Resolved: The United States federal government should substantially increase fiscal redistribution in the United States by adopting a federal jobs guarantee, expanding Social Security, and/or providing a basic income.
From the National Speech & Debate Associaton
What is Medicare for All?
“Medicare for All” is a healthcare policy proposal that aims to provide comprehensive healthcare coverage to all residents of a country, regardless of their income or employment status. The concept of Medicare for All is based on the idea that healthcare is a basic human right and that the government has a responsibility to ensure that everyone has access to affordable and high-quality healthcare services.
In the United States, the term “Medicare for All” generally refers to a single-payer healthcare system that would be publicly funded and administered by the federal government. This system would replace the current multi-payer system, in which private insurance companies play a major role in providing healthcare coverage.
Under a Medicare for All system, all healthcare services, including doctor visits, hospital care, prescription drugs, and long-term care, would be covered by the government. This would eliminate the need for individuals to purchase private health insurance and would create a more streamlined and efficient healthcare system.
What does Medicare have to do with the topic?
Medicare is a separate program from Social Security, but it is often associated with it because both programs are administered by the Social Security Administration (SSA) in the United States.
Social Security is a federal program that provides retirement, disability, and survivor benefits to eligible individuals and their families. Workers pay into the Social Security program through payroll taxes, and the program uses those funds to provide benefits to those who are eligible.
Medicare, on the other hand, is a federal health insurance program that provides coverage for eligible individuals who are 65 years of age or older, as well as those who have certain disabilities or end-stage renal disease. Like Social Security, Medicare is funded by payroll taxes, but it is a separate program with its own funding source and eligibility criteria.
So while both programs are administered by the SSA, they serve different purposes and have different eligibility requirements.
It is possible that Medicare for All could be administered by the Social Security Administration (SSA), as it is a federal agency that has experience administering large-scale programs like Social Security and Medicare. However, the specifics of how Medicare for All would be administered would depend on the details of the policy proposal.
For example, some Medicare for All proposals would create a new government agency to administer the program, while others would expand the existing Medicare program and have it administered by the Department of Health and Human Services (HHS). The exact structure and administration of Medicare for All would also depend on factors such as funding mechanisms, eligibility criteria, and the role of private insurance.
Ultimately, the decision of how to administer Medicare for All would be up to policymakers and would be based on what is deemed to be the most effective and efficient approach for providing universal healthcare coverage to all residents of a country.
While it is possible to expand Social Security to include Medicare for All, the two programs serve different purposes and have different funding sources. Social Security is primarily a retirement, disability, and survivor benefit program, funded by payroll taxes on workers and employers.
In contrast, Medicare is a federal health insurance program that provides coverage for healthcare services, funded by a combination of payroll taxes and premiums paid by beneficiaries. Expanding Social Security to include Medicare for All would require significant changes to the Social Security program, such as a substantial increase in payroll taxes or the creation of a new funding source.
Furthermore, Medicare for All would likely require a significant increase in government spending to cover the costs of providing comprehensive healthcare coverage to all residents of the country. While expanding Social Security to include Medicare for All could be a way to achieve this goal, it would require careful consideration of the impact on the financial stability of the Social Security program.
Overall, while it is possible to consider expanding Social Security to include Medicare for All, it would require significant changes to both programs and careful consideration of the impact on government spending and the financial stability of Social Security.
What are the Benefits of Medicare for All?
Expanding Medicare for All would have several potential benefits for individuals and society as a whole. These are some of the main benefits.
Saving Lives
Expanding Medicare for All would ensure that all individuals, regardless of their income, employment status, or pre-existing conditions, have access to comprehensive healthcare coverage. This means that everyone would be able to receive the medical care they need without worrying about whether they can afford it or whether their insurance will cover it.
By providing universal coverage, Medicare for All could improve health outcomes by enabling more people to access preventative care and necessary medical treatments. This could lead to earlier detection and treatment of illnesses, and ultimately better health outcomes.
It is difficult to estimate exactly how many lives would be saved if Medicare for All was adopted, as it would depend on a number of factors, such as the specific details of the policy, the level of healthcare access and quality that it provides, and how it is implemented.
However, studies have shown that lack of healthcare coverage is associated with higher mortality rates. According to a study published in the American Journal of Public Health in 2009, lack of health insurance was responsible for 44,789 deaths in the United States in 2005.
Expanding Medicare for All to provide comprehensive healthcare coverage to all residents of the country could help to reduce these mortality rates. By providing access to preventative care, early detection and treatment of illnesses, and necessary medical treatments, more lives could be saved.
Overall, while it is difficult to estimate an exact number, expanding Medicare for All could potentially save tens of thousands of lives each year by providing universal healthcare coverage and improving access to necessary medical treatments.
Lower healthcare costs: With a Medicare for All system, healthcare costs could be reduced because the government would have greater bargaining power to negotiate lower prices for medical services, prescription drugs, and medical supplies. Also, the administrative costs of private health insurance companies would be eliminated, which can consume a significant portion of healthcare spending.
The exact amount that healthcare costs would decline under Medicare for All is difficult to predict and would depend on the specifics of the policy, such as the level of benefits provided, the funding mechanism, and the role of private insurance.
However, there is evidence to suggest that a single-payer healthcare system, such as Medicare for All, could lead to significant cost savings. For example, a study published in the Annals of Internal Medicine in 2021 found that a single-payer healthcare system could result in overall healthcare cost savings of 13.1% to 16.0% compared to the current system in the United States.
Some of the factors that could contribute to cost savings under Medicare for All include
Reduced administrative costs. A single-payer system would eliminate the administrative costs associated with multiple private insurance companies, which can consume a significant portion of healthcare spending.
Lower Drug Prices
The government could use its bargaining power to negotiate lower prices for prescription drugs, reducing the cost of healthcare for individuals and the government.
Improved preventative care: By providing universal coverage, individuals would have greater access to preventative care, which could reduce the need for expensive medical treatments later on.
Simplified billing and payment. A single-payer system would simplify the billing and payment process for healthcare services, reducing administrative costs and streamlining the healthcare system.
Financial security. With Medicare for All, individuals and families would no longer have to worry about medical bills bankrupting them or going into debt to pay for necessary medical treatment. This could provide greater financial security and peace of mind for 100 million individuals and families who have medical debt.
According to a study published in the American Journal of Public Health in 2019, medical debt is the largest cause of consumer debt and financial stress in the United States, and it is a major contributor to bankruptcy.
The study found that in 2016, 66.5% of bankruptcies in the United States were related to medical issues, such as high medical bills, lost income due to illness, or both. The study also found that people who filed for bankruptcy due to medical debt had higher levels of income and education compared to those who filed for other reasons.
Medical bills can be a major financial burden for individuals and families, even for those who have health insurance. High deductibles, co-payments, and out-of-pocket costs can quickly add up, especially for those with chronic or serious medical conditions. Even a single unexpected medical emergency can result in large bills that can be difficult to pay. Medical bills can also have long-term financial consequences, such as damaged credit scores, wage garnishments, and debt collection lawsuits. These consequences can further compound financial stress and make it more difficult to recover from a medical crisis.
Simplified health Care. Under a Medicare for All system, the healthcare system would be simplified, with a single entity responsible for administering healthcare benefits. This could reduce confusion and make it easier for individuals to navigate the healthcare system. How could it do this?
Streamlined coverage. Medicare for All would provide comprehensive coverage for all necessary healthcare services, including doctor visits, hospital care, prescription drugs, and long-term care. This would eliminate the need for individuals to navigate complex and confusing insurance plans with different coverage levels, deductibles, and co-pays.
No more networks. Medicare for All would not have provider networks that individuals would need to navigate. Under the current system, individuals often need to choose doctors and hospitals that are in their insurance network to avoid high out-of-pocket costs. With Medicare for All, individuals would be able to choose any healthcare provider that accepts Medicare, regardless of their location or network.
Simplified billing. Medicare for All would simplify the billing and payment process for healthcare services. Individuals would no longer need to navigate multiple bills from different healthcare providers and insurance companies. Instead, healthcare providers would bill the government directly for services provided.
No more surprise medical bills. Under Medicare for All, there would be no more surprise medical bills. Currently, individuals can receive unexpected bills for out-of-network services or for services that are not covered by their insurance plan. With Medicare for All, all necessary healthcare services would be covered, eliminating surprise bills.
Lower out-of-pocket costs. Medicare for All would eliminate or reduce out-of-pocket costs, such as deductibles and co-pays, which can be confusing and difficult to budget for. This would simplify the healthcare system for consumers by providing greater financial predictability.
Racism and Discrimination
Medicare for All could reduce racism and discrimination in a number of ways.
First, Medicare for All would provide more equitable access to healthcare for people of color, who are more likely to be uninsured or underinsured than white Americans. This lack of access to quality healthcare has been linked to worse health outcomes and increased mortality rates for communities of color. By providing universal coverage, Medicare for All would help level the playing field and ensure that everyone has access to the same quality of care.
Second, Medicare for All would eliminate the financial burden of healthcare on low-income communities and people of color, who are more likely to live in poverty or work in low-wage jobs without access to employer-sponsored healthcare. This would help reduce the racial wealth gap, which has been perpetuated by the high cost of healthcare and medical debt.
Third, Medicare for All would address the racial disparities that exist within the healthcare system itself. For example, studies have shown that people of color are less likely to receive appropriate treatment for chronic conditions like diabetes, hypertension, and heart disease, and are more likely to receive substandard care for certain procedures. By creating a more comprehensive and equitable healthcare system, Medicare for All could help reduce these disparities and improve health outcomes for communities of color.
Finally, Medicare for All would help address the underlying social determinants of health that contribute to systemic racism, such as poverty, lack of access to education and job opportunities, and environmental pollution. By providing universal coverage and reducing the financial burden of healthcare, Medicare for All could free up resources that could be invested in addressing these broader social issues.
Gender Inequality
Medicare for All ould help reduce gender inequality in several ways.
Access to Reproductive Healthcare. Medicare for All would provide comprehensive reproductive healthcare to all Americans, including access to contraception, abortion, and other reproductive services. This would help reduce the gender gap in healthcare, as women are more likely to need these services and face barriers in accessing them due to cost or lack of availability.
Eliminating Gender-Based Pricing. In the current healthcare system, women often pay more than men for the same services, due to gender-based pricing. For example, women pay more for insurance coverage that includes maternity care, even if they do not plan to have children. Medicare for All would eliminate gender-based pricing, ensuring that women pay the same as men for the same services.
Equal Access to Preventive Care. Medicare for All would provide universal coverage for preventive care, such as mammograms and Pap tests, which are critical for women’s health. Women are more likely to use preventive services, but are also more likely to face barriers in accessing them, such as cost or lack of insurance. By providing universal coverage, Medicare for All would ensure that all women have equal access to these services.
Addressing the Gender Pay Gap. Medicare for All could indirectly help address the gender pay gap by reducing healthcare costs for employers. Currently, healthcare costs are a significant expense for many employers, and this can be a barrier to hiring and promoting women, who are more likely to use healthcare services. By reducing healthcare costs, Medicare for All could make it easier for employers to hire and promote women, thus helping to reduce the gender pay gap.
Supporting Caregivers. Women are more likely than men to be caregivers for children, the elderly, or family members with disabilities. Medicare for All would provide universal coverage for long-term care, which would reduce the financial burden of caregiving and provide support for those who provide care. This could help reduce the gender gap in caregiving, which can limit women’s career opportunities and earnings.
Disabilities
Medicare for All could provide significant support to people with disabilities in several ways.
Comprehensive Services. Medicare for All would cover a wide range of healthcare services and treatments, including primary care, specialty care, hospitalizations, prescription drugs, mental health care, and long-term care. This would help address the complex and varied healthcare needs of people with disabilities, who often require ongoing care and support.
Coordination of Care. Medicare for All would provide a coordinated approach to healthcare, with a focus on patient-centered care and care coordination. This would be particularly helpful for people with disabilities, who may have multiple healthcare providers and need assistance in coordinating their care.
Assistive Technology. Medicare for All would cover assistive technology, such as wheelchairs, prosthetics, and hearing aids. This would help ensure that people with disabilities have access to the equipment they need to live independently and participate fully in their communities.
The Negative
Attacking the General Harms
The first two sets of arguments concern negative “case” arguments and relate to minimizing and trying to turn the Pro’s health care arguments. These arguments manifest themselves in different ways, but they generally concern improving health care outcomes for all and may focus on certain groups such as women, minorities and the disabled.
First, negative debaters should attempt to minimize the harm of a lack of health insurance. Affirmative teams will cite evidence that claims that millions lack health insurance, but the number of deaths that occur from that is small. Why? Because people can pay for medical care, go into debt to access it, obtain basic care under Obamacare and seek emergency treatment in many hospitals. While there are many uninsured, the consequences of that under-insurance are not nearly as large as the amount.
Second, negative debaters should attempt to turn the solvency for access by arguing that quickly attempting to expand health care outside of market mechanisms will result in long wait lines, a rationing of health care and an overall dillution of the quality of care.
Disadvantages
There are a number of strong disadvantages against Medicare for All.
Spending Spending Estimates for the cost of Medicare for All vary, but generally fall between $30 trillion and $40 trillion over 10 years [second course] The Urban Institute estimated a cost of $32 trillion over the same period, while the Center for Health and Economy estimated a cost of $36 trillion through 20293.
The federal government spends approximately $6.5 trillion total (2022), so this would be a large increase in spending.
Where would the money come from? Such a large spending increase would arguably come from multiple sources, including increased borrowing (which would increase the debt), tax increases, spending cuts to social service programs and spending cuts to military programs. While I won’t go into each of these here, negative teams could argue that these are undesirable.
Politics. The political capital required to pass Medicare for All is significant. Medicare for All is a highly controversial and polarizing issue, and while some Democrats support it, others believe in more modest measures to expand health insurance, and some are concerned that Medicare for All could trigger a political backlash. Implementing Medicare for All would require significant changes to the current healthcare system, which could be difficult to achieve and could face opposition from various stakeholders3. Therefore, the Biden administration would need to invest significant political capital to build support for the policy and overcome opposition from those who are against it. The debate over Medicare for All is expected to play a major role in the race for the Democratic presidential nomination1.
Elections. Passage of Medicare for all before the 2024 election could potentially impact Biden’s chances of reelection, but it is difficult to predict how exactly. Biden has proposed plans to strengthen and extend the life of Medicare, but he has not explicitly endorsed Medicare for all. The issue of healthcare is complex and divisive, and opinions on Medicare for all vary widely among voters and politicians. It is possible that passage of Medicare for all could energize progressive voters and increase support for Biden, but it could also face opposition from Republicans and moderate Democrats. Ultimately, the impact on Biden’s reelection would depend on a variety of factors, including the state of the economy, foreign policy, and other issues that may take precedence in voters’ minds.
Federalism. Passing national health care legislation might infringe on states’ rights because it could be seen as an overreach of federal power. Some argue that the Constitution does not obligate the federal government to pay for medical expenses or regulate health care (The debate – Politico, Congressional Research Service) The Affordable Care Act sought to preserve the current division of authority between federal and state governments (Commonwealth Fund). Those who oppose national health care legislation on constitutional grounds argue that Congress lacks the authority to compel people to purchase health insurance or pay a tax or a fine, and that this would infringe on individual liberties1. There is also debate over whether states have the right to opt out of federal health care reform.
Pharmaceutical industry good. Pharmaceutical price controls could undermine pharmaceutical industry revenue and, consequently, research & development needed to bring new drugs to market.
Counterplans
Non-Social Security. The affirmative needs to fit Medicare for All within the administrative framework of Social Security in order to be topical (see above), but this doesn’t mean that Medicare For All has to fit within that framework, as the above explanation makes clear. A simple counterplan to implement Medicare for All outside that framework with arguments about how implementing it within that framework is likely to hurt the program and/or undermine existing Social Security programs will be a strong counterplan that may ultimately make this affirmative unwinnable.
States.The 50 state governments could implement equivalent health care programs. These have been proposed in many states. The states counterplan will be discussed in another essay.
Alternative Approaches. Health care in the United States arguably needs reformed, but this is not the only way to do it. These include –
Medicare Buy-In. This proposal would allow people to buy into the Medicare program at various ages, such as 55 or 60. This would expand access to Medicare coverage without eliminating private insurance options, as Medicare for All would.
Public Option: This proposal would create a government-run health insurance plan that would compete with private insurance plans on the individual and small group markets. This would allow people to choose between public and private insurance options, but would not eliminate private insurance entirely.
Medicare-X Choice Act:. This proposal would create a new public health insurance plan that would be available on the individual and small group markets. It would also allow people to keep their existing insurance if they prefer. The plan would be modeled after Medicare but would be available to people of all ages.
Medicaid Buy-In: This proposal would allow people to buy into the Medicaid program, which provides health insurance to low-income individuals and families. This would expand access to Medicaid coverage without eliminating private insurance options.
These could potentially be their own affirmative cases, as long as they fall under Social Security and the affirmative could defend them as needing to be expanded under Social Security.
Kritiks
Capitalism. Reforming health care could simply protect the corporate structure of health care provision (at a basic level, it pays costs to private hospitals, doctors and insurance companies) and prop-up its capitalist structures. This is arguably the government simply supporting private interests.
Anti-Blackness. Propping up an anti-black health care system will increase ant-blackness.
Coercion. Government funded programs arguably simply steal money from those who earned it and give it away to those who don’t.