Eric and I negate,

Contention 1: Pharmaceutical Drugs

Subpoint A: The Developing World

Summers ‘09 tells us that Research and development is a critical component to the
pharmaceutical industry and explains it as the driving force behind the development of new
health-enhancing and life-saving drugs. Lichtenberg ‘19 finds that for the past 32 years, new
drugs that have gone into the pharmaceutical market have saved 276 million life-years, which
when accounting for the average life expectancy sums up to be approximately 93,000 lives
saved per year. However, Francis ‘05 finds that cutting drug prices in the U.S. will lead to up to
60% fewer research and development projects taken underway, leading to a steep increase in
lives that are lost. Further, Toy ‘19 finds that with the enactment of M4A, drug manufacturers
would have to pare prices down because the government would have substantial negotiating
power, reducing drug prices by at least 30%. However, Filson 07 finds that if there is a reduction
in profit, the flow of new medications would decrease by 75% nationwide.

The impact is lives

Mello ‘18 writes that currently because of the high prices in America, companies are willing to
sell already existing drugs at a lower cost in developing nations. However, Mello concludes that
by implementing price controls, medicare for all would significantly cut profits for companies in
America, forcing them to hike prices elsewhere, preventing people in the developing world to
receive necessary treatment. Critically, according to Zarocostas ‘07 when improving the access
and quality to existing medicines that reach those countries, 10 million lives could be saved
each year. Therefore, with the price cuts to drugs and development that come with enacting
M4A, the U.S. paints a grim future for the developing world.

Subpoint B: Vaccine Investment

Stossel ‘20 finds that more than 80% of innovative drug approvals originate from work solely
performed by small pharma companies. However, according to Schaht 11 only 5% of small
pharma have sales meaning the remaining 95% rely on equity capital from investors as venture
capital firms supply nearly all of the capital for early-stage biotech companies. Therefore,
investment in these companies is the principal engine for advancement towards innovating the
market against emerging diseases. This becomes problematic because we drag prices down
with M4A. Easton ‘18 confirms that value creation opportunities will decline and the appetite for
venture capitalists will become low causing biopharmaceutical investment to shrink. He confirms
that with that trajectory, 100% of the drugs produced within the next 10 years would be generic,
crippling the country’s ability to produce critical medicines towards diseases that are bound to
arise and those that affect us today.

The impact is lives:

The CDC 19 estimates that new vaccinations brought onto the market have prevented more
than 21 million hospitalizations and 732,000 deaths in the last 20 years. While looking to the
future, Duffy ‘18 concludes that vaccines could save as many as 36 million lives and avert 24
million cases of medical impoverishment within the next 10 years.

Contention 2: Taxes

Unfortunately, implementing M4A will leave our economy in shambles, as Booth ‘20 writes that
the bill funds the extensive program through taxes. Sarlin ‘19 finds that M4A would cost $30
trillion dollars over 10 years and would require payroll-tax increases of 32% on workers and
businesses.

The impact of is collapsing economic growth.

CRFB ‘20 finds that because of these increased taxes, Medicare For All would decrease total
work hours by 12.2% because employers now hire less workers and employees are
disincentivized to work due to lower pay, decreasing US GDP by 15%. For this reason, they
predict that 17 million Americans would lose their job based on tax increases from a Medicare
for All plan. And overall, Haislmaier ‘19 concludes that 73.5% of the population would
experience a decrease in income, making them financially worse off because of Medicare for
All.

Contention 3: Hospitals

Because M4A pays less than private insurance, the program would make it impossible for
hospitals to break even. In fact, Blahous ‘18 finds that over 80% of hospitals will lose money
when treating all patients with the implementation of M4A.

Expanding Medicare would compound the existing strain on hospitals as Luthi ‘19 finds that
M4A would cut hospital revenues by nearly 800 billion by 2030. This lost revenue is especially
problematic for the already inadequate medical coverage of rural america, which the AHA
reports 57 million Americans depend on for medical needs. Unfortunately, many of these
hospitals are already struggling to survive as Archer ‘20 finds that in the status quo, 25% of rural
hospitals are already at risk of imminent closure due to a lack of funding. With any
miscalculation that the government makes in the field, these hospitals will inevitably close while
Luthi 19 explains that on top of that, with M4A, rural hospitals would lose 14% of their revenue
on average, placing another 55% of them at a risk of closure.

The impact becomes significant when looking at the fact that Rural hospital closures are more
serious than urban ones, as rural patients have nowhere else to turn to, often for hundreds of
miles. Rural patients will forego medical treatment as it will become less and less convenient.
Ultimately, Gujral 20 finds that each rural hospital closure increases mortality in the area by an
average of 8.7%, directly impacting approximately 5 million rural residents per hospital closure
giving the government virtually no margin for error as lives are on the line.
Thus, we urge a negative ballot.

CARDS USED (DO NOT READ)

Laura Summers, 2009, "How Medicare's Drug Pricing Can Hurt R&D," Heritage Foundation, https://www.heritage.org/health-care-
reform/report/how-medicares-drug-pricing-can-hurt-rd
Research and development is a critical component of the pharmaceutical industry. It is the driving
force behind the development of new health-enhancing and life-saving drugs. As a result, the
pharmaceutical industry is one of the most research-intensive industries in the United States.

David Francis, 2005. The Effect of Price Controls on Pharmaceutical Research, https://www.nber.org/digest/may05/w11114.html

"...cutting
prices by 40 to 50 percent in the United States will lead to between 30 and 60 percent fewer
R and D projects being undertaken in the early stage of developing a new drug. Relatively modest price
changes, such as 5 or 10 percent, are estimated to have relatively little impact on the incentives for product development - perhaps a negative 5
percent."

Sarah Toy, 2019, "What ‘Medicare for All’ would do to the health-care sector," MarketWatch,
https://www.marketwatch.com/story/what-medicare-for-all-would-do-to-the-health-care-sector-2019-04-11

Drug manufacturers would have to pare prices down considerably under a single-payer system , said
analysts at Raymond James, who published an analysis on Thursday looking at how a single-payer system would affect the health-care sector.
The single payer — in this case, the government — would have substantial negotiating power and could “claw
back patents” if companies refused to pay the government its desired rate , Raymond James health-care policy
analyst Chris Meekins wrote in a note to clients. “We believe this would reduce prices at least 30%,” he wrote.

Darren Filson 2007. Claremont Graduate University. “The Impact of Price Controls on the Performance of the Pharmaceutical
Industry” http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.377.7990&rep=rep1&type=pdf

What happens if the U.S. adopts price controls like those in the rest of the world? Firms
reduce research substantially, and in the long run, the flow of new drugs falls by
approximately 75%. Industry firm value falls approximately 80%. The full impact takes over a decade to occur,
because most late-stage candidates in the pipeline remain profitable under the policy change. The option to pursue a late-stage candidate is
usually well “in the money” because many hurdles have been overcome, many R&D costs are sunk, and the prospect of obtaining profits is
more near.

Frank Lichtenberg 2019, "How many life-years have new drugs saved? A three-way fixed-effects analysis of 66 diseases in 27
countries, 2000–2013," OUP Academic, https://academic.oup.com/inthealth/article/11/5/403/5420236

For the year 2000, the WHO’s Global Health Estimates figure for YLL (based on an age threshold of 91.93 y) is 63% higher than YLL85. Therefore,
the estimates imply that if no new drugs had been launched after 1981, YLL85 in 2013 would have been 276.8
million, and that the number of life-years before age 85 y gained in 2013 from drugs launched after 1981 was 148.7 million.

Michelle Mello 2018 “What Makes Ensuring Access to Affordable Prescription Drugs the Hardest Problem in Health Policy?”
Minnesota Law Review. http://www.minnesotalawreview.org/wp-content/uploads/2018/07/Mello_MLR.pdf

Another perplexing moral problem is that tradeoffs

may exist between improving the affordability of prescription
drugs for Americans and maintaining their affordability to patients in other countries. 53 Branded drug prices
in the United States are generally higher than in other countries because most foreign governments have adopted stronger mechanisms than
the United States for controlling prices—for example, more consolidated price negotiations or direct price controls.54 Because
we pay
so much, pharmaceutical companies may be more willing or able to grant price concessions
elsewhere, including outright donation of critical medications to low-income countries.
Actions we take to restrict price, therefore, could have unintended, but real, effects on drug
affordability in less wealthy countries. This prospect raises the question of what obligations, if any, Americans have to
patients in the rest of the world. Some conceptions of global justice hold that members of relatively wealthy societies have a moral obligation
to consider the welfare of individuals in poorer countries in making policy decisions.55 Other views challenge the notion that such duties
exist.56 Some even assert that the status quo is unfair: Americans not only pay more for marketed drugs, they shoulder a disproportionate
share of the cost of developing those drugs.57 Pharmaceutical R&D is underwritten both by the high prices Americans pay for medicines and
the tax dollars we spend on basic-science research to identify promising new molecules.58 Americans have not openly confronted these
clashing viewpoints as a polity, but strong measures to reduce the cost of prescription drugs here would make the global-justice dilemma hard
to ignore. Further, as with the other moral dilemmas discussed above, the problem has greater salience in the context of prescription drugs
than in other areas of health policy. It is true that other health policy decisions we make, such as how much of federal agencies’ budgets to
devote to health system capacity building in low-income countries, also affect the healthcare costs that poor countries must bear. However,
because the market for prescription drugs is global but is propped up by high prices in the
United States, tamping down drug prices has a zero-sumgame quality that is unique .
Squeezing one part of the drug-price balloon may cause it to bulge out in other areas.

John Zarocostas 2007 "Better access to drugs could save 10 million lives a year, says UN expert," PubMed Central (PMC),
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1995491/

Better access to drugs, especially in poor countries, could save 10 million lives each year , four million of
them in Africa and South East Asia, an independent UN expert said as he unveiled a set of draft guidelines for pharmaceutical companies on
access to drugs. The 50 draft provisions drew a mixed response from interested parties. They were welcomed by groups that advocate for
access to affordable drugs but were strongly criticised by the industry. Announcing the guidelines, Paul Hunt, the United Nations' special
rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, said, “ Almost
two
billion people lack access to essential medicines. Improving access to existing medicines could save 10
million lives each year. Professor Hunt, who is professor at the department of law and the human rights centre at Essex University,
continued: “Access to medicines is characterised by profound global inequity, as 15% of the world's
population consumes over 90% of the world's pharmaceuticals.”

Tom Stossel, 7-9-2020, "Don’t Thank Big Government for Medical Breakthroughs," WSJ, https://www.wsj.com/articles/dont-thank-big-
government-for-medical-breakthroughs-1483660786 finds that
Today, researchers compete for government grants at increasingly shorter intervals and with diminishing chances of success: Less than 1
in 5 grant applications succeeds. This inhibits risk taking. By contrast, private investment in medicine has kept pace
with the aging population and is the principal engine for advancement[, as over]. More than 80% of new drug
approvals originate from work solely performed in private companies. Note that such drug approvals come on
average 16 years after the beginning of clinical trials, which typically cost $2.5 billion from start to finish. Even if grant-subsidized academics
wanted to create a new drug, economic reality prevents it.

Wendy Schacht, 06-10-2011, “Federal R&d, Drug Discovery, and Pricing: Insights from the NIH-University-Industry,” Relationship,
https://books.google.com/books?
id=cNNxxeeEwn4C&pg=PA23&lpg=PA23&dq=pharmaceutical+startups+require+venture+capital+price+controls&source=bl&ots=eVkU861kcj&s
ig=WG539suUf9zfolsUsokhSSFKUv4&hl=en&sa=X&ved=2ahUKEwjI9qrxuLzeAhVohq0KHfViA744ChDoATAAegQIABAB#v=onepage&q=only
%205%25&f=false of the Congressional Research Center explains that
Intellectual property is important because the “costs of drug innovation are very high while the costs of imitation are ... CEO of Genentech.126
Ownership of intellectual property is particularly important to biotechnology companies that typically are small and do not have profits to
finance additional R&D. According to the Biotechnology Industry Organization, most of these firms finance research and development from
equity capital not profits. Only 5% of [small] biotech companies have sales and therefore depend on venture
capital and IPOs.127 Industry advocates maintain the patents are a necessity for raising this equity capital and that price controls would
deter investors.

Lynn Pasahow, 08-28-2015, https://www.pbwt.com/content/uploads/2016/09/NVCA-brief.pdf finds that

See Biologics Hearing (NVCA testimony that venture capital firms “supply nearly all of the capital for early-stage
biotechnology companies”). And continued funding of life sciences companies will depend, as it has, on strong patent
protection[...]The life sciences industry would not exist today if not for venture capital investment.

Robert J. Easton, 1-22-2018, "Price controls would stifle innovation in the pharmaceutical industry," STAT,
https://www.statnews.com/2018/01/22/price-controls-pharmaceutical-industry/ explains,
An important corollary is that, if profitability and value
creation opportunities for new drugs declined, the appetite of
the venture community for risky, long-term biopharmaceutical investments would shrink exponentially.
Price controls on drugs would have the surprising effect of accelerating the flow of investment into high technology, where timelines to market
are shorter, less regulated, and less risky. The venture capital community is flush with cash and anxious to invest where high returns can be
achieved — ideally within a much shorter time than is typically possible in the realm of drug R&D.

Robert J. Easton, 1-22-2018, "Price controls would stifle innovation in the pharmaceutical industry," STAT,
https://www.statnews.com/2018/01/22/price-controls-pharmaceutical-industry/
Forcing drug prices down would surely shave a few percentage points off what we spend on health care today. By
2032, drug prices could
be half of what they are today, as every drug would be a generic. But our ability to treat or cure the many
serious diseases that still afflict us will have been crippled and squandered. In my view that is a terrible policy.

CDC, 2-4-2019, "CDC Press Releases," https://www.cdc.gov/media/releases/2014/p0424-immunization-program.html

The CDC estimates that vaccinations will prevent more than 21 million hospitalizations and 732,000
deaths among children born in the last 20 years (see Benefits from Immunization during the Vaccines for Children Program
Era — United States, 1994-2013, MMWR). Despite the U.S. immunization program’s success, according to CDC officials, 129 people in the U.S.
have been reported to have measles this year in 13 outbreaks, as of April 18. In 1994, the Vaccines for Children program (VFC) was launched in
direct response to a measles resurgence in the United States that caused tens of thousands of cases and over a hundred deaths, despite the
availability of a measles vaccine since 1963. The VFC program provides vaccines to children whose parents or caregivers might otherwise be
unable to afford them.

Sean Duffy, 2-5-2018, "Vaccines Could Prevent 36 Million Deaths by 2030," No Publication, https://www.courthousenews.com/vaccines-
could-prevent-36-million-deaths-by-2030/
Vaccines could save as many as 36 million lives and avert roughly 24 million cases of medical
impoverishment in 41 low- and middle-income nations by 2030 , a new study.

Sarah Toy, 2019, "What ‘Medicare for All’ would do to the health-care sector," MarketWatch,
https://www.marketwatch.com/story/what-medicare-for-all-would-do-to-the-health-care-sector-2019-04-11

Pricing pressures and fears around Medicare for All may also be playing into the declining share prices of drug companies like Merck and Pfizer.
Drug manufacturers would have to pare prices considerably under a single-payer system , Raymond James
health-care policy analyst Chris Meekins wrote in a recent note to clients. The single payer — in this case, the government — would
have substantial negotiating power and could “claw back patents” if companies refused to pay the
government its desired rate, he wrote.

Andrew Spiegel 2017, "The tragic toll of drug price controls," TheHill, https://thehill.com/blogs/pundits-blog/healthcare/332145-
the-tragic-toll-of-drug-price-controls
The price
control process significantly degrades patient well-being. Pharmaceutical firms have to undergo a long,
drawn-out negotiating process every time they want to sell a new medication in a controlled market.
All the while, sick people aren't getting the medicines they need. In America, which has a relatively free drug market, the average medicine is
approved 90 days quicker than in Europe and about a year quicker than in Canada. This delay can be deadly, especially for colon cancer
patients. The drug industry has invented advanced drugs proven to beat back this disease, including specialty chemotherapy agents such as
panitumumab and "angiogenesis inhibitors," which prevent colon cancer cells from growing by cutting off their blood supply. Obviously, these
drugs can only help patients if regulators approve them. Too often, that approval is slow to come. And such delays are now common across a
wide variety of drug classes, leading to serious carnage: some
600,000 European deaths could be avoided each year if
the continent's healthcare systems simply offered "timely and effective medical treatments," according to
the European Union's own data.

M4A would increase payroll taxes by 32% AND taxes on rich aren’t enough
Benjy Sarlin 19 [Benjy Sarlin. . “Study: 'Medicare for All' means taxes on the middle class, but
it could save them money”. 10-29-2019. NBC News. https://www.nbcnews.com/politics/2020-
election/study-medicare-all-means-middle-class-taxes-could-save-them-n1073431. Accessed 9-
3-2020] AM
WASHINGTON — Paying for "Medicare for All" could require raising payroll taxes by 32 percent
on workers and businesses, among other options, according to a new report from a think tank that advocates for
balanced budgets. But the report, released Monday by the Committee for a Responsible Federal Budget, also suggested that middle
class families could save money overall, even with significantly higher taxes. The study comes as Sens. Bernie Sanders, I-Vt., and
Elizabeth Warren, D-Mass., both presidential candidates, face pressure from rivals to detail how they would pay for their proposal to
move the country onto a more generous Medicare program with no premiums and minimal out-of-pocket costs. Warren has said she
is working on such a plan. The new report assumed Medicare
for All would add an additional $30 trillion in
federal spending over 10 years, which is toward the lower end of outside studies and in line with rough estimates by
Sanders, the author of the Medicare for All bill. “It’s probably generous for how much it would cost in the real world,” Marc Goldwein,
the committee's senior vice president, told NBC news. Other options that on their own could fund Medicare for All, according to the
study, include a 25 percent income surtax; a 42 percent value-added tax on consumption; a move to more than double all individual
taxing the rich, corporations and
and corporate tax rates; or, more likely, a combination of taxes. The report estimated that
the financial sector couldcover only one-third of the total cost on its own. Recommended While the report
warned that some of the tax options presented would slow economic growth or push top tax rates so
high that they no longer maximize revenue, its authors also suggested that Medicare for All could reduce average total costs for
lower- and middle-income families by eliminating more medical expenses than they would pay in taxes and requiring higher earners
to pay a larger share of their tab — the standard both Warren and Sanders have argued voters should apply to their plan. The report
also grants the assumption of the plan's supporters that the new system will save some money by making health care more efficient.
But the benefits would vary depending on the individual, and some low-income recipients of federally backed health care plans
could see their costs go up depending on how it’s financed. While Medicare for All proponents have emphasized the lack of
premiums in their plan, the report notes that an average $7,500 mandatory premium per U.S. resident could pay for it. The premium
would rise to an average of $12,000 if it exempted current Medicare, Medicaid and CHIP recipients. Proponents of Medicare for All
have offered a menu of options to help finance their plan, including requiring states and employers to continue their existing
contributions to help offset the cost. Sanders has suggested a payroll tax, a wealth tax, a financial transactions tax and an increased
estate tax, among others, though the details have not been fully fleshed out and do not appear to cover the full cost of his plan.

Taxes hurt the economy – work hours reduced

CRFB 20 [No Author. . “”. xx-xx-xxxx. No Publication.
http://www.crfb.org/sites/default/files/March2020_Choices_for_Financing_Medicare_for_All.pdf.
Accessed 9-3-2020] AM
Raising payroll taxes to finance expanded Medicare, PWBM estimates, would reduce projected
GDP by 7.3 percent in 2030 – the equivalent of about $6,500 per person. It would reduce hours
worked by 12.2 percent – the equivalent of 17 million full-time equivalent (FTE) jobs. In other
words, this tax would cause many Americans to reduce hours worked or leave the labor force.
Deficit financing Medicare for All would also harm the economy, mainly by crowding out investment in productive capital. PWBM
finds it would reduce projected GDP by 5.9 percent in 2030 – the equivalent of about $5,300 per person – and gross national
product would likely fall by significantly more. PWBM also finds that deficit financing Medicare for All would reduce hours worked by
nearly 10 percent – the equivalent of 14 million full-time equivalent jobs. Lastly, PWBM estimates that charging mandatory
premiums, while subsidizing low-income beneficiaries, would reduce GDP by 2.3 percent – the equivalent of $2,100 per person. It
Over the long run, PWBM
would reduce hours worked by 7 percent – the equivalent of 10 million full-time equivalent jobs.
estimates the effects of a payroll tax and especially deficit financing would become more pronounced. By
2060, raising payroll taxes to finance Medicare for All would reduce projected GDP by 15
percent, while deficit financing Medicare for All would reduce GDP by 24 percent. Premium-financed Medicare for All, on the
other hand, would have virtually no impact on long-run GDP; beyond 2060, it might even improve the economy

Single payer requires significant payroll taxes – that results in wage

deflation and massive unemployment.
Feyman ‘16 (2/11, Yevgeniy, a fellow and deputy director of health policy with the Manhattan
Institute, research assistant in the department of health policy at the Harvard T.H. Chan School
of Public Health, “The Single-Payer Sacrifice: 11.6 Million Jobs”,
http://www.realclearpolicy.com/blog/2016/02/11/single-
payer_sacrifice_116_million_jobs_1551.html)
Democratic candidate Bernie Sanders recently released his health-care plan: a government-run single-
payer system for the U.S., similar to what many European countries have. Criticism of the plan has so far focused on its lack of political
feasibility, but there is an even more important reason to be wary: Accounting for costs and tax increases, it would
reduce labor supply by 11.6 million. In a struggling economy, with tepid wage growth,
hurting employment should be the last thing on any politician’s agenda. The plan truly promises
everything under the sun. Not only will everyone be able to get any medical treatment needed — with no cost at the point of service — but the plan
The funding mechanism boils down to an increase in payroll
won’t require a terribly high tax increase.
taxes: an “income-based premium” of 2.2 percent for individuals and a tax of 6.2 percent on employers. Because economists, as well as the non-
partisan Congressional Budget Office and the Joint Committee on Taxation, recognize that the "employer share" of payroll
taxes is mostly borne by workers in the form of lower wages, this translates to an 8.4 percentage point
increase overall. These elements of the plan were the first to draw criticism. Not only do most single-payer countries fund their health-care systems
with higher taxes on the middle class, but they also typically exclude a variety of services and drugs from coverage. Without being able to say no to
some expensive drugs and services, the government would have a tough time driving down prices. But perhaps the most stinging rebuke came from
Sanders’ plan would require a total
veteran health economist Kenneth Thorpe of Emory University. In Thorpe’s estimation,
tax hike of 20 percentage points, and would cost $1.1 trillion more each year than the
campaign has estimated. This is at least partly because the government would have to pay more than Medicare’s low rates to keep
doctors and hospitals in the system, and making health care free at the point of delivery would also increase use of health-care services. These
criticisms alone should make Sanders’ plan a nonstarter. But that’s not the end of the laundry list of problems with the proposal. Few economists would
dispute that tax
rates can affect people’s decision to work. The higher a person’s marginal tax
rate, the bigger the disincentive to work more; a 50 percent rate, for instance, means that
earning another dollar nets only an extra 50 cents. This is what economists call the “substitution” effect. But there is a
countervailing effect as well. As you pay more in taxes, you may want to try to maintain your previous standard of living, and thus decide to work more.
The CBO, for
This is called the “income effect.” The ultimate effect of taxes on the workforce depends on which of these forces is stronger.
instance, has come to the conclusion that the Affordable Care Act’s combination of taxes, tax
credits, and mandates will reduce full-time equivalent employment (one full-time equivalent employee works 40
hours per week; two part-time workers equal one full-time equivalent) by about 2 million in 2025. As it turns out, the
ACA’s many taxes are relatively insignificant compared with those in the Sanders plan.
Applying the CBO’s approach and assumptions, along with tax data from the National Bureau of
Economic Research, to the Sanders plan indicates that the campaign’s assumed taxes
would reduce employment by 4.9 million full-time equivalent workers in 2025. Not an insignificant
number. When we take Thorpe’s more realistic assumptions and apply the same approach, the
fully-implemented plan reduces employment by a whopping 11.6 million full-time
equivalent workers. Under these assumptions, the average marginal tax rate would grow from around 22
percent to 42 percent, while the average total tax rate would increase from 11 percent to 31
percent. At the upper end of income, total tax rates would be far beyond 50 percent. And none of this factors in state and local taxes. Of
course, some of drop in employment might be considered “voluntary.” Some would stop working
because they no longer needed to be employed to receive health insurance — escaping "job
lock," as House Minority Leader Nancy Pelosi once put it. But others would simply find it meaningless to put in
extra hours or look for more lucrative positions when so much of their earnings get sucked away
as taxes.
CRFB’ 20 http://www.crfb.org/papers/choices-financing-medicare-all

Raising payroll taxes to finance expanded Medicare, PWBM estimates, would reduce
projected GDP by 7.3 percent in 2030 – the equivalent of about $6,500 per person. It
would reduce hours worked by 12.2 percent – the equivalent of 17 million full-time
equivalent (FTE) jobs. In other words, this tax would cause many Americans to reduce
hours worked or leave the labor force. Deficit financing Medicare for All would also harm the
economy, mainly by crowding out investment in productive capital. PWBM finds it would reduce
projected GDP by 5.9 percent in 2030 – the equivalent of about $5,300 per person – and gross
national product would likely fall by significantly more. PWBM also finds that deficit financing
Medicare for All would reduce hours worked by nearly 10 percent – the equivalent of 14 million
full-time equivalent jobs. Lastly, PWBM estimates that charging mandatory premiums, while
subsidizing low-income beneficiaries, would reduce GDP by 2.3 percent – the equivalent of
$2,100 per person. It would reduce hours worked by 7 percent – the equivalent of 10 million full-
time equivalent jobs. Over the long run, PWBM estimates the effects of a payroll tax and
especially deficit financing would become more pronounced. By 2060, raising payroll taxes
to finance Medicare for All would reduce projected GDP by 15 percent, while deficit
financing Medicare for All would reduce GDP by 24 percent. Premium-financed Medicare for All,
on the other hand, would have virtually no impact on long-run GDP; beyond 2060, it might even
improve the economy

Taxes would significantly increase under Medicare For All, hurting 73.5% of
Americans
Edmund Haislmaier 19 [Edmund Haislmaier “How “Medicare for All” Harms Working
Americans”. 11-19-2019. Heritage Foundation. https://www.heritage.org/health-care-
reform/report/how-medicare-all-harms-working-americans. Accessed 7-28-2020] AM
Over half of the Democrats in the House and 14 Democrats in the Senate are calling for enactment of a new government-run health
coverage program to replace all existing private health insurance, including employer-sponsored health benefits, as well as the
current publicly funded coverage for Americans enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program
(CHIP). The proposed new program would be operated and funded solely by the federal
government, and private insurers and employers would be prohibited from offering coverage that duplicated any of the
program’s benefits.1 While the terminology (such as single-payer and Medicare for All) and the details may vary, any such
proposal would significantly increase federal government spending and require major
tax increases. Advocates of this idea suggest that Americans currently covered by private health plans would be financially
better off, even after their taxes are raised to fund the proposed new government program. For example, Senator Bernie Sanders (I–
VT) has said: “Are people going to pay more in taxes? Yes. But at the end of the day, the overwhelming majority of people are going
to end up paying less for health care because they aren’t paying premiums, co-payments or deductibles.”2 That assertion is
in order to fund such a program, it would be necessary for the federal
incorrect. Our analysis finds that
government to impose substantial, broad-based taxes equal to 21.2 percent of all wage and
salary income. Those taxes would be in addition to the payroll taxes that most workers already pay for the existing Social
Security and Medicare programs, bringing total payroll taxes to 36.5 percent for most workers.3 We
also find that nearly two-thirds of American households (65.5 percent, comprising 73.5 percent of
the population) would experience reductions in their disposable income, making them
financially worse off. Those households would pay more in new taxes to fund the program than they
would save as a result of the program eliminating their current spending on private health insurance and
out-of-pocket medical expenses. After accounting for both the tax increases and the reductions in private spending
for health insurance and medical care, we find that average annual household disposable income would
decline by $5,671 (or 11 percent) under a new government-run health care program. Among households with
employer-sponsored health benefits, 87.2 percent would be worse off financially under a new
government-run health care program, and their annual disposable income would be $10,554 lower, on
average. That would occur despite those households receiving wage increases, as employers
responded to the new program by converting the value of current tax-free, employer-provided
health benefits into additional taxable cash income.4 The reason: Workers would pay much higher taxes to fund
the cost of the new program because workers would need to (1) replace their own private spending, (2) replace non-workers’ private
spending, and (3) pay for the additional spending that would result from the program stimulating increased use of medical care.

Scott Atlas 2018. An Overlooked Key To Lower Drug Prices. Retrieved September 11, 2020, from
https://www.hoover.org/research/overlooked-key-lower-drug-prices

Price caps may seem intuitively attractive, yet price caps always restrict supply of the product, and drugs are no different. Iain Cockburn of
Boston University showed that price regulation strongly delayed drug launches of 642 new drugs in 76
countries. The University of Connecticut’s Thomas Abbott showed that price controls significantly diminish early-stage research and
development. In that study, cutting prices by 40 to 50 percent in the United States would lead to 30 to 60 percent fewer early-stage R&D
projects. And Rexford Santerre of the University of Connecticut calculated that drug
price controls would have led to 198
fewer new drugs being brought to the U.S. market from 1981 to 2000, at a societal cost of about $100
billion more than the estimated savings from those price controls.

Sally Pipes 2020. Opinion | Medicare for All Could Mean Doctors for None. https://www.wsj.com/articles/medicare-for-all-could-mean-
doctors-for-none-11581379209

Some doctors evidently believe Medicare for All would deliver better health care for Americans. Some no doubt think more insurance
would mean more patients. But it would also force physicians to work longer hours for less pay. A single-payer
program would pay doctors at rates similar to Medicare reimbursement levels, already at least 25% less than private
insurance pays, according to estimates by Charles Blahous of the Mercatus Center. Under the current legislative drafts of
Medicare for All, government rates over the first decade would be 40% lower than those paid by
private insurers.

Rachana Pradhan 2019, "Medicare for All’s jobs problem ," POLITICO,
https://www.politico.com/news/agenda/2019/11/25/medicare-for-all-jobs-067781

Initial research from University of Massachusetts economists who have consulted with multiple 2020 campaigns has estimated that 1.8
million healthcare jobs nationwide would no longer be needed if Medicare for All became law , upending
health insurance companies and thousands of middle class workers whose jobs largely deal with them, including
insurance brokers, medical billing workers and other administrative employees . One widely cited study
published in the New England Journal of Medicine estimated that administration accounted for nearly a third of the U.S.’ health care expenses
Sally Pipes 2020. Doctors need a second opinion on 'Medicare-for-all'. Retrieved August 22, 2020, from
https://www.pacificresearch.org/doctors-need-a-second-opinion-on-medicare-for-all/

Medicare’s payment rates are projected to be 40 percent lower than those for private insurance over
the first ten years of Medicare-for-all’s implementation, according to the Mercatus Center’s Charles Blahous. That would
represent some kind of pay cut for doctors. By making physicians’ lives more miserable , “Medicare-for-all” would drive many
from the profession. Already, about half of physicians say they want to change career paths; 17 percent are
planning to retire. A “Medicare-for-all”-induced exodus would exacerbate America’s doctor shortage.
According to the Association of American Medical Colleges, the United States will face a shortage of more than 120,000
physicians by 2032. Patients everywhere would struggle to get timely care, particularly in rural and urban areas.

Barbara Starfield The Effects Of Specialist Supply On Populations’ Health: Assessing The Evidence. Retrieved from
https://www.aafp.org/dam/AAFP/documents/media_center/access-to-care/Effects-Of-Specialist-Supply-Starfield.pdf

When state-level economic and demographic characteristics were controlled for, an increase of one primary care physician
per 10,000 population (about a 20 percent increase) was associated with a 6 percent decrease in all-cause
mortality and about a 3 percent decrease in infant, low-birth weight, and stroke mortality. For total mortality, an increase of one
primary care physician per 10,000 population was associated with a reduction of 34.6 deaths per
100,000 population at the state level.

CBO 2019, "Key Design Components and Considerations for Establishing a Single-Payer Health Care System," No Publication,
https://www.cbo.gov/publication/55150
An expansion of insurance coverage under a single-payer system would increase the demand for care and put pressure on the available supply
of care. People who are currently uninsured would receive coverage, and some people who are currently insured could receive additional
benefits under the single-payer system, depending on its design. Whether the supply of providers would be adequate to meet the greater
demand would depend on various components of the system, such as provider payment rates. If
the number of providers was
not sufficient to meet demand, patients might face increased wait times and reduced access to care. In
the longer run, the government could implement policies to increase the supply of providers.

Sally Pipes 2020 False Premise, False Promise: the Disastrous Reality of Medicare for All.
https://drive.google.com/file/d/1uQW1u_hmx7sZBsU8Tzxbmx93yDz5zfvy/view

All told, Canadians

were waiting for nearly 1.1 million procedures in 2018 . That means nearly 3 percent of
the population were on a waiting list, if we assume one patient per procedure. Extrapolate those numbers to the
United States, and that’s the equivalent of more than 9.8 million Americans waiting for care.

Charles Blahous 2018 "How Much Would Medicare for All Cut Doctor and Hospital Reimbursements?," Economics21,
https://economics21.org/m4a-reimbursements-blahous

On average, Medicare hospital payment rates are substantially below hospitals’ reported costs of providing services. The
CMS Medicare
Actuary projects that by 2019, over 80% of hospitals will lose money treating Medicare beneficiaries. If
these data are correct, M4A would mean that over 80% of hospitals would lose money when treating all of their patients. We simply don’t
know what would happen—for example, how many hospitals would stay in business—if M4A is enacted as written. Clearly there would be
some disruption of the availability and timeliness of healthcare services, but no one can say how much.
Susannah Luthi 2019 “Hospitals Could Lose $800 Billion from Medicare Buy-in, AHA Says.” Modern Healthcare
www.modernhealthcare.com/politics-policy/hospitals-could-lose-800-billion-medicare-buy-aha-says.

In a new analysis of a universal Medicare buy-in policy, the American Hospital Association and Federation of American Hospitals on Tuesday
projected hospitals
would lose $800 billion over a decade through the lower Medicare reimbursements
and raise premiums within the private market—disrupting the employer insurance market where the majority of people get
coverage.

AHA 2020, "Rural Health Services," https://www.aha.org/advocacy/rural-health-services

Some 57 million rural Americans depend on their hospital as an important source of care as well as a critical
component of their area's economic and social fabric.

Diane Archer 2020, "453 rural hospitals are failing — Medicare for All would save them," TheHill, https://thehill.com/blogs/congress-
blog/healthcare/487026-453-rural-hospitals-are-failing-medicare-for-all-would-save

Our for-profit health care system isn’t working for rural Americans. More
than 120 rural hospitals have closed since 2010.
According to a new report from Chartis Center for Rural Health, another 453—almost one in four—are at risk of failing.
Corporate health insurers can’t provide coverage to meet rural patients’ needs, and it’s endangering the bottom line of rural hospitals.
Medicare for All would save them.

Susannah Luthi 2019 “Hospitals Could Lose $800 Billion from Medicare Buy-in, AHA Says.” Modern Healthcare
www.modernhealthcare.com/politics-policy/hospitals-could-lose-800-billion-medicare-buy-aha-says.

Rural hospitals could lose between 2.3% and 14% of their revenue if the U.S. opens up Medicare to people
under 65, the consulting firm Navigant projected in its estimate. The analysis assumed just 22% of the remaining 30 million uninsured
Americans would choose a Medicare plan. The study based its projections of financial losses primarily on people leaving the commercial market
where payment rates are significantly higher than Medicare. The estimate assumed Medicaid wouldn't lose anyone to Medicare, and plotted
out various scenarios where up to half of the commercial market would shift to Medicare. The analysis was commissioned by the Partnership
for America's Health Care Future, a coalition of hospitals, insurers and pharmaceutical companies fighting public option and single-payer
proposals. In their most drastic scenario
of commercial insurance losses, co-authors Jeff Goldsmith and Jeff Leibach predict
more than 55% of rural hospitals could risk closure, up from 21% who risk closure today according to
their previous studies.

Kritee Gujral 2020, "Rural hospital closures increase mortality," No Publication, https://voxeu.org/article/rural-hospital-closures-
increase-mortality

The left-hand side shows that in urban areas, there is no change in unadjusted inpatient mortality after the hospital closure, similar to Figure 2
above. However, the right-hand side shows a post-hospital-closure increase in mortality for rural areas. The difference-in-difference estimation
shows that ruralclosures increase inpatient mortality by 8.7%, while urban closures have no measurable
impact. This suggests that when no distinction is made between rural or urban closures, the null effect of urban closures have the potential
to dominate and mask the significant and detrimental impact of rural closures.
 REMOVED (DO NOT READ)

We can make the comparison between Canada and the U.S. due to the fact that they have
almost equivalent physicians per 10,000 citizens and that the U.S. has an even lower hospital
per 10,000 citizen rate than Canada.

According to Paranicas ‘14 By using medical innovations to prevent or better manage the most
common chronic diseases, the U.S. could decrease treatment costs by $218 billion per year and
reduce the economic impact of disease by $1.1 trillion annually.

David Francis, 2005. The Effect of Price Controls on Pharmaceutical Research, https://www.nber.org/digest/may05/w11114.html
"...cutting
prices by 40 to 50 percent in the United States will lead to between 30 and 60 percent fewer
R and D projects being undertaken in the early stage of developing a new drug. Relatively modest price
changes, such as 5 or 10 percent, are estimated to have relatively little impact on the incentives for product development - perhaps a negative 5
percent."

Joanna Shepherd 2017 The Prescription for Rising Drug Prices: Competition or Price Controls?,
https://scholarlycommons.law.case.edu/cgi/viewcontent.cgi?article=1609&context=healthmatrix

Furthermore, brand companies must price a drug not only to recoup the drug’s own costs; they must
also consider the costs of all the product failures in their pricing decisions . Only about ten percent of drugs that
begin clinical trials are eventually approved by the FDA.149 Moreover, even the ten percent of drugs that receive FDA approval are not all
commercial successes. Data indicate that only twenty percent of marketed brand drugs will ever earn enough sales to cover their development
costs.150 The other eighty percent of approved drugs generate losses for drug makers. Thus, if only ten percent of drugs are approved and
twenty percent of those are able to recoup costs, then only
one in fifty drugs developed by brand companies is a
winner that earns positive profits. The price of these winners must not just recoup their own costs,
they must also help recoup the costs of the forty-nine out of fifty drugs that never earn a profit.
Failure to cover the losers’ costs will slow investment in R&D; drug companies will not spend millions
and billions of dollars developing drugs if they cannot recoup the costs of that development.

Subpoint b) Drug Delays

Toy ‘19 finds that with the government’s negotiating power they could “claw back patents” if
companies refuse to pay the government its desired rate leading to a. Spiegel ‘17 finds that
under price controls, pharma has to undergo a long drawn-out negotiating process to sell new
medication. Critically, Atlas ‘18 finds that price regulations severely delay the production of
drugs, finding that price controls would have led to 200 fewer drugs brought to the U.S. in a
period of 19 years.

The impact is lives

Spiegel ‘17 makes this issue critical as he finds that delays in the receival of drugs would have
led to an additional 600,000 European deaths. Extrapolating these numbers to the United States
makes price controls a dangerous path to the inability to receive drugs in a timely manner
leading to hundreds of thousands of potential deaths.

subpoint a) Doctors

M4A would severely underfund salaries for doctors. Indeed, Pipes 20 notes that M4A would
force physicians to work longer hours for less pay and that doctors and hospitals combined
would receive pay cuts of approximately 40%. Overall, Pradhan ‘19 tells us that 1.8 million
healthcare jobs nationwide would be eliminated, causing patients to have less access to care.

our impact is lives

Specifically, Pipes 20 quantifies that Medicare for All will result in a nationwide loss of 10,000
physicians per year until 2032. However, Starfield finds this devastating as an increase of one
physician for every 10,000 people is associated with a 6 percent decrease in mortality meaning
that for every physician that we keep per 10,000 people will save 600 lives making it crucial to
sustain a healthy number.