Userdocs PublicDocs Universal Health Care Topic Analysis

7/29/2019 Userdocs PublicDocs Universal Health Care Topic Analysis

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November/December Topic Analysis: Gabriel Bronshteyn

As we approach the 2012 Presidential election, several issues dominate our national consciousness. Since

President Obamas campaign in 2008, the idea of Universal Healthcare has been particularly important to

Americans. Many will judge his presidency with regards to the effectiveness of the landmark legislation

commonly termed Obama Care, while thinking hard about Romneys proposals to repeal and reform

the system. Given the circumstances of this election season, and the rather recent SCOTUS (Supreme

Court of the United States) decision about Obamas health care plan (to which I will devote a bit of time

to), this topic can hardly be any more relevant to you or your potential judges.

In terms of persuasion, it may be instructive to consider the actual impact the arguments you make on

the topic will have on your judge a strong narrative will be even more powerful on this health care

topic than with other more distant issues. Whatever consequences you may discuss, it is highly likely

whoever is judging you will be able to imagine them playing out in some way that affects them. Before

we discuss the application of your argumentation in too much depth, though, here are some fundamental

things you should start with in approaching this topic:

This may seem obvious, but I cant stress enough how important it is for a topic like this to take the time

to become acquainted with the issue. So many debates will surely be riddled with misconceptions and just

complete falsities about the American healthcare system and the SCOTUS decision. Your first job as a

debater on this topic needs to be generally educated on the issue every time your opponent claims


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that in our current system, people can just walk into a hospital and get treated without paying a dime,

youll know the problems with this assertion. That being said, lets look at some background.

Properly known as the Patient Protection and Affordable Care Act, this policy (passed back in March,

2010) is aimed at expanding the levels of coverage across the United States and the costs of

healthcare. Important parts of the legislation to consider include the mandate requiring insurance

companies to cover applicants with equal rates regardless of pre-existing conditions. According to the

CBO, this would lower future deficits and Medicare spending (though the true levels of cost-efficiency

can and should be argued with counter-evidence that is definitely floating around out there). The most

controversial part of Obamacare is the individual mandate, requiring anyone not covered by an

employer, Medicare, etc. to purchase an approved insurance policy (or pay a penalty). Subsidies for low-

income/poor individuals and small businesses offering insurance will be available, and Medicaid eligibility

will be expanded (meaning more people will be eligible for government funded insurance benefits).

This is the long form name of the landmark SCOTUS decision that upheld most provisions of the

PPACA/HCERA (Obamacare). The most controversial of all parts of the policy was the Individual Mandate

(you may recall pundits referring to the idea as one comparable to the government forcing everyone to

eat broccoli, just because it is good for you). Technicalities aside, the basis of the decision was to uphold

the Individual Mandate penalty as a within the Congressional taxation powers granted by the

constitution. Looking to the decision for arguments on the topic is difficult, unless you are planning to

run a constitutionality framework.

I would try to refrain, generally, from spending too much time discussing the current political discourse

on the subject of Obamacare. By that I mean quoting either Romney or Obama may not be the best


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strategy, really not even because of bias (though thats an issue), but because of how muddled what they

are saying has become. There is also the question of how relevant Obamacare itself is to the issue. Dont

take this to mean the arguments being made on both sides of the issue today by reputable sources

(economists, healthcare professionals, etc) are to be discounted, though. The fresher data will be a nice

addition to any case.

Theres a lot to consider here, and how you frame this resolution will be a huge determinant of how the

round plays out. Spending some time picking out an appropriate framework for this topic seems

particularly important for a good negative, considering the imbalance in arguments/literature on the

topic.

The inclusion of the actor (the U.S) in the resolution is very important for your arguments. The specificity

offers you the opportunity to discuss a specific policy decision, rather than only the general principle of

instituting universal healthcare. Good evidence that points to chances of effectiveness (or lack thereof)

of a universal healthcare system will be especially important and persuasive. It might also offer the

negative an interesting (and less abstract) way to persuasively negate the resolution, on grounds of

application of universal health care to the United States specifically, or how the policy would likely be

implemented.

Looks like were back to another ought topic after a year-long hiatus in the 2011-2012 season. Generally,

the most common definition of ought will be moral obligation. Under that interpretation, the

resolution is a question of whether or not the United States has the moral obligation to guarantee

universal health care to its citizens. Of course, this still begs the question of what constitutes a moral

obligation, and a good case/debater will answer that question within the Value/Value Criterion analysis.


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So, if you define ought as a moral obligation, and I suspect many of you will, it will be critical for you to

use your V/VC and argumentation to show two things:

a. What does it mean for the U.S to have a moral obligation? What moral obligations does the U.Shave, then?

b. How does guaranteeing universal health care fall under your idea of a moral obligation?We will discuss both of those questions in the argumentation section of the topic analysis. If youd like to

keep things simple, and possibly incline the debate towards a more consequentialist approach, you can

always define ought as should. This doesnt really help frame the debate, and largely begs the same

questions as moral obligation. How does the U.S decide what it should do? The use of the word

should definitely frames the debate towards the consequences of implementing a given policy, though a

moral obligation does not rule out this approach at all. Finally , you can define ought as logical

expectancy, as in The apple ought to fall from the tree. This is certainly the least common definition. I

suppose you could argue that all modern/democratic/liberal nations naturally move towards universal

health care, and so it would be logically expected that the United States does guarantee it, but this would

be a difficult case to pull off.

I think this is a rather clever choice of wording for the topic. A good affirmative debater can definitely

consider what it means to guarantee a service versus providing it. The argument can definitely be made

that the resolution is asking if the U.S ought to guarantee the option of government healthcare, rather

than just provide it outright. There are a lot of different ways you can twist this depending on what your

opponent is arguing, but its a strategic tool I would at least keep in your arsenal as part of a grander

defense against the negative.


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Torrey 1 defines Universal health care:

"Universal healthcare" or "universal coverage" refers to a scenario where

everyone is covered for basic healthcare services, and no one is denied care as

long as they are legal residents in the geography covered, such as all the

residents in the state of Massachusetts, or all the citizens in the country of

Canada.

This is a workable definition, and the whole notion seems pretty self-explanatory. The affirmative is free

to interpret the level to which the government is controlling the administration of health care (or at

least argue that you are free to do so) is necessary to meet that definition. For the sake of a less extreme

position, in this case, less is definitely more meaning that you may want to avoid arguing for the very

left side of the spectrum of socialized medicine. I take no issue with that particular position, and even s ee

a lot of merit there, but it may be smart to avoid a lot of negative complaints about government

intervention from the start.

This is very self-explanatory. The only reason Im commenting on this part of the resolution is because it

throws out the prospect of most debate regarding the problems of undocumented/illegal immigrants

using our health care system, though I guess the argument can be made on some level with regards to

their children.

The affirmative for this topic can be made incredibly persuasive. You have many things at your disposal,

including but not limited to: more evidence, more applicable frameworks, more applicable arguments,

better applicable arguments. I think it might be clear, then, that this is an AFF biased topic. Lets look at a

few ways of approaching an affirmative to the topic.

1Torrey, Trisha [Masters Degree in Education from Elmira College]. What is Universal Healthcare Coverage? Patient

Empowerment. 2008.


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The most obvious framework/set of arguments for the affirmative appears to follow

consequentialist/utilitarian ethics. The basis is simple. Going back to our discussion of a moral obligation,

you would argue that the United States has the moral obligation to promote the wellbeing of the

populace (a very reasonable argument to make), and that the only way to judge a policy like universal

health care is to estimate the consequences for the American public. This appeals to the most basic way

of thinking about an arguments impact, and you can argue that this reflects the way that the U.S

legislative body makes decisions. The arguments that follow from such a framework are both varied and

well supported. To begin with, its good to have an idea of how big of a problem we are addressing.

DeGrazia2writesthat:

American health care is a terrible mess. Over 46 million Americansabout

16 percent of the populationlack health insurance; millions more are

underinsured.

Clearly a lot is at stake here. The affirmative should argue that enacting universal health care will bring

about the best consequences for the United States. What kinds of consequences are there? How can I

frame these consequences? Both are good questions to answer. Obviously you cannot write a case that

lists the dozen or more possible positive consequences of enacting a true universal health care system. A

better approach would be, after going through arguments and evidence on the topic, to focus yourself

on a sort of theme that ties them together. A case entirely focused on life could be very different than a

case that focuses on rights, or economics, or whatever else you can dream up. Lets move on now to go

over the various arguments available to the consequentialist affirmative.

You may be thinking to yourself that the consequentialist argument for the affirmative is painfully

obvious. Universal health care = more people covered = more people healthy. Done! Right? Probably

not. Any good negative will not let you get away with making such assumptions, as with any topic, these

2DeGrazia, David [Professor of Philosophy, George Washington University]. "Single Payer Meets Managed Competition."

Hastings Center Report38.1 (2008): 23-33. Print.


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arguments really do need to be supported. If it were that easy or obvious, there may not be such

controversy over the issue here in the U.S, and it definitely wouldnt be a National Forensic League topic.

More people covered:

This part you can nearly assume. However, it would be very wise to find a quick piece of evidence that

predicts just how large of a gain in coverage rates we could foresee for Americans. Evidence will

definitely surface on the negative side regarding possible issues with private insurance companies that

could even lead to fewer people being covered, for one reason or another. That would be a very silly

way to lose the entire foundation to your argument, so come prepared.

More people healthy:

This can definitely not be assumed. Tons of evidence exists that suggests that the relative quality of

health care would decline significantly if we switch to a universal system. A very basic example: Chua3

writesthat:

Notice, however, that this piece of evidence merely shows the dangers of a large UNINSURED populace.

While it may seem obvious, then, that conditions would improve in the affirmative world, it would be key

to provide evidence supporting that claim. Otherwise, a negative debater can argue that even if mortality

rate decreases, it wont be by significant enough of a margin to warrant the vast changes/problems that a

universal system would create.

3Chua, Kao-Ping [Fellow at the American Medical Student Association]. "The Case for Universal Health Care." American

Medical Student Association(2008): n. pag. Print.


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There are many variances on this basic argument. You can argue about the importance of helping those

with pre-existing conditions. The idea is, before our semi-universal-ish system of Obamacare was put in

place, insurance companies discriminated against customers with pre-existing conditions. Oftentimes, even

those who could afford to pay for insurance were denied.Seshamani4writesthat:

Arecentnational survey estimated that 12.6 million non-elderly adults 36

percent of those who tried to purchase health insurance [in 2010] directly

fromaninsurancecompanyintheindividualinsurancemarketwere

infactdiscriminated against because of a pre-existing condition in theprevious three years.

You can (and should) also consider arguing about the moral necessity for guaranteeing universal health

care. There are many variant on this argument, so lets look at a few. First off, you can practically expect

the negative to discuss autonomy (we will explain this later) so a good argument on the affirmative to

preempt any discussion of lost freedom of choice is well explained by Menzel5:

Paradoxically,however,thisbeliefalsoformsanargumentfor

universalhealthinsurance:people need universal access to basic healthcare in order to maximize their ability to care for themselves. When people

are ill, individual liberty and personal responsibility are quickly

compromised. Even small disorders like mild depression or a bad back can

turn liberty and responsibility into dependency.

Another interesting avenue to take is to consider who gets insurance in modern America and why? A

compelling argument can be made that many people are stripped of the ability to protect their right to

life because of economic factors outside of their own control. In this way, they are pretty much

arbitrarily being stripped of that right which can actually inhibit their ability to progress economically. In

this way, you can appeal to the equality or rights based argument (depending on how you spin it), while

also providing an impact that shows how a cycle gets perpetuated in the negative world. The warrant for

this argument can be articulated in a different way, but you can also just layer it on top of the first

4Seshamani, Meena [Director of Policy Analysis at the Department of Human Health and Services]. "Coverage Denied: How

the Current Health Care System Leaves Millions Behind." U.S. Department of Human Health and Services(2010): Print.5

Menzel, Paul T. [Professor of Philosophy, Pacific Lutheran University], and Donald Light. "A Conservative Case for Universal

Access to Health Care." Hastings Center Report36.4 (2006): 36-45. Print.


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warrant. On top of issues of arbitrary rights deprivations due to economic factors, you can argue that,

because private insurance companies turn down those with pre-existing conditions, even those who can

afford health insurance may be arbitrarily deprived of the ability to protect their health. Keep in mind that

all of these different arguments can be brought together with various themes safety, rights, life, etc.

Your value criterion should reflect the theme you choose to tie together your case.

One other position that Id like to briefly look at is a bit more esoteric. This more philosophical approach

to the resolution is based on John Rawls Veil of Ignorance. The argument itself is rather simple, but is

rooted in deeper philosophy. Rawls devised the Veil of Ignorance as a heuristic device (an experience-

based approach to deriving philosophical conclusions) in order to decide what is the most moral option.

To see more on how he justified this as the preferable way of viewing Justice (ie. How you explain why

moral obligations are judged in this way) look to the Stanford Encyclopedia of Philosophys article. The

V.O.I is a veil that would blind people from any relevant biasing factors in their life, like social status,

economic status, or even physical/mental ability/status. He concludes that because humans are rational,

they would opt for the option that provides for the worst off, as well as the best off. In that way, you

can use the V.O.I to justify a universal approach to health care. Look into the philosophy more deeply if

you are interested, though.

The negative on this topic is a bit less appealing. The topic literature in general seems less inclined to

support a negative position, but there is a lot to work with. It will require more strategy and preparation

for a negative to adequately oppose a good affirmative, though. First and foremost, the negative debater

ought to make sure their opponent is not weaseling out of defending a particular advocacy. That doesnt

mean a specific policy, but rather a particular idea of how universal health care would be implemented, or

at least what it entails. Otherwise, affirmative debaters will likely claim that whatever problems you are


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discussing are only relevant to a particular administration of health care that they are not defending.

Watch out for this.

Perhaps the most common and most important argument on the negative side of the topic will be

focused on autonomy. There may be a few variants on how to articulate the argument, but the basic idea

is that the action of enacting universal health care would be a violation of autonomy. One way to argue

this is by claiming that a universal health care system will surely deprive people of the ability to choose

their own health provider, and even of the ability to have certain independence regarding what

treatment to obtain. This isnt really the strongest way to articulate the argument, though. A more

common version of the autonomy argument will involve discussion of taxation on two levels. The

most basic level is that this will necessitate an increase in taxes, and taxes violate autonomy. This argument

is rather weak, though because it can be easily argued that it would be unreasonable to stop the

government from taxing the people at all. The best articulation of the autonomy argument is one that

focuses on the fact that the healthy individuals of society will often have to pay the tab for those who

arent healthy an imbalanced system that arbitrarily deprives people of their autonomy for the benefit

of others. These arguments can be used on their own or in tandem, depending on your preference.

If running an autonomy case, make sure to really warrant why autonomy is central to the existence of

moral obligations to citizens of the United States. There are many ways to do this, but an important tie

connecting morality and autonomy is human rationality. You can make the argument that it is our

rationality that defines us, which means our ability to make choices and want certain outcomes is

dependent on our autonomy. In that sense, its arguable that the very source of our desire for life and

rights is rooted in our ability to have and exercise autonomy. You can also mention that the social

contract is entirely dependent on an autonomous choice to participate, showing how important that right

really is to the foundation of society. Make sure you have rehearsed or at least entirely understand how


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to articulate these arguments well and defend them, most prepared affirmatives will be ready to answer

the standard autonomy arguments this is necessarily a reason not to run them, but be prepared!

Other negative arguments are rather obvious, as well . You can definitely make the argument that a

universal health care system is inefficient, and thus will actually exacerbate the problems the affirmative

world addresses. This type of argumentation and evidence is important to collect and prepare regardless

of what you are running, because it will be effective in responding and turning most affirmative positions.

The case could have a similar framework to a standard affirmative case and go on to argue that universal

healthcare will actually make healthcare more expensive, less accessible, hurt the quality, etc. All of these

arguments are definitely supported by some evidence, and you can argue each logically. One can support

the arguments about accessibility and quality by discussing the economic merits of a competitive system

this is where it may be instructive to look at the thoughts of conservative economist Milton Friedman,

who would contend that economic markets operate in the most effective and efficient manner when left

unfettered. Such arguments will apply well for the health care topic, because a universal health care

system will arguably take away from the competitive market for insurance, or even remove it

completely, depending on what you can force the affirmative into defending. Libertarian and other

conservative economic literature will be useful, because it will argue that the competitive market forces

the development of cheaper and better treatment options, while a sort of government-run system will

be inefficient and prevent progress. This negative may also be effective if it includes a discussion of the

alternatives to the affirmative advocacy. A good article to look at if youre interested in the effectiveness

arguments is John Goodmans Health Care in a Free Society: Rebutting the Myths of National Health

Insurance from CATO.

A final topic to look at for the negative is the much-loved categorical imperative. This case would look to

Kants deontological framework for understanding morality particularly regarding the treatment of

humans as ends. If this sounds confusing or foreign, you can brush up on the philosophy by searching on


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Stanford Encyclopedia of Philosophy, or possibly avoiding the case position. Overall , though, its a rather

simple position to run, and is rather similar to the autonomy arguments that we made above. Simply put,

Kant argued that because humans are ends, morality requires that we use people as a means to

some other end. The very common application of this philosophy is the killing one to save one hundred

example but like I said, look to the S.E.P for more information before you run the position. You would

argue, then, that because health care would inevitably force wealthier and/or healthier individuals to pay

the tab for the worse off/sicker individuals of society, they are being used as a means to the end of

helping others. This is a little bit messy, so a good case on the subject will really define exactly where the

abuse is happening. I would suggest going the autonomy route with this logic, but this is an option if

youre interested in mixing things up.

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