Tuesday, October 16, 2012

LD 2012 Health Care - Arguments and Values


For part 1 in the series click here

Introduction

It's been a while since I've posted anything new on this topic so I thought it is due for some further discussion.  It has been very intriguing watching how my own LD debaters work with this topic.  From novice to senior, it is providing a fairly rich stream of diverse ideas from the extremely pragmatic to the abstract.  Several of my debaters are concerned I will reveal the premises of their cases on this site and somehow that will leave them exposed or vulnerable.  As pointed out often by our assistant coach, the novelty of a case will typically last about two tournaments before everyone in the district has written Neg frontlines against the arguments.  National circuit debate is well known for disclosure and seems no less competitive as a result.  Nevertheless, my approach to laying out positions or revealing arguments is based upon my own ideas as if I were I writing the cases, so I have no trepidation about freely expressing my opinions.


Running the Value Framework

As a quick review, the case framework can be thought of as a justification for your stance.  It basically explains, in summary fashion, why you will take the position you intend to debate and this provides one or more standards by which the judge can evaluate the quality or value of your position as opposed to your opponent's position.  By standards, I mean, the guidelines the judge may use to determine if your position truly is superior or you actually achieve the value you choose to defend.  Its sort of like saying, judge, let's use a scale of one to ten where ten is 100% of the citizens in the U.S. receives life-sustaining health care and the case which comes closest to that ideal wins.  Generally, in LD the standards are a little less pragmatic in that, the case which saves more lives wins, or which is most just wins.  Often, competing frameworks result in a clash of values when Neg reads her case.  Neg's framework may establish a standard with an additional claim such as, "my opponent's value is life, but my value of justice should be preferred because a life without justice has no value."  I think it is important to remember that when values clash, your case burden doubles.  Not only must you prove you achieve your value, you must also prove your value is superior and what I see more often than I like, the debater will get caught up in the value clash and forget to uphold her own value.  At the end of the round, even if you prove your value is superior, if you fail to achieve your value, you have lost the round to an alert judge.  Another strategy by either side is to subsume the opponent's value.  This literally means absorb the opponent's value and it is a common strategy in value debate.  For example, Neg may say, "my opponent's value is life and I also protect life, but I do it better because only through the justice my case provides, can the lives of the poor be protected."  Of course, now you must prove your case uniquely does what the opponent's cannot do in order to successfully subsume the opponent's value.  I have seen many cases, run this way and some were masterfully presented.


Definitions Matter But...

I asked one my debaters, when this resolution says the "United States ought" does that mean the U.S. federal government or does it mean the collective state or local governments?  Does it matter?  Obviously it matters a great deal if one wants to claim, the United states has failed to uphold the resolution because one person in some remote corner of the nation is not receiving health care.  Of course, the resolution does not say the U.S. must provide health care, but merely says guarantee it and if one claims "universal" refers to the degree of coverage, does it truly mean 100% of the individuals or does it merely mean universally available even if some choose not to take advantage of its availability.  I think it is obvious the definitions you choose can be essential to the framework you wish to establish and critical to helping the judge understand how you are achieving your value. 

There is an enormous potential for clash over definitions.  Please don't go there.  It makes for an ugly debate which consumes a lot of time and achieves little unless the intent is to try to win the debate on a topicality argument.  My advice, is choose your definitions carefully if they are essential to establishing your case framework.  This usually means, if you think, for example, a narrow and specific definition of some word, like "universal" is a necessary part of your case strategy, then choose it carefully, be prepared to defend it if necessary, but do not get caught up in making it the principle thesis of your case.  Generally speaking, I think if you feel it necessary to research and cut a lot of evidence and spend a lot of time defending a definition, you should probably rethink your case and choose a different approach altogether.

For you debaters who think a topicality argument is justified (sometimes it is because an opponent is intentionally trying to gain advantage through over-limiting or over-broadening a definition) then run the topicality argument as part of a multi-pronged attack and run it to completion.  By this I mean, run topicality but not just topicality.  You must still make your case advocacy and if possible, attack the opponent's case because if the judge rejects your topicality argument you may still win on the strength of your other case arguments.  When I say run it to completion, I am of the opinion that once you make the decision to run topicality you better be prepared to carry it to the end of the debate.  Dropping an apriori argument hurts your credibility and risks the ire of the judge.


Societal Values

Prior to discussing specific values, I want to point out what may already be obvious to some.  Regardless of the value chosen, it is often possible to address the principles as they relate to individuals or to society as a whole.  Each of these requires very different arguments which still meet the resolution since U.S. citizens may refer to the individual members of a class or may refer to the class itself.  Therefore cases which broaden their perspective to focus on achieving values for the collective are still resolutional and need not get bogged down in the particulars of dealing with comparing one individual to another.  Why do this?  I think one good reason for taking the societal approach is it is compatible with how democratic nations function and it is compatible with general principles of social contract theory.  Individuals, give up certain rights or privileges for the common good.  As a result, the individual becomes less important than the collective but that is desirable in order to have cohesion.  Therefore, the nation operates in a utilitarian framework.  What we see in the United States, generally speaking, is a narrowing of the focus of government duties as one goes from top to bottom.  As we go from federal to state to local government we go from broad-based measures toward approaching a much more community-based approach to governance and some degrees of paternalism (e.g. New York state banning certain sizes of soft-drinks, school districts placing restrictions on the content of school lunches).

In our debate class, we spent some time considering some of the broader aspects of health care at the federal level, such as the protections provided by the Food and Drug Administration (FDA) and Environmental Protection Agency (EPA).

"The FDA serves as a consumer watchdog—it makes sure that safe and effective drugs are available to improve the health of patients who need them. The FDA evaluates new drugs before they can be sold and ensures that prescription and over-the-counter drugs, both brand name and generic, work correctly and that the health benefits outweigh known risks. The FDA’s review of new drug applications not only prevents unsafe drugs from entering the market, but it provides doctors and patients with the information they need to use medicines wisely.
In addition, the FDA continues to actively monitor and ensure the safety of drugs after approval. Among its post-marketing activities, the agency analyzes reports of adverse reactions submitted by companies and health care practitioners, and in some cases requires pharmaceutical manufacturers to conduct additional post-marketing testing (Phase IV trials) to evaluate long-term effects of approved medicines."
(src: http://www.phrma.org/about/faq/what-fda%E2%80%99s-role)(also see: http://www.fda.gov/AboutFDA/Transparency/Basics/ucm194877.htm)
Much or EPA's literature cites its purpose in protecting the health and well-being of human beings as a key motivation for its existence and research: "EPA’s Motivations, Increasing recognition that our health, well-being & economy depend on functioning ecosystems" (src: http://www.doi.gov/restoration/upload/Munns.pdf ) (Also see http://www.epa.gov/tribalcompliance/hcare/hchealthdrill.html and http://www.epa.gov/sciencematters/january2011/ecosystem.htm)

These are two examples of U.S. federal government regulations guaranteeing some aspects of health care without a national insurance plan or individual treatment plans which Neg may easily argue are beyond the scope of the U.S. government on several levels.  The regulatory role of providing health care is an approach to possible solvency while avoiding many of the debt, cost and tax arguments expected from some Neg positions.  


Other Kinds of Health Care

Some definitions of health care tend to be very specific, citing the treatment and prevention of physical illnesses while others are more generalized citing the maintenance of health: the condition of being of sound mind, body or spirit.  Such open definitions allows the exploration of alternative health care Affirmatives which focus on mental, emotional, social or spiritual well-being, either of which can have direct spill-over effects on physical well-being.  That leads into all kinds of -er- squirrelly - or maybe I should say - non-standard affirmatives, in which churches and spiritual enlightenment centers are a form of health care; social media can be a form of health care; recreation centers, golf courses, and swimming pools are a form of health care.  Another variant of that theme, is a strong military is another form of health care since, dying by nuclear attack or suffering from terrorist attacks are certainly non-conducive to a healthy life.  Admittedly, this is using a broad definition to allow one to focus on a narrow aspect of the resolution and one could certainly say it is far from the framers intent for the resolution, or so we presume.  I don't know what you can do with such positions, but I thought I would throw them on the table just to stimulate your thought processes.  In policy debate, these could be expanded into valid positions, but LD is not exactly policy debate is it?  Take it for what its worth.


The Common Values

Quality of Life
The value of quality of life will no doubt be seen in many cases.  There are many aspects to the "quality of life" which addresses the general well-being of individuals.  One may make the obvious claim and say the quality of life is protected when the individual can be free of disease or at least be provided treatment for disease or other aspects of health.  There are obvious approaches to achieving the value through mandating universal health care as a form of insurance or health industry services.  But, I think the best cases focus on the duty of the state (U.S.) to provide for the well-being of its citizens and thus provide for a better quality of life.  The justification for state support of well-being may be legal in a broad interpretation of the constitutional mandate to provide for the general welfare or a philosophical framework based on some interpretation of the social contract.  If you run social contract (as a contention, not a value nor criterion), choose the correct theory.  Locke's concept of social contract is decidedly different than Rousseau's.  Take time to understand the differences.

Life
Defending the value of life may be a no-brainer based on evidence that many U.S. citizens die prematurely from lack of affordable health care.  The "ought" of the resolution can be framed as a moral imperative to prevent avoidable death.  While, like the quality of life, cases may look to the duty of states on a legal or philosophical basis, a straight-up pragmatic argument for moral duty is possible.  However, when running this value, do not allow yourself to be trapped by arguments which may claim your position requires a coercive or paternalistic approach to protecting life.  You simply want to extend the guarantee of health care to all who would be willing to accept it.

Morality
Of course, if you see above, the moral imperative to protect life, morality itself is a valid value position implied by the word "ought" in the resolution.  There is evidence to support the position states have a moral duty to provide for the health of their citizens.  Possible standards (criteria) include; minimizing suffering, protection of life, helping the poor, etc.

Justice
There are several really good variants of the value of justice which can be applied to this resolution. Of course, there is the old tried and true, "giving each her due" which addresses themes of proportionality, just desserts and fairness.  Certainly, the victims of inadequate health care are often those who are poor or under-insured due to no fault of their own and states which value justice seek to reduce inequities which cause harms.  This leads to a second and perhaps more resolutional application of justice built around the concept of distributive justice espoused in the philosophy of John Rawls.  It is discussed specifically in relation to this topic in many sources, including the resources suggested by the National Forensics League so I am sure many debaters will be running it.

Equality
Equality could be another value upheld by some cases.  Equality can be an independent value but it often overlaps or is discussed in conjunction with other values, such as justice.  I think it is tough to argue each individual is entitled to the same things.  For example, if one person works very hard and acquires wealth it does not mean others should also be given wealth to promote equality.  The strength of the equality value lies in the the concept of equal opportunity.  Therefore, the state promotes equality when all citizens have the opportunity to receive health care if they make good personal choices.  The difficulties of this value and distributive justice lies in the fact some people end up in bad circumstances only because they are unlucky and not due to any choices they have made or from lack of opportunity.

Autonomy / Personal Freedom
This will, more than likely, become a Negative value and will argue that a national health care plan violates personal choice and freedom.  There are many ways to make this case.  Health care requires someone be forced to pay.  Health care requires someone be forced to provide the service.  Health care required everyone to participate or it is not universal.  All of these positions will advocate coercion by the state harms autonomy (whether the word coercion is used or not).

Quality of Life as a Neg Value
QoL is a versatile value and can also be used to support the Negative side of the resolution.  Again, arguments will focus on state coercion, forcing, intrusion and claim these harm the QoL.  These arguments will extend to dehumanization, biopower, slavery, and other forms of extreme degradation.  These arguments can be effective in undermining Affirmative values so be prepared.


For links to other LD topics, click here

10 comments:

  1. Can you please elaborate and/or clarify what you said in the last paragraph of societal values?

    "The regulatory role of providing health care is an approach to possible solvency while avoiding many of the debt, cost and tax arguments expected from some Neg positions. "

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    1. It can be argued the US has long been providing universal health care by way of its regulatory agencies such as the Evironmental Protection Agency (EPA), Occupational Safety and Health Administration (OHSA), Food and Drug Administration (FDA) and the myrad of services which fall under the Department of Health and Human Services. While these groups have an enforcement role, their primary function is to manage the well-being of people through regulations, not by clinical patient care. What we see, therefore, is the government can provide solvency by establishing a regulatory environment aimed at protecting public health. In fact, you can easily find evidence that public health services have done more to save lives and promote health care than all the medical services combined since medical services are provided patient by patient but public health deals with entire populations. The framework for such a case rests in the definitions and interpretation of the resolution.

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  2. What do you suggest would be a good value criterion to uphold the value of quality of life for the negative case. I am trying to say that this will lower the quality of health care overall and could cause deaths for one of my contentions. And for another that the goverment may intrude further to keep costs down.

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    1. This is a very difficult question to answer without knowing specifics of your contentions. Many health care related issues affect the QoL such as the ability of the individual to make decisions (freedom of choice) about their bodies and care, having a personal relationship with one's care-giver, general happiness, being pain-free or comfortable, having mobility or freedom of movement, etc. Generally, QoL is measured by hedonistic ideals such as maximizing pleasure and happiness. Any thing that harms one of those subjective ideals harms the QOL. Let's assume, for example, your contention states government health care will result in wait-lists. Build a link like this: 'x' improves the QoL. Wait-lists are not (or 'do not') 'x'. Therefore wait-lists do not improve the QoL. 'x' is your value criterion and may be something like minimizing suffering. The choice, therefore depends on the theme of your contentions, how you make the links and what you can prove.

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    2. Okay.. So say my conetentions were 1)universal health care sacrifices quality (through waiting lists) and technological advancements 2)Health care does not mean healthy/healthier 3)Paying for this "free" health care and what the absurd things the gov't will do to lower costs. Perhaps my Value shouldn't be QOL?? I've always had trouble with figuring out what my value/criterion should be...

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    3. I don't think QoL should be rejected. It can be easily worked into your case and as I already suggested "minimize suffering" could work as a VC. When the quality of service fails and people have trouble getting access to HC they suffer. Some will die due to delays or poor quality. Even something like "maximizing access to quality care" is a VC. Your C1 links to access, C2 & C3 to quality of care. When people do not have access to quality care, their quality of life is diminished.

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  3. Is societal welfare a good value for a flex neg case?

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  4. And if so, what can the criterion be?

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    1. I like "general welfare" better than societal welfare since general welfare is in the preamble of the constitution.

      Perhaps you can also consider social well-being. Well-being is easy to connect with health care and is supported by many contentions. Some criteria for both may be upholding the social contract, providing for the common good, etc.

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