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

PF March 2013 Health Insurance - Con Position

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

For part 1 of this analysis, click here.

Con Position

I am posting the Con position first. It advocates for health insurance which, in March 2013 is the position represented by the status quo.  As much as possible I have tried to avoid a defense of "Obamacare".  The resolution does not demand a debate about Obamacare even though Obamacare is a law which does require citizens to have health insurance.  While it may be difficult to avoid all mention of Obamacare, the strategy for doing so is to deemphasize any possible negative views the judge may hold based on her political views.  Con needs to emphasize, the debate is not about Obamacare. It is about government mandated health insurance.  Con will be arguing the government SHOULD require its citizens to have health insurance because the advantages outweigh the negative outcomes of incomplete insurance coverage.

There are many ways to advocate for universal health insurance and I have selected a few key contentions to help you get started in your research.  For the most part you will see that I am presenting the contentions as ideas.  By this, I mean they will need to be fully developed into complete arguments.  If you get up and simply read some of these cards there is a very good chance you will lose.  In many cases you will need to add text which completes the impact of the evidence and tells the judge why the evidence is significant to her life.

Contention: Requiring health insurance protects the vulnerable

For this contention the basic argument is certain groups of individuals are particularly vulnerable due to the lack of adequate health insurance.  Such groups include, children, the disabled, immigrants (both legal and illegal), elderly and poor.  The evidence will show that while some of these groups do have access to insurance, often the coverage they have is inadequate to fully cover their needs and the needs of the families which support them.  Examples:

Protection for Children
Kenney & Dorn (2009):
While children have higher coverage rates than adults, millions of children remain uninsured. They could gain health insurance under health care reform, increasing their access to needed care. Over two-thirds of uninsured children are already eligible for Medicaid or CHIP, and the vast majority have parents who say they would enroll their children in public programs if they were eligible. Thus, addressing barriers to enrollment and retention in public programs will be essential to achieving universal coverage for children. Achieving that goal will also require affordable coverage options for the families with uninsured children whose incomes are too high to qualify for CHIP but who lack access to employer-sponsored insurance.
Children would also benefit if health care reform increases their parents’ health insurance coverage. It is expected that uninsured children will be more likely to enroll in coverage if their parents become eligible for subsidized coverage through health care reform. By reducing barriers to needed care, increased coverage for parents would also improve their health status and functioning, leading to gains in their children’s health status, health care use, and general well-being.

Protection for Immigrants
Ku (2006):
Because so many immigrants lack the protections of health insurance, the cost of even a single hospitalization can drive many into debt and financial insolvency. The Institute of Medicine, a component of the National Academy of Sciences, has estimated that lack of health insurance in the United States costs between $65 and $130 billion per year, due to health impairments and years of productive life lost of all uninsured, not just immigrants.

Immigrants, both legal and unauthorized, often rely on a patchwork system of safety-net clinics and hospitals for free or reduced-price medical care, including state- and county-owned facilities, as well as charitable and religiously affiliated facilities. Their reliance on this system has led many states and communities to be concerned about uncompensated health care costs for uninsured immigrants and the state and local fiscal burdens that result.
Recent immigrants are more likely to be uninsured. Over time, their rates of insurance improve and their incomes grow. This is partly because immigrants tend to find better-quality jobs with time, and partly because both citizens' and immigrants' incomes increase with age and greater job experience. The main reason immigrants are less insured than native-born citizens is that, despite their high rates of employment, fewer immigrants have employer-sponsored health insurance.

Contention: Health outcomes are better for the insured

This contention argues that insured people tend to be healthier for obvious reasons.  This may seem intuitive but I think it must be mentioned in order provide additional advantages which favorably impact the Con case.  This advantage links to many other arguments, including the idea that healthier people are more productive contributing more to the GDP.

Improving Outcomes
Bernstein, et al (2010):
Uninsured people generally receive much less care, either preventive or for acute and chronic conditions, than insured people. In particular, uninsured adults report lower levels of self-perceived wellness and functioning. Estimating the number of premature deaths attributable to lack of insurance presents methodological challenges, but some research indicates that as many as 44,500 deaths per year in the United States are linked to lack of insurance.
Research on the use of preventive services, which has focused separately on children and adults, suggests that:
• Uninsured young children have lower immunization rates than insured children.
• Uninsured adults are less likely than insured adults to receive preventive services or screenings, such as mammograms, pap smears, or prostate screening.
In turn, inadequate prevention and screening increase the likelihood of preventable illness, missed diagnoses, and delays in treatment. When uninsured people seek emergency care for severe illness or injury, their health outcomes generally are poorer—whether they are children or adults.
For example:
• Uninsured children are 70 percent less likely than insured children to receive medical care for common childhood conditions, such as sore throat, or for emergencies, such as a ruptured appendix.
• When hospitalized, uninsured children are at greater risk of dying than children with insurance.
• Uninsured adults are 20 percent less likely than insured adults to receive care following an automobile accident and are at greater risk of death.
• At-risk adults without insurance have higher rates of stroke and greater risk of death than at-risk adults with insurance.
• Adult stroke victims without insurance are more likely to have neurological impairment and longer hospitals stays, and are at greater risk of dying, than adult stroke victims with insurance.

People with chronic illnesses who lack insurance have limited access to both health care services and effective care management. In addition, children with special health care needs who do not have adequate insurance coverage are more likely to go without needed care. For example:
• Parents of uninsured children are more likely to report unmet need for mental health services for their children.18 Uninsured children are also less likely to receive treatment for chronic conditions such as diabetes and asthma.
• Uninsured children have less access to a usual source of care, community-based services, and services to make transitions to adulthood
Because uninsured people are less likely to have a usual source of care, they generally have poorer control of chronic conditions, such as hypertension. Even when they are aware that they have a chronic condition, uninsured adults are less likely than adults who are insured to have a usual source of care or regular checkups. As a result, they have more emergency department visits and report greater short-term reductions in health; if they return to full health, they take longer to do so. The prognosis for uninsured cancer patients also is worse than that for insured patients. In general, uninsured cancer patients die sooner after diagnosis, largely because they are less likely to be diagnosed in early stages of the disease. However, even when diagnosed at similar stages, uninsured patients with certain types of cancer die sooner than insured patients.

Contention: Universal health insurance improves the economy

Several key economic benefits can be isolated.  In the previous contention we see how favorable health outcomes result in a healthier and more productive workforce.  We can also isolate direct impacts based on increased spending in the health care industry and reduction of government spending.  For these advantages one may look to the Congressional Budget Office studies but the Cutler, et al evidence I provide below, represents an independent evaluation which corroborates the CBO estimates and improves upon them.

Economic Benefits
Cutler, et al (2009):
Extending health insurance coverage to essentially all Americans will increase medical spending, at least in the short run. (Some argue that increased coverage will lower spending over time by making it possible to pursue more-aggressive cost-containment policies without risking access to care for the uninsured, but in this analysis we do not consider such effects.) From previous studies, data are available to estimate the magnitude of the increase in spending. Hadley and colleagues, for example, estimated that each uninsured individual who gains coverage will incur annually an additional $1,600 of medical care expenses—an increase of 70 percent. The Congressional Budget Office estimated that spending for uninsured individuals, if they become insured, will increase by 25 percent to 60 percent. The actual increase will depend in part on the rates that are paid to health care providers for treating currently uninsured patients.
For our estimates, we increase the $1,600 figure over time with expected increases in medical costs. We then multiply the revised amounts by the number of newly insured resulting from health reform to produce a total estimate. Fully phased in, incremental coverage costs about $75 billion per year to cover 60 percent of the uninsured, or 2 percent of total health care spending. This is comparable to Davis and Schoen’s projection that covering all of the uninsured would add 3 percent to medical spending,7 and Schoen, Davis, and Collins’s finding that covering all of the uninsured would add 2 percent to medical spending.8 This methodology suggests that the new law will lead to a 10-year cumulative medical spending increase of $415 billion over the period 2010–2019.

Federal Budget Impact
Cutler, et al (2009):
The Congressional Budget Office estimates that the reform law will reduce the federal deficit by $143 billion over the 10 years, 2010–2019. Our estimates of the federal deficit impact differ from CBO’s in two ways. First, we include savings to Medicare and Medicaid resulting from health system modernization. In addition, reductions in employer spending for health insurance lead to increases in wage and salary payments, which are taxed by the federal government. While CBO accounted for some of this effect in recent estimates, further reductions in employer spending for health insurance can be expected from modernization and lower administrative costs. We assume that 90 percent of private health insurance savings are passed on to employees through increased wages, which are taxed at an average marginal rate of 28 percent.
The net effect is a federal deficit reduction of $400 billion over 2010–2019 (Exhibit 4). This reduction results from several factors. As estimated by CBO, the federal cost of insurance coverage expansion is $788 billion. Savings from payment and system reform provisions are projected to generate $682 billion—more than is estimated by CBO, owing to the reasonable estimates of health system modernization provisions. Our federal tax revenue projection mirrors that of CBO’s, though we also add in the additional revenue from employer savings and increased wages from modernization and lower administrative costs—projected to raise $86 billion over the 10-year, 2010–2019 period.

Answer: Employers will not drop employee health insurance

Since a majority of the insured receive their coverage as a benefit of their employment, a decision by employers to cease offering the benefit could greatly impact the evaluation of advantages for the Con.  For this reason, a common argument for the Pro and one we have heard in the political campaigns of the last Presidential election may be the idea that employers will stop offering health insurance to their employees due to costs or any number of possible reasons as a reaction to the government mandate for insurance.  This CBO report disputes that argument.  It it a fairly specific answer to an anticipated Pro claim.

Employers will continue to offer Insurance
CBO 2012:
On the basis of both economic theory and empirical evidence, CBO and JCT also
think that employers generally construct compensation packages to attract the best available workers at the lowest possible cost.6 That is, firms attempt to offer the mix of wages and nonwage benefits—such as vacation time, retirement benefits, and health insurance—that will be most attractive to their current and potential
employees while having the lowest cost. The attractiveness and cost of different mixes of compensation depend on the relative price and availability of services (such as health insurance) when provided by firms or purchased separately by workers. That relative price and availability depend partly on features of private
markets and partly on the structure of government programs and the tax rules applying to firms and workers. The fact that many firms currently offer health insurance coverage to their workers despite the high cost of premiums and rapid growth in those premiums for many years shows that many firms continue to find health insurance coverage to be a worthwhile element of their compensation packages. If firms could have attracted employees more cheaply by dropping health benefits and adding wages or other benefits that cost less, then they would have done so. One reason that the
provision of health insurance by firms remains cost-effective is that the price of health insurance with a given scope and comprehensiveness of benefits is often higher in the individual (nongroup) market than in the employer (group) market, owing to higher administrative costs for individual policies. A second reason that firms continue to provide health insurance is that wages received by workers are subject to both individual income taxes and payroll taxes, whereas health insurance benefits received by workers are generally not taxed. Finally, individual market coverage may not be viewed by employees as a good substitute for employment-based coverage because of the possibility of coverage exclusions or premium surcharges due to specific health conditions of a family member.

For the Pro position, click here


Health Care Reform for Children with Public Coverage: How Can Policymakers Maximize Gains and Prevent Harm?
Timely Analysis of Immediate Health Policy Issues
June 2009
Genevieve M. Kenney and Stan Dorn

Why Immigrants Lack Adequate Access to Health Care and Health Insurance
Leighton Ku
Center on Budget and Policy Priorities
September 2006

Annotated Bibliography
Health Care and Children in Immigrant Families Project
January 2007

How Does Insurance Coverage Improve Health Outcomes?
Mathmatica Policy Research, Inc., April 2010
by Jill Bernstein, Deborah Chollet, and Stephanie Peterson

Baker Institute Policy Report, James A. Baker III, Institute for Public Policy, Rice University
June 2009
The Economic Impact of Uninsured Children on America

CBO and JCT’s Estimates of the Effects of the Affordable Care Act on the Number of People Obtaining Employment-Based Health Insurance, Congressional Budget office, 2012

Center For American Progress
The Impact of Health Reform on Health System Spending
David M. Cutler, Karen Davis, and Kristof Stremikis

PF March 2013 Health Insurance - Background

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

For part 1 of this analysis, click here.

My Approach to the Analysis

Since the topic has more or less already been debated in Lincoln-Douglas last November and December, it was tempting to simply resurrect the old analysis and simply recycle it.  However, I was not satisfied with this idea because our state tournament is coming up and I felt the topic deserved a fresh look.  The November 2012 LD resolution, reversed the advocacy with Aff supporting universal health care.  In this resolution, Pro rejects the idea government should require citizens to have health insurance.  Besides the obvious reversal of the advocacy between the LD and PF versions of the resolution, there is also another significant difference.  The LD version debated universal health care which can be provided in number of ways, insurance being just one.  The PF version of the resolution, limits the debate to health insurance

About Insurance

I guess it makes sense we should understand insurance and how it works.  Basically, when you take out an insurance policy, you are making a bet with the provider the event being covered will occur and the provider is betting it will not.  With a health insurance policy you are betting you will get sick, the provider is betting you will not.  As long as you continue to lose the bet (you stay healthy) you pay, when you win the bet (you get sick), the provider pays.  Insurance is a game of risk management.  There is a risk that you will get sick or injured and if you are engaged in a life-style that increases the risk, you will pay more than if you are considered healthy and a low-risk.  In the case of health insurance, there is a very good chance the insurance provider will lose the bet eventually and need to pay.  Because the cost of health care is incredibly high, the insurance provider runs the risk of having to pay out more money than it collected from you.  The insurance provider can prevent going bankrupt by charging enough to cover the potential risk.  Another way the insurance provider protects itself is to cover the risks for many individuals.  Each of them pays as they remain healthy and the insurance provider collects enough to cover the expenses when a member becomes sick. Let's look at a practical example.  Let us assume there are 100 students in a school and on average one student a year will suffer an injury requiring care that costs $4800 to cover.  Without insurance, each family would need to keep $4800 in reserve on the chance their child will be the one injured.  However, if each of the families got together and pool their resources, each family could pay $4 per month which would be used to pay for an injured student.  In this way, each family pays a total of $48 per year instead of holding $4800 on the chance their student will be the injured one.  In this example, the school can reduce the amount families pay be reducing the risk a student will be injured (by safety rules, perhaps rubberizing the playground, etc).

To understand a little about how the costs can be minimized by spreading the risks over many people, consider the following example.  Let say, each year a given city of 100,000 has medical expenses of 1,000,000 dollars per year on average treating 1000 individuals who get sick or injured.  If 10,000 of them decided to pool their money to cover the risk, each must pay $100 per year to cover the $1,000,000 on the outside chance all 1000 injuries or illnesses will come from that group of individuals.  If 20,000 people decided to pool their resources, doubling the number of participants, cuts their cost in half to 50 dollars per year.

What it all means is the cost of health insurance can be kept low by decreasing the risk or spreading the risk over more individuals.  The idea of spreading the risk over many individuals as a way to minimize cost is one of the objectives behind requiring everyone to have insurance rather than only a few.  It should also be obvious that as the cost to the individual decreases, more people can join the group since the insurance becomes more affordable to those in lower income brackets.

The "Free-Rider" Program

It is well known by most people that thanks to a 1986 federal law called the Emergency Medical Treatment and Active labor Act (EMTALA), publicly funded hospitals are required to provide medical treatment to everyone, regardless of their citizenship and ability to pay.  In most cases the hospital will attempt to recover the cost of treatment from the patient through the normal billing and collections process.  Sometimes, the cost of treatment is unrecoverable.  The U.S. federal government does not provide any compensation to hospitals which treat those who cannot pay.  Some hospitals receive compensation through the state in which they are situated.  To compensate for unrecoverable costs, hospitals raise the cost of care for those who can pay.  However, because the health insurance providers have become increasingly vigilant to the practice of cost shifting, hospitals and physicians are being forced to "eat" the losses.

Obamacare (PPACA)

In 2010, the Patient Protection and Affordable Care Act (commonly called Obamacare) was signed into law.  This law was designed specifically to reduce the number of uninsured in America, which basically amounts to reducing the cost of medical care by spreading the risk over more people.  PPACA provides a number of important benefits such as requiring coverage for pre-existing conditions and coverage without regard to gender or geographical location.  The PPACA requires everyone to obtain some kind of insurance in one of four ways; through your or your domestic partner's employer provided insurance; through government programs such as Medicare; through private insurance; or through a state run Exchange (health benefit exchanges to be established in all 50 states which will help individuals find affordable private or public coverage). Citizens who fail to get insurance will be required to pay a penalty in the form of higher taxes.  There are several exceptions allowed for uncommon situations or religous exemptions.  No doubt, a lot of debate will flow around this particular law and there will be literally hundreds of opinions and countless statistics, most politically charged, which will say it increases the deficit and reduces the deficit, increases unemployment, does not increase unemployment, increases taxes, reduces taxes, etc.  I and I am sure many judges will hate that debate since in my opinion, while the effects of PPACA may be significant one way or the other, it is merely an implementation of a national health insurance coverage plan which may or may not be ideal.  The resolution, thankfully, does not mention PPACA or Obamacare.  It mentions health insurance.  To be sure, I do not see PPACA as a national health insurance per se.  I do see it as a plan to reduce the number of uninsured through a variety of mechanisms and incentives.  The topic of this debate is, should citizens be required to have health insurance without mention of where or how the insurance is obtained.  Specific provisions of PPACA not withstanding, there may be valid reasons why the US should not require its citizens to have health insurance.  Those reasons may be philosophical or legal and they may be practical due to the economic impact on the economy, but they needn't be specific to PPACA and indeed, I would think the more broadly your arguments can be applied, the better chance you will have of winning.

The Status-Quo

In the status-quo, a large number of people remain uninsured due to the high cost of health insurance or for personal reasons.  Most ordinary citizens would probably not have insurance if it was not provided or subsidized by their employers as a benefit of employment.  Since federal law requires public hospitals to provide emergency care only, many of the uninsured lack "routine" care (wellness care) such as yearly examinations, care during pregnancy, and screenings for certain common diseases such as diabetes or colon cancer.

Young 2012:
The number of uninsured Americans declined from 2010 to 2011 to 48.6 million people, according to a U.S. Census Bureau report on income, poverty and health insurance released Wednesday. In 2011, 15.7 percent of Americans had no health insurance compared to 16.3 percent in 2010.
The uninsured rate for people aged 19 to 25 also decreased from 29.8 percent in 2010 to 27.7 percent in 2011, when 8.3 million of them had no health insurance, the data also show. One reason may be that young adults are benefiting from a provision in the 2010 health care reform law enabling them to remain on their parents' health insurance plans until they turn 26.
Enrollment in Medicaid, the government health program for the poor, rose from 48.5 million to 50.8 million between 2010 and 2011 amid a sluggish economy. The rates of people covered by private insurance, including job-based health benefits, remained statistically the same, according to the Census Bureau. "The increase in public coverage and no statistical change in private coverage may account for the increase in overall coverage," David Johnson, chief of the Census Bureau's Social, Economic and Housing Statistics Division, said during a conference call with reporters.

O'Neill & O'Neill (undated):
Many people believe that the number of uninsured signifies that almost 50 million Americans are without healthcare simply because they cannot afford a health insurance policy and as a consequence, suffer from poor health, and premature death. However this line of reasoning is based on a distorted characterization of the facts. Although it is important that we be concerned about the provision of resources to those who are too More careful analysis of the statistics on the uninsured shows that many uninsured individuals and families appear to have enough disposable income to purchase health insurance, yet choose not to do so, and instead self-insure. We call this group the “voluntarily uninsured” and find that they account for 43 percent of the uninsured population. The remaining group—the “involuntarily uninsured”—makes up only 57 percent of the Census count of the uninsured. A second important point is that while the uninsured receive fewer medical services than those with private insurance, they nonetheless receive significant amounts of healthcare from a variety of sources—government programs, private charitable groups, care donated by physicians and hospitals, and care paid for by out-of-pocket expenditures. Third, although the involuntarily uninsured by some estimates appear to have a significantly shorter life expectancy than those who are privately insured or voluntarily uninsured, it is difficult to establish cause and effect.

For the Con position and more, click here.


Census: Uninsured Rate Falls As Young Adults Gain Coverage And Government Programs Grow
jeffery Young, Huffington Post
Posted: 09/12/2012 1:30 pm Updated: 09/13/2012 1:58 am

Definitions of Health Insurance Terms

WHO ARE THE UNINSURED?, An Analysis of America’s Uninsured Population, Their Characteristics and Their Health
June E. O’Neill
Baruch College and City University of New York
Dave M. O’Neill
Baruch College and City University of New York

Kaiser Commission on Medicaid and the Uninsured
October 2011
The Uninsured and Their Health Care Needs: How Have They Changed Since the Recession?
By Emily Carrier, Tracy Yee, and Rachel L. Garfield

Saturday, February 23, 2013

LD March 2013 Humanitarian Intervention - Neg position

Resolved: The United States is justified in intervening in the internal political processes of other countries to attempt to stop human rights abuses.

For part one of this analysis, click here.

Neg Position

In this debate the Neg will be defending the idea that state sovereignty is an immutable ideal.  Having already defined and discussed the background information (if you have not read it, start here) surrounding the necessity for this debate, let's focus on the key issues for the Negative side.  First the resolution, states the US is justified to intervene to attempt to stop human rights abuses.  The negative position would hold they are never "justified".  There can be several arguments why they are never justified.  First, recall the definition of justified strongly suggests the US must commit an illegal action in order to receive justification.  After all, why does a legal action need justified? The mere fact that action is illegal is, in itself, a red flag.  If a nation (or anyone for that matter) feels an act justifiable given the circumstances, there must be a very high-level of scrutiny applied to the examination.  I think one of the things Neg must consider, if an act can be justified then why is there a prohibition against it and if there is no prohibition then why must it be justified? 

The Legal Issue

The key issue which prohibits one nation from intervening in the internal politics of another is simple to understand.  Each nation has a right to govern itself.  Within the US, for example, there is a great deal of homogeneity from state to state, meaning people in Ohio pretty much have the same culture and values as people from Texas.  On the other hand, in places like Europe, the individual nations are often very diverse, having completely unique languages, customs and cultures.  The idea that one nation ought to impose its values or morals upon another is part of what is at stake in this debate.  If Neg wants to take on the legal debate, one must give consideration to the fact that most laws require an enforcement component.  In other words, as we have seen in the last debates on "rehabilitation vs. retribution" a law that does not punish violations is pretty much useless.  International law therefore is based on treaties and in the modern world, actions sponsored by the United Nations as a collection of world opinions on how nations behave.  Under this framework, the consequence for violating international laws would likely be some levels of reaction by other nations such as isolation, sanctions, or possibly war.  Generally, in the spirit of cooperation, nations have agreed to defer to the opinions of the UN as a sort of check against taking actions which other nations may deem as abusive, aggressive, dangerous or otherwise not in the best interests of the world community.  However, when dealing with a super-power such as the US, the UN ability to limit the actions of the US are decidedly limited.

The Republic of Nicaragua v. The United States of America was a 1984 case of the International Court of Justice (ICJ) in which the ICJ ruled in favor of Nicaragua and against the United States and awarded reparations to Nicaragua. The ICJ held that the U.S. had violated international law by supporting Contra guerrillas in their rebellion against the Nicaraguan government and by mining Nicaragua's harbors. The United States refused to participate in the proceedings after the Court rejected its argument that the ICJ lacked jurisdiction to hear the case. The U.S. later blocked enforcement of the judgment by the United Nations Security Council and thereby prevented Nicaragua from obtaining any actual compensation. The Nicaraguan government finally withdrew the complaint from the court in September 1991, following a repeal of the law requiring the country to seek compensation, thus settling the matter.

Kahn (1987):
In the long run, the position by the United States will be of more significance than the opinion of the International Court of Justice.  That opinion is likely to be an exercise in legal form without force: already the United States has indicated that it will ignore the ruling.  The U.S. position, on the other hand, manifests itself daily in the policies that the government pursues, not just in Central America, but around the world.  For this reason alone, the U.S. position requires careful analysis and critique.  But analysis of the U.S. position is valuable not just from a practical point of view.  Even more important, it reveals much about the current state of international law.  The Nicrargua case throws into vivid relief the two-fold character of international law.  On the one hand, there is authoritative text - treaties, judicial opinions, General Assembly resolutions; on the other hand, there is state practice.  International law advances - or retreats - along both dimensions at once.  Without any institution to work a convergence of authoritative, institutional decision-making and state practice, internation law is characterized by the possibility of divergence between the two.  That gap, however, does not justify the measure of illegality of a controverted practice. Because international law has the curious institutional form of allowing deviant practice to create law, the gap equally signifies the variety of creatvie forces at work in international law.  The Nicaragua case and the events it triggered suggest that the gap is very wide now and that the two sources of internation law are moving along radically different paths.

Professor Kahn suggests, there are two principle drivers which constitute the basis of international law. One is the textual law, codified in treaties, rulings and declarations and the other is the traditional interaction of nations among themselves, which are not formalized.  In fact, I would suggest the traditional behaviors which create a defacto set of laws finds its roots in international relations theory and in the attempts to understand why nations behave as they do with other nations.  A very interesting and in depth analysis of International law and in particular, what are the forces which drive compliance can be found in the Koh article, "Why Do Nations Obey International Law?", cited below .  Interestingly, much of the reason for state compliance to international law, according to many theorists, is driven by self-interest.

Koh (1997):
"almost all nations observe almost all principles of international law... almost all of the time."' When a nation deviates from that pattern of presumptive compliance, frictions are created? t To avoid such frictions in a nation's continuing interactions, national leaders may shift over time from a policy of violation to one of compliance. It is through this transnational legal process, this repeated cycle of interaction, interpretation, and internalization, that international law acquires its "stickiness," that nation-states acquire their identity, and that nations come to "obey" international law out of perceived self-interest. In tracing the move from the external to the internal, from one-time grudging compliance with an external norm to habitual internalized obedience, the key factor is repeated participation in the transnational legal-process. That participation helps to reconstitute national interests, to establish the identity of actors as ones who obey the law, and to develop the norms that become part of the fabric of emerging international society.

What does this mean for the Neg?  Our traditional sense of law, as a set of enforceable rules has no real corollary in the international arena without a capable enforcement mechanism.  As we can see in the Nicaragua case, the fact a country like the U.S. can pretty much do what it feels is right in protecting its self-interests and thumb its nose at the international justice system illustrates that international law, in and of itself is not a justification for Affirming or Negating the resolution. This means, in my opinion, Neg must take a position not on the law per se.  I suggest two alternative ways to uphold the legal framework.

First No matter how international law is established (by code or tradition) any allowed violation undermines the legitimacy of law.  The rule of law must be maintained.

Hurd 2011:
The case for the illegality of humanitarian intervention rests on the plain language of existing treaties and emphasizes the clarity of the UN Charter, as well as its near constitutional status in international politics and its universal adoption. Together, these lead to the conclusion that the purpose behind the use of force (other than self-defense) is irrelevant in law, and the effort to respond to humanitarian emergencies in states that refuse to cooperate ends up confronting the same prohibition on interstate war that was meant to stop aggression. As Byers notes, “The UN Charter provides a clear answer to these questions: in the absence of an attack, the Security Council alone can act.” One might follow this tradition and yet still argue in favor of a specific act of humanitarian intervention. In so doing, however, one must confront the fact that the act is illegal. The now classic example of this is the post hoc explanation that the NATO intervention in Kosovo was “illegal but legitimate.” Brownlie considers this to grant “a waiver of the illegality” of the act, and he opposes the claim that it provides any evidence of a change in the law itself. Thomas Franck agrees on its illegality but maintains that international justice is better served by sometimes breaking the law rather than respecting it, and that Kosovo/NATO is one such case. This is a provocative position since it suggests that the idea of the rule of law is not as absolute as is usually maintained; other values might be more important than rule following.

Second, no matter how international law is expressed, we must look to the underlying moral and
ethical principles behind it. It is interesting how Americans in general are very defensive of their own national sovereignty. The idea another nation can intervene in their internal affairs is simply unimaginable.  Yet, how many times has the US intervened in the internal affairs of other nations?  The principles which Americans see as foundational for national security are the principles which establish why national sovereignty must be preserved without exception.  While the Aff will argue that intervention to protect human rights is a moral high ground it is not that simple.  We are talking about nations and when they intervene it potentially means, armies, bombs, weapons, death and destruction in the name of humanitarian intervention.  The big question then, considering the potential cost of human intervention (war), how does a nation justify imposing its ideas of morality and justice on another people with different standards, customs and socio-economic conditions.  Sovereignty is recognition that legitimate states have a right to be self-determining.

In the world of Lincoln-Douglas debate, legal debates can be over-ruled by philosophical justifications.  Just because something is law does not mean it is a moral or just law (slavery for example).  To be sure, even if Neg can make a very good case for the immutability of sovereignty based on legal principles, Aff can and will argue that humanitarian intervention preserves greater values which the judge must respect.  But such arguments should not be insurmountable for the Neg. Often the choice to take the moral high-ground comes at a tremendous cost as we shall soon see in the next section.

The Cost of Intervention

As I have emphasized many times we are talking about nations and when one nation intervenes in the internal affairs of another, the result is often destructive.  Of course one such justification lays in the claim that no cost is too high to save human lives.  In LD we have seen these kinds of notions of human behavior and morality often extended to non-human entities such as corporations and nation-states and we have often argued that governments do not experience guilt or shame and are organized for specific purposes aimed toward preserving themselves and their citizens.  When external circumstances, such as potential genocide in another place, challenge the collective conscious of people what are the obligations of a country such as the US?  First of all, to claim we ought to intervene suggests we can intervene since ought implies can.  Whereas, the US may have the financial or military strength to intervene, it is constrained by the will of the people and the government in most cases can not act apart from the consent of the governed (yeah, I know that sometimes even that is controversial in light of recent executive orders).  When challenged by the potential genocide of Albanian Kosovars in Serbia and the relentless slaughter of innocents in Bosnia, the US decided to intervene through NATO.  Not long afterwards, when faced with the mass annihilation of Tutsis in Rwanda, the US chose to not intervene.  Both situations were equally horrifying in their consequences yet for some reason the US felt intervention in Rwanda carried a "cost" it was not willing to pay.

Valentino (2011):
Proponents of such interventions usually make their case in terms of the United States’ moral responsibilities. Yet perhaps the most important costs incurred by military interventions have been moral ones. On the ground, the ethical clarity that advocates of human rights have associated with such actions—saving innocent lives—has almost always been blurred by a much more complicated reality.
To begin with, aiding defenseless civilians has usually meant empowering armed factions claiming to represent these victims, groups that are frequently responsible for major human rights abuses of their own. Although advocates of humanitarian intervention in the 1990s frequently compared the atrocities of that period to the Holocaust, the moral calculus of intervening in these conflicts was inevitably more problematic. The Tutsi victims of Hutu génocidaires in Rwanda and the Bosnian Muslim and Kosovar Albanian victims of Serbian paramilitaries in the former Yugoslavia were just as innocent as the Jewish victims of the Nazis during World War II. But the choice to aid these groups also entailed supporting the less than upstanding armed factions on their side...
Another set of moral costs stems not from the unsavory behavior of the groups being protected but from the unavoidable consequences of military intervention. Even if the ends of such actions could be unambiguously humanitarian, the means never are. Using force to save lives usually involves taking lives, including innocent ones. The most advanced precision-guided weapons still have not eliminated collateral damage altogether. Many Americans remember the 18 U.S. soldiers who died in Somalia in 1993 in the “Black Hawk down” incident. Far fewer know that U.S. and un troops killed at least 500 Somalis on that day and as many as 1,500 during the rest of the mission—more than half of them women and children.

In his article on the subject, Valentino explains how intervention often produces what is commonly referred to in other studies as a "rally around the flag" response, in which the citizens of the country being attacked by the US will harden their resolve and rally behind their government, even if that government is committing atrocities against a minority.

The Basis for Violation

As I have mentioned, the idea of a state or government possessing moral duties can be difficult to defend and even more so, if the basis for the moral obligation arises from the duty to follow international law.

Roth 2005:
In a provocative recent essay, Eric A. Posner has called into question whether international law, as such, is ever morally binding, and thus whether breaches of existing legal norms should be evaluated entirely on the basis of prudential considerations. He concludes as follows:
It can be useful for international-law scholars to point out that an act of the United States or some other country “violates international law” as long as we understand what this phrase means. It means that the United States is not acting consistently with a treaty or a customary international-law norm, and as a result the expectations of other states might be disappointed (or not), and these states might retaliate (or not), or adjust their expectations in ways that may not be to the advantage of the United States. These are all reasons not to violate international law, but they are prudential reasons, and they are reasons to be taken into account even when international law is not at issue. The phrase does not mean that the United States has a moral obligation to bring its behavior within the requirements of the treaty or customary international-law norm, or that its citizens or leaders have a moral obligation to cause the United States to do this.
Although Posner’s is a realist perspective, many moralists display a parallel resistance to regarding
international law as a source of moral obligation; the latter selectively regard particular positive
norms (especially human rights norms) as a reflection of moral duties binding on independent
grounds (just as Posner regards particular positive norms as supported by prudential considerations), but do not ascribe moral significance to positive norms that impede, rather than further, their moralistic designs...
Posner’s contention rests essentially on two points. The first is that the supposed consensual basis of international legal norms is illusory. Posner has chosen to emphasize in this regard the difficulty of establishing a moral obligation on the part of individual citizens – the sole bearers, he believes, of moral personality – to shoulder the burden of a past government’s commitment. He might equally have focused on the methodological finesses by which consent is imputed to states, on the power imbalances that mark international negotiation processes, or on the problematic relationship between a government’s consent and the collective will of the underlying political community – all of which constitute facially plausible objections.
Second, Posner argues, the international legal order is inefficacious. Although admitting that state behavior most frequently conforms to the standards of international law, Posner concludes that it does so principally for reasons of convenience and confluence of interests, not because the standards have the authority of law. International law does not, according to his empirical assessment, prevail upon states to do what they are disinclined to do.

Assigning Blame

I think it is interesting to turn the problem of external intervention around and look at the issues from an internal point of view.  Suppose, within the US, a distinct group of individuals, bound by a common ideology exists within the confines of the US which is deemed antagonistic or otherwise undesirable to the interests of the US majority.  There would undoubtedly be some period of time early in the evolution of events which lead to rights violations in which the leaders of the group and the US government authorities can settle their differences.  Failure to settle differences can expand into violent confrontations and there is a possibility the government may decide massive retaliation is the most cost-effective way of settling the dispute.  At any stage of the process, the idea that an outside nation would intervene apart from criticising the US would be completely unacceptable to most of the citizens in the US not directly involved in the conflict.  Still, one must recognize the obligations not only of the government but also of the repressed group and the ordinary citizens whom the government represents.  One can assume each at various points had opportunity and obligation to intervene on the behalf of best interests of the US to avoid conflict.  Does the fact they failed constitute a bonafide justification for an outside force to intervene?

In looking at the situation from the inside it may be possible to realize that most often situations which arise in a nation leading to mass violation of rights, evolve from a process in which actors (government, opposition group, and citizens) all play roles.  Each makes practical and rational evaluations about the cost and benefits of their actions and in some cases it may even be argued the victim group welcomed intervention, not out of humanitarian interests but rather political interests.

Nzelibe (2008):
This Article illustrates the perverse logic of humanitarian interventions and prosecutions by exploring two contemporary cases: Sudan (Darfur) and Kosovo. While these case studies are by no means exhaustive, they are highly representative of the kinds of civil wars in which mass atrocities are likely to take place. Together, these case studies reveal a consistent pattern: rebel or victim leaders engage in provocative actions against a dominant group largely (or partly) because they hope to attract humanitarian intervention or prosecution against the dominant group, the dominant group responds by aggressively committing even more atrocities against the victim group, but humanitarian intervention either does not come or comes too late to prevent the bulk of the atrocities. Traditionally, the question of how humanitarian interventions affect atrocities has been answered by reference to both the motivation of the intervening party and the sovereignty costs imposed on the target of intervention. Thus, much of the legal and philosophical scholarship on humanitarian intervention is devoted to institutional design mechanisms for screening out pre-textual humanitarian interventions from well-motivated ones.6 At bottom, however, much of this literature assumes that well-motivated humanitarian interventions will have benign effects. Recently, a number of political scientists have begun to question this conventional wisdom regarding the interaction between humanitarian interventions and mass atrocities. In this picture, since outside intervention during a humanitarian crisis is likely to bias the outcome of dispute in favor of the rebel group that is the target of atrocities, some political scientists have argued that rebel groups might rationally gamble on humanitarian intervention by provoking the dominant group to commit atrocities.8 Such accounts often stress the fact that humanitarian interventions suffer the same pathologies as insurance schemes because they create moral hazard by encouraging risk-taking among the intended beneficiaries.

The Nzelibe paper is particularly interesting for the Neg debater in that it illustrates the view that the kinds of rights violations which trigger external interventions arise from evaluations by the respective parties (oppressor and victim alike) which are often designed to trigger the intervention which ultimately results.  The idea for example, that the victims, or more properly, their leaders are to blame for atrocities is controversial to say the least, but backed by empirical evidence.

The Motivation for Intervention

A very reasonable argument can be put forth that states only intervene when it serves their interests to do so.  In fact, proponents of the realist school of international relations theory believe that states will never act out of purely humanitarian motivations since the decision to risk the lives of one's own citizens and resources is only taken when national interests are preserved.

Bellamy & Wheeler:
States almost always have mixed motives for intervening and are rarely prepared to sacrifice their own soldiers overseas unless they have self-interested reasons for doing so. For Realists this means that genuine humanitarian intervention is imprudent because it does not serve the national interest. For other critics, it points to the idea that the powerful only intervene when it suits them to do so and that strategies of intervention are more likely to be guided by calculations of national interest than by what is best for the victims in whose name the intervention is ostensibly being carried out. Realists not only argue that states do not intervene for humanitarian purposes; their statist paradigm also asserts that states should not behave in this way. Political leaders do not have the moral right to shed the blood of their own citizens on behalf of suffering foreigners. Bhikhu Parekh (1997: 56) encapsulates this position: „citizens are the exclusive responsibility of their state, and their state is entirely their own business‟. Thus, if a civil authority has broken down or is behaving in an appalling way towards its citizens, this is the responsibility of that state‟s citizens, and crucially its political leaders.

Putting it Together

Admittedly I have thrown a lot into this position and I urge you to take my advice and read the sources I link below.  You find much, much more that I did not include in the interests of keeping this article from exploding in length.  Neg must disarm the Aff framework and I think one of the key ways to do so will be to question the rationale behind the Aff position that intervention can be justifiable.  The idea of personifying states and governments and assigning moral responsibilities to them is problematic.  The legal framework of international law does not constitute a good basis in and of itself for moral duty and in fact the whole principle of laws which are obeyed by mutual consent without an enforcement mechanism is also difficult to defend.  Neg can leverage these facts to turn the Aff case.  Additionally, Neg must advocate the importance of maintaining national sovereignty as check against abuse in which states use protection of human rights as a pretext to war.

Generally speaking, the idea that one nation can impose its own standards of right and wrong upon another is rife with difficulties.  In some cases, an authoritative or religious government may behave in ways which the Western democratic peoples consider abusive to the rights of individuals such as women or ethnic minorities and yet within the context of their lives such actions are completely within the scope of normalcy and even expected.

I may include more approaches for the Aff and Neg later as I discover new information or decide to clarify more completely but for now I will call it a day.


Humanitarian Intervention, Evolution of a Dangerous Doctrine
by Walden Bello
Focus on the Global South, January 25, 2006

Ryan Goodman, Harvard University

Zia Modabber, Collective Self-Defense: Nicaragua v. United States, 10 Loy. L.A. Int'l & Comp. L. Rev. 449 (1988).
Available at:

Kahn, Paul W., "From Nuremberg to the Hague: The United States Position in Nicaragua v. United States and the Development of International Law" (1987). Faculty Scholarship Series. Paper 339.

Koh, Harold Hongju, "Why Do Nations Obey International Law?" (1997). Faculty Scholarship Series. Paper 2101.

Is Humanitarian Intervention Legal? The Rule of Law in an Incoherent World,Ethics & International Affairs, 25, no. 3 (2011), pp. 293–313. ©2011 Carnegie Council for Ethics in International Affairs
Ian Hurd

The True Costs of Humanitarian Intervention, The Hard Truth About a Noble Notion
©2o11 Council on Foreign Relations, Inc
Benjamin A. Valentino

State Sovereignty, International Legality, and Moral Disagreement
Brad R. Roth
Updated Version of Paper Presented at the Panel on “Questioning the Aspiration to Global Justice”
Annual Meeting of the American Political Science Association, September 2, 2005

Nzelibe, Jide, "Courting Genocide: The Unintended Effects of Humanitarian Intervention" (2008). Faculty Working Papers. Paper 168.

Humanitarian Intervention in World Politics
Alex J. Bellamy and Nicholas J. Wheeler

PF 2013 Proposed topics for April.

The TOPIC AREA for the month of April is, "U.S. / Latin America Relations." The two resolutions from which advisors may choose are as follows:

Resolved: The U.S. should seek to develop multilateral rather than bilateral trade agreements with Latin American nations.

Resolved: The continuation of current U.S. anti-drug policies in Latin America will do more harm than good.

Tuesday, February 19, 2013

About March Topics

Hello debaters and coaches.

I know may of you are expecting some additional information about the March topics, both LD and PF and I have much more to say.  In fact I have large parts of the LD Neg position written but I have not been able to post. 

The main reason for the delays, are stemming from the fact this month has been extremely, extremely busy.  Within the last few weeks we participated in our district and region tournaments (two very important tournaments to the say least) and there are other pressing activities on a more personal level that have prevented me from giving these posting the time they deserve in order to make them the best they can be to serve you and the debate community.  This coming weekend, I hope to have everything caught up and posted.

Thank you for your patience and support.  I hope to make it worth the wait.

Friday, February 15, 2013

LD Mar 2013 Humanitarian Intervention - Aff Position

Resolved: The United States is justified in intervening in the internal political processes of other countries to attempt to stop human rights abuses.

For part one of this analysis, click here.

Aff Position

Obviously Aff will be trying to prove the US is justified in intervening, etc.  Whatever we define those terms to mean.  Generally speaking there is not a lot of specificity in this round.  Most importantly Aff is not expected to argue the US MUST intervene as one would expect if there was a moral duty to stop human rights abuses within the borders of another country.  So for the purposes of this debate and when it is convenient to the Aff case, the US may pick and choose its interventions.  In fact this position is not all that far removed from the status-quo (for example our intervention in Libya). I suppose the difficulty for the Aff will be in proving that any decision taken by the US to intervene can only be justified on the grounds of stopping human rights abuses.  So, if the US goal is to topple a regime and in the process eases the suffering of a mass of people, does that violate the resolution?  It seems it does, although I suppose one could always claim, "yeah, we toppled that government because our primary purpose was to stop human rights abuses."

Clearly, the empirical evidence will show there have been precious few military interventions despite numerous incidents of human rights abuses around the world.  "Operation Provide Comfort" was one such humanitarian intervention which took place in the 1990s in northern Iraq to protect Kurds following the 1991 Gulf War.  In this example, there was a UN resolution 688 issued calling for members to provide assistance for Kurdish refugees, but clearly, despite support from the coalition partners, the intervention was unwelcome by Iraq and seen by them as a violation of their national sovereignty.  A second major example of US intervention occurred in 1999 when Serbian troops were accused of mass killing of Kosovar Albanians.  (see Operation Allied Force).  Once again, there was UN support, the action was conducted by a US led coalition (NATO forces) and involved a significant air-war and bombing campaign in Serbia which resulted in their withdrawal from Kosovo.

So, despite the fact there are few examples and in each case there was really no unilateral actions on the part of the US, the Aff must prove the justification for such actions, even unilaterally are a given when humans are being deprived of their rights.  This brings us to another major area where lack of specificity harms the Aff.  According to the Universal Declaration of Human Rights everyone has a right to move within or out of their country.  So technically if a nation restricts the movements of a group of people (or perhaps even one) assuming they have not forfeited such right through the commission of a crime, that nation is violating human rights.  On the other hand, everyone has a right to life so if a nation is killing a group of people it is depriving them of their human rights.  Obviously there is a huge difference between repressing movement and killing and so the wide spectrum of human rights violations strongly suggests the intervention must be proportional to the violation.  So now we see a very familiar concept of proportionality in Lincoln-Douglas debate which lends itself very naturally to the value of justice.

Aff needs to create a framework which accommodates the lack of specificity and I see definite parallels in the Aff position for this resolution and several recent resolutions dealing with the right of self-defense as related to the protection of innocent bystanders or victims unable to defend themselves.  If you have been debating long or have been following this blog over the last year and a half, you are already familiar with the philosophical and moral arguments which can be reworked for this case.

The Legal Case

To anyone who has researched this topic, a legal framework for Affirming the resolution probably seems difficult if not impossible.  A great deal of evidence will highlight decades upon decades of precedence which claims that national sovereignty is a paramount value.  Especially given the potential for abuse, since every war could be "justified" on the basis it is a humanitarian action.  Let's not forget, homicide is illegal but there is a thing known as justifiable homicide and it recognizes there are times when the illegal act may be necessary as the only way to avoid another equal or worse harm.  Killing in self-defense is one such example.  So it stands to reason that certain utilitarian principles come to bear when examining the justification for an act.  The fact of the matter is, there can be no evaluation of the act of intervention until after it occurs.  Therefore one must evaluate what was the situation before and what is the situation after and if the consequence of the intervention is an increase in desirable outcomes, perhaps the act can be deemed justified.  Now of course, Neg is undoutedly going to think of some scenario in which something which seems good today turns out to be awful tomorrow.  But a strong utilitarian case makes sense if the result turns out to be  humanitarian disaster is averted with minimal harms inflicted by the US.

Nevertheless, perhaps there is a reasonable legal framework already in place, called the Responsibility To Protect, also known as R2P.

Ensuring the protection of human rights implies that there are limits to sovereignty, for if there were not there would be no grounds on which to justify humanitarian intervention except in cases in which is was requested. According to Stanley Hoffman, humanitarian intervention can be justified and sovereignty overridden “whenever the behavior of states even within its own territory threatens the existence of elementary human rights abroad, and whenever the protection of the rights of its own members can be assured only from the outside.” Related to this, the International Commission on Intervention and State Sovereignty (ICISS) argues that there is a right to protect the victims of human rights abuses and a subsequent duty that is held first by the home state and second by the international community. If the home state is unable or unwilling to put an end to the human rights abuses going on within its borders, the international community has a duty to intervene to stop them. Therefore, “sovereignty then means accountability to two separate constituencies: internally, to one’s own population; and internationally, to the community of responsible states.”

R2P emerged from the UN mainly as a response to the failure of the International community to respond to the Rwanda genocide in the mid-1990s.  R2P states that each nation has a duty to protect its own people from massive human rights abuses and other countries have a responsibility to assist that nation in fulfilling its duty.  Now of course those provisions basically create a reasonable threshold for intervention when a state fails to perform its duty and is either unable or unwilling to seek outside assistance. At that point, the international community now has a duty to take coercive actions to stop the atrocities taking place.  The legal grounds for R2P is based upon existing international laws and is administered by the UN. In other words, the UN will declare when the action may escalate to coercive intervention.

PILPG (2012):
R2P, an emerging norm of international law endorsed by the UN Security Council, represents a profound evolution in the way international law treats humanitarian crises. Under R2P, state sovereignty is not absolute. A state forfeits sovereignty when it fails to protect its citizens from genocide, ethnic cleansing, war crimes, or crimes against humanity...The Responsibility to Protect developed in response to the international community‟s failure to prevent the humanitarian tragedies in Rwanda and the Balkans during the 1990s. R2P establishes that states have the responsibility to provide security for their populations and protect them from crimes against humanity. When states fail in this responsibility, the international community can intervene to protect the civilian population through peaceful or coercive means.

The US invoked the principles of R2P to justify its intervention in Libya.  While some may argue the US "abused" R2P as an excuse to topple the Libyan regime, it has been a significant precedent.

The Limits of Sovereignty

Most LD debaters should already have a working knowledge of social contract theory.  There are several flavors of it which basically states people in the state of nature, band together for their mutual protection and each person relinquishes her right to preserve their own properties and liberties in deference to the "state" which then assures their mutual protection.  In other words, we choose to give some of our rights to a government in order to enjoy the benefits of its protection.  However, when the government fails its duty, the government loses its legitimacy.
Heyman (1984):
Locke emphasized that, because government is established for this purpose, it is "obliged" to secure every individual's life, liberty, and property. When it acts contrary to this trust, the government is dissolved and the community regains the right to establish a new form of government. Such dissolution occurs, in Locke's view, where the government invades the rights of subjects, or where it fails to use its power to secure those rights. Locke implied that the Glorious Revolution of 1688, in which King James II was dethroned and replaced by William and Mary, was justified on these grounds.

The Westphalian notion of sovereignty is no longer valid in a world which has mostly overturned the authoritarian regimes or monarchies of the 17th century.  The rise of democracy has changed the meaning and recognition of what constitutes legitimate sovereignty.

Wallerstein (2004):
There is one further fundamental feature of sovereignty. It is a claim, and claims have little meaning unless they are recognized by others. Others may not respect the claims, but that is in many ways less important than that they recognize them formally. Sovereignty is more than anything else a matter of legitimacy. And in the modern world-system, the legitimacy of sovereignty requires reciprocal recognition. Sovereignty is a hypothetical trade, in which two potentially (or really) conflicting sides, respecting de facto realities of power, exchange such recognitions as their least costly strategy.
These ideas support the argument that prohibitions on infringing the state sovereignty apply only to legitimate states, states which fulfill their duty to their citizens and are recognized by other legitimate states.

The Moral Framework

Of course there must be a moral reason to favor the Affirmative.  Despite the talk of nations and states, they are generally agents of the people they represent so we can deal with the subject on a very human level.

Bagnoli (2004):
Framing a moral universalist argument for intervention has important consequences whose significance is greater than the intervention debates suggest. First, to claim that respect for humanity grounds a moral basis for humanitarian intervention is to say that intervention is morally justified whenever human rights are seriously violated. If intervention to protect human rights is defended on moral grounds, any reference to whether the state against which we act is dangerous or aggressive is irrelevant.6 Its threat can be considered a secondary supporting reason for undertaking war, but it is neither a primary nor a moral reason. In some cases, the violation of human rights might occur exactly because such a state failed as a state, that is, it failed to guarantee law and order, and it is in such a state of dissolution that it does not represent a threat to anyone. By paying attention to the threat that such a state may pose to other countries, when considering the moral status of intervention, we make a prudential case for intervention. Prudential and moral reasons may pull in the same direction, but I am urging that in discussing the wrongdoing that justifies armed intervention, we should keep these two kinds of reasons separate. My claim is that a moral argument applies universally and unconditionally, that is, independently of (although not necessarily incompatibly with) prudential considerations.
Second, to ground the duty to intervene on the principle of respect for humanity makes any consideration of special relationships or other contingencies irrelevant. There is a duty to intervene independently of considerations of proximity, friendship, capability, expertise, or effectiveness.
Third, to appeal to humanity importantly affects both the normative status of armed intervention and the question of proper authority...
In violating another person’s dignity, I fail as a moral as well as a rational being in that I fail to act upon a maxim that can be conceived and willed as a universal law.35 Others are then permitted and required to coerce me, if coercion is needed to obstruct my wrongdoing. Although the underlying reasoning is clearly moral, Kant defends the permission to coerce as a juridical permission, according to which one person may force another to act rightly; that is, we may obstruct wrong actions.36 This conception of coercion is based on the idea that the wrongdoer and the victim are both members of a moral community of mutually accountable equals. The moral norms that regulate the moral community are merely the standards of respect for the equal dignity of all members. All members of the community have equal standing to demand compliance. When those standards are violated, the victims have a claim on the wrongdoer, and they have grounds for complaint if he does not comply.

Nardin (2000):
Though derived ultimately from the principle of respect, the right to use force to defend the innocent from violence rests more proximately on the idea of beneficence–the idea that human beings should assist one another in appropriate ways. To respect other human beings as rational creatures means not only that we must not interfere with their freedom but also that we should help them to achieve their own ends. Common morality is at its core a morality of constraint, but its precepts are not limited to those that constrain us. It also requires us to further the well-being of others in ways that are morally permissible and not disproportionately costly. In other words, we are forbidden to do wrong for the sake of others and we are not required to do more than we can reasonably afford.

At the end of this discussion on a moral framework for the Aff I wish to bring up the Doctrine of Double-Effect as an answer to potential Neg arguments about how any kind of forced intervention will likely result in unintended consequences of innocent deaths and loss of property.  Just keep telling yourself, DDE is my friend.

For the Neg position, click here.

McIntyre (2011):
The doctrine (or principle) of double effect is often invoked to explain the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end. It is claimed that sometimes it is permissible to cause such a harm as a side effect (or “double effect”) of bringing about a good result even though it would not be permissible to cause such a harm as a means to bringing about the same good end. This reasoning is summarized with the claim that sometimes it is permissible to bring about as a merely foreseen side effect a harmful event that it would be impermissible to bring about intentionally.

Humanitarian Intervention, Cambridge University Press,
Edited by J.L Holzgrefe & Robert O. Keohane, 2003

Treva Panajoti
UN & Humanitarian Governance
Humanitarian Crises and World Politics: the Conflict between Ethics and Pragmatism in Humanitarian Intervention Decisions

The Legality of Humanitarian Intervention, University of Georgia School of Law
Eric Dejei, 2005

Memorandum, Prepared by the Public International Law & Policy Group
May 2012


Immanuel Wallerstein
DUKE UNIVERSITY PRESS Durham and London 2004

Humanitarian Intervention as a Perfect Duty: A Kantian Argument
Carla Bagnoli, 2004

The Moral Basis of Humanitarian Intervention, Symposium on the Norms and Ethics of Humanitarian Intervention, Center for Global Peace
and Conflict Studies, University of California, Irvine, May 26, 2000
Terry Nardin

McIntyre, Alison, "Doctrine of Double Effect", The Stanford Encyclopedia of Philosophy (Fall 2011 Edition), Edward N. Zalta (ed.), URL = <>.