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T Single Payer

Interpretation---national health insurance exclusively refers to single-payer

systems which eliminate private insurance---that includes plenty of room to
Marie Gottschalk 2K, Professor of Political Science at the University of Pennsylvania, Fall
2000, ““It’s the Health-Care Costs, Stupid!”: Ideas, Institutions, and the Politics of Organized
Labor and Health Policy in the United States,” Studies in American Political Development, Vol.
14, p. 234-252
1. The term n ational h ealth i nsurance has many meanings. As used here, it refers to health-
care reform proposals modeled on the Canadian experience in which the government replaces
private insurance with its own public insurance system, thus eliminating the commercial
health insurers. Commonly referred to as “ single-payer ” plans today, proposals for n ational
h ealth i nsurance can vary enormously on important details like financing, budgeting,
taxation, and the role of individual states.

Violation---the plan doesn’t eliminate private insurance, it’s explicitly designed to

foster public-private competition.

Vote neg:

1) Limits---their interp opens the floodgates to any type of publicly-provided

insurance for single services, niche populations, etc---there’s no limiting principle
once the topic accepts a deviation from debates over single payer.

2) Ground---mixing public and private insurance should be neg ground because

it’s less change from the status quo---their interpretation shifts the topic away
from the fundamental debates in health care policy
States CP

The governments of the fifty states and relevant sub-federal territories should
provide public health insurance options that:

-- are available on Affordable Care Act exchanges to individuals and employers

with 50 or fewer employees

-- utilize Medicare’s contractors and payment systems

-- condition continued participation in other state-provided health insurance on

health care providers participating in the public option

State public options solve the case and don’t trigger ERISA preemption
Jon Walker 17, expert on politics, health care and drug policy, 5/2/17, “ROAD TO SINGLE-
3) Keep goals and proposals within the legal restrictions. It would be possible for states to greatly expand the
use of public insurance without risking running afoul of ERISA . An all-carrot approach might
convince companies to ditch private insurance.
Rand found Oregon could create a strong public option without a federal waiver . It
would have lowered administrative costs and reimbursement rates, making it significantly
cheaper than private insurance. If it was open to all companies, it is likely many employers would
switch to it. It is not what many single-payer supporters want, but it is achievable in the short term . When
most of the state is covered by public insurance, additional reforms become easier .
Low Competition CP

The United States Federal Government should:

-- make a Medicare fee-for-service plan permanently available on state and federal

health insurance exchanges in counties where fewer than three insurers offer
plans on individual exchange markets

-- require private insurers that offer Medicaid Advantage plans in such counties to
offer those plans on individual exchange markets

Competes---the CP’s not national health insurance because it’s nowhere close to
universally available

Solves the case, avoids the crowd-out DA, and avoids midterms because the CP’s
perceived as the GOP only bailing out red states
Gerard Anderson 17, professor in the Department of Health Policy and Management and
director of the Center for Hospital Finance and Management at the Johns Hopkins Bloomberg
School of Public Health, et al., 8/9/17, “Making The Exchanges More Competitive By Bringing
Medicare Into The Fold,”
With the GOP repeal drive on hold, members of Congress from both parties have declared that they want to
shore up the health exchanges. One of the top priorities is increasing competition
among insurers . Boosting the number of plans within the exchanges not only would
increase options for consumers ; it would also reduce the risk an exchange could end up
with no plans at all. Perhaps most important, it would likely lead to lower premiums as plans
competed to attract enrollees .
Yet in many counties, there’s little chance additional private plans will enter the exchanges . In what
is a highly consolidated industry, some of the dominant insurers have scaled back their involvement or left the
market entirely. According to the Kaiser Family Foundation, 70 percent of the 2,194 counties in the U nited
S tates have fewer than three health insurers participating in the individual health insurance exchanges.
The New York Times projects that in 2018, 45 counties will have no insurers participating in the exchanges, and 1,388 counties
(44 percent) will have only one. Most of these 1,433 counties are in rural America .
Obviously, exchanges don’t work when there are no participating insurers. But even when exchanges have a few
insurers, they offer limited choice, are likely to have higher prices , and face the risk of defections
leaving them with a single (or no) insurer. Ideally, exchanges should have four or more
insurers . Yet, at last count, just 354 counties (11 percent) met this standard. This hardly suggests a robust market.
The severe shortage of insurers in many of the exchanges poses risks to the goals of Republicans
as well as Democrats. For Democrats, the stakes are clear: The exchanges are the centerpiece of the ACA, and their continued
problems stand in the way of achieving its promise, as well as building broader support for the law among middle-income Americans
who are not eligible for Medicaid.
Yet Republicans should also want to boost plan participation and competition. Not only are the
exchanges weakest in rural “red” areas of the country , the fragility of the exchanges increases reliance
on Medicaid, which many conservatives view as less attractive than subsidized private insurance.
So increasing competition within the exchanges should be a bipartisan project. Yet the main proposal on the table—substantially
greater financial incentives to induce insurers to enter exchanges—would require big new federal outlays. Meanwhile, more
insurers are leaving the market, especially in rural America .
A Better Way Forward: Adding Medicare FFS And Medicare Advantage To The Exchanges
We think there is a better approach: allow Medicare to enter the market in counties where
fewer than three health insurers participate on the exchange . Introducing Medicare
wouldn’t require significant new spending. It would provide competition in counties with only one or two
insurers. And it would ensure that all counties would always have at least one insurance
option available. What’s more, Medicare could be used to provide new private plan options by
allowing Medicare Advantage private plans to offer coverage to nonelderly
Americans through the exchanges.
The main worry about the Medicare option is that it would displace private plans . Under
our proposal, however, Medicare would enter the exchanges only in counties that already
have a small number of plans, limiting potential “crowd out .” Any crowd out that did
occur, moreover, would be a result of consumer choices, not federal fiat. So
long as Medicare competes on a level
playing field—with the same subsidies and rules and a premium set to reflect local costs —it would
gain enrollees only by offering coverage more attractive than that offered by private insurers.
Indeed, the competition posed by Medicare could encourage insurers to improve their offerings and
gain market share as well. The exchanges are not a fixed pie: If they offer more diverse and affordable
options, more Americans are likely to buy coverage through them, allowing both the
public option and private plans to grow .
To be sure, private insurers will complain that Medicare has lower administrative costs and pays providers at lower rates than do
private insurers. But here again, adding Medicare to the mix wouldn’t prevent insurers from improving
their products. After all, private plans compete effectively against Medicare within Medicare
Advantage. Currently, they enroll approximately one third of all Medicare beneficiaries. If insurers are able to lower
their administrative costs and negotiate lower rates with local providers, they could do so within
the exchanges as well.
This brings us to the second element of our proposal: Since Medicare already features private plans, it should
be used not only to add a Medicare option, but also to expand the range of private options. Private insurers
that offer M edicare A dvantage plans in a region should be required to offer such plans
within the exchanges as well . Because many more private insurers participate in the
Medicare Advantage program than offer coverage in the exchanges, this would substantially
increase the number of private insurers in the small group and individual markets.
How Much Would Our Proposal Help?
How much would a Medicare option with Medicare Advantage plans increase competition? To form a rough estimate, we
examined the extent of competition in Zanesville, Ohio, the main city in one of the counties in
rural America without any insurers on the exchange . Using’s Plan Finder tool, we found 21
Medicare Advantage plans operating there: three offered by Medigold, five by Anthem Blue Cross Blue Shield, four
by Humana, six by Aetna, and three by The Health Plan. Thus, if Medicare and Medicare Advantage plans were
exchange options in Zanesville, a subscriber would have access to 21 different Medicare
Advantage plans as well as traditional Medicare coverage.
The picture is roughly the same in most other rural counties in Ohio — our proposal would result in a major
increase in private insurance options alongside a new Medicare fee-for-service option.
Trade DA

Public option violates U.S. commitments to the WTO by introducing unfair

government competition in the market to supply health care services---that leads
to DSB challenges that we’d lose---collapses trade in services and global growth
Ethan Marks 14, J.D. Candidate, Boston College Law School, 2014, “Federalism in an Era of
International Free Trade: The General Agreement on Trade in Services And the Regulation of
Insurance in the United States,” Tort Trial & Insurance Practice Law Journal, vol. 50, p. 129-153
State health insurance reforms may be particularly likely to conflict with GATS . To address high
health care costs, poor health care quality, and low access to care, state legislatures have reformed their health
insurance markets in increasingly aggressive ways. Many proposed reforms , and some enacted reforms,
could violate current GATS commitments . Universal single-payer health insurance, on either the state or
federal level, would likely violate GATS’ prohibition of new monopolies.98 Minimum benefits requirements for plans offered in state
health insurance exchanges could violate GATS’s market access provisions or its ban on the establishment or authorization of a small
number of exclusive service providers.99 A state “ public option” health insurance plan , if subsidized by the
state, would also likely violate GATS . If the public option competed with private health
insurance plans —as it is designed to do—it would not be exempt from GATS as a service
supplied in the exercise of government authority. 100 The public option would likely contravene
GATS’s national treatment principle , assuming that the subsidies or other favorable treatment it received
from the state were not available to private plans.101 If the public option had the effect of placing a numerical
quota on the number of service providers that could enter the market, it would violate GATS’s
market access provision .102
Perhaps most importantly, the Council for Trade in Services might develop disciplines on domestic regulation under GATS Article
VI.4 that would restrict the licensing requirements states could adopt. These disciplines might go so far as to prohibit any state
licensing requirement “more burdensome than necessary to ensure the quality of the service.”103 Under this standard, long delays
in the processing of insurance licenses could violate GATS. 104 A new discipline might even subject the entire state system of
licensing to a GATS challenge.105 If the costs of complying with multiple states’ licensing requirements are deemed to be more
burdensome than necessary, the United States might have no choice but to create a federal agency for the licensing of insurers.
If an insurance reform statute passes both houses of the legislature and is signed by the governor, it becomes law within the state.
Considering the wide latitude accorded to states to enact insurance regulations, the aforementioned insurance statutes could not
reasonably be attacked on constitutional grounds. Once such a statute took effect, however, another country
might decide to initiate consultations with the U nited S tates under the DSU if that country believed
that the state statute violated GATS to the disadvantage of its insurers. A country could challenge a state law if the law
caused foreign insurers to suffer economic loss on a discriminatory basis . But foreign
insurers also recognize that the state system of regulation, considered as a whole, creates high administrative costs for both domestic
and foreign insurers. 106 Foreign insurers could eliminate the fragmented system of licensing and regulation altogether by
challenging the system itself under the new domestic disciplines currently being negotiated. Even panel and Appellate Body
determinations that individual state insurance statutes violated GATS could pressure the federal government to centralize its
insurance regulatory authority in the federal government. For these reasons, countries with expansion-minded
insurers have strong incentives to challenge state statutes under GATS.
If another country initiated consultations with the United States, the federal government—not the state—would have to defend the
state statute in any ensuing dispute settlement proceedings. Under the Uruguay Round Agreements Act, the state would play a
minimal advisory role to the federal government. But the state would not be formally recognized as a third party before the DSB and
therefore could not make written submissions or participate in panel or Appellate Body hearings on its own accord.
If the DSB concluded that the statute did not violate GATS, no further action would be necessary on the part of the state or
the federal government. If the statute did violate GATS, however, the federal government would have several options: it
could negotiate with the state for repeal of the statute; Congress could expressly preempt the statute; the FIO could expressly
preempt the statute; or, the federal executive branch could initiate a preemptory lawsuit against the state. The federal government
has important economic reasons to ensure that states comply with dispute settlement rulings. If
a state statute remains in
effect after an adverse panel or Appellate Body ruling , the DSB could authorize punitive trade
sanctions against the federal government. 107 The state might feel the brunt of these sanctions. Yet because only federal
representatives sit at the bargaining table in the WTO, the states do not experience the full international political consequences of
their refusal to comply with the DSB.
V. Recommendations for Preserving a Dual System of Insurance Regulation
The Unites States’ GATS commitments serve important economic goals . The elimination of
barriers to the expansion of trade in services is designed to promote the economic growth
of all countries involved in international trade. 108 For United States service suppliers to realize these
benefits, the nation must be willing to open its own borders to foreign firms . But the aims
of international cooperation must not take precedence over the protections afforded to policyholders and citizens at large by the
current system of domestic insurance regulation. The preservation of these consumer protections requires that the values underlying
the traditionally strong role of states be given a greater platform in the ongoing Doha Round of WTO negotiations.

Global nuclear war

Nouriel Roubini 17, professor at NYU’s Stern School of Business and Chairman of Roubini
Macro Associates, was Senior Economist for International Affairs in the White House's Council
of Economic Advisers during the Clinton Administration, 1/2/17, ““America First” and Global
Conflict Next,”
Trump, however, may pursue populist, anti-globalization, and protectionist policies that hinder trade and restrict the
movement of labor and capital. And he has cast doubt on existing US security guarantees by suggesting that he will force America’s
allies to pay for more of their own defense. If Trump is serious about putting “America first,” his administration will shift US
geopolitical strategy toward isolationism and unilateralism, pursuing only the national interests of the homeland.
helped sow the seeds of World War II .
When the US pursued similar policies in the 1920s and 1930s, it
Protectionism – starting with the Smoot-Hawley Tariff, which affected thousands of imported goods – triggered
retaliatory trade and currency wars that worsened the Great Depression. More important, American
isolationism – based on a false belief that the US was safely protected by two oceans – allowed Nazi Germany and
Imperial Japan to wage aggressive war and threaten the entire world . With the attack on Pearl Harbor in
December 1941, the US was finally forced to take its head out of the sand.
Today, too, a US turn to isolationism and the pursuit of strictly US national interests may eventually lead to
a global conflict . Even without the prospect of American disengagement from Europe, the European Union and the
eurozone already appear to be disintegrating, particularly in the wake of the United Kingdom’s June Brexit vote and Italy’s failed
referendum on constitutional reforms in December. Moreover, in 2017, extreme anti-Europe left- or right-wing populist parties
could come to power in France and Italy, and possibly in other parts of Europe.
Without active US engagement in Europe, an aggressively revanchist Russia will step in. Russia is already challenging the US and the EU in Ukraine, Syria, the Baltics, and the Balkans, and it may capitalize on the
EU’s looming collapse by reasserting its influence in the former Soviet bloc countries, and supporting pro-Russia movements within Europe. If Europe gradually loses its US security umbrella, no one stands to
benefit more than Russian President Vladimir Putin.
Trump’s proposals also threaten to exacerbate the situation in the Middle East. He has said that he will make America energy independent, which entails abandoning US interests in the region and becoming more
reliant on domestically produced greenhouse-gas-emitting fossil fuels. And he has maintained his position that Islam itself, rather than just radical militant Islam, is dangerous. This view, shared by Trump’s
incoming National Security Adviser, General Michael Flynn, plays directly into Islamist militants’ own narrative of a clash of civilizations.
Meanwhile, an “America first” approach under Trump will likely worsen the longstanding Sunni-Shia proxy wars between Saudi Arabia and Iran. And if the US no longer guarantees its Sunni allies’ security, all
regional powers – including Iran, Saudi Arabia, Turkey, and Egypt – might decide that they can defend themselves only by acquiring nuclear weapons, and even more deadly conflict will ensue.
In Asia, US economic and military primacy has provided decades of stability; but a rising China is now challenging the status quo. US President Barack Obama’s strategic “pivot” to Asia depended primarily on
enacting the 12-country Trans-Pacific Partnership, which Trump has promised to scrap on his first day in office. Meanwhile, China is quickly strengthening its own economic ties in Asia, the Pacific, and Latin
America through its “one belt, one road” policy, the Asian Infrastructure Investment Bank, the New Development Bank (formerly known as the BRICS bank), and its own regional free-trade proposal to rival the
If the US gives up on its Asian allies such as the Philippines, South Korea, and Taiwan, those countries may have no choice but to prostrate themselves before China; and other US allies, such as Japan and India,
may be forced to militarize and challenge China openly. Thus, an American withdrawal from the region could very well eventually precipitate a military conflict there.

As in the 1930s, when protectionist and isolationist US policies hampered global economic growth
and trade, and created the conditions for rising revisionist powers to start a world war , similar
policy impulses could set the stage for new powers to challenge and undermine the American-
led international order. An isolationist Trump administration may see the wide oceans to its east and west,
and think that increasingly ambitious powers such as Russia, China, and Iran pose no direct threat to the
But the US is still a global economic and financial power in a deeply interconnected world . If left
unchecked, these countries will eventually be able to threaten core US economic and security
interests – at home and abroad – especially if they expand their nuclear and cyberwarfare capacities .
The historical record is clear: protectionism, isolationism, and “America first” policies are a recipe for
economic and military disaster .
Midterms DA

Failed GOP health care policy means Republicans can’t expand their Senate
majority now---the plan allows the GOP to pick up 10 seats for a total of 62
James Arkin 17, Real Clear Politics staff, 7/25/17, “GOP Fears Health Care Fail Could Thin
Senate Majority,”
Senate Republicans have a favorable electoral map in 2018, with far more Democrats up for re-election,
including in states President Trump won last year. But there is growing concern within the party that a failed vote
on Obamacare this week could imperil the GOP’s effort to expand the Senate majority next
After months of negotiations and weeks of false starts, Republicans will finally move ahead Tuesday on a procedural vote to begin
debate on their Obamacare measure – though as of late Monday, it was unclear precisely what would receive a vote after the
procedural motion – repeal with a replacement, or repeal alone.
GOP leaders expressed confidence they would secure the votes to start debate on the measure Tuesday, and some Republican
senators said there was momentum in favor of the vote Monday evening. If GOP senators do vote to support debate, the political
consequences will shift based on how the bill is changed, and whether the final, amended version can pass the Senate.
Either way, there has been strong opposition from both the moderate and conservative wings of the party.
For the few Republicans up for re-election next year, including Sens. Dean Heller of Nevada and Jeff
Flake of Arizona, the vote could be central to Democrats’ efforts to defeat them . While most of
the senators opposed to the GOP plans are not up for re-election next year, the effort still has a significant impact
on the party’s chances in 2018.
The favorable map makes it unlikely that Republicans will lose their Senate majority – unlike the
House majority, which many Republicans admit could be in play next year. But there is concern that failure on the
measure could imperil their chances to knock off the 10 Democratic incumbents
running next year in states President Trump won .
In particular, Republican Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia have been two of the
most vocal senators opposing the replacement plans, concerned about the impact Medicaid cuts could have on
their states. Neither is up for re-election next year, but Republicans had considered their Democratic colleagues, Sens.
Sherrod Brown of Ohio and Joe Manchin of West Virginia, to be two of the most vulnerable next year. Sen. Ron
Johnson of Wisconsin has also spoken out against the GOP plan, and Republicans plan to target Sen. Tammy Baldwin in her re-
election in the Badger State.
Josh Holmes, a Senate GOP strategist and former chief of staff to Majority Leader Mitch McConnell, said there was “no question”
that opposition from GOP senators made it more difficult to challenge Democrats in those states.
“There has, up until about four weeks ago, been an incredibly clear contrast between the Republican position on health care and the
Democratic support of Obamacare,” Holmes said. “To say that that has been muddled a bit, I think, is an understatement.”
Capito, Portman and Johnson have not backed away from their support for repealing and replacing Obamacare as a principle, but
Capito and Portman have expressed serious reservations about the party’s replacement plan. And despite voting in 2015 to repeal
the measure outright, with a two-year delay to craft a solution, both said they oppose that strategy now. They haven't indicated how
they'll vote on Tuesday's measure to proceed.
“The reality is that the president is going to sign this bill. I think that’s a big change,” Capito said in a local radio interview last week,
defending the switch in position. She emphasized that in a meeting with all GOP senators last week, Trump himself pushed for
repealing and replacing the ACA. “I don’t think that it’s a responsible way to repeal something, have everything fall off a cliff in two
years, have more people uninsured, have no plan in front of us. I want to see the plan in front of us so I can stay consistent with my
repeal-and-replace votes in the past.”
Trump spoke to thousands of Boy Scouts at a national jamboree in West Virginia Monday evening – and singled out the state's GOP
senator, saying Republicans "better get Sen. Capito to vote for it." He was scheduled for a campaign rally in Ohio Tuesday evening.
Democrats have noticed the GOP opposition and think it will be a useful tool in making the case
against the GOP efforts on Obamacare.
"The fact that even Republican senators are speaking out against the GOP’s health care plan
should tell you everything you need to know about how toxic their agenda will be on the campaign
trail,” said David Bergstein, spokesman for Democrats’ campaign committee.
Manchin and Brown have avoided politicizing their GOP colleagues’ position on the health care bill, focusing on their own
opposition to repealing Obamacare and the impact it would have in their state – though they have also proposed bipartisan
conversations to fix certain aspects of the law. But Manchin did express support for Capito’s position Friday.
“I’m just very proud of her,” Manchin said of Capito last week. “A lot of pressure was on her. She made a tough decision, but she
knows her state the same as I know my state – very, very well. This is something we talked about just couldn’t happen.”
Some Republicans think that opposition from Republican senators could help the case of challengers seeking Democratic seats. One
GOP strategist, who requested anonymity to avoid criticizing Republicans, said outsider candidates in West Virginia could use GOP
opposition to further their own case – arguing either in Ohio or West Virginia that with two senators voting against repeal, the state
needs to elect someone who would vote for the measure.
But in an interview on a local radio program last Friday, Rep. Evan Jenkins – one of two candidates running in the primary to
challenge Manchin next year – defended Capito’s position even while touting his support for the House repeal measure that passed
in May.
“You will not hear me criticizing Sen. Capito for the due diligence with which she is approaching this very difficult, challenging
issue,” Jenkins said. “She’s looking at the proposals being presented in the Senate, not from the House. I have a wonderful working
relationship with Sen. Capito and appreciate the hard work that she puts into it.”
His primary opponent, state Attorney General Patrick Morrisey, has also struck a similar position to Capito. In a local newspaper
interview after his announcement earlier this month, he said, “I would sit in for as long as it takes to repeal Obamacare, preserve
Medicaid and protect it for those who need it.”
But Morrisey was endorsed by the conservative group FreedomWorks, which sent an email last week labeling Capito a “fraud” –
along with Portman and Maine Sen. Susan Collins – for her opposition to the repeal-only strategy.
In Ohio, state Treasurer Josh Mandel is likely to face Brown in a campaign next fall. But Mandel has long opposed the state’s
Medicaid expansion – his website says he “did everything he could” to prevent the expansion – which puts him at odds with both
Portman and Gov. John Kasich.
Yetsome Republicans caution that if the health effort fails, it’s unlikely that it will be a central
campaign issue a year from now, particularly with an ever-changing news cycle and myriad issues to
focus on against Democrats in Trump states. If Obamacare isn’t a successful campaign issue for them ,
Republicans say, they simply won’t spend television money advertising on it , and will seek other ways to
animate their base ahead of the midterms.
But Holmes, the former McConnell aide, argues it would have serious consequences for the party .
“The worst-case scenario for Republicans is they miss the opportunity to make conservative
reforms and as the insurance market collapses, they are forced to engage with Dem ocrats on a
whole-sale insurance bailout,” he said. “From a policy perspective it’s a disaster, and from a political
perspective it’s a catastrophe.”

Filibuster-proof majority means the GOP expands offshore drilling---locks in

warming which causes extinction
Patrick Parenteau 17, professor of law at Vermont Law School, 1/3/17, “Will Trump Scuttle
Obama's Offshore Drilling Bans?,”
President Obama gave environmental advocates a Christmas present when he announced in late December that he was
banning oil and gas drilling in huge swaths of the Arctic and Atlantic oceans. This action
“ indefinitely ” protects almost 120 million acres of ecologically important and highly sensitive marine environments from the
risks of oil spills and other industrial impacts.
President Obama acted boldly to conserve important ecological resources and solidify his
environmental legacy. But by making creative use of an obscure provision of a 1953 law, Obama ignited a
legal and political firestorm .
Republicans and oil industry trade groups are threatening to challenge the ban in court or through
legislation . They also contend that the Trump administration can act directly to reverse it. But a close reading of the law
suggests that it could be difficult to undo Obama’s sweeping act.
The power to withdraw
Congress passed the law now known as the O uter C ontinental S helf L ands A ct in 1953 to assert federal control over
submerged lands that lie more then three miles offshore, beyond state coastal waters. Section 12(a) of the law authorizes the
president to “withdraw from disposition any of the unleased lands of the outer Continental
Starting in 1960 with the Eisenhower administration, six presidents from both parties have used this power. Most withdrawals were
time-limited, but some were long-term. For example, in 1990 President George H. W. Bush permanently banned oil and gas
development in California’s Monterey Bay, which later became a national marine sanctuary.
President Obama used section 12(a) in 2014 to protect Alaska’s Bristol Bay, one of the most productive wild salmon fisheries in the
world. In 2015 he took the same step for approximately 9.8 million acres in the biologically rich Chukchi and Beaufort seas.
Obama’s latest action bars energy production in 115 million more acres of the Chukchi and Beaufort seas – an area known as
the “Arctic Ring of Life” because of its importance to Inupiat Peoples who have lived there for millennia. The order also
withdraws 3.8 million acres off the Atlantic Coast from Norfolk, Virginia to Canada, including
several unique and largely unexplored coral canyons.
Why Obama acted
In a Presidential Memorandum on the Arctic withdrawals, Obama provided three reasons for his action. First, he asserted, these
areas have irreplaceable value for marine mammals, other wildlife, wildlife habitat, scientific research and Alaska Native subsistence
use. Second, they are extremely vulnerable to oil spills. Finally, drilling for oil and responding to spills in Arctic waters poses unique
logistical, operational, safety and scientific challenges.
In ordering the Atlantic withdrawals, Obama cited his responsibility to “ensure that the unique resources associated with these
canyons remain available for future generations.”
Market forces support Obama’s action. Royal Dutch Shell stopped drilling in the Chukchi Sea in 2015 after spending US$7 billion
and drilling in what proved to be a dry hole. Since 2008 the Interior Department has canceled or withdrawn a number of sales in
Alaskan waters due to low demand. Shell, ConocoPhillips, Statoil, Chevron, BP and Exxon have all to some degree abandoned
offshore Arctic drilling.
Low oil prices coupled with high drilling costs make business success in the region a risky prospect. Lloyd’s of London forecast this
scenario in a 2012 report that called offshore drilling in the Arctic “a unique and hard-to-manage risk.”
What happens next?
Critics of President Obama’s action, including the state of Alaska and the U.S. Chamber of Commerce, say they may challenge
Obama’s order in court, in hopes that the Trump administration will opt not to defend it. But environmental groups, which hailed
Obama’s action, will seek to intervene in any such lawsuit.
Moreover, to demonstrate that they have standing to sue, plaintiffs would have to show that they have suffered or face imminent
injury; that this harm was caused by Obama’s action; and that it can be redressed by the court. Market conditions will make this very
The Energy Information Administration currently projects that crude oil prices, which averaged about $43 per barrel through 2016,
will rise to only about $52 per barrel in 2017. Whether these areas will ever be commercially viable is an open question, especially
since rapid changes are taking place in the electricity and transportation sectors, and other coastal areas are open for leasing in
Alaska’s near-shore waters and the Gulf of Mexico.
The Royal Dutch Shell drilling rig Kulluk broke loose and ran aground near Kodiak Island in the Gulf of Alaska as it was being towed
to Seattle for winter maintenance in December 2012. This Coast Guard overflight video shows the harsh conditions along Alaska’s
coast in winter.
Alternatively, Donald Trump could issue his own memorandum in office seeking to cancel Obama’s. However, section 12(a)
does not provide any authority for presidents to revoke actions by their predecessors. It delegates
authority to presidents to withdraw land unconditionally. Once they take this step, only Congress can

undo it .
This issue has never been litigated. Opponents can be expected to argue that Obama’s use of section 12(a) in this manner is
unconstitutional because it violates the so-called “nondelegation doctrine,” which basically holds that Congress cannot delegate
legislative functions to the executive branch without articulating some “intelligible principles.”
However, one could argue that Obama’s action was based on an articulation of intelligible principles gleaned from the stated policies
of the OCSLA, which recognizes that the “the outer Continental Shelf is a vital national resource reserve held by the Federal
Government for the public.” The law expressly recognizes both the energy and environmental values of the OCS. Thus President
Obama’s decision reflects a considered judgment that the national interest is best served by protecting the unique natural resources
of these areas, while at the same time weaning the nation from its dangerous dependence on fossil fuels.
The section 12(a) authority is similar in some respects to the authority granted by the Antiquities Act, which authorizes the president
to “reserve parcels of land as a part of [a] national monument.” Like the OCSLA, the Antiquities Act does not authorize subsequent
presidents to undo the designations of their predecessors. Obama has also used this power extensively – most recently, last week
when he designated two new national monuments in Utah and Nevada totaling 1.65 million acres.
Some laws do include language that allows such actions to be revoked. Examples include the Forest Service Organic Administration
Act, under which most national forests were established, and the 1976 Federal Land Policy and Management Act, which sets out
policies for managing multiple-use public lands. The fact that Congress chose not to include revocation language in the OCSLA
indicates that it did not intend to provide such power.
What can the new Congress do?
Under Article IV of the Constitution, Congress has plenary authority to dispose of federal property as it
sees fit. This would include the authority to open these areas to leasing for energy
development . Members of Alaska’s congressional delegation are considering introducing legislation to override Obama’s
drilling ban. But Democrats could filibuster to block any such move , and Republicans –
who will hold a 52-48 margin in the Senate – would need 60 votes to stop them.
On the other hand, Congress may be content to let President-elect Trump make the first move and see how it goes in court. If Trump
attempts to reverse the withdrawal, environmental groups contesting his decision would face some of the same obstacles as an
industry challenge to Obama’s action. It could be especially challenging for environmental groups to show that the claim is “ripe” for
judicial review, at least until a post-Obama administration acts to actually open up these areas for leasing. That may not occur for
some time, given the weak market for the oil in these regions.
In the meantime, this decision is a fitting capstone for a president who has done everything within
his power to confront the existential threat of climate change and rationally move
the nation and the world onto a safer and more sustainable path .
Econ DA

The plan collapses the health care industry instantaneously---causes financial

Paul Starr 9, professor of sociology and public affairs at Princeton University, 6/26/9,
“Debating the Public Option,”
Robert Reich seems to consider the "apoplectic" opposition of private insurers and other health care interests as proof that the
public option, in whatever form, is a good idea. The
industry is genuinely scared of a public plan that
would pay doctors and hospitals Medicare rates, which run 20 to 30 percent below what private
insurers now pay providers for the under-65 population. According to the most widely cited estimate, a public plan
on those lines, if offered to all employee groups and individuals , could enroll more than
100 million people who now have private insurance .
But what would happen in that event? The resulting sudden drop in the flow of funds to the

health-care sector would cause a monumental financial crisis throughout the

system . There is no way that Congress is going to bring on that kind of a crisis, which would immediately discredit reform. So
if a public plan is introduced, it is going to have to pay rates that are closer to those of private insurers. The ability of a public plan to
constrain growth in prices -- that is, its ability to control costs through its bargaining leverage -- could only be exerted gradually. But
the public option may never be able to get to that point if it first becomes a dumping ground for high-cost people.

Global nuclear war

Stein Tønnesson 15, Research Professor, Peace Research Institute Oslo; Leader of East Asia
Peace program, Uppsala University, 2015, “Deterrence, interdependence and Sino–US peace,”
International Area Studies Review, Vol. 18, No. 3, p. 297-311
Several recent works on China and Sino–US relations have made substantial contributions to the current
understanding of how and under what circumstances a combination of nuclear deterrence and
economic interdependence may reduce the risk of war between major powers . At least four conclusions
can be drawn from the review above: first, those who say that interdependence may both inhibit and drive
conflict are right. Interdependence raises the cost of conflict for all sides but asymmetrical or
unbalanced dependencies and negative trade expectations may generate tensions leading to
trade wars among inter-dependent states that in turn increase the risk of military conflict (Copeland,
2015: 1, 14, 437; Roach, 2014). The risk may increase if one of the interdependent countries is governed by an inward-looking socio-
economic coalition (Solingen, 2015); second, the risk of war between China and the US should not just be analysed bilaterally but
include their allies and partners. Third party countries could drag China or the US into confrontation; third, in this context it is of
some comfort that the three main economic powers in Northeast Asia (China, Japan and South Korea) are all deeply integrated
economically through production networks within a global system of trade and finance (Ravenhill, 2014; Yoshimatsu, 2014: 576);
and fourth, decisions for war and peace are taken by very few people, who act on the basis of their
future expectations. International relations theory must be supplemented by foreign policy analysis in order to assess the
value attributed by national decision-makers to economic development and their assessments of risks and opportunities. If
leaders on either side of the Atlantic begin to seriously fear or anticipate their own nation’s
decline then they may blame this on external dependence, appeal to anti-foreign sentiments,
contemplate the use of force to gain respect or credibility, adopt protectionist policies, and ultimately
refuse to be deterred by either nuclear arms or prospects of socioeconomic calamities.
Such a dangerous shift could happen abruptly , i.e. under the instigation of actions by a third party – or against a
third party.
Yet as long as there is both nuclear deterrence and interdependence, the tensions in East Asia are unlikely to escalate to war. As
Chan (2013) says, all states in the region are aware that they cannot count on support from either China or the US if they make
provocative moves. The
greatest risk is not that a territorial dispute leads to war under present circumstances
but that changes in the world economy alter those circumstances in ways that render inter-
state peace more precarious. If China and the US fail to rebalance their financial and trading relations (Roach, 2014) then
a trade war could result, interrupting transnational production networks, provoking social distress, and exacerbating nationalist
emotions. This could have unforeseen consequences in the field of security, with nuclear deterrence
remaining the only factor to protect the world from Armageddon , and unreliably so .
Deterrence could lose its credibility : one of the two great powers might gamble that the other
yield in a cyber-war or conventional limited war, or third party countries might engage in conflict with each other,
with a view to obliging Washington or Beijing to intervene.
The version of the option that got the closest to passing solved nothing because it
locked in level playing field competition---no subsidies, no bargaining, and states
could opt out
Daniel Miller 11, Visiting Faculty at Singapore Management University, et al., November 2011,
“The Consequences of a Public Health Insurance Option: Evidence From Medicare Part D
Prescription Drug Markets,”
In 2010 US legislators passed a major health insurance reform bill. A controversial provision
that was ultimately struck from the bill is the “Community Health Insurance Option”1 ,
colloquially known as a “Public Option.”2
2The language in an earlier bill proposal (H.R. 3962) proposed by Nancy Pelosi, used the term
“Public Health Insurance Option,” which was was changed to “Community Health Insurance
Option” in the passed bill. The descriptions in the two bills are nearly verbatim
identical . The key difference is that in the passed legislation states may opt-out of the
community option whereas in the earlier bill states could not opt-out.
When fully enacted in 2014, the reformed health care system will continue to rely on private
health insurance markets, but under the “Community Option” the government would have
offered a zero-profit basic coverage health insurance plan that sells alongside private plans. The
legislation stipulates that the government plan compete on a level playing field with
private plans. It will not be subsidized , is subject to the same regulations as private plans,
has no special mandates on coverage, and negotiates provider fees without statutory
mandate .

Political resistance means the public option would be watered down, which is
worse than nothing
Robert Kuttner 9, professor at Brandeis University's Heller School for Social Policy and
Management, 6/26/9, “Debating the Public Option,”
It's interesting and significant that the three co-founders of the Prospect are reprising the three major strands of progressive views
on health reform. Robert Reich is arguing that the Obama plan, with the public option, is the best practical brand of reform
available. Paul Starr, holding out for something that looks a lot like the Clinton plan, argues (convincingly in my view) that the
most likely form of the public option will backfire . And I continue to be the single-payer guy. We've been
having different versions of this friendly argument for two decades, as has the progressive community.
Reich says that single-player has "no skin in the game." Well, let's put some there, rather than being apologists for a threadbare
cloak of a public option.
Where Starr and I disagree is on both his diagnosis of Medicare for All, and on his optimism that "exchanges" could be designed in a
way that would meet his hopes (the exchanges sound a lot like the purchasing pools of the Bill Clinton plan that Paul Starr helped
Although Starr and Reich seem to disagree, they have one thing in common. They are both somewhat wishful about what it would
take politically to legislate the crucial details of either the Obama public option (Reich) or the exchanges (Starr) necessary to achieve
meaningful reforms. In order for the fine print in either approach to do the job, progressives would
need first to crush the industry influence in Congress that is very likely to hobble
either strategy . And both Reich and Starr are right that a weakened version of the Obama plan could
well be worse than nothing .
The political reality is that Medicare for All is no harder politically than a version of the
Obama plan that would meet all the tests that Reich and Starr apply. And it would be far simpler and more cost

The public option would not be available to people who get large-group employer
Jacob Hacker 17, the Stanley B. Resor Professor of Political Science at Yale, 7/26/17,
“Assessing the healthcare debate, with Jacob Hacker,” interviewed by Mike Cummings,
Politics aside, what could be done to extend health coverage to more people?
I would argue that we should move toward the system I proposed in the 2000s, which provided
the template for the more progressive versions of what became the A ffordable C are A ct.
It’s worth remembering that President Obama initially supported a much more extensive and
robust system and what emerged from the legislative process had been whittled down to
something that could pass through the gauntlet of interest groups.
What did those more robust policies contain? They all had a public option — a health-
insurance plan modeled after Medicare that would be available to anyone who is seeking
coverage through the so-called health insurance exchanges. This would mean that anyone
who didn’t have coverage through their employer would have access to a
Medicare-like plan that offers a broad choice of physicians with reasonable rates and low
administrative costs.

Specifying the design details of employment eligibility’s key to assessing the plan’s
utility---the most likely versions are limited to people without large-group
employer coverage
Greg D’Angelo 9, Senior Research Fellow at the Heritage Foundation, 6/12/9, “A New Public
Health Plan: How Congressional Details Will Impact Doctors and Patients,”
According to the Lewin Group, a nationally prominent econometrics firm, the two most crucial design details of
this new option are the size of employers eligible to buy into the new plan and the provider payment levels
used for reimbursement under the plan.[1]
These key issues are bound to be contentious in the upcoming debate over health care reform.[2] The
Obama campaign
proposal would have made individuals without employer coverage , the self-employed ,
and small employers (defined as fewer than 25 employees ) eligible for the public plan. But the
President never specified provider payment levels or the method for determining reimbursement rates for doctors, hospitals, and
other medical professionals for the thousands of medical services that would be delivered.[3]
Members of Congress and their staffs will thus have to hammer out these crucial details in legislation if a public plan is to be
Unlevel Playing Field
If Congress creates a public plan modeled on Medicare--as some have previously proposed--the result, of course, would be to
undercut any pretense of a promised "level playing field" for competition with private health insurance.[4] Public plan premiums
would be 25-40 percent lower than private insurance premiums as the public plan would reimburse providers less than private
payers would--and often less than the cost of care delivered.
Payment rates for doctors and hospitals under public programs are set administratively, not by the market. They are, on average,
lower than private payment rates for similar care.[5] Medicare provider payments for hospital care are only 71 percent of private
rates, while Medicare provider payments for physician care are only 81 percent of private rates.[6] In other words, Medicare
payment levels are roughly 19-29 percent lower than private levels.
Congress's ability to impose low provider payments and artificially reduce the cost of the public option compared to private
insurance will increase enrollment in the public plan while crowding out, or displacing, existing private coverage.
Loss of Private Coverage
When considering a public plan modeled after Medicare, Lewin finds that the estimated reduction in the number of uninsured does
not vary greatly (observing a change of only 800,000 individuals) as eligibility for the plan is extended beyond small employers to
employers of all sizes.[7] Instead, there is a substantial increase in enrollment in the public plan and in the loss of private coverage.
If the public plan were opened to only small employers, enrollment in the public plan would
reach 42 .9 million , and 32 million Americans would lose their private coverage.[8] However, if the public plan is
opened to all employers, enrollment in the public plan increases dramatically to 131.2
million, and 119.1 million Americans would lose their private coverage.[9] In this particular case, of the 171.6 million
people who currently have private coverage, about 70 percent of them would lose the
coverage that they have today.[10]
More specifically, of the estimated 157.4 million Americans who have private employer coverage, up to 107.6 million people could
lose their private employer coverage, even if they like it and would prefer to keep it.[11]
The public option fails to expand coverage---it only matters to people who can
already buy insurance on the exchanges, and won’t control costs
Adam Gaffney 17, fellow in pulmonary and critical care medicine at Massachusetts General
Hospital, advisor to the board of the Physicians for a National Health Program, 7/19/17, “The
Case Against the Public Option,”
But here again lies one of the public’s option’s cardinal flaws: whatever it does for those buying insurance on
the Obamacare marketplaces (which I’ll return to in a minute), it does basically nothing for the large
majority of the nation not insured through them . The so-called “Obamacare” plans cover some
12.2 million enrollees — a substantial number of people to be sure, but still a very small fraction of the
What would a public option do, for example, for the 28 .6 million US residents who are
uninsured? According to the Congressional Budget Office’s (CBO) 2013 scoring of a public option added to
the ACA marketplaces, the answer is nothing : the public option, the CBO estimated, “would have
minimal effects . . . on the number of people who would be uninsured.”
The goal of single-payer is to reduce that 28.6 million figure to zero; under the public option — at least according to this
admittedly old CBO score of one particular variation of the public option — the number wouldn’t so much as
budge . Perhaps a more ambitious public option could do a bit better. Nonetheless, it’s not clear that even a more
robust plan would be a step toward universal coverage.
And how about for the underinsured? The roughly half of the nation currently covered through their employer
saw a 2016 deductible that was 300 percent higher than a decade ago. Such cost-shifting of health care
costs to workers is a major cause of financial suffering, as well as deferred medical care. Yet the public option would do
nothing for the great majority of these families.
A longstanding aim of universal health care advocates — stretching back to the German Social Democrats’ 1891 Erfurt Program,
which called for “[f]ree medical care, including midwifery and medicines” — has been to eliminate out-of-pocket payments (for
example, copayments and deductibles) at the time of health care use. In Canada and the United Kingdom, this goal has largely been
achieved: most health care remains free when patients use it. The public option, however, would do little to nothing to bring us
closer to this goal.
Nor would the public option ameliorate existing deficiencies in the two big public insurance programs,
Medicare and Medicaid. Medicare, like private insurance, often imposes high out-of-pocket payments on enrollees, and it
excludes coverage for important health services like dentistry and long-term care. The partial privatization of the program (via
Medicare Advantage plans, which are managed by private insurance companies) has yielded little but colossal waste over the years.”
And while Medicaid has broader benefits and usually minimal out-of-pocket payments, as a result of its lower reimbursements, it
sometimes provides inferior access to providers (a vestige of its heritage as a “poor person’s program).
The public option wouldn’t address the inadequacies of either public program.
Finally, interms of global costs , the public option’s effect would again be quite minor , as single-
payer advocates have long noted. Eliminating both uninsurance and underinsurance would cost money ,
and reduced administrative spending ($503 billion dollars a year, according to one estimate) and reduced drug
costs ($113.2 billion a year) are typically cited as key sources of savings. But although a Medicare-like
public option may have lower administrative costs, only a small fraction of the efficiency
savings of single-payer would be achieved if the multi-payer framework persisted (and drug
prices wouldn’t be controlled on a system-wide level ).
Or as Physician for a National Health Program’s Don McCanne puts it, the “public option would be only one more
player in our wasteful, administratively-complex, fragmented system of financing care.” The
upshot? It wouldn’t generate anywhere near the savings needed to fund a truly universal
expansion of health care.
Alt causes – undocumented immigrants, religious groups, anti-vacciners

No impact to bioterror
Filippa Lentzos 14, PhD from London School of Economics and Social Science, Senior
Research Fellow in the Department of Social Science, Health and Medicine at King’s College
London, Catherine Jefferson, researcher in the Department of Social Science, Health, and
Medicine at King’s College London, DPhil from the University of Sussex, former senior policy
advisor for international security at the Royal Society, and Dr. Claire Marris, Senior Research
Fellow in the Department of Social Science, Health and Medicine at King's College London, “The
myths (and realities) of synthetic bioweapons,” 9/18/2014,
The bioterror WMD myth. Those who have overemphasized the bioterrorism threat typically portray it as an

imminent concern , with emphasis placed on high-consequence, mass-casualty attacks ,

performed with weapons of mass destruction (WMD). This is a myth with two dimensions.¶ The first involves the identities of terrorists and

what their intentions are. The assumption is that terrorists would seek to produce mass-casualty weapons

and pursue capabilities on the scale of 20th century, state-level bioweapons programs. Most leading biological

disarmament and non-proliferation experts believe that the risk of a small-scale bioterrorism attack is very
real and present. But they consider the risk of sophisticated large-scale bioterrorism attacks to be quite

small. This judgment is backed up by historical evidence . The three confirmed attempts to use biological agents
against humans in terrorist attacks in the past were small-scale , low-casualty events aimed at causing panic and disruption rather
than excessive death tolls. ¶ The second dimension involves capabilities and the level of skills and resources available to terrorists. The implicit
assumption is that producing a pathogenic organism equates to producing a weapon of mass
destruction. It does not. Considerable knowledge and resources are necessary for the processes of

scaling up, storage, and dissemination. These processes present significant technical and logistical
barriers .¶ Even if a biological weapon were disseminated successfully, the outcome of an attack would be affected
by factors like the health of the people who are exposed and the speed and manner with which public health authorities and medical professionals
medical countermeasures, such as
detect and respond to the resulting outbreak. A prompt response with effective

antibodies and vaccination, can significantly blunt the impact of an attack .

Infectious diseases don’t cause extinction

Owen Cotton-Barratt 17, et al, PhD in Pure Mathematics, Oxford, Lecturer in Mathematics at
Oxford, Research Associate at the Future of Humanity Institute, 2/3/2017, Existential Risk:
Diplomacy and Governance,
For most of human history, natural pandemics have posed the greatest risk of mass global fatalities.37 However, there are some
natural pandemics are very unlikely to cause human extinction . Analysis of
reasons to believe that
the International Union for Conservation of Nature (IUCN) red list database has shown that of the 833 recorded plant
and animal species extinctions known to have occurred since 1500, less than 4% (31 species)
were ascribed to infectious disease.38 None of the mammals and amphibians on this list were
globally dispersed, and other factors aside from infectious disease also contributed to their
extinction. It therefore seems that our own species, which is very numerous , globally
dispersed , and capable of a rational response to problems , is very unlikely to be killed
off by a natural pandemic.
One underlying explanation for this is that highly lethal pathogens can kill their hosts before they have a
chance to spread, so there is a selective pressure for pathogens not to be highly lethal .
Therefore, pathogens are likely to co-evolve with their hosts rather than kill all possible hosts.39
Status quo ACA solves enough bioterror preparedness---it doesn’t have to be
Kimberly Ann Petersen 14, M.A. Candidate in Security Studies, Naval Post-Graduate School,
September 2014, “The Affordable Care Act: a prescription for homeland security
As Shane Green notes in his article, “Bioterrorism and Health Care Reform: No Preparedness
Without Access,”
With the U.S. presently engaged in a ‘war on terror,’ in which not only soldiers but also civilians are targets, a healthy fighting force
is no longer enough to ensure national security; the time has come for this country to take up reforms that promote the health of all
Americans.” 234 The perspective on health care must change so it becomes viewed as part and parcel of homeland security
preparedness by the civilian community and the government.
Health care and homeland security are inextricably linked. Investment in health care confers
benefits upon U.S. homeland security all-hazards preparedness because increased health insurance
coverage through the ACA equals increased access to health care, which equals improved health. This in
turn equals improved homeland security preparedness and a more resilient population . The
A ffordable C are A ct is already considered the largest health care reform in America in one-hundred
years, and only time will tell if it is a game-changer for homeland security preparedness as well. But if the A ffordable C are
A ct does deliver even in part on its promise to improve access to health care, then homeland
security all-hazards preparedness is likely to improve in kind. The health of homeland security depends
on the health of our population: the ACA promises to improve both .

We’d just respond to an attack by making the treatment free for everyone
Kimberly Ann Petersen 14, M.A. Candidate in Security Studies, Naval Post-Graduate School,
September 2014, “The Affordable Care Act: a prescription for homeland security
Another way that a robust and accessible health care system aids homeland security is through
prevention. Vaccines are one of the tools used to prevent bioattacks, or at least to manage a successful
attack. Homeland security experts have long considered smallpox a potential bioweapon, hence the
stockpiling of the smallpox vaccine since 9/11. Smallpox is an infectious disease caused by the virus variola major or
variola minor. The more common and more virulent form, variola minor, has a mortality rate of about 30 percent.70 The disease
was present throughout the world for tens of thousands of years, but was eradicated via a worldwide vaccination program prior to
1980. The smallpox virus only exists now in laboratory stockpiles.71 One of the concerns post-9/11 was the stockpiles would be
pilfered and used to intentionally reintroduce the virus to humans. The U.S. currently has 300 million doses of smallpox vaccine in
stockpiles around the U.S.—enough to vaccinate nearly the entire population. Recently, the U.S. government purchased enough of a
new smallpox medication to treat two million people.72 However, for the vaccination process and the treatment process
to be successful in the event of an outbreak, the population will need access to health care providers.
The Department of Homeland Security’s fact sheet on what to do in the event of a bioterror directs us as follows: “People in the
group or area that authorities have linked to exposure who have symptoms that match those described should seek emergency
medical attention.”73
It is likely in the event of such a dramatic scenario as a smallpox attack, the U.S. government will
set up emergency distribution centers , where all people will receive prophylaxis antibiotics,
without regard for health insurance or payment , as outlined in the C enter for D isease
C ontrol’s Smallpox Response Plan and Guidelines. 74 So perhaps the smallpox vaccination program serves
as a model for universal health care access .
Antitrust suits solve insurance consolidation
WSJ 17, Wall Street Journal, “The ObamaCare Merger Deathblow”, 2-15-2017, Accessed via
The conceit that the five major commercial health insurers will consolidate to three seems to be
dissolving, as four of those insurers called off a pair of mega-mergers on Tuesday. The immediate
reasons were legal objections, but perhaps this retreat is a sign of hope for insurance
markets .
After 18 months of courtship among the Big Five starting in 2015, the outgoing Obama Justice Department's antitrust
division sued to block the $34 billion Aetna-Humana tie-up as well as Anthem's $48 billion
acquisition of Cigna. Federal judges blocked both transactions earlier this year. Anthem had planned to
appeal but on Tuesday Cigna pulled the plug after Aetna and Humana did the same.
This is due less to the legal merits than to the pliability of antitrust law that lets enforcers and
judges define a market as they see fit. The court's analysis of the Anthem "market" was limited to "national accounts" --
large businesses with more than 5,000 employees in at least two states, which is suspiciously specific.
The Aetna deal was meant to expand participation in Medicare Advantage, which allows seniors to opt for private plans. The trial
judge ruled that fee-for-service Medicare doesn't compete with Advantage plans, when the reason the Advantage alternatives exist is
to drive down premiums or improve quality through competition with traditional Medicare.
In theory, the mergers are justified by economies of scale and to build negotiating leverage against the increasingly consolidated and
sometimes oligopolistic hospital supersystems. ObamaCare promotes and rewards health-care consolidation on the premise
that larger conglomerates lead to efficiencies and are more responsive to government control.
By converting insurers into public utilities, the law reduced choice and eliminated most margins
for competition. Price controls suppress innovation and discourage new entrants. The ObamaCare business, which has left
most insurers underwater, was never the great profit-making opportunity that some imagined in 2009-2010. The CEOs pursuing
mergers were responding to ObamaCare's regulatory logic.

Alt causes to consolidation – plan cant solve them

Wendell Potter 15, NYT bestselling author, Senior Analyst at The Center for Public Integrity,
fellow at the Center for Media and Democracy, and a consumer liaison representative to the
National Association of Insurance Commissioners, 7-13-2015, "GOP myth: Obamacare is driving
insurance mergers," Center for Public Integrity,
Republican lawmakers and their friends in Washington’s conservative think tanks have put forth
another reason Americans should hate Obamacare: it’s making the country’s biggest insurance
companies gobble each other up. If the recently announced deals actually happen, they say, we’ll have fewer insurance
When the CEOs of Aetna and Humana announced a few days ago that they had agreed to a deal in which Aetna will pay $37 billion
for Louisville-based Humana, Senate Majority Leader Mitch McConnell of Kentucky pointed the finger of blame
straight at Obamacare.
"This morning’s announcement, as I predicted during the debate five years ago, is the inevitable result of Obamacare’s push toward
consolidation as doctors, hospitals, and insurers merge in response to an ever-growing government," McConnell said on July 3.
Added Edmund Haislmaier of the Heritage Foundation: “The incentives are in there for consolidation. For all the talk about
competition, it’s really much more about consolidating everything so the government can better manage it.”
You can’t expect McConnell and Haislmaier to pass up an opportunity to reinforce their false
meme that Obamacare represents a government takeover of health care. Their sound bites undoubtedly
will resonate with the GOP’s base.
The reality, though, is that Aetna’s
proposed acquisition of Humana and Anthem’s $54 billion bid for
Cigna—and UnitedHealthcare's reported interest in Cigna—is McConnell’s and Haislmaier’s beloved free
market at work.
And in an ironic twist, the GOP’s insistence that billions of Medicare dollars must flow through private insurers is a major factor in
the recent flurry of M&A announcements. It might ultimately even mean that Kentucky could lose thousands of good-paying jobs as
Aetna’s executives begin laying off employees they consider redundant.
There are three big reasons for the recent spate of corporate marriage proposals in the health
insurance business, and not one of them has anything to do with Obamacare.
Size matters : As I noted last week, the big five for-profit health insurers (Aetna, Anthem, Cigna, Humana and
UnitedHealthcare) are the result of several deals that were consummated in the mid- to late 1990s.
The consolidation occurred because the more health-plan enrollees an insurer has in a given
market, the more leverage it has at the negotiating table with hospitals and physician groups. An unintended
consequence of that consolidation, however, was self-defense consolidation on the provider side. Just about every city in the country
has seen its hospitals combine. Hospitals have merged with each other to regain the negotiating clout they lost temporarily after
consolidation in the insurance industry.
Changing demographics : The average age of Americans has been increasing for several years,
primarily because of the aging Baby Boomers. Millions of Boomers are becoming eligible for
Medicare every year, and the Medicare program has contributed billions of dollars in revenue and profits to the insurers that
participate in the private Medicare Advantage program, which wouldn’t exist without its Republican champions in Congress. One
of the main reasons Aetna wants Humana is because of Humana’s huge Medicare Advantage
membership. An Anthem-Cigna deal would also give the combined company a large Medicare
Advantage enrollment. Both Anthem and Cigna have bought smaller Medicare Advantage insurers in recent years to
increase their presence in the program.
A shrinking employer-based health insurance market : Although the vast majority of Americans
with private health insurance get their coverage through the workplace, employers no longer present insurers with
growth opportunities. This is especially troublesome for Cigna and Aetna, which have long been known
as companies that cater to large employers. When I left Cigna in 2008, about 85 percent of its members were enrolled in large
employer-sponsored plans. In recent years, however, the only way the big insurers could increase their
membership in employer-sponsored plans was to steal market share from each other or to
acquire each other. As the Urban Institute noted in a report last month, enrollment in employer-sponsored
plans fell 11 percent between 2000 and 2012—two years before most of the provisions of
Obamacare went into effect—from 76.9 percent to 69.4 percent. Fueling the declines were the growing
numbers of workers who chose to opt out of employer-sponsored coverage because of the cost and the
growing numbers of employers that chose to stop offering coverage to workers’ dependents.
Interestingly, Obamacare
appears to have halted this erosion . Membership in employer-
sponsored plans has remained stable over the past couple of years , according to the Urban Institute
So the next
time you hear a politician or pundit claim that Obamacare is to blame for the
dwindling number of big for-profit insurers, know that they either don’t know what
they’re talking about or they’re trying to mislead you . More than likely it’s some of both.

Provider consolidation inev---IT investment, risk management, and declining

inpatient demand
Monica Noether 17, Ph.D. Economics, University of Chicago Graduate School of Business,
M.A. Economics, George Washington University, M.B.A. Finance and Economics, University of
Chicago Graduate School of Business, Vice President, Charles River Associates, Sean May, Ph.D.
Economics, Massachusetts Institute of Technology, “Hospital Merger Benefits: Views from
Hospital Leaders and Econometric Analysis,” January 2017, Charles River Associates,
The demands of the evolving health care delivery framework encourage the development of scale. For example,
hospitals must make substantial investments in the clinical and administrative information technology (IT)
infrastructure necessary to provide the type of integrated care envisioned in both private and public health care reform
Infrastructure investments, such as construction of a robust and productive IT system, benefit from
substantial economies of scale : they are expensive to develop and operate but are highly
scalable. These systems require more than the installation of an electronic health record (EHR) system, which itself
can be a costly undertaking. In addition, they require linkage of that system with financial data derived from a
sophisticated cost accounting system, training of staff to input data, development and production of
informative reports from the data to measure and monitor performance, usage of the reports to provide feedback to
system participants, and development of reward systems that hold participants accountable to certain standards based
on quality and cost.
Moreover, new payment initiatives that require providers to become financially responsible for the
outcomes of the services they provide and the general health status of the population they treat also demand scale in order
to mitigate the risk of inevitably high cost patients. Without sufficient patient volumes, a few
unusually high cost patients can undermine an otherwise stable financial position. As a result, it is not surprising
that hospital system leaders indicated that they are frequently approached by smaller hospitals and systems that see the need
to become part of a larger system, because they cannot unilaterally enter into a payment approach that
imposes downside risk.
At the same time, demand for inpatient hospital services has been declining, making it more difficult for
hospitals to achieve scale unilaterally. Between 2004 and 2014, inpatient admissions at community hospitals fell by 5.8
percent (from 35.1 million to 33.1 million) while the number of inpatient days declined by 8.7 percent (from 197.6 to 180.5 million).3
These trends are causing even larger hospitals to seek scale externally.
Finally, for many hospital services, additional volume enables the delivery of higher quality at lower cost.
Consolidation of clinical services across merging hospitals can allow them to take advantage of these benefits.
A recent review and synthesis of the literature on the effects of integrated delivery systems on cost and quality found that “ the
majority of these studies reported positive correlation between health system integration and quality of
care.”4 Such improvements are particularly feasible when the merging hospitals are geographically proximate and can combine
clinical service teams. Combinations of hospitals in the same geographic region, however, are precisely those that are most likely to
raise competitive concerns.

No competitiveness impact
Stephen G. Brooks and Wohlforth 16, Associate Professor of Government in the Department
of Government at Dartmouth College, William Wohlforth, Daniel Webster Professor of
Government in the Dartmouth College Department of Government, June 2016, “The once and
future superpower: why China won't overtake the United States,”
After two and a half decades, is the United States' run as the world's sole superpower coming to an end?
Many say yes, seeing a rising China ready to catch up to or even surpass the U nited S tates in
the near future. By many measures, after all, China's economy is on track to become the world's biggest, and even if its growth
slows, it will still outpace that of the United States for many years. Its coffers overflowing, Beijing has used its new wealth to attract
friends, deter enemies, modernize its military, and aggressively assert sovereignty claims in its periphery. For many, therefore, the
question is not whether China will become a superpower but just how soon. But this is wishful, or fearful, thinking.
Economic growth no longer translates as directly into military power as it did in the
past, which means that it is now harder than ever for rising powers to rise and established ones
to fall. And China--the only country with the raw potential to become a true global peer of the
United States--also faces a more daunting challenge than previous rising states because of how far
it lags behind technologically . Even though the United States' economic dominance
has eroded from its peak, the country's military superiority is not going anywhere , nor is
the globe-spanning alliance structure that constitutes the core of the existing liberal
international order (unless Washington unwisely decides to throw it away). Rather than expecting a power
transition in international politics, everyone should start getting used to a world in which the
United States remains the sole superpower for decades to come. Lasting preeminence will help
the United States ward off the greatest traditional international danger, war between the world's
major powers. And it will give Washington options for dealing with nonstate threats such as terrorism and transnational
challenges such as climate change. But it will also impose burdens of leadership and force choices among competing priorities,
particularly as finances grow more straitened. With great power comes great responsibility, as the saying goes, and playing its
leading role successfully will require Washington to display a maturity that U.S. foreign policy has all too often lacked.
the wealth of nations
In forecasts of China's future power position, much has been made of the country's pressing
domestic challenges: its slowing economy, polluted environment, widespread corruption,
perilous financial markets, nonexistent social safety net, rapidly aging population , and
restive middle class. But as harmful as these problems are, China's true Achilles' heel on the
world stage is something else: its low level of technological expertise compared with the United
States'. Relative to past rising powers, China has a much wider technological gap to close with the leading power.
China may export container after container of high-tech goods, but in a world of globalized production, that doesn't reveal much.
Half of all Chinese exports consist of what economists call "processing trade," meaning that parts are imported into China for
assembly and then exported afterward. And the vast majority of these Chinese exports are directed not by Chinese firms but by
corporations from more developed countries.
When looking at measures of technological prowess that better reflect the national origin of the expertise, China's true position
becomes clear. World Bank data on payments for the use of intellectual property, for example,
indicate that the United States is far and away the leading source of innovative
tech nologies, boasting $128 billion in receipts in 2013--more than four times as much as the
country in second place, Japan. China, by contrast, imports technologies on a massive scale yet
received less than $1 billion in receipts in 2013 for the use of its intellectual property. Another good indicator of the
technological gap is the number of so-called triadic patents, those registered in the United States, Europe, and Japan. In 2012,
nearly 14,000 such patents originated in the United States, compared with just under 2,000 in China. The distribution of
highly influential articles in science and engineering--those in the top one percent of citations,
as measured by the National Science Foundation--tells the same story, with the United States
accounting for almost half of these articles, more than eight times China's share. So does the breakdown of Nobel
Prizes in Physics, Chemistry, and Physiology or Medicine. Since 1990, 114 have gone to U.S.-based researchers. China-based
researchers have received two.
Precisely because the Chinese economy is so unlike the U.S. economy, the measure fueling
expectations of a power shift, GDP, greatly underestimates the true economic gap
between the two countries . For one thing, the immense destruction that China is now
wreaking on its environment counts favorably toward its GDP, even though it will reduce
economic capacity

over time by shortening life spans and raising cleanup and health-care costs . For another thing,
GDP was originally designed to measure mid-twentieth-century manufacturing economies, and so the more knowledge-based and
global-ized a country's production is, the more its GDP underestimates its economy's true size.
A new statistic developed by the UN suggests the degree to which GDP inflates China's relative
power. Called "inclusive wealth," this measure represents economists' most systematic effort to
date to calculate a state's wealth. As a UN report explained, it counts a country's stock of assets in three
areas: "(i) manufactured capital (roads, buildings, machines, and equipment), (ii) human capital
(skills, education, health), and (iii) natural capital (sub-soil resources, ecosystems, the
atmosphere)." Added up, the United States' inclusive wealth comes to almost $144 trillion--4.5 times China's $32
The true size of China's economy relative to the United States' may lie somewhere in between the numbers provided by GDP and
inclusive wealth, and admittedly, the latter measure has yet to receive the same level of scrutiny as GDP. The problem with GDP,
however, is that it measures a flow (typically, the value of goods and services produced in a year), whereas inclusive wealth measures
a stock. As The Economist put it, "Gauging an economy by its GDP is like judging a company by its quarterly profits, without ever
peeking at its balance-sheet." Because inclusive wealth measures the pool of resources a government can
conceivably draw on to achieve its strategic objectives, it is the more useful metric when
thinking about geopolitical competition . But no matter how one compares the size of the
U.S. and Chinese economies, it is clear that the United States is far more capable of converting
its resources into military might. In the past, rising states had levels of technological prowess
similar to those of leading ones. During the late nineteenth and early twentieth centuries, for example, the United States
didn't lag far behind the United Kingdom in terms of technology, nor did Germany lag far behind the erstwhile Allies during the
interwar years, nor was the Soviet Union backward technologically compared with the United States during the early Cold War. This
meant that when these challengers rose economically, they could soon mount a serious military challenge to the dominant power.
China's relative technological backwardness today, however, means that even if its economy
continues to gain ground, it will not be easy for it to catch up militarily and become a true global
strategic peer, as opposed to a merely a major player in its own neighborhood.

No China war
Bilahari Kausikan 16, Ambassador-at-large and policy adviser in the Ministry of Foreign
Affairs, and the Institute of Policy Studies' 2015/16 S R Nathan Fellow for the Study of
Singapore, “War is unlikely but distrust runs deep,” Feb 27 2016,
This is not a question that should lend itself to facile answers. US-China relations defy simple characterisation. But it is certainly not "a

Clash of Civilisations". ¶ China could not have succeeded without the US. China's success is, in a very
fundamental way, also an American success, albeit a not entirely comfortable one for America. This perhaps adds in no small part to the complexity of the strategic adjustments
that are under way between the US and China. But whether it admits it or not, the US too has begun to adapt. There can be no "Clash of Civilisations" because we are now all
hybrids.¶ The inevitably irregular rhythms of economic growth ought to make us cautious about accepting simplistic characterisations of US-China relations as some variant of a
contrast between a rising China and a declining US. This posits a false dichotomy. China is certainly rising but the US is not in decline. All who have underestimated American
creativity and resilience have come to regret it. The changes in the distribution of power are relative, not absolute. The US is still pre-eminent in most indices of power and is
Before too long, China will reach a more
likely to remain so for the foreseeable future.¶ This is most obvious in the military realm.

symmetrical military equation with the US in East Asia. This will have very important implications for the maritime disputes in the
South China Sea. While military planners cannot ignore any contingency, war is not a very

probable scenario. Neither the US nor China is looking for trouble or spoiling for a
fight. The essential priorities of both are internal, not external . The most vital of all
Chinese interests is the preservation of Chinese Communist Party ( CCP) rule. Chinese leaders
sometimes talk tough. But they are not reckless .¶ As the sole global power, the US cannot retreat into complete isolationism.
Like it or not, the world will intrude and in East Asia specifically, there has been a fundamental consistency in US policy over the last 40 years or more that I expect will be
maintained.¶ But the political mood that has sustained contenders Donald Trump and Bernie Sanders in their unlikely presidential campaigns is disillusionment with
globalisation and working- and middle-class insecurity about their future in an increasingly unfamiliar and uncertain world. Whoever next occupies the White House will talk

and even act tougher. Butno American president can ignore the national mood, which is not for more
wars of choice .¶ If war between the US and China is highly improbable , is there or will there be a "new Cold
War" between the two? There will almost certainly be tense episodes. But I do not think this is

an appropriate metaphor to understand the US-China dynamic.¶ So where does all this leave us? I do not think it makes the strategic

adjustments any easier. But it does imply that the parameters within which the US and China must seek a new

accommodation are narrower than what we might have been led to expect by the media or the more
sensationalist sort of academic analysis .

Geoe—no one has plans -

No impact to nanotech or AI
Edward Moore Geist 15, MacArthur Nuclear Security Fellow at Stanford University's Center for
International Security and Cooperation, 8/9/15, “Is artificial intelligence really an existential
threat to humanity?,”
Bostrom’s mistaken conflation of inference mechanisms with intelligence is also apparent in his
colorful descriptions of how intelligent machines might annihilate humanity . Simply
depriving AIs of information about the world is not adequate to render them safe, he claims, as they
might be able to accomplish such feats as solving extremely complex problems in physical science without the
need to carry out real-world experiments. In a scenario borrowed from Yudkowsky, Bostrom posits that a
superintelligence might “crack the protein folding problem” and then manipulate a gullible human into mixing
mail-ordered synthesized proteins “in a specified environment” to create “a very primitive ‘wet’ nanosystem, which,
ribosome-like, is capable of accepting external instructions; perhaps patterned acoustic vibrations delivered by a speaker attached to
the beaker.” It could then employ this system to bootstrap increasingly sophisticated
nanotechnologies, and “at a pre-set time, nanofactories producing nerve gas or target-seeking mosquito-like
robots mightthen burgeon forth simultaneously from every square meter of the globe (although more
effective ways of killing could probably be devised by a machine with the technology research superpower).” This
doesn't just strain a reader’s credulity ; it also implies a fanciful understanding of the nature of
technological development in which “genius” can somehow substitute for hard work and countless
intermediate failures. In the real world , the “lone genius inventor” is a myth; even smarter-
than-human AIs could never escape the tedium of an iterative r esearch and
d evelopment process.

Global multilateral cooperation structurally fails---overwhelming data confirms

Robert J Lieber 14, Professor, Department of Government, Georgetown University, 2014, “The
Rise of the BRICS and American primacy,” International Politics, Vol. 51, p. 137-154
Equally important, liberal internationalists and others tend to assume that i nternational r elations are a
positive sum game (Keohane, 1984; Ruggie, 1993). Experiences with multilateralism and with regional international
institutions are said to encourage cooperation. Transparency, reciprocity and habits of collaboration are seen as self-reinforcing. In
order to achieve their own domestic needs for economic growth, countries find not only these experiences beneficial, but such
cooperation spills over across related functions and issue areas. A generation ago, scholars writing and theorizing about regional
integration in Western Europe defined this process as one of ‘spillover’. For liberal internationalists and globalists there is at least an
implied analogy with that European experience despite the immense differences in geography, history and path dependence.5 That
assumption has some basis in the areas of economics and trade, though the mercantilist and predatory behavior of China provides a
In the security realm , however, there is little reason for such an optimistic
serious contrary indicator.
assumption. Cases in point include nuclear proliferation (North Korea, Iran), tensions in East Asia
(China, Japan, Vietnam, South Korea, the Philippines, the East and South China Seas) and conflicts in the Middle East
(Iran, Syria, Saudi Arabia, Qatar, Egypt, Lebanon, as well as Israel and the Palestinians). Nonetheless there are exceptions. Brazil
has played a continuing role in UN Peacekeeping. It assigns nearly 2500 military and police personnel to those missions and has
played a leading role in Haiti, where it has commanded the UN’s operation since 2004. It also has headed the maritime component
of UNIFIL (Lebanon) since 2011. In addition, Turkey has participated actively in NATO-led peacekeeping missions in Bosnia
(SFOR), Kosovo (KFOR), and Afghanistan (ISAF).
Skepticism about the BRICS and the momentum assumed by liberal internationalists has not
been scarce.6 Realist scholars have understandably been critical of the assumptions underlying these approaches as well as of
the foreign policy choices they imply. However, other scholars too have found increasing reason for criticism . For
example, Barma et al (2013, p. 56) have recently observed that, ‘Instead of a gradual trend toward global problem
solving punctuated by isolated failures, we have seen over the last several years essentially the opposite :
stunningly few instances of international coope

ration on significant issues’. Moreover, Patrick (2010, p. 44) of the Council on Foreign Relations has cautioned that, ‘ The
United States should be under no illusions about the ease of socializing rising nations. Emerging
powers may be clamoring for greater global influence, but they often oppose the political and
economic ground rules of the inherited Western liberal order, seek to transform existing
multilateral arrangements , and shy away from assuming significant global responsibilities’. In this
regard, Laidi has argued that despite their own heterogeneity, the BRICS actually share a common
objective in opposing Western liberal internationalist narratives that run counter to traditional state
sovereignty. Instead, they seek to protect their own prerogatives, independence of action and national
autonomy in an increasingly interdependent world (Laidi, 2012, pp. 614–615).
No risk of Russia war---neither side will escalate
Andrei Tsygankov 16, Professor at the Departments of Political Science and International
Relations at San Francisco State University, PhD from USC, “5 reasons why the threat of a global
war involving Russia is overstated,” Feb 19 2016,
Experts and politicians are warning of high
The contemporary discussion of security interactions among major powers is depressing to participants and observers alike. us an increasingly

likelihood of a military conflict – possibly a nuclear one – between Russia and , on the one hand,

the U.S. or NATO ¶ In the West, many argue the dangers associated with a “resurgent”
, on the other.

Russia and vow to defend themselves from Russian President Vladimir Putin’s “aggressive” actions in Eastern Europe and the Middle East. Last month, U.S. Defense Secretary Ash Carter accused Russia of threatening the world order and starkly

¶ tensions have been growing

warned: “Make no mistake, the United States will defend our interests, our allies, the principled international order, and the positive future it affords us all.” The and have become

since the Ukraine crisis

especially high 2014 . Russian military flights over the Baltic and Black Sea in response to NATO’s active buildup on Russia’s European borders has done little to calm these fears. The Turkish decision to

possible military conflict with Istanbul and

shoot down a Russian warplane by claiming violation of its airspace in November 2015 revived the discussion of Moscow’s NATO, of which Turkey

alleged preparations to invade the Baltic States

is a member. More recently, the hype has been over the Kremlin’s ¶ and the West’s need to respond. In Russia, these
threats and discussions are taken seriously, and the responsibility for these security tensions has been squarely placed on the Western powers. The frequently repeated charges are that the West and NATO have encircled Russia with military bases and refused to
recognize Moscow’s global interests. Russian media have actively discussed the U.S. National Security Archive’s Cold War documents on a nuclear attack against Russia and China declassified on Dec. 22, 2015. ¶ Last week, while attending the Munich Security
Conference, Prime Minister Dmitry Medvedev compared the contemporary security environment with the one that led to the Cuban Missile Crisis and reminded the audience of U.S. President John F. Kennedy’s words that “foreign policy can kill us." ¶ In the
meantime, contradicting Medvedev, Russian experts often bemoan the fact that the Cold War was far more predictable and less dangerous than today’s multipolar world. What many have initially viewed as a generally positive transition from the U.S. “diktat” is now
presented as leading toward a great power war.¶ This increasingly apocalyptic mood on both sides reflects a growing international instability and breakdown of important communication channels between Russia and the West. Since the beginning of Ukraine crisis
and up until the G20 meeting in Antalya in December 2015, the two sides have barely interacted. Appalled by Russia’s annexation of Crimea and support for Ukrainian separatists, Western leaders pursued policies of sanctions and isolation, whereas the indignant
Kremlin has sought to demonstrate its indifference toward such policies. ¶ Only since Antalya have Putin and U.S. President Barack Obama resumed their attempts to regularly discuss issues of importance. Western and Russia military, too, severed their contacts

alarmist views and arguments are misplaced because

although the two sides have recently begun to coordinate their actions in the Syrian airspace. The aforementioned

they underestimate the dangers of the Cold War and overestimate those of today’s world ¶ .
Despite some attempts to present the Cold War as generally stable, predictable, and peaceful, this is not the time to feel nostalgic about it. Multiple crises from Berlin to Cuba and Afghanistan extended across much of the Cold War era. State propaganda on both
sides was reinforced by an intense ideological confrontation accompanied by drills and necessary preparations for a nuclear war. ¶ The Oscar-nominated film “Bridge of Spies” directed by Steven Spielberg reproduces some of that hysterical atmosphere in the United
States where the public was mobilized for any actions in support of the government. In the Soviet Union it was no different. For the world outside the West and the U.S.S.R., this was not a peaceful, but rather an increasingly chaotic and violent time – the conclusion

well documented by scholars of the Third World. ¶ Why today's world is less dangerous than the Cold War ¶ Today’s world, while threatening and uncertain, is hardly more dangerous than the Cold War, for the following reasons. ¶ First,

the rhetoric, major powers are not inclined towards risky behavior when their core interests are
at stake. This concerns not only the nuclear superpowers, but also Turkey. The prospect of countries such as

confronting Russia's military should give pause even to

overwhelmingly superior Erdogan someone as hot-tempered as Turkish President Tayyip . Even if

¶ NATO has been careful to not be drawn into highly

Erdogan wanted to pit Russia against NATO, it wouldn’t work. So far,

provocative actions , whether responding to Russia seizing the Pristina Airport in it is by International

June 1999, getting involved on Georgia’s side or providing support during the military conflict in August 2008 by lethal military assistance and

for Ukraine. Unless Russia is the clear and proven aggressor, NATO is unlikely to begin support Turkey and

World War III .¶ Russia remains a defensive power aware of its responsibility for

maintaining international stability. Moscow wants to work with major powers, not against them .

¶ the U S has
Its insistence on Western recognition of Russia’s interests must not be construed as a drive to destroy the foundations of the international order, such as sovereignty, multilateralism, and arms control. Third, nited tates

important interests to prevent regional conflicts from escalating or becoming trans-regional. Although its relative military capabilities are not where they

U.S. military and diplomatic resources are sufficient to restrain key regional
were ten years ago, the

players proxy wars are happening, but they are unlikely to

in any part of the world. Given the power rivalry across several regions, possible and indeed are

escalate ¶ . Fourth, unlike the Cold War era, the contemporary world has no rigid alliance structure. The so-called Russia-China-Iran axis is hardly more than a figment of the imagination by American neoconservatives and some Russia

conspiracy-minded thinkers. The world remains a space in which international coalitions overlap and are mostly formed on an ad hoc basis. ¶ Fifth, with the exception of the Islamic State of Iraq and the Greater Syria (ISIS), there is no fundamental conflict of values
and ideologies. Despite the efforts to present as incompatible the so-called “traditional” and “Western” values by Russia or “democracy” to “autocracy” by the United States and Europe, the world majority does not think that this cultural divide is worth fighting for. ¶

Despite the dangers the world contains a number of important underappreciated ,

of we live in, it , even

checks threat talk may be a way to pressure the opponent

on great powers’ militarism. The coming from politicians is often deceiving. Such talk

into concessions rather than to signal real intentions. When such pressures do not
various political and military

bring expected results rhetoric of war subsides Then a dialogue begins.

, the and isolation .¶ Perhaps, the

increasing frequency of exchanges between Obama and Putin including since December 2015 - their recent

phone conversation following the Munich conference - suggest recognition that the record of a growing

pressuring has been mixed at best.

States CP
State public options solve just as well as the plan---every plank written into our CP
plays a role in expanding coverage and reducing costs
Chapin White 17, Senior Policy Researcher; Faculty Member, Pardee RAND Graduate School,
et al., 2017, “A Comprehensive Assessment of Four Options for Financing Health Care Delivery
in Oregon,”
Under this option, a state-run health plan would be offered along with commercial health plans
in the ACA Marketplace in Oregon. Covered benefits, premiums, and cost-sharing in Oregon’s Public Option would conform
to the requirements in the ACA for Marketplace plans. The premiums for the Public Option would be set so that they cover enrollees’
claims costs and the administrative expenses of the plan, and the plan would be subject to the same regulations as other Marketplace
plans, including age rating, guaranteed issue, and covered benefits. Because the Public Option would only be offered through the
Marketplace, it would be much more modest in scope and less disruptive than Single Payer or HCIP. We specified that small
employers (1–50 employees) could purchase the Public Option for their employees through Oregon’s Small Business Health Options
Program (SHOP).
A national public option was included in one of the early versions of the ACA, though it was dropped due to opposition in the U.S.
Senate. More recently, President Obama called for the introduction of a public option in the ACA Marketplaces to address a lack of
insurer competition in some parts of the country (Obama, 2016).
The sources of financing for the Public Option would be the same as Marketplace plans under the Status Quo and would include
premium payments by individuals, federal APTCs, and federal payments for cost-sharing reduction subsidies. The premium would
be set to cover paid claims and the costs of administering the plan.
When analyzing the impact of the Public Option, one of the key questions is how well the plan would fare in
attracting enrollees and competing with commercial health plans . Merely being government-run does not
confer any inherent advantage or disadvantage relative to commercial health plans. Instead, the relative competitiveness
of the Public Option depends on the plan’s ability to offer a competitive premium, good
customer service, and an appealing provider network. The premium for the Public Option depends, in
turn, on whether it can pay health care providers competitive payment rates, limit its administrative
overhead, and reduce wasteful health care utilization. All of those outcomes depend on the specific regulations and
administrative structure for the plan.
In modeling the Public Option, we specified that the
plan would pay hospitals and physicians rates equal,
on average, to those in the traditional Medicare program . Medicare payment rates are
substantially lower than the rates paid by commercial plans in Oregon, which could give the Public
Option a competitive advantage over commercial health plans in the Oregon Marketplace.
This is generally consistent with the proposed approach to BHP in Oregon, which would set provider reimbursements at 82 percent
of commercial rates on average (Oregon Department of Consumer and Business Services, 2016). We also assumed that the
Public Option would incur relatively low administrative expenses —that would be consistent with
the state hiring the same contractors used by traditional Medicare and adopting Medicare’s
systems for claims processing and utilization review .
Medicare has instituted a variety of value-based payment approaches, including Accountable Care
Organizations (ACOs) and the Hospital Value-Based Purchasing Program, which we assumed would be incorporated into the Public
Option. Providers in Oregon and nationally are preparing for the state goal that 85 percent of all Medicare providers be engaged in
value-based payments by 2018 and for the new Merit Based Incentive Payment System (MIPS) established under the Medicare
Access and CHIP Reauthorization Act of 2015 (MACRA) (Centers for Medicare & Medicaid Services, 2016a).
We also assumed that the Public Option would include a broad set of providers in the plan’s network,
making it relatively attractive to potential enrollees . In order to achieve broad provider
participation while paying rates lower than commercial plans, we assumed that the state would link
provider participation in the Public Option and in other state-run health plans . For example,
the state could bar providers who do not participate in the Public Option from participating either
in OHP or any of the plans offered through PEBB and OEBB.
No ERISA Preemption---2NC
ERISA really really doesn’t apply
Chapin White 17, Senior Policy Researcher; Faculty Member, Pardee RAND Graduate School,
et al., 2017, “A Comprehensive Assessment of Four Options for Financing Health Care Delivery
in Oregon,”
The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that regulates how private-sector
employer-sponsored health and other benefits are administered. ERISA was enacted to allow
multistate employers to offer a uniform package of benefits to all their workers , protect employee
benefits from loss or abuse, and encourage employers to offer benefits. Among its provisions are rules about benefits and coverage
standards, the information employer plans must provide, a fiduciary standard for plan administrators, appeal rights for plan
beneficiaries, and access to the courts when a provision of the act is violated.
The ACA attempts to encourage employers to offer health coverage to employees but allows the
employer to pay a fee rather than offer coverage. This “pay or play” provision avoids running afoul of
ERISA because it allows individual self-insured employers to determine whether and how to
offer coverage to employees.10
In general, ERISA preempts states’ ability to establish laws that apply to self-insured
employer coverage , which has limited state-based health reform efforts (Monahan, 2007; Jacobson, 2009; Supreme
Court of the United States, 2016; Brown and King, 2016).11 ERISA does have an exception to this preemption rule, a “savings clause”
that preserves state regulatory authority over the business of insurance. Most large employers self-insure their
health plans, meaning that they are not technically purchasing health insurance and their plans
are, therefore, exempt from state regulation.
Hawaii is the only state with an ERISA exemption, which it received in 1983 in support of the state’s Prepaid Health Care Act of 1974
(PHCA). Congress passed this exemption in large part because the PHCA was passed prior to the passage of ERISA and after
significant lobbying by Hawaii’s congressional delegation. While there is no evidence that this is likely in the near future, it is
possible for Congress to enact legislation allowing ERISA waivers that support state health reform experiments.
The boundaries of the ERISA preemption language are vague, meaning that most of the limitations imposed by the law have been
identified by court decisions. Prior to the passage of the ACA, some legal experts speculated that Massachusetts’ “pay or play”
requirement under that state’s health reform law would be challenged under ERISA. However, this challenge was not made, and this
provision was implemented successfully. Maryland passed a Fair Share Act, which required any employer with at least 10,000
employees to spend at least 8 percent of its total payroll on employees’ health care or health care costs.12 If this standard was not
met, the employer would have to pay the difference between its spending and the 8 percent requirement into the state Medicaid
fund. The law was successfully challenged on the basis that it interfered with plan administration by forcing the employer to
restructure its plan to offer a state-imposed minimum level of health benefits.13
An ordinance in San Francisco requires employers with 20 or more full-time employees (50 or more full-time equivalents for
nonprofits) to make minimum health care expenditures for employees. Health care expenditures are either direct contributions to
employees, reimbursement for health services, or payment to the city to be used to pay for employee care. When this law was
challenged, the court ruled that ERISA did not preempt the ordinance. Rather than forcing employers to spend their health care
dollars on a particular set of benefits, the law only required that the money be spent on health care; further, the law applies both to
employers subject to ERISA and those that are not.
There have been no ERISA preemption cases regarding a state universal health care system with tax financing, making it difficult to
remark on the chances of a legal challenge or its outcome. Employers would likely argue that offering state-funded comprehensive
health benefits to residents of Oregon would, in effect, compel them to discontinue their current plans and offer a different benefit
package to employees who are residents of the state (Hsiao et al., 2011). However, taxation and health care financing are generally
seen as areas of state authority, which could deflect an ERISA preemption challenge. The uncertainty is one reason health reform
proponents have encouraged Congress to allow elements of ERISA to be waived by states implementing reforms that expand health
insurance access.
Opportunities and Challenges for Each Option
Single Payer
A Single Payer option in Oregon would most likely raise an ERISA challenge from large, self-insured
employers, and seeking an exemption of ERISA for Single Payer would require federal legislation .
Without such an exemption, large employers and those that self-insure could argue that a payroll tax–financed
single-payer program would place pressure on employers to drop coverage or effectively pay twice by
providing coverage and paying a tax. The size of the tax is part of the argument. Massachusetts implemented an
employer pay-or-play requirement, but with a “pay” requirement that was modest enough ($295 per employee) to allow employers
offering ERISA plans to continue to decide whether or not to offer coverage. Maryland, in contrast, enacted a much more stringent
pay-or-play requirement for very large firms, which was challenged under ERISA and struck down (Monahan, 2007). Another
potential issue is that a requirement for employers to pass on to employees some of the savings associated with no longer providing
employee health coverage (via higher wages) could be challenged as forcing employers’ hands.
The counterargument to a challenge is that ERISA does not preempt the state’s traditional authority over taxation and health care
financing. If the impact on employer plans is seen as indirect, ERISA would not be grounds for a challenge. As the details of ERISA
have mostly been defined through court decisions, there is a relative lack of clarity in this area because, to date, there have not been
any cases focused on a state tax-financed universal health system.
Health Care Ingenuity Plan
As with Single Payer, HCIP would, in effect, compel all employers to give up or significantly modify their current health benefits,
which would likely be the basis for a challenge by multistate employers.
Public Option
ERISA does not affect the Public Option, which only affects the nongroup and
small-group fully insured markets .

No waiver requirement or ERISA preemption---the CP wouldn’t regulate self-

funded employer benefits
Chapin White 17, Senior Policy Researcher; Faculty Member, Pardee RAND Graduate School,
et al., 2017, “A Comprehensive Assessment of Four Options for Financing Health Care Delivery
in Oregon,”
The Single Payer option would represent a substantial change from the Status Quo and would
significantly impact health care providers and insurers. In addition, federal waivers would be needed to enable
Oregon to redirect federal outlays for Medicare, Medicaid, and the Marketplace. Beyond the waiver
challenges, the Employee Retirement Income Security Act of 1974 ( ERISA ) could pose a major hurdle. ERISA
preempts states’ regulation of self-funded employer-sponsored health plans . Because
the Single Payer option would provide universal coverage and use payroll taxes to help fund the system,
self-funded employers operating in Oregon could argue that the option effectively compels them to
discontinue their current health plans and offer alternative benefits. Unless the state were able to obtain a federal
exemption from ERISA, the Single Payer option would very likely be challenged in court by self-funded employers.
Like the Single Payer option, HCIP could face an ERISA challenge, although the threat may be lower because HCIP would be
financed through a sales tax levied on consumers rather than a payroll tax paid by employers. The state could argue that it has the
authority to levy a sales tax and that HCIP does not explicitly require that employers offer specific health benefits or modify current
ERISA plans. A possible counterargument is that HCIP would create a “Hobson’s choice” for ERISA plans, meaning that employers
would have no reasonable option except to modify or eliminate their plan (Abel et al., 2008). Relying on a sales tax may help
withstand the ERISA challenge, but it puts the state in the position of relying on recaptured savings stemming from the federal tax
advantage associated with employer insurance.
Adding a Public Option to the Marketplace would be relatively straightforward compared with
the other options and would not require a federal waiver . A major hurdle that policymakers would face
in establishing a Public Option would be setting provider payment rates low enough to make the plan affordable while also achieving
broad provider participation. We assume in our analysis that the state would leverage provider participation in the Oregon Health
Plan (OHP) and plans offered to public employees and would adopt Medicare’s administrative contractors and payment systems,
including rates and performance incentives. That approach to setting provider payment rates allows the Public Option to offer a
competitive premium that attracts enrollees, which, in turn, leads to a reduction in total health care expenditures in Oregon.
Increasing provider payment rates in the Public Option would attenuate, or eliminate entirely, that reduction in expenditures.

The CP allows businesses with less than 50 employees

Chapin White 17, Senior Policy Researcher; Faculty Member, Pardee RAND Graduate School,
et al., 2017, “A Comprehensive Assessment of Four Options for Financing Health Care Delivery
in Oregon,”
Under this option, a state-run health plan would be offered along with commercial health plans
in the ACA Marketplace in Oregon. Covered benefits, premiums, and cost-sharing in Oregon’s
Public Option would conform to the requirements in the ACA for Marketplace plans. The
premiums for the Public Option would be set so that they cover enrollees’ claims costs and the
administrative expenses of the plan, and the plan would be subject to the same regulations as
other Marketplace plans, including age rating, guaranteed issue, and covered benefits. Because
the Public Option would only be offered through the Marketplace , it would be much
more modest in scope and less disruptive than Single Payer or HCIP. We specified that small
employers (1–50 employees) could purchase the Public Option for their employees through
Oregon’s Small Business Health Options Program (SHOP).

Here’s a chart that proves ERISA is irrelevant to the CP

Chapin White 17, Senior Policy Researcher; Faculty Member, Pardee RAND Graduate School,
et al., 2017, “A Comprehensive Assessment of Four Options for Financing Health Care Delivery
in Oregon,”

States have historical supremacy over health insurance regulation---the Court will
defer towards the states on ERISA questions
Elizabeth McCuskey 16, Associate Professor of Law, University of Toledo College of Law,
“Body of Preemption: Health Law Traditions and the Presumption Against Preemption,” 2016,
Temple Law Review, 89 Temp. L. Rev. 89
Commercial health insurance. Since the 1850s, states have been the primary regulators of
insurance ; therefore, they have supplied most laws governing private health insurance.343 Insurers did not cover health care,
however, until after 1908.344 The first two categories of true health insurance sprung up in the early 1930s: Groups of hospitals
offered prepaid services (known as “Blue Cross” model plans), and groups of physicians offered similar arrangements (known as
“Blue Shield” plans).345 Health insurance policies were rare until after World War II, when they became
ubiquitous and largely employer-sponsored because insurance offered as an employee fringe benefit was exempt
from the wartime wage and price controls.346
Over their roughly 150 years of insurance regulation, states have both exercised licensing authority over
insurers and have regulated issuance of policies.347 Since 1945 with the passage of the McCarran-Ferguson Act,348
some state insurance regulation has enjoyed a form of reverse preemption in which state
insurance law is supreme to federal law.349 The Health Maintenance Organization Act of 1973350 “marked the first
time that Congress created a direct federal role in the regulation of health insurance;” the legislation was “designed to supplement,
rather than replace . . . state functions” through federal funding and qualifications.351
State health insurance regulation thus can quite accurately be described as “primary” from its inception. The federal government,
however, unintentionally assumed a major role with the passage of the ERISA352 in 1974. Although passed primarily with pension
benefits in mind, ERISA applies to all employer-sponsored benefits, which has come to include health insurance. ERISA’s original
purposes were to safeguard employees’ pensions and to encourage the provision of pension benefits by establishing a uniform
system of federal regulation.353 To promote uniformity, Congress wrote into ERISA a “terse but comprehensive”354 provision
expressly preempting state laws that “relate to” any “benefit plan[s]”355 covered by the Act. ERISA thus preempts vast swaths of
state initiatives aimed at increasing access to employer-sponsored health insurance.356
ERISA’s savings clause exempts state regulation of “the business of insurance ” from
preemption under the statute.357 The difficulty of determining when state laws “relate to” employer-sponsored health
insurance (and are preempted) versus when they relate to the “business of insurance” (and are saved from preemption) has resulted
As the Supreme Court
in one of the most contentious preemptions in health law—perhaps in any law, period.358
has noted in ERISA contexts, health insurance is a “field[] of traditional state regulation ,” and
Congress must not have intended ERISA to “displace general health care regulation, which
historically has been a matter of local concern.”359 By that logic, the Supreme Court held that ERISA does not
preempt a state statute requiring hospitals to collect a surcharge from commercial insurers,
despite the impact on employer-sponsored insurance .360 On the other hand, the Court has held
that ERISA does preempt state law remedies for health insurers’ faulty eligibility and coverage decisions, despite state law’s
traditional role in supplying remedies.361

Courts will defer against ERISA preemption

Samuel Salganik 9, JD Candidate, Columbia Law School, “What the Unconstitutional
Conditions Doctrine Can Teach Us About ERISA Preemption: Is It Possible to Consistently
Identify “Coercive” Pay-or-Play Schemes?” Columbia Law Review, Volume 109, Number 6,
October 2009, pp. 1482-1530
In New York State Conference of Blue Cross äf Blue Shield Plans v. Travelers Ins. Co.107 and California Division of Labor Standards
Enforcement v. Dillingham Construction, N.A., Inc.,108 when faced with laws creating indi- rect economic influences on ERISA
plans, the Court retreated from the literalist line of Shaw.109 Discussing Shaw, the Court noted that "if
‘relate to' were taken to extend to the furthest stretch of its interdeterminacy, then for all practical purposes
preemption would never run its course , for '[r]eally, universally, relations stop nowhere.'"110
The Court similarly rejected "uncritical literalism"111 with respect to the "connection with" prong of the Shaw test: "For the same
reasons that infinite relations can- not be the measure of pre-emption, neither can infinite connections."112 In place of the hard line
drawn by Shaw, where a literal reading of the words "relate to" gave § 514(a) very strong preemptive force, Travelers and
Dillingham produce a softer standard, instructing courts to "look in- stead to the objectives of the ERISA statute as a
guide"113 to determine its preemptive scope.
Following this softened approach, laws which merely influence the decisions of plan administrators by
altering the economic incentives they face - such as those at issue in Travelers and Dillingham - need not be
preempted, so long as the influence is not too acute. In Travelers, the Court upheld a New York law that required hospitals to
impose surcharges on patients covered by insurers other than Blue Cross & Blue Shield (“the Blues").114 While the law "ma[d]e the
Blues more attractive . . . and thus ha[d] an indirect economic effect on choices made by insurance buy- ers,"115 the Court held that
such an "indirect economic influence [did] not bind plan administrators to any particular choice and thus function as a regulation of
an ERISA plan."116 Likewise, in Dillingham, the Court upheld a California law that produced an economic incentive for local
apprenticeship programs to comply with state regulations in addition to ERISA.117 As in Travelers, a state law which "alter
[ed] the incentives, but d[id] not dictate the choices, facing ERISA plans"118 was not preempted.
Travelers and Dillingham therefore weakened the Shaw standard by saving from preemption state laws that merely influence the
decisionmaking of ERISA plan managers.119
In De Buono v. NYSA-ILA Medical and Clinical Services Fund, the Court reaffirmed that its traditional
presumption applies "unequivocally"121 to ERISA preemption jurisprudence as well. In that case,
the Court saved from preemption a new tax on hospitals , which hap- pened to affect a hospital operated by an
ERISA plan,122 stressing that where a regulation "operates in a field that 'has been traditionally
occupied by the States' . . . [those challenging the statute] bear the considerable burden of
overcoming 'the starting presumption that Congress does not intend to supplant state
law.'"123 This tax on hospitals, the Court went on to conclude, was "one of 'myriad state laws' of general applicability that
impose some burdens on the administration of ERISA plans but nevertheless do not 'relate to' them
within the meaning of the governing statute ."124 This presumption rationale asks courts to
err on the side of allowing a state law to stand when its "relation to" ERISA plans is ambiguous.125
AT: Jost 9
Jost concludes fiat solves
Timothy Jost 9, Emeritus Professor at the Washington and Lee University School of Law, 2009,
“State Run Programs Are Not a Viable Option for Creating a Public Plan,”
The biggest problem of relying on the states to offer public options, however, is that they are
unlikely to do it . States can already offer a public option , but none have done so (except
for high risk pools, which are not the same thing as a true public option and are expensive and poorly subscribed in most states).
Health care reform has proved very difficult at the state level, as failed reforms in California, Illinois and other states demonstrate.
Reforms opposed by providers or by the business community, who often have even stronger lobbies at the state than at the federal
level, are unlikely to happen. Reforms that require state expenditures, particularly in the current tight fiscal environment, are also
unlikely. Relegating the public plan to a state option is essentially a polite way of dismissing the idea.
State public options would use Medicare’s contractors and payment systems---
means it solves costs just as much as the plan
Chapin White 17, Senior Policy Researcher; Faculty Member, Pardee RAND Graduate School,
et al., 2017, “A Comprehensive Assessment of Four Options for Financing Health Care Delivery
in Oregon,”
Adding a Public Option to the Marketplace would be relatively straightforward compared
with the other options and would not require a federal waiver. A major hurdle that policymakers
would face in establishing a Public Option would be setting provider payment rates low enough
to make the plan affordable while also achieving broad provider participation. We assume in our
analysis that the state would leverage provider participation in the Oregon Health Plan (OHP)
and plans offered to public employees and would adopt Medicare’s administrative contractors
and payment systems, including rates and performance incentives. That approach to setting
provider payment rates allows the Public Option to offer a competitive premium that
attracts enrollees , which, in turn, leads to a reduction in total health care
expenditures in Oregon. Increasing provider payment rates in the Public Option would
attenuate, or eliminate entirely, that reduction in expenditures.
50-State Fiat Good---2NC
Education---understanding the role of federalism in healthcare is essential to
policy discussion
Michael Doonan 13, assistant professor at the Heller Graduate School at Brandeis University,
executive director of the Massachusetts Health Policy Forum and director of the Council for
Health Care Economics and Policy, 8/29/13, "American Federalism in Practice, The
Formulation and Implementation of Contemporary Health Policy," Brookings Institution Press,
Chapter 1
Understanding how federalism—the division of power between the federal government and the
states—plays out is essential to understanding contemporary health policy . The case
studies presented here describe a dynamic intergovernmental relationship that varies
dramatically depending on the political context in each case and the manner within each state in which
rulemaking and implementation are conducted. Health policymaking is entangled in a
complex web of shared, overlapping, and/or competing power relationships between levels of
government.9 While traditional studies of federalism offer great insight into federal-state interactions, most do little to
explain variations in interactions across the policy process. Understanding those variations is
essential to understanding the ultimate impact of federalism on programs and policy.
AT: Cyber
No risk of cyber war---disputes empirically deescalate
Dr. Brandon Valeriano 14, Senior Lecturer (Politics), Univ of Glasgow, and Ryan C. Maness,
visiting fellow of security and resilience studies in the Department of Political Science at
Northeastern University, “The dynamics of cyber conflict between rival antagonists, 2001–11,”
Journal of Peace Research May 2014 vol. 51 no. 3 347-360,
Even considering our past investigators and theory, we were surprised to find little actual evidence of cyber

conflict in the modern era. Why then are there so few rivals engaging in cyber
warfare? Furthermore, why are the incidents and disputes limited to mostly defacements or
denial of service when it seems that cyber capabilities could inflict more damage to their adversaries? ¶ Based on our
analysis, we find our notion of restraint is a better explanation of cyber interactions than any
conception of continuous or escalating cyber conflict. States will not risk war with their
cyber capabilities because there are clear consequences to any use of these technologies. States are not reckless,
but terrorists and other cyber activists might not be so restrained. The interesting result of the process is that while cyber terrorists will likely
proliferate, their ability to do damage will be limited due to the massive resources and conventional intelligence methods needed to make an operation
like Stuxnet successful.14 Stuxnet and Flame could be the harbingers of the future, but in reality it was a collusion of discrete events that worked out for
the attacker (Lindsay, 2013). With a will to attack, there must also come a way to attack. With such a high burden on luck and ability, it will be rare to
see such important disputes continue in the future.¶ The recently discovered cyber incidents of Red October and Flame represent the typical outcome of
cyber conflict.15 They are massive cyber operations, but have to date been used for information extraction and espionage purposes. Cyber conflict is in
our future, but these events will only be as devastating as the target allows them to be as long as the attacker is restrained by logic, norms, and fear of
retaliation. Restraint is clearly in operation for cyber conflict. Constraints can change the behavior of an actor into not
doing something it would usually do if left to its own devices. A rival will not blatantly attack its adversary’s

infrastructure or secret government databases because that state may perceive the attack as it
would a physical attack and respond with an equally devastating cyber incident or even with
conventional military forces. There is also the fear of collateral damage which remains high for
many actors, and this simple limitation may prevent persistent cyber conflict from
becoming a reality. Another fear is cyber blowback, as noted by Farwell & Rohozinski (2011), in that tactics could be replicated and targeted
back towards the attacker.¶ The range of relations in the realm of cyberspace has yet to be determined, but it does seem clear that rivals
operate as rivals should. They are able to manage their tensions in such a way as to forestall violence yet
prolong tensions for long periods of time. Therefore, states have yet to employ widespread damage via cyberspace out of fear of the unknown. They

fear the escalation of the rivalry in the absence of a critical event like a territorial invasion. Malicious and
damaging cyber tactics seem not to be the norm. The best hope for reducing the possibility of cyber conflict in the future comes from strong institutions
capable of managing and restricting cyber-based disputes.
Politics General
The politics of health care have gotten worse since the examples of watered-down
public options in 2009---makes our args more likely now
Ed Kilgore 16, politics writer for New York Magazine, 8/19/16, “Just a Reminder: Congress
Isn’t Going to Fix Obamacare — or Enact Single-Payer — Any Time Soon,”
That is all well and good, but the very same political problems that prevented the adoption of a
public option (much less “Medicare for all”) in 2009 and 2010 when Democrats controlled Congress by
comfortable margins have gotten worse, not better . Yes, if Hillary Clinton is elected in November she has
already announced support for adding a public option to Obamacare, and there’s a decent chance she will bring a narrowly
Democratic Senate along with her. A Democratic House, however, remains a very long shot, and even if it happens, getting
something as controversial as an Obamacare “fix” through a closely divided Congress is at best
an even longer shot. Yes, in theory, something like an increase in insurance subsidies to lure the private companies back in
could be enacted via a budget reconciliation bill that is immune to a GOP Senate filibuster. But progressive Democrats who want to
abandon private insurance entirely aren’t likely to go along with that, and it’s doubtful a major structural reform
could be accomplished without the kind of legislation that could be filibustered (barring elimination of
the filibuster altogether).
In all likelihood, then, congressional Republicans will maintain their veto power over
any Obamacare “fix.” And there’s absolutely no evidence they’ll be interested in anything short of
the destruction of the whole A ffordable C are A ct. The lusty cheers with which they are greeting the
system’s current problems ought to show that to anyone under the illusion that the GOP is
concerned about the human cost of insufficiently available or affordable health insurance . It will be
astonishing if Donald Trump doesn’t make the repeal of Obamacare (and its replacement with something “incredible” down the
road, by and by) a presidential campaign issue down the stretch. If Republicans hold on to one or both congressional chambers, the
odds of anything good happening to Obamacare are virtually nil. If Trump somehow wins, the fate of Obamacare may be the least of
the country’s problems, but it will be a problem nonetheless.

There’s an overwhelming political incentive to exclude people who get coverage

through employment
Robert Kuttner 9, professor at Brandeis University's Heller School for Social Policy and
Management, 6/26/9, “Debating the Public Option,”
The public option, as it is evolving, is even more dubious than Paul Starr's apt critique suggests.
Under the House leadership bill , people who have coverage through their employers are
ineligible . So the proposed, head-to-head competition between the public plan and private
competitors is left to employers, not individuals .
What's distressing is that progressives have put all their eggs in this leaky basket. It's clear that Jacob Hacker's original
inspiration -- that over time the superior efficiencies of a true public plan would crowd out
private alternatives -- is being undermined by the politics of compromise . Even Sen. Max
Baucus, not exactly a lefty, remarked the other day that he wished that single-payer hadn't been taken off the table, if only for tactical
In public opinion polls and in liberal advocacy, the badly flawed public option has become a kind of proxy for what most Americans
really want -- national health insurance. That's the true public option. It would be far more cost-effective, because it would eliminate
so many industry middlemen and would remove the incentive to put health dollars into profit centers. Politically ,
protecting the public option from industry mischief is no less a heavy lift than single-
payer . It's a pity that all the progressive energy that's gone into defending the public option hasn't gone to advocate national
health insurance.

The aff would be offered on the exchanges---means only available to people

without employer-provided insurance
Richard Hirth 16, Professor, Department of Health Management and Public Policy, University
of Michigan; and John Z. Ayanian, Director, Institute for Healthcare Policy and Innovation,
University of Michigan, 7/27/16, “Going public: Could Clinton’s health care proposals work?,”
As the spotlight shifts from the Republican to Democratic convention, Hillary Clinton’s plans for health care reform, including a
proposed new “ public option ” for health insurance for some Americans, may draw greater attention from voters.
This option would offer a government-run health insurance plan that would be in direct
competition with other options offered by private health insurers. It would be provided through
the federal and state health insurance exchanges operating under the A ffordable C are
A ct. The public option could be structured similarly to the Medicare program, the federally funded health insurance program for
senior citizens and persons with certain disabilities.
As health care policy experts who have studied and analyzed insurance coverage for over 20
years, we will explain the public option in greater detail.
Public option originally considered in ACA debates
The health insurance exchanges under the ACA provide a competitive marketplace in which
individuals and families who have incomes above the poverty level, but no access to
employer-sponsored insurance , can buy private insurance from companies. The
exchanges also provide premium subsidies for households that earn between one and four times
the federal poverty level if they are not eligible for Medicaid. The federal poverty level varies by
family size. For an individual, this range is from US$11,880 to $47,520.
Broad employer exclusions doom the public option to be a marginal high-risk pool
Paul Starr 9, professor of sociology and public affairs at Princeton University, 6/23/9, “Perils of
the Public Plan,”
In any event, the success of a reformed insurance system is going to depend more on general
features of its design , such as the rules that apply to all insurers and in particular whether premiums
will be risk-adjusted (providing a bonus to plans with higher-risk enrollees and imposing a tax on other plans). A key question
is whether the exchanges will serve nearly all employers , creating broadly shared risk, or
remain on the margins as limited, high-risk pools .
There are a lot of ways to defeat reform, not just by blocking it entirely, but by setting it up for failure .
Those who think a public plan is a good idea no matter how badly designed are not thinking ahead.
Bioterror D
Assembling gene fragments into a virus is impossible
Catherine Jefferson 14, researcher in the Department of Social Science, Health, and Medicine
at King’s College London, et al., 9/18/14, “The myths (and realities) of synthetic bioweapons,”
Building a dangerous virus from scratch is hard. DNA synthesis is one of the key enabling
technologies of synthetic biology. There are now a number of commercial companies that provide DNA synthesis services, so
the process can be out-sourced: A client can order a DNA sequence online and receive the synthesized DNA material by post within
days or weeks. The price charged by these companies has greatly reduced over the last 20 years and is now around 3 cents
a base pair, which puts the cost within reach of a broad range of actors. This has led to routine statements
suggesting that it is now cheap and easy to obtain a synthesized version of any desired DNA
sequence. There are however several challenges that need to be taken into account when assessing
the potential for misuse that inexpensive DNA sequencing might enable .
Even specialized DNA synthesis companies cannot easily synthesize, de novo, any desired DNA
sequence. Several commercial companies provide routine gene synthesis services for sequences of less than 3,000 base pairs, but
length is a crucial factor; the process is error prone, and some sequences are resistant to chemical synthesis. A number of
entirely new synthesized DNA fragments would have to be assembled to produce a full genome,
and, even if doing so were not already regulated by guidelines, simply ordering the full-length genome sequence
of a small virus online is not possible .
Ordering short DNA sequences and assembling them into a genome requires specialist expertise,
experience, and equipment available in academic laboratories but not easily accessible to an
amateur working from home.
For longer sequences, assembly of DNA fragments becomes the crucial step . This was the major
technological feat in the work conducted at the J. Craig Venter Institute that produced a “synthetic” bacterial genome, and the
Gibson assembly method developed for that project is now widely used. The description of that work, however, demonstrates how
the assembly of smaller fragments into larger ones and eventually into a functioning genome
requires substantial levels of expertise and resources , including those needed to conduct trouble-shooting
experiments to identify and correct errors when assembled DNA constructs do not perform as expected.
Constructing a genome-size DNA fragment is not the same as creating a functional genome . In
particular, ensuring the desired expression of viral proteins is a well-documented, complex
Disease D
Their evidence assumes a level of virulence that has literally never occurred
Wendy Orent 15, anthropologist and freelance science writer whose work has appeared in The
Washington Post, The LA Times, The New Republic, Discover, and The American Prospect,
instructor in science journalism @ Emory, Ignore predictions of lethal pandemics and pay
attention to what really matters, LA Times, 1/3/15,
Prophets of doom have been telling us for decades that a deadly new pandemic — of bird flu, of SARS or MERS
coronavirus, and now of Ebola — is on its way. Why are we still listening? If you look back at the furor raised at many distinguished publications —

Nature, Science, Scientific American, National Geographic — back in, say, 2005, about a potential bird flu (H5N1) pandemic, you wonder what planet they were on. Nature ran a special

section titled — “Avian flu: Are we ready?” — that began, ominously, with the words “Trouble is brewing in the East” and went on to present a mock
aftermath report detailing catastrophic civil breakdown . Robert Webster, a famous influenza virologist, told ABC News in 2006 that “society just can't
accept the idea that 50% of the population could die. And I think we have to face that possibility.” Public health expert Michael T. Osterholm of the University of Minnesota, at a meeting in Washington of scientists
brought together by the Institute of Medicine, warned in 2005 that a post-pandemic commission, like the post-9/11 commission, could hold “many scientists … accountable to that commission for what we did or
didn't do to prevent a pandemic.” He also predicted that we could be facing “three years of a given hell” as the world struggled to right itself after the deadly pandemic. And Laurie Garrett, author of what must be
the urtext for pandemic predictions, her 1994 book “The Coming Plague,” intoned in Foreign Affairs that “in short, doom may loom.” Although she followed that with “But note the may,” the article went on to

hysteria still goes on: Whether it's over the MERS coronavirus, a
paint a terrifying picture of the avian flu threat nonetheless. And such

whole alphabet of chicken flu viruses, a real but not very deadly in flu enza pandemic in 2009, or a kerfuffle like the one
in 2012 over a scientist-crafted ferret flu that also was supposed to be a pandemic threat. Along the way,
virologist Nathan Wolfe published “The Viral Storm: the Dawn of a New Pandemic Age,” and David Quammen warned in his gripping “Spillover” that

some new animal plague could arise from the jungle and sweep across the world. And now there's Ebola. Osterholm, in a widely read
op-ed in the New York Times in September, wrote about the possibility that scientists were afraid to mention publicly the danger they discuss privately: that Ebola “could mutate to become transmissible through
the air.” “The Ebola epidemic in West Africa has the potential to alter history as much as any plague has ever done,” he wrote. And Garrett wrote in Foreign Policy, “Attention, World: You just don't get it.” She
went on to say, “Wake up, fools,” because we should be more frightened of a potential scenario like the one in the movie “Contagion,” in which a lethal, fictitious pandemic scours the world, nearly destroying
civilization. But there were fewer takers this time. Osterholm's claims about Ebola going airborne were discounted by serious scientists, and Garrett seemingly retracted her earlier hysteria about Ebola by claiming

The scientific world has changed since 2005. Now, most scientists
that, after all, evolution made such spread unlikely.

understand that there are significant physical and evolutionary barriers to a

blood- and fluid-borne virus developing airborne transmission , as Garrett has acknowledged. Though Ebola virus has
been detected in human alveolar cells, as Vincent Racaniello, virologist at Columbia University, explained to me, that doesn't mean it can replicate in the airways enough to allow transmission. “Maybe … the virus
can get in, but can't get out. Like a roach motel,” wrote Racaniello in an email. H5N1, we understand now, never went airborne because it attached only to cell receptors located deep in human lungs, and could not,
therefore, be coughed or sneezed out. SARS, or severe acute respiratory syndrome, caused local outbreaks after multiple introductions via air travel but spread only sluggishly and mostly in hospitals. Breaking its

There probably will always be significant barriers preventing the

chains of transmission ended the outbreak globally.

easy adaptation of an animal disease to the human species. Furthermore, Racaniello insists that there are no
recorded instances of viruses that have adapted to humans, changing the way they are
spread. So we need to stop listening to the doomsayers, and we need to do it now. Predictions
of lethal pandemics have — since the swine flu fiasco of 1976, when President Ford vowed to vaccinate “every man, woman and child
in the United States” — always been wrong. Fear-mongering wastes our time and our emotions and

diverts resources from where they should be directed — in the case of Ebola, to the ongoing tragedy in West Africa. Americans have all but forgotten
about Ebola now, because most people realize it isn't coming to a school or a shopping mall near you. But Sierra Leoneans and Liberians go on dying.
Advantage 2
1NC card
over time by shortening life spans and raising cleanup and health-care costs . For another thing,
GDP was originally designed to measure mid-twentieth-century manufacturing economies, and so the more knowledge-based and
global-ized a country's production is, the more its GDP underestimates its economy's true size.
A new statistic developed by the UN suggests the degree to which GDP inflates China's relative
power. Called "inclusive wealth," this measure represents economists' most systematic effort to
date to calculate a state's wealth. As a UN report explained, it counts a country's stock of assets in three
areas: "(i) manufactured capital (roads, buildings, machines, and equipment), (ii) human capital
(skills, education, health), and (iii) natural capital (sub-soil resources, ecosystems, the
atmosphere)." Added up, the United States' inclusive wealth comes to almost $144 trillion--4.5 times China's $32
The true size of China's economy relative to the United States' may lie somewhere in between the numbers provided by GDP and
inclusive wealth, and admittedly, the latter measure has yet to receive the same level of scrutiny as GDP. The problem with GDP,
however, is that it measures a flow (typically, the value of goods and services produced in a year), whereas inclusive wealth measures
a stock. As The Economist put it, "Gauging an economy by its GDP is like judging a company by its quarterly profits, without ever
peeking at its balance-sheet." Because inclusive wealth measures the pool of resources a government can
conceivably draw on to achieve its strategic objectives, it is the more useful metric when
thinking about geopolitical competition . But no matter how one compares the size of the
U.S. and Chinese economies, it is clear that the United States is far more capable of converting
its resources into military might. In the past, rising states had levels of technological prowess
similar to those of leading ones. During the late nineteenth and early twentieth centuries, for example, the United States
didn't lag far behind the United Kingdom in terms of technology, nor did Germany lag far behind the erstwhile Allies during the
interwar years, nor was the Soviet Union backward technologically compared with the United States during the early Cold War. This
meant that when these challengers rose economically, they could soon mount a serious military challenge to the dominant power.
China's relative technological backwardness today, however, means that even if its economy
continues to gain ground, it will not be easy for it to catch up militarily and become a true global
strategic peer, as opposed to a merely a major player in its own neighborhood.
AT: GOP Drilling

It controls their Trump arguments – he’ll work with republicans to do that but
only with a filibuster
Keith Goldberg 16, writer for Law360, 12/21/16, “Obama's 11th-Hour Offshore Drilling Ban
May Be Hard To Sink,”
President-elect Donald J. Trump would likely face an uphill battle trying to undo outgoing President Barack
Obama's indefinite blockage of oil and gas drilling in large swaths of the Arctic and Atlantic
Oceans, though the resulting legal fight could clarify the currently untested limits of presidential authority under U.S. offshore law,
experts say.
Handing a major victory to environmental groups and many coastal lawmakers, Obama on Tuesday withdrew the entire U.S. portion
of the Arctic's Chukchi Sea and major portions of the Beaufort Sea from future drilling, as well as U.S. portions of the north and mid-
Atlantic Oceans. The withdrawn area covers 115 million acres in the Arctic and 3.8 million acres in the Atlantic.
In a presidential memorandum sent to the U.S. Department of Interior, Obama invoked his executive authority
under Section 12(a) of the O uter C ontinental S helf L ands A ct, a 24-word provision which simply reads, “The
president of the United States may, from time to time, withdraw from disposition any of the unleased lands of
the o uter c ontinental s helf.”
“ The provision , by itself, is unambiguous , so it's hard to see where there's any discretion on
the president's part that can be challenged,” Stroock & Stroock & Lavan LLP special counsel Gail Suchman said.
Though the timing and the size of the withdrawal made waves, Obama's use of his Section 12(a) authority isn't unprecedented.
Presidents dating back to Dwight Eisenhower have used the provision to withdraw OCS areas from
leasing; Obama himself withdrew three areas prior to Tuesday's decision.
There's no other language in the OCSLA that mentions the president's withdrawal authority
outside of Section 12(a). And the law's judicial review provisions are limited mainly to challenges of
regulations and permitting decisions by U.S. offshore regulators.
“There doesn't appear to be any discussion on whether you can challenge the actions of the
president under the provision,” Suchman said.
That may be why oil and gas industry groups appear to be turning to the incoming Trump administration, not the courts, in their
efforts to fight the withdrawal. The American Petroleum Institute, for one, has urged Trump to undo the withdrawal with a
presidential memorandum of his own, noting that President George W. Bush used his Section 12(a) authority to reverse OCS
withdrawals made by his predecessor, Bill Clinton.
“There isn't anything in there that prevents the president from withdrawing the withdrawal,” said Jason Hutt, who heads Bracewell
LLP's environmental and natural resources practice and frequently represents the oil and gas industry. “I suspect there will be a
legal fight over that, but I don't see it as insurmountable from a Trump administration's perspective."
Proponents of Obama's decision have already vowed to fight Trump in court if he attempts to undo it.
Their main argument will likely be that while there isn't any language in the OCSLA that prohibits a
president from reversing a previous withdrawal, there isn't any language that expressly says a
president can , like in similar statutes including the Antiquities Act.
“The proponents of Obama's action are suggesting the [OCSLA] provision is unidirectional,” Hutt said.
The Natural Resources Defense Council and Earthjustice, which back Obama's decision, have also noted that the Clinton
withdrawals reversed by Bush had specific time limits. No indefinite or permanent withdrawal under Section 12(a) has ever been
undone, the groups said in a November report.
But that doesn't mean it isn't possible, and the language of Section 12(a) offers that possibility, according to Hutt.
“The provision states 'from time to time.' It envisions that there's a temporal nature to the withdrawal, not a permanent withdrawal,”
Hutt said. “What would prevent Trump from saying, 'now is the time to withdraw the withdrawal'?"
It's issues like that which courts will likely have to wrestle with, experts say.
“It'sall about statutory construction,” Suchman said. “If there's no ambiguity, the court looks at the
exact words of the statute . There is nowhere in the statute, nothing specific, that says you can
put an area back for leasing.”
Given that no court has yet weighed in on the scope of Section 12(a) of the OCSLA, expect any legal fight to be a drawn-
out process, something supporters of Obama's decision are likely counting on , experts say.
"The very effect of those legal challenges is that there will be a delay in the ability of the Arctic and
Atlantic leasing program to move forward,” Hutt said. “That is the desired effect of the action taken by the Obama
Instead of inviting a lengthy court battle, Trump could choose to work with the Republican-
controlled Congress to override the decision, experts say. That includes crafting legislation that
would make the Arctic and Atlantic areas available again for leasing, or amending the OCSLA itself to
expressly allow presidents to rescind previous withdrawals.
“All of those options are on the table,” Hutt said.
But with the Senate filibuster still in place, securing enough votes to advance such
legislation will be a challenge .

Republicans did propose -- Dems currently have the votes to filibuster drilling
legislation, but it’s close
Esther Whieldon 16, alternative energy reporter for Politico Pro, 11/18/16, “Obama cuts Arctic
waters from five-year drilling plan,”
Lawmakers in this Congress have proposed measures that would expand the program and allow
states to receive some of the revenues from the sales. Sen. Ted Cruz, for example, floated a bill, S. 791, that would reinstate most of
the Bush administration's draft offshore drilling plan for 2010-2015, but it never even received a hearing in
Earlier this week, the
Senate fell nine votes short of advancing a narrower measure from Sen. Bill
Cassidy (R-La.) that would have expanded revenue sharing associated with offshore energy
production. That suggests that offshore drilling legislation would similarly fall
victim to a Democratic filibuster next year, unless Republicans change the rules.
No ! – Warming

Warming causes extinction--- increases in emissions make adaptation impossible

Naomi Klein 14, award-winning journalist, syndicated columnist, former Miliband Fellow at
the London School of Economics, member of the board of directors of, This Changes
Everything: Capitalism vs. the Climate, pp. 12-14
In a 2012 report, the World Bank laid out the gamble implied by that target. “ As global warming approaches and
exceeds 2-degrees Celsius, there is a risk of triggering nonlinear tipping elements .
Examples include the disintegration of the West Antarctic ice sheet leading to more rapid sea-level rise, or large-scale
Amazon dieback drastically affecting ecosystems, rivers, agriculture, energy production, and
livelihoods. This would further add to 21st-century global warming and impact entire continents.” In other words, once we allow
temperatures to climb past a certain point, where the mercury stops is not in our control. ¶ But the bigger problem—and the reason
Copenhagen caused such great despair—is that because governments did not agree to binding targets, they are free to pretty much
ignore their commitments. Which is precisely what is happening. Indeed, emissions are rising so rapidly that unless something
radical changes within our economic structure, 2 degrees now looks like a utopian dream. And it’s not just environmentalists who
are raising the alarm. The World Bank also warned when it released its report that “ we’re on track to a 4-C warmer
world [by century’s end] marked by extreme heat waves , declining global food stocks , loss
of ecosystems and biodiversity, and life-threatening sea level rise .” And the report cautioned
that, “there is also no certainty that adaptation to a 4-C world is possible .” Kevin Anderson,
former director (now deputy director) of the Tyndall Centre for Climate Change, which has quickly established itself as one of the
U.K’s premier climate research institutions, is even blunter; he says 4 degrees Celsius warming—7.2 degrees Fahrenheit—
is “incompatible with an organized, equitable, and civilized global community .”¶ We don’t know exactly
what a 4 degree Celsius world would look like, but even the best-case scenario is likely to be calamitous. Four degrees of
warming could raise global sea levels by 1 or possibly even 2 meters by 2100 (and would lock in at least a
few additional meters over future centuries). This would drown some island nations such as the Maldives and Tuvalu, and inundate
many coastal areas from Ecuador and Brazil to the Netherlands to much of California and the northeastern United States as well as
huge swaths of South and Southeast Asia. Major cities likely in jeopardy include Boston, New York, greater Los Angeles, Vancouver,
London, Mumbai, Hong Kong, and Shanghai.¶ Meanwhile, brutal heat waves that can kill tens of thousands of
people, even in wealthy countries, would become entirely unremarkable summer events on every
continent but Antarctica. The heat would also cause staple crops to suffer dramatic yield
losses across the globe (it is possible that Indian wheat and U.S. could plummet by as much as 60 percent), this at a time
when demand will be surging due to population growth and a growing demand for meat. And since
crops will be facing not just heat stress but also extreme events such as wide-ranging droughts, flooding, or pest outbreaks, the
losses could easily turn out to be more severe than the models have predicted . When you add
ruinous hurricanes, raging wildfires, fisheries collapses, widespread disruptions to water
supplies, extinctions, and globe-trotting diseases to the mix, it indeed becomes difficult to
imagine that a peaceful, ordered society could be sustained (that is, where such a thing exists in the first
place).¶ And keep in mind that these are the optimistic scenarios in which warming is more or less stabilized at 4 degrees Celsius and
does not trigger tipping points beyond which runaway warming would occur. Based on the latest modeling, it is becoming safer to
assume that 4 degrees could bring about a number of extremely dangerous feedback loops —an Arctic
that is regularly ice-free in September, for instance, or, according to one recent study, global
vegetation that is too
saturated to act as a reliable “sink”, leading to more carbon being emitted rather than stored. Once this happens, any
hope of predicting impacts pretty much goes out the window. And this process may be starting sooner than anyone predicted. In
May 2014, NASA and the University of California, Irvine scientists revealed that glacier melt in a section of West Antarctica roughly
the size of France now “appears unstoppable.” This likely spells down for the entire West Antarctic ice sheet, which according to lead
study author Eric Rignot “comes with a sea level rise between three and five metres. Such an event will displace millions of people
worldwide.” The disintegration, however, could unfold over centuries and there is still time for emission reductions to slow down the
process and prevent the worst. ¶ Much more frightening than any of this is the fact that plenty of mainstream analysts
think that on our current emissions trajectory, we are headed for even more than 4 degrees of
warming. In 2011, the usually staid International Energy Agency (IEA) issued a report predicting that we are actually on
track for 6 degrees Celsius—10.8 degrees Fahrenheit—of warming. And as the IEA’s chief economist put it: “Everybody,
even the school children, knows that this will have catastrophic implications for all of us.” (The evidence indicates
that 6
degrees of warming is likely to set in motion several major tipping points —not only slower ones
like massive releases
such as the aforementioned breakdown of the West Antarctic ice sheet, but possibly more abrupt ones,
of methane from Arctic permafrost.) The accounting giant PricewaterhouseCoopers as also published a report warning
businesses that we are headed for “4-C , or even 6-C” of warming. ¶ These various projections are the equivalent of every alarm in
your house going off simultaneously. And then every alarm on your street going off as well, one by one by one. They mean, quite
simply, that climate change has become an existential crisis

for the human species . The only historical precedent for a crisis of this depth and scale was the Cold War fear that we
were headed toward nuclear holocaust, which would have made much of the planet uninhabitable. But that was (and remains) a
threat; a slim possibility, should geopolitics spiral out of control. The vast majority of nuclear scientists never told us that we were
almost certainly going to put our civilization in peril if we kept going about our daily lives as usual, doing exactly what we were
already going, which is what climate scientists have been telling us for years. ¶ As the Ohio State University climatologist Lonnie G.
Thompson, a world-renowned specialist on glacier melt, explained in 2010, “ Climatologists, like other scientists, tend to be
a stolid group. We are not given to theatrical rantings about falling skies. Most of us are far more comfortable in
our laboratories or gathering data in the field than we are giving interviews to journalists or speaking before Congressional
committees. When then are climatologists speaking out about the dangers of global warming? The answer is that virtually all of
us are now convinced that global warming poses a clear and present danger to
civilization .”

Turns Adv 2 – crushes growth

Marshall Burke et al. 15, Assistant Professor Dept. of Earth System Science Center
Fellow, Center on Food Security and the Environment at Stanford University, Solomon Hsiang,
Chancellor's Associate Professor of Public Policy at the University of California Berkley, Edward
Miguel, Oxfam Professor in Environmental and Resource Economics, Dept. of Economics,
10/21/16, “Global non-linear effect of temperature on economic production”,
- Equations omitted
Consistent with micro-level findings that both agricultural and non-agricultural labour-related productivity are highly non-linear in instantaneous
temperature3, 4, 6, we find agricultural and non-agricultural aggregate production are non-linear in average annual temperature for both rich and poor
countries (Fig. 2d, e and Extended Data Fig. 2g–l). Low temperature has no significant effect on these subsamples, although limited poor-country
exposure to these temperatures severely limits statistical precision. High
temperatures have significant negative effects in all
cases for poor countries, and significant or marginally significant effects for rich countries (Extended Data Fig. 2p–u).¶ A global
non-linear response of economic production to annual temperature has important implications for the likely
economic impact of climate change. We find only weak suggestive evidence that richer populations
are less vulnerable to warming, and no evidence that experience with high temperatures or
technological advances since 1960 have altered the global response to temperature. This
suggests that adaptation to climatic change may be more difficult than previously believed 9, 10,
and that the accumulation of wealth, technology and experience might not substantially mitigate
global economic losses during this century8, 21.¶ We quantify the potential impact of warming on national and global incomes by
combining our estimated non-linear response function with ‘business as usual’ scenarios (Representative Concentration Pathway (RCP)8.5) of future
warming and different assumptions regarding future baseline economic and population growth22 (see Supplementary Information). This approach
assumes future economies respond to temperature changes similarly to today’s economies—perhaps a reasonable assumption given the observed lack
of adaptation during our 50-year sample.¶ In
2100, we estimate that unmitigated climate change will make 77%
of countries poorer in per capita terms than they would be without climate change. Climate change may
make some countries poorer in the future than they are today, depending on what secular growth rates are assumed. With high baseline growth and
unmitigated climate change (RCP8.5 and Shared Socio-economic Pathway (SSP)5; see Supplementary Information), we project that 5% of countries are
poorer in 2100 than today (Fig. 3a), while with low growth, 43% are (SSP3; Fig. 3b). ¶ Differences in the projected impact of warming are mainly a
function of countries’ baseline temperatures, since warming raises productivity in cool countries (Fig. 4). In particular, Europe could benefit from
increased average temperatures. Because warming harms productivity in countries with high average temperatures, incomes in poor regions are
projected to fall relative to a world without climate change with high confidence (P < 0.01), regardless of the statistical approach used. Models allowing
for delayed effects project more negative impacts in colder wealthy regions; projections assuming rich and poor countries respond differently (Fig. 2b)
are more uncertain because fewer data are used to estimate each response (Extended Data Fig. 4). ¶ The impact of warming on global economic
production is a population-weighted average of country-level impacts in Fig. 4a. Using our benchmark model (Fig. 2a), climate change
reduces projected global output by 23% in 2100 (best estimate, SSP5) relative to a world without climate
change, although statistical uncertainty allows for positive impacts with probability 0.29 (Fig. 5a and Extended Data Table 3). Estimates vary in
magnitude, but not in structure, depending on the statistical approach (Fig. 5b and Extended Data Table 3). Models with delayed impacts project larger
losses because cold countries gain less, while differentiated rich–poor models have smaller losses (statistical uncertainty allows positive outcomes with
probability 0.09–0.40). Models allowing both delayed impacts and differentiated rich–poor responses (the most flexible approach) project global
losses 2.2 times larger than our benchmark approach. In all cases, the likelihood of large global losses is substantial: global losses exceed 20% of income
with probability 0.44–0.87 (Extended Data Table 3 and Extended Data Fig. 5). ¶ Accounting for the global non-linear effect of temperature is crucial to
constructing income projections under climate change because countries are expected to become both warmer and richer in the future. In a previous
analysis in which a linear relationship was assumed and no significant linear effect was observed in rich countries5, it was hypothesized that countries
adapted effectively to temperature as they became wealthier. Under this hypothesis, the impacts of future warming should lessen over time as countries
become richer. In contrast, when we account for the non-linear effect of temperature historically, we find that rich
and poor countries
behave similarly at similar temperatures, offering little evidence of adaptation . This indicates that we
cannot assume rich countries will be unaffected by future warming , nor can we assume that the impacts of future
warming will attenuate over time as countries become wealthier. Rather, the impact of additional warming worsens over
time as countries becomes warmer. As a result, projections using linear and non-linear approaches diverge substantially—by
roughly 50–200% in 2100 (Extended Data Fig. 3c, d)—highlighting the importance of accounting for this non-linearity when assessing the impacts of
future warming.¶ Strong negative correlation between baseline income and baseline temperature indicates that warming may
amplify global inequality

because hot, poor countries will probably suffer the largest reduction in growth (Fig. 5c). In our
benchmark estimate, average income in the poorest 40% of countries declines 75% by 2100 relative to a world
without climate change, while the richest 20% experience slight gains, since they are generally cooler. Models with delayed impacts do not project as
dramatic differences because colder countries also suffer large losses (Extended Data Fig. 5). ¶ We use our results to construct an empirical ‘damage
function’ that maps global temperature change to global economic loss by aggregating country-level projections. Damage functions are widely used in
economic models of global warming, but previously relied on theory for structure and rough estimates for calibration11, 12. Using our empirical results,
we project changes to global output in 2100 for different temperature changes (Fig. 5d; see Supplementary Information) and compare these to
previously estimated damage functions12. Commonly used functions are within our estimated uncertainty, but differ in two important respects. ¶ First,
our projected global losses are roughly linear—and slightly concave—in temperature, not quadratic or exponential as previously theorized. Approximate
linearity results from the broad distribution of temperature exposure within and across countries, which causes the country-weighted average
derivative of the productivity function in Fig. 2a to change little as countries warm and prevents abrupt transitions in global output even though the
contribution of individual productive units are highly non-linear (see Fig. 1). Global losses are slightly concave in global temperature because the effect
of compounding negative growth declines mechanically over time (Extended Data Fig. 6e and Supplementary Information). These properties are
independent of the growth scenario and response function (Extended Data Fig. 6a). ¶ Second, the slope of the damage function is large even for slight
warming, generating expected costs of climate change 2.5–100 times larger than prior estimates for 2 °C warming, and at least 2.5 times larger for
higher temperatures (Extended Data Fig. 6b–d). Notably, our estimates are based only on temperature effects (or effects for which historical
temperature has been a proxy), and so do not include other potential sources of economic loss associated with climate change, such as tropical
cyclones15 or sea-level rise23, included in previous damage estimates. ¶ If societies continue to function as they have in the recent past, climate
change is expected to reshape the global economy by substantially reducing global economic
output and possibly amplifying existing global economic inequalities, relative to a world without climate change.
Adaptations such as unprecedented innovation24 or defensive investments25 might reduce these effects, but social
conflict or disrupted trade—either from political restrictions or correlated losses around the
world—could exacerbate them.
AT: Trump
The U.S. will meet our Paris targets now under business as usual due to market
David Goldwyn 17, Chairman of the Atlantic Council Energy Advisory Board; president of
Goldwyn Global Strategies, LLC, an international energy advisory consultancy; and is of counsel
to Sutherland LLC, January 2017, “The Outlook for Energy Under a Trump Administration:
Major Volatility Ahead,”
It is early yet to predict Mr. Trump’s policies and outcomes. They will be shaped by White House and agency personnel;
influenced by Congress, including Republicans who favor trade and some level of
environmental protection ; mitigated by the US judicial system; ameliorated by the long
term investment vision and risk tolerance of US utilities; and may face intense backlash
from citizens, partner nations, and even energy producers . Because of this, it is unlikely that
any of Mr. Trump’s domestic policy measures will have a material impact on the US fuel mix
or global energy markets i

n the next four years. (In contrast, the effect of these policies on US participation in clean energy innovation, on meeting G-7
goals of global decarbonization by 2100, on the Paris agreement’s target of no more than 2 degrees warming above preindustrial
levels, and on investment in climate science could be dramatic).
The economic drivers that led to the retirement of coal fired generation and the rise of renewables
deployment (low cost gas and the dramatic decline in the cost of wind and solar equipment) preceded the Clean Power
Plan ( CPP ). With the Investment Tax Credit (solar) and Production Tax Credit (wind) in place until 2020,
twenty-nine states utilizing renewable portfolio standards, California and the northeast organized into
emissions trading regimes, and the nine states joining a Zero Emission Vehicle Initiative, the U nited
S tates may reach its Paris Agreement target on a business-as-usual basis .14

Atlantic drilling breaks the carbon budget, collapses U.S. climate leadership, and
shatters the Paris framework
NRDC 15 – Natural Resources Defense Council, 10/22/15, “Here’s why President Obama must
block oil drilling in the Atlantic,”
This December, world leaders will convene in Paris to make one of the most important
decisions in human history : how the world is going to finally address the ever-growing climate
President Obama has already made huge progress on climate change. The C lean P ower P lan will limit
dangerous carbon pollution from U.S. power plants for the first time ever, and he’s brokered a historic
climate accord with China. But now President Obama risks tarnishing his climate legacy by
leaving vast swaths of the Atlantic coast vulnerable to oil and gas drilling .
Early this year, the Obama administration proposed a five-year plan for drilling off America’s eastern seaboard. Here are five
reasons this is a terrible idea.
1. Disasters will happen.
Just as we’ve seen with oil spills in Alaska and the Gulf of Mexico, wherever
there is oil drilling, disasters will
follow. Drilling in the Atlantic —which has been off-limits—could have grave consequences
not only for marine habitats but also for millions of people living along the East Coast, from Virginia to
2. Oil can’t be un-spilled.
When the inevitable does occur, there’s no way to completely eradicate the mess left behind. Drilling
technologies have advanced over the years, but no new cleanup methods have been developed to keep up
with them.
Of the combined 211 millions of gallons that were spilled in the Exxon Valdez and Deepwater Horizon disasters, only 8 percent of the
oil was cleaned up. Nearly 30 years later, oil from the 1989 Valdez spill still clings to Alaskan beaches. And the Gulf continues to
struggle with the mess from the 2010 Deepwater Horizon incident. Why would we allow this to happen on our Atlantic coast?
3. The economic benefits aren’t worth the risks.
Oil spills are financial disasters as well. The Deepwater Horizon spill cost the Gulf of Mexico’s
commercial fishing industry almost $250 million. And over just three years, the tourism business lost $23
billion. Along the Atlantic coast, the tourism, fishery, and recreational industries employ almost one million people. The expense
of a spill in this area would be on a potentially unprecedented scale.
4. Itcould break the carbon budget .
In order to prevent an unsafe rise in global temperatures , scientists say we need to start
reducing our expansion of fossil fuels and begin converting to renewable energy. By opening
new sources of oil and gas to drilling, President Obama would be negating the positive
steps he’s taken to reduce carbon emissions .
5. We need to walk the walk, not just talk the talk .
As one of the world’s leading polluters, America needs to lead by example . If the
international community sees the U nited S tates as being hypocritical and not pulling our
own weight on climate action, it could hinder a global agreement . President Obama should
continue to take the reins on climate action and declare the Atlantic off-limits to drilling
once and for all.
AT: Dem Turnout

Health care’s the key issue currently motivating Dem voters who sat out of the last
GSG 17 – Global Strategy Group, public relations and research firm; specializing in research,
strategic communications, digital strategy, grassroots and grasstops organizing, marketing and
branding, April 2017, “Post-Election Research: Persuadable and Drop-off Voters,”
GSG and GHY conducted a survey of 803 registered voters nationwide from March 31st to April 5th, 2017,
conducting interviews with 401 midterm drop-off voters (voted for Clinton in 2016 but did not
vote in 2014 ) and 402 presidential drop-off voters (voted for Obama in 2012 but did not vote in
Understanding Drop-off and Persuadable Voters
A key commonality between turnout voters and Obama-Trump voters is that they are struggling
economically .
• Clinton and Democrats’ economic message did not break through to drop-off or Obama-Trump voters,
even though drop-off voters are decidedly anti-Trump .
• Drop-off voters already believe that Trump’s policies will benefit the wealthy over other groups, but there is more work to be done
to convince Obama-Trump voters that this is the case.
• Ensuring corporations pay their fair share of taxes, modernizing infrastructure, and increasing the development of renewable
energy are seen as economically beneficial by both groups.
Health care is a critical motivator for both Democratic drop-off voters and persuadable
Trump voters.
• Both groups identify cuts to Medicare, Medicaid, and other healthcare programs as policies that would
have a very bad effect on them personally.
• Among drop-off voters, items related to health care (increasing costs for seniors, cutting important programs,
and millions of Americans losing coverage) are frequently rated as very major concerns .
Health care’s the biggest issue for 2018---voters are mad precisely because they
don’t think the plan will pass
Rachel Roubein 17, writer for The Hill, 7/17/17, “Poll: Americans see healthcare as most
important issue,”
Americans view healthcare as the most important issue facing the country but are doubtful
Congress will pass legislation that will lower premiums and cover more people, according to a
Bloomberg poll released Monday.
With the GOP push to repeal and replace ObamaCare serving as the poll’s backdrop, 35 percent of Americans
surveyed indicated healthcare was their top issue, more than twice as many as any other
option . The other leading issues included unemployment and jobs (13 percent), terrorism (11 percent),
immigration (10 percent) and climate change (also 10 percent).
A majority, 64 percent, disapproves of how President Trump is handling healthcare, compared to 28
percent approving.
Senate Majority Leader Mitch McConnell (R-Ky.) has delayed a vote on healthcare legislation that leadership hoped would be this
week, as Sen. John McCain (R-Ariz.) recovers from an unexpected surgery. Without McCain, Republican leadership didn’t have
enough votes to begin debate on the bill because Sens. Rand Paul (R-Ky.) and Susan Collins (R-Maine) said they would vote against
a motion to proceed.
About 60percent of those surveyed believe it’s unrealistic legislation will pass in the next
several years that both lowers premiums and leads to more people with health coverage .
Conservative lawmakers have consistently pushed for a bill lowering health insurance premiums. A provision from Sen. Ted Cruz (R-
Texas) that was added to the revised version of the GOP plan lets insurers sell plans that don’t comply with ObamaCare’s coverage
regulations as long as they also sell a plan that does.
But the measure has received pushback from healthcare experts and insurers. In a strongly worded letter sent Friday, America’s
Health Insurance Plans — the major insurance trade group — and the Blue Cross Blue Shield Association warned that it is “simply
unworkable in any form and would undermine protections for those with pre-existing medical conditions, increase premiums and
lead to widespread terminations of coverage for people currently enrolled in the individual market.”
Bloomberg surveyed approximately 1,000 people over the phone from July 8 to July 12. The poll has a margin
of error of plus or minus 3.1 percent
AT: Public Option Link Turn
The GOP’s committing political suicide but fully enacting the public option saves
Chris Weigant 17, HuffPo political commentator, 6/28/17, “Democrats Should Bring Back The
Public Option,”
Up until now, congressional Democrats have been smart to merely stand on the sidelines
and watch Republicans flail on their “repeal and replace Obamacare” efforts. This follows the sound
political theory of: “When your opponent is digging his own grave, don’t interrupt him .” But at
some point in the near future, Democrats are going to have to offer up their own better ideas for what to do next on health care.
There are already many pushing for single-payer or (as Bernie Sanders likes to call it) “Medicare for all.” This, however, is quite
likely a bridge too far ― even within the Democratic Party. Instead of such a radical change, Democrats would do much better to
rally around a more transitional idea that was jettisoned during the drafting of the Obamacare law: the public option.
The biggest political selling point about this is that a public option would be just that ― optional . Call
it “Medicare for all, if that’s what you want,” perhaps. Or rebrand it entirely as something like “Medichoice,” to take its place
alongside Medicare and Medicaid. By doing so, Democrats could avoid a tsunami of Republican negative ads which screamed:
“Washington bureaucrats are going to force you into their plan!” But unlike universal single-payer, Medichoice might actually
have a prayer of garnering Republican votes and passing this Congress .
If the Senate Republican bill fails (which is by no means assured, even at this point), then Mitch McConnell has
already expressed an interest in working with Democrats to fix some of the worst problems with
Obamacare, because McConnell knows that if the system collapses at this point, Republicans
will be held accountable for letting it happen. Fixing Obamacare mostly means addressing the problems with the
individual market exchanges (a relatively small part of Obamacare, but also the most publicly visible). This could probably be
quickly accomplished with a good-faith effort by both parties, and it may indeed be all that happens to Obamacare for the next two
years. But Democrats should at least make the attempt at something more ambitious in these negotiations.
if they fail , they will at least have created a campaign platform for the 2018
midterm elections ― a positive message of change instead of just “we’re not as bad

as those evil Republicans.”

Many Democrats ― including, now, Elizabeth Warren ― are convinced that this next step should be a push for single-payer. But
while they’re right that this should be the ultimate goal, to push too hard for it now only sets Democrats up for another round of
massive disappointment. In the first place, to get anything passed now would require not just a unified Democratic Party, but also
peeling off a significant amount of Republican votes in both the House and Senate. Does anyone expect any single-payer plan to
clear this very high bar in the next year and a half? I don’t.
Regular readers of mine know that I am not generally a big fan of incrementalism. I regularly take Democrats to task for being too
timid and for not thinking big enough (including, most prominently, Hillary Clinton). But with the congressional math Democrats
currently face, at this point it seems like the best that could even be reasonably hoped for. So while I would support an eventual
move to single-payer, I just don’t now see it as a realistic possibility, unless Democrats have a spectacular midterm election and
regain control of both houses of Congress. Until that comes to pass, though, I think the public option is what Democrats should focus
The recent history of single-payer efforts at the state level bears this out. At least two states have attempted to move to this liberal
Utopia of health care for all. They both failed, when confronted with the cost. Politically, single-payer couldn’t even get enough
support in deep-blue Vermont and California, so it’s hard to see the entire country getting behind the idea at this point.
The political problem isn’t so much the cost as it is the disruption to the system. This disruption wouldn’t just impact the insurance
companies and health care providers, it would also radically change everyone’s paychecks. Even if your take-home pay turned out to
be exactly the same as before, how it got to that figure would be very different. Change scares people, to state the obvious, and it’s
clear that not everyone’s take-home pay would be exactly the same. There would be winners and losers, most likely. It would be
incredibly disruptive to everyone’s paycheck, even if you turned out to be one of the winners.
Another political problem is the sheer size of the numbers involved. Take the case of California. This year, the state senate passed a
single-payer bill. The only problem? It didn’t address the funding for the program at all. They were trying to punt that thorny
problem to the state assembly (which, in response, just refused to deal with the bill). Single-payer care in California would cover
everyone, at a projected total cost of $400 billion per year. Of that, something like $200 billion would be from federal funds, and the
rest would have to be made up with a new income tax. This tax would replace all the money now paid by both employers and
employees for health insurance. An academic study found that doing so ― even while insuring all the currently-uninsured people in
the state ― would successfully save California something like $37 billion each year. Even so, that $400 billion number is huge. By
comparison, California’s entire state budget (including federal aid) is currently only $250 billion a year.
What true single-payer systems lack is choice. Absent that choice, everyone is forced into the new system. But American voters aren’t
crazy about being forced into much of anything. The liberal dreamers insist that since the new system will be so much better,
everyone just needs to bite the bullet, adapt to the change, and happiness will then ensue for all. But such technocratic “we know
what’s best for you, trust us” thinking is not exactly a proven winner at the ballot box. This reason alone is why the better route for
Democrats to take would be a public option, or Medichoice ― in other words, “we think it’s better, but the choice is totally up to
you.” This is a much easier political message to sell, for obvious reasons.
Which is why more attention should have been paid to what recently happened in Nevada, rather than to California and the other
states attempting true single-payer. Because Nevada attempted to create a “Medicaid-for-all” system, which is just another way of
saying “a public option.” It passed the statehouse, but the governor vetoed it, mostly due to lack of specifics (the entire bill was
reportedly only four pages long). But what was proposed is exactly what Democrats should consider proposing nationwide.
The Republicans have been complaining about Obamacare since before it was even written . Most of
their criticisms were wildly inaccurate, designed merely as scary stories to frighten the public (see: death panels, Sarah Palin). But
since Obamacare has become law, they have had to refocus their complaints on the reality of
Obamacare. In the health care debate this year, their complaints have focused on three flaws with the exchanges:
rising premiums, lack of choice in certain counties and states, and large deductibles .
Introducing a public option would seem to address all of these problems . It would provide a choice
for everyone in every county. It would stabilize the premiums and deductibles by giving the private insurance companies a baseline
to shoot for. It would guarantee that Republicans couldn’t complain that there were “zero” choices on the exchanges in certain parts
of the country.
Of course, the insurance companies would howl, but they had their chance ― and in the places that currently only have one or zero
choices, the private marketplace has obviously failed to deliver. Perhaps the system could be phased in, initially only covering
markets with fewer than three insurers on the exchanges. But eventually, everyone in the country should get the same choice ― buy
private health insurance in some fashion (through employer-provided insurance or through the exchanges), or sign up for the public
option instead.
The Nevada legislators obviously weren’t completely serious about their new idea. Four pages? That’s not much detail. Studies would
have to be done to figure out how many people would choose a public option if offered, what such a public option would actually
cover, and what all the expected costs would be (premiums, deductibles, and other out-of-pocket costs for consumers; as well as the
government’s costs to run the system). But at least Nevada moved the debate forward in a significant way. They have shown there
may be a possible compromise to be struck between those demanding single-payer health systems and those who just want to fix the
worst problems of the Obamacare system already in place.
Over time, if enough people migrated to the public option, either through choice on the exchanges or through employers deciding to
sign their workers up for the idea, then the American insurance market would have to change to adapt. It would move towards a
system already in use in several European countries (France or Ireland, for instance), where basic health insurance is provided on a
single-payer basis, but private insurance also exists for a whole range of extras ― lower out-of-pocket costs, better hospital rooms
(private instead of shared), and other enticements. American insurance companies would turn to concentrating on selling such
extras, and the public option could begin to morph into a basic guarantee of health insurance for all (a real universal single-payer
system instead of an optional one).
Because health insurance is such a contentious issue, this would seem to be the better path forward. Defining it as Medichoice rather
than single-payer would be a lot more appealing to a lot more people, perhaps on both sides of the political divide. It would only be
an incremental step forward, not the giant leap towards single-payer some now wish to see, but it would be a lot more possible
politically. A few Blue Dog Democrats killed the possibility of the public option in Obamacare (Max Baucus and Joe Lieberman, to
name the two most prominent), but it now seems like an idea whose time has come. The national Democratic Party
should closely examine what Nevada just tried to do, and then dive deep into the details to see how plausible
such a system could be, nationwide. Then when the time is ripe (when either the Republican plan dies in
the Senate or passes and begins throwing people off their insurance by the tens of millions), Democrats would have a
solid plan ready on a better way to move forward. For now, it’s fine that they’re
content to sit back and watch Republicans shoot themselves in the foot , but at
some point in the very near future, Democrats are going to need to be ready and willing to offer a way forward that actually solves
problems with the health care system by making it better for more people, rather than (as with the GOP plan) making all the
problems much worse.
AT: Bernie
Dem support for single payer has no downside now because it’s theoretical and
moderates in the party don’t have to sign on---that allows them to focus on the
downsides of Republican policies
Jeet Heer 17, senior editor at the New Republic, 6/28/17, “Trump Is Getting Pummeled for His
Cruel Health Care Plan,”
Trumpcare is such a fiasco that Democrats can afford some flexibility in their health care
policies. Left-wing firebrands like Warren can push for single payer while centrist Democrats argue
for mending and expanding Obamacare . This is a national debate that’s worth having, an immeasurably
more valuable one than the current debate. Nor would it distract from the stark difference between
the two party’s positions: While all Democrats want to increase health care coverage, Trump and the
Republicans are deliberately trying to take it away from more than 20 million Americans. If voters
empower the Democrats to stop or reverse the Republican plan, they’ll also be empowering Democrats to go even further to achieve
universal health care in America.
Enten goes neg – general first term curse wont affect the midterm but healthcare
anger is durable and a good predictor of voter enthusiasm
Harry Enten 17, senior political writer and analyst for FiveThirtyEight, 3/22/17, “This Health
Care Bill May Haunt The GOP,”
Imagine a Congress and a president of the same party working on health insurance reform. They
write up a piece of legislation, and it’s not popular. Within two weeks of its introduction in
Congress, the bill garners just 41 percent support from the American public, and the opposition
party is completely against it. People protest. People yell at lawmakers. The lawmakers pass the
bill anyway, and the party and president are summarily punished in the next election : They
lose a ton of seats in Congress . That was President Obama, Democrats and the A ffordable
C are A ct in 2009 and 2010. Minus the passing-the-bill part, that was President Bill Clinton, Democrats and
“Hillarycare” in 1993 and 1994 too.
Now imagine a bill that’s even more unpopular, and you have House Republicans’ health care
legislation in 2017, the A merican H ealth C are A ct. The bill is aimed at repealing and
replacing parts of the ACA. It’s polling worse than the ACA and the Clinton effort, and history
suggests that it could have disastrous consequences for the GOP .
First, the basics: The AHCA is much more disliked than the ACA and Clinton’s health care reform bill were when they were first
introduced. Across nine surveys, the AHCA has garnered an average of just 32 percent in favor compared with 45 percent opposed.
Health care is difficult, so it shouldn’t be too surprising that people dislike the Republican health care
bill. What is surprising is how quickly opposition has coalesced . More people
supported than opposed Obama’s health care bill in every poll before July 2009. Two weeks
after Clinton’s health care bill was introduced in October 1993, it had plurality support — 46
percent in favor to 41 percent opposed — in an average of four surveys.
Just as scary for proponents of the GOP’s bill is that the status quo (the ACA, aka Obamacare) is more popular than
unpopular for the first time in seven years, and opposition to changing it is growing .
As recently as December, the Kaiser Family Foundation, a health policy research organization, found that 49 percent of Americans
said the ACA should be repealed, compared with 47 percent who said it should not be. In a March Kaiser survey, 51 percent said it
should not be repealed, and 45 percent said it should be. In other words, the trend is in the wrong direction for Republicans.
The same thing happened to Democrats with the ACA and Bill Clinton’s health care bill. Although Americans were initially open to
Obama’s health care reforms, the bill that eventually morphed into the ACA had more opposition than support from the public
within two weeks of its introduction in Congress. (Opposition climbed even higher before the bill was passed in March 2010.) nd
although Clinton’s bill started out as relatively popular, just 39 percent were in favor and 50 percent were opposed in an average of
surveys in July and August 1994. Clinton gave up on the legislation that August.
Second, enthusiasm is on the side of those against change — just as it was in 1993 and 2009. In the
most recent Fox News poll, only 17 percent of Americans strongly favored the AHCA. (Pollsters often ask respondents if they have a
strongly favorable, somewhat favorable, somewhat unfavorable or strongly unfavorable view.) Forty percent strongly opposed it.
SurveyMonkey and YouGov polls show comparable splits. These numbers look a lot like an NPR poll from late July 2009, in which
only 25 percent of Americans were strongly in favor of Obama’s health care bill and 39 percent were strongly against it. The Clinton
health care bill was more popular at the outset, but even in early November 1993, a Wirthlin Group survey found that those strongly
opposed (27 percent) outnumbered those who were strongly in favor (21 percent).
Those strong feelings were important in 1993 and 2009 because they foretold an
opposition that would prove loud and durable . Congress heard those voices in 1993 through
hundreds of thousands of phone calls and letters from angry constituents. You saw this strong opposition in the raucous
congressional town halls of 2009. The AHCA is facing the same type of opposition at angry town halls this year.
In 1993 and 2009, that deep disdain grew among the public as the bills became better
Third, and perhaps the most worrisome for AHCA proponents: Many self-identified Trump voters are not
supporting the bill. Trump won the election without a plurality of the national popular vote, and Republicans tend to win
more seats in the House and Senate than their national vote percentage would lead us to expect. These factors suggest that many
congressional Republicans can survive as long as their base stays with them.
AT: Other Issue – RTT
It says the top issue is terrorism overall because that’s true for Republican voters,
which the poll over-sampled. For people planning on voting Democratic, health
care is a huge issue, and that’s all that matters for the link---this ev is about the
same poll as their ev
Jason Millman 17, Deputy Health care reporter for Politico, 7/14/17, “POLITICO-Harvard poll:
Voters don't like Obamacare repeal, but other issues may sway midterms,”
That's a key takeaway from the latest POLITICO-Harvard T.H. Chan School of Public Health poll, which finds the policy
fights consuming Washington aren’t necessarily what's on voters’ minds.
As Republican leaders struggle to patch together 50 votes for an Obamacare repeal bill in the Senate next week, the poll results
indicate the next congressional election may be settled by a range of issues broader than the fight over the 2010 health care law.
“The race, if it was held tomorrow, health care will be one of the big issues , but other
issues could decide this race on both sides,” said Bob Blendon, a Harvard expert on health care policy and public
opinion who designed the poll with POLITICO.
Trump and Republican leaders have frequently said they need to finish work on Obamacare repeal before moving onto a tax
overhaul. But the POLITICO-Harvard poll finds the tax agenda also lacks public support. That could complicate the GOP’s ability to
advance an effort that Trump has billed as a cakewalk.
“I think after health care, taxes are gonna be so easy,” Trump told Christian Broadcasting Network founder Pat Robertson in an
interview broadcast Thursday. “Health care is very hard. Health care’s hard because you’ll do something a little bit this way, and
you’ll pick up that final vote and you lose four votes over here.”
But the general public — and even Republicans — are pessimistic about Trump’s still-hazy plans for overhauling the tax code. The
proposal, largely comprised of tax cuts along with promises to eliminate tax breaks for the wealthy and “special interests,” is favored
by just 24 percent of the general public and opposed by 62 percent.
Still, other issues right now hold more weight with voters. Trump’s efforts to protect the
country from terrorism (39 percent), his Obamacare replacement effort (37 percent ) and
his proposed budget (34 percent) will rank among the most important issues when considering which congressional
candidate to vote for in 2018, said registered voters surveyed in the poll. Ranking closely behind are allegations about the White
House’s involvement with the Russian government, Trump’s crackdown on undocumented immigrants and his ban on travel from
some Middle Eastern countries.
The top issue for registered voters who said they plan to vote for a Republican candidate in
2018 is terrorism (47 percent ) — well ahead of illegal immigration (32 percent) and Obamacare replacement (31
For registered voters planning to support a Democrat, Obamacare

replacement (46 percent) ranks as a top issue just behind allegations of White House ties to
Russia and Trump’s decision to withdraw the United States from the Paris climate change pact.
Both parties see an advantage in the Obamacare repeal effort. For Republicans, it would be the fulfillment of a
longtime pledge to scrap an onerous health care law. For
Democrats , who are energized by the health
care issue after suffering through years of Obamacare attacks, it's their chance to tie Republicans to an even
more unpopular plan.
There’s a clear lack of enthusiasm on the Republican side for their party's Obamacare
replacement — which is being revised and massaged in the tougher-than-expected effort to get it through the Senate. Just
20 percent of Republicans said they would support a plan providing financial assistance for
health coverage to a lot fewer people, while about 42 percent would accept a plan subsidizing “somewhat fewer people”
that saves taxpayer money. And by a slight margin, Republicans oppose their party’s plans to roll back enrollment in Medicaid, a
program covering nearly 75 million low-income Americans.
Only about one in three Republicans favor allowing insurers to charge more to people with pre-existing medical conditions, a
practice that was banned by Obamacare and has complicated the repeal effort. Conservative Republicans have sought to ease that
protection to bring down health insurance costs for healthier people, but they haven’t been able to craft a policy that would prevent
costs from skyrocketing for sick people.
“From the core issue that they’re trying to push, [Republican lawmakers] have lost this battle ,” Blendon said.
“ Their own constituency isn’t with them in this current debate .”
Senate Democrats in red states will win reelection now by mobilizing anger over
GOP health care proposals
Alex Roarty 17, McClatchy writer, and Katie Glueck, 7/18/17, “Democrats giddy over GOP’s
health care flop,”
For the first time since November, Democrats are feeling good.
The GOP’s quest to repeal and replace Obamacare has collapsed. Its unpopular president is under investigation
by a special counsel. And the rest of the Republican Party’s legislative agenda is, at best, on shaky ground.
Now, Democrats are brimming with a new optimism about next year’s midterm elections. They
think the GOP’s stymied policy plan gives them a chance to make the case that Republicans — in
complete control of Washington — are incompetent , a potentially significant new line of attack for
a party in desperate need of winning over conservative voters in red states and battleground
House districts.
“Democrats are beginning to believe that we can be good at politics again,” said Adam Jentleson, a former top aide to onetime
Senate Majority Leader Harry Reid. “There’s still a heavy, high degree of trauma that still has not worn off from election night, but
we’re finding our footing step by step.”
Even if Congress tries to put health care behind it , top Democratic operatives say it will remain
a major issue for voters , especially those who voted for House Republicans in special elections earlier this year.
And even if the issue fades, they’re hopeful the loss will be offset by an angry conservative base that wonders why it should even turn
out for the next election.
Not even GOP strategists are sure the Democrats are wrong about that last point.
“Right now, it's devastating,” said one conservative strategist working on the midterms. If lawmakers don't find another way to
repeal the law, “it will be absolutely devastating. It's so myopic of Republicans in terms of how they're handling this, because where
they’re going to end up is back in the minority, like we were in ‘09.”
The Senate's health plan insures more Americans and reduces the deficit more than the House's plan did, but also cuts Medicaid
more drastically than any plan to date, according to the a report by the nonpartisan Congressional Budget Office.
The conservative base, this strategist said, doesn't understand how Republicans could vote multiple times to repeal the law under
President Barack Obama, but fail to reach the same consensus when the GOP actually has power to act.
"Why were they able to get it done under Obama, and they're not getting anything done now?" the strategist said. “The challenge
Republicans are going to have in turning out conservatives is like nothing we've seen since ‘06.”
Democrats and Republicans alike think the GOP still has time to resuscitate its agenda, maybe as early as later this summer when
the party has said it will take up tax reform as its next major initiative. Democrats also say they think Republicans will try again to
repeal Obamacare, whether in the coming weeks or even into next year.
But if they don’t, Republicans run the risk of going before voters next year with nothing to show for
their time in office .
And Democrats say that could change the nature of their attacks, switching from one focused on
the details of the GOP’s agenda to the party’s broader failure to govern effectively .
“This is what happens when you have a Republican Congress that is not used to governing,” said John Lapp, a Democratic strategist.
“Turns out health care is really hard, really difficult."
Lapp knows how potent a competence argument can be: He was the executive director of the Democratic Congressional Campaign
Committee in 2006, the last time House Democrats retook a majority.
That year, the party capitalized on the aftermath of Hurricane Katrina and the then-unpopular Iraq War to depict Republicans as
incompetent, an argument that — in part — helped them win a net of 31 seats in the House. (Democrats need to win 24 seats next
year to win a majority, though the map of battleground seats is more difficult this time around.)
Lapp and other Democrats say they don’t think a failed legislative agenda rises to the level of either of those events. But they added
that acompetence argument can reach red-state voters in red states and right-leaning
House districts, the kind Democrats need to win over in a year when they’re defending 10

Senate seats in states Trump won last year.

lines up well with the map and the types of the people who are running and the types of
arguments they’re going to want to make ,” Jentleson said. “Republicans are certainly handing us a ton of
ammunition to make the competence case.”
Republicans will face two additional governing tests later this year, when they must pass a budget to avoid a government shutdown
and raise the debt ceiling.
Democrats have spent months vowing that the Republican health care bill would be the biggest
issue of the 2018 midterm elections, legislation that would alienate elderly voters and some
of Trump’s supporters who depend on government assistance for health insurance.