1NC

Off
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Deficit DA

The plan causes the deficit and debt to skyrocket

CRFB 16 – Committee for a Responsible Federal Budget, “Analysis of the Sanders Single-Payer
Offsets,” 2/3/16, http://www.crfb.org/blogs/analysis-sanders-single-payer-offsets/
Overall, based on our rough estimates and excluding most potential interactions, it appears that Sen. Sanders’s proposal would raise
$11.0 to $11.2 trillion of revenue.2 Depending on whether one uses Sen. Sanders’s estimates of the cost of his single-payer plan
or Thorpe’s estimates, this means his plan would cost between $2.6 trillion and $13.5 trillion, net of offsets, over a decade.
These costs could have a substantial effect on debt . Currently, CBO projects debt will grow to 86
percent of Gross Domestic Product (GDP) in 2026, and based on the Sanders campaign’s estimates it would grow to roughly
the same place. But based on our analysis, the shortage of offsets would actually cause debt to grow 13 percentage points higher;
adding Thorpe’s cost estimate, debt would grow nearly 60 percentage points higher . In other words,
under Sen. Sanders’s plan, debt could ultimately reach between 100 and 150 percent of GDP
by 2026 .
The Limits of Taxing High Earners
Even our estimates of the Sanders plan are likely overly optimistic as they do not account for
economic effects or any additional behavioral effects beyond those from a small tax increase. While small tax
increases are likely to have little economic impact, economists almost universally believe that exorbitantly high taxes will slow
economic growth and at some point actually lead to a reduction in revenue .

That makes accomplishing any other budgetary priorities impossible---the

counterplan isn’t free, but it’s far more affordable than the plan
Paul Starr 16, professor of sociology and public affairs at Princeton University, “The False Lure
of the Sanders Single-Payer Plan,” 2/1/16, http://prospect.org/article/false-lure-sanders-single-
payer-plan
Should Democrats—should anyone—support devoting so much federal revenue to health care? The
country has a lot of other needs. Transferring all private health spending to the federal treasury is not
necessarily the best use of federal tax capacity . Sanders’s health plan is so costly it would
make it impossible to do much else .
It’s not just private insurers that would stand in the way of this plan. Thorpe estimates that 70 percent of people with private
insurance would end up paying more than they do today.
But what about other countries that Sanders often cites? Don’t those examples show that a system of national health insurance is
cheaper and better than one with private insurance?
Here’s where I agree with that argument: If we could wind back the clock to the 1940s, when health care was just 4 percent of GDP
and private insurance was just beginning to develop, we might well be able to design a national insurance program—as Harry
Truman proposed—that would have kept down the growth of costs. But we can’t wind back the clock. In the mid-to-late 20th
century, a very different system developed with the rise of both private, employer-based insurance and the adoption of public
programs that accommodated the interests of physicians and hospitals.
This is a story I’ve told in two books—The Social Transformation of American Medicine (1983) and Remedy and Reaction (revised
edition, 2013). The financing arrangements that emerged in the United States had two complementary effects: They created
incentives for high-cost specialized care and protected much of the public from the full, direct cost of that system. As a result,
starting from 4 percent of GDP, health care grew to 17.5 percent, far more than in any other country. That level of costs is reflected in
investments in medical technology, the physical infrastructure of hospitals and other facilities, the patterns of medical training and
specialization, and the size and structure of the health-care labor force. Adopting a government insurance plan won't undo a system
that's been built up over decades, though it would certainly alter its future evolution.
While having the federal government take over all private health expenditures (and state and local government spending too, unless
Sanders can also appoint new justices to the Supreme Court), the Sanders plan attempts to squeeze per capita health expenditures
down to Canadian levels. The plan doesn’t explain how it is going to bring this about, and Thorpe’s analysis says it won’t. But if the
federal government did impose sufficient controls, the results would be to bankrupt many institutions that are counting on future
streams of revenue to cover debt payments, meet payroll, and satisfy other obligations.
The Affordable Care Act does not try to roll back spending levels to the share of GDP that health care represented decades ago. It has
the limited, uninspiring, but ultimately more sensible goal of “bending the cost curve”—slowing the rate of growth of health-care
costs, which has actually happened in the years since the law’s passage.
 Most countries
The ACA is far more in keeping with the lesson to be drawn from the history of health policy in other countries.
have built on their existing institutions as they have pursued universal coverage and
sought to control costs. The governments that instituted unified national insurance systems generally did so before private
insurance had developed on a large scale. Many countries that had multiple insurance funds have
maintained them; rather than centralizing all payment, they have created regulatory and
negotiating arrangements that keep costs in check. This is the direction we can and should take.
In the wake of the adoption of the ACA—if it isn’t repealed by Republicans— the United States could adopt additional
reforms to improve coverage and control costs, including measures opening Medicare to wider
enrollment . One possibility is to provide a basis for 55-to-64-year-olds to buy into Medicare. The idea of a Medicare
buy-in was supported by Bill Clinton in the late 1990s and by Al Gore in the 2000 election campaign. It is even more
practical now as a result of the ACA’s individual mandate, which reduces the likelihood of adverse selection
(higher enrollment by those with high medical costs). A Medicare buy-in came up late in the 2009 Senate debate about the ACA as
an alternative version of the “public option,” but it died as a result of Joe Lieberman’s objections and worries among other
Democrats about its impact on the financial stability of hospitals in their states—a concern that would have to be dealt with in any
effort to revive the idea.
I mention a Medicare buy-in for people in the decade before full Medicare eligibility only to illustrate the kind of incremental
measure that is both practical and consistent with the aspirations of many progressives. It would
be difficult to enact, but it wouldn’t require a Sanderista revolution and heroic assumptions
about Americans’ support for increased taxation.

Unchecked deficits destroy the foundation of U.S. global power---causes global war
Kenneth G. Lieberthal 12, senior fellow emeritus in the Foreign Policy program at Brookings;
and Michael E. O’Hanlon, senior fellow in Foreign Policy at the Brookings Institution, 7/10/12,
“The Real National Security Threat: America’s Debt,” https://www.brookings.edu/opinions/the-
real-national-security-threat-americas-debt/
Drones, kill lists, computer viruses and administration leaks are all the rage in the current political debate. They indeed merit
serious scrutiny at a time when the rules of war, and technologies available for war, are changing fast. That said, these issues are not
the foreign policy centerpiece of the 2012 presidential race.
Economic renewal and fiscal reform have become the preeminent issues, not only for domestic and economic policy but for foreign
policy as well. As the former chairman of the Joint Chiefs of Staff, Adm. Michael G. Mullen, was fond of saying, national debt
has become perhaps our top national security threat . And neither major presidential candidate is doing
enough about it. This issue needs to be framed as crucial not just for our future prosperity but for
international stability as well.
The United States has been running trillion-dollar deficits, resulting in a huge explosion in the country’s indebtedness. Publicly held
debt now equals 70% of gross domestic product, a threshold many economists consider significant and highly worrisome. Making
matters worse, half of our current deficit financing is being provided by foreigners. We are getting by with low interest rates and
tolerable levels of domestic investment only because they find U.S. debt attractive, which may not last.
According to the nonpartisan Committee for a Responsible Federal Budget, President Obama’s long-term budget plan would allow
publicly held debt as a fraction of GDP to rise further, up to 75%, within a decade. Mitt Romney’s proposal, featuring tax cuts and
defense spending increases and as-yet-unspecified (and thus less than fully credible) entitlement reform, appears worse. It would
probably drive publicly held debt to 95% of GDP over the same period. Put differently, though both are serious and pragmatic men,
neither major party’s presidential candidate is adequately stepping up to the plate, with Romney’s plan the more troubling of the
two.
Why is this situation so serious? First, we are headed for a level of debt that within a decade could require
us to spend the first trillion dollars of every year’s federal budget servicing that debt. Much less
money will be left for other things. That is a prescription for a vicious cycle of
underfinancing for our infrastructure , national education efforts , science
research and all the other functions of government that are crucial to long-term
economic growth . Robust defense spending will be unsustainable too. Once we get in this rut,
getting out will be very hard.
Second, such a chronic economic decline would undercut what has been 70 years of strong national
political consensus in favor of an activist and engaged American foreign policy . One reason the
United States was so engaged through the Cold War and the first 20 years of the post-Cold War world was fear of threats. But the
other reason was that the strategy was associated with improvements in our quality of life as well. America became even more
prosperous, and all major segments of society benefited.
Alas, globalization and automation trends of the last generation have increasingly called the American dream into question for the
working classes. Another decade of underinvestment in what is required to remedy this situation will make an isolationist or
populist president far more likely because much of the country will question whether an internationalist role makes sense for
America — especially if it costs us well over half a trillion dollars in defense spending annually yet seems correlated with more job
losses.
Lastly, American economic weakness undercuts U.S. leadership abroad. Other countries sense our
weakness and wonder about our purported decline. If this perception becomes more widespread,
and the case that we are in decline becomes more persuasive, countries will begin to take actions that reflect their
skepticism about America’s future. Allies and friends will doubt our commitment and may pursue
nuclear weapons for their own security, for example; adversaries will sense opportunity and be
less restrained in throwing around their weight in their own neighborhoods. The crucial Persian Gulf and
Western Pacific regions will likely become less stable. Major war will become more likely .
When running for president last time, Obama eloquently articulated big foreign policy visions: healing America’s breach with the
Muslim world, controlling global climate change , dramatically curbing global poverty through development aid,
moving toward a world free of nuclear weapons. These were, and remain, worthy if elusive goals. However, for
Obama or his successor, there is now a much more urgent big-picture issue: restoring U.S.
economic strength . Nothing else is really possible if that fundamental prerequisite to
effective foreign policy is not reestablished.
 1NC
Trade DA

Single payer violates U.S. commitments to the WTO by ending competition in the
market to supply health care services---that leads to DSB challenges that we’d
lose---collapses trade in services and global growth
Ethan Marks 14, J.D. Candidate, Boston College Law School, 2014, “Federalism in an Era of
International Free Trade: The General Agreement on Trade in Services And the Regulation of
Insurance in the United States,” Tort Trial & Insurance Practice Law Journal, vol. 50, p. 129-153
State health insurance reforms may be particularly likely to conflict with GATS . To address high
health care costs, poor health care quality, and low access to care, state legislatures have reformed their health
insurance markets in increasingly aggressive ways. Many proposed reforms , and some enacted reforms,
could violate current GATS commitments . Universal single-payer health insurance, on either the state
or federal level, would likely violate GATS’ prohibition of new monopolies .98 Minimum benefits requirements for
plans offered in state health insurance exchanges could violate GATS’s market access provisions or its ban on the establishment or
authorization of a small number of exclusive service providers.99 A state “ public option” health insurance
plan , if subsidized by the state, would also likely violate GATS . If the public option competed with
private health insurance plans —as it is designed to do—it would not be exempt from GATS
as a service supplied in the exercise of government authority. 100 The public option would likely
contravene GATS’s national treatment principle , assuming that the subsidies or other favorable
treatment it received from the state were not available to private plans.101 If the public option had the effect of
placing a numerical quota on the number of service providers that could enter the market, it
would violate GATS’s market access provision .102
Perhaps most importantly, the Council for Trade in Services might develop disciplines on domestic regulation under GATS Article
VI.4 that would restrict the licensing requirements states could adopt. These disciplines might go so far as to prohibit any state
licensing requirement “more burdensome than necessary to ensure the quality of the service.”103 Under this standard, long delays
in the processing of insurance licenses could violate GATS. 104 A new discipline might even subject the entire state system of
licensing to a GATS challenge.105 If the costs of complying with multiple states’ licensing requirements are deemed to be more
burdensome than necessary, the United States might have no choice but to create a federal agency for the licensing of insurers.
If an insurance reform statute passes both houses of the legislature and is signed by the governor, it becomes law within the state.
Considering the wide latitude accorded to states to enact insurance regulations, the aforementioned insurance statutes could not
reasonably be attacked on constitutional grounds. Once such a statute took effect, however, another country
might decide to initiate consultations with the U nited S tates under the DSU if that country
believed that the state statute violated GATS to the disadvantage of its insurers. A country could
challenge a state law if the law caused foreign insurers to suffer economic loss on a
discriminatory basis . But foreign insurers also recognize that the state system of regulation, considered as a whole,
creates high administrative costs for both domestic and foreign insurers. 106 Foreign insurers could eliminate the fragmented
system of licensing and regulation altogether by challenging the system itself under the new domestic disciplines currently being
negotiated. Even panel and Appellate Body determinations that individual state insurance statutes violated GATS could pressure the
federal government to centralize its insurance regulatory authority in the federal government. For these reasons, countries with
expansion-minded insurers have strong incentives to challenge state statutes under GATS.
If another country initiated consultations with the United States, the federal government—not the state—would have to defend the
state statute in any ensuing dispute settlement proceedings. Under the Uruguay Round Agreements Act, the state would play a
minimal advisory role to the federal government. But the state would not be formally recognized as a third party before the DSB and
therefore could not make written submissions or participate in panel or Appellate Body hearings on its own accord.
If the DSB concluded that the statute did not violate GATS, no further action would be necessary on the part of the state or
the federal government. If the statute did violate GATS, however, the federal government would have several options: it
could negotiate with the state for repeal of the statute; Congress could expressly preempt the statute; the FIO could expressly
preempt the statute; or, the federal executive branch could initiate a preemptory lawsuit against the state. The federal government
has important economic reasons to ensure that states comply with dispute settlement rulings. If
a state statute remains in
effect after an adverse panel or Appellate Body ruling , the DSB could authorize punitive trade
sanctions against the federal government. 107 The state might feel the brunt of these sanctions. Yet because only federal
representatives sit at the bargaining table in the WTO, the states do not experience the full international political consequences of
their refusal to comply with the DSB.
V. Recommendations for Preserving a Dual System of Insurance Regulation
The Unites States’ GATS commitments serve important economic goals . The elimination of
barriers to the expansion of trade in services is designed to promote the economic growth
of all countries involved in international trade. 108 For United States service suppliers to realize these
benefits, the nation must be willing to open its own borders to foreign firms . But the aims
of international cooperation must not take precedence over the protections afforded to policyholders and citizens at large by the
current system of domestic insurance regulation. The preservation of these consumer protections requires that the values underlying
the traditionally strong role of states be given a greater platform in the ongoing Doha Round of WTO negotiations.

Global nuclear war

Nouriel Roubini 17, professor at NYU’s Stern School of Business and Chairman of Roubini
Macro Associates, was Senior Economist for International Affairs in the White House's Council
of Economic Advisers during the Clinton Administration, 1/2/17, ““America First” and Global
Conflict Next,” https://www.project-syndicate.org/commentary/trump-isolationism-
undermines-peace-worldwide-by-nouriel-roubini-2017-01
Trump, however, may pursue populist, anti-globalization, and protectionist policies that hinder trade and restrict the
movement of labor and capital. And he has cast doubt on existing US security guarantees by suggesting that he will force America’s
allies to pay for more of their own defense. If Trump is serious about putting “America first,” his administration will shift US
geopolitical strategy toward isolationism and unilateralism, pursuing only the national interests of the homeland.
helped sow the seeds of World War II .
When the US pursued similar policies in the 1920s and 1930s, it
Protectionism – starting with the Smoot-Hawley Tariff, which affected thousands of imported goods – triggered
retaliatory trade and currency wars that worsened the Great Depression. More important, American
isolationism – based on a false belief that the US was safely protected by two oceans – allowed Nazi Germany and
Imperial Japan to wage aggressive war and threaten the entire world . With the attack on Pearl Harbor in
December 1941, the US was finally forced to take its head out of the sand.
Today, too, a US turn to isolationism and the pursuit of strictly US national interests may eventually lead to
a global conflict . Even without the prospect of American disengagement from Europe, the European Union and the
eurozone already appear to be disintegrating, particularly in the wake of the United Kingdom’s June Brexit vote and Italy’s failed
referendum on constitutional reforms in December. Moreover, in 2017, extreme anti-Europe left- or right-wing populist parties
could come to power in France and Italy, and possibly in other parts of Europe.
Without active US engagement in Europe, an aggressively revanchist Russia will step in. Russia is already challenging the US and the EU in Ukraine, Syria, the Baltics, and the Balkans, and it may capitalize on the
EU’s looming collapse by reasserting its influence in the former Soviet bloc countries, and supporting pro-Russia movements within Europe. If Europe gradually loses its US security umbrella, no one stands to
benefit more than Russian President Vladimir Putin.
Trump’s proposals also threaten to exacerbate the situation in the Middle East. He has said that he will make America energy independent, which entails abandoning US interests in the region and becoming more
reliant on domestically produced greenhouse-gas-emitting fossil fuels. And he has maintained his position that Islam itself, rather than just radical militant Islam, is dangerous. This view, shared by Trump’s
incoming National Security Adviser, General Michael Flynn, plays directly into Islamist militants’ own narrative of a clash of civilizations.
Meanwhile, an “America first” approach under Trump will likely worsen the longstanding Sunni-Shia proxy wars between Saudi Arabia and Iran. And if the US no longer guarantees its Sunni allies’ security, all
regional powers – including Iran, Saudi Arabia, Turkey, and Egypt – might decide that they can defend themselves only by acquiring nuclear weapons, and even more deadly conflict will ensue.
In Asia, US economic and military primacy has provided decades of stability; but a rising China is now challenging the status quo. US President Barack Obama’s strategic “pivot” to Asia depended primarily on
enacting the 12-country Trans-Pacific Partnership, which Trump has promised to scrap on his first day in office. Meanwhile, China is quickly strengthening its own economic ties in Asia, the Pacific, and Latin
America through its “one belt, one road” policy, the Asian Infrastructure Investment Bank, the New Development Bank (formerly known as the BRICS bank), and its own regional free-trade proposal to rival the
TPP.
If the US gives up on its Asian allies such as the Philippines, South Korea, and Taiwan, those countries may have no choice but to prostrate themselves before China; and other US allies, such as Japan and India,
may be forced to militarize and challenge China openly. Thus, an American withdrawal from the region could very well eventually precipitate a military conflict there.

As in the 1930s, when protectionist and isolationist US policies hampered global economic growth
and trade, and created the conditions for rising revisionist powers to start a world war , similar
policy impulses could set the stage for new powers to challenge and undermine the American-
led international order. An isolationist Trump administration may see the wide oceans to its east and west,
and think that increasingly ambitious powers such as Russia, China, and Iran pose no direct threat to the
homeland.
But the US is still a global economic and financial power in a deeply interconnected world . If left
unchecked, these countries will eventually be able to threaten core US economic and security
interests – at home and abroad – especially if they expand their nuclear and cyberwarfare capacities .
The historical record is clear: protectionism, isolationism, and “America first” policies are a recipe for
economic and military disaster .
 1NC
States CP

The fifty states and relevant subnational territories of the United States should
establish single-payer health insurance plans.

States solve
PPG 8/5, Pittsburgh Post-Gazette editorial board, 8/5/17, "Healthy devolution: For the next
round of health care reform, look to states," www.post-
gazette.com/opinion/editorials/2017/08/06/Healthy-devolution-For-the-next-round-of-
health-care-reform-look-to-states/stories/201708310015
The conservative principle of federalism and the liberal cause of a single-payer option could, for example, be combined.
Both sides understand that the source of ballooning health care costs lies in the system’s vast
complexity , which makes government and insurance companies alike unaccountable in
keeping costs under control . Liberals recognize that simplifying the health insurance
market on free enterprise principles would make insurance utterly unaffordable or simply inaccessible for
millions of Americans. But conservatives fear that a health care service based in Washington would be
too far removed from patient needs . They also bridle against the rationing and wait
times such a system would require to control costs and equalize access. Canadians in need of a hip or knee
replacement wait an average of six months for the procedure. With a much larger population
than Canada — or any of the other countries with single-payer health care and comparable governments —
America under an equivalent system could see substantially worse waiting periods.
But such a system need not be administered from Washington —
a state could do it .
This is where conservatives
and liberals could find common cause: having states create their own
systems . The reason Massachusetts’ and Vermont’s experiments in state-provided health care
failed is that they were basically state-sized Medicaid programs added on top of the
existing Byzantine structure .
Conservatives have good reason to believe the health care systems of Europe and the Pacific Rim
would translate poorly to our much larger democracy and its history of individualism. But they are
wrong to deny the relative success of the universal model in those countries . Rather than
simply copying and pasting that model, consider an adaptation . Government health care
administration could be steered toward the states , building on the American traditions of federalism and choice.
With Congress often paralyzed by partisan conflict , states and cities are taking more
matters into their own hands , in any event.
 1NC
Two Tier CP

The United States federal government should establish universal primary health
care through Community Health Centers, mandatory universal catastrophic health
insurance through means-tested subsidies, and a tax on supplementary private
health insurance, and should eliminate tax privileges for employer-provided
health insurance.

It’s competitive---the plan makes the government the only player in health
insurance, which bans supplemental insurance
Patrick Caldwell 17, Health reporter for Mother Jones. 6/7/17, “Everything You Need to Know
About the Single-Payer Fight in California”
http://www.motherjones.com/politics/2017/06/single-payer-california-brown-trump/
Not unless you go to the VA, the only non-Healthy California system that would remain in place. Private insurance
would no longer exist . The roughly 50 percent of people who get insurance through their employers would switch over.
Medicare, the federal program that provides insurance for the elderly, would cease to operate in the state. So would Medicaid, which
Companies would be banned from selling any form of
insures low-income people.
supplemental insurance that covers the same things as the state’s program. It is single payer after all,
with the singular entity being the California government.

Solves the case by increasing coverage, driving down costs, and fostering
supplementary insurance
Gunnar Almgren 17, Associate Professor of Social Work at the University of Washington,
Health Care as a Right of Citizenship: The Continuing Evolution of Reform, 2017, pp. 143-145
Although there are other formidable considerations, these are the principal contextual limits that shape the boundaries of what is
feasible in health-care financing that will yield some version of a social right to health care for all Americans. The worst-case
scenario for the form of this social right to health care, aside from the status quo of a piecemeal implementation of the ACA, is
eminent health economist Uwe Reinhart's predicted vision of a three-tiered health-care system comprising a poorly funded public
health-care tier that would provide a minimal standard of health services to the poor, a preferred provider network tier for the
middle class, and "boutique" medicine tier for the elites (see "A Conversation," 2013). The best-case scenario for a
far more equitable vision of health-care financing, which this book advances as both optimal and feasible in
light of the four core health-care policy aims developed in chapter 4, is what amounts to a
“soft” two-tiered health-care
system—that is, a health-care system financed by (1) a universal social insurance fund that
provides a basic scheme of health insurance benefits commensurate with adequate financial risk protection and the
functional requisites of democratic citizen- ship and (2) a vibrant voluntary complementary insurance
market that caters to individual and social class demands for more convenience and a broader array of
health insurance benefits. While this vision of a hybrid social insurance/private complementary insurance approach might appear
to be no more than an extension of the current system of financing health care for the nation's older adults, a kind of universal
Medicare, there are three important differences:
1. In contrast to Medicare as we know it; which is dominated by a traditional fee-for-service payment model for approved
services, technologies, and treatments that fuels unnecessary health-care utilization and fragmented health care, the
health-care financing mechanisms of the proposed universal social insurance fund would be
integrated with an outcomes-based health-care delivery system , such as has already
been advanced as essential to the future solvency of the current Medicare program and, to a limited extent, already
implemented under the ACA (The Brookings Institution, 2014).
2. Also in contrast to Medicare as we know it, there would be an individual and family household cap on out-of-pocket
expenditures that is means tested—also akin to current proposals for Medicare reform that include a so-called catastrophic
cap (The Brookings Institution, 2014).
3. As a final contrast to the current version of Medicare, the "catastrophic cap" would be set at a level of
income and assets that would preclude the necessity of purchasing private
 market supplemental insurance as a hedge against unaffordable health-care
expenditures and medical bankruptcy. That is, the role of private supplemental insurance would
be complementary (in the sense of providing a mechanism for the financing of a broader array of nonessential
health-care services and a high standard of personal convenience for those who demand and are willing to pay for it)
rather than as the supplementary private component that is essential to realize an adequate level of health insurance risk
protection and access to comprehensive health care.
In sum, what has been proposed is the broad outline of an approach to the financing of health care that is a credible
alternative to the unrealizable egalitarian ideal of a wholly uniform
comprehensive social insurance fund and the repugnant three-tiered approach that relegates the poor to
minimalist and stigmatized health care. It is a rational approach to health-care financing that balances the desirability of a
basic and adequate social right to health care with the twin realities of a nonegalitarian and heterogeneous society
and an entrenched health insurance industry that thrives on both cultural diversity and social stratification. Tie next
task of this chapter is to address whether the proposed approach is ideologically acceptable.

Primary care at community health centers solves while maintaining a significant

role for supplementary insurance
Carolyn McClanahan 17, health care writer for Forbes, “Rising From The Ashes – A Novel
Bipartisan Approach To Health Care Reform,” 3/27/17,
https://www.forbes.com/sites/carolynmcclanahan/2017/03/27/rising-from-the-ashes-a-novel-
bipartisan-approach-to-health-care-reform/#1f1ef3262ab4
In this proposal, everyone is eligible to receive their care at a CHC, regardless of income or other insurance
status. There will be no eligibility determinations – people can just walk in the door. The centers will be funded directly
through the government based on patient population, and the patient will not receive a bill. Although anyone
could receive care at a CHC, people could choose to get their care elsewhere and pay for it directly
through direct primary care providers not employed by community health centers. This provides an element of choice.
CHCs will be paid directly by the government based on patient population, not fee for service.
CHCs will be required to provide a broad yet well-defined range of services in a patient centered
approach. This includes evening and weekend hours, urgent care, telemedicine, group visits, mental health care, dental and
pharmacy services. Centers will be clean, modern, and comfortable.
The electronic medical record will move from a focus on billing to a focus on telling the patient’s story, so the records will be easier to
use and truly useful for patient care and research. Physicians will spend more time on patient care and less on charting and
administrative work.
Health insurance policies will be guaranteed issue, but costs will be significantly lower because all primary care
will be removed from essential services. Patients will be required to have health insurance coverage to cover care not provided by the
community health system. It can be purchased privately or through Medicaid or Medicare eligibility.
Basic specialty care will be available at CHCs, but specialists within the system will be salary based. They will
serve as consultants to primary care providers and may not always provide care directly. One consultant can theoretically serve
many patients through multiple community health centers.
If a patient develops a serious illness and requires extensive specialty care, expensive treatment, or hospitalization, they will access
their insurance policy that covers high cost events not handled by primary care . Their care will be
provided in the private system of specialists and hospitals.
People can buy more extensive private coverage that may be priced based on multiple factors such as age,
benefits, and area utilization charges. These policies will not be medically underwritten but will require a continuous coverage
provision to be issued and only offered during an open enrollment period.
By providing a base of health care through CHCs, many choices of care will be available:
Receive base care through a CHC and buy private medical insurance to cover care not
provided by CHCs.
 1NC
Midterms DA

Senate Democrats in red states will win reelection now by mobilizing anger over
GOP health care proposals---the plan puts at least 10 Dem seats at risk
Alex Roarty 17, McClatchy writer, and Katie Glueck, 7/18/17, “Democrats giddy over GOP’s
health care flop,” http://www.charlotteobserver.com/news/politics-
government/article162255743.html
For the first time since November, Democrats are feeling good.
The GOP’s quest to repeal and replace Obamacare has collapsed. Its unpopular president is under investigation
by a special counsel. And the rest of the Republican Party’s legislative agenda is, at best, on shaky ground.
Now, Democrats are brimming with a new optimism about next year’s midterm elections. They
think the GOP’s stymied policy plan gives them a chance to make the case that Republicans — in
complete control of Washington — are incompetent , a potentially significant new line of attack for
a party in desperate need of winning over conservative voters in red states and battleground
House districts.
“Democrats are beginning to believe that we can be good at politics again,” said Adam Jentleson, a former top aide to onetime
Senate Majority Leader Harry Reid. “There’s still a heavy, high degree of trauma that still has not worn off from election night, but
we’re finding our footing step by step.”
Even if Congress tries to put health care behind it , top Democratic operatives say it will remain a
major issue for voters , especially those who voted for House Republicans in special elections earlier this year. And
even if the issue fades, they’re hopeful the loss will be offset by an angry conservative base that wonders why it should even turn out
for the next election.
Not even GOP strategists are sure the Democrats are wrong about that last point.
“Right now, it's devastating,” said one conservative strategist working on the midterms. If lawmakers don't find another way to
repeal the law, “it will be absolutely devastating. It's so myopic of Republicans in terms of how they're handling this, because where
they’re going to end up is back in the minority, like we were in ‘09.”
The Senate's health plan insures more Americans and reduces the deficit more than the House's plan did, but also cuts Medicaid
more drastically than any plan to date, according to the a report by the nonpartisan Congressional Budget Office.
The conservative base, this strategist said, doesn't understand how Republicans could vote multiple times to repeal the law under
President Barack Obama, but fail to reach the same consensus when the GOP actually has power to act.
"Why were they able to get it done under Obama, and they're not getting anything done now?" the strategist said. “The challenge
Republicans are going to have in turning out conservatives is like nothing we've seen since ‘06.”
Democrats and Republicans alike think the GOP still has time to resuscitate its agenda, maybe as early as later this summer when
the party has said it will take up tax reform as its next major initiative. Democrats also say they think Republicans will try again to
repeal Obamacare, whether in the coming weeks or even into next year.
But if they don’t, Republicans run the risk of going before voters next year with nothing to show for
their time in office .
And Democrats say that could change the nature of their attacks, switching from one focused on
the details of the GOP’s agenda to the party’s broader failure to govern effectively .
“This is what happens when you have a Republican Congress that is not used to governing,” said John Lapp, a Democratic strategist.
“Turns out health care is really hard, really difficult."
Lapp knows how potent a competence argument can be: He was the executive director of the Democratic Congressional Campaign
Committee in 2006, the last time House Democrats retook a majority.
That year, the party capitalized on the aftermath of Hurricane Katrina and the then-unpopular Iraq War to depict Republicans as
incompetent, an argument that — in part — helped them win a net of 31 seats in the House. (Democrats need to win 24 seats next
year to win a majority, though the map of battleground seats is more difficult this time around.)
Lapp and other Democrats say they don’t think a failed legislative agenda rises to the level of either of those events. But they added
that acompetence argument can reach red-state voters in red states and right-leaning
House districts, the kind Democrats need to win over in a year when they’re defending 10
Senate seats in states Trump won last year.
“It
lines up well with the map and the types of the people who are running and the types of
arguments they’re going to want to make ,” Jentleson said. “Republicans are certainly handing us a ton of
ammunition to make the competence case.”
Republicans will face two additional governing tests later this year, when they must pass a budget to avoid a government shutdown
and raise the debt ceiling.
Democrats have spent months vowing that the Republican health care bill would be the biggest
issue of the 2018 midterm elections, legislation that would alienate elderly voters and some
of Trump’s supporters who depend on government assistance for health insurance.

Enacting single-payer dooms incumbent Democrats in states Trump won---it

eliminates the advantage of running against unpopular GOP plans and triggers
voter backlash against socialized medicine
Jonathan S. Tobin 17, the opinion editor of JNS.org and a contributor to National Review
Online, 6/6/17, “Will the Left Help Republicans Get Their Health-Care Mojo Back?,”
http://www.nationalreview.com/article/448324/democrat-single-payer-health-care-dream-
could-help-republicans-win-2018-midterm
The only thing that can save the GOP from being sunk by its Obamacare repeal is the
Democrats’ embrace of a single-payer scheme.
Health care was the making of the current Republican congressional majorities and a key factor in Donald Trump’s victory. But
with the GOP sinking under the weight of its unpopular efforts to repeal and replace the A ffordable
C are A ct, it could well become the factor that breaks the party . Unless , that is, Democrats
save Republicans from themselves by following the Bernie Sanders wing of their party off the proverbial
cliff.
At the moment, members of the Republican caucus are behaving pretty much the same way Democrats did in 2010. They
are shunning town-hall meetings lest they get tarred and feathered by angry constituents .
With the party divided between those who think the repeal goes too far and those who think it doesn’t go far enough, the issue
has become a cudgel that Democrats are using to their advantage. As the 2018 election cycle
approaches, that problem may only get worse . This time, it could be Republicans who will have to
defend an unpopular bill and who will be blamed for rising insurance premiums — even if,
as they will argue, the collapse of Obamacare is the fault of its architects rather than those who wish to undo it.
The result could be a stunning reversal of fortune that puts Nancy Pelosi back in the speaker’s chair .
Anger about the passage of Obamacare helped Republicans take control of the House of Representatives in 2010. Then, in 2014, the
shaky rollout of the Affordable Care Act and the realization that President Obama was lying when he promised many times that
consumers could keep their plans and doctors if they liked them helped the GOP take the Senate. And though their repeated futile
attempts to repeal the law while Obama was in the White House got them nowhere, the slow-motion collapse of the law ensured that
it remained unpopular.
But along with the spoils of victory comes the responsibility of governing. While the “burn it down” spirit of the Tea Party bolstered
the GOP in opposition, it is of little use to a party that, whether it likes it or not, now owns the problem Obama left for them.
The basic political problem of Obamacare wasn’t so much that it made government responsible for the one-sixth of the American
economy that is the health-care industry. Rather, it was that — unlike other historic attempts by the Democratic party to expand
entitlements such as Social Security and Medicare — it adversely affected the lives and the pocketbooks of a large portion of the
American electorate. It was the
voices of those losers under Obamacare that sounded the loudest as
Republicans won the 2010 and 2014 midterms. But once they got the chance to do what they’ve been talking about
for seven years, Republicans found they had no palatable answer to the question of how to handle the
millions of Americans who had benefited from Obamacare. It is that group that is now hounding Republican
members of the House and Senate and giving confidence to a Democratic party that hit bottom last fall when it unexpectedly lost the
presidency to Trump.
The GOP’s built-in advantages in House races , together with the large number of
Senate Democrats (including many in red states carried by Trump ) facing reelection,
mean that the math still favors Republicans in 2018 . But the party is facing the possibility
that their recent midterm magic is about to disappear . Driven by anger over everything Trump
does and stands for, and spooked by the prospect of a new health-care law that will be every
bit as messy as Obamacare, a Democratic wave next year is now a possibility.
But the Democrats are, as they proved in 2016, a party fully capable of seizing defeat from the jaws
of victory . And if a Sunday New York Times front-page feature is any indication, they might be about to do just that.
According to the Times, Democrats are not content to merely oppose Republicans’ ham-handed efforts to overturn or fix
Obamacare. The rising tide of “resistance”
against Trump has created a pronounced tilt to the left
among Democrats. As was obvious last year, it is hard-core left-wingers such as Bernie Sanders and Elizabeth Warren who
speak for Democratic activists, not more mainstream figures like last year’s loser, Hillary Clinton.
That means Democrats
are increasingly speaking up in favor of expanding government control
of health care rather than merely preserving the current situation. Support among liberal Democrats for
a single-payer system is no longer an ideal to be longed for but a nonnegotiable demand. It is probably a given that whoever the
Democrats nominate for president in 2020 will support a universal health-care system. Unions, which are still the shock troops of
the Democrats, are now openly calling for their party to back some form of socialized medicine — and they are getting a hearing.
No one on the left has a plausible plan for paying for this vast expansion of a federal
entitlement or any clear idea of how to deal with the havoc it would cause, but that isn’t stopping Democrats from embracing a
measure that goes far beyond what President Obama forced down the country’s throat on a party-line vote in 2010.
Democrats know that they are riding a wave of sympathy for the idea of universal health care. After all, late-
night host Jimmy Kimmel’s pleas to ensure that all are covered went viral last month. But
there is a difference between
reforming an existing entitlement (the GOP’s goal) and supporting
getting rid of or
socialized medicine . And that’s where, amid the current Republican turmoil on Obamacare,
hopes for a GOP recovery begin .
At this point , beset by their seeming inability to govern and by Trump’s shortcomings, Republicans have
lost the focus they had in previous midterms. They know that running for reelection while
defending a repeal-and-replace law that even most of their own voters don’t like could be a death wish
outside of the deepest red districts and states. But running against a single-payer system
and socialized medicine is the potential cure for all that ails the GOP .
If the Democratic base bullies swing-district Democrats into backing a single-payer system,
they will be throwing away the advantage that the Republicans’ health-care-legislation
problems have handed them. Liberals might believe that history is on their side, with the backlash against Obamacare being
merely a bump on the road to the inevitable adoption of universal health care. But running on such a platform is the
one thing that could revive a dispirited conservative base and cause it to turn out
in the kind of numbers that won Congress for the Republicans . Instead of a historic
opportunity to fulfill their liberal dream, single payer health-care could be the formula that ensures the GOP will hold the House
in 2018.

Filibuster-proof majority means the GOP expands offshore drilling---locks in

warming which causes extinction
Patrick Parenteau 17, professor of law at Vermont Law School, 1/3/17, “Will Trump Scuttle
Obama's Offshore Drilling Bans?,” https://www.desmogblog.com/2017/01/03/will-trump-
scrap-obama-s-offshore-drilling-bans
President Obama gave environmental advocates a Christmas present when he announced in late December that he was
banning oil and gas drilling in huge swaths of the Arctic and Atlantic oceans. This action
“ indefinitely ” protects almost 120 million acres of ecologically important and highly sensitive marine environments from the
risks of oil spills and other industrial impacts.
President Obama acted boldly to conserve important ecological resources and solidify his
environmental legacy. But by making creative use of an obscure provision of a 1953 law, Obama ignited a
legal and political firestorm .
Republicans and oil industry trade groups are threatening to challenge the ban in court or through
legislation . They also contend that the Trump administration can act directly to reverse it. But a close reading of the law
suggests that it could be difficult to undo Obama’s sweeping act.
The power to withdraw
Congress passed the law now known as the O uter C ontinental S helf L ands A ct in 1953 to assert federal control over
submerged lands that lie more then three miles offshore, beyond state coastal waters. Section 12(a) of the law authorizes the
president to “withdraw from disposition any of the unleased lands of the outer Continental
Shelf.”
Starting in 1960 with the Eisenhower administration, six presidents from both parties have used this power. Most withdrawals were
time-limited, but some were long-term. For example, in 1990 President George H. W. Bush permanently banned oil and gas
development in California’s Monterey Bay, which later became a national marine sanctuary.
President Obama used section 12(a) in 2014 to protect Alaska’s Bristol Bay, one of the most productive wild salmon fisheries in the
world. In 2015 he took the same step for approximately 9.8 million acres in the biologically rich Chukchi and Beaufort seas.
Obama’s latest action bars energy production in 115 million more acres of the Chukchi and Beaufort seas – an area known as
the “Arctic Ring of Life” because of its importance to Inupiat Peoples who have lived there for millennia. The order also
withdraws 3.8 million acres off the Atlantic Coast from Norfolk, Virginia to Canada, including
several unique and largely unexplored coral canyons.
Why Obama acted
In a Presidential Memorandum on the Arctic withdrawals, Obama provided three reasons for his action. First, he asserted, these
areas have irreplaceable value for marine mammals, other wildlife, wildlife habitat, scientific research and Alaska Native subsistence
use. Second, they are extremely vulnerable to oil spills. Finally, drilling for oil and responding to spills in Arctic waters poses unique
logistical, operational, safety and scientific challenges.
In ordering the Atlantic withdrawals, Obama cited his responsibility to “ensure that the unique resources associated with these
canyons remain available for future generations.”
Market forces support Obama’s action. Royal Dutch Shell stopped drilling in the Chukchi Sea in 2015 after spending US$7 billion
and drilling in what proved to be a dry hole. Since 2008 the Interior Department has canceled or withdrawn a number of sales in
Alaskan waters due to low demand. Shell, ConocoPhillips, Statoil, Chevron, BP and Exxon have all to some degree abandoned
offshore Arctic drilling.
Low oil prices coupled with high drilling costs make business success in the region a risky prospect. Lloyd’s of London forecast this
scenario in a 2012 report that called offshore drilling in the Arctic “a unique and hard-to-manage risk.”
What happens next?
Critics of President Obama’s action, including the state of Alaska and the U.S. Chamber of Commerce, say they may challenge
Obama’s order in court, in hopes that the Trump administration will opt not to defend it. But environmental groups, which hailed
Obama’s action, will seek to intervene in any such lawsuit.
Moreover, to demonstrate that they have standing to sue, plaintiffs would have to show that they have suffered or face imminent
injury; that this harm was caused by Obama’s action; and that it can be redressed by the court. Market conditions will make this very
difficult.
The Energy Information Administration currently projects that crude oil prices, which averaged about $43 per barrel through 2016,
will rise to only about $52 per barrel in 2017. Whether these areas will ever be commercially viable is an open question, especially
since rapid changes are taking place in the electricity and transportation sectors, and other coastal areas are open for leasing in
Alaska’s near-shore waters and the Gulf of Mexico.
The Royal Dutch Shell drilling rig Kulluk broke loose and ran aground near Kodiak Island in the Gulf of Alaska as it was being towed
to Seattle for winter maintenance in December 2012. This Coast Guard overflight video shows the harsh conditions along Alaska’s
coast in winter.
Alternatively, Donald Trump could issue his own memorandum in office seeking to cancel Obama’s. However, section 12(a)
does not provide any authority for presidents to revoke actions by their predecessors. It delegates
authority to presidents to withdraw land unconditionally. Once they take this step, only Congress can
undo it .
This issue has never been litigated. Opponents can be expected to argue that Obama’s use of section 12(a) in this manner is
unconstitutional because it violates the so-called “nondelegation doctrine,” which basically holds that Congress cannot delegate
legislative functions to the executive branch without articulating some “intelligible principles.”
However, one could argue that Obama’s action was based on an articulation of intelligible principles gleaned from the stated policies
of the OCSLA, which recognizes that the “the outer Continental Shelf is a vital national resource reserve held by the Federal
Government for the public.” The law expressly recognizes both the energy and environmental values of the OCS. Thus President
Obama’s decision reflects a considered judgment that the national interest is best served by protecting the unique natural resources
of these areas, while at the same time weaning the nation from its dangerous dependence on fossil fuels.
The section 12(a) authority is similar in some respects to the authority granted by the Antiquities Act, which authorizes the president
to “reserve parcels of land as a part of [a] national monument.” Like the OCSLA, the Antiquities Act does not authorize subsequent
presidents to undo the designations of their predecessors. Obama has also used this power extensively – most recently, last week
when he designated two new national monuments in Utah and Nevada totaling 1.65 million acres.
Some laws do include language that allows such actions to be revoked. Examples include the Forest Service Organic Administration
Act, under which most national forests were established, and the 1976 Federal Land Policy and Management Act, which sets out
policies for managing multiple-use public lands. The fact that Congress chose not to include revocation language in the OCSLA
indicates that it did not intend to provide such power.
What can the new Congress do?
Under Article IV of the Constitution, Congress has plenary authority to dispose of federal property as it
sees fit. This would include the authority to open these areas to leasing for energy
development . Members of Alaska’s congressional delegation are considering introducing legislation to override Obama’s
drilling ban. But
Democrats could filibuster to block any such move , and Republicans – who
will hold a 52-48 margin in the Senate – would need 60 votes to stop them.
On the other hand, Congress may be content to let President-elect Trump make the first move and see how it goes in court. If Trump
attempts to reverse the withdrawal, environmental groups contesting his decision would face some of the same obstacles as an
industry challenge to Obama’s action. It could be especially challenging for environmental groups to show that the claim is “ripe” for
judicial review, at least until a post-Obama administration acts to actually open up these areas for leasing. That may not occur for
some time, given the weak market for the oil in these regions.
In the meantime, this decision is a fitting capstone for a president who has done everything within
his power to confront the existential threat of climate change and rationally move
the nation and the world onto a safer and more sustainable path .
Econ
 Econ D---1NC
Economic crises don’t cause war
Christopher Clary 15, Ph.D. in Political Science from MIT, Postdoctoral Fellow, Watson
Institute for International Studies, Brown University, “Economic Stress and International
Cooperation: Evidence from International Rivalries,” April 22, 2015,
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2597712
Do economic downturns generate pressure for diversionary conflict? Or might downturns encourage austerity and economizing
behavior in foreign policy? This paper provides new evidence that economic stress is associated with
conciliatory policies between strategic rivals. For states that view each other as military threats, the biggest step
possible toward bilateral cooperation is to terminate the rivalry by taking political steps to manage the competition. Drawing on
data from 109 distinct rival dyads since 1950, 67 of which terminated , the evidence suggests
rivalries were approximately twice as likely to terminate during economic downturns than they were
during periods of economic normalcy. This is true controlling for all of the main alternative
explanations for peaceful relations between foes (democratic status, nuclear weapons possession, capability imbalance,
common enemies, and international systemic changes), as well as many other possible confounding variables. This
research questions existing theories claiming that economic downturns are associated with diversionary war, and instead argues that
in certain circumstances peace may result from economic troubles .
Defining and Measuring Rivalry and Rivalry Termination
I define a rivalry as the perception by national elites of two states that the other state possesses conflicting interests and presents a
military threat of sufficient severity that future military conflict is likely. Rivalry termination is the transition from a state of rivalry
to one where conflicts of interest are not viewed as being so severe as to provoke interstate conflict and/or where a mutual
recognition of the imbalance in military capabilities makes conflict-causing bargaining failures unlikely. In other words, rivalries
terminate when the elites assess that the risks of military conflict between rivals has been reduced dramatically.
This definition draws on a growing quantitative literature most closely associated with the research programs of William Thompson,
J. Joseph Hewitt, and James P. Klein, Gary Goertz, and Paul F. Diehl.1 My definition conforms to that of William Thompson. In
work with Karen Rasler, they define rivalries as situations in which “[b]oth actors view each other as a significant political-military
threat and, therefore, an enemy.”2 In other work, Thompson writing with Michael Colaresi, explains further:
The presumption is that decisionmakers explicitly identify who they think are their foreign enemies. They orient their military
preparations and foreign policies toward meeting their threats. They assure their constituents that they will not let their adversaries
take advantage. Usually, these activities are done in public. Hence, we should be able to follow the explicit cues in decisionmaker
utterances and writings, as well as in the descriptive political histories written about the foreign policies of specific countries.3
Drawing from available records and histories, Thompson and David Dreyer have generated a universe of strategic rivalries from
1494 to 2010 that serves as the basis for this project’s empirical analysis.4 This project measures rivalry termination as occurring on
the last year that Thompson and Dreyer record the existence of a rivalry.5
Why Might Economic Crisis Cause Rivalry Termination?
Economic crises lead to conciliatory behavior through five primary channels. (1) Economic crises lead to austerity
pressures , which in turn incent leaders to search for ways to cut defense expenditures. (2)
Economic crises also encourage strategic reassessment , so that leaders can argue to their peers and their
publics that defense spending can be arrested without endangering the state. This can lead to threat deflation, where
elites attempt to downplay the seriousness of the threat posed by a former rival. (3) If a state faces multiple
threats, economic crises provoke elites to consider threat prioritization , a process that is postponed
during periods of economic normalcy. (4) Economic crises increase the political and economic
benefit from international economic cooperation . Leaders seek foreign aid, enhanced trade,
and increased investment from abroad during periods of economic trouble. This search is made easier if tensions are
reduced with historic rivals. (5) Finally, during crises, elites are more prone to select leaders who are perceived as capable of
resolving economic difficulties, permitting the emergence of leaders who hold heterodox foreign policy views. Collectively, these
mechanisms make it much more likely that a leader will prefer conciliatory policies compared to during periods of economic
normalcy. This section reviews this causal logic in greater detail, while also providing historical examples that these mechanisms
recur in practice.
 Offense
Single-payer decks healthcare industry jobs---insurance workers, administrative
personnel, and physicians all lose out
Margot Sanger-Katz 16, domestic correspondent for The New York Times, where she writes
about health care. 5/16/16, “A Single-Payer Plan From Bernie Sanders Would Probably Still Be
Expensive” https://www.nytimes.com/2016/05/17/upshot/why-single-payer-health-care-
would-probably-still-be-expensive.html
The Sanders plan would require a huge reorganization of the country’s health care system.
Overnight, it would put the private insurance industry out of business , along with many
other businesses that support it. It would shift billions of dollars of spending from individuals,
workers and states into the federal budget. Doing that might well reduce some of the country’s health care spending that is
going toward insurer profits and paper-pushing.
But more than 80 percent of the dollars we currently spend on health care actually go toward health care. And
making big
cuts all at once to doctors and hospitals could cause substantial disruptions in care. Some
hospitals would go out of business . Some doctors would default on their mortgages and
student loans. Even if the country decided that medicine should become a more middle-class profession — not an obvious
outcome, given the substantial public support for the medical professions — it would be difficult to get there at once.

The healthcare industry powers the economy---job losses in the sector cause
economic recession
Chad Terhune 17, works for the Kaiser Health News, a nonprofit health newsroom. 4/25/17,
“In bid to revamp health care, Trump could hurt one of U.S.'s biggest job creators”
http://money.cnn.com/2017/04/25/news/economy/health-care-jobs-trump-
obamacare/index.html
In many ways, the health care industry has been a great friend to the U.S. economy. Its plentiful jobs
helped lift the country out of the Great Recession and, partly due to the Affordable Care Act, it now employs
one in nine Americans — up from one in 12 in 2000.
As President Donald Trump seeks to fulfill his campaign pledge to create millions more jobs, the industry
would seem a promising place to turn . But the business mogul also campaigned to repeal Obamacare and
lower health care costs — a potentially serious job killer.
"The goal of increasing jobs in health care is incompatible with the goal of keeping health care affordable," said Harvard University
economist Katherine Baicker, who sees advantages in trimming the industry's growth. "There's a lot of evidence we can get more
bang for our buck in health care. We should be aiming for a health care system that operates more efficiently and effectively. That
might mean better outcomes for patients and fewer jobs."
But the country has grown increasingly dependent on the health sector to power the economy .
Thirty-five percent of the nation's job growth has come from health care since the recession hit in late
2007, the single biggest sector for job creation.
Hiring rose even more as coverage expanded in 2014 under the health law and new federal dollars flowed in. It gave hospitals,
universities and companies even more reason to invest in new facilities and staff. Training programs sprang up to fill the growing job
pool. Cities welcomed the development — and the revenue. Simply put, rising health spending has
been good for some economically distressed parts of the country, many of which voted for
Trump last year.
In Morgantown, West Virginia, the West Virginia University health system just opened a 10-story medical tower and hired 2,000
employees last year. In Danville, Pennsylvania, the Geisinger Health System has added more than 2,200 workers since July and is
trying to fill 2,000 more jobs across its 12 hospital campuses and a health plan. Out West, the UCHealth system in Colorado
expanded its Fort Collins hospital and is building three hospitals in the state.
In cities such as Pittsburgh, Cleveland and St. Louis, health care has replaced dying industries
like coal and heavy manufacturing as a primary source of new jobs.
"The industry accounts for a lot of good middle-class jobs and, in many communities, it's the
single-largest employer," said Sam Glick, a partner at the Oliver Wyman consulting firm in San Francisco. "One of the
hardest decisions for the new Trump administration is how far do they push on health care costs at the expense of jobs in health
care."
House Republicans, with backing from Trump, took the first swipe. Their American Health Care Act sought to roll back the current
health law's Medicaid expansion and cut federal subsidies for private health insurance. The GOP plan faltered in the House, but
Republican lawmakers and the Trump administration are still trying to craft a replacement for Obamacare.
Neither the ACA nor the latest Republican attempt at an overhaul tackle what some industry experts and economists see as a serious
underlying reason for high health care costs: a system bloated by redundancy, inefficiency and a growing number of jobs far
removed from patient care.
Labor accounts for more than half of the $3.4 trillion spent on U.S. health care, and medical professionals from health aides to nurse
practitioners are in high demand. But the sheer complexity of the system also has spawned jobs for
legions of data-entry clerks, revenue-cycle analysts and medical billing coders who must
decipher arcane rules to mine money from human ills.
For every physician, there are 16 other workers in U.S. health care . And half of those 16 are in
administrative and other nonclinical roles, said Bob Kocher, a former Obama administration official who worked on
the Affordable Care Act. He's now a partner at the venture capital firm Venrock in Palo Alto, California.
"[W]hat's driving our health insurance premiums is that we are paying the wages of a whole bunch of people who aren't involved in
the delivery of care. Hospitals keep raising their rates to pay for all of this labor," Kocher said.
Take medical coders. Membership in the American Academy of Professional Coders has swelled
to more than 165,000, up 10,000 in the past year alone. The average salary has risen to nearly
$50,000.
 Offense #2

Deficit spending spikes interest rates

Justin Bogie 8/16, is a senior policy analyst in fiscal affairs at The Heritage Foundation.
8/16/17, “America Is Heading Straight Into Its Most Avoidable Crisis Ever”
http://dailysignal.com/2017/08/16/america-is-heading-straight-into-its-most-avoidable-crisis-
ever/
The consequences of Washington’s excessive spending will manifest in several ways.
For one, such a massive federal debt stifles economic growth . Interest rates could rise more
steeply, either at the behest of creditors seeking protection from the risk associated with investing
in a country with an unsustainable debt trajectory, or simply because the government is
attempting to sell more bonds than people are willing to buy at current rates.
Regardless of the pathway, higher interest rates would raise the cost of debt and lead the government to either tax more or borrow
even more money.
According to the Congressional Budget Office, a large amount of federal debt will also restrict the government’s
ability to use tax and spending policies to respond to unforeseen circumstances, such as
an economic downturn or financial crisis.
As a result, those unexpected challenges could have a much larger negative impact than they otherwise would have.

Slow tightening creates global economic stability and prevents downturn---faster

pace causes a financial crash
Stratfor 16---Stratfor Geopolitical Diary, “A Globally Fraught Fed Rate Hike,”
https://www.stratfor.com/geopolitical-diary/globally-fraught-fed-rate-hike)
The value of the dollar has a ripple affect that reaches all countries---accelarated cycles that are
delinked from previous announcements dampen ecnomoic activity---rate hikes decimate fragile
Italy’s fragile banks and lowers of the value of Chinese reserves, creating a financial storm that
outweighs any aff internal link
Today, the Federal Reserve raised the U.S. benchmark interest rate for the first time in a year and only the second time in a decade. That the move had been widely expected and the increase was held to a quarter

of a percentage point does not detract from its significance.The U.S. dollar's central role in the global economy means that ripples
from Fed policy shifts reach all countries . The central bank's most recent interest rate hike in December 2015
sparked a dramatic reaction in international capital markets as investors sold off risky assets over the
next two months. Signals by the Fed that another rate hike was not imminent stopped the capital flight to safer

havens. The chance of a repeat of that drama as 2017 dawns appears to be somewhat lessened by an overall improvement in the global economic outlook

and less volatile markets. That said, all of last year's fragilities — such as teetering Italian banks, Chinese capital

outflows, and notable dollar-denominated debt exposure in the emerging markets — are still in place, so
there remains a high risk that today's move will trigger economic turbulence in the coming months.
Because the dollar reigns supreme in global markets, both as a currency in which to hold savings and as a medium used to conduct international
transactions, other currencies are measured against it. (A stronger dollar weakens other currencies in comparison.) So higher interest rates in the U nited S tates

increase the dollar's allure as a means to hold money because of the higher return it offers for international investors. Of
course, the markets anticipate these moves in advance, so the dollar-strengthening from this rate hike
had already occurred, largely over the past few months. The key question going forward is when and how
often more rate hikes will occur . An accelerated cycle of rate increases will result in
continued market adjustments and thus an even stronger dollar .
Donald Trump's election has increased the expectation of a higher pace of Fed rate hikes. His campaign platform was based on policies that would both increase economic activity — such as greater infrastructure

The central bank's key job is to

spending and corporate tax cuts — and raise barriers to imports that could boost prices domestically. Such plans are recipes for higher inflation.

keep prices stable, which it does by adjusting interest rates. Higher rates raise the costs of borrowing and dampen
economic activity. Thus, increasing inflation generally will lead to more rate increases. There is good reason to
believe that this linkage will hold, at least for the remainder of Federal Reserve Board Chair Janet Yellen's term. In 2018, her position
will be up for renewal, raising the possibility that she might be replaced by a leader more resistant to interest rate hikes, particularly if the new administration proves to be less concerned about inflation than it is
about about sustaining growth. But for the time being, at least, the path to higher spending, higher inflation and higher rates resulting in a stronger dollar appears to be set.
One notable aspect of today's move by the Fed is that it increases the gap between the U nited S tates
and other major currency areas like Japan and the eurozone, both of which have negative interest rates and are still following aggressive
bond-buying policies. Such divergence among the world's major central banks is historically rare , and as

the disparity grows, it will boost the gains to be made by borrowing in the lower-rate countries
and lending in the higher-rate ones. Such flows of capital among the world's major
centers can be destabilizing and indeed might have contributed to the instability on display after the last Fed rate hike. With this in mind, recent moves by the Bank of
Japan (which has stepped back from its quantitative focus on bond-buying and begun stabilizing bond prices) and the European Central Bank (which has reduced its rate of bond purchases) could be seen as
attempts to reduce the divergence effect ahead of the U.S. hike to keep the gap under control. That said, each central bank also had other reasons for its strategy shift, from the dwindling supply of bonds available
for purchase by the Japanese bank to the overall improvement in global economic circumstances and increasing signs of general inflation as commodity prices have stabilized.

the improving global economic climate has allowed the market to largely ride out
In fact,

developments that at the beginning of 2016 seemed to be filling it with panic . Last December's U.S. rate hike made
China's yuan look overvalued, especially following the move in 2015 by the People's Bank of China to break its currency's dollar peg. The resulting rapid increase in capital outflows prompted the Chinese central
bank to spend $100 billion a month in foreign exchange reserves to staunch the bleeding. The trend has resumed over the past few months, but to a lesser degree. The yuan's decline has been consistent, and

China's reserves have shrunk by around $40 billion per month, but this has not caused much disturbance in the markets. More
recently, instability in the Italian banking system , corresponding to political uncertainty in the wake of Italy's failed

constitutional referendum, has created a much more muted reaction than it did in January , when the banks were, at least on paper,

considerably less vulnerable. In sum, global markets this year generally have been taking events in stride — even

the Brexit referendum in June, when Britain became the first country to choose to leave the European Union, surely a highly unsettling event.
This market calmness can be traced to the announcement in February that the Fed would be
tightening the monetary supply more slowly than had been expected . There is a
danger that an accelerated rate-hike cycle, which by all appearances began today,
could re-create the conditions that led to the upsets that began the year. With Italy's banks
now at an extremely fragile point, and with China's $3 trillion in reserves now 25 percent lower
than they were in 2014, countries around the world are hoping that another financial
storm will not descend .
 Offense #3
Single payer’s massive tax hikes dis-incentivize employment---causes the loss of
11.6 million jobs
Yevgeniy Feyman 16, is a fellow and deputy director of health policy with the Manhattan
Institute. 2/11/16, “The Single-Payer Sacrifice: 11.6 Million Jobs”
http://www.realclearpolicy.com/blog/2016/02/11/single-
payer_sacrifice_116_million_jobs_1551.html
Democratic candidate Bernie Sanders recently released his health-care plan: a government-run single-payer system
for the U.S., similar to what many European countries have. Criticism of the plan has so far focused on its lack of political
feasibility, but there is an even more important reason to be wary: Accounting for costs and tax
increases, it would reduce labor supply by 11.6 million . In a struggling economy, with
tepid wage growth, hurting employment should be the last thing on any politician’s agenda.
The plan truly promises everything under the sun. Not only will everyone be able to get any medical treatment needed — with no
cost at the point of service — but the plan won’t require a terribly high tax increase. The funding
mechanism boils down to an increase in payroll taxes: an “income-based premium” of 2.2 percent for individuals
and a tax of 6.2 percent on employers. Because economists, as well as the non-partisan Congressional
Budget Office and the Joint Committee on Taxation, recognize that the "employer share" of
payroll taxes is mostly borne by workers in the form of lower wages, this translates to an 8.4
percentage point increase overall.
These elements of the plan were the first to draw criticism. Not only do most single-payer countries fund their health-care systems
with higher taxes on the middle class, but they also typically exclude a variety of services and drugs from coverage. Without being
able to say no to some expensive drugs and services, the government would have a tough time driving down prices.
But perhaps the most stinging rebuke came from veteran health economist Kenneth Thorpe of
Emory University. In Thorpe’s estimation, Sanders’ plan would require a total tax hike of 20
percentage points , and would cost $1.1 trillion more each year than the campaign has
estimated. This is at least partly because the government would have to pay more than
Medicare’s low rates to keep doctors and hospitals in the system, and making health care free at
the point of delivery would also increase use of health-care services.
These criticisms alone should make Sanders’ plan a nonstarter. But that’s not the end of the laundry list of problems with the
proposal.
Few economists would dispute that tax rates can affect people’s decision to work. The higher a
person’s marginal tax rate, the bigger the disincentive to work more ; a 50 percent rate, for
instance, means that earning another dollar nets only an extra 50 cents. This is what economists
call the “substitution” effect.
But there is a countervailing effect as well. As you pay more in taxes, you may want to try to
maintain your previous standard of living, and thus decide to work more. This is called the
“income effect.”
The ultimate effect of taxes on the workforce depends on which of these forces is stronger. The CBO, for instance, has come
to the conclusion that the A ffordable C are A ct’s combination of taxes, tax credits, and
mandates will reduce full-time equivalent employment (one full-time equivalent employee works 40 hours per
week; two part-time workers equal one full-time equivalent) by about 2 million in 2025.
As it turns out, the ACA’s many taxes are relatively insignificant compared with those in the
Sanders plan. Applying the CBO’s approach and assumptions, along with tax data from the
National Bureau of Economic Research, to the Sanders plan indicates that the campaign’s
assumed taxes would reduce employment by 4.9 million full-time equivalent workers in
2025. Not an insignificant number.
When we take Thorpe’s more realistic assumptions and apply the same approach, the fully-
implemented plan reduces employment by a whopping 11.6 million full
-time equivalent workers. Under these assumptions, the average marginal tax rate would
grow from around 22 percent to 42 percent, while the average total tax rate would increase from
11 percent to 31 percent. At the upper end of income, total tax rates would be far beyond 50
percent. And none of this factors in state and local taxes.
Of course, some of drop in employment might be considered “voluntary.” Some would stop working because they no longer
needed to be employed to receive health insurance — escaping "job lock," as House Minority Leader Nancy Pelosi once put it. But
others would simply find it meaningless to put in extra hours or look for more lucrative positions
when so much of their earnings get sucked away as taxes.
For employers, this would all mean a large increase in hiring costs , too. Sure, as Sanders’
campaign likes to remind us, employers would no longer pay for private health insurance. But economists also recognize
that health insurance is a form of compensation. And if you cut health insurance (with or
without raising taxes), wages must in turn go up.
Sanders might be correct that health-care reform is unfinished. There remain many problems with the ACA that must be addressed
and many problems that the ACA left untouched. But it’s quickly becoming apparent that the Sanders plan for American health care
is the wrong way to fix these problems and offers a bad deal for workers.
 Costs Not K2 Econ---1NC
Health care costs aren’t key to the economy
John R. Graham 16, a public-policy analyst, is Director of the Health Technology Forum: DC;
and a Senior Fellow at the National Center for Policy Analysis. 4/20/16, “The U.S. Health
System Is Not An Economic Burden”
https://www.forbes.com/sites/theapothecary/2016/04/20/the-u-s-health-system-is-not-an-
economic-burden/#10720a622832
Health spending consumes a higher share of output in the United States than in other countries .
In 2013, it accounted for 17% of Gross Domestic Product. The next highest country was France, where health
spending accounted for 12% of GDP. Critics of U.S. healthcare claim this shows the system is too expensive
and a burden on our economy, demanding even more government intervention. This conclusion is misleading
and leads to poor policy recommendations, according to new research published by the National Center for Policy
Analysis (U.S. Health Spending is Not A Burden on the Economy, NCPA Policy Report No. 383, April 2016).
Discussing health spending in dollars, rather than proportion of GDP, the report notes Americans spent $9,086 per capita on
healthcare in 2013, versus only $6,325 in Switzerland, the runner-up. (These dollar figures are adjusted for purchasing power parity,
which adjusts the exchange rates of currencies for differences in cost of living). This big difference certainly invites us to question
whether we are getting our money’s worth. However, it is not clear that this spending is a burden on
Americans, given our very high national income .
After subtracting health spending from U.S. GDP, we still had $44,049 per capita to spend on all
other goods and services we value. Only two countries, Norway and Switzerland, beat the U nited
S tates on this measure. But compared to larger developed countries , Americans have
higher income per capita after subtracting healthcare spending . For example, in the United
Kingdom, GDP per capita after health spending was only $34,863 in 2013. So, even though
Americans spent significantly more on healthcare than the British, the average American
enjoyed $9,185 more GDP after health spending than his British peer; and just under $6,000
more than his Canadian neighbor.
Britain socialized its health system shortly after World War II, completing the work by 1948. Canada’s healthcare was more
gradually socialized by provincial and federal governments during the period 1947 through 1966. Many assert these so-called single-
payer systems relieved the burden of private payment from citizens and made the economy more productive.
On the contrary: Since 1960, the U.S. economy has outperformed all comparable developed countries
except Norway and Switzerland with respect to economic growth, after subtracting health
spending. From 1960 through 2013, the share of U.S. GDP allocated to healthcare more than
tripled. However, this had no impact on the ability of the U.S. economy to deliver
high GDP per capita, outside healthcare . Adjusted for purchasing power parity, U.S. health spending
increased $8,937, while GDP per capita increased $50,269, from 1950 through 2013. Thus, GDP per capita available for other goods
and services, after spending on health care, increased $41,332, or $780 per year.
 Bargaining Power Fails---1NC
Bargaining power fails to reduce rates---it’ll get politicized and abused, which
causes increases in payment and costs
Chris Pope 16, senior advisor at the West Health Policy Center, “Medicare's Single-Payer
Experience,” Winter 2016, https://www.nationalaffairs.com/publications/detail/medicares-
single-payer-experience
These thought leaders believe that single-payer health care could replicate the cost-control enjoyed by
other countries, while preserving the quality and access to care Americans expect. They argue that the government could negotiate
better rates with providers and eliminate administrative costs incurred by insurers. New York Times columnist Paul Krugman has
endorsed this vision: "[W]e don't have to imagine such a system, because it already exists. It's called Medicare, it covers all
Americans 65 and older, and it's enormously popular. So why didn't we just extend that system to cover everyone?"
Medicare's
Yet, rather than offering a solution to the inefficient and costly fragmentation of American health care,
structure is responsible for much of the current situation . While it is known to voters as an
entitlement for seniors and the disabled, the program's purchasing power has been prized by policymakers
as an instrument for controlling and shaping the delivery of American health care. But rather than promoting the
coordination of care and efficient purchase of services, it is too easily forced by the most politically
powerful providers into subsidizing their operations and protecting them from
competition. The result has been the gradual consolidation of American health care, often
creating local hospital monopolies — able to impose excessive fees and deferential contracting
arrangements on insurers required to pay for their services.
Hamstrung competition and regulated prices curtail incentives to enhance the quality of care. Medicare's rigid payment
structures and artificial targets for thousands of different procedures are also too easily abused by
providers seeking to maximize their revenue from the government. Yet recent attempts to reform Medicare
away from mechanistic fee-for-service payments are ill-suited to a single-payer system, whose resistance to special
pleading and aggressive lobbying by powerful provider interests depends on its payment structure being simple, transparent, and
rule-based.

Single payer’s massive tax hikes dis-incentivize employment---causes the loss of

11.6 million jobs
Yevgeniy Feyman 16, is a fellow and deputy director of health policy with the Manhattan
Institute. 2/11/16, “The Single-Payer Sacrifice: 11.6 Million Jobs”
http://www.realclearpolicy.com/blog/2016/02/11/single-
payer_sacrifice_116_million_jobs_1551.html
Democratic candidate Bernie Sanders recently released his health-care plan: a government-run single-payer system
for the U.S., similar to what many European countries have. Criticism of the plan has so far focused on its lack of political
feasibility, but there is an even more important reason to be wary: Accounting for costs and tax
increases, it would reduce labor supply by 11.6 million . In a struggling economy, with
tepid wage growth, hurting employment should be the last thing on any politician’s agenda.
The plan truly promises everything under the sun. Not only will everyone be able to get any medical treatment needed — with no
cost at the point of service — but the plan won’t require a terribly high tax increase. The funding
mechanism boils down to an increase in payroll taxes: an “income-based premium” of 2.2 percent for individuals
and a tax of 6.2 percent on employers. Because economists, as well as the non-partisan Congressional
Budget Office and the Joint Committee on Taxation, recognize that the "employer share" of
payroll taxes is mostly borne by workers in the form of lower wages, this translates to an 8.4
percentage point increase overall.
These elements of the plan were the first to draw criticism. Not only do most single-payer countries fund their health-care systems
with higher taxes on the middle class, but they also typically exclude a variety of services and drugs from coverage. Without being
able to say no to some expensive drugs and services, the government would have a tough time driving down prices.
But perhaps the most stinging rebuke came from veteran health economist Kenneth Thorpe of
Emory University. In Thorpe’s estimation, Sanders’ plan would require a total tax hike of 20
percentage points , and would cost $1.1 trillion more each year than the campaign has
estimated. This is at least partly because the government would have to pay more than
Medicare’s low rates to keep doctors and hospitals in the system, and making health care free at
the point of delivery would also increase use of health-care services.
These criticisms alone should make Sanders’ plan a nonstarter. But that’s not the end of the laundry list of problems with the
proposal.
Few economists would dispute that tax rates can affect people’s decision to work. The higher a
person’s marginal tax rate, the bigger the disincentive to work more ; a 50 percent rate, for
instance, means that earning another dollar nets only an extra 50 cents. This is what economists
call the “substitution” effect.
But there is a countervailing effect as well. As you pay more in taxes, you may want to try to
maintain your previous standard of living, and thus decide to work more. This is called the
“income effect.”
The ultimate effect of taxes on the workforce depends on which of these forces is stronger. The CBO, for instance, has come
to the conclusion that the A ffordable C are A ct’s combination of taxes, tax credits, and
mandates will reduce full-time equivalent employment (one full-time equivalent employee works 40 hours per
week; two part-time workers equal one full-time equivalent) by about 2 million in 2025.
As it turns out, the ACA’s many taxes are relatively insignificant compared with those in the
Sanders plan. Applying the CBO’s approach and assumptions, along with tax data from the
National Bureau of Economic Research, to the Sanders plan indicates that the campaign’s
assumed taxes would reduce employment by 4.9 million full-time equivalent workers in
2025. Not an insignificant number.
When we take Thorpe’s more realistic assumptions and apply the same approach, the fully-
implemented plan reduces employment by a whopping 11.6 million full-time
equivalent workers. Under these assumptions, the average marginal tax rate would grow
from around 22 percent to 42 percent, while the average total tax rate would increase from 11
percent to 31 percent. At the upper end of income, total tax rates would be far beyond 50
percent. And none of this factors in state and local taxes.
Of course, some of drop in employment might be considered “voluntary.” Some would stop working because they no longer
needed to be employed to receive health insurance — escaping "job lock," as House Minority Leader Nancy Pelosi once put it. But
others would simply find it meaningless to put in extra hours or look for more lucrative positions
when so much of their earnings get sucked away as taxes.
For employers, this would all mean a large increase in hiring costs , too. Sure, as Sanders’
campaign likes to remind us, employers would no longer pay for private health insurance. But economists also recognize
that health insurance is a form of compensation. And if you cut health insurance (with or
without raising taxes), wages must in turn go up.
Sanders might be correct that health-care reform is unfinished. There remain many problems with the ACA that must be addressed
and many problems that the ACA left untouched. But it’s quickly becoming apparent that the Sanders plan for American health care
is the wrong way to fix these problems and offers a bad deal for workers.

That’s more jobs than were lost in the great recession---job losses now would
decimate the economy and throw us into a new recession
Jim Puzzanghera 14, writes about business and economic issues from the Times’ Washington,
D.C., bureau. 6/6/14, “Economy has recovered 8.7 million jobs lost in Great Recession”
http://www.latimes.com/business/la-fi-jobs-20140607-story.html
The nation's employers created a solid number of jobs last month that pushed the economy to a milestone: It
finally recovered all 8.7 million jobs lost during the Great Recession.
But economists warned that it's not time yet to break out the champagne for a labor market that
has failed to keep up with population growth over the last 6 1/2 years and continues to struggle to create
higher-wage jobs.
"Things are improving, but it's happening agonizingly slowly," said Heidi Shierholz, a labor market economist at the Economic
Policy Institute.
The milestone also marks the recession, which officially ran from December 2007 to June 2009,
as the deepest and the slowest to recover since the Great Depression.
In addition, as government reports show, all jobs aren't equal.
Low-paying positions at restaurants, hotels and temp agencies now account for a greater percentage of the workforce than those in
higher-paying fields such as construction, manufacturing and banking.
The increased number of lower-paying jobs is a key reason the recovery has been so slow: With less in their wallets,
workers have less money to spend, economists pointed out. Consumer spending accounts for
about 70% of the economy .
Still, the 217,000 net new jobs added last month were cheered by many analysts, who said the growth showed the recovery has
shaken off a winter slowdown caused by extreme weather.
Although the May figure released Friday by the Labor Department was down from the revised 282,000 jobs added in April, it was
consistent with stronger overall economic growth in the second quarter of the year.
The unemployment rate held steady at 6.3%, the lowest level since September 2008.
"The underlying hiring trend ... is encouraging, with more good news expected through the summer and into the
autumn months," said Bart van Ark, chief economist at the Conference Board.
The economy has averaged 197,000 net new jobs a month for the last year, a moderate amount that is far different from the steep
losses of the recession. At the labor market's low point in March 2009, the nation's employers shed 826,000 jobs.
May's job growth pushed total non-farm employment to 138.46 million, surpassing the 138.37 million jobs at the previous peak in
January 2008, the Labor Department said.
From that point, the nation lost 8.7 million jobs until the labor market began slowly to grow
again in February 2010.
Meantime, population growth since January 2008 has meant that the economy still is about 6.9 million jobs short of where it should
be, said Shierholz, the labor market economist.
"At the pace we are currently going, it will take nearly four more years to get back to pre-recession labor market conditions," she
said.
The gap partly is reflected in the unemployment rate. May's 6.3% level is well above the 5% mark in January 2008.
Besides, economists said, today's unemployment rate probably overstates the health of the labor market.
The labor force participation rate remained at 62.8% in May, the lowest level since 1978 and a sign that many people have given up
looking for work. The low participation skews the unemployment rate, a reason Federal Reserve policymakers said they were using
other labor market indicators to determine how much stimulus the economy still needs.
Even more disconcerting to many economists is the lower quality of the jobs being created to replace many higher-paying ones lost
in the recession.
Compared to January 2008, jobs in construction are down 20%, manufacturing 11.7% and banking 4.8%.
Some lower-paying fields have seen increases. Temp jobs are up 16% and leisure and hospitality positions have risen 8.1%. Retail
sales jobs are down slightly from the 2008 peak, but that masks an increase of about 925,000 positions since the labor market
bottomed out in early 2010.
"It is a quality game much more than it is a quantity game," said Lindsey Piegza, chief economist at brokerage Sterne Agee.
"We're really not seeing that high-wage recovery that is indicative of a strong consumer lining their pockets with wages and going
out and spending," she said.
It's typical for lower-paying jobs to lead the way out of a recession, economists said.
But even before the recession, there was a trend in the U.S. toward lower-paying jobs, with businesses contracting services to
temporary workers rather than hiring full-time employees, said Arne L. Kalleberg, a sociology professor at the University of North
Carolina at Chapel Hill.
The trend accelerated during the recession.
"It's
definitely a drag on the economy because these folks don't have the purchasing power to
buy stuff, and companies don't see the demand for their products," said Kalleberg, author of the 2013 book
"Good Jobs, Bad Jobs."
Even so, the quality of new jobs has improved in the last 12 to 18 months, said Mark Zandi, chief economist at Moody's Analytics.
"Now we're seeing increasingly greater numbers of high-paying jobs being created and some middle-
paying jobs," he said. "My sense is, going forward we're going to see much better- quality job creation ."
 Administrative Costs---1NC
No solvency---other countries have high administrative overhead, and government
bureaucracy is notoriously inept at administrative efficiency
Robert Pearl 17, MD Forbes Healthcare Contributor. 3/27/17, “3 myths about a single-payer
system and why it’s doomed to fail” http://www.kevinmd.com/blog/2017/03/3-myths-single-
payer-system-doomed-fail.html
Myth 1: It would lower administrative costs
Supporters claim a single-payer system would siphon out billions of dollars in administrative
overhead. How they reach this conclusion varies by the source, but in each case, a deeper analysis reveals
oversimplification and fallacious assumptions .
One line of reasoning is based on the lower cost of health care in other countries with a
government-run system. But the reduced costs in other nations reflect other factors — their
cheaper drug prices, lower wages , and a higher number of primary care physicians
compared to specialists — rather than lower administrative overhead.
A second comparison drawn is between Medicare and commercial insurance in the United States. Here cost is confused with price,
and vice versa. The federal government has a unilateral ability to set prices, and often does so at levels below the actual cost of care
delivery. When it does this, hospitals and doctors offset the reduced payments they receive from the government by raising prices
elsewhere. Published economic analyses indicate that only 90 percent of cost is reimbursed through Medicare today and that, as a
consequence, commercial insurers pay, on average, approximately 120 percent of the Medicare rates to doctors and hospitals.
Finally, some backers of a single-payer system look at the Medical Loss Ratio (percentage of health care premium spent on direct
patient care) of some of the publicly traded insurance companies and note that, for some, nearly 20 percent of their revenues are
used for administrative purposes. What is left unsaid is that there are already several not-for-profit
insurance programs that spend more than 90 percent of their revenue on patient care — and as
such, little savings would be achieved.
The idea that a government-run plan could function without incurring major administrative
costs is naive , especially if fee-for-service is the method of provider reimbursement. In such a system, doctors and
hospitals would still need to complete claims forms . Government employees would, in
turn, be required to sort through them, make certain they’re appropriate, question coding, and
pay the providers accordingly. There is little evidence, whether we look at the U.S. Postal
Service or the Department of Motor Vehicles, that the government is particularly efficient at
these types of administrative tasks.
 *General Solvency---1NC
Single-payer can’t solve health care costs---even the biggest states can’t make it
affordable
Megan McArdle 17, Bloomberg View columnist, “States Where Single-Payer Health Care Could
Work (If It Could Work Anywhere),” https://www.bloomberg.com/view/articles/2017-05-
30/states-where-single-payer-health-care-could-work-if-it-could-work-anywhere
Casual believers in single payer often eyeball European governments, eyeball what the U.S. spends, and conclude that there must be
fabulous cost savings to be had from a single-payer system, making it easily affordable even for states on a tight budget. Folks
actually charged with designing a single-payer system know the truth: single payer will not make health care cheap.
Analyses by single-payer-friendly sources (such as Gerald Friedman of UMass Amherst, and the heavily Democratic California State
Senate) tend to indicate that moving to single payer would involve roughly doubling the budgets of even
high-tax, high-spending states like New York and California. Less friendly sources suggest that the cost might be
substantially higher than that . Unless they find some way to dramatically slash the incomes
of health-care workers (not gonna happen), then single-payer advocates are going to have to persuade
voters to support breathtaking tax increases. It hardly needs pointing out that this will be difficult.
The second thing to say is that New York and California represent absolutely the best possible
scenarios for single payer in this country. If they can’t make it work (and I’m betting they can’t), then single
payer cannot be done in this country --full stop, end of story, print as written .
These states are, obviously, extremely liberal and firmly under the control of the Democratic Party. That is a huge advantage in the
battle for single payer. But it is not the only advantage that they have. New York and California are also, for example, very big. That’s
important for a state looking to move toward single payer. Though not, as you might think, because health care offers economies of
scale (it does, some, but it also offers diseconomies of scale: the bigger your state and population, the more
layers of bureaucracy that will be required to supervise its health-care system, making it more
prone to inefficiencies and fraud ).
 ACA UQ---1NC
ACA markets resilient
Dylan Scott 8/24, Vox health care writer, “Why Obamacare didn't implode,” 8/24/17,
https://www.vox.com/policy-and-politics/2017/8/24/16193682/obamacare-empty-counties-
fixed
Two months ago, things looked dire for Obamacare — and not just because Republicans in Congress were still hell-bent
on repealing and replacing it. Nearly 50 counties across the United States lacked any insurers willing to sell plans on the law’s
marketplaces in 2018, leaving almost 40,000 people at risk of having no options for coverage next year.
But now, after reports in the past 24 hours that the last two empty counties in Ohio and Wisconsin would be filled, the problem is
gone: No counties currently lack health plans for next year.
The law seems to have healed itself, or at least staved off disaster, even as President Trump has
been swearing that
Obamacare would implode or threatening to nuke it himself.
What happened? It’s actually pretty simple: Obamacare provides significant federal assistance for
many lower-income and middle-class Americans to buy insurance. It is explicitly designed to make coverage reasonably
affordable for people, while requiring the government to pick up any excess costs.
That’s a pretty good proposition for any business.
So while Obamacare still has a monopoly problem — there are 1,340 counties, with 2.7 million customers, where only one insurer is
available — its market hasn’t imploded. Instead, the design of the law itself seems to have helped bring it back from the edge. State
officials also worked at the local level to provide coverage for their constituents.
“ It
shows how resilient the market is . The open-ended premium subsidies are an enormous
carrot for insurers to go into underserved areas, even in the face of significant
uncertainty ,” Larry Levitt, senior vice president at the Kaiser Family Foundation, told me. “It's not a great outcome to have
monopoly insurers, but it's a whole lot better than having no insurers.”
Disease
 Bioterror—1NC
Text: The Federal government of the United States should:
1. Create a new interagency entity charged with oversight of biodefense
activities at the federal, state, and local level,
2. Increase bio-surveillance capacity,
3. Increase medical countermeasures and development,
4. Fund additional private-public partnerships and fundamental research
related to the development of antibiotic and antiviral drugs.
 Bioterror D---1NC
No bioterror impact
Filippa Lentzos 14, PhD from London School of Economics and Social Science, Senior
Research Fellow in the Department of Social Science, Health and Medicine at King’s College
London, Catherine Jefferson, researcher in the Department of Social Science, Health, and
Medicine at King’s College London, DPhil from the University of Sussex, former senior policy
advisor for international security at the Royal Society, and Dr. Claire Marris, Senior Research
Fellow in the Department of Social Science, Health and Medicine at King's College London, “The
myths (and realities) of synthetic bioweapons,” 9/18/2014, http://thebulletin.org/myths-and-
realities-synthetic-bioweapons7626
The bioterror WMD myth. Those who have overemphasized the bioterrorism threat typically portray it as an

imminent concern , with emphasis placed on high-consequence, mass-casualty attacks ,

performed with weapons of mass destruction (WMD). This is a myth with two dimensions.¶ The first involves the identities of terrorists and
what their intentions are. The assumption is that terrorists would seek to produce mass-casualty weapons

and pursue capabilities on the scale of 20th century, state-level bioweapons programs. Most leading biological disarmament

and non-proliferation experts believe that the risk of a small-scale bioterrorism attack is very real and present. But they
consider the risk of sophisticated large-scale bioterrorism attacks to be quite small. This judgment is

backed up by historical evidence . The three confirmed attempts to use biological agents against humans in terrorist attacks
in the past were small-scale , low-casualty events aimed at causing panic and disruption rather than excessive death tolls. ¶ The
second dimension involves capabilities and the level of skills and resources available to terrorists. The implicit assumption is that
producing a pathogenic organism equates to producing a weapon of mass destruction. It does not.
Considerable knowledge and resources are necessary for the processes of scaling up, storage, and
dissemination. These processes present significant technical and logistical barriers .¶ Even if a biological
weapon were disseminated successfully, the outcome of an attack would be affected by factors like the health of the people who
are exposed and the speed and manner with which public health authorities and medical professionals detect and respond to the resulting outbreak. A
medical countermeasures, such as antibodies and vaccination, can
prompt response with effective

significantly blunt the impact of an attack .

 Disease D---1NC
Infectious diseases don’t cause extinction
Owen Cotton-Barratt 17, et al, PhD in Pure Mathematics, Oxford, Lecturer in Mathematics at
Oxford, Research Associate at the Future of Humanity Institute, 2/3/2017, Existential Risk:
Diplomacy and Governance, https://www.fhi.ox.ac.uk/wp-content/uploads/Existential-Risks-
2017-01-23.pdf
For most of human history, natural pandemics have posed the greatest risk of mass global fatalities.37 However, there are some
natural pandemics are very unlikely to cause human extinction . Analysis of
reasons to believe that
of the 833 recorded plant
the International Union for Conservation of Nature (IUCN) red list database has shown that
and animal species extinctions known to have occurred since 1500, less than 4% (31 species)
were ascribed to infectious disease.38 None of the mammals and amphibians on this list were
globally dispersed, and other factors aside from infectious disease also contributed to their
extinction. It therefore seems that our own species, which is very numerous , globally
dispersed , and capable of a rational response to problems , is very unlikely to be killed off
by a natural pandemic.
One underlying explanation for this is that highly lethal pathogens can kill their hosts before they have a
chance to spread, so there is a selective pressure for pathogens not to be highly lethal .
Therefore, pathogens are likely to co-evolve with their hosts rather than kill all possible hosts.39
 IL D---1NC
The internal link is asinine---either a disease kills everyone and people going to
their doctor checkups doesn’t solve it, or it burns out and has low lethality

Bioterror can’t cause extinction because it won’t kill people in countries that
already have single payer, or single payer is insufficient to solve it

We’d just respond to an attack by making the treatment free for everyone
Kimberly Ann Petersen 14, M.A. Candidate in Security Studies, Naval Post-Graduate School,
September 2014, “The Affordable Care Act: a prescription for homeland security
preparedness?,”
https://calhoun.nps.edu/bitstream/handle/10945/43979/14Sep_Petersen_Kimberly.pdf?
sequence=1
Another way that a robust and accessible health care system aids homeland security is through
prevention. Vaccines are one of the tools used to prevent bioattacks, or at least to manage a successful
attack. Homeland security experts have long considered smallpox a potential bioweapon, hence the
stockpiling of the smallpox vaccine since 9/11. Smallpox is an infectious disease caused by the virus variola major or
variola minor. The more common and more virulent form, variola minor, has a mortality rate of about 30 percent.70 The disease
was present throughout the world for tens of thousands of years, but was eradicated via a worldwide vaccination program prior to
1980. The smallpox virus only exists now in laboratory stockpiles.71 One of the concerns post-9/11 was the stockpiles would be
pilfered and used to intentionally reintroduce the virus to humans. The U.S. currently has 300 million doses of smallpox vaccine in
stockpiles around the U.S.—enough to vaccinate nearly the entire population. Recently, the U.S. government purchased enough of a
new smallpox medication to treat two million people.72 However, for the vaccination process and the treatment process
to be successful in the event of an outbreak, the population will need access to health care providers.
The Department of Homeland Security’s fact sheet on what to do in the event of a bioterror directs us as follows: “People in the
group or area that authorities have linked to exposure who have symptoms that match those described should seek emergency
medical attention.”73
It is likely in the event of such a dramatic scenario as a smallpox attack, the U.S. government will
set up emergency distribution centers , where all people will receive prophylaxis antibiotics,
without regard for health insurance or payment , as outlined in the C enter for D isease C ontrol’s
Smallpox Response Plan and Guidelines. 74 So perhaps the smallpox vaccination program serves as a
model for universal health care access .
 Offense
NHI 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 U nited
S tates, 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 companies which innovate in the United States chargetheir 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 U nited S tates 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.
 Squo ACA Solves Bioterror
Status quo ACA solves enough bioterror preparedness---it doesn’t have to be
perfect
Kimberly Ann Petersen 14, M.A. Candidate in Security Studies, Naval Post-Graduate School,
September 2014, “The Affordable Care Act: a prescription for homeland security
preparedness?,”
https://calhoun.nps.edu/bitstream/handle/10945/43979/14Sep_Petersen_Kimberly.pdf?
sequence=1
As Shane Green notes in his article, “Bioterrorism and Health Care Reform: No Preparedness
Without Access,”
With the U.S. presently engaged in a ‘war on terror,’ in which not only soldiers but also civilians are targets, a healthy fighting force
is no longer enough to ensure national security; the time has come for this country to take up reforms that promote the health of all
Americans.” 234 The perspective on health care must change so it becomes viewed as part and parcel of homeland security
preparedness by the civilian community and the government.
Health care and homeland security are inextricably linked. Investment in health care confers
benefits upon U.S. homeland security all-hazards preparedness because increased health insurance
coverage through the ACA equals increased access to health care, which equals improved health. This in
turn equals improved homeland security preparedness and a more resilient population . The
A ffordable C are A ct is already considered the largest health care reform in America in one-hundred
years, and only time will tell if it is a game-changer for homeland security preparedness as well. But if the A ffordable C are
A ct does deliver even in part on its promise to improve access to health care, then homeland
security all-hazards preparedness is likely to improve in kind. The health of homeland security depends
on the health of our population: the ACA promises to improve both .
2NC
CP
 Solvency ev
Solves UCC
Ed Dolan 17, senior fellow at the Niskanen Center, “What a good conservative health care plan
would look like,” 7/12/17, https://www.vox.com/the-big-idea/2017/7/12/15955782/health-
care-senate-conservative-ideas-universal-catastrophic-coverage
Conservatives policy experts have made some very reasonable proposals for dealing with those at the top of the cost curve. One of
the most attractive is universal catastrophic coverage, or UCC for short. UCC would cover the top-of-the-curve
health care needs of all Americans, subject to a deductible that limited out-of-pocket expenses to a substantial, but not
impossibly high, percentage of their income.
Universal catastrophic coverage has an impeccable conservative pedigree. It was proposed back in the 1970s by Martin Feldstein,
who would go on to serve as Ronald Reagan’s chief economic adviser. In 2004, Milton Friedman, then a fellow at the Hoover
Institution, endorsed the concept. An up-to-date version, specifically designed to address the problems of the ACA, is outlined by Kip
Hagopian and Dana Goldman in National Affairs.
What a universal catastrophic coverage plan might look like
The exact parameters of the program would be subject to negotiation, of course, but let’s sketch some possibilities, for the sake of
discussion. Suppose the deductible is set at 10 percent of the amount by which a household’s income exceeds the Medicaid eligibility
level, now about $40,000 for a family of four. Under that formula, a middle-class family earning $85,000 a year would face a
deductible of $4,500 per family member, with a cap of twice that amount for households of more than two people. By the same
formula, the deductible for a household with $1 million of income would be $96,000.
The high-deductible policy might be provided directly by the government, as an extension of Medicare. Alternatively, following the
Swiss example, people could choose among private insurers offering policies meeting the program’s standards. In that case, UCC
would resemble an expanded version of Medicare Advantage — originally a Republican idea but one
that now enjoys bipartisan support.
People could choose among several ways to meet their out-of-pocket costs. As you can see from the examples above, for
middle-
class families, out-of-pocket costs would be comparable to those now faced under
individual policies purchased on ACA exchanges, while for high-income families they would be substantially
higher.
One option for meeting those costs would be to buy supplemental insurance to cover all or part
of the UCC deductible. Such supplemental coverage would cost far less than policies now sold in the
market for individual insurance, since the UCC deductible would set an automatic ceiling on claims for which the insurer
would be responsible. Alternatively, consumers could pay out-of-pocket expenses from funds accumulated in a tax-deductible health
savings account — yet another conservative idea, and one that is already on the books.
Very likely, many middle-income families would decide simply to cover all of their routine health care costs out of pocket. After all,
as the chart shows, the healthiest 50 percent of the population accounts for less than 3 percent of all personal health care spending,
and the next 20 percent of the population for only another 7 percent of spending. People on the bottom half of the spending curve
could reasonably pay their routine health care costs in cash, just as they now pay for oil changes or wiper blades for their cars. (After
all, no one assumes that automobile insurance covers routine maintenance.)
How to remove one costly distorter of the health insurance market
Fiscal conservatives might, quite properly, ask how UCC could be financed. A large chunk of it could be paid for with
another proposal favored by many on the political right — abolishing the tax deductibility of employer-
sponsored insurance (ESI), which currently costs the federal budget an estimated $235 billion
per year . That oddity of the US health care system is a holdover from World War II, when employers lavished in-kind benefits
on scarce workers to evade wartime wage controls. Both its liberal and conservative critics say it is long overdue for repeal.
Liberals object to ESI because it’s inequitable. Suppose the cost of health insurance to your employer is $10,000 per employee. If
that were taxed as ordinary income, you would pay more tax — but how much depends on your tax bracket. If your taxable income is
$200,000 a year, putting you in the 33 percent bracket, the exclusion saves you $3,300 annually. At $35,000 a year, placing you the
15 percent bracket, the exclusion saves you just $1,500. The inequity is even greater for minimum wage workers.
That’s because higher-paid workers (or their unions) often negotiate compensation packages that take advantage of the tax
deduction by slowing the growth of cash wages while increasing the share of health benefits. However, for workers who are already
at the minimum wage, there is no room for negotiation. Wages for such workers cannot be cut (and they must rise when the legal
minimum increases). As a result, the entire cost of employer-sponsored insurance falls on employers. That is one reason minimum
wage jobs are less likely to include health benefits.
Conservatives have other objections. For one, ESI imposes disproportionately large administrative burdens on small businesses,
which, unlike large corporations, cannot afford to self-insure. And ESI produces job lock. Workers who have jobs with good
insurance fear to leave them for jobs elsewhere that would make better use of their skills but might not have the same health
benefits. Quitting a job with ESI to work as an independent contractor or start a small business of one’s own is even riskier.
The BCRA, like the House bill, takes a baby step in the right direction by lifting the employer mandate that makes ESI compulsory
for businesses with 50 or more workers. However, as long as the tax preference remains in place, workers and many employers still
have an incentive to stick with ESI, shifting part of its cost to other taxpayers, low-wage workers, the self-employed, and would-be
entrepreneurs.
And what about the poor? Liberal critics look at the way the BCRA slashes Medicaid and conclude that Republicans simply don’t
care whether the poor have access to health care or not. Maybe that is true for some, but not all. Medicaid is simply not
the only way to provide health care for people with low incomes.
For the poor, an alternative to Medicaid
For example, the Hagopian-Goldman variant of universal catastrophic coverage could be implemented in a way that would render
Medicaid unnecessary. Suppose, as in our earlier example, the UCC deductible is set at 10 percent of the amount by which household
income exceeds $40,000, roughly the Medicaid threshold for a family of four. The deductible for families below the
threshold would therefore fall to zero . These families would get “ first dollar” coverage from
their UCC policy , so there would be no need for Medicaid as a separate program. (Such a scheme
would also increase work incentives for low-income households, who would no longer have to worry that extra earnings would cause
them to lose Medicaid benefits.)

It covers everyone and makes it free for those who need it to be

Dana Goldman 14, director of the Leonard D. Schaeffer Center for Health Policy and
Economics, holds the Norman Topping Chair in Medicine and Public Policy at the University of
Southern California, “How To Achieve Universal Health Coverage At Half The Cost,” 1/10/14,
https://www.forbes.com/sites/realspin/2014/01/10/how-to-achieve-universal-health-coverage-
at-half-the-cost/#354c996913dc
The centerpiece of our plan is to provide catastrophic insurance coverage to 100% of the approximately 200
million Americans not covered by Medicare or Medicaid . These policies would be in effect from birth until
Medicare availability. For the uninsured, the coverage would be new, and for the insured, it would supplant the catastrophic
portion of existing insurance. Inasmuch as the meaning of catastrophic loss depends on one’s financial resources, the
deductible would be means-tested by varying it as a percent of the income that exceeds the Federal
Poverty Line (FPL). Thus, for a family with income of $28,000, the individual deductible would be
only a few hundred dollars , while a family earning $50,000 would have an individual deductible of about $2,500.
To make beneficiaries more cost conscious, we would require modest cost-sharing after the deductible has been reached, which
would phase out as costs approach a multiple of the deductible. Thus, poorer families would have a proportionately
lower cost-sharing obligation.
We recognize the importance of preventive medicine in a system like we are proposing, so certain preventive-care services—
particularly those that can be demonstrated to save money (such as statins, anti-asthma medications, and childhood vaccinations)—
would be provided for free. (Free preventive care is particularly important for those with lower incomes.) And for
people with chronic illnesses (such as diabetes) who regularly use up the deductible, there would be a process by which
the deductible could be reduced, thus lowering the threshold at which the insurance kicks in.
We estimate the cost to the beneficiary of the catastrophic insurance will be less than $2,000 per year per person (about $150 per
month), or half the cost of a typical single-person policy. The substantial majority of the beneficiaries of the plan would pay the full
$2,000 premium. But for those who require support to make it affordable, the policies would be subsidized on a sliding scale
according to income.
Although the vast majority of people would have to pay for all or part of the costs of their catastrophic policies, almost none would
see a reduction in their disposable income. This is because the
government-sponsored insurance will eliminate
the costs of the catastrophic portion of all pre-existing, private-market insurance (either employer
provided or individually purchased). This will free up the cash necessary to pay for the government-sponsored insurance.
(Economists agree that insurance provided by an employer, is effectively paid for by the employee by giving up cash income. Thus, if
the insurance is eliminated, the employer will be obliged by market forces to pass the savings on to the employee by raising his or
her income.) For those who self-insure, the government-sponsored policy will cover the expected-value of any out-of-pocket costs
necessary to cover a catastrophic situation.
Those who insist on broader coverage than our plan offers would be free to acquire
supplemental insurance , either from their employer or individually in a national market. We suspect, however, that
because of the lower premiums, many people will choose to self-insure for their routine health
expenses . And those that do will more likely be price-conscious.
Currently, markets for health care are shockingly opaque; there needs to be much more transparency. To this end, we would have
the government construct a consumer-friendly website housing a comprehensive database of prices of commonly-used medical
goods and services. Providers would be required to post prices, and consumers and other quality-rating services could post their
ratings. This will allow consumers to comparison shop for the best combination of price and efficacy.
Because so much of the funding for this plan will come from people who already have insurance or can afford to buy it, only the
truly needy will have to be subsidized by public funds. We estimate the amount of those subsidies
will total about $95 billion per year . This will fully fund coverage for the roughly 30
million legal residents who cannot afford it (this number excludes seven million illegal immigrants and
11.5 million uninsured who can afford insurance but don’t buy it). It will also fund premium subsidies for those
whose income is below 300% of the FPL. The $95 billion cost estimate for this plan contrasts with the ACA’s $180
billion, 10-year average cost projected by the CBO.

It solves all the advantages of single-payer---best comparative ev (Rationing ev

cited in 2NR)
Jia Yu 17, Professor of Economics, Christopher Newport University, “Comparison of Single-
Payer and Non Single-Payer Health Care Systems: A Study of Health Administration Efficiency,”
Modern Economy, Volume 8, 2017, pp. 816-833
The government has proposed fundamental health reforms for years. There are a wide variety of reform models, and a number of
different ways to get to universal coverage. Many argue that the only logical approach to such reform is a
single-payer system, as in Canada, where one monopoly government insurer provides coverage for the entire population.
Learning from single-payer system (like Canada) has been a long-term debate among health economists. This approach has a
number of major efficiency advantages, including lower government expenditure, improve quality of care, maximize the bargaining
power of the government, make the administration costs application more efficient than the US. Also the biggest
disadvantage of this model is the long waiting time for almost everything —to get appointments
with physicians, to get tests, to obtain surgeries, etc. In terms of waiting times and bureaucratic hassles, health care for patients may
come to resemble the Canadian healthcare system.
Meanwhile, there are economists also said such an approach is highly unlikely to succeed in the US [17]. Gruber claimed that this
approach would display the majority of insured Americans who are largely satisfied with the health insurance they receive from their
employers, and require nationalizing an industry, private health insurance, with more than $500 billion in revenues per year. In this
situation, there are also two other choices, such as two-tier system and insurance mandate system.
From the perspective of this article, two-tiered healthcare system also shows the efficiency of
healthcare administration costs , especially Japan. The health care system in Japan provides services with the
patient accepting responsibility for 30% of these costs while the government pays the remaining 70%. Japan has a healthcare
system that costs half as much and often achieves better medical outcomes than its American
counterpart. The healthcare insurance includes publicly financed health insurance, i.e. the PHIS (public health insurance
system), and private health insurance, which plays a supplementary role. However, many health economists say
Japan’s low-cost system is probably not sustainable without significant change. For example, to keep the costs down, most of
Japanese doctors make far less than their US counterparts with way more working loads; and also the moral hazard, due to the equal
treatment to all patients, hurts the medical system as well.
Our results also demonstrate the efficiency of insurance mandate healthcare system when we evaluate the total healthcare
administration costs. Switzerland, as an example of insurance mandate healthcare system, displays a more efficient way of operation
than the US, who has the similar healthcare system. Healthcare in Switzerland is regulated by the Swiss Federal Law on Health
Insurance. There are no free state-provided health services, but private health insurance is compulsory for all persons residing in
Switzerland. The example of the Swiss system shows a) that the consumer-driven model does not work to control the costs and b)
the irrelevancy of the argument over whether individuals are consumers at all [18]. Switzerland also has amongst the highest life
expectancy in the world, and positive patient satisfaction reflect the high performance of the healthcare system, with a relative high
healthcare expenditure, which is still much lower than how much the US spend on healthcare.
Our goal of this research is actually pointing out a direction for the US healthcare reforms using empirical proof, which has been
argued over decades, especially after the Obamacare has been activated in 2010. Our research results, indeed, illustrate that
besides single-payer system; all other healthcare system could perform the same level of healthcare
outcomes, or even provide better medical results for patients or residents, with same or even lower
administration costs. Comparing with single-payer system, two-tier system and insurance mandate system also
reveal several advantages. To save on healthcare administration costs without harming the quality of care and health
outcomes, the US federal government may look over more examples or experiences from other countries and other healthcare
systems.
 Solves costs
The counterplan has a huge initial cost cut, and supplementary private insurance
causes innovation, competition, and lower costs
Bradley H. Vernon 9, ASA, MAAA, actuary at Eastern Life and Health Insurance Company in
Lancaster, Pennsylvania, “The Future Of U.S. Health Care: A Two-Tiered System,” 2009,
https://www.soa.org/library/essays/health-essay-2009-vernon.pdf
The first tier in this two-tiered system will be a federally run, universal system in which basic health
care is provided to everyone living in our country; costs are controlled to an affordable level; and quality of
care continues to improve. The first step might be a national health database which is already being discussed by the Obama
Administration. Allowing currently uncovered persons to enroll into the system the first time they receive service, by the provider,
will help prevent people from falling through the cracks. It will also eliminate the need for the large distribution market currently
used by private insurance.
This first tier of health care will enjoy a substantial one-time cost cut due to the removal of
numerous costs. The costs to be eliminated or greatly reduced include commissions,
underwriting, marketing, profits and much of the duplicated expenses, including
management , associated with a competitive insurance market. In order to keep the first tier affordable on
an ongoing basis, the plan will also involve rationing, restrictions and limits that we are not currently accustomed to in the United
States. This means long wait times for many services, while other procedures that many believe to be helpful may be denied or
strictly limited. The key to making and keeping this universal system affordable will be the government focusing on costs and
benefits and not being clouded by emotion or politics. Focusing on the cost associated with extending a person’s life by one year or
alleviating pain for a day is not something we are accustomed to, but this will need to become the way of thinking in order to reach
our conflicting goals. The third goal for our government will be to continue to improve the quality of care provided within this first
tier of health care. This means using quality measures to evaluate and take action with health care providers, but it also means
finding a way to continue the funding of research and development. One of the biggest fears around a universal system is that it will
stifle the innovation and advancement we have seen in medicine. Government funding, as well as a clear understanding of how new
procedures and prescription drugs can become a part of the government run plan, will be required to support continued medical
advancement. One advantage we have in formulating this first tier of health care is that we have other countries to look to, and even
states within our own country, for feedback regarding what does and does not work.
Second Tier—Preservation Of Autonomy
The second tier in our future health care system is one that allows a person to buy his or her way out of the
waiting times, restrictions and limitations of the first tier. This second tier is where autonomy is
preserved and individuals and groups can purchase insurance that looks much like what some
of us enjoy today. It is supplemental to the first tier with the focus being more on flexibility and individual
choice. Those who do not want to succumb to rationing or the government, deciding that a year of their life is not worth the cost
associated with a certain procedure, can purchase private insurance to cover these services. The second tier will be
privately run but will continue to require government regulation similar to what we have today. This second tier will make
up a much smaller portion of the health care pie than private insurance does today, but cost containment,
accessibility
and quality of care will remain the goals for this sector.
 Solvency---Insurance Access/Health Outcomes
It solves better---insurance and access are distinct---the counterplan more
effectively guarantees access even with a lack of insurance
RGC 7 – Robert Graham Center, medicine and health policy think tank, “Access Granted: The
Primary Care Payoff,” August 2007, http://www.graham-
center.org/content/dam/rgc/documents/publications-reports/monographs-books/rgcmo-
access-granted.pdf
Most Americans agree that an expansion of health insurance coverage is needed, but coverage alone
is no guarantee of access to health care . A strong and evenly distributed primary care workforce is
essential for good health. America, sadly, is far from reaching that goal. This report is the second in a series developed by
the National Association of Community Health Centers (NACHC), the Robert Graham Center of the American Academy of Family
Physicians, and Capital Link. The first report, Access Denied: A Look at Americans Medically Disenfranchised, 5 revealed that a
staggering 56 million Americans – nearly one in five – lack adequate access to primary health care because
many of them
of shortages of such physicians in their communities. These “medically disenfranchised” live in every state;
are insured . More importantly their numbers are increasing. The medically disenfranchised and the millions of others who
face additional barriers to care require a place and a relationship in which they can receive preventive care, make sense of their
conditions, integrate their care, and be coached on changing their behaviors to improve their overall health. Such medical
homes have been shown to prevent sickness, manage chronic illness, and reduce the need for
avoidable, costlier care such as an emergency department visits or hospitalizations.6
Providing a medical home to the disenfranchised has been a hallmark of the national network of Community, Migrant, and
Homeless Health Centers since their inception. For over 40 years, health centers have brought affordable health care services
to communities overlooked and underserved by mainstream medicine. Health center patients – who total over 16 million in all – are
predominately low income, uninsured or publicly insured, and members of racial or ethnic minorities. In fact, health centers
currently serve one in every five low income uninsured individuals, one in nine Medicaid beneficiaries, and one in four low income
minorities. Most health centers have broadened the scope of conventional health care services to
include dental and mental health services, as well as case management, transportation, translation, and outreach. Because they go
above and beyond the role of a medical home, health centers may be more appropriately described as “health care homes.”
The public
health benefits that health centers generate are well-documented in a growing body
of research ; less appreciated, until now, has been their economic value in terms of cost-savings, economic growth, and
production of jobs. The Lewin Group recently found that taking full advantage of primary care medical homes would produce $67
billion in annual health care savings.7 Health centers provide access to primary care for people, and by doing so, increase potential
savings. This report – prepared jointly by NACHC, the Robert Graham Center, and Capital Link – finds that people who receive a
majority of their medical care at a Community Health Center have significantly lower medical expenses than do people who receive
the majority of their care elsewhere, due to health centers’ record as effective medical homes. Medical expenses for health center
patients are 41% lower ($1,810 per person) compared to patients seen elsewhere. As a result, NACHC estimates that health centers
save the health care system $9.9 to $17.6 billion a year – a figure that could grow to $22.6 billion or even $40.4 billion once health
centers are expanded to serve a total of 30 million people by 2015. These substantial savings are attributed to a host of factors, not
least of which is a reduced reliance on hospital emergency departments among Medicaid beneficiaries and the poor – populations
increasingly marginalized from primary health care services.
Perhaps even more remarkable are the substantial economic gains that can be realized locally from the investment in primary health
care services. Today, health centers nationally generate $12.6 billion in economic benefits for their predominately low income, rural
and inner-city communities, through direct employment of local residents, goods and services purchased from local businesses, and
capital development projects. Health centers also generate more than 143,000 jobs for local residents. Expanding health centers to
serve 30 million people by 2015 will produce $40.7 billion in overall economic gains, predominantly benefiting the very
communities that need them most.
The Primary Care Payoff
If every American made use of primary care, the health care system would see $67 billion in savings annually.8 This reflects not only
those who do not have access to primary care, but also those who rely extensively on costly specialists for most of their care, leading
to inefficiencies in the system. More specifically, the
expansion of medical homes can even more dramatically
facilitate effective use of health care , improve health outcomes, minimize health
disparities, and lower overall costs of care.9 Medical homes are patient-centered, regular, and continuous sources of
care, coordinated by a team of medical professionals committed to quality improvement.
While health insurance often facilitates access to care, it does not guarantee access to a usual source of
care or to a medical home. 11 In fact, people who have a usual source of care but no health
insurance actually receive more primary and preventive care than those who have
insurance but no usual source of care. Not surprisingly, those who have both fare best.12 Having a medical home
is associated with better utilization and outcomes, including recognizing the need to seek care, receiving earlier
and more accurate diagnoses, reduced emergency department use, fewer hospitalizations, lower overall costs, better prevention,
fewer unmet needs, and higher patient satisfaction.13 Moreover, primary care characterized by enhanced accessibility, continuity,
and interpersonal relationships with physicians is associated with better self-rated general and mental health, and is found to
mitigate disparities related to income, race and ethnicity, and insurance inequalities.14 Low income, minority, and uninsured
populations would especially benefit from the expansion of medical homes because their health is more likely to be compromised
and they run the greatest risk of using costly hospital-based care for avoidable conditions.15
 Avoids Spending DA---2NC
1) A fully public system causes over-spending and pressure to constantly
expand the scope of services provided---the counterplan’s private escape
hatch keeps spending down
Jonathan Gruber 9, Ford Professor of Economics at the Massachusetts Institute of Technology,
“The Case for a Two-Tier Health System,” https://economics.mit.edu/files/6415
Given these facts, how should health insurance coverage be reformed to increase equality in a fiscally
responsible manner? First and foremost, all citizens must be guaranteed some form of insurance
coverage. But that base level should be no more generous than is necessary to produce health efficiently. This would be achieved
by a plan that made individuals pay their up-front costs of health care, but with an out-of-pocket maximum that is income-related so
no family is bankrupted by their health care needs.
At the same time, the government should allow individuals who wish to purchase more generous
coverage to do so. Without this “escape mechanism ,” there will be enormous pressure to
continually ratchet upward the generosity of the base level to meet the needs of higher-income
individuals who prefer, and can afford, to be over-insured . However, a key change must be to end
government subsidies to insurance coverage that are above that base level: If higher-income
individuals want to buy more generous coverage, they should be allowed to, but not with government-subsidized dollars. Such a
two-tier system can then ensure that all have cost-effective insurance coverage ,
while also reducing government expenditures on health care.
Another example of an explicit two-tier approach is with respect to quality of care. As researchers at Dartmouth and elsewhere have
emphasized, there are enormous discrepancies in the quality of care that is delivered around the United States. For example,
sensible preventive measures, such as the use of beta blockers after a heart attack, are ignored by a sizeable share of primary care
doctors and specialists around the nation.

2) The entire community health system would likely cost less than 100 billion
dollars, which is several orders of magnitude less than the plan
Carolyn McClanahan 17, health care writer for Forbes, “Rising From The Ashes - A Novel
Bipartisan Approach To Health Care Reform,” 3/27/17,
https://www.forbes.com/sites/carolynmcclanahan/2017/03/27/rising-from-the-ashes-a-novel-
bipartisan-approach-to-health-care-reform/#1f1ef3262ab4
Community Health Centers provide primary health care at a cost of $516 per patient per year for
medical service and $439 per patient per year for dental services. They currently serve 25 million patients but have the structural
capacity to serve approximately 50 million patients. Many centers also provide mental health care, vision and pharmacy services.
The average cost of care including these other services is $763 per patient per year. However, this number does not take into account
that only two-thirds of centers provide comprehensive care including mental health and dental, so the cost will actually be higher to
provide all these services.
CHCs are managed more like private practices, and because they take Medicaid, Medicare, and private insurance, they also have the
headache of increased costs due to inefficient billing practices. By removing CHCs from traditional payer models,
costs could further be reduced . In private practice, billing may utilize approximately 14% of revenue.
For purposes of this illustration, we will use a yearly cost of $955 per patient per year. This is a total of medical
and dental cost which will mitigate the effect of the “average” total cost due to centers that do not provide the additional services.
Costs if all 325 million people in this country fully utilize CHCs for health and dental care: $310.4
billion per year.
Costs if only 50% of the population utilize CHCs for health and dental care: $155.2 billion per year.
Costs to provide only medical care to the entire population: $167.7 billion per year.
Costs to provide medical care only to 50% of the population: $83.9 billion per year .
There will be expenses in building infrastructure and rebuilding the primary care work force. However, this is
a fraction of the cost of the $1.5 trillion taxpayers put into the health care system today.
 AT PDCP
1) Community health centers are direct primary care, not health insurance,
because the government is directly supplying medical services and not
acting as a third-party payer
Alex Tolbert 16, writer for Bernard Health, “How to use direct primary care and health
insurance,” 4/20/16, http://www.bernardhealth.com/woofstreetjournal/direct-primary-care-
and-health-insurance
[DPC = Direct Primary Care]
The bill states that DPC arrangements are not health insurance , and are not regulated by the Department
of Commerce and Insurance. In fact, most direct primary care physicians don’t even take health insurance.
This has created some confusion for consumers. How does DPC work outside of the insurance system ?
Traditional primary care
Under traditional primary care, consumers find doctors through their health insurer. Let’s say Susan
has moved to a new city and is looking for a primary care physician. Susan contacts her insurance company to find out which
primary care physicians are in-network. Susan finds Dr. Smith and makes an appointment.
Dr. Smith is paid through Susan’s insurance plan . He has to file claims for her care, and Susan has to pay her
copay and coinsurance for her doctor’s visits and lab work.
Direct primary care
Susan’s husband, Jim, hears about a new kind of primary care offering in their new city. He decides to check out a direct care
arrangement with Dr. Williams instead of visiting Dr. Smith. He doesn’t contact the insurance provider, but
instead agrees to a contract with Dr. Williams, paying $75 per month to cover office visits and basic lab work.
Additional fees may be required for a special lab test or service, but these fees are outlined upfront. Jim can’t count any fees toward
his and Susan’s deductible, but he also doesn’t have to wrangle with insurance over claims or bills.
Because Dr. Williams doesn’t take insurance, her office has far fewer administrative responsibilities, doesn’t have to negotiate
reimbursement rates from insurance companies and doesn’t have to file claims.
Jim likes his new doctor so much, he convinces Susan to start going to Dr. Williams, too.
The big question
So why don’t Susan and Jim forgo insurance altogether?
One reason is that the Affordable Care Act requires families who can afford health insurance to carry it. If Jim and Susan didn’t have
a health plan, they would have to pay a fine.
But the more important reason is because DPC arrangements don’t cover everything. Primary care
physicians don’t handle serious cases, like treating cancer or performing surgery.
If Jim or Susan had a car accident or heart attack, they would need insurance to pay for those high
medical costs. And truthfully, many believe that’s what health insurance was intended to be —
protection in case of expensive emergencies, not advance payment for primary care. Compare it to
car insurance, which protects you if you are in a big accident, but doesn’t cover regular maintenance.
Econ
 Stem Alt Cause---1NC
Alt cause---STEM shortages outweigh health care costs
Stephanie Kelton 8, Associate Professor of Economics, University of MissouriKansas City and
Research Scholar, Center for Full Employment and Price Stability. With Alla Semenova, Ph.D.
student at the University of Missouri-Kansas City and Partner in Excellence with the Center for
Full Employment and Price Stability. 2008. “Are Rising Health Care Costs Reducing U.S. Global
Competitiveness?” http://www.cfeps.org/health/chapters/pdf/Rising%20costs%20and%20US
%20competitiveness.pdf
Part IX: Alternative Explanations for the Declining Competitiveness of the U.S. Economy Having shown that the Forum’s approach
to competitiveness is not without analytical weaknesses and should be taken with caution, we now seek alternative
explanations for the (potentially) declining competitiveness of the U.S. economy.
To begin with,
a number of recent competitiveness studies have voiced a uniform concern about
a decline in U.S. scientific and technological potential, particularly in comparison to other
nations’ experiences. Whereas scientific and engineering discoveries have been gaining strength worldwide, the scientific
and technological base of the U.S. has been “eroding” (The National Academy of Sciences, 2007, p. 3). While
the U.S. continues to neglect its technology infrastructure, “many countries are adopting
economic reforms and are directly competing with the U nited S tates for foreign talent,
innovation, and technology products and services” (American Electronics Association, 2005, p. 23). At the time
when “foreign governments are creating public-private partnerships to invest in R&D projects and persuade their brightest youth to
pursue high-tech careers,” the U.S. has been cutting its federal R&D funding (ibid., p. 7). From 1.25% of GDP in 1985, federal R&D
spending dropped to 0.75% of GDP in 2002. Its absolute levels peaked at $75 billion in 1987, dropping to $71 billion by 2002
(adjusted for inflation to 1996 dollars). Unfortunately, these negative trends have not been offset by private efforts in R&D funding,
as they have been on a decline as well (ibid., p. 15). As a result, some worrisome trends are revealed in patent statistics. For example,
from 1988 to 2001, “the percent of patents awarded to U.S. corporations dropped to slightly more than half,” while patents granted
by the U.S. to foreign corporations increased (ibid., p. 11).
Many have argued that the quality of the K-12 and university education in the U.S. make the
U.S. workforce “ increasingly unprepared for the 21st century economy ” that is
knowledge-based and driven by technology (ibid., pp. 4, 17). To give some examples from the
sphere of university education, the U.S. has been overtaken by China, Japan and the European
Union by the number of bachelor’s degrees awarded in engineering. At the same time, the EU-15 countries have bested the U.S. in
the number of doctoral degrees they grant in science and engineering (ibid., p. 7). The skills competition from
emerging market economies such as China and India has been increasing at an alarming rate .
With wage differentials between Indian and American engineers narrowing, it is the skills sets rather than cost (wage) differentials
that will determine the patterns of global competitiveness (ibid., pp. 6-7). The cumulative effect of these and other
trends indicates that the U.S. leadership in science, technology, engineering and R&D is eroding
with the risk of never being recovered again (ibid., p. 4; The National Academy of Sciences, 2007, p. 3). I n order
to remain competitive and renew and sustain its manufacturing base, the U.S. must maintain
strong commitments to R&D, innovation, science, technology, engineering, high-tech
manufacturing, skills-based jobs, high quality education, advancement of knowledge, human
capital, recruiting and retaining top engineers and scientists, as well as attracting the brightest of students from around the world
(The Manufacturing Council, 2005, pp. 2, 8; The National Academy of Sciences, 2007). These steps, in which federal support,
incentives and initiatives are crucial, define the path to competitiveness, rather than production of cheaper commodities through
direct cost cutting.
 AT Bubble
The aff bursts the bubble
Andrew Foy 12, M.D., is a cardiology fellow at Penn State Hershey Medical Center. 6/5/12,
“Understanding the Healthcare Bubble: How It Was Inflated, and Why It Must Burst”
https://aapsonline.org/understanding-the-healthcare-bubble-how-it-was-inflated-and-why-it-
must-burst/
Why the Bubble Must Burst
The healthcare bubble cannot possibly be maintained without this continuing line of credit to
the federal government. When either government policy changes to reflect this reality, or
government cannot raise enough revenue to meet its full commitments to all federal
healthcare programs, then healthcare revenue will decline and profits will dry up .
In 2010, 47.5 million people were covered by Medicare, which paid a total of $516 billion in benefits. According to the Medicare
Trustee’s Report, “HI [Part A] expenditures have exceeded income annually since 2008 and are projected to continue doing so
through the short-range period until the fund becomes exhausted in 2024…5 years earlier than was shown in last year’s report.”23
They go on to state, “The HI trust fund has not met the Trustees’ formal test of short-range financial adequacy since 2003.” 23 In
regard to Part B,
[Costs] have been increasing rapidly, having averaged 6.9% annual growth over the last 5 years, and are likely to continue doing so.
Under current law, an average annual growth rate of 4.7 percent is projected for the next 5 years. This rate is unrealistically
constrained due to a physician fee reduction of over 29 percent that would occur in 2012 under current law. If Congress overrides
this reduction, as they have for 2003 through 2011, the Part B growth rate would instead average 7.5 percent. For Part D, the average
annual increase in expenditures is estimated to be 9.7 percent through 2020. The U.S. economy is projected to grow significantly
more slowly than Part D and the probable growth rate for Part B. 23
Transfers from the general revenue fund represent an important source of Medicare financing, especially for Parts B and D (also
known as the SMI trust fund). According to the Trustees, “The difference between Medicare’s total outlays and its “dedicated
financing sources” is estimated to reach 45 percent of outlays in fiscal year 2011,” which triggered a statutory “Medicare funding
warning.” 23 Furthermore, in 2011, the federal government spent $350 billion on Medicaid from the general fund.
Altogether, the federal government is projected to spend $1.1 trillion on healthcare in fiscal year 2012, which will account for 17% of
all government spending. 21 The projected deficit for fiscal year 2012 is $1.3 trillion, and the gross federal debt (the debt
owed by the U.S. federal government), a
staggering, $16.4 trillion or 109% of GDP! 21, 24 Given these historic
conditions, there is simply no way the federal government can indefinitely prolong the trend in
healthcare spending. According to John Embry, chief investment strategist for Sprott Asset Management,
One of the few reasons that this remarkable debt edifice is still standing is the Fed’s zero interest rate policy…in conjunction with
massive Fed monetization of Treasury debt [which] has kept the interest rates on government debt ridiculously low, and thus the
charade has been allowed to continue… [I]f the interest rates on US government debt truly reflected both the real level of inflation in
this country and the rising risk of some form of default, rates would already be sky-high and the US would resemble a massive
Greece.25
There is no circumstance under which this degree of government spending can be financed, and
when it’s not, the slack won’t be taken up by individuals . In 2008, HHS estimated that national health
expenditures per individual were $7,845—more than $31,000 for a family of four. 19 At the same time, the Census Bureau claimed
that the average household size was 2.63 and thus, the average household share of national health expenditure was $20,632.26 The
census estimated that almost one-fifth of U.S. households earn less income than their share of
national health expenditure. 8
As the above figures make clear, U.S. citizens as a whole cannot afford what the U.S. spends on
healthcare. Therefore, when government spending on healthcare declines (as it must) overall
healthcare spending will decrease dramatically , healthcare prices will drop, revenue will
decline, and profits for the healthcare industry and related industries will dry up — the
healthcare bubble will burst . This could be brought about in several ways, such as a failure to raise the debt ceiling,
as Dr. Gilbert G. Berdine has pointed out; 26 a failure by the government to raise capital at historically low interest rates, as John
Embry suggested; 25 or government policies that actually reduce healthcare spending such as using the Independent Payment
Advisory Board (IPAB) to restrict which patients are eligible for certain medical care; or simply having CMS reduce allowed fees.
1NR
1NR
 Deficit DA
Midterms---concede no impact to warming
Trade DA---concede no one cares about GATs commitments
States CP---concede the perm, just a test of competition---50 state fiat: reject arg not the team
 O/V---2NC

DA o/w the case – heg solves nuclear war

Zalmay Khalilzad 16, former U.S. ambassador to the United Nations, counselor at the CSIS,
3/23/16, “4 Lessons about America's Role in the World,” http://nationalinterest.org/feature/4-
lessons-about-americas-role-the-world-15574?page=show
Ultimately, however, we concluded that the United States has a strong interest in precluding the
emergence of another bipolar world —as in the Cold War—or a world of many great powers ,
as existed before the two world wars. Multipolarity led to two world wars and bipolarity resulted in a
protracted worldwide struggle with the risk of nuclear annihilation . To avoid a return such
circumstances, Secretary of Defense Dick Cheney ultimately agreed that our objective must be to prevent a
hostile power to dominate a “critical region,” which would give it the resources, industrial capabilities and
population to pose a global challenge . This insight has guided U.S. defense policy throughout the post–Cold War era.
Giving major powers the green light to establish spheres of influence would produce a
multipolar world and risk the return of war between the major powers . Without a stabilizing U.S.
presence in the Persian Gulf and U.S. relationships with Jordan and the Gulf States, Iran could shut down oil shipments in its
supposed sphere of influence. A similar scenario in fact played out during the 1987 “tanker war” of the Iran-Iraq war, which
eventually escalated into a direct military conflict between the United States and Iran. Iran’s nuclear program makes these scenarios
even more dangerous.
The United States can manage the rise and resurgence of great powers like China, Russia and
Iran at an acceptable cost without ceding entire spheres of influence. The key is to focus on normalizing
the geopolitics of the Middle East, Europe and the Asia-Pacific, which the United States can do by strengthening its transatlantic and
transpacific alliances and adapting them to the new, dangerous circumstances on the horizon. The United States should
promote a balance of power in key regions while seeking opportunities to reconcile differences
among major actors.

Independently solves the case – contains every geopolitics conflict

David W. Kearn 14, Assistant Professor of Government and Politics at St. Johns University,
5/19/14, “1914 Revisited: Great Power War in the 21st Century,” http://www.isn.ethz.ch/Digital-
Library/Articles/Detail/?id=179733
Today, great power war has returned to the realm of possibility , which makes the 1914 analogy an apt one.
This time, however, it is East Asia rather than Europe that resembles a ‘powder keg.’ The presence of several
great powers with longstanding historical enmities and outstanding territorial disputes has created
conditions where aggressive policies and misperception may once again conspire to spark a major conflict .
The reconciliation of China’s rise with East Asia’s existing security architecture – which is founded upon US alliances with Japan and
South Korea – is likely to be the central geopolitical challenge of this century. Nevertheless, while a skirmish over disputed
territories could escalate into a larger conflict, there are other forces at work to mitigate those dynamics. Most importantly, high
levels of economic interdependence and extensive trade and financial relations among the East Asian
powers would make conflict extremely costly. Although the First World War also occurred after a period of economic
openness and relative ‘globalization,’ the scale and scope of interdependence in East Asia today dwarfs that of pre-war Europe.
Moreover, conflict in East Asia is still perceived to be far less likely than it was in European capitals in 1914. Overall, this can be
attributed to the role of the U nited S tates as a regional balancer in Asia , which has no parallel in the pre-war
period in Europe. Of course, the capacity of the US to play this role may diminish over time, but it makes the worst-case scenario
unlikely in the short-term.
An alternative analogy: The interwar period
Russia's recent annexation of Crimea and the prospect of further intervention in Ukraine are troubling and have
stoked fears about a new ‘great war’. Rather than 1914, however, a better analogy for Europe's current situation may be
the interwar period, which was characterized less by great power rivalry and realpolitik than by the external implications of unstable
and troubled domestic politics. The severe economic turmoil of Europe’s inter-war years exacerbated underlying social divisions and
undermined the efforts of political leaders to restore order and “normalcy” to war-weary populations. The influence of clashing
ideologies, revolution and counter-revolution, and unstable domestic politics shaped the foreign policies of leading states, ultimately
precipitating war.
In central and eastern Europe, several new, weak states emerged in formerly imperial lands. Though considered a triumph for
democracy and self-determination, the consolidation of the Bolshevik Revolution and Stalin's rise to power in the Soviet Union left a
revolutionary, revisionist state on Europe's eastern flank. Moreover, domestic politics across Europe remained unstable, as the
burdens of post-war reconstruction proved daunting for most states. The financial crash of 1929 and the onset of the Great
Depression then further taxed the capacities of national governments and set the stage for reactionary forces to take power,
including fascist governments in Italy and Spain, and the National Socialist party in Germany.
When the flawed League of Nations failed to deter or reverse Italy’s aggression against Ethiopia (or Japan’s against China), the
perceived costs of belligerence declined. The subsequent inability of Great Britain and France to come to an agreement with Moscow
precluded any realistic chance of deterring Germany. Appeasement at Munich bought time, but – once Poland had suffered yet
another partition through the Molotov-Ribbentrop pact – war became difficult to avoid.
Putin’s adventure: How far will he go?
Comparisons can be made between Putin's Russia and inter-war Germany . Even if the National
Socialists had not come to power in Germany in 1933, war would have been likely. Any nationalist or militarist government would
have sought to use force, if necessary, to address the perceived humiliations and territorial penalties of the Versailles Treaty –
though probably without the military adventure against the Soviet Union or the final solution. Of course, whether these attempts
would have led to another World War is difficult to say.
The parallel between post-Weimar Germany and Putin's Russia is most useful in highlighting how nationalism and an
assertive foreign policy—especially in the context of perceived national humiliations – can be used to consolidate
domestic political power. Today, the collapse of the Soviet Union, the loss of influence over
historically compliant territories in Russia's "near abroad," and the expansion of NATO during a period of
Russian weakness, animate Moscow elites, just as war guilt, reparations, the loss of territory, and mandated disarmament
drove the resentment of German elites a century ago. Putin clearly appreciates the domestic political benefits of a strong Russian
foreign policy, and Ukraine has presented an opportunity to reassert Russian interests vis-à-vis the West.
Now as then, democratic Western Europe is less than resolute in the face of this belligerence .
Preoccupied with recovering from the most serious economic crisis since the inception of the Eurozone, neither Brussels nor
(more importantly) Berlin seems to have any appetite for a forceful stand against Russia . But even with its
problems, Europe today is unified (at least by historical standards) and remains a global economic power that possesses the latent
the presence of US military forces within
capabilities to punish Russian transgressions. No less significantly,
NATO provides a robust deterrent . While limited economic sanctions have been criticized, the prospect of greater pain
for the Russian economy (which is already in serious distress) may be sufficient to prevent further aggression. Unless Putin has truly
become an irrational adventurer, committed to expansion at the expense of Russia’s interests, his policies will continue to be merely
opportunistic in nature.
The current period in world affairs may indeed seem more uncertain and potentially dangerous
than any since the collapse of the Soviet Union . However, the increased assertiveness of non-
Western powers only reaffirms the centrality of the U nited S tates to the peace, security, and
prosperity of its allies around the globe. The threat of force by Moscow or Beijing is likely to be
self-defeating , as those threatened will naturally seek to reinforce and re-energize their ties to the
keeper of global order, the United States. As long as America’s unwieldy and divided political system does not
fundamentally erode its power and jeopardize its standing in the world , the probability of great
power war should remain remote .

Turns their impacts:

A. Long-term increases in government spending cause a tipping point in US public

debt---that immediately crushes the global economy
HBC 13 – House of Representatives Budget Committee, “Debt Crisis in America: What It Might
Look Like,” 2/22/13, https://budget.house.gov/uploadedfiles/debt_crisis_analysis.pdf
If such a debt crisis were to materialize, Gross warns:
[T]he U.S. would no longer be in the catbird’s seat of global finance and there would be damage aplenty, not just to the
U.S. but to the global financial system itself, a system which for 40 years has depended on the U.S. economy as the
world’s consummate consumer and the dollar as the world’s global medium of exchange. If the fiscal gap isn’t closed
even ever so gradually over the next few years, then rating services, dollar reserve holding
nations and bond managers embarrassed into being reborn as vigilantes may together force a
resolution that ends in tears . It would be a scenario for the storybooks, that’s for sure, but one which in this
instance, investors would want to forget. The damage would likely be beyond repair. 10
At the macroeconomic level, the risk is that the U.S. could eventually reach a “tipping point” on its debt
levels, precipitating a sudden change in investor sentiment and behavior. If, for instance, market
psychology changes, and foreign investors suddenly begin to lower their demand for U.S. debt—or even move out of dollar-
denominated assets more generally— interest rates could spike to a dangerous level, forcing the U.S. to
make immediate and painful fiscal adjustments (like the austerity programs that have provoked riots in
Greece and Spain). Facing the inability to borrow at a reasonable rate in the market, the U.S. would have to slash
government spending and raise taxes to narrow its large fiscal gap. In such a crisis, the Federal Reserve may also face
rising pressure to step in and “monetize” the government’s debt—essentially printing money to buy up the public debt that private
investors refuse to finance. Len Burman, former director of the Tax Policy Center, writes in a recent paper that this would
amount to “a catastrophic budget failure” that would be “ disastrous ” for the U.S. and global economy.11
Importantly, because this would fundamentally be a crisis of U.S. federal finances, the government would be unable to
borrow money to support the private economy, as it did during the recent financial crisis. If the U.S. was forced to address such
a situation internally without the benefit of cheap foreign credit, meaning by cutting domestic spending and raising taxes to close the
budget gap, Burman estimates that the economy could shrink by 25 or 30 percent, a contraction that
would rival the economic decline of the Great Depression .12
U.S. Treasury bonds are the lynchpin of global debt markets, held as safe and highly liquid assets by virtually all financial
institutions worldwide. A U.S. debt crisis would lead to sharp declines in the price of these bonds,
causing a deterioration in the balance sheet of large financial institutions that would be orders of
magnitude more disruptive than the subprime crisis . Burman and his colleagues write that “it could
easily take the nation a generation or longer to recover from (such a) disaster.”13

B. Heg collapses causes terrorism and prolif

Arbatov 7 Alexei, corresponding member of the Russian Academy of Sciences, member of the
Editorial Board of Russia in Global Affairs, “Is a New Cold War Imminent,” Russia in Global
Affairs, No. 2, July-September 2007, http://eng.globalaffairs.ru/numbers/20/1130.html
However, the low probability of a new Cold War and the collapse of American unipolarity (as a political doctrine, if not in reality)
cannot be a cause for complacency. Multipolarity, existing objectively at various levels and interdependently, holds
many difficulties and threats. For example, if the Russia-NATO confrontation persists, it can do
much damage to both parties and international security . Or, alternatively, if Kosovo secedes from Serbia, this may
provoke similar processes in Abkhazia, South Ossetia and Transdniestria, and involve Russia in armed conflicts with Georgia and Moldova, two
countries that are supported by NATO. Another flash point involves Ukraine. In the event of Kiev’s sudden admission into the North Atlantic Alliance
(recently sanctioned by the U.S. Congress), such a move may divide Ukraine and provoke mass disorders there, thus making it difficult for Russia and
the West to refrain from interfering. Meanwhile, U.S. plans to build a missile defense system in Central and Eastern Europe may cause Russia to
withdraw from the INF Treaty and resume programs for producing intermediate-range missiles. Washington may respond by deploying similar
This
missiles in Europe, which would dramatically increase the vulnerability of Russia’s strategic forces and their control and warning systems.
could make the stage for nuclear confrontation even tenser. Other “centers of power” would
immediately derive benefit from the growing Russia-West standoff, using it in their own interests. China
would receive an opportunity to occupy even more advantageous positions in its economic and
political relations with Russia, the U.S. and Japan, and would consolidate its influence in Central and South Asia and the Persian Gulf
region. India, Pakistan, member countries of the Association of Southeast Asian Nations and some
exalted regimes in Latin America would hardly miss their chance , either. A multipolar
world that is not moving toward nuclear disarmament is a world of an expanding Nuclear Club. While Russia and the West
continue to argue with each other, states that are capable of developing nuclear weapons of their own will
jump at the opportunity . The probability of nuclear weapons being used in a
regional conflict will increase significantly . International Islamic extremism and terrorism
will increase dramatically; this threat represents the reverse side of globalization. The situation
in Afghanistan, Central Asia, the Middle East, and North and East Africa will further destabilize.
The wave of militant separatism, trans-border crime and terrorism will also infiltrate Western
Europe, Russia, the U.S., and other countries. The surviving disarmament treaties (the Non-Proliferation
Treaty, the Conventional Armed Forces in Europe Treaty, and the Comprehensive Nuclear Test Ban Treaty) will collapse. In a worst-case
scenario, there is the chance that an adventuresome regime will initiate a missile launch against territories or space satellites of one or several great
powers with a view to triggering an exchange of nuclear strikes between them. Another
high probability is the threat of a
terrorist act with the use of a nuclear device in one or several major capitals of the world.

C. Heg solves disease

Meier 10 – Asst. Professor of Global Health Policy @ UNC Chapel Hill (Benjamin Mason, The
Obama Administration’s Global Health Initiative: Public Health Law, U.S. Foreign Policy &
Universal Human Rights, Public Health Law)
Global health is fast becoming an explicit goal of U.S. policy – with legislation, regulations, and
policy statements guiding our funding, activities, and programs to address public health abroad.
At the intersection of foreign policy and health policy, this global health imperative for public health law is poised to grow under the Obama Administration’s Global Health
Initiative. With contemporary institutions of global health governance now over 60 years old, the nature of the global health architecture has changed considerably as the United
States has shifted its global health priorities.[i] As a leading progenitor of the global health governance framework, the United States has long sought a place for global health
policy to alleviate suffering in an increasingly interconnected world. However, with U.S. policymakers harboring suspicions that global governance would advance “socialized
medicine” in the midst of the Cold War, the United States constrained international organizations to medical “impact projects” that would advance U.S. foreign policy interests.
[ii] Despite fleeting U.S. support for global health policy in the 1970s,[iii] the 1980 election of President Reagan—and with it, principled opposition to international
organizations—would limit opportunities for global health governance.[iv] Given a growing leadership vacuum in global health,
the global health architecture began to shift toward greater U.S. hegemony in global health
policy, with scholars increasingly noting that “the U.S. domestic agenda is driving the global
agenda.”[v] Moving away from a model of working through international institutions for global
health governance, the United States is bypassing multilateral organizations and pursuing a
herculean expansion in bilateral health assistance, increasingly making U.S. foreign policy a
singular force for global health.[vi] As the largest donor to global health—in absolute dollars, albeit less committed relative to GDP—foreign health
assistance is fast becoming an anchor of U.S. soft power – answering the call for global health leadership in a post-Cold War world.[vii] Where once this role

was defined by uncoordinated medical approaches to select high-profile diseases, the United
States is moving toward coordinated foreign assistance to public health systems . With U.S. health diplomacy
once grounded solely in the containment of the Cold War—to combat the “unsatisfactory living conditions on which Communism feeds,” influencing minds as much as
bodies[viii]—the 1961 establishment of the U.S. Agency for International Development (USAID) galvanized foreign assistance for public health, administering technical and
economic assistance for the provision of health services.[ix] However, even as extended by President Bush’s 2003 Emergency Plan for AIDS Relief (PEPFAR), these ambitious
global health commitments would be criticized for excessive reliance on medical services and for “crowding out” public health systems in the developing world.[x] In spite of
burgeoning efforts to address HIV, malaria, and tuberculosis, these fragmented U.S. efforts continued to lack coordination across government agencies, attention to health
systems, and strategy for foreign assistance. But as ethical claims and human rights have renewed attention to the plight of the world’s poor,[xi] the United States has moved to
coordinate foreign assistance for global health. Given the need for a comprehensive strategy to govern U.S. engagement with global health[xii]—a need that grew dire as the
global financial crisis decimated global health[xiii]—the Institute of Medicine (IOM) recommended that the United States engage more deliberately in global health leadership.
[xiv] To reshape foreign health assistance across U.S. agencies, programs, and partners, the Obama Administration’s Global Health Initiative (GHI) seeks to develop a unified
global health strategy to integrate and organize U.S. global health efforts. Focusing on public health systems (specifically health financing, information management, and
workforce capacity-building institutions)—adding onto existing disease-specific efforts (with 70% of funds earmarked for PEPFAR, notwithstanding a stabilization in HIV
funding)—the GHI seeks to shape how the U.S. government coordinates its resources across global health activities and engages with developing countries in meeting nine
targets for global health (delineated in figure 1), achieving these targets through seven key principles (delineated in figure 2).[xv] While it is unclear to what extent this foreign
policy effort will meet its targets and principles for health system strengthening, preliminary coordination among agencies has begun to identify areas in which the United States
could have the greatest sustainable impact on public health outcomes.[xvi] With $63 billion requested for this Initiative over a six year period, the GHI will seek to prioritize
These changes in U.S. policy will greatly
country-led efforts to reach the most effective and efficient improvements for public health systems.

influence disease prevention and health promotion throughout the world, with public health
lawyers holding key positions in shaping this policy. With an imperative to create policy
frameworks to guide our innovative programs in global health, the need has never been greater
to rethink how we in public health law endeavor to meet global health needs – viewing ourselves
as key actors in the global health architecture and viewing our work as medicine on a global
scale.
 AT: Cost Savings
Their cost projections are optimistic hand-waving---it’s impossible to
comprehensively solve the case and assume great cost savings
Paul Krugman 16, economist, “Weakened at Bernie’s,” 1/19/16,
https://krugman.blogs.nytimes.com/2016/01/19/weakened-at-bernies/
On health care: leave on one side the virtual impossibility of achieving single-payer. Beyond the politics, the Sanders “plan”
isn’t just lacking in detail; as Ezra Klein notes, it both promises more comprehensive coverage than
Medicare or for that matter single-payer systems in other countries, and assumes huge cost savings
that are at best unlikely given that kind of generosity. This lets Sanders claim that he could make it work with
much lower middle-class taxes than would probably be needed in practice.
To be harsh but accurate: the Sanders health plan looks a little bit like a standard Republican tax-cut
plan , which relies on fantasies about huge supply-side effects to make the numbers
supposedly add up. Only a little bit: after all, this is a plan seeking to provide health care, not lavish windfalls on the rich — and
single-payer really does save money, whereas there’s no evidence that tax cuts deliver growth. Still, it’s not the kind of brave
truth-telling the Sanders campaign pitch might have led you to expect.
 Link---2NC

Here are all the cards Nate asked for in CX:

The plan costs 30 trillion dollars---even with huge tax increases, that still boosts
the deficit by 16 trillion
John Holahan 16, Institute fellow in the Health Policy Center at the Urban Institute, “The
Sanders Single-Payer Health Care Plan: The Effect on National Health Expenditures and
Federal and Private Spending,” May 2016,
http://www.urban.org/research/publication/sanders-single-payer-health-care-plan-effect-
national-health-expenditures-and-federal-and-private-spending
 National health expenditures for acute care for the nonelderly would increase by $412.0
billion (22.9 percent) in 2017. Aggregate spending on acute care services for those otherwise enrolled in Medicare would
increase by $38.5 billion (3.8 percent) in 2017. Long-term service and support expenditures would increase by $68.4 billion (28.6
percent) in 2017.
 Together, national health expenditures would increase by a total of $518.9 billion (16.9 percent) in
2017, and by 6.6 trillion (16.6 percent) between 2017 and 2026.
 The increase in federal expenditures would be considerably larger than the increase in national health
expenditures because substantial spending borne by states, employers, and households under current law
would shift to the federal government under the Sanders plan. Federal expenditures in 2017 would increase by
$1.9 trillion for acute care for the nonelderly, by $465.9 billion for those otherwise enrolled in Medicare, and by $212.1 billion for
long-term services and supports.
 In total, federal
spending would increase by about $ 2.5 trillion (257.6 percent) in 2017 . Federal
expenditures would increase by about $32.0 trillion (232.7 percent) between 2017 and 2026. The
increase in federal spending is so large because the federal government would absorb a substantial amount of current spending by
state and local governments, employers, and households. In addition, federal spending would be needed for newly
covered individuals, expanded benefits and the elimination of cost sharing for those insured under
current law, and the new long-term support and services program.
 State and local governments could save $319.8 billion in 2017 and $4.1 trillion between 2017 and 2026 as the federal government
absorbs these costs under the Sanders plan (not shown in table 1). A maintenance-of-effort requirement could make state and local
funds available to help pay for the plan, but the legality of such a requirement is in question.
 Private health care spending by households and employers would drop as the federal government would absorb their spending
under current law. Private sector expenditures for these groups would decrease by $1.7 trillion in 2017 and by $21.9 trillion between
2017 and 2026. These considerable savings would partially offset the impact on the private sector of new taxes required to pay for
the Sanders plan.
 Analysis by the Tax Policy Center indicates that Sanders’s revenue proposals, intended to finance all new health and
nonhealth spending, would
raise $15.3 trillion in revenue over 2017 to 2026. This amount is approximately
$ 16.6 trillion less than the increased federal cost of his health care plan estimated here. The discrepancy
suggests that to fully finance the Sanders approach, additional sources of revenue would have to be identified; that is, the proposed
taxes are much too low to fully finance the plan.

Even if you assume the plan costs half of what our other link evidence says, it still
boosts federal spending as a share of GDP from 20 to 30 percent---even bigger
than the New Deal or Great Society
Laura Meckler 15, political reporter for The Wall Street Journal, “Price Tag Of Sanders
Proposals: $18 Trillion,” Wall Street Journal, 9/15/15, ProQuest
WASHINGTON -- Sen. Bernie Sanders, whose liberal call to action has propelled his long-shot presidential campaign, is
proposing an array of new programs that would amount to the largest peacetime expansion of
government in modern American history.
In all, he backs at least $18 trillion in new spending over a decade, according to a tally by The Wall Street Journal, a sum that alarms
conservatives and gives even many Democrats pause. Mr. Sanders sees the money as going to essential government services at a
time of increasing strain on the middle class.
His agendaincludes an estimated $15 trillion for a government-run health-care program that
covers every American, plus large sums to rebuild roads and bridges, expand Social Security and make tuition free at public
colleges.
To pay for it, Mr. Sanders, a Vermont independent running for the Democratic nomination, has so far detailed tax increases that
could bring in as much as $6.5 trillion over 10 years, according to his staff.
A campaign aide said additional tax proposals would be offered to offset the cost of some, and possibly all, of his health program. A
Democratic proposal for such a "single-payer" health plan, now in Congress, would be funded in part through a new payroll tax on
employers and workers, with the trade-off being that employers would no longer have to pay for or arrange their workers' insurance.
Mr. Sanders declined a request for an interview. His campaign referred questions to Warren Gunnels, his policy director, who said
the programs would address an array of problems. "Sen. Sanders's agenda does cost money," he said. "If you look at the problems
that are out there, it's very reasonable."
Calling himself a democratic socialist, Mr. Sanders has long stood to the left of the Democratic Party, and at first he was dismissed as
little more than a liberal gadfly to the party's front-runner, Hillary Clinton. But he is ahead of or tied with the former secretary of
state in the early-voting states of Iowa and New Hampshire, and he has gained in national polling. He stands as her most serious
challenger for the Democratic nomination
Mr. Sanders has filled arenas with supporters, where he thunders an unabashedly liberal agenda to tackle pervasive economic
inequality.
"One of the demands of my campaign is that we think big and not small," he said in a recent speech to the Democratic National
Committee.
Enacting his program would be difficult, if not impossible, given that Republican control of the House appears secure for the
foreseeable future. Still, his agenda is exerting a leftward pressure on the party's 2016 field.
The Sanders program amounts to increasing total federal spending by about one-third -- to a
projected $68 trillion or so over 10 years.
For many years, government
spending has equaled about 20% of gross domestic product annually; his
proposals would increase that to about 30% in their first year . As a share of the economy, that would
represent a bigger increase in government spending than the New Deal or Great Society and is surpassed
in modern history only by the World War II military buildup.
Mrs. Clinton so far has proposed programs that together would cost an estimated $650 billion over 10 years. Those are modest sums
next to Mr. Sanders's agenda.
He proposes $1 trillion to repair roads, bridges and airports. His college-affordability program would cost $750 billion over a
decade. He would raise $1.2 trillion in Social Security taxes in order to increase benefits and pay those already promised for 50
years.
His most expensive proposal, by far , is his plan to extend Medicare, the federal health program for
seniors, to all Americans.
Mr. Sanders hasn't released a detailed plan, but a similar proposal in Congress, sponsored by Rep. John Conyers (D., Mich.),
would require $ 15 trillion in federal spending over 10 years, on top of existing federal health spending,
according to Gerald Friedman, an economist at the University of Massachusetts at Amherst.
Mr. Gunnels, the Sanders aide, said the campaign hasn't worked out all details on his plan. But he said the $15 trillion figure was a
fair estimate.

Vermont, Colorado, and California all prove---single-payer annihilates budgets

Edward Morrissey 17, politics writer and columnist for the Week, “California's looming single-
payer disaster,” 5/24/17, http://theweek.com/articles/700800/californias-looming-
singlepayer-disaster
Progressives advocating single-payer health care need to face financial reality .
Vermont had to abandon its attempts to impose a single-payer health-care system when its greatest champion, Gov.
Peter Shumlin, discovered that it would cost far more than he had anticipated. Similarly, last year Colorado voters
resoundingly rejected ColoradoCare when a study discovered that even tripling taxes wouldn't be enough to keep up
with the costs.
Now it's California's turn.
The Golden State's legislature has
plowed ahead with a plan to impose single-payer care. But a new analysis from the
state Senate on SB562 shows
that the annual costs of such a system would exceed the state's
current annual budget — even if federal funding continued at the same pace. "California would have to find an
additional $200 billion per year, including in new tax revenues, to create a so-called 'single-payer' system," the Sacramento Bee
reported after the publication of a report by the Senate Appropriations committee. Even that estimate assumes the state would
retain the existing $200 billion in local, state, and federal funding it currently receives to offset half of a $400 billion total price tag.
$400 billion a year. That's 223 percent of California's total annual expenditures in an already bloated budget.
Let's put it another way: California could build four high-speed rail systems between San Francisco and Los
Angeles every year for the same amount of money . (Assuming, of course, that the state ever manages to build the one in
progress now, which is also being funded in large part by people who live outside of California.)
But wait! Can't they just use the money California employers pay now for health care by transferring those funds to the state in
taxes? Theoretically yes — but it's still not enough. According to the Bee's report of the Senate analysis, "Employers currently spend
between $100 billion to $150 billion per year, which could be available to help offset total costs. To get that cash into the California
system, the state would have to impose new taxes to seize those funds — and even then, California's new health-care system would
still come up short by between $50 billion to $100 billion every year."
As both Colorado and Vermont discovered, the
prospects inevitably get worse from there. An analysis from the
Colorado Health Institute showed that their state's ColoradoCare proposal would
start off with a deficit of over
$200 million in its very first year of full operation , even with a three-year headstart on new taxes to launch the
system. By the end of the tenth year, the cumulative red ink would have exceeded $7 billion — which would be
more than twice the state's annual GDP .
 Overall Heg IL---2NC

The budget’s a zero-sum game---controlling spending undergirds hard power,

which controls all other aspects of the international arena
Charles J. Dunlap 17, Professor of the Practice of Law and Executive Director, Center on Law,
Ethics and National Security, at Duke Law School, 3/29/17, “Why the Foreign Policy Sky is Not
Falling,” https://www.justsecurity.org/39337/foreign-policy-sky-falling/
In that regard, it’s important to recognize the US is still considered to be the most powerful country on the
planet . The cruel reality is that we live in a world where being the preeminent military power is essential for
our security, and I think most Americans understand this instinctively, and want the US to remain in
the lead.
I’m convinced that this is why a new Politico poll shows most Americans want more spent on national defense. As to humanitarian
aid to other countries? 45 percent wanted less spent, while only 16 percent wanted more and just 27 percent wanted the same
amount spent. Of course, many Americans may overestimate how much is spent on foreign aid, but I also wonder how many of its
supporters genuinely understand it. For example, around 40 percent is dedicated to selling weapons overseas and “building armies.”
We can, I think, all agree that we need an informed national discussion about foreign aid, but until that takes place, I can understand
some pulling back as we evaluate its value.
The U.S. budget is, unfortunately, a zero-sum game . Trump’s proposal is decidedly a hard
power one , but America’s global leadership cannot be maintained in the face of hard
power opponents like Russia , China , North Korea , Iran , as well as terrorist entities like ISIS ,
absent preserving its place as having the world’s most powerful military. No truly objective
observer can say that the U.S. military doesn’t need more resources – and this is something that predates the
rise of Trump. Do we really think that our diplomats will have the leverage they need with , for example, an
Air Force that is the smallest it has ever been, and flying airplanes averaging 27 years old?
Sure, I suppose we could just add to the debt and fully fund all the programs whose cuts Michael
and Jack decry, but recall that the former chairman of the J oint C hiefs of S taff Admiral Mike Mullen said in 2010
that the “most significant threat to our national security is our debt .” While I do think there
are places and circumstances where foreign aid can advance U.S. interests, at the moment, our top priority needs to be
ensuring we have the military means to create the circumstances for the diplomats to use the
billions they will still get most effectively.

Aff can’t possible solve our internal link better---controlling entitlement spending
is the single biggest internal link to overall US primacy---out-of-control deficits
crush competitiveness and military engagement---that causes global conflict
Zalmay Khalilzad 11, heg guy, “The Economy and National Security,” 2/8/11, http://gryphon-
partners.com/gryphon/the-economy-and-national-security/
Today, economic and fiscal trends pose the most severe long-term threat to the United
States’ position as global leader. While the United States suffers from fiscal imbalances and low
economic growth, the economies of rival powers are developing rapidly . The continuation of these two
trends could lead to a shift from American primacy toward a multi-polar global system ,
leading in turn to increased geopolitical rivalry and even war among the great powers .
The current recession is the result of a deep financial crisis, not a mere fluctuation in the business cycle. Recovery is likely to be
protracted. The crisis was preceded by the buildup over two decades of enormous amounts of debt throughout the U.S. economy —
ultimately totaling almost 350 percent of GDP — and the development of credit-fueled asset bubbles, particularly in the housing
sector. When the bubbles burst, huge amounts of wealth were destroyed, and unemployment rose to over 10 percent. The decline of
tax revenues and massive countercyclical spending put the U.S. government on an unsustainable fiscal path. Publicly held national
debt rose from 38 to over 60 percent of GDP in three years.
Without faster economic growth and actions to reduce deficits, publicly held national debt is projected to reach dangerous
proportions. If interest rates were to rise significantly, annual interest payments — which already are larger
than the defense budget — would crowd out other spending or require substantial tax increases that would
undercut economic growth. Even worse, if unanticipated events trigger what economists call a “sudden stop” in credit markets for
U.S. debt, the United States would be unable to roll over its outstanding obligations, precipitating a
sovereign-debt crisis that would almost certainly compel a radical retrenchment of the
United States internationally .
Such scenarios would reshape the international order . It was the economic devastation of
Britain and France during World War II, as well as the rise of other powers, that led both countries to relinquish
their empires. In the late 1960s, British leaders concluded that they lacked the economic capacity to maintain a presence “east
of Suez.” Soviet economic weakness, which crystallized under Gorbachev, contributed to their decisions to withdraw from
Afghanistan, abandon Communist regimes in Eastern Europe, and allow the Soviet Union to fragment. If the U.S. debt
problem goes critical, the United States would be compelled to retrench, reducing its
military spending and shedding international commitments .
We face this domestic challenge while other major powers are experiencing rapid economic growth . Even
though countries such as China, India, and Brazil have profound political, social, demographic, and economic problems, their
economies are growing faster than ours, and this could alter the global distribution of power. These trends could in the long term
produce a multi-polar world. If U.S. policymakers fail to act and other powers continue to grow, it is not a question of whether but
when a new international order will emerge. The closing of the gap between the United States and its rivals could
intensify geopolitical competition among major powers, increase incentives for local powers to
play major powers against one another, and undercut our will to preclude or respond to
international crises because of the higher risk of escalation.
The stakes are high. In modern history, the longest period of peace among the great powers has been the era of U.S. leadership. By
multi-polar systems have been unstable , with their competitive dynamics resulting
contrast,
in frequent crises and major wars among the great powers. Failures of multi-polar international systems produced both
world wars.
American retrenchment could have devastating consequences. Without an American security blanket, regional powers could
rearm in an attempt to balance against emerging threat s. Under this scenario, there would be a
heightened possibility of arms races , miscalculation , or other crises spiraling into all-
out conflict . Alternatively, in seeking to accommodate the stronger powers, weaker powers may shift their geopolitical
posture away from the United States. Either way, hostile states would be emboldened to make aggressive
moves in their regions.
As rival powers rise, Asia in particular is likely to emerge as a zone of great-power competition .
Beijing’s economic rise has enabled a dramatic military buildup focused on acquisitions of naval, cruise, and ballistic missiles, long-
range stealth aircraft, and anti-satellite capabilities. China’s strategic modernization is aimed, ultimately, at denying the United
States access to the seas around China. Even as cooperative economic ties in the region have grown, China’s expansive territorial
claims — and provocative statements and actions following crises in Korea and incidents at sea — have roiled its relations with South
Korea, Japan, India, and Southeast Asian states. Still, the United States is the most significant barrier facing
Chinese hegemony and aggression.
Given the risks, the United States must focus on restoring its economic and fiscal condition while checking and managing the rise of
While we face significant challenges , the U.S.
potential adversarial regional powers such as China.
economy still accounts for over 20 percent of the world’s GDP . American institutions — particularly
those providing enforceable rule of law — set it apart from all the rising powers. Social cohesion underwrites political
stability. U.S. demographic trends are healthier than those of any other developed country. A culture of innovation, excellent
institutions of higher education, and a vital sector of small and medium-sized enterprises propel the U.S. economy in ways difficult
to quantify. Historically, Americans have responded pragmatically, and sometimes through trial and error, to work our way through
the kind of crisis that we face today.
The policy question is how to enhance economic growth and employment while cutting discretionary
spending in the near term and curbing the growth of entitlement spending in the out years. Republican
members of Congress have outlined a plan. Several think tanks and commissions, including President Obama’s debt commission,
have done so as well. Some consensus exists on measures to pare back the recent increases in domestic spending, restrain future
growth in defense spending, and reform the tax code (by reducing tax expenditures while lowering individual and corporate rates).
These are promising options.
 AT: Squo Solves Readiness

Debt crisis crushes military financing---key to overall power

HBC 13 – House of Representatives Budget Committee, “Debt Crisis in America: What It Might
Look Like,” 2/22/13, https://budget.house.gov/uploadedfiles/debt_crisis_analysis.pdf
A debt crisis would limit the federal government’s ability to rollover debt— much less to
increase debt to finance existing benefits. While Greece and Spain have experienced a debt crisis, an economy
in a deep recession, the imposition of austerity programs, and civil unrest, they have had the European Union and the
IMF provide financing to buy them time. If the U.S. encountered a debt crisis, it’s unclear whether
other countries would provide interim financing. Even if other countries wanted to assist the U.S., they might not
have the capacity to do so. The Greek economy, for example, amounts to about $300 billion annually—compared with a $16 trillion
U.S. economy. In other words, the federal-budget deficit for the first two months of this year amounted to $292 billion, enough debt
to finance the entire Greek economy for a year.
Public finance is critical to national security . In a debt crisis, the federal
government’s ability to finance its military could be compromised . Though defense
spending has been declining as a share of the federal budget, the U.S. was also engaged in war during the
financial crisis. As the federal government was responding to the financial crisis, President Obama also ordered the surge in
operations for the War in Afghanistan on December 1, 2009. Though the cost of the surge of $35 billion was relatively small,
history shows that a country’s ability to finance its military is critical to success on the
battlefield. In The Ascent of Money, Niall Ferguson attributes Wellington’s victory over Napoleon to the
British’s ability to borrow funds .20

Even independent of a debt crisis, jacking up federal spending forces defense cuts
which collapse readiness
Justin Bogie 8/16, is a senior policy analyst in fiscal affairs at The Heritage Foundation.
8/16/17, “America Is Heading Straight Into Its Most Avoidable Crisis Ever”
http://dailysignal.com/2017/08/16/america-is-heading-straight-into-its-most-avoidable-crisis-
ever/
It is also important to note that increasing levels of federal debt threaten national security.
As major entitlement programs and payments on interest from the debt continue to consume a larger portion
of federal spending, other programs, such as defense, have faced significant cuts . Already
underfunded and ill-prepared, the U.S. military needs more funding, not less .

Declines in readiness cause global war

Alan Dowd 15, senior fellow with the Sagamore Institute, “Shield & Sword: The Case for
Military Deterrence,” 12/31/15, https://providencemag.com/2015/12/shield-sword-the-case-
for-military-deterrence/
The world has tried these alternatives to peace through strength , and the outcomes have
been disastrous .
After World War I, Western powers disarmed and convinced themselves they had waged the war
to end all wars. By 1938, as Churchill concluded after Munich, the Allies had been “reduced…from a position of security so
overwhelming and so unchallengeable that we never cared to think about it.”[xi] Like predators in the wilderness, the Axis powers
sensed weakness and attacked.
In October 1945—not three months after the Missouri steamed into Tokyo Bay—Gen. George Marshall decried the “disintegration
not only of the Armed Forces, but apparently…all conception of world responsibility,” warily asking, “Are we already, at this early
date, inviting that same international disrespect that prevailed before this war?”[xii] Stalin answered Marshall’s question by
gobbling up half of Europe, blockading Berlin, and arming Kim Il-Sung in patient preparation for the invasion of South Korea.[xiii]
The U.S. military had taken up positions in Korea in 1945, but withdrew all combat forces in 1949.[xiv] Then, in 1950, Secretary of
State Dean Acheson announced that Japan, Alaska and the Philippines fell within America’s “defensive perimeter.”[xv] Korea didn’t.
Stalin noticed. Without a U.S. deterrent in place, Stalin gave Kim a green light to invade. Washington
then reversed course and rushed American forces back into Korea, and the Korean peninsula plunged into one of the most ferocious
wars in history. The cost of miscalculation in Washington and Moscow: 38,000 Americans, 103,250 South Korean troops, 316,000
North Korean troops, 422,000 Chinese troops and 2 million civilian casualties.[xvi] The North Korean tyranny— now under
command of Kim’s grandson—still dreams of conquering South Korea. The difference between 2015 and 1950 is that tens of
thousands of battle-ready U.S. and ROK troops are stationed on the border. They’ve been there every day since 1953.
The lesson of history is that waging
war is far more costly than maintaining a military capable of
deterring war . As Washington observed, “Timely disbursements to prepare for danger frequently
prevent much greater disbursements to repel it.” Just compare military allocations, as a percentage of GDP, during
times of war and times of peace:
In the eight years before entering World War I, the United States devoted an average of 0.7 percent of GDP to defense; during the
war, U.S. defense spending spiked to 16.1 percent of GDP. In the decade before entering World War II, the United States spent an
average of 1.1 percent of GDP on defense; during the war, the U.S. diverted an average of 27 percent of GDP to the military annually.
During the Cold War, Washington spent an average of 7 percent of GDP on defense to deter Moscow;
it worked .
Yet it seems we have forgotten those hard-learned lessons. In his book The World America Made, Robert Kagan explains how
“America’s most important role has been to dampen and deter the normal tendencies of other
great powers to compete and jostle with one another in ways that historically have led
to war .” This role has depended on America’s military might. “There is no better recipe for
great-power peace,” Kagan concludes, “than certainty about who holds the upper hand.”[xvii]