600 page file + resources — Resolved: The United States federal government has a moral obligation to provide universal health care for its citizens (Starter Essay)

A couple comments out of the gate —

(1) The resolution asks two questions — should the government provide universal health care and is there a moral obligation to provide that care? Certainly, one could conclude that providing universal care is a desirable policy objective and also conclude that there is no moral obligation to do so.  Affirmative debaters have to prove both that that providing the care is desirable AND that there is a moral  obligation. Negative debaters can win by either arguing that providing universal care is undesirable (if it is net undesirable, there is no moral obligation) or that there is no moral obligation to do so.

(2) There is a debate as to how to provide “universal care.”  Universal care generally that all persons are covered by at least basic health care.  Of course, there are different mechanisms that can accomplish this, such as “single payer,” which is probably the one most commonly advocated. It does not, however, simply mean, “single payer.” It can also simply mean access to affordable insurance —

Trisha Torrey, July 10, 2017, Verywell, What is Universal Health Care Coverage? https://www.verywell.com/what-is-universal-healthcare-coverage-2615254

“Universal health care” or “universal coverage” refers to a system of allocating health care resources where everyone is covered for basic health care services and no one is denied care as long as he or she remains legal residents in the territory covered—such as all the residents of the Commonwealth of Massachusetts, or all the citizens of the country of Canada.

The concept of universal health care is often incorrectly equated to a single-payer, government health care system, where all medical expenses are paid by one entity, usually the government.

However, “single payer” and “universal” are not the same.

Universal Coverage

A system of “universal coverage” can mean two slightly different things. First, it can refer to a system where every citizen can access either public or private health insurance. Second, it can refer to a system where every citizen automatically obtains free or low-cost basic services (prevention, emergency medicine) for a government-mandated set of standard benefits.

In the United States, the goal of universal coverage animated the adoption of the Affordable Care Act—sometimes called Obamacare—and arguments about how to maximize coverage while containing costs has consumed the early Trump administration. Under the ACA, health insurance companies could offer specific health policies with a mix of benefits required by law. For people who fall at certain percentages of the federal poverty line, a sliding scale of public subsidies pay some or all of their premiums.

The intended net effect was that anyone, regardless of income, could afford at least a reasonable basic health-insurance plan.

Single-Payer Systems

In a single-payer system, however, there are no private insurance companies to begin with. The government alone authorizes and pays for health benefits. The classic example of a single-payer system is the Great Britain’s National Health Service; the NHS controls access to health care resources and even employs the health care providers.

Canada offers a similar scheme.

Some members of the U.S. progressive movement have suggested that the United States could arrive at a form of single-payer health care by offering “Medicare for all”—that is, by taking the government-payer program for the elderly and universalizing it to all citizens. It’s not clear, however, that such an approach has any significant political support beyond some experiments proposed in individual states.

Public-Private Partnerships

Throughout the world, many countries offer health care universally, to all their citizens, in public-private combinations, and not through single-payer systems. Examples of these countries include Germany, the Netherlands, and Singapore. Singapore enjoys one of the most successful health systems in the world, with long life expectancies and low infant mortality rates.

This article identifies three different types of systems — single payer, employment based, managed competition.

Han Hennenberger, Connecticut College, 201, Health Care and Justice: A Moral Obligation? Philosophy Honors Papers, https://digitalcommons.conncoll.edu/philhp/1 DOA: 6-16-16

I characterize the systems found worldwide: single payer, employment based, and managed competition. A single payer system is one of the most widely cited as universal healthcare takes this form in Canada, the United Kingdom, Australia, and Taiwan. In such an arrangement the government provides healthcare to all people and collects taxes in order to do so. The government controls the supply of healthcare and pays providers directly for services rendered. Prices are set for the providers who are compensated either as salaried government employees or through reimbursement. The total amount and quality of care distributed is indirectly determined by whatever budget is set by the government. Depending upon the nation additional private insurance may be available though in the strictest single payer systems opting out is impossible. Germany stands as the model for employment based systems of universal healthcare. Under this arrangement employers are required to provide healthcare to their employees. This is done through the formation of insurance or “sickness” funds either within or across a given industry. The value and nature of premiums and benefits are often set by the government. Premiums are taken out as a sort of payroll tax which goes directly to the fund. The final type of universal healthcare is managed competition. This system can be seen in Switzerland, Massachusetts, the Netherlands, France, and to some extent in many other nations. Healthcare which comes in this form tends to vary from country to country though some defining traits are characteristic. In all cases     managed competition means universal healthcare which is provided privately in a heavily government controlled marketplace. This is paired with a government mandate for all to buy insurance and for employers to provide insurance to all employees. It is left up to the individual to choose healthcare providers and insurers. The standard benefits package is set by the government though insurers are allowed to compete on price and additional benefits. While these are the standard characteristics of managed competition many variations exist. In order to control costs and stave off overutilization France and Japan impose significant cost sharing. In other nations strict limits are set on how much consumers must pay out of pocket. In some countries it is forbidden to purchase additional or private insurance while in others this practice is common. Not surprisingly outcomes vary with some nations marked by cost and low access and others which manage to contain expenditures and keep lines short (Tanner, 7).

While all three systems are designed to achieve universal health care, they are radically different and cannot co-exist.  So, this brings up the question of can the Affirmative advocate?

While plans are not permitted in some regions, it seems difficult to determine if universal care is desirable or undesirable until we know which type of system the affirmative is advocating. One may be undesirable (and hence immoral) while the other one may be desirable.

Of course, I supposed it is possible to generally debate the question of whether or not the government should support universal health care, but it seems difficult to separate it from how it should be done.

To get started, we do have three files available — single payer, health care morality, and general morality  (morality impacts and answers)

There is also a single payer bibliography available here and morality in health care bibliography here

For now, a few more definitions —

Universal health care means all residents are covered by basic health care

World Health Organization (WHO definition)

World Health Organization, no date, Universal Coverage Definition, https://www.who.int/health_financing/universal_coverage_definition/en/