Thursday, October 4, 2012

LD 2012 Health Care - Aff Positions

For part 1 in the series click here


There are many avenues Aff can pursue in arguing for the support of UHC.  There is a financial justification based merely on the loss of productivity due to preventable or treatable illness.  There is a historical precedent in cases where the government, in full support of the U.S. Supreme Court has ordered mass inoculations against small pox.   The USFG has mandated seat-belt laws and forced certain manufacturers of harmful products like cigarettes to display warnings to consumers.  These are all forms of national health care initiatives aimed at protecting the health and well-being of the American people. Then, besides the pragmatic arguments, there is a vast array of philosophical as well as ethical/moral justifications of health care.  A fundamental argument can be, is health care a right, a privilege or a simply a commodity to be bought and sold?  Aff should really have little problem finding evidence for any of these areas of contention.

Revisiting the Question of Insurance

Some claim the United States has one of the best health care systems in the world in terms of facilities, technology, medical research, innovative treatments, etc.  Nevertheless there is a cost to obtain access to this system and in some it can be said that access to the best treatments and standards of care is a privilege of those that can afford to meet that cost.  Even the most basic services have a cost.  Whether free-clinics or emergency room service someone, somewhere must bear the cost and quite often those are borne by all U.S. consumers.  If the major barrier for people to access care is cost, then insurance can be a legitimate means to an end as a "plan" for achieving the solvency of UHC.  Indeed, much of the economic justification for health care is centered on the issue of insurance coverage and if you choose an economic framework then providing insurance may be a legitimate solution in meeting the resolution as long as your case defends a government mandated or managed insurance system or alternative insurance for those who can not afford private insurance.

Duty of States

I think it would interesting to look at the resolution in light of one simple question.  If we are going to Affirm that a state such as the United States ought guarantee some something, then we should ask ourselves why?  Why ought the United States guarantee UHC to its citizens? (An interesting follow up for the Neg, would be, why limit to the United States as opposed to any state? More on this when I look at the Neg positions.)  In our definitions we suggest "ought" implies a duty, so what determines the duties of a state?  How many times in the last twelve months or for that matter the last twelve years has LD attempted to answer that question?

The Duty of the state is any function the members agree so long as it does not violate moral law
Spencer 1851:
"morality stands towards government only in the nature of a limitation—behaves negatively with regard to it, not positively—replies to all inquiries by silently indicating the conditions of existence, constitution, and conduct, under which alone it may be ethically tolerated. And thus, ignoring government altogether, the moral law can give us no direct information as to what a government ought to do—can merely say what it ought not to do. That we are left with no precise knowledge beyond this, may indeed be inferred from a preceding chapter. For if, as was shown, every man has a right to secede from the state, and if, as a consequence, the state must be regarded as a body of men voluntarily associated, there remains nothing to distinguish it in the abstract from any other incorporated society—nothing to determine its specific function; and we may conceive its members assigning to it any function that does not involve a breach of the moral law"

Internationally, the right to health care is a basic human right
Gostin 2008:
"The International Bill of Human Rights, as well as numerous U.N. and regional human rights treaties, proclaim the right to health.15 Many countries have also incorporated a right to health or health care in their domestic law.16 In affirming that human beings are entitled to the “highest attainable standard of physical and mental health,” Article 12 of the ICESCR lists elements that are necessary steps for its realization: 
  • reduction in stillbirths and infant mortality;
  • healthy development of the child;
  • improvement in environmental and industrial hygiene;
  • prevention, treatment and control of epidemic, endemic, and occupational diseases; and
  • creation of conditions to assure medical services in the event of sickness.
The ICESCR, therefore, defines health to include both physical and mental health and lists a range of objectives that need to be achieved in cooperation with the international community."

Economic Justification

Lack of health care impacts the nation's GDP
Davis, et al 2005:
Investing in the health of workers and the prevention of disability and serious illness could have an economic payoff.The U.S. labor force would expand, with the potential for a significant increase in the nation’s standard of living and economic output. Even valuing lost work-time at the minimum wage, the nation gives up $185 billion each year in economic output because of its workers’ health problems.

Functional limitations resulting for poor health care impacts productivity
ACP 2004:
It has been estimated that lack of health insurance leads to the death of 18,000 adults ages 25 to 64 each year—making it the sixth-leading cause of death in this age group, ahead of HIV/AIDS or diabetes. (1) Furthermore, uninsured people with chronic conditions report worse health and more functional limitations and are three times more likely not to get needed medical care compared to those who are privately insured. The vast majority delay or forgo needed care because of the cost...
Functional limitations brought on by poor health can adversely affect workforce productivity and carry large economic costs. The report, Sicker and Poorer: The Consequences of Being Uninsured, commissioned by the Kaiser Commission on Medicaid and the Uninsured, notes that the combination of less ability to work and lower productivity resulting from poor health has been estimated to reduce earnings by between 10-28%, depending on race and gender, over a ten-year period.

Lack of UHC results in high-priced consumer products
Chua 2006:
Health insurance costs are built into the prices of American products. Because businesses in other industrialized countries are not responsible for shouldering most of the costs of employee health insurance, American companies are at a competitive disadvantage globally. General Motors reports that every car it makes is $1,500 more expensive because of health care costs, far more than what Japanese and German automakers have to pay.

The Precedence for UHC

State mandated health initiatives are legal
Malone (undated):
Analogously, a community free of an infectious disease because of a high vaccination rate can be viewed as a common. As in Hardin’s common, the very existence of this common leads to tension between the best interests of the individual and those of the community. Increased immunization rates result in significantly decreased risk for disease. Although no remaining unimmunized individual can be said to be free of risk from the infectious disease, the herd effect generated from high immunization rates significantly reduces the risk for disease for those individuals. Additional benefit is conferred on the unimmunized person because avoidance of the vaccine avoids the risk for any adverse reactions associated with the vaccine. As disease rates drop, the risks associated with the vaccine come even more to the fore, providing further incentive to avoid immunization. Thus, when an individual in this common chooses to go unimmunized, it only minimally increases the risk of illness for that individual, while conferring on that person the benefit of avoiding the risk of vaccine-induced side effects. At the same time, however, this action weakens the herd effect protection for the entire community. As more and more individuals choose to do what is in their “best” individual interest, the common eventually fails as herd immunity disappears and disease outbreaks occur. To avoid this “tragedy of the commons,” legal requirements have been imposed by communities (in recent times, by states) to mandate particular vaccinations.
In Jacobson, the Commonwealth of Massachusetts had enacted a statute that authorized local boards of health to require vaccination. Jacobson challenged his conviction for refusal to be vaccinated against smallpox as required by regulations of the Cambridge Board of Health. While acknowledging the potential for vaccines to cause adverse events and the inability to determine with absolute certainty whether a particular person can be safely vaccinated, the Court specifically rejected the idea of an exemption based on personal choice.b To do otherwise “would practically strip the legislative department of its function to [in its considered judgment] care for the public health and the public safety when endangered by epidemics of disease” (197 U.S. at 37, 25 S.Ct. at 366). The Court elaborated on the tension between personal freedom and public health inherent in liberty: “The liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good. On any other basis organized society could not exist with safety to its members” (197 U.S. at 26, 25 S.Ct. at 361).

Protection of health requires collective action
Leonard 2009:
The Institute of Medicine articulated a classic conception of public health: ―Public health is what we, as a society, do collectively to assure the conditions for people to be healthy.  As that definition suggests, public health goals typically cannot be achieved through individual action, but require collective, coordinated interventions. Often, that ―we, the organizer of public health efforts, is the government. In addition, the benefits accrue to the people—the community, the body politic, the public. ―The government‘s concern . . . is not . . . for this or that individual but . . .for all individuals[,] . . . the welfare of the community. Collective action and public benefit are hallmarks of public health interventions.

For Neg positions, click here.

For links to other LD topics, click here


Public Health Law in a New Century
Health Law and Ethics
Lawrence O. Gostin, JD, LLD

Herbert Spencer, Social Statics: or, The Conditions essential to Happiness specified, and the First of them Developed, (London: John Chapman, 1851). Chapter: CHAPTER XXI.: the duty of the state. on 2012-10-03

The Duty of States to Assist Other States in Need: Ethics, Human Rights, and International Law
Lawrence O. Gostin and Robert Archer
O’Neill Institute for National & Global Health Law Scholarship, Research Paper No. 7, February 2008

Universal Health Care, American Pragmatism, and the Ethics of Health Policy: Questioning Political Efficacy

Mamdouh Gabr Professor of Pediatrics, Faculty of Medicine, Cairo University, Egypt

State and Federal Roles in Health Care
Rationales for Allocating
Health and Productivity Among U.S. Workers
Karen Davis, Sara R. Collins, Michelle M. Doty, Alice Ho, and Alyssa L. Holmgren
The Cost of Lack of Health Insurance
American College of Physicians, (ACP), A White Paper

The Case for Universal Health Care
Written by Kao-Ping Chua
AMSA Jack Rutledge Fellow 2005-2006
Updated by Flávio Casoy
AMSA Jack Rutledge Fellow 2007-2008
Vaccination Mandates: The Public Health Imperative and Individual Rights
The Public's Right to Health: When Patient Rights Threaten the Commons
Washington University Law Review
Elizabeth Weeks Leonard


  1. 8=D---

    1. This comment has been removed by the author.

    2. Thanks. They did the same to one of the older articles as well. I guess they didn't realize or didn't care every comment sends me a notification with comment details. I thought about deleting them but its more childish than offensive so I left it.

    3. Ah, I agree.
      Thank you, my good sir/ma'am, for spamming this amazing article. Anyways, exceptional work, as always, Mr. Kellams.

      Note: I deleted my comment and Re-posted because I used the word "amazing" twice. Yes I am that OCD.

  2. Could you send me any sample cases because I am really lost in writing my case I have nothing and need inspiration. Also could you maybe throw out some core values or contentions for a boost? Thank you my email is

    1. I could send you cases but it is better if you write your own. Did you look at my post "Arguments and Values" (

  3. I am having alot of trouble figuring out what value and value criterion best fit together. Could you suggest some? I don't really have contentions together yet so, just anything?

    1. Health is an obvious value all by itself as is life. VC would be anything which increases or protects health or life like minimizing disease, increasing access to care, ensuring equal access (like for the disadvantaged), so on. Other values would be quality of life, justice, fairness, government legitimacy. Again, the VCs will be anything which protects or promotes the value chosen.


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