislated solution to any health problem.
Doctors ought to be able to have free control over their labor.
Robert Sade, MD from Columbia University, “The Political Fallacy that Medical Care is a
Right”, New England Journal of Medicine, 1971.
In fact, no service or commodity lies outside the economic laws. Regarding health care, market
demand, individual want, and medical need are entirely different things, and have a very
complex relation with the cost and the total supply of available care, as recently discussed and
clarified by Jeffers et al. They point out that " 'health is purchaseable,' meaning that somebody
has to pay for it, individually or collectively, at the expense of foregoing the current or future
consumption of other things." The question is whether the decision of how to allocate the
consumer's dollar should belong to the consumer or to the state. It has already been shown that
the choice of how a doctor's services should be rendered belongs only to the doctor: in the same
way the choice of whether to buy a doctor's service rather than some other commodity or service
belongs to the consumer as a logical consequence of the right to his own life.
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Resolved: A just government should provide health care to its citizens.
Coercing doctors’ choices is an invasion of freedom.
Robert Sade, MD from Columbia University, “The Political Fallacy that Medical Care is a
Right”, New England Journal of Medicine, 1971.
Any doctor who is forced by law to join a group or a hospital he does not choose, or is prevented
by law from prescribing a drug he thinks is best for his patient, or is compelled by law to make
any decision he would not otherwise have made, is being forced to act against his own mind,
which means forced to act against his own life. He is also being forced to violate his most
fundamental professional commitment, that of using his own best judgment at all times for the
greatest benefit of his patient.
Allowing a right to medical care creates unjust demands on doctors.
Robert Sade, MD from Columbia University, “The Political Fallacy that Medical Care is a
Right”, New England Journal of Medicine, 1971.
The concept of medical care as the patient's right is immoral because it denies the most
fundamental of all rights, that of a man to his own life and the freedom of action to support it.
Medical care is neither a right nor a privilege: it is a service that is provided by doctors and
others to people who wish to purchase it. It is the provision of this service that a doctor depends
upon for his livelihood, and is his means of supporting his own life. If the right to health care
belongs to the patient, he starts out owning the services of a doctor without the necessity of either
earning them or receiving them as a gift from the only man who has the right to give them: the
doctor himself. In the narrative above substitute "doctor" for "baker" and "medical service" for
"bread." American medi- cine is now at the point in the story where the state has proclaimed the
non-existent "right" to medical care as a fact of public policy, and has begun to pass the laws to
enforce it. The doctor finds himself less and less his own master and more and more controlled
by forces outside of his own judgment.
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Minh A. Luong & Company Tutorial
September-October 2006 National Forensic League Lincoln-Douglas topic
Resolved: A just government should provide health care to its citizens.
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PlanetDebate.com 39
Minh A. Luong & Company Tutorial
September-October 2006 National Forensic League Lincoln-Douglas topic
PlanetDebate.com 40
Resolved: A just government should provide health care to its citizens.
About the author:
Minh A. Luong teaches in the Department of History and is Assistant Director of International Security Studies at Yale
University. He previously held the Forrest Mars Sr. Visiting Professorship in Ethics, Politics, and Economics (2000-2006) and
served a two-year term as International Affairs Council Fellow at the Yale Center for International and Area Studies. Prof. Luong
also holds two additional academic appointments at Brown University as Adjunct Assistant Professor of Public Policy at the A.
Alfred Taubman Center for Public Policy and American Institutions and Visiting Fellow in International Affairs at the Watson
Institute for International Affairs. Professor Luong teaches courses on national and global security, espionage and intelligence,
privacy and civil liberties, ethics and negotiations, Grand Strategy, and international relations.
He has appeared on major television and radio news networks, has been quoted in newspapers internationally, and lectures
around the world on international security as well as intelligence issues at U.S. Government agencies and in partner countries at
the invitation of the U.S. Government. The views expressed in this essay and other open-source work are those of the author and
do not necessarily reflect the official policy or position of the U.S. Department of Defense, U.S. Intelligence Community, or the
U.S. Government.
A former high school and college debate coach, Prof. Luong served as the founding curriculum director at the Lincoln-Douglas
debate institutes at Stanford University, University of California at Berkeley, NFC-Austin, and the National Debate Forum. He
founded and directs the Ivy Scholars Program for Lincoln-Douglas debaters at Yale University (www.yale.edu/ivyscholars) and
is the volunteer director of the National Debate Education Project, a public service organization that conducts weekend debate
seminars around the country. Prof. Luong can be reached at <minh.a.luong@yale.edu>.
Heather Mecham, M.A. provided research assistance in preparing the resource list. Rick Brundage, B.A., provided argument and
research assistance in preparing the strategy and quotation sections of this topic briefing.
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