Medical Industries DA

1NC shells

Organ Sales

1NC Obamacare Bad

Uniqueness: Perception of cost savings preserves Obamacare nowMcCarter 14 Daily Kos staff reporterJoan, Daily Kos, April 15, http://www.dailykos.com/story/2014/04/15/1292183/-Treasury-bonds-get-Obamacare-boost-as-health-care-costs-nbsp-slow#Health care costs increased just 2 percent last year, the slowest rate of growth in 65 years, in large part because of the cost controls created with the Affordable Care Act. That means inflation is curbed, and it also means that U.S. treasury bonds are a good bet for investors.Less inflation, which boosts the purchasing power of fixed-rate payments, may help attract buyers to Treasuries as the economy strengthens and the Federal Reserve pares its own bond buying. While yields have fallen this year, the compensation 10-year notes provide after inflation is close to the highest in five years. Excluding food and energy, health care accounted for about a third of the slowdown in consumer prices, which rose 1.1 percent in the past year from 2 percent in the prior 12 months.“This is good news” for bonds, Kathy Jones, a New York-based fixed-income strategist at Charles Schwab & Co., which has $2.25 trillion in client assets, said in a telephone interview on April 4. By holding costs down, “it may be a benefit to inflation, longer-term.” Jones, who has been advising clients on the bond-market implications of the health-care law, is recommending that investors buy 10-year Treasuries because low inflation will keep the Fed from lifting interest rates. […] Inflation has remained below the Fed’s 2 percent target for 22 straight months and “a couple” of policy makers said at its March meeting that “unusually slow growth” in health-care prices has played a “notable role” in holding back prices, minutes of the gathering released on April 9 show. These cost controls in the law are largely through cuts in Medicare payouts to poor-performing hospitals and through the incentives it created to curb readmission rates, as well as and changed payment programs to reduce unnecessarily expensive procedures. Just think what savings could be achieved if Medicare could negotiate prescription drug prices. Or how much could be saved in a public option where the government was setting reimbursement rates for all care. The Republican mantra that the law is a total disaster that will doom the nation is sounding more and more ridiculous. This news, combined with the latest projections from the Congressional Budget Office on the cost savings ($104 billion over previous projections in the next decade), is going to make a hard sell for Republicans with their traditional allies in the financial sector, not to mention the millions of people who would lose access to health care.

Threat of cost increases could kill ObamacareNorman 14 health care reporter for POLITICO Pro. Before joining POLITICO, he worked as a science writer at The Rockefeller University. He previously covered the politics and policy of Medicare for Part B News and started out at the Pensacola News Journal.Brett, “Obamacare: Anger over Narrow Networks,” Politico Pro, July 22, http://www.politico.com/story/2014/07/obamacare-health-care-networks-premiums-109195.htmlAmericans for Prosperity is hitting on these “narrow networks” against Democrats such as Sen. Jeanne Shaheen of New Hampshire, whose GOP opponent Scott Brown has made the health law a centerpiece of his campaign to unseat her. And Republicans have highlighted access challenges as another broken promise from a president who assured Americans they could keep their doctor. It’s not just a political problem. It’s a policy conundrum. Narrow networks help contain health care costs. If state or federal regulators — or politicians — force insurers to expand the range of providers, premiums could spike.

And that could create a whole new wave of political and affordability problems that can shape perceptions of Obamacare.

Link: Plan reduces health care costsSmith 08 online writer for Yahoo Contributor NetworkJohn, April 11, “Legalizing the Sale of Human Organs: Necessary for Survival.” http://voices.yahoo.com/legalizing-sale-human-organs-necessary-for-1368813.html?cat=5John has been writing online for several years. An avid hockey player and fan, he is enjoys writing sports articles, but is familiar with a wide variety of topics. Oftentimes the cost of a transplant ends up costing less than the lifetime cost of dialysis for a patient with kidney problems, so it would be cheaper for insurance companies to purchase an organ on behalf of their clients, rather than having to pay lifetime costs. This would reduce the cost of insurance rates across the board as the companies would not need as much to cover their costs, but will continue making the same, if not a larger amount of profit (Nelson 1). Countries overseas have started to realize this fact. "In Israel, there is even tacit government acceptance of the practice [of selling human organs] -- the national health-insurance program covers part, and sometimes all, of the cost of brokered transplants" (Finkel 1).

Preserving Obamacare will kill the economy – loss of low wage jobs and marginal excess burden of taxationConover 12 Research Scholar in the Center for Health Policy & Inequalities Research at Duke University, an adjunct scholar at AEI, and a Mercatus-affiliated senior scholar. Christopher, August 10th, “Health care law will cost 1 million or more jobs” http://www.aei.org/article/health/healthcare-reform/ppaca/healthcare-law-will-cost-1-million-or-more-jobs/)Moreover, the biggest losers under the ACA will be the least educated and least skilled workers in society. Under the law, large employers who do not provide health coverage will be fined $2,000 per full-time worker not counting the first 30. This increase is equivalent to about $1 an hour or a 14 percent increase in the minimum wage -a relative increase larger than nearly all others over the past 50 years. ¶ Voluminous studies have demonstrated that minimum wage laws-however well-intentioned-actually increase unemployment among the very group they are intended to help. Even the CBO analysis acknowledges this negative impact [2]. Yes, some low-wage workers will benefit from the Medicaid expansions and exchange subsidies, but this will

be little consolation to those who lose their job as a result of this mandate. How many such low wage workers will be put out of work by their employers? A reasonable estimate is more than 110,000 [3]. As AEI President Arthur Brooks has shown in his latest book The Road to Freedom, taking away someone's chances at earned success isn't good for them or for society.¶ Still, the direct job losses imposed by the ACA pale in comparison to the hidden losses that will result from its more than $500 billion in new taxes. I have elsewhere calculated that in its first ten years, the ACA would shrink the economy by a minimum of $157 billion (if its scheduled tax increases all are implemented) and perhaps by as much as $550 billion (if, as is likely, Congress elects to soften the blow of draconian cuts in Medicare payment rates to doctors and hospitals by raising taxes to avoid having to impose them) [4]. Since GDP per worker is roughly $59 per hour, and the average U.S. worker works 1,787 hours, these GDP losses are roughly equivalent to the loss of 150,000 to 520,000 jobs on an annualized basis [5]. The CBO has never calculated the impact of higher taxes on lost output, so there is no special significance to its

ignoring this impact in its cost estimate of ACA. The point is that when we consider both the direct and "hidden" costs of ACA, the adverse impact is 19 to 65 percent higher than the formally estimated 800,000 jobs figure.

Economic downturn risks great power nuclear war Mead 09 Senior Fellow in U.S. Foreign Policy at the Council on Foreign Relations(Walter Russell, New Republic, http://www.tnr.com/politics/story.html?id=571cbbb9-2887-4d81-8542-92e83915f5f8&p=2), Feb. 4If current market turmoil seriously damaged the performance and prospects of India and China, the current crisis could join the Great Depression in the list of economic events that changed history, even if the recessions in the

West are relatively short and mild. The United States should stand ready to assist Chinese and Indian financial authorities on an emergency basis--and work very hard to help both countries escape or at least weather any

economic downturn. It may test the political will of the Obama administration, but the United States must avoid a protectionist response to the economic slowdown. U.S. moves to

limit market access for Chinese and Indian producers could poison relations for years. For billions of people in nuclear-armed countries to emerge from this crisis believing either that the United States was indifferent to their well-being or that it had profited from their distress could damage U.S. foreign policy far more severely than any mistake made by George W. Bush. It's not just the great powers whose trajectories have been affected by the crash. Lesser powers like Saudi Arabia and Iran also face new constraints. The crisis has strengthened the U.S. position in the Middle East as falling oil prices reduce Iranian influence and increase the dependence of the oil sheikdoms on U.S. protection. Success in Iraq--however late, however undeserved, however limited--had already improved the Obama administration's prospects for addressing regional crises. Now, the collapse in oil prices has put the Iranian regime on the defensive. The annual inflation rate rose above 29 percent last September, up from about 17 percent in 2007, according to Iran's Bank Markazi. Economists forecast that Iran's real GDP growth will drop markedly in the coming months as stagnating oil revenues and the continued global economic downturn force the government to rein in its expansionary fiscal policy. All this has weakened Ahmadinejad at home and Iran abroad. Iranian officials must balance the relative merits of support for allies like Hamas, Hezbollah, and Syria against domestic needs, while international sanctions and other diplomatic sticks have been made more painful and Western carrots (like trade opportunities) have become more attractive. Meanwhile, Saudi Arabia and other oil states have become more dependent on the United States for protection against Iran, and they have fewer resources to fund religious extremism as they use diminished oil revenues to support basic domestic spending and development goals. None of this makes the Middle East an easy target for U.S. diplomacy, but thanks in part to the economic crisis, the incoming administration has the chance to try some new ideas and to enter negotiations with Iran (and Syria) from a position of enhanced strength. Every crisis is different, but there seem to be reasons why, over time, financial crises on balance reinforce rather than undermine the world position of the leading capitalist countries. Since capitalism first emerged in early modern Europe, the ability to exploit the advantages of rapid economic development has been a key factor in international competition. Countries that can encourage--or at least allow and sustain--the change, dislocation, upheaval, and pain that capitalism often involves, while providing their tumultuous market societies with appropriate regulatory and legal frameworks, grow swiftly. They produce cutting-edge technologies that translate into military and economic power. They are able to invest in education, making their workforces ever more productive. They typically develop liberal political institutions and cultural norms that value, or at least tolerate, dissent and that allow people of different political and religious viewpoints to collaborate on a vast social project of modernization--and to maintain political stability in the face of accelerating social and economic change. The vast productive capacity of leading capitalist powers gives them the ability to project influence around the world and, to some degree, to remake the world to suit their own interests and preferences. This is what the United Kingdom and the United States have done in past centuries, and what other capitalist powers like France, Germany, and Japan have done to a lesser extent. In these countries, the social forces that support the idea of a competitive market economy within an appropriately liberal legal and political framework are relatively strong. But, in many other countries where capitalism rubs people the wrong way, this is not the case. On either side of the Atlantic, for example, the Latin world is often drawn to anti-capitalist movements and rulers on both the right and the left. Russia, too, has never really taken to capitalism and liberal society--whether during the time of the czars, the commissars, or the post-cold war leaders who so signally failed to build a stable, open system of liberal democratic capitalism even as many former Warsaw Pact nations were making rapid transitions. Partly as a result of these internal cultural pressures, and partly because, in much of the world, capitalism has appeared as an unwelcome interloper, imposed by foreign forces and shaped to fit foreign rather than domestic interests and preferences, many countries are only half-heartedly capitalist. When crisis strikes, they are quick to decide that capitalism is a failure and look for alternatives. So far, such half-hearted experiments not only have failed to work; they have left the societies that have tried them in a progressively worse position, farther behind the front-runners as time goes by. Argentina has lost ground to Chile; Russian development has fallen farther behind that of the Baltic states and Central Europe. Frequently, the crisis has weakened the power of the merchants, industrialists, financiers, and professionals who want to develop a liberal capitalist society integrated into the world. Crisis can also strengthen the hand of religious extremists, populist radicals, or authoritarian traditionalists who are determined to resist liberal capitalist society for a variety of reasons. Meanwhile, the companies and banks based in these societies are often less established and more vulnerable to the consequences of a financial crisis than more established firms in wealthier societies. As a result, developing countries and countries where capitalism has relatively recent and shallow roots tend to suffer greater economic and political damage when crisis strikes--as, inevitably, it does. And, consequently, financial crises often reinforce rather than challenge the global distribution of power and wealth. This may be happening yet again. None of which means that we can just sit back and enjoy the recession. History may suggest that financial crises actually help capitalist great powers maintain their leads--but it has other, less reassuring messages as well. If financial crises have been a normal part of life during the 300-year rise of the liberal capitalist system under the Anglophone powers, so has war. The wars of the League of Augsburg and the Spanish Succession; the Seven Years War; the American Revolution; the Napoleonic Wars; the two

World Wars; the cold war: The list of wars is almost as long as the list of financial crises. Bad economic times can breed wars.

Europe was a pretty peaceful place in 1928, but the Depression poisoned German public opinion and helped bring Adolf Hitler to power. If the current crisis turns

into a depression, what rough beasts might start slouching toward Moscow, Karachi, Beijing, or New Delhi to be born? The United States may not, yet, decline, but, if we can't get the world economy back on track, we may still have to fight.

Physician-Assisted Suicide

1NC Obamacare Bad

Uniqueness: Perception of cost savings preserves Obamacare nowMcCarter 14 Daily Kos staff reporterJoan, Daily Kos, April 15, http://www.dailykos.com/story/2014/04/15/1292183/-Treasury-bonds-get-Obamacare-boost-as-health-care-costs-nbsp-slow#Health care costs increased just 2 percent last year, the slowest rate of growth in 65 years, in large part because of the cost controls created with the Affordable Care Act. That means inflation is curbed, and it also means that U.S. treasury bonds are a good bet for investors.Less inflation, which boosts the purchasing power of fixed-rate payments, may help attract buyers to Treasuries as the economy strengthens and the Federal Reserve pares its own bond buying. While yields have fallen this year, the compensation 10-year notes provide after inflation is close to the highest in five years. Excluding food and energy, health care accounted for about a third of the slowdown in consumer prices, which rose 1.1 percent in the past year from 2 percent in the prior 12 months.“This is good news” for bonds, Kathy Jones, a New York-based fixed-income strategist at Charles Schwab & Co., which has $2.25 trillion in client assets, said in a telephone interview on April 4. By holding costs down, “it may be a benefit to inflation, longer-term.” Jones, who has been advising clients on the bond-market implications of the health-care law, is recommending that investors buy 10-year Treasuries because low inflation will keep the Fed from lifting interest rates. […] Inflation has remained below the Fed’s 2 percent target for 22 straight months and “a couple” of policy makers said at its March meeting that “unusually slow growth” in health-care prices has played a “notable role” in holding back prices, minutes of the gathering released on April 9 show. These cost controls in the law are largely through cuts in Medicare payouts to poor-performing hospitals and through the incentives it created to curb readmission rates, as well as and changed payment programs to reduce unnecessarily expensive procedures. Just think what savings could be achieved if Medicare could negotiate prescription drug prices. Or how much could be saved in a public option where the government was setting reimbursement rates for all care. The Republican mantra that the law is a total disaster that will doom the nation is sounding more and more ridiculous. This news, combined with the latest projections from the Congressional Budget Office on the cost savings ($104 billion over previous projections in the next decade), is going to make a hard sell for Republicans with their traditional allies in the financial sector, not to mention the millions of people who would lose access to health care.

Threat of cost increases could kill ObamacareNorman 14 health care reporter for POLITICO Pro. Before joining POLITICO, he worked as a science writer at The Rockefeller University. He previously covered the politics and policy of Medicare for Part B News and started out at the Pensacola News Journal.Brett, “Obamacare: Anger over Narrow Networks,” Politico Pro, July 22, http://www.politico.com/story/2014/07/obamacare-health-care-networks-premiums-109195.htmlAmericans for Prosperity is hitting on these “narrow networks” against Democrats such as Sen. Jeanne Shaheen of New Hampshire, whose GOP opponent Scott Brown has made the health law a centerpiece of his campaign to unseat her. And Republicans have highlighted access challenges as another broken promise from a president who assured Americans they could keep their doctor. It’s not just a political problem. It’s a policy conundrum. Narrow networks help contain health care costs. If state or federal regulators — or politicians — force insurers to expand the range of providers, premiums could spike.

And that could create a whole new wave of political and affordability problems that can shape perceptions of Obamacare.

PAS will reduce the cost under ObamacareNYS Health Department 11 (New York State Department of Health Task Force on Life and the Law, “When Death is Sought,” https://www.health.ny.gov/regulations/task_force/reports_publications/when_death_is_sought/ chap6.htm, NG)Physicians are also increasingly aware of and subject to pressures generated by the need to control costs. Limits on hospital reimbursement based on length of stay and diagnostic group, falling hospital revenues, and the social need to allocate health dollars may all influence physicians' decisions at the bedside. In many

respects, physicians serve as gatekeepers in medical practice. Risk managers, administrators, and third-party payers also

now have a less visible, but still significant role in treatment decisions. The growing concern about health care costs will not be diminished by health care reform. Under any new system of health care delivery, as at present, it

will be far less costly to give a lethal injection than to care for a patient throughout the dying process . (12) The current debate about medical futility reflects, in part, the extent to which the cost of treatment is viewed as relevant to decisions at the bedside. Some physicians have argued that they should determine when the benefits

of treatment are too low to justify the cost in order to allocate health care resources. To date, the futility debate has focused on certain aggressive treatments, such as cardiopulmonary resuscitation, or on continued treatment for certain patients, such as those

who are permanently unconscious. But once a decision is made not to pursue cure or treatment, and assisted suicide and euthanasia are available, the economic logic will be inescapable. The care provided to dying or very ill patients, not just their treatment, is expensive and demanding for health care professionals. The extra weeks or months of caring for patients who do not opt for assisted suicide or euthanasia will seem all the more "futile" and costly.

Preserving Obamacare will kill the economy – loss of low wage jobs and marginal excess burden of taxationConover 12 Research Scholar in the Center for Health Policy & Inequalities Research at Duke University, an adjunct scholar at AEI, and a Mercatus-affiliated senior scholar. (Christopher, August 10th, “Health care law will cost 1 million or more jobs” http://www.aei.org/article/health/healthcare-reform/ppaca/healthcare-law-will-cost-1-million-or-more-jobs/)Moreover, the biggest losers under the ACA will be the least educated and least skilled workers in society. Under the law, large employers who do not provide health coverage will be fined $2,000 per full-time worker not counting the first 30. This increase is equivalent to about $1 an hour or a 14 percent increase in the minimum wage -a relative increase larger than nearly all others over the past 50 years. ¶ Voluminous studies have demonstrated that minimum wage laws-however well-intentioned-actually increase unemployment among the very group they are intended to help. Even the CBO analysis acknowledges this negative impact [2]. Yes, some low-wage workers will benefit from the Medicaid expansions and exchange subsidies, but this will

be little consolation to those who lose their job as a result of this mandate. How many such low wage workers will be put out of work by their employers? A reasonable estimate is more than 110,000 [3]. As AEI President Arthur Brooks has shown in his latest book The Road to Freedom, taking away someone's chances at earned success isn't good for them or for society.¶ Still, the direct job losses imposed by the ACA pale in comparison to the hidden losses that will result from its more than $500 billion in new taxes. I have elsewhere calculated that in its first ten years, the ACA would shrink the economy by a minimum of $157 billion (if its scheduled tax increases all are

implemented) and perhaps by as much as $550 billion (if, as is likely, Congress elects to soften the blow of draconian cuts in Medicare payment rates to doctors and hospitals by raising taxes to avoid having to impose them) [4]. Since GDP per worker is roughly $59 per hour, and the average U.S. worker works 1,787 hours, these GDP losses are roughly equivalent to the loss of 150,000 to 520,000 jobs on an annualized basis [5]. The CBO has never calculated the impact of higher taxes on lost output, so there is no special significance to its

ignoring this impact in its cost estimate of ACA. The point is that when we consider both the direct and "hidden" costs of ACA, the adverse impact is 19 to 65 percent higher than the formally estimated 800,000 jobs figure.

Economic downturn risks great power nuclear war Mead 09 Senior Fellow in U.S. Foreign Policy at the Council on Foreign Relations(Walter Russell, New Republic, http://www.tnr.com/politics/story.html?id=571cbbb9-2887-4d81-8542-92e83915f5f8&p=2), Feb 4If current market turmoil seriously damaged the performance and prospects of India and China, the current crisis could join the Great Depression in the list of economic events that changed history, even if the recessions in the

West are relatively short and mild. The United States should stand ready to assist Chinese and Indian financial authorities on an emergency basis--and work very hard to help both countries escape or at least weather any

economic downturn. It may test the political will of the Obama administration, but the United States must avoid a protectionist response to the economic slowdown. U.S. moves to

limit market access for Chinese and Indian producers could poison relations for years. For billions of people in nuclear-armed countries to emerge from this crisis believing either that the United States was indifferent to their well-being or that it had profited from their distress could damage U.S. foreign policy far more severely than any mistake made by George W. Bush. It's not just the great powers whose trajectories have been affected by the crash. Lesser powers like Saudi Arabia and Iran also face new constraints. The crisis has strengthened the U.S. position in the Middle East as falling oil prices reduce Iranian influence and increase the dependence of the oil sheikdoms on U.S. protection. Success in Iraq--however late, however undeserved, however limited--had already improved the Obama administration's prospects for addressing regional crises. Now, the collapse in oil prices has put the Iranian regime on the defensive. The annual inflation rate rose above 29 percent last September, up from about 17 percent in 2007, according to Iran's Bank Markazi. Economists forecast that Iran's real GDP growth will drop markedly in the coming months as stagnating oil revenues and the continued global economic downturn force the government to rein in its expansionary fiscal policy. All this has weakened Ahmadinejad at home and Iran abroad. Iranian officials must balance the relative merits of support for allies like Hamas, Hezbollah, and Syria against domestic needs, while international sanctions and other diplomatic sticks have been made more painful and Western carrots (like trade opportunities) have become more attractive. Meanwhile, Saudi Arabia and other oil states have become more dependent on the United States for protection against Iran, and they have fewer resources to fund religious extremism as they use diminished oil revenues to support basic domestic spending and development goals. None of this makes the Middle East an easy target for U.S. diplomacy, but thanks in part to the economic crisis, the incoming administration has the chance to try some new ideas and to enter negotiations with Iran (and Syria) from a position of enhanced strength. Every crisis is different, but there seem to be reasons why, over time, financial crises on balance reinforce rather than undermine the world position of the leading capitalist countries. Since capitalism first emerged in early modern Europe, the ability to exploit the advantages of rapid economic development has been a key factor in international competition. Countries that can encourage--or at least allow and sustain--the change, dislocation, upheaval, and pain that capitalism often involves, while providing their tumultuous market societies with appropriate regulatory and legal frameworks, grow swiftly. They produce cutting-edge technologies that translate into military and economic power. They are able to invest in education, making their workforces ever more productive. They typically develop liberal political institutions and cultural norms that value, or at least tolerate, dissent and that allow people of different political and religious viewpoints to collaborate on a vast social project of modernization--and to maintain political stability in the face of accelerating social and economic change. The vast productive capacity of leading capitalist powers gives them the ability to project influence around the world and, to some degree, to remake the world to suit their own interests and preferences. This is what the United Kingdom and the United States have done in past centuries, and what other capitalist powers like France, Germany, and Japan have done to a lesser extent. In these countries, the social forces that support the idea of a competitive market economy within an appropriately liberal legal and political framework are relatively strong. But, in many other countries where capitalism rubs people the wrong way, this is not the case. On either side of the Atlantic, for example, the Latin world is often drawn to anti-capitalist movements and rulers on both the right and the left. Russia, too, has never really taken to capitalism and liberal society--whether during the time of the czars, the commissars, or the post-cold war leaders who so signally failed to build a stable, open system of liberal democratic capitalism even as many former Warsaw Pact nations were making rapid transitions. Partly as a result of these internal cultural pressures, and partly because, in much of the world, capitalism has appeared as an unwelcome interloper, imposed by foreign forces and shaped to fit foreign rather than domestic interests and preferences, many countries are only half-heartedly capitalist. When crisis strikes, they are quick to decide that capitalism is a failure and look for alternatives. So far, such half-hearted experiments not only have failed to work; they have left the societies that have tried them in a progressively worse position, farther behind the front-runners as time goes by. Argentina has lost ground to Chile; Russian development has fallen farther behind that of the Baltic states and Central Europe. Frequently, the crisis has weakened the power of the merchants, industrialists, financiers, and professionals who want to develop a liberal capitalist society integrated into the world. Crisis can also strengthen the hand of religious extremists, populist radicals, or authoritarian traditionalists who are determined to resist liberal capitalist society for a variety of reasons. Meanwhile, the companies and banks based in these societies are often less established and more vulnerable to the consequences of a financial crisis than more established firms in wealthier societies. As a result, developing countries and countries where capitalism has relatively recent and shallow roots tend to suffer greater economic and political damage when crisis strikes--as, inevitably, it does. And, consequently, financial crises often reinforce rather than challenge the global distribution of power and wealth. This may be happening yet again. None of which means that we can just sit back and enjoy the recession. History may suggest that financial crises actually help capitalist great powers maintain their leads--but it has other, less reassuring messages as well. If financial crises have been a normal part of life during the 300-year rise of the liberal capitalist system under the Anglophone powers, so has war. The wars of the League of Augsburg and the Spanish Succession; the Seven Years War; the American Revolution; the Napoleonic Wars; the two

World Wars; the cold war: The list of wars is almost as long as the list of financial crises. Bad economic times can breed wars.

Europe was a pretty peaceful place in 1928, but the Depression poisoned German public opinion and helped bring Adolf Hitler to power. If the current crisis turns

into a depression, what rough beasts might start slouching toward Moscow, Karachi, Beijing, or New Delhi to be born? The United States may not, yet, decline, but, if we can't get the world economy back on track, we may still have to fight.

1NC Racism K

PAS legalization ensures societal racism is manifest in violence and pressure against black and poor bodies to prematurely end their lives, reifying racist violencePittman 97 Assistant Professor of Law at Mississippi Law (Larry J., Physician-Assisted Suicide in the Dark Ward: The Intersection of the Thirteenth Amendment and Health Care Treatments Having Disproportionate Impacts on Disfavored Groups, pp. 792-793, NG)Therefore, the only state interest that arguably might outweigh a terminally ill person’s desire for self-induced death is the interest in protecting a patient from the adverse consequences of legalized physician-assisted suicide. This interest assumes added importance where the protection of disfavored African

Americans and other minorities are concerned because they are generally more vulnerable to physicians’ abuses and coercion. In furtherance of their patient- protection interests, states might be concerned about the undue influence and coercion that physicians, family members, and other persons might assert to force or improperly persuade terminally ill persons to relinquish their remaining lives in order to reduce health care expenditures , speed up the conferment of inheritances, and conserve health care resources for healthier patients. In Compassion in Dying, the Ninth Circuit held that the State’s interest in preventing those abuses did not outweigh a terminally ill patient’s interest in having physician-assisted suicide. That conclusion was based primarily on an assumption that physician-assisted suicide does not expose patients to the above-stated risk any more than the withdrawal of life-sustaining treatments. This analysis sounds more like an equal protection argument than a balancing of the state’s interests in avoiding abuses against the

terminally ill patient’s interests in physician-assisted suicide. Even if one were to accept the Ninth Circuit’s conclusion that the terminally ill patient’s short life expectancy and the presence of an “impartial physician” mitigate against family abuses, there is still the possibility of physicians’ and hospitals’ unmitigated potential for abuses in advocating physician-assisted suicide to conserve health care costs and to perpetuate their own racial prejudices.

It is our apriori ethical obligation to reject racism in all instances- any other reaction ensures endless violenceMemmi 2k Professor Emeritus of Sociology at the University of Paris Albert, “RACISM”, translated by Steve Martinot, pp.163-165)The struggle against racism will be long, difficult, without intermission, without remission, probably never achieved, yet for this very reason, it is a struggle to be undertaken without surcease and without concessions. One cannot be indulgent toward racism. One cannot even let the monster in the house, especially not in a mask. To give it merely a foothold means to augment the bestial part in us and in other people which is to diminish what is human. To accept the racist universe to the slightest degree is to endorse fear, injustice, and violence. It is to accept the persistence of the dark history in which we still largely live. It is to agree that the outsider will always be a possible victim (and which [person] man is not

[themself] himself an outsider relative to someone else?). Racism illustrates in sum, the inevitable negativity of the condition of the dominated ; that is it illuminates in a certain sense the entire human condition. The anti-racist struggle, difficult though it is, and always in question, is nevertheless one of the prologues to the ultimate passage from animality to humanity. In that sense, we cannot fail to rise to the racist challenge. However, it remains true that one’s moral conduct only emerges from a choice: one has to want it. It is a choice among other choices, and always debatable in its foundations and its consequences. Let us say, broadly speaking, that the choice to conduct oneself morally is the condition for the establishment of a human order for which racism is the very negation. This is almost a redundancy. One cannot found a moral order, let alone a legislative order, on racism because racism signifies the exclusion of the other and his or her subjection to violence and domination. From an ethical point of view , if one can deploy a little religious language, racism is “the truly capital sin. ” fn22 It is not an accident that almost all of humanity’s spiritual traditions counsel respect for the weak, for orphans, widows, or strangers. It is not just a question of theoretical counsel respect for the weak, for orphans, widows or strangers. It is not just a question of theoretical morality and

disinterested commandments. Such unanimity in the safeguarding of the other suggests the real utility of such sentiments. All things considered, we have an interest in banishing injustice, because injustice engenders violence and death. Of course, this is debatable. There are those who think that if one is strong enough, the assault on and oppression of others is permissible. But no one is ever sure of remaining the strongest. One day, perhaps, the roles will be reversed. All unjust society contains within itself the seeds of its own death . It is probably smarter to treat others with respect so that they treat you with respect. “Recall,” says the bible, “that you were once a stranger in Egypt,” which means both that you ought to respect the stranger because you were a stranger yourself and that you risk becoming once again someday. It is an ethical and a practical appeal – indeed, it is a contract, however implicit it might be. In short, the refusal of racism is the condition for all theoretical and practical morality. Because, in the end, the ethical choice commands the political choice. A just society must be a society accepted by all. If this contractual principle is not accepted, then only conflict, violence, and destruction will be our lot. If it is accepted, we can hope someday to live in peace. True, it is a wager, but the stakes are irresistible.

1NC Ableism K

The aff ensures the supremacy ablest discourse equating disability with a fate worse than death- the impact is social death and genocideGolden 05 Policy Analyst for the Disability Rights & Education Fund (Marilyn, “Why Assisted Suicide Must Not be Legalized,” http://euthanasia.procon.org/ view.answers.php?questionID=000207, NG)Fear, bias, and prejudice against disability play a significant role in assisted suicide. Who ends up using assisted suicide? Supporters advocate its legalization by arguing that it would relieve untreated pain and discomfort at the end of life. But all but one of the people in Oregon who were reported to have used that state's assisted suicide law during its first year wanted suicide not because of pain, but for fear of losing functional ability, autonomy, or control of bodily functions (Oregon Health Division, 1999). Oregon's subsequent reports have documented similar results. Furthermore, in the Netherlands, more than half the physicians surveyed say the main reason given by patients for seeking death is "loss of dignity" (Birchard, 1999). This fear of disability typically underlies assisted suicide. Said one assisted suicide advocate, "Pain is not the main reason we want to die. It's the indignity. It's the inability to get out of bed or get onto the toilet ... [People] ... say, ‘I can't stand my mother – my husband – wiping my behind.' It's about dignity" (Leiby, 1996). But as many thousands of people with disabilities who rely on personal assistance have learned, needing help is not undignified, and death is not better than reliance on assistance. Have we gotten to the point that we will abet suicides because people need help using the toilet? Diane Coleman, President and Founder of Not Dead Yet, a grassroots disability organization opposed to legalizing assisted suicide, has written that the "public image of severe disability as a fate worse than death … become(s) grounds for carving out a deadly exception to longstanding laws and public policies about suicide intervention services … Legalizing assisted suicide means that some people who say they want to die will receive suicide intervention, while others will receive suicide assistance. The difference between these two groups of people will be their health or disability status, leading to a two-tiered system that results in death to the socially devalued group" (Coleman, 2002).

Ableism operates as foundational tactic of oppression that must be resistedSiebers 09 University of Michigan, Professor of Literary and Cultural Criticism(Tobin, “The Aesthetics of Human Disqualification”, Oct 28, Lecture, http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCoQFjAA&url=http%3A%2F%2Fdisabilities.temple.edu%2Fmedia%2Fds%2Flecture20091028siebersAesthetics_FULL.doc&ei=LWz4T6jyN8bHqAHLkY2LCQ&usg=AFQjCNGdkDuSJkRXMHgbXqvuyyeDpldVcQ&sig2=UCGDC4tHbeh2j7-Yce9lsA, accessed 7/7/12, sl)Oppression is the systematic victimization of one group by another. It is a form of intergroup violence. That

oppression involves “groups,” and not “individuals,” means that it concerns identities, and this means, furthermore, that oppression always focuses on how the body appears, both on how it appears as a public and physical presence and on its specific and

various appearances. Oppression is justified most often by the attribution of natural inferiority—what some call “in-

built” or “biological” inferiority. Natural inferiority is always somatic, focusing on the mental and physical features of the group, and it figures as disability. The prototype of biological inferiority is disability . The representation of inferiority always comes back to the appearance of the body and the way the body makes other bodies feel. This is why the study of oppression requires an understanding of aesthetics—not only because oppression uses aesthetic judgments for its violence but also because the signposts of how oppression works are visible in the history of art, where

aesthetic judgments about the creation and appreciation of bodies are openly discussed. One additional thought must be noted before I treat some analytic examples from the historical record. First, despite my statement that disability now serves as the master trope of human disqualification, it is not a matter of reducing other minority identities to disability identity. Rather , it is a matter of understanding the work done by disability in oppressive systems. In disability oppression, the physical and mental properties of the body are socially constructed as disqualifying defects, but this specific type of social construction happens to be integral at the present moment to the symbolic requirements of oppression in general . In every oppressive system of our day, I want to claim, the oppressed identity is represented in some way as disabled, and

although it is hard to understand, the same process obtains when disability is the oppressed identity. “ Racism” disqualifies on the basis of race , providing justification for the inferiority of certain skin colors, bloodlines, and physical features. “ Sexism” disqualifies on the basis of sex/gender as a direct representation of mental and physical inferiority. “Classism” disqualifies on the basis of family lineage and socioeconomic power as proof of inferior genealogical status. “Ableism” disqualifies on the basis of mental and physical difference s, first selecting and then stigmatizing them as disabilities . The oppressive system occults in each case the fact that the disqualified identity is socially constructed, a mere convention, representing signs of incompetence, weakness, or inferiority as undeniable facts of nature. As racism, sexism, and classism fall away slowly as justifications for human inferiority—and the critiques of these prejudices prove powerful examples of how to fight oppression—the prejudice against disability remains in full force, providing seemingly credible reasons for the belief in human inferiority and the oppressive systems built upon it.

This usage will continue, I expect, until we reach a historical moment when we know as much about the social construction of disability as we now know about the social construction of race, class, gender, and sexuality. Disability represents at this moment in time the final frontier of justifiable human inferiority .

2NC/1NR Obamacare Bad

2NC BrinkThe plan fulfills Obamacare’s mandate for end of life care savings- national policy spills overCahill 13 Editor of VISTA Health Solutions (Michael, Could Obamacare Inadvertently Legalize Physician-Assisted Suicide?, http://snoringscholar.com/2013/07/could-obamacare-inadvertently-legalize-physician-assisted-suicide/,NG)While we cannot say what the real purpose of Section 1553 is, we can deduce that it might eventually be used to offer protection to doctors who assist in ending a patient’s life in states where it is illegal .

It also has the potential to set the stage for a national policy on physician-assisted suicide . It’s not far-fetched to consider that the whole nation could experience something similar to what happened in Montana. In the 2009 court ruling of the case of Baxter v. Montana, the court found no public policy exists against assisting suicide. So doctors in the state can use patient’s consent as a defense during trial. It may not be what the law truly intends, but it’s a likely consequence. If the administration wants the public to support its health care bill, then it should lay its cards down and let the people know where it stands on sensitive issues like this one. It’s likely that the government will move away from controversy and let the Supreme Court decide on the matter. However, when we look back at an interview during the 2008 campaign, then presidential candidate Barack Obama shared his view about physician-assisted suicide. When asked about Oregon’s decision to legalize the procedure he said that the state “did a service for the country in recognizing that as our population gets older, we’ve got to think about issues of end of life care, and people having autonomy to make these decisions.” In the same interview, he also conveyed his belief that terminally ill patients should be given the right to decide whether or not to end their suffering.

2NC Uniqueness

Overenrollment by the chronically sick and high costs means Obamacare is doomed now- cost-cutting is the only wayBalyeat 14 Guest Columnist for the Misoulian and Public Accountant(Joe, http://missoulian.com/news/opinion/columnists/understanding-obamacare-and-why-it-will-fail/article_e6afc854-a2dd-11e3-84b7-001a4bcf887a.html, NG)This “cost redistribution” is achieved via three new mandates on all health insurance. 1. No pre-existing condition exclusions: Even people waiting till after they’re sick to buy insurance can’t be denied coverage. 2. Community rating: With

few limited exceptions, unhealthy people can’t be charged more than healthy people. 3. All policies must cover all issues; i.e., a 60-year-old man’s policy must cover pregnancy, nuns’ policies must cover abortion, and nobody can choose which illnesses they want covered. These three cost socialization mandates are what Barack Obama means

when he says “It’s better insurance.“ But they’re also a three-pronged pitchfork prodding insurance costs skyward. How? This turns insurance’s mathematical sense into nonsense. Pre-existing conditions are 100 percent probability. Follow my math – 100 percent x $1 million is $1 million. Forcing these three redistribution mandates into everyone’s insurance not only eventually doubles cost – it dooms health insurance to destruction. Why? The “square deal” has become a

bad deal. No one who understands financial math will buy insurance costing twice what the actuarial equation dictates – except the chronically sick. Because the healthy won’t voluntarily buy it, that’s precisely why Obamacare mandates everyone must buy insurance. Hence, Obamacare’s noncompliance penalties: In 2014 – 1 percent x your income; 2015 – 2 percent x your income; 2016 – 2.5 percent x your income.

AT: Narrow networks make the plan link nonunique. No narrow networks if costs continue to decline.Norman 14 health care reporter for POLITICO Pro. Before joining POLITICO, he worked as a science writer at The Rockefeller University. He previously covered the politics and policy of Medicare for Part B News and started out at the Pensacola News Journal.Brett, “Obamacare: Anger over Narrow Networks,” Politico Pro, July 22, http://www.politico.com/story/2014/07/obamacare-health-care-networks-premiums-109195.htmlAs it turns out, the market — not politics — may be taking care of the problem in New Hampshire, although the political perceptions may not change. “I think the whole question about narrow networks may turn out to be kind of a flash in the pan,” said Alex Feldvebel, deputy commissioner of the state’s insurance department. “There is a big change from year one to year two,” he said. Five insurers have said they will be on the exchange next year, and every hospital in the state is expected to have contracts with at least three of them, he said. The new competition may drive down prices as well.

2NC Organ Sales Links

Link- $$$

Legalizing organ sales would relegitimate private health care industrySmith 08 online writer for Yahoo Contributor NetworkJohn, April 11, “Legalizing the Sale of Human Organs: Necessary for Survival.” http://voices.yahoo.com/legalizing-sale-human-organs-necessary-for-1368813.html?cat=5John has been writing online for several years. An avid hockey player and fan, he is enjoys writing sports articles, but is familiar with a wide variety of topics. One of the main objections of people who do not support the legalization of the sale of human organs is the idea that only the rich will be able to have access to organs. Nelson writes, "Within the current climate of health care reform, financial incentives have become a part of medicine (Drs, preferred providers, etc.) and it might be reasonably assumed will become a greater part of health care delivery in the future (1). Since individuals and companies looking to make a profit currently run the health care industry in the United States, the sale of organs should fall in to the same category as other medicinal services. The field of medicine is constantly evolving and doctors and researchers are constantly developing new ways to save lives; however, they do not freely give these ideas and developments away. The willing sale of human organs should be no different, in that it takes the same approach that other medical developments currently take.

Even in the least efficient allocation system organ sales reduce healthcare costs and save the government tens of thousands per organMonti 09 M.D. Internal Medicine at Case Western Reserve University (Dr. Jennifer, http://cei.org/sites/default/files/Jennifer%20Monti%20-%20The%20Case%20for%20 Compensating%20Live%20Organ%20Donors.pdf, NG)Economists at the University of Chicago have estimated a kidney to be worth $15,200. These estimates were compared to the average price agreed upon among 305 sellers in India in 2005 ($1,177).18 This estimate corroborates very well with the underground kidney market in India. When adjusted for standards of living, the price paid in India for a kidney equals $17,000. Similar modeling estimates a liver donation to be worth $37,600 to the donor. Current costs of procuring an organ for transplant in the United States are over $50,000. These estimates demonstrate that the cost of transplants would effectively go down in a well-supplied market system. Legislative action to legalize direct payment for organ donation would result in substantial cost savings to a government spending exorbitantly for dialysis treatments. Cost savings occurs if a recipient lives free of dialysis for more than 1.5 years; 95 percent of organ recipients would fall into this category.19 In the United States, a direct payment system for live organ donation could be regulated and managed by the United Network for Organ Sharing (UNOS), in a similar manner to the non-profi t organization established in Iran. UNOS currently manages the waiting list for potential organ recipients. It has over 20 years of experience in managing the cadaveric donor pool and could easily extend its jurisdiction to include donation by living donors.20 Even if a system of payment for organ donations were instituted in the United States, UNOS could continue to allocate organs to recipients on the basis of medical, not social or economic, criteria, in line with NOTA guidelines.

2NC PAS Links

Perception Link extension

Legalizing PAS helps ensure the perception of program solvencySmith 13 Staff Writer for the National Review (Wesley J., http://www.nationalreview.com/human-exceptionalism/360303/will-obamacare-boost-assisted-suicide-wesley-j-smith, NG)I rarely agree with assisted suicide proponents. But an article in Salon may be onto something–that the passage of the Affordable Care Act could boost assisted suicide legalization. From the article: Currently only three states have Death With Dignity laws – a

surprisingly low number given that there isn’t a one among the other 47 in which somebody isn’t dying right now. Could the Affordable Care Act change that? Peg Sandeen, executive director of the National Death With Dignity Center, speculates: “I think the ACA is going to change how we access healthcare and that change is going to come slowly. What I hope it means is that people have access to a wide span of options across the health spectrum.” In other words, that

is the plan! Assisted suicide is not only about so-called “death with dignity”–a gooey euphemism swallowed whole by

the reporter–but despite the article’s spin to the contrary, ultimately about saving money. Do you remember Barbara Wagner and Randy Stroup? Both were on Medicaid and terminally ill with cancer. Their doctors prescribed life-extending chemotherapy. But Oregon’s death panel rationers refused to pay for their prescriptions. Both received letters telling them not to worry, while the state wouldn’t pay to extend their lives, it would readily fund their assisted suicides.

Link- Industry $$$

The plan ensures healthcare cost-cutting perceptionMarker and Hamlon 10 J.D and Policy Analyst for International Task Force on Euthanasia and Assisted Suicide, Rita and Cathy, http://www.patientsrightscouncil.org/site/frequently-asked-questions/, NG)Could euthanasia or assisted suicide be used as a means of health care cost containment? Yes . Perhaps

one of the most important developments in recent years is the increasing emphasis placed on health care providers to contain costs. In such a climate, euthanasia or assisted suicide certainly could become a means of cost containment. These implications were acknowledged during a historic argument before the U.S. Supreme Court.

Arguing against assisted suicide, acting solicitor general Walter Dellinger said, “The least costly treatment for any illness is lethal medication.”(34) In the United States alone, millions of people have no medical insurance and studies have shown that the

elderly, the poor and minorities are often denied access to needed treatment or pain control.(35) Doctors are being pressured by HMOs to reduce care; “futile care guidelines” are being instituted, enabling health facilities to deny necessary and wanted interventions; and health care providers are often likely to benefit financially from providing less, rather than more, care for their patients.(36) In Oregon, some patients have been told by their health insurance provider that a costly drug prescribed by a doctor to treat the patient’s illness would not be covered but inexpensive lethal drugs for assisted suicide would be. (37) See: “Oregon’s Suicidal Approach to Health Care”

More Ev- Financial Pressure ensures widespread use of PAS is the key relief for perceived financial strains on the health care systemNimcheski 03 under Marla DeSota, Professor of English at Glendale College Steven, Physician Assisted Suicide: A Slippery Slope, http://web.gccaz.edu/~mdinchak/101online_new/assistedsuicide1.htm, NG)Physician-assisted suicide should not be a legal option as it may readily lead to a societal acceptance of euthanasia. By adopting euthanasia our society may next condone the mercy killings of anyone who is or is perceived to be disabled, depressed, or elderly. The Netherlands is one place that has already moved from assisted suicide to euthanasia and “mercy killings.” Doctor Herbert Hendin, director of the American Foundation for Suicide Prevention, argues that legalized assisted suicide in the Netherlands confirms his fears that suicide will eventually be extended to people who are not terminally ill. He cites a case in the Netherlands where a woman who suffered from depression was helped to die by her psychiatrist. Hendin also co-authored a 1997 article in the Journal of the American Medical Association were he cited studies conducted in the Netherlands that argue toleration has led to wide spread abuses there. He said, “The most disturbing fact to emerge from the studies was that in close to 1,000 cases annually, Dutch doctors admitted to ending lives without the patient’s consent. While many of those patients were not mentally competent,” he says, “many were” (“Assisted Suicide Update” 9). What kind of a message are we sending our elderly, poor and sick when we as a society embrace any form of euthanasia? We are telling them to pass on unless they have the financial resources to pay the medical bill to stay around a little longer. The legalization of physician-assisted suicide could place financial pressures on healthcare providers and patients to choose assisted suicide, when they otherwise might not have. In a recent survey,

“93% of physicians in Oregon thought that a patient might request physician-assisted suicide because he or she feared being a burden on others; 83% thought that the request might result from financial pressures on the patient”

(Dickamer, Lee, and Ganzini, 2). The USA is in the midst of a medical insurance crisis. In today’s managed care environment there are realistic concerns that health care providers such as doctors, already faced with increasing financial incentives to cut costs, will pressure patients into assisted suicide. In the article "Economic Motives for Physician-Assisted Suicide," Mehlman writes that: Hospitals are under economic constraints similar to managed care plans. In some cases, the hospital actually may be part of a managed care plan. In other cases, such as Medicare, the hospital may be paid a fixed amount for a patient regardless of how long the patient stays…. This may lead hospital

administrators to encourage their medical staffs to recommend physician-assisted suicide to hospital in-patients.

Link- Family $$$

Family pressures will fuel the perceptionForsythe 97 lecturer at St. John’s School of law (CD, http://scholarship.law.stjohns.edu/cgi/viewcontent.cgi?article=1344&context=jcred, NG)Other disincentives will be social. Certainly legalization will change the incentives and the psychodynamics for patients and family members. While this may be overt in a case or two, it is most likely to be subtle and unconscious in most cases. Still others will be economic. At a time when managed care is more and more common, and some form of explicit rationing seems more and more likely, the disincentives against alternatives should be fought rather than promoted. The economic pressure for assisted suicide will be heightened if assisted suicide is publicly subsidized, as Oregon has moved to do. Because of these incentives and disincentives, I think it is appropriate to say that legalizing assisted suicide would simply create more physical and psychological suffering than it would alleviate. Ironically, legalizing assisted suicide would both aggravate the primary fears that drive public opinion on this issue and create disincentives for addressing those fears. It would do this in four ways: By undermining the provision of pain medication and the developments of new treatment; by undermining incentives for the diagnosis and treatment of depression; by increasing financial pressures on patients to opt for assisted suicide; and by creating financial and social pressures on family members, which will be inevitably deflected onto patients. Consequently, legalizing assisted suicide for any will undermine healthcare for everyone.

Impact EXT- Obamacare badThe aff stops Republicans from undercutting Obamacare by persuading the public that it will reduce health are costs, that’s NYS Health Department; the impact is Obamacare kills the economy by penalizing small businesses and slowing growth in the hospital industry, causes reversal of growth kills employment and ensures nationalistic waves result in escalatory wars and nucs, that’s Mead.

The ACA kills the economy – small businessesVollmer 12 principal with Hyde Park Wealth Management. Jeff S., The Butterfly Effect Of The Affordable Care Act, July 11th, http://seekingalpha.com/article/714461-the-butterfly-effect-of-the-affordable-care-act)Many business owners say it may, in fact, be more cost-effective for them to pay the $1,800 per year penalty tax than to provide healthcare for every employee. Yet another backdoor way to soak the American business owner via another penalty tax. This comes at a time when many businesses are grappling with the challenge of saving the jobs of current employees.¶ Can assessing yet another mandated expense (or penalty) be positive with the economy still smoldering? This leads to my last point. One must consider the context in which this reform was enacted.¶ When the current administration took over, our nation's economy was in conflagration. The American Skyscraper was burning. Productivity was nil. Unemployment was rampant. And the small business owner could see no further than the week's economic releases to discern when he might begin to hire and spend.¶ Given the economic wild fire, did the administration ensure that everyone was safely clear of the building? Did the administration then endeavor to extinguish the fire through forward looking, stimulus-based economic policy? Efforts focused on helping small- and mid-sized business owners to escape from the tar pits of fiscal paralysis in which they were entrenched?¶ No. Amidst the flames, the administration took the opportunity to overhaul the human resources department. Dodd-Frank. Healthcare reform. Suddenly, the primary employers of the nation's economy, small business owners, went from blurry eyed to bat-cave blind. No spending. No lending. No hiring. No growth.¶ Still curious as to why this economic recovery has been anemic?¶ In the end, the ripples go well beyond the healthcare pond. The Butterfly Effect of the SCOTUS decision , potentially upheld or overturned by November's election, will have consequences throughout the U.S. economy . Jobs. Strategy. Capex decisions.¶ As you read this, a business owner somewhere is trying to decide how to keep his team intact. He's struggled to keep his doors open these past four years. Now, he wonders whether it is better to buy the healthcare or pay the penalty. Could he offer each of his thirty employees a $2,000 salary reduction, and then divert those funds to the $60,000 penalty tax he'll be assessed for not providing everyone with healthcare? That way, at least he can keep his staff employed.¶ Realize that most of the nation's business owners do not have a choice. These risk takers, these employers, these stewards of the American economy, cannot simply drop a country club membership , sell a yacht and a vacation home in order to provide for the cost of the Affordable Care Act. Most of these entrepreneurs are struggling just to get by. To keep staff. To make payroll.¶ Would you rather have a job without healthcare or no job and no healthcare? That's the conundrum facing many at this moment. Healthcare needs a reformation. But, first things first. The fire should have been extinguished. The nation's economy lifted from its knees.

Small businesses are a key internal link to economic recoveryLeo 10 writer for Wall Street JournalLuca Di, November 10, 2011, “Bernanke: Small Businesses Important To Economic Recovery”, http://blogs.wsj.com/in-charge/2011/11/10/bernanke-small-businesses-important-to-economic-recovery/, 8/4/12, atl)Small businesses are important to the economic recovery and to U.S. global competitiveness , Federal

Reserve Chairman Ben Bernanke said Wednesday in welcoming remarks at a Fed conference on small business entrepreneurship

during the recovery.¶ “We need to think carefully about how, in the current economic environment, our nation can best provide small businesses and entrepreneurs with the support they need to expand job opportunities,” Bernanke said in prepared remarks.¶ Bernanke said that small businesses support their local communities while also

helping the U.S. compete globally.¶ “They often offer a level of agility in bringing innovative products to the

global marketplace that larger firms cannot match,” Bernanke said.¶ Bernanke also said that entrepreneurship offered “an important option for people confronting economic challenges in their lives , such as insufficient retirement savings.”

Extra Impact to Obamacare Bad- PharmaObamacare devastates the pharmaceutical industry — prevents research and drugsSmith 11 former vice president for U.S. public affairs and policy at Pfizer, Inc., currently managing director at NSI, a D.C.-based consulting firm, William S., “Obamacare vs. Drug Innovation,” National Review Online, 2/16/2011, Available Online: http://www.nationalreview.com/blogs/print/259846, Accessed: 09/04/2012With the release of the president’s budget, it is now beyond dispute — Beltway spin notwithstanding — that the decision by the Pharmaceutical Research and Manufacturers of America (PhRMA) to support the health-care bill was one of the worst self-inflicted wounds in the history of lobbying. For biotech and pharmaceutical companies, the president’s

budget repudiates one of the most important benefits of their “deal” with the White House: the ability to market biotech drugs without generic competition for twelve years. The president would reduce that period to seven years, precisely the position of the generics industry and a position that the pharmaceutical industry had fought aggressively before it decided to make a deal with the president. This embarrassing repudiation of the deal follows another hostile act from the Obama administration. On February 3, health and human services secretary Kathleen Sebelius released a letter to all the governors encouraging them to modify their states’ Medicaid rules so as to use more generic drugs and to make deeper price cuts for drugs purchased in Medicaid. Since the industry had already agreed, when it signed onto the health-care bill, to cut deeply their prices for Medicaid drugs, Sebelius’s inclusion of this advice in her letter to the governors was a gratuitous slap. In fact, the best thing that could happen to the industry — and therefore to all those individuals, here and around the world, who benefit from the strides it has taken in research — would be an unraveling of PhRMA’s deal. Since the president has walked away from the deal, now is the moment for the industry to walk away from a law that will significantly weaken the all-important U.S. market for pharmaceuticals. What will Obamacare do to America’s premier health-care

research industry? First, Obamacare inflicts a series of balance-sheet hits on pharmaceutical companies. Last year, companies scrambled to write large rebate checks to satisfy the new price controls that the law imposed

in the Medicaid program. In total, the price-control provisions of Obamacare will cost the industry $38 billion over the next ten years. During 2011, pharmaceutical companies will again be required to take out their checkbooks to pay a new $2.5 billion excise tax for this

year, a tax that will grow to over $4 billion by 2018; this will cost the industry another $23 billion. Also, every January 1 the drug companies will be required to provide a 50 percent price discount for seniors who have reached the “doughnut hole” (i.e., the coverage gap in Medicare Part D); this represents about $30 billion in industry revenue that will need to be recovered elsewhere. While these hits to the balance sheet will undoubtedly weaken the industry, cost U.S. jobs, and hinder further research, Beltway lobbyists persuaded Wall Street analysts that the industry “got off easy” because these extortion payments allowed it to fend off more serious congressional threats such as imposing price controls in Medicare and permitting unrestricted drug importation. But the lobbyists missed the forest for the trees. These taxes and fees are less important than the implications of the law’s gargantuan reordering of the pharmaceutical marketplace. Over the long term, Obamacare will cause a significant degradation of the private-sector market for pharmaceuticals, a market that has been the best in the world. In the United States, 150 million citizens get their prescription drugs through their health insurance rather than directly from the government. Employers (and unions) contract with private health insurers to deliver the drug benefit, and the insurers negotiate with the pharmaceutical companies to decide which drugs they will cover and at what price. Employees and retirees generally want access to the newest and best medicines, and their companies want to keep them happy and healthy. Therefore, the health plans serving employers do their best to balance cost with the need to provide high-quality medications. Thus, the U.S. employer-provided insurance market offers the primary feature that drug companies need: a market that has incentives to reimburse for new medicines. When Medicare Part D was created, Congress attempted, with some success, to re-create these market forces for seniors through a government-financed, but privately managed, health benefit. Under Part D, if a plan doesn’t cover the particular drugs that a senior may want, he can sign up for another plan. Seniors will seek out new medicines that work, and so plans have reason to provide them. Combined, employer-based and Part D health plans account for over 70 percent of the U.S. market for pharmaceuticals, meaning that the overwhelming majority of the U.S. market is a healthy one, where prices are

established by buyers and sellers negotiating innovation versus cost. Obamacare would undermine this market by creating considerable incentives for employers to drop coverage for both employees and retirees. Douglas Holtz-Eakin, former director of the Congressional Budget Office, has estimated that the employer segment of the market may lose 35 million customers. The law also rescinds a tax deduction for employers who provide drug coverage to their retirees. Even those private-sector employees who keep their coverage will see their pharmaceutical benefits degraded as so-called “Cadillac plans” — the plans with the best pharmaceutical coverage — will take a huge 40 percent tax hit, giving

employers significant cause to scale back drug benefits. The law also contains two provisions that will weaken the market features of the Part D program: a Medicare payment commission that has the authority to set prices, and an “evidence-based” research institute that will tell Medicare patients (and everyone else) that they do not need all these new drugs.

While the healthy part of the pharmaceutical market will be pounded, the government-run segment of the market, Medicaid, will be expanded by 16 million patients. Medicaid has the worst pricing structure and the worst track record in paying for innovations of any sector in the United States market. Like government health-care systems around the world, Medicaid must be dragged to pay for medical advances. Unlike employers and seniors in Part D, Medicaid patients cannot vote with their feet if their health plan does not provide the new

medicines they want. The incentives in Medicaid all run against paying for pharmaceutical innovations. So, Obamacare significantly expands

the worst sectors of the pharmaceutical market while degrading the best. Despite these body blows to the

pharmaceutical marketplace, Beltway business “experts” provide soothing reassurance that there will be “so many new customers” that no one should worry about the health of the industry. These new customers will appear in the so-called state exchanges that are slated to cover tens of millions of the currently uninsured. In fact, the exchanges are a market that does not yet exist and, one can surmise, will be a bad market for pharmaceuticals. Because of adverse selection and costly subsidies for lower-income participants, these exchanges will be plagued with cost overruns, as the Massachusetts exchange program currently is. Such a fiscal train wreck can only portend a market where pharmaceutical benefits are lousy, prices are controlled, and innovation is not rewarded. Many of the Medicaid bureaucrats

who currently impose price controls are the very people designing the state exchanges. So, in exchange for a Beltway “win,” PhRMA agreed to restructure the entire U.S. pharmaceutical marketplace, to its considerable disadvantage. U.S. pharmaceutical companies already face huge legal, scientific, and regulatory challenges and have shed more than 100,000 jobs in the last two years. PhRMA committed lobbying malpractice by agreeing to the Obamacare deal. How did this happen? At the time the deal was struck, PhRMA was headed by a wheeler-dealer former congressman from Louisiana, Billy Tauzin, who was unfamiliar with the pharmaceutical business. Most of the CEOs of individual companies who might have stood up to Tauzin were either Democrats eager to please the administration, or Europeans without a

sound footing in American politics. It is not too late. The 2010 election, new leadership of PhRMA, and the movement to repeal Obamacare had already offered hope that the worst might be avoided. Now that the president has repudiated a central pillar of the deal, the industry is free to support a wholesale repeal of the law, not through clever back-room deals or partisan maneuvering, but through an open declaration that drug innovation is at stake. The pharmaceutical industry will never be popular, but if Beltway dealmaking replaces innovation, it will simultaneously court public opprobrium and commercial disaster.

Pharmaceutical innovation is critical to stop the next global epidemic — kills 40-50 millionBandow 05 senior fellow at the Cato Institute(Doug, “A strong pharmaceutical industry is the best defense against pandemics,” The San Diego Union-Tribune, 3/27/05, Available Online: http://www.signonsandiego.com/uniontrib/ 20050327/news_lz1e27bandow.html, Accessed 09/04/2012)For a time SARS, severe acute respiratory syndrome, seemed to threaten a deadly new global epidemic. But, thankfully, SARS faded away after killing fewer than 800 people. Bird, or avian, flu now worries many medical professionals. Outbreaks have been reported in Indonesia and North Korea, and the disease has killed two score people in Thailand and Vietnam. Should the disease mutate and infect humans, we could see a phenomenon like the flu pandemic that swept the world in 1918 and 1919, killing 40 million or 50 million people. Indeed, former Health and Human Services Secretary Tommy Thompson called the avian flu "a really huge bomb" that could kill upward of 70 million people. Diseases like SARS and avian flu, which have proved resistant to drugs commonly used to fight influenza viruses, demonstrate how we all benefit from profitable drugmakers and abundant pharmaceutical research. Although governments have an important role to play in fighting any disease pandemic, necessary for developing any effective treatment and putting into mass production any vaccine or other medicine is private industry.

A/T PAS #’s SmallEven if that’s true, health care structures ensures families will use suicide to reduce costs and payouts, still proves the linkBopp 97 law graduate, University of Florida (James P., Just the Medical Facts: An Argument in Support of the Continued Ban on Physician Assisted Suicide, http://scholarship.law.stjohns.edu/cgi/viewcontent.cgi?article=1336&context=jcred&sei-redir=1&referer=http%3A%2F%2Fscholar.google.com%2Fscholar%3Fq%3D%2522assisted%2Bsuicide%2522%2Band%2Bhealthcare%2Bcosts%26btnG%3D%26hl%3Den%26as_sdt%3D0%252C3%26as_ylo%3D2010%26as_vis%3D1#search=%22assisted%20suicide%20healthcare%20costs%22, NG)Medical fact number six: Pressure to contain healthcare costs will cause people to seek suicide. 55 The American Medical Asso ciation also addressed this issue:56 Pressure to contain health care costs exacerbates the problem. Even if, as one would expect, health care insurers would consciously seek to avoid suggesting to patients or physicians that they consider financial costs in making a decision to hasten death, the continuing pressure to reduce costs can only constrain the availability and quality of palliative care and support services that patients and families need. These limitations on the availability of proper care clearly can place pressure on patients to express a wish for suicide that they might not otherwise feel. Moreover, poor and minority individuals are at the greatest risk of receiving inadequate care. 58 Thus, they feel the greatest pressure to request physician-assisted suicide.

s

2NC PAS Racism and Ableism Ks

Link- Targets MinoritiesDiscrimination DA- PAS reshapes healthcare into a culture of death and ableism which disproportionality affects minorities and those in povertyNYS Health Department 11 (New York State Department of Health Task Force on Life and the Law, “When Death is Sought,” https://www.health.ny.gov/regulations/task_force/reports_publications/ when_death_is_sought/chap6.htm, NG)These subtle but potentially pervasive changes will have the most significant impact on certain groups of patients - patients most likely to be considered "hopeless," such as those with acquired immunodeficiency syndrome (AIDS);

patients who pose a risk to health care providers and family members, including those with multidrugresistant tuberculosis; or patients who are least compliant, such as those who are mentally ill or drug addicted. Some health care professionals already regard caring for these patients as a special burden. Given the overall life circumstances of

some of these patients, both health care professionals and family members may find it easy to rationalize that euthanasia or assisted suicide would be in these patients' best interests.(13) Establishing a quick, painless death as a state-sanctioned option may also mean that society becomes less committed to creating ways for patients, especially those who are socially disadvantaged, to live longer and better. Finally, it must be recognized that assisted suicide and euthanasia will be practiced through the prism of social inequality and prejudice that characterizes the delivery of services in all segments of society, including health care. Those who will be most vulnerable to abuse, error, or indifference are the poor, minorities, and those who are least educated and least empowered. This risk does not reflect a judgment that physicians are more prejudiced or influenced by race and class than the rest of society - only that they are not exempt from the prejudices manifest in other areas of our collective life.(14) While our society aspires to eradicate discrimination and the most punishing effects of poverty in employment practices, housing, education, and law enforcement, we consistently fall short of our goals. The costs of this failure with assisted suicide and euthanasia would be extreme. Nor is there any reason to believe that the practices, whatever safeguards are erected, will be unaffected by the broader social and medical context in which they will be operating. This assumption is naive and unsupportable.

Impact Extension- Racism The plan ensures the worst racist abuses in society are amplified and given state sanction, that’s Pittman, racist pressures to withhold treatment from black and poor bodies for financial gain ensures that the most marginalized in society will be killed off at greater rates than the privileged sick the aff was meant to assist, the impact is an apriori ethical obligation, all violence is predicated off of the division and tribalism inherent in the racist act, any complicity ensures that violence is reentrenched in more insidious forms, that’s Memmi.

More ev- Empowering racist physicians with the power of life and death over disadvantaged bodies ensures the perpetuation of racism in its most violent formPittman 97 Assistant Professor of Law at Mississippi Law (Larry J., Physician-Assisted Suicide in the Dark Ward: The Intersection of the Thirteenth Amendment and Health Care Treatments Having Disproportionate Impacts on Disfavored Groups, pp. 795, NG)The majority’s conclusions stem from its comparison of race- based arguments against abortion with similar arguments against physician-assisted suicide.84 At first blush, the majority’s discounting of those arguments seems well-grounded because African-American women have not undergone the number of abortions that some ob¬servers feared.85 Instead of being a tribute to the powerlessness of racial discrimination, however, the lack of coercive abortions might be due to an absence of financial resources.86 Even racist physicians will not give free abortions.87 On the other hand, racist physicians who lack financial re¬sources to treat African Americans and other minorities properly and fully will have an opposite incentive when it comes to physician- assisted suicide. In a health care environment dominated by man¬aged care, it will be cheaper for physicians to proscribe a lethal dose of medication than it will be to keep a terminally ill African Ameri¬can or other disfavored minority patient hospitalized for a day, a week, or a month, especially if continued treatment is not profitable

for the hospital or other medical provider. Some commentators are already looking at physician-assisted suicide as a means of rationing health care resources.88 The Ninth Circuit’s failure to prop¬erly acknowledge the racially motivated dangers emanating from physician-assisted suicide is consistent with a societal norm that minimizes the concerns of minority groups and the dangers that the health care industry poses to African Americans It is somewhat encouraging, however, that the Ninth Circuit in Compassion in Dying recognized that minorities and poor people “have historically received the least adequate health care.” Never¬theless, unlike its exhaustive historical analysis of suicide, the court did not spend a great deal of time discussing the perceived racism that exists in the health care industry. A better historical analysis of racism in the health care industry should have influenced the court’s balancing of a terminally ill patient’s interest against the state’s in¬terest in protecting African Americans and other minorities from physician-assisted suicide. The historical persistency of racial dis¬crimination in the health care industry warrants extreme caution when evaluating whether physicians should be given more power over the life and death of terminally ill patients.

Extra Impact to PAS bad- GenocideExtra Impact- plan provides the legal/medical mechanism for alleviating healthcare costs by killing the elderly- the impact is genocideThomasma 94 Michael I. English Professor of Medical Ethics, Loyola University Chicago (Dr. David C., Medicine Unbound: The Human Body and the Limits of Medical Intervention: Emerging Issues in Biomedical Policy Volume 3, pp. 223-224, NG) How soon would we turn our attention from other issues to the high cost of caring for extremely elderly and debilitated persons? Already the discus- sion of euthanizing the demented elderly has begun in the United States (Thomasma 1992). At first blush, what would appear to be the explicit downgrading of the intrinsic value of human life seems very foreign to our way of thinking. Most Americans would react with dismay, even horror, at such a state- ment. We also have the advantage of hindsight

into the devastating consequences of such thinking. The stench of the death camps is a pall that still hangs over Western civilization. Yet attitudes of superiority and of devaluing individual lives creep into our own thinking as well, for instance,

while constructing what we consider to be rational allocation plans for health are. While we intend to min- imize suffering and maximize the common good, large numbers of indi- viduals face neglect. Perhaps the biggest worry about euthanasia today is the forthcoming crisis in health care that will be created by an increasingly elderly population. Those over eighty-five years of age in the next fifty years will increase fivefold, from three million to fifteen million citizens. Many of these people will be dependent on long-term nursing home care. Such are is the most expensive medical cost for the elderly. In all state budgets, Medicaid is the second largest budget item after education. Peo- ple over eighty-five,

in fact, take four times as much money to cover a hos- pitalization than those under eighty-five. There will be fewer individuals "in the middle," able to bear the burden of caring for the young and the elderly. The phenomenon of

the elderly (seventy to eighty-five years of age) caring for the "old old" (those over eighty-five) has already begun. Recall that the fundamental argument for forcible euthanasia is almost invariably economic. Once the official mechanism for active voluntary euthanasia is in place, habits of finding other areas for "mercy/' coupled with hard economic times, could easily lead to involuntary euthanasia. This is yet another form of the traditional slippery slope argument, based on fears about the violence in American society and the natural human propensity to find technical solutions to difficult social problems, ones we can only imagine for the future, but ones that our children must face soon enough. If we set the wrong precedents in the present, why would we think the same sort of thinking that occurred in Nazi Germany would not arise again? Proponents of direct euthanasia usually argue that fences can be built on the slope, legal requirements that would eschew even the most remote possibility of a society tuming mercy into murder

once more (Cassel and Meier 1990). The United States is a nation under the rule of law. If anything, we tend to appeal too readily to law to resolve disputes. It is one of our strengths, that in a highly pluralistic culture, we are able to resolve funda- mental disagreements by such an appeal. Does the evidence so far support the view that concerns about misuse and abuse can be met by establishing those "fences" in the law? While no immediate conclusion can be drawn at this time, it is important for acade- mic debate to include an awareness of the level of social violence in Amer- ican society today, where individuals are killed simply because another person wants their sports jacket, or

small children are killed in projects on their way to school. This violence not only manifests itself in the inner city. lt is a pandemic of our society. It infects us even when we are wary of it, it barrages us in "coming attractions" in the movie theaters.

Hence, the smile of reason from the Enlightenment is, today, an anachronism. Humanism itself, it seems

to me, does not take sufficient account of the power of evil in human society and in human hearts, an

acknowledgement we must make. It is the respect we must pay to all those who did lose their lives in the Holocaust. Thus, it is not entirely inconceivable that the Nazi experience could be a preview of our own coming attractions.

Extra impact to PAS bad --Palliative Care DA

Plan disempowers physician-decision making, destroys health care quality and boosts healthcareGolden 05 Policy Analyst for the Disability Rights & Education Fund, Marilyn, “Why Assisted Suicide Must Not be Legalized,” http://euthanasia.procon.org/ view.answers.php?questionID=000207, NG)Perhaps the most significant problem is the deadly mix between assisted suicide and profit-driven managed health care. Again and again, health maintenance organizations (HMOs) and managed care bureaucracies have overruled physicians' treatment decisions. These actions have sometimes hastened patients' deaths. The cost of the lethal medication generally used for assisted suicide is about $35 to $50, far cheaper than the cost of treatment for most long-term medical conditions. The incentive to save money by denying treatment already poses a

significant danger. This danger would be far greater if assisted suicide is legal. Assisted suicide is likely to accelerate the

decline in quality of our health care system. A 1998 study from Georgetown University's Center for Clinical Bioethics

underscores the link between profit—driven managed health care and assisted suicide. The research found a strong link between cost—cutting pressure on physicians and their willingness to prescribe lethal drugs to patients, were it legal to do so. The study warns that there must be "a sobering degree of caution in legalizing [assisted suicide] in a medical care environment that is characterized by increasing pressure on physicians to control the cost of care" (Sulmasy et al., 1998). The deadly impact of legalizing assisted suicide would fall hardest on socially and economically disadvantaged people who have less access to medical resources and who already find themselves discriminated against by the health care system. As Paul Longmore, Professor of History at San Francisco State University and a foremost disability advocate on this subject, has stated, "Poor people, people of color, elderly people, people with chronic or progressive conditions or disabilities, and anyone who is, in fact, terminally ill will find themselves at serious risk" (Longmore, 1999).

PAS destroys palliative care, downgrades healthcare qualityBopp 97 law graduate, University of Florida James P., Just the Medical Facts: An Argument in Support of the Continued Ban on Physician Assisted Suicide, http://scholarship.law.stjohns.edu/cgi/viewcontent.cgi?article=1336&context=jcred&sei-redir=1&referer=http%3A%2F%2Fscholar.google.com%2Fscholar%3Fq%3D%2522assisted%2Bsuicide%2522%2Band%2Bhealthcare%2Bcosts%26btnG%3D%26hl%3Den%26as_sdt%3D0%252C3%26as_ylo%3D2010%26as_vis%3D1#search=%22assisted%20suicide%20healthcare%20costs%22, NG)Medical fact number eight: Assisted suicide undermines the trust patients have in healthcare providers.6l Here,

an associa- tion representing some one-thousand nursing homes gave their opinion:62 Many medical ethicists have written that introducing phy- sician-assisted suicide into the physician·patient relation- ship will seriously undermine patients’ trust that physicians are committed to preserving life, which is at the core of the relationship. This breakdown of trust has even more drastic effects on the relationship between [nursing homes] and the people they serve. Unlike the selection of a doctor, the choice to enter a nursing home or other facility for the aging entails a fundamental life shift—uprooting one’s home and placing large areas of One’s life into the hands of others. Many seniors choose to make this move even when their physical state does not make it necessary because they view it as beneficial; they can trust in a facility’s mission of pre- serving life and health when they entrust their lives to it. One of this nation’s most vulnerable populations relies on [nursing homes] to show a compassionate commitment to life at one of its most trying yet precious moments. Especially if residents feel that the choice will be subtly forced upon them, physician-assisted suicide will threaten this relation- ship and poison the environment in which long-term care and services are provided. 63

Apriori ethical obligation to reject it- quality end of life care is key to the medical profession Paulus 08 Undergraduate Honors Thesis Writer at Santa Clara University (Stephanie, http://www.scu.edu/ethics/practicing/focusareas/medical/palliative.html, NG)Studies on palliative care reveal numerous positive outcomes for patients, their families, and hospitals, yet only thirty-percent of American hospitals have some sort of palliative care program. After seeing the high-

quality, beneficial, patient-centered care provided to patients at the end of life through O'Connor's Palliative Care Team, I realized that the lack of palliative care programs in American hospitals is a complete ethical failure-a failure on the part of hospitals to attend to the needs, and to relieve the pain and suffering, of their patients when it is entirely possible to do so. The basic philosophy of palliative care is to achieve the best quality of life for patients even when their illness cannot be cured. Palliative care is provided through comprehensive management of the physical, psychological, social, and spiritual needs of patients, while remaining sensitive to their personal, cultural, and religious values and beliefs. Hospital palliative care services are often provided through an interdisciplinary team of health care professionals including, but not limited to: physicians, nurses, psychologists, social workers, and chaplains. There is a great need for palliative care services in American hospitals. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) and many subsequent studies discovered poor quality of care at the end of life in many hospitals and in-hospital death characterized by uncontrolled pain and prolonged suffering. I have found palliative care to provide many positive outcomes for hospitalized patients including: expert pain and symptom management, assistance with difficult decision making, and assistance in establishing goals of care and appropriate treatment plans. In-patient palliative care services better coordinate patient care, ensure and respect patient autonomy, and improve patient-physician communication. Overall, palliative care improves quality of life for patients suffering incurable, progressive illness in accordance with their values and preferences. In addition, palliative care helps hospitals to provide cost-effective, high-quality care by placing patients in the most appropriate level of care, decreasing hospital length of stay,

expediting appropriate treatment, and reducing the use of non-beneficial resources. Hospital palliative care services are significant in realizing that "the task of medicine is to care even when it cannot cure." Patients deserve the best quality of health care hospitals can provide at all stages of illness. The complex needs of dying patients in particular can be met most effectively through dedicated palliative care programs. Hospitals are ethically obligated to offer such programs because the principles of beneficence and nonmaleficence require that hospitals, in addition to clinicians, seek to improve the quality of life and relieve the pain and suffering of all patients to the best of their ability. Meet Mrs. Smith Mrs. Smith, a 71 year old female, was admitted to the hospital with an exacerbation of her chronic obstructive pulmonary disease (COPD) and pneumonia. Her symptoms were cough, fever, headache, and shortness of breath. Mrs. Smith also had a history of diabetes and was in the hospital with pneumonia three weeks prior. Over the next few days, Mrs. Smith's condition worsened. She was transferred to the intensive care unit (ICU) when the infection spread to other organs of her body, inducing shock. Her care was transferred to the on-call resident who was unfamiliar with her case. She continued to complain of headache and shortness of breath, and the nurses noted that she was increasingly irritable and hardly slept. During the night, Mrs. Smith suffered an acute nose bleed and aspirated blood into her lungs, causing respiratory distress, and she was intubated. Once a fairly independent woman, Mrs. Smith now lay in the ICU with a spreading infection and a ventilator pumping air into her lungs to keep her alive. Mrs. Smith's son and daughter-in-law came to visit every afternoon. They noticed a significant change in Mrs. Smith's health status and spirit, but remained hopeful that she "was a fighter," and would turn around. By writing on a pad of paper, Mrs. Smith communicated to her son that she was very uncomfortable and particularly worried about missing Sunday Mass. As Mrs. Smith's condition continued to decline, she became confused and disoriented. She did not have an advance health care directive, and when the doctor initiated a discussion about her code status, the family was uncertain of what to do because they had never discussed it before. The family did not understand why her condition was not improving and became increasingly worried about the cost of the hospital stay. The case of Mrs. Smith presents several concerns: First, Mrs. Smith failed to receive adequate pain and symptom management-she continued to be short of breath while her headache and insomnia were completely overlooked. Second, inadequate communication between the patient, family, and clinical team meant that goals of care were not discussed while Mrs. Smith was still able to communicate, and the family never realized the severity of Mrs. Smith's condition. This led to uncoordinated care that compromised Mrs. Smith's quality of life and her autonomy when decisions needed to be made. Mrs. Smith received suboptimal care that failed to meet her physical, psychosocial, and spiritual needs. What if Mrs. Smith were your mother? You would want her to have the best quality of life possible. Ideally, you would want to see her battle the pneumonia, come off the respirator, and return home to a happy life. In the meantime, you would want her pain to be relieved, her breathing to be eased, and her spiritual and financial concerns to be recognized. If recovery to her previous state of health was not possible, you would want to assure that your mother received care that was consistent with her personal values. All physicians want to be able to provide such holistic care for their patients, but the reality is that hospital stays are expensive and physicians simply do not have the time to provide adequate psychosocial and spiritual care, especially in acute care settings such as the ICU.1 The ethically responsible solution to providing quality care for Mrs. Smith, and others in similar circumstances, is to provide in-patient palliative care services through a dedicated interdisciplinary health care team. What is Palliative Care? The basic philosophy of palliative care is to achieve the best quality of life for patients

even when their illness cannot be cured. In contrast to hospice care, palliative care is offered at any stage of illness: in conjunction with life-prolonging therapy or as comfort care at the end of life.2 Palliative care is provided through comprehensive management of the physical, psychological, social, and spiritual needs of patients, while remaining sensitive to their personal, cultural, and religious values and beliefs.3 In order to accomplish such holistic care, hospital palliative care services are most often provided through an interdisciplinary team that draws on the expertise of a variety of health care professionals. Palliative care teams require knowledgeable, skilled, and experienced clinicians and may consist of physicians, nurses, psychologists, pharmacists, chaplains, social workers, nutritionists, and physical therapists.4 A distinctive palliative care unit may be set up within a hospital to care for patients, but more often a specific Palliative Care Team will provide services to patients throughout the hospital. Either way, a clearly identified, accessible, and accountable team is essential in order to coordinate care, facilitate communication, and ensure that changing needs and goals of patients are met throughout their hospitalization.5 Studies on palliative care reveal numerous positive outcomes for patients, their families, and hospitals, yet only thirty-percent of American hospitals have some sort of palliative care program.6 In my opinion, this is a complete ethical failure-a failure on the part of hospitals to attend to the needs, and to relieve the pain and suffering, of their patients when it is entirely possible to do so. Hospitals are ethically obligated to offer palliative care services because the principles of beneficence and nonmaleficence require that hospitals, in addition to clinicians, seek to improve the quality of life and relieve the suffering of all patients to the best of their ability. Ethics and Palliative Care

The Principles of Beneficence and Nonmaleficence The ethical principle of beneficence states that "we should act in ways that promote the welfare of other people."7 In a very basic way, beneficence is implicit to the role of all health care professionals as part of the "helping professions:" doctors, nurses, and other health care workers daily accept the

duty to seek to benefit their patients. Similarly, the principle of nonmaleficence claims that "we ought to act in ways that do not cause needless harm or injury to others."8 While we recognize that the practice of medicine is not

perfect, and all medical therapies involve some risk of harm, we trust and expect that health care professionals are cautious, diligent, and thoughtful when providing care. In the same way, hospitals and health care organizations are also held to certain ethical standards. Hospitals have an ethical obligation to support their staff, as well as manage their organization, in ways that ensure patient safety and patient rights, and in

ways that promote quality health care. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) holds its accredited hospitals to national standards for health care quality, including effective pain management.9 Most hospitals recognize these duties and have mission statements claiming a dedication to high-quality health care, and often a specific dedication to patient-centered care. Hence, patients admitted to hospitals with acute medical conditions expect appropriate, high-quality health care.

AFF ANSWERS TO OBAMACARE DA

Perception Uniqueness takeouts

GAO Report overwhelms the link. Republicans and Fox News will use it in the midterms to kill Obamacare support. Their link is too long-term to affect perceptionHoward 08-05-14 digital artist and graphic designer. Publisher and proprietor of Crass Commerce, an enterprise dedicated to promoting an alternative consumerismMark, “FOX NEWS ALERT: ObamaCare Website Rollout Had Problems (Who Knew?), http://www.newscorpse.com/ncWP/?tag=obamacareNot too long ago, the Affordable Care Act (aka ObamaCare) dominated the political landscape in both Congress and the media. It virtually sucked the oxygen out of every other issue that didn’t involve Benghazi. But lately there has been a conspicuous absence of news about the program. And Republicans, once devoted to its demise, have all but banished it from their public communications. Until today. That’s right. Fox News has brought ObamaCare back into the spotlight to announce that a Government Accounting Office report has found that “management failures” led to the botched rollout of the website. The network banged their signature gong and ran their “Fox Alert” graphics to broadcast this breaking news. After all, who would have ever imagined that a lack of managerial oversight and efficiency were responsible for the debacle that accompanied the launch of the ObamaCare exchange? Thank goodness Fox News is here to enlighten us with their probing journalism. Such tenacity is representative of their professionalism and surely has nothing to do with trying to shove an old and obvious story into the news cycle in order to damage the President’s standing. Perhaps they are just nostalgic for the good old days when they had a juicy drama with which they could smear the administration. Back when Congress held over fifty votes to cripple or repeal the legislation. At the same time, multiple committees were investigating everything from the faulty website, to alleged security risks, to threats of criminal navigators, to allegations of false audits, and the ever-present fantasy of death panels. The media, led by Fox News, obsessed over the same issues as they emerged from the GOP committees investigating them. But they added their own scare mongering in an effort to frighten citizens away from the program and hasten its failure. The press falsely reported conservative assessments that claimed millions would lose their insurance, that premiums would skyrocket, and that their personal health and financial records would be compromised.

People will remember the GAO Report indictmentNew Bern Sun Journal Editorial, 08-01-14 North Carolina newspaper“Editorial: Obamacare problems, a lesson in government.” http://www.newbernsj.com/opinion/editorials/editorial-obamacare-problems-a-lesson-in-government-1.353804A months-long study of the problems marring the Obamacare website has turned up a host of culprits.From ineffective planning to poor oversight, the Government Accountability Office points to a number of flaws in the Obama administration’s handling of the website, which went public last fall.Despite administration claims that the website would be heavily used as soon as it opened, the site stumbled for weeks, at times frozen by the traffic. The administration encountered problems as numerous people gave different orders to government contractors, incurring huge costs even in dozens of cases when the people giving the orders lacked the authority to approve cost overruns. In just two

and a half years, the cost of the program more than tripled. Altogether, the study paints a picture of government ineptitude and inefficiency — some of the very characteristics opponents of the health care law cited in arguing against it. By the end of last year, most of the software problems were cleared up, and the site now functions well, according to reports. The questions, though, remain.Why didn’t the government agencies responsible for overseeing the process stumble so badly?Why was such a sub-par product accepted by the government at vast expense to taxpayers?How often do these same mishaps play out in the federal government without the public scrutiny that this incident incurred?

In this case, while the website rollout initially harmed the public perception of Obamacare, the eventual fixes ironed out much of the political fallout. What is left is a lesson in oversight and public administration that should not be localized on this one news story. Instead, government planners in Washington, D.C., should take it as a cautionary tale. Any public project requires clear lines of authority and careful oversight to avoid waste, contradiction and repetition. HealthCare.gov required much more time, expense and inconvenience than it should have to become fully functional. The whole ordeal was a lesson in government waste. Unfortunately, it is unlikely that those responsible for these glaring failures will learn from them, since the waste and delay was paid for by the public, not by them. The people they serve, though, should have a painful and lasting reminder of why Washington solutions should be the last resort.

PAS Doesn’t Link to ObamacareAFF CARD: The Link doesn’t account for the high cost of PAS in the U.S., their methodology is wrong and PAS doesn’t save moneyGolden 05 Policy Analyst for the Disability Rights & Education Fund, (Marilyn, “Why Assisted Suicide Must Not be Legalized,” http://euthanasia.procon.org/view.answers.php?questionID=000207, NG)Rex Greene, M.D., Medical Director of the Dorothy E. Schneider Cancer Center at Mills Health Center in San Mateo, California and a leader in bioethics, health policy and oncology, underscored the heightened danger to the poor. He said, "The most powerful predictor of ill health is [people's] income. [Legalization of assisted suicide] plays right into the hands of managed care."2 Supporters of assisted suicide frequently say that HMOs will not use this procedure as a way to deal with costly patients. They cite a 1998 study in the New England Journal of Medicine that estimated the savings of allowing people to die before

their last month of life at $627 million. Supporters argue that this is a mere .07% of the nation's total annual health care costs. But significant problems in this study make it an unsuitable basis for claims about assisted suicide's potential impact. The researchers based their findings on the average cost to Medicare of patients with only

four weeks or less to live. Yet assisted suicide proposals (as well as the law in Oregon) define terminal illness as having six months to live. The researchers also assumed that about 2.7% of the total number of people who die in the U.S. would opt for assisted suicide, based on reported assisted suicide and euthanasia deaths in the Netherlands .

But the failure of large numbers of Dutch physicians to report such deaths casts considerable doubt on this estimate. And how can one compare the U.S. to a country that has universal health care? Taken together, these factors would skew the costs much higher (Rowen, 1999).

Oregon modeling proves- the aff also removes malpractice requirements from PAS, solves key source of insecurity among physiciansBecker 06 Assistant Professor in the University of Kansas Medical Center(David W., Problems with Death reporting in Opposing viewpoints in Context, http://ic.galegroup.com/ic/ovic/ViewpointsDetailsPage/DocumentToolsPortletWindow?displayGroupName=Viewpoints&jsid=22a201952de6dd9e0de079097de35ea1&action=2&catId=&documentId=GALE%7CEJ3010160250&u=gotitans&zid=2838830242978b1d4527a1d076151303, NG)Specifically, the Act disallows recourse to malpractice suits by these patients and their family members in that it exempts assisted-suicide doctors from the requirement of meeting the ordinary standards of medical care in like communities nationally, and instead holds them only to a "good faith" standard, which is something heretofore unknown in a medical-legal sense, and inapplicable to any legitimate medical treatment. [The Act] states, "No person shall be subject to civil or criminal liability or professional disciplinary action for participating in good faith compliance with [the Act]." The statute actually replaces traditional "standard of care" requirements with a "good faith" standard that is, in essence, totally subjective, and virtually impossible to evaluate within the established context of medical practice, and treats assisted-suicide as different from any legitimate medical purpose or treatment.

2AC PAS Obamacare Link TurnMajority of American Physicians Oppose PASHealthday 13 (Medical Polling/Information Service, http://consumer.healthday.com/general-health-information-16/doctor-news-206/most-doctors-don-t-favor-physician-assisted-suicide-680082.html, NG)

WEDNESDAY, Sept. 11, 2013 (HealthDay News) -- Whether doctors should help patients die continues to be a hotly debated topic within the medical community, a New England Journal of Medicine poll finds. The journal questioned readers about a hypothetical near-death case and received more than 2,000 valid responses. Roughly two-thirds worldwide -- including 67 percent of replies from the United States -- said they disapprove of physician-assisted suicide. Most readers of the journal are doctors. Some said assisting a suicide violates a physician's oath to do no harm and might lead to euthanasia -- intentional killing to relieve suffering and pain.

The plan causes mass quitting by physicians- ethical polling provesCNewswire, 2009 (Citing CMA CEO David Stevens, M.D., accessed on deaconforlife.com, http://deaconforlife.blogspot.com/2009/10/cma-doctors-sen-harry-reids-well-put-up.html, NG)"Such a sellout would be the watershed event that historians would point to as marking the de- professionalization of medicine, when physicians traded convictions for cash. If physicians abandon their professed commitment to the patient's welfare in order to solely pursue financial reward, patients will pay the price--some with their lives. "The fact that Mr. Reid would stoop to backroom bargaining tactics is an indication of desperation, an acknowledgement that physicians are roundly opposed to his healthcare legislation. As polling has shown, an impressive 45 percent of physicians say they actually are ready to quit medicine if current healthcare legislation passes. "Add to that data what a national survey of faith-based physicians found: That 95 percent are ready to leave medicine if a weakening of conscience protections would force them to violate their conscientiously held convictions. "Mr. Reid and his allies may be

working behind closed doors on a clever way to pass healthcare legislation, but maybe they should be working on who's going to carry out their new scheme if over half the nation's physicians quit medicine. "Cold cash offers are not going to sway principled physicians. The question that Mr. Reid and his colleagues should be asking is not

how to buy off the ever-shrinking AMA or a small cadre of cash- conscious doctors, but how to accommodate the concerns of the vast majority of principled physicians who value conscience rights and want to keep the government from interfering with the physician-patient relationship."

That causes a shift toward unsustainable RN-centered care, which collapses perceptions of Obamacare.O’Reilly 12 Medical Ethics Correspondent at amednews.com(Kevin B., http://www.amednews.com/article/20121008/profession/310089946/1/, NG)Shortage sparks debate over NPs’ role The looming physician shortage is drawing more attention to the use of nurse practitioners, physician assistants and other midlevel health professionals to help maintain access to care. But the shift toward more team-based care in patient-centered medical homes should occur in a physician-led environment, the AAFP said in a Sept. 18 report. The American Academy of Nurse Practitioners objected to the report, arguing that NPs could help fill the physician gap by independently treating patients. Dr. Stream, of the AAFP, said a two-tier system of primary care — physicians for some, nurse practitioners for others — is untenable. “To the people who propose that to fill this gap that we should somehow alter our expectations of the kind of care people should

get — that is not what we want in this country,” he said. “It’s not a viable, ethical or reasonable solution.” Primary care doctors complete 21,700 hours of education and training over 11 years, said the AAFP report. That compares with 5,350 hours of training and education NPs get during five to seven years. The AMA backed the academy’s report, noting a recent survey showing that 86% of patients believe they benefit from a physician-led primary care team. “Physicians and other health professionals have long worked together to meet patient needs for a reason — the physician-led team approach to care works,” said AMA President Jeremy A. Lazarus, MD. “Patients win when each member of their health care team plays the role they are educated and trained to play.”

Physician Opposition Link Turn extensions--Nurses

Doctor Nurse conflict high now- plan ensures even more doctors leave ObamacareModern Healthcare 10 Health Care News Sourcehttp://www.modernhealthcare.com/article/20101220/MAGAZINE/312209917, NG)The long-simmering struggle between doctors and nurses over the national patchwork of laws on nurses' powers in healthcare finally boils over into a public skirmish, on the heels of a healthcare reform law that puts a premium on patient-centered primary care. Nurses' groups push their case in a 586-page tome from the Institute of Medicine, titled The Future of Nursing and released in October, in which the authors assert that the country can no longer afford to let its nurses not practice up to the fullest extent of their training. They argue that nurses are quicker and cheaper to produce than doctors, and that they make no more medical errors than physicians. Meanwhile, doctors, who in 2009 published their own massive set of reports opposing changes in state scope-of-practice laws, say that if the reform law ends up pushing lesser-trained clinicians into positions of higher authority in medicine, the change will only fuel public resentment of the law.

PAS elevates the position of nurses over physicians- reshaping the relationshipNursing Spectrum 2k American Nursing Newsletter http://www.consciencelaws.org/background/procedures/assist003.aspx, NG)"This man was not the picture of suffering as I know it," says Allene, who, though she did not witness the death, was a party to it all the same. Since Oregon broke new ground with its 1997 Death with Dignity Act - becoming the only state in the nation to

legalize PAS - nurses there are assuming roles they may not have anticipated, sometimes uncomfortably so. Ironically,

Oregon's nurses are finding themselves, not physicians, on the front line of PAS. It's a place where physicians might actually prefer them and one to which some nurses have already gone. Better You Than

Me "Initially, when the law was designed, the assumption was that physicians would be the first ones to explore PAS with patients," says Pam Matthews, RN, BSN, administrator for Evergreen Hospice, Albany, OR, "but in reality, nurses are usually the ones in the line of fire. Patients often feel nurses understand their wishes for good quality of life

and good quality of death, too." Much of nurses' roles lies behind the scenes long before the drama of PAS unfolds. Home care and hospice nurses actively help patients understand their rights, acting as advocates for those who are considering

PAS. "Patients often ask about PAS," says Allene. "They want to learn more and feel comfortable asking their nurses about it." Allene's agency has cared for four patients who have opted to use PAS. Gus was Allene's first such patient. "Our entire hospice team was involved in this patient's case - all trying to pick his brain, making sure he had no unmet needs we could fill or pain that was going untreated," she says. "We wanted to be sure that he saw all possible options before using PAS." It's that kind of strong patient advocacy that has physicians - in general opposed to PAS - speculating whether nurses are better-suited to a more direct role in the process. Some physicians have stated publicly that they may not be the best members of the healthcare team to lead assisted dying, confessing that they are not always the

most properly prepared for the task. A recent article in the Annals of Internal Medicine (AIM) stated PAS violates physicians' professional integrity and suggests that other disciplines, such as nursing, may be more capable of leading assisted-dying efforts.1 "To say that physicians alone are the only ones capable of assisting a patient's suicide is not that easy," says Jason Karlawish, MD, of the University of Pennsylvania Center for Bioethics' Assisted Suicide Consensus Panel, and coauthor of the AIM article. "The problem is that it [PAS] requires skills that the average physician does not have - and shouldn't have. We [physicians] should be able to treat those who are dying, relieving their pain and symptoms, but not helping them kill themselves."

Legalization debates focus exclusively on doctors; elevating their agency to primacy even though nurses spend more time with patients, ethical PAS requires nurse-centric approachesOlin 12 Resident Nurse and lead writer at RN Central(Jennifer, http://www.rncentral.com/blog/2012/nursings-role-in-assisted-suicide/, NG)In ethical debates about euthanasia and assisted suicide the focus is usually on the involvement of doctors; nurses are seldom given much thought at all. Yet, it is a topic that greatly affects nurses. Nurses are the ones at the bedside of the dying—24 hours a day, every day. Nurses are there for the patients, assessing and managing pain, and other symptoms. They are there for the patients and their families addressing their spiritual needs, their anxieties, and their questions. Nurses often find themselves in a quandary. While many of the professional nursing and hospice associations have come out publicly against the legalization of and participation in euthanasia or assisted suicide, this doesn’t usually help the nurse who is standing in front of the patient asking to die with an appropriate response. Surveys over the years show that somewhere between 17-40 percent of nurses working in critical care and hospice have received requests from patients or family members to perform euthanasia or assist in suicide. One of these surveys showed that 16 percent of nurses responding have participated in these practices. And, while there is debate over the actual validity of the number and the actual acts (the administration of opiates to dying patients, a practice that generally is considered different from assisted death and morally acceptable) a significant number of nurses have said they have provided or prescribed drugs to a patient knowing the patient intended to use them to end their own lives. These studies have highlighted a number of important issues surrounding nurses and euthanasia, assisted suicide and relief of suffering: Nurses are witness to tremendous suffering. – Nurses need to be supported and educated in ways to lessen suffering. Also, RNs need to identify their own responses to suffering and distress or they won’t be able to identify which patient’s suffering is being addressed through assistance in dying. There is confusion about the differences between euthanasia, assisted suicide and relief of suffering. – If nurses are unable to discriminate between these actions they may unwittingly place themselves at risk for unexpected emotional and legal consequences. Nurses need guidance in discerning the moral and legal distinctions among various nursing actions at the end of life.

2AC Obamacare Impact Turns (Obamacare Good)

Obamacare repeal tanks the economy by destroying business confidenceCutler 11 Otto Eckstein Professor of Applied Economics, Harvard University, and a Senior Fellow at the Center for American Progress, (David,“Repealing Health Care Is a Job Killer: It Would Slow Job Growth by 250,000 to 400,000 Annually,” January, http://www.politico.com/pdf/PPM182_110107_cutler.pdf)The implications of repealing health care for national medical spending (public and private) are shown in Figure 1. Repealing health reform would add $25 billion to spending in 2014 and $185 billion to spending in 2019 . The impact on family premiums will be equally large (see Figure 2). Repealing health reform would add 9 percent or nearly $2,000 annually to family health insurance premiums in 2019. Any proposal that adds $200 billion to our medical spending after a decade will have enormous economic implications. The employment impacts of health care repeal will be particularly severe because many of these costs will fall on businesses. As we’ve already seen, employers facing higher health costs will hire fewer people, lay workers off, and pay lower wages . To estimate these employment impacts, I followed the methodology of myself and Neeraj Sood.13 That paper took estimates of the medical spending change associated with health reform and combined that with the econometric model of Sood, Arkadipta Ghosh, and José Escarce that estimated the employment impacts of changes in medical costs. I use the model to estimate the employment impact of repealing reform. Figure 3 shows the net impact of repealing health reform on total employment. The baseline estimates show that 250,000 jobs will be lost annually if health reform is repealed. Annual job losses would average 400,000 using the greater estimate of 1.5 percentage point cost increases annually resulting from repeal. Figure 4 shows the estimated employment change by industry in 2016 (omitting health care, which will have more employment). More than 200,000 jobs will be lost in manufacturing and nearly 900,000 jobs will be lost in nonhealth care services. A total of 250,000 jobs will be lost annually if health reform is repealed. These job losses are not the only impact of repealing health reform, however. Family incomes would fall by as much as $2,000 annually as medical costs increase beyond forecasted levels. Federal deficits also would rise. The Congressional Budget Office has predicted that repealing health reform would add $230 billion to federal deficits in the next decade because provisions in the law intended to bring down costs would be repealed. Job transitions would also be affected. Millions of people are “locked” into their current job because they fear becoming uninsured or underinsured if they were to change. Repealing health reform would thus stifle job transitions, new business startups, and movements into and out of the labor force. Millions more workers would be affected.

Obamacare is key to prevent BioterrorSklar 02 Coauthor of “Raise the Floor,” Knight Ridder/Tribune News Service Holly, “Rolling the Dice on Our Nations’ Health”, December 19, http://www.commondreams.org/views02/1219-07.htmImagine if the first people infected in a smallpox attack had no health insurance   and delayed seeking care for their flu-like symptoms. The odds are high. Pick a number from one to six. Would you bet your life on a roll of the dice? Would you play Russian Roulette with one bullet in a six-chamber gun? One in six Americans under age 65 has no health insurance. The uninsured are more likely to delay seeking medical care, go to work sick for fear of losing their jobs, seek care at overcrowded emergency rooms and clinics, and be poorly diagnosed and treated. The longer smallpox--or another contagious disease--goes undiagnosed, the more it will spread, with the insured and uninsured

infecting each other. Healthcare is literally a matter of life and death. Yet, more than 41 million Americans have no health insurance of any kind, public or private. The uninsured rate was 14.6 percent in 2001--up 13 percent since 1987. The rate is on the rise with increased healthcare costs, unemployment and cutbacks in Medicaid and the State Children's Health Insurance Program (SCHIP). One in four people with household incomes less than $25,000 is uninsured. One in six full-time workers is uninsured, including half the full-time workers with incomes below the official poverty line. The share of workers covered by employment health plans drops from 81 percent in the top fifth of wage earners to 68 percent in the middle fifth to 33 percent in the lowest fifth, according to the Economic Policy Institute. As reports by the American College of Physicians, Kaiser Family Foundation and many others have shown, lack of health insurance is associated with lack of preventive care and substandard treatment inside and outside the hospital. The uninsured are at much higher risk for chronic disease and disability, and have a 25 percent greater chance of dying (adjusting for physical, economic and behavioral factors). To make matters worse, a health crisis is often an economic crisis. "Medical bills are a factor in nearly half of all personal bankruptcy filings," reports the National Academy of Sciences Institute of Medicine. The U.S. is No. 1 in healthcare spending per capita, but No. 34--tied with Malaysia--when it comes to child mortality rates under age five. The U.S. is No. 1 in healthcare spending, but the only major industrialized nation not to provide some form of universal coverage. We squander billions of dollars in the red tape of myriad healthcare eligibility regulations, forms and procedures, and second-guessing of doctors by insurance gatekeepers trained in cost cutting, not medicine. Americans go to Canada for cheaper prices on prescription drugs made by U.S. pharmaceutical companies with U.S. taxpayer subsidies. While millions go without healthcare, top health company executives rake in the dough. A report by Families USA found that the highest-paid health plan executives in ten companies received average compensation of $11.7 million in 2000, not counting unexercised stock options worth tens of millions more. The saying, "An ounce of prevention is worth a pound of cure," couldn't be truer when it comes to healthcare. Yet, we provide universal coverage for seniors through Medicare, but not for children. We have economic disincentives for timely diagnosis and treatment of diseases. Universal healthcare is a humane and cost-effective solution to the growing healthcare crisis. Universal coverage won't come easy, but neither did Social Security or Medicare, which now serves one in seven Americans. Many proposals for universal healthcare build on the foundation of "Medicare for All," albeit an improved Medicare adequately serving seniors and younger people alike. Healthcare is as essential to equal opportunity as public education and as essential to public safety as police and fire protection. If your neighbor's house were burning, would you want 911 operators to ask for their fire insurance card number before sending--or not sending--fire trucks? Healthcare ranked second behind terrorism and national security as the most critical issue for the nation in the 2002 Health Confidence Survey released by the Employee Benefit Research Institute. The government thinks the smallpox threat is serious enough to start inoculating military and medical personnel with a highly risky vaccine. It's time to stop delaying universal healthcare, which will save lives everyday while boosting our readiness for any bioterror attack .

Bioweapons attacks cause extinctionSteinbruner 97 Senior Fellow, Brookings Institution, and Vice Chair, Committee on International Security and Arms Control, National Academy of Sciences, John D. 12/22/1997 (“Biological Weapons: A Plague Upon All Houses” – Foreign Policy) p. lexisAlthough human pathogens are often lumped with nuclear explosives and lethal chemicals as potential weapons of

mass destruction, there is an obvious, fundamentally important difference: Pathogens are alive, weapons are not. Nuclear and chemical weapons do not reproduce themselves and do not independently engage in adapt ive

behavior; pathogens do both of these things . That deceptively simple observation has immense implications. The use of a manufactured weapon is a singular event. Most of the damage occurs immediately. The aftereffects, whatever they may be, decay rapidly over time and distance in a reasonably predictable manner. Even before a nuclear warhead is detonated, for instance, it is possible to estimate the extent of the subsequent damage and the likely level of radioactive fallout. Such predictability is an essential component for tactical military planning. The use of a pathogen , by contrast, is an extended process whose scope and timing cannot be precisely controlled. For most potential biological agents, the predominant drawback is that they would not act swiftly or decisively enough to be an effective weapon. But for a few pathogens - ones most likely to have a decisive effect and therefore the ones most likely to be contemplated for deliberately hostile use - the risk runs in the other direction. A lethal pathogen that could efficiently spread from one victim to

another would be capable of initiating an intensifying cascade of disease that might ultimately threaten the entire world population . The 1918 influenza epidemic demonstrated the potential for a global contagion of this

sort but not necessarily its outer limit .

Obamacare Impact Turn ExtensionsObamacare key to economy – employment and consumer spendingGruber 12 professor of economics at MIT, (Jonathan, July 12, 2012 “New Republic: Obamacare Means Higher Employment” http://www.npr.org/2012/07/12/156660203/new-republic-obamacare-means-higher-employment)Forget death panels. Lately critics of the Affordable Care Act have been promoting a different claim — that "Obamacare" is a job-killer. Specifically, they say, it will stifle the economy with regulations and taxes. But the economic literature doesn't support this claim. If

anything, it suggests the opposite: The Affordable Care Act will boost the economy . By now, most people who follow

politics know that the law will result in more than 30 million additional Americans getting health insurance. But what few realize is that, by expanding insurance coverage, the law will also increase economic activity. These newly insured individuals will demand more medical care than when they were uninsured. And while it takes many years to

train a family physician or nurse practitioner, it doesn't take much time to train the assistants and technicians (and related support staff) who can fill much of this need. In many cases, these are precisely the sort of medium-skill jobs that our economy desperately needs — and that the health care sector has already been providing,

even during the recession.¶ More immediately, the increase in economic security for American families will also mean an increase in consumer spending. Many uninsured consumers are forced to set aside money in low interest liquid accounts to make sure they have enough to cover unexpected medical costs. With the security provided by health insurance, they can free that money up for consumption that is much more valuable to them. When the federal government expanded Medicaid in the 1990s, my own research has shown, the newly insured significantly increased their spending on consumer goods. More purchases of consumer goods will provide short-run stimulation to the economy and more hiring .

Also solves small businessesRussell 10 Menzies Foundation fellow at the Menzies Centre for Health Policy at Australian National University & the University of Sydney, PhD, John Curtin School of Medical Research at ANU, Visiting Senior Fellow at the Center for American Progress Lesley, “Health Reform Means More Jobs for Small Businesses”, http://www.americanprogress.org/ issues/ healthcare/news/2010/04/05/7610/health-reform-means-more-jobs-for-small-businesses/)The Small Business Majority commissioned a study by Professor Jonathan Gruber that examined how health care reforms would affect businesses with fewer than 100 employees. This study concluded that small businesses will fare far better under the substantially reformed health care system , which includes appropriate levels of

assistance to small businesses to help them meet their health care obligations.¶ The SBM study shows that health care reform will help small business by dramatically reducing the costs small businesses pay to provide health insurance coverage to their employees . If Congress had not passed reform, small businesses would have had to pay nearly $2.4

trillion over the next 10 years in health care costs for their workers. With reform, the study shows that small businesses can save as much as $855 billion, a reduction of 36 percent.¶ It is estimated that 178,000 small business jobs would have been lost

in 2018 as a result of escalating health care costs. Health care reform can save up to 128,000 of these jobs, reducing job losses by as much as 72 percent, and will contribute to increased profits, competitiveness, and higher wages . The SBM study found that health care reform will save workers up to $309 billion in wages over the next 10 years.¶ But perhaps the biggest benefit for small business employers and employees is that health care reform will eliminate “job lock ,” the situation that arises when people, especially those with pre-existing conditions, are fearful of changing jobs and losing their health insurance coverage. Approximately 1.6 million small business workers are in this situation—that’s roughly one in 16 people currently insured by their employers. Health care reform will

ban exclusions on the basis of pre-existing conditions and enable individuals and families to purchase health coverage at an affordable rate, likely bringing the new rate of job lock close to zero.¶ Several recent studies highlight how health care reform will boost jobs growth across all business sectors. David Cutler and Neeraj Sood estimate in a study for the Center for American Progress that health care reform could boost employment by 250,000 to 400,000 a year over the next decade. Their findings are very similar to those of President Obama’s Council of Economic Advisors, which estimated that health care reform will create approximately 500,000 new jobs a year, remove unnecessary barriers to job mobility, and help to “level the playing field” between large and small businesses.¶ Small businesses are the “engines of the economy.” Firms with fewer than 500 employees accounted for 64 percent, or 14.5 million, of the 22.5 million net new jobs between 1993 and the third quarter of 2008. These small businesses will benefit significantly from these new pieces of legislation and are likely to claim a majority of the new jobs that are generated from it.

AFF ANSWERS TO ABLEISM K

2AC Ableism K

Their analysis of ableism only recreates oppressive binaries, turns the KHumphrey 2k, Faculty of Applied Social Sciences, The Open University UK(Jill C., Disability & Society, Vol. I5, No. I, “Researching Disability Politics, Or, Some Problems with the Social Model in Practice”, Proquest, p. 64-65)In academic texts, the social model begins with an appreciation of the individual and collective experiences of disabled people (e.g. Swain a al, 1993). It goes on to elaborate the nature of a disabling society in terms of the physical environment, the political economy, the welfare state and sedimented stereotypes (e.g. Barnes et ah, 1999). Finally, it endorses a critical or emancipatory paradigm of research (e.g. Barnes & Mercer 1997a). This analysis lends itself to a recognition of the array of diverse experiences of disabling barriers; a realistic appraisal of the need for broader political coalitions to combat entrenched structural inequalities and cultural oppressions; and an openness about the potential for non-disabled people to contribute to critical theory and research. In activist discourses, the emphasis is upon the fact that it is non-disabled people who have engineered the physical environment, dominated the political economy, managed welfare services, controlled research agendas, recycled pejorative labels and images, and translated these into eugenics policies. This analysis lends itself to a dichotomy between non-disabled and disabled people which becomes coterminous with the dichotomy between oppressors and oppressed; and this tightens the boundaries around the disabled identity, the disabled people's movement and disability research. Whilst this hermeneutic closure is designed to ward off incursions and, therefore, oppressions from non-disabled people, it may also have some unfortunate consequences. I would like to illustrate these consequences by drawing upon a research project involving the four self-organised groups (SOGs) for women, black people, disabled members, and lesbian and gay members in UNISON (see Humphrey, 1998, 1999). Material drawn directly from conversations and observations in the disabled members' group is supplemented by interview transcripts with members of the lesbian and gay group, my own personal experiences of and reflections upon disability and discrimination, and recent developments in various social movements and critical research texts. The rest of the article depicts three problematic consequences of the social model in practice and redirects them back to the social model as critical questions which need to be addressed by its proponents. First, there are questions of disability identity where a kind of 'purism' has been cultivated from the inside of the disability community. Here, it can be demonstrated that some people with certain types of impairments have not been welcomed into the disabled members1 group in UNISON, which means that the disability community is not yet

inclusive, and that its membership has been skewed in a particular direction. Second, there are questions of disability politics where a kind of 'separatism' has been instituted. Whilst the UNISON constitution allows for separatism to be supplemented by both coalitions and transformations, these have been slow to materialise in practice, and the dearth of such checks and balances in the wider disabled peoples* movement implies that the danger of developing a specific kind of disability ghetto is more acute. Third, there are questions of disability research where a kind of 'provisional-ism1 is suspended over the role of researchers. The most obvious dilemmas arise for the non-disabled researcher as would-be ally, but it is becoming clear that disabled academics can also be placed in a dilemmatic position, and it is doubtful whether any researcher can practise their craft to their own standards of excellence when operating under the provisos placed upon them by political campaigners.

Traditional medical discourses of disability are useful in raising awareness and recovering from loss Barker & Murray 10 English Professors University of Birmingham, University of Leeds [Clare Barker, Stuart Murray, Journal of Literary & Cultural Disability Studies Volume 4, Number 3, 2010 “Disabling Postcolonialism: Global Disability Cultures and Democratic Criticism,” accessed 7-13-12 BC]Given that the history of colonialism (and its post/neocolonial aftermath) is indeed a history of mass disablement, and that the acquisition of disability may be tied into wider patterns of dispossession— the loss of family, home, land, community, employment—there is a pressing need, as we see it, to resist the too-easy censure of narratives that construct disability as loss. We would caution especially against the blanket rejection and/or critique of medical discourse and medicalized terminology, which

may be strategically important when campaigning for resources and raising awareness of (neo)colonial abuses. What individuals in such circumstances experience as loss should not be rendered an invalid response by arguments that fail to recognize the wider contexts and material environments in which disablement occurs.

2AC Racism K

Regulatory checks would prevent PAS discrimination against minoritiesPark 13 American author and existentialist philosopher from Minneapolis,MNJames Leonard, http://www.debate.org/opinions/would-legalizing-physician-assisted-suicide-endanger-minoritiesAn advocate of that minority group could review the life-ending decision. When medical care is provided by doctors and nurses primarily from one racial group, then there are justifiable fears from members of minority groups that they will not receive medical care of the same quality as patients who belong to the same group as the providers. To prevent even the appearance of discrimination, one of the safeguards might be to have the life-ending decision reviewed by an (open-minded) leader of that minority community: http://www.tc.umn.edu/~parkx032/SG-ADVOC.html.

Doctors are not racistsPark 13 American author and existentialist philosopher from Minneapolis,MNJames Leonard, http://www.debate.org/opinions/would-legalizing-physician-assisted-suicide-endanger-minoritiesNo, legalizing physician assisted suicide would not endanger minorities anymore than it would endanger any other segment of the population. There is no reason to believe that all of the doctors out there are a bunch of racists who want to kill off minorities. Physician assisted suicide carries a high likelihood of abuse, but it is not targeted towards minorities.

Informed consent would check racismPark 13 American author and existentialist philosopher from Minneapolis,MNJames Leonard, http://www.debate.org/opinions/would-legalizing-physician-assisted-suicide-endanger-minoritiesThis would not be a concern. No, there would be no widespread culling of minorities if physician assisted suicide was allowed. For one thing, it wouldn't be considered suicide if a medical professional could simply terminate human life, we'd call it murder. The permission would have to be granted beforehand, by the patient, understanding what is going on.

Reject the Kritik as an absurd idea. Previous legalization proves it.Park 13 American author and existentialist philosopher from Minneapolis,MNJames Leonard, http://www.debate.org/opinions/would-legalizing-physician-assisted-suicide-endanger-minoritiesLegalizing physician assisted suicide would not endanger minorities. This make absolutely no sense at all. If it was legal, do you think doctors everywhere would start killing minority groups just because of physician assisted suicide was legal? No, and why is that? Because that is an absolutely absurd way of thinking.

Right to die with dignity outweighs the risk of the kritikPark 13 American author and existentialist philosopher from Minneapolis,MNJames Leonard, http://www.debate.org/opinions/would-legalizing-physician-assisted-suicide-endanger-minoritiesLegalizing physician assisted suicide would not endanger minorities. Legalizing physician assisted suicide would not endanger minorities. Minorities are not more subject to this law than any one else. Every one, under this law, would have a right to die with some dignity. Every one dies, so it is not like the law is favoring one race over another.