Neg - Medicare - Michigan 7 2023 BEJJP

Neg – Medicare for All
Big thanks to Andrew, Arish, Calista, Dylan, Ian M, Jamie, Kailey, Kavneer, Neha, Risha and Sarah J for their help generating this file.
I’m sure thanks are also due to the college debate community in 2017-2018.
Solvency
1NC – General
Negative repercussions tank solvency.
Diane Omdahl 22, registered nurse and holds a master’s degree in Health Services Administration, number 89 vol 4, 2022, CSA Journal, “Why “Medicare for All” Is Not at All Like Medicare,” pg 12-14, http://progressally6yogf8hc32ioroi.s3.amazonaws.com/list/Journal/89/omdahl.pdf, kcab
What Are the Possible Negatives? A system that sounds too good to be true usually comes with some issues.
This system would replace all private health insurances. This could have a significant impact on the economy. In 2020, the health insurance industry had $31 billion in net earnings and an increase in their profit margin by 3.8% (National Association of Insurance Commissioners, 2021). Eliminating these plans would also eliminate jobs. The health and medical insurance industry employed almost 600,000 people in 2022 (IBISWorld, 2022), so losing these jobs would have a huge impact. It’s possible Medicare for All could create replacement jobs, but to what degree is unknown.
There could be an impact on provider and patient satisfaction. In today’s world, doctors can choose which networks to join and can opt in or out of accepting Medicare assignment. With a single-payer system, there are concerns about more government oversight affecting patient care decisions. (However, today’s system has prior authorization, which is insurance oversight affecting the decisions.) Likewise, patients have several options. If they don’t like their current plan, they can change during open enrollment or open season. In a single-payer system, there are no options.
The cost estimates for Medicare for All are all over the map. Just as with cost savings, there are all kinds of numbers. A report from the Congressional Budget Office (2019) projects that federal subsidies for health care would be $1.5 trillion to $3 trillion higher in 2030 under the illustrative single-payer options than they would be in that year under current law (Swagel, 2020). Economists estimate that Bernie Sanders’ Medicare for All proposal would cost somewhere between $30 trillion and $40 trillion over 10 years (Luthra, 2020).
That money would have to come from somewhere. A study by the Committee for a Responsible Federal Budget (2020) noted that paying for Medicare for All could require raising payroll taxes by 32% on workers and businesses. Other options that on their own could fund Medicare for All, according to the study, include a 25% income surtax; a 42% value-added tax on consumption; a 100% increase in individual and corporate tax rates; or, more likely, a combination of taxes (Committee for a Responsible Federal Budget, 2020).
Why Is This Called Medicare for All? This proposed system carries the name “Medicare,” but when you start digging into the facts, today’s Medicare is not anything like the Medicare for All proposals. Medicare is not a single-payer system. Some of the payers include:
• Payroll taxes and other sources—such as income taxes paid on Social Security benefits and interest on trust fund investments—fund the Hospital Insurance Trust Fund, which covers many Part A (hospital insurance) benefits.
Then, premiums paid for Part B (medical insurance) and Part D (prescription drug coverage), along with funds authorized by Congress, pay for Part B and Part D benefits.
Funding for Medicare Advantage (Part C) plans comes from the Part A and Part B accounts. Medicare pays a fixed amount each month to the private insurers that administer Medicare Advantage plans. Medicare supplement insurance plans (Medigap policies) do not receive any federal funding.
Healthcare providers receive payment from the federal government for services delivered to Original Medicare beneficiaries and from the Medicare Advantage plans for care to their members.
Healthcare providers receive payment from the federal government for services delivered to Original Medicare beneficiaries and from the Medicare Advantage plans for care to their members.
In 2022, the monthly premium for Part B is $170.10 a month. Everyone pays this. • Those who have not earned 40 Social Security credits must pay for Part A. That adds $274 to $499, depending on how many credits the person has.
• Part D drug plans and Medigap policies, along with some Medicare Advantage plans, come with monthly premiums.
• Higher-income beneficiaries subject to IRMAA (income-related monthly adjustment amount) can pay anywhere from $180 to $486 a month more for Part B and Part D, on top of the premiums.
• There are out-of-pocket costs in the form of deductibles, copayments, and coinsurance. For those with Medicare Advantage plans, the maximum out-of-pocket limit is $7,550 in 2022. (Plans can offer lower limits.)
• And we can’t forget late enrollment penalties. Missing the window to enroll in Part A, Part B, or Part D can cost more every month for life (Medicare.gov, n.d.).
Pre-existing medical conditions can jeopardize one’s ability to get Medicare coverage. The Affordable Care Act eliminated the impact of these conditions in many situations, but it did not have an impact on Medicare supplement plans. Insurers can use medical underwriting when someone applies for CSA JOURNAL 89 / VOL. 4, 2022 / SOCIETY OF CERTIFIED SENIOR ADVISORS / WWW.CSA.US PAGE 13 a plan. Pre-existing conditions can lead to a denial of the application or higher premiums (Omdahl, 2018). So, if it’s not anything like Medicare, why is this proposed system called Medicare for All? It may be that including “Medicare” in the title removes the negative connotations “single-payer for all” carries.
What are Obstacles to Medicare for All Implementation? There are many opinions about what it would take to implement this system, but these barriers must be considered. Opposition by big players. These three groups could present formidable challenges. • Health insurance companies would be left out in the cold with just one payer. There is little doubt that the health insurance industry has considerable clout. In the Medicare Advantage industry, there are 3,834 plans available this year: that’s 284 more than last year (Damico et al., 2021).
• The Partnership for America’s Health Care Future (PAHCF), an alliance of American hospital, health insurance, and pharmaceutical lobbyists, spent over $140 million in 2018. The alliance’s goals include protecting patient choice, expanding access, lowering costs, improving quality, and fostering innovation. And, according to the “Our Mission” statement on the PAHCF website, “whether it’s called Medicare for All, Medicare buy-in, or the public option, one-size-fits-all health care will never allow us to achieve those goals” (n.d.).
• The American Medical Association is opposed to Medicare for All. It believes the best way to expand health care is through a mix of private and public health insurance options (Finnegan, 2018).
Putting the system in place. What would implementation involve and how long would it take? Because everything is proposed, there are no details available. But stop and think about this. Today, there are hundreds, maybe thousands, of different insurance options. And, then tomorrow, everyone has the same coverage. Establishing a single-payer system would involve substantial changes in coverage, provider payment rates and systems, financing methods of health care, and patient behavior and expectations.
Healthcare veterans who have survived at least one implementation of a new government payment program are probably shaking in their boots. To understand their concerns, consider the government’s distribution of new Medicare cards (Centers for Medicare and Medicaid Services, 2017). A 2015 law mandated the replacement of Social Security numbers with unique identifier by January 2020. It took five years to give new cards to approximately 62 million beneficiaries. Granted, this was a big task, but it was not nearly as big as changing a payment system for everyone in the country. Replacing today’s mishmash with one government program means new systems for enrollment, claims submission, payments, coverage, appeals, education—the list goes on, for 333 million people (United States Census Bureau, 2022). What would that timeline look like?
History. Our country’s efforts to implement universal health insurance started over 80 years ago when President Roosevelt realized that including health insurance would jeopardize the entire Social Security Act (Healthcare-Now, n.d.). A 1960 national debate topic was “Resolved: that the United States should adopt a program of compulsory health insurance for all citizens” (Wake Forest University, n.d.). (If you ever debated, you know most topics have little chance of seeing the light of day.) A slew of proposals have come and gone since then, without the government approving even one demonstration project.
Giving up what you’ve got. Change is difficult; many don’t want to deal with it. Medicare for All would be a major upheaval. It would replace all insurance options available today, throwing everyone into an unknown world.
There is so much uncertainty surrounding Medicare for All, but there are two things we know for certain.
1. Medicare for All is not today’s Medicare. 2. Medicare for All would be the end of Medicare as we know it.
Dangers of the single payer system prove it wouldn’t be successful.
Parthay Patel 23, Virginia Commonwealth University, Joshua Barton, Virginia Commonwealth University, 3/8/23, Journal of Student Research, pg 4-6, “Administrative Inefficiency and The United States Healthcare System”, DOI: https://doi.org/10.47611/jsr.v11i3.1674, kcab
A Discussion of Single-Payer Healthcare
Although adoption of similar policies is vital for the United States, an argument can be made that it is necessary to fully adopt a single-payer system, where a single entity (like the government) is responsible for reimbursements to healthcare professionals and hospitals for medical services (Diamond, 2009). Certain proponents of this system would contend that nothing else would suffice to fix our healthcare system – administratively and otherwise. This argument generally stems from the idea that the majority of administratively efficient countries have single-payer systems and that a single-payer system could control costs greatly. It is contended that the goal is to improve access to care and reduce healthcare costs through a reduction of administrative expenses (Diamond, 2009). Although this may seem like an appealing proposition, there are other dangers to switching to the single-payer system, leading to negative ripple effects in our healthcare system. Diamond, a medical professional who publishes healthcare research, explains that an over-attention to administrative costs can distract us from other issues that arise from single-payer systems (2009). The single-payer system allows the government to set prices, which leads to inadequate reimbursement by physicians and hospitals, reduction in quality of care and healthcare innovation, and an increased rationing of resources and wait times for services (Diamond, 2009). This type of intervention may seem to be successful by reducing administrative costs, but through the negative effects in quality of care, innovation, and resource allocation, it would eventually become abundantly clear that the single-payer system is not the perfect solution. Reducing administrative costs at the expense of other components of our healthcare system wouldn’t be a good plan of action; it does not make logical sense to create a drastic change in our healthcare system if there are not exponentially more gains than losses from switching to a single-payer system. More importantly, previous attempts to implement single-payer type systems at small-scales have proved unsuccessful in the United States. In 1994, Tennessee attempted this with TennCare which provided health insurance to most uncovered patients while attempting to control costs and in 2006, when Massachu-setts created legislation to move towards near-universal healthcare (Diamond, 2009). Unfortunately, TennCare col-lapsed, which was credited to improper management and impractical financial planning. Similarly, Massachusetts had inadequate expansion of the provider workforce, which led to some patients having absolutely no access to care with costs rising beyond expectations (Diamond, 2009). If single-payer government-run healthcare doesn’t work at the small-scale, it would be preposterous to take the risk for the US to adopt this system at an exceedingly large scale. It is more than likely, therefore, that this could lead to an even worse healthcare system. Therefore, it is clear that allow-ing the government to set up such a system could be detrimental to other determinants of healthcare performance and, given the evidence we have of state-level interventions, may not even be practical for the United States.
Standardization and Simplification
It is rather far more reasonable to aim for cost-containment rather than a single-payer system. This means that it should be sought out to obtain the benefits of the single-payer system without fully integrating a single-payer system. This should be done through standardizing and simplifying administrative tasks through a variety of methods. Ginsburg et al. suggest developing administrative tools and technologies for healthcare, similar to those that are common in other industries which can be adapted for healthcare (2020). Ginsburg et al. also advocate for standardizing prior authori-zation through the use of federal legislation, and standardizing quality reporting by creating agreed upon requirements between private insurers and Medicare (2020). Chernew & Mintz additionally contend that policy must acknowledge the negative ramifications of unnecessary costs and can be used to standardize requirements and rules for patient care administrative work (2021). Lastly, Ginsburg et al. advocate that increased data interoperability to improve sharing of health data would also contribute to a reduction of costs and would be a better alternative plan to lead to savings (2020). Through this method, it is possible to keep the benefits of the single-payer system without sacrificing the other benefits that already exist in the US. These methods would improve simplicity, which would help us capture savings through addressing the complexity of the US multi-payer system.
Sahni et al. expand on this idea by suggesting potential organizational level and industry level interventions to simplify administration. At the organization level, the researcher suggests the automation of repetitive work through the:
Generation of standard invoices and financial reports; using analytical tools for human resources departments to better predict and address temporary labor shortages; integrating a suite of tools and solutions to coordinate staffing for nurse managers; and building strategic communications platforms between payers and hospitals to send unified messages. (Sahni et al., 2021)
These solutions would allow firms to simplify repetitive work and streamline processes through the use of healthcare technologies. If used correctly, technology can be a powerful tool to improve efficiency, which would produce a lower net cost. Sahni et al. (2021) contend that an implementation of current technologies have been suc-cessful in certain healthcare organizations, where tools are used to streamline financial and human resource ineffi-ciencies. These tools not only reduce costs but are beneficial for the organizations in terms of economic profit, indi-cating that improving efficiency by firms improves financial success (Sahni et al., 2021). At the industry level, the researcher supports the use of broad level intervention, where collaboration between firms is necessary to bring mas-sive change to the healthcare system. Particularly, the researcher identified sets of macro-level interventions:
2NC – General Solvency
Uncertain quality and higher taxes render the plan ineffective and triggers political gridlock.
Tyler Cowen 17, Holbert L. Harris Chair of Economics at George Mason University and serves as chairman and faculty director of the Mercatus Center at George Mason University, 9/12/17, Mercatus Center, “Incentives Are All Wrong for Single-Payer Health Care,” https://www.mercatus.org/economic-insights/expert-commentary/incentives-are-all-wrong-single-payer-health-care, kcab
Americans won't give up their private insurance unless the government option is better. And that won't be cheap.
The conventional wisdom these days is that the major Democratic presidential candidates for 2020 will end up endorsing some version of single-payer health care. Senator Bernie Sanders is expected to introduce his Medicare for All bill this week, with a considerable number of co-sponsors. This political posturing, however, is far from a practical proposal.
There’s an obvious problem with moving Americans to a single-payer system: Most people with private health insurance are pretty happy with their current arrangements. They are not looking to trade in that coverage for a new government program of uncertain quality, along with unknown higher taxes. When President Barack Obama was selling the Affordable Care Act, he promised Americans that they could keep their health insurance if they wanted to. When this didn’t turn out to be true for everyone, there was a significant backlash.
Progressive analysts thus have turned to how a single-payer system might come about more gradually. But longer transition times don’t solve the core problem.
Let’s say the federal government sets up a “public option,” as it sometimes is called. Individuals would have the opportunity to buy into government insurance at some price. The new government program would be competing with private insurance, but just how good will the new benefits be? If you’re healthy and have other coverage, you probably won’t switch -- if you did, that would be a sign that the new government program was of very high quality and probably too expensive for the nation as a whole. Boosting the health care of the best-covered Americans isn’t the policy priority right now.
Instead, the public option might be set up to attract those who don’t already have good coverage. But those are the same people who don’t have the money to pay a fair market price for health insurance now. In essence, the program would come to resemble a Medicaid expansion, whether or not it would fall under the formal rubric of Medicaid.
That’s a plausible option for a marginal change; many states, of course, have already done a Medicaid expansion. The question remains whether such a program can evolve into single-payer health insurance. The answer is probably not. To become a single-payer system, as coverage climbs up the income ladder, the new reform would have to lure Americans out of private health insurance. It either has to make the private alternative worse, say by penalties like a stiff “Cadillac tax” on policies that exceed a certain level, or it has to make the public alternative especially appealing. We are then back to the change either being unpopular or spending too much money on people who already have decent coverage.
You can make a good case for continuing the forthcoming Cadillac tax on private insurance, as is embedded in Obamacare. But the point of that change was to get people to move to less health insurance coverage and to use less health-care resources, not to bounce them into a system with yet lower marginal cost for a doctor’s visit or extra medical procedures.
It’s worth thinking through why some single-payer systems, such as those on the European continent or in Hong Kong and Taiwan, seem to work. Typically those sys

Preview shortened. Download the file for the full document.