1NC

The aff must specify how the right to health is enacted and what regulations govern
the right---key to neg ground and policy effectiveness---lack of specification turns case
Michael F. Cannon 7, Cato Institute’s director of health policy studies. 6/29/07, “A “Right” to Health
Care?” https://www.cato.org/publications/commentary/right-health-care

Suppose Congress created a legally enforceable right to health care. Even if such a measure could win
approval, the debate would not and could not end there.

The first difficulty would be to define the scope of that right.

Do we have a right to preventive care? If so, health care spending (and taxes) would explode. Researcher J.
D. Kleinke notes that if everyone followed government recommendations, the number of people taking preventive medications for
hypertension, asthma, obesity, and high cholesterol would increase anywhere from 2- to 10- fold.

Should mammograms be available to women regardless of their likelihood of developing breast cancer?
What about experimental treatments?

With the wide variety of tests and treatments, someone

must decide where the right to health care ends, lest the
nation be bankrupted . Whoever makes those decisions will wield enormous power over people’s health. Who
should have that power? Most nations hand that power to unelected bureaucrats, who ration medical care - often by making even
seriously ill patients wait for care.
 1NC
Establishing a right to health decks the economy---bankrupts the government, cuts
investment spending, and leads to a health care death spiral---turns case
Timothy Goodman 5, holds a Ph.D. in Government from Georgetown University, and works at Pfizer
Inc., a leading research-based pharmaceutical company. The views expressed in this article are his own,
and do not necessarily reflect those of Pfizer. 2005. “Is There A Right To Health?” Journal Of Medicine
and Philosophy. http://www.tandfonline.com/doi/pdf/10.1080/03605310500421413?needAccess=true

Governments would likely respond to the vastly increased demand for health care by imposing new
regulatory restrictions on innovators and providers, including price controls and other forms of cost-
containment and rationing. Such rationing is already widespread in the European Union, even in the absence of a health entitlement,
as a consequence of aggressive government efforts to contain spending on pharmaceuticals and other health interventions. As is currently the
case in Europe, price controls, prescribing restrictions, reference pricing, mandatory manufacturer rebates, and other forms of pharmaceutical
cost-containment delay or prevent access by patients to the latest, most effective therapies. They also undermine incentives for research-based
firms to continue their expensive and high-risk R&D investments, obstructing the continued flow of new cures and treatments upon which
patients have come to depend. Curtailed access to innovative medicines—both current ones and those yet to be developed—would result in
less prevention, greater incidence of disease, more hospitalization, and additional health spending. It
is not hard to imagine the
health care economy descending into a death spiral of overuse, access restrictions, increased outlays,
decreased innovation, and overall impoverishment.17
The drive to establish an individual right to health is motivated mainly by concern to ensure safe and reliable access to health care. If successful,
though, it would create only the illusion of security. By establishing an entitlement to any material benefit, governments
might be
able in the short term to emancipate access to that benefit from market constraints, but they cannot
abolish the production constraints imposed by scarcity of resources. The multiplication of welfare rights
not only threatens to impoverish governments, which typically find it hard to produce and pay for the
promised benefit. It also tends to reduce the society’s total output of goods and services, since the
government coercion required to redistribute resources from producers to the beneficiaries of welfare
rights discourages continued production (Epstein, 1997, p. 44).

The foregoing analysis suggests that defining health as an individual right is likely to limit rather than
enhance access to health care. Advocates of this new entitlement wrongly presume that health care has characteristics unique
among consumer goods and services that exempt it from the normal constraints and trade-offs imposed by the market. Arnold Relman’s
assertion in The New Republic notwithstanding, health care is a business. Formulating
health policy within a rights-based
framework would result in expanded government involvement in and control over the health sector. It
would also stimulate demand for health care while discouraging supply, leading to short-run shortages
and longer-run distortions in investment flows . Moreover, efforts to secure expanded access to health care by designating it
a legal entitlement would divert attention from the need to achieve political consensus, mobilize resources, develop new technologies, and
encourage locally appropriate reforms that actually improve health outcomes.

Global nuclear war

Stein Tønnesson 15, Research Professor, Peace Research Institute Oslo; Leader of East Asia Peace
program, Uppsala University, 2015, “Deterrence, interdependence and Sino–US peace,” International
Area Studies Review, Vol. 18, No. 3, p. 297-311

Several recent
works on China and Sino–US relations have made substantial contributions to the current
understanding of how and under what circumstances a combination of nuclear deterrence and economic
interdependence may reduce the risk of war between major powers. At least four conclusions can be drawn from the
review above: first, those who say that interdependence may both inhibit and drive conflict are right.
Interdependence raises the cost of conflict for all sides but asymmetrical or unbalanced dependencies and
negative trade expectations may generate tensions leading to trade wars among inter-dependent states
that in turn increase the risk of military conflict (Copeland, 2015: 1, 14, 437; Roach, 2014). The risk may increase if one of the
interdependent countries is governed by an inward-looking socio-economic coalition (Solingen, 2015); second, the risk of war between China
and the US should not just be analysed bilaterally but include their allies and partners. Third party countries could drag China or the US into
confrontation; third, in this context it is of some comfort that the three main economic powers in Northeast Asia (China, Japan and South
Korea) are all deeply integrated economically through production networks within a global system of trade and finance (Ravenhill, 2014;
Yoshimatsu, 2014: 576); and fourth, decisions for war and peace are taken by very few people, who act on the basis
of their future expectations. International relations theory must be supplemented by foreign policy analysis in order to assess the
value attributed by national decision-makers to economic development and their assessments of risks and opportunities. If leaders on either
side of the Atlantic begin to seriously fear or anticipate their own nation’s decline then they may blame this on
external dependence, appeal to anti-foreign sentiments, contemplate the use of force to gain respect or
credibility, adopt protectionist policies, and ultimately refuse to be deterred by either nuclear arms or
prospects of socioeconomic calamities. Such a dangerous shift could happen abruptly , i.e. under the
instigation of actions by a third party – or against a third party.

Yet as long as there is both nuclear deterrence and interdependence, the tensions in East Asia are unlikely to escalate to war. As Chan
(2013) says, all states in the region are aware that they cannot count on support from either China or the US if they make provocative moves.
The greatest risk is not that a territorial dispute leads to war under present circumstances but that changes in the
world economy alter those circumstances in ways that render inter-state peace more precarious. If China
and the US fail to rebalance their financial and trading relations (Roach, 2014) then a trade war could result, interrupting transnational
production networks, provoking social distress, and exacerbating nationalist emotions. This
could have unforeseen
consequences in the field of security, with nuclear deterrence remaining the only factor to protect the
world from Armageddon, and unreliably so . Deterrence could lose its credibility : one of the two great
powers might gamble that the other yield in a cyber-war or conventional limited war, or third party countries
might engage in conflict with each other, with a view to obliging Washington or Beijing to intervene.
 1NC
Interpretation---national health insurance exclusively means universal public
insurance programs administered by government---the plan must make the
government a payer in the insurance market, but not necessarily the single payer
Ellen M. Immergut 92, the Ford International Development Chair and Associate Professor of Political
Science for Public Policy, Massachusetts Institute of Technology, 1992, Health Politics: Interests and
Institutions in Western Europe, p. 46-47

Monopsony = “a market condition similar to a monopoly except that a large buyer, not a seller,
controls a large proportion of the market,” Investopedia

National health insurance, the second type of program, implies a more active role for government. Rather than
subsidizing private arrangements, governments create public insurance programs that citizens are
required to join and to which employers are required to contribute. The extent of government
monopsony under national health insurance depends upon four factors, each of which had been politically contested:
the financing of the program, the administration of the program, the percentage of the population covered by the
program, and the type of benefits provided.

National health insurance programs tend to be financed by payroll taxes, although governments often provide some supplemental financing
from general tax revenues. As these are public programs required by government, governments are politically
responsible for financing, but the monies collected are usually separate from general tax revenues, and hence, considered "parafiscal."
In most nations with national health insurance, the payroll tax rate is set by central governmental authorities at the national level, but in some,
the health insurance administration may set the payroll tax rates independently. (In Germany, for example, they vary by region and by type of
insurance fund.) In comparison with mutual society legislation, the financial role of government is increased, but the financial pressure is
somewhat attenuated by its parafiscal nature.

National health insurance programs are public , yet the administration of the programs has often been
delegated to organizations on the border of the public and private realms. Many nations simply converted the old,
independent mutual aid societies into quasipublic carriers that were highly regulated by the government. Important administrative issues have
concerned the degree to which national health insurance carriers should be centralized - that is, covering all occupational groups together or
separately, and whether different insurance risks, such as health, old-age, invalidity, unemployment and family allowances, should be covered
by the same program or separate ones. In addition, the degree to which the insurance carriers should retain their former independence as
representatives of the insured, maintaining social insurance elections and other forms of "self-administration," has been a political issue.

Government regulation under national health insurance affects consumers as well as the insurance carriers. National
health insurance
programs are compulsory, not voluntary. Governments decide which groups are to be covered by public
insurance . Early health insurance programs were generally earmarked for low-income wage earners. Later programs, especially those
enacted after the Second World War, tended to include all salaried employees. Farmers and other self-employed groups were often added in
the 1950s. The compulsory health insurance of the United States - Medicaid and Medicare - can be considered as a form of national health
insurance. However, these programs are unusual in that they cover only the aged and those falling below an income limit. Today, the term
"national" health insurance generally connotes universal programs that cover entire populations at all
ages for medical care. To the extent that these government programs compel citizens to insure
themselves, they cut into the available clientele for private insurance policies. Depending upon who is
compulsorily insured and what types of health benefits are covered, the public programs determine how much
scope there will be for supplemental, private insurance.
The increased role of government as payor under national health insurance creates pressures to control the costs engendered by providers
such as doctors, hospitals, and manufacturers of pharmaceuticals and medical technology. Depending on the financing and administration of
National health insurance
the program, however, the incentive to control the price and supply of services will affect different actors.

introduces collective payment for health services, but the type of monopsony that ensues depends upon
how extensive the portion of the population covered by the program is, how centralized the administration is, and whether the
government itself or an administrative authority at one remove from the government is in charge of
payment.

Thus, national health insurance inevitably raises the issue of controlling payments to providers, but these
economic incentives are filtered through different financial and administrative arrangements. Of course, collective payment
through private insurers will raise the same issues. To the extent that private insurers band together in a payor cartel, their
ability to dictate terms of payment to providers will increase, as there will be fewer alternative buyers. If, however, the collective payor
is a government health insurance agency, political resources are added to economic power and the
threat of regulation is more imminent.

Violation--- theyre aff literally doesn’t do anything

Vote neg:
1) Limits---including private insurance policies explodes topic limits by allowing any
aff that subsidizes, facilitates, or regulates private insurance to make it more
accessible---our interp’s key to mechanism limits.

2) Ground---only our interp guarantees the aff makes meaningful change from the
status quo---our ground is premised on the aff moving away from the current private
insurance system. Private and market strategies should be built-in neg ground.
 1NC
Democrats will win the midterms now by exploiting voter anger over GOP health care
proposals---the plan ensures continued GOP control
Jennifer Rubin 17, Washington Post columnist, 6/21/17, “Will the health-care issue tip 2018 to the
Democrats?,” https://www.washingtonpost.com/blogs/right-turn/wp/2017/06/21/will-the-health-care-
issue-tip-2018-to-the-democrats/?utm_term=.113eabd519d6
While Republican flacks hype the results of the special election in Georgia’s 6th Congressional District and Democrats bemoan a loss they likely
should have expected, we know that the
political landscape will change dramatically between now and 2018.
That’s good news for Democrats and reason for Republicans to avoid sitting back to admire their victory in a Republican “9.5-plus”
district.

As David Wasserman explains: “Last night’s results were far from a disaster for Democrats, and Republicans shouldn’t be tempted
to believe their House majority is safe. In fact, their majority is still very much at risk .” For one thing, “unheralded
Democratic tax expert Archie Parnell — who ran on a similarly conciliatory, post-partisan message but generated a tiny fraction of the hype
[Jon] Ossoff did — shockingly came within three points of Republican Ralph Norman in a district President Trump carried by 18 points last
November.” Special elections also tend to be “lagging — rather than leading — indicators,” Wasserman writes. Most important:

If Democrats were to outperform their “generic” share by eight points across the board [as they have in
special elections] in November 2018, they would pick up 80 seats. Of course, that won’t happen because
Republican incumbents will be tougher to dislodge than special election nominees. But these results fit a
pattern that should still worry GOP incumbents everywhere , regardless of Trump’s national approval rating and the
outcome of the healthcare debate in Congress.

Put another way, Democratic candidates in these elections have won an average of 68 percent of the votes Hillary
Clinton won in their districts, while Republican candidates have won an average of 54 percent of Trump’s votes.
That’s an enthusiasm gap that big enough to gravely imperil the Republican majority next November—even if
it didn’t show up in “the special election to end all special elections.”

So which significant event(s) might tip the scales even further in Democrats’ direction, and which by contrast
would help Republicans hold on? Republicans need to deliver on health care, taxes and jobs while also praying that an
economic setback or further foreign conflicts do not unsettle the electorate. If you think they can accomplish all that, then the GOP can rest
easy. Of all of those issues, health care — which Republicans used to gain majorities in the House and Senate — may be
the most decisive because it is the most personal (and hence most emotional) policy issue. Democrats ,
by contrast, need evidence that Republicans cannot govern — or do not govern with voters’ interests in mind.
A good deal of imagination — if not self-delusion — would be required in order to imagine that the Senate can pass its secret health-care bill
and then agree with the House on a bill that can be jammed through via budget reconciliation (which requires a budget). One has to get really
creative to see that the result would be a health-care bill that the country likes.

With each iteration, the GOP health-care plan has gotten worse marks. To that point, Politico reports:

As the GOP-led Senate prepares to take up the measure, only 35 percent of voters surveyed approve of the bill passed by the House last month.
Nearly half of voters, 49 percent, disapprove of the bill. The other 16 percent don’t know or don’t have an opinion, the poll shows.

POLITICO/Morning Consult polling indicates the bill has become less popular since the House advanced it in early May. Immediately after the
bill passed, slightly more voters approved of the bill, 38 percent. Opposition to the bill was lower, too, immediately after the House passed it:
44 percent. . . .

Among Republican voters, 30 percent disapprove of the GOP health care bill. That is up from 15 percent of Republicans disapproving in early
May.
Moreover, independent voters disapprove of the bill by a 2-to-1 margin: 26 percent approve, versus 53 percent who disapprove.

Democrats, in other words, will have something in 2018 they don’t have now — a verdict on Trumpcare.
Republicans will either fail to pass something , despite the best efforts of the GOP to use Medicaid savings to give the rich big
tax cuts, or they’ll pass a bill along the lines we have seen. (Leaks from the Senate negotiations indicate that the cuts to

Medicaid could be even more severe in the Senate proposal.) That may take a generic 8-point advantage for

Democrats even higher .

In short, Republicans have to govern between now and 2018. Unless they miraculously rethink their
agenda and become legislatively adept , Democrats will have concrete evidence to bolster their
argument that the Republicans shouldn’t be left in control.

Resounding Dem victory’s key to constrain Trump’s impact on the U.S. democratic
model
Ezra Klein 17, Editor-in-Chief, Vox, 2/7/17, “How to stop an autocracy,” https://www.vox.com/policy-
and-politics/2017/2/7/14454370/trump-autocracy-congress-frum

There is nothing about the Trump administration that should threaten America’s system of government.
The Founding Fathers were realistic about the presence and popularity of demagogues. The tendency of political systems to slip into autocracy
weighed heavily on their minds. That power corrupts, and that power can be leveraged to amass more power, was a familiar idea. The
political system the founders built is designed to withstand these pressures, and to a large extent, it
has .

So why, then, are we surrounded by articles worrying over America’s descent into fascism or autocracy?
There are two reasons, and Trump is, by far, the less dangerous of them.

Trump has shown himself unconcerned with the norms of American democracy. He routinely proclaims elections
rigged, facts false, the media crooked, and his opponents corrupt. During the campaign, he flouted basic traditions of transparency and
threatened to jail his opponent. His tendencies toward nepotism, crony capitalism, and vengeance unnerve. His oft-stated admiration for
authoritarians in other countries — including, but not limited to, Vladimir Putin — speaks to his yearning for power.

Amid all that, David Frum’s Atlantic cover story, “How to Build an Autocracy,” is a chilling read. “We are living through the
most dangerous challenge to the free government of the U nited S tates that anyone alive has
encountered,” he writes. The argument works because its component parts are so plausible. Frum does not imagine a coup or a crisis. He
does not lean on the deus ex machina of a terrorist attack or a failed assassination attempt. The picture he paints is not one in which everything
is different, but one in which everything is the same.

He imagines a Trumpian autocracy built upon the most ordinary of foundations: a growing economy, a
cynical public, a cowed media, a self-interested business community, and a compliant Republican Party. The picture resonates
because it combines two forces many sense at work — Trump’s will to power and the fecklessness of the institutions meant to stop him — into
one future everyone fears: autocracy in America.

But what Frum imagines is not an autocracy. It is what we might call a partyocracy — a quasi-strongman leader empowered only because the
independently elected legislators from his party empower him. The
crucial sentence in Frum’s account is this one: "As politics has
become polarized, Congress has increasingly become a check only on presidents of the opposite party ."
I am a critic of America’s system of government. For all its genius, I believe it is more fragile, and less sensible, than civics textbooks admit. I
think the profusion of veto points makes governance too difficult, the disproportionate power given to small states is indefensible, and the
absence of any mechanism to resolve conflicts between different branches is dangerous.

But the danger of a demagogic, aspirational autocrat winning the White House is one problem the Madisonian constitutional order is
exquisitely designed to handle. The founders feared charismatic populists, they worried over would-be monarchs, and so they designed a
system of government meant to frustrate them.

The system showed its power this weekend, when Judge James Robart of the Western District of Washington issued a temporary restraining
order freezing enforcement of Trump’s immigrant and refugee ban. Trump raged before the ruling — “if something happens blame [Robart]
and court system,” he tweeted — but his administration complied with it. The spectacle of the president of the United States seeing his
signature program stopped by a district judge in Washington state ruled is a reminder of how many veto points the system contains.

The judiciary, however, is not the branch of government with the most power or the most responsibility to curb
Trump’s worst instincts. That designation belongs to the US Congress .
The president can do little without Congress’s express permission. He cannot raise money. He cannot declare war. He cannot even staff his
government. If Congress, tomorrow, wanted to compel Trump to release his tax returns, they could. If Congress, tomorrow, wanted to impeach
Trump unless he agreed to turn his assets over to a blind trust, they could. If Congress, tomorrow, wanted to take Trump’s power to choose
who can and cannot enter the country, they could. As Frum writes, “Congress can protect the American system from an
overbearing president.” He just thinks they won’t.

Frum offers a persuasive account of why congressional Republicans are likely to fall before Trump’s will, and he is
probably right. But I want to make the argument that there is nothing inevitable about that : it is not the system envisioned by
the Constitution and it is not the system we would have if voters took Congress’s enormous power seriously
and were as interested in who ran it as in who ran the presidency.

And I want to shift the locus of responsibility a bit: if Trump builds an autocracy, his congressional enablers will, if
anything, be more responsible than him. After all, in amassing power and breaking troublesome norms, Trump will be doing what
the Founders expected. But in letting any president do that, Congress will be violating the role they were built to play. We need to stop talking
so much about what Trump will do and begin speaking in terms of what Congress lets him do.

Donald Trump is a paper tiger. But the US Congress is a tiger that we pretend is made of paper. It
is, at this point, taken for granted
that congressional Republicans will protect their co-partisan at any cost. It is, at this point, expected that they will
confirm Trump’s unqualified nominees, ignore his obvious conflicts of interest, overlook his dangerous comments, and rationalize his worst
behavior.

That expectation — and the cowardice it permits — is the real danger to American democracy.
How the founders failed

The framers of the Constitution were not infallible, and they were particularly wrong about a core feature of the government they built: They designed the American political system believing
it would, uniquely, resist the creation and influence of political parties. It did not.

In his farewell address, George Washington warned, “The alternate domination of one faction over another, sharpened by the spirit of revenge, natural to party dissension, which in different
ages and countries has perpetrated the most horrid enormities, is itself a frightful despotism.”

But even there, the cracks in the system showed. Washington’s warning against the dangers of parties was, in truth, an argument for the supremacy of his chosen political party. Rather than
the alternate domination of one faction over the other, he sought the sustained domination of his Federalist faction over all others. As historian Sean Wilentz has argued, it was a “highly
partisan appeal delivered as an attack on partisanship and on the low demagogues who fomented it. Washington’s address never explicitly mentioned Jefferson or his supporters, but its
unvarnished attack on organized political opposition was plainly directed against them.”

The framers’ mistaken belief that America’s political system would resist organized parties was consequential. Their vision of American government — a vision children are still taught in civics
classes — was that it would be balanced by competition among branches. The president, the courts, and the Congress would compete for power and prestige. They would check each other
naturally, as a byproduct of exerting and protecting their authority.

The reality of American government today is quite different. American politics is balanced by organized political parties competing across branches of government. The president is checked
not by Congress, but by the opposition party in Congress. The courts remain more independent — Judge Robart, it’s worth noting, was appointed by President George W. Bush — but they are
by no means untouched by partisan competition. Federal judges are selected through a political process driven by organized ideological groups that vet candidates with the goal of ensuring
predictable, friendly rulings in the future.
In normal times, this works well enough. These are not normal times. Congressional Republicans find themselves, or at least
feel themselves, yoked to Donald Trump — an abnormal president who hijacked their primary system and mounted a hostile takeover
of their party. Trump now holds them hostage: Their legislation requires his signature, their reelection requires his popularity, and he is willing
to withhold both.

And so the institution meant to check the president now finds itself protecting him. As Frum perceptively writes:

A scandal involving the president could likewise wreck everything that Republican congressional leaders have waited years to accomplish.
However deftly they manage everything else, they cannot prevent such a scandal. But there is one thing they can do: their utmost not to find
out about it.

But an absence of incentive should not be confused with an absence of responsibility. Trump
does not, himself, have the power
to reinforce his rule with a web of corruption. Trump does not, himself, have the power to launch fraudulent investigations of
nonexistent voter fraud and then use the results to disenfranchise voters. Trump does not, himself, have the power to confirm his
Cabinet while refusing to put his assets into a blind trust. In these cases, and others, Trump’s power exists at
the pleasure of Congress . He can only do what they let him do.

That Congress is not using its power is Congress’s fault , not Trump’s. Whatever danger Trump poses to the
system is their fault as much or more than his — it is their job, after all, to check an out-of-control president.
To put it differently, Trump deserves a bit less attention, and Rep. Jason Chaffetz deserves a lot more.

A case study of congressional abdication: Jason Chaffetz

Jason Chaffetz, the Utah Republican who chairs the House Oversight Committee, is an eager investigator. He’s dug into Benghazi, Planned Parenthood, and Hillary Clinton’s emails. And he was
no fan of Trump’s. “I can no longer in good conscience endorse this person for president,” he said shortly after the Access Hollywood tapes were released. The reason, he explained, was that
he had a 15-year-old daughter, and he could not look in her the eye and defend what Trump said about women.

Like other Republicans, Chaffetz ultimately decided that beating Hillary Clinton was worth overlooking Trump’s transgressions, and he returned, reluctantly, to the fold. But like other
Republicans, Chaffetz expected Clinton to win the election. And he was ready. “Even before we get to Day One, we’ve got two years’ worth of material already lined up,” he said in October. So
that was Chaffetz weeks before the 2016 election — ready to launch a years-long investigation into the next president over email server management.

Last week, Chaffetz released the House Oversight Committee’s agenda for the next two years. It lists 43 items — none of which involve Donald Trump. Actually, that’s not quite right. Chaffetz
does intend to investigate the Office of Government Ethics, which Republicans believe has been too outspoken in its concern over Trump’s conflicts of interest.

So here, then, is Chaffetz after the 2016 election: planning investigations into those raising the alarm over Trump’s conflicts of interest, rather than actually investigating Trump’s conflicts of
interest.

There are obvious reasons for this. The danger for a House Republican in investigating Trump is that he’ll find something, and that something will be used by Democrats to win back Congress
and, ultimately, the White House. Chaffetz is also ambitious to move up in his party — he ran for speaker of the House after John Boehner stepped down in 2015, and he knows that an
overzealous investigation of a Republican president that puts both the Republican majority and conservative legislation at risk will doom his chances of future advancement.

The Salt Lake City Tribune was appalled. “All that stuff about the constitutional separation of powers, each of the three branches of government keeping a wary eye on the other two, doesn't
mean very much if it is taken seriously only when Congress and the White House are held by different parties,” they wrote. The end of their editorial is worth quoting, and considering:

The Constitution assumes that human nature will push officials of each branch of government to jealously guard their own powers, creating a balance that prevents anyone getting up to too
much mischief. But when elected officials are less interested in protecting their institution than in toeing the party line, it all falls apart.

It is Chaffetz’s job, more than it is anyone else’s, to hold Trump accountable, to demand that he govern in a transparent and ethical manner. And he has the power to do it. He can subpoena
administration officials and Trump’s business associates. He can make sure the media and the public have much of the information Trump refuses to release, and he can make it costly for
Trump to abandon longstanding norms around transparency, divestment, and governance. The American political system is prepared for the sort of challenge Trump represents, and there are
corrective powers in place.

But the
wielder of those corrective powers must want to use them. And Chaffetz doesn’t. His identity as a
Republican supersedes his identity as chair of the House Oversight Committee , or even as congressman from
Utah’s third district.

This, and not Trump, is what poses a threat to American democracy. Here, in miniature, you can see the problem we
face: not a president who can’t be checked, but a president whose co-partisans don’t want to check him.

Partyocracy, not autocracy, is the danger. It is the danger now, and it is the danger in the future, when the presidency
might be held by a would-be strongman smoother and cleverer than Trump.

Trump’s bluster shouldn’t distract from Congress’s power

American politics is covered like an episode of The West Wing: The president is the main character, his top aides are the supporting cast, and
Congress acts and reacts in the background. But the reality is much the reverse: Congress
holds the bulk of the power, and the
president and his aides must act and react in response to its whims. Trump
can only pass the bills Congress sends him, he
can only staff his government with the nominees they confirm, and even his executive actions routinely rely
on authority Congress has handed over and could , at any point, wrench back . The president is weak but public;
Congress is strong but often ignored.

Congress is also a much more accountable institution than the White House. It is closer to the people it represents and more sensitive to their
frustrations. Every
member of the House of Representatives is up for reelection in 2018 — and if they believe their
constituents want more out of them than to act as a blank check for Trumpism, then more will be given .
Already, there are signs that simply protecting the president may not prove popular:

A recent poll by The Salt Lake Tribune and Hinckley Institute of Politics surveyed more than 600 voters, finding that 65 percent were in favor of
Chaffetz investigating Trump's conflicts of interest, while 31 percent were opposed, the Tribune reported.

It’s worth noting that there are 24

districts held by Republicans that voted for Clinton. If Democrats won every one
of those seats, they would take back control of the House. Congressional Republicans know they
cannot simply ignore public opinion. What they are hoping is that public opinion ignores them — that those
who are worried by Trump’s behavior disengage until 2020 , thinking that there are no real remedies until the next
presidential election.

The problem America faces right now isn’t what Donald Trump will do, but what Republicans in Congress will let
him do . That is an unintuitive way to think in a polity that obsesses over the president’s every tweet but barely shows up to vote in midterm
elections. But it’s the reality.

This task is as urgent for Republicans as for Democrats — perhaps more so. In part, that’s true for reasons of legacy. The history books will not
speak fondly of Paul Ryan’s tax reforms if their cost was a presidency under which corruption flourished and crucial norms of governance and
transparency were abandoned.

But more optimistically, this is, for Republicans, a moment of opportunity. Nothing about the Trump administration is fixed. Few of his Cabinet
officials have been confirmed. Few of his priorities have been chosen. Little about his relationship with Congress has been set. Both sides are
feeling the other out. This is the point when they can set his presidency on a course that is safer both for them and for the country.

Given Trump’s inexperience in government, it matters greatly what rules he believes himself to be
operating under. If he can’t act unethically at an acceptable cost, he won’t . If he can’t confirm unqualified
nominees, he will instead be forced to surround himself with qualified nominees. If he can’t govern without actually cutting himself off from his
businesses, he will cut himself off from his businesses or hand the presidency over to Mike Pence, whom Republicans prefer anyway. If Trump’s
worst instincts are curbed early, it makes it more likely that Republicans will pass their policies, and less likely they are eventually engulfed by
scandal or incompetence emanating from the White House.

But if Republicans in Congress abandon their constitutional role to protect their partisan interests, then they must be held no less accountable
than Trump.

There is much talk of the resistance to the Trump administration, and many protests happening outside the White House. But it is in Congress
members’ districts — at their town halls, in their offices, at their coffee shops — where this fight will be won or lost. This is why it matters that
the anti-Trump movement has begun adopting the tactics the Tea Party used to great success against President Obama in 2010: Those tactics
focused on congressional offices, and that’s why they worked.

They are working for liberals, too. Already, congressional Republicans are complaining that their phone lines are jammed, that their town halls
are swarmed, that protesters are, as Rep. Dave Brat said, “in my grill no matter where I go.” And already, congressional Republicans are
beginning to slow down on repealing Obamacare and peel off from Trump’s most unqualified nominees, like Betsy DeVos.

But this
is the beginning, not the end, of Trump’s opposition seeing Congress as the core battleground.
The real test will be in 2018 — Democratic turnout tends to plummet in midterm elections, and overall
turnout was historically low in 2014. The
result, as political scientist Seth Masket writes, is that Republicans are more afraid of
their primary voters than general election voters. Their behavior will change if and when that changes .

And that should change. It should change in 2018 , and it should change thereafter. Congress is more powerful than the president. It
comes first in the Constitution for a reason. The public should demand more of it, and care more who runs it.

But for now, the crucial question — the question on which much of American democracy hinges — is
not what Trump does. It is what Congress does . The danger posed by Trump is one that America’s political system is built to
protect against. But the officials charged with its protection need to take their role seriously.

In the end, it is as simple as this: The way to stop an autocracy is to have Congress do its damn job .

Shoring up the U.S. democratic model’s key to all aspects of U.S. leadership and global
liberal norms
James Traub 17, Fellow at the Center on International Cooperation, 1/3/17, “Donald Trump: Making
the World Safe for Dictators,” http://foreignpolicy.com/2017/01/03/donald-trump-is-making-the-world-
safe-for-dictators/

Presidents keep returning to these formulations because Wilson

was right about the relationship between democracy
and the modern world order. There’s another reason as well: At least since the end of World War II, the idea that the United
States stands for something more than its own self-interest has underwritten its claims to world
leadership. That idea is the basis of America’s “soft power.” The Marshall Plan, to take the most famous example, did
almost as much for the United States, by enhancing its global prestige, as it did for its European beneficiaries.

So what happens if we abandon this tradition? The silver lining of Trump’s chilly agnosticism toward democratic values might
be this: No more hypocrisy. The Obama administration has shaken a finger at autocratic allies in the Middle East without inflicting or even
threatening serious consequences, thus offending foreign governments without mitigating their brutalities. On the other side, Obama has
halfheartedly supported Syrian rebels without making any effort to tip the scales of the horrendous civil war there. Trump will deliver no
lectures, and may openly join Syrian President Bashar al-Assad in his alleged campaign against Islamic extremism. Honesty bought at such a
price, however, is a commodity not worth having.

President Trump might well feel more comfortable with the increasingly illiberal states of Eastern Europe — including Russia, the fountainhead
of anti-liberal doctrine — than with the social democratic West. One can all too easily imagine him launching a fusillade of tweets at Atlantic
allies who stubbornly persist in using the language of universal rights, including German Chancellor Angela Merkel, who not-so-subtly warned
the incoming president to abide by Western values. How long will it be, in fact, before “Western values” can no longer be used as a taken-for-
granted synonym for secularism, individual freedom, or tolerance for diverse opinion?

But there’s a more subtle consequence to forswearing America’s traditional moral claims about its global role. The U nited S tates is able
to serve as honest broker in disputes all over the world because it is not seen, as for example China is, as a
prop to existing regimes, however odious. Thus the Obama administration’s patient diplomacy in Myanmar has given the United States
influence with both new democratic leaders and the former military regime. What happens if any of Trump’s favorite
strongmen are overthrown or, God help them, voted out of office? What influence will Washington have with the
successor regime? How, more broadly, will America compete with China’s growing soft power, or even
Russia’s?

Putin’s greatest windfall in recent years has not been his stealth conquest of Crimea or winning the war in Syria for Assad, but
rather the growing eclipse of liberal values across the West . Trump’s election is a crucial part of that

bounty . (It seems increasingly clear that Putin deserves some credit for that outcome thanks to Russia’s hacking of damaging emails from
Democratic Party leaders.) The prestige of liberal democracy has not sunk so low since the 1930s. Anti-liberal parties lead the polls in much of
Western Europe and now govern in Hungary, Poland, and Slovakia. It
is a matter of greater urgency today than it was after 9/11,
that the U nited S tates act as a beacon of, and spokesman for, democracy. Yet under a President Trump it will
cede that role . Who will inherit it? Germany, perhaps. But Merkel, gravely weakened by her open-door policy toward refugees, may well
lose her bid to return as chancellor in September. In any case, Germany is a lesser power that in any case has very strong historical reasons for
speaking softly and modestly.

If the U nited S tates does not lead in the promotion of democratic and liberal principles, as it has for the last
century, no one else will . And that vacuum will be filled by someone else whose values are neither
democratic nor liberal. Donald Trump’s promise to make American great again will have descended to
tragic farce .

Extinction
Chas W. Freeman 17, served in the United States Foreign Service, the State and Defense Departments
in many different capacities over the course of thirty years, past president of the Middle East Policy
Council, co-chair of the U.S. China Policy Foundation and a Lifetime Director of the Atlantic Council,
3/9/17, “Reimagining Great Power Relations,”
http://www.unc.edu/depts/diplomat/item/2017/0106/ca/freeman_greatpower.html

Across the globe, the lessened security that results from the erosion of rule-bound order has been compounded by
hysteria over attacks by terrorists. The spread of Islamophobia has paved the way for the revival of other forms of xenophobia, like racism and
Illiberalism looks like the wave of the future. We are witnessing the consolidation of national
anti-Semitism.
security-obsessed garrison states.

Some sub-global powers—like Iran, Turkey, Russia, and China—are demanding deference to their power by
the countries in their "near abroad" or "near seas." They thus negate the near-universal sphere of influence that America asserted during the
so-called "unipolar moment" of worldwide U.S. hegemony that followed the Cold War. They are imposing their own military precautionary
zones ("cordons sanitaires") to manage and reduce external threats from other powers. This pushback is resented by the United States,
which— with no sense of irony, given its own insistence on exclusive control of the Americas—charges them with attempts to project
illegitimate "spheres of influence" beyond their borders.

By disavowing longstanding U.S. commitments, the Trump administration has inadvertently confirmed foreign
doubts about American reliability . Efforts to allay these concerns have garnered little credence. The ebb of U.S.
influence is forcing countries previously dependent on Washington's protection to make unwelcome choices between
diversifying their international relationships, decoupling their foreign policies from America's, forming their own ententes and coalitions to
buttress deterrence, or accommodating more powerful neighbors. Whatever mix of actions they choose, they also boost spending to build
more impressive armed forces.

Almost all countries still under U.S. protection continue to affirm their alliance with the United States even as they ramp up a capacity to go it
alone. Arms races are becoming the norm in most regions of the world. Global military expenditures grew by fifty percent from 2001 to 2015.

Not long ago, geopolitics was largely explicable in bipolar terms of US-Soviet rivalry. After a unipolar moment, the political and
economic orders have gone fractal—understandable only in terms of evolving complexities at the regional or sub-regional level.
Intra-regional rivalries now fuel huge purchases by middle-ranking powers of state-of-the-art weaponry produced by the great powers. No one
should confuse increased weapons purchases with a deepening of alliance commitments.

So, for example, Saudi Arabia's arms purchases have tripled in the past five years. Trends in other Gulf Cooperation Council (GCC) member countries are similar. At the same time, the Gulf
Arabs are reaching out to China, the EU, India, Indonesia, Japan, Russia, and Turkey and convening pan-Muslim coalitions against Islamist terrorism and Iran. They have undertaken
unprecedentedly unilateral and aggressive military interventions in places like Libya, Syria, and Yemen. As they have done so, the countries of the Fertile Crescent—Iraq, Lebanon, and Syria—
have drawn ever closer to Iran. Iraqi Kurdistan has become a de facto Turkish dependency.

Before a Western-supported coup ousted Ukraine's elected president2, that country wobbled between East and West but was on its way into the Russian embrace. The Philippines has
distanced it from the United States and bundled with China. So has Thailand. Myanmar and Vietnam, by contrast, are seeking partners to balance China. The Baltic states of Estonia, Latvia, and
Lithuania have doubled down on their reliance on NATO, which they joined in 2004 to secure their independence from Russia. Cuba and Venezuela look to Russia and China for support against
ongoing American policies of regime change.

Meanwhile, international governance of trade and investment continues to devolve to the regional level and configure itself to supply chains. Examples include new trade pacts, like the RCEP,3
the Pacific Alliance,4 and the Eurasian Economic Union;5 preexisting blocs like the GCC,6 Mercosur,7 and the Shanghai Cooperation Organization;8 as well as well-established confederations
like the 27-member post-Brexit EU and the Economic Community of West African States (ECOWAS)9 . Each of these groupings has one or two heavyweight members at its core, constituting a
natural leadership.

Where such regional arrangements have been implemented, rules are made and enforced without much, if any, reference to external powers. Thus, the EU has had no role to speak of in
shaping relations between Canada, Mexico, and the United States under the North American Free Trade Agreement (NAFTA). Conversely, the United States has had very little say in decisions
made in Brussels on rules for trade and investment in the EU and its associated economies. Given the Trump administration's aversion to multilateralism, the United States will have no say at
all in the standard-setting that will take place in either the RCEP or the 65-country pan-Eurasian economic community that is beginning to emerge from China's "belt and road" initiative.
Regionalism limits the reach of great powers. Bilateralism limits it even more.

The decentralization of authority over global economic, political, and defense issues represents a net loss of influence by the U.S. and other great powers over the evolution of the
international state system. But it presents both a challenge and an opportunity for middle-ranking powers. On the one hand, as U.S. and EU influence atrophies, they have an expanding role in
international rule-making. On the other, they are now subject to pressure from neighboring great powers that is unmoderated by any global rules.

Take Mexico as an example. This is a proud nation of nearly 130 million people, the world's 13th largest country geographically and its 11th most populous. It has the world's 11th largest
economy. By every measure, Mexico is a middle-ranking power. As such, even if it were not a member of NAFTA and the Pacific Alliance, it would have a significant voice in the G-20, the WTO,
the United Nations, Latin America, the Caribbean, and the Asia-Pacific.

Interdependence has mitigated but not erased historic Mexican resentment of domineering American behavior. Mexicans have not forgotten that the United States invaded their country and
annexed 55 percent of its territory in 1846–1848. But, since the entry into force of NAFTA in January 1994, Mexico's economy has become almost fully integrated with the American economy
through complex supply chains. Eighty percent of Mexican exports now go to the U.S. Mexico has become the United States' second largest export market and its third largest trading partner
(after China and Canada). It has also quietly transformed itself into a reliably pro-American bulwark against influences from extra-hemispheric powers like Russia and China. It has proven the
efficacy of economic opening and reform and has become an influential advocate of liberal economics as opposed to the perennial statism and mercantilism of most other Latin American
nations.

Now Mexico is faced with demands from the Trump administration to cooperate in dismantling its interdependence with the United States. At the same time, the U.S. president is denigrating
Mexicans, proposing to wall them out, and threatening to deport masses of undocumented migrants and alleged criminals to Mexico, whether they are Mexican or not and whether Mexico
has any legal reason to accept them or not. Not surprisingly, Mexican opinion is now hostile to the United States. Mexico's government has little leeway for compromise. Surrender to
American demands is not an option. But Mexico currently has little leverage over Washington.

So Mexico faces highly unwelcome choices. It can bargain as best it can on its own, risking its prosperity and stability on what is almost certainly a bad bet. It can seek leverage over the United
States by suspending cooperation against transit by illegal migrants and the supply of narcotics to American addicts. It can make common cause against the United States by forming a global
united front with other economies targeted by the Trump administration for their bilateral trade surpluses, like China, Germany, Japan, and south Korea. It can adopt Cuban-style defiance of
Washington's efforts to bring it to heel, allying itself with extra-hemispheric powers like China and/or Russia or Iran. Or it could choose some mixture of all of these options. It is too early to
predict what course Mexican-American relations will take in the age of Trump. They will be affected by many factors, including the state of relations between the United States and other great
powers – especially China and Russia.

Mexico is far from the only middle-ranking power now of necessity maneuvering between the world's great powers. Ukraine has yet to find its place between Russia, the EU, and the United

Turkey has distanced itself from the EU and America and formed an entente (limited partnership for limited
States.

purposes) with Russia. Iran has reached out to India as well as Russia in order to counter the U nited S tates and the
Gulf Arabs. Saudi Arabia—once exclusively attached to the United States—is actively courting China, India, Indonesia,
Japan, and Russia. Pakistan is seeking to avoid having to choose between Saudi Arabia and Iran. At the same time, it has accepted the
task of coordinating the activities of a pan-Islamic military alliance that implicitly counters both Iran and an ever more assertively Islamophobic
India. To reduce dependence on the United States and the GCC, Egypt
is courting cooperation with Iran, Russia, and
Turkey. Old global alignments are everywhere giving way to more complex patterns.

Despite an unprecedented degree of interdependence between them, relations between the great powers are
also in motion . Brazil, China, the EU, India, Japan, Russia, and the United States are each one another's largest or second largest trading
partners and sources of foreign direct investment. They are linked to each other in global supply chains, which tend to converge in and between
large economies. All are members of the Bretton Woods legacy institutions – the International Monetary Fund (IMF), World Bank, and WTO.
These institutions earlier accommodated the rise of Japan. More recently, they have lagged in reflecting the rapidly increasing weight of other
non-Western economies in world trade and finance.

The formation of the "BRICS" group was a collective effort by Brazil, Russia, India, and China (soon joined by South Africa) to develop
institutions to reflect the current distribution of global commercial and financial power and contemporary governance requirements. When
Bretton Woods took place the world had just been crushed by World War II. America dominated the world economy, justifying its preeminent
role in global governance. Recent shifts in economic balances of power have not been reflected in legacy institutions. Washington remains the
nominal leader in them but finds itself increasingly sidelined as others feel obliged to work around it. The Trump administration's skepticism
about the value of the international economic institutions that earlier generations of Americans created has accelerated the diminishment of
U.S. managerial control over the global economy.

Similar erosion of U.S. primacy is evident in international politics. China, India, and Russia have met annually since 2002 to discuss how to
establish a multipolar world order in which U.S. unilateralism cannot hold sway. Antagonism between the world's greatest
powers is growing. With the United States pushing back against Russia in the West and China in the East, the two are being nudged
together to counter America.

To offset Sino-Russian partnership, Japan seeks rapprochement with India and Russia, leavening its longstanding exclusive reliance on the
United States. China, Europe, Russia, and the United States are also courting India, which is, as always, playing hard to get. Meanwhile, China is
reaching out to Europe and the EU is attempting to work with it to fill the leadership vacuum in the Asia-Pacific created by the sudden U.S.
abandonment of the economic leg of its "pivot to Asia." No region is immune from realignment in its international
relationships. Brazil's membership in the BRICS group symbolizes its cultivation of relationships with emerging powers to balance those it
has with the United States and middle-ranking powers in the Western Hemisphere.

As a consequence of these trends, we are now well into a world of many competing power centers and regional
balances . Long-term vision and short-term diplomatic agility are at a premium. Neither is anywhere evident. In their absence, territorial
disputes rooted in World War II and Cold War troop movements and lines of control, arms races (nuclear as well as
conventional), shifting balances of prestige, and the reduced moderating effect of international
organizations are helping to escalate alienation and tension between the great powers.

The stakes are high. Trade wars that could wreck the global economy and degrade the prosperity of all
are now all too easy to imagine. Armed conflict could break out at any time along the unsettled borders between
China and India and China and Japan. The U.S. and Chinese navies are maneuvering against each other in
the South China Sea. The two countries appear to be headed for a military confrontation over Taiwan. The Peloponnesian War and World War I
remind us that squabbles between lesser powers can drag their patrons into existential strife despite their better
judgment.

Notwithstanding ample opportunity to do so, the U.S., EU, and Russia failed to craft a cooperative post-Cold War order to regulate their
interaction in Europe. There is no agreement on where NATO ends and Russia begins. We now face the possibility that it will take an armed
face-down to define a dividing line between them.

All great powers now share an avowed interest in containing Islamist terrorism and remediating its causes. Escalating antipathies born of
territorial disputes and Chinese and Russian opposition to U.S. primacy prevent cooperation to this end. The politically expedient demonization
of strategic rivals in democracies like the United States inhibits cooperation even where specific interests nearly completely coincide. The same
factors diminish the likelihood of cooperation on other matters where interests substantially overlap —like Syria and Korea.

Meanwhile, U.S. deployments of ballistic missile defenses and the increasing lethality of American nuclear warheads have convinced both
Russia and China that Washington is reaching for the ability to decapitate them in a first strike. Russia and the United States are in a nuclear
arms race again. China seems to have been provoked to develop a second-strike capability that, like Russia's, will be able to annihilate, not just
maim America. The Bulletin of the Atomic Scientists has moved its "Doomsday Clock" the closest to
midnight since 1954 .

The risks the world now faces were not (and are not) inevitable. They are the product of lapses of
statesmanship and failures to consider how others see and react to us. The setbacks to America's ability to shape the
international environment to its advantage are not the result of declining capacity on its part. They are the
consequence of a failure to adapt to new realities and shifting power balances. Raging against change will not halt
it. Pulling down the frameworks and trashing the rules on which North American and global prosperity were built

is far more likely to prove counterproductive than empowering. Buying more military hardware will not remedy the national
strategy deficit. Gutting the foreign affairs agencies and doubling down on diplomacy-free foreign policy will deepen it.

Americans are badly in need of a national conversation about their aspirations in foreign affairs and how to take
advantage of the changing world order to realize them. That conversation did not take place during the run-up to
the 2016 election . The inauguration did not mark an end to the chaos of the presidential transition . Forty-
eight days later, most government policy positions remain unfilled. Policy processes have yet to be defined.
In the current atmosphere, slogans displace considered judgments, intelligence about the outside world is unwelcome, expertise is dismissed as
irrelevant or worse, and policy pronouncements appease the delusions of political constituencies instead of addressing verifiable realities. The
Congress has walked off the job . Some sort of order must eventually reassert itself in the U.S.
government, but the prospects for intelligent dialogue about the implications for American interests of
developments abroad seem exceptionally poor.

But such dialogue cannot be deferred for another four years . It seems ever clearer that it will not originate in
Washington. It must begin somewhere. Why not here? Why not now?
 1NC
The United States federal government should strengthen the Patient Protection and
Affordable Care Act by: significantly increasing penalties for the requirement to
maintain minimum essential coverage, guaranteeing out-of-pocket financial assistance
on the Health Insurance Marketplace and expanding premium financial assistance on
the Health Insurance Marketplace.
Strengthening the ACA solves norms and I-law
Ben Mason Meier 13, Assistant Professor of Global Health Policy, Department of Public Policy,
University of North Carolina at Chapel Hill. With Lance Gable, Associate Law Prof @ Wayne State
University Law. 2013. “US Efforts to Realise the Right to Health through the Patient Protection and
Affordable Care Act” http://bmeier.web.unc.edu/files/2013/10/167.full_.pdf
In prioritising public health in future policy reforms and appropriations, the Affordable Care Act has created a policy precedent by which
evidence-based interventions can focus on the structural forces that extend beyond the traditional purview of health care providers.
Building from a universal entitlement to free preventive care services, the Affordable Care Act seeks to
coordinate government efforts to address underlying determinants of health.106 The identification of
specific social determinants of health suggests that the recognition of unhealthy structural forces must
become an integral component of broader health policies.107 By forming and funding a national strategy
to broadly and consistently address underlying determinants of health, these public health components
of the Affordable Care Act more closely align US health policy with international health and human
rights norms requiring governments to establish comprehensive whole-of-government plans to address public health concerns through a
focus on health in all policies.108 With WHO Director-General Margaret Chan declaring that universal health coverage is ‘the single most
powerful concept that public health has to offer’, the American model provides a path to link health care reform with
public health promotion.

the Affordable Care Act buttresses

As part of a global transition to address the organisation and financing of health care systems,
international efforts to realise universal health coverage .109 In spite of America’s for-profit health care
system, the Affordable Care Act represents a significant shift, promoting a normative foundation for
national efforts to set a universal standard of health care.110 Rather than looking only to the ratification
of international law treaties, US fulfilment of the right to health should be assessed by the content of
its health policy , the performance of its health system, and the results for the public’s health. Avoiding past limitations in US health
policy, the Affordable Care Act invokes the strongest US proclamation of a moral imperative for expanding health access. While cautious of the
precedent set by the US Supreme Court in upholding key tenets of the Affordable Care Act, the American model nevertheless presents a
compelling example of efforts to realise the right to health through a market-based health care system.
Advantage 1
 Innovation
The US is key to global medical innovation---Right to health trades off with new drugs
Ryan Huber 17, PhD, Executive Editor of Arc digital magazine. 3/29/17, “U.S. Health Care Reality Check
#1: Pharmaceutical Innovation” https://arcdigital.media/u-s-health-care-reality-check-1-pharmaceutical-
innovation-574241fb80ba

That is, despite the many regulations and laws aimed at consumer protection and safety that do exist in
the United States, our
health care market is relatively freer and more dynamic than those of other developed countries. This
leads to a high rate of medical and pharmaceutical innovation that ends up benefiting the rest of the
world, particularly other rich countries, in a similar way that NATO nations, for example, benefit from
close military alliance with the United States. In short and somewhat reductive terms: we spend more money so everyone else
can be healthier.

But this doesn’t make total sense at first. If

the United States is developing more innovative medicines, devices, and
procedures than every other advanced economy, why aren’t we making money by selling these medical
innovations to others for a hefty profit? Why aren’t there many more billions of dollars of revenue coming into the United States
Treasury because of our status as a medical innovator?

The answer is complicated, but here are some facts you need to know:

First, pharmaceutical companieswhich innovate in the United States charge their domestic customers much
more than they do their customers abroad. This is because, if countries don’t like the prices charged by a
given pharmaceutical company for a certain drug, they will simply ignore the patent that company holds
for their drug in the United States or elsewhere.
Novartis spent nearly 15 years seeking a patent in India for Glivec, a medicine for chronic myeloid leukemia. That quest reached its dead end, at
last. India’s Supreme Court rejected the Swiss drugmaker’s patent application. Glivec (marketed in America as “Gleevec”) is a blockbuster,
earning the Swiss drugmaker $4.7 billion last year. Its prospects in India are now zilch.

Although in this example Novartis happens to be a Swiss drug company, the ruling sends the same clear message to drug makers in the United
States: Give us your drugs for next to nothing or you’ll get exactly nothing.

Second, and relatedly, notice that there seems to be a correlation between how much a country spends
on prescription drugs and the percentage of NMEs (New Molecular Entities) produced by that country.

If you combine points 1 and 2, you start to understand that the high spending of health care consumers
in the United States is arguably funding not only global pharmaceutical innovation but is also
facilitating the availability of new medicines to other countries at much lower prices than domestic
consumers pay.
There is a third factor that might help explain why health care, especially with regard to pharmaceutical innovation, is so much more expensive
in the United States: our massive regulatory agency of all things drugs and food, also known as the FDA, is significantly more burdensome for
medical innovation than the analogous agency for all of Europe, the EMA (European Medicines Agency).

The EMA doesn’t get the final say on whether a drug gets approved for sale in the EU, and perhaps even more significantly, they don’t breathe
down their drug companies’ necks during clinical trials.

In the U.S., because of the cumbersome bureaucracy of the FDA and its processes, we decide to tackle more targets in the drug development
scene through “Fast Track” and “Breakthrough Therapy” route than through the more traditional and more costly standard drug approval
processes.

Does this represent an implicit admission that government is inefficient?

It’s understandable that, given limited resources, the regulatory process can’t be automatic, or even fast-tracked, for all applicants. But if the
FDA can put a medication on a path where an evaluation can be made “quickly and efficiently,” does that mean the normal course of action is
to proceed slowly and inefficiently? If so, this could represent a needless driver of health care costs.

We need to be able to ask this question: Is there something going wrong with the drug development process to have the costs so high and
climbing higher every year?

Looking at a cost breakdown of Big Pharma companies from 2014, a big chunk of their costs, almost equal to the sum of the entire first and
second phase of their clinical trials, come from the 4th phase of clinical trials, which is often referred to as “post-marketing surveillance.”

This is the phase of a drug’s life that takes place after its approval for sale on the U.S. market, in which the FDA requires continued and ongoing
studies to validate the drug’s safety and efficacy using data generated from every phase of clinical trials leading up to its approval in the first
place. It’s in this phase of a drug’s life where, after spending large amounts of money to get the drug approved, companies can still watch as the
FDA rescinds a drug’s approval status, which leads to the drug getting withdrawn from the market, in many cases never to be seen again.

In fact, as of 2015, 462 medicinal products were withdrawn from the market between 1953 and 2013, and the supporting evidence in 72 % of
cases consisted of anecdotal reports. Only 43 (9.34 %) drugs were withdrawn worldwide and 179 (39 %) were withdrawn in one country only.
Withdrawal was significantly less likely in Africa than in other continents (Europe, the Americas, Asia, and Australasia and Oceania).

So, not only is almost a fourth of a drug’s average R & D cost attributable to legislative constraints the government imposes on pharmaceutical
companies to police their own products even after they’ve been approved based on incredibly high standards of safety and testing, but also,
compared to less developed countries, we’re more likely to pull drugs off the market and revoke their
status as a result of anecdotal case reports of adverse effects that generally go unverified.
We consistently decide to err on the side of safety, even if it means pulling the plug on a 10–15-year-long investment (the average length of
development for a drug), which helps clarify how aspiring for safer and more effective drugs begins to preclude cheaper drugs.

So the United States produces the most novel and cutting edge therapeutic compounds despite the
most expensive and stringent approval process and sells them to other countries at much lower prices
than we do at home. In doing this, we are indeed subsidizing research and development of drugs and
medical devices for the rest of the world. This subsidized medical innovation is a major contributing factor to the out-of-control
health care costs in the United States, and losing this innovation will be one of the sacrifices we make if we move
toward a more cost-controlled or government-run health care system over the next several years.

Medical innovation solves pandemics, turns case

Thomas Bollyky 16, senior fellow for global health, economics, and development at the Council on
Foreign Relations. Adjunct professor of law at Georgetown. With Steve Davis. 5/31/16, “Back to the
Future of Global Health Security” https://www.cfr.org/expert-brief/back-future-global-health-security

Growing populations, rising global temperatures, urbanization, and easier trade and travel are all changing the
world in ways conducive to the spread of infectious disease. The recent Ebola and Zika outbreaks have dominated news
headlines and their toll has been terrible, but a more lethal infectious disease could do far worse harm.

“For infectious diseases, you cannot trust the past when planning for the future,” warned Margaret Chan, the head of the World Health
Organization (WHO), at the World Health Assembly last week in Geneva. “What
we are seeing,” she said, is “a dramatic
resurgence of the threat from emerging and reemerging infectious diseases. The world is not prepared to cope.”

To improve pandemic preparedness we must embrace the hard-won lessons of the past decade in global health, not ignore
them. This is true in deploying people and resources to prepare for the inevitability of future outbreaks, but even more so when it comes to
accelerating the development of the medical tools to diagnose, treat, and prevent those infectious
disease outbreaks from turning into epidemics, or even pandemics.
After Ebola and Zika
After widespread concerns over the global response to the Ebola crisis, four separate review panels convened and made similar
recommendations for improving the WHO’s capacity to manage dangerous disease events. Most of the proposed reforms are sensible, but
depend on institutional, financial, and legal commitments that WHO member countries have been unwilling to make for more than a decade.

While the Ebola and Zika epidemics and rising alarm over yellow fever should motivate WHO member countries to do more, it is not self-
evident that they will. Similar concerns were also expressed following outbreaks of SARS (2003), H1N1 (2009–2010), MERS (2012), and
Chikungunya (2014–15). There may be more hope for creative approaches to capacity building. The new World Bank Pandemic Emergency
Financing Facility (a $500 million outbreak insurance mechanism for poor countries) and the alliance for country-led assessment of compliance
with the International Health Regulations (the legal rules supporting global health security) must be expanded and better resourced, but they
are moves in the right direction.

Particularly given
the slow pace of WHO reform and lagging improvements in countries’ surveillance and
response capabilities, the role of groundbreaking innovations in medical technologies will be critical .
Diagnostics, prophylactics, and treatment aren’t the only answers to the increasing threat of emerging
infectious disease, but they can help control epidemics early and ensure the sustained engagement of
medical personnel and volunteers.

Successfully spurring more development of medical tools won’t come primarily from extending the
capacities of governments or intergovernmental institutions. Instead, it depends on inspiring, enabling,
and coordinating the activities of the private sector , academia, and nonprofits. Each participant has a critical role to play.
Governments bring their public health mandate, resources, and regulatory oversight. The private sector offers critical
technologies, manufacturing assets, and expertise in commercializing and scaling innovations. Nonprofits
and academic institutions have research and development capabilities, global reach into poor communities, and the mission to work on tough
issues where markets otherwise fail.

All of these roles are essential, but they aren’t often well aligned. In the two years since the Ebola outbreak in West Africa began, hundreds of
millions of dollars have been invested in clinical trials for more than a dozen drug and vaccine candidates, but no vaccine or drug for Ebola has
been submitted for regulatory approval. And while it’s been nearly a year since reports first linked birth defects to the Zika virus in Brazil, there
are still no adequately sensitive diagnostics to test for the virus and no clear vaccine candidate to prevent it.
 Judicialization Bad---1NC
Judicializing the right to health increases structural inequality---courts would grant
wealthy individuals with the ability to bring claims to court access to drugs at the
expense of subjugated populations
Lenoardo Cubillos 16, Resident in Psychiatry & Senior Policy Advisor at Dartmouth College. With
Rebecca Dittrich et al. 2016, “The International Right to Health: What Does It Mean in Legal Practice and
How Can It Affect Priority Setting for Universal Health Coverage?”
http://www.tandfonline.com/doi/pdf/10.1080/23288604.2016.1124167

THE ETHICS OF ALLOCATING RESOURCES

Priority setting confronts a critical question: how does society ethically allocate scarce resources?
Patients utilizing Article 12 of the International Covenant on Economic, Social and Cultural Rights, or
similar rights, in their right to health claim could argue that they have a right to their “highest attainable
standard” of health, for example.9,17 However, states cannot guarantee a carte blanche highest attainable
standard of health to every citizen without consideration of resource constraints. Attempting to meet
the maximal healthcare needs of every individual would overwhelm a society’s capacity to provide other
social goods, such as education anddefense.21 The question, then, is: what is a reasonable principle for
allocating resources, and to what body is the decision maker accountable in applying such a principle?

Equity and ethics should be critical considerations to ensure proper priority setting. Governments should
consider whether the interests of some groups are unfairly promoted over those of another. Attention to the
principle of equity in access to care, quality of care, outcomes, and financial protection can promote a fair distribution of benefits across
different population and disease groups.22

When seeking to maximize population health, the government should not disregard its ethical obligation to secure benefits for, and reduce
harms to, individuals.22In some instances, attention
to population-level health may disregard the individualized
needs of a highly vulnerable disease group. The government may wish to develop policies to recognize and offer protections for
these highly individualized needs. It is important to give particular attention to the needs of society’s most vulnerable and marginalized
inhabitants. Even if an intervention is not the most cost-effective, it maybe necessary to ensure vulnerable disease groups an equal opportunity
to their right to health.
Court decisions to over-turn a coverage decision may maximize individual health only
for those with the resources to bring a claim but not those in vulnerable disease groups. An equitable
benefits package generally excludes healthcare products that cannot be provided to everyone for whom that product is medically indicated.22
A court’s decision to grant a patient access to the product she demands typically applies only to that
patient.5 Thus, decisions granting individuals access to the interventions they demand can create
horizontal inequity because others having the same need for the intervention are treated differently.6If
we understood the right to health strictly on an individual level the outcome is likely to be an unequal,
subjective access to the highest attainable health standard. To prevent this, courts could seek to uphold priority setting
decisions when they are in reason-able alignment with the evidence and the social value judgments of that broader society.21,23

The highest attainable standard of health of a citizenry can only be determined within the confines of
what the country can fairly afford. This is true as long as the government is already allocating a fair percentage of its total budget
to health care. By granting access to products based on an individual’s right to health without carefully
considering that the product may have been rationally denied, courts could secure one individual access
to a product unaffordable for all who would need it. In doing so, the courts threaten the broader
population right to health.24
 Coverage
Health care is not a right
David Weinberger March 10, 2017 (writer for the Federalist) “Why Nobody Has A Right To Health Care”,
http://thefederalist.com/2017/03/10/nobody-right-health-care/

Buried beneath the Obamacare replacement debates is the philosophical question of whether health
care is a “right.” Article 25 of the United Nations’ Declaration of Rights, for instance, declares it so. While
this is correct as a means, it’s wrong as an end. Understanding the distinction is vital. For the first time in
human history, the Declaration of Independence announced that “all men are created equal.” As Abraham Lincoln argued, everyone is equal
because everyone is free, and everyone is free because everyone is equal. Hence no man has the authority to rule over another without the
other’s consent. Furthermore, because this equality emanates from the “Laws of Nature and of Nature’s God,” it imbues every individual with
the rights to life, liberty, and the pursuit of happiness. Government’s first purpose is to secure these natural rights, which means it’s proper for
government to pursue policies that help carry them out. Our right to life, for instance, subsumes the means necessary to achieve it. As Harry
Jaffa put it, “Providing food and medical care are among the means by which the purpose of securing the right to life is implemented”
(emphasis added). But
just because our rights are secured by government, it does not follow that they must
be provided by government. This means that while it is correct to suggest that people have a right to
food, it is incorrect to say that the state must provide it. Indeed, flowing from our rights to liberty and life, we have the
right to keep the fruits of our labor, through which the marketplace has proved superior in providing access to food, as failed communist states
have made clear. This brings us to the heart of what is wrong with declaring health care—ex nihilo—a human
right. If Health Care Is a Right, Doctors Are Slaves While in a sense we have a right to medical care (which is rightly
why nobody is refused in an emergency), we possess it only as a means to an end (the right to life), not
as an end itself. Making it an end—a “human right”— signifies that it is no longer legitimate to debate the wisdom and prudence of
various means of providing it. In a word, means and ends become inverted. Health care turns into a categorical imperative of
government. The result is a betrayal of both natural law and sound public policy. Natural law emerges from our
equality rooted in our common human nature as spelled out in the Declaration of Independence. In the words of Thomas Jefferson: “The
evidence of this natural right, like that of our right to life, liberty, the use of our faculties, the pursuit of happiness, is not left to the feeble and
sophistical investigations of reason, but is impressed on the sense of every man. We do not claim these under the charters of kings or
legislators, but under the King of kings.” Ergo, rights must emerge from and accord with human nature. Here’s Jefferson’s compatriot, George
Mason: “Now all acts of legislature apparently contrary to natural right and justice, are, in our laws, and must be in the nature of things,
considered as void. The laws of nature are the laws of God: A legislature must not obstruct our obedience to him from whose punishments they
cannot protect us. All human constitutions which contradict His laws, we are in conscience bound to disobey. Such have been the adjudications
of our courts of justice.” Medical care stems not from human nature but from outside of it. This “positive
rights” view allows for government to grant as a “human right” anything that may be desirable. But this
leads to the problem of our “rights” competing with and contradicting one another. If I have a right to
health care, then resources must be channeled for that purpose. But what if doing so sucks resources
away from providing access to, say, food? Which right trumps which? It’s Turtles All the Way Down Some might
reply that the solution to this dilemma is to simply legislate food as a human right, too. But that is no
solution. For what, then, about housing? A decent wage? Education? Transportation? On what grounds
can we reject these as “rights”? The regrettable fact of life is that our desires are infinite, but resources
are not. Natural law remains the sole remedy for this predicament. Moreover, increasing bureaucracy in
health care is bad public policy. There is almost no arena in which government offers a good or service cheaper or more abundantly
than private markets. Despite what we often hear, health care is hardly a “free market.” The U.S. government spends more on
health care per capita than all but three countries in the world. Indeed, nearly half of all our health-care dollars are spent by the state. It’s no
wonder costs have spiraled out of control. Importantly, areas of the health industry where Uncle Sam has interfered least, such as cosmetic
surgery and eye surgery, have witnessed either stable or declining prices. We would therefore do well to move health policy toward a more, not
less, free-market solution. But the first step in doing so is to understand the true basis of our rights, which begins by reacquainting ourselves
with the natural law principles of the founding. “Let us readopt the Declaration of Independence, and with it the practices and policy which
harmonize with it,” Lincoln implored. We should take his advice. We might begin with the truth that all men are created equal.
Declaring healthcare a right is meaningless --- rationing’s inevitable for scarce
resources.
Kevin D. Williamson, 5/7/2017. National Review’s roving correspondent and director of the National Review Institute’s William F.
Buckley Jr Fellowship Program in Political Journalism. “The ‘Right’ to Health Care,” National Review.
http://www.nationalreview.com/article/447389/there-isnt-one

The ‘Right’ to Healthcare

There isn’t one.

With the American Health Care Act dominating the week’s news, one conversation has been unavoidable: Someone — someone who pays
attention to public policy — will suggest that we pursue policy x, y, or z, and someone else — someone who pays a little less careful attention,
who probably watches a lot of cable-television entertainment masquerading as news — responds: “The first thing we have to do is
acknowledge that health care is a human right!” What follows is a moment during which the second speaker visibly luxuriates in his display of
empathy and virtue, which is, of course, the point of the exercise.

It’s kind of gross, but that’s where we are, politically, as a country.

Here is a thought experiment: You have four children and three apples. You would like for everyone to
have his own apple. You go to Congress, and you successfully persuade the House and the Senate to endorse a
joint resolution declaring that everyone has a right to an apple of his own. A ticker-tape parade is held in
your honor, and you share your story with Oprah, after which you are invited to address the United Nations, which passes
the International Convention on the Rights of These Four Kids in Particular to an Individual Apple Each. You are visited by the souls
of Mohandas Gandhi and Mother Teresa, who beam down approvingly from a joint Hindu-Catholic cloud in
Heaven.

Question: How many apples do you have?

You have three apples, dummy. Three. You have four children. Each of those children has a congressionally endorsed, U.N.-

approved, saint-ratified right to an apple of his own. But here’s the thing: You have three apples and four children. Nothing has
changed.

Declaring a right in a scarce good is meaningless. It is a rhetorical gesture without any application to the
events and conundrums of the real world. If the Dalai Lama were to lead 10,000 bodhisattvas in meditation, and the subject of
that meditation was the human right to health care, it would do less good for the cause of actually providing people with health care than the
lowliest temp at Merck does before his second cup of coffee on any given Tuesday morning.

Health care is physical, not metaphysical. It consists of goods, such as penicillin and heart stents, and services, such as
oncological attention and radiological expertise. Even if we entirely eliminated money from the equation,
conscripting doctors into service and nationalizing the pharmaceutical factories, the basic economic
question would remain.

We tend to retreat into cheap moralizing when the economic realities become uncomfortable for us. No
matter the health-care model you choose — British-style public monopoly, Swiss-style subsidized
insurance, pure market capitalism — you end up with rationing: Markets ration through prices,
bureaucracies ration through politics. Price rationing is pretty straightforward: Think of Jesse James and his “Pay Up,
Sucker!” tattoo on his palm. Political rationing is a little different: Sometimes it happens through waiting lists and the
like, and sometimes it is just a question of money and clout. American progressives love the Western European medical
model, but when Italian prime minister Silvio Berlusconi needed a pacemaker, he came to the United States to have it implanted.
Rich people always get better stuff. That’s what it means to be rich. And money is only one resource: Political connections matter enormously
in some places, as might a good family name or employment in a powerful firm. If you live in one of the poorer corners of the world, you may
have “free” health care, meaning that if you should become infected with HIV, you will get a free aspirin. On the other hand, the Coca-Cola
Company distributes antiretroviral drugs, free of charge, to employees around the world being treated for HIV. That may seem unfair to us.
That may be unfair. It
may be unfair that you have four kids and three apples. After we are done lamenting
the unfairness of it all, what do we do?

Ideally, we’dplant some apple trees. We would find ways to invest in medical care with an eye toward
making it more effective and less expensive. There is no substitute for abundance. And the great enemy
of abundance is the bias against profit. There is something deeply rooted in us that instinctively thinks we are being abused if
someone else makes a profit on a deal. That is a dumb and primitive way of thinking — our world is full of wonders because
it is profitable to invent them, build them, and sell them — but the angel is forever handcuffed to the ape.
 Risk
Must evaluate consequences
Issac, ’02 (Jeffery, Professor of Political Science at Indiana University, Dissent, Vol. 49 No. 2, Spring)
Politics, in large part, involves contests over the distribution and use of power. To accomplish anything in the political world one must attend to
the means that are necessary to bring it about. And to develop such means is to develop, and to exercise, power. To say this is not to say that
power is beyond morality. It is to say that power is not reducible to morality. As writers such as Niccolo Machiavelli, Max Weber, Reinhold
Niebuhr, Hannah Arendt have taught, an unyielding concern with moral goodness undercuts political responsibility.
The concern may be morally laudable, reflecting a kind of personal integrity, but it suffers from three fatal flaws: (1) It fails to see that
the purity of one’s intentions does not ensure the achievement of what one intends. Abjuring violence or
refusing to make common cause with morally comprised parties may seem like the right thing, but if such tactics entail impotence,
then it is hard to view them as serving any moral good beyond the clean conscience of their supporters;
(2) it fails to see that in a world of real violence and injustice, moral purity is not simply a form of powerlessness, it
is often a form of complicity in injustice. This is why, from the standpoint of politics-as opposed to religion-pacifism is always a
potentially immoral stand. In categorically repudiating violence, it refuses in principle to oppose certain violent injustices with any effect; and
(3) it fails to see that politics is as much about unintended consequences as it is about intentions; it is the
effects of action, rather than the motives of action, that is most significant. Just as the alignment with “good” may
engender impotence, it is often the pursuit of “good” that generates evil. This is the lesson of communism in
the twentieth century: it is not enough that one’s goals be sincere or idealistic; it is equally important,
always, to ask about the effects of pursuing these goals and to judge these effects in pragmatic and
historically contextualized ways. Moral absolutism inhibits THIS judgment. It alienates those who are not true believers. It
promotes arrogance. And it undermines political effectiveness.

Policy makers have to use util

Gary Woller 97, Professor of Economics at Brigham Young University, 1997, “A Forum On The Role of
Environmental Ethics in Restructuring Environmental Policy and Law for the Next Century”, Policy
Currents, p. 10-11

Moreover, virtually all

public policies entail some redistribution of economic or political resources, such that
one group's gains must come at another group's expense. Consequently, public policies in a democracy
must be justified to the public, and especially to those who pay the costs of those policies. Such justification cannot simply
be assumed by invoking some a priori higher-order moral principle. Appeals to a priori moral principles,
such as environmental preservation, also 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, and since public policies inherently imply winners and losers, the policymakers' duty
to the public interest requires them to demonstrate that the redistributive effects and value trade-offs implied by their
polices are somehow to the overall advantage of society. At the same time, deontologically based ethical
systems have severe practical limitations as a basis for public policy. It therefore follows that in a democracy,
policymakers have an ethical duty to establish a plausible link between policy alternatives and the problems they address, and the public
must be reasonably assured that a policy will actually do something about an existing problem; this require s the means-end language

and methodology of utilitarian ethics. Good intentions, lofty rhetoric, and moral piety are an insufficient, though perhaps at times
a necessary, basis for public policy in a democracy.
 Mismanagement---1NC
Mismanagement and inadequate planning undermines solvency
Michael A. Diamond 9, family medicine doctor in Miami, Florida and is affiliated with multiple
hospitals in the area. 2009. “Con: Single-Payer Health Care Why It's Not the Best Answer”
http://www.atsjournals.org/doi/full/10.1164/rccm.200906-0882ED

Single-payer health insurance would also lead to rationing and long waiting times for medical services.
The adverse consequences of waiting for health services in countries with single-payer insurance are
well documented (12, 13). Access to a waiting list for health care does not equate with access to health care, which is one reason why
patients from abroad often prefer to come to the U.S. for treatment. It is unlikely that Americans would welcome these changes.

The strongest argument against a single-payer system may well be the outcomes in states that have
attempted to expand health care access through the use of government programs and mandates. TennCare
was a widely touted managed-care Medicaid program adopted by Tennessee in 1994 that was
characterized as the solution to providing health insurance to most uncovered residents while simultaneously
controlling costs (14). TennCare's subsequent collapse has been attributed to mismanagement and

unrealistic fiscal planning, a perhaps predictable consequence of government administration of health

care (15). Massachusetts enacted legislation in 2006 that was intended to move that state to near-universal
health care coverage. Indeed, by 2008 some 165,000 more residents were insured through a combination of employer mandates and
government subsidized insurance, and overall, almost 93% of nonelderly adults had coverage by late 2007 (16). However, because inadequate
(or no) provision was made to expand the provider workforce, many of these patients had no access to care (16), and costs have
escalated so far beyond estimates that additional financial support is required (17).
 Doctor Shortages---1NC
Right to health causes doctor shortages---lower payment rates force retirement and
deters people from going to med school
Robert A. Book 9, Senior Research Fellow in Health Economics. 4/3/9, “Single Payer: Why Government-
Run Health Care Will Harm Both Patients and Doctors” http://www.heritage.org/health-care-
reform/report/single-payer-why-government-run-health-care-will-harm-both-patients-and
The Medicare Model

If Medicare or something like it were the "single

payer"-the sole purchaser of health care-no such pressure would exist. If the single payer
established lower payment rates, by definition physicians could not drop out and make their living from
other patients, because there wouldn't be any other patients .[3] The only alternative for a physician
would be to cease the practice of medicine and either retire or find another profession. While this would
certainly happen to some degree, a large percentage of physicians-who have invested many dollars and years of training in their practices-
would be unable to find an alternative profession that is nearly as satisfying or as remunerative. The inevitable result would be
much lower payment rates and lower income for physicians.[4]

Patients would suffer as well, especially in the long run. Because fewer highly talented people would be willing to
undergo the years of training (under difficult