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My 101st Debate: Universal Health Care

Thanks to Uchiha! I am looking forward to a great debate--hopefully I can do better at affirming this topic that I did previously. JUST SOCIETY To know what a just society ought to do, we must first know what a just society is. Merriam-Webster writes that the term just denotes "conformity with what is morally upright or good" as well as that which is "reasonable." [1] So, the logical follow-up query is "what makes a society upright or good." In this sense, because we're talking about UHC, which specifically entails government action--if the insurance is found in the private market, it's not UHC. So, we can perhaps re-frame the question to what makes a government upright or good, as the government is the representative of society as a whole. George Kennan writes, "the functions, commitments and obligations of governments are not the same as those of the individual. Government is an agent, not a principal. Its primary obligation is to the interests of the national society it represents, not to the moral impulses that individual elements of that society may experience. No more than the attorney vis-a-vis the client, nor the doctor vis-a-vis the patient, can government attempt to insert itself into the consciences of those whose interests it represents." [2] Gary Woller adds, "Appeals to a priori moral principles...often fail to acknowledge that public policies inevitably entail trade-offs among competing values. Thus since policymakers cannot justify inherent value conflicts to the public in any philosophical sense...the policymakers' duty to the public interest requires them to demonstrate that...their policies are somehow to the overall advantage of society." In other words, governments cannot fairly or justly make decisions by engaging in ideological favoritism; they must back up decisions with hard facts. Thus, we should evaluate this debate through the lens of cost-benefit analysis. SAVING LIVES AND IMPROVING THE QUALITY OF CARE There are myriad problems that the uninsured face due to a lack of coverage. The problems include an inability to afford and fill prescriptions, greater difficulty (3-4 times) in obtaining needed care for even serious ailments, a lack of a regular place to go to seek care (40% of the uninsured don't have such a place), a 50% less likelihood to receive preventative care, a tendency to delay seeking care (the uninsured are 1.5 times as like to be diagnosed late for many types of cancers), and reduced quality of care. All of these factors "translates into 18,000 excess deaths for people between age 25-64 per year, which is of comparable magnitude to the number of people in this age group who die each year from diabetes, stroke, HIV, and homicide." [3] Other reputable studies place the number of death from a lack of insurance closer to 45,000 per year. [4] Clearly, the uninsured face dire problems regarding the quality of medical care they receive--if they're luck enough to receive any at all. This poor quality or nonexistent care in turn has an alarming impact on the death rate among the uninsured. Fortunately, UHC presents a solution to the problem. It seems fairly obvious, intuitively, that covering everyone will reduce, if not end, the problems that have arisen due to a lack of coverage. Logically and empirically, this intuitive truth is borne out. One empirical example evidencing this truth is that of Massachusetts. MA instigated a UHC program for its citizenry before the rest of the U.S. had, and so it provides an interesting test-case for UHC. After it implemented UHC, it's death rates dropped by 2.9%. [5] That's 320 lives saved each year in one state alone. Moreover, "A study from the National Bureau of Economic Research in 2010 found that there were fewer hospital visits after the state's reforms. Another study, released last year, showed that between 1 and 2 per cent of Massachusetts residents reported better health statuses." [5] Infant mortality is also higher in the U.S. than UHC countries. [6] If we look at the World Health Organization's rankings of national health systems, 8 of the top 10 are systems with UHC (the two that aren't are micro-nations--San Marino and Malta--that can probably use other means of ensuring their smaller populations are well-covered.) Of the top 40, just 6 do not have UHC. Of the top 50, just 10 do not have UHC. [7, 8] It seems then that there is a link between UHC and the quality, comprehensiveness, and life-saving capacity of a medical system. THE ECONOMY First, high uninsurance causes a variety of problems, including high bankruptcy rates, job lock, poor work performance, and unnecessary use of the ER. Let's look at each one of these points in turn: High Bankruptcy - Recent research indicates "that more than half of all US bankruptcies are due, at least in part, to medical illness or medical bills." [9] In fact, medical bills are the number one cause of bankruptcy in the U.S. [10] "15 million people will deplete their savings to cover medical bills. Another 10 million will be unable to pay for necessities such as rent, food and utilities because of those bills...More than 25 million people are skipping doses, taking less medication or delaying refilling prescriptions to save money." [10] Job Lock - "Job lock refers to the idea that people stay with their jobs when they would rather work elsewhere because their current job offers health insurance...Although the number of people who would be self-employed if there were universal health care is controversial, one study from 2001 put the number at 3.8 million Americans. This loss of entrepreneurship is a real economic cost in a society that is relying on start-ups to offset the loss of jobs that are moving offshore." [?] Performance At Work - Firstly, it's logical to assume that there will be higher rates of absenteeism in a sicker society. [11] If I am sick more often, I will come into work less, and thus my productivity is reduced. Even if I did come into work, I would likely to be able to function at peak levels, and could possibly infect colleagues, impacting their productive capacity in turn. Secondly, people who are chronically ill due to lack of medical attention will live shorter lifespans. It stands to reason then that countries with poorer medical infrastructure will, on balance, have people who live fewer years than in more advance countries. This shorter lifespan phenomenon is economically costly: "the annual cost of diminished health and shorter life spans of Americans without insurance is $65-$130 billion. People who do not live as long do not work and contribute to the economy as long." [?] Unnecessary Use of the ER - When uninsured people cannot see normal physicians, they're forced to use the ER. "An average visit to an emergency room costs $383,11 whereas the average physician’s office visit costs $60.12 It is estimated that 10.7% of ER visits in 2000 were for non-emergencies, costing the system billions of dollars." [?] I have already demonstrated the success of UHC systems to provide high-quality care, and this care will in turn create a healthier population that will address the issues listed above. Moreover, UHC will save money. Studies have revealed that various UHC options can "save $320.5 billion...and...$1.1 trillion over 10 years." [12] And, if you look at healthcare spending as a portion of GDP, France--a UHC nation--spends less than the U.S.--a non-UHC nation--does on healthcare. [13] In fact, no country spends more on healthcare as a percentage of their GDP than the U.S., and so UHC countries, like Oman, spend the least on their healthcare programs (just 2.6% compared to America's 17.9%). This same discrepancy holds up on a per-capita basis. [14] So, it seems that UHC actually would reduce healthcare costs. “Overall, US healthcare expenditures are 2.4 times the average of those of all developed countries ($2759 per person), yet health outcomes for US patients, whether measured by life expectancy, disease-specific mortality rates, or other variables, are unimpressive.” [15] SOURCES [1] - http://www.merriam-webster.com... [2] - http://www.foreignaffairs.com... [3] - http://www.amsa.org... [4] - http://www.reuters.com... [5] - http://www.newscientist.com... [6] - http://en.wikipedia.org... [7] - http://thepatientfactor.com... [8] - http://upload.wikimedia.org... [9] - Stephanie Woolhandler [Prof., Cuny School of Public Health at Hunter College] and David Himmelstein [Prof., Cuny School of Public Health at Hunter College], “Healthcare Reform 2.0,” Social Research Vol. 78: No. 3 : (Fall 2011) [10] - http://www.cnbc.com... [11] - Dale Murray [Prof. of Philosophy, University of Wisconsin-Baraboo], “The Massachusetts Health Plan, Individual Mandates, and the Neutrality of the Liberal State,” Journal of Medicine and Philosophy, 36: 466–483, (2011) [12] - http://www.amsa.org... [13] - http://data.worldbank.org... [14] - http://www.theatlantic.com... [15] - Ezekiel J. Emanuel [MD, PhD; Department of Bioethics, The Clinical Center, National Institutes of Health] and Victory R. Fuchs [Prof. Department of Economics, Stanford University], “The Perfect Storm of Overutilization,” JAMA, Vol 299, No. 23 (June 18, 2008) The resolution is affirmed--UHC is the beneficial action to take. Thanks again to Con! I turn the floor over to him...