Rookie Policy Evidence Set - Aff

Rookie Policy RULES:

1.       Rookies may only use evidence provided in this set at the Fullerton College Classic. Rookies using any evidence not found in this set will receive a loss and 0 speaker points for the round.

2.       All Affirmatives must read the Plan as listed in the Affirmative Evidence Set.

Debate Round Speech Times:

1^st Affirmative Constructive – 5 minutes

                Cross-Examination of the 1^st Affirmative by the Negative – 3 minutes

1^st Negative Constructive – 5 minutes

                Cross-Examination of the 1^st Negative by the Affirmative – 3 minutes

2^nd Affirmative Constructive – 5 minutes

                Cross-Examination of the 2^nd Affirmative by the Negative – 3 minutes

2^nd Negative Constructive – 5 minutes

                Cross-Examination of the 2^nd Negative by the Affirmative – 3 minutes

1^st Negative Rebuttal – 3 minutes

1^st Affirmative Rebuttal – 3 minutes

2^nd Negative Rebuttal – 3 minutes

2^nd Affirmative Rebuttal – 3 minutes

**Each team gets 5 minutes of prep time to use over the course of the round.

Shout out to the Arizona Debate Institute and NCC for making evidence accessible to many people. You are the real champs!

Dear Debaters,

Build your own 1^st Affirmative Constructive using: 1. The Plan, 2. Advantage(s), 3. Solvency Research. Make sure you have at least one of each!

Love,

Fullerton College Speech & Debate

Mandatory Plan Text: The United States Federal Government should implement a National Health Insurance policy modeled off the Expanded and Improved Medicare for All Act.

Inherent Barrier

Even if Obamacare survives, it has massive problems

Gaffney, MD et. al. 2016 [Adam Gaffney MD et. al., Steffie WoolhandlerMD, MPH, Marcia AngellMD, and David U. HimmelsteinMD, 2016, “Moving Forward From the Affordable Care Act to a Single-Payer System”, American Journal of Public Health 106(6) pp.987-988 available online at http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.303157 accessed 7/2/17 TOG *NDCC WAVE ONE*]

But was that the message? There’s reason for skepticism. A decade from now, according to the Congressional Budget Office, 27 million Americans will remain uninsured despite full implementation of the law. Many more are underinsured or constrained by “narrow networks” of providers that limit choice and rupture longstanding therapeutic relationships. Doctors and nurses contend with growing requirements for mind-numbing electronic documentation1b in a health care marketplace increasingly tilted toward giant insurers and hospital conglomerates that amass power through consolidation. Finally, the system’s administrative complexity, which robs patients and providers of time, money, and morale, was further fueled by the ACA.

Gaps in the ACA leave many people uninsured; we need universal health care

Gaffney, Fellow in Pulmonary and Critical Care at Massachusetts General, 2016 (Adam, “Is the Path to Racial Health Equity Paved with “Reparations”? The Politics of Health, Part II”, Los Angeles Review of Books, https://lareviewofbooks.org/article/is-the-path-to-racial-health-equity-paved-with-reparations-the-politics-of-health-part-ii/#!, DoA 8/19/2017, DVOG, *NDCC WAVE ONE*)

Tweedy, for instance, sees firsthand the harm inflicted on the uninsured when he works at the rural health clinic described earlier. But, even so, like Matthew, he gives insufficient attention in his book to the fact that, even with the reforms of the Affordable Care Act, we will continue to lack universal health care.[22] For instance, under current reforms, 27 million are expected to remain uninsured 10 years from now, according to an approximation of the Congressional Budget Office. We know that Hispanics and blacks are disproportionately represented among the uninsured.[23] Covering these excluded millions seems critical. Moreover, neither author discusses the fact that the US health care system imposes substantial financial burdens at the “point of use,” in the form of copayments, deductibles, and co-insurance for medical care, which may deter care for those who need it. Some have legitimately suggested that these forms of cost-sharing disproportionately harm minorities, who have lower median income and net wealth.[24] In other words, the potential harm of, say, a $2,000 medical deductible is dependent on your income and assets: those with fewer resources may lose out on important health care. And finally, though Tweedy refers to the shortcomings of Medicaid, neither he nor Matthew emphasizes that a health care system with a separate tier of access for the poor may be inherently unequal.

Advantage: Health

Diseases are a continuing and increasing threat

Tappero, MD Division of Global Health Protection Atlanta, GA, et. al. 2015 [Jordan W Tappero, MD Division of Global Health Protection Atlanta, GA, et. al., Mathew J Thomas, MPH Division of Global Health Protection, Thomas A Kenyon, MD Center for Global Health and Thomas R Frieden, MD Center for Disease control, “Global health security agenda: building resilient public health systems to stop infectious disease threats” section of “Global health security: the wider lessons from the west African Ebola virus disease epidemic”  Heymann, David L et al., The Lancet , Volume 385 , Issue 9980 , 1884 – 190, May 9, 2015 available at: http://dx.doi.org/10.1016/S0140-6736(15)60858-3 accessed 7/30/17 TOG *NDCC WAVE ONE*]

The Ebola epidemic has shown how connected we are as a global community; we are only as safe as the most fragile states. Ebola will not be the last infectious disease threat that we face—other recent examples include HIV, Middle East respiratory syndrome coronavirus, H1N1 influenza, and SARS. Population growth, encroachment on previously sparsely populated areas in Africa, Asia, and elsewhere, civil unrest and conflict, natural disasters, and the increasing density of urban areas in the developing world are being amplified in many of the most vulnerable corners of the world; the frequency of outbreaks and epidemics might well increase.45, 46 Thus, we can expect infectious diseases to continue to emerge and re-emerge unpredictably in places where we are not looking—or simply cannot see because of lack of adequate, resilient public health surveillance systems and infrastructure.

Disease is inextricably tied to poverty and disproportionately affects marginalized populations

Rees 15 (Anna, citing Global Report for Research on Infectious Diseases of Poverty, "Diseases and the Links to Poverty", 1/15, Accessed 7/8/16, https://en.reset.org/knowledge/diseases-and-links-poverty)//SN *NDCC WAVE ONE*)

Poverty and disease are stuck in an ongoing, vicious relationship. One goes a long way towards intensifying the other with studies demonstrating that infection rates of certain diseases are highest in regions where poverty is rife.

According to the World Bank, an estimated 1.2 billion live in extreme poverty (defined as those who live on less than 1,25 USD per day) worldwide. Running parallel to statistics about global poverty are statistics about infectious diseases. Terms such as “neglected tropical diseases” and “infectious diseases of poverty” are employed to define a number of infectious diseases more commonly found in areas where poverty is high. This list includes widely recognised diseases such as HIV/AIDS, malaria and tuberculosis as well as lesser-known ailments such as dengue, chagas disease and foodborne trematode infections.

The relationship between poverty and diseases is emphatically intertwined however we paint with too broad a brush when we generalise that infection rates go down as poverty declines. This trend is not a given and spikes in infection rates do occur when disastrous events take place such as natural disasters or the outbreak of conflict.

The Chicken and the Egg

A common train of thought is that poverty is a driving force behind poor health and disease. While certainly not disputable, that fact reflects only one side of the argument and does not take into account the nuanced links between poverty and health. The fact of the matter is that the relationship between poverty and health is inextricably linked, presenting a chicken-an-egg situation where one seemingly exists, in part, because of the other.

The Global Report for Research on Infectious Diseases of Poverty (put together by the European Commission, the World Health Organization and TDR) offers a clear rationale of this relationship “Poverty creates conditions that favour the spread of infectious diseases and prevents affected populations from obtaining adequate access to prevention and care. Ultimately, these diseases...disproportionately affect people living in poor or marginalised communities. Social, economic and biological factors interact to drive a vicious cycle of poverty and disease from which, for many people, there is no escape.” 

Single Payer would save 18,000 lives per year

Woolhandler, MD, MPH and Himmelstein, MD, professors CUNY School of Public Health, 2017 [David Himmelstein and Steffie Woolhandler, founders of Physicians for a National Health Program, “Lack of Insurance is Deadly Single Payer Saves Lives”, Single Payer Action, June 27, 2017, available at: https://www.singlepayeraction.org/2017/06/27/lack-of-insurance-is-deadly-single-payer-saves-lives/ accessed 7/29/17 TOG *NDCC WAVE ONE*]

That’s according to a comprehensive review of studies published today in the Annals of Internal Medicine.

The review updated a 2002 study conducted by the Institute of Medicine (IOM – now called the National Academy of Medicine) that concluded that 18,000 persons died each year from lack of health insurance.\

The authors carried out an intensive search for all research examining whether health insurance coverage affects overall mortality among adults age 18-64.

They found that multiple studies published since the completion of the IOM study have confirmed that insurance lowers mortality.

They cite consistent findings from a randomized trial carried out in Oregon, as well as multiple quasi-experimental and observational studies.

The studies indicate that insurance decreases the odds of dying among adults by at least 3% and as much as 29%.

Advantage: Medical Debt

Repeal of the ACA threatens 32 million people with serious medical debt.

Michelle Andrews, Jan 24, 2017, NPR, “Medical Debt Is Top Reason Consumers Hear From Collection Agencies”, http://www.npr.org/sections/health-shots/2017/01/24/511269991/medical-debt-is-top-reason-consumers-hear-from-collection-agencies

The proportion of families that said they were having trouble paying their medical bills declined between September 2013, before the health law's insurance marketplaces opened in 2014, and March 2015, according to an analysis by the Urban Institute. The study found that the percentage of families that had problems paying medical bills declined from 22 percent in 2013 to 17.3 percent in 2015. Being uninsured, having a low income and enrolling in a high-deductible plan each increased the odds of having trouble paying medical bills, the study found.

Republicans have vowed to press ahead with plans to repeal the Affordable Care Act, but since they don't have enough votes in the Senate to get a full repeal through, they are initially focusing on specific provisions that can be undone by a simple majority vote during the budget process. The nonpartisan Congressional Budget Office reported Jan. 17 that under a Republican plan last year to partially repeal the law 18 million people would become uninsured in the first year, rising to 32 million in 2026.

"Because more people would be uninsured, they'd be exposed to the full cost of their care and you'd very likely see the number of people who are carrying medical debt increase," said Sara Collins, vice president of health care coverage and access at the Commonwealth Fund, whose biennial insurance surveys examine issues of medical debt and underinsurance.

Medical debt encourages people to not get care they need and crushes our credit scores

Michelle Andrews, Jan 24, 2017, NPR, “Medical Debt Is Top Reason Consumers Hear From Collection Agencies”, http://www.npr.org/sections/health-shots/2017/01/24/511269991/medical-debt-is-top-reason-consumers-hear-from-collection-agencies

A recently released report says medical debt is the No. 1 reason consumers reported being contacted by a collection agency. If efforts to overhaul the Affordable Care Act result in more people losing their coverage, those numbers could rise.

The study by the federal Consumer Financial Protection Bureau found that 59 percent of people who reported they had been contacted by a debt collector said it was for medical services. Telecommunications bills were the second most common type of overdue bill for which debt collectors pursued payment, at 37 percent, and utilities were third, reported by 28 percent.

Unlike other types of debt, people with medical debt were prevalent across a range of income levels, credit scores and ages. A poll conducted in 2015 by NPR, The Robert Wood Johnson Foundation and Harvard's T.H. Chan School of Public Health found that many people with health insurance still struggle to pay medical bills. Some 26 percent said health care expenses have taken a serious toll on family finances.

The CFPB's survey sample was drawn from the agency's consumer credit panel, a random sample of credit records from one of the three major credit reporting agencies. Conducted between December 2014 and March 2015, the survey asked respondents about their experiences over the past year with debt collectors.

Having medical debt turned over to collections can be a double whammy. "It's not just that people may be reluctant to go for care because of the debt they might incur," said Mark Rukavina, a Boston-based health care consultant whose work has focused on affordability and medical debt. "It might also ruin their credit." Having a medical bill in collection can substantially reduce consumers' credit scores, Rukavina said.

The risk of Bankruptcy is very high

David U. Himmelstein, MD, Deborah Thorne, PhD, Elizabeth Warren, JD, & Steffie Woolhandler, MD, 2009, The American Journal of Medicine, “Medical Bankruptcy in the United States, 2007: Results of a National Study”, p. 4-5

Since 2001, the proportion of all bankruptcies attributable to medical problems has increased by 50%. Nearly two thirds of all bankruptcies are now linked to illness. How did medical problems propel so many middle-class, insured Americans toward bankruptcy? For 92% of the medically bankrupt, high medical bills directly contributed to their bankruptcy. Many families with continuous coverage found themselves under-insured, responsible for thousands of dollars in out-of-pocket costs. Others had private coverage but lost it when they became too sick to work. Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another quarter do so within a year. Income loss due to illness also was common, but nearly always coupled with high medical bills. The present study and our 2001 analysis provide the only data on large cohorts of bankruptcy filers derived from in-depth surveys. As with any survey, we depend on respondents’ candor. However, we also had independent checks— from court records filed under penalty of perjury— on many responses. Because questionnaires and court records were available for our entire sample, we used them for most calculations. The lowest plausible estimate of the medical bankruptcy rate from these sources is 44.4%—the proportion who directly said that either illness or medical bills were a reason for bankruptcy. But many others gave reasons such as “aggressive collection efforts” or “lost income due to illness” and had large medical debts. Indeed, detailed telephone interview data available for 1032 debtors revealed an even higher rate of medical bankruptcy than our 62.1% estimate—at least 68.8% of all filers.

The financial stress is literally making us sick

Christopher Brown & Lisa Robinson, 2016, Policy Link, “Breaking the Cycle: From Poverty to Financial Security for All”, p. 12

In addition to the adverse impact that poor health has on financial insecurity, research indicates that financial insecurity itself has a direct negative impact on physical and mental health. According to a 2012 study by the American Psychological Association, the majority of Americans experience multiple causes of stress related to financial security: money (69 percent), work (65 percent), and the economy (61 percent) were the most frequently cited stressors. An Associated Press-AOL health poll found that among the people reporting high debt stress, 27 percent had ulcers or digestive-tract problems, compared with 8 percent of those with low levels of debt stress, and 29 percent suffered severe anxiety, compared with 4 percent of those with low debt stress. Lower-income communities of color continue to face systemic barriers to optimal health. Sub-optimal health, in turn, is exacerbated by financial insecurity, which takes a toll on physical and emotional well-being, as well as financial resources.

Single Payer solves the stress of medical debt

Caruso, Himmelstein, and Woolhandler, writing for the Harvard Public Health Review, 2015 (Dominic, David, and Steffie, MDs, July, “Single-Payer Health Reform: A Step Toward Reducing Structural Racism in Health Care”, http://harvardpublichealthreview.org/single-payer-health-reform-a-step-toward-reducing-structural-racism-in-health-care/, DoA 8/19/2017)

High cost-sharing particularly impacts minority families, whose average incomes are far lower than those of non-Hispanic whites. Yet even figures on income disparities understate minorities’ disadvantage when confronted with high out-of-pocket costs. With medical bills often reaching into the thousands for even routine care such as childbirth and appendectomy, many families must tap savings or other assets like housing equity, and racial/ethnic disparities in assets dwarf the differences in income. ¹⁴ African American and Hispanic median household income was 58 percent and 70 percent, respectively, that of non-Hispanic whites in 2011.¹⁵  In contrast, the median net worth of black and Hispanic householders was $6,314 and $7,683, respectively, vs. $110,500 for non-Hispanic whites, a 15-fold difference.¹⁶ Hence, the average family deductibles for bronze and silver plans would bring financial ruin to most African American and Hispanic households. Even the lower cost-sharing now increasingly common under Medicaid may be prohibitive for poor families, many of whom have zero or negative net worth.

The ACA’s drafters erred in relying on private, for-profit insurers to fund health care. Health insurance’s social purpose is to pay for care in order to promote access to health services and prevent financial hardship. For-profit insurers’ purpose is to maximize shareholders’ profits, a goal that provides strong incentives to maximize premiums and minimize the health care they pay for. Historically, this incentive led to such practices as denying coverage for pre-existing conditions and canceling policies for expensive enrollees. Although the ACA prohibits these tactics, recent evidence indicates that insurers are finding ways to subvert these regulations, e.g. through tiered pharmacy benefits that discriminate against enrollees with potentially expensive illnesses such as HIV, Parkinson’s, seizures, psychosis and diabetes. ¹⁷¹⁸

The persistence of our corrupt and irrational insurance system may stem in part from the way Americans (and particularly health professional students) are taught to think about health care. In a recent conversation with a Canadian student at Harvard’s school of public health, he expressed surprise that many of his U.S. classmates perceive health care interactions as business transactions, and reflected that Canadians, who have a publicly-funded universal coverage system, view health care as a fundamental right to be provided for all.

Should we in the U.S. continue to treat health care as a commodity distributed according to financial ability, or shift to a financing system that assures it as a right equally available to all without regard to income, health status, race or ethnicity? While market theorists might claim that a commodity-based approach to care breeds efficiency, facts on the ground argue otherwise. At present, we have the world’s highest per-capita health care expenditures, yet tens of millions remain un- and under-insured, and our health outcomes trail most other wealthy nations.^[9]192021

This isn’t just an indication of failed policy, it’s a national embarrassment. We have the resources to provide everyone in the U.S. with access to health care. And Canada provides a working model for how to put those resources to good use: a public, single-payer, national health insurance program, similar to an expanded and improved Medicare for all.

In our view a national single-payer health insurance program offers the best possibility for equitable financing of U.S. health care. It would eliminate the motive to deny needed care or discriminate against the expensively ill for the sake of profit. A national public insurance system would provide coverage based on residence in the U.S., not employment status, income level or ability to pay, as in the current regime. A program that abolished co-payments and deductibles would level the playing field for minorities and the poor who generally lack the assets to surmount these barriers.²²

A single-payer system would also offer economic benefits. A federally-run financing system would have far lower administrative costs than private insurance, as the Medicare program consistently demonstrates. A universal public model would lift a significant financial burden from businesses that currently fund health insurance for their employees. Finally, a single-payer program would largely eliminate the financial burden of illness, a leading cause of bankruptcy and debts sent to collection.^[19].23

Perhaps most importantly, a single-payer system would make a clear statement that health care is a human right. This framework recognizes health care as a universal necessity, not a commodity reserved for those lucky enough to have won the economic lottery, and most definitely not a scheme for denial and discrimination. While implementing a single-payer insurance program will not solve all of our nation’s health, racial or social inequities, it is clearly a step in that direction.

Advantage: US Leadership

Attempts by President Trump and Congressional GOP leadership to repeal Obamacare have destroyed our human rights leadership—they resulted in a warning from the UN that successful attempts would violate international law and put us in conflict with our international human rights treaty obligations.

Milbank, Washington Post Political Commentator and author, 2017 (Dana, “Apparently repealing Obamacare could violate international law”, Washington Post, April 25, https://www.washingtonpost.com/opinions/apparently-repealing-obamacare-could-violate-international-law/2017/04/25/2794a77c-29f4-11e7-b605-33413c691853_story.html?utm_term=.0ad8959a6874, DOA 7/29/2017, DVOG, *NDCC WAVE ONE*)

We’ve already seen that repealing Obamacare is politically perilous. Now there’s a new complication: It may also violate international law.

The United Nations has contacted the Trump administration as part of an investigation into whether repealing the Affordable Care Act without an adequate substitute for the millions who would lose health coverage would be a violation of several international conventions that bind the United States. It turns out that the notion that “health care is a right” is more than just a Democratic talking point.

A confidential, five-page “urgent appeal” from the Office of the U.N. High Commissioner on Human Rights in Geneva, sent to the Trump administration, cautions that the repeal of the Affordable Care Act could put the United States at odds with its international obligations. The Feb. 2 memo, which I obtained Tuesday, was sent to the State Department and expresses “serious concern” about the prospective loss of health coverage for almost 30 million people, which could violate “the right to social security of the people in the United States.”

The letter urges that “all necessary interim measures be taken to prevent the alleged violations” and asks that, if the “allegations” proved correct, there be “adequate measure to prevent their occurrence as well as to guarantee the accountability of any person responsible.”

OHCHR requested that copies of the letter be shared with majority and minority leadership in both chambers of Congress and proposed that “the wider public should be alerted to the potential implications of the above-mentioned allegations.”

Apparently that didn’t happen. House Minority Leader Nancy Pelosi’s office and Senate Minority Leader Charles E. Schumer’s office said they didn’t receive the letter, and officials in House Speaker Paul D. Ryan’s and Senate Majority Leader Mitch McConnell’s offices said Tuesday that they were unaware of it. The letter did make its way to the Department of Health and Human Services, where an employee leaked it to congressional Democratic leadership. A State Department spokesman said my inquiry was “the first I’m hearing of this.”

A spokesman for the U.N.’s human rights office in Geneva confirmed the authenticity of the letter, which was sent by Dainius Puras, a Lithuanian doctor who serves the United Nations under the absurdly long title “Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”

The spokesman, Xabier Celaya, said Puras cannot comment on his Obamacare inquiry until it becomes public at the next session of the Human Rights Council in June.

None of this, of course, will deter President Trump and congressional Republicans, who are again attempting to get a repeal bill through the House. They scoff at lectures from U.N. bureaucrats, particularly on domestic affairs, and the world body has no practical way to impose its will on Congress. There’s also a logical question: If repealing Obamacare violates international law, wasn’t the country in violation before Obamacare? Puras addresses this by writing that the U.N. Committee on Economic, Social and Cultural Rights “notes that there is a strong presumption that retrogressive measures taken in relation to the right to health are not permissible.”

Though of questionable legal value, the U.N. letter is at least a bit of moral support for those defending Obamacare. Those attempting to deny health care to tens of millions of Americans would hurt their own constituents in a way that falls short of the standards we hold for ourselves and other countries.

Specifically, Puras writes that Article 25 of the Universal Declaration of Human Rights “establishes everyone’s right to a standard of living adequate for the health and well-being, including food, medical care and necessary social services.” He notes that Article 5(e) of the International Convention on the Elimination of All Forms of Racial Discrimination, ratified by the United States in 1994, calls on states to “guarantee the right of everyone,” including “the rights to public health, medical care, social security and social services” without regard to race or color.

The special rapporteur also cites Article 12 of the International Covenant on Economic, Social and Cultural Rights, under which states have “the core obligation to ensure the right of access to health facilities, goods and services on a non-discriminatory basis, especially for vulnerable or marginalized groups.” The agreement was signed but not ratified by the United States, which is still “obliged to refrain from acts that would defeat the covenant’s object or purpose, in conformity with Article 18 of the Vienna Convention on the Law of Treaties.”

The Trump administration has shown its contempt for such considerations by failing to pass along the U.N. letter to congressional leaders. But you don’t have to care about international law to know that the essence of the OHCHR criticism is true: Taking away health coverage from millions without an adequate replacement is abject cruelty.

Plan restores credibility—it aligns us with international treaty obligations that require us to adopt measures aimed at universal access to health care. 

Yamin, Georgetown Law Professor, 2005 (Alicia Ely, Visiting Professor of Law at Georgetown University Law Center and the Program Director of the Health and Human Rights Initiative, Adjunct lecturer on Law and Global Health at the Harvard TH Chan School of Public Health, Global Fellow at the Center on Law and Social Transformation in Norway, “The Right to Health Under International Law and Its Relevance to the United States”, American Journal of Public Health, Am J Public Health. 2005 July; 95(7): 1156–1161., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449334/, DOA 7/29/2017, DVOG, *NDCC WAVE 1*)

Since the end of the Cold War, the interdependence and indivisibility of economic, social, and cultural rights and civil and political rights has been broadly accepted.20 Further, there is now widespread agreement that the right to health entails both negative freedoms (e.g., from nonconsensual medical treatment and experimentation) and positive freedoms or entitlements (e.g., access to care).1 Under international law, states that are party to a variety of different treaties assume tripartite obligations: (1) to respect the right to health by refraining from direct violations, such as systemic discrimination within the health system; (2) to protect the right from interference by third parties, through such measures as environmental regulation of third parties; and (3) to fulfill the right by adopting deliberate measures aimed at achieving universal access to care, as well as to preconditions for health.1^,10 Thus, it is wrong to think of the right to health in terms of a package of services, even a package extending beyond medical care.

Realization of the right to health further implies providing individuals and communities with an authentic voice in decisions defining, determining, and affecting their well-being.1^,19 Public health has a long tradition of recognizing that participation is integral to health promotion.21 Further, analyses of the importance of structural determinants of health and political economic context are increasingly common.3^–6^,22^–25 Framing health as a right adds to the growing literature in social epidemiology that links health with social justice; it does this by first making explicit the link between health and the construction of a functional democracy. That is, health-related resource distribution, evidence of discrimination and disparities, and the like are analyzed not just in terms of their impact on health status but also their relation to laws, policies, and practices that limit popular participation in decisionmaking and, in turn, the establishment of a genuinely democratic society.2^,6^,26

Second, failure to respect, protect, or fulfill responsibilities relating to health are construed not only in terms of ensuing social or economic problems, but also explicitly in terms of the accountability of the state and, to a certain extent, other actors, under national and international law.1^,6^,10^–12^,26 Thus, a human rights framework simultaneously acknowledges health as inherently political—intimately bound up with social context, ideologies, and power structures—and removes health policy decisions from being matters of pure political discretion by placing them squarely into the domain of law.

As with all international human rights, implementation and enforcement of the right to health critically depend on legislative and judicial action at the national level. More than 70 national constitutions recognize the right to health, and far more countries legislate various aspects of the right to health.11Further, recent clarification of normative obligations has permitted greater attention to be devoted to potential violations of the right to health by treaty-monitoring committees in their “concluding observations”—or judgments on states’ compliance—as well as enforcement by quasi-judicial international institutions and national courts in specific cases.27^–32

Domestic courts and regional bodies that have addressed the question have generally agreed on what minimal standards governments can be required to meet. First, states have an obligation not to adopt retrogressive measures. For example, if a state administers a program to provide antiretroviral drugs, backsliding because of budgetary difficulties is impermissible.33^,34 Second, health policies and programs must not be discriminatory.33^–35 Third, states must undertake efforts to regulate the conduct of third parties that are interfering with the right to health, such as environmental polluters.36 Fourth, governments can be required to develop national policies and plans of action to respond to health concerns.37

US international leadership has stabilized the world and guaranteed freedom and rights to millions worldwide since the end of World War 2—continued leadership is key to global survival.

Daalder and Kagan, 2016 (Ivo Daalder, U.S. ambassador to NATO from 2009 to 2013, is president of the Chicago Council on Global Affairs. Robert Kagan is a senior fellow at the Brookings Institution. April 22, https://www.washingtonpost.com/opinions/the-us-cant-afford-to-end-its-global-leadership-role/2016/04/22/da297be0-062a-11e6-b283-e79d81c63c1b_story.html?utm_term=.5f4864e124a1, DVOG)

The economic, political and security strategy that the United States has pursued for more than seven decades, under Democratic and Republican administrations alike, is today widely questioned by large segments of the American public and is under attack by leading political candidates in both parties. Many Americans no longer seem to value the liberal international order that the United States created after World War II and sustained throughout the Cold War and beyond. Or perhaps they take it for granted and have lost sight of the essential role the United States plays in supporting the international environment from which they benefit greatly. The unprecedented prosperity made possible by free and open markets and thriving international trade; the spread of democracy; and the avoidance of major conflict among great powers: All these remarkable accomplishments have depended on sustained U.S. engagement around the world. Yet politicians in both parties dangle before the public the vision of an America freed from the burdens of leadership.

What these politicians don’t say, perhaps because they don’t understand it themselves, is that the price of ending our engagement would far outweigh its costs. The international order created by the United States today faces challenges greater than at any time since the height of the Cold War. Rising authoritarian powers in Asia and Europe threaten to undermine the security structures that have kept the peace since World War II. Russia invaded Ukraine and has seized some of its territory. In East Asia, an increasingly aggressive China seeks to control the sea lanes through which a large share of global commerce flows. In the Middle East, Iran pursues hegemony by supporting Hezbollah and Hamas and the bloody tyranny in Syria. The Islamic State controls more territory than any terrorist group in history, brutally imposing its extreme vision of Islam and striking at targets throughout the Middle East, North Africa and Europe.

None of these threats will simply go away. Nor will the United States be spared if the international order collapses, as it did twice in the 20th century. In the 21st century, oceans provide no security. Nor do walls along borders. Nor would cutting off the United States from the international economy by trashing trade agreements and erecting barriers to commerce.

Instead of following the irresponsible counsel of demagogues, we need to restore a bipartisan foreign policy consensus around renewing U.S. global leadership. Despite predictions of a “post-American world,” U.S. capacities remain considerable. The U.S. economy remains the most dynamic in the world. The widely touted “rise of the rest” — the idea that the United States was being overtaken by the economies of Brazil, Russia, India and China — has proved to be a myth. The dollar remains the world’s reserve currency, and people across the globe seek U.S. investment and entrepreneurial skills to help their flagging economies. U.S. institutions of higher learning remain the world’s best and attract students from every corner of the globe. The political values that the United States stands for remain potent forces for change. Even at a time of resurgent autocracy, popular demands for greater freedom can be heard in Russia, China, Iran and elsewhere, and those peoples look to the United States for support, both moral and material. And our strategic position remains strong. The United States has more than 50 allies and partners around the world. Russia and China between them have no more than a handful.

For instance, one prime task today is to strengthen the international economy, from which the American people derive so many benefits. This means passing trade agreements that strengthen ties between the United States and the vast economies of East Asia and Europe. Contrary to what demagogues in both parties claim, ordinary Americans stand to gain significantly from the recently negotiated Trans-Pacific Partnership. According to the Peterson Institute for International Economics, the agreement will increase annual real incomes in the United States by $131 billion. The United States also needs to work to reform existing international institutions, such as the International Monetary Fund, so that rising economic powers such as China feel a greater stake in them, while also working with new institutions such as the Asian Infrastructure Investment Bank to ensure that they reinforce rather than undermine liberal economic norms.

The revolution in energy, which has made the United States one of the world’s leading suppliers, offers another powerful advantage. With the right mix of policies, the United States could help allies in Europe and Asia diversify their sources of supply and thus reduce their vulnerability to Russian manipulation. Nations such as Russia and Iran that rely heavily on hydrocarbon exports would be weakened, as would the OPEC oil cartel. The overall result would be a relative increase in our power and ability to sustain the order.

The world has come to recognize that education, creativity and innovation are key to prosperity, and most see the United States as a leader in these areas. Other nations want access to the American market, American finance and American innovation. Businesspeople around the world seek to build up their own Silicon Valleys and other U.S.-style centers of entrepreneurship. The U.S. government can do a better job of working with the private sector in collaborating with developing countries. And Americans need to be more, not less, welcoming to immigrants. Students studying at our world-class universities, entrepreneurs innovating in our high-tech incubators and immigrants searching for new opportunities for their families strengthen the United States and show the world the opportunities offered by democracy.

Finally, the United States needs to do more to reassure allies that it will be there to back them up if they face aggression. Would-be adversaries need to know that they would do better by integrating themselves into the present international order than by trying to undermine it. Accomplishing this, however, requires ending budget sequestration and increasing spending on defense and on all the other tools of international affairs. This investment would be more than paid for by the global security it would provide.

All these efforts are interrelated, and, indeed, a key task for responsible political leaders will be to show how the pieces fit together: how trade enhances security, how military power undergirds prosperity and how providing access to American education strengthens the forces dedicated to a more open and freer world.

Above all, Americans need to be reminded what is at stake. Many millions around the world have benefited from an international order that has raised standards of living, opened political systems and preserved the general peace. But no nation and no people have benefited more than Americans. And no nation has a greater role to play in preserving this system for future generations.

Answer To: Pharmaceutical Innovation Disadvantage

Industry consolidation is crushing innovation right now!

Fassbender, 16-- Melissa Fassbender, writer, Outsourcing-Pharma, October 2016, "Is industry consolidation stifling pharma innovation?," http://www.outsourcing-pharma.com/Preclinical-Research/Is-industry-consolidation-stifling-pharma-innovation, NCC Packet Draft

In a year of “merger mania,” researchers suggest the elimination of competition is reducing innovation in the pharmaceutical industry.

Earlier this year, PwC told us that this so-called “merger mania” could leave strategic contract research organizations (CROs) vulnerable in 2016. In fact, mergers topped the research institute’s annual list of top health industry issues.

“Over the past couple years we’ve seen a tremendous amount of acquisition,” said James Prutow, advisory partner, PcW. And as M&A increases, researchers at the Düsseldorf Institute for Competition Economics (DICE), Germany, Joel Stiebale and Justus Haucap, suggest innovation does the opposite.

According to the researchers, within the sample of pharmaceutical companies, innovation activities – which were measured by patents and R&D expenditures – decline substantially, both for the merged entity and among its non-merging competitors after M&As.

“While a reduction in innovation of merging firms could in principle be due to efficient elimination of duplicated R&D, our results for competitors indicate that innovation declines due to a reduction of competition induced by mergers,” Stiebale told us.

For the researchers, these results raise concerns about the negative consequences for patients in the long run, given the rate of M&A in the industry.

Corporations are a barrier to innovation

Fran Quigley, Feb 9, 2016, Counterpunch, “How Corporations Killed Medicine”, https://www.counterpunch.org/2016/02/09/how-corporations-killed-medicine/

When corporations do develop a new drug, it more than likely doesn’t provide much value to society. Remarkably, a full 70 percent of the medicine brought to market by the industry in the past 20 years provided no therapeutic benefit over the products already available. Instead, these “me too” drugs were put forward in order to grab a share of an existing lucrative market.

The inefficiency of the enclosed medicine is paired with the creation of real barriers to medicine innovation across the board. By definition, a reward system based on artificial exclusivity will wall off knowledge from being shared. For-profit pharmaceutical corporations are known for discouraging innovations by creating voluminous “packet thickets” and seeking extended protection for their monopolies in a process known as “evergreening” their patents.

Answer To: Economy Disadvantage

Plan would give money back to consumers

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