Sunday, February 24, 2013

PF March 2013 Health Insurance - Pro Position

Resolved: The U.S. government should not require its citizens to have health insurance.

For part 1 of this analysis, click here.



The Pro Position

The Pro side of this debate must argue that mandated health insurance should not be required of US citizens.  To make such a case in light of the currently-in-force Affordable Care Act and the Supreme Court ruling the mandate is constitutional, Pro must convince the judge that mandated insurance is a bad idea, costly, or harmful to the interests of America.  It means making a legal case will be difficult, but appelaing to the judge on practical, impact laden terms is the best approach,  For this reason, I think there is a certain advantage for Pro to use the idea of "Obamacare", ACA and government ordered health insurance interchangeably.  The terminology may create a negative association in the mind of the judge which advantages the Pro.  Below, I present some possible contentions as ideas to get you started.  As with the Con position, the contentions need to be expanded into complete arguments which express the importance of the evidence to the judge.  Give her a reason to be concerned.

Contention: Mandated insurance harms business

Johnson (2012):
Employer-funded coverage is the structural mainstay of the U.S. health insurance system. A November 2008 Kaiser Foundation report says access to employer-sponsored health insurance has been on the decline (PDF) among low-income workers, and health premiums for workers have risen 114 percent in the last decade (PDF). Small businesses are less likely than large employers to be able to provide health insurance as a benefit. At 12 percent, health care is the most expensive benefit paid by U.S. employers, according to the U.S. Chamber of Commerce....For large multinational corporations, footing healthcare costs presents an enormous expense. General Motors, for instance, covers more than 1.1 million employees and former employees, and the company says it spends roughly $5 billion on healthcare expenses annually. GM says healthcare costs add between $1,500 and $2,000 to the sticker price of every automobile it makes. Health benefits for unionized auto workers became a central issue derailing the 2008 congressional push to provide a financial bailout to GM and its ailing Detroit rival, Chrysler.

Eibner, et al (2011):
The Patient Protection and Affordable Care Act as modified by the Health Care and Education Reconciliation Act of 2010, known as the Affordable Care Act (ACA), may create new incentives for small businesses to offer self-insured health care coverage. When a firm self-insures, it pays for enrollees’ health expenditures out of general assets or through a trust and bears the risk for unexpectedly large claims. In contrast, fully insured firms pay a fixed premium per enrollee to a health insurance company, which then bears the risk for unusually high claims. While fully insured and self-insured plans serve the same purpose—providing health insurance to workers—they are subject to different regulations...
These regulations may tend to increase prices for lower-risk groups (i.e., groups that tend to have lower claims costs), while reducing premiums for higher-risk groups. As a result, lower-risk groups may opt to avoid the regulations by self-insuring. The differences in regulations applied to the fully insured and self-insured markets, as well as the potential for an increase in self-insurance following the full implementation of the ACA, raise many policy questions about the comparability of the two types of insurance. In addition, the option to self-insure to avoid regulation could lead to adverse selection in the health insurance exchanges, resulting in only firms with high-risk, potentially expensive workers choosing to enroll in exchange plans. In an extreme scenario, adverse selection could lead to “death-spiraling,” where exchange premiums increase to the point at which the market becomes unstable.

Contention: Mandated health insurance increases costs for citizens

Insurance will not reduce the cost of health care
Johnson (2012):
The healthcare reform legislation passed by Congress largely focuses on decreasing the number of uninsured--projections estimate a reduction by about 60 percent, but it is less clear how much these reforms would affect the U.S. economy. Overall, the new law would produce close to $1 trillion in new government spending. Although the CBO found that the final law would reduce the federal deficit (PDF) by as much $138 billion by 2019, the Centers for Medicare and Medicaid Services, a U.S. government agency, also found that the legislation would do little to stem the rise in healthcare expenditures--expected to increase to more than 20 percent of GDP in the next decade...a spokesman for the National Federation of Independent Business disagreed that the law was a good thing. "The effects will hit small business especially hard, and small business is the country's engine of job growth and source of much of the economy's innovation," writes Robert Graboyes. "The healthcare law is laden with disincentives for businesses to grow, to innovate, and to hire. Businesses will experience higher financial and administrative costs, and both effects will diminish American productivity."

Eliminating Free-Riders increases costs
Cannon (2009):
Uncompensated care for the uninsured does not appear to be the major cost driver that the president claims. According to the Urban Institute:
It is commonly argued that the privately insured pay for uncompensated care through cost shifting—that is, health care providers offset uncompensated care “losses” by charging higher prices to privately insured patients. . . . Private insurance premiums are at most 1.7 percent higher because of the shifting of the costs of the uninsured to private insurers in the form of higher charges.
Including the cost of uncompensated care covered by taxpayers, the authors concluded, “Uncompensated care represents 2.2 percent of health spending in 2008.” The Congressional Budget Office agrees: “Uncompensated care is less significant than many people assume.” Making health insurance compulsory is unlikely to eliminate the problem of uncompensated care. (In Massachusetts, an estimated 4 percent of residents remain uninsured.) Even if it did, however, those who already purchase coverage would see their health care spending fall by at most 2.2 percent. In the process, compulsory health insurance would impose costs on the already insured that would almost certainly exceed those savings. The insured would pay more, not less.

Mandatory health insurance favors insurance providers
Cannon (2009):
A final indication that compulsory health insurance is a flawed concept is that the health insurance lobby supports it. Indeed, making health insurance compulsory would deliver an unjustified windfall to an already heavily subsidized private health insurance industry. All leading Democratic proposals would force tens of millions of Americans to purchase private health insurance, would give incumbent insurers a guaranteed customer base, would increase federal subsidies for private insurers, and would protect private insurers from competition by standardizing product design. Compulsory health insurance is less health care reform than yet another industry bailout.

Contention: Mandated health insurance increases government control

The slippery slope
Somin (2012):
Opponents of the mandate argue that a decision upholding it would give Congress unlimited power to impose mandates of any kind.4 That includes the much-discussed broccoli purchase mandate postulated by Federal District Judge Roger Vinson, the author of one of the three district court opinions striking down the mandate. If the mandate were upheld, he explains, “Congress could require that people buy and consume broccoli at regular intervals, not only because the required purchases will positively impact interstate commerce, but also because people who eat healthier tend to be healthier, and . . . put less of a strain on the health care system.” Such slippery slope concerns have been prominently emphasized in three of the four federal court decisions striking down the law...The slippery slope case against the health insurance mandate comes down to a simple proposition: If the mandate is upheld, Congress will have virtually unlimited power to impose mandates of other kinds. The federal government argues that the mandate is authorized by the Commerce Clause, the Tax Clause, and the Necessary and Proper Clause. All three arguments logically imply unlimited federal authority to impose virtually any other mandate, especially one that has economic effects of some kind. The only exceptions are those barred by individual rights provisions of the Constitution. In addition, it seems likely that Congress and various interest groups will try to take advantage of this slippery slope in practice.

Contention: Mandatory health insurance violates religious freedom

Klukowski (2012):
After repeated assurances that the Affordable Care Act (ACA) would not mandate abortion or people of faith violating their religious beliefs, the Obama administration issued a mandate requiring both, when Secretary Kathleen Sebelius issued a rule from the U.S. Department of Health and Human Services (HHS) saying that a vague provision in the ACA requiring employers provide “preventive care” means that employer healthcare policies must cover birth control, abortion-related, and sterilization services.
A torrent of lawsuits have flooded the federal courts, with people of faith arguing that the HHS Mandate is both unconstitutional and a violation of the Religious Freedom Restoration Act (RFRA).
Richey (2012):
The US Supreme Court on Monday set the stage for further litigation over the constitutionality of President Obama’s health-care reform law. In a somewhat unusual maneuver, the high court agreed to send one of several cases challenging the Affordable Care Act (ACA) back to a federal appeals court to consider the underlying merits of the lawsuit – including whether the measure violates religious freedom...The unresolved aspects of the suit involve the ACA’s requirement that companies with 50 or more employees provide a government-approved level of health insurance or pay a penalty.
The suit also alleges that the reform law forces members of Liberty University’s community to jettison their religious beliefs by paying into a required health-care system that they believe supports and funds abortions.
The suit charges that a religious exemption included in the ACA violates the First Amendment prohibition on excessive entanglement of government and religion. The ACA places the government in a position to decide which religions are authentic and deserving of an exemption and which are not, the suit says.

Click here to read about my experience judging this topic.


Healthcare Costs and U.S. Competitiveness, council on Foreign Relations
Toni Johnson, March 26, 2012

Employer Self-Insurance Decisions and the Implications of the Patient Protection and Affordable Care Act as Modified by the Health Care and Education Reconciliation Act of 2010 (ACA)
Christine Eibner, Federico Girosi, Amalia Miller, Amado Cordova, Elizabeth A. McGlynn, Nicholas M. Pace, Carter C. Price, Raffaele Vardavas, Carole Roan Gresenz

Associate Professor of Law, George Mason University School of Law

Appeals Court Oral Arguments Signal Trouble for Obamacare HHS Mandate
Breitbart News Service
Ken Klukowski 15 Dec 2012

Obamacare: Supreme Court orders new look at university’s lawsuit
Christian Science Monitor
Warren Richey, Staff writer / November 26, 2012

What if Supreme Court is not done with health reform law?
American Medical News
By Alicia Gallegos, amednews staff. Posted Dec. 10, 2012

All the President’s Mandates Compulsory Health Insurance Is a Government Takeover
Michael F. Cannon, Cato Institute, 2009


  1. Thank you for this, but-- couldn't government require you have health insurance by providing that insurance; essentially, a single payer system?

    In which case the mandate arguments do not apply, right? In the case of a single-payer system, everyone pays higher taxes instead of paying for insurance, and so it would become an argument of taxes.

    1. Yes it could be a single payer system like Canada but now things shift a bit. In a way the mandate still exists because citizens have no other options (eg. one usually can not buy private insurance). While a single payer system may have many disadvantages, it is a specific plan and there is no reason Con needs to defend it. On the other hand, if Con advocates it, the Pro will pull out all the issues Americans dislike about the Canadian system.

  2. Do you see ground for Aff. to say that the gov. should not mandate Health Insurance purchase, because the citizens of america should all buy health insurance to solve the problem of our current Health care/insurance problems?

    1. I am not quite sure what you mean. If you are saying the gov't should not mandate because people should just know to do it on their own, I think it's a difficult argument since up until now, people have not done it on their own which suggests, that left to their own, folks will not buy insurance if they don't think they need it. You could always turn it into a LD-like moral obligation for the people and perhaps you may be able to convince some judges.

  3. I love this (like usual, thank you) however I feel you under stress a major point, liberty. You do touch on government expansion of power, however I think the loss of liberty to choose is the biggest argument to be made by the pro side, and I would have thought there would be more cards on that. Not a complaint just a comment :).

    1. Excellent point and you are correct. Liberty is an important point that slipped through the cracks.

  4. I'd like to run something like the contention you have above about the violation of religious freedoms; however, I'm a bit confused. Under a system of mandatory health care, would citizens who purchase insurance be paying for abortions and birth control for others. The way I understand it, you pay for your insurance- if you get an abortion then perhaps your insurance would cover it but I fail to see how that is other citizens covering the fee. Is there something I am missing?? Maybe I'm just totally missing the point????

    1. Under the provisions of the ACA, insurers are required to provide contraceptive services "free of charge". The Catholic Church for example, provides insurance for its employees and so they would be forced to provide insurance which must cover services they consider a violation of the religious principles. This is the crux of the problem. The Liberty University case views certain contraceptive drugs as "abortion drugs", which further inflames their opposition and claim of violation of religious freedoms.

  5. I am concerned about a problem I predict will come up. How do we mention things like the ACA or talk about things like subsides without the con side simply saying they don't apply. I fear they will say something like this debate is about everyone simply having insurance, not the problems that will inherently but not directly come with it.

    1. I saw several applications of the ACA this past weekend in a major tournament. A few teams cited it in their framework and several just simply read evidence for the ACA. In fact, the major aim and provisions of ACA is to reduce the number of uninsured and so serves as an example implementation of the resolution. It does get tricky, though, when you try to explicitly exclude those parts of the ACA aimed toward improving health care outcomes. See my last post in this series. Click here


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