Negatives against the resolution, “Should government provide health care for all citizens?” argued against both a single-payer plan as well as the provisions of the Obama administration’s Affordable Care Act in Thursday evening’s Allegany County Day of Civility event. 

The first negative-side speaker, University of Connecticut economics student Isadore Johnson said that “even if attainable in other countries … our country would not be good at this.” The federal bureaucracy is not efficient with health care, he said, noting that one Veterans Administration hospital in Phoenix “had a 1,400 to 1,600 patient waiting list for two years.”

According to Johnson, Medicare has higher per-capita administrative costs, so costs under a universal system “might actually go up.”  Johnson cited the Rand Health Experiment of 1974-82, in which the non-profit corporation created its own health care system and placed study subjects into different insurance systems. The experiment did not make at-risk and poor people better off with subsidized health care, he said.

“When you don’t have to pay the costs for things you want, people tend to overpay and overuse,” Johnson said. 

Private insurance pays more for pharmaceuticals, and so a single-payer plan would stifle investment for innovations in vaccines and medicines. Government health care would be run capriciously, he added.

Johnson pointed to universal care failures, citing Massachusetts (then-Republican Gov. Romney’s program, which President Obama used as a model for the ACA) and Tennessee, as well as England (“22 weeks for any specialized health care,” and they “rely on health tourists to pay”) and Canada, which underpays doctors and thus must bring in foreign medical personnel.

From the audience, Marisa Cooper asked about Rand Health Experiment co-morbidity differences between poor and middle-class study groups in the Rand experiment, and of patient non-compliance affecting the data.

“I believe they looked at a number of co-morbidities,” Johnson replied. He noted two slight improvements regarding patient anxiety and lower cases of rare diseases. "Other than that, no differences in co-morbidities" were reported. “I don’t see how (universal) health care would affect compliance,” he added.

Brent Thomas, also in the Zoom audience, asked whether subsidies for private insurance would work in the U.S.

“It is possible and would be less-bad than universal health care but would be less good than” the free market, Johnson responded. “Obamacare attempted to do this (middle-ground subsidies),” but was unsuccessful, he added.

“It boils down to a social contract,” the second negative, Luke Nathan Phillips, a Braver Angels staffer, said. “Do Americans deserve to have the same standard of services? Most conservatives and libertarians would say ‘yes.’” 

Universal care is “welfare-state insurance” Phillips says, while what we’ve got now is “welfare individualism” (the ACA) and “welfare capitalism” (employer provided insurance). A better alternative to welfare-state insurance, he said, would be “expansion of incentives and pressure on the American business community to provide better packages.” 

But Phillips concedes there is a divide between the middle-class and working class, the latter is less likely to have employer-supplied health care, and that issue needs to be addressed.

The next negative debater, Greta Wagley, of the Association of the American Council of Trustees and Alumni (ACTA), has a much-different point-of-view.

“Health care is not a human right,” Wagley said. “The government doesn’t buy me a gun or give me land.” The difference in these rights is between “needs” and “wants,” and if she comes across, say, a woman in need on the street, “I reach into my pocket and help her myself,” or take her to a church or get her a GoFundMe account. 

“As long as people disagree whether health care is a right, it is immoral to consider a universal health care system,” she said, arguing that there are some medical procedures to which she is morally opposed.

The previous negative, Luke Nathan Phillips, asked Wagley whether a taxpayer who opposes government-funded road construction can make the same argument.

“There is no moral equivalent between taxpayers paying for roads, and paying for abortions and assisted suicides,” she replied.

“I pay for my own health care insurance; I think it’s a good thing to pay for,” she concluded. “President Trump reduced a lot of regulations (from the ACA). I think that’s a good thing.”

Fellow negative Connor Murnane, also of ACTA, had a much different take on the “rights” issue.

“Health care is a right, but a right in the sense that free speech or education is a right. … There are far too many dangerous consequences to universal coverage, including government mandating specific treatments.” He noted that tech companies already have launched programs that reduce costs and operate outside the insurance system, citing smartphone/video medical provider Teledoc. “The government must not infringe on a citizen’s right to choose.” (While universal care might, like the ACA, let insured Americans keep their insurance, it is less likely the government would consider something like Teledoc a valid alternative.)

Affirmative Logan Carlile asked how a citizen with no money can fulfill his or her right to health care.

“It is not the government’s responsibility, but for those in need, there are safety nets in place,” Murnane replied.