1NC

European populism declining thanks to Trump incompetence.

Silver 17 (6/14, Nate, “Donald Trump Is Making Europe Liberal Again”, https://fivethirtyeight.com/features/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.

Trump incompetence is a bulwark against the spread of populism in Europe – plan

reverses a string of governing disasters.
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?”,
http://www.cnn.com/2017/02/08/opinions/trump-european-populism-andelman/index.html)

(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

Above all, what Europeans value most from their leaders is

popularity, as contiguous as it may appear with the views of Donald Trump.

competence and a 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 action he has taken since his inauguration." So, Trump's actions are being
monitored closely across the Atlantic . Ironically, 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,” https://www.stratfor.com/weekly/new-drivers-europes-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 racial overtones.

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

It was the first to face default to impose austerity to experience the brutal weight and
, the first , the first that resulted now it is the first

to elect a government that pledges to end austerity Left or right, these parties are 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 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. There is reason to 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 are afoot will end or inhibit Europe's free-trade zone. Right-wing parties' goal of limiting the cross-border movement of workers already

But Germany, the export addict, needs the free-trade zone badly This is one
represents an open demand for an end to the free-trade zone for labor. .

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. Rational 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 the free-trade zone. Having open borders seemed like a good idea during prosperous times,

but the fear of Islamist terrorism make those open borders less and less likely
and the fear of Italians competing with Bulgarians for scarce jobs

to endure if nations can erect walls for people, then why not erect walls for goods to protect their
. And

own industries and jobs? protectionism hurts the economy In the long run, , but Europe is dealing with many people who don't have a long run, have fallen from the professional

For Germany
classes and now worry about how they will feed their families. the loss of the euro would be
, which depends on free access to Europe's markets to help prop up its export-dependent economy,

the loss of a tool for managing trade But the rise of protectionism in Europe would be a calamity. The German economy
within and outside the eurozone.

would stagger the argument about austerity is over

without those exports. From my point of view, . The European Central Bank ended the austerity regime half-heartedly last week, and the Syriza

If Europe's defaults surge the question of

victory sent an earthquake through Europe's political system, although the Eurocratic elite will dismiss it as an outlier. — structured or unstructured — as a result,

the euro 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 as

It is not hard to imagine the disaster that would ensue if the United States were to export 50
the conventional wisdom.

percent of its GDP, and half of it went to Canada and Mexico that is . A free-trade zone in which the giant pivot is not a net importer can't work. And

exactly the situation 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-

the political base is dissolving

states in Europe by 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 whether

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

Europe, unable to maintain its union, will see a return of nationalism and its possible consequences . As I

The most important question in the world is whether conflict and war have actually been
put it in Flashpoints:

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 – multiple warrants.
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,
http://www.forbes.com/sites/lorenthompson/2014/04/24/four-ways-the-ukraine-crisis-could-escalate-to-use-of-nuclear-weapons/)

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

One facet of
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 up.

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 says Russia has about 2,000 nonstrategic nuclear warheads in its

Russian military strategy appear “to place a greater

active arsenal — many of them within striking distance of Ukraine — and that successive revisions of

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 N uclear P osture R eview, 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

i nter c ontinental b allistic m issile 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 http://blogs-images.forbes.com/lorenthompson/files/2014/04/19-03-2012-parade-rehearsal_-_topol-m.jpg) 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 in Ukraine, which Washington and Moscow approach from very different

perspectives. Any sizable deployment of U.S. forces in the region could 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 rationale for an invasion, sending a warning signal to Kiev about its internal counter-terror campaign, or trying to accomplish some other purpose.

Misinterpretation of such signals can 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

the use of “only” one or two tactical nuclear warheads to

Washington might face the collapse of NATO, its most important alliance. In such circumstances,

avert an outcome with 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
 When you consider all the processes working to degrade
homeland, and obstacles to local initiative often break down once hostilities commence.

restraint 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.
 1NC
The plan is committed to austerity logic – that ideology is tied to the project of
neoliberalism. Together, these have become an unmitigated disaster
Breu ’14 CHRISTOPHER BREU is Associate Professor of English at Illinois State University. He is author of Insistence of the Material:
Literature in the Age of Biopolitics (2014) and Hard-Boiled Masculinities (2005).

The link between primitive accumulation, or what Harvey terms accumulation by dispossession, and austerity is not an accidental or arbitrary
one. As a morality, austerity works to naturalize and further the work of accumulation by dispossession, or
the generation of profit by the transfer or appropriation of wealth from one person or one entity to another. Accumulation by
dispossession works through various means, including copyright law, interest rates, privatization, appropriations of the commons,
and, when all else fails, violent acquisition (other words for primitive accumulation, as Marx points out, are “conquest, enslavement,

robbery, murder, in short, force,”) (1977, 874). Austerity works to justify previous moments of accumulation by
dispossession, such as the interest produced by credit and especially subprime credit, that fueled both the housing bubble before the
2007 crash and much of the wealth generated and utilized by the derivative markets in the same era. As Blyth argues, the current “sovereign
debt crisis,” the ostensible justification for current austerity measures, is an effect of the bank bailouts and losses that occurred after the 2007-
2008 crash: That there is a crisis in sovereign [i.e. sovereign nation-state] debt markets, especially in Europe, is not in doubt. But that is an
effect not a cause. There was no orgy of government spending to get us there. … There is no crisis of sovereign debt caused by sovereigns’
spending unless you take account of actual spending and continuing liabilities caused by the rupture of the national banking systems. What
begins as a banking crisis ends with a banking crisis, even if it goes through the states’ accounts. But there is a politics of making it appear to be
the states’ fault such that those who made the bust don’t have to pay for it. Austerity is not just the price of saving the banks. It’s the price that
Austerity is thus first an ideology , one that masks and naturalizes the
the banks want someone else to pay.

appropriation and use of public and common resources by private entities. Moreover this ideology is not merely
retrospective, a means to justify not only the on-going bank bailouts and the unprecedented appropriations of public and common resources
that has taken place under neoliberalism, but [End Page 29] also future-oriented as well. To the degree that we assent to austerity’s allegory,
it
presents the public (both collectively and as individual citizens) as being at fault for the moral and
economic insolvency of the state and of its own position within the capitalist world system. It thus presents
an ongoing justification for asset stripping, the destruction of public services, and a renewed commitment to an ascetic work ethic. The
effectiveness of such a narrative is in its individualizing effects. Not only are individual citizens judged in terms of their relationship to
insolvency and debt, but countries are treated like individuals. This
personification is one of the most pernicious effects
of the allegory of austerity: the common sense produced by austerity has the effect of imagining
public debt on the order of personal debt, even as these are radically different forms of debt. Austerity
as an ideology is thus built upon and works to justify the fragmenting effects that David Harvey attributes to
accumulation by dispossession: “Dispossession, on the other hand, is fragmented and particular--a privatization here, an environmental
degradation there, a financial crisis of indebtedness somewhere else” (2005, 178). Austerity and accumulation by dispossession thus both work
by particularizing more generalized social dynamics--thus transforming, like most ideologies within capitalism, collective and socially produced
into the particular and individualized. Such a position of course also masks any systematic understanding of debt as a necessary product of the
capitalist world system, with its exploitative and unequal relationships, as Immanuel Wallerstein argues, between core and periphery (mediated
by forces such as the IMF and their national equivalents, like the Federal Reserve), which in turn shapes the position of both states and
individuals to the structures of debt and solvency (2000, 88-92). In this way, austerity as an allegory both echoes and differs from the logic of
“human capital” that Michel Foucault argues is central to the form of biopolitics distinctive to neoliberalism (2008, 226). Foucault argues that
biopolitics (the political and economic management and direct shaping of biological life in the aggregate) works via the market under
neoliberalism. Individual subjects are seen primarily as bearers of human capital, which measures the subject’s ability to generate profit and
income and thus maximize their life opportunities. In neoliberal biopolitics, all social relationships are privatized and marketized; individuals are
deemed investment worthy (a.k.a. employable) or disposable depending on the share of human capital they possess. As ugly as this rhetoric is,
with its spoils go to the winner mentality, the rhetoric of human capital still articulates a vision of economic investment (although one targeted
to the already well off and socially advantaged). In contrast, the
rhetoric of austerity treats all laboring subjects (whether
citizens or nation states) as
indebted and guilty before the law of accumulation. It thus can be used to justify
all kinds of cost-cutting, appropriation, and asset stripping, even in situations of marked productivity
and efficiency. If “human capital” is the logic of neoliberalism in its expansionist periods, then austerity is its logic in periods of decline and
divestment. [End Page 30]
The impact is extinction
Robinson 16 (William I., Prof of Sociology, Global Studies, and Latin American Studies @
UC Santa Barbara, “Sadistic Capitalism: Six Urgent Matters for Humanity in Global
Crisis,” Truthout, 4/12/16, http://www.truth-out.org/opinion/item/35596-sadistic-
capitalism-six-urgent-matters-for-humanity-in-global-crisis)
In these mean streets of globalized capitalism in crisis, it has become profitable to turn poverty and inequality into a tourist attraction. The
South African Emoya Luxury Hotel and Spa company has made a glamorized spectacle of it. The resort recently advertised an opportunity for
tourists to stay "in our unique Shanty Town ... and experience traditional township living within a safe private game reserve environment." A
cluster of simulated shanties outside of Bloemfontein that the company has constructed "is ideal for team building, braais, bachelors [parties],
theme parties and an experience of a lifetime," read the ad. The luxury accommodations, made to appear from the outside as shacks, featured
paraffin lamps, candles, a battery-operated radio, an outside toilet, a drum and fireplace for cooking, as well as under-floor heating, air
conditioning and wireless internet access. A well-dressed, young white couple is pictured embracing in a field with the corrugated tin shanties
in the background. The only thing missing in this fantasy world of sanitized space and glamorized poverty was the people themselves living in
poverty. The "luxury shanty town" in South Africa is a fitting metaphor for global capitalism as a whole. Faced with a stagnant
global economy , elites have managed to turn war , structural violence and inequality into
opportunities for capital, pleasure and entertainment. It is hard not to conclude that unchecked capitalism has become
what I term "sadistic capitalism," in which the suffering and deprivation generated by capitalism become a source of aesthetic pleasure,
leisure and entertainment for others. I recently had the opportunity to travel through several countries in Latin America, the Middle East, North
Africa, East Asia and throughout North America. I was on sabbatical to research what the global crisis looks like on the ground around the
world. Everywhere I went, social polarization and political tensions have reached explosive dimensions . Where is
the crisis headed, what are the possible outcomes and what does it tell us about global capitalism and resistance? This crisis is not like

earlier structural crises of world capitalism, such as in the 1930s or 1970s. This one is fast becoming
systemic . The crisis of humanity shares aspects of earlier structural crises of world capitalism, but there are six novel,
interrelated dimensions to the current moment that I highlight here, in broad strokes, as the "big picture" context in which
countries and peoples around the world are experiencing a descent into chaos and uncertainty. 1) The level of global social

polarization and inequality is unprecedented in the face of out-of-control, over-accumulated capital.

In January 2016, the development agency Oxfam published a follow-up to its report on global inequality that had been released the previous
year. According to the new report, now just 62
billionaires -- down from 80 identified by the agency in its January 2015 report -- control
as much wealth as one half of the world's population, and the top 1% owns more wealth than the
other 99% combined. Beyond the transnational capitalist class and the upper echelons of the global power bloc, the richest 20
percent of humanity owns some 95 percent of the world's wealth, while the bottom 80 percent has to
make do with just 5 percent. This 20-80 divide of global society into haves and the have-nots is the new global social
apartheid . It is evident not just between rich and poor countries, but within each country, North and South,
with the rise of new affluent high-consumption sectors alongside the downward mobility, "precariatization,"
destabilization and expulsion of majorities. Escalating inequalities fuel capitalism's chronic problem of
over-accumulation : The transnational capitalist class cannot find productive outlets to unload the enormous amounts of surplus it has
accumulated, leading
to stagnation in the world economy . The signs of an impending depression are
everywhere. The front page of the February 20 issue of The Economist read, "The World Economy: Out of Ammo?" Extreme levels
of social polarization present a challenge to dominant groups. They strive to purchase the loyalty of that 20 percent,
while at the same time dividing the 80 percent, co-opting some into a hegemonic bloc and repressing the rest. Alongside the spread of
frightening new systems of social control and repression is heightened dissemination through the culture industries and corporate marketing
strategies that depoliticize through consumerist fantasies and the manipulation of desire. As
"Trumpism" in the United States so well
illustrates, another strategy of co-optation is the manipulation of fear and insecurity among the
downwardly mobile so that social anxiety is channeled toward scapegoated communities . This
psychosocial mechanism of displacing mass anxieties is not new, but it appears to be increasing around the
world in the face of the structural destabilization of capitalist globalization. Scapegoated communities
are under siege, such as the Rohingya in Myanmar, the Muslim minority in India, the Kurds in Turkey, southern African immigrants in
South Africa, and Syrian and Iraqi refugees and other immigrants in Europe. As with its 20th century predecessor, 21st century fascism

hinges on such manipulation of social anxiety at a time of acute capitalist crisis. Extreme inequality
requires extreme violence and repression that lend to projects of 21st century fascism. 2) The system
is fast reaching the ecological limits to its reproduction. We have reached several tipping points in what
environmental scientists refer to as nine crucial "planetary boundaries." We have already exceeded these

boundaries in three areas -- climate change , the nitrogen cycle and diversity loss . There have been five previous
mass extinctions in earth's history. While all these were due to natural causes, for the first time ever, human conduct is intersecting with and
fundamentally altering the earth system. We have entered what Paul Crutzen, the Dutch environmental scientist and Nobel Prize winner,
termed the Anthropocene -- a new age in which humans have transformed up to half of the world's surface. We are altering the composition of
the atmosphere and acidifying the oceans at a rate that undermines the conditions for life. The ecological dimensions of
global crisis cannot be understated. "We are deciding, without quite meaning to, which evolutionary pathways will remain open and which will
forever be closed," observes Elizabeth Kolbert in her best seller, The Sixth Extinction. "No other creature has ever managed this ... The Sixth
Extinction will continue to determine the course of life long after everything people have written and painted and built has been ground into
dust." Capitalism cannot be held solely responsible. The human-nature contradiction has deep roots in civilization itself. The ancient Sumerian
empires, for example, collapsed after the population over-salinated their crop soil. The Mayan city-state network collapsed about AD 900 due
to deforestation. And the former Soviet Union wrecked havoc on the environment. However, given capital's implacable impulse
to accumulate profit and its accelerated commodification of nature, it is difficult to imagine that the
environmental catastrophe can be resolved within the capitalist system. "Green capitalism" appears
as an oxymoron, as sadistic capitalism's attempt to turn the ecological crisis into a profit-making opportunity, along with the conversion
of poverty into a tourist attraction. 3) The sheer magnitude of the means of violence is unprecedented, as is the
concentrated control over the means of global communications and the production and circulation of knowledge, symbols and images. We
have seen the spread of frightening new
systems of social control and repression that have brought us into the
panoptical surveillance society and the age of thought control . This real-life Orwellian world is in a sense more perturbing
than that described by George Orwell in his iconic novel 1984. In that fictional world, people were compelled to give their obedience to the
state ("Big Brother") in exchange for a quiet existence with guarantees of employment, housing and other social necessities. Now, however, the
corporate and political powers that be force obedience even as the means of survival are denied to the vast majority. Global apartheid involves
the creation of "green zones" that are cordoned off in each locale around the world where elites are insulated through new systems of spatial
reorganization, social control and policing. "Green zone" refers to the nearly impenetrable area in central Baghdad that US occupation forces
established in the wake of the 2003 invasion of Iraq. The command center of the occupation and select Iraqi elite inside that green zone were
protected from the violence and chaos that engulfed the country. Urban areas around the world are now green zoned through
gentrification, gated communities, surveillance systems, and state and private violence. Inside the world's
green zones, privileged strata avail themselves of privatized social services, consumption and entertainment. They can work and communicate
through internet and satellite sealed off under the protection of armies of soldiers, police and private security forces. Green zoning takes on
distinct forms in each locality. In Palestine, I witnessed such zoning in the form of Israeli military checkpoints, Jewish settler-only roads and the
apartheid wall. In Mexico City, the most exclusive residential areas in the upscale Santa Fe District are accessible only by helicopter and private
gated roads. In Johannesburg, a surreal drive through the exclusive Sandton City area reveals rows of mansions that appear as military
compounds, with private armed towers and electrical and barbed-wire fences. In Cairo, I toured satellite cities ringing the impoverished center
and inner suburbs where the country's elite could live out their aspirations and fantasies. They sport gated residential complexes with spotless
green lawns, private leisure and shopping centers and English-language international schools under the protection of military checkpoints and
private security police. In other cities, green zoning is subtler but no less effective. In Los Angeles, where I live, the freeway system now has an
express lane reserved for those that can pay an exorbitant toll. On this lane, the privileged speed by, while the rest remain one lane over, stuck
in the city's notorious bumper-to-bumper traffic -- or even worse, in notoriously underfunded and underdeveloped public transportation,
where it may take half a day to get to and from work. There is no barrier separating this express lane from the others. However, a near-invisible
closed surveillance system monitors every movement. If a vehicle without authorization shifts into the exclusive lane, it is instantly recorded by
this surveillance system and a heavy fine is imposed on the driver, under threat of impoundment, while freeway police patrols are ubiquitous.
Outside of the global green zones, warfare and police containment have become normalized and sanitized for
those not directly at the receiving end of armed aggression. "Militainment" -- portraying and even glamorizing war and violence
as entertaining spectacles through Hollywood films and television police shows, computer games and corporate "news" channels --
may be the epitome of sadistic capitalism. It desensitizes, bringing about complacency and indifference. In between the
green zones and outright warfare are prison industrial complexes, immigrant and refugee repression and control
systems, the criminalization of outcast communities and capitalist schooling. The omnipresent media and
cultural apparatuses of the corporate economy, in particular, aim to colonize the mind -- to undermine the ability to think

critically and outside the dominant worldview. A neofascist culture emerges through militarism ,
extreme masculinization , racism and racist mobilizations against scapegoats. 4) We are reaching limits to
the extensive expansion of capitalism . Capitalism is like riding a bicycle: When you stop pedaling the bicycle, you fall over. If
the capitalist system stops expanding outward, it enters crisis and faces collapse. In each earlier
structural crisis, the system went through a new round of extensive expansion -- from waves of colonial
conquest in earlier centuries, to the integration in the late 20th and early 21st centuries of the former socialist countries,
China, India and other areas that had been marginally outside the system. There are no longer any new territories to
integrate into world capitalism. Meanwhile, the privatization of education, health care, utilities, basic services and public land are
turning those spaces in global society that were outside of capital's control into "spaces of capital." Even poverty has been turned into a
commodity. What is there left to commodify? Where can the system now expand? With
the limits to expansion comes a turn
toward militarized accumulation -- making wars of endless destruction and reconstruction and expanding
the militarization of social and political institutions so as to continue to generate new opportunities
for accumulation in the face of stagnation. 5) There is the rise of a vast surplus population inhabiting a
"planet of slums," alienated from the productive economy, thrown into the margins and subject to these sophisticated systems
of social control and destruction. Global capitalism has no direct use for surplus humanity. But indirectly, it holds wages down

everywhere and makes new systems of 21st century slavery possible. These systems include prison labor , the forced

recruitment of miners at gunpoint by warlords contracted by global corporations to dig up valuable minerals in the Congo, sweatshops
and exploited immigrant communities (including the rising tide of immigrant female caregivers for affluent populations).
Furthermore, the global working class is experiencing accelerated "precariatization." The "new precariat" refers to the
proletariat that faces capital under today's unstable and precarious labor relations -- informalization, casualization, part-time,
temp, immigrant and contract labor. As communities are uprooted everywhere, there is a rising reserve army of
immigrant labor. The global working class is becoming divided into citizen and immigrant workers. The latter are particularly attractive
to transnational capital, as the lack of citizenship rights makes them particularly vulnerable, and therefore, exploitable. The
challenge for dominant groups is how to contain the real and potential rebellion of surplus humanity, the immigrant workforce and the
precariat. How can they contain the explosive contradictions of this system? The 21st century megacities become
the battlegrounds between mass resistance movements and the new systems of mass repression. Some populations in these cities (and
also in abandoned countryside) are at risk of genocide , such as those in Gaza, zones in Somalia and Congo, and swaths of Iraq and

Syria. 6) There is a disjuncture between a globalizing economy and a nation-state-based system of

political authority. Transnational state apparatuses are incipient and do not wield enough power and
authority to organize and stabilize the system, much less to impose regulations on runaway
transnational capital. In the wake of the 2008 financial collapse, for instance, the governments of the G-8 and G-20 were unable to
impose transnational regulation on the global financial system, despite a series of emergency summits to discuss such regulation. Elites
historically have attempted to resolve the problems of over-accumulation by state policies that can regulate the anarchy of the market.
However, in recent decades, transnational capital has broken free from the constraints imposed by the nation-
state. The more "enlightened" elite representatives of the transnational capitalist class are now clamoring for transnational mechanisms of
regulation that would allow the global ruling class to reign in the anarchy of the system in the interests of saving global capitalism from itself
and from radical challenges from below. At the same time, the division of the world into some 200 competing nation-states is not the most
propitious of circumstances for the global working class. Victories in popular struggles from below in any one country or region can (and often
do) become diverted and even undone by the structural power of transnational capital and the direct political and military domination that this
structural power affords the dominant groups. In Greece, for instance, the leftist Syriza party came to power in 2015 on the heels of militant
worker struggles and a mass uprising. But the party abandoned its radical program as a result of the enormous pressure exerted on it from the
European Central Bank and private international creditors. The Systemic Critique of Global Capitalism A growing number of transnational elites
themselves now recognize that anyresolution to the global crisis must involve redistribution downward of income.
However, in the viewpoint of those from below, a neo-Keynesian redistribution within the prevailing corporate
power structure is not enough. What is required is a redistribution of power downward and transformation
toward a system in which social need trumps private profit. A global rebellion against the
transnational capitalist class has spread since the financial collapse of 2008. Wherever one looks,
there is popular, grassroots and leftist struggle, and the rise of new cultures of resistance: the Arab Spring; the resurgence of
leftist politics in Greece, Spain and elsewhere in Europe; the tenacious resistance of Mexican social movements following the Ayotzinapa
massacre of 2014; the favela uprising in Brazil against the government's World Cup and Olympic expulsion policies; the student strikes in Chile;
the remarkable surge in the Chinese workers' movement; the shack dwellers and other poor people's campaigns in South Africa; Occupy Wall
Street, the immigrant rights movement, Black Lives Matter, fast food workers' struggle and the mobilization around the Bernie Sanders
presidential campaign in the United States. This global revolt is spread unevenly and faces many challenges . A number
of these struggles, moreover, have suffered setbacks, such as the Greek working-class movement and, tragically, the Arab Spring. What type of
a transformation is viable, and how do we achieve it? How
we interpret the global crisis is itself a matter of vital
importance as politics polarize worldwide between a neofascist and a popular response. The systemic
critique of global capitalism must strive to influence, from this vantage point, the discourse and
practice of movements for a more just distribution of wealth and power. Our survival may depend on
it.

The alternative is to align yourself with the anti-capitalist demand for universal and
comprehensive national health care. That’s key to anti-capitalist movements.
CPUSA 5 (Communist Party USA Healthcare Commission, “A United States Socialist
Vision of Health,” 4/5/5, http://www.cpusa.org/party_voices/a-united-states-socialist-
vision-of-health/)
Current State Of the Struggle for Healthy Families in the USA; And What to do About It The
outright greed of the health care
industry in the United States generates huge corporate profits on the one hand, and at the same time increasingly
excludes access to quality health care for millions of working families across the nation. Untold misery and
uncounted premature deaths are left in its wake. These two processes have become inseparable in the United States.
They have resulted in the highest health care costs in the worldboth in terms of the cost of health care relative to the
rest of the nations economy, and in terms of the per-person cost of health care. A significant portion of these costs are in
actuality profits. At the same time, the health of American families, compared to the health of the people of all nations, has been steadily
falling behind for decades. The World Health Organization continually lists the United States at 37th of all nations in the world. The class

and race aspects of the U.S. system are dramatic . If you have the money, you can afford to pay the excessive out-of-pocket
costs for expensive health services like chemotherapy, MRI tests and related diagnostic and treatments. The fancy technology that health
industry power brokers proclaim is often reserved for those with financial resources. The racist edge has been proven over and over again. A
few simple statistics prove the point: African American males life expectancy is just 61 years old, well below the normal retirement age; and
Monopoly is the
infant mortality in African American inner cities is two to three times greater than in more affluent parts of U.S. cities.

central feature of the U.S. health care industry. During the last several decades control over vast health
resources have been concentrated in the hands of fewer and fewer corporate entities. Hospitals and nursing
homes are owned by the hundreds by these entities. The old health insurance companies have grown to become diversified international
corporations that both sell health insurance on the one hand, and provide health care through vast holdings of hospitals, clinics, and health
maintenance organizations (HMOs), on the other. They are working both sides of the street, so to speak, in a way that has no precedent in the
industry. These health industry giants have come to dominate entire communities, and increasingly entire regions as monopolies. The
invasion of communities by these corporate health care giants has resulted in a series of destructive,
sometimes deadly, changes in the capacities of communities to care for families. Where there used to be a large number of health
facilities, expanding hospital chains often buy up both public and private nonprofit hospitals in communities. Sometimes they convert them to
for-profit hospitals as an acquisition to their holdings, and sometimes they simply close them down. In New York, investor owned
hospitals are not allowed, so the massive voluntary, not for profit hospitals are being combined as if they were for profit. These hospitals act is
if they are profit generating. The guiding principle is todestroy the health services competition. Typically public and private non-
profit hospitals provide a higher proportion of charity care, so when these facilities are gone, it is tremendously destructive to
low-income and racial minority families . Corporate hospital chains also have a long history of eliminating less profitable medical services such as emergency rooms, labor and delivery and burn unitsan unequivocal act of profit maximization and the destruction of critical community health needs in one blatant action. In rural areas, this regional economic monopolization is leaving tens of

thousands of people with no hospital and physician access. After all, these companies feel that if a hospital or physician is located with a few hours, this is good access. Monopoly power has never been greater, In fact, for the first tim e in our nations history, these financial and political power elites have one of their own guiding the United States Senate. U.S. Senator Bill Frist, MD, may be a medical doctor, but more importantly, he is the heir, and financially linked to the Hospital Corporation of America [HCA]. HCA is the largest for-profit hospital chain in the United States.
There is desperate and despicable self-interest in HCAs leaders seeking political power. Their executives have been found guilty of Federal Medicare fraud, with a number of them doing federal prison time. They are in league with corporate scofflaws like the federally indicted Richard Scrushy, the former CEO HealthSouth. HealthSouth is the largest U.S. chain of outpatient surgery, diagnostic imaging and rehabilitation centers. It was founded by Scrushy in 1984 and has some 50,000 employees and about 1,700 sites in all 50 states and ov erseas. He was indicted for falsifying
the books to enrich him by $2.7 billion. HCA and HealthSouth are the poster children of Profits in Health Care, a system which the Republican Party and too many Democrats are committed to preserving. The White Houses obsession with trial lawyers and eagerness to dump what Bush refers to as frivolous law suits including medical malpractice suits are directly linked to these fraud cases. This is the only country in the industrial world that has a medical malpractice problem because we are only country without a national health program that takes care of peoples medical
needs. The Institute of Medicines report that over 100,000 patients die each year in hospitals has these corporate scofflaws shaking in their boots in fear of legitimate negligence suits which are needed to help victims of medical errors and neglect to put their families back together after massive hospital bills. [The other leg of this anti-law suit attack is the asbestos suits facing corporate scofflaws like Halliburton, Vice President Cheneys company. Bushs recent attack on asbestos law suits is gruesomely anti-victim and a direct payoff to his contributors] Profits Dictate Health
Care The invasion of profit-maximizing health maintenance organizations has forced entire families to abandon their health providers of choice for someone on the list. The health care of families is fragmented when different members of a family fall under different plans, and are forced to use different providers. Too often patients with complicated treatment regimens, such as chemotherapy, are forced to change physicians because of a change in the list. In Medicare, the sudden collapse of large numbers of entrepreneurial HMOs, spurred on by the privatization of the
federal Medicare system, has left untold hundreds of thousands of families in debt or bankrupt from unpaid medical bills that were supposed to hav e been be paid by the HMO. Moreover, even when bills are paid, elders, among our most frail, suffer discontinuity of, and lapses in, care, as they are shuffled from plan to plan, and doctor-to-doctor. There is little profit in low-income communities, which are disproportionately minority and/or rural communities. These communities are often entirely abandoned by the health care industry. Families in these communities are
forced to use abusive and ineffective Medicaid mills, or the vastly overcrowded and poorly equipped offices of sliding-fee community clinics. Often they simply do without care at all, relying on ineffective over-the-counter drugs, or tailgate venders of fraudulent or outdated drugs. The soaring costs of health care have pushed it to become in recent years the single most frequent cause of personal bankruptcies in the United States. This has been reflected in decades of health insurance cost increases that have consistently outstripped the annual inflation rate. Employers,
who have to use insurance carriers, respond to this dent in their profits by shifting more and more health related costs to workers, while forcing workers to accept increasingly inferior plans. Workers are also forced to choose between much needed wage increases and health benefits. Every year growing numbers of employers have simply abandoned health benefits altogether, often with disastrous consequences for the workers and their families. There are approximately 45 million people in the United States with no health insurance at all. Tens of millions of additional

tens of millions of family members who do have health insurance cannot afford the co-
people spend some part of the year uninsured. Finally, additional

payments and deductibles, and are therefore effectively barred from adequate health care. The
safety net is seriously shredded . Millions of Americans have Medicare health insurance coverage, but physicians are not required
to honor it. Medicare and Medicaid are increasingly becoming unredeemable vouchers. As a result, while a community may have an adequate
supply of health care providers, few if any may be willing to see a patient with Medicare insurance, because the provider could see a patient
with private health insurance and make much more money. Furthermore, Medicare does not cover the cost of drugs. Recent federal
prescription drug legislation purports to address this serious omission, but the legislation does not take effect for several years even then it
is so plagued with giveaways to corporations , and inferior coverage , and incredible cost overruns ,
that its effectiveness is seriously in question. Attacks on Medicare and Medicaid, as weak as these insurance systems have
become, are very real cynical efforts to abolish altogether meaningful health care for seniors, dependent children, the working poor, and
disabled. In addition, hundreds of thousands, perhaps millions, of additional workers and their families are losing health care coverage in the
economic crisis. Meanwhile, hospital and public clinic closings continue unabated. These are life and death struggles that must be met with
militant mass action. Medicare and Medicaid Since their inception in the mid-1060s, Medicare and Medicaid have been increasingly privatized,
with grave consequences for cost containment, equity, efficiency, quality and continuity of care. The CPUSA supports the demand
to refederalize the Medicare and Medicaid systems, a demand which engages broad sectors of the nation in the struggle. It adds an anti-
monopoly and anti-corporate element that every public poll indicates would be very popular among the electorate. In addition, the logical
trajectory of this reform leads directly toward the goal of
a completely public sector n ational h ealth s ervice. The
popular rallying cry for the struggle could be, Medicare & Medicaid Funds for Health Care, Not Profits. Or, Healthcare
for People, Not Profits. National Health Service The Party has continually supported popular struggles and
legislation that pave the way for, or would establish, a national health service (NHS). The uniqueness
of a national health service strategic direction is that this form of socialism can and does take place
within the capitalist system. The NHS in the United Kingdom remains the jewel of health services despite its underfunding problems.
Raising the banner of socialized medicine sends the kind of message that a Party of Socialism needs to communicate.
Also, this demand with its logic and realism is the kind of anti-monopoly program that can combine with other peoples struggles such as
increased public housing, jobs, etc. Key elements of a national health service include, but are not limited to: 1. the
elimination of profit from all aspects of health care and public health measures; 2. payment for all health care
including true public health measures from steeply progressive taxes ; 3. the delivery of all health care and public
health services from
publicly owned hospitals and community health facilities federally financed via global
budgeting; 4. the delivery of all health care and public health services by salaried public health care providers
and workers, who earn a living wage, have job security and full benefits and who have the right to organize; 5. the
elimination of all financial barriers to access to health care; 6. a tiered and publicly system of governance relying on local,
regional, and national elected boards; 7. a national system of quality assurance and guaranteed services; 8. a regionally based system of
publicly owned health care worker education and research facilities which have no financial barriers to access and no ties to corporations. It
is against these anti-monopoly, pro-people principles that all n ational h ealth i nsurance and service proposals
must be judged . Insurance Based Systems: Single Payer/National Health Insurance National health systems based on
reimbursement are insurance systems and will inevitably have major gaps in services . These gaps are usually
filled easily by people with money, but not by working class people. The racist edge will be apparent ,
as it is in the Medicaid and to some extent the Medicare systems. The Party cannot fully support n ational h ealth
i nsurance schemes that funnel public funds into the for-profit health care industry or a so-called not-
for-profit system that behaves the same as profiteers. Such schemes are the health care equivalent of vouchers in
education. This is obvious when the high sounding proposals are made by the American Medical Association, the American Hospital Association
and even the Insurance Association. But, there
is also no guarantee that a single payer system proposed for
individual city and states or the federal government would be comprehensive. Most single payer system that
have been proposed in the past would result in an ongoing, giant financial payoff to the health care industry.

Costs would rise precipitously , as the government and politicians with feed their industry buddies and
single payer would evolve into an ‘unfunded mandate.’ This would result in the uninsured suffering
the same problems as faced by Medicare and Medicaid participants . Our Party activists, while playing a role in
these movements, should also put forward a more advanced position that actually solves the problems. That is
the Communist plus that our Party stands for. However, we believe it is important to work with single payer advocates in broader coalitions
around positions that are open to the advocacy of National
Health Service or key elements of NHSfor example, bills that directs
Congress to enact legislation that provides real access to comprehensive health care for all Americans.
Some proposed single payer bills are far better than other proposed similarly labeled legislation. Some such
proposals, for example, seem to exclude any role for insurance carriers, for example as third party administrators.

However, even the most advanced single payer proposal , at this time, preserves the antiquated fee-for-
service physician payment system at the exclusion of salaried physician emphasis. Single payer
insurance-based systems also do not guarantee the delivery of services since hospitals and community
clinics would remain in private hands . There are important physician groups working on one such a proposal, HR 676 [see
below], with whom we work. The efforts to gain labor support for HR 676 are very useful for future struggles for national health legislation.
Health Care Policy And Trade Union Work But, while labor support for HR 676 is increasing there are objective reasons that organized labor has
not been at the front of the struggle for national health legislation, i.e., any health legislation. This is a key issue for labor and therefore for our
Party. The key issue for labor is: What happens to our negotiated health benefits in any national health
bill? There are major objective reasons that labor union leaders and members worry about any national health program. For example, the
year 2003/4 enactment of the Bush Medicare Prescription Drug program could allow employers to cut back on negotiated prescription drug
plans. This will further put the worry sign up for labor leaders and members. In addition for organizing purposes and identification purposes,
labor has become wedded to their negotiated health benefit programs. The is a fact that must be taken into consideration by all health care
activists. Solving this series of issues is not easy, but it is achievable. Labor
unions must be allowed to continue their
current health benefits programs regardless of any national health program. This will help to unite all elements
of labor to endorse progressive national health legislation including the building trades, manufacturing, services and public sector unions. The
Party has a special role in making sure that workers are protected from any detrimental actions of
their national government. This is also integral to an anti-monopoly strategy . How can this be accomplished? Our answer would be to ‘grandfather-in’ all labor-negotiated health benefit programs, and fashion a national

health insurance program around them. We would also ‘grandfather-in’ the current and refederalized Medicare & Medicaid programs. Individual labor unions could then voluntarily fold their health benefit programs into the federal program, at their own discretion. The Canadian health system was started with this kind of approach. And, the French, German and other European health systems still maintain a special role for organized labor. This could then be called: ‘Labor Programs Plus Medicare for All’ or ‘Labor/Medicare for All.’ But, first the Medicare agenda must
include the demand to fully federalize Medicare and Medicaid. The ‘Medicare for All’ slogan is shorthand for a national health insurance program that would resonate with policy makers, workers, retirees, and many others. Since the failure to enact national health legislation in 1994, the Democratic Party and the AFL-CIO had agreed to keep health policy issues ‘Off Agenda.’ This approach resulted from a misreading of conditions, since health care was, and is, high on the agenda of all people in the USA. Recent movement by the AFL-CIO on health policy is part of the
prescription to throw out the Republicans from Congress and the White House and make health care a right, not a privilege, in our country. It didnt succeed in 2004, but the seeds for future victories have been sown. If organized labor were to adopt this approach then it could protect their own legitimate interests and once again be at the head of the peoples movement for health. We believe organized labor and the Medicare movement should work together to write their own bill and then cover everyone else. After all, who has more direct, on-the-ground experience in
the organization, delivery and financing of health services. This is a good starting point. Our job is to work with organized labor to support a progressive health bill. The Partys Health Commission members are working with leaders of the labor movement to encourage organized labor to develop, write, and propose labors own national health legislation. This new approach is being well received by health policy people and labor leaders/activists who are trying various ways to get labor to drop its opposition to national health legislation. The issue of protecting currently
negotiated health benefits is crucial to continued labor support. Once this stage of struggle is attained, then the next stage of a National Health Service is within reach. State Actions There is a groundswell of activity by various city state labor councils seeking to find solutions to the crisis in health care. Wisconsin and California are two examples of state labor councils seeking state action to get health care for everyone in that state, and others are contemplating similar action. The issue is becoming, Should labor expend its political strength and energy on state governments,
or should the focus be on Congress? The AFL-CIO Executive Council made it clear that many actions will be necessary to get health care to be a focus of the year 2004, 20 06 and the presidential and congressional elections of 2008. The key issue remains here as with national health legislation: What happens to our negotiated health benefits? That is the key issue that even the most progressive national legislation reform, HR 676, has failed to address. Labor unions must be allowed to continue their current health benefits programs regardless of any national health
program. The legislative Struggle for National Health Legislation The details of proposed legislation changes from revision to revision, and certainly from year to year. This is to be expected given the vagaries of Congress and politicians. Nevertheless, we can use recent examples to clarify important health care issues. Three pieces of progressive legislation for national health care that were introduced in the 107th Congress show the levels of action that will probably cont inue through the next period of time. Congressman John Conyers was the primary sponsor of two of
them, and a secondary on the third. Congresswoman Barbara Lee from California is a supporter of all three and lead sponsor of the National Health Service proposal: ‘House Concurrent Resolution 99’ ‘HR 676 Single Payer National Health Bill’ ‘HR 3080 National Health Service Bill’ The tactic of The Health Care Access Resolution (HCAR), embodied in House Concurrent Resolution 99 (H. Con Res. 99), and Senate Concurrent Resolution 41 (S. Con. Res. 41), directed Congress to enact legislation by October 2005 that would provide access to comprehensive health care for all

Americans. While not an actual piece of legislation, it was meant to gain broader support for a national health bill. The struggle for national health legislation began taking the form of a House Concurrent Resolution 99 for Universal Health sponsored by Congressman John Conyers. This was seen as an effort to allow all progressive organizations and professionals to unite behind a set of principles. It is the precursor to an actual bill; and, still is. The principles looked very similar to those embodied in HR 676 and HR 3080 The most
recent version of a federal Single Payer National Health Insurance system [HR 676] has responded to the demands
that previous single payer proposals were deficient. It is vastly superior to the single payer proposal of the late US Senator from Minnesota,
Paul Wellstone, since the Conyers proposal is federal and not state-based; and, it the federal government is the administrator, not private
insurance companies which mimicked the Medicare mistake. These factors make the current version far more supportable and anti-
monopoly in character since there is no role for insurance carriers in the financing aspects. It is a reform that is certainly and short be
supportable. But, the delivery of services under this system is still in private hands and fee-for-service
physicians take precedent over salaried physicians. HR 676 sponsors have been unwilling to offer labor the option of
maintaining their own health benefit programs. On the sate and local level, most of the single payer proposals are not on the same level as HR
676. As we tactically and strategically consider, support and organize for insurance-based national
health legislation, we must continue to treat the proposed legislation of Barbara Lee, ‘United States Universal Health
Service Act [US UHSA]’ with complete respect. Congresswoman Lee is carrying the torch of Ronald V Dellums in keeping alive the
only piece of national health legislation that systematically addresses the major contradictions in our
current health system. Its principles are public health and hospital services; salaried doctors to make sure
they are available in the urban and rural settings; health planning; educational program for professional positions with maximum
affirmative action; etc. It recently had ten sponsors, and it provides a guide to measure other proposals by. In reality it stands as much a chance
of passage as bills similar to the two Conyers bills. Conyers has been a sponsor of the Lee bill. HR 3080 is a direct attack on all the monopolies in
the health industry. We strongly encourage organizing delegations to meet with their U.S. Senators and members of the House of
Representatives to get them to co-sponsor all proposed progressive health legislation. We encourage local, national and international labor
union leaders and members to join in support. Grassroots movements like these can galvanize a movement to put
people before profits in health care, and smash the root cause of the health care crisis . As a Party,
we must be careful about what is called comprehensive, single-payer, full access; and uses all the hot
button terms to gain support for a piece of legislation. Measure what is being said against the
principles outlined earlier. Many political candidates put forward their idea for national health care.
Most of these ideas are calculated to sound like a universal, fully accessible health care proposal.
Some are totally unsupportable. Others proposed by some liberal members of Congress scale back
their financing and benefit proposals to withstand the assault from the Republican Party, the Medical-
Industrial Complex, and their politicians and media wizards. Candidates fear to be too advanced since
the price tag would appear to be too expensive. Typically these proposals are not completely supportable.
Nonetheless, it is a good sign that the candidates are at least joining the debate. Critical thinking and critical actions have

never been more important for movements to see the unique contribution of Party members working
with them. Big Tent HCAR 99/S41 came as a response to health activists seeking to bring the broadest number of politicians to begin to pay attention to the issue of national health care. The American Public Health Association, The Universal Health Care Action Network and many other groups have signed on to the proposals. Labor has also joined in. According to the Universal Healthcare Action Network (UHCAN) there were over 450 national, state, and local organizations on board. For the first time since the collapse of

health care reform in the early 1990s, the U.S. Senate showed some positive movement. Key liberal Senators signed on to this HCAR movement. They are: Senators Edward Kennedy of Mass; Russell Feingold of Wisconsin; and Jon Corzine of New Jersey. These are the Senators who will have to be in the leadership of the Senate if the Health struggle is to succeed. The formal title of this proposal is Senate Concurrent Resolution 41. Given the apparent fear by members of Congress–fear of powerful corporate and political enemies–to put forward a serious major piece of
comprehensive health legislation, the following statement by UHCAN is important: HCAR is part of a broad effort to educate the American public about the need for affordable access to comprehensive health care for all, and to mobilize them to take action toward that goal. HCAR is seen an essential first step to enacting heath care reform that provides health coverage for everyone. Popular Actions; Uniting with Social Security Struggle It is clear that there are many grassroots health care action coalitions developing around the country, from prescription drug campaigns to
state and local referendums and legislation demanding comprehensive, universal health care. In Philadelphia a citywide referendum demanding city wide universal health care and in Ohio a statewide effort for reduced prescription drug benefits are good examples of building broad local coalitions. In many areas we are already deeply involved in others we need to join and become active. The new national retiree organization, Association of Retired Americans, is a great way for comrades to become active in the health care fight. Also union retiree organizations, like SOAR

the unique feature of a National Health Service is that it

are important avenues of struggle. All health struggles must unite with the struggle to preserve and expand social security against the Bush Agenda of privatization, greed and profit. Party of Socialism Must Promote Socialist Ideas and Ideals As stated earlier,

is socialized medicine and it is at work in the United Kingdom and is very similar to systems in other European countries. It is an
advanced demand that challenges monopoly and greed with practical, within capitalist economic
systems. The Cuban system is a beacon for developing countries. The World Health Organization
regularly commends the Cuban health system as the best for developing countries. Health systems in
the former Soviet Union and its Socialist country partners worked and worked well. The health status
declines and horrendous mortality increases in the decade since 1991 has shown that to be true. This
simple fact is critical in exposing the lies about the Soviet Union and its amazing victories and
advances during its 75-year history. Our Party as a Party of Socialism must continue to propose socialist
solutions within capitalism that make sense. Socialized Medicine makes sense. And, with the
international mobility of our working class, they are seeing, first hand, this fact for themselves.
Progressive insurance-based systems, conjoined with the strategy for labor to write their own national health proposal, that pull
the peoples movement toward socialized medicine must be supported and pushed in that direction.
These movements will rise and fall and will offer different legislative proposals . They need to be
weighed against our socialist alternative , the N ational H ealth S ervice. That is our rudder of action.
Party activists are encouraged to use the big tent approach to health struggles. A united health care movement is our goal .
There must be a movement that unites behind clearly stated, broad goals ; and, that maximizes the
role of labor and its members as the only force, along with Medicare and Medicaid activists, that can
have the political weight to gain health care for all and make a constitutional demand of Health Care
for the People, Not Profit a reality.
 1NC
[Plank 1] The United States federal government should
- Promote payment rates within global targets
- Accelerate alternatives to fee-for service payment
- Use competitive bidding for all commodities
- Require all exchanges to be active payers
- Simplify administrative systems
- Require full price transparency
- provide bonus payments to states that meet scope-of-practice standards
delineated by the Institute of Medicine
- Expand the Stark law fee-for-service exemptions and close regulatory loopholes
- Align the Federal Employees Health Benefits Program with Medicare
- Implement safe harbor programs
- offer substantial subsidies and prizes for cloud-based computing for space
situational awareness for space debris and NEOs.
- Completely subsidize deductibles and copays
[Plank 2] The United States federal government should enroll individuals not eligible
for employer provided health insurance in a public health insurance option.
The counterplan solves cost inefficiencies holistically – broad reforms are necessary
Emanuel et. al 12 -- Ezekiel Emanuel, M.D., Ph.D., Neera Tanden, J.D., Stuart Altman, Ph.D., Scott Armstrong, M.B.A., Donald Berwick, M.D.,
M.P.P., François de Brantes, M.B.A., Maura Calsyn, J.D., Michael Chernew, Ph.D., John Colmers, M.P.H., David Cutler, Ph.D., Tom Daschle, B.A.,
Paul Egerman, B.S., Bob Kocher, M.D., Arnold Milstein, M.D., M.P.H., Emily Oshima Lee, M.A., John D. Podesta, J.D., Uwe Reinhardt, Ph.D.,
Meredith Rosenthal, Ph.D., Joshua Sharfstein, M.D., Stephen Shortell, Ph.D., M.P.H., M.B.A., Andrew Stern, B.A., Peter R. Orszag, Ph.D., and
Topher Spiro, J.D. (Emanuel, “A Systemic Approach to Containing Health Care Spending,” The New England Journal of Medicine, 367:949-954,
September 6, 2012, http://www.nejm.org/doi/full/10.1056/neJmsb1205901#t=article)

PROMOTE PAYMENT RATES WITHIN GLOBAL TARGETS

Under our current fragmented payment system, providers can shift costs from public payers to private payers and
from large insurers to small insurers.5 Since each provider negotiates payment rates with multiple insurers,
administrative costs are excessive. Moreover, continued consolidation of market power among providers will increase prices over
time.6 For all these reasons, the current system is not sustainable.

Under a model of self-regulation, public and private payers would negotiate payment rates with
providers, and these rates would be binding on all payers and providers in a state. Providers could still offer rates
below the negotiated rates.

The privately negotiated rates would have to adhere to a global spending target for both public and private
payers in the state. After a transition, this target should limit growth in health spending per capita to the
average growth in wages, which would combat wage stagnation and resonate with the public. We
recommend that an
independent council composed of providers, payers, businesses, consumers, and economists set and
enforce the spending target.

We suggest that the federal government award grants to states to promote this self-regulation model.
States could phase in this model, one sector (e.g., hospitals) at a time. To receive grants, states would need to publicly
report measures of quality, access, and cost and would receive bonus payments for high performance.
For providers, the negotiated rates would be adjusted for performance on quality measures, which should be
identical for public and private payers.

Funding for research, training, and uncompensated care — currently embedded in Medicare and Medicaid payments —
should be separated out and increased with growth in the global spending target. These payments
must be transparent and determined through negotiations or competitive bidding.

ACCELERATE USE OF ALTERNATIVES TO FEE-FOR-SERVICE PAYMENT

Fee-for-service payment encourages wasteful use of high-cost tests and procedures. Instead of paying a fee for each
service, payers could pay a fixed amount to physicians and hospitals for a bundle of services (bundled payments) or for

all the care that a patient needs (global payments).

Payers will need to accelerate the use of such alternative payment methods. As soon as possible, both public and
private payers should adopt the bundles for 37 cardiac and orthopedic procedures used in the Medicare
Acute Care Episode program.7,8 The bundles will also need to include rehabilitation and postacute care for 90 days

after discharge. Within 5 years, Medicare should make bundled payments for at least two chronic conditions, such as cancer or coronary artery disease.
Within 10 years, Medicare and Medicaid should base at least 75% of payments in every region on alternatives to fee-for-service payment.

Together, these policies would remove uncertainty about transitions from fee-for-service payment,
allowing sufficient time for investment in infrastructure and technology by payers and providers.

USE COMPETITIVE BIDDING FOR ALL COMMODITIES

Evidence suggests that prices for many products, such as medical equipment and devices, are excessive.9 Instead of the
government setting prices, market forces should be used to allow manufacturers and suppliers to
compete to offer the lowest price . In 2011, such competitive bidding reduced Medicare spending on medical
equipment such as wheelchairs by more than 42%. The ACA requires Medicare to expand competitive bidding for equipment, prosthetics, orthotics, and
supplies to all regions by 2016.11

We suggest that Medicare immediately expand the current program nationwide. As soon as possible, Medicare
should extend competitive bidding to medical devices, laboratory tests, radiologic diagnostic services,
and all other commodities.12 Medicare's competitively bid prices would then be extended to all federal health programs. To oversee the process,
we recommend that Medicare establish a panel of business and academic experts. Finally, we recommend that exchanges — marketplaces for insurance

starting in 2014 — conduct competitive bidding for these items on behalf of private payers and state

employee plans.
REQUIRE EXCHANGES TO OFFER TIERED PRODUCTS

The market dominance of select providers often drives substantial price variation. To address this problem, insurers can offer tiered plans. These insurance products designate a high-value tier
of providers with high quality and low costs and reduce cost sharing for patients who obtain services from these providers. For instance, in Massachusetts, one tiered product lowers
copayments by as much as $1,000 if patients choose from 53 high-value providers.15

We suggest that exchanges and state employee plans offer at least one tiered product at the bronze and silver levels of coverage. This requirement can be implemented by 2016 or sooner if
feasible. To encourage participation in the tiered product, it must achieve a minimum premium discount. For instance, in Massachusetts, insurers must offer at least one tiered product with a
premium that is at least 12% lower than the premium for a similar nontiered product.16
Transparency and consumer education are essential.17 Quality
and cost measures must be standardized and publicly
disclosed, and standards must be set for how these measures are used to create tiers. Whenever
possible, quality measures should use data from all payers. Finally, in contracts between insurers and providers, clauses
that inhibit tiered products must be prohibited .

REQUIRE ALL EXCHANGES TO BE ACTIVE PURCHASERS

If exchanges passively offer any insurance product that meets minimal standards, an important opportunity will be lost. As soon as reliable quality-reporting
systems exist and exchanges achieve adequate scale, it
is critical that federal and state exchanges engage in active purchasing —
leveraging their bargaining power to secure the best premium rates and promote reforms in payment
and delivery systems.

The ACA will provide bonus payments to Medicare Advantage plans with four- or five-star ratings on
the basis of their performance on measures of clinical quality and patients' experience.18 We recommend that exchanges adopt this or a similar pay-
for-performance model for participating plans and award a gold star to plans that provide high quality at a low premium.

SIMPLIFY ADMINISTRATIVE SYSTEMS FOR ALL PAYERS AND PROVIDERS

The United States spends nearly $360 billion a year on administrative costs,19 accounting for 14% of excessive health spending.20 Section 1104 of the ACA requires
uniform standards and operating rules for electronic transactions between health plans and providers.11 Although plans must comply with these standards and
rules, the law does not require providers to exchange information electronically.

First, we suggest that payers and providers electronically exchange eligibility, claims, and other administrative information as soon as possible. Second, public

and private payers and providers should use a single, standardized physician credentialing system.
Currently, physicians must submit their credentials to multiple payers and hospitals. Third, payers should provide monthly explanation-

of-benefits statements electronically but allow patients to opt for paper statements. Fourth, electronic
health records should integrate clinical and administrative functions — such as billing, prior authorization, and payments
— over the next 5 years. For instance, ordering a clinical service for a patient could automatically bill the

payer in one step.

Most important, we recommend that a task force consisting of payers, providers, and vendors set
binding compliance targets, monitor use rates, and have broad authority to implement additional
measures to achieve systemwide savings of $30 billion a year.21

REQUIRE FULL TRANSPARENCY OF PRICES

Prices for the same services vary substantially within the same geographic area.14 Yet consumers almost never receive price information before treatment. Price

transparency would allow consumers to plan ahead and choose lower-cost providers, which may lead
high-cost providers to lower prices. Although price transparency could facilitate collusion, this risk could be addressed through aggressive
enforcement of antitrust laws.

both private and public models can achieve meaningful price transparency without leading to
Moreover,

collusion.22 Aetna provides the price it negotiated with a specific provider to members through an Internet website. Similarly, New Hampshire has a public website that provides the
median price paid by an insurer to a specific provider on the basis of claims data.

It is important that all private insurers and states provide price information that reflects negotiated
discounts with specific providers. The information should include one price that bundles together all
costs associated with a service, individualized estimates of out-of-pocket costs at the point of care, and information on quality of care and volume of patients so that consumers can make
informed decisions on the basis of value.
In contracts between insurers and providers, many providers prohibit insurers from releasing price information to their members.22 These so-called gag clauses and other
anticompetitive clauses must be prohibited. Finally, we recommend that state insurance commissioners and exchanges collect, audit, and publicly report
data on prices and claims.

MAKE BETTER USE OF NONPHYSICIAN PROVIDERS

Restrictive state scope-of-practice laws prevent nonphysician providers from practicing to the full
extent of their training. For instance, 34 states do not allow advanced-practice nurses to practice without physician supervision.23 Making greater use of these providers
would expand the workforce supply, which would increase competition and thereby lower prices.

We recommend that the federal government provide bonus payments to states that meet scope-of-
practice standards delineated by the Institute of Medicine. Medicare and Medicaid payments to
nonphysician providers should allow them to practice to the full extent permitted under state law.

EXPAND THE MEDICARE BAN ON PHYSICIAN SELF-REFERRALS

Many studies show that when physicians self-refer patients to facilities in which they have a financial interest,
especially for imaging and pathology services, they drive up costs and may adversely affect the quality of care.24,25 Under the so-called
Stark law, physicians are prohibited from referring Medicare and Medicaid patients to facilities in which they have a financial interest. However, an exception allows physicians to provide “in-
house ancillary services,” such as diagnostic imaging, in their own offices.26

the Stark law should be expanded to prohibit physician self-referrals for services that are
We believe that

paid for by private insurers. In addition, the loopholes for in-office imaging, pathology laboratories,
and radiation therapy should be closed. Physicians who use alternatives to fee-for-service payment
should be exempted because these methods reduce incentives to increase volume.

LEVERAGE THE FEDERAL EMPLOYEES PROGRAM TO DRIVE REFORM

The Federal Employees Health Benefits Program (FEHBP) provides private health insurance to 8 million federal employees
and their families. Although the FEHBP has encouraged various reforms to improve the quality of care,27 it could be much more innovative.

We recommend that the FEHBP align with Medicare by requiring plans to transition to alternative
payment methods, reduce payments to hospitals with high rates of readmissions and hospital-
acquired conditions, and adjust payments to hospitals and physicians on the basis of their
performance on quality measures. In addition, the FEHBP should require carriers to offer tiered products and
conduct competitive bidding on behalf of plans for all commodities. Finally, the FEHBP should require plans to provide price
information to enrollees and prohibit gag clauses in plan contracts with providers.

REDUCE THE COSTS OF DEFENSIVE MEDICINE

More than 75% of physicians — and virtually all physicians in high-risk specialties — face a malpractice claim over the course of
their career.28 Regardless of whether a claim results in liability, the risk of being sued may cause physicians to practice a type of defensive medicine that increases costs without
improving the quality of care.

Strategies to control costs associated with medical malpractice and defensive medicine must be
responsible and targeted. These strategies must not impose arbitrary caps on damages for patients
who are injured as a result of malpractice. According to the Congressional Budget Office, arbitrary caps on damages would reduce national health spending by only 0.5%.29 But
although such caps would have a barely measurable effect on costs, they might adversely affect health outcomes.30,31

A more promising strategy would provide a so-called safe harbor, in which physicians would be presumed
to have no liability if they used qualified health-information-technology systems and adhered to evidence-based clinical
practice guidelines that did not reflect defensive medicine. Physicians could use clinical-decision support systems that incorporate
these guidelines.
Under such a system, the physician could use the safe harbor as an affirmative defense at an early stage in the litigation and could introduce guidelines into evidence to avoid a courtroom
battle of the experts. The patient could still present evidence that the guidelines were not applicable to the particular situation, and the judge would still determine their applicability.

It is critical to develop guidelines with credibility. A promising step is an initiative called Choosing Wisely, in which leading physician groups released guidelines on 45 common tests and

Given the important role of guidelines, physicians who participate in

procedures that might be overused or unnecessary.32

developing them must be free from financial conflicts of interest.

Public Option solves

Halpin ’10 Helen A. Halpin is a professor at the School of Public Health, University of California, Berkeley. Peter Harbage is a consultant
with Peter Harbage Consulting, in Washington, D.C. HEALTH AFFAIRS 29, NO. 6 (2010): 1117–1124

In most of the bills, individuals who were not eligible for either existing public or employer insurance would have
been eligible to purchase through the exchange and to have the choice of the public option. The differences across
bills related to how much access to give employers. Most bills included provisions for small employers
to move their workers into the exchanges, with some proposals phasing in eligibility over time based on firm size. Other
proposals would have enabled any employer, regardless of size, to move workers into the exchange or
simply let each worker decide. The issue boiled down to how important it was to preserve the employer

insurance market. Clearly, the small-group market was not serving small firms well, and new options for them were a priority. But for
those who wanted to see the public option succeed and attract a large, stable risk pool, it was important to open the exchange to anyone with
employer coverage. This side feared that limiting eligibility could lead to ad- verse selection into the public plan, threatening its long-term
viability.27 In contrast, others were worried that opening the exchange to large employers would cause many of
them to stop providing coverage, thereby breaking the pledge that people who were happy with their current coverage could keep
it. The CBO estimated that only eleven to twelve million Americans—less than 5 percent of the population—would enroll in
the public option under the House bill, which restricted employ- ers’ eligibility for exchange
participation. In contrast, the Lewin Group estimated that the number of enrollees in the public option could be as high as 100 million—
approximately 32 per- cent of the population—if workers for all firms were allowed to purchase insurance through the exchange.28
Economy
 1NC
Equity markets strong but on the brink
Patterson 7/6 (Rebecca, chief investment officer with Bessemer Trust, a private, independent office that oversees more than $106 billion for 2,300
families, foundations, and endowments. “The Risks Ahead for the Economy and Markets”, http://www.barrons.com/articles/the-risks-ahead-for-the-economy-and-
markets-1499369276)

As we approach the 10-year anniversary of the last equity peak (October 2007) and the 2008–2009 financial crisis, we
examine the current economic expansion and stock market rally with the benefit of hindsight, seeking to uncover lessons
that can help us to anticipate risks and opportunities ahead. Lesson No. 1: Peaks Are Often Further Away Than You Think Equity

performance is – obviously – heavily influenced by economic trends. Peaks and sustained equity declines
often emerge into and during recessions. Since the late 1960s, there have been six bear markets registering a 25%-or-greater decline for the
Standard & Poor’s 500, and five of these coincided with a U.S. recession. That means looking for an equity peak requires an

understanding of where an economy is in the business cycle and how near the next recession might
be. This is easier said than done. Since the end of World War II, the U.S. has had 11 business cycles, with expansions lasting an average of about
six years. The expansion of the 2000s was in its fourth year, and the equity “bull market” in its third, when then Federal Reserve Chairman Alan Greenspan told
Congress that some local housing markets were exhibiting “froth” and that he saw signs of risky financing. He added at the time, though, that he did not see a
national bubble and that the economy did not appear at risk. About a year later, U.S. Treasury Secretary Hank Paulson noted, “When there is a lot of dry tinder out
there, you never know what will light it. We have these periods every six, eight, ten years and there are plenty of excesses.” Another six months later, in March
2007, after the U.S. housing market had started its decline, then Fed Chairman Ben Bernanke testified to Congress that “the impact on the broader economy and
the financial markets of the problems in the subprime markets seems likely to be contained.” All three policy makers, supported by reams of data and armies of
economists, knew there might be a problem but could not put a finger on the timing, much less the scale, of the economic or market downturn to come. So what

do we watch to try to see equity peaks and recessions on the horizon? We start with trends in
economic and financial data that can shed light on the probability of a looming recession. Our short list
includes labor market and housing data, business and consumer confidence, and consumer credit,
among other economic metrics. It also includes financial data that can be causes and/or symptoms of economic vulnerability, such as energy
prices, corporate profit margins, credit spreads, mortgage interest rates, and monetary policy variables . Backtests of our recession model

have correctly “flashed red” before recessions in 1990, 2001, and 2007, although the model has not always picked up all
signals adequately (it underestimated the degree of housing vulnerability in 2007). As of June this year, our proprietary model suggested

only a 38% chance of a U.S. recession over the next few quarters , with some of the greatest relative risk coming from a
slowing labor market. Historically, equities have been much more likely to see sustained declines when recession
probability readings reached 70% or higher . Barring some shock , the economy for now doesn’t look
at risk of imminent recession , though we continue to believe we are in the later stages of this
economic cycle . All else equal, our next equity peak is likely still a ways off. A similar takeaway can be reached by looking at
positioning. Equities will be relatively more vulnerable when there are more owners who could get

spooked (see Lesson No. 3) and suddenly sell en masse. That was definitely the case back in 2007 and 2008:
between October 2002 and October 2007, equity inflows totaled $947 billion compared to $259 billion for bonds. The 2008–2009 equity bear market, perhaps
alongside some short-lived but still-painful crises in subsequent years (the 2011 U.S. debt-ceiling standoff, the 2012 European debt crisis, and the 2015–16 oil
shock), resulted in an investor base much more skeptical toward stocks. Indeed, since March 2009, when the S&P bottomed, net fund flows into bonds have far

exceeded flows into stocks. This is not a “crowded” market. While economic momentum and investor positioning both give
reason for near-term calm or even optimism toward equities , valuations provide a different,
somewhat more cautious message. Equities are relatively more vulnerable to whatever shock
emerges at higher valuations. While one can use a number of metrics here, most today at least directionally paint a similar picture. Looking
specifically at price-earnings ratios (PEs), the current global PE ratio of about 16x (as of May 31 for the MSCI All
Country World Index, on a next-12-months basis) has reached its highest level post-tech bubble. Lesson No. 2: It’s Not Just This Time But
Every Time That Is Different When It Comes to Economic and Equity Cycles While economic trends, investor positioning, and valuations are all important inputs
when assessing the probability of an equity-market peak, we have to acknowledge that these metrics, in absolute terms or in a historical context, are not sufficient
to form a view. Just as economies and financial markets evolve, so too do catalysts for downturns. Every cycle is different in this regard. The 2008–2009 crisis that
followed the October 2007 equity peak has been thoroughly researched and discussed. While many factors contributed to this downturn, most would agree that at
least near the top of the list would be a bubble in U.S. housing, in turn exacerbated by subprime mortgages; a bullish commodity market that, along with home
prices, pushed inflation higher and led central banks to tighten monetary policy; a relatively relaxed regulatory environment; and a significant increase in leverage
and the use of financial derivatives that were not sufficiently understood by relevant parties. Looking
at the current economic and market
backdrops, we see some forces that leave us thinking this cycle could extend substantially longer,
maybe even becoming the longest expansion and equity bull market in modern times . Other factors, however,
could even now be sowing the seeds for the next equity peak and descent. We have to consider both sides as we construct portfolios. In our minds, global

monetary policy today creates two-way risks for this cycle. The 2008–2009 crisis led the Fed and its
global counterparts to slash interest rates and expand balance sheets to provide liquidity and credit to
the global economy. While baby steps to reverse low or negative interest rates are now under way in a few countries, balance sheets remain at a
cumulative record high, having more than tripled in the last decade. While one can debate the costs and benefits of prolonged,

exceptionally easy monetary policy, it does appear to have helped lift equity and credit prices, in part
as investors reached for yield. With inflation remaining stubbornly low around much of the world),
there is potential for this easy monetary backdrop to persist well into 2018 or longer . Central bankers are
subject to the same emotional biases as the rest of us (see Lesson No. 3). Given the choice between tightening too early and

threatening a recession (not a legacy many policy makers seek) or tightening too slowly and possibly creating asset-price bubbles
and/or inflation, they tend to lean toward the latter. Easy monetary policy may be helping to support

equities today, but it has also contributed to some of the economy’s growing vulnerabilities. Indeed,
low interest rates factor directly and indirectly into several of the potential catalysts we are watching
for the next equity-market descent — sparks that could set off the “dry tinder,” as the Treasury’s Paulson described it
back in 2006.

The plan would make a significant amount of private health care companies worthless
overnight – hits the entire market.
Hellner 17 (4/20, Jack, Writer for Real Clear Politics and the American Thinker. “The single-payer health care insurance trap”,
http://www.americanthinker.com/blog/2017/04/the_single_payer_health_care_insurance_trap.html)

Individuals, corporations, mutual funds, and private and public pension funds would lose when the
private health companies become worthless . I am curious how they would handle the loss of
hundreds of billions (if not more) in value of the stocks, bonds and property that private health
companies own. What would happen to the millions of employees supported by the private health
care system? Over 500,000 people work in the offices of health insurance companies. Think of the
number of family members these people support and how many additional jobs these people
generate by buying cars, houses, and all other products . How would communities and states replace
the property taxes, income taxes, sales taxes, and all other taxes these people generate with their
income? Think of the cost to the government if a significant proportion become dependent on the government.

Institutional investors are heavily invested in health insurance company

Button ’13 [Keith Button, Institutional investors drawn to health-care sector, July 16, 2013,
http://www.pionline.com/article/20130716/ONLINE/130719926/institutional-investors-drawn-to-health-care-sector]

Opportunities inhealth-care investing through hedge funds, private equity funds and long-only equity strategies seem to be drawing increasing
interest from institutional investors. But not all areas of the sector are flourishing. One indicator of the interest is the growth of
U.S. health-care mutual funds for institutional investors over the last 12 months. According to Morningstar, total net assets for those funds
have increased to $1.8 billion as of May 31, up from $1.2 billion as of Nov. 30, 2012, and from $1 billion as of June 30, 2012. Institutional investors are very
interested in the health-care sector now, especially because of excellent returns in health-care subsectors, including

drug manufacturers, insurance companies and providers, said Roderick Wong chief investment officer and
the stocks of

managing partner of RTW Investments LLC, a health-care hedge fund firm in New York with $60 million in assets under management. For some sectors,
the returns are about 20% so far in 2013, Mr. Wong said. RTW's offshore fund (RTW Master Fund Ltd.) was up 26.8% for 2013 through June and up 21.9% for 2012, both net of fees, according
to the firm. The HFRI EH: Sector — Technology/Healthcare Index is up 8.92% for 2013 through June. In comparison, the HFRI Fund Weighted Composite Index is up 3.55% for the same period.
Health-care reform also is driving institutional investor interest in the space, Mr. Wong said. The Affordable Healthcare Act will add up to 30 million people to the insured rolls. The ACA is
“clearly a short- and medium-term net positive for many players in health care,” Mr. Wong said. Carter Neild, a general partner at health-care investment firm OrbiMed Advisors LLC, New

institutional investor interest in the health-care sector driven more by innovation in the
York, said he sees

industry and drug launches, and less by the ACA changes. Last year, for example, the U.S. Food and Drug Administration approved 39 new
drugs, a 15-year high. OrbiMed is considered the largest health-care investment manager in the world, with about $7 billion under management. That includes about $2.5 billion in hedge
funds, $2.5 billion in long-only equity funds, $1.5 billion in private equity funds and $500 million in health-care royalty funds. Within health care, investor interest has varied according to wide
disparities in returns. Royalty funds, the illiquid investment vehicles that monetize royalties for drugs or medical devices, are “white hot” and wildly oversubscribed because they provide great
returns and steady cash flow in a low/no-interest environment, Mr. Neild said. And only a handful of health care royalty fund managers exist, including OrbiMed, DRI Capital Corp. of Toronto,
Royalty HealthCare Partners of Stamford, Conn., Capital Royalty L.P. of Houston and Royalty Pharma of New York Venture capital an exception In contrast, the returns for health-care venture
capital funds are tanking, along with investor interest in the space, Mr. Neild said. Health-care venture capital, primarily investing in the biopharmaceutical or medical device space, has
typically made up about 25% of the total venture space. Awful returns for the space are killing fundraising. “Those funds are just dying; there's massive attrition,” Mr. Neild said. “Many of
these groups that have been in business for a long, long time will just disband.” Among the established venture capital firms that have publicly indicated they will not raise another health care
venture fund are Skyline Ventures of Palo Alto, Calif.; Scale Venture Partners of Foster City, Calif.; Essex Woodlands Health Ventures of Palo Alto; and Prospect Venture Partners, also of Palo
Alto. For long-only health-care strategies and long-short equity health-care hedge funds, returns have generally reflected the healthy returns of health-care public equities. And the Nasdaq
Biotechnology index, for one benchmark, is up about 40.7% for 2013, through July 15. Whether the health-care sector in general experiences a long-term, sustainable profit boost as a result of
ACA reforms will depend on what mechanisms are created to control prices and health-care utilization, Mr. Wong said. But the drug and biotech sectors are well-positioned for long-term
profitability, he said. The current productivity boom in drug discovery will translate into “real value creation” through important new drugs that have a significant impact on disease, Mr. Wong
said. “We are in the early stages of a research productivity boom that should fill pipelines for the next decade or more,” he said. Endowments and foundations in the $500 million to $3 billion
range and larger family offices seem to have a real appetite for the health care investment strategies followed by RA Capital Management LLC, said Michael Calore, director of investor
relations for the hybrid hedge/private equity fund manager. The Boston-based manager runs more than $500 million, investing in small-cap, development-stage biotech companies.

Uncorrelated alpha Health care has become attractive for institutional investors in part because uncorrelated
alpha , which is harder to find in other segments, is available from the good managers in the space, Mr. Calore said. And with health
care product development companies developing technologies at faster rates and deep-pocketed big
pharmaceutical companies looking to acquire technologies through mergers and acquisitions, fund managers have a
lot of opportunities in the space, he said. Ferenc Sanderson, a partner in PrevInvest, a pension fund advisory a pension fund consultant and research firm based in
Cleveland and Rome, Italy said institutional investor interest in health care has definitely received a boost from the ACA. Over the first five months of the year, long-short equity hedge funds
have moved more into health-care stocks, Mr. Sanderson said. Through April, year-to-date stock prices in the health care sector of the S&P 500 were up 18.4%, second only to the utilities
sector. Another factor has been the high level of consolidation in the health-care industry, especially with hospitals in urban areas, mostly driven by pressure to reduce costs, he said. A third
factor has been the boom in retirement and specialty health-care facilities, such as those that treat Alzheimer's patients, as occupancy rates have increased. Because this sector is
characterized by steady returns over the long term, a lot of private equity firms and some institutional investors, such as university endowments with large real estate portfolios, are jumping
in, Mr. Sanderson said. Other exposure A lot of the hedge fund money invested in health care is through multistrategy funds, not pure health care plays, rather in stocks of large companies
that are outside of the sector but stand to benefit from changes in technology platforms, insurance and pharmaceuticals that ACA will bring. “That's the opportunity. It's the big picture which
is the real alpha story, I think,” Mr. Sanderson said. “When you've got consolidations of companies, there's going to be winners and losers. When you've got consolidation of data, there's

opportunities if you can capture that data and manage it.” Institutional investors also might have more riding on health-care
investments than what meets the eye . For a typical global long-short equity hedge fund, health-care
sector positions might be less than 5%. But considering related companies — tech, insurance and real estate investments that
will be affected by the health-care industry changes — the exposure could be more than 20% , Mr. Sanderson said.

Institutional investors pose a systematic risk to the entire financial system.

Elliott ’14 [Douglas J. Elliott, Fellow, The Brookings Institution, Systemic Risk and the Asset Management Industry, May 2014,
https://www.brookings.edu/wp-content/uploads/2016/06/systemic_risk_asset_management_elliott.pdf]

Asset managers control the investment decisions for a substantial percentage of the total assets
invested in financial markets. This particularly matters in the U.S. because of the relative importance of
financial markets , as compared with more bank-centric financial systems in most of the rest of the world, including Europe, Japan, and China. A crisis in the
financial markets can harm the real economy through multiple channels: Credit supply. Crises cause a
substantial contraction of the supply of credit and equity funding, reducing economic growth. Wealth
effects. Crises also create a significant decline in household wealth with the attendant reduction in
spending and slowdown in the economy. Confidence effects. Crises damage consumer and business confidence, leading to lessened business activity and
employment. Links to the bank sector. Problems in the financial markets can be transmitted to the banks with which markets are
interlinked in a number of different ways, including by reducing the value of bank assets and capital and by tightening bank liquidity conditions by making it difficult to sell certain assets at a
reasonable price. Liquidity effects. Money market funds have been a partial substitute for bank deposits and a “run” on such funds could have effects on the economy similar to a bank run,
forcing fire sales, blocking credit channels, and harming confidence. Some analysts are concerned that other asset management activities could have similar attributes. Decisions by
asset managers affect , or are affected by, these systemic risks principally through two related channels: asset prices and
liquidity conditions in financial markets . Asset managers decide what volumes of specific assets they
are willing to buy or sell and at what prices. These decisions are partly a result of analysis by the managers and partly a response to financial market
conditions and, importantly, inflows and outflows of funds from their investor clients. One risk related to asset management is the potential for large-scale redemptions from funds during
times of market stress. Unwinding positions during turbulent periods may require conducting costly and unprofitable trades. This risk would be exacerbated if investors believe that they will
gain an economic advantage by being the first to redeem. 24 There has been such an advantage to some extent for money market funds because of the artificial use of a Net Asset Value of
$1.00 per share even when the actual NAV is slightly above or below that amount. In such a situation, the costs of trades in troubled markets could primarily be borne by the remaining
investors, creating a “first- mover advantage” to withdrawing funds. 25 The presence of a “first-mover advantage” may distort investor expectations and serve as a source of risk to a fund. 26
In general, redemptions on a scale that threatens financial stability or that triggers heavy selling and price declines in markets have not been observed. According to analysis conducted by the
Investment Company Institute, “investors do not redeem heavily from stock and bond funds during periods of market stress and fund portfolio managers are not heavy sellers of portfolio
securities in down markets.” 27 Nevertheless, redemption risk remains a concern for asset managers and regulatory authorities insofar as it is presents a legitimate channel through which
funds may be exposed to financial shocks. Securities lending programs serve as another channel through which asset managers may touch systemic risk. During the financial crisis, some asset
managers that were involved in securities lending programs bore significant losses on cash collateral that had been invested in assets that were severely impacted by the crisis, such as
structured investment vehicles and Lehman Brothers notes. 28 Moreover, securities lending programs create another source of redemption risk. Borrowers may seek to return securities if they
are concerned about the safety of their collateral in stressful market periods. Since asset managers typically reinvest cash collateral in money markets, in the event that markets have seized up
and borrowers demand the return of their collateral, lenders may be forced to sell at a loss assets that have become illiquid in order to return the cash collateral. 29 Asset managers may also
touch systemic risk through interconnections with other financial institutions or business lines. According to the OFR, the complex network of interconnections among asset managers and
other financial services firms may expose asset managers to risks that arise in other market sectors. 30. 31 Likewise, asset managers may be exposed to risks through interconnections within
their own firm or fund complexes. Asset managers that work in a division of a bank or insurance company or that work in an asset management company that offers ancillary services, such as
in-house broker-dealers, commodity pool operators, trust companies, or consulting services, may be exposed to risks in other market segments. Asset managers act autonomously in many
ways and in others act solely as agents passing through the decisions of their investors. Therefore, it is important in considering systemic risk to separate out the impacts on risk arising from
the structure of asset managers and their decision-making processes from those that merely represent the pass- through of decisions by their customers. It will generally be ineffective to try to
reduce systemic risk at the asset manager level in those cases where the real determinants are decisions by end-investors. That is, the distinction must be made between exposure to systemic
risk, as has been discussed in this section, and creation or amplification of systemic risk. In what ways do asset managers create or amplify systemic risk? It is critical to determine whether the
existence of an asset manager causes the total level of systemic risk to be significantly higher than it otherwise would be. This should exclude the effects of simply pooling together systemic

risks that would otherwise exist, unless there is an amplification effect caused by the act of pooling. Some read the OFR report to imply that asset managers can create
systemic risk by entering into fire sales of troubled asset categories in a time of crisis . A “fire sale” is the sale of an
asset at a price below its value that takes place because it is forced in some manner, rather than as the result of a discretionary investment decision that happens to undervalue the asset. It is
not clear that this implication was intended by the OFR, but if it was, the key question is whether such fire sales are simply a straight pass-through reflecting choices by end-investors. For
example, if mutual funds dumped tech shares during the Tech Crash of 2001, but did so simply by proportionally lowering the size of their holdings in response to investor redemptions from
the mutual funds, then it does not seem meaningful to view the asset managers running those funds as having created the fire sales. Thus, asset managers do not bring a fire sale risk unless
their mode of operation makes such risks higher than would exist simply due to the changing preferences of their end-investors. This would hold even if the end- investor choices are
themselves the result of fire sale conditions. That is, if end-investors want or need to dispose of assets quickly, for whatever reason, this would be reflected in overall financial market

having large amounts of assets

conditions whether those investors owned the assets directly or did so through an asset manager. It is theoretically possible that

pooled together under one asset manager could raise the risk of fire sales, because of an amplification
effect. For example, if millions of end-investors entrust their funds to the management of a single asset manager, it is possible that the manager would concentrate their investments in a
few assets and create fire sale risks for those assets that would be more severe than would have existed if the end-investors had acted independently or had spread their money across more

For this theoretical risk to exist in reality, it

managers. Of course, higher concentration in an asset at a given manager might be offset by lesser holdings at another manager.

would have to be true that asset managers, as a class, “herd,” or create greater concentration in
specific assets, or that asset managers with high concentrations in specific assets are more prone to forced sales. There is an extensive body of
theoretical and empirical literature on institutional herding. Institutional investors may exhibit herding
behavior for a number of reasons, some of which do not apply to retail investors, including information cascades – that is, inferring information from one
another’s trades, 32 relying on similar information or market signals to make investment decisions, 33 the possibility of reputational costs to investing against the crowd, 34 or the presence of

competitive pressures. 35 While there is empirical evidence suggesting that institutional investors broadly may exhibit
herding behavior, thereby increasing market concentration in specific assets or asset classes, such is not necessarily the case for every type of institutional investor. Mutual
funds as a class, for example, tend to exhibit less herding behavior. 36, 37
 AT: Bargaining power
If insurers are colluding to lower prices – that solves bargaining power. Or the
government doesn’t solve
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”, https://www.nytimes.com/2016/05/17/upshot/why-single-payer-health-care-would-probably-still-be-
expensive.html?_r=0)

-Most of $ we spend on HC goes to care – not administrative – cutting costs means cutting qual of care/doctors pay

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 imagine
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 .
 AT: Administrative costs
Single payer won’t solve administrative costs – doesn’t assume government
inefficiency
Pearl 17 – M.D., Professor at Stanford School of Business, Executive Director and CEO of The Permanente Medical Group and President and CEO
of the Mid-Atlantic Permanente Medical Group (Robert, “3 myths about a single-payer system and why it’s doomed to fail,” Kevin MD, March
27, 2017, http://www.kevinmd.com/blog/2017/03/3-myths-single-payer-system-doomed-fail.html)

It sounds great, almost too good to be true: Coverage for all with lower costs, a broad choice of providers,
and minimal paperwork.

The problem is that it won’t work.

For more than half a century, advocates for a government-run, single-payer approach to health care coverage have touted its
potential. With debate over the Affordable Care Act heating up by the day, progressives, both at the state and federal levels are now
pushing anew to move to some form of this system. Most recently, the California Legislature introduced a bill to accomplish this, although
without any details of how it would work.

On the surface, the arguments sound reasonable. Cut out the middleman — the insurance company — and use the savings
to provide universal coverage at lower cost. Yet all attempts in the United States to implement this concept have
failed. For example, Vermont made a serious run at a state-based, single-payer system — only to see it
abandoned after only three years, due to major cost increases and the need to dramatically raise
taxes to fund the expense.

In practice, a single-payer system would cost more than the most efficient and effective programs
that exist today, all while compromising access and, over time, quality.
Let’s look at three of the myths around this approach and why, if tried, it would be doomed to fail.

Myth 1: It would lower administrative costs

Supporters claim a single-payer system would siphon out billions of dollars in administrative
overhead. How they reach this conclusion varies by the source, but in each case, a deeper analysis
reveals oversimplification and fallacious assumptions.

One line of reasoning is based on the lower cost of health care in other countries with a government-run system. But the
reduced costs
in other nations reflect other factors — their cheaper drug prices, lower wages, and a higher number of
primary care physicians compared to specialists — rather than lower administrative overhead.

A second comparison drawn is between Medicare and commercial insurance in the United States. Here cost
is confused with price, and vice versa. The federal government has a unilateral ability to set prices, and often does so at levels
below the actual cost of care delivery. When it does this, hospitals and doctors offset the reduced payments they receive from the government
by raising prices elsewhere. Published economic analyses indicate that only 90 percent of cost is reimbursed through Medicare today and that,
as a consequence, commercial insurers pay, on average, approximately 120 percent of the Medicare rates to doctors and hospitals.

Finally, some backers of a single-payer system look at the Medical Loss Ratio (percentage of health care
premium spent on direct patient care) of some of the publicly traded insurance companies and note that, for
some, nearly 20 percent of their revenues are used for administrative purposes. What is left unsaid is
that there are already several not-for-profit insurance programs that spend more than 90 percent of
their revenue on patient care — and as such, little savings would be achieved.
The idea that a government-run plan could function without incurring major administrative costs is
naive , especially if fee-for-service is the method of provider reimbursement. In such a system, doctors and hospitals
would still need to complete claims forms. Government employees would, in turn, be required to sort
through them, make certain they’re appropriate, question coding, and pay the providers accordingly .
There is little evidence , whether we look at the U.S. Postal Service or the Department of Motor Vehicles , that the
government is particularly efficient at these types of administrative tasks .
 1NC – Markets stable
Health care markets are stabilizing---no death spiral
Demko 7-13-17 (Paul, healthcare reporter for Politico, “Despite doomsday rhetoric, Obamacare markets are stabilizing”
http://www.politico.com/story/2017/07/13/obamacare-markets-health-care-240487)

But reports of its demise appear to be premature. For the first time ever this year, insurers selling plans in
Obamacare’s markets appear to be on a path toward profitability . And despite the drumbeat of headlines about fleeing
insurers, only about 25,000 Obamacare customers live in communities facing the prospect of having no insurer next year. Insurers in the Obamacare

marketplaces spent 75 percent of premiums on medical claims in this year's first quarter, an indication the

market is stabilizing and insurers are regaining profitability, according to a Kaiser Family Foundation study released
this week. By comparison, in the prior two years, insurers spent more than 85 percent of premiums on medical costs

during the same period, which translated into huge losses. “ We’re not seeing any evidence of a death spiral or a market

collapse,” said Cynthia Cox, Kaiser’s associate director of health reform and private insurance. “Rather, what it looks like is insurers are on track
to have their best year since the [ A ffordable C are A ct] began.” The financial results are only for the first quarter, and
there are still plenty of problems with the markets: Just 141 insurers submitted plans to sell on the exchange market for next year — a nearly 40
percent decrease from this year, HHS said this week. And there are 38 counties nationwide where no insurer has filed any plans to sell for 2018, potentially leaving
25,000 individuals with no coverage options. In addition, insurers in many states are
once again seeking eye-popping premium
increases, often exceeding 20 percent. Another sign of trouble: The uninsured rate nationwide ticked up to 11.7 percent, according to a Gallup
survey this week, up from a historic low of 10.9 percent. But those woes don’t mean the Obamacare markets are on the

verge of collapse. One big reason for their resilience : the overwhelming majority of Obamacare customers
are eligible for subsidies that shield them from big price spikes. “You have about 10 million people, mostly low-income, who
are relying on this program for their sole source of health care coverage,” said Dan Mendelson, president of the health care consultancy Avalere Health. “That gives
the program some level of stability and implies that it is unlikely that there will be a complete implosion of this benefit program.” Much of the current turmoil can
be attributed at least in part to questions about the future. The ongoing slog to pass an Obamacare repeal package means insurers have no clear understanding of
the long-term makeup of the individual market. In addition, mixed signals from the Trump administration about whether it will continue making crucial subsidy
payments or keep enforcing the individual mandate are further unsettling insurers. “The Trump administration has poured gasoline on the fires of uncertainty in the
private insurance market,” said Sen. Ron Wyden of Oregon, the top Democrat on the Senate Finance Committee. “What plans need more than anything else is some
predictability and some certainty.” “It’s been six and a half months so far and they still haven’t gotten to any clear policy or even a clear signal,” added Joe Antos, a
health care finance expert at the conservative American Enterprise Institute. Insurers' filings for 2018 highlight how that uncertainty is contributing to struggles in
the markets. In Tennessee, for example, the state's dominant Blue Cross Blue Shield plan wants to raise rates by an average of 21 percent for next year. But the
insurer attributed that increase entirely to uncertainty about federal subsidy payments and enforcement of the individual mandate. The Kaiser
data
tracks projections by industry analysts that the Obamacare markets are on a path toward viability,
despite the financial bloodletting of the law's early years that saw billions of dollars in losses. An April
report by analysts at Standard and Poor’s found that Blue Cross Blue Shield plans, which dominate many

Obamacare markets, saw big improvements in their bottom line last year and that many would approach break-even margins this
year. “It’s an improving market, but still fragile, and uncertainty doesn’t help,” said Deep Banerjee, one of the authors of the S&P report. Any blanket statements
about the viability of the Obamacare markets are bound to be misleading. That’s because there are really 51 different state markets, including D.C. with unique
characteristics. California has experienced vigorous competition, relatively stable pricing and healthy enrollment from the outset. A recent report from the Trump
administration showed that the average enrollee in the state's marketplace, Covered California, last year was 20 percent less expensive than Obamacare customers
nationwide. “I sort of feel like we’re in an alternate universe to some of the national rhetoric,” said Peter Lee, Covered California’s executive director. “We continue
to have a very stable and well-functioning market in California, as is the case in much of the nation.” California hasn’t announced rates for 2018, but Lee stressed
that uncertainty around the cost-sharing subsidies, the individual mandate and GOP repeal efforts will drive prices much higher than otherwise would be necessary.
“The business of health insurance is not like rolling the dice or playing blackjack,” Lee said. “It is actuaries that bet on certainty.” Maryland’s marketplace looks very
different. The state’s largest insurer, CareFirst BlueCross BlueShield, wants to raise rates by more than 50 percent for 2018. The other three competing insurers are
seeking increases of at least 23 percent. It’s the second straight year that Maryland's individual market insurers are seeking huge increases. “You’ve heard the term
death spiral? I think unfortunately that’s where we are,” said Maryland Insurance Commissioner Al Redmer, Jr., a Republican. Redmer is dismissive of suggestions
that the market’s struggles are the result of uncertainty caused by the actions of congressional Republicans and the Trump administration. “To say we’re seeing a 50
percent rate increase because of uncertainty is ludicrous,” Redmer said. “That ignores history. Uncertainty did not create half a billion dollars in losses over the last
four years.” The biggest blow to the Obamacare markets in recent months has been Anthem’s decision to pull back from the marketplaces. The Blue Cross Blue
Shield plan, which this year sold coverage in 14 states, is exiting or scaling back its footprint significantly in Ohio, Wisconsin, Indiana and Nevada, leaving potentially

bare counties in three of those states. But those exits have been at least partially offset by Centene’s decision to
significantly expand its Obamacare footprint. The insurer is entering three new states and expanding its presence in six others. In
Missouri, for example, 25counties were at risk of having no insurer before Centene announced it would sell plans in those markets. The problem of counties without
insurers could still blow up in the coming weeks. That’s because insurers typically have until late September to make final decisions about market participation. If
they see more signs of market mayhem -- in particular, if the Trump administration follows through on threats to cut off cost-sharing subsidies -- there could still be
a mass exodus. “I would have expected more insurance companies to be exiting,” said Kaiser’s Cox. “It has been remarkable how resilient
this market has been.”
 No Impact to Cost
Rising healthcare costs won’t dramatically affect competitiveness of manufacturing –
single-payer and other reforms have more distortionary effects on the economy.
Miller ‘9 (Thomas Miller is a resident fellow at the American Enterprise Institute (AEI), where he studies health care policy, including health insurance.
Former senior health economist for the Joint Economic Committee (JEC) in Congress. “Squaring Healthcare with the Economy”, https://www.cfr.org/expert-
roundup/squaring-healthcare-economy)

Leading versions of healthcare legislation before Congress this year remain more likely to weaken U.S. economic competitiveness, at the margin, than to improve it.
The direct impact of higher healthcare costs on the competitiveness of U.S. businesses has been
overstated by interest groups either looking to transfer their immediate burdens to others or to enact
broader health policy agendas unrelated to competitiveness. Health benefits are largely substitutes
for other forms of labor compensation . Hence U.S. firms have performed well [in the past], despite
rising levels of healthcare costs , because high levels of productivity and a favorable investment
climate were (and remain) much more important factors in determining competitiveness . As CBO Director
Douglas Elmendorf concluded in congressional testimony earlier this year, "[ T]he costs of providing health insurance to their
workers are not a competitive disadvantage for U.S.-based firms. " We should do better in improving the value of healthcare
services. However, the pending bills mostly promise more care and more insurance, with little essential health reform in return. Partially shifting the high

cost of health benefits from one set of pockets--employer payrolls--to the pockets of taxpayers (which
include business firms and their customers)--will neither reduce their net claim on the overall
economy nor strengthen incentives to produce better health outcomes at lower costs. The current bills
unfortunately would set us back in that regard. Their most likely results would be further spikes upward in government

spending, unfunded entitlement obligations, federal budget deficits, tax burdens, and regulatory drag
on the economy; and tighter squeezes on investment, innovation, and human capital development .
The legislation’s complex, layered schemes of mandated costs, cross-subsidies, and taxes will discourage increased

labor force participation, work effort, and job growth.

 AT Job Lock
Ending job lock doesn’t meaningfully improve entrepreneurship.
McArdle and Shane 10 (Megan, columnist at Bloomberg View and a former senior editor at The Atlantic and Scott, PhD, is the A. Malachi Mixon
III Professor of Entrepreneurial Studies and professor of economics, “Will Health Insurance Reform Spur Entrepreneurship?”,
https://www.theatlantic.com/business/archive/2010/03/will-health-insurance-reform-spur-entrepreneurship/37888/)

I've heard a lot of arguments that health care reform will increase the rate of entrepreneurship. Most
of them go along the lines of this piece from Jonathan Gruber: lack of an alternative source of health insurance creates "job lock" , where employees are
afraid to switch jobs. The better your recourse to alternate insurance, the more likely you are to be self-employed. It's certainly a plausible story. And certainly, the number of people who wish

The question is, is that number actually large? The age group
to start businesses, but are held back by the health insurance problem, cannot be zero.

that worries most about health insurance is also the age group that has other commitments, like mortgages. How many people are financially stable

enough to strike out on their own, but have no recourse to COBRA, and cannot afford to buy private
insurance? It is not enough to point to self employment statistics. Self employment is not the same thing as entrepreneurship--a
lone consultant, professional, or contractor is a fine thing, but it's not quite what we are talking about when we worry about rates of entrepreneurship. For some people,

self-employment is essentially tax arbitrage, so it's not surprising that you see more of it when people are able to take advantage of, say, a spouse's
generously tax-subsidized health care. But moving those people between self-employment and wage slavery would not

much change the dynamism of the American economy . Similarly, a physician who starts his own practice is probably not affecting GDP much
one way or another. Which is not to say that it isn't a large problem. Here are the questions you need to ask about the net effect of this bill: 1) How many "job locked"

people would really create new businesses? About 2/3 of Americans say they'd like to start a company, but far fewer than that actually do. How
many marginal entrepreneurs are being held back by health care, rather than the other risk aversions
of middle age? 2) Has the marginal impact changed over time? It is now easier to port insurance than it used to be, so how much extra boost can we get from health care reform, over things

like COBRA and HIPAA? 3) Is this the kind of entrepreneurship where you start a new firm, or where you take a professional practice
solo, or go to contract work? The best data we have is on Medicare, which seems to show a noticeable discontinuity around age 65--but the

size of the effect is small , and as I understand it, entrepreneurship among the elderly is usually a matter of retiring into a part-time consulting practice, not founding a
new company with the potential for major economic impact. Arguably, Medicare is actually slowing the economy, by letting people retire before they otherwise would. 4) How many

would-be entrepreneurs have no recourse to spousal insurance, and also are so resource-constrained
that they can't afford to buy insurance? 5) New taxes on capital income are a major source of funding
for this health care plan. Does this ultimately make a difference in rates of entrepreneurship? I can see
two ways that it would: by reducing the return on the entrepreneur's savings, so that they need to dip into the principal;
and by reducing the prospective return of investing in said entrepreneur. On the other hand, how significant is a 4% tax? 6) Does
the health care reform slow cost growth? That would be beneficial for small businesses, especially--either because they're in a bigger pool, or because we've slowed the rate of inflation. But
that does not seem to have been the experience in Massachusetts. 7) Does the health care bill create a threshold effect that impedes firm growth? Firms smaller than 50 employees don't have
to offer insurance; firms with 50 or more workers do. Other regulations of this sort tend to encourage firms to keep their companies artificially small, because hiring that fiftieth worker is so

If social safety nets are

costly: his salary, plus health benefits or a $2.000 fine for him and the other 49 workers. But is this really a large problem? I'm not sure we know. 8)

so great for entrepreneurship, why are European rates of entrepreneurship so much lower than
ourshuh? I can imagine a countervailing force: people left without a good, insured job who become
so desperate to make it that they build an exciting new business . But that is merely a just-so story; there are a lot of differences
between us and Europe, and perhaps universal health coverage simply isn't adequate to overcome the other barriers. 9) What about the regulatory

compliance costs? Will these increase for firms under the new regulation, and what does that imply for their growth rates?
These suggest some empirical tests. For starters, around 2020, do we see higher rates of
entrepreneurship? Entrepreneurship seems to have been fairly stable in this country, so an uptick would be meaningful (though not right around 2014--you might see
bunching, as people wait a few months to start their companies, without any real increase in the overall rate of entrepreneurship). And, do we see firms bunching right under that 50 employee
mark? That's complicated by the fact that 50 is one of those nice, intuitive cut-offs, and so probably there's already some bunching due to state-level regulations. But if this is a meaningful
problem, it should get worse in the latter part of this decade. On net, I'd suspect that this will be positive for entrepreneurship--but I don't know that this will translate into a lot more growth.

Enabling people to become self-employed is a fine thing, but it is not the same as enabling them to
start transformative new businesses. Update: economist Scott Shane quantifies it better: The latest Small Business Economy an annual publication of The Office
of Advocacy of the Small 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

Data from the Small Business Administration's

job lock that would be the source of any additional jobs. JOB LOSSES FROM HEALTH-CARE REFORM?

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.
While this may sound like a lot of jobs, it is not . In general, estimates of the number of jobs that will be
lost because of health reform are larger. For instance, the Lewin Group, a health-care consulting firm owned by UnitedHealth Group (UNH), calculated that
the original House bill would have destroyed 260,000 to 600,000 jobs and that "the estimate would increase a bit under the House bill as passed, because employer costs are a little higher."
Researchers at RAND Corporation make similar estimates to those of the Lewin Group. Note--that's the previous House bill, not the current version, for which I don't have any estimates on job
loss or creation.
 AT Space Debris
No space debris impact
CNN ‘2 (“Scientist: Space weapons pose debris threat” http://www.cnn.com/2002/TECH/space/05/03/orbit.debris/)
That scenario would likely never succeed or even happen in the first place, other space experts said.

Military satellites are hardened to resist impacts from debris already in space and future orbiters will
likely become even more protected as the technology improves, said Michael Kucharek, spokesperson for the
U.S. Air Force Space Command. The Colorado-based outpost tracks almost 10,000 thousands of pieces of space junk four inches (10
cm) in diameter or larger.

Moreover, such an attack would be technologically and economically daunting.

"Very few nations could do that today. Even If you were to put tens of thousands of particles out
there, it would pale in comparison to what is already out there," said Nick Johnson of NASA's Orbital Debris Program Office, which
monitors the threat of small space debris to spacecraft.

"We've looked at so-called chain reaction scenarios and it would require an exceptionally large
number of particles," Johnson said.
 AT Asteroids
There’s no imminent threat to the Earth and we would have centuries of warning in
the status quo
Bennett 2010 (James, Prof of Economics at George Mason, The Doomsday Lobby: Hype and Panic from Sputniks, Martians, and
Marauding Meteors, p. 168-169)

Cooler heads intervened. Donald Yeomans of the Jet Propulsion Laboratory said, “The comet will pass no closer to the Earth than 60 lunar
distances [14 million miles] on August 5, 2126. There is
no evidence for a threat from Swift-Tuttle in 2126 nor from any other
known comet or asteroid in the next 200 years.”96 Even Brian Marsden concurred. He retracted his prediction, though he
held out the possibility that in the year 3034 the comet could come within a million miles of Earth. Surveying this very false and very loud alarm,
Sally Stephens, writing in the journal of the Astronomical Society of the Pacific, observed, “Marsden’s
prediction, and later
retraction, of a possible collision between the Earth and the comet highlight the fact that we will most
likely have century-long warnings of any potential collision, based on calculations of orbits of known
and newly discovered asteroids and comets. Plenty of time to decide what to do.”
Coverage
 1NC AT Solves Access
The plan leads to supply constraining measures that lock in health care inaccessibility
Emanuel 8
(Ezekiel, former chief health policy advisor to the Obama administration, and the chair of the Department of
Medical Ethics and Health Policy at the University of Pennsylvania; The problem with single-payer plans.; Hastings
Center Report; Ebsco)

Ineffective cost-control strategies. Efficiency

savings from reduced administrative costs or cheaper drug prices
should not be confused with controlling costs overall. Efficiencies, such as reducing administrative waste, are onetime
savings. Controlling costs means reducing the increase in medical spending year after year. Single-payer
plans use the savings from efficiencies to extend coverage to the uninsured and expand covered
services without raising the total amount spent on health care. But these one-time savings do not
attack the fundamental forces that drive health care cost inflation. Unless there is some mechanism to control
those pressures, the one-time savings would be used up in a few years, and overall health care spending
would go higher and higher. How can single-payer plans respond to this health care inflation? There are three possible
approaches. One is to “constrain the supply”: use the national health plan’s control to constrain the introduction and
deployment of technology. A single-payer plan could decide to limit the number of MRI scanners, for example.
Indeed, in the Physicians’ Working Group proposal, the national health plan would negotiate with hospitals on
capital expansion and could easily limit how many hospitals can build facilities for MRI scanners or
new specialized surgical suites.4 This strategy creates queuing for access to the technology. As every major
country trying this has learned, queuing creates huge public resentment. People on the waiting list get furious at the central
administration. Americans, especially the upper middle class, are unlikely to tolerate it. Constraining

supply also promotes gaming of the system and inequality. When technology is limited, patients—and
physicians—try to jump the queue. Physicians are not great at creating priority lists based on medical
need. Particularly when they have their own practices, their obligation is to their individual patients, not to ensuring
that other physicians’ patients get care and not to promoting the overall health of the population.
Countries that have tried this approach have found, not surprisingly, that such gaming tends to favor well-off patients. In

many facets of life, well-off people have learned how to come out on top in situations where there are
limits. Limits on health care technology gives them one more setting in which their greater gaming
skills can be deployed. A study in Winnipeg, Canada, showed that although all Canadians were legally entitled to the same services,
the well-off had substantially better access to high technology services that were constrained.5
 1NC AT Pandemics
Natural pandemics are impossible
Sandberg 6/11/14 (Anders, James Martin Research Fellow at University of Oxford, “The five biggest threats to human existence”,
http://www.washingtonpost.com/posteverything/wp/2014/06/11/the-five-biggest-threats-to-human-existence/)

Natural pandemics have killed more people than wars. However, natural pandemics are unlikely to be existential
threats : There are usually people resistant to the pathogen, and the offspring of survivors would be
more resistant. Evolution also does not favor parasites that wipe out their hosts, which is why syphilis went
from a virulent killer to a chronic disease as it spread in Europe.
 1NC AT Cyber
No significant impact to cyber attacks – probability, current defense checks, and too
difficult to coordinate
Gartzke and Lindsay ’15 [Erik Gartzke is professor of political science at the University of California, San Diego. Jon R. Lindsay is
assistant professor of digital media and global affairs at the Munk School of Global Affairs, University of Toronto. Weaving Tangled Webs:
Offense, Defense, and Deception in Cyberspace, Security Studies, 24:316–348, 2015.]

Indeed, the US Department of Defense gets attacked ten million times a day; a US university receives a
hundred thousand Chinese attacks per day; and one firm measures three thousand distributed denial of service (DDoS) attacks
per day worldwide.23 In reality, however, most of these so-called attacks are just routine probes by automated
networks of compromised computers (botnets) run by profit-seeking criminals or spy bureaucracies—a
far cry from terrorism or military assault. The most alarming scenarios of a “digital Pearl Harbor” or
“cyber 9/11” have yet to materialize despite decades of warning. The Stuxnet worm caused limited and
temporary disruption of Iran’s nuclear program in the late 2000s, the only known historical case of infrastructure damage
via deliberate cyber attack, but this operation seems to reveal more about the strategic limitations of cyber war
than its potency.24 The cyber revolution should presumably provide rivals with potent new tools of influence, yet actual cyber
disputes from 2001 to 2011 remain restrained and regionalized, not disruptive and global.25 Computer
espionage and nuisance cybercrime thrive, to be sure, but they are neither as prevalent nor as costly as they
might be, leading skeptics to describe US losses as “a rounding error” in a fifteen trillion dollar economy.26 It is
possible in principle that the same tools used for computer-network exploitation may one day be leveraged for more destructive strikes. Yet
even if the nontrivial operational challenges of cyber war can be overcome,
proponents of the cyber-revolution thesis have
yet to articulate convincing strategic motives for why a state or non-state actor might actually use
cyber capabilities effectively.27 A considerable shortage of evidence in the study of cyber conflict is thus a source both of concern
and relief. That cyber war remains unusual is puzzling in light of the widely held belief that offense is easier than defense in cyberspace. A
straightforward implication of the notable scarcity of cyber war would be that, contrary to conventional
wisdom, cyberspace is defense dominant for some reason. More carefully stated, since clearly there is much mischief
online, offense dominance may exist only for nuisance attacks that are rarely strategically significant,
such as piracy, espionage, and “hacktivist” protest, even as the Internet is defense dominant for more harmful or
complicated forms of attack. Serious cyber attacks against complicated infrastructure require considerable intelligence
preparation, test and evaluation infrastructure, planning capacity, technical expertise, and
complementary military or non-cyber intelligence assets.28 If so, it would be a categorical error to mistake the frequency
of irritant activity for a more general tendency toward offense dominance across the entire cyber domain.
 1NC AT Bioterror
Producing a pathogen isn’t the same as producing a bioweapon – tons of logistical
barriers - zero historical evidence for this impact
Jefferson et al. 8/21/14 (Catherine, senior policy advisor for international security at the Royal Society, where she led a project on
Neuroscience, Conflict and Security. Prior to this she was a research fellow with the Harvard Sussex Program on Chemical and Biological
Weapons at the University of Sussex, where she also obtained her DPhil, Filippa Lentzos, Senior Research Fellow in the Department of Social
Science, King’s College, Claire Marris, Department of Social Science, Health and Medicine, King’s College, “Synthetic biology and biosecurity:
challenging the “myths”’, http://journal.frontiersin.org/Journal/10.3389/fpubh.2014.00115/full)

Myth 5

Terrorists want to pursue biological weapons for high consequence, mass casualty attacks
Underlying the first four myths are certain assumptions about who the terrorists might actually be, what their intentions are, what capabilities they might pursue, and the level of skills and resources available to them. Despite a lack of analysis of the potential adversaries involved in the
misuse of life science research, the bioterrorism threat has generally been portrayed in policy circles as an imminent concern, and emphasis is placed on high consequence, mass casualty attacks, performed with “weapons of mass destruction” (WMD).

For example, in one of the President George W. Bush’s earliest statements following 9/11 and the “anthrax letter” attacks that drew the American people’s attention to the biological weapons threat, he said:

Since September 11, America and others have been confronted by the evils these [biological] weapons can inflict. This threat is real and extremely dangerous. Rogue states and terrorists possess these weapons and are willing to use them (58).

Later, he set up a WMD Commission and tasked it with examining the threat posed by the nexus of international terrorism and the proliferation of weapons of mass destruction. In its report, this Commission asserted:

Unless the world community acts decisively and with great urgency, it is more likely than not that a weapon of mass destruction will be used in a terrorist attack somewhere in t he world by the end of 2013. The Commission further believes that terrorists are more likely to be able to
obtain and use a biological weapon than a nuclear weapon. The Commission believes that the U.S. government needs to move more aggressively to limit t he proliferation of biological weapons and reduce the prospect of a bioterror attack [(59), p. xv].

Bioterrorism became one of the Bush Administration’s key security concerns over its two terms in office. One estimate of civilian biodefense expenditure across the federal government since 2001 is that more than $70 billion have been spent (60). Despite this, on the 10-year anniversary
of 9/11 and the “anthrax letter” attacks, the former US senators who chaired the WMD Commission, Bob Graham and Jim Talent, released a “report card” on America’s bio-response capabilities that concluded the US was still unprepared to respond to large-scale biological attacks. It also
warned:

Naturally occurring disease remains a serious biological threat; however, a thinking enemy armed with these same pathogens — or with multi-drug-resistant or synthetically engineered pathogens — could produce catastrophic consequences. A small team of individuals with graduate
training in several key disciplines, using equipment readily available for purchase on the Internet could produce the type of bioweapons created by nation-states in the 1960s. Even more troubling, the rapid advances in biotechnology, such as synthetic biology, will allow non-state actors
to produce increasingly powerful bioweapons in the future [(61), p. 11].

We see here how the myths we previously discussed, about de-skilling and increased access, and about the ease of designing new dangerous pathogens, underlie concerns about terrorists’ potential ability to launch a mass attack, and how these are connected, by actors, with the advent
of synthetic biology.

The senators were not alone in their assessments. For instance, the US Senate Majority Leader Bill Frist made a similar warning in an earlier speech outlining the global threat of infectious disease and bioterrorism, and the need to better prepare the US and the world to respond to
epidemics and outbreaks:

No intelligence agency, no matter how astute, and no military, no matter how powerful and dedicated, can assure that a few technicians of middling skill using a few thousand dollars worth of readily available equipment in a small and apparently in nocuous setting cannot mount a first-
order biological attack … Never have we had to fight such a battle, to protect so many people against so many threats that are so silent and so lethal (62).

Similar messages were reinforced at the highest level. Addressing BWC members at their five-yearly meeting in 2011, Secretary of State Hillary Clinton said:

The advances in science and technology make it […] easier for states and non-state actors to develop biological weapons. A crude, but effective, terrorist weapon can be made by using a small sample of any number of widely available pathogens, inexpensive equipment, and college-level
chemistry and biology (63).

She also acknowledged, however, that not everyone in the international community shared the US assessment:

I know there are some in the international community who have their doubts about the odds of a mass biological attack or major outbreak. They point out that we have not seen either so far, and conclude the risk must be low. But that is not the conclusion of the United States, because
there are warning signs, and they are too serious to ignore (63).

The belief that the focus should be on mass attacks was bluntly stated by an FBI agent at a symposium on synthetic biology this year (1st May), when she warned: “These technologies do not just pose a risk to individual buildings or cities, but if cleverly deployed, can reduce our
population by significant percentages” (64).

Challenges to Myth 5
There are two dimensions to Myth 5. The first is about the intention of would-be terrorists, and the assumption is that terrorists would seek to
produce mass casualty weapons and pursue capabilities on the scale of twentieth century state-level bioweapons programs. While most leading
biological disarmament and non-proliferation experts believe that the risk of a small-scale bioterrorism attack is very real and very present,
they consider the risk of sophisticated large-scale bioterrorism attacks to be very small (65). This is
backed up by historical evidence . The three confirmed attempts to use biological agents against humans in terrorist
attacks in the past were small-scale, low casualty events aimed at causing panic, and disruption rather than
excessive death tolls: (i) the Rajneesh cult’s use of Salmonella on salad bars in local restaurants to sicken potential voters and make
them stay away from the polls during Oregon elections in 1984; (ii) the 1990–95 attempted use of botulinum toxin and anthrax by the Japanese
Aum Shinrikyo cult; (iii) and the “anthrax letters” sent to media outlets and members of US Congress in 2001 resulting in at
least 22 cases of anthrax, five of which were fatal (66, 67).

The second dimension to Myth 5 is the implicit assumption that producing a pathogenic organism
equates producing a weapon of mass destruction. It does not . Considerable knowledge and resources
are necessary for the processes of scaling up, storage, and developing a suitable dissemination
method. These processes present significant technical and logistical barriers . Drawing from her in-depth study of
the Iraqi, Soviet, and US bioweapons programs (3, 4), Ben Ouagrham-Gormley explains:

Scaling up fragile microorganisms that are sensitive to environmental conditions and susceptible to
change — and viruses are more sensitive than bacteria — has been one of the stiffest challenges for past
bioweapons programs to overcome, even with appropriate expertise at hand . Scaling-up requires a
gradual approach, moving from laboratory sample, to a larger laboratory quantity, to pilot-scale
production, and then to even larger-scale production. During each stage, the production parameters need to
be tested and often modified to maintain the lethal qualities of the agent; the entire scaling-up
process can take several years (68).

The dissemination of biological agents also poses difficult technical challenges. Whereas persistent chemical
agents such as sulfur mustard and VX nerve gas are readily absorbed through the intact skin, no bacteria and
viruses can enter the body via that route unless the skin has already been broken. Biological agents
must either be ingested or inhaled to cause infection. To expose large numbers of people through the gastrointestinal
tract, possible means of delivery are contamination of food and drinking water, yet neither of these scenarios would be easy to accomplish.
Large urban reservoirs are usually unguarded, but unless
terrorists added massive quantities of biological agent, the
dilution effect would be so great that no healthy person drinking the water would receive an
infectious dose (66). Moreover, modern sanitary techniques such as chlorination and filtration are
designed to kill pathogens from natural sources and would probably be equally effective against a
deliberately released agent. Bacterial contamination of the food supply is also unlikely to inflict mass casualties. Cooking,
boiling, pasteurization, and other routine safety precautions are generally sufficient to kill pathogenic
bacteria.

The most likely way to inflict mass casualties with a biological agent is by disseminating it as a respirable aerosol: an invisible cloud of infectious
droplets or particles so tiny that they remain suspended in the air for long periods and can be inhaled by large numbers of people. A high-
concentration aerosol of B. anthracis or some other pathogen, released into the air in a densely populated urban area, could potentially infect
thousands of victims simultaneously. After an incubation period of a few days, depending on the type of agent and the inhaled dose, the
exposed population would experience an outbreak of an incapacitating or fatal illness. Although
aerosol delivery is potentially
the most lethal way of delivering a biological attack, it involves major technical hurdles that most
terrorists would be unlikely to overcome. To infect through the lungs, infectious particles must be
microscopic in size – between 1 and 5 μm in diameter. Terrorists would therefore have to develop or acquire a
sophisticated delivery system capable of generating an aerosol cloud with the necessary particle size
range and a high enough agent concentration to cover a broad area . Overall, an important trade-off
exists between ease of production and effectiveness of dissemination. The easiest way to produce
microbial agents is in a liquid form, yet when such a “slurry” is sprayed into the air, it forms heavy
droplets that fall to the ground so that only a small percentage of the agent is aerosolized. In contrast, if
the bacteria are first dried to a solid cake and then milled into a fine powder, they become far easier to aerosolize, yet the drying and milling
process is technically difficult.

The Aum Shinrikyo cult struggled with dissemination (67, 69, 70). In one of its anthrax dissemination attempts, it sprayed unknown, but
probably very large, quantities of a liquid aerosol (most likely crude culture, unprocessed in any way) of B. anthracis from the roof of the Aum’s
headquarters building in Tokyo. For the dissemination, the Aum set up two sprayers on the roof of the eight-story building, each within a large
round cooling tower. Pipes were extended from the cooling towers to tanks below, which were filled with a liquid suspension of B. anthracis.
The device worked poorly, producing large droplets rather than the very fine aerosol needed for effective transmission of anthrax. It also
appears the spore concentration was very low (at least five orders of magnitude below that necessary for a highly infectious wet aerosol).

In another dissemination attempt, targeting the area around the Kanagawa prefectural office and the Imperial Palace, the Aum equipped
vehicles with spraying devices, but according to prosecutors’ statements, the nozzle of the sprayer clogged and the operation failed. Despite its
200 m2 laboratory containing, amongst other equipment, a glove box, incubator, centrifuge, drier, DNA/RNA synthesizer, electron microscope,
two fermenters each having about a 2,000 litre capacity, and an extensive scientific library, and despite its repeated attempts at dissemination,
the Aum was unsuccessful in causing any disease, and in retrospect it is clear that the cult did not even make the first substantive step toward
an effective bioweapon.

If, despite the odds, aerosolization was achieved, the effective delivery of biological agents in the open
air is highly dependent on atmospheric and wind conditions, creating additional uncertainties. Only
under highly stable atmospheric conditions would the aerosol cloud remain close to the ground where
it can be inhaled, rather than being rapidly dispersed. Moreover, most microorganisms are sensitive to
ultraviolet radiation and cannot survive more than 30 min in bright sunlight, limiting their use to
night-time attacks. One major exception is anthrax, which can be induced to form spores with tough outer coats that enable them to
survive for several hours in sunlight. Terrorists could, of course, stage a biological attack inside an enclosed space such as a building, a subway
station, a shopping mall, or a sports arena. Such an attack, if it involved a respiratory aerosol, might infect thousands of people, but even here
the technical hurdles would by no means be trivial.
 1NC AT ISIS
ISIS sucks
Byman ’17 (Daniel, professor and Senior Associate Dean at Georgetown University's Walsh School of Foreign Service, “Beyond Iraq and
Syria: ISIS’ ability to conduct attacks abroad,” 6/8/17, https://www.brookings.edu/testimonies/beyond-iraq-and-syria-isis-ability-to-conduct-
attacks-abroad/)

The Islamic State poses a real but manageable threat to the U.S. homeland. Since the September 11th attacks, 95
Americans have died in jihadist-related attacks in the United States. The two deadliest attacks, in San Bernardino in 2015 and in Orlando in
2016, which together killed 63 Americans, involved individuals who claimed some allegiance to the Islamic State but acted independently of the
group—often referred to as “Lone Wolves.”

Although any death from terrorism is unacceptable, it is worth noting several positive aspects of these numbers. First, the
number of
deaths—95—is far lower than many experts , both inside and outside of government, predicted. Second,
the individuals involved in both the Orlando and San Bernardino attacks did not travel abroad to fight with
the Islamic State, were not controlled by Islamic State leaders, and their violence seemed to mix personal and psychological issues
with traditional terrorism, suggesting they might have embraced violence for other reasons had the Islamic State not
existed. Third, although their targets—a workplace holiday party in a community center and a gay nightclub—show they might
strike anywhere, they are hardly the high-profile, well-guarded targets that gained Al Qaeda
popularity. Fourth, deaths from terrorism and terrorist plots on the U.S. homeland in the post-9/11 era
are often below levels for the pre-9/11 era.

Multiple factors likely explain this relatively low level of violence. First, senior U.S. officials
overestimated the number of radicals in the United States after 9/11 when they spoke of thousands of Al Qaeda
terrorists in the United States.[1] Second, the American Muslim community regularly works with law enforcement,
leading to many arrests. As former FBI Director James Comey explained, “They do not want people committing violence, either in their
community or in the name of their faith, and so some of our most productive relationships are with people who see things and tell us things
who happen to be Muslim.”[2] Almost half of all tips on potential extremist individuals come from the
American Muslim community.[3] (Indeed, a member of the local Muslim community reported the Pulse nightclub shooter to the
FBI before the attack.) Additionally, U.S. efforts abroad,

notably targeting terrorist leaders in their sanctuaries, exacerbates the leaders’ ability to organize, train, and
plot attacks, particularly “spectaculars” that require years to plan and orchestrate. This disruption also
hinders the group from accessing the United States . Finally, the massive increase in funding and
aggressiveness of the FBI and foreign-oriented intelligence agencies enabled a broader effort to
disrupt potential attackers, foreign fighters, and other radicals. Global intelligence cooperation in
particular resulted in the identification and disruption of numerous potential terrorist plots. Similarly, the
FBI’s efforts at home, while at times leading to arrests of individuals who had little or no chance of conducting an attack, led to the
early disruption of some plots that might have killed many people.
Block
DA
 AT Populism High
European populism is declining and Trump is driving it.
Graham 17 (3/16, DAVID A. GRAHAM is a staff writer at The Atlantic, where he covers U.S. politics and global news. “Is Trump Dragging Down the
European Far-Right?”, https://www.theatlantic.com/international/archive/2017/03/is-trump-hurting-the-european-far-right/519735/)

Is Trump Dragging Down the European Far-Right? Donald Trump’s victory in the U.S. presidential election in November was heralded
as the latest in a series of triumphs for the populist right: First there was Brexit, followed by a series of gains for right-wing, anti-immigration parties in Europe.
When Italians voted against a referendum backed by Prime Minster Matteo Renzi in December, it looked like proof of the populist wave’s continued surge. But a
poorer-than-expected showing by Geert Wilders’s Dutch Freedom Party (PVV), with nearly 80 percent turnout, in elections on Wednesday complicates the picture.
While Prime Minister Mark Rutte’s center-right People’s Party for Freedom and Democracy lost eight seats, it will be the biggest party in the 150-seat Dutch

parliament. Wilders’s party won 20, short of the 30 it hoped to pick up. It’s too soon to declare the populist wave dead , but with
Wilders’s stumble, it’s worth at least raising the question of whether Trump’s victory may have been
the high-water mark for the right-wing populist movement . Rutte, who is expected to remain in power, is hardly a dove on
immigration, but he’s not as hardline as Wilders. And unlike the platinum-pompadoured populist, he is favorable toward European integration. Wilders has been
styled in the press as the Dutch Donald Trump, a comparison that he has at times courted—Wilders
dropped by the 2016 Republican
National Convention, where Trump was formally nominated, even as many top Republicans stayed
away. He contributes to Breitbart, the court organ of the Trump administration. Even his campaign
slogan was a variation on Trump’s. But as the Dutch campaign ramped up, Wilders grew much more
cautious about invoking the U.S. president. This was no coincidence: By mid-February, when the race
in the Netherlands began, Trump had been in office for several weeks, and Dutch voters had gotten a
chance to observe him as president. They didn’t like what they saw. “It’s a hard start for Wilders—
he’s losing momentum, and this is partly because of Trump,” pollster Gijs Rademaker told The Wall Street Journal. Among poll
respondents who had backed the PVV in December but no longer did by February, 60 percent thought Trump was doing a bad job. Wilders’s caginess about Trump
doesn’t seem to have saved him; although PVV gained seats on Wednesday, it fell short of expectations, as well as his own prediction of a surprisingly strong result.

And if Wilders is in fact a victim of Trump backlash in Europe, he might not be the last . While immediate reactions
tend to be overly rash, Bloomberg’s Joe Weisenthal noted that immediately after preliminary results came in from the Netherlands, betting markets became much
more bearish on the electoral chances of Marine Le Pen, the French presidential candidate who is aligned with Wilders, and who consciously tried to associate
herself with Trump: In Germany, meanwhile, Martin Schulz of the center-left Social Democratic Party (SPD) has found his fortunes surging ahead of September’s
general election. The SPD has been lost in the political wilderness for years, finding little purchase against the once-invincible Chancellor Angela Merkel. While
Merkel has shown little use for Trump, or his disdain for the EU and NATO, Schulz has seized on the American president as a perfect foil, using him as a vehicle to
make the case for European cooperation. The far-right Alternative for Germany party, meanwhile, remains far back, and has seen its standing fall somewhat in
recent months. There’s
a danger of overstating Trump’s effect on European politics, especially when viewing
the situation from the United States. Internal dynamics play an essential role in each of these
elections, and each country has its own problems. But there are good reasons to believe that Trump
is playing some role in these contests . Even before he was formally nominated, Trump was deeply unpopular in Europe. A June 2016 Pew
poll found just 9 percent of Europeans had confidence in the Republican. With a few more months to evaluate him, they’ve hardly changed their minds. A
YouGov/Handelsblatt poll at the beginning of the year found that sizable majorities in several European countries expected Trump to be a poor president; in France,
the only country where a majority did not feel that way, a plurality did. A
November poll found rising approval of the EU across
the board, another sign of the pendulum potentially beginning to swing back.
 AT No Credit
Trump takes credit for the plan and uses it to get tons of voters
deLespinasse 4/24 (Paul, Professor Emeritus of Political Science and Computer Science at Adrian College. He received his PhD from
Johns Hopkins University in 1966, and has been a National Merit Scholar, an NDEA Fellow, a Woodrow Wilson Fellow, and a Fellow in Law and
Political Science at the Harvard Law School. “Trump Could Score Politically With Medicare For All”
http://www.newsmax.com/PaulFdeLespinasse/medicare/2017/04/24/id/786094/)

Donald Trump campaigned promising to "repeal and replace" Obamacare. He has now discovered that
insurance reform is more complicated than he realized. Congressional Republicans, happy to pass irresponsible
repeals when they could count on a veto from President Obama, cannot agree on a replacement now that it will have

real political consequences . Trump sensibly said that replacement and repeal should be simultaneous. Simultaneity meant that
repeal would be delayed since there was no Republican consensus on a replacement. But delay was preferable to the mess a mere repeal
would cause. Obamacare insured millions of additional people. Some parts are very popular, especially its ban on denying insurance to people
with preexisting conditions. But insurance
markets would be destroyed if this ban is retained and the most unpopular part of
Obamacare, mandatory purchase of insurance, is eliminated. The obvious way to escape from this dilemma is
to enact a single-payer system — an improved Medicare for all — financed by general taxation.
Nobody would have to buy insurance, but everyone would be insured. People would not have to choose between
incomprehensible policies with different coverage and doctor "networks." Patients would no longer "churn" between different types of
insurance, each with its own network, as incomes change. People would no longer have to document their finances in order to qualify for
subsidies. And it would save Americans a lot of money. Medical providers would no longer need huge staffs — now costing about $80,000 per
year for every doctor — to bill dozens of insurance companies. Readers familiar with TV's Doc Martin may remember that this irascible English
doctor has only one employee. Conservatives bemoan duplicated government programs and administrative bloat. But we now have separate
government agencies for insuring poor people, retirees, veterans, and native Americans. We also have private bloat: back-room staffing at
medical providers and huge staffs insurance companies use to figure out reasons for not covering people. The situation presents an
opportunity for Donald Trump, a world-class opportunist. Imagine him explaining to supporters,
often economically disadvantaged, why a system covering medical bills with only nominal co-
payments, no deductibles , and no out-of-network doctors would be strongly in their interest . Or,
explaining to black Americans how an improved Medicare for all would do more for minorities than
any other conceivable government program. If Trump were to propose Medicare for all, Dem ocrat s in
Congress would have to bite their tongues and support him. Support would also come from many of
the voters, Republicans and independents , who supported him. Medicare for all would not require establishment of a
new bureaucracy, since Medicare is already a going concern. Indeed, it would allow elimination of the organizations now covering the poor,
veterans, and native Americans. Trump,knowing how to get national attention , would be uniquely able to
explain why inevitable criticism of his proposal by the medical-pharmaceutical-insurance complex is
rooted in self-interest and misleading. He could explain why the taxes to pay for Medicare for all will
cost Americans with average or especially lower incomes less than they now pay, directly and
indirectly, for medical care. Critics might note that Medicare for all, by making insurance more efficient, would cause immense
unemployment among non-medical people currently working for doctors, hospitals, and insurance companies. But Trump could
correctly reply that people will take the money previously spent to support these administrators and
spend it on other things, thereby creating an equal number of new jobs in other industries. Any
unemployment created by this reform would be temporary, and implementing the reform during a booming economy would mitigate even this
damage. Althoughmost congressional Republicans have opposed a single-payer system, if Trump
convinces public opinion many Republicans in Congress would have to vote for it. If single-payer failed
to pass, Trump could urge voters to unseat those who opposed it in 2018. Conservative public opinion
may already be starting to turn around to support an improved Medicare for all. Charles Krauthammer —
a trained psychiatrist as well as a nationally syndicated columnist — spoke favorably of it recently. And conservative columnist
George F. Will — Princeton Ph.D. in political science — has just indicated that it is probably the best way to escape from
the complex inadequacies of Obamacare. One of my own columns, published in 2009, urged conservatives to reconsider their
knee-jerk hostility to a single-payer system, so perhaps I was a little ahead of the pack. If President Trump decides to endorse
an improved Medicare for all, I recommend that— after previous quiet consultation — he invite Senator Bernie Sanders to the
White House so the two of them could make a dramatic joint announcement. This could be political theater on a

Shakespearean scale and, hopefully, one of the high point s of the Trump presidency.
 Link
Reversing Trump failure undoes the Trump effect and strengthens nationalist parties
in Europe. HC Link!
Kellner 17 (3/6, Peter, a journalist, political commentator, and former president of YouGov. “Peak Populism, Perhaps”,
http://carnegieeurope.eu/strategiceurope/68183?lang=en)

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 presidential election in France; and the anti-
immigration Alternative for Germany (AfD) might drag German politics way to the Right. Let’s
look at 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 around 15 percent. An average of more recent polls
puts its support at 10 percent, down one-third since the start of the year. In
Finland, 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 struggle to avoid coming sixth at the next election, due in 2019. Perhaps
these are no more than flimsy straws in a fickle 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
This is certainly no time for the opponents of right-wing nationalism to relax their guard .
come roaring back.

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 .
 IL – Europe Fragmentation
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”, https://worldview.stratfor.com/article/why-
decline-europes-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 how to fight the new war, and until it does, it may find itself relegated to political
weakness. Europe
will face numerous tests in the 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.
CP
 Bundling Solves
Bundled payment improves cost savings and quality of care – pilot projects prove
Delbanco 14 – Ph.D. M.P.H, executive director of Catalyst for Payment Reform, sits on the Coordinating Committee of the Measures Application
Partnership for HHS, HFMA’s Healthcare Leadership Council, and the National Commission on Physician Payment Reform, the Health Care
Incentives Improvement Institute board, the Anvita Health Advisory Counci (Suzanne, “The payment reform landscape: bundled payment,”
Health Affairs, July 2, 2014, http://healthaffairs.org/blog/2014/07/02/the-payment-reform-landscape-bundled-payment/)

Does bundled payment improve the quality and affordability of care?

No widespread study has been completed in the private sector about the quality impact or savings derived from bundled payment. However,
there are some specific small studies that demonstrate its potential impact.

In 2011 CaroMont Health and North Carolina’s largest health insurer, Blue Cross and Blue Shield of North Carolina
(BCBSNC), implemented a bundled payment arrangement based on the PROMETHEUS payment model for
entire knee replacement. The bundle includes the pre-surgical period of 30 days prior to hospitalization, the surgery itself, and most follow-up
care within 180 days after discharge from the hospital. In a one-year pilot, BCBSNC saved about 8 to 10 percent on average
per-episode cost.
Geisinger Health System has implemented a unique performance-based bundled payment system called ProvenCare, developed as a way to
reimburse providers for coronary artery bypass graft surgery (CABG). ProvenCare achieved notable results for CABG surgery, including a 10
percent reduction in readmissions, shorter average length of stay, and reduced hospital charges. Since the program’s inception in 2006,
Geisinger has added the following diagnoses to ProvenCare: elective coronary angioplasty (PCI); bariatric surgery for obesity; perinatal care; and
treatment for chronic conditions.

In the public sector, CMS is expanding its use of this payment model with the Bundled Payments for Care
Improvement (BPCI) Initiative. Under BPCI, started in 2013, organizations enter into payment arrangements that include financial and
performance accountability for episodes of care. CMS
has had a good track record with bundled payment; over the
life of the ACE Demonstration and Heart Bypass Center Demonstration, Medicare saved $42.3 million on bypass
patients treated in the demonstration hospitals.
How and when is bundled payment most likely to work best?

As Rand succinctly explains, when

looking at bundled payment models, “Savings will depend on the design of
the payment system, the particular services that are bundled, and the performance of the participating
system before implementation.” Clearly some types of care, such as a joint replacement, or labor and delivery, lend themselves to the model
better than others because they are common and have easily identifiable start and end points.

Not every provider system is well-equipped to participate in a bundled payment arrangement. Some
providers have experience with taking full financial risk and can engage in that approach right away.
These providers may be more centralized and vertically integrated, and therefore capable of managing a full episode
of care in a coordinated fashion. Where providers are decentralized, it may work best to start with a shared
savings payment arrangement and work toward bundled payment as the delivery and coordination of care becomes more seamless.
Benefit design matters too. Providers are more likely to organize around bundled payment if they think they will be rewarded with more cases.
Benefit designs such as reference pricing, centers of excellence, and co-insurance differentials can help encourage consumers to use providers
in bundled payment arrangements. In a paper CPR authored with the Health Care Incentives Improvement Institute (HCI3) last year, we
discussed the potential savings that could come from pairing reference pricing with bundled payment arrangements.

While payment methods are usually a matter of discussion for health care providers and the health
insurance carriers with whom they contract, some employers and other health care purchasers are
getting directly in the game. These purchasers must consider their organization’s culture regarding employee choice of provider; the
level of internal resources they have to devote to arranging a direct contract with providers; and how modest or aggressive they want to be in
seeking cost savings.
What is next?

Bundled payment has real potential to improve care coordination and quality and reduce costs .
Unfortunately, it isn’t quick or easy to implement. Anecdotally, we know that today’s providers and health plans are not well equipped to
bundle their claims. Today, identifying and paying for care bundles is a largely manual process, slowing the adoption of this model.

To help employers and other purchasers think through the steps required, CPR has just released a How To Guide for implementing a total joint
replacement (hip and knee) bundled payment program. While the Guide is designed to help employers and purchasers, it addresses many of
the issues discussed here and may be helpful for plans and providers to peruse as well.

When we release our next National Scorecard on Payment Reform this September, we expect to see a jump in the percent of commercial
dollars flowing through bundled payments. This would be encouraging, since bundled payment, if well-constructed and
implemented, typically improves the value of health care.
Disease
 Impact D – Disease
No impact to diseases.
Sebastian FARQUHAR ET AL. 17. *Project Manager at FHI responsible for external relations, M.A in Physics and Philosophy,
Oxford. **John Halstead, Global Priorities Project. ***Owen Cotton-Barratt, Research Associate in the FHI at Oxford, Lecturer in Mathematics
at St. Hugh’s College. ****Stefan Schubert, PhD in philosophy, Researcher at the Centre for Effective Altruism. *****Haydn Belfield, Academic
Project Manager, Centre for the Study of Existential Risk, Cambridge. ******Andrew Snyder-Beattie, Director of Research at FHI. “Existential
Risk: Diplomacy and Governance.” Future of Humanity Institute. Oxford, Global Priorities Project. https://www.fhi.ox.ac.uk/wp-
content/uploads/Existential-Risks-2017-01-23.pdf.

For most of human history, natural pandemics have posed the greatest risk of mass global fatalities .37
However, there are some reasons to believe that natural pandemics are very unlikely to cause human
extinction . Analysis of the International Union for Conservation of Nature (IUCN) red list database has shown that of the 833
recorded plant and animal species extinctions known to have occurred since 1500, less than 4% (31
species) were ascribed to infectious disease.38 None of the mammals and amphibians on this list were
globally dispersed , and other factors aside from infectious disease also contributed to their
extinction. It therefore seems that our own species, which is very numerous, globally dispersed, and capable
of a rational response to problems, is very unlikely to be killed off by a natural pandemic .
One underlying explanation for this is that highly
lethal pathogens can kill their hosts before they have a chance to
spread, so there is a selective pressure for pathogens not to be highly lethal . Therefore, pathogens are
likely to co-evolve with their hosts rather than kill all possible hosts.39
 Medical Tourism
Single payer jacks up wait times- drives patients to seek care abroad
Runnels et al. 14 Vivien Runnels is Senior Researcher with the Globalization and Health Equity Research Unit in the Faculty of
Medicine, University of Ottawa. She holds a Ph.D. in Population Health (2011) from the University of Ottawa and an Ontario Training Centre
Diploma in Health Services and Policy Research (2011). She also has carried out post-doctoral work with the Population Health Improvement
Research Network based at the University of Ottawa. Her Master’s degree from City University, London, UK is in Disability Management in Work
and Rehabilitation (1999). Ronald Labonté holds a Canada Research Chair in Globalization and Health Equity at the School of Epidemiology and
Public Heath. He is Professor in the Faculty of Medicine, at the University of Ottawa, and in the Faculty of Health Sciences, Flinders University of
South Australia. He is also adjunct Professor in the Department of Community Health and Epidemiology, University of Saskatchewan. Corinne
Packer is the Assistant Director and Senior Researcher at the University of Ottawa’s School of Epidemiology and Public Health, working on
global health equity matters. Owen Adams OBE, Pro-Vice-Chancellor (Master’s degree in Defence Studies from King’s College London, a
Postgraduate Diploma in Strategic Management and Leadership from the Chartered Management Institute and a Master’s degree in Leadership
and Management from Portsmouth University.) Dr. Jeff Blackmer, MD, MHSC, FRCPC (BSc, University of New Brunswick MD, University of
Western Ontario FRCPC, Physical Medicine & Rehabilitation, University of Saskatchewan Masters in Medical Ethics, University of Toronto).
"Canadian physicians’ responses to cross border health care." Globalization and health 10.1 (2014): 20.

The survey questions encouraged physicians to reflect on their experiences with MT and OOCC, and have provided some insights into physician
concerns with medical travel. In summary, over
a quarter of the sample of physician respondents had determined
that one or more of their patients needed OOCC provided by provincial/territorial health insurance
plans, and had applied for OOCC on their behalf. The rate of approval experienced by respondents was less than half for the
48% of those who responded, and fully successful in just over a quarter of the responses. The most common OOCC treatments received were
diagnostic procedures followed closely by treatment for life threatening conditions, and the overwhelming majority of treatments were
received in the United States.

Regardless of the procedure sought, respondents reported that their patients engaged in medical
tourism because they considered waiting time for treatment in Canada was too long . An OECD report
indicated that among 11 countries surveyed in 2010, Canada experienced some of the longest waiting times
for health care; 59% of Canadians surveyed reported waiting four weeks or more to see a specialist,
while 25% waited four months or more for elective surgery [5]. In 2012, nine out of ten Ontarians living in the eastern
region of the province waited an average 343 days for hip replacement, making this the most poorly performing region in an already poorly
performing province [8]. These
wait times may not necessarily pose medical risks but, as one respondent in
the physician survey wrote, patients experience “…anxiety re: waiting [ even if] not founded on
reality”.

Turns the case- rise in medical tourism just exports inequality globally
Chen & Flood 13 Y.Y. Brandon, J.D., M.S.W., is a Doctor of Juridical Science candidate at the University of Toronto, Faculty of Law. He
is a Vanier Canada Graduate Scholar, a Canadian Institutes of Health Research Fellow in Health Law, Ethics and Policy, as well as a Lupina Senior
Doctor Fellow in the Comparative Program on Health and Society. He holds a Bachelor of Science degree from Emory University as well as
Master of Social Work and Juris Doctor degrees from the University of Toronto., and Colleen M. Flood, LL.B., LL.M., S.J.D., is a Professor and
Canada Research Chair at the Faculty of Law, University of Toronto and is cross-appointed to the School of Public Policy and the Institute of
Health Policy, Management & Evaluation. From 2006-2011 she served as the Scientific Director of the Canadian Institute for Health Services and
Policy Research. She holds a Bachelor of Arts and Bachelor of Laws (Honours) from the University of Auckland, New Zealand as well as a Master
of Laws and Doctorate in Juridical Science from the University of Toronto, Canada.. "Medical tourism's impact on health care equity and access
in low-and middle-income countries: making the case for regulation." The Journal of Law, Medicine & Ethics 41.1 (2013): 286-300.

On the other hand, some observershave raised concerns about medical tourism potentially worsening the
accessibility of health care for citizens of LMICs. The expansion of medical tourism, they argue, diverts
resources from basic health and social services depended upon by the majority of the local
populations to secondary and tertiary care demanded by foreign patients, thus distorting health
spending in LMICs.9 These critics contend that a successful medical tourism industry is likely to compete with
the domestic health care regime for the limited number of health professionals available and
therefore contribute to internal brain drain .10 The increased demand due to influx of medical tourists
could also elevate the costs of health care and price out local patients, especially the poor .11 Unlike
proponents of medical tourism, these commentators are less optimistic about the prospect of revenues generated from medical tourism cross-
subsidizing the public health care system. Instead, they fear that proceeds
are reinvested back into the medical tourism
industry to support its continuing growth and to satisfy its investors’ profitmaking objectives.12
Ultimately, as suggested by Laura Hopkins and colleagues, “the prime beneficiaries are limited to medical tourists and the enterprises that
provide services. The
global entrenchment of twotiered health care following medical tourism poses the
broader and larger ethical health equity concern .”13
Econ
 1NR Stocks Uniqueness
Stock price rise will keep going
Kramer 9/29/17 – Michael Kramer (“Why The S&P 500 Could Rise To Over 3,000 in 2018,” Investopedia, September 29 th,

http://www.investopedia.com/news/why-sp-500-could-rise-over-3000-2018/)

The S&P 500 (SPY SPDR S&P500 ETF Trust Units SPY 251.23 +0.35% ) is likely to continue rising well into 2018 based on
current earnings trends. Everyone tries to predict which way the market will go. If you want to figure out the direction
of the market, just follow the trend of earnings ; it's just that simple. Based on current earnings
expectations , the market is likely to continue to rise into 2018. And if the current pace of earnings growth continues,
the S&P 500 could rise to over 3,000 by year's end in 2018, an increase of 21 percent from current levels.

For the most part, the equity market follows the direction of earnings; it is just a matter of how much investors are willing
to pay for those earnings. Based on Wall Street's expectations for 2018, the S&P 500 has further room to rise. And based on earnings
growth rates, it can do so without multiple expansion.
The Case for 3,050

Should earning continue to grow at a pace faster than the S&P 500, the market has more upside
without the risk of it getting too expensive , giving it the ability to rise well into 2018. Should the S&P 500
trade at today's multiple of 23 times earnings, with earnings expectations for the S&P 500 at $131.25 for 2018, you could see an S&P 500 that is
trading at nearly 3,050 by the end of 2018. The S&P 500 has been trading at roughly 23 times earnings since the fourth quarter of 2015.
 1NR AT Cost Growth/Death Spiral
Health care cost growth has tapered.
Bryan 16 (Bob, Business Insider Writer, citing a report from the Dallas Fed and the Kaiser Family Foundation, “There's one huge myth about the cost of
healthcare”, http://www.businessinsider.com/healthcare-costs-growing-slower-than-normal-not-skyrocketing-2016-8)

If you didn't know better, then it would appear that healthcare costs are skyrocketing. The amount that the US
spends on healthcare passed $3 trillion for the first time in 2014. Obamacare premiums are on the rise. There's seemingly always a

controversy over a new drug with a massively inflated price. Appearances are not reality, however , according to new research from the

Federal Reserve Bank of Dallas. In a monthly economic letter, Mine Yücel and the Dallas Fed research team pointed out that healthcare-services
costs are actually running below core personal consumption expenditure (PCE) inflation . Put another way,
healthcare services are actually a drag on inflation right now. For one thing, according to the research from Yücel and
company, prices for healthcare services — which include things like the cost of a hospital visit, the cost of nursing-home services, and net health-

insurance costs — have been growing at a much slower rate than in the past. "The growth rate of health care services prices has
slowed dramatically, from around 4 percent per year in 2004 to a low of about 0.5 percent in 2015," said the Dallas Fed team. "The rate has since moved slightly
higher, to just less than 1.2 percent on a 12-month basis in 2016." According to the Dallas Fed, this measure includes not just spending from households, but also
those paying for households by proxy. Thus, government spending through programs such as Medicare and employers spending through group health plans are also
included. The impact on core PCE — which is used by such groups as the Federal Reserve in interest-rate decisions and strips out volatile food and energy prices —
from healthcare services is significant. Core
PCE has been running well under the Fed's target of 2% for some time
now, but without the drag from healthcare services, it would be very close to the goal . "For the ex-food-and-
energy index, excluding health care services raises current 12-month inflation to 1.69 percent from 1.57 while lowering longer-term average inflation to 1.61
percent from 1.94 percent," said the Dallas Fed study. "That means ex-food-and-energy inflation is 0.08 percentage points above its longer-term average rate rather
than 0.37 percentage points below, the deviation when health care services are included." Of note, this data is on an aggregate level. It is not to say that individual
health-insurance plans or experiences at the hospital were not more expensive in recent years. But, in total, price growth slowed. Additionally, according
to
data from the Kaiser Family Foundation, the growth for total health spending in the US based on data
from the US Center for Medicare and Medicaid Services hit the lowest point in decades in 2013 and
remains well below the long-run average . While Kaiser projects that there will be some normalization in spending growth over the next 10
years, the Dallas Fed's and Kaiser's measures show that prices for healthcare aren't exactly ballooning.

Enrollment is also increasing, solves market spirals

Graves 17 (Allison Graves: PolitiFact Florida staff writer, previously reported for PolitiFact Missouri, University of Missouri graduate, Journalism
major, “Is Obamacare in a 'death spiral'?,” 3/26/17, http://www.politifact.com/punditfact/statements/2017/mar/26/hugh-hewitt/obamacare-
death-spiral/, Accessed: 8/28/17)

Still no ‘death spiral’¶ "Death

spiral" is a health industry term built around three components:¶ Shrinking
enrollment;¶ Healthy people leaving the system;¶ Rising premiums.¶ Specifically, a death spiral occurs when shrinking
enrollment leads to a deteriorating risk pool (or when healthy people leave the plan due to the cost). That leads to higher premiums for the
people remaining in the insurance pools, which causes enrollment to shrink even further, continuing the cycle until the entire system fails.¶ The
latest government figures show enrollment in
the Affordable Care Act is slightly down from last year. Through
Jan. 31, 2017, some 12.2 million people were signed up for coverage through a federal or state
marketplace, which is a decrease of 500,000, or 4 percent, from the same point last year.¶ Experts noted that
marketplace sign-ups were running in line with their 2016 pace as of the middle of January, which experts
said might suggest the decline in sign-ups was somehow related to the Trump administration, not an impending death spiral.¶ For example, the
Trump administration decided to at least partially halt marketing and outreach encouraging people to sign up for health coverage.¶ But experts
saythe enrollment decline isn’t an indication the health care law is in a death spiral . There is no direct
connection, they said, showing that the declining enrollment is causing premiums to increase.¶ Why not?
Because federal
government subsidies in the form of tax credits are largely shielding customers from
feeling the premium increase.¶ As we have reported, premiums are increasing. But that isn’t affecting the
cost for most consumers, due to built-in subsidies under the Affordable Care Act. The subsidies cap premium
prices at a certain percentage of income for anyone below 400 percent of the federal poverty level (in 2016 that would be $47,520 for a single
person).¶ Among the people who have signed up so far for 2017, 81 percent will receive a subsidy.¶ Data
also shows no uptick in healthy people leaving the health insurance market .¶ The U.S. Centers for
Medicare and Medicaid Services reports the share of people signing up for health care in the low-risk
demographic — ages 18-34 — remains about the same in 2017 as it was in 2016, at 26 percent of enrollees.¶ "There is
no data to indicate a drop in the number of younger enrolled, although the announced policy not to enforce the IRS penalty, if not reversed,
could result in a decline over time," said John Rother, president and CEO of the National Coalition on Health Care.¶ Hewitt referred to a New
York Times article that quotes the president of Aetna saying that in many places people will lose health care insurance.¶ We couldn’t find that
article, but a simple remark on how premiums are rising and insurers are leaving the marketplace is not enough evidence to meet the actuarial
definition of a death spiral.¶ CBO, independent analysis: No death spiral¶ Others have also concluded that the Affordable Care Act is not in a
death spiral. The nonpartisan Congressional Budget Office, as part of its recent analysis of the GOP legislation, described the Affordable Care
Act as stable.¶ Matthew Fiedler, a fellow with the Center for Health Policy at the Brookings Institution, similarly concluded in a recent analysis
that the Affordable Care Act is not in a death spiral.¶ Fiedler found that marketplace
premium increases had little if any
impact on health insurance sign-ups and that the impact on the individual market risk pool will more
than likely be minor, despite the small decline in enrollment numbers.¶ "It therefore remains likely that insurers’
individual market business will return to a roughly break-even or slightly profitable position in 2017,
absent other policy changes," Fiedler wrote.

Employer plans ensure stability

Miller 16 (Andy Miller: CEO and Editor of Georgia Health News, award-winning health care journalist for his newspaper reporting on hospitals
and health insurers, state government and Georgia’s mental hospitals, “Employer plans’ premiums much more stable than ACA exchange
plans,” 10/26/16, http://www.georgiahealthnews.com/2016/10/employer-plans-premiums-stable-exchange-plans-study-shows/, Accessed:
8/20/17)

The combined cost of premiums and deductibles for a Georgia family with employer-based insurance,
on average, took up 11.6 percent of their income last year, a new report released Wednesday shows. Those family
expenditures were higher than the national average of 10.1 percent, said the Commonwealth Fund report. The
study also showed that nationally, the Affordable Care Act did not have a significant impact on health insurance

costs borne by employer plans, which cover more than 150 million Americans . Annual premium
growth rates for employer-sponsored plans have slowed on average nationally since 2010, the year the
ACA was passed, the report said. The employer insurance market has remained relatively stable, said Sara Collins, a
Commonwealth Fund vice president. She added that there is “considerable variation of health care costs’’ among states. The new data
appear at a time when millions of Americans are selecting their health plans for 2017, during the annual open
enrollment period.
 AT Debt Bubble – Leverage Window
Leverage window means now is key – health sector is highly leveraged now which
magnifies the impact of shocks, but leverage is set to decline which builds resiliency
against their thumpers.
Neuburger et al. 17 (June, Megan Neuburger, Britton Costa Robert Kirby, Caitlin Blalock Benjamin Immordino. All are CFAs working for Fitch
Ratings, one of the three largest credit rating agencies in the US. “The Checkup: High-Yield Healthcare Handbook”, available to Fitch Ratings subscribers)

Debt/Earnings = 4.6:1.

Welcome to the Checkup: This is the fifth annual edition of The Checkup. The
report includes analysis of the business profiles and
capital structures of 18 of the largest issuers of high-yield debt in the U.S. healthcare industry. The
companies included in this report have a cumulative $155 billion of debt outstanding, including high-yield bonds and bank loans, up from $148 billion as of last
year’s publication. Healthcare Providers Dominate List: The group of companies profiled in The Checkup is diverse, representing the healthcare provider, specialty
pharmaceutical, medical device and diagnostics subsectors. Ratings and Credit Opinions on these companies are concentrated in the ‘B’ and ‘BB’ categories and 22%
of the sample currently has a Negative Rating Outlook, which is higher than in past years. Healthcare providers are the most heavily represented in this group,
comprising 11 of the 18 companies profiled. Median FCF Generation Drops: The group has a median LTM FCF (CFO minus capex and dividends) margin of 4.1%,
down from 4.8% a year ago. Many of the pharmaceutical and medical device manufacturers produced FCF margins stronger than the median while most of the
healthcare providers produced FCF close to or below the median; four of the 18 companies posted negative FCF in 2016, with two of those being close to break-
even. M&A Drives Higher Leverage: Median
leverage (total debt to EBITDA) was higher at the end of 2016 versus the prior
year, rising to 5.7x from 4.9x. Much of this is temporary since it is due to the timing of acquisitions ;
Fitch Ratings forecasts normalized median leverage of 4.6x at the end of 2017. Median interest coverage remains
solid but deteriorated to 4.4x from 5.1x a year ago. Financing terms remain favorable, but higher interest expense on unhedged floating-rate
debt exposure could be a headwind to interest coverage in 2017–2018. 2018 Maturities Largely Addressed: Community Health Systems, Inc. (CHS), Valeant
Pharmaceuticals International, Inc. (VRX) and Select Medical Holdings Corporation faced large maturities in 2018. Despite concerns about the operating outlook and
divestiture plans of VRX and CHS, all three were able to refinance this debt early in 2017. Heavy Hospital Company Maturities: The six acute care hospital companies
in the group represent 71% of bonds and loans maturing for all 18 companies in 2017–2019. The median percentage of total debt in the capital structure maturing
through 2019 is 20% for the six hospital companies, versus 7% for the group of 18 companies. Amongst the hospitals, only Quorum Healthcare Corp. and LifePoint

Health, Inc. have light near-term maturity schedules, with almost no debt coming due in the next two years. Solid Fundamental Outlook : Fitch
sees the U.S. leveraged healthcare sector facing low risk of deteriorating fundamentals but high levels
of event risk driven by political and regulatory uncertainty. Fundamentals are solid relative to some
other corporate sectors, with strong organic demand growth driven by demographics and innovation ,
and Fitch is forecasting low or mid-single-digit organic EBITDA growth for most of these companies in
2017–2018, but headline risk will be a persistent backdrop.
 Link
Prioritize our short-term links – economies get more resilient deeper into recoveries
which solves the impact to their turns.
Draghi 17 (Mario, ECB President, “Accompanying the economic recovery”, https://www.ecb.europa.eu/press/key/date/2017/html/ecb.sp170627.en.html)
For many years after the financial crisis, economic performance was lacklustre across advanced economies. Now,
the global recovery is firming
and broadening. A key issue facing policymakers is ensuring that this nascent growth becomes
sustainable . Dynamic investment that drives stronger productivity growth is crucial for that – and in
turn for the eventual normalisation of monetary policy. Investment and productivity growth together
can unleash a virtuous circle , so that strong growth becomes durable and self-sustaining and,
ultimately, is no longer dependent on a sizeable monetary policy stimulus. The discussions we will
have over the next two days – in particular understanding the puzzles of slowing productivity growth and persistently low investment – are
therefore highly relevant for the path of the economy and of our monetary policy .

Single-payer tanks institutional investor portfolios and the S&P index.

Strubel 7/16 [Ben Strubel is Graduate of Drexel University with a Master of Business Administration in Investment Management, and is
the President and Portfolio Manager of Strubel Investment Management, LLC, Strubel Investment Management employs a careful and rigorous
qualitative and quantitative screening and research process, taking into account both macroeconomic and firm specific factors, “Health Care
Stocks Could Be The New Bubble”, https://seekingalpha.com/article/4087909-health-care-stocks-new-bubble]

Summary Health care spending has grown from 5% to 18% of GDP. Health care spending now eats up 20% of per capita income. Voters seem to have had enough,

naming health care as top issue. What happens to health care stocks if the sector is reformed? The political trends of the last
few years point to potential problems in the health care sector. The health care sector is a very popular one for investment.

The health care sector is the S&P 500’s second largest (13.89% weighting as of 5/31/2017) and for years has
been characterized by growth that easily outpaced overall GDP growth . Among investors that are
more conservative, the temptation to overweight health care companies in their portfolio is very
strong . The sector offers very low volatility (a beta of .82 using the Health Care Select Sect SPDR ETF (NYSEARCA:XLV) as a proxy) and
many companies pay generous dividends. Growth, low volatility, and dividends, what’s not to like? However, we see some dark storm
clouds on the horizon for the sector. Since perhaps the 2008 presidential election, the topic of health care has been one of the most significant in voters’ minds.
Indeed, there is a good argument that backlash against the ACA was the driving force behind the Democrats losing a combined 1,000 state and federal legislative
seats since 2010. There is also every reason to believe that health care will be a significant factor in the 2018 midterms and 2020 presidential election. Whether the
BCRA passes or not is largely irrelevant to this thesis. We will either have a situation where some 20 million lose health care coverage (BCRA passes) or a situation
where the existing health care system still needs fixing. In 2016, the US spent an average of $10,345 in per capita health care costs. This compares to an OECD34
average of $3,453 per capita in 2015. The US is spending almost three times as much on health care as the average developed country. In fact, as the graph below
from the Kaiser Family Foundation shows since the 1960’s, health care costs have grown from 5.0% of GDP to over 17% of GDP! But to best understand why
reducing health care costs has become one of the most preeminent issues for voters, it’s helpful to look at health care costs in relation to income. We looked at
same per capita health care spending data from the Kaiser Foundation shown above, but this time graphed it as a percent of per capita income. We can see that in
1960, health care spending was about 6% of per capita income. Today, the number is over 20%. Add in the fact that medical debt is the number one cause of

personal bankruptcy filings and it’s easy to see why voters have pushed health care reform to the top of the political issues heap. The big question is, when
true health care reform does come to the US what will it look like? We think the best answer to that
question is to simply look at where the US health care system is spending more money than other
OECD countries. The two biggest cost drivers we identified were administrative costs and prescription
drug prices. In the US, administrative costs average around 8% of all health care spending compared to
just 3% for the worldwide OECD average. This should be no surprise as the US is the only developed
country without some form of universal, single-payer health care. We have a disjointed system made up of government
entities (Medicare, Medicaid, VA, etc.), a myriad of private health insurance companies, and self pay customers. In fact, the
8% figure likely
underestimates the true administrative burden, as many health care practitioners who would not be
formally counted as administrative staff undoubtedly spend significant time on administrative tasks .
Not only that but administrative management employees, not physicians as many assume, tend to be the highest paid employees of a health care organization. In
fact, physician wages make up only 9% of all health care spending, which is below the OECD average. The other outsized cost center in the
US health care system is prescription drugs. In the US, prescription drug spending accounts for 10% of all health care costs. In 2013, this
amounted to about $1,026 per person (measured in USD purchasing power parity). As the chart below from the Business Insider shows, this is double the OECD
average. In
every other country, single-payer systems have allowed the government to bargain down
drug prices. By contrast, the US largest single payer, Medicare, is legally prohibited from negotiating
with pharmaceutical companies for lower drug prices. When change comes, drug prices are likely to
be one of the areas where companies see profit margins reduced . Summary While we have no idea what
true health care reform will end up looking like, we can be pretty sure it will significantly impact the
two largest profit centers in the health care industry (administrative services and drug pricing). This is
particularly important for investors because pharmaceutical companies make up over half of the
health care sector! The chart below shows the industry type breakdown for the Health Care Select Sector SPDR ETF. Pharmaceutical and
biotechnology companies make up 55.13% of the index. Additionally, health care providers and
services which contain health insurance companies make up 19.79% of the index. Almost 75% of the
sector is at risk of undergoing radical changes over the next decade .

The plan causes a massive shock to the insurance sector that ripples through the
whole financial system – insurance is a significant player in the corporate bond
markets.
- insurance companies no longer have a source of revenue to invest in the corporate bonds, makes borrowing more expensive

- insurance companies would have to pay off old claims and lose their main source of revenue, would have to sell off corporate bonds, which
lowers price of current bonds

Gelos and Valckx 16 (7/27, Gaston Gelos Division Chief of the Global Financial Stability Analysis Division, IMF, Nico Valckx Senior Economist, Global
Financial Stability Analysis Division, IMF, “The insurance sector and systemic risk”, http://voxeu.org/article/insurance-sector-and-systemic-risk)

Insurance companies – life insurers, as well as providers of property, casualty, health , and financial coverage –
perform important economic functions and are big players in financial markets . Traditionally,
however, they were not considered to pose systemic risks. Insurers have longer-term liabilities than banks, a greater
diversification of assets, and less extensive interconnections with the rest of the financial system. However, the near-collapse of AIG during the Global Crisis

prompted a rethinking of the sector’s systemic riskiness. A number of insurance firms were subsequently among
the financial institutions designated as globally systemically important .
[Figure 1 Omitted]

Systemic risk analysis has typically focused on the risks of failure of individual institutions and their
potential knock-on effects (the ‘domino’ view of systemic risk; see Acharya 2015). However, the contribution to systemic
risk by insurers and other financial firms extends beyond this dimension. In the ‘tsunami’ or
macroprudential view, even solvent firms may propagate or amplify shocks to the rest of the financial
system and the real economy . Systemic risk may stem from common exposures of a few large firms or
many small ones (Acharya 2015, IMF 2013). For example, insurance companies play a critical role in corporate bond
markets , and if they are hit by a large common shock , a consequent cessation of funding could hurt
other companies badly (Bank of England 2015). In principle, the insurance sector could therefore be a significant
contributor to systemic risk even if no single insurance company were systemically important .
Figure 2 Insurance and systemic risk
 AT Life Insurance Solves
Insurance company margins are extremely thin – there’s hardly any profit to squeeze
out of them, so the AFF would put them out of business.
Posen 17 (6/30, Alexis, professor of Health Economics at CUNY School of Public Health and a co-author of the textbook "Navigating Health Insurance." “Five
myths about health insurance”, https://www.washingtonpost.com/outlook/five-myths/five-myths-about-health-insurance/2017/06/30/0136f34e-5cd2-11e7-a9f6-
7c3296387341_story.html?utm_term=.83e2a745dfae)

MYTH NO. 3 Health insurance companies make massive profits by cheating consumers. To strengthen
the case for reform, proponents of the ACA scapegoated private insurers in the debate leading up to its passage,
blaming outsize premiums and skimpy coverage on unethical behavior. In a 2009 radio address, Obama cited insurers’ undue “profits and

bonuses.” Insurers, however, were not earning particularly high profits then . A 2010 Congressional Research Service
study showed that among large, publicly traded health insurers, profits averaged 3.1 percent of revenue . In
comparison with other health-care players, that put them in the middle of the pack — well below pharmaceutical and biotech companies and medical-device
manufacturers, on par with pharmacy companies, and above hospitals. Yet this rhetoric has persisted in both liberal and conservative outlets. “The ACA gets blamed
for rising premiums, while insurance companies are reaping massive profits,” a Salon article declared in October. A Weekly Standard piece published around the
same time pointed to rising profits among the health insurers on the Fortune 500 as “another fine example of the natural alliance between Big Government and Big
Business.” But the
beginning of the ACA coincided with the end of the recession. From 2007 to 2009, 8 of
the 10 largest insurers had double-digit losses , and one — WellCare — had triple-digit losses. In a phenomenon
economists call “regression to the mean” and financial analysts call “the business cycle,” profits across
all industries recovered around the same time the ACA was implemented. A nationwide study of
insurers supports the argument that their profits are more aligned with economic growth than
anything else . In 2013, when GDP growth was slower, insurers on average operated at a loss; but they
recovered by 2014 when growth picked up. Moreover, the bulk of insurer profits were from investments
rather than enrollees .
 Stock Crisis Collapses Economy
Asset price collapses create spiraling recessions.
Miao et al. 12 (Jianjun Miao† , Pengfei Wang‡ , and Lifang Xu§. †Department of Economics, Boston University ‡Department of Economics, Hong Kong
University of Science and Technology, §Department of Economics, Hong Kong University of Science and Technology, “Stock Market Bubbles and Unemployment”,
https://pdfs.semanticscholar.org/51ee/14529d89b630638b0ca428e929f56d7f3b48.pdf)

This paper provides a theoretical study that links unemployment to the stock market bubbles and crashes. Our theory is based on three observations from the U.S.
labor, credit, and stock markets. First, the U.S. stock market has experienced booms and busts and these large swings may not be explained entirely by
fundamentals. Shiller (2005) documents extensive evidence on the U.S. stock market behavior and argues that many episodes of stock market booms are attributed
to speculative bubbles. Second, the stock market booms and busts are often accompanied by the credit market booms and busts. A
boom is often
driven by a rapid expansion of credit to the private sector accompanied by rising asset prices.
Following the boom phase, asset prices collapse and a credit crunch arises . This leads to a large fall in
investment and consumption and an economic recession may follow.1 Third, the stock market and
unemployment are highly correlated.2 Figure 1. plots the post-war U.S. monthly data of the price-
earnings ratio (the real Standard and Poor’s Composite Stock Price Index divided by the ten-year moving average real earnings on the index) constructed
by Robert Shiller and the unemployment rate downloaded from the Bureau of Labor Statistics (BLS).3 This figure

shows that, during recessions, the stock price fell and the unemployment rate rose. In particular, during the recent Great
Recession, the unemployment rate rose from 5.0 percent at the onset of the recession to a peak of 10.1 percent in October 2009, while the stock market fell by
more than 50 percent from October 2007 to March 2009.

[Insert Figure 1 Here.]

Motivated by the preceding observations, we build a search model with credit constraints, based on Blanchard and Gali (2010). The
Blanchard and Gali model is isomorphic to the Diamond-Mortensen-Pissarides (DMP) search and matching model of unemployment (Diamond (1982), Mortensen
(1982), and Pissarides (1985)). Our key contribution is to introduce credit constraints in a way similar to Miao and Wang (2011a,b,c, 2012a,b).4 The
presence
of this type of credit constraints can generate a stock market bubble through a positive feedback loop
mechanism . The intuition is the following: When investors have optimistic beliefs about the stock market value
of a firm’s assets, the firm wants to borrow more using its assets as collateral . Lenders are willing to
lend more in the hope that they can recover more if the firm defaults. Then the firm can finance
more investment and hiring spending . This generates higher firm value and justifies investors’ initial
optimistic beliefs. Thus, a high stock market value of the firm can be sustained in equilibrium.
There is another equilibrium in which no one believes that firm assets have a high value. In this case,
the firm cannot borrow more to finance investment and hiring spending . This makes firm value
indeed low, justifying initial pessimistic beliefs. We refer to the first type of equilibrium as the bubbly equilibrium and to the second
type as the bubbleless equilibrium. Both types can coexist due to self-fulfilling beliefs. In the bubbly equilibrium, firms can hire more workers and hence the market
tightness is higher, compared to the bubbleless equilibrium. In addition, in the bubbly equilibrium, an unemployed worker can find a job more easily (i.e., the job-
finding rate is higher) and hence the unemployment rate is lower.

[Insert Figure 2 Here.]

After analyzing these two types of equilibria, we follow Weil (1987), Kocherlakota (2009) and Miao and Wang (2011a,b,c, 2012a,b) and
introduce a third type of equilibrium with stochastic bubbles . Agents believe that there is a small
probability that the stock market bubble may burst. After the burst of the bubble, it cannot re-emerge
by rational expectations . We show that this shift of beliefs can also be self-fulfilling . After the burst of the
bubble, the economy enters a recession with a persistent high unemployment rate . The intuition is the following.
After the burst of the bubble, the credit constraints tighten, causing firms to reduce investment and
hiring. An unemployed worker is then harder to find a job, generating high unemployment. Our model
can help explain the high unemployment during the Great Recession. Figures 2 and 3 plot the hires rate and the job-finding
rate from the first month of 2001 to the last month of 2011 using the Job Openings and Labor Turnover Survey (JOLTS) data set.5 These figures reveal that both the
job-finding rate and the hires rate fell sharply following the stock market crash during the Great Recession. In particular, the hires rate and the job-finding rate fell
from 4.4 percent and 0.7, respectively, at the onset of the recession to about 3.1 percent and 0.25, respectively, in the end of the recession.
 AT Jobs/Stimulus Link Turn
The aff’s demand-side stimulus will fail – it assumes a large output gap resulting from
spare capacity in the economy, which does not currently exist.
Romer and Romer ‘16 (Both authors are Professors of Economics at the University of California, Berkeley, and Christina Romer was Chair of the
Council of Economic Advisers from 2009 to 2010. Both authors have provided informal advice to the Clinton campaign, but this analysis was done independently
and we bear full responsibility for its content. “SENATOR SANDERS’S PROPOSED POLICIES AND ECONOMIC GROWTH”,
https://www.ineteconomics.org/uploads/downloads/Romer-and-Romer-Evaluation-of-Friedman.pdf)

even if the estimated effects of Senator Sanders’s policies on

II. PRODUCTIVE CAPACITY CONSTRAINTS ARE LIKELY TO BE BINDING A second problem with Friedman’s analysis is that

demand were correct, it is highly unlikely that the impact on output that he foresees could actually come to pass. That is because productive capacity constraints
would be likely to bind well before output rose nearly as much as Friedman predicts. Implicit in Friedman’s focus on demand-side
effects is the assumption that there is currently a very large output gap (or spare capacity ) that could be
closed before inflation rose significantly and the Federal Reserve raised interest rates substantially to
choke off demand. However, a wide range of evidence suggests that while there is likely some output gap
currently, it is not nearly large enough to accommodate growth of 5.3% per year for ten years without pushing the economy well above its productive capacity. a. Standard Indicators of Slack First, standard

indicators of slack suggest that the output gap is currently no more than moderate. The unemployment rate, at 4.9%, is at normal levels. A broader measure of

unemployment (the “U-6” measure) is just 2 percentage points above its low point before the 2008 recession. The Federal Reserve index of capacity utilization is about 4 percentage points below its pre-recession level. Job

vacancies , which one would expect to be low with vast slack, are above their pre-recession levels .
And inflation, which one would expect to fall in an economy operating far below capacity, is flat or
perhaps creeping slightly upward. None of this is remotely consistent with a shortfall of output from
capacity of even 10%, much less the amount that would be needed to accommodate Friedman’s estimate that the Sanders policies would raise output in 2026 37% above the CBO forecast. b. Expert Opinion Second,
experts think that slack is small. The two institutions that devote the most resources to estimating the economy’s productive capacity are probably the Congressional Budget Office, which
uses those estimates as an essential input into its economic forecasts and budget projections, and the Federal Reserve, for which estimates of slack are a critical input into its decisions about monetary policy. CBO estimates that as
of the end of 2015, output was 2.2% below potential.9 Federal Reserve Chair Janet Yellen has recently argued that the unemployment rate, which has returned to normal levels, likely understates the amount of slack in the labor
market by perhaps half a percentage point—suggesting a positive but small shortfall of output from capacity.10 Professional forecasters also have a strong interest in correctly estimating the productive capacity of the economy,
since the estimate of productive capacity often factors into their projections of monetary policy and inflation. The Third Quarter 2015 Survey of Professional Forecasters, conducted by the Federal Reserve Bank of Philadelphia,
asked forecasters for their estimate of the natural or normal rate of unemployment. The median estimate was 5.0%—just above the current unemployment rate.11 This suggests that, at least by this measure,

professional forecasters see little if any slack in the current economy. [Footnote begins here] 8 One could also argue that moving to a single-
payer system would deliver efficiency gains, and so raise output. It appears that (continuing to assume that output is determined by demand) this would raise the output effects somewhat, but lower the employment effects. As a
concrete example, suppose more efficient administration allows the same healthcare to be delivered with fewer workers, and that these savings are passed on to the households receiving the healthcare. Their disposable incomes
are higher, and so their demand is higher. This will tend to increase output. But, under standard assumptions, the additional employment generated by this increase in demand will not be enough to offset the direct downward
impact on employment from the fact that fewer workers are needed to deliver a given amount of healthcare. [Footnote ends here]