Arguments and Counterarguments about Health Care Reform FA CIL ITA TOR’ S GUIDE This issue forum is designed to last 60 mi nutes . You should try to provi de a fi ve‐
mi nute introduction and a 10‐minute wrap‐up, lea ving 45 minutes for solid dis cussion. Ha ve fun!! ARGUMENTS BY TH OSE W H O ARE OPP OSED TO TH E ID EA OF H EAL TH C ARE FOR AL L The unins ured in this country are just irresponsible. It’s their own fault that they don’t have insurance.  Eight out 10 of the uninsured a re members of working families. They pla y by the rules and work ha rd, yet they cannot get insurance from thei r employer, or they can’t afford i t if i t is offered.  The hi gh cos ts of heal th ca re a re a ttributable to unnecessary administra ti ve cos ts , overuse of technology, and a s trong profit moti ve in the pri va te heal th insurance industry tha t pri ces many working families out of the heal th insurance ma rket. The unins ured should take more individual res ponsibility to get insurance. 
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Onl y a very s mall percenta ge of the uninsured can afford i nsurance but choose not to obtain i t. The vas t ma jori ty of the uninsured, however, cannot afford insurance. It is reasonable to a rgue that members of society shoul d take indi vidual responsibility if a ffordable i nsurance is readil y a vailable. Since this is not the case for the majori ty of the uninsured, indi vidual manda tes a nd indi vidual responsibility a re not the solution to the crisis of the uninsured. A single payer health care system (or a robust public option) would essentially be a government handout to the uninsured. 
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A single pa yer s ys tem would resul t in a number of moral, economi c, and cul tural benefi ts . It is not a welfa re poli cy for the uni nsured; ra ther, i t is a policy whose benefi ts would a ccrue to all Ameri cans . For exa mple, single pa yer would sa ve money, i mprove health, and create a s ociety wi th more equal opportuni ty. These a re things all Ameri cans can enjoy. There a re many servi ces tha t a re provi ded by the government tha t can be seen as “handouts .” The recent bailout of the financial and automoti ve industries serves as a pri me exa mple of corpora te welfa re. Educa tion is provided by the government to benefit s ociety. Similarl y, heal th ca re should be financed by the government based on a simila r ra tionale. Why should I pay for someone else’s poor health choices? I don’t want to pay for some crackhead’s addiction.  Even i f you’re healthy a nd ha ve pri va te heal th insurance through your employer, your health ca re cos ts a re currentl y subsidized by the federal government through ta x exemptions . This is a net loss of hundreds of billions of ta xpa yer dollars to the federal government, a loss tha t is financed by all Ameri cans.  Si ngle pa yer would promote healthier lifes tyle choices by provi ding all Ameri cans a ccess to preventi ve ca re.  Some people a re unhealthy because they don’t take ca re of thei r heal th, but ma ny people a re unhealthy because of fa ctors beyond thei r control , such as geneti c predisposi tions . The s trong intera ction between envi ronment and geneti cs makes i t extremel y diffi cul t to determine whether poor health can trul y be enti rel y a ttri butable to an indi vidual ’s beha vior. ARGUMENTS TH AT TH E UNI NSURED ARE AL READ Y TAK EN C ARE OF I N THI S C OUNTRY. “I mean, people have access to health care in America. After all, you just go to an emergency room." – Pres. George W. Bush The unins ured get free health care.  There is a common myth. In fa ct, among families wi th a t least one uninsured member, less tha n one‐qua rter report getting free or discounted ca re in any gi ven yea r. 
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There is indeed a safety net for a minority of the uninsured, including government‐sponsored clini cs and hospi tals, as well as ca re provi ded by pri va te physi cians. However, financial pressures due to managed ca re a re reducing the abili ty of pri va te physi cians to provi de cha rity ca re. The uni nsured a re much less likel y than the insured to ha ve a usual source of ca re. This resul ts in inappropria te ER utiliza tion and ul ti matel y dri ves up cos ts for the insured. ARGUMENTS REL ATED TO H OW H EAL TH C ARE SH OUL D BE VI EW ED Health care is not a right. 
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Even i f health ca re is not a right, single pa yer mi ght still be the wisest public policy because of i ts moral , economi c, a nd cul tural benefits . Educa tion is not defined in our cons titution as a ri ght, yet the vas t ma jori ty of Ameri cans support the idea that everyone should ha ve a ccess to publi c educati on. Heal th ca re should be no di fferent. No one should get free health care. 
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There is no such thing as free heal th ca re a nywhere in the worl d. Every s ys tem has some sort of cos t sha ring mechanism or fails to cover some servi ces , such as dental ca re. Moreover, every health ca re s ys tem is financed by ta xes to some degree, so nothing is reall y “free.” If the purpose of a health ca re s ys tem is to ma ximi ze health, then i t ma kes sense to align financial incenti ves such that people will utilize the mos t effecti ve, low‐cos t interventions. For ins tance, prima ry ca re visi ts a re less cos tl y than ER ca re or being hospi talized for preventable condi tions . Ma king pri ma ry ca re visits free or extremel y low cos t removes a ma jor ba rrier to seeking out such ca re and therefore sa ves money. In this sense, the health ca re s ys tem should be desi gned to ensure tha t cos t‐effecti ve pri ma ry ca re servi ces a re free or a vailable at low cos t, while making less effecti ve interventions more cos tl y. Health care should be treated like an individual commodity ‐ it should only available to those who can afford it. 
Heal th ca re is a basic human need. You can li ve wi thout indi vidual commodi ties (like an i Pod or cell phone), but a lot of people can’t li ve wi thout heal th ca re in thei r everyda y li ves , and no one ca n li ve wi thout heal th ca re when they a re seriousl y ill . 
Heal th ca re cos ts a re unpredi ctable – you never know when you a re going to get si ck. ARGUMENTS REL ATED TO AMERI C A Single payer is fundamentally anti‐American because America is a capitalist and individualist society. 
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It is anti‐Ameri can to perpetua te a s ys tem tha t hurts innocent, ha rd working ci tizens and tha t puts Ameri ca a t a tremendous economi c disadvantage rela ti ve to other countries . Ameri cans s tri ve for financial securi ty. In the current s ys tem there is increasingl y less protection a gainst skyrocketing cos t. It is esti mated that more than 78% of all bankruptcies a re related to medi cal bills. Our current s ys tem is un‐Ameri can by depri ving people of financial securi ty. A healthy Ameri ca is a weal thy Ameri ca. Single pa yer will boost our economy and help us remain s trong. We have the best health care system in the world, why change it? 
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There is no wa y to objecti vel y measure whi ch health ca re s ys tem is the best in the world. The United Sta tes, however, does not measure well agains t compa rable countries with rega rd to many heal th indi ca tors . For exa mple, our life expectancy lags behind that of ma ny countries and our infant mortality ra te is higher than that of many countries. The World Heal th th
Organiza tion ranks our heal th ca re s ys tem 37 on overall performance, and th
24 on heal th level attainment. All of these mediocre performance measures a re una cceptable, especially gi ven tha t we spend more than any other na tion in the world per capi ta on health ca re. It is true tha t Ameri ca offers some of the bes t ca re i n the world ‐‐‐ but onl y for the select few who can afford i t. ARGUMENTS REL ATED TO TH E GOVERNMENT VERSUS TH E FREE MARK ET The government can’t do anything right and definitely shouldn’t be involved in our health care system. 
Medica re is a government‐administered program tha t, despi te its problems , includi ng underfunding, is s till one of the most effi cient and popula r social progra ms in the country. Other effecti ve government programs include the NIH, CDC, and social securi ty. I don’t want government‐run health care. 
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There is nothing about single pa yer or a robus t publi c option that implies tha t the government “runs ” health ca re. The idea is to gi ve a basic gua rantee of a ccess to heal th ca re to all Ameri cans – clini cal decisions a re completel y left up to the provi der. In such a s ys tem, health ca re would be publicl y financed but pri va tel y deli vered. Medica re is a government‐run insurance progra m, but the government does not deli ver servi ces, ra ther the deli very of Medi ca re servi ces occurs through pri va te providers and hospitals . I don’t like the idea of big government and single payer would be just that. 
The hidden assumption in this a rgument is tha t single pa yer would somehow requi re a massi ve outla y of federal spending. Physi cians for a National Heal th Progra m recentl y released a study projecting tha t single pa yer health ca re reform would save the federal government a t leas t $ 3.5 trillion over ten yea rs . The free market is the best solution to the lack of insurance. 
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The heal th ca re ma rket is fundamentall y imperfect. o There is signifi cant asymmetry of informa tion between providers and consumers . o A functional free ma rket requi res a la rge number of buyers and sellers . Because of the consolida tions of hospi tals and insurance companies , there a re a ctuall y few buyers and sellers of heal th ca re in any gi ven a rea . In more than 90% of measured a reas in the Uni ted Sta tes , competi tion is res tri cted to less than three pri va te insurers . An unfettered free ma rket would pri ce many people out of insurance. In order to provide a ccess to life savi ng medi cal ca re to all Ameri cans , there is a need for signifi cant governmental regulation of the heal th insurance industry. I don’t want single payer because it is socialized medicine. 
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Si ngle pa yer i tself is not socialized medi cine, whi ch refers to medi cine tha t is both financed and deli vered by the federal government (where the government owns and opera tes the enti re s ys tem). In the U.S., any politi call y viable single pa yer sol ution would not be socialized medi cine as health ca re deli very would remain pri va te. ARGUMENTS BY TH OSE W H O MIGH T SUP P ORT SI NGL E P AYER BUT ARE C ONC ERNED ABOUT TH E I MPL EMENTATI ON We can’t afford single payer. 
We can’t a fford to not ha ve single pa yer. The Insti tute of Medicine es tima tes tha t a t least $500 billion is los t annuall y due to the di minished producti vi ty of our uninsured population, who a re less healthy and therefore less able to be producti ve members of society. Other economi c costs include a loss of global competi ti veness, unnecessary use of the expensi ve ER, strain on s mall businesses, and pa yi ng for preventable cos tl y diseases due to lack of heal th ca re a ccess. People will abuse the free health care in a single payer system. 
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There is alwa ys a balance tha t must be s truck between overutili zation and underutiliza tion. Al mos t every heal th ca re s ystem in the worl d has some degree of cos t‐sha ring (co‐pa ys, deductibles , etc) to prevent overutiliza tion, and the U.S. would be no different under a single‐pa yer s ys tem. The key is to ma ke the cos t sha ring equi table and to set the level of cost‐sha ring i n a wa y tha t dis coura ges inappropria te ca re wi thout discoura ging appropria te ca re. Even i f health ca re were “free” in a financial sense, there a re other cos ts associated with using heal th ca re. For exa mple, i t takes a long time to visit a doctor’s offi ce and medi cal ca re is often uncomfortable. Common sense di cta tes that people wouldn’t be lining up for corona ry a rtery bypass gra fts even i f they were free. Single payer would create waiting lists. 
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There is al ready an infi nite waiting list for people who a re uninsured in Ameri ca. Wai ting lists in other countries a re frequentl y deployed as a s ca re ta cti c. Few, if any, single pa yer s ystems ha ve extensi ve wai ting lists for medi call y necessa ry procedures . Single payer or a robust public option would result in rationing of care. 
A single pa yer s ys tem would resul t in much more equita ble and effi cient dis tribution of s ca rce health ca re resources . How can we possibly transition from our current system to single payer? 
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Through the establishment of a robust publi c option. Such a phased approa ch would provide appropria te ti me and resources for retraining of heal th insurance industry empl oyees . The pa yment and provider s tructures al ready exis t wi thin the Medi ca re progra m to permi t a smooth and seamless transition to a single pa yer heal th ca re s ys tem in this country. Single payer is not a good idea because we would have to pay for the health care of immigrants. 
Immi grants a re humans . Heal th ca re is a basic human ri ght. Single payer will restrict provider choice. 
A single pa yer s ys tem would promote increased pa tient autonomy and choi ce of providers by removi ng all “network” res tri ctions . Currentl y, many pri va te insurers severel y limi t pa tients’ ability to choose thei r heal th ca re provider. Quality of care will suffer under single payer. 
Si ngle pa yer provides the most effecti ve financial incenti vi za tion s tructure for increasing the quality and efficiency of ca re through la rge‐s cale adopti on of Quali ty Improvement ini tia ti ves such as surgi cal checklists . Research will slow down. 
The vas t ma jori ty of biomedi cal resea rch is currentl y publicl y funded (by the NIH). Technology will decrease under single payer. 
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Inappropriate use of technology will decrease under single pa yer because there will be incenti ves to dis coura ge the use of procedures tha t ha ve little or no proven clini cal benefi t. Based on government sponsored cos t‐effecti veness resea rch, the appropria te use of technology will increase in a single pa yer s ys tem for all indi vi duals. Doctors will never buy into single payer because it will interfere with their autonomy. 
More than 60% of physi cians currentl y support a single pa yer s ys tem. Pri va te insurance companies currentl y restri ct physi cians’ ability to pra cti ce medi cine. Doctors will never buy into single payer because it will decrease their salaries. 
There is inherent aspect of a single pa yer s ystem or a robus t public option tha t will decrease physi cians’ salaries.