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DA – CTR Politics
CTR will pass—PC key
Bloomfield 9/21 ― Mark Bloomfield, journalist at The Hill, 2017. (“The bumpy road to tax reform is still
driveable”, The Hill, September 21st, 2017, Available Online at:
the-bumpy-road-to-tax-reform-is-still-driveable Accessed 9-28-17)

A word of caution to anyone preparing to throw dirt on the prospect of tax reform this year: Don’t break
out your shovels just yet. Tax reform is still alive because of a strategic decision by the White House and Republican congressional leaders.
The path to passing comprehensive tax reform is becoming clearer. Step one was for the “Big Six” — the
White House, Treasury secretary, House speaker, Senate majority leader and the chairmen of the congressional tax writing committees — to get Republicans on

one page. This was achieved in their joint statement released in July with more detailed consensus principles expected the week of
September 25. With unified principles in hand, advancing tax reform should avoid the pitfalls and intraparty

fractures that plagued repealing ObamaCare. While it might be hard to fathom in today’s populist and often divisive climate that broad agreement can be reached on an
issue as politically-charged as tax reform, there is nonetheless consensus among most Republicans, including the key

players. Permanent, comprehensive tax reform is a major part of fixing the American economy. After all, the U.S. tax rate on businesses is the fourth-highest rate in the
world, placing American firms at a disadvantage against their global competitors. It’s also long overdue. House Speaker Paul Ryan (R-Wis.) recently illustrated this point,
commenting that the last time Congress fixed the tax code was the same year he got his first driver’s license. Ryan’s anecdote would be funnier if it weren’t horrifyingly true. The
trillion dollar question is how to pay for making taxes competitive. The consensus plan to make tax reform permanent includes moving the U.S. to “a system that encourages
American companies to bring back jobs and profits trapped overseas.” In other words, repatriated earnings would help offset any anticipated revenue losses. The “Big Six”
proposal aims to reform international tax treatment for U.S. businesses and prevent inversions so that American companies are no longer tempted to move abroad. As ex-
Treasury Secretary George Shultz and other former Treasury officials stated, “Inversions are a symptom. The disease is America’s anomalous international tax code.” The path
to permanent and long-lasting tax reform will involve at least three steps. Step one has largely been accomplished. Step two, the passage of a budget that paves the way for
debate on tax reform, is critical. That’s why the White House recently dispatched Treasury Secretary Steven Mnuchin and National Economic Council Director Gary Cohn to
meet with key congressional leaders. Given the recent ruling by the Senate parliamentarian that temporary budget rules will expire after September 30, many Republicans are
Mnuchin and Cohn’s trip to Capitol Hill likely
worried that the absence of a new budget could derail tax reform efforts this year. As a result,

signaled the beginning of a full court press toward budget passage. After all, no budget means Republicans can't count on reconciliation to pass
tax reform. For a president and a Congress eager to deliver a key victory, the passage of a budget is an obstacle that simply must be cleared. The fate of tax

reform is inextricably linked to the reconciliation process — the path Majority Leader Mitch McConnell (R-Ky.) indicated the Senate will
pursue. The Republican majority needs 51 votes, instead of 60, to pass tax reform through reconciliation. Factoring in the possibility that some Republicans could defect,
Trump has attempted to win over Democrats. Successfully doing so would demonstrate bipartisanship

and would be politically effective.

Single payer destroys PC – invokes powerful GOP and industry opposition

Oberlander 16 (Jonathan, PhD, Professor of Poli Sci + Social Medicine @ Univ. of North Carolina-
Chapel Hill "The Virtues and Vices of Single-Payer Health Care,"

The substantive virtues of single-payer programs are compelling. But so are their political liabilities. Medicare for
All, which aims to constrain health care spending, faces intense opposition from insurers, the medical care
industry, and much of organized medicine. It would trigger fierce resistance from conservatives and
the business community and anxiety in many insured Americans fearful about changing coverage and the specter of
rationing. The ACA’s comparatively conservative reform approach inspired false charges of “socialized
medicine,” “pulling the plug on grandma,” and “death panels.” It takes only a little imagination — or a look
back at the history books — to predict the reactions that an actual single-payer plan would evoke.

Tax reform is key to renewable energy—solves warming

Rossetti 17 (Philip, data analyst at the American Action Forum who specializes in energy policy, with an
emphasis on clean energy, 8/30/17, “Tax reform: Full expensing could make clean energy competitive,”

Fixing the nation's tax code is not only smart economic policy. It can also be good energy policy. There is a
longstanding, often-heated debate over how the federal government should treat energy subsidies in the tax code. While one side hauls the small pot
of fossil fuel subsidies before the court of public opinion, the other accuses the wide array of renewable energy subsidies of tipping the scales. Such
arguments miss the point.
The fundamental problem with the U.S. system of energy tax preferences is that it
preserves the status quo, locking Americans into a system that keeps energy costs high and stifles
innovation toward cleaner, safer, and cheaper energy alternatives. Indeed, if a magic wand was waved and all $94 billion
of existing energy subsidies were eliminated (exemptions of corporate tax for natural gas pipelines, investment tax credits for solar power, production
tax credits for wind, etc.), the tax code would still be biased. That's because investments are taxed, while the costs of goods sold (like fuel) are not. In
other words, a business with high expenses (wages, cost of goods, etc.) can be more profitable than one that has the same lifetime costs and lifetime
The incentive under the current tax system is to narrow your taxable
income, but which faces mostly capital costs.
income with expenses, and to avoid capital investments that tie up your funds and don't offer a tax write-off.
This affects the energy industry because the newest (and cleanest) sources of energy tend to be very capital
intensive, and are thus less attractive as investments. As an example, the nuclear power plant project that was just abandoned
in South Carolina had an estimated capital cost of around $11.5 billion. But of course, the money invested in this venture is taxed. And given the
statutory rate of that tax, an investment of $11.5 billion requires earnings of $17.7 billion -- $6.2 billion to pay the taxes involved, leaving $11.5 billion
after taxes. Although the depreciation of the investment over time would narrow the tax base of the investment by 87 percent, the taxes paid for $11.5
billion of capital investment at a 35 percent tax rate are still $800 million – certainly not a sum to sneeze at. Further, even when investors can deduct
100 percent of their investment under the current system, it can only be done over a period of anywhere between 3 and 50 years, discouraging
investors who prefer near-term profits. The solution is simple: Eliminate investments from the tax base in a reliable manner, via full and immediate
expensing. I explained how this would work in recent research from the American Action Forum. Under full expensing, that tax for a new nuclear power
plant is zero. The capital costs of a$11.5 billion nuclear power plant would be exactly $11.5 billion. Meanwhile, ambitious projects like NetPower (a
zero-emission natural gas power plant), NuScale (a small modular nuclear reactor that is 5,000 times less likely to have an incident than today's
reactors), and others would no longer pay higher taxes than incumbents in the industry, on top of the costs of being early adopters. Global energy
addressing the energy-security and environmental concerns of
demand is expected to climb 48 percent between 2012 and 2040, and
tomorrow will require
innovation-friendly policies today. History tells us that innovation takes time, and it takes
even longer if policies stifle competitiveness and profitability. Arguably, the greatest disadvantage of expensing is that it
frontloads the loss of revenue from deducted investments, placing them all in the first year. But budget hawks should rest easy. At the proposed 20
percent corporate tax rate, full-expensing for projected new power plants over the next ten years would be $54 billion, nearly equal to the revenue we
could raise by eliminating permanent energy tax breaks that would no longer be needed. For energy, at least, full-expensing can be a revenue-neutral
policy that finally helps to stop penalizing innovators. The bottom line is that the U.S. approach to energy innovation gets it exactly backwards, as if
Henry Ford's first cars had been taxed and horses were subsidized in order to avoid losing access to horses. Tax
reform offers an
opportunity to break free of the energy status quo, and remove the roadblocks to a future of cleaner,
safer, and cheaper energy alternatives.

Torres 16 (Phil, Affiliate Scholar at the Institute for Ethics and Emerging Technologies, and founder of
the X-Risks Institute, 7/22/16, “Op-ed: Climate Change Is the Most Urgent Existential Risk,”

Climate change and biodiversity loss may pose the most immediate and important threat to human
survival given their indirect effects on other risk scenarios. Humanity faces a number of formidable challenges this century. Threats to our collective survival
stem from asteroids and comets, supervolcanoes, global pandemics, climate change, biodiversity loss, nuclear
weapons, biotechnology, synthetic biology, nanotechnology, and artificial superintelligence. With such threats in mind, an informal survey
conducted by the Future of Humanity Institute placed the probability of human extinction this century at 19%. To put this in perspective, it means that the average American is more than a thousand times more
likely to die in a human extinction event than a plane crash.* So, given limited resources, which risks should we prioritize? Many intellectual leaders, including Elon Musk, Stephen Hawking, and Bill Gates, have

suggested that artificial superintelligence constitutes one of the most significant risks to humanity. And this may be correct in the long-term. But I would argue that two other risks, namely

change and biodiveristy loss, should take priority right now over every other known threat . Why? Because
these ongoing catastrophes in slow-motion will frame our existential predicament on Earth not just for the rest of this century, but for
literally thousands of years to come. As such, they have the capacity to raise or lower the probability of other

risks scenarios unfolding. Multiplying Threats Ask yourself the following: are wars more or less likely in a world marked by extreme
weather events, megadroughts, food supply disruptions, and sea-level rise? Are terrorist attacks
more or less likely in a world beset by the collapse of global ecosystems, agricultural failures, economic
uncertainty, and political instability? Both government officials and scientists agree that the answer is “more likely.” For example, the
current Director of the CIA, John Brennan, recently identified “the impact of climate change” as one of the “deeper causes of this rising instability” in countries like Syria, Iraq, Yemen, Libya, and Ukraine. Similarly,

climate change as a “threat multiplier” with “the potential to

the former Secretary of Defense, Chuck Hagel, has described

exacerbate many of the challenges we are dealing with today — from infectious disease to terrorism.” The Department of Defense has also
affirmed a connection. In a 2015 report, it states, “Global climate change will aggravate problems such as poverty, social tensions, environmental degradation, ineffectual leadership and weak political institutions

Scientific studies have further shown a connection between the environmental

that threaten stability in a number of countries.”

crisis and violent conflicts. For example, a 2015 paper in the Proceedings of the National Academy of Sciences argues that climate change was a causal factor behind the record-
breaking 2007-2010 drought in Syria. This drought led to a mass migration of farmers into urban centers, which fueled the 2011 Syrian civil war. Some observers, including myself, have suggested that this

struggle could be the beginning of World War III, given the complex tangle of international involvement and overlapping interests. The study’s conclusion is
also significant because the Syrian civil war was the Petri dish in which the Islamic State consolidated its forces, later emerging as the largest and most powerful terrorist organization in human history.
The plan is limited to catastrophic coverage---routine reimbursement for expected care is a
subsidy, not insurance
Thomas 16 – PhD in economics @ GMU, Professor of economics @ BSU (David and David Henderson,

The misdiagnosis of moral hazard emerges from an over-reaching use of the term “health-care insurance,”
which would normally refer to any guarantee of indemnification in the case of an insurable event in return
for the payment of a premium. An insurable event has three characteristics: (1) it is largely unavoidable or
random1 , (2) it is high cost, and (3) its probability is low and known (Kling 2006; Karten 1997, 518). Health insurance, as the
term is in use today, is actually a bundle of two services—insured catastrophic care and subsidized routine and preventive care. The insurance portion
covers insurable medical events while the subsidized portion is largely devoted to reimbursing health-care providers for preventive and routine care.
The reimbursement of routine medical expenses, when financed by an employer or the government, is a
subsidy and not insurance in the traditional sense. There are at least two cases in which the existence of health-care subsidies increases
a patient’s moral hazard. First, the insurance premium subsidy, provided by employers and the government, encourages greater consumption of health
care insurance, which further decreases the desire to engage in costly healthy behavior. Second, the same behaviors that increase the risk of
catastrophic conditions also increase the demand for routine care. The subsidized routine care serves as a substitute for healthy behavior and
effectively masks the true level of catastrophic risk. Obesity, for example, increases the likelihood of health conditions that require routine care such as
“diabetes, hypertension, osteoarthritis, chronic back pain, carpal tunnel syndrome, urinary incontinence, gastroesophageal reflux disease, gallstones,
and asthma” (Frankenburg and Zanarini 2006). Over time, obesity also dramatically increases the likelihood of the catastrophic conditions of heart
failure and stroke (Frankenburg and Zanarini 2006). The
purpose of this paper is to draw a bright line between moral hazard and
as an aid in thinking clearly about, and performing empirical studies of , the
subsidy effects in the U.S. health care system
effects of health-care insurance and subsidies on the behavior of consumers and producers.

Vote neg
First---education---they distort the theoretical economics debate over ‘insurance’ vs subsidies
Second---extra-t---including both insurance and subsidies give solvency boosters and unique
angles against DAs that should be core neg ground
DA – Europe
European populism declining thanks to Trump incompetence
Silver 17 (6/14, Nate, “Donald Trump Is Making Europe Liberal Again”,
The result didn’t get that much attention in the news outlets I follow, perhaps because it went against the emerging narrative that right-wing populism
was on the upswing. But the May and December elections in Austria made for an interesting controlled experiment. The same two candidates were on
the ballot, but in the intervening period Trump had won the American election and the United Kingdom had voted to leave the European Union. If the
populist tide were rising, Hofer should have been able to overcome his tiny deficit with Van der Bellen and win. Instead, he backslid. It struck me as a
potential sign that Trump’s
election could represent the crest of the populist movement, rather than the
beginning of a nationalist wave: It was also just one data point, and so it had to be interpreted with caution. But the pattern has
been repeated so far in every major European election since Trump’s victory. In the Netherlands, France and
the U.K., right-wing parties faded down the stretch run of their campaigns and then further underperformed their polls on election day. (The latest
example came on Sunday in the French legislative elections, when Marine Le Pen’s National Front received only 13 percent of the vote and one to five
seats1 in the French National Assembly.) The right-wing Alternative for Germany has also faded in polls of the German federal election, which will be
contested in September. The beneficiaries of the right-wing decline have variously been politicians on the left (such
as Austria’s Van der Bellen2), the center-left (such as France’s Emmanuel Macron) and the center-right (such as Germany’s Angela Merkel, whose
Christian Democratic Union has rebounded in polls). But there’s been another pattern in who gains or loses support: The warmer a candidate’s
relationship with Trump, the worse he or she has tended to do. Merkel, for instance, has often been criticized by Trump and has often criticized him
back. Her popularity has increased, and her advisers have half-jokingly credited the “Trump factor” for the sharp rebound in her approval ratings over
the past year. By contrast, U.K. Prime Minister Theresa May has a warmer relationship with Trump. She was the first foreign leader to visit Trump in
January after his inauguration, when she congratulated him on his “stunning electoral victory.” But she was criticized for not pushing back on Trump as
much as her European colleagues or her rivals from other parties after Trump withdrew the U.S. from the Paris climate accords on June 1 and then
instigated a fight with the mayor of London after the terrorist attack in London two days later. Her Conservatives suffered a humiliating result, blowing a
17 percentage point polling lead and losing their majority in Parliament; it’s now not clear how much longer she’ll continue as prime minister. Trump
was not May’s only problem, but he certainly didn’t help. Let’s take a slightly more formal tour of the evidence from these countries: The Netherlands
The Netherlands’ Geert Wilders, of the nationalist Party for Freedom (in Dutch, Partij voor de Vrijheid or PVV), hailed Trump’s victory and predicted
that it would presage a populist uprising in Europe. And PVV initially rose in the polls after the U.S. election, climbing to a peak of about 22 percent of
the vote in mid-December — potentially enough to make it the largest party in the Dutch parliament. But it faded over the course of the election, falling
below 15 percent in late polls and then finishing with just 13 percent of the vote on election day on March 15.3 Those results were broadly in line with
the 2010 and 2012 elections, when Wilders’ party had received between 10 and 15 percent of the vote. The center-right, pro-Europe VVD remains the
largest party in the Netherlands. France Reciprocating praise that Le Pen had offered to Trump, Trump expressed support for Le Pen after a terrorist
attack in Paris in April and predicted that it would “probably help” her to win the French presidential election. But over the course of a topsy-turvy race,
Le Pen’s trajectory was downward. Last fall, she’d projected to finish with 25 to 30 percent of the vote in the first round of the election, which would
probably have been enough for her to finish in pole position for the top-two runoff.4 Her numbers declined in December and January, however, and
then again late in the campaign. She held onto the second position to make the runoff, but just barely, with 21 percent of the vote.5 Then she was
defeated 66-34 percent by Macron in the runoff, a considerably wider landslide than polls predicted. Le Pen’s National Front endured another
disappointing performance over the weekend in the French legislative elections. Initially polling in the low 20s — close to Le Pen’s share of the vote in
the first round of the presidential election — the party declined in polls and turned out to receive only 13 percent of the vote, about the same as their 14
percent in 2012. As a result, National Front will have only a few seats in the French Assembly while Macron’s En Marche! — which ran jointly with
another centrist party — will have a supermajority. The United Kingdom While the big news in the U.K. was May’s failed gamble in calling a “snap”
parliamentary election, it was also a poor election for the populist, anti-Europe UK Independence Party. Having received 13 percent of the vote in 2015,
UKIP initially appeared poised to replicate that tally in 2017 (despite arguably having had its raison d’être removed by the Brexit vote). But it began to
decline in polls in the spring, and the slump accelerated after the election was called in April. UKIP turned out to receive less than 2 percent of the vote
and lost its only seat in Parliament. UKIP’s collapse in some ways makes May’s performance even harder to excuse. Most of the UKIP vote went to the
Conservatives, providing them with a boost in constituencies where UKIP had run well in 2015. But the Conservatives lost votes on net to Labour
(although there was movement in both directions), Liberal Democrats and other parties. It’s perhaps noteworthy that Conservatives performed
especially poorly in London after Trump criticized London Mayor (and Labour Party member) Sadiq Khan, losing wealthy constituencies such as
Kensington that had voted Conservative for decades. Germany The German election to fill seats in the Bundestag isn’t until September, but there’s
already been a fair amount of movement in the polls. Merkel’s CDU/CSU has rebounded to the mid- to high 30s from the low 30s last year. And the
left-leaning Social Democratic Party surged after Martin Schulz, the former president of the European Parliament, announced in January that he’d be
their candidate for the chancellorship (although the so-called “Schulz effect” has since faded slightly). Thus, the election is shaping up as contest
between Schulz, who has sometimes been compared to Bernie Sanders and who is loudly and proudly pro-Europe, and Merkel, perhaps the world’s
most famous advocate of European integration. The losers have been various smaller parties, but especially the right-wing Alternative for Germany (in
German, Alternative für Deutschland or AfD) and their leader, Frauke Petry, who have fallen from around 12 to 13 percent in the polls late last year to
roughly 8 percent now. Meanwhile, both Schulz and Merkel have sought to wash their hands of Trump. Instead of criticizing Merkel for being too
accommodating to Trump, Schulz instead recently denounced Trump for how he’d treated Merkel. So if you’re keeping score at home, right-wing
nationalist parties have had disappointing results in Austria, the Netherlands, France and the U.K., and they
appear poised for one in Germany, although there’s a long way to go there. I haven’t cherry-picked these outcomes; these are the the major elections
in Western Europe this year. If you want to get more obscure, the nationalist Finns Party underperformed its polls and lost a significant number of seats
in the Finnish municipal elections in April, while the United Patriots, a coalition of nationalist parties, lost three seats in the Bulgarian parliamentary
elections in March. Despite the differences in electoral systems from country to country — and the quirky nature of some
of the contests, such as in France — it’s
been a remarkably consistent pattern. The nationalist party fades as the
election heats up and it begins to receive more scrutiny. Then it further underperforms its polls on election day, sometimes by
several percentage points.6 While there’s no smoking gun to attribute this shift to Trump, there’s a lot of
circumstantial evidence. The timing lines up well: European right-wing parties had generally been
gaining ground in elections until late last year; now we suddenly have several examples of their position
receding. Trump is highly unpopular in Europe, especially in some of the countries to have held elections so far. Several of
the candidates who fared poorly had praised Trump — and vice versa. He’s explicitly become a subject of
debate among the candidates in Germany and the U.K. To the extent the populist wave was partly an
anti-establishment wave, Trump — the president of the most powerful country on earth — has now become a symbol of the
establishment, at least to Europeans. There are also several caveats. While there have been fairly consistent patterns
in elections in the wealthy nations of Western Europe, we have little evidence for what will happen in the former nations of the Eastern Bloc, such as
Hungary, which has moved substantially to the right in recent years. (The next Hungarian parliamentary election is scheduled for early next year.)
Turkey is a problematic case, obviously, especially given questions about whether elections are free or fair there under Tayyip Erdogan. And even
within these Western European countries, while support for nationalist parties has generally been lower
than it was a year or two ago, it may still be higher than it was 10 or 20 years ago. Politics is often cyclical, and
endless series of reactions and counterreactions. Sometimes, what seems like the surest sign of an emerging trend can
turn out to be its peak instead. It’s usually hard to tell when you’re in the midst of it. Trump probably hasn’t set the
nationalist cause back by decades, and the rise of authoritarianism continues to represent an
existential threat to liberal democracy. But Trump may have set his cause back by years, especially in
Western Europe. At the very least, it’s become harder to make the case that the nationalist tide is still on
the rise.

The plan makes Trump look credible—that causes populism to win in Europe
Andelman 17 (2/8, David A. Andelman, editor emeritus of World Policy Journal and member of the board
of contributors of USA Today, is the author of "A Shattered Peace: Versailles 1919 and the Price We Pay
Today." “Is Trump causing European populism to crumble?”,

(CNN) Donald Trump's travails are apparently sending shivers through Europe's so-called populist right . This
seems particularly true in France. Marine Le Pen -- the leader of France's National Front party and darling of the French far right -- had hoped to ride President Trump's coattails
to power -- and in the process, bring down the entire European project. As France, Italy and the Netherlands gear up for critical elections this spring, many of Trump's more
outrageous pronouncements -- not to mention actions -- are casting a pall over Europe's populism. Trump's continuing embrace of Vladimir Putin, his support for a Brexit that
even many Brits are now viewing with fear, and above all his de-facto Muslim ban all appear to be moving much of the European electorate closer to the center and driving
these often-bickering nations closer to each other. The first test comes in France barely 10 weeks from now in the first round of France's presidential election. Already, it holds
the promise of a most contentious period. In an effort to smooth her own image and ease her way into the hearts of a broader electorate than her explosive father, far-right
demagogue Jean-Marie Le Pen, Marine has dropped her toxic last name from her campaign material -- at about the same time she released a 144-point program that's clearly
designed to smooth some of her sharpest edges. No longer does Le Pen want France to "exit the eurozone," but rather "restore the national currency," which many in France
worry will do little to improve their economic plight. No longer does she seek to reinstate the death penalty but rather life imprisonment for "the worst crimes." She doesn't even
want to leave the European Union but rather renegotiate France's terms of membership. Still she does want an end to the Schengen, passport-free travel within Europe, and an
exit from the military functions of NATO, much as President Charles de Gaulle did 50 years ago. But this retro view of Europe is hardly exploding in popularity, as contiguous as
Above all, what Europeans value most from their leaders is competence and a
it may appear with the views of Donald Trump.

steady hand on the tiller. That is clearly, to most, been glaringly absent from the early days of the Trump
presidency. It is also not something that Marine Le Pen, or many of her populist counterparts in other countries, can promise. Le Pen has never held
any national elective office in France (though she has been a member of the European Parliament). She has never served in the National Assembly or
as a minister of government. That means she has never been forced to face the consequence of any of her

pronouncements or her positions that to an increasing number of Europeans would appear to offer
existential threats to the continent. Such threats have not been lost on other leading European politicians
seeking office this year, the vast bulk of them distancing themselves persuasively from a broad range
of positions taken by the Trump administration. In Germany, the far-right Alternative for Germany (AfD) party has managed to poll barely
11% of the popular vote. And, since Trump's arrival in the White House, the center-left Social Democrats (SPD) have announced that their candidate to take on Chancellor
Angela Merkel in the election will be Martin Schulz, a former President of the European Parliament and an outspoken critic of Trump. His party has now pulled within four points
of Merkel's conservative alliance. Of course Merkel, who's seeking a fourth term on September 24, is also no friend of Donald Trump. And while recognizing the need for some
relationship with the American leader, she "will see issue by issue where we can cooperate and where we have different opinions, but it's in Germany's interest to strengthen the
common ground there is." In a joint news conference with France's president, Francois Hollande, Merkel elaborated, "We see that global conditions are changing dramatically
and quickly, and we must respond to these new challenges, both in terms of defending a free society and defending free trade, as well as in terms of the economic challenges."
Merkel is clearly walking a delicate line between extremes in her own nation. The first election to test the Trump effect in Europe comes five weeks from now in the Netherlands,
which will choose a new parliament and ruling prime minister. Here, a Trump clone is generating quite a lot of interest. Geert Wilders and his Freedom Party have promised to
pull their nation out of the EU. Wilders promises a "Patriotic Spring." Should he become the next prime minister, all that could restrain his anti-Islam sympathies and preserve a
united Europe is the fact that 28 political parties are on the ballot, and any prime minister will need to assemble a coalition of as many as four or five parties to rule. Le Pen faces
a similar problem in France. Even if Marine Le Pen should manage the unthinkable and pull out an election victory in the final round of the presidential election on May 7, the
French will still go back to the ballot boxes a month later to vote for the parliament. Le Pen's National Front party has never managed more than 35 seats (out of 573 -- in 1986),
and currently holds just two seats out of 577. Such a showing makes it most unlikely that Le Pen would be able to push through much of her 144-point agenda. Above all, it
must be remembered, that the French, like much of Europe, have long seen themselves in starkly different terms from those of a Trump-tinged America. While many French
people don't especially like foreigners and -- since their own terrorist attacks from radical Islam -- are in some fear of importing terror, they also still consider themselves
bastions of freedom and human rights. Closing all frontiers and barring the desperate and needy is anathema to broad swaths of the French electorate. Moreover, the French
are hardly inclined to make their own vast domestic Muslim population feel even more disenfranchised and receptive to attacks on their Christian neighbors. In these respects,
France is not alone. In Germany, Angela Merkel, who had to deal with the Christmas terrorist truck assault in Berlin, has her own cross to bear in the wake of her decision to
admit 890,000 refugees in 2015, though that number dropped to 280,000 last year. Still, her humanitarian decision to continue accepting victims of Middle East violence has
been reinforced by what's being regarded as a 1930s-style approach to such issues by Trumpworld in America. "It often seemed as though Donald Trump could no longer outdo
himself when it came to demonstrating his lunacy," the German magazine Der Spiegel suggested in its issue with a cover of Donald Trump holding aloft the head of Lady Liberty
dripping with blood in his right hand, and a meat cleaver in his left, with the caption, "America First." But, the magazine added, the travel ban "is more dangerous than any other
Trump's actions are being monitored closely across the Atlantic. Ironically,
action he has taken since his inauguration." So,

the more intense the madness, the broader the backlash, and the more likely that Europe could
return to a much-needed path of sanity.

Extremist takeovers cause war in Europe

Friedman 15 (1/27, George, PhD in Government, former Professor of Political Science at Dickenson
College, founder, CIO, and CEO of STRATFOR, “The New Drivers of Europe's Geopolitics,”

Virtually every European country has developed growing movements that oppose the European Union
and its policies Most on the right of the political spectrum
. of these are they want to regain . This means that in addition to their economic grievances,

control of their borders to limit immigration. Opposition movements have also emerged from the left — Podemos in Spain, for instance, and of course, Syriza in Greece. The left has the same grievances as the right, save for the

Greece has been seen as the outlier, but it is in fact the leading edge of the
racial overtones. But what is important is this:

European crisis It was the first to face default . to impose austerity to experience the brutal weight , the first , the first that

resulted to elect a government that pledges to end austerity Left or right, these parties are
now it is the first .

threatening Europe's traditional parties , which the middle and lower class see as being complicit with Germany in creating the austerity regime. Syriza has moderated its position on the European

There is reason to
Union, as parties are wont to moderate during an election. But its position is that it will negotiate a new program of Greek debt repayments to its European lenders, one that will relieve the burden on the Greeks.

believe that it might succeed . The Germans don't care if Greece pulls out of the euro. Germany is, however, terrified that the political movements that ar e afoot will end or inhibit Europe's free-trade zone. Right-wing

But Germany, the export addict, needs the free-

parties' goal of limiting the cross-border movement of workers already represents an open demand for an end to the free-trade zone for labor.

trade zone badly This is one of the points that people miss. They are concerned that countries will

withdraw from the euro . As Hungary showed when the forint's decline put its citizens in danger of defaulting on mortgages, a nation-state has the power to protect its citizens from debt if it wishes to do so. The Greeks, inside or
outside the eurozone, can also exercise this power. In addition to being unable to repay their debt structurally, they cannot afford to repay it politically. The parties that supported austerity in Greece were crushed. The mainstream parties in other European countries
saw what happened in Greece and are aware of the rising force of Euroskepticism in their own countries. The ability of these parties to comply with these burdens is dependent on the voters, and their political base is dissolving. Rat ional politicians are not dismissing
Syriza as an outrider. The
issue then is not the euro. Instead, the first real issue is the effect of structured or unstructured defaults on the European banking system and how the
European Central Bank, committed to not making Germany liable for the debts of other countries, will handle that. The second, and more important, issue is now the future of
Having open borders seemed like a good idea
the free-trade zone. but the fear of Islamist terrorism during prosperous times, and the fear

make those open borders less and less likely to endure if nations can erect
of Italians competing with Bulgarians for scarce jobs . And

walls for people, then why not erect walls for goods to protect their own industries and jobs? In the long run,

protectionism hurts the economy For

, but Europe is dealing with many people who don't have a long run, have fallen from the professional classes and now worry about how they wi ll feed their families.

Germany the loss of the euro would be the loss of a tool for
, which depends on free access to Europe's markets to help prop up its export-dependent economy,

managing trade But the rise of protectionism in Europe would be a calamity. The German economy would stagger
within and outside the eurozone. without

the argument about austerity is over

those exports. From my point of view, . The European Central Bank ended the austerity regime half-heartedly last week, and the Syriza victory sent an earthquake through

If Europe's defaults
Europe's political system, although the Eurocratic elite will dismiss it as an outlier. surge the question of the euro — structured or unstructured — as a result,

becomes an interesting but non-critical issue What will become the issue, and what is already .

becoming the issue, is free trade. That is the core of the European concept and that is the next issue ,

on the agenda as the German narrative loses credibility and the Greek narrative replaces it It as the conventional wisdom.

is not hard to imagine the disaster that would ensue if the United States were to export 50 percent of its
GDP, and half of it went to Canada and Mexico that is exactly the situation
. A free-trade zone in which the giant pivot is not a net importer can't work. And

in Europe . Its pivot is Germany, but rather than serving as the engine of growth by being an importer, it became the world's fourth-largest national economy by exporting half its GDP. That can't possibly be sustainable. Possible Seismic Changes
Ahead There are then three drivers in Europe now. One is the desire to control borders — nominally to control Islamist terrorists but truthfully to limit the movement of all labor, Muslims included. Second, there is the empowerment of the nation-states in Europe by

the political base is dissolving

the European Central Bank, which is making its quantitative easing program run through national banks, which may only buy their own nation's debt. Third, there is , which

under Europe's feet the most daunting question is

. The question about Europe now is not whether it can retain its current form, but how radically that form will change. And

whether Europe, unable to maintain its union, will see a return of nationalism and its possible
consequences The most important question in the world is whether conflict and war have
. As I put it in Flashpoints:

actually been banished or whether this is merely an interlude, a seductive illusion Europe is the single .

most prosperous region in the world. It touches Asia, the Middle East and Africa
Its collective GDP is greater than that of the United States. .

Another series of wars would change not only Europe, but the entire world .
Europe war goes nuclear
Thompson 14 (4/24, Loren, PhD in Government from Georgetown, Chief Operating Officer of the non-
profit Lexington Institute and Chief Executive Officer of Source Associates, former Deputy Director of the
Security Studies Program at Georgetown University, has taught at the Harvard Kennedy School, “Four
Ways The Ukraine Crisis Could Escalate To Use Of Nuclear Weapons,” Forbes,

Although the Obama Administration is responding cautiously to Moscow’s annexation of Ukraine’s province of
Crimea in March, its credibility is on the line with regional allies and Russian leader Vladimir Putin has not been helpful in defusing the fears
of his neighbors. Having fomented revolt in eastern Ukraine, Moscow now says it might be forced to come to the aid of ethnic Russians there (it has massed 40,000 troops on the other side of the border, in what
was first called an exercise). Meanwhile, the U.S. has increased its own military presence in the neighborhood, reiterating security guarantees to local members of NATO. So little by little, tensions are ratcheting

One facet of the regional military balance that bears watching is the presence of so-called nonstrategic nuclear

weapons on both sides. Once called tactical nuclear weapons, these missiles, bombs and other devices were bought during the Cold War to compensate for any shortfalls in conventional
firepower during a conflict. According to Amy Woolf of the Congressional Research Service, the U.S. has about 200 such weapons in Europe, some of which are available for use by local allies in a war. Woolf

Russian military
says Russia has about 2,000 nonstrategic nuclear warheads in its active arsenal — many of them within striking distance of Ukraine — and that successive revisions of

strategy appear “to place a greater reliance on nuclear weapons” to balance the U.S. advantage in high-
tech conventional weapons. A 2011 study by the respected RAND Corporation came to much the same
conclusion, stating that Russian doctrine explicitly recognizes the possibility of using nuclear weapons in response to conventional aggression. Not only does Moscow see
nuclear use as a potential escalatory option in a regional war, but it also envisions using nuclear
weapons to de-escalate a conflict. This isn’t just Russian saber-rattling. The U.S. and its NATO partners
too envision the possibility of nuclear use in a European war. The Obama Administration had the opportunity to
back away from such thinking in a 2010 Nuclear Posture Review, and instead decided it would retain forward-deployed nuclear
weapons in Europe under a doctrine known as extended deterrence. Eastern European nations that joined NATO after the Soviet collapse have been especially supportive of having U.S.

nuclear weapons nearby. This mobile intercontinental ballistic missile launcher is emblematic of Moscow’s continuing investment in nuclear

weapons, reflecting a doctrinal emphasis that includes potential nuclear use in response to conventional
aggression. (Retrieved from So improbable though it may seem, doctrine and capabilities exist
on both sides that could lead to nuclear use in a confrontation over Ukraine. Here are four ways that what started out as a local crisis could turn

into something much worse. Bad intelligence. As the U.S. has stumbled from one military mis-adventure to another over the last several decades, it has become
clear that Washington isn’t very good at interpreting intelligence. Even when vital information is available, it gets filtered by preconceptions and bureaucratic processes so that the wrong conclusions are drawn.
Similar problems exist in Moscow. For instance, the Cuban missile crisis of 1962 arose partly from Soviet leader Khrushchev’s assessment that President Kennedy was weaker than he turned out to be, and the
U.S. Navy nearly provoked use of a nuclear torpedo by a Russian submarine during the blockade because it misjudged the enemy’s likely reaction to being threatened. It is easy to imagine similar misjudgments

Any sizable deployment of U.S. forces in the region could

in Ukraine, which Washington and Moscow approach from very different perspectives.

provoke Russian escalation. Defective signaling. When tensions are high, rival leaders often seek to
send signals about their intentions as a way of shaping outcomes. But the meaning of such signals can easily be confused by the need of leaders to address
multiple audiences at the same time, and by the different frames of reference each side is applying. Even the process of translation can change the apparent meaning of messages in subtle ways. So when
Russian foreign minister Lavrov spoke this week (in English) about the possible need to come to the aid of ethnic Russians in eastern Ukraine, Washington had to guess whether he was stating the public

Misinterpretation of such signals can

rationale for an invasion, sending a warning signal to Kiev about its internal counter-terror campaign, or trying to accomplish some other purpose.

become a reciprocal process that sends both sides up the “ladder of escalation” quickly, to a point where nuclear
use seems like the logical next step. Looming defeat. If military confrontation between Russia and NATO gave way to
conventional conflict, one side or the other would eventually face defeat. Russia has a distinct numerical advantage in the area around
Ukraine, but its military consists mainly of conscripts and is poorly equipped compared with Western counterparts. Whichever side found itself losing would have to weigh the drawbacks of losing against those of
escalating to the use of tactical nuclear weapons. Moscow would have to contemplate the possibility of a permanent enemy presence near its heartland, while Washington might face the collapse of NATO, its

the use of “only” one or two tactical nuclear warheads to avert an outcome with
most important alliance. In such circumstances,

such far-reaching consequences might seem reasonable — especially given the existence of relevant capabilities and supportive doctrine on both sides.
Command breakdown. Strategic nuclear weapons like intercontinental ballistic missiles are tightly
controlled by senior military leaders in Russia and America, making their unauthorized or accidental use nearly impossible. That is less
the case with nonstrategic nuclear weapons, which at some point in the course of an escalatory process need to be released to the
control of local commanders if they are to have military utility. U.S. policy even envisions letting allies deliver tactical
warheads against enemy targets. Moscow probably doesn’t trust its allies to that degree, but with more tactical nuclear weapons in more locations, there is a greater likelihood that
local Russian commanders might have the latitude to initiate nuclear use in the chaos of battle. Russian doctrine endorses nuclear-weapons use in response to conventional aggression threatening the homeland,

When you consider all the processes working to degrade restraint

and obstacles to local initiative often break down once hostilities commence.

in wartime — poor intelligence, garbled communication, battlefield setbacks, command attenuation, and a
host of other influences — it seems reasonable to consider that a military confrontation between NATO and Russia might in some
manner escalate out of control, even to the point of using nuclear weapons. And because Ukraine is so close to the Russian heartland

(about 250 miles from Moscow) there’s no telling what might happen once the nuclear “firebreak” is crossed . All this

terminology — firebreaks, ladders of escalation, extended deterrence — was devised during the Cold War to deal with potential warfighting scenarios in
Europe. So if there is a renewed possibility of tensions leading to war over Ukraine (or some other former Soviet possession), perhaps the time has come to revive such thinking.
DA – Military
National health insurance undermines US military recruitment efforts – decks US efforts in
Norris 8 (Floyd, former chief financial correspondent of The New York Times and The International
Herald Tribune, "Health’s Gain May Be Army’s Loss," 5/30,

If the Democrats win the election this year, and are able to enact a health care plan that extends adequate
coverage to all Americans, the loser could be the Army. Getting enough people to enlist could become a major
problem for the next president. Senator John McCain, the presumptive Republican candidate, has already pointed out that Senator
Barack Obama, the likely Democratic candidate, never served in the military. It remains to be seen how potent that will be as an
issue, given the fact that the last four presidential elections have been won by the candidate with the less impressive military
resume. But there is something else that distinguishes Mr. Obama from all recent candidates for the presidency. He would be the
first presidential nominee to come of age after the draft was abolished in the administration of Richard M. Nixon. He never had to
decide how to deal with the draft, and legally was under no more pressure to enlist than he was to go to medical school or become a
bus driver. Joining the military was a career option like any other. And that has made it harder to put the Army together. Government
polls show that the proportion of young people who think they might enlist is roughly half what it was in the late 1980s. The military
has responded with more recruiters and higher cash enlistment bonuses, and has met its goals. A significant factor for
many recruits, it turns out, is the military’s generous health benefits for dependants. Michael Massing, writing
in the April 3 issue of The New York Review of Books, tells the story of one part-time college student from Brooklyn, who was
holding down two jobs but still going into debt. “Meanwhile, he got married, his wife got pregnant, and he had no health care. From a
brother in the military, he had learned of the Army’s many benefits, and, visiting a recruiter, he heard about Tricare, the military’s
generous health plan.” He enlisted. It seems a bit perverse that the incentives for a young person with children to join are greater
than the incentives for his childless friend. But that is the way it is. All that could change if the push for some kind of
national health insurance program were to be successful. It is true, of course, that Democrats have been talking about
such things for generations. The failure of health care legislation during Bill Clinton’s first two years in office left some viewing the
issue as political dynamite — good for a campaign but fatal to anyone who tries to pass a specific program. It is quite unclear how
the government would pay for a comprehensive program, and no candidates seem eager to discuss ways to hold down health
care spending. But if such a program were adopted, it
seems likely that the military, and particularly the
Army, would feel the immediate effect. To expand the Army, as all the candidates say they want to do, would require
some other incentive for enlistment, particularly when the economy recovers. In the near term, it is possible that a recession will
improve the military’s recruiting success. The official unemployment rate is still low, but the proportion of Americans who expect the
job picture to improve is at its lowest level in a quarter century, according to the Conference Board’s consumer confidence survey.
That survey shows that younger people are still more confident than older ones, but the confidence of both groups has fallen sharply
this year. One partial solution to the negative effect on enlistment of a health care plan for all could be a new G.I. education benefit.
Both the House and Senate have approved such a plan, but as part of the Iraq funding bill on which there are major differences.
President Bush is opposed to the legislation, which its sponsors say would cost $50 billion over 10 years, and it is far from clear it
will be enacted. The bill approved by the Congress would give enhanced education benefits to all veterans who spent three years in
the military after Sept. 11, 2001. They would be eligible for full tuition at a public university, and about $1,000 a month for living
expenses and more for books. Senator Jim Webb, a freshman Democrat and Vietnam veteran, is the principal Senate sponsor of
the legislation. He argued — with something less than precise data — that passage of the bill would increase enlistment by 16
percent, and bring in more high-quality recruits who valued the education benefit. Both Senator Obama and his Democratic rival,
Senator Hillary Rodham Clinton, support that bill. Senator McCain has proposed a less costly alternative that would provide better
benefits to those who stay in the military longer. He may have a point. Last year about three-quarters of Army volunteers who
completed their first term of enlistment, and nearly as many marines, chose not to re-enlist. Offering better education benefits after
three years could encourage enlistment and discourage re-enlistment. If we get a real health care plan for all
Americans, it might require something like the Webb bill — or a very unpopular revival of the draft — just to keep
fighting in Iraq and Afghanistan. The backers of health care legislation do not want to hurt the Army, but
that is what could happen.

That sparks nuclear war in South Asia – strong US presence in Afghanistan is vital
Datla 16 (Anand, consultant and former Defense Department civilian who has worked on strategic
planning, policy, and operations + served as a professional staff member of the House Armed Services
Committee, 6/19, "U.S. Withdrawal from Afghanistan: Implications for Regional Nuclear Rivalries,"
The security challenges facing South Asia following the drawdown of U.S. forces in late 2014 and complete withdrawal by 2016 go
well beyond those highlighted by General Joseph Dunford (Commander International Security Assistance Force and U.S. Forces
Afghanistan) in recent testimony before the U.S. Senate Armed Services Committee. Over the last twelve years, both Pakistan
and India’s new nuclear capabilities have altered the potential for nuclear conflict in South Asia.
These developments in nuclear force posture by the region’s nuclear powers suggest a potentially far more
dangerous situation. The effect of the U.S. military presence in the region to temper nuclear rivalries is
underappreciated. Currently, neither India nor Pakistan wants to disturb Washington by raising the threat
level in the region. Both countries realize any step towards nuclear escalation will distract U.S. forces from operations in
Afghanistan and draw negative diplomatic attention from Washington. This leaves both countries in a stalemate, thus
preventing tensions from escalating further. When U.S. forces begin departing later this year, it is difficult to imagine
the nuclear deadlock will remain the same. Nuclear tensions between Pakistan and India have changed considerably in the past two
decades. Shortly before U.S. forces arrived in the region in 2001, both countries drew international alarm by conducting nuclear
tests without warning. In May 1998, India’s Pokrahn II and Pakistan’s subsequent Chagi-I nuclear tests officially declared the
countries as nuclear powers. The arrival of U.S. forces helped contain decades old tensions, as neither side
wanted to upset the U.S. and its allies. By all accounts, the region has witnessed a relatively calm period in nuclear
relations since September 11. During this time there have not been any further nuclear tests by Pakistan or India. However, this
period also witnessed significant advances to both Pakistan and India’s nuclear weapons programs setting the stage for renewed
nuclear rivalry. These new capabilities may change the nuclear landscape as the U.S. departs from the region .
For starters, over the last decade Pakistan’s nuclear arsenal grew in size and complexity. Currently, Pakistan holds
between100-120 nuclear warheads, much more than India’s arsenal. The Pakistani arsenal now includes tactical low yield nuclear
warheads for conventional force-on-force conflict. In order to support these warheads, a considerable effort is underway to improve
weapon delivery options. Recent advances to delivery systems, such as the Shaheen I short range missile in April 2013, make it
possible for Pakistan to reach targets up to 900 kilometers away. These advances are a concern for India, given
Pakistan’s controversial first strike nuclear policy. This policy declares that Pakistan reserves the right to use nuclear weapons for
threats to its national security. India has also further developed its nuclear program over the past decade . The
most recent advance is the development of a submarine launch ballistic missile (SLBM) capability. The successful launch of an
SLBM in 2013 bolstered India’s existing nuclear triad capability. Although still in its early stages, this SLBM capability will support a
second strike option and provide for an effective nuclear deterrent. There has also been a push to develop an advanced
intercontinental ballistic missile (ICBM) capability. Following the Agni-V ICBM test launch in 2013, India now has a long range strike
capability up to 5,000 kilometers. This gives India the ability to strike targets across Asia and Europe. The most interesting question
is what effect the U.S. withdrawal will have on Chinese nuclear force posture in the region. China’s sizable arsenal and
strategic relationships with both Pakistan and India make it an influential player in the region’s nuclear
dynamics. Present estimates put the number of Chinese nuclear warheads at 250, making it the largest nuclear power in Asia.
Similar to Pakistan, China is developing tactical nuclear warheads. Over the last few years, there have been questions about the
location of these weapons, particularly medium and long range missiles massed at the Indian border. While the existence of these
missiles is disputed, there is considerable speculation that nuclear weapons are aimed at both India and Russia. In recent months,
there have been claims that China intends to arm submarines with nuclear missiles. These nuclear developments are likely to draw
reaction from India and others. As U.S. troops draw down in 2014, it is difficult to determine how Chinese nuclear posture in the
region may shift. These developments in Pakistan, India, and China’s nuclear programs suggest a more
complicated picture ahead. The U.S. will not be able to exert the same level of pressure on
Afghanistan or Pakistan without a “boots-on-the-ground” military presence in the region. Clearly, as
we edge closer towards the 2016 withdrawal deadline, there are more questions about nuclear relations in South Asia than ever
before. After the U.S. departs, a decade long barrier will be lifted, leaving open the possibility for renewed tensions with far more
developed and advanced nuclear programs in the region.
CP – Advantage
The United States federal government should
- establish Maryland’s all-payer rate setting system in the United States
- apply rates to all medical drugs, physicians, hospitals, and clinics in the United States
- enforce the Medical Loss Rule
- re-direct its data mining operations toward disease monitoring
- offer regime and security assurances, official diplomatic recognition, sanctions relief, and
aid to the Democratic People’s Republic of Korea
- and establish a secret policy of non-retaliation towards the Democratic People’s Republic
of Korea.

rate setting solves the aff’s internal links

Volsky 11 (June 2nd, 2011, Igor Volsky is a vice president at the Center for American Progress and the
deputy director for the Center for American Progress Action Fund, In 2011, Forbes named Igor one of
their top “30 under 30” in Law & Policy, “Other Options For Reducing Health Costs: All-Payer Rate

Austin Frakt argues that the Affordable Care Act’s investment in Affordable Care Organizations (ACO) —
 which proponents believe would help improve care coordination — could increase the market power of hospitals and doctors and

empower them to negotiate higher reimbursement rates with insurers and other payers . Increased market clout could
translate into health care costs, as insurers would be forced to pay higher rates to keep well known providers in their networks and would then transfer those increases to
beneficiaries in the form of higher premiums. To understand the problem of provider consolidation you need to look no further than Massachusetts, where insurance companies
are paying some hospitals “significantly more than others for providing similar care,” even though the higher paid hospitals are not producing better outcomes. The “highest paid
hospitals had more market clout, some because of their brand names,” a state report concluded. So what can be done to reduce provider
consolidation? Frakt suggests all-payer rate setting: An all payer rate setting system would allow
associations of insurers to negotiate with each provider for a single price for each service it offers. In
contrast, the way it works now is that each insurer (or third-party administrator of self-insured employers) negotiates with each provider separately. Thus, today, prices

vary by insurer for the same service at a single hospital. Under an all payer system, insurers would pay
one price, jointly negotiated By allowing insurers to, essentially, collude for the purposes of price
negotiation, their individual degrees of market power are combined. It’s a bit like collective bargaining in labor. Or think of it as bulk
purchasing on steroids. In economics-speak, they have monopoly power. This should drive price lower. Indeed, according to

a Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey from October 2010, a
majority of experts actually “favor either all-payer payment rate setting or a single system of
payment negotiation on behalf of all payers.” The strategy was popular in the 1970s and 1980s, when at least 30 states used all-payer rate setting
to contain health care spending. Lawmakers established rate boards that considered “the differences in labor markets and how much a hospital pays in wages; the amount of
charity care the hospital does; and whether it treats a large number of severely ill patients” and set rates accordingly. By setting prices at the actual cost
of delivering services, lawmakers hoped to reduce wasteful spending and spur efficiency — while freeing hospitals
from the uncertainly of annual rate negotiations with insurers. And it worked. At least, a little. One study found that from 1982 through 1986, “all-payer ratesetting

reduced hospital expenditures by 16.3 percent in Massachusetts, 15.4 percent in Maryland, 6.3 percent
in New York, and 1.9 percent in New Jersey, compared with the national average.” Other studies disagreed and
during the conservative revolution of the 1980s, most states abandoned the practice in the hopes that managed competition could deliver lower rates. Today, Maryland is the
the strategy is also used in France, the Netherlands, Japan,
only state that continues to maintain an all-payer rate setting system, but

Australia and Germany. As Maggie Mahar notes, “a review of the Maryland plan published in a recent issue of Health Affairs reports that, since 1976, state
regulation of hospital rates has saved $40 billion. Had a similar system been in place over the same period of time for all

states, savings would have totaled $1.8 trillion or more.” The Maryland system is “widely regarded as
having created a market in which payments are predictable, transparent, and fair, and in which profits
have not suffered as a result,” Mahar argues. “Providers are protected from having to negotiate rates with
payers; payers, meanwhile, are shielded from the high markups attached to hospitals services in
other states; and patient access to hospital care is protected.” Regulators in Massachusetts have also been eying all-payer
rate setting as a way to control health costs. A RAND study of 12 options for reducing health care spending in the state

ranked traditional hospital all-payer rate setting as the second most likely tool for changing the
trajectory of health care growth, but concluded that “there were no ‘silver bullets’ that, alone, would reduce the rate of growth in health spending to that
of GDP.” The report found that, “at a maximum, hospital rate setting could reduce health spending in Massachusetts by nearly 4 percent between 2010 and 2020.” RAND warns
however, that providers could try to undermine rate setting by unbundling certain services, increasing admissions or length of stay. Frakt writes that he doesn’t know if all-payer
lawmakers are years away from
rate setting is in our future, and I tend to agree. Given the process of implementing the Affordable Care Act, however,

considering or applying this apparently popular method of cost control on a federal level, but if they do, at
least some insurers may be on board. During the health care reform debate, it was rumored that the insurers would have
accepted the public option if the law adopted a rate scheme under which all payers would reimburse
providers at the same price for the same service.

Data monitoring solves disease

Bamford, 15 – columnist at Foreign Policy, author of a book on NSA domestic surveillance after 9/11,
visiting professor at UC Berkeley, JD from Suffolk University (James Bamford, 1/29/15, “Big Brother
Doesn’t Have to Be a Bully,”

It’s worth noting that rogue viruses pose far greater risks to most countries than do rogue terrorists. For
example, in Liberia in 2006 (the last year the U.S. government published such statistics), terrorism accounted for 11 deaths — but
between March and November 2014, the country reported more than 3,000 deaths from Ebola. In a worst-case scenario, the U.S.
Centers for Disease Control and Prevention (CDC) estimates that the disease could infect more than 1.4 million people in Sierra
Leone and Liberia by early 2015. An obvious tool that could help address this crisis would be the NSA’s
supercomputers — the largest collection in the world. And there are models to follow: In Canada last year, for example,
researchers drafted their country’s most powerful supercomputer into the fight against Ebola. Hoping to find a drug to stop the virus,
Chematria, a start-up supported by the University of Toronto, began evaluating millions of potential drugs using a 32,767-core IBM
Blue Gene/Q computer. “What we are attempting would have been considered science fiction, until now,” Abraham Heifets,
Chematria’s chief executive officer, stated in a news release. “We are going to explore the possible effectiveness of millions of
drugs, something that used to take decades of physical research and tens of millions of dollars, in mere days with our technology.”
The NSA’s massive data-mining capability could also be redirected from reading everyone’s telephone
to searching the Internet for any clues or indications
metadata, a practice that has turned up virtually no terrorists,
of new diseases or outbreaks in news reports and other publicly available data. According to world
health experts, there is an enormous need for powerful computers to better extract patterns from
data. With these computers and thousands of personnel expert in data mining, the agency could
contribute greatly. Another key area in which the NSA could provide invaluable assistance is in
translation. The agency — which has spent billions of dollars on developing highly sophisticated translation
hardware and software to identify even the slightest signs of terrorism — could use its technologies for
early detection of infectious diseases and for transmitting this information, in near real time, to a
White Center. (Some of the preliminary signs of the Ebola outbreak were reported in local newspapers, but in French or Portuguese,
and much of the U.S. government’s data mining is limited to English-language newspapers.)

Engagement solves north Korean war

Gurtov 14 (Mel, professor emeritus of political science at Portland State University, editor-in-chief of
Asian Perspective, and a contributor to Foreign Policy In Focus, "Why the U.S. Should Engage North
Korea Right Now,"
The case for persisting in finding engagement opportunities with North Korea comes down to seven considerations. First, North
Korea has at least several nuclear weapons and is now widely rumored to be restarting production of more. More nukes can only
add to strategic instability and the danger of a terrible miscalculation. The longer the United States persists in making any form of
engagement dependent on North Korea’s denuclearization, the more determined North Korea will be to test and refine its nuclear
weapons and their delivery systems. Second, every time North Korean leaders feel threatened or ignored, they
undertake a weapons test or other provocative action. U.S.-ROK military exercises and strengthened defense ties with
South Korea and Japan may seem like standard procedures to us; but to the North Koreans, they are a reminder of their weakness
and vulnerability. Former Secretary of Defense William Perry’s reminder in 1999, after visiting the North as a special emissary of
President Clinton, remains relevant: “We do not think of ourselves as a threat to North Korea, but I fully believe that they consider us
a threat to them and, therefore, they see this missile [program] as a means of deterrence.” That is why U.S. security
assurances to North Korea are so essential. When two prominent Americans visited Pyongyang in November 2002,
they received a written personal message from Kim Jong-il to President George W. Bush that said: “If the United States
recognizes our sovereignty and assures nonaggression, it is our view that we should be able to find a way
to resolve the nuclear issue in compliance with the demands of a new century. … If the United States makes a bold
decision, we will respond accordingly.” That position has been restated a number of times since. Third, China’s view of North
Korea has changed. It has come to regard the Kim regime as a strategic liability, though not to the extent of dumping it
altogether or consistently carrying out UN-approved sanctions. Numerous Chinese commentaries of the last few years display
impatience and irritation with North Korea, seeing it as a potential threat to China’s own security. China’s changed attitude presents
an opportunity for creative multilateral diplomacy, so long as we finally jettison the notion that China holds the key to forcing
changes in Pyongyang’s behavior. (Chinese Ambassador to the United States Cui Tiankai, for instance, complained about
Washington’s demands that his country do more to pressure Pyongyang into halting its atomic arms development or contend with
U.S. repercussions for not doing so.) Fourth, as the former South Korean president Kim Dae-jung argued in crafting his “Sunshine
policy,” greater security for the North actually promotes greater security for the South . Rather than continue to
rely exclusively on alliance with the United States, Kim proposed “to lead North Korea down a path toward peace, reform, and
openness through reconciliation, interaction and co-operation with the South.” Military deterrence and “non-tolerance of military
threat or armed provocation by North Korea,” Chung-in Moon explains in his definitive study of the Sunshine policy, were also part of
Kim’s approach. But Kim was determined to avoid giving the North any reason to believe that South Korea was out to absorb or
threaten it. Fifth, abandoning engagement strengthens North Korea’s military and forecloses opportunities for
credible dialogue with leaders there who want to reduce tensions and gain concessions from the United States and others. As
Kim Jong-il reportedly told Madeleine Albright in October 2000, if North Korea could get the same kinds of security
assurances that Deng Xiaoping got in the 1970s, “he would be able to convince his military that the United
States was no longer a threat and then be in a position to refocus his country’s resources .” There is no reason
to think Kim Jong-un does not possess similar authority. Sixth, engagement increases opportunities for direct contact
with the North Korean people and lower-level officials. We have many concrete examples of how appreciative Koreans
are when they receive meaningful help, such as in medical supplies and training, wind and solar power technology, and foreign-
financed fisheries, apple orchards, and scientific and academic exchanges. Focusing on young people, as for example the
Pyongyang Project does, is especially important. Someday, the work of NGOs may transform North Korea’s political system and
facilitate peaceful Korean unification. That is why a new U.S. approach to North Korea based on an
engagement strategy is so vital. It would provide a framework of support for the critical projects that NGOs carry out.
Seventh, we have to accept that the Kim regime is not going to go away. Critics of engagement will argue that since the Jang
execution, regime stability in North Korea is uncertain, and the usefulness of talking with Kim Jong-un may be doubted. Even
gaining a hearing in Pyongyang is proving very difficult, as the State Department has discovered in trying to send an emissary there
to free two U.S. citizens who have been jailed for espionage. But by every indication Kim Jong-un remains firmly in command, and
the cyclical expectations in Washington that the regime will either self-destruct or wither away under outside pressure seem largely
to be wishful thinking. Consider the likely scenario if the United States and its allies reject engagement and
continue the approach of insisting that North Korea must first eliminate its nuclear option before serious negotiations can get
underway. It will embolden the most hawkish elements in the North Korean leadership , providing them
with evidence that more nukes provide the only real security against an untrustworthy America. Influential figures in South Korea
and Japan will argue that the time has come to have their own nuclear weapons. North Korea will carry out more nuclear and missile
tests, and will keep selling weapons components to militant groups and governments. It will create armed incidents with the ROK
that will compel a violent response. It will crack down even harder on its population in search of “enemies of the state” who have cell
phones or listen to South Korean broadcasts. It will bar or greatly limit NGO activities even if they offer valuable assistance. North
Korea is just as tired of talk for talk’s sake as the United States is. It too won’t “buy the same horse twice.” The challenge, however,
is not about buying but about selling: How to reach agreement on the “horse’s” fair selling price. For Pyongyang, that means no
denuclearization without prior compensating incentives. In other words, Pyongyang must see engagement as
strengthening regime and state survival. North Korea would therefore most likely be interested in a U.S.
(or U.S.-South Korean) proposal that would provide the following. It would offer some assurance against U.S.
designs to bring about regime change. It would enhance North Korea’s legitimacy as an independent socialist state—
meaning U.S. diplomatic recognition in particular—thus also preventing absorption by the South. It would provide
international guarantees of North Korea’s security and ease and eventually end sanctions . It would at worst
warehouse the North’s nuclear weapons until the terms of a new agreement are largely fulfilled, thus helping satisfy the DPRK’s
military. It would pave the way for long-term development assistance, increased trade and investment, and
short-term food and fuel aid, thus also reducing dependence on China. And it would eliminate the nuclear-weapon option for
South Korea and Japan
CP – States
The 50 states and U.S. territories should uniformly
- establish a universal social insurance fund that provides coverage for all basic health care
in the United States
- amend their respective constitutions to eliminate balanced budget amendments
- amend their respective constitutions to enshrine a right to healthcare
- and apply for Section 1332 waivers under the PPACA to implement these reforms.

States solve
Emanuel 16 - Senior Fellow at the Center for American Progress and the vice provost for global
initiatives, the Diane S. Levy and Robert M. Levy University Professor, and chair of the Department of
Medical Ethics and Health Policy at the University of Pennsylvania [Zeke Emanuel, 4-8-2016, “State
Options To Control Health Care Costs And Improve Quality,” Health Affairs Blog.]

The current political environment makes it unlikely that reforms to control system-wide health care costs
will be achieved at the federal level in the near future. States, however, are well-positioned to take the
lead on implementing cost control and quality improvement reforms. Indeed, many states are already
innovating and seeing positive results. There are several advantages to implementing reforms at the state level. State-level reforms
can be tailored to work best for each state, depending on its size and demographics and the structure of its insurance markets. States also
have considerable authority over the regulation of health insurance and the provision of health care
within their borders. States control their own insurance markets: They run their Medicaid and CHIP
programs and state employee plans, and certain states run the exchanges for individual health
insurance. States also control the rate review process, scope-of-practice regulations, physician licensing,
antitrust laws, and provider and insurer regulations. Lastly, states and governors have considerable
convening power to bring together diverse stakeholders, making reform efforts more politically feasible.
The innovations that some states are implementing to reduce costs while maintaining or improving quality can and
should be replicated by other states. Following is a comprehensive summary of options that states can choose from to improve the quality and
sustainability of their health care systems. Generally, these options relate to implementing new payment models, increasing accountability and transparency, collecting more
data, increasing the use of high-value services and practices, and removing barriers to effective practices. (More detail on each of these options and examples and successful
these reform options would help states slow
strategies from pioneering states can be found in a recent report from the Center for American Progress.) All of

the growth of health care costs and improve the quality of their health care systems. States should
adopt as many of these reforms as possible.
1NC—AT: Bioterror
Terrorists won’t use bioweapons
Lentzos 7/3 (July 3rd, 2017, Filippa Lentzos is a senior research fellow jointly appointed in the
Departments of War Studies and of Global Health and Social Medicine at King’s College London, Her
research focuses on biological threats and on the security and governance of emerging technologies in
the life sciences, “Ignore Bill Gates: Where bioweapons focus really belongs,”

Bioterrorism seems to be back in fashion. In the past, it has received bursts of attention that arose from particular incidents—the “anthrax letters”
sent through the mail to US politicians and media outlets in 2001, for instance, or the purchase of plague bacteria by white supremacist Larry Wayne Harris in 1995. This time,
it’s an unlikely individual calling attention to the bioterror threat—Bill Gates, the Microsoft founder turned philanthropist. Over the last several years, the world’s richest man has
spent vast sums of money on global health, and in the last few months he has turned his attention to bioterrorism. At a high-profile security summit in Munich in February, he
warned that bioterrorism could kill tens of millions. At a London security meeting a couple of months later, he said terrorists could wipe out 30 million people by weaponizing a
terrorists taking advantage of advances in biology might be able to create a
disease such as smallpox. I disagree. At a stretch,

viable pathogen. That does not mean they could create a sophisticated biological weapon, and
certainly not a weapon that could kill 30 million people. Terrorists in any event tend to be
conservative. They use readily available weapons that have a proven track record—not unconventional weapons that are
more difficult to develop and deploy. Available evidence shows that few terrorists have ever even contemplated using

biological agents, and the extremely small number of bioterrorism incidents in the historical record shows
that biological agents are difficult to use as weapons. The skills required to undertake even the most basic of bioterrorism attacks are more
demanding than often assumed. These technical barriers are likely to persist in the near- and medium-term future.

Trump decks pandemic containment and response

Walsh 17 (May 4th,2017, Bryan Walsh is a contributor to TIME. Previously, he was TIME’s International
Editor, its energy and environmental correspondent and was the Tokyo bureau chief in 2006 and 2007,
"The Next Global Security Threat Isn’t What You Think," Time,

Experts say the U.S. needs sustained funding for pandemic preparedness that extends out for years. That kind of
money could help push vaccine candidates across the valley of death from R&D to commercialization as well as fund entirely new
vaccine technologies. It could also ensure a steady supply of doctors and nurses trained to deal with pandemics at home, support
U.S. efforts to build defenses abroad and provide a fund that could be easily tapped in the event of an outbreak. Will Trump do
that? His proposed budget from March contained some encouraging signs , including a pledge to create a new
federal emergency-response fund for public-health threats as well as commitments to continue funding international programs on
HIV/AIDS. But the details of the emergency fund are vague, and Trump's pledge to increase the defense budget
by $54 billion would have to be offset in part by slashing spending on health, including the NIH, which
would have seen its budget cut by a fifth. Some research groups, like the NIH's Fogarty International Center, which works
on emerging-disease research overseas, would have been eliminated altogether. Proposed cuts to foreign
aid and the State Department--which could eventually hit pandemic-prevention programs like PREDICT--
would also be felt when the next pandemic hits. Trump's budget proposal is just that--Congress holds the ultimate
power over government spending. But in the event of a pandemic, it is the President who must lead the
country. During Ebola, Trump issued a series of tweets that have sown doubts about how he would
handle a true health crisis. One called for stopping American health care workers who had been
infected with Ebola from returning to the U.S. "The U.S. cannot allow EBOLA infected people back. People that go to far
away places to help out are great--but must suffer the consequences!" he wrote. Another tweet warned, without evidence,
that "Ebola is much easier to transmit than the CDC and government representatives are admitting ." In the
past he has raised doubts about the safety of vaccines, a long-discredited belief that is nonetheless
shared by an increasing number of Americans, leading to a resurgence of preventable childhood
diseases like measles.
Status quo ACA solves enough bioterror preparedness—it doesn’t have to be perfect
Petersen 14 (September 2014, Kimberly Ann Peterson is a M.A. Candidate in Security Studies, Naval
Post-Graduate School, “The Affordable Care Act: a prescription for homeland security preparedness?,”
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
Affordable Care Act 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 Affordable Care Act 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
Petersen 14 (September 2014, Kimberly Ann Peterson is a M.A. Candidate in Security Studies, Naval
Post-Graduate School, “The Affordable Care Act: a prescription for homeland security preparedness?,”

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 Center for Disease Control’s Smallpox Response Plan and Guidelines. 74
So perhaps the smallpox vaccination program serves as a model for universal health care access.

Squo solves—we’re overprepared

Kolssak 15 (October 12th, 2015, Spencer Kolssak is a writer for the PHC Intelligencer, “BIOTERRORISM:

Implications for US Policy

The United States has developed an intensive bio-preparedness program. According to a Scientific
American scorecard in 2014, the United States ranked first out of 55 nations in biotechnology by a
very large margin.13 The United States has 14 discrete biodefense R&D programs, less than half of
which exist under the DoD. The other programs reside under the Environmental Protection Agency, the Department of Health and Human Services, the
Centers for Disease Control and Prevention, the Department of Agriculture, and the Department of Homeland Security. During the 2011 to 2014 period, Department of

Homeland Security’s biodefense funding increased by around 40% while combined funding for human
health programs under Department of Health and Human Services and the Centers for Disease Control
have increased by 18%.13 Different agencies also have bio-threat detection systems. For instance, Department of
Homeland Security subjects travelers who have recently been in Ebola-infected areas to intensive screening.14 Studies show that government programs

over-emphasize the threat of biological attacks. A study conducted by the RAND Corporation from 1997 to 2010 examined a mix of 1,593
federally-funded national health security research projects—including those by the Centers for Disease Control and Department of Homeland Security. The

researchers found that over 1,000 of the initiatives, or 66 percent, were dedicated to biological
threats, including bioterrorism. 10 percent of the projects focused on natural disasters, 8 percent
addressed chemical threats, 5 percent examined radiological issues, 4 percent addressed nuclear
threats, and the remaining 4 percent focused on explosives.15 Dr. Art Kellermann, chief analyst at RAND, commented, “The current mix
of federally-funded national health security research projects may not be ideally configured for achieving the broad preparedness goals that face our nation.”15 To resolve this
each of the agencies studied determines its own research priorities
problem, US agencies should implement two reforms. First,

with little effort to coordinate with other agencies. Biodefense programs should increase their cooperation
and information-sharing methods. Second, current priorities do not accurately reflect the likelihood of possible threats. Agencies should
move toward implementing a risk-based system that allocates priorities based on threat probability and
magnitude.15 Whenever an outbreak occurs or a dangerous disease breaks loose, public panic and
paranoia ensue. This response is somewhat understandable; the potential consequences of an invisible, weaponized super-disease are indeed frightening. Yet
these perceptions are flawed. The media—and to some extent government agencies—over-hypes the
threat of pandemics and bioterrorism . To be sure, governments should always be prepared to prevent and combat such threats. However, recent
research suggests that the US government focuses too much attention on the threat of biological
warfare and not enough on other pressing issues. Both a proper understanding of the threat posed by bioterrorism and a proper balance
of priorities are necessary if the United States wants to prepare itself for all potential dangers to the nation’s security.
1NC—AT: Korea
Absolutely no risk of a North Korean bioweapons impact
Ben Ouagrham-Gormley 17 (July 18th, 2017, Sonia Ben Ouagrham-Gormley is an associate professor in
the Schar School of Policy and Government’s biodefense program, at George Mason University, and the
author of Barriers to Bioweapons: The Challenges of Expertise and Organization for Weapons
Development, “Potemkin or real? North Korea’s biological weapons program,”
Kim Jung-un’s June 2015 visit to a pesticide facility—Pyongyang’s Bio-technical Institute—rekindled long-standing suspicions that North Korea might be developing
bioweapons. Photos of the tour, shown on North Korean television, showed a smiling Kim. He posed with military officers and personnel in lab coats in front of apparently new
buildings, with sparkling laboratories and shiny equipment. The tour took place amid tensions with the United States—and soon after a US military laboratory accidentally
shipped live anthrax to a US airbase in South Korea, an accident that Pyongyang translated as an act of aggression. These circumstances contributed to a belief that the visit to
the pesticide facility was designed to send a message to the United States: that North Korea has an active bioweapons program. North Korea’s hermetically
sealed borders, along with its limited economic and political connections with the rest of the world, make it
impossible to verify current or past allegations about the existence of a bioweapons program . One must
be prudent when discussing North Korea, and not jump to conclusions or ascribe a threatening
meaning to any sliver of information that manages to emerge, particularly when it emerges in time
of crisis. Otherwise, the risk of adopting costly policies or engaging in unnecessary conflicts
increases. What’s needed instead is to systematically analyze the available information, keeping an eye on what it takes to produce functioning bioweapons and keeping
in mind that a country’s ability to produce such weapons is constrained by its political, economic, scientific, and social context. When such an analysis is

performed, the odds that North Korea has established a successful bioweapons program appear
much lower than some estimates would suggest. What is known? Very little is known for sure about North
Korea’s alleged bioweapons program. Much of the available data is drawn from scant intelligence estimates issued by the US, Russian, and South
Korean governments, most of these estimates over a decade old. Additional information can be found in the media and from other independent sources, but such information
Most government sources seem to agree that North Korea’s
cannot be corroborated and some of it is of questionable reliability.

interest in biological weapons started in the 1960s, in the same era when Pyongyang launched its chemical weapons effort. On December 25,
1961, President Kim Il-sung issued a “Declaration of Chemicalization,” ordering the military to develop chemical weapons. Around the same time, he reportedly instructed the
Academy of Defense Sciences to investigate biological weapons. According to South Korea’s National Intelligence Service, North Korea established a testing center at the
academy in the 1960s, and reportedly acquired strains of the causative agents of anthrax, plague, and cholera from an unidentified source in Japan in 1968.

program’s research and production infrastructure is difficult to discern with any precision. The South Korean
government estimates that 10 facilities might be involved in bioweapons activities—seven research centers and three production facilities. Media and other independent sources
provide more details about facilities suspected of involvement in the program, but this data cannot be verified. Four facilities are often mentioned in academic publications and
other media sources as carrying out activities dedicated to biological weapons (with the South Korean government sometimes cited as a source): the Germ Research Institute,
established in the 1970s; as well as the Central Biological Research Institute, the military biodefense unit, and the No. 5 Factory (sometimes referred to as the February 25
Factory, or No. 25 factory), all created in the 1980s. South Korean and Japanese media outlets list up to a dozen other dual-use and medical facilities that are potentially
Government and open-source documents
connected to the program, but do not provide clear evidence of bioweapons activities at these facilities.

are also decidedly vague about the activities of the program and the agents under study. Several sources claim that
North Korean bioweapons research has focused on 13 agents, including the usual suspects: anthrax, plague, botulinum toxin, and hemorrhagic fevers (link in Korean). In

the 1990s, US intelligence suspected that North Korea was working on a smallpox weapon based on
samples obtained from the Soviet Union in the 1980s. But these claims have not been substantiated. In
addition, several defectors have made allegations of human testing at military and medical institutions. None

of these claims has been confirmed. Furthermore, some of the defectors later acknowledged that they had no first-hand knowledge of bioweapons
activities. Experience shows that one always needs to be cautious about defector testimony: Recall the Iraqi defector Curveball, whose

claims about mobile biological weapons laboratories were used by the George W. Bush administration to
build a case for the invasion of Iraq. Those claims were eventually debunked by the Iraq Survey Group. The evolution and current
status of the North Korean program are equally uncertain—government estimates generally provide no details on these issues, or on the
possible achievements of a bioweapons program. For example, US assessments are consistently vague and continually changing. While some US estimates

have taken the view that North Korea is engaged in research and development but that the country has
not yet weaponized bio-agents or produced bioweapons, others state that North Korea may already possess ready-to-use biological
weapons. A 1997 CIA assessment indicated that North Korea was “capable of supporting a limited [biological weapons] effort.” Defense Department assessments of the late
1990s and early 2000s concurred, describing North Korea’s bioweapons infrastructure as “rudimentary” and capable of producing “limited quantities” of bio-agents. Starting in
2000, CIA estimates began to change, placing more emphasis on North Korea’s production capabilities and indicating that “North Korea [was] capable of producing and
delivering via munitions a wide variety of chemical and biological agents,” and “possibly [had] biological weapons ready to use.” In 2002, State Department official John Bolton
dialed up the threat dramatically, declaring during a meeting of the Korean-American Association in Seoul that the North “has one of the most robust offensive bioweapons
programs on Earth … and … has developed and produced, and may have weaponized, [biological weapons] agents… .” He added that “North Korea likely has the capability to
produce sufficient quantities of biological agents within weeks of a decision to do so.” It is worth noting that in 2002 John Bolton also accused Cuba of having a biological
weapons program. His claims were soon contradicted by US intelligence. A 2011 report by the Office of the Director of National Intelligence sharply deflated the North Korean
threat, merely stating that North Korea has “a biotechnology infrastructure that could support the production of various [biological weapons] agents” and that the country could
More recent reports issued by the office provide no
use its conventional munitions production infrastructure to weaponize bio-agents.

assessment of a potential bioweapons program in North Korea. It remains to be seen whether this indicates the absence of a
bioweapons program or the absence of evidence to substantiate suspicions. In a rare assessment made public in 1993, Russia’s Foreign Intelligence Service seemed to agree
with pre-2000 US assessments that North Korea’s biological activities were of a defensive nature. The report indicated that various research institutes, universities, and medical
institutions were engaged in “applied military-biological research” and that “bio-agents are being tested on the island territories belonging to the DPRK.” The report, however,
noted that “there is no evidence of offensive bioweapons activities” (link in Russian). A 2005 report by the Swedish Defense Research Agency came to the same conclusion,
indicating that no evidence suggested a large-scale bioweapons program with dedicated production facilities in North Korea. South Korea, on the other hand, has consistently
claimed that the North Korean bioweapons program has advanced to the production phase—but official reports do not explicitly state that North Korea has produced or
stockpiled bioweapons. Reports published by South Korea’s Ministry of National Defense generally state that Pyongyang has been producing biological agents since the 1980s,
but the reports are more cautious about the North’s weaponization capabilities, indicating that North Korea is “likely capable” or is “suspected” of being able to produce
bioweapons including anthrax, plague, and smallpox. But like the United States, Seoul provides few details and little evidence to support its assessments. Equipment is only a
small part of the story. It is not surprising that Kim Jung-un’s visit to a pesticide facility resulted in alarming analyses—government threat assessments are inconsistent and
vague, international access to North Korea is extremely limited, and fear about bioterrorism has been elevated since 9/11 and the US anthrax-letter episode. But recent history
demonstrates that access to relevant material and equipment is hardly a guarantee of a successful bioweapons program. When threat assessments are made solely on the
basis of the equipment to which nations have gained access, grossly exaggerated evaluations of capabilities are possible—just witness Libya and Iraq’s nuclear and biological
Images of dual-use equipment at the pesticide facility do not reveal anything about the
weapons programs.

activities occurring there. One can’t assess the activities occurring at the site without knowing whether personnel can actually use the dual-use equipment
and adapt its technology to bioweapons development. Iraq, for example, acquired drying equipment necessary for bioweapons development but was not able to use it for lack of
expertise. Also, claims that because the pesticide facility might produce Bacillus thuringiensis (Bt), and that therefore it can produce anthrax, are shortsighted at best. Bt has
As is known from
indeed been used as a simulant for anthrax, but individuals who have expertise working with Bt cannot automatically produce an anthrax weapon.

the Soviet bioweapons program, scientific expertise in the civilian field does not necessarily translate
into expertise in the weapons field. For example, when the Soviet research facility “Vector” was created in the 1970s, its staff of virology experts
(including smallpox experts) all came from the university system and had no weapons expertise. Five years of experimentation and testing—and the help of experienced
bioweapons scientists from another facility—were required for the university experts to master the specialized bioweapons knowledge needed to succeed. Further, several
pieces of laboratory equipment that could be used in a bioweapons program, such as the autoclave shown in the North Korean television report about Kim Jong-un’s visit to the
If the power supply at the facility is intermittent—and power in North Korea is indeed
pesticide facility, require electricity.

intermittent—it is unlikely that such devices can be used effectively. Finally, to ascertain the existence of
bioweapons activity, one needs to visit a site and determine whether it displays hallmarks or signatures of
bioweapons infrastructure or activity. For example, during site visits to Russian facilities that took place under the 1992 Trilateral Agreement signed by
Russia, the United States, and the United Kingdom, US and British inspectors found evidence of bioweapons activity—such as high containment equipment and aerosol testing
what is missing in assessments of the North
chambers—even though the Russians undoubtedly had tried to hide such traces. More broadly,

Korean bioweapons threat is an understanding of the conditions required to produce bioweapons

successfully—and an evaluation of whether North Korea meets the required conditions . Analyses of past state and
terrorist bioweapons programs indicate that the continuity and stability of scientific and production work must be ensured over a long period of time to allow scientists and
bioweapons are based on fragile
technicians to accumulate the knowledge necessary for development of a working bioweapon. In addition, because

microorganisms that are sensitive to their handling and to environmental conditions, the development
stages of bioweapons are highly interdependent—a stage cannot occur until the previous stage has been
successfully completed. This calls for an organizational structure that carefully coordinates and synchronizes the work of the teams involved. It also requires a
management model that allows scientists to communicate freely, share information, and openly acknowledge failures in order to learn from them. When these conditions are not
failures. Very few of the known state
met, programs face steeper learning curves, long delays in project development, and numerous

bioweapons programs have produced a working weapon, and many have failed despite having access to
the required material and financial resources. In North Korea’s case, the data available from open sources and
government assessments raise many questions about the country’s ability to produce a working
bioweapon. Required: Expertise, continuity, management. The North Korean bioweapons program is suspected of having been
launched in the 1960s, with new infrastructure built in the 1970s and 1980s. But was this a continuous program—or a series of separate and independent programs? Did the
team that reportedly started to investigate bioweapons with strains obtained from Japan in 1968 continue its involvement in the 1970s and 1980s when new facilities were
established, or did the work switch to new teams at those facilities? Did the original teams transfer their expertise and accumulated knowledge to the new teams? What was the
knowledge base of both teams when they started, and did they have expertise working with the agents selected for work? Answers to these questions could provide important
The Iraqi bioweapons
clues about the continuity and speed of the program and about the personnel’s ability to accumulate knowledge and make progress.

program, which was long suspected of having reached an advanced stage, and even of producing a
smallpox weapon together with mobile production sites, provides a good illustration of how difficult it
is to assess a bioweapons program with limited knowledge about the program’s continuity or
level of expertise. After the two Gulf wars and countless UN inspections, it became clear that prior threat assessments had been grossly exaggerated. The Iraqi
program lasted about two decades, but it was only able to produce crude liquid agents, such as anthrax and botulinum toxin, which were hastily placed in bombs that would
A close analysis of the program shows that it faced two key problems: a lack
have destroyed most of the agent upon impact.

of continuity and a lack of expertise. The Iraqi program is best described as a succession of three separate programs, each conducted independently
from the others and with little or no transfer of expertise and knowledge. The first effort started in 1974 but was ended after four years, officially due to “scientific fraud.” A
second program was launched in 1979 that investigated plant diseases, and possibly assassination weapons, but it also soon faltered because of lack of expertise. The third
program was launched in 1983 with a new team investigating anthrax and botulinum toxin as potential bioweapons. Although this third program came to include a large number
of facilities, it relied on a relatively small number of personnel—who had no expertise working with the two agents selected for work and also lacked expertise in important
As a result, each team had to start work from scratch.
stages of bioweapons development, such as scale-up, drying, and weaponization.

Each faced a steep learning curve due to its lack of expertise. The teams had access to equipment, but lack of expertise prevented
them from using it. The autocratic management of the program, and the atmosphere of fear created by Saddam Hussein and his son-in-law (who was responsible for weapons
Failure bore serious consequences for one’s career or life. If the
programs), created further challenges to knowledge accumulation:

North Korean program has faced similar issues, it is unlikely that it has made substantial progress
over the past 30 years. Needed: Economic stability. Another issue that requires investigation is the impact of North Korea’s economic
circumstances on a potential bioweapons program. North Korea’s command economy has suffered from serious material shortages since the country’s founding. The
demise in the early 1990s of the Soviet Union, Pyongyang’s main supplier of fuel, sent the economy into
a downward spiral, resulting in a four-year famine that killed close to 3 million people. Although the famine ended in
1998, thanks to international humanitarian assistance, the country continues to face food crises and the majority of the population is still malnourished . In 2016,

Pyongyang warned its population to get ready for another possible famine due to a new set of
international sanctions. The country also suffers because, in its planned economy, output objectives are
set for each institution and resources are centrally (and inefficiently) allocated . Despite several attempts at economic reform,
the North’s economy is still unable to meet the people’s needs. Some would argue that the defense sector gets priority in allocation

of resources and therefore is shielded from incessant economic crises. But this is a faulty assumption.
The Soviet Union also had a planned economy, with centralized allocation of resources and a defense sector that received priority status. Yet the defense complex could not
escape the shortages that plagued the Soviet system. For example, bioweapons facilities routinely lacked the required equipment or
reagent necessary for their work. The output objectives set by central authorities did not always take into account scientific realities, nor did they factor in
the difficulties that the economic system itself imposed on obtaining the required technical and human resources. As a result, scientists sometimes had to

stop work in order to independently procure material and equipment that they could not get through
official procurement routes, creating substantial delays in bioweapons development . And when they failed to meet
centrally set objectives, they either lied about the outcome of their work or produced bad science. Thus, despite its priority status, the Soviet bioweapons program suffered due
It is likely that North Korean facilities suffer from
to an inefficient economic system, and its achievements were much reduced as a result.

much greater challenges: While the Soviet economy could obtain some resources from overseas and
send some personnel to learn new techniques in the West, North Korea is a closed country due both
to its own system and to international sanctions. Pyongyang’s bioweapons program is unlikely to benefit from outside expertise. North
Korea could in theory obtain missing equipment or material illegally—the country is adept at establishing illicit procurement networks. But in the bioweapons field, illicit
procurement can harm scientific work, especially when laboratory equipment or material is obtained from different suppliers. For example, a change in the quality or
North Korea experiences regular
characteristics of reagents can doom an experiment because unknown variables can be introduced. Furthermore,

power outages, and the quality of its water is notoriously bad. These factors too can affect scientific work. Power outages
can cause fragile microorganisms to die due to improper storage or working conditions—and if outages
occur during production, they can compromise weeks, or possibly months, of work. North Korea’s unsanitary water might
also harm experiments by introducing foreign organisms that could contaminate a batch of bio-agents. Such challenges ultimately create additional disruptions in scientific work
Compulsory: A scientific foundation. Understanding Pyongyang’s
and lengthen the time required to obtain positive results.

alleged bioweapons efforts also requires a good understanding of the status of natural and medical
science in North Korea. Without a solid foundation in natural and medical sciences, a bioweapons
program cannot succeed. When Soviet authorities issued a decree to expand the country’s bioweapons program in the early 1970s, they had to face the reality
that Soviet science had fallen behind and needed modernization. Years of Stalin’s purges, along with the policy of Lysenkoism—which negated the role of genetics in science—
had resulted in the elimination of a whole generation of competent scientists. Some of them had been at the forefront of bioweapons development, but now they were replaced
with a new generation of scientists educated in flawed science. It took the Soviet Union close to a decade to catch up and create the modern infrastructure needed to meet the
bioweapons challenge. The Soviet Union procured some needed equipment overseas and sent some of its scientists for training in Western laboratories. Even so, Soviet
Decades of economic sanctions, and the
scientists could not reach the objectives set by central authorities to create new types of bioweapons.

desperate state of North Korea’s economy and society, have undoubtedly had an effect on the
scientific sector. Reports about the nation’s health care system are revealing: Hospitals are reportedly unable to procure medication for patients and are otherwise
poorly equipped. If North Korean natural science is in as bad a state as the medical sector, it is likely that North

Korea does not have the knowledge base required to support bioweapons development. A poor public
health system also places a country at risk if an accident should occur in a bioweapons facility.
And such an accident would ensure international detection of the program. Potemkin villages? One can
develop a more accurate assessment of a country’s bioweapons capabilities, and the speed of its
progress, by gathering data about the scientific, economic, political, and social conditions in which
scientific work occurs than by relying solely on isolated pieces of information about equipment acquisition.
Reaching an evidence-based assessment is all the more important in North Korea’s case because the regime often builds Potemkin villages for internal and external
From fake missiles displayed during military parades to malls filled with modern electronics and

clothes that are only for show and not for sale, to the incessant barrage of reports on North Korean
television showing a smiling Kim Jong-un visiting technology fairs or plants that produce food products, the
regime aims to project an image of strength and abundance both to the outside world and to its starving population. The visit to the pesticide facility might well have been
it is unlikely that the country has
another Potemkin exercise. It is quite possible that North Korea has engaged in exploratory bioweapons research, but

been able to establish the conditions required to achieve a working bioweapon. The poor state of North
Korea’s medical and (most probably) science sector implies that the country does not have a sufficient
knowledge base to research, design, produce, and dry bio-agents, not to mention weaponize them. The
deficiencies of North Korea’s economic system, along with the weight of decades of international
sanctions, cast doubt on the country’s ability to acquire but also to ensure a continuous supply of
equipment and material needed in bioweapons work . Little is known about the organization of scientific work in North Korea, but it is more
than likely that science is managed in an autocratic manner, and that subordinates do not challenge orders from higher-ups or openly report failures, particularly if they risk
All this casts doubt on the ability of scientists and technicians to learn from each other,
sanctions for doing so.

accumulate knowledge, and acquire outside expertise when needed—traits that have been a hallmark of past successful
bioweapons programs. Without a solid knowledge base and a continuous and stable work environment and infrastructure, scientists are less likely to overcome the challenges
One might ask why, if North Korea has been able to produce a nuclear
of working with fragile, living microorganisms.

weapon in the same adverse conditions, it shouldn’t also be successful in the bioweapons field. The
answer lies in the decidedly different nature of bio-agents and nuclear weapons. Unlike nuclear
material, living microorganisms are fragile and unpredictable. They are more sensitive than nuclear
material to changes in work conditions, equipment, laboratory materials, and other disruptions. A country that
cannot ensure a stable and continuous work environment is unlikely to operate a successful bioweapons program. More research is needed to

characterize North Korea’s political, economic, organizational, and managerial circumstances, and probe
the effects of these circumstances on bioweapons work . But if the United States and the international community are serious about
preventing the emergence of a North Korean bioweapons threat, they might seek to forestall the threat by means of the Biological and Toxin Weapons Convention (BTWC).
If a verification regime for the treaty were
North Korea has been a party to the convention since 1987—but the BTWC lacks a verification mechanism.

instituted, the United States could not only obtain more accurate data about the North’s program but,
more importantly, promote routine inspections that would prevent progress in Pyongyang’s bioweapons
development. Conducting international inspections, or merely threatening to do so, has proved to be an effective strategy in creating disruptions and delays in past
biological weapons programs, including in the Soviet Union and Iraq, and even in the program of the terrorist group Aum Shinrikyo.
Turn – Economy

The economy is goldilocks—growth is stable but vulnerable to shocks

Cushman and Wakefield 9/27 (September 27th, 2017, Cushman and Wakefield is among the largest
commercial real estate services firms with revenue of $6 billion across core services of agency leasing,
asset services, capital markets, facility services (C&W Services), global occupier services, investment &
asset management (DTZ Investors), project & development services, tenant representation, and valuation

NEW YORK – The U.S. economy has entered a Goldilocks scenario, one that is not too hot or too cold, but
“just about right,” Cushman & Wakefield’s U.S. Macro Forecast reveals. Real GDP is on track to grow slightly over 2% in 2017,
generating nearly 2 million net new jobs this year. The economy’s temperature also seems to be “just
about right” for consumers. Confidence is hovering at a near-15-year high, retail sales are
accelerating at a 5% rate year-over-year and credit is flowing. In addition, the global economy is also resurgent. World nominal GDP
growth is expected to be four times greater this year than it was last year, bolstering global trade and business confidence. But by many metrics, the economy is

certainly not “too hot.” Inflation is one such measure. Despite a low unemployment rate, wage growth
remains mostly muted and core inflation remains stubbornly below the Federal Reserve’s target
rate of 2%. History suggests that when the labor market is near full employment, core inflation should be higher; however, in August, the Fed’s preferred
measure of inflation—the core Personal Core Expenditures (PCE) index —was up only 1.4% year-over-
year. “While this may be related to transitory factors, such as pass-through effects from lower oil prices, a one-off decline in medical costs and cell phone prices, the reality
is that inflation, or lack thereof, has been baffling economists for years, “said Revathi Greenwood, Cushman & Wakefield Americas Head of Research. “Complicating matters
further are Hurricanes Harvey and Irma, which will distort monthly data and make it very difficult for the Fed to get a clean read on economic performance.” Added Rebecca
Rockey, Head of Americas Forecasting , “The next interest rate hike, which was previously expected in December, now
looks less likely. Prospects for 2018 look good. Downside risks lie mostly on the policy side, but assuming there
is a bit of fiscal stimulus, real GDP will finally flirt with that 3% threshold next year, at least on a quarterly basis. There is a decent chance that the

current economic expansion will be longest in the post WWII era.” Property market fundamentals are performing well, aside
from retail, which continues to face headwinds from eCommerce. Demand metrics such as net absorption are on par with, if not slightly off, last year’s levels. Construction will
soon start to drive vacancy rates upward, but any increase will be gradual. Leasing markets will be carried by the broad and steady health of the labor markets and consumers.
The wave of new supply that hits in 2017 and 2018 will put a cap on rent growth, and a shift towards a more occupier friendly market should be expected in most U.S. cities next
year. The capital markets are a bit slower in terms of sales volume, but pricing continues to hold, and investors continue to seek opportunities in primary and secondary cities.
supportive global monetary policy and relatively
However, the tenuous interest rate outlook adds to the uncertainty in capital markets. Even so,

low interest rates are expected to drive sufficient capital into CRE over the coming years.

Single payer would necessitate massive spending and borrowing—it crushes the economy
CRFB 9/12 (September 12th, 2017, The Committee for a Responsible Federal Budget is a non-partisan,
non-profit public policy organization, “Sanders to Introduce Single-Payer Bill – How Much Will It Cost?”
Tomorrow, Senator Bernie Sanders (I-VT) is expected to introduce a single-payer health care bill (“Medicare for All”). The legislation also has several co-sponsors and has
While the
sparked significant interest in moving the U.S. towards a single-payer health system, where the federal government would be the sole insurer of health care.

details of this particular legislation are unknown, we analyzed a related proposal Senator Sanders made
during his 2016 presidential run. At the time, we found his proposal would cost roughly $25 trillion over a
decade, and we estimated that only $11 trillion of that would be paid for with higher taxes. The
remaining $14 trillion would be added to the national debt. Including interest but excluding possible economic effects of this plan,
debt would be about $16 trillion higher after a decade because of its enactment. As a result, debt as a share of
the economy would rise from 77 percent of Gross Domestic Product (GDP) today to 148 percent of GDP
by 2027 (compared to 91 percent under current law) – more than 40 percent higher than the previous record set in
1946. While tomorrow’s legislation is likely to differ from Senator Sanders’s campaign proposal in some key ways, it is clear that any proposal to
reshape the U.S. health care system as a single-payer system will have substantial fiscal implications . In
order to avoid adding to the national debt, Senator Sanders’s legislation will need either to offer less generous coverage

than his campaign proposal, provide more robust offsets, or both. And unfortunately, there is limited space to raise those remaining offsets
from high earners alone. Read more about the Sanders campaign’s original offsets and additional offsets as well as its full policy proposals. Some aspects are also discussed
below. What Did the Sanders Campaign Single-Payer Plan Propose? During the 2016 presidential campaign, Senator Sanders frequently touted his support for “Medicare for
All” and released an outline for how he’d like to replace the U.S. health care system. Under the Sanders plan, all Americans would have access to health coverage through the
federal government as the sole health insurer, responsible for paying providers (hence the term single-payer) and negotiating payment rates. Although the system is framed as
“Medicare for All,” its details are actually quite different than Medicare and in many ways would be far more generous. Under the Sanders plan, individuals would face no
deductibles, co-payments, or direct premiums (though they would be taxed) – the government would pay all costs. Additionally, the package of covered benefits would be much
more generous than Medicare, adding in full vision, dental, mental health, substance abuse, and long-term services and supports to the Medicare package (our cost estimate
does not include long-term care). Importantly, this new system would entirely subsume current government spending on health care with just two exceptions for the Indian
Health System and the Veterans Health Administration. That means that all funding for Medicaid and Medicare, two of the largest government programs, would fall into this
system. States would be required to contribute their approximately $4 trillion of funding streams over ten years currently going towards Medicaid and the Children's Health
While the Sanders campaign itself estimated its plan
Insurance Program How Much Would The Sanders Campaign Single-Payer Plan Cost?

would cost about $13.8 trillion over a decade, their estimates likely overstate savings from administrative costs,
drug prices, and provider costs and underestimate the effect of the plan on utilization. Based on a number of

independent estimates at the time, we concluded the cost would be much higher – closer to $25
trillion over a decade, incorporating savings from eliminating nearly all current law federal health spending and excluding the cost of the long-term care
component. We are aware of three different independent estimates of the Sanders campaign health plan . On the

low end, health economist Kenneth Thorpe estimated the plan would cost the federal government $24.7 trillion over

a decade. On the high end, the Center for Health and Economy estimated the plan would cost between $34.7

trillion and $47.6 trillion. Finally, a number of analysts at the Urban Institute estimated the Sanders
campaign plan would cost roughly $32 trillion. Importantly, this estimate includes Senator Sanders's plan to
offer universal long-term care benefits (about $3 trillion) and assumes the federal government is unable to
compel states to continue paying what they currently do under Medicaid (about $4 trillion). Removing those two assumptions
would reduce their estimate to about $25 trillion. How Would The Sanders Campaign Pay for Its Single-Payer Plan? To finance his health care
plan, encouragingly, Senator Sanders proposed a series of offsetting tax increases. However, we concluded that these offsets would cover less than half of the plan’s costs and
The specific proposals form the Sanders campaign included a 6.2
would virtually max out available revenue from higher earners.

percent employer payroll tax, a 2.2 percent across-the-board income tax, significant income tax rate hikes for high earners,
estate tax reforms and increases, and changes to the tax treatment of capital gains and dividends so that both are taxed as ordinary income and capital gains are generally
taxed at death. More detail on the offsets can be found at Analysis of the Sanders Single-Payer Offsets and Additional Offsets for Senator Sanders’s Health Plan. Including
revenue gains from ending employer-provided health insurance, we estimated these taxes would raise about $11.1 trillion over a decade. This is somewhat lower than the
Sanders campaign's estimates of $13.9 trillion but relatively close to the $11.9 trillion estimate put forward by the Tax Policy Center (TPC) – the major difference being that TPC
estimates significantly higher revenue from taxing capital gains at death than official scorekeepers have found. Revenue Policies of Sanders Campaign's Single-Payer Plan
Policy CRFB Estimated Ten-Year Savings 6.2% Employer Tax $5.3 trillion 2.2% Individual Premium $1.6 trillion Progressive Income Tax Increases $0.8 trillion Tax Capital
Gains/Dividends as Ordinary Income $0+ Tax Capital Gains at Death $0.4 trillion Reform Tax Deduction Limits for High Earners -$0.3 trillion "The Responsible Estate Tax" $0.2
trillion Savings From Health Tax Expenditures $3.1 trillion+ Total $11.1 trillion Source: CRFB calculations. Table footnote appears at bottom of this document. Importantly,
actual revenue from these policies is likely to be less due to the negative economic effect of the large marginal tax rate increases. Although there is considerable disagreement
over the exact revenue-maximizing tax rate for ordinary income (the top of the Laffer curve), many economists believe it to be in the range of 60 or 70 percent. When combined
with his other campaign proposals, we found the Sanders campaign’s plan would lead to a top tax rate of about 73 percent - which is at or above the likely revenue-maximizing
rate. Without Senator Sanders’s non-health care tax policies, the rate would be somewhat lower but still quite high. As a result of these very high rates and aggressive base
While there are many potential
broadening, few options would remain to finance the remaining costs by levying taxes on high earners alone. ***

benefits to a single-payer health care system, it can come with an extremely high cost to the federal
Treasury. Senator Sanders’s campaign plan would likely cost $25 trillion over a decade – effectively increasing total
spending by more than 50 percent. And with only $11 trillion of offsets, the plan would add $16 trillion to
the national debt and bring it to 148 percent of GDP by 2027, higher than any time in history. While Senator Sanders’s campaign deserved credit for trying to pay for
its health plan, we hope that tomorrow’s legislation will learn from that effort and actually succeed in doing so. A fiscally responsible single-payer plan may have to find ways to
reduce costs to the federal government, including through deductibles, co-pays, premiums, and various provider payment changes. At the same time, any single-payer plan will
It’s not enough to believe every
require substantial new tax revenue – revenue that almost certainly cannot be raised through taxes on high earners alone.

American should receive government-provided health care; policymakers need to say how the
government will pay for it. No plan that requires trillions of dollars of new debt, on top of today’s debt levels, will be passable or sustainable. Whether
it’s free health care, free college, or massive tax cuts, policymakers that promise dessert without
vegetables will end up delivering neither.

Taxes crush the economy

Romer and Romer 10 (June 2010, Christina Romer is the Garff B. Wilson Professor of Economics at UC
Berkeley, David H. Romer is the Herman Royer Professor of Political Economy at UC Berkeley, “The
Macroeconomic Effects of Tax Changes: Estimates Based on a New Measure of Fiscal Shocks,”
American Economic Review, Volume 100, Pages 763-801, Accessed through EconLit via GALILEO @

VII. Conclusions This paper investigates the causes and consequences of changes in the level of taxation
in the postwar United States. We find that despite the complexity of the legislative process, most significant tax changes have a dominant motivation that fits
fairly clearly into one of four categories: counteracting other influences on the economy, paying for increases in government spending (or lowering taxes in response to
reductions in spending), addressing an inherited budget deficit, and promoting long-run growth. The last two motivations are essentially unrelated to other factors influencing
Our results indicate that tax changes
output, and so policy actions taken because of them can be used to estimate the effects of tax changes on output.

have very large effects on output. Our baseline specification implies that an exogenous tax increase of one percent of
GDP lowers real GDP by almost three percent. Our many robustness checks for the most part point to
a slightly smaller decline, but one that is still typically over 2.5 percent. In addition, we find that the output
effects of tax changes are much more closely tied to the actual changes in taxes than to news about
future changes, and that investment falls sharply in response to exogenous tax increases We also examine the behavior of output following changes in other
measures of taxes. The estimated output effects obtained using broader measures of tax changes, such as the

change in cyclically adjusted revenues or all legislated tax changes, are substantially smaller than those
obtained using our measure of exogenous tax changes. Thus, failing to account for the reasons for tax changes can lead to
substantially biased estimates of the macroeconomic effects of fiscal actions. Finally, we find suggestive evidence that tax increases to reduce an inherited budget deficit do not
Our results are largely silent concerning whether the output
have the large output costs associated with other exogenous tax increases.

effects operate through incentives and supply behavior or through disposable income and demand
stimulus. The persistence of the effects is suggestive of supply effects. But other studies have found that monetary policy, which necessarily works through demand, also
has highly persistent output effects (for example, Ben S. Bernanke and Ilian Mihov 1998; and Romer and Romer 2004). The speed of the effects is suggestive of demand
effects. But rapid supply responses are not out of the question.34
1NC—Slow Growth
No impact to slow growth
Lowy 9/17(September 3rd, 2017, Martin, “We Should Celebrate Slow Growth Like The Stock Market
Does, Not Wring Our Hands And Do Radical Things That Might Make The Economy Worse, Not Better,”

what is the bottom line here, after all this sashaying hither and yon? First, the slow growth
The slow growth period dates to 2000, not to 2010 So

period dates to 2000, not to 2010. If we want to know what happened, it would be good to look in the right
time period. Demography is likely a material cause of the slow-growth period Second, are there demographic
likely causes for a substantial part of the reduction in the real GDP growth rate since 2000? The answer is
“yes.” We have found that there is less population growth and more student population growth, which, combined,
could account for a reduction of 1% in the annual real GDP growth rate, which is approximately the decline since 2000. The
opioid problem might account for a substantial part of the workforce participation rate, perhaps thereby
accounting for the entire slowdown with demographic causes. Indeed, if we just add up the reasonable
demographic possible causes, we could conclude that the economy is doing amazingly well despite such
strong headwinds. That does not tell us “why” the year 2000. Many data sets begin to look different at some time during that year. And that year followed four
excellent years for GDP growth and productivity growth. The good might be blamed on Y2K expenditures or something like that. But why did the negatives begin in 2000? My
guess is that something cultural happened that is not yet well understood. But I am sure that you gumshoes out there in seekingalphaland are going to educate me on that.
But there may be a third lesson If demography is a material part of the growth slowdown causes, then maybe
all the hand-wringing and policy-wonking about what to do about it is off base. Maybe the economy is really
pretty good. No recession in 8 years, perhaps none in prospect if some global political or military event doesn’t blow up the relative
prosperity. Yes, there have been many people left behind. And our society should do things to help them get back into the workforce and the

economy. But perhaps the perfect is, as so often, the enemy of the good. And, their impact evidence is not

reverse casual – says more growth is good for leadership not that less growth crushes leadership
1NC—AT: Lead
No chance of economic leadership under Trump
Roberts 17 (June 5th, 2017, William Roberts is a staff writer at Al Jazeera, “Decoding Donald Trump's
foreign policy,”

In the opening foreign policy acts of Donald Trump's presidency, he is defining American
Washington, DC -

interests much more narrowly than past US leaders and is championing economic nationalism over
international cooperation, drawing sharp and mocking criticisms both at home and abroad. Following a
blundering first trip overseas trip, Trump announced a unilateral decision to withdraw from the US-sponsored Paris climate accord. He criticised the mayor of London on Twitter
"We have
following the attack over the weekend, and in the US renewed his call for a controversial ban on travel to the United States from six Muslim countries.

never really seen from a Republican leader in the modern era anybody as completely isolationist and anti-
cooperation as Donald Trump," said David Victor, professor of international relations at the University of
California, San Diego. "There is no question that the Trump presidency is going to accelerate the
American exit from its international leadership, institution-building role. That is a more dangerous
world where it's harder for any individual country to muster the incentives to go off and build effective
international institutions. It's a world that is going to be a whole lot less cooperative," Victor told Al Jazeera.
Analysts see a president who is deeply unpopular in the US. To remain in power, Trump needs to secure his right-wing political base. That means delivering on campaign
promises. Trump's chief political strategist in the White House, his campaign adviser Steve Bannon, is an ardent advocate for Trump's "America First" approach. It's a winning
Trump appears to have a
message among disenfranchised workers in the rural US who provided Trump with his margin of victory in 2016. Add to that,

highly narcissistic personality that drives him to invite constant ratification of the legitimacy of the election,
credit and respect from the people around him . That makes it difficult for cabinet secretaries to tell him he's wrong. "It's troublesome. You can't
talk about it in any quantifiable, definitive sort of way, but we have to be honest with ourselves, this is an unusual leader. He does have authoritarian instincts. This level of
narcissism colours his behaviour and his choices," said Jeffrey Gemin, a senior fellow The Atlantic Council and an expert on the Trans-Atlantic relationship. The pressure on
Trump to deliver for his voters is amplified because in many respects he has failed so far to produce real results in a number of key political initiatives. His push to repeal and
replace Obamacare, the US' health insurance exchange markets established under former President Barack Obama, failed early tests in Congress. Tax reform legislation is
Worse for the White House, the FBI and Congress
delayed. His executive orders, particularly the Muslim travel ban, are tied up in litigation.

are investigating his campaign ties to Russia. This week, former FBI Director James Comey will testify before a Senate committee for the first
time since Trump fired him in an ill-advised move to ease pressure from the Russia investigation. Democrats in Congress will use the scandal to stymie Trump's policy agenda.
"None of Trump's foreign policy moves seem to hook up much together other than he seems to be
checking off some of his campaign promises," said Richard Longworth, a distinguished fellow at the Chicago Council on Global Affairs and an
expert on the Cold War, NATO and globalisation. Trump's speech at the new NATO headquarters in Brussels was not well

received. It was an opportunity for the new American president to thank NATO members for their support following the September 11 attacks and speak to NATO's loftier
goals of peace and stability. Instead, Trump chose that moment to pressure allies to increase their defence budgets.

"That was really a problematic speech. It just displayed bad manners. The entire speech was
inappropriate," said Cecile Shea, a former US Department of State Foreign Service officer in the Asia Pacific who specialises in international communications. "You
could see it, watching the other leaders standing around, how uncomfortable and embarrassed they were
that he was saying those things in this setting," Shea told Al Jazeera. Trump was unprepared to engage in
substantive discussions at the G-7 summit in Taormina. Behind closed doors, he signalled an unwillingness to commit to a declaration on climate
action and said he was still undecided. German Chancellor Angela Merkel expressed her distress afterwards. "We have to know that

we must fight for our future on our own, for our destiny as Europeans," Merkel said in remarks describing
the G-7 talks with Trump as "difficult and unsatisfactory". Upon his return to Washington, Trump and his White House team organised a grandiose

Rose Garden event to announce his decision to withdraw from the Paris accord. "The rest of the world is actually looking at this and

wondering, you know, what's leaked in the water supply at the White House," Victor said.
1NC—AT: China/US
Multiple checks on US China conflict
Leon 17 (David Pak Yu - Assistant Professor Department of Political Science & History, Keuka College,
“Economic Interdependence and International Conflict: Situating China's Economic and Military Rise,”
Asian Politics & Policy, vol 9, is 1, January 2017, Wiley //Red)

China has, in the past 30 years, experienced economic growth and military modernization to such an extent as to position
itself as a power capable of shaping the Asian regional order and, potentially, the rules and institutions governing
the international system.1 In the existing literature, various policy analysts and international relations scholars have argued
that, historically, systemic risks of conflicts tend to increase at critical junctures of power transitions or major
power shifts when the power gap narrows between a hegemon and a rising challenger, especially a revisionist one committed to
overturning the established set of institutional arrangements (see Copeland, 2000; Gilpin, 1983; Kugler & Lemke, 1996; Organski,
1958; see also Chan, 2008; Harris, 2014). An increasingly powerful China in the context of the relative decline of the
United States (Layne, 2012; Zakaria, 2008; although see Beckley, 2011) has brought these debates into sharper relief
because whether or not China can rise peacefully and whether or not it will challenge the United States in its dual role as the
premier global power and traditional underwriter of global governance institutions will have major implications for both theory and
policy as analytical apparatuses are reexamined and reworked, and policy prescriptions developed and dispensed. This article first
suggests that neither theoretical nor policy questions pertaining to China's rise can be properly addressed without examining the
nature and meaning of any power shifts that are said to be in process, or the balance of economic and military forces within the
intersecting global and East Asian regional systems. Clarifying these issues in turn requires an analysis of such factors
constraints of
as the trajectories, reversibility, and distributional consequences of differential growth; the possibilities and
China's current and expected military capabilities, especially in relation to power projection and strategic means of
coercion (i.e., naval and air forces capable of long-range operations, as well as nuclear forces and the capabilities and ranges of
delivery vehicles); economic interdependence; and China's dispositions toward rule-based
international institutional complexes. This article argues that while China has seen tremendous economic
growth and substantial military modernization, sustaining its economic prosperity depends to a large extent
on global trade, internal and external stability, and the ability to access natural resources. A deep
level of international institutional engagement that it has exhibited while rising in wealth and
power is quite dissimilar to aggressive rising challengers in the past (e.g., Imperial Japan and Nazi
Germany) where autarky or economic self-sufficiency and aloofness from rule-based institutions tended to
mark their behavior. Inasmuch as engagement and enmeshment continue to be prioritized in Chinese foreign policy, China
will likely have strong disincentives to initiate conflicts that may disrupt trade and resource flows and
essentially slow its own rise. For the foreseeable future, its military also does not have the kind of power
projection capability and its foundational sources—or what can be called the command of the commons (Pose, 2003)—that
would allow it to mount a serious challenge to U.S. military primacy in the Western Pacific, much less
to initiate a revisionist war to reorder the core systemic arrangements; on the contrary, it has seldom been
more involved and engaged in such arrangements in modern times. This relatively benign conclusion, however, is
conditional on China's continued access to the resources necessary for further development and growth by means of trade or
acquisition, which also serves as a linchpin of domestic regime stability. This can be attributed to Deng Xiaoping's admonition for
China to “hide its capabilities and bide its time” in international politics, a concept traceable to Sun Tzu's classic notion that high
strategic virtue lies in winning without a fight (see Sun, 2009; see also Friedberg, 2011; Kissinger, 2011). It is still too early to tell if
tensions in China's geographical periphery and China's more recent assertiveness in international affairs indicate a fundamental
reorientation or an adjustment in policy, but in any case, such tensions and the possibility of escalation should not be taken lightly. In
short, China has been rising within a rule-based system characterized by the institutionalization of world trade and
politics (Baviera, 2016; Ikenberry, 2011), conceived initially as U.S.-led institutional design, and more broadly intensified in the
closing decades of the 20th century and the beginning of the 21st century. If this institutional architecture proves not to
be robust and resilient enough to ensure reasonably unhindered access to the lifeblood of growth,
dangers may still loom for a concerted drive for autarky that in earlier times had emanated from great power anxieties and
heralded international conflicts. The very existence and pervasiveness of contemporary global institutions,
however, do present China with the possibility to rewrite or create its own set of global institutions,
something that totalitarian rising powers in the first half of the 20th century did not seriously attempt to do.
1NC—Small Business Growth High
Small business growth is strong and challenges have nothing to do with health care
Reuters 17 (“U.S. small businesses expect continued 2017 growth,” 4/11/17,

U.S. small businesses expect stronger revenue this year and many anticipate adding employees, a
generally optimistic read that could support job growth in coming months, the New York Fed reported on Tuesday. In a
national survey that covered nearly 16,000 firms with fewer than 500 employees, more than 60 percent said they expect more
revenue in 2017 than last year, and around 40 percent anticipated expanding their workforce. A third of firms said they had
added workers in 2016, with fewer than 20 percent saying they had reduced employment. The findings on employment were “a positive

note” in a report that detailed a broader picture of businesses struggling to get the financing needed to expand, said a Federal Reserve official who worked on the study but
was not authorized to speak on the record. Steady national job growth and a 4.5 percent unemployment level have

convinced Federal Reserve policymakers that the economy is near full employment, or perhaps even slightly
beyond it. Though job growth slowed in March, the small business survey is a sign that hiring may
continue since smaller firms are responsible for the bulk of U.S. hiring. The NY Fed began surveying small businesses
in 2014 but the project has since expanded into a national effort covering all 12 regional Fed districts. Participants in the online survey were not randomly selected, but the
the results cited
results were weighted by firm size, geography and other factors to make it more representative. The focus was on credit to small firms, and

struggles among businesses owners to find funding. Problems were particularly acute among firms with less than a million dollars in
annual revenue, a group that made up 70 percent of the sample. Two-thirds said they faced a shortfall in financing, and a quarter said

they had dipped into personal finances to fund their businesses. The smallest firms also struggled to get credit from large banks
as opposed to credit unions or community institutions: fewer than half the financing applications to larger banks were approved.
1NC – Job Lock
No impact to job lock---people who leave won’t create productive businesses, and the safety net
de-motivates entrepreneurship---empirics
Megan Mcardle 10, columnist at Bloomberg View and a former senior editor at The Atlantic. 12/16/10,
“Will National Health Care Improve Our Economic Health?”

Where conservatives
During the latter half of the debate over the health care bill, you started to hear an intriguing argument about the effects of the bill.

claimed that it would stifle the economy, liberals countered that in fact, it would unleash the
entrepreneurial power of people "locked into" their jobs by fear of losing their health coverage. David
Leonhardt rehearses this argument in his most recent column: It's easy to look at the current debate and see an unavoidable trade-off between this country's two economic
traditions -- risk-taking and security. But I don't think that's quite right. I think it is ultimately as misplaced as those worries about Social Security and Medicare equaling
Bolshevism. Guaranteeing people a decent retirement and decent health care does more than smooth out the rough edges of capitalism. Those guarantees give people the
freedom to take risks. If you know that professional failure won't leave you penniless and won't prevent your child from receiving needed medical care, you can leave the comfort
of a large corporation and take a chance on your own idea. You can take a shot at becoming the next great American entrepreneur. With every previous major expansion of the
safety net, history has had a chance to prove the naysayers wrong. It may yet in the case of universal health coverage. But the decision now seems to rest with the nine
members of the Supreme Court. This is the sort of argument I am fond of because it's so intuitively counterintuitive--it gives you one of those, "A-ha! Of course!" moments that
are the main pleasure of writing about economics. But while that a-ha! reaction means a theory is plausible, it doesn't actually mean it's true. And while I think that Leonhardt's
narrative about freedom from fear is certainly one possible outcome of passing health care reform, there are also quite a few reasons to think
that it might not be true. I worked through a bunch of them earlier in the year, and still believe, as I noted then, that "the number of
people who wish to start businesses, but are held back by the health insurance problem, cannot
be zero." But that is a far cry from saying that on net, creating this new safety net will help spur labor
mobility and entrepreneurship. Creating the safety net imposes costs, as well as benefits. Some of
those costs come in forms that discourage entrepreneurship. Net cost or net benefit? How do we know? A lot of self
employment is what economists call tax and regulatory arbitrage. In plain words, companies often
employ contractors because the overhead cost is cheaper, since contractors aren't subject to the
same tax and work rules. They can pay the contractors higher hourly rates, because their overhead is lower. It's not surprising that
people are more willing to be contractors or consultants when they have access to benefits
through another company. But this is not really the same thing as the entrepreneurship that
Leonhardt is describing. Nonetheless, they tend to get conflated when people are looking for the
effect of the safety net. It's easier to measure "people who are working for themselves" than
"people who are starting a company that will do something new and innovative and improve the
economy's net productivity". Tthe latter number, the one we really care about, is certainly much smaller than the former. Let's look at
another attempt to quantify the problem: net jobs created. Economist Scott Shane took a crack at
calculating the number of people who will start companies that eventually employ someone else.
This is not a perfect proxy for entrepreneurship and dynamism--very small operations can add to an economy's growth, as I've written elsewhere. But net jobs

created is a pretty powerful way to approximate what Leonhardt is talking about. Here's Shane's
math: Small Business Economy an annual publication of The Office of Advocacy of theSmall Business Administration explains that 60.7 million people have employer-
sponsored health insurance from their employment (people covered by their spouses don't matter here because they don't face job lock). Therefore, 607,000

additional people per year would begin the entrepreneurial process if we eliminated health
insurance job lock. But not everyone who begins the process of starting a business manages to get
one up and running. In fact, analysis of the Panel Study of Entrepreneurial Dynamics data by Paul
Reynolds shows that a new business results from about one-third of startup efforts. So we will get
about 200,000 new businesses if we can eliminate the job lock that comes from employer-
sponsored health insurance. This same research shows that only about 19% of new businesses employ
someone other than the founder. Because people who leave jobs to start nonemployer
businesses don't generate any net new jobs, it's the 38,000 additional new employer businesses
that would be created if we eliminated the health insurance job lock that would be the source of
any additional jobs. Data from the Small Business Administration's Web site reveals that the average number of employees in a
new employer firm is 5.6. Therefore, we will create an estimated 213,000 annually if universal
health care eliminates the problem of job lock. It actually might be slightly smaller than that--people currently covered by their employer
might still have access to spousal coverage if they decided to leave (or so I read the data). Meanwhile, as Shane points out later, the bill will also cost jobs--
Doug Elmendorf, the head of the CBO, has estimated that PPACA will cause employment to fall by about half a percent, or about 700,000 people. The job losses come from two
sources: the taxes and penalties that make hiring more expensive for a company, and the Medicaid expansion and the subsidies making it more attractive to leave the workforce
altogether. Knowing that Elmendorf is a very smart and thorough man, I presume that he has already accounted for the positive effects of PPACA on entrepreneurship. But even
if he hasn't, that's a net loss of about half a million jobs. Of course, maybe we're trading 700,000 terrible jobs for 200,000 awesome ones. That could be a net gain. But to me,
we just don't have a lot of good evidence that generous social safety nets somehow spur labor
mobility or entrepreneurship. For every "just so" story you can tell about health insurance or
generous welfare benefits making someone willing to leave their cushy corporate job in order to
risk it all founding a company, you can tell an equal and opposite "just so" story about someone
who doesn't bother to become an entrepreneur because it's so comfortable there on the dole,
someone discouraged from pursuing a promising idea because taxes reduce the potential payoff
or make it harder to turn a profit, or someone who isn't motivated to work harder because they're
not so worried about security. Looking at the Big Picture In fact, probably both effects exist. The prophets of dynamism tend to focus only on the studies
that show the benefit side--mostly studies that show people are more likely to become self-employed if they have access to alternative health insurance, such as a spouse's
insurance, COBRA, or Medicare. But when we try to look at the net effect, it's hard to see much dynamism coming
out of the places with a generous safety net. Rates of entrepreneurship and labor mobility are far
lower in Europe than they are in America--and one of the many factors restraining European labor
mobility is thought to be the social safety net, both because of the difficulty of moving between
benefit system, and because the benefits lessen the urgency of say, relocating in order to find a
job. Nor do US states show much of a pattern of dynamism created by generous benefits. Unemployment in Massachusetts after RomneyCare passed does not drop (or rise)
noticeably compared to the rest of the US. High-tax, high-benefit states like New York don't seem to generate a lot of

new businesses--in fact, New York routinely ranks last or next to last on surveys of business climate. Then there are states like California, with high rates of
innovation in entertainment and tech--but even before the state's budget crisis, it was losing manufacturing jobs and experiencing net out-migration to other states. It's hard to
know how to score that one. And of course, there are other things going on in all these states, so it's not as simple as drawing a straight line from the government safety net, to
I'd say that if the safety net made a significant positive
the entrepreneurship rate--one way or another. Nonetheless,

difference, we should see a clearer pattern than we do in state and national comparisons . Instead, if
anything, the pattern points in the opposite direction. So I'm pretty skeptical that on net, PPACA is going to build us a better economy.
However, unless the Supreme Court strikes it down, we have an excellent test. If the law really makes a different on net, then by late in this decade, we should see significantly
rising rates of entrepreneurship and labor mobility, and at least a slight uptick in trend productivity growth and GDP. I'll certainly be watching avidly.
1NC—AT: Administrative Costs
The aff does not make health-care cheaper
AAPS 9 (June 29th, 2009, The Association of American Physicians and Surgeons – AAPS – is a non-
partisan professional association of physicians in all types of practices and specialties across the country,
“Myth 2: A public plan could save enough on administrative costs to provide coverage to all,”

It is frequently asserted, especially by groups such as Physicians for a National Health Program (PNHP), that a “single payer” (government)
system could “save” enough money on administration to buy coverage for all the uninsured. The basis for
the assertion is the claim that Medicare spends only 2% to 3% of its outlays on administration, compared
with private plans’ alleged costs of 20% to 25%. In fact, data from the Congressional Budget Office (CBO)
shows that insurance companies spend at least 50% less on administration than government does on
its health programs. (The Congressional Budget Office Reports: Comparing health care admin cost: who’s less costly?) CMS (Centers for
Medicare and Medicaid Services) divides spending data into care (paid to doctors, hospitals, pharmacies, and others for patient
care) and non-care (everything else). For 2009, CMS projects spending on care at $2.13 trillion, and non-care at $424

billion or 16.7% of total spending. Of the $879 billion projected to be paid in 2009 by private insurance,
CMS estimates $128 billion for non-care—12.7%. For all public programs except Medicare, the comparable
percentage is 26%, without adjustment for the taxes and assessments paid only by private insurers. Unlike Medicare, other public
programs—Medicaid, SCHIP, Veterans Administration, and military programs—are internally administered. Medicare is externally
administered by private companies; its non-care costs are 5.7%. If it were administered like other government programs,
administrative cost would increase by $1 trillion over the next 10 years. There are many reasons why private companies have
higher non-care costs for their private plans than for Medicare: Private insurance plans must pay government taxes and

assessments up to 5% of premiums. When these are factored out, the real net cost of private
administration is less than 10%. CMS excludes the cost of its own employees who enroll recipients,
perform outreach and education, handle customer service, and do auditing and other functions. Private
plans include these in overhead. Private plans have on average a higher number of claims to process
for a given amount of expenditure. Insurance companies have to collect premiums. The IRS does that for
Medicare. Private companies do underwriting; their premiums have to cover their costs. Medicare
deficits have to be covered by taxpayers. The cost of servicing the public debt is not included in Medicare costs—and Part B is 75% subsidized by
general revenues, not beneficiary premiums. Greg Dattilo and Dave Racer conclude: “Though one has to dig for the truth, the CBO report makes the case: Competition

in a private health insurance market saves tens of billions each year that government agencies would
waste on administrative cost.” Benjamin Zycher of the Manhattan Institute for Policy Research also notes that it costs the economy more than a dollar
to send a dollar to Washington (Wall St J 10/29/07). The lowest plausible assumption for the excess economic cost of the

tax burden, 20%, would raise the cost of delivering Medicare benefits to at least 24% to 25% of Medicare
outlays, and a more realistic estimate to about 52%, or four to five times the net cost of private
insurance. Other facts to remember about Medicare administration: The information given on their “customer service” hotlines about their own rules is inaccurate 85%
of the time. The threshold for investigating fraud by carriers is about $200 million. Physicians are subjected to career or life-destroying audits, civil monetary penalties, or
criminal prosecutions, over what should be simple billing disputes (Libby RT, The Criminalization of Medicine: America’s War on Doctors, Praeger 2008, reviewed in J Am Phys
Surg, summer 2008).
1NC—AT: Reimbursement Rates
Single payer in the US won’t solve health care costs – reimbursement rates in the US will be
higher than other countries.
Sanger-Katz 16 (Margot, Health Reporter for NYT, cites a study from the Urban Institute, a public policy
think tank. “A Single-Payer Plan From Bernie Sanders Would Probably Still Be Expensive”,
One of his signature proposals is to move the country’s health care system to a government-run, single-payer system. Last week, Hillary Clinton
nodded in that direction, suggesting that she would be open to allowing Americans older than 50 to buy into the government Medicare program that
currently covers those 65 and older. But also last week, a detailed analysis of the Sanders health care plan from researchers at
the Urban Institute showed that it would probably cost the government double what the campaign proposed . It is
the second credible analysis to suggest that the Sanders plan costs more than advertised. (The other comes from the Emory health policy professor
Kenneth Thorpe.) The Sanders plan is light on some key details, but even in sketch form, it seems clear that it
would require even
bigger tax increases than the sizable ones the campaign has called for. If you look around the world, lots of
countries have single-payer systems. And all of them pay substantially less for health care than we do in the United States. I am reminded of this often,
in the comments by readers in some of my articles. So how could a single-payer system here still be so expensive? One reason is that the Sanders
plan covers far more than typical insurance plans in the United States — or abroad. The Sanders plan would charge no premiums, require no out-of-
pocket spending and would pay for services like dental care and long-term nursing home stays. Those things boost the total price tag. But
a universe where we had a single-payer health plan that was more like normal insurance. Perhaps it
would be a true “Medicare for all,” where everyone has exactly the insurance that the federal government
currently provides to older people and the disabled. That Medicare-for-all plan would still cost more than
single-payer plans in other countries. Here’s why: Medicare pays doctors and hospitals higher prices
than single-payer systems do in other countries. “The big thing is that providers here make quite a bit more
money than they do anywhere else, and in order to get in the ballpark of where these other countries are,
you’d have to reduce payment rates to physicians to much, much lower levels,” said John Holahan, one of the authors
of the Urban analysis. “That’s just hard to do.” The Organization for Economic Cooperation and Development, which looks at a group of
developed countries, has found that the United States pays substantially higher prices for doctors, hospital stays and
prescription drugs than the rest of the group. Medicare pays less than the United States average, but not
enough less to make up that difference. Making the American health care system significantly cheaper would
mean more than just cutting the insurance companies out of the game and reducing the high
administrative costs of the American system. It would also require paying doctors and nurses substantially
lower salaries, using fewer new and high-tech treatments, and probably eliminating some of the perks of
American hospital stays, like private patient rooms. The average family physician in the United States earns $207,000, according
to the Medscape Physician Compensation Report. General practitioners in Britain, which has a single-payer system, earn an average pay of around
$130,000. The gaps in pay for specialists are even bigger. The Urban Institute report assumes that the Sanders plan would cut pay for doctors
substantially, but not by half. That’s a reasonable assumption. We also pay more for drugs than the rest of the world, but many experts think that a
single-payer health plan could push down drug prices because drug companies earn such high profit margins. The Urban analysis assumes that the
country could quickly get to prices 25 percent lower than what Medicare pays. (That change assumes a political revolution, of course, because the
pharmaceutical companies are an extremely effective lobby.) The Sanders campaign and its academic allies dispute some of the Urban Institute’s
assumptions. A critique of the Urban analysis from David Himmelstein and Steffie Woolhandler, professors of public health at the City University of
New York, argues, for example, that drug prices could be pushed even lower. And the Sanders team says that the researchers overestimated the costs
associated with administering the government program. But it doesn’t argue that the prices paid to medical providers could be cut more sharply. The
same problem exists for other attempts to reduce health spending in the United States. Efforts by the Obama administration to pay doctors and
hospitals differently are designed to squeegee some waste out of the system, by eliminating extra care that may not help people’s health. But it has
done little to change the prices paid for medical care. That means that its best hope is to “bend the cost curve,” or reduce the rate that health spending
grows. Republican proposals to make health care into more of a free market also tend to assume that they will slow spending growth, not actually
Sanders plan would require a huge reorganization of the country’s health care system .
reduce it. The
Overnight, it
would put the private insurance industry out of business , along with many other
businesses that support it. It would shift billions of dollars of spending from individuals, workers and states into
the federal budget. Doing that might well reduce some of the country’s health care spending that is going
toward insurer profits and paper-pushing. But more than 80 percent of the dollars we currently spend
on health care actually go toward health care . And making big cuts all at once to doctors and hospitals
could cause substantial disruptions in care. Some hospitals would go out of business. Some doctors
would default on their mortgages and student loans. Even if the country decided that medicine should become a more middle-
class profession — not an obvious outcome, given the substantial public support for the medical professions — it would be difficult to get there at once.
All of that means that bringing a government-run, single-payer health care system could achieve many of
the goals of its advocates: more equity, lower complexity and some reductions in cost . But the United
States would probably continue to have the most expensive health care system in the world. And
we’d have to raise taxes high enough to pay for it.
2NC—Solves Premiums
APRS lowers costs—savings on a national scale are massive
Conis 9 (2009, Elena Conis is a writer and historian of medicine, public health, and the environment.
Prior to joining the Graduate School of Journalism with Department of Behavioral Science and Health
Education, Rollins School of Public Health, Emory University, “Impact of a State-Level All-payer System,”

Results of evaluation

Generally,Maryland's all-payer system is credited with controlling hospital length-of-stay, cost per admission,
and payment levels from one year to the next (Murray, 2009). From 1976 to 2007, the average cost of a hospital
admission in the state of Maryland fell from 26% above the national average to 2% below the national
average. From fiscal year 2007 to 2008, the average cost of a hospital stay in the state rose 4%,
compared to 5.5% nationally. Over the thirty years since the system's inception, Maryland had the lowest markup of hospital
charges of any state in the U.S. The cost per admission also increased more slowly in Maryland than in
any other state during that time. The savings and financial stability engendered by the system also receive credit for granting the state the lowest health
insurance premiums (as a fraction of income) in the country. 6. Expected outcome A recent analysis in Health Affairs reported that

Maryland's all-payer system has resulted in savings of $40 billion since 1976, based on the national average for hospital
spending. Had a similar system been in place over the same period of time for all states, according to the

HSCRC, savings would have totaled $1.8 trillion or more (Murray, 2009). The system is also credited with
improving access to hospital care, keeping markup charges well below national averages , improving the financial
stability of Maryland hospitals, and winning the broad support of a variety of stakeholders through the transparency it has created.
2NC—Solves HC Costs
Costs—the counterplan stops price inflation
Brown 15 (Erin C. Fuse - Assistant Professor of Law at Georgia State University College of Law,
“Resurrecting Health Care Rate Regulation,” 67 Hastings Law Journal 85, Lexis Nexis)

Most importantly, all-payer

rates combat the market power of hospitals that drives price inflation, either
because the rates are set by an administrative body or by combining the bargaining power of all the
payers to negotiate lower prices. n275 By constraining market power and regulating prices, all-payer rate
setting also has the potential to control rising health care spending. n276 As a result of its all-payer system,
Maryland has by far the lowest hospital price markups in the country, almost a hundred times lower than New
Jersey's, a state that abandoned its own all-payer system in 1992. n277 Maryland's all-payer rate setting has effectively constrained
growth in costs per hospital case. n278 Skeptics note, however, that the cost-per-case savings in Maryland's system have been
[*131] offset by increases in patient volume, so without other mechanisms to control incentives to boost volume, the cost savings
may be ephemeral. n279

Rate setting effectively controls healthcare prices

Frankford 16 (David M. - Professor at Rutgers Law School and the faculty director at Camden of the
Rutgers Center for State Health Policy, “SYMPOSIUM HEALTH REFORM: ASSESSING THE
AFFORDABLE CARE ACT AND MOVING FORWARD: It's the Prices, Advanced Capitalism, and the
Need for Rate Setting – Stupid,” 44 Journal of Law, Medicine and Ethics 569, Lexis Nexis)

How do we slow down this giant engine? To start, we turn to state rate setting because when done
correctly, rate setting controls prices and expenditures. n28 Rate setting has a strong track record in
the United States, particularly in Maryland, n29 and moreover internationally. At different times it controlled prices
to various degrees in a number of states, and one can reasonably conclude that its failure at other times -- for example, in New
Jersey -- was due to capture or features of design, some of which are discussed below, that can be avoided. n30 Indeed, in 2011
the Urban Institute canvassed policy options to align growth in health expenditures with GDP growth, and the potential savings from
rate setting greatly eclipsed any other option. n31 It is the most promising policy option available. Rate setting works because
it consolidates the demand-side of payment into one unit, thereby asserting collective power against the
provider side. It is the aggregation of purchasing power. Properly designed, it can control prices and the
volume and intensity of services. It also promises large administrative savings in that rates are
transparent and they are standardized, n32 in contrast to the bedlam we have now in which everyone
has to keep track of a myriad of conflicting, complex rules negotiated among a horde of payers, insurers
and providers. n33
2NC—Conditionality Good New NDT
2NC—AT: MD Fails
Maryland has been successful at reducing costs
Sabatini 17 (January 31st, 2017, Nelson Sabatini is a widely recognized leader in both the Maryland and
federal health care arenas, he is the Chair of the Health Services Cost Review Commission, “Maryland’s
All-Payer Model—Achievements, Challenges, And Next Steps,”

Slowing Per Capita Hospital Cost Growth Under the model, hospital spending per Medicare beneficiary rose less rapidly than it did
nationwide. At the same time, hospital spending for all payers was kept in check. These trends indicate that the Medicare savings
Maryland achieved were not shifted to the private sector. Maryland committed to limiting the growth in the per capita
hospital revenues for all payers to the long-term growth rate of the State’s economy (3.58 percent per year). Actual
growth was much lower (1.47 percent in 2014 and 2.31 percent in 2015), and the year-to-date growth in 2016 over 2015 was 0.35 percent per capita
(Exhibit 1). This success is largely attributable to the efforts of hospitals and others working under the global
payment system. Lower inflation and reductions in uncompensated care also contributed. Meeting Hospital Savings Targets Maryland has
achieved an estimated $429 million in total Medicare hospital savings to date (Exhibit 2), exceeding the
model’s five-year hospital savings requirement of $330 million. Hospital savings for Medicare relative to the base year of 2013 were
$116 million in 2014, $135 million in 2015, and are estimated to be $178 million through August 2016. From 2013 through August 2016,
the hospital spending growth rate underlying the savings was more than 4 percent below the national
growth rate.
2NC—AT: Job Lock
HIPAA solves, and alt causes stop labor mobility
Graham 14 (April 3rd, 2014, John R. Graham is an American financial economist, a professor at the Duke
University Fuqua School of Business, a research associate for the NBER and a regular guest
commentator on CNBC, “Employer-Based Health Insurance: “Job Lock” Is Not the Problem, “Insurance
Lock” Is”)

We get our health benefits from our employer because they are non-taxable. If employees bought health
insurance on our own, we would pay premiums with after-tax dollars. Given this government
discrimination, the idea of job lock makes sense: If we got our homes from our employers we would surely
hesitate to switch jobs, which would result in forced eviction from the current home to a new one. But while
there may be some job lock due to employer-based benefits, the problem has become way overblown
in public discourse, with politicians like Nancy Pelosi claiming that ObamaCare would free the masses to
pursue artistic dreams, free of wage slavery. As discussed in a previous blog entry, job lock — as an independent
factor in employees’ choices — is significantly reduced (if not eliminated) by HIPAA, a law passed in
1996. If you had a job with health benefits and took a new job, HIPAA meant that the new employer’s
insurer could not underwrite you for health status, or exclude pre-existing conditions, if you had maintained
continuous coverage at your old job. (Most states had similar laws by 1996.) So, some of the consequences identified as
deriving from job lock are likely from other factors. For example, people with chronic illnesses are
significantly less likely to switch jobs than healthy people. But the employer-based nature of health insurance itself
cannot cause this, because the next employer cannot charge a newly employed, chronically ill person a
higher premium, or deny coverage for the chronic illness. The real reason for chronically ill employees’ likelihood of
sticking with their jobs is that they are more likely to fear other risks associated with getting a new job, or that
potential new employers can identify the chronic illness and draw back from hiring the person (although, of
course, they would never admit this).
2NC—Reimbursement Rates
Single payer in the US won’t solve health care costs – reimbursement rates in the US will be
higher than other countries.
Sanger-Katz 16 (Margot, Health Reporter for NYT, cites a study from the Urban Institute, a public policy think tank. “A Single-Payer Plan From
Bernie Sanders Would Probably Still Be Expensive”,

One of his signature proposals is to move the country’s health care system to a government-run, single-payer system. Last week, Hillary Clinton
nodded in that direction, suggesting that she would be open to allowing Americans older than 50 to buy into the government Medicare program that
currently covers those 65 and older. But also last week, a detailed analysis of the Sanders health care plan from researchers at
the Urban Institute showed that it would probably cost the government double what the campaign proposed. It is
the second credible analysis to suggest that the Sanders plan costs more than advertised. (The other comes from the Emory health policy professor
Kenneth Thorpe.) The Sanders plan is light on some key details, but even in sketch form, it seems clear that it
would require even
bigger tax increases than the sizable ones the campaign has called for. If you look around the world, lots of
countries have single-payer systems. And all of them pay substantially less for health care than we do in the United States. I am reminded of this often,
in the comments by readers in some of my articles. So how could a single-payer system here still be so expensive? One reason is that the Sanders
plan covers far more than typical insurance plans in the United States — or abroad. The Sanders plan would charge no premiums, require no out-of-
pocket spending and would pay for services like dental care and long-term nursing home stays. Those things boost the total price tag. But
a universe where we had a single-payer health plan that was more like normal insurance. Perhaps it
would be a true “Medicare for all,” where everyone has exactly the insurance that the federal government
currently provides to older people and the disabled. That Medicare-for-all plan would still cost more than
single-payer plans in other countries. Here’s why: Medicare pays doctors and hospitals higher prices
than single-payer systems do in other countries. “The big thing is that providers here make quite a bit more
money than they do anywhere else, and in order to get in the ballpark of where these other countries are,
you’d have to reduce payment rates to physicians to much, much lower levels,” said John Holahan, one of the authors
of the Urban analysis. “That’s just hard to do.” The Organization for Economic Cooperation and Development, which looks at a group of
developed countries, has found that the United States pays substantially higher prices for doctors, hospital stays and
prescription drugs than the rest of the group. Medicare pays less than the United States average, but not
enough less to make up that difference. Making the American health care system significantly cheaper would
mean more than just cutting the insurance companies out of the game and reducing the high
administrative costs of the American system . It would also require paying doctors and nurses substantially
lower salaries, using fewer new and high-tech treatments, and probably eliminating some of the perks of
American hospital stays, like private patient rooms. The average family physician in the United States earns $207,000, according
to the Medscape Physician Compensation Report. General practitioners in Britain, which has a single-payer system, earn an average pay of around
$130,000. The gaps in pay for specialists are even bigger. The Urban Institute report assumes that the Sanders plan would cut pay for doctors
substantially, but not by half. That’s a reasonable assumption. We also pay more for drugs than the rest of the world, but many experts think that a
single-payer health plan could push down drug prices because drug companies earn such high profit margins. The Urban analysis assumes that the
country could quickly get to prices 25 percent lower than what Medicare pays. (That change assumes a political revolution, of course, because the
pharmaceutical companies are an extremely effective lobby.) The Sanders campaign and its academic allies dispute some of the Urban Institute’s
assumptions. A critique of the Urban analysis from David Himmelstein and Steffie Woolhandler, professors of public health at the City University of
New York, argues, for example, that drug prices could be pushed even lower. And the Sanders team says that the researchers overestimated the costs
associated with administering the government program. But it doesn’t argue that the prices paid to medical providers could be cut more sharply. The
same problem exists for other attempts to reduce health spending in the United States. Efforts by the Obama administration to pay doctors and
hospitals differently are designed to squeegee some waste out of the system, by eliminating extra care that may not help people’s health. But it has
done little to change the prices paid for medical care. That means that its best hope is to “bend the cost curve,” or reduce the rate that health spending
grows. Republican proposals to make health care into more of a free market also tend to assume that they will slow spending growth, not actually
reduce it. The Sanders plan would require a huge reorganization of the country’s health care system .
Overnight, it would put the private insurance industry out of business, along with many other businesses
that support it. It would shift billions of dollars of spending from individuals, workers and states into the federal
budget. Doing that might well reduce some of the country’s health care spending that is going toward
insurer profits and paper-pushing. But more than 80 percent of the dollars we currently spend on
health care actually go toward health care. And making big cuts all at once to doctors and hospitals
could cause substantial disruptions in care. Some hospitals would go out of business. Some doctors
would default on their mortgages and student loans. Even if the country decided that medicine should become a more middle-
class profession — not an obvious outcome, given the substantial public support for the medical professions — it would be difficult to get there at once.
All of that means that bringing a government-run, single-payer health care system could achieve many of
the goals of its advocates: more equity, lower complexity and some reductions in cost . But the United
States would probably continue to have the most expensive health care system in the world. And
we’d have to raise taxes high enough to pay for it.
2NC—AT: Debt
States spend very little on healthcare---they fund less than 19% of overall costs
Avik Roy 16, the President of the Foundation for Research on Equal Opportunity. Non-partisan, non-profit
think tank. 1/18/16, “Sanders Adviser: Berniecare Would Increase Total Federal Spending by 55 Percent
(at Least)”
Nonetheless, if you take Friedman’s rosy scenario for granted, you’re still looking at an astounding 55 percent increase in total
federal spending from 2017 to 2026. That’s because under current law, “only” 31 percent of U.S. health-care spending
is run through the federal government, while 19 percent goes through state and local governments, 21
percent through businesses, and 29 percent through households. So if the federal government were to assume responsibility for all
U.S. health-care spending, even with some rationing and price controls, federal spending would increase by $28 trillion from 2017 to
2026. Of that, $14 trillion would be paid for by taxes, and the rest would increase the deficit.
2NC—AT: Trump Leads
2NC—AT: US/China War
2NC—True Argument
Solvency deficits to the squo are silly---health insurance isn’t a magical shield against
bioterrorism---the current ACA solves enough of the risk
Petersen 14 (Kimberly Ann Petersen is an M.A. Candidate in Security Studies, Naval Post-Graduate
School, September 2014, “The Affordable Care Act: a prescription for homeland security preparedness?,” As
outlined to this point, the Affordable Care Act has significant potential to bolster the homeland security goal of all-
hazards preparedness. The ACA will not, by itself, fully protect the U.S. population from all biological threats ,
emerging diseases, or food and water-borne illnesses. Health insurance and expanded health care access do not provide
a magical shield from such dangers. However, the ACA is an important step toward improved access to
affordable health care for eligible U.S. residents and is a foundational improvement for homeland
security all-hazards preparedness.
Econ DA
And economic decline turns terror
Schaub 4 (Drew, Professor of Political Science – Penn State University, Journal of Conflict Resolution,
48(2), April)
Despite the caveats, our analysis suggests important policy implications for the war against terrorism. National governments should
realize that economic globalization is not the cause of, but a possible partial solution to, transnational terrorism. Although opening up
one’s border facilitates the movement of terrorists and their activities, our results show that the effect of such facilitation appears
weak. It does not precipitate a significant rise in transnational terrorist attacks within countries. This is an important lesson for policy
makers who are designing antiterrorism policies. More important, economic openness, to the extent that it promotes economic
development, may actually help to reduce indirectly the number of transnational terrorist incidents inside a country.
Closing borders to foreign goods and capital may produce undesirable effects. Economic closure and autarky can
generate more incentives to engage in transnational terrorist activities by hindering economic development.
Antiterrorism policy measures should be designed with caution. They should not be designed to slow down economic globalization.
Promoting economic development and reducing poverty should be important components of the global war
against terrorism. Such effects are structural and system-wide. It is in the best interest of the United States not
only to develop by itself but also to help other countries to grow quickly. The effect of economic development on the
number of transnational terrorist incidents is large. The role of economic development deserves much more attention from
policy makers than it currently enjoys.
AT: Link D
Being topical requires raising taxes to at least partially fund the program
Black’s Law Dictionary (Definition of NATIONAL HEALTH INSURANCE (Black's Law Dictionary),

What is NATIONAL HEALTH INSURANCE? A federal government's insurance benefits system

established to cover all or almost all national citizens. The United States is developing such a program. Tax
money funds these systems entirely or partially.

Be skeptical of Himmelstein and Woolhandler – history of bias and shoddy research

Catron 15 (David – health care consultant and Director of Revenue Cycle services at Memorial Hospital
and Manor, “Obamacare Overhead Study a Trojan Horse,” 6/1/15,

During the past few days the legacy media and the Internet have been flooded with news articles , editorials, and
blog posts with titles like “Overhead costs exploding under ObamaCare.” This all-too-predictable phenomenon has
been breathlessly reported by outlets as different in their ideological perspectives as the Wall Street Journal and the Daily Kos.
Sadly, when liberal and conservative publications are equally enthusiastic about breaking a story, it usually means the latter have
been duped into promoting progressive propaganda. This case is no exception. The basis for these reports is a “study”
produced by a couple of notorious lefty data diddlers. The con artists in question are Doctors David
Himmelstein and Steffie Woolhandler, and their “analysis” can be found at the Health Affairs blog. This pair co-
founded Physicians for a National Health Program (PNHP), whose mission is to get the U.S. on a single-
payer health care system, and their research is uniformly biased against the free market. The purpose of
their Health Affairs post is to pitch a single-payer program based on the Medicare model as a replacement for Obamacare when it
finally collapses: The overhead angle is just a Trojan horse used to sneak their statist infomercial into the
editorial offices of conservative news outlets. The subterfuge worked. Investor’s Business Daily, for example, guilelessly
repeats their figures in the full knowledge that they are longtime single-payer evangelists: “David Himmelstein and Steffie
Woolhandler found ObamaCare increased health care overhead costs by $17 billion last year and will add a total of more than $270
billion by 2020.… Just because these two professors are wrong on their health care prescription doesn’t mean they’re wrong on the
diagnosis.” Are the IBD editors kidding? The “diagnosis” arrived at by these two characters identifies the private health insurance
industry as the underlying disease causing Obamacare’s excess costs. As they wrote in Health Affairs, “Most of this soaring private
insurance overhead is attributable to… private plans which carry high costs for administration and profits.” But Himmelstein and
Woolhandler’s work has more flaws than mere bias against the free market and insurance companies. They have a history
of fudging their figures. During the 2009 health reform debate, for example, they produced two
hopelessly disingenuous studies—one claiming lack of health insurance killed 45,000 people annually
and another alleging the 54 percent of all bankruptcies were caused by medical bills. Both were
debunked by honest researchers here and here respectively. There is no reason to believe that the
numbers used by Himmelstein and Woolhandler in their latest analysis are any more trustworthy
than those used in their other faux studies. But when they seemed to reflect badly on Obamacare, many
conservative outlets jumped on the story and linked to Health Affairs. This provided a lot of undeserved publicity for a piece of
agitprop that consists primarily of long discredited claims about private health insurance and the traditional Medicare program which
ostensibly demonstrate that “a universal single payer system would pare down both insurers’ and providers’ overhead, yielding huge
administrative savings.” In fact, Himmelstein and Woolhandler exhume some claims that have been buried by the facts so many
times that it’s surprising that even they had the audacity to dig them up again. My personal favorite is this preposterous
assertion: “Traditional Medicare runs for 2 percent overhead.” This old chestnut also goes back to the 2009 health
care reform debate and, as Robert A. Book of the Heritage Foundation showed at the time, “On a per-person
basis Medicare’s administrative costs are actually higher than those of private insurance—this despite the
fact that private insurance companies do incur several categories of costs that do not apply to Medicare.”
Even if we take the 2 percent overhead figure seriously, the savings can’t possibly offset the huge sums
Medicare loses to fraud. As John Graham writes in Forbes, “Last February, the Government Accountability Office issued its
annual report on federal programs that it identifies as high risk due to… fraud, waste, abuse, and mismanagement. Medicare is a
longstanding member of the list.” Even the New York Times admits that fraud accounts for an “estimated $60 billion of Medicare’s
costs every year.” It’s a good bet that, if we adopt a single-payer system based on the Medicare model, it will be
equally susceptible to fraud—probably more so. Thus, their own math suggests that we can save countless billions by
doing precisely the opposite of what Himmelstein and Woolhandler advocate. If the high overhead costs they attribute to the
combination of private health insurance and Obamacare are broken down by year, the annual cost is about $34 billion, which
amounts to a little more than half of the money lost by Medicare to fraud and abuse. That suggests we should move toward rather
than away from free market solutions. It would mean more of the free market innovations associated with Medicare Advantage that
have actually slowed the overall annual increase in Medicare spending. But these innovations are anathema to Himmelstein and
Woolhandler. Their criticism of Obamacare notwithstanding, they are by no means against government-run health care. Indeed, they
are dedicated to eliminating private health insurance. They end their Health Affairs post as follows: “In health care, public insurance
gives much more bang for each buck.” The image that sentence evoked can’t be described in this space. Suffice it to say that, unlike
The Crying Game, it doesn’t start with kisses. Conservative news outlets should be more careful about how they quote these
people. They should beware of single-payer shills bearing statistical gifts.

Even starting from Medicare spending would require 14 trillion in new spending over the decade
Pipes 16 (January 21st, 2016, Sally Pipes is president, CEO, and Thomas W. Smith fellow in health care
policy at the Pacific Research Institute, “The Ugly Reality of Single-Payer,”
Late Sunday night, just hours before the fourth Democratic presidential debate, Vermont Sen. Bernie Sanders unveiled what's probably the purest expression to date of his
unreconstructed 1970s radicalism: a plan for "universal" single-payer health care in the United States. Proudly titled "Medicare-for-All," the Sanders scheme would eliminate the
private insurance industry and establish a single, federally run insurance pool open to all. Sanders promises a healthcare utopia – a future of "no more co-pays, no more
deductibles and no more fighting with insurance companies." During Sunday's debate, the candidate claimed that his health care plan would "save the average middle-class
family thousands of dollars a year." This is complete nonsense. Every other single-payer system around the world delivers subpar
care at astronomical cost. Worse still, the multitrillion-dollar tax hikes – that's "trillion," with a "t" – that
Sanders has proposed to finance his single-payer monstrosity would decimate the American economy.
Voters in need of a definitive reason to dismiss Vermont's "democratic socialist" as a legitimate candidate now have one. Sanders's "Medicare-for-All" proposal

would require $14 trillion in new public spending over the next decade and would expand the size of the
federal government by over 50 percent. He plans to cover those costs by ratcheting up taxes on virtually
everyone. He wants to hike income tax rates by 2.2 percentage points and levy a new 6.2 percent payroll tax on employers. He'd also dramatically crank up income tax
rates for families making over $250,000 year. And he'd set the estate tax at 65 percent. These new taxes would slow our economy to a

halt. They'd rob businesses of capital to invest in expansion and job creation. The returns on
entrepreneurship would dwindle. Corporations would direct investments to friendlier environs abroad.
Sanders ought to be intimately familiar with the eye-popping costs of single-payer. They just prevented leaders in his home state from implementing a single-payer scheme
within their borders. Four years ago, the Vermont legislature approved a plan to create a state-level single-payer system with basically all the features of Sanders's "Medicare-
for-All." But last month, Gov. Peter Shumlin announced that he'd be killing the project, specifically because the requisite tax increases on individual earners and businesses
"might hurt our economy." The Sanders "Medicare-for-All" plan is specific about how much lucre it'll extract from the American public, but short on the details about how it would
actually be administered. How will physicians' compensation be determined? Who will they work for? For those that refuse to leave private employment, what will the
punishment be? Who will own hospitals? The list of unanswered questions goes on and on. Sanders and his ilk are pushing for single-payer in the United States in large part
because they admire socialized health care systems in other countries like the United Kingdom and Canada. In their romanticized view, single-payer is more efficient, more
ingle-payer systems typically use price controls to control
egalitarian, more humane and less costly. But the facts don't fit that portrayal. S

the cost of health care goods and services. Those price controls cause the purveyors of health care
goods and services to limit the supply that they'll deliver. Limited supply meets unlimited patient demand – after all, health care
appears "free" – and shortages result. There isn't enough equipment. There aren't enough doctors. And patients, while technically insured, have to endure long wait times
Take the United Kingdom. Over 3.4 million British patients are currently stuck on
before they actually receive care.

waiting lists for care, the biggest total in nearly a decade. That includes 6,100 that have been forced
to wait for at least a year. Those waiting lists have consequences. According to one major study, some 13,000 Brits died unnecessarily while in government
hospitals between 2005 and 2012. Researchers unearthed systemic abuse and negligence. Sick patients were left to waste away in soiled beds without food or water In

Canada, over 40 percent of patients have been forced to wait two months or more to see a specialist. In rural
provinces, the problem is even worse. A recent report found that 90 percent of spine surgery patients in Alberta have had to wait at least six months to get treated. This is the
ugly reality of single payer. And it's what Sanders would bring to America if he becomes president.

Perception of the plan alone reverses Trump’s perception as anti-regs and kills momentum
Tellone 17 (January 23rd, 2017, Dean C. Tellone is an advisor for Tellone Financial, “The Rise of Investor
Confidence & Market Expectations,”
The 2016 stock market year finished off with a rally based on anticipated higher valuations for stocks due
to a new political environment. The new narrative implies that the administration of President
Donald Trump will cut taxes, increase infrastructure spending, reduce regulation, and allow for the repatriation of foreign corporate profits,
along with a host of other business friendly ideas. The expectation of these various tailwinds has re-
ignited investor confidence and lifted economic growth assumptions. Of course, we undoubtedly anticipate volatility in
the markets from legislation bottle necks, unprecedented use of social media as a political weapon, bouts of geopolitical uncertainty in the world community, a stronger dollar
we are cautiously optimistic about the prospects of
impacting multinational companies, and rising interest rate concerns. Nevertheless,

2017, for although the recovery in the US is already seven and a half years old, it is only now starting to take on typical characteristics of a normal recovery in which banks
have been providing credit instead of the Fed, and businesses and households are in good financial shape and can resume normal spending momentum. If you look at the
incoming president, vice president, and the key cabinet positions, its collective 83 years’ worth of business experience is an all-time record in the modern era. This dramatic shift
the NFIB Small Business Optimism Index surged in
in the makeup of political leadership is certainly being noted by businesses. As a result,

December to its highest level in 12 years and at its fastest pace since October 1983, signaling
strengthening upward momentum in response to expectations for pro-growth and more business
friendly policies. The benefit for tax reform is clear, as the system is highly complicated and heavily manipulated. Last year, House Republicans issued a
“blueprint” for reform that is similar to proposals Trump outlined during the campaign, including slashing both individual and corporate tax rates, eliminating the estate tax and
. A reduction in personal income tax rates could provide the underpinning
repealing the Alternative Minimum Tax

for an increase in consumer spending which would further support economic growth. A lowering of
corporate taxes will likely make the US more internationally competitive for major businesses to promote
domestic job creation and bring back cash from overseas. As it stands now, the US marginal corporate tax rate is nearly 39% when
including state/local taxes; ranking it highest among all global industrial countries. The median rate for the other 34 OECD countries is less than 25%. A move to the 15-20%
With concerns for keeping the federal debt in check, we expect the political
range could bolster corporate earnings immensely.

wrangling for how to pay for these tax cuts to be contentious at times and for the actual laws to be full of
compromise. Need for sweeping improvements to national infrastructure is another area that is widely agreed upon. However, while an infrastructure spending
proposal is likely to be discussed this year, the timing and scope of such a program remains unknown. Furthermore, given the fact that the total size of the U.S. GDP exceeds
$18 trillion, it would take a massive infrastructure spending program to materially increase economic growth, particularly given the fact that any such program would likely be
implemented over a period of several years, thereby reducing its impact in any given calendar year. A Caterpillar executive stated that “Even if you step back and thought about
when we would start to see some impact from any sort of infrastructure program, I think the best case scenario you are talking about late 2017.” Such tax reform and fiscal
In many ways, an increasingly harsh
stimulus legislation is complex and it will take time to take effect, so any results won’t be felt until next year.

regulatory environment of the past few years has burdened small business owners from reaching their
potential. While there are undeniable benefits from making sure that markets run fairly and have built-in protections for individual rights and environmental conservation,
there will likely be benefits from rolling back several regulations. Fewer regulations will lower compliance
costs for companies and permit spending on more productive investments. The upcoming year is scattered with political risks
that have the potential to shake up longstanding economic and security arrangements. While the US Presidential election is behind us, many major European nations will
experience significant decisions at the ballot box that will influence their national direction moving forward. The rise of populism and protectionism is likely to continue and the
world is curious to see the implications of the “Brexit” negotiations. Simply stated, uncertainly is abound and rising geopolitical tensions could undermine business confidence at
times. Following the December 2016 quarter point increase in the Federal Feds Rate, we expect further increases to be dependent on global economic stability, the strength of
the dollar, and the pace of inflation. It appears that change from economic policies driven by the Fed have outlived their benefit and a slow but steady normalization of rates is
welcomed. If bond yields are rising due to growth improving, but without inflation taking off, stocks tend to do well in this environment. Overvalued yield proxies may suffer but
this process will benefit sectors heavy in cash and low on debt. Additionally, the absence of an inverted yield curve strongly suggests that recession risk is low and the economy
will remain on an upward path. We will be keeping an eye on investor sentiment for overt signs of excess optimism, as
it can be guaranteed that some of the expectations of the Trump administration and the Republican
Congress will not be met in a time frame being discounted by markets. However, while disappointments are likely on the US
policy front, we would view those as buying opportunities for now. With correlations between individual stocks falling, opportunities

for active management are growing. While it may be a more challenging and tactical environment, there is still upside potential and this regime shift is
ideal for those that are attentive to the signs of momentum and the ability to adjust investment exposure accordingly. Analyst consensus expectation of

about 13% earnings growth for 2017 does not include much benefit from tax reform, infrastructure
spending, or regulatory reform, proving that positive catalysts remain in play. If the new administration executes on its key
initiatives, business and investor confidence could significantly move cash off the sidelines and propel stocks higher. With knowledge and experience in security selection, we
are excited to capture investment opportunities for our clients.

And they kill the insurance industry – devastates the economy

Katz 16 (Margot Sanger-Katz, domestic correspondent for The New York Times, where she writes about health care. 5/16/16, “A
Single-Payer Plan From Bernie Sanders Would Probably Still Be Expensive”
The Sanders plan would require a huge reorganization of the country’s health care system.
Overnight, it would put the private insurance industry out of business, along with many other
businesses that support it. It would shift billions of dollars of spending from individuals, workers and
states into the federal budget. Doing that might well reduce some of the country’s health care spending that is going toward
insurer profits and paper-pushing. But more than 80 percent of the dollars we currently spend on health care actually go toward
health care. And making big cuts all at once to doctors and hospitals could cause substantial
disruptions in care. Some hospitals would go out of business. Some doctors would default on
their mortgages and student loans. Even if the country decided that medicine should become a more middle-class
profession — not an obvious outcome, given the substantial public support for the medical professions — it would be difficult to get
there at once.

The healthcare industry powers the economy – job losses in the sector cause economic recession
Terhune 17 (Chad Terhune, works for the Kaiser Health News, a nonprofit health newsroom. 4/25/17, “In
bid to revamp health care, Trump could hurt one of U.S.'s biggest job creators”

In many ways, thehealth care industry has been a great friend to the U.S. economy. Its plentiful jobs
helped lift the country out of the Great Recession and, partly due to the Affordable Care Act, it now employs
one in nine Americans — up from one in 12 in 2000. As President Donald Trump seeks to fulfill his campaign
pledge to create millions more jobs, the industry would seem a promising place to turn . But the business
mogul also campaigned to repeal Obamacare and lower health care costs — a potentially serious job killer. "The goal of increasing
jobs in health care is incompatible with the goal of keeping health care affordable," said Harvard University economist Katherine
Baicker, who sees advantages in trimming the industry's growth. "There's a lot of evidence we can get more bang for our buck in
health care. We should be aiming for a health care system that operates more efficiently and effectively. That might mean better
outcomes for patients and fewer jobs." But the country has grown increasingly dependent on the health
sector to power the economy. Thirty-five percent of the nation's job growth has come from health
care since the recession hit in late 2007, the single biggest sector for job creation. Hiring rose even more as
coverage expanded in 2014 under the health law and new federal dollars flowed in. It gave hospitals, universities and companies
even more reason to invest in new facilities and staff. Training programs sprang up to fill the growing job pool. Cities welcomed
the development — and the revenue. Simply put, rising health spending has been good for some
economically distressed parts of the country, many of which voted for Trump last year. In
Morgantown, West Virginia, the West Virginia University health system just opened a 10-story medical tower and hired 2,000
employees last year. In Danville, Pennsylvania, the Geisinger Health System has added more than 2,200 workers since July and is
trying to fill 2,000 more jobs across its 12 hospital campuses and a health plan. Out West, the UCHealth system in Colorado
expanded its Fort Collins hospital and is building three hospitals in the state. In cities such as Pittsburgh, Cleveland
and St. Louis, health care has replaced dying industries like coal and heavy manufacturing as a
primary source of new jobs. "The industry accounts for a lot of good middle-class jobs and, in
many communities, it's the single-largest employer," said Sam Glick, a partner at the Oliver Wyman
consulting firm in San Francisco. "One of the hardest decisions for the new Trump administration is how far do they push on health
care costs at the expense of jobs in health care." House Republicans, with backing from Trump, took the first swipe. Their American
Health Care Act sought to roll back the current health law's Medicaid expansion and cut federal subsidies for private health
insurance. The GOP plan faltered in the House, but Republican lawmakers and the Trump administration are still trying to craft a
replacement for Obamacare. Neither the ACA nor the latest Republican attempt at an overhaul tackle what some industry experts
and economists see as a serious underlying reason for high health care costs: a system bloated by redundancy, inefficiency and a
growing number of jobs far removed from patient care. Labor accounts for more than half of the $3.4 trillion spent on U.S. health
care, and medical professionals from health aides to nurse practitioners are in high demand. But the sheer complexity of
the system also has spawned jobs for legions of data-entry clerks, revenue-cycle analysts and
medical billing coders who must decipher arcane rules to mine money from human ills. For every
physician, there are 16 other workers in U.S. health care. And half of those 16 are in administrative
and other nonclinical roles, said Bob Kocher, a former Obama administration official who worked on the Affordable Care
Act. He's now a partner at the venture capital firm Venrock in Palo Alto, California. "[W]hat's driving our health insurance premiums
is that we are paying the wages of a whole bunch of people who aren't involved in the delivery of care. Hospitals keep raising their
rates to pay for all of this labor," Kocher said. Take medical coders. Membership in the American Academy of
Professional Coders has swelled to more than 165,000, up 10,000 in the past year alone. The
average salary has risen to nearly $50,000.

Single payer’s taxes devastates their small business link

Scott 17 (Tom – State executive director at the California National Federation of Independent Business,
“Single Payer Government Takeover of Health Care Would Devastate Small Business,” 6/22/17,
Each year, our NFIB small business owners rank their top 75 concerns in our “Problems and Priorities” survey, which provides
critical insight as to which policy issues are having the greatest impact on our job creators. The rising cost of health care has
a government takeover of our health
consistently ranked as the No.1 issue to our members for the last several years, and
care industry would only exacerbate this growing concern. Senate Bill 562 (Senators Lara and Atkins) creates an enormous
bureaucracy which would add unbearable costs on struggling small business owners, at a time when the
state is already burdening them with higher minimum wage costs and drastic gas tax increases. In California, 99.8% of businesses
are small business, and half of all workers in the state are employed by a small business. The cost and bureaucracy
created by single payer health care in California would be a direct assault on our vulnerable small
businesses. And we must remember who owns and operates small businesses: working families. Do we really have faith in
government to manage and deliver a complex health care system to our nearly 40 million residents? This state has mismanaged
public employee pension funds, resulting in a half-trillion-dollar unfunded taxpayer liability. This state has mismanaged billions in gas
tax dollars, resulting in crumbling roads and even higher taxes. This state can’t even build a bridge under budget, or maintain a
critical dam. Now some in the Legislature want to hand over our entire health care system to the state? The annual $400 to
$500 billion price tag on SB 562 is more than three times our state General Fund, and can only be funded through
steep tax increases on struggling small businesses and working families. As the highest taxed state in the
nation, single payer can only be funded through drastic tax increases on struggling small
businesses and middle-class families. This bill will kill jobs, hurt working families, and make
health care more expensive for all.
Populism DA
AT: Link
Reversing Trump failure undoes the Trump effect and strengthens nationalist parties in Europe—
this card is about health-care
Kellner 17 (3/6, Peter, a journalist, political commentator, and former president of YouGov. “Peak
Populism, Perhaps”,

The question is this: Did

populism in Europe and the United States peak on November 8, 2016? This was the
day Donald Trump was elected U.S. president. A few months earlier, the UK had voted to leave the EU. Since then, forests have
been laid bare to provide the paper on which speculation has been printed about the populist future of the Western world. Austria might elect a
neofascist president; far-right politician Geert Wilders might dominate Dutch politics; National Front Leader Marine Le Pen might win the 2017
Let’s look at
presidential election in France; and the anti-immigration Alternative for Germany (AfD) might drag German politics way to the Right.
what has actually happened since November. Six weeks after his inauguration, Trump is the least
popular new U.S. president in polling history. His administration is mired in scandal. He has had to tone down a
number of the policies on which he was elected, from repealing his predecessor’s healthcare reform, known as
Obamacare, and withdrawing from the July 2015 international agreement with Iran on nuclear weapons to weakening support for NATO and getting
Mexico to pay for a wall on the United States’ southern border . Trump’s speech to the U.S. Congress on February 28 was widely
praised—and cheered by the financial markets—because it signaled a reversion to a conventional right-of-center agenda. In the battle
between reality and populism, reality is now winning. In the UK, the picture is more mixed. Prime Minister Theresa May is
expected to formally start the process of Brexit this month when she triggers Article 50 of the Treaty on European Union. Britain will probably be out of
the EU by spring 2019. But it is becoming clear that Brexit will not lead the people who voted for it to a land of milk and honey. Even though the British
economy continued to grow in the months after last June’s referendum, signs of fragility are beginning to emerge. Rising inflation is eating into living
standards; the housing market is weak; international investors are holding back; and advertising on the UK’s main commercial television channel has
suffered an unexpected fall as a result of business nervousness. It is far too early to predict the political consequences of all this, but the possibility of
an anti-Brexit backlash cannot be ruled out. Meanwhile, the Euroskeptic UK Independence Party (UKIP) is in bad shape and getting worse. Its former
leader, Nigel Farage, has been having a furious row in public with its only member of parliament, Douglas Carswell. On March 2, the party’s new
leader, Paul Nuttall, fought a parliamentary by-election that he was widely expected to win. Instead, he came a distant second, after claims about his
past on his website turned out to be untrue. The party’s days as a significant force may be drawing to a close. In mainland Europe, Austria
rejected Norbert Hofer, the far-right Freedom Party of Austria candidate, in its presidential election. In the initial vote in May 2016, he came
within 31,000 votes of Alexander Van der Bellen, an independent candidate supported by the Green Party, in a total vote of 4.5 million. After the
Constitutional Court ruled that there had been irregularities in the count, the contest was rerun in December 2016. This time, Van der Bellen won by
almost 350,000 votes. Le Pen is heading for defeat in France’s presidential election. She is likely to be in the second-round runoff on May
7, but polls suggest she will struggle to win more than 40 percent of the vote in that ballot. Indeed, she is no longer as certain as she seemed a few
weeks ago to win the first-round ballot. The latest polls put her first-round support at 25–27 percent, only fractionally ahead of the independent
candidate Emmanuel Macron, on 23–25 percent. Her support has stalled, while his is rising—and the polls have yet to measure the impact of the
Republican candidate Fran-çois Fillon being placed under investigation over payments to his wife. A clear Macron victory in May would suggest that it
is possible for a centrist leader to defeat a populist insurgency. In the Netherlands, Wilders’s
Party for Freedom (PVV) may also
fail to come first in the March 15 parliamentary election. Polls in December 2016 suggested that the PVV might win as many as 37 seats in the
150-member parliament, comfortably ahead of any other party. The latest surveys suggest that the PVV may end up with around 25 seats and may
even cede first place to the center-right People’s Party for Freedom and Democracy (VVD). In Germany, support for the AfD peaked in early January at
In Finland,
around 15 percent. An average of more recent polls puts its support at 10 percent, down one-third since the start of the year.
support for the far-right Finns Party has halved since the 2015 parliamentary election, from 18 percent to
9 percent. This is largely because the party has paid the price of doing well enough last time to join the governing coalition. The compromises of
power and the need to accommodate to reality have deprived the party’s message of its populist clarity. Coming third last time, the Finns Party may
Perhaps these are no more than flimsy straws in a fickle
struggle to avoid coming sixth at the next election, due in 2019.
wind. Perhaps Trump will shrug off his recent setbacks. Perhaps Britain’s UKIP, the Freedom Party of Austria, France’s
National Front, the Netherlands’ PVV, Germany’s AfD, and Finland’s Finns Party will all come roaring back. This is certainly no time for
the opponents of right-wing nationalism to relax their guard. But perhaps November 8 did represent peak populism.
Future historians may look back on the political turmoil of recent years in many Western countries not as
the overture to a new age of nationalism but as a short-lived threat that challenged, but did not in the
end destroy, the international liberal order.
AT: Internal Link
Weakening center causes political instability across the continent – makes coordinated responses
to migration, terrorism, and climate change impossible.
Bosoni 17 (5/23, Adriano, Senior Europe Analyst, Stratfor, “Why the Decline of Europe's Center-Left Matters”,

Implications of a Weakened Center After World War II, political competition in Western Europe pitted
centrist forces that, while separated by ideology on many issues, shared common objectives on fundamental domestic and foreign
policy questions. This system produced stable, prosperous democracies that kept most voters close to the
political center and relegated those with extreme views to the fringes. In any democracy, groups representing certain economic and political
interests hold power while groups representing other interests find themselves in the opposition. For most of the past seven decades in Europe
(perhaps with the exception of the turbulent 1970s), the views of the groups in the opposition were not radically different from those of groups in power.
Most political players accepted the rules of the game, and a change in government did not mean a radical change of direction for the country. The
decline of social democratic parties could upend this stability. If the center-left is no longer relevant,
then the center-right no longer has a moderate interlocutor. If the segment of society not represented by
the government is fundamentally opposed to the current social, economic and political system, it sets the
stage for significant disruptions to the existing order. Social democratic parties in Europe have some soul-searching ahead
of them if they want to remain relevant. If the economic system that brought them to power no longer exists, and if parts of their political platforms are
obsolete, then how can they adapt to the new reality? The emergence of populist parties demonstrates that the concerns that originally led to the rise
of social democracy such as inequality and redistribution of wealth still resonate in the 21st century. The challenge for social democrats will be to
present their views in ways that connect with today's voters but are still different than those of their extremist rivals. The center-left has yet to figure out
Europe will face numerous tests in the
how to fight the new war, and until it does, it may find itself relegated to political weakness.
coming years. Countries will have to restructure their economies to regain competitiveness and redesign
their welfare states to make them more sustainable. They will also have to figure out how to respond to
issues like terrorism, immigration, global warming and demographic change . In the absence of
political stability or a degree of consensus among social, political and economic interests, the reforms
necessary to address those problems will be difficult to introduce . Without them, the ground for
additional, and perhaps more virulent, social and political instability will remain fertile. As the strong
performance of right-wing and left-wing populist parties in the French presidential election demonstrated, a disappointed electorate can embrace the
extremes if it feels that the political center is no longer serving them.