UAA team debates single-payer health care
The award-winning University of Alaska Anchorage Seawolf debate team argued the question of whether America should adopt a single-payer health care system on Oct. 25 before a Commonwealth North audience.
On the pro side was Jacob Sherecliffe, a senior and Truman Scholar majoring in political science, and Sarah Gray, a junior majoring in nursing. On the con side was Genevieve Mina, a junior with a biology-political science major, and Robert Hockema, a junior majoring in international relations.
Gray argued access to health care is a fundamental human right, relating to the proclamation in Article 25 of the Dec. 10, 1948, Universal Declarations of Human Rights: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.”
“There is inaccessibility in the status quo,” she said.
Modeled after the Canadian and the United Kingdom systems, an American system would sweep in the 44 million families that reported at least one uninsured member on their IRS tax forms, Gray said. Spread across more people, the cost of paying for health services goes down.
“That’s almost the same as the entire population of the Ukraine. Why deny the population of an entire country access to the health care system?” Gray said.
An unequal system exists now between those who don’t have good insurance and the privileged that do, she argued, and single-payer evens the distribution so all can have access.
According to the National Association of Insurance Commissioners, Gray said, some 5,926 insurance companies operate in the U.S. Eliminating them cuts paperwork for a savings that can be applied to the single-payer system.
The ability of a government-led health care system means spending virtually nothing on advertising, Gray said. Governments can negotiate for more favorable prices from providers and hospitals.
Bypass surgery in the U.S. cost $73,000, versus the same procedure cost of $23,000 in France where they have a public-private partnership to cover health, she said.
Gray gave a cost analysis comparison to roads. If you increase taxes to pay for better roads maintenance, it will cost less in the long run than building new ones.
Health care savings in the long run come from better coverage through a single-payer system at lower costs, she said, and savings comes from taking resources out of a system that currently goes into administering and advertising the private health insurance system.
Genevieve Mina “deconstructed” Gray’s contentions by saying eliminating advertising costs would save mere pennies.
“It won’t work in the U.S. High costs are the true evil in American health care,” she said.
The other big question is how to pay for it? Increasing taxes to pay for it would prove problematic, she said.
“Universal coverage is a good thing but the problem is how to get it — through a single-payer or multi-player system?” Mina asked.
Another weakness in the American health care construct is the lack of incentive for hospitals and providers to help bring down costs, Mina said.
“In fee-for-services, hospitals simply applied to increase their Medicaid payments. Sure, some went for new equipment and procedures, but millions and millions of dollars went to CEOs and higher wages,” she said.
Mina, and later her partner Hokema, countered that America’s system would fail when it is government controlled. They gave examples from Vermont, the home state of Democratic presidential candidate and single-payer advocate Bernie Sanders, where 11 percent tax hikes went to pay for a single-payer system and in the first year alone its program cost $2.5 billion.
Politicians have an incentive to not regulate prices or cause price containment due to the lobbying efforts they succumb to, Mina argued. Hospitals can apply to increase Medicaid payments, so there’s no ability to bring the costs down through political pressure.
“Special interests inherently control Washington,” she said. “They have a powerful interest against change and will get as much as they can out of the single-payer system.”
Sherecliffe proposed that people simply want health care that is adequate and of good quality.
“People don’t care where a restaurant gets their avocados from, but they do want good guacamole,” he said.
High costs in America’s current system come from people who wait too long to get attention for an illness or chronic condition. By having insurance and emphasis on preventive care, the costs to the system go down, Sherecliffe argued, and added that lobbying in Washington could be outlawed to avoid the mess of over-influencing a political outcome.
States that see the highest health care costs — such as Alaska — would go into a pool of coverage that includes people from lower-cost states. A government pool could negotiate for lower drug prices and allow everyone to pay less, he argued.
But Hokema countered that it will cost far more to bring in a new system when holes can be poked to undermine it, such as is occurring to the Affordable Care Act, or Obamacare, under the Trump administration.
Those who have insurance now that they are perfectly happy with will have to move to system that likely won’t pay as many benefits, Hokema said. When cutting the pay for rich CEOs, health field jobs would also get cut, causing an economic problem in another direction, he added.
This leaves it open for a projected loss of 800,000 jobs, Hokema said.
He also predicted the single-payer system would be prohibitively expensive, as California found estimates of such a system came in at $400 billion per year. Estimates for Sanders’ single payer plan are $1 trillion the first year alone.
The con side premised their arguments on the better ability of a free-market system to force changes. This takes it out of the political arena where “opposition parties control the narrative,” such as occurred in the ACA debates, he said.
“We need to solve the problems… Try price transparency. Through competition there is an incentive to reduce prices,” Hokema said.
What America needs is an incentive to remove “anti-competitive behavior” that came about through hospital mergers across the nation in the past few decades. A public-private system — such as seen in France — offers ways to do that, he said.
“How you get there is important,” Hokema said.
Two of the three judges gauging the debate sided with the pro single-payer team. Karen Hunt, a retired Alaska Superior Court judge, said she wasn’t convinced that “people can’t change” is a valid argument against trying a single-payer system. She also had more faith in the government’s ability to bring down health care costs by expanding on what is already in place.
Dr. Tom Nighswanber, an Alaska Native Medical Center physician who also is a retired University of Washington professor, likewise was more convinced by the pro camp.
He agreed that doctors do keep up prices and costs by creating demand. If you come for a headache, for example, the doctor can recommend a CAT Scan.
“I have colleagues in the U.K. and they don’t want to give up their (single-payer) system,” he said.
Judy Brady, the third judge and a former Department of Natural Resources commissioner, said she has heard about corruption in the Canadian Health Care system. To get good health care in Canada, “you barter behind closed doors or pay under the counter,” she said. She sided with the anti-single payer team.
Those attending the Commonwealth North luncheon voted 67 percent to 31 percent against the pro single payer system arguments.
Over the last two years, the Seawolf Debate program brought three teams to the Worlds Debating Championships and climbed in the official World Debate Council’s ranking to the 9th most competitive program in the world based on its cumulative success at the last five World Universities Debating Championships. This ranking places the team in second-highest team from the United States, Coach Steve Johnson told the group.
Naomi Klouda can be reached at firstname.lastname@example.org.